Accurate, reproducible outcome measures are essential for the evaluation of any orthopaedic procedure, in both clinical practice and research.

Commonly used patient-reported outcome measures (PROMs) have drawbacks such as ‘floor’ and ‘ceiling’ effects, limitations of worldwide adaptability and an inability to distinguish pain from function. They are also unable to measure the true outcome of an intervention rather than a patient’s perception of that outcome.

Performance-based functional outcome tools may address these problems. It is important that both clinicians and researchers are aware of these measures when dealing with high-demand patients, using a new intervention or implant, or testing a new rehabilitation protocol.

This article provides an overview of some of the clinically-validated performance-based functional outcome tools used in the assessment of patients undergoing hip and knee surgery.

Cite this article: Bone Joint J 2014;96-B:1431–5.

Cardiac and neurological functions were evaluated at the time of operation in 81 randomly selected elderly patients who had sustained a fracture of the neck of the femur. Although only one-fifth of the patients had clinical signs of senile dementia or cerebrovascular disease on admission to hospital, more than half had seriously abnormal EEGs including 12 of the 15 patients who died within six months. ECGs before operation showed that patients with signs of arrhythmia or previous myocardial infarction had a much lower survival rate than those with normal or other pathological ECG signs. Nerve conduction velocity findings proved inconclusive when correlated with survival or return home. Routine EEG and ECG examinations are of value in detecting underlying dysfunctions which may not be observable clinically on admission but are important prognostic indicators for survival or return home, and may be implicated as causative factors of fracture in the elderly

Fractures of the distal end of the radius should be treated on the same principles as other fractures involving joints. Displaced articular fractures require open reduction to allow anatomical reconstruction of both the radiocarpal and the radio-ulnar joints. For extra-articular fractures with severe comminution and shortening this enables the radial length to be re-established achieving radio-ulnar congruency. Stable internal fixation can be achieved with two 2.0 AO titanium plates placed on each of the ‘lateral’ and the ‘intermediate’ columns of the wrist at an angle of 50° to 70°. This gives good stability despite the tiny dimensions of the plates, and allows early function. We report a series of 20 fractures treated by this method of internal fixation with satisfactory results in all

Periprosthetic bone loss after total joint arthroplasty is a major clinical problem resulting in aseptic loosening of the implant. Among many cell types, osteoblasts play a crucial role in the development of peri-implant osteolysis. In this study, we tested the effects of calcitriol (1α,25-dihydroxy-vitamin-D. 3. ) and the bisphosphonate pamidronate on titanium-particle- and TNF-α-induced release of interleukin-6 and suppression of osteoblast-specific gene expressions in bone-marrow-derived stromal cells with an osteoblastic phenotype. We monitored the expression of procollagen α1[1], osteocalcin, osteonectin and alkaline phosphatase mRNAs by Northern blots and real-time reverse transcription and polymerase chain reaction analyses. The release of various cytokines was also analysed by ELISA. We found that calcitriol or pamidronate could only partially recover the altered functions of osteoblasts when added alone. Only a combination of these compounds restored all the tested functions of osteoblasts. The local delivery of these drugs may have therapeutic potential to prevent or to treat periprosthetic osteolysis and aseptic loosening of implants

We report the case of an eight-month-old girl who presented with a poliomyelitis-like paralysis in her left upper limb caused by enterovirus 71 infection. She recovered useful function after nerve transfers performed six months after the onset of paralysis. Early neurotisation can be used successfully in the treatment of poliomyelitis-like paralysis in children

A small proportion of children with Gartland type III supracondylar humeral fracture (SCHF) experience troubling limited or delayed recovery after operative treatment. We hypothesised that the fracture level relative to the isthmus of the humerus would affect the outcome.

We retrospectively reviewed 230 children who underwent closed reduction and percutaneous pinning (CRPP) for their Gartland type III SCHFs between March 2003 and December 2012. There were 144 boys and 86 girls, with the mean age of six years (1.1 to 15.2). The clinico-radiological characteristics and surgical outcomes (recovery of the elbow range of movement, post-operative angulation, and the final Flynn grade) were recorded. Multivariate analysis was employed to identify prognostic factors that influenced outcome, including fracture level. Multivariate analysis revealed that a fracture below the humeral isthmus was significantly associated with poor prognosis in terms of the range of elbow movement (p < 0.001), angulation (p = 0.001) and Flynn grade (p = 0.003). Age over ten years was also a poor prognostic factor for recovery of the range of elbow movement (p = 0.027).

