The Rotaglide+ knee arthroplasty was introduced in 2000 as a successor to the Nuffield and Rotaglide knees. Both prosthesis were used in our unit and data was collected prospectively on sex, diagnosis, range of motion, pain score and American knee association score (AKSS). All operations were done under the care of one Surgical team (BBM) using the same instrumentation and the same pathway. Between 1987 and 2000 444 primary Nuffield were performed. 278 primary Rotaglide+ knees between 2000 and 2006.

65% of Nuffields implanted were in female candidates and 55% in the Rotaglide+. 75% of Nuffields were performed for Osteoarthritis, 69% in the Rotaglide+, this reflects the authors growing interest in inflammatory arthritis. Pre-operative functional range of motion and pain scores were similar. Both series showed a significant and sustained improvement in pain score, and walking time. Similar improvement was seen in range of motion. Comparison of the two series showed the Nuffield knee scored better on AKSS at year’s one and two and on pain score at year one but other than this outcomes were similar for both series. Revision rate in the Nuffield series is 9% at 25 years and in the Rotaglide+ series 4% at 8 years. This compares favourably with other published knee series’.

Despite being introduced as an improved design the Rotaglide+ fails to demonstrate any improvement in function and pain compared to its predecessor the Nuffield knee. Knee surgeons need to maintain a healthy cynicism of manufacturers ‘improved’ implants.

Introduction: Postoperative pain management following shoulder arthroscopy procedures is important, especially if they are to be performed as a day case surgeries. A variety of techniques are currently used to reduce postoperative pain such as patient controlled infusion pump and Interscalene block

Aim: In this study we evaluate the effect of Baxter elastomeric continuous infusion pump in managing pain following shoulder arthroscopy procedures.

Methods & Materials: We prospectively reviewed thirty four patients who had shoulder arthroscopy procedures between January and July 2007. All patients had arthroscopic subacromial decompression. Baxter elastomeric infusion pump was used in all patients to provide postoperative pain relief. All patients had 10ml of 0.5% Marcaine as a bolus followed by 5ml/hr for 10 hours through the infusion pump.

Visual analogue scale (VAS) was assessed at 4, 6,8 and 24 hours postoperatively. Discharge time and patients’ satisfaction were also assessed

Results: The Baxter elastomer pump provided effective pain relief postoperatively with median VAS(IQR) of 2.5(1.5–4.5), 2.5(1–5), 3(2–6), 6 (2–8) at 4, 6, 8 and 24 hours respectively. Our cohort had short hospital stay postoperatively with median (IQR) discharge time of 4.6 hours (3.5–5.3).Majority of patients reported that they are either very satisfied or satisfied with the pump.

Conclusion: We conclude that Baxter Infusion Elastomer pump is effective in managing pain postoperatively following shoulder arthroscopy with a high patients’ satisfaction which resulted in a short hospital stay. It is simple to insert under direct visualisation ensuring adequate placement, simple to use and doesn’t require skilled nursing care. Also it has got less morbidity compared to other means which are used to provide postoperative pain relief such as interscalene block.

Aim: A prospective study to quantify the functional outcome of the Aequalis Shoulder Arthroplasty in our local population.

Method: 110 Aequalis shoulder arthroplasties have been performed in 99 patients by a single surgeon in a district general hospital. Rheumatoid arthritis was the indication in 61 shoulders, Osteoarthritis in 26 and 23 for other indications. There were 78 females and 32 males.

Patients were assessed using the Constant-Murley (CM) Score, the corrected Constant-Murley (CM) Score and the American Shoulder and Elbow Society (ASES) function score pre and post-operatively. Pain was measured on a reverse Visual Analogue Scale (VAS) and a range of movement was clinically assessed. All these parameters including standard radiographs were regularly assessed during the follow up period.

Results: Mean length of follow up is 2.29 years (range 6 months to 8 years). 27/110 (24.55%) had a Glenoid replacement.

There have been steady and significant improvements in all parameters over the follow up period. Improvements have been sustained and continue to increase the longer the prosthesis has been in situ. The pain score is measured on a reverse analogue score, which accounts for the increasing scores. There have been 2 cases complicated by deep infection requiring revision and 2 cases of peri-prosthetic fracture.

Conclusion: The Aequalis shoulder prosthesis gives good, reliable results which are reproducable outside specialised centres.

Aims: The purpose of this study was to quantify the functional outcome of the Aequalis shoulder system. Methods: Pre-operatively, 85 patients were scored using the constant scoring system to assess pain, activity, mobility and strength and adjusted (for age) and modified (excluding strength) scores were calculated. Range of movement (ROM) was assessed using a nominal scale. All patients were regularly followed up and were assessed functionally, using the constant scores and ROM, using a nominal scale Results: Pre-operatively, modified constant score range was 4 – 76 with mean 30.3. ROM was variable but poor overall. Abduction was < 600 in 69% and internal rotation was < ‘hand to buttock’ in 77%. At follow up (range 6 – 60 months, mean 24 months), modified constant score range was 29–126 with mean 74.6. Abduction was > 600 in 76% and internal rotation was > ‘hand to sacrum’ in 77%. No implant has been revised. There have been 2 periprosthetic fractures and 2 implants appear radiologically to be loose. Subjectively, only 6 patients are disappointed with the clinical outcome. Conclusion: The Aequalis shoulder system has been demonstrated to be a reliable implant with up to 5 year follow up. It has a good functional outcome with demonstrable improvement with pain, activity and mobility.

We report a retrospective study of 62 total ankle arthroplasties performed between 1972 and 1981. Forty-one of these have been reviewed clinically after an average follow-up of five and a half years; only 13 can be described as satisfactory. The complications encountered in all 62 arthroplasties are detailed, the most significant being superficial wound healing problems, talar collapse, and loosening of the components; 13 prosthetic joints have already been removed and arthrodesis attempted. The management of the complications is discussed. In view of the high complication rate and the generally poor long-term clinical results, we recommend arthrodesis as the treatment of choice for the painful stiff arthritic ankle, regardless of the underlying pathological process.

A case of bilateral avascular necrosis of the capitate is presented. A review of the literature has identified a clear-cut clinical syndrome. The aetiology and pathology of this syndrome is discussed and a new method of treatment is proposed.

A retrospective study of the development of the hip opposite a congenitally dislocated hip was carried out to identify at an early age those hips which would develop abnormally. Recognised radiological measurements were used showing the development of the joints with age. The development was compared with that of a control group of normal hips. Single measurements were shown to be unreliable in predicting the development of the hip. A simple hip ratio is proposed which predicts, at an early age and with a high degree of accuracy, the developmental outcome.