Aims

With recent progress in cancer treatment, the number of advanced-age patients with spinal metastases has been increasing. It is important to clarify the influence of advanced age on outcomes following surgery for spinal metastases, especially with a focus on subjective health state values.

Aims. The sacrum is frequently invaded by a pelvic tumour. The aim of this study was to review our experience of treating this group of patients and to identify the feasibility of a new surgical classification in the management of these tumours. Patients and Methods. We reviewed 141 patients who, between 2005 and 2014, had undergone surgical excision of a pelvic tumour with invasion of the sacrum. In a new classification, pelvisacral (Ps) I, II, and III resections refer to a sagittal osteotomy through the ipsilateral wing of the sacrum, through the sacral midline, or lateral to the contralateral sacral foramina, respectively. A Ps a resection describes a pelvic osteotomy through the ilium and a Ps b resection describes a concurrent resection of the acetabulum with osteotomies performed through the pubis and ischium or the pubic symphysis. Within each type, surgical approaches were standardized to guide resection of the tumour. Results. The mean operating time was 5.2 hours (. sd. 1.7) and the mean intraoperative blood loss was 1895 ml (. sd. 1070). Adequate margins were achieved in 112 (79.4%) of 141 patients. Nonetheless, 30 patients (21.3%) had local recurrence. The mean Musculoskeletal Tumor Society (MSTS93) lower-limb function score was 68% (. sd. 19; 17 to 100). According to the proposed classification, 92 patients (65%) underwent a Ps I resection, 33 patients (23%) a Ps II resection, and 16 (11%) patients a Ps III resection. Overall, 82 (58%) patients underwent a Ps a resection and 59 (42%) patient a Ps b resections. The new classification predicted surgical outcome. Conclusion. We propose a comprehensive classification of surgical approaches for tumours of the pelvis with sacral invasion. Analysis showed that this classification helped in the surgical management of such patients and had predictive value for surgical outcomes. Cite this article: Bone Joint J 2018;100-B:798–805

The development of spinal deformity in children with underlying neurodisability can affect their ability to function and impact on their quality of life, as well as compromise provision of nursing care. Patients with neuromuscular spinal deformity are among the most challenging due to the number and complexity of medical comorbidities that increase the risk for severe intraoperative or postoperative complications. A multidisciplinary approach is mandatory at every stage to ensure that all nonoperative measures have been applied, and that the treatment goals have been clearly defined and agreed with the family. This will involve input from multiple specialities, including allied healthcare professionals, such as physiotherapists and wheelchair services. Surgery should be considered when there is significant impact on the patients’ quality of life, which is usually due to poor sitting balance, back or costo-pelvic pain, respiratory complications, or problems with self-care and feeding. Meticulous preoperative assessment is required, along with careful consideration of the nature of the deformity and the problems that it is causing. Surgery can achieve good curve correction and results in high levels of satisfaction from the patients and their caregivers. Modern modular posterior instrumentation systems allow an effective deformity correction. However, the risks of surgery remain high, and involvement of the family at all stages of decision-making is required in order to balance the risks and anticipated gains of the procedure, and to select those patients who can mostly benefit from spinal correction.

Introduction

Brachymetatarsia is a rare deformity affecting the toes and leading to functional and psychological impact. The main aim of the study is to assess the efficacy of the surgical callus distraction technique in terms of length achievement in the paediatric group. Secondary objectives are functional improvement, reported complications and overall duration of treatment.

In a prospective study, we have evaluated the impact of psychological disturbance on symptoms, self-reported disability and the surgical outcome in a series of 110 patients with carpal tunnel syndrome. Self-reported severity of symptoms and disability were assessed using the patient evaluation measure and the Boston carpal tunnel questionnaire. Psychological distress was assessed using the hospital anxiety and depression scale. There was a significant association between psychological disturbance and the pre-operative symptoms and disability. However, there was no significant association between pre-operative psychological disturbance and the outcome of surgery at six months. We concluded that patients with carpal tunnel syndrome should not be denied surgery because of pre-operative psychological disturbance since it does not adversely affect the surgical outcome

