No abstract

No abstract

In 2006 over 55,000 primary total hip replacements were implanted in the UK. A crucial aspect of follow-up for these patients is the assessment of the postoperative radiograph. Information gained from the initial radiograph includes assessment of the quality of implantation and hence the likelihood of long term success. Follow-up radiographs can be assessed for signs of component failure. Orthopaedic surgeons, radiologists, junior surgical trainees, general medical practitioners, and advanced nurse/extended scope practitioners may all be required to interpret these radiographs during clinical practice. The authors feel that certainly during orthopaedic surgical training, not enough time is allocated to formal training on the systematic assessment of such radiographs. This review aims to provide the reader with a systematic approach to analysing the initial postoperative total hip arthroplasty radiograph, and subsequent follow-up films. Basics of patient positioning for obtaining radiographs, types of prosthesis encountered, and terminology used are covered. Assessment of initial radiographs focuses on assessing leg length, acetabular and femoral positioning, and cement mantle adequacy. Follow-up radiographs are assessed for signs of component failure. A review of the literature provides evidence for the assessment and importance of adequacy of component positioning, and good cementing technique. Normal and abnormal follow-up radiographic features are outlined to allow assessment of loosening or impending failure of a prosthesis.

No abstract

Background The present study aimed to assess the accuracy and characterize the learning curve of surgeon-lead shoulder ultrasound scans (USS) performed in outpatients for suspected rotator cuff tears, with intra-operative findings considered as the gold standard.Methods From 2009 to 2011, all patients having arthroscopic shoulder surgery by the senior author were identified. Clinic letters were reviewed to identify those who had undergone USS in clinic. This was then compared with the operating findings.Results A total of 66 patients had an USS and proceeded to arthroscopic shoulder surgery during that time. Overall sensitivity and specificity was 0.86 and 0.70, respectively. Comparing values from 2009 to 2011: specificity improved from 0.50 to 0.8; sensitivity remained much the same with 2009 values of 0.88 to 2011 values of 0.86. ConclusionsThe results reflect good sensitivity and specificity, which was comparable with that reported in the literature. There was an improvement in specificity over time displaying a learning curve and emphasizing the question of how much experience in shoulder USS is required before it can be relied upon as the patient's primary imaging preoperatively?

Dislocation of the shoulder joint is a common injury. Initial management takes the form of urgent reduction, for which many methods have been described. Associated injuries carry significant morbidity and must be recognised. Further post-reduction treatment for the first-time dislocator has traditionally been non-operative; however, increasing evidence suggests a role for acute surgical arthroscopic stabilisation in certain patient groups. This article aims to give an evidence-based overview of the epidemiology, pathology and initial and further treatment options for shoulder dislocation.

No abstract

Background Rotator cuff tears are associated with significant morbidity. Ultrasound scanning in the diagnosis and evaluation of cuff tears has been shown to be highly sensitive and specific. However, it is hypothesized that ultrasound may not be such a precise modality in the setting of a district general hospital. Materials and methods The present study identified all patients in a 1‐year period who underwent shoulder arthroscopy and who had also undergone a preceding ultrasound scan. Tables (2 × 2) were drawn up to compare findings and calculate sensitivity, specificity and predictive values. Results Eighty‐five patients were identified with a total of 59 (69%) cuff tears detected at surgery. Overall, the sensitivity and specificity of ultrasound was 66% and 54%, respectively. This equated to an overall accuracy of 62%. The positive predictive value was 76% and the negative predictive value was 41%. Discussion The results obtained in the present study demonstrate disappointingly low sensitivity, specificity, positive and negative predictive values, as well as accuracy, for the use of ultrasound scanning in the assessment of the rotator cuff. This has implications not only for the diagnostic process, but also in terms of theatre time logistics. It is suggested that a regular multidisciplinary team meeting is held to discuss imaging and consideration of magnetic resonance imaging as an alternative modality in this setting.