Introduction: Knee arthroscopy is a common orthopaedic procedure. Growing demand on orthopaedic services has led to the introduction of new initiatives to reduce waiting lists and streamline services. Recently extended scope physiotherapists have placed patients directly on arthroscopy waiting lists without prior assessment by an orthopaedic surgeon.

Aim: To determine if extended scope physiotherapists perform to the same standards as their orthopaedic colleagues with regards to diagnosing knee pathology and making appropriate referrals for arthroscopy.

Method: Data was collected prospectively from Aug 2005. Patients were seen either in the physiotherapy led acute knee clinic or in orthopaedic outpatients by a consultant or registrar. Any patient placed onto a waiting list for knee arthroscopy was considered for the study. The clinical indications and diagnoses were recorded as well as demographic data. The arthroscopies were performed by one surgeon. The arthroscopic findings were compared with the clinical findings.

Results: 300 patients were included in the study – 100 in each of the groups. The physiotherapists saw fewer patients per clinic and had longer time-slots per patient. All three groups had similar presenting complaints, indications for surgery and demographics. The Consultant performed best with 87% agreement with his initial diagnosis. The physiotherapists had 77% agreement and the registrars 68% agreement. No unnecessary arthroscopies were performed in any group.

Conclusions: Extended scope physiotherapists perform a useful role in orthopaedic outpatients. They perform as well as their orthopaedic colleagues with regards to the selection of patients for arthroscopy and making appropriate diagnoses.

Aim: To determine if extended scope physiotherapists perform to the same standards as their orthopaedic colleagues with regards to diagnosing knee pathology and making appropriate referrals for arthroscopy.

Method: Data was collected prospectively from Aug 2005. Patients were seen in a consultant led orthopaedic clinic by an Extended Scope Physiotherapist (ESP), a registrar or the consultant. All patients placed onto the waiting list for knee arthroscopy were considered for the study. The outpatient diagnosis and demographic data were recorded and compared against the arthroscopy findings. A single consultant surgeon performed the arthroscopies.

Results: 300 patients were included in the study (100 in each group). Each group was similar in terms of presenting complaint and demographics. There was no significant difference between the ESP’s and registrars in their ability to diagnose intraarticular pathology (CHI squared test: X 2.031, df 1, p=0.15). When only cruciate and meniscal pathology were considered there was also no significant difference between the ESP’s and the registrars (Fishers test p=0.12 and p=0.22 respectively, 2-tail test) The ESPs performed particularly well in their ability to diagnose cruciate injuries (sensitivity 100%, specificity 100% and PPV 100%). Both ESPs and registrars had high sensitivity but low specificity with regards to diagnosing meniscal pathology suggesting a low threshold for a positive diagnosis and a poor ability to correctly diagnose those patients who did not have a meniscal injury. Of the 300 patients only 9 unnecessary arthroscopies were requested. None were requested by the ESPs.

Conclusions: Extended scope physiotherapists perform a useful role in orthopaedic outpatients. They perform as well as orthopaedic registrars with regards to making the correct diagnosis and the selection of patients for arthroscopy.

To determine if extended scope physiotherapists perform to the same standards as their orthopaedic colleagues with regards to diagnosing knee pathology and making appropriate referrals for arthroscopy.

Data was collected prospectively from Aug 2005. Patients were seen in a consultant led orthopaedic clinic by an Extended Scope Physiotherapist (ESP), a registrar or the consultant. All patients placed onto the waiting list for knee arthroscopy were considered for the study. The outpatient diagnosis and demographic data were recorded and compared against the arthroscopy findings. A single consultant surgeon performed the arthroscopies.

300 patients were included in the study (100 in each group). Each group was similar in terms of presenting complaint and demographics. There was no significant difference between the ESP’s and registrars in their ability to diagnose intraarticular pathology (CHI squared test: X 2.031, df 1, p=0.15). When only cruciate and meniscal pathology were considered there was also no significant difference between the ESP’s and the registrars (Fishers test p=0.12 and p=0.22 respectively, 2-tail test) The ESPs performed particularly well in their ability to diagnose cruciate injuries (sensitivity 100%, specificity 100% and PPV 100%). Both ESPs and registrars had high sensitivity but low specificity with regards to diagnosing meniscal pathology suggesting a low threshold for a positive diagnosis and a poor ability to correctly diagnose those patients who did not have a meniscal injury. Of the 300 patients only 9 unnecessary arthroscopies were requested. None were requested by the ESPs.

Extended scope physiotherapists perform a useful role in orthopaedic outpatients. They perform as well as orthopaedic registrars with regards to making the correct diagnosis and the selection of patients for arthroscopy.

We describe the use of intramedullary reconstruction nails in the treatment of 14 patients with pathological subtrochanteric fractures and coexisting metastases in the femoral shaft. After nailing, all patients were free from pain and regained mobility. They were followed up clinically and radiologically until death from the primary disease. There were no mechanical failures even when a less than ideal reduction had been achieved.