Current UK practices in the management of subacromial impingement.

BACKGROUND: Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. METHODS: BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. RESULTS: Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. CONCLUSIONS: Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections.

The Rotaglide mobile bearing knee arthroplasty A 10- to 13-year review from an independent centre.

The Rotaglide knee arthroplasty has a highly congruent mobile meniscal bearing allowing both rotation and antero-posterior translation. We reviewed 137 consecutive primary arthroplasties in 120 patients at mean 11.1 years (10-12.9) following surgery. No cases were lost to follow-up. Hospital for Special Surgery (HSS) and American Knee Society (AKSS) scores were recorded at a review clinic. Radiographs were assessed using the Knee Society's roentgenographic evaluation system. Forty-two patients had died, leaving 78 patients (87 knees) available for review. Sixty-four patients (70 knees) were assessed at a clinic and in 14 (17 knees) clinical outcomes were obtained via telephone and their most recent radiographs were assessed. There were three cases of aseptic loosening and one deep infection requiring revision surgery. Two meniscal bearings were replaced with thicker inserts, one following bearing fracture and one following bearing dislocation. Survival at 11 years for aseptic loosening was 97.6% (95% CI 94.3 to 1.0) and survival using re-operation for any cause was 95.3% (95% CI 90.8 to 99.8). The Rotaglide mobile-bearing total knee replacement demonstrates good survivorship and outcome scores at 11 years following surgery.

The M77 Highway: saving lives and money.

Upgrading of a stretch of the A77, a major road in South West Scotland to Highway status has resulted in a significant reduction in the incidence of serious and fatal road traffic accidents on a major international route. Notwithstanding the pain and suffering prevented, the annual economic savings amount to over pound 6.1 Million ($12.14 M/euro 7.96 M) The Highway, with an effective central reservation barrier, will pay for itself in 17 years and will continue to prevent serious injury and save lives.