Introduction MRI accuracy in detecting knee lesions is a discussed controversy. Not always different knee lesions, diagnosed by MRI are confirmed by arthroscopy. The aim of this study is to correlate the accuracy of history, physical examination and MRI in evaluating meniscal and ACL lesions.

Methods A prospective comparative study was performed to compare anamnestic and clinical data, MRI findings and arthroscopic findings to better understand the role of these methods and to assess if there are significative differences between various knee disorders. One hundred patients undergoing to arthroscopy for knee injuries were evaluated before surgery, registering anamnestic data, clinical examination and MRI findings. At the time of surgery every finding was registered and then compared with the previous acquired data.

Results The most accurate data for diagnosis appears from history and clinical examination. The study showed a statistically significative differences between the RMI and arthroscopic findings. Differences between radiologist were detected in MRI data.

Conclusion The results of such type of study, underlining the reliability and accuracy of patient’s history, clinical examination and MRI, comparing the different results among them and in various knee injuries. The accuracy of every test is the first step for an evidence based decision analysis process and represent a step forward an efficacious and economical pattern in diagnosis.

Shoulder replacement has increased exponentially over the past decades due to good results reported in literature and improvement of surgical technique and devices efficacy. Previous studies suggested the effectiveness of shoulder replacement in fractures, assessing objective parameters as range of motion and radiographic images and evaluating the of postoperative complications and subsequent revision; pain relief, physical function level and health related quality of life (QoL) improvement were often left out. A prospective study was conducted on 21 patients surgically treated with shoulder emiarthroplasty for proximal humeral fractures (18 women and 3 men, mean age at follow-up 70 years – range: 57–82). The purpose of the present study is to collect the patient-relevant outcomes in a homogeneous sample (for surgeon, surgery, implant, inclusion-exclusion criteria, neurological status) of patients who underwent shoulder replacement for proximal humeral fractures. Preoperatively patients were evaluated through x-rays (trauma series), Ct-scans were performed when necessary for surgical decision. Postoperatively, two independent examiners examined all patients clinically and radiographically. For patient-oriented standardized measure SF-36, DASH (Disability of Arm, Shoulder and Hand questionnaire), ASES (American Shoulder and Elbow Surgeon), OSQ (Oxford Shoulder Questionnaire) and SST (simple Shoulder test) were chosen. Outcomes of our series were statistically compared with literature data and widely analyzed. This kind of data are unavailable in literature and could represent the first step towards the definition of outcome for this kind of procedure.

Systematic and prospective collection of data (Registro degli Interventi di Protesi d’Anca – RIPA-L) on hip replacement operations is underway in the Lazio Region (Italy) as part of a multi-regional registry on orthopaedic prosthetic surgery. The project is partially funded by the Ministry of Health and includes five regions of Italy, coordinated by Istituti Ortopedici Rizzoli, Bologna, in co-operation with the Italian National Institute of Health. The aim of the project is to create – as a first attempt in Italy – a national database on hip replacement operations in order to monitor adverse events related to orthopaedic prostheses. First, in the Lazio region, standardised methods and data collection instruments were developed and assessed in a pilot study at three hospitals in Rome (teaching, public and private). The case report form (CRF) includes identification data, clinical findings, details of the operation (duration, grade of surgeon, and operative technique) and characteristics of the prosthesis. A web-based CRF facilitates data registration (www.asplazio.it). Second, 32 orthopaedic centres agreed to participate in the initiative and started collecting data. Indeed, 53% of all hip replacement operations in the Lazio region are performed in these centres (n=6355, source: Regional Hospital Information System, 2003).

RIPA-L represents an important instrument to monitor the quality of hip replacement surgery in the Lazio region and to collect information on types of orthopaedic prostheses, contributing to the national database and, more generally, promoting quality in orthopaedic surgery.

Introduction: Quality of life is becoming in the last years an essential element of evaluation of treatments. The aimof this prospective cohort study is to assess the quality of life and the speciþc patient perspective on knee replacement. A pre- and post-operative patient-oriented study was conducted on patients operated on knee replacement for symptomatic knee arthritis to measure their quality of life. Material and Methods: There were 50 patients, mean age 71.3 (5.1 SD) years, affected by knee arthritis. The SF-36 questionnaire (ofþcial Italian version) and Oxford validated Italian version questionnaire (OKQ) were administered preoperatively and post-operatively (at 2 years of follow-up Ð SD 1.5). The results were compared within and with those of an age-matched and sex healthy sample (n=351) published in Literature. The appropriated statistical analysis was used on results data. Results: The SF-36 domain scores for the pre- and post-operative data were respectively the following: PF 32.50±24.43 and 50,81±27.21; RF 13.63±28.58 and 63.09±47.18; BP 14.47±11.44 and 50.45±28.61; GH 55.08±15.36 and 56.71±20.29; VT 44.77±15.77 and 58.19±16.84; SF 55.08±25.15 and 71.81±25.60; RE 42.00±46.31 and 65.09±40.14; MH 58.72±16.85 and 61.71±20.14; PCS 27.00±6.22 and 38.71±9.51; MCS 46.13±11.10 and 47.76±9.43. The OKQ respectively 47.00±7.86 and 27.72±10.66. Appropriated statistical tests were performed. Conclusions: Knee replacement signiþcantly improve patientsñ perception of their own health. Moreover the patient-oriented speciþc measure give results really reassuring on knee replacement results. A better knowledge of the health status changes induced by knee replacement might help further deþne the indications to surgery and cost-beneþt relationship.

There is no consensus regarding the best method of assessing outcomes after total knee arthroplasty. There are now many questionnaires in the literature, well constructed and validated in the original language. Dawson’s questionnaire (1998) is designed as a 12-item self-administered instrument, and has undergone a complete validation procedure in its original English version.

Aim of this paper is to present the procedure of cultural adaptation and some data from the validation process of the Italian version of the questionnaire.

Two independent translations into Italian and back-translations into English were obtained, from specialised and general translators. The material was then evaluated in a multidisciplinary panel including elderly patients. A provisional version was obtained and tested in a pilot study. Results and comments were reviewed within the panel again which came up with the final version.

The questionnaire was administered to 100 patients scheduled for knee replacement. Other outcomes collected included a general health questionnaire, in its validated Italian version (SF-36), and several objective and radiographic parameters.

The burden on the patient and comprehension’s difficulties were registered. Validation included the assessment of internal consistency, construct and content validity. Correlation between different parameters were investigated. Test-retest reliability was assessed on 20 patients. Comparisons with the data presented in the original paper were performed.

The questionnaires were accepted favourably by the patients, even though the combination with the SF-36 increased the amount of time required for completion. Some difficulties were registered with the comprehension of the answering method, as well as of the meaning of single items. Results of the validation process were substantially equivalent to those of the original paper.