Arthritis of the glenohumeral joint accompanied by an irreparable tear of the rotator cuff can cause severe pain, disability and loss of function, particularly in the elderly population. Anatomical shoulder arthroplasty requires a functioning rotator cuff, however, reverse shoulder arthroplasty is capable of addressing both rotator cuff disorders and glenohumeral deficiencies. The Aequalis Reversed Shoulder Prosthesis design is based on two bio-mechanical principles by Grammont; a medialized center of rotation located inside the glenoid bone surface and second, a 155 degree angle of inclination. Combined, they increase the deltoid lever arm by distalizing the humerus and make the prosthesis inherently stable.

24 consecutive primary reverse total shoulder arthroplasties were performed by a single surgeon for arthritis with rotator cuff compromise and 1 as a revision for a failed primary total shoulder replacement between December 2009 and October 2012. Patients were assessed postoperatively with the use of the DASH score, Oxford shoulder score, range of shoulder motion and plain radiography with Sirveaux score for scapular notching.

Mean age at the time of surgery was 72.5 years (range 59 to 86). Average follow up time was 19.4 months (range 4 to 38). Functional outcome scores from our series were comparable with patients from other follow up studies of similar prosthesis design. All patients showed improvement in range of shoulder movement postoperatively. Complications included one dislocation, one acromion fracture and one humeral shaft fracture. No cases of deep infection were recorded. Overall, the short-term clinical results were promising for this series of patients and indicate reverse shoulder arthroplasty as an appropriate treatment for this group of patients.

Magnetic resonance imaging (MRI) continues to become more widely accessible as an investigation, with an increasing number of scans being performed in the outpatient setting for suspected shoulder pathology.

We performed a retrospective review of all shoulder MRI scans performed in an orthopaedic outpatient setting in a district general hospital between October 2010 and October 2011. We also reviewed the medical notes for these patients. 75 MRI Shoulder scans were performed on 74 patients. In 5 cases (7%), no other form of imaging was performed prior to MRI scan. 11 patients (15%) had no provisional diagnosis included in the referral. The nature of referral, indication for MRI and subsequent management of these patients was also examined.

Our findings may support the use of guidelines for requesting MRI scans of the shoulder in outpatients.

Aims: To evaluate the outcome of open excision of the Acromio-Clavicular Joint (ACJ) in isolated Acromio-Clavicular Joint osteoarthritis and compare it with the published rates for arthroscopic intervention.

Introduction: Anectdotally this operation has been reported as very successful. There are no reviews of this particular operation in the literature. Arthroscopic excision has been advocated as being successful in > 90% of patients in repeated studies.

Methods: A two year period of theatre records produced a group of patients who had undergone this procedure. Case-notes were obtained and the patients with isolated ACJ were identified. Information on patient demographics, duration of symptoms, length of operation, operative complications and follow up were obtained. The patients were contacted and asked to fill out a DASH form. They were invited to a research clinic for clinical review.

Results: 31 patients with 32 isolated osteoarthritic ACJs were identified. Ratio of men to women was 22:9. Mean age at surgery was 48 years. Duration of symptoms before surgery was 105 weeks (mean). Mean time of surgery was 17 minutes. 80% were discharged from follow up by 4 months, mean follow up being 12 weeks. Complications were limited to 2 superficial wound infections. One patient did not have resolution of symptoms.

DASH score results were excellent in all bar one of those returned.

Conclusion: This simple operation has been shown to be effective in 96.9% of patients. The complication rate was 6.2%. Patient satisfaction is high.

These results are comparable to the best results of arthroscopic ACJ Excision.

Introduction More than 2% of the general population is reported to be affected by adhesive capsulitis. The incidence is greater in patients with diabetes than in the general population for both IDDM and NIDDM. This study sought to test the hypotheses that diabetes does not have an effect on outcome and does not contribute to morbidity.

Materials and methods Data were collected retrospectively by reviewing medical records from 1996 to 2005. A total of 148 case notes were evaluated to identify patients with a diagnosis of frozen shoulder who underwent MUA ± arthroscopy ± release. Twenty-two patients (22 shoulders), 12 of whom had diabetes, agreed to participate and were included. The diabetic and non-diabetic groups were broadly comparable with respect to demographic characteristics. Invited patients were asked to assess current physical function and symptoms by completing a shortened version of the DASH outcome measure questionnaire prior to attending the clinic and a further questionnaire detailing pre-op symptoms. Physical function was assessed and calculated using the Constant score system.

Results The median pre-operative DASH score was 72.73 in the diabetic group and 71.00 in the non-diabetic group (difference 2.3%). The median post-operative DASH score was 27.27 in the diabetic group and 28.86 in the non-diabetic group (difference 5.51%). The median postoperative Constant score was 60.00 in the diabetic group and 59.50 in the non-diabetic group (difference 0.83%).

Conclusion The pre- and post-operative DASH results and post-operative Constant score showed little difference between diabetic and non-diabetic patients. While giving due cognisance to the small number of patients included and the retrospective design of the study, the results support the hypothesis that diabetes does not have an effect on outcome following MUA or arthroscopy for adhesive capsulitis and does not contribute to morbidity.

