Recent research has questioned the role of arthroscopic meniscectomy in patients with a meniscal tear leading to the development of treatment recommendations for these patients. There is a clear need to understand patient perceptions of living with a meniscal tear in order to plan future research and treatment guidelines. To explore the experiences and expectations of treatment of young patients with a meniscal tear of the kneeAbstract
Introduction
Aims
Persistent medial laxity increases the risk of failure for ACL reconstruction. To address this, multiple reconstruction techniques have been created. To date, no single strand reconstruction constructs have been able to restore both valgus and rotational stability. In response to this, a novel single strand Short Isometric Construct (SIC) MCL reconstruction was developed. Eight fresh-frozen cadaveric specimens were tested in three states: 1) intact 2) after sMCL and dMCL transection, and 3) after SIC MCL reconstruction. In each state, four loading conditions were applied at varying flexion angles: 90N anterior drawer, 5Nm tibial external rotation torque, 8Nm valgus torque, and combined 90N anterior drawer plus 5Nm tibial external rotation torque.Abstract
Introduction
Methods
Total joint arthroplasty (TJA) is one of the commonest and most successful orthopaedic procedures, used for the management of end-stage arthritis. With the recent introduction of robotic assisted joint replacement, Computed Tomography (CT) has become part of required pre-operative planning. The aim of this study is to quantify and characterise incidental CT findings, their clinical significance, and their effect on planned joint arthroplasty. All consecutive patients undergoing an elective TJR (hip or knee arthroplasty) were retrospectively identified, over a 3-year period (December 2019 and December 2022). Data documented and analysed included patient demographics, type of joint arthroplasty, CT findings, their clinical significance, as well as potential delays to the planned arthroplasty because of these findings and subsequent further investigation.Abstract
Introduction
Methodology
Meniscal tears affect 222 per 100,000 of the population and can be managed non-operatively or operatively with an arthroscopic partial meniscectomy (APM), meniscal repair or meniscal transplantation. The purpose of this review is to summarise the outcomes following treatment with a meniscal tear and explore correlations between outcomes. A systematic review was performed of MEDLINE, EMBASE, AMED and the Cochrane Central Register of Controlled Trials to identify prospective studies describing the outcomes of patients with a meniscal tear. Comparisons were made of outcomes between APM and non-operative groups. Outcomes were graphically presented over time for all treatment interventions. Pearson's correlations were calculated between outcome timepoints.Abstract
Background
Methodology
Daycase pathways which aim to discharge patients the same day following Unicompartmental Knee Replacement have been introduced in some centres, though most continue with Standard pathways. While Daycase pathways have cost savings, recovery data comparing pathways is limited. This study aims to compare patient-reported early recovery between Daycase and Standard pathways following UKR. This study was carried out in two centres that originally used the same Standard recovery pathway for UKR. In one centre, the Standard pathway was modified into a Daycase pathway. 26 Daycase-Outpatient, 11 Daycase-Inpatient, and 18 Standard patients were recruited. Patients completed the Oxford Arthroplasty Early Recovery Score (OARS) and SF-36 (Acute) measure between Days 1–42.Abstract
Background
Method
Total knee replacement (TKR) aims to reduce pain and functional limitations. Despite a good outcome for many, 15–20% patients report chronic pain three months after TKR. The STAR Care Pathway is a clinically important and cost effective treatment to improve pain outcomes over 1 year for people with chronic pain at 3 months after total knee replacement surgery. The care pathway is delivered by specially trained Extended Scope Practitioners (ESPs). There is a gap between research findings and translation into practice. This work shows how the STAR trial findings were implemented into NHS practice at a single centre and the further work required to enable national implementation. Trial findings were presented to NHS managers with a business case for an implementation pilot. Trial documentation was adapted for use in usual care using the COM-B model for behaviour change and evidence-based approaches to increase the return of postal questionnaires. Trial sites were contacted to understand their capacity to implement the intervention locally.Abstract
Introduction
Methodology
In cementless UKR, early post-operative tibial fractures are 7x more common in very small tibias. A smaller keel has been shown to reduce this fracture risk, but its effect on fixation is unassessed. This mechanical study assesses the effect of keel interference and size on sagittal micromotion of the tibial component in physiological loading positions. A high-resolution Digital Image Correlation setup was developed and validated to an accuracy of 50 micrometres. Variants of tibial components were 3D-printed: Abstract