The purpose of this study was to investigate the clinical predictors of surgical outcome in patients with cervical spondylotic myelopathy (CSM). We reviewed a consecutive series of 248 patients (71 women and 177 men) with CSM who had undergone surgery at our institution between January 2000 and October 2010. Their mean age was 59.0 years (16 to 86). Medical records, office notes, and operative reports were reviewed for data collection. Special attention was focused on pre-operative duration and severity as well as post-operative persistence of myelopathic symptoms. Disease severity was graded according to the Nurick classification. Our multivariate logistic regression model indicated that Nurick grade 2 CSM patients have the highest chance of complete symptom resolution (p < 0.001) and improvement to normal gait (p = 0.004) following surgery. Patients who did not improve after surgery had longer duration of myelopathic symptoms than those who did improve post-operatively (17.85 months (1 to 101) vs 11.21 months (1 to 69); p = 0.002). More advanced Nurick grades were not associated with a longer duration of symptoms (p = 0.906). Our data suggest that patients with Nurick grade 2 CSM are most likely to improve from surgery. The duration of myelopathic symptoms does not have an association with disease severity but is an independent prognostic indicator of surgical outcome. Cite this article: Bone Joint J 2013;95-B:966–71

The intra-articular supracondylar fractures of the femur are difficult fractures that occur with increasing frequency in the last years. Their complex management is a source of controversy, since surgical outcome is not acceptable in all instances. In the last 6 years we treated 30 comminuted intra-articular supracondylar fractures of the femur (type-C). The mean age was 28 years (17– 65 years). We made any effort to apply a method which could guarantee reduction and articular reconstruction, rigid fixation and bridging of metaphysic-epiphysis, in order to achieve early mobilization and to avoid post-traumatic osteoarthritic lesions. The extra-articular portion of the fractures was fixed using DCS, condylar plates, Ô plates and in some cases the whole construct was protected by an external fixation device. In some other cases, stability was enhanced using a second bridging plate in the medial side or applying a massive cortical graft properly adapted and fixed to the plate. The articular surface was reconstructed using cancellous lag-screws. Intra-articular epiphyseal portions were regularly bone grafted when there was comminution and bone loss, Bone grafting was also carried out in cases of meta-diaphyseal severe comminution and major bone defects. Clinical and radiological outcome was evaluated. Radiological parameters (axial valgus deformity, shortening, development of post-traumatic osteoarthritis etc.) were correlated to the method of surgical treatment. There were major complications (such as infection, especially in open fractures, delayed healing, hardware failure, refracture etc.). In some instances re-operation was necessary. In problematic C3 supracondylar fractures of the knee, poor surgical results are associated to early complications and development of degenerative lesions. This handicap is particularly is particularly important since it occurs in a major weight bearing joint of young patients. Using meticulous surgical technique (including bone-grafting, minimal devitalization of the fragments etc.), and choosing the most appropriate implant in every case, reconstruction can be performed reliably with good results and a low rate of complications

The purpose of this study was to investigate the use of early post-operative bone scintigraphy to predict surgical outcome following vascularized fibular grafting (VFG) for osteonecrosis of the hip. Bone scans from one hundred and four hips (Steinberg stage I–IV) treated with VFG between 1994 and 2000 were retrospectively reviewed. Bone scan scores were significantly lower in the failed group (n=31) compared to the successful group (n=73), p=0.03. Logistic regression demonstrated that a higher bone scan score was associated with success, p=0.028, with an odds ratio of 3.08 (1.13–8.40). The purpose of this study was to investigate the use of bone scintigraphy to predict surgical outcome following vascularized fibular grafting (VFG) for osteonecrosis of the hip. Subjects with a higher bone scan score post-operatively had a three-fold higher chance of success than subjects with the lowest score. These results suggest that having a well perfused and viable graft in the early post-operative period improves the chances of a successful result. Single Photon Emission Computed Tomography images from one hundred and four hips (Steinberg I–IV) treated with VFG between 1994 and 2000 were retrospectively reviewed. Each scan was divided into three regions, the greater trochanter, neck, and head. The intensity at the graft in each region (axially and coronally) was compared to the intensity at the ipsilateral proximal femoral diaph-ysis and assigned a score: less than diaphysis (one), equal to (two), and greater than (three). Cumulative scores were obtained for each subject. Intraobserver variability was 0.93. Surgical failure was defined as conversion to or on the waiting list for total hip arthroplasty. Thirty percent of hips failed treatment (n=31, mean survival 34.9 months, range 5–98), while 70% were successful (n=73, mean follow-up 56.6 months, range 22–100). Bone scan scores were significantly lower in the failed group (mean 7.1, range 6–12) compared to the successful group (mean 8.5, range 6–18), p=0.03. Positive skewness (+1.7) was demonstrated as 64% of hips had a score of six while 36% had a score > 6 (range 8–18). Logistic regression demonstrated that a bone scan score > 6 was associated with success, p=0.028, with an odds ratio of 3.08 (1.13–8.40)

