The inquisitive and skeptical nature of humans drives research. Questions continue to be raised from a basic, applied and clinical perspective related to our areas of interest—be it molecular biology, biomaterials, biomechanics or clinical. The future of research will only be realised by understanding the past and the planning a pathway for the future. Translating advances in the laboratory to the patient are key to improving clinical outcomes. The future holds great promise, as long as we continue to challenge ourselves and ask those fundamental questions of ‘why’ and ‘how’ things happen.

The transosseous equivalent/Suture Bridge or TOE/SB repair has received much attention in recent years as more shoulder surgeons transition to all arthroscopic rotator cuff repairs. The purpose of this study was to compare the biomechanical behaviour of several variants of the Suture Bridge repair performed by the authors.

Four different Suture Bridge constructs were performed six times on 24 sheep infraspinatus tendon humerus constructs. The first group was a standard Suture Bridge with two medial mattress stitches with knots (KSSB4). The second group had four medial mattress stitches with knots and was called KDSB8. The third group had two medial mattress stitches without knots and was called USBFT4. These first three repairs used two medial 5.5 mm Bio-Corkscrew FT Anchors and two lateral 3.5 mm PushLock Anchors (Arthrex). The fourth repair had two medial mattress stitches without knots and used all Pushlocks and was called USBP4.

The repairs were then analysed for failure force, cyclic creep and stiffnessafter. Cycling was performed from 10 to 100 N at 1 Hz for 500 cycles. Following cyclic testing a single cycle pull to failure at 33 mm/sec was performed. The constructs were also observed for failure mechanism and gap formation using digital video recording.

The KDSB8 repair with a mean failure force of 456.9N was significantly stronger than the USBP4 repair at 299.7N (P=0.023), the KSSB4 repair at 295.4N (P=0.019) and lastly the USBFT4 repair at 284.0N (P=0.011). There was no statistical difference between the measured failure force for the two mattress stitch KSSB4 repair with knots and the knotless two mattress stitch repairs USBFT4 and USBP4. There was not a statistical difference between any of the repairs for measured stiffness and cyclic creep. However, the KDSB8 repair showed no discernable gap formation or movement at the footprint during cyclic testing. The KSSB4, USBFT4 and USBP4 repairs demonstrated bursal sided gap formation in the range of 1 to 3 mm.

Based on the results of this study the transosseous equivalent/Suture Bridge repair with four stitches tied in the medial row and maximal lateral suture strand utilization (KDSB8 TOE/SB) is the strongest. The KDSB8 also appeared to show less bursal sided gap formation and greater footprint stability than the other Suture Bridge constructs tested.

Introduction: Osteoporosis is a skeletal disorder characterised by decreased bone mineral density (BMD) and a subsequent increased risk of fragility fractures. This disease is commonly associated with postmenopausal females with an increasing incidence into later life, over 50% of females over 80 have osteoporosis. At the opposite spectrum of life, decreased BMD is traditionally associated with the female athletic triad, with hormonal imbalance leading to skeletal insufficiency. Considered a “silent disease” until a fracture occurs, as orthopaedic surgeons we must be able to identify those at risk of osteoporosis and refer promptly for dual energy x-ray absorptiometry (DEXA) scanning to prevent future fragility fractures in this specific patient cohort.

Methods: We carried out an epidemiological analysis of all female patients under the age of 30 referred for DEXA scanning in a university teaching hospital over a 3 year period. We analysed mode of referral, risk factors, T-score and subsequent fractures with an aim to highlight an underestimated level of osteopenia/osteoporosis in the younger patient.

Results: We identified 102 patients eligible for our study, with a mean age of 25.34 (Range- 17–29). As per the World Health Organisation (WHO) osteopenia was defined as osteopenia as a T-Score between −1 and −2.5, with osteoporosis below −2.5. The mean T score of these patients was −1.037 (range −3.2 to 2.4). Medical teams initiated the majority of referrals (77%), followed by General Practitioners (17%), Gynaecologists (4%), Paediatricians (1%) and Surgeons(1%). Risk factors included excess steroid use for medical conditions (41%), decreased body mass index (BMI) (27%), ceoliac disease (12%) and radiological evidence of osteopenia (7%). 34% of these patients had suffered a fall with 12% of patients suffering from a fragility fracture.

Conclusion: We identified a definite cohort of young female patients who had a mean T-score within the levels for osteopenia. Over one third had suffered a fall and 12% had suffered a fragility fracture despite a young age. With ever increasing patient numbers in both fracture and orthopaedic clinics and increased pressure on resources, it is imperative that we still take thorough histories to identify those young female patients that are at risk of osteoporosis. With appropriate follow up and investigations, they can be started on necessary treatment and prevent subsequent fragility fractures, the incidence of which appears to be underestimated.

Introduction: The revision of a resection arthroplasty of the hip to total hip arthroplasty is a demanding procedure with higher complication rates than those of primary hip arthroplasty.

Aim: To evaluate the outcome of revising resection arthroplasties and thereby assist in deciding which patients would benefit from the procedure.

Methods: We reviewed the experience of an orthopaedic surgeon (WJMB) who performed revisions of resection arthroplasties to total hip arthroplasties for 10 patients from 1990 to 1999. The reason for resection arthroplasty was established or suspected infection in all patients.

Results: The time since the resection arthroplasty ranged from 12 to 36 months, with an average of 14.7 months. The Harris hip scores with the resection arthroplasties ranged from 21 to 44 with an average of 38.3. The follow-up ranged from one to eight years with an average of 4.2 years. Five patients had died from other causes at the time of the study. The Harris hip scores at the latest follow-up ranged from 46 to 89 with an average of 66.

The complications included instability requiring a constrained acetabular liner, an intra-operative femoral fracture requiring a long-stem prosthesis, the breaching of a femoral cortex by a prosthesis requiring a revision and recurrence of infection in a patient who was non-compliant with the prescribed antibiotics.

Conclusions: The revision of a resection arthroplasty to a total hip arthroplasty is a demanding procedure with a high complication rate and prolonged recovery. Revising only those patients with poorly functioning resection arthroplasties optimises the possibility of a positive surgical outcome, being an improvement in pain and function.