Introduction
Method
High tibial osteotomy (HTO) is a well-recognised procedure to address medial compartment osteoarthritis (OA). There remains dispute on the impact of pre-operative patient factors on patient related outcome measures (PROMS). Does BMI and age affect > 2 year and > 5 year oxford knee scores (OKS) and Knee injury and osteoarthritis outcome scores (KOOS). A retrospective review of a prospectively collected database was performed. Timeframe was 26/6/2014 and 25/8/2022. BMI and age were recorded. OKS and KOOS were collected at > 2 years and > 5 years. There were 81 procedures included, of these 50 had OKS and KOOS scores at > 2 years and 35 at > 5 years. Median BMI was 28.5kg/m2, range was 18.6–40.8kg/m2. Spearman's rank for >2 year OKS was p(df)=−0.210 p=0.157, > 5 year OKS p(df)=−0.215 p=0.230. For > 2 year and > 5 year KOOS subscales there were no statistically significant associations on Spearman's rank. For age, median age was 52.5, range 26–71 years old. OKS at >2 year p(df)=0.068 p=0.664, OKS >5 years p(df)=0.065 p= 0.709. For >2 year and > 5 year KOOS subscales there were no statistically significant associations on Spearman's rank. There were no adverse outcome in patients up-to the age of 71. There were no statistically significant Spearman's rank correlations between PROMS and OKS/KOOS scores. This supports recent KOG consensus statement highlighting physiological age importance vs chronological age. Of note there were more negative associations in the BMI group compared with age.Abstract
The Syn-VAR RCT is the first of its kind comparing hamstrings autograft v synthetic neoligament for MPFL reconstruction. Our aim is to evaluate short and long term patient related outcomes measures (PROMs) following synthetic / autologous MPFL reconstruction in a heterogenous cohort of patients with recurrent patellar instability. 20 patients meeting inclusion criteria were recruited and randomised. Standardised surgery was performed by a single surgeon in Altnagelvin Hospital with data collected over 3 years from 2016. Kujala score was the primary outcome measure with data captured preoperatively and 12 weeks/2 years postoperatively. Secondary outcomes included four other validated scores and complications including Norwich Patellar Instability, Lysholm, IKDC and BanffAbstract
Introduction
Method
There is little published literature to support the claim that a successful total knee replacement (TKR) is predictive of future good outcomes on the contralateral side. The objective was to identify whether outcome from the first of staged TKRs could be used to predict the outcome of the contralateral TKR. This was a retrospective cohort study of 1687 patients over a 25-year period undergoing staged bilateral TKRs in a UK arthroplasty centre. A control group of 1687 patients undergoing unilateral TKR with matched characteristics was identified. Primary outcomes: satisfaction and Knee Society Score (KSS) at one year.Abstract
Introduction
Methodology
Rehabilitation exercise is critical for patients’ recovery after knee injury or post-surgery. Unfortunately, adherence to exercise is low due to a lack of positive feedback and poor self-motivation. Therefore, it is crucial to monitor their progress and provide supervision. Inertial measurement unit (IMUs) based sensing technology can provide remote patient monitoring functions. However, most current solutions only measure the range of knee motion in one degree of freedom. The current IMUs estimate the orientation-angle based on the integrated raw data, which might lack accuracy in measuring knee motion. This study aims to develop an IMU-based sensing system using the absolute measured orientation-angle to provide more accurate comprehensive monitoring by measuring the knee rotational angles. An IMU sensing system monitoring the knee joint angles, flexion/extension (FE), adduction/abduction (AA), and internal/external (IE) was developed. The accuracy and reliability of FE measurements were validated in human participants during squat exercise using measures including root mean square error (RMSE) and correlation coefficient. The RMSE of the three knee angles (FE, AA, and IE) were 0.82°, 0.26°, and 0.11°, which are acceptable for assessing knee motion. The FE measurement was validated in human participants and showed excellent accuracy (correlation coefficient of 0.99°). Further validation of AA and IE in human participants is underway. The sensing system showed the capability to estimate three knee rotation angles (FE, AA, and IE). It showed the potential to provide comprehensive continuous monitoring for knee rehabilitation exercises, which can also be used as a clinical assessment tool.Abstract
Isolated patellofemoral joint(PFJ) osteoarthritis affects approximately 10% of patients aged over 40 years and treatment remains controversial. Our aim was to evaluate long term functional and radiological outcomes following PFJ arthorplasty with the Femoro Patella Vialli (FPV) prosthesis as this evidence is lacking in literature. A retrospective review of prospectively collected PROMS in patients undergoing Patellofemoral arthroplasty. Single centre trial. Between 2004 and 2008, 101 FPV patellofemoral arthroplasties were performed in 80 patients with isolated patellofemoral joint osteoarthritis. Data was collected as a part of routine follow-up for up to 6 years and additional long term data was collected at 16 years.Abstract
