We investigated the relationship between the pain experienced by 50 patients with osteoarthritis of the hip and the resting intra-articular pressure of the synovial fluid. We found a significant linear correlation between these factors, greater pain being experienced by patients with higher pressures. In 20 cases we showed that the pressure rises in extension and medial rotation and is least in flexion and mid-abduction. These results help to explain the benefits of rotation osteotomy of the hip and of psoas release. They also help explain the natural resting position of the hip in patients with an acute effusion and the fixed deformities associated with late osteoarthritis of the hip.

The use of a rotation osteotomy of the humerus in 10 patients with disabling loss of lateral rotation at the shoulder due to brachial plexus birth injuries is described. The operative technique and complications are discussed. Before operation only one patient was independent, but after operation nine of them were. Restoration of lateral rotation at the shoulder can improve the function, the appearance and the independence of these handicapped patients.

Five children with atlanto-axial rotatory fixation (AARF) in association with fractures of the clavicle are described. It is postulated that the rotary fixation is a direct result of the trauma which produces the fracture. The importance ofearly diagnosis is sfressed, since delayed diagnosis may lead to chronic deformity. Early diagnosis depends on awareness of the possibifity of AARF, and either fluoroscoping the patient in order to take appropriate spot films or imaging the atlanto-axial joint by CT. A simple classification of AARF is proposed based on distinct radiological features

Synoviorthesis (medical synovectomy) is a commonly utilized procedure employed in the management of recurrent intra-articular bleeds and secondary chronic synovitis in haemophilic patients. The procedure involves the intra-articular administration of an agent in order to induce fibrosis in the inflamed synovium so reducing the bleeding tendency. Such agents may either be chemical based (osmic acid, rifampicin) or radioactive (yttrium, gold or phosphorus). Whichever agent is employed care must be taken to avoid extra-articular complications (radiation burn and/or inflammatory reaction) as a result of extravasation or needle track contamination. The most frequently affected joints in haemophilia are the elbows, knees and the ankles, and to a lesser extent the shoulders and hips. This article outlines the techniques of injection of the five aforementioned joints, with details of the anatomical landmarks to perform the injections correctly. Injection of the elbows, knees and ankles may be carried out simply on an out-patient basis under local anaesthesia. However, it is advisable to perform injection of the shoulder or hip under radiographic control in order to ensure accurate placement. Very young children may require either sedation or a general anaesthetic. Strict asepsis is naturally a paramount requirement.

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