Alastair Konarski

Aims: Pyrocarbon has been used as a bearing surface in hemiarthroplasty (HA) of the shoulder for more than a decade. The use of pyrocarbon is thought to reduce the rate of glenoid erosion compared with metal HA, and reduce the risk of glenoid complications compared with anatomical total shoulder arthroplasty (aTSA). However, there is little information about the long-term outcomes. The aim of this study was to investigate the use of pyrocarbon HA (PyCHA) in New Zealand, and the clinical outcomes and revision rates. Methods: The New Zealand National Joint Registry was used to obtain data on all patients undergoing HA of the shoulder with a stemmed PyCHA. Data which were assessed included the indication for surgery, patient-reported outcome scores, and revision rates. Results: Between January 2014 and December 2024, 288 stemmed PyCHAs were recorded in 277 patients, with a mean age of 55 years (20 to 86). The mean follow-up was 50 months (3 to 128). The use increased 2.3-fold during the study period. The most common indication for surgery was osteoarthritis (OA) (154 (53.5%)), followed by avascular necrosis (AVN) (52 (18.1%)), the sequelae of trauma (48 (16.7%)) and after recurrent dislocation (38 (13.2%)). The mean Oxford Shoulder Score (OSS) was 36.4 (SD 8.2) six months postoperatively, increasing to 40.8 (SD 7.9) at five years. The revision rate was 0.75 per 100 component-years (95% CI 0.34 to 1.42). The mean six-month OSS was significantly lower in the sequelae of trauma group than in the OA (p = 0.014) or AVN groups (p = 0.020). Conclusion: The use of PyCHA is increasing in New Zealand. It is typically used in younger patients with OA. It has good clinical outcomes and low revision rates at mid-term follow-up. Further study is needed to assess the ideal indications for this procedure and the long-term clinical outcomes and revision rates. Cite this article: Bone Joint J 2026;108-B(6):787–792.

Background: Frozen shoulder (FS) is a common condition causing pain and stiffness in the shoulder. There is controversy over whether hydrodilatation (HD) gives improved outcomes compared to corticosteroid injection (CSI) alone. The aim of this study was to investigate if HD improves outcomes compared to CSI alone. Methods: This was a double‐blinded RCT. Patients aged 18–90 with FS were included. The CSI group received an injection of contrast followed by local anaesthetic and steroid. The HD group received the same, followed by saline until capsular rupture or severe resistance. The primary outcome was pain‐free range of motion (ROM), along with Shoulder Pain and Disability Index (SPADI) 8 weeks post‐intervention, and American Shoulder and Elbow Surgeons Score (ASES), Simple Shoulder Test (SST) and Constant score. Results: Seventy‐nine patients were included, with a mean age of 54 (29–70), 53% female. The ROM and SPADI improved in both groups (CSI from 57.4 to 35.8, HD from 57.7 to 32.7) along with ASES, SST and Constant. There were no significant differences between the groups at 8 weeks. HD was found to be more painful than CSI. Male patients achieved greater improvement in ER with HD, while females, patients with severe pain at presentation, and symptoms for less than 120 days favoured CSI. Conclusion: Both groups significantly improved, but there were no significant differences between the groups, although there were some differences between subgroups. We recommend tailoring the first‐line treatment according to patient symptoms and baseline characteristics.

Introduction Risk factors for mortality associated with COVID-19 have been reported to include increased age, male sex and certain comorbidities. Fracture neck of femur (NOF) patients is high-risk surgical patients, often with multiple comorbidities and advanced age. We quantify the 30-day mortality rate in fractured NOF patients with a positive peri-operative COVID-19 antigen test and identify risk factors for increased mortality. Methods This is a retrospective multi-centre review of all patients admitted with a fractured NOF and a confirmed laboratory diagnosis of COVID-19 between 1 March and 26 April 2020. Demographic data, comorbidities, ASA grade and date of death (if applicable) were collected. Results There were 64 patients in the cohort with an overall 30-day mortality rate of 32.8% (n = 21). Thirty-five (55%) were female, and mean age was 83 (SD 9, range 46–100) years. There was significantly increased mortality for those with a history of myocardial infarction (p = 0.03). Sixty-four percent of patients underwent surgery within the 36-h target, which is comparable to previous data for the same time of year. Overall mortality increased to 50% (n = 32) at 45 days post-operatively. Conclusion This is a large review of 30-day mortality in NOF patients with concurrent COVID-19 infection. We report a substantial increase from the pre-COVID-19 mean 30-day mortality rate (6.5% in 2019). We highlight the need for counselling patients when presenting with a NOF in relation to peri-operative COVID-19 infection and the associated increased risks.

This study aimed to assess training of Senior House Officer-grade equivalent doctors in postgraduate surgical training or service (SHO-DIPST) in surgical specialties across the United Kingdom (UK), against nationally agreed Joint Committee on Surgical Training Quality Indicators (JCST QIs). Specific recommendations are made, with a view to improving quality of training, workforce retention and recruitment to Higher Surgical Training. Prospective, observational, multicentre study conducted by the Association of Surgeons in Training, using the UK National Research Collaborative model. Any centres in the UK providing acute surgical services were eligible. SHO-DIPST with a permanent contract, on out-of-hours 'on-call rota' were included across four, one-week data capture periods (September to October 2016, February to March 2017). Adherence to five quality indicators was reported using descriptive statistics. P-values were calculated using Student's t-test for continuous data, with a 5% level of significance. 2569 SHO-DIPST were included from all ten surgical specialties in 141 NHS trusts across all 16 Local Education and Training Boards in the UK. 960 SHO-DIPST were in registered 'training' posts (37.3%). The median number of SHO-DIPST per rota was 7.0 (IQR 5.0-9.0). Adherence to the five included JCST QIs ranged from 6.0 to 53.1%. Only four SHO-DIPST posts across the study population met all five JCST QIs (0.3%). The total number of training sessions was higher for those in registered training posts (p < 0.001), with significant specialty and regional variation. Only four early years postgraduate surgical training posts in the UK meet nationally approved minimum quality standards. Specific recommendations are made to improve training in this cohort and to bolster recruitment and retention into Higher Surgical Training.