Introduction
Methodology
Aseptic loosening is the most common cause of failure following cemented total knee arthroplasty (TKA) and this has been linked to poor cementation technique. We aimed to develop a consensus on the optimal technique for component cementation in TKA. A UK based, three round, online modified Delphi Expert Consensus Study was completed focussing on cementation technique in TKA. Experts were identified as having a minimum of 5 years Consultant experience in the NHS and fulfilling any one of the following three criteria:
· A ‘high volume’ knee arthroplasty practice (>150 TKA per annum) as identified from the National joint registry (NJR). · A senior author of at least 5 peer reviewed articles related to TKA in the previous 5 years · A named trainer for a post CCT fellowship in TKA.Abstract
Introduction
Methodology
Customised individually made implants(CIM) total knee arthroplasty(TKA) are custom-made to better fit patients native anatomy and aim to improve outcomes which can be variable with conventional off-the-shelf(OTS). A systematic review and meta-analysis was conducted searching the MEDLINE and Embase databases. Studies reporting on patient reported outcome measures, clinical or radiological outcomes were included. 23 studies satisfied the search criteria (case-control studies14, case series8, cross-sectional studies1). There were 2,856(CIM) and 1,877(OTS) implants. The overall revision-rate was higher in CIM 5.9%vs3.7%OTS [OR 1.46(95% CI 0.82–2.62)]. MUA was higher in the CIM group 2.2%vs.1.1%OTS [OR 2.95(95% CI 0.95–9.13)] and overall complications rate was also higher in the CIM group 5% vs. 4.5%OTS [OR 1.45(95% CI 0.53–3.96)]. LOS was significantly shorter in the CIM group 2.9 days vs. 3.5 days [MD −0.51(95% CI −0.82–0.20)]. Pooled analysis for KSS showed no difference between CIM and OTS groups(Knee=90.5 vs. 90.6 [MD-0.27,(95% CI −4.27–3.73)] and Function=86.1 vs. 90.6[MD 1.51 (95% CI −3.69–6.70)] component of the scores. There was no significant difference in post-operative ROM between CIM and OTS groups 117.3° vs. 115.0° [MD 0.02,(95% CI −1.70–1.74)]. CIM TKAs has theoretical benefits over OTS TKAs however in this review they were associated with higher complication, MUA and revision rates with no difference in outcome scores and no improvement in target alignment. The findings of this review does not support the use of CIM over OTS prosthesis in total knee arthroplasty.Abstract
The Montgomery ruling advocates patients be informed of ‘material risks’ of a procedure. With no guidelines for patients wishing to return to high activity levels after knee arthroplasty, we explore patient and surgeon perceptions in climbers. Ethical approval was granted by the University of Central Lancashire. Anonymous questionnaires were sent via email and social media to consultant knee arthroplasty surgeons and to climbers/mountaineers across the UK. Consultants were asked about advice given for patients who participate in climbing. Climbers were asked about their experiences of knee arthroplasty and return to activity. Of 33 knee arthroplasty surgeons, 11(33%) were firmly against any return to climbing, 10(30%) counselled against it, and 12(36%) were open to return to previous activity. Of 11(33%) surgeons who do not gather information about levels of climbing, 8 would not provide specific advice regarding risks of returning to sport. Of 28 climbers, only 5(18%) were informed to cease completely, with 11(39%) cautioned against and 12(43%) permitted to return. There was no correlation between the advice received and climbing ability post-operatively, (kappa=0.143,p=0.058), with a substantial agreement between ability 1-year post-operatively and currently, (kappa=0.689,p<0.001). There is a discrepancy between the advice given and received by climbers/mountaineers prior to knee arthroplasty, with ability post-operatively having no relationship to advice given. Climbing is possible at high level with no reported complications following knee arthroplasty. The 1-year time point is predictive of longer-term outcome. This information should help surgeons better inform their patients preoperatively.Abstract
