Incidence of knee arthroscopy in patients over 60 years of age in Scotland.

Arthroscopy has been utilised in the management of knee osteoarthritis for over 70 years but in recent years there has been growing debate about the efficacy of such treatment. We reviewed data from a national register, the Scottish Arthroplasty Project. We analysed 8897 knee arthroscopies performed in patients aged over 60 in Scotland between 1997 and 2006. Marked regional differences were noted for the rate of arthroscopy, with an upper rate of 230 arthroscopies per 100,000 age corrected population and a low of 80 per 100,000. No apparent reasons could be identified for this disparity. Regions with the highest rate of arthroscopy also had the highest rate of conversion to knee arthroplasty within 2 years, indicating a high level of ineffective and inappropriate arthroscopic surgery being performed in many areas of Scotland.

Evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee.

Arthroscopy continues to be widely used in the management of knee osteoarthritis despite concerns regarding its effectiveness. The Scottish Arthroplasty Project has demonstrated a three-fold variation in rates of arthroscopy for osteoarthritis of the knee across different regions of Scotland. This has clear ramifications for the utilisation of finite health care resources. In light of such variations in national clinical practice this review identifies the evidence based factors which permit identification of patients who will obtain sustained benefit from arthroscopic treatment of knee osteoarthritis. Such a patient should have symptoms of short duration affecting the medial compartment of the knee, have localised tenderness at the medial joint line, mechanical symptoms and positive findings on meniscal stress testing. There should be neither significant mechanical malalignment nor flexion contracture, there should be preservation of the joint space on radiographs and the patient should not be obese. If these criteria are fulfilled the likelihood for long lasting reduction in symptoms is increased.

Disease-centred advice for patients with superficial transitional cell carcinoma of the bladder.

INTRODUCTION: Urologists tend to regard superficial tumours (e.g. pTa or pT1 transitional cell carcinoma of the bladder) as being of low pathogenicity. There is a clearly established link between cigarette smoking and bladder cancer, with incidence, recurrence and mortality being positively associated with duration of smoking and number of cigarettes smoked. PATIENTS AND METHODS: A questionnaire-based audit was undertaken to determine the amount of information being provided by urologists for patients who had been diagnosed with pTa or pT1 transitional cell carcinoma of the bladder about both their disease, its aetiology and appropriate advice regarding life-style change. RESULTS: A total of 78 patients adequately completed the questionnaire. Of these, 55 (71%) had been smokers at some time, and 24 (31%) continued to smoke at the time of follow-up. Only 26 of these 55 (47%) were aware of their underlying diagnosis. This level of knowledge was similar in non-smokers, of whom only 12 (52%) were aware of their disease. Of the ever-smokers, only 12 (22%) were aware that smoking was a risk factor for the development of bladder cancer, and 7 (13%) were aware that continued smoking could worsen the prognosis. Only 18 (33%) of the 55 smoking patients had been told to stop smoking, for any reason, by their general medical practitioner, and only 4 (7%) had been told to stop by a urologist. CONCLUSION: In the urology department in which the audit was performed, patients with bladder cancer were not being provided with adequate information about their disease.