Background Manipulation under anaesthesia and arthroscopic capsular release are costly and invasive treatments for frozen shoulder, but their effectiveness remains uncertain. We compared these two surgical interventions with early structured physiotherapy plus steroid injection. MethodsIn this multicentre, pragmatic, three-arm, superiority randomised trial, patients referred to secondary care for treatment of primary frozen shoulder were recruited from 35 hospital sites in the UK. Participants were adults (≥18 years) with unilateral frozen shoulder, characterised by restriction of passive external rotation (≥50%) in the affected shoulder. Participants were randomly assigned (2:2:1) to receive manipulation under anaesthesia, arthroscopic capsular release, or early structured physiotherapy. In manipulation under anaesthesia, the surgeon manipulated the affected shoulder to stretch and tear the tight capsule while the participant was under general anaesthesia, supplemented by a steroid injection. Arthroscopic capsular release, also done under general anaesthesia, involved surgically dividing the contracted anterior capsule in the rotator interval, followed by manipulation, with optional steroid injection. Both forms of surgery were followed by postprocedural physiotherapy. Early structured physiotherapy involved mobilisation techniques and a graduated home exercise programme supplemented by a steroid injection. Both early structured physiotherapy and postprocedural physiotherapy involved 12 sessions during up to 12 weeks. The primary outcome was the Oxford Shoulder Score (OSS; 0-48) at 12 months after randomisation, analysed by initial randomisation group. We sought a target difference of 5 OSS points between physiotherapy and either form of surgery, or 4 points between manipulation and capsular release. The trial registration is ISRCTN48804508.

The use of volar locking compression plates for the treatment of fractures of the distal radius is becoming increasingly popular because of the stable biomechanical construct, less soft-tissue disturbance and early mobilisation of the wrist. A few studies have reported complications such as rupture of flexor tendons. We describe three cases of rupture of extensor tendons after the use of volar locking compression plates. We recommend extreme care when drilling and placing the distal radial screws to prevent damaging the extensor tendons.

The present study demonstrates that although female patients initially may appear to have a greater risk of revision, this increased risk is related to differences in the femoral component size and thus is only indirectly related to sex. Patient selection for hip resurfacing is best made on the basis of femoral head size rather than sex.

Patients with osteoarthritis of the knee often require bilateral knee replacement before fulfilling their full ambulatory potential. Despite extensive research there is considerable debate about the risks of performing simultaneous bilateral knee replacements under the same anaesthetic. Our aim was to compare the relative short-term morbidity of one-stage bilateral with unilateral total knee arthroplasty in a retrospective, consecutive cohort of patients. Seventy-two bilateral knee replacements were case-matched for age and gender with 144 unilateral knees. One-stage bilateral arthroplasty was associated with increased morbidity with respect to wound (6.0 vs 0.7%; p=0.003) and deep prosthetic (3.5% vs 0.7 %; p=0.02) infections, cardiac complications (3.5% vs 0.7%; p=0.04) and chest infections (7.0% vs 1.4%; p=0.04). No differences were observed in the mortality rates (p=0.30) and risk of thrombo-embolism (p=0.70). We conclude that one-stage bilateral total knee arthroplasty is associated with increased morbidity compared with unilateral knee replacement.Résumé Les patients ayant présenté une ostéoarthrite du genou nécessitent parfois une prothèse du genou bilatérale. Des travaux font état des risques survenant lors de la réalisation d'une prothèse totale unilatérale du genou, risques anesthésiques notamment. Le but de notre étude est de comparer la morbidité à cours terme du remplacement du genou par prothèse unilatérale en un temps d'un côté ou des deux côtés, ceci à propos de l'étude rétrospective d'une cohorte de patients. 72 prothèses totales du genou bilatérales en un temps ont été analysées en terme d'âge, de sexe en comparaison avec 144 prothèses du genou unilatérales. La prothèse totale du genou bilatérale en un temps est associée une augmentation de la morbidité (6.0 vs 0.7% ; p=0.003) et à un taux d'infection profonde important (3.5% vs 0.7% ; p=0.02), de même, en ce qui concerne les complications cardiaques (3.5% vs 0.7% ; p=0.04), les complications pulmonaires (7.0% vs 1.4% ; p=0.04). Nous n'avons pas observé de différence sur le plan de la mortalité (p=0.30) de même en ce qui concerne les risques thromboemboliques (p=0.70). Nous pouvons donc conclure que la prothèse totale du genou bilatérale en un seul temps entraîne une augmentation importante de la morbidité si on l'a compare à la prothèse totale du genou, unilatérale.

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