Introduction: With the recent advancement, total ankle arthroplasty has been performed more frequently for painful end-stage ankle arthritis. However the indications of total ankle arthroplasty have yet to be determined. There is no clear consensus regarding the use of total ankle arthroplasty in end-stage arthritis with severe varus talar tilt. The present study evaluated the surgical outcome of total ankle arthroplasty performed in the cases with varus talar tilt of more than 20 degrees within the mortise. Material and Method: Among 33 TAAs that were performed at our institution by single surgeon between August 2006 and February 2008, 4 cases showed varus talar tilt of more than 20 degrees determined by tibio-talar angle on preoperative standing ankle AP radiograph. There were 2 males and females, their ages were 60, 74, 75 and 76 years old. All the patients were not able to walk more than 10 minutes. Preoperative AOFAS ankle/hindfoot scale were rated as 28, 57, 60 and 50. The degree of varus talar tilt for each patient was 23, 25, 29 and 27. In 2 cases only TAA was performed, while a calcaneal osteotomy and peroneus longus transfer to peroneus brevis was added for one case, and a dorsiflexion osteotomy of the first metatarsus for the other case to address combined or remaining deformity and instability. Result: There was no postperative surgical complication such as wound problems or surgical infection. The tibio-talar angle measured at sixth month postoperatively was 4, 4, 2 and 3 degree for each patient. Neither instability nor loosening was shown for all the patients. Postoperative AOFAS score improved to 72, 86, 87 and 98 at sixth month after the surgery. Conclusion: Total ankle arthroplasty could be performed safely in the cases with varus talar tilt of more than 20 degrees within the mortise, of which results were satisfactory. For successful surgery, preoperative and intraoperative evaluation of the deformed ankle should be done, and if necessary additional surgeries should be performed to address combined or remaining deformity and instability

Introduction: Pseudoarthrosis in Ankylosing spondylitis is often misdiagnosed as infection. It is a slow progressing lesion resulting in a kyphosis and slow onset weakness of the lower limbs. We are presenting our strategy and experience in treating 9 patients with such a lesion. Method: 9 patients age range from 40–55 years who presented with pseudoarthrosis of the ankylosed spine underwent back-front surgery during 2001–204. 6 patients had dorsal spine lesion, 2 had dorso-lumbar junctional lesion and 1 had cervico-dorsal junctional lesion. 8/9 patients had insidious onset with progressive weakness of both lower limb. 1 patient had an acute onset with deformity. 7/9 patients had neurodeficit (Frankel C) 1/9 had complete paraplegia. All patients underwent posterior kyphosis correction and decompression of the spinal cord. During posterior decompression 8/9 patients had an incidental dural tear due to adherence fractured lamina. The dura was repaired primarily or patch graft. 5/9 patients had single stage back and front surgery. The rest of the patients had staged surgery. The front surgery was excision of the tough fibrotic psuedoarthosis and reconstruction using strut graft/cage. Results: Average duration of surgery was 4 ½ hours (3 ½ to 6 hours). Blood loss was 800 ml (600–1300 ml). All patients required blood transfusion. Primary dural repair was done in 7/8 cases, patch graft in 3/8 cases, ceiling with fusion glue and fat graft in 1 patient. 5 patients who had less that 1000 ml blood loss during posterior surgery had same stage anterior reconstruction. Rest of the patient had 2 staged surgery. 4/9 patients had previous THR B/L. All patients showed rapid improvement in the neurological status and at 3 months follow up all were Frankel E. Conclusion: The surgical outcome of the ankylosing spondylitis patients with Andersson lesion with neurological deficit is encouraging. Excision of the pseudoarthroses anteriorly and posterior spinal stabilization resulted in full recovery of the deficit. However there were difficulties encountered during the posterior decompression due to adhesions of the posterior elements to the dura

