A strong clinical impression exists that joint lavage often provides symptomatic relief for painful osteoarthritis of the knee. A controlled trial was conducted to test this hypothesis. A group of 37 painful osteoarthritic knees were treated by arthroscopic lavage and physiotherapy, and a control group of 24 knees were treated by physiotherapy alone. There was better relief of pain in the lavage group, and the effect was still present at one year. An improvement in the signs of inflammation lasted for about three months. Pain was relieved more effectively in patients with slight radiographic changes than in those with advanced changes. Our results confirm the effectiveness of joint lavage in the management of painful osteoarthritis of the knee.

We report a prospective double-blind trial of the efficacy of a single epidural dose of buprenorphine on pain after spinal decompression. Postoperative pain was assessed by a linear analogue pain chart and by the additional requirement for analgesia. The patients receiving buprenorphine were significantly more comfortable (p less than 0.005) and required less analgesia in the first 12 hours after operation (p less than 0.05) than the control group. This simple procedure is recommended as an effective and safe method of reducing pain.

The factors involved in the mechanism leading to traumatic posterior dislocation of the hip are examined. In 47 adult patients who had previously suffered such a dislocation, ultrasound scans were used to measure femoral anteversion on both the affected and the uninjured side. In 36 normal adult volunteers, used as controls, similar measurements were made. Femoral anteversion on both the injured and uninjured side was significantly reduced in the patients compared with the volunteers. These findings are discussed in the light of previous work which indicates that medial rotation is a factor in the mechanism of posterior dislocation of the hip. It is suggested that reduced anteversion acts like medial rotation to make the hip more susceptible to posterior dislocation, and that the less the anteversion the more likely is the injury to be a dislocation rather than a fracture-dislocation. It is concluded that patients who suffer such dislocated hips belong at one extreme of the normal population, having either reduced femoral anteversion or even retroversion, and that this anatomical feature selects towards hip dislocation rather than to injury of the femoral shaft, knee or tibia during the appropriate type of accident.

The long-term results of 74 cases of simple traumatic dislocation of the hip are reported and the effects of the cause of dislocation and of the occupation and age of the patient on the prognosis are assessed. The average follow-up was 14.65 years. Contrary to the widely held view that there are no long-term complications of this injury, we found that, overall, 24 per cent of the dislocated hips went on to develop osteoarthritis. The incidence was highest in manual workers with 37.5 per cent of miners injured in car accidents developing osteoarthritis compared with only 20 per cent of the sedentary workers. The incidence of osteoarthritis in miners injured in pit accidents was 45 per cent compared with only 17 per cent for those involved in motor cycle accidents. These differences could be due to continued heavy work after the accident rather than to any difference in the violence of the initial injury. The incidence of osteoarthritis was highest in patients aged between 31 and 40 years and, as expected, was found to increase with length of follow-up.

The measurements of the angle of anteversion of the femoral neck by ultrasound scanning is described. The method was compared with direct measurement in 30 dried femora, and was then used in 18 normal volunteers and eight patients. The method is non-invasive, accurate and easily applicable. Findings in normal subjects included variation of the angle of anteversion from 10 to 34 degrees with a maximal difference between sides of six degrees. The expected rotational deformity of the femur was found in patients with unilateral intoeing.

Out of a total of 91 patients with traumatic posterior dislocation of the hip treated between 1936 and 1974 in the Mansfield area, 81 patients were reviewed. The average follow-up period was 12.5 years, although there was a large number of cases with a follow-up of more than 15 years and a smaller number with a follow-up of 30 years. The overall results were surprisingly poor despite early reduction of the dislocation in the majority of cases. We found that 15 years after simple dislocation 24 per cent of the cases had a poor result by both clinical and radiological criteria, but in the more severe grades of initial injury the results became worse, with 73.3 per cent of the patients graded as fair and poor, and only 26.7 per cent graded excellent or good.