The shoulder is the least constrained of all joints of the body and is more susceptible to injury including dislocation. The rate of recurrent instability following primary stabilization procedure at 10 years of follow-up ranged from 3.4 to 35 %. We describe the outcomes of 74 patients who underwent knotless arthroscopic anterior stabilisation using 1.5 mm Labral Tape with 2.9mm Pushlock anchors for primary anterior instability. We performed a retrospective analysis of patients who underwent surgery for post-traumatic recurrent anterior instability for 2 years by a single surgeon. Patients with glenoid bone loss, >25% Hill Sachs lesion, posterior dislocation, paediatric age group and multidirectional instability were excluded from this study. Over 90% of our case mix underwent the procedure under regional block anaesthesia and was discharged on the same day. The surgical technique and post-operative physiotherapy was as per standard protocol. Outcomes were measured at 6 months and 12 months. Of the 74 patients in our study, we lost 5 patients to follow up. Outcomes were measured using the Oxford Shoulder Score apart from clinical assessment including the range of motion. We noted good to excellent outcomes in 66 cases using the Oxford Instability Scores. All patients achieved almost full range of motion at the end of one year. Our cumulative Oxford Instability Score (OIS) preoperatively was 24.72 and postoperatively was 43.09. The Pearson correlation was .28. The t Critical two-tail was 2.07 observing the difference between the means of the OIS. Complications included recurrent dislocation in 2 patients following re-injury and failure of procedure due to recurrent instability requiring an open bone block procedure in one case. We had no reported failures due to knot slippage or anchor pull-out. We publish the largest case series using this implant with distinct advantages of combining a small bio absorbable implant with flat braided, and high-strength polyethylene tape to diminish the concern for knot migration and abrasive chondral injury with the potential for earlier rehabilitation and a wider footprint of labral compression with comparative outcomes using standard techniques. Our results demonstrate comparable and superior results to conventional suture knot techniques for labral stabilization.
A comparison of patient satisfaction of service provided by independent sector treatment centres versus an index NHS hospital in total knee replacement surgery. Patients were all initially listed for total knee replacement (TKR) by a single consultant from the index NHS hospital, Derbyshire Royal Infirmary (DRI). Patients were sent a postal questionnaire and asked to rate the TKR service provided by a given hospital, based on recent inpatient experience. Questions covered quality of care delivered by hospital staff and quality of ward environment. Overall satisfaction was rated. Patients electing surgery under Patient Choice at an independent sector treatment centre (ISTC) were asked about factors that influenced their hospital choice. 100 consecutive patients undergoing TKR at DRI and 100 patients choosing ISTC hospitals were identified. All surgery occurred between April 2003 and September 2006.Purpose
Methods