Introduction: Clavicle fractures represent 5% of fractures in adults and almost 44% of shoulder injuries and are usually treated none operatively with good results. However significantly displaced fractures can be associated with high non-union rate and there is a lack of consensus on when surgical treatment is indicated for such fractures. The aim of this study was to identify guidelines for surgical intervention, safer surgical approach and outcome of surgical intervention. Method: A retrospective audit of all clavicle fractures managed surgically over past 5 years (March 2004 to 2009) in a district general hospital. Case notes were reviewed to study the surgical indication, surgical approach, patient satisfaction and oxford should score and need for metal work removal. In all 35 patients (29 male) underwent surgery for significant fracture displacement with shortening, manual workers and keen sportsmen at the time of injury. The infraclavicular approach was used in 21 patients and 14 patients had direct incision approach. Radiological union was achieved in all patients after an average of 13.26(8–24) weeks. Six patients required plate removal at 6 months following surgery, infraclavicular (2 patients) & direct approach (4 patients). All patients returned to their original occupation at average 2.55 months. The Oxford Shoulder Score at 3 months after surgery was average 15 (range12–20) and all patients, except one, scored excellent on subjective scoring. Conclusion: Our study showed excellent surgical outcome for displaced clavicle fractures in young and active patients and is supported by the high union rate, good oxford shoulder score, early return to work and high patient satisfaction scores. The infraclaviculr approach is a betterthan direct approach based on the low complication rate and less need for metal work removal

From the European Osteosarcoma Intergroup study 202 patients were assessed with respect to their surgical treatment. Although treated in three different centres the survival of the three groups was identical (57% at five years). Two of the centres had rates of limb salvage of 85% and 83%, respectively, while the third had a rate of 49%. The corresponding risks of local recurrence were 13.3%, 6.8% and 2.5%, with all local recurrences arising in limbs with attempted limb salvage. Local recurrence was closely related to the adequacy of the margins of excision and to the chemotherapeutic response. Patients who had undergone limb-salvage surgery and who developed local recurrence still survival at five years). Of patients who relapsed, 31% of those with local recurrence alone were cured by further treatment, as compared with only 10% of those with metastases. Limb-salvage surgery with effective chemotherapy remains the optimum treatment for osteosarcoma.

Objective: The aim of this study was to delineate parents’ and professional caretakers’ satisfaction after spinal fusion in children with spasticity, and to determine differences in their perceptions. Study Design-Methods: A questionnaire assessing patients’ functional improvement after spinal arthrodesis for correcting scoliosis was addressed to 190 parents. An expanded questionnaire was also addressed to 122 educators and therapists working exclusively in the care of children with cerebral palsy. Results: The vast majority of parents and caregivers reported a very positive impact of the surgery on patients’ overall function, quality of life, and ease of care. Caretakers did not recognize effects of the scoliotic deformity on patients’ head control, hand use, and feeding ability. Parents had more appreciation of the benefits in the children’s appearance, while educators and therapists acknowledged more improvement in gross and oral motor function. Most parents (95.8%) and caretakers (84.3%) would recommend spinal surgery, considering that the benefits from scoliosis correction clearly outweigh the increased risk of surgical complications in this group of severely involved patients. Conclusions: Correction of spinal deformity in children with cerebral palsy is associated with a very high parents’ and caretakers’ satisfaction rate, with both groups reporting excellent improvement in appearance, comfort, ease of care, and some functional gains. The answers received during the survey demonstrated clearly that the vast majority of parents and caretakers consider the surgical outcome of the spinal fusion very beneficial for the patients’ overall function and level of care. There were documented differences in the perceived positive impact of spine surgery in children with cerebral palsy between the two groups. Parents stated more consistent benefits from correcting scoliosis in the patients’ appearance, whereas therapists and educators delineated the improvement in the gross and oral motor function. However, both groups considered that the benefits from correcting scoliotic deformity undoubtedly offset the potential risks from surgery, and would have no hesitation in recommending this procedure for children with cerebral palsy who develop significant scoliosis interfering with their level of function and their overall quality of life