Aims: In this study we present the outcome for patients with the Rotaglide mobile meniscal knee prosthesis implanted for osteoarthritis. Method: All patients reviewed had this prosthesis implanted as a primary total knee Arthroplasty in Crosshouse Hospital. The minimum follow up period was 5 years (range 5–8.2). Patients were assessed clinically by the junior author (CW) and results were standardised using the Hospital for Specialist Surgery (HSS) knee score. Standard radiographs were taken in AP and lateral planes to assess for loosening using the Knee Society roentgenographic system. Case notes were then examined for evidence of peri and postoperative problems. Results: Sixty-seven patients (73 knees) were reviewed. 97% of patients had an excellent clinical outcome with HSS scores of 85 or more. Two knees (2.7%) were revised, one for meniscal fracture and one for meniscal dislocation. There have been no revisions for aseptic loosening and no deep infections to date. Both these revisions may be related to incorrect tissue balancing of the ßexion and extension gaps early in our learning curve with this prosthesis. These meniscal complications highlight the exacting nature of the surgical technique required for this prosthesis, particularly for the Surgeon used to implanting þxed bearing TKRñs which are more forgiving of suboptimal soft tissue balancing. Conclusions: We feel this prosthesis offers a safe and effective treatment for osteoarthritis with a good clinical outcome at 5 years with a low level of complications.

In this study we intend to evaluate the outcomes for patients with the Rotaglide mobile meniscal knee prosthesis implanted for osteoarthritis. All patients reviewed had this prosthesis implanted as a primary total knee arthroplasty in Crosshouse hospital.

The minimum follow up period was 5 years (range 5 to 8.2). Patients were assessed clinically by the junior author (CW) and the results were standardised using the Hospital for Specialist Surgery (HSS) knee score. Standard radiographs were taken in AP and lateral planes to assess for loosening using the Knee Society roentgenographic system. Case notes were then examined for evidence of complications in the peri and postoperative complications.

Sixty-five patients (71 knees) were reviewed. There was an excellent clinical outcome with HSS scores of 85 in 97.1% of patients. Two knees (2.9%) were revised, one for meniscal fracture and one for meniscal dislocation. Both these patients also attended for review and were making good progress. Both of these failures occurred early in our series and in a total of 312 knees to date there have been no other meniscal failures. No knees were revised for aseptic loosening and there have been no deep infections.

We feel this prosthesis offers a safe and effective treatment for osteoarthritis with a good clinical outcome at 5 years with a low level of complications.

The Use of bone allograft in orthopaedic Surgery has been predicted to increase particularly in joint revision surgery. This has led to a potential problem with supply. Questionnaires were distributed to all 146 Consultant orthopaedic Surgeons working in Scotland in 2000. They were asked to indicate their current usage of bone and tissue allograft, any problems encountered with supply and if alternatives to allograft such as processed bone, might be used. The questions asked were very similar to those asked in a survey by the author (GG) in 1995 to enable comparisons to be made. 74% of all bone issued by the SNBTS in 2000 –2001 was used in revision hip arthroplasy. This compares with only 66% of bone issued in 1998–1999.

Replies were received from 125 consultants (87%) of whom 93 reported using bone allograft. 41 consultants (46%) predicted an increase in their requirement for bone allograft, and 23 (26%) felt they could currently use more bone if this became available. Sixty percent of Surgeons would consider using processed bone as an alternative. In comparison with figures from a previous study in 1995, an increasing number of surgeons are prepared to use processed bone as an alternative to fresh frozen allograft. As the number of revision THR’ s continues to increase the amount of bone required is likely to continue to increase. The need to increase efficiency in harvest and supply of bone is therefore great. The use of more SNBTS nurses in selection of patients and collection of bone may increase efficiency. More surgeons may have to use processed bone, which would allow more bone to be released. Also processing may help reduce transmission of infective particles such as HIV and new variant CJD. With rising public and medical concerns over these issues this seems most desirable.

Purpose: In this study we intend to evaluate the outcomes of patients with the Rotaglide prosthesis implanted for osteoarthritis.

Method: All patients reviewed had this prosthesis implanted for primary total knee arthroplasty in Cross-house hospital. The minimum follow up period was 5 years (range 5–8). Patients were assessed clinically and results were standardised using the Hospital for Specialist Surgery (HSS) knee score. Standard radiographs were taken in AP and lateral planes to assess for loosening. Case notes were then examined for evidence of complications in the peri and postoperative complications.

Results: Sixty seven patients (73 knees) were reviewed with the Rotaglide total knee replacement implanted for osteoarthritis. 94% of patients had an excellent clinical outcome with HSS scores of 85 or more. The average HSS score was 90.2. Two patients were revised, one for meniscal fracture and one for meniscal dislocation. Two patients were treated with anti-biotics for superficial wound infection.

Conclusions: We feel this prosthesis offers a safe and effective treatment for osteoarthritis with a good clinical outcome at 5 years with a low level of complications.