Aim: The aim of the study was to analyse the long-term follow-up of patients who were treated with chemonucleolysis for single level disc prolapse. Method: In our retrospective study we reviewed 112 cases that underwent chemonucleolysis for single level lumber disc herniation during the period of 1988–1996. Mean follow up was 9.5 years. In order to estimate the functional outcome of chemonucleolysis Oswestry Disability Index questionnaire was used. Results: An excellent or good response occurred in 79 patients (70.5%); 12 patients (10.7%) showed moderate response with minimal disability. Treatment failed in 21 patients (18.5%) who showed poor response and 12 of these 21 patients went for surgery within a mean period of 6 months. One patient had surgery at different level than chemonucleolysis. There was only one incident of procedure termination because of epidural contrast leak. There was no case of anaphylaxis or discitis. Conclusion: We conclude on the basis of our results that chemonucleolysis is a safe and effective treatment modality for lumber disc herniation in carefully selected patients.

Aim: To assess the radiological appearance and subsequent behaviour of impacted allograft in revision hip surgery using the Charnley femoral prosthesis. Method: A prospective radiological study of hip arthroplasty revised for aseptic loosening with femoral bone loss was performed. Preoperative bone loss was assessed using the Endo Klinik grading. Impaction grafting with fresh frozen femoral head allograft and the Charnley stem was used in all cases. Postoperative X-rays and annual review films were examined for graft distribution, cortical repair and stem subsidence. Graft consolidation and cortical repair was assessed. Results: Twenty cases were followed up for 6 to 8 years. Fourteen cases had even distribution of graft and 6 had deficiency in one Gruen zone. Graft consolidation was identified in all cases at one year. Cortical repair was noted in 14 out of 15 Endo Klinik III cases. One patient died after 2 years and 9 months. Two stems have subsided by more than 5 mm and are asymptomatic. Two cases with subsidence have been revised. All cases with subsidence were associated with graft deficiency in Gruen zone II or III on the postoperative X-ray. Conclusions: Good initial graft distribution on the postoperative X-ray is associated with graft consolidation, cortical repair and minimal stem subsidence. Initial deficiency in graft distribution is associated with stem subsidence and revision. These findings highlight the importance of a surgical technique, which ensures even graft distribution.

Aims: Dynamic hip screw (DHS) is a common implant used for extracapsular fracture neck of femur. Accurate placement of the guide wires for the DHS insertion is the most important surgical step. In order to improve precision and accuracy of the guide wire placement, Computer Assisted Orthopaedic Surgery System (CAOSS) was used , which was developed at the University of Hull.

Methods: CAOSS helps in surgical planning and aid surgeons for accurate guide wire placement into femoral neck. After fracture reduction, intra-operative computer based surgical planning was performed using one fluoroscopic image in two planes each. A trajectory obtained thus helped surgeon to place a guide wire along with the required course under the computer guidance.

Results: CAOSS system was used on 11 patients for guide wire placement. Intra-operative fluoroscopic images of all the patients showed accurate position of the guide wire both in AP and lateral planes. In theory only 4 fluoroscopic images are required during this surgical procedure in total. But in practice, more than 4 were required depending upon the experience of the radiographer. None of the patient had any intra-operative complication. Conclusions: The computer aided surgery was found to be safe, accurate and reliable for guide wire placement for dynamic hip screw insertion.

Rotator cuff pathologies are related with higher incidence of morbidity in the modern society in young patients. Although it is well known that rotator cuff is sandwiched between the acromion and humeral head during various movements of the shoulder joint, only few studies have investigated this looking at the humeral head as a culprit for the rotator cuff pathology.

We carried out the cadaveric study of 15 shoulder joints to find out the influence of the humeral head anatomy on the rotator cuff pathology. We dissected 15 shoulder joints and looked at the rotator cuff tears. All the specimens were examined and photographed digitally from the superior aspect of shoulder joint. All these images were entered into a computer and using special software, we carried out 3D reconstruction of these images. With this software, the outermost point of intersection of humerus head with acromion decided. We calculated the area of the humeral head in an outside the acromion and correlated with the rotator cuff tear.

We found that the area of the humeral head outside the acromion is variable, ranging from 18% to 50% of diameter of humeral head (mean 34%, median 33%, mode 20%, 33%, 45%). When the area of humerus head outside the acromion is less than 32% of the diameter of head (i.e. humerus head was more under the acromion and less outside the outer most point of acromion), those specimens had either incomplete or complete rotator cuff tear.

We conclude that when the area of humeral head, covered under the acromion is more than 68% of the diameter of the head, they have more chances of developing rotator cuff pathology as compare to other individual.

The results of hip injections for 63 patients with hip pain are presented. Injection of 80mg of methylprednisolone and bupivacaine by an anterior approach was performed with x-ray screening. Patients were noted as having either a normal x-ray (10), mild osteoarthritis (21), moderate osteoarthritis (13) and severe osteoarthritis (19), those in the severe group were generally unfit for hip surgery. Outcome was judged by an Oxford hip score, which was calculated pre-injection, at one month, and at three months. At three months all with a normal x-ray were improved, 19 with mild changes were improved 2 deteriorated, 9 with moderate changes improved, 2 stayed the same, 2 deteriorated and 13 with severe changes were improved, 4 deteriorated and 2 were unchanged. Improvements were with pain scores not function. Of those improved all thought the procedure worthwhile. Two patients described numbness and weakness at the anterior thigh area, which recovered quickly. We feel that this is a useful technique to give symptomatic relief in-patients not suitable for hip replacement.