Purpose of the study. To compare the effectiveness of unilateral and bilateral pedicle screw techniques in correcting adolescent idiopathic scoliosis. Summary of Background Data. Pedicle screw constructs have been extensively used in the treatment of adolescent patients with idiopathic scoliosis. It has been suggested that greater implant density may achieve better deformity correction. However, this can increase the neurological risk related to pedicle screw placement, prolong surgical time and blood loss and result in higher instrumentation cost. Methods. We reviewed the medical notes and radiographs of 139 consecutive adolescent patients with idiopathic scoliosis (128 female-11 male, prospectively collected single surgeon's series). We measured the scoliosis, thoracic kyphosis (T5-T12), and lumbar lordosis (L1-L5) before and after surgery, as well as at minimum 2-year follow-up. SRS 22 data was available for all patients. Results. All patients underwent posterior spinal arthrodesis using pedicle screw constructs. Mean age at surgery was 14.5 years. We had 2 separate groups: in Group 1 (43 patients) correction was performed over 2 rods using bilateral segmental pedicle screws; in Group 2 (96 patients) correction was performed over 1 rod using unilateral segmental pedicle screws with the 2. nd. rod providing stability of the construct through 2-level screw fixation both proximal and distal. Group 1. Mean Cobb angle before surgery for upper thoracic curves was 37°. This was corrected by 71% to mean 11° (p<0.001). Mean Cobb angle before surgery for main thoracic curves was 65°. This was corrected by 71% to mean 20° (p<0.001). Mean Cobb angle before surgery for thoracolumbar/lumbar curves was 60°. This was corrected by 74% to mean 16° (p<0.001). No patient lost >2° correction at follow-up. Mean preoperative thoracic kyphosis was 24° and lumbar lordosis 52°. Mean postoperative thoracic kyphosis was 21° and lumbar lordosis 50° (p>0.05). Mean theatre time was 5.5 hours, hospital stay 8.2 days and intraoperative blood loss 0.6 blood volumes. Complications: 1 transient IOM loss/no neurological deficit; 1 deep wound infection leading to non-union and requiring revision surgery; 1 rod trimming due to prominent upper end. Mean preoperative SRS 22 score was 3.9; this improved to 4.5 at follow-up (p<0.001). Pain and self-image demonstrated significant improvement (p=0.001, p<0.001 respectively) with mean satisfaction rate 4.9. Group 2. Mean Cobb angle before surgery for upper thoracic curves was 42°. This was corrected by 52% to mean 20° (p<0.001). Mean Cobb angle before surgery for main thoracic curves was 62°. This was corrected by 70% to mean 19° (p<0.001). Mean Cobb angle before surgery for thoracolumbar/lumbar curves was 57°. This was corrected by 72% to mean 16° (p<0.001). No patient lost >2° correction at follow-up. Preoperative scoliosis size for all types of curves correlated with increased surgical time (r=0.6, 0.4). Mean preoperative thoracic kyphosis was 28° and lumbar lordosis 46°. Mean postoperative thoracic kyphosis was 25° and lumbar lordosis 45° (p>0.05). Mean theatre time was 4.2 hours, hospital stay 8.4 days and intraoperative blood loss 0.4 blood volumes. Complications: 1 deep and 1 superficial wound infections treated with debridement; 1 transient brachial plexus neurapraxia; 1 SMA syndrome. Mean preoperative SRS 22 score was 3.7; this improved to 4.5 at follow-up (p<0.001). Pain, function, self-image and mental health demonstrated significant improvement (p<0.001 for all parameters) with mean satisfaction rate 4.8. Comparison between groups showed no significant difference in regard to age at surgery, preoperative and postoperative scoliosis angle for main thoracic and thoracolumbar/lumbar curves, as well as SRS scores and length of hospital stay. Better correction of upper thoracic curves was achieved in Group 1 (p<0.05), but upper thoracic curves in Group 2 were statistically more severe before surgery (p<0.05). Increased surgical time and blood loss was recorded in Group 1 (p<0.05, p=0.05 respectively). The implant cost was reduced by mean 35% in Group 2 due to lesser number of pedicle screws. Conclusion. Unilateral and bilateral pedicle screw instrumentation has achieved excellent deformity correction in adolescent patients with idiopathic scoliosis, which was maintained at follow-up. This has been associated with high patient satisfaction and low complication rates. The unilateral technique using segmental pedicle screw correction has reduced surgical time, intraoperative blood loss and implant cost without compromising surgical outcome for the most common thoracic and thoracolumbar/lumbar curves. The bilateral technique achieved better correction of upper thoracic scoliosis

