Registry of shoulder arthroplasty - the Scottish experience.

INTRODUCTION: Recognising that timely dissemination of information in the orthopaedic community was important and in the absence of any national guidelines for shoulder arthroplasty, the Scottish shoulder arthroplasty registry, a voluntary registry, was started in 1996. The goals of the registry were to assess contemporary practice, provide a benchmark against which surgeons could compare their practice, identify risk factors for a poor outcome, and to improve outcomes through continuous feedback to the participating surgeons. PATIENTS AND METHODS: A standardised proforma was used to collect information on the diagnostic and demographic data, type of procedure performed, type of implant used, any associated procedures performed in conjunction with the arthroplasty, and peri-operative complications. Postoperative pain, activity and patient satisfaction were assessed annually using another standardised proforma. RESULTS: Twenty surgeons have contributed to the register and 451 shoulder arthroplasties were registered over a 5-year period. Of patients, 23.2% were male and 76.8% female. The mean age was 65 years (range, 37-90 years). Shoulder arthroplasty was commonly performed for rheumatoid arthritis followed by trauma, osteoarthritis and avascular necrosis of the humeral head. Overall, 397 (88%) patients had a hemi-arthroplasty and 54 (12%) had a total shoulder replacement. Of the 54 cases that had a glenoid replacement, 28 were performed for inflammatory arthritis, 21 for osteoarthritis and 5 were for revisions. The humeral component was cemented in 204 (45%) cases, 160 of whom had a shoulder replacement for trauma. The glenoid component was cemented in 48 (89%) cases. Cross referencing our data with the figures of the actual number of shoulder arthroplasties performed, however, indicated that our registry at best collected only 53% of all the shoulder arthroplasties performed in Scotland annually. CONCLUSIONS: The value of a joint registry is dependent on the accuracy and completeness of the data entered. Our registry, therefore, fails as an implant registry. We believe that compliance for data registration can only be ensured if dedicated data collection staff are employed to co-ordinate the data collection and collation process.

Primary bone tumours of the hand and wrist.

Primary bone tumours are rare in the hand and wrist. This 34-year survey of the Leeds Regional Bone Tumour Registry reveals 80 such tumours, representing 3.9% of the total number of bone tumours in the registry. The large majority of these tumours were benign (86%), and were found predominantly in younger patients. Malignant lesions were found more frequently in older patients. 61% of tumours were found in the metacarpals and proximal phalanges. Two-thirds of patients (67.5%) presented with features of swelling, either with or without pain. We conclude that the information gathered from Bone Tumour Registries is of value in describing tumour characteristics, where such information could not be gathered by personal experience alone.

Primary tumors of the axial skeleton. Experience of the Leeds Regional Bone Tumor Registry.

Primary tumors of the axial skeleton are rare and a survey of the Leeds Regional Bone Tumor Registry found them to constitute only 55 of the 1950 cases (2.8%). Chordoma was the most frequent tumor in the cervical and sacral regions as well as the most common diagnosis overall and osteosarcoma ranked second. Pain was the most frequent presenting symptom but over half the patients developed some neurological abnormality. In spite of treatment survival was poor in patients with malignant lesions or neurological involvement. The establishment of Bone Tumor Registries is the only way that sufficient data on large numbers of these rare tumours can be amassed to provide a valuable and otherwise unavailable source of information for research, education and service.

Tumour or infection? Misleading spinal radiographs.

Radiological appearances alone are often insufficient to make a precise diagnosis of spinal pathology, and should be supplemented by appropriate investigations, which ideally should include histological and bacteriological examination of the diseased tissues.

Slipped upper femoral epiphysis--a review of 12 years of experience in Glasgow (1972-1983).

We conducted a retrospective study of 97 cases of slipped capital femoral epiphysis occurring in 77 children. Gradual epiphyseal slip frequently occurred, and complications were more frequent with greater degrees of slips. Diagnostic delay should, therefore, be avoided, and a high index of suspicion is necessary when adolescents with leg pain or limp are examined. Minor epiphyseal slip should be carefully fixed in situ, and we suggest that the remainder undergo a gentle manipulation. Only those hips with a persisting deformity need undergo femoral osteotomy.

The effect of seat belt legislation on a district general hospital.

The introduction of legislation making the use of seat belts compulsory was associated with a marked reduction in the number of patients coming to the Accident and Emergency Department of a district general hospital as a result of road traffic accidents. Those patients who were not wearing seat belts required hospital admission twice as often as restrained car occupants. The only deaths occurring during the period of study occurred in those not using seat belts. Rear seat passengers were found to suffer from more severe and more numerous injuries than restrained car occupants. Injuries caused by seat belts were seen, usually causing bruising of the chest wall or minor fractures, and, excluding the chest, those wearing seat belt were less likely to suffer an injury to any part of the body than those not protected by a belt.