This is the first study demonstrating a subclassification system of Gartland III fractures with prognostic significance. This will guide surgeons in peri-operative planning and counselling as well as directing future research aimed at improving outcomes.

Cite this article: Bone Joint J 2015;97-B:134–40.

Objectives

The purpose of this study was to investigate whether the femoral head–neck contour, characterised by the alpha angle, varies with the stage of physeal maturation using MRI evaluation of an asymptomatic paediatric population.

We made a study of 49 total hip arthroplasties at five years, comparing the Charnley hip score, the Nottingham Health Profile (NHP) score and the appearance on serial radiographs. Each of the three investigations was performed by an independent observer with no knowledge of the results of the other two studies. The eight patients with radiographic signs of prosthetic loosening had significant reductions in function and quality of life as measured by the NHP questionnaire, but no differences in the mean Charnley hip scores. None of the eight patients had clinical signs of prosthetic loosening sufficient to recommend revision of their THR. The NHP is a relatively low-cost method of providing long-term follow-up of THR

The role of computer-assisted surgery in maintaining the level of the joint in primary knee joint replacement (TKR) has not been well defined. We undertook a blinded randomised controlled trial comparing joint-line maintenance, functional outcomes, and quality-of-life outcomes between patients undergoing computer-assisted and conventional TKR. A total of 115 patients were randomised (computer-assisted, n = 55; conventional, n = 60).

Two years post-operatively no significant correlation was found between computer-assisted and conventional surgery in terms of maintaining the joint line. Those TKRs where the joint line was depressed post-operatively improved the least in terms of functional scores. No difference was detected in terms of quality-of-life outcomes. Change in joint line was found to be related to change in alignment. Change in alignment significantly affects change in joint line and functional scores.

We used a modification of the wake-up test to monitor spinal cord function in 102 consecutive scoliotic patients undergoing Harrington instrumentation. Four patients were found to have a neural deficit when they were awakened during the operation. Three recovered immediately after partial release of the distracting force; one required immediate removal of the rod and was left with a slight neural deficit. Using our method, we have encountered no problem in performing the wake-up test, although attention is drawn to the difficulty in repeating the test if the patient is re-anaesthetised with diazepam. There were no false negative results in this series

Thirty-three patients with impingement syndrome of the rotator cuff were studied before and at operation. It was shown that the rotator cuff lengthens and twists during elevation of the arm. Elevation is achieved by early glenohumeral abduction and continuous flexion and external rotation. The range of free rotation at the glenohumeral joint diminishes progressively during elevation. Rotator cuff impingement occurs towards the end of the early glenohumeral abduction. Excision arthroplasty of the acromioclavicular joint and anterior acromioplasty is highly effective for impingement under the acromion, but only moderately effective where impingement is under the acromioclavicular joint.

1. A series of patients with respiratory paralysis after anterior poliomyelitis is reported.

2. The examination routine is described and its value discussed.

3. Details are given of methods of respiratory rehabilitation and of the various pitfalls encountered, with suggestions for their avoidance.

4. The rates of recovery of vital capacity (and percentage of the expected vital capacity) in adults and children are analysed and compared with the rates given by Sharrard for nonrespiratory individual muscles in treated patients. It is shown that during the first year treated patients tend to recover approximately 3 to 4 per cent of their expected vital capacity per month rather than to regain any definite proportion of their current vital capacity.

Many analyses of the geometric arrangement of trabeculae in the proximal end of the femur have accepted and perpetuated the theories of Ward (1838), Culmann (1866) and Meyer (1867), and have contributed to the belief that the structure of the femoral neck embodies mechanical principles which are foreign to bony formations elsewhere. This isolated departure from the normal pattern of skeletal behaviour is considered to be most unlikely, and an attempt has been made to show that the structure of the femoral head and neck departs but little from the normal anatomy of the long bone.

From a developmental point of view, the proximal end of the human femur is believed, in its simplest interpretation, to represent an upward continuation of the original shaft which has undergone rotation and expansion. The cancellous arrangements of the internal weight-bearing system are likewise believed to represent the expanded and rotated lamellae of the neck as they are presented radiologically or on coronal section.

The forces acting upon the proximal end of the femur are considered to be mainly compressive in nature, and both crane and street-lamp bracket theories have therefore been rejected. The spiral conformity of the proximal end of the femur has been related to the spiral disposition of the soft-tissue structures that surround the hip, and in the interpretation of hip joint mechanics the principle of the screw has been preferred to the principle ofthe lever.