Purpose: The purpose of this study was to examine the measurement properties of four commonly used disability measures. We hypothesized that all measures would have a high (0.8 or > 0.8) internal consistency and ability to discriminate between men and women’s level of disability. A moderate convergent validity (0.5 to 1.00).

Method: This was a prospective longitudinal study of patients with advanced primary osteoarthritis of glenohumeral joint who underwent a Total Shoulder Arthroplasty (TSA). Four measures [Western Ontario Osteoarthritis Shoulder (WOOS) Index, the American Shoulder and Elbow Surgeon’s (ASES) assessment, Constant-Murley Score (CMS), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH)] were completed 2–3 weeks before surgery and at 6 months after surgery. The measurement properties were examined in:

internal consistency as a measure of reliability,

Analysis involved calculating Cronbach Coefficient Alpha to measure internal consistency. Convergent validity was examined by the Pearson correlation coefficient. Analysis of Variance examined the extent of known group validity. The Standardized Response Mean (SRM) was used to measure the relative sensitivity to change.

Results: Seventy patients (mean age: 65, range: 35–86, 44 females, 26 males) participated in the study. The Cronbach Coefficient Alpha was high at 0.91, 0.86, and 0.83 for WOOS, ASES, and QuickDASH respectively. Cross-sectional convergent validity was moderate with correlations varying from 0.54 to 0.79. Longitudinal convergent validity ranged from 0.58 to 0.88. All measures were able to discriminate between men and women at p< 0.05 with Cohen’s d of 1.07, 0.85, 0.82, and 0.55 for QuickDASH, CMS, WOOS, and ASES respectively. The SRM was 2.41, 2.17, 1.88, and 1.63 for WOOS, CMS, ASES and QuickDASH respectively.

Conclusion: All four disability measures were valid and reliable in candidates for TSA. The WOOS, a disease-specific outcome demonstrated a higher reliability and sensitivity to change than other measures. QuickDASH had a better ability to differentiate between men and women. Clinicians may not gain additional information by administrating multiple similar outcome measures. Researchers will decrease their chance of declaring a statistical significance by choosing one primary outcome measure.

We examined the roles of methylmethacrylate (MMA) monomer and cementing technique in the formation, and haemodynamic outcome, of pulmonary fat emboli. The preparation of the femoral canal and the cementing technique were studied in four groups of adult dogs as follows: control (no preparation); lavage; cement pressurisation; and cement pressurisation after lavage. We measured the intramedullary pressure, pulmonary artery pressure (PAP), pulmonary capillary wedge pressure and bilateral femoral vein levels of triglyceride, cholesterol and MMA monomer at rest and after reaming, lavage, and cementing.

Femoral vein triglyceride and cholesterol levels did not vary significantly from resting levels despite significant elevations in intramedullary pressure with reaming, lavage and cementing (p = 0.001). PAP was seen to rise significantly with reaming (p = 0.0038), lavage (p = 0.0031), cementing (p = 0.0024) and cementing after lavage (p = 0.0028) while the pulmonary capillary wedge pressure remained unchanged.

MMA monomer was detected in femoral vein samples when cement pressurisation was used. Intramedullary lavage before cementing had no significant effect on the MMA level. Haemodynamic evidence of pulmonary embolism was noted with reaming and intramedullary canal preparation, irrespective of the presence of MMA monomer. We found no relationship between MMA monomer level and intramedullary pressure, PAP or pulmonary capillary wedge pressure.

Our findings suggest that the presence of MMA monomer in femoral venous blood has no effect on the formation of fat emboli or their pulmonary haemodynamic outcome during cemented hip arthroplasty.

We reviewed 23 patients who had had 25 Darrach procedures for traumatic or post-traumatic disorders of the wrist at a mean follow-up of 75.5 months (36 to 121). The mean age at the time of operation was 61.1 years (34 to 82). All patients were reviewed in person. Assessment included a history, a questionnaire on patient satisfaction and a detailed physical examination. Standardised radiographs of both wrists were taken with the patient’s hands in a resting position and during maximal grip.

Convergence of the distal ulnar stump towards the distal radius during maximal grip (dynamic radio-ulnar convergence) was seen in 14 wrists including five with actual contact (dynamic radio-ulnar impingement), but this produced symptoms in only two cases. The presence of dynamic radio-ulnar convergence did not correlate with grip strength, pinch strength, range of movement or wrist score, but was associated with increased length of excision of the distal ulna. Nineteen of the 23 patients were satisfied with the procedure.

Dynamic radio-ulnar convergence is common after the Darrach procedure, but is rarely symptomatic; resection of the distal ulna remains a reliable procedure in the older patient with pain and loss of movement. Excision of the lower end of the ulna should be restricted to the least required to restore full rotation.