Visiting other departments.

CDH, revision of devices with loose intramedullary stems or failed bearings, can only be reconstructed with any degree of soundness and restoration of normal geometry and mechanics by use of an individualized approach. Rationalization of designs by using an Expert System approach can speed the design and manufacturing time and minimize costs. With such potential benefits, the actual expansion in usage will depend upon the willingness of surgeons to provide appropriate radiographic and clinical data, and to confront more exacting surgical procedures. A degree of specialization is indicated in this type of surgery. Because these specialized joint replacements, from off-the-shelf uncemented coated implants to more complex individualized devices, are more costly than standard devices, it is essential that this is recognized in equipment budgets. The modest increase in costs should not become a barrier to the patients with these more serious problems, where the technology for treatment exists. Finally, a steady increase in standards will rely on a continuing education process not only among the surgical community, but also of scientists, designers, manufacturers and those in government and regulatory agencies. Hence, appropriate courses and conferences must play an increasing role in the future. Because advances in joint replacement are now played out on a global scale, the importance of international participation in such educational events cannot be overemphasized. In conclusion; it is proposed that joint replacement has already provided immense benefits to patients, and is undoubtedly the most effective way forward for yet further advances in the treatment of disabling conditions of joints. REFERENCES 1. Rand JA, Ilstrup DM. Survivorship analysis of total knee arthroplasty. effect of a stem on the tibial component of knee arthroplasty. The effect of improved cementing techniques on component loosening in total hip replacement. The influence of stem size and extent of porous coating on femoral bone resorp-tion after primary cementless hip arthroplasty. Wear analysis of retrieved alumina heads and sockets of hip pros-thesis.miento A. Comparison of the stability of press-fit hip prosthesis. Femoral stems using a synthetic model femur. RHEUMATOLOGY in the United Kingdom is being practised in an ever-changing NHS where new consultants must not onjy be competent clinicians but are expected to run, develop and be financially responsible for the organization of their service. How often are trainees in rheumatology taught these management skills and can it be improved to nurture the rheumatologists of tomorrow? Some Regional Health Authorities organize general management …