Purpose: To investigate the natural history and clinical outcomes of patients suffering from various stages of Kienbock’s disease (KD) in the NL population.

Method: The present study was a retrospective analysis of 66 patients (42 male and 24 female) diagnosed with KD. Following chart reviews of these patients, a telephone interview was conducted to acquire responses to the DASH questionnaire. All analyses were performed using SPSS for Windows (version 15.0), and significance was set at P10 years). Pearson correlation was used to assess for a correlation between DASH scores and age of diagnosis as well as radiographic stage of disease. Multivariate linear regression analysis was used to account for confounding factors.

Results: The average age of diagnosis was 38.8 ±11.6 (18–70), right wrist affected in 61.5% of cases and left in 38.5%. History of trauma was present in 25 cases. With respect to radiographic stage of KD at time of diagnosis, 6 cases were in stage I, 26 in stage II, 9 in stage IIIa, 16 in stage IIIb, 5 in stage IV, and 4 with unknown stage. Forty-eight patients were treated conservatively, while 18 surgically (7 following failed conservative treatment). Thirty-nine patients provided a response to the DASH questionnaire. There was no statistically significant difference in DASH scores between any of the groups according to time since first diagnosed. There was also no significant difference in DASH scores between surgically treated and conservatively treated patients, regardless of stage of KD. Nor was there any difference in DASH scores among surgical and conservatively treated patients when individual stages of KD were considered. Furthermore, because of low numbers within each KD stage, stage III and stage IV were combined. However, once again no significant difference was found between the surgical and conservative treatment modalities. Interestingly, a positive correlation was found between age of diagnosis and DASH score (r=0.42, p=0.007). Multivariate linear regression analysis showed that the correlations remained significant after accounting for the radiographic stage of KD, gender, and time since diagnosed (p=0.02).

Conclusion: No statistically significant difference in DASH scores were found between surgically treated and conservatively treated patients in the NL population with KD regardless of stage of disease. A positive association was found between age of diagnosis of KD and DASH score, even after accounting for gender, stage of disease, and time since diagnosis. This finding suggests that those patients’ who are diagnosed and treated for KD later in life, tend not to do as well as their younger counterparts.

We determined the survival of primary total hip and knee replacements and patients who had undergone surgery between 1989 and 2007 in Dunedin with the aim to using these figures to provide information on

whether our arthroplasty population is changing,

The initial search using records held by the audit department at Dunedin Hospital returned 6,328 patient records with total hip and knee arthroplasty between 1988 and 2007. These reports however, included many procedures which were neither hip/knee nor primary/revision total joint arthroplasty. The data was filtered, resulting in 4,773 hip and knee arthroplasties. The final data included 3194 primary total hip replacements and 1579 primary total knee replacements. Comorbidity scoring of these patients was also undertaken.

The mean age of patients who underwent primary hip replacement was 67.6 yrs (SD 12.4) and the mean age of patients who underwent a primary knee replacement was 70.8 yrs (SD 9.8). Around 25% of patients who have had a primary joint replacement died after a mean of 10 yrs after the operation. In the group of patients who died after 10 years, the mean age at surgery was around 74 years. The mean age at the time of death was around 80 years. No difference was found in the death rate, revision rate, and the combined outcomes with death or revision as the end point with respect to the following-THRs. TKR, the grade of the surgeon, the comorbidity score or in men vs. women as compared to the general population.

Patients over 59 years of age at time of primary arthroplasty have a > 90% chance of dying before the need for revision surgery. Patients of less than 51 years of age have a > 90% chance of requiring revision surgery. Patients of 55 years of age have a 50% chance of requiring revision surgery. In a setting of ongoing scarce resources symptomatic/questionnaire targeted follow-up with radiology may be the only long term viable solution.

There has been debate in the literature over the years regarding whether

rib resection, and

We undertook a minimum 10 year review of prospective data in patients who had undergone corrective surgery for idiopathic scoliosis.

Patients had pre-operative, two year (where available) and 10 year follow-up respiratory function tests performed. Variables noted were sex, age at surgery, surgical approach, rib release (simple rib osteotomy, not resection), and percentage correction of curvature. All absolute respiratory function values were converted to percentages relative to a normal population of the same height, sex and age with reference to both arm span and height nomograms thus avoiding the need for a control group. Using accepted statistical norms and appropriate analysis we would be able to confirm a 10% difference in respiratory function.

A literature review was also undertaken as part of this study.

The only statistically significant change in respiratory function was a drop in FVC at 10 years in patients in whom a posterior approach had been used for correction without a rib release. In no other group (by other approach, sex, age, initial curvature, or curvature correction) was there a significant difference in long term respiratory function.

In our study the surgical approach did not have a significant impact on long term respiratory function. Rib release is a safe procedure to undertake as part of scoliosis correction.