Unicompartment knee replacement (UKR) has been an effective treatment of isolated medial compartment osteoarthritis (OA). There has been several studies which suggest that patellofemoral (PFJ) wear may not be a relative contraindication for UKR with no statistical difference in failure rates. There is currently conflicting evidence on the role of BMI. We will review if BMI and PFJ wear impacts on the post operative functional scores following UKR. A retrospective review of a prospectively collected database was performed. Data was collected between 26/6/2014 and 25/8/2022. 159 UKR procedures were identified. BMI and PFJ cartilage wear were collected. Oxford knee scores (OKS) were collected at > 2 years. PFJ wear was split into International Cartilage Research Society (ICRS) grades I&II and III&IV. 159 UKR procedures were identified, of these 115 had 2 year follow up. There were 77 who had OKS recorded at 2 years. For PFJ wear there was no statistical difference in the median OKS at 2 years 45 vs 43.5 (p=0.408). Assessing the BMI the median was 29kg/m2, range 20–43kg/m2. Spearman's rank was performed to assess the correlation between BMI and >2 year OKS, this demonstrated a moderately negative correlation p(df)=−0.339 (CI 95% −0.538, −0.104) p=0.004. There is no statistically significant difference in >2 year OKS following UKR regardless of PFJ wear. There is a moderately negative correlation between BMI and >2 year OKS which was significant p=0.004. Therefore BMI is a more important consideration when counselling patients for UKR.Abstract
Multidisciplinary team (MDT) meetings in orthopaedic surgery are evolving. The goals include patient optimisation, surgical planning and discharge arrangements, individually on a patient specific basis. In line with British Association Surgery of the Knee and GIRFT guidelines, we report our regional experience on the implementation and evolution of our regional Revision Knee Arthroplasty MDT. We undertook a retrospective review of the process, cases discussed and quality assurance conducted in the weekly MDT. Since implementation of the MDT meeting in January 2019, 550 patients with painful joint replacements have been discussed. In May 2021, we formalised our ‘terms of reference’ and ‘standard operating procedures’ which are adhered to by the consultants operating within the network, all of whom attend the meeting. A proforma has been developed and is completed for all cases capturing all pertinent information. All cases are graded according to R1, R2, or R3 complexity scale. Since its inception, the MDT has looked at all post-operative imaging, we now describe a new classification system for grading the appearances. Confirmation of the pre-operative plan and actual surgical intervention is reviewed and audited. In addition, confirmation of indication of revision at the time of operation is reviewed and validated for accuracy with benefits to the unit, individual surgeon and the NJR. In conclusion, the implementation of the revision MDT facilitating pre-operative revision arthroplasty discussion and post-operative quality assurance processes enable surgeons to educate, reflect on their practice and ensure that the highest standards of care are being provided.Abstract
Revision total knee arthroplasty (RTKA) is a complex procedure with higher rates of re-revision, complications and mortality compared to primary TKA. We report the effects of the establishment of a Revision Arthroplasty Network (The East Midlands Specialist Orthopaedic Network; EMSON). The Revision Arthroplasty Network was established in January 2015 and covered the Nottinghamshire and Lincolnshire areas of England. This comprises a collaborative weekly multidisciplinary meeting where upcoming RTKA procedures are discussed, and a plan agreed. Using the Hospital Episode Statistics database, RTKA procedures carried out between 2011 and 2018 from the five EMSON hospitals were compared to all other hospitals in England. Age, sex, and Hospital Frailty Risk scores were used as covariates. The primary outcome was re-revision surgery within 1 year of the index revision. Secondary outcomes were re-revision surgery within two years, any complication within one and two years and median length of stay.Abstract
Introduction
Methodology
Compared to the standard Tomofix plate, the anatomical Tomofix medial high tibial (MHT) plate has been shown to improve anatomical fit and post correction tibial contour, following high tibial osteotomy (HTO). Clinical data on surgical complications, osteotomy union rates and survivorship with the anatomical Tomofix MHT plate however remain limited. This study reports mid-term results of HTO surgery, using the anatomical Tomofix MHT plate. All patients undergoing HTO surgery using the anatomical Tomofix MHT plate between 2017 and 2022 were included in the study. Data on complications, osteotomy union rates and survivorship were collected prospectively and retrospectively analysed.Abstract
Introduction
Methods
Since arthroscopic reconstruction of the anterior cruciate ligament (ACL) started, the use of peroneus longus grafts for primary ACL reconstruction (ACLR) was never thought of as there is very scant literature on it. So, our study aims to compare the functional outcome and complications in patients with ACL injury managed by ACLR with peroneus longus tendon (PLT) and hamstring tendons (HT) respectively. Patients with 16–50 years of either gender presenting with symptomatic ACL deficiency were admitted for arthroscopic single bundle ACLR and allocated into two groups (PLT and HT) operated and observed. Functional scores (IKDC and Lysholm score), clinical knee evaluation, donor site morbidity (AOFAS score) and thigh circumference were recorded preoperatively and at six months, one year post-operatively. The same post-op rehabilitation protocol was followed in both groups.Abstract
Purpose
Materials and Methods