The treatment of patients with arthritis of the glenohumeral joint with an associated massive irreparable cuff tear is challenging. Since these patients usually have proximal migration of the humerus, the CTA extended head allows a surface with a low coefficient of friction to articulate with the acromion.

Between 2001 and 2006 a total of 48 patients with arthritis of the shoulder joint associated with a massive cuff tear, were treated with a CTA head. The indications for use being Seebauer Type 1a and 1b appearances on x-ray and active abduction of the arm to more than 60° with appropriate analgesia. Preoperatively, a Constant score and an ASES pain and function score were completed as well as standard radiological assessment. These were repeated at follow up. Paired t tests were carried out for all the variables. A Kaplan-Meier survival analysis was performed.

Follow up varied between 2 and 8 years. Improvements in pain, function and all movement parameters were significant at p< 0.001. There was no change in the strength component. Survival analysis showed 94% survival at 8 years (95% CL 8%) there were 2 revisions and 5 deaths. Radiological assessment at follow up revealed no evidence of humeral stem loosening. In 5 (17%) cases however there was evidence of erosion in the surface of the acromion and in 13 (45%) erosion of the glenoid. Finally one component was also seen to have subluxed anteriorly.

This head design has been in use for a number of years. To date there appears to be no reported outcome of their use. This series shows that in an appropriately selected patient a satisfactory clinical outcome can be maintained in the short to medium term. The presence of erosion of the glenoid but also the under surface of the acromion does require continuing monitoring.

Aims: To determine the anthropometric measurements of bony landmarks in the knee using MR scans and so assist revision knee surgeons in prostheses placement.

Methods: We analysed 100 MR scans of patients aged 16–50 (50 male, 50 female) which were performed for meniscal pathology, patellar dislocation and ACL injury. Those over the age of 50 or with symptoms suggestive of general osteoarthritis, or where the epiphyses had not yet fused were excluded. All measurements recorded were to the level of joint line and are shown below.

Results: (Tables removed)

Conclusions: To ensure near normal knee mechanics are achieved during revision knee surgery the joint line should be within 5mm of the original. Our study provides mean values for the distance from various bony landmarks to the joint line in non-arthritic knees on MR scan. The use of the medial epicondyle value as a sole reference will place the joint line within 5mm in 88% of males and 96% of females. Use of multiple landmarks further increases accuracy. The final position of the joint will depend on trialling prostheses.

Introduction: Hypothesis: Patients undergoing operations at the end of the week are disadvantaged by the lack of weekend physiotherapy. Aim: To test the hypothesis by review of a single surgeon series of patients identifying factors affecting the post-operative length of stay

Methods: A cohort of patients with OA undergoing elective primary joint replacement was identified. Data was collected for demographics, procedures undertaken and length of stay.

Results: 42 patients were included in the cohort. There were 23 hip and 19 knee replacements with an average age of 73.47 years. Multivariate analysis of the data was performed to ensure that the age, pathology, ASA and days of the week were equally represented. Further analysis revealed that the main factor contributing to length of stay was the age of the patient (5.13 days if age< 75 vs. 6.33 days if olderthan 75 years). Patients having surgery at the end of the week actually had a reduced length of stay compared to those at the start of the week (5.27 vs. 6.22 days).

Discussion: The day of surgery does have effect on the length of stay post op. The widespread assumption that weekend physio to mobilise patients early post op may not be well founded. It is more likely that targetting patients to encourage discharge would be a more effective use of resource.