Cam-type femoral acetabular impingement (FAI), is a common structural hip deformity and thought to be a leading cause of early hip osteoarthritis. Although patients who undergo surgical correction notice improved clinical function it is unclear what impact this has on the overall health of the cartilage. T1rho MRI cartilage mapping has been shown to be a reliable imaging technique to assess the proteoglycan (PG) content potentially serving as a biomarker. This study analyses post surgical changes in T1rho levels in hip joints treated with cam FAI.

Eleven patients with a mean age of 38 (all males) underwent pre and post T1Rho Cartilage mapping of their hips at a mean time of 20 months post surgical intervention. The acetabulum was spatially divided into 4 main regions of interest (ROI), with levels of T1Rho in cartilage quantified as a whole and in each spatial segment. T1Rho signal is inversely correlated with level of PG content.

All patients demonstrated loss of PG content on pre-op imaging with a T1Rho of 33.5ms+2.6ms. Preop T1rho levels were found to significantly correlated with the difference between pre-op and post-op T1rho in entire hip cartilage (R: 0.73; p=0.016). This correlation was reflected both in the anterolateral quadrant (R: 0.86; p=0.002), and in the posteriosuperior quadrant (R:0.70; p=0.035). Additionally, significant correlation was found between improvement of WOMAC pain score over time, and difference of T1rho values over time in the most lateral 3mm slice of the anterolateral quadrant (R: 0.81; p=0.045). Significant correlation was found between pre-op alpha angle at 1:30 and difference between pre-op and post-op total cartilage T1rho content (R: −065;p=0.038).

T1Rho Cartilage mapping of the hip is a useful biomarker in the assessment of the surgical management of Cam type FAI. This preliminary data provides some evidence that surgical correction of the deformity can help minimise disease progression.

We evaluated the duration of hospitalisation, occurrence of infections, hip dislocations, revisions, and mortality following primary hip and knee replacement in 857 patients with Parkinson’s disease and compared them with 2571 matched control patients. The data were collected from comprehensive nationwide Finnish health registers. The mean follow-up was six years (1 to 13). The patients with Parkinson’s disease had a longer mean length of stay (21 days [1 to 365] vs 13 [1 to 365] days) and an increased risk for hip dislocation during the first post-operative year (hazard ratio (HR) 2.33, 95% confidence intervals (CI) 1.02 to 5.32). There was no difference in infection and revision rates, and one-year mortality. In longer follow-up, patients with Parkinson’s disease had higher mortality (HR 1.94, 95% CI 1.68 to 2.25) and only 274 (34.7%) were surviving ten years after surgery. In patients with Parkinson’s disease, cardiovascular and psychiatric comorbidity were associated with prolonged hospitalisation and cardiovascular diseases also with increased mortality.

Cite this article: Bone Joint J 2014;96-B:486–91.

