We analysed data from the Oxford hip and knee questionnaires collected by the New Zealand Joint Registry at six months and five years after joint replacement, to determine if there was any relationship between the scores and the risk of early revision. Logistic regression of the six-month scores indicated that for every one-unit decrease in the Oxford score, the risk of revision within two years increased by 9.7% for total hip replacement (THR), 9.9% for total knee replacement (TKR) and 12.0% for unicompartmental knee replacement (UKR). Our findings showed that 70% of the revisions within two years for TKR and 67% for THR and UKR would have been captured by monitoring the lowest 22%, 28% and 28%, respectively, of the Oxford scores. When analysed using the Kalairajah classification a score of < 27 (poor) was associated with a risk of revision within two years of 7.6% for THR, 7.0% for TKR and 24.3% for UKR, compared with risks of 0.7%, 0.7% and 1.8%, respectively, for scores > 34 (good or excellent).

Our study confirms that the Oxford hip and knee scores at six months are useful predictors of early revision after THR and TKR and we recommend their use for the monitoring of the outcome and potential failure in these patients.

Introduction: The patterns of forearm and hand paralysis in traumatic tetraplegia are recognised and classified by an international classification system. Although weakness and wasting are common around the shoulder in tetraplegia, it is harder to discern individual muscle function.

Aim: To determine the activity of shoulder girdle muscles in patients with traumatic tetraplegia and to relate these results to the subjects’ international forearm classifications.

Methods: Twenty-five male tetraplegic subjects (50 upper limbs) were examined. Forearm muscle strengths were recorded according to the international classification system. The strengths of nine shoulder movements were recorded according to the Medical Research Council (MRC) grading system. The presence of wasting and the electromyographic (EMG) activity of nine shoulder muscle regions were noted. Using surface electromyography we noted whether voluntary EMG patterns were present or absent and whether lower motor denervation signs were present or absent.

Results: Absence of voluntary EMG activity was only seen in latissimus dorsi, and only in patients with very high-level lesions (either no MRC grade IV forearm muscles, or brachioradialis only, i.e. international forearm grade I or less). Lower motor neuron signs were observed in latissimus dorsi in most patients without ipsilateral MRC grade IV finger extension (international forearm grade VI or less). Lower motor neuron signs were observed in infraspinatus in most patients without MRC grade IV forearm pronation (international forearm grade IV or less).

Conclusions: Only patients with very high level lesions showed paralysis of any shoulder girdle muscles and, then, only latissimus dorsi. In most cases of traumatic tetraplegia shoulder girdle muscles have the capacity to be strengthened by use and rehabilitation.