The NHS Plan (2000) identified the need for change in the way patients are asked to give consent for surgery to make the process more explicit. A new NHS operation consent form was introduced in April 2002 following the Bristol enquiry into deaths associated with Cardiac Surgery.

Methods: We have addressed the obtaining of consent for surgery as an evidence-based exercise. The published literature has been reviewed and we have attempted to accurately quantify the success rates for surgery, complication rates and poor outcomes in order to identify what the likely benefits and risks are for our common operations –

Shoulder – Arthroscopic Sub-Acromial Decompression, Anterior stabilisation, Rotator Cuff repair, excision lateral end of clavicle and Shoulder Arthroplasty.

Evidence was therefore been categorised into 4 levels:

National & International published results

Results: We have taken the standard NHS Consent Form and modified it in a printed format to present to the patient a clearer description of the anticipated outcome from their surgery (with percentages). This evidence based consent form was evaluated in a combined prospective and retrospective survey of 60 patients who attended our pre-operative assessment clinic. We will present the results of the survey and demonstrate the standardised Consent Forms.

Conclusions: The majority of the information the patient wished to know was Level 4 evidence!

Aseptic loosening of orthopaedic implants is usually attributed to the action of wear debris from the prosthesis. Recent studies, however, have also implicated physical pressures in the joint as a further cause of loosening. We have examined the role of both wear debris and pressure on the secretion of two chemokines, MIP-1α and MCP-1, together with M-CSF and PGE2, by human macrophages in vitro.

The results show that pressure alone stimulated the secretion of more M-CSF and PGE₂ when compared with control cultures. Particles alone stimulated the secretion of M-CSF and PGE₂, when compared with unstimulated control cultures, but did not stimulate the secretion of the two chemokines. Exposure of macrophages to both stimuli simultaneously had no synergistic effect on the secretion of the chemokines, but both M-CSF and PGE₂ were increased in a synergistic manner. Our findings suggest that pressure may be an initiating factor for the recruitment of cells into the periprosthetic tissue.