We compared the length of hospitalisation, rate of infection, dislocation of the hip and revision, and mortality following primary hip and knee arthroplasty for osteoarthritis in patients with Alzheimer’s disease (n = 1064) and a matched control group (n = 3192). The data were collected from nationwide Finnish health registers. Patients with Alzheimer’s disease had a longer peri-operative hospitalisation (median 13 days vs eight days, p < 0.001) and an increased risk for hip revision with a hazard ratio (HR) of 1.76 (95% confidence interval (CI) 1.03 to 3.00). Dislocation was the leading indication for revision. There was no difference in the rates of infection, dislocation of the hip, knee revision and short-term mortality. In long-term follow-up, patients with Alzheimer’s disease had a higher mortality (HR 1.43; 95% CI 1.22 to 1.70), and only one third survived ten years post-operatively. Increased age and comorbidity were associated with longer peri-operative hospitalisation in patients with Alzheimer’s disease.

Cite this article: Bone Joint J 2015;97-B:654–61.

Purpose: There is controversial information on recovery of patients with compensable injuries. The purpose of this matched case-control study was to examine the impact of an active compensation claim following a work-related shoulder injury on reporting disability as measured by subjective and objective outcomes at 1 year post-operatively.

Method: Data of 506 consecutive patients who had undergone a decompression or rotator cuff repair were reviewed. One hundred and fourteen patients were on compensation related to their shoulder problems. Patients were matched with a historical control group (patients without a compensation claim) based on age (4 age groups: < 40, 40–49, 50–59, 60–70), sex, and pathology (full-thickness tear vs. no tear). Outcome measures used were a disease-specific outcome, the Western Ontario Rotator Cuff Index (WORC) and two shoulder specific instruments, the American Shoulder and Elbow Score (ASES) and the Constant Murley (CM) score. Paired and independent t-tests and an analysis of covariance were performed.

Results: Data of the 214 patients (72 males and 35 females in each group) was used for analysis (mean age 48, SD: 10, range 20–69). Out of 107 patients in each group, 42 patients (58%) had undergone a full-thickness repair and 65 (61%) had surgeries related to impingement syndrome. Paired and independent t-tests showed that both groups improved significantly regardless of their claim status. However, the compensation group had a significantly lower level of improvement than the non-compensation group. An analysis of covariance which adjusted for pre-operative differences in disability scores showed that an active claim was indeed a strong predictor of follow up scores.

Conclusion: This is the first study that has used a matched case-control design to control for potential confounding factors in injured worker population. Our results indicate that although patients with work-related injuries demonstrate a lower level of recovery, they still benefit from surgery.

Patients due to have a major orthopaedic operation should be assessed in advance, in order to be fully prepared for the operation the scheduled day the without cancellations and be cost-effective. We studied 208 patients the last 2 years scheduled for hip and knee replacement. Mean Age 68.7. F=150, M=58. The patients were formally admitted in the assessment stay unit where a fully orthopaedic and anaesthetic examination was done and appropriate lab tests were carried out. The whole procedure lasted 4 hours and was charged 88 Euros.

Only 37 patients have no medical problems. 98 suffered from hypertension and 10 of them needed further adjustment of their treatment. Out of 27 patients who had coronary artery disease, 12 referred to a cardiologist. All of the 12 patients with various heart problems needed further assessment. Readjustment of their treatment needed 3 out 15 diabetic patients. 1 out of the 8 patients with rheumatoid arthritis 1 needed reevaluation and 1 out 19 who suffered from various diseases 1 needed reassessment (Renal failure). Statistically 39 out of 208 had problems p< 0.001.

The anaesthetic assessment contributes to 1.Reduction of cancellations due to medical reasons. 2. Effective use of the theatre time. 3. Reduction of cost.

Background

Several orthopaedic studies have found significant correlation between pre-operative psychological status and post-operative outcomes. The majority of research has focused on patients requiring lower limb and spine surgery. Few studies have investigated the effect of psychological status on the outcome of upper limb operations. We prospectively investigated the association between pre-operative psychological status and early postoperative shoulder pain and function in patients requiring arthroscopic subacromial decompression (ASAD) for impingement syndrome.