Scarf osteotomy for correction of painful hallux valgus is an effective technique, giving a predictable correction of the deformity. However, some patients remain less than fully satisfied, despite normalisation of the usual radiographic parameters. This study examines whether lateral soft tissue release can cause late splaying of the forefoot.

A series of 32 feet in 29 consecutive patients in a single centre, operated on by a single surgeon, over a 12 month period were studied. After pre-operative weight-bearing x-rays and consenting, a standardised ‘Barouk-technique’ Scarf procedure was undertaken with on-table assessment for lateral soft tissue release and phalangeal varisation. Post-operatively, patients were kept heel weight-bearing without cast for 6 weeks, with use of a fabric splint after removal of bandages at 2 weeks.

HVA and IMA were measured pre-operatively, at 6 weeks, and at 6-12 month follow-up. Distance from the mid-points of the 1st to the 5th metatarsal heads and distance from lateral sesamoid to 2nd metatarsal shaft were also recorded by blinded observers. AOFAS Foot Scores were collected prospectively. Student's t-test for single-tailed paired data was applied and p-values calculated. There were 22 female and 10 male feet; in patients aged 27 to 74 (mean 58).

Average HVA improved from 34° to 17° and was maintained at 16°. IMA improved from 14° to 7°, but then increased significantly to 10°. Overall inter-metatarsal width reduced from 76mm to 65mm but then significantly increased to 71mm. Sesamoid distance was also reduced and later increased, but not significantly. Mean foot scores improved from 52 to 85 at late follow-up. Complication rate was low.

Late widening occurred more in those feet with bigger original HVA, which were likely to have had more extensive soft tissue release (deep inter-metatarsal ligament). We recommend cautious release; and pre-operatively counselling specifically regarding eventual overall foot-width.

Aim: Patient Relevant Outcome Measures are increasingly used to assess the quality of care and clinical effectiveness of surgical intervention but lack clear definitions of success or failure. We sought to evaluate and compare the ability of two outcome scores, the Lysholm and the KOOS, to determine a successful outcome following ACL reconstruction by defining discrete criteria.

Methods & Results: 204 patients underwent single bundle ACL reconstruction (four strand hamstring graft) from 2003 – 2007 and had minimum 12 months follow up. 118 (58%) patients had complete KOOS and Lysholm scores recorded pre-operatively and at 12 months post operation.

Lysholm scores at 12 months gave an average score of 90 with 82% of scores categorised “good” or “excellent” according to previously published ratings.

The 12 month KOOS were then analysed against previously published, calculated KOOS cut-off criteria for a symptomatic knee and in addition, the magnitude of change in pre- & post-op scores, as reported by the Scandinavian Ligament Registries. Applying these two patient derived definitions produced results with noticeably varied rates of success. For the most valid and sensitive KOOS subscales - Sport & Recreation and Quality of Life – the results ranged from 95% to 37%, depending on criteria selected.

Conclusions: The Lysholm Score and KOOS have to date been used primarily for comparison studies in ACL reconstruction. There has been no consensus regarding specific scores that define ‘successful outcome’ following a surgical intervention. We have shown that a patient derived KOOS could be used with a combination of absolute values and change in score to identify a successful surgical outcome.

Use of “Change in Score” represents the “Value – Added” effect of surgical intervention and demonstrates clinical effectiveness, as well as permitting comparison of individual surgeon’s performance with the standards being established by the Scandinavian Ligament Registries.

Objective To survey current antithrombotic prophylaxis regimes of foot and ankle surgeons in the UK, and their self-reported rates of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Method A postal questionnaire was sent to 180 members of the British Orthopaedic Foot and Ankle Society requesting regime and types of antithrombotic prophylaxis (if any) used for elective forefoot, elective midfoot, open elective ankle, elective ankle arthroscopy and ankle trauma surgery, and numbers of cases of DVT and PE.

Results Ninety surgeons responded (50%). Surgeons had been practising as consultants with a special interest in foot and ankle surgery for an average of 8.9 years, and performed an average of 24 foot and ankle cases per month. Ten per cent never used antithrombotic prophylaxis in foot and ankle surgery, 64/90 used it routinely for certain cases, and 17/90 used it routinely in all patients. The most common types of prophylaxis were low molecular weight heparin, aspirin and TED stockings. In an approximate overall total of 223,500 foot and ankle cases, the self reported DVT rate was 0.1%. There were 45 reported PEs (0.02%). There was no significant difference in the rate of DVT between those who never, sometimes or always used prophylaxis. Only 5.5% surgeons employed a specific screening protocol to identify high risk patients.

Discussion There is widely varying clinical antithrombotic practice among foot and ankle surgeons in the UK, with no significant difference in reported DVT rates. This has implications for clinical practice and medicolegal issues.

We carried out a prospective study of 93 patients undergoing surgery for conditions of the rotator cuff during 1994 and 1995. They were assessed before operation and after six months, and four years, using the patient-based Oxford Shoulder Score (OSS), the SF-36 questionnaire and the Constant shoulder score. The response rates were higher for the OSS and SF-36. The correlation coefficients were high (r > 0.5) between all scores at each stage of the study. While all scores improved substantially at six months, the Constant score was reduced significantly at four years. This did not correlate with the patients’ judgement of the change in symptoms or of the success of the operation. Our study suggests that patient-based measures of pain and function can reliably assess outcomes in the medium term after surgery to the shoulder.