The use of patient reported outcome measures (PROMs) of function is increasing in popularity. Self reported outcome instruments are used to measure change in health status over time allowing for the collection of accurate and relevant data on the quality of healthcare services. With recent changes outlined by the government, it will become increasingly important for surgeons to be able to demonstrate, with quantitative data, positive benefit of the surgery they perform. This study demonstrates the effectiveness of, and issues involved with setting up a PROMs database in a busy orthopaedic unit.

We have previously shown that a high proportion of our orthopaedic patients have access to the Internet. Suitable patients were identified at foot and ankle clinics or from surgical lists, and the well validated Foot and Ankle Ability Measure (FAAM) regional scoring system was used. The FAAM is a self-reported, region specific, instrument consisting of 21-item activities of daily living (ADL) subscale and an eight-item sports subscale. This was completed pre-operatively and also online at six-months post operatively, using limesurvey, a free online survey with internet/email based responses.

The software was simple to use and took about 4 hours to develop. 77% of the patient cohort for the period of study had email access and the majority of patients without email were happy to have the questionnaire completed over the phone. This took approximately ten minutes per survey. Patients who did not conduct the study prior to their admission were able to fill it in on the ward using a laptop.

This project has demonstrated that the initiation and continuation of a PROMs data collection system is feasible in a busy orthopaedic unit, producing reliable data which will enable us to monitor and improve standards of clinical practice. We discuss the issues involved with its introduction and usage.

This study evaluates the relationship between radiographic knee osteoarthritis and the presence of a relevant meniscal tear detected with MRI in symptomatic patients over the age of 60.

Seventy-seven patients over 60 investigated with a knee MRI in a 1 year period were identified. 60 patients had a full set of data available for analysis. The plain radiographs were graded for osteoarthritis using the Kellgren – Lawrence (K-L) scale in a blinded manner. The indication for the MRI was subdivided into: meniscal symptoms, general knee pain and other. These indications were correlated with the K-L grade and result of the MRI.

Overall, 40% of patients with a K-L grade of 0 had a meniscal tear compared to 89% of patients with a K-L score of 3 and 88% with a K-L score of 4. The indication for a MRI was meniscal symptoms in 49, general pain in 6 and other in 5. In the group investigated for meniscal symptoms, the incidence of meniscal tears was 92% and 100% with a K-L grade of 3 and 4 respectively.

In patients with meniscal symptoms and significant radiographic osteoarthritis the outcome of the MRI is so predictable that the scan is unnecessary.

To assess the value of physiotherapy in the treatment of patients with subacromial impingement syndrome

Patients with subacromial impingement syndrome were identified. Those who had not previously had any physiotherapy and had failed to respond to non-surgical management were selected and placed on the waiting list for subacromial decompression.

Patients were randomised into two groups. One group was referred for physiotherapy while waiting for surgery. The control group had no intervention prior to surgery.

The patients in the physiotherapy arm underwent assessment and treatment by a single physiotherapist.

All patients were evaluated independently at 3 and 6 months. The Constant Score was used to assess all patients initially and at each visit.

Physiotherapy group: All patients (n=42) increased their Constant score. 11 of the 42 patients improved to an extent that surgery was no longer required (26%). In patients not requiring surgery, the mean improvement in Constant score was 25 (12–45) In patients requiring surgery (n=31), the mean improvement was 21 (3–34).

Patients not requiring surgery had a higher initial Constant score, 65 (30–84) than those requiring surgery 48 (17–59). Patients not requiring surgery also tended to be younger 52 (27–68) than those requiring surgery 59 (48–68).

Control group: All patients (n=23) went on to have surgery.

The mean improvement in Constant score was 2 (−16 to 12).

All patients with subacromial impingement syndrome improved with physiotherapy when compared to a control group that did not receive physiotherapy. Some patients in the physiotherapy group improved to the extent that surgery was no longer required (26%)