This retrospective study evaluates the midterm results of the Rotating Platform PFC Sigma Total Knee Arthroplasty System. We reviewed 161 cases in 147 patients with an average follow-up of 5 years (4 to 7 years) operated on at our institution between June 2001 and June 2004. Patient outcomes were measured using the Oxford and American Knee Society Scores and radiographs underwent independent radiological evaluation. Average pre-operative Oxford Scores improved from 43(29-55) to 21 (13 - 44) postoperative;y and average Knee Society Scores improved from 57 (43-70) preoperatively to 80 (58-90) at last follow up. Range of movement improved from 91 degrees (70 - 110) to 113 degrees (75 - 130). There were 5 complications reported; one superficial infection treated with antibiotics, one patient required manipulation under anaesthesia at 3 months for post operative stiffness, which improved. There was one arthrotomy for dislocation of the bearing immediate postoperatively. There was one case of DVT and one non-fatal PE. There were no deep infections. The PFC Sigma Knee Rotating Platform system offers excellent mid-term results in our review.
The aim of this study was to study the course of the infra-patellar branch of the saphenous nerve (IPBSN) and describe its anatomical variations and relations. Twenty-eight formalin-fixed cadaver lower extremity specimens were methodically dissected in the University Department of Anatomy. Dissection included identifying the saphenous nerve and tracing it distally till it pierced the deep fascia between the tendons of gracilis and sartorius. At this point, the saphenous nerve gave a branch that pierced the sartorius and became subcutaneous, known as the infrapatellar branch. The association of the nerve trunk with the sartorius muscle in terms of whether it originated above it, below it or pierced through it was studied. Following this the nerve was dissected along its course distally to the point of its termination where it gave one to three branches. The relationship of the point of termination of the IPBSN with bony surface landmarks like the medial border of the patella, the apex of the patella and the tibial tuberosity were also studied. The distance of the trunk from medial margin of patella was measured.Aim
Materials and Methods
We report the clinical results of seven consecutive allograft knee ligament reconstructions using Achilles tendon prepared using a chemical treatment process. Results have been disappointing with six clinical failures at short durations of follow-up. All allografts are not the same and the method of tissue preparation may have important consequences for clinical outcomes. Debate regarding the use of allograft or autograft tissue for knee ligament reconstruction continues. A variety of allograft tissues are available from commercial and NHS sources: fresh frozen, freeze dried, irradiated or chemically prepared. There are gaps in the literature with respect to clinical outcomes for these various methods of graft preparation. A recent systematic review indicated similar short-term clinical outcomes for fresh frozen allografts and autografts. The senior author began using allograft Achilles tendon for revision ACL reconstruction or primary multiple ligament reconstruction in 2007. Tissues were obtained from a commercial supplier. These tissues had been harvested in Eastern Europe, transported to the USA and sterilised using a patented “Biocleanse” chemical treatment process. This involves sequential ultrasonic baths of detergent, peroxide and alcohol for fixed periods of time along with pressure and vacuum cycles. Between April 2007 and April 2009, 7 allograft ligament reconstructions were performed in 5 knees. These comprised 5 ACL and 2 LCL reconstructions. At follow up of between 4 months and 2 years, clinical failure of 6 grafts has been observed. We are aware of one previous series of results for ACL reconstructions using chemically sterilised and irradiated allograft tissues. A 45% graft failure rate was reported. We have not been able to identify any clinical outcome studies for grafts prepared using the “Biocleanse” process. Our results have prompted us to change to UK sourced, donor screened allografts, which are fresh frozen after decontamination with 70% ethanol.
Analysis of the effect of administration of antibiotics before collection of microbiology samples in patients with septic arthritis of the native and prosthetic knee. A retrospective analysis of patients admitted to the unit with a diagnosis of septic arthritis of the knee. There were 27 infections in 26 native knees and 27 infections in 26 prosthetic knees. Sixty-three percent of the native knees had received antibiotics prior to collection of microbiology samples. Fifty-three percent of these grew an organism from at least one of their aspirate, washout fluid or swab. Of the 37% that did not have antibiotics 100% grew an organism. There was no difference in the type or length of treatment required between the groups. Forty-one percent of the prosthetic knees had received antibiotics prior to collection of microbiology samples. Forty-five percent of these had an organism identified. Of the 59% that did not have antibiotics 81% had an organism identified. Overall 67% had an organism isolated, fifty-six percent of these retained their implant. Thirty-three percent of those with no organism identified retained their implant.Aim
Method and Results
To identify the early functional outcomes, survivorship and complications associated with the Corin Uniglide Unicompartmental Knee Replacement (UKRs) from an independent centre. A prospective consecutive case series of sixty Uniglide UKRs was carried out in fifty-one patients between January 2006 and March 2009. The data collected included:
Primary outcome measures: Pre- and post-operative American Knee Society Score (AKSS), Oxford Knee Scores (OKS), WOMAC Survivorship Secondary outcome measures: X-ray error scores assessing component position Complications No cases were lost to follow-up. Mean follow-up time was 19 months (12 to 36months) and mean age was 66 years (39 to 78 years). Kaplan-Meier Survivorship showed 95% survival at 3 years (CI:6.4). All functional outcomes showed significant improvement p <0.05. There were two revisions within the first year, which were the main complications, secondary to aseptic tibial loosening and collapse of the posteromedial tibia. The x-ray error score identified the most common error as the femoral flexion/extension angle followed by the anterior/posterior fit.Purpose of Study
Methods and Results
A case series with functional and radiographic outcomes, of modular endoprosthetic distal femoral replacement in complex cases of periprosthetic fracture. Sixteen cases were identified of endoprosthetic replacement (EPR) from the bone and soft tissue cancer implant registry. A retrospective review was undertaken.Aim
Method
The purpose of this study was to investigate whether combining PRP or concentrated bone marrow aspirate (CBMA) with a biphasic collagen/glycosaminoglycan (CG) scaffold would improve the outcome of the treatment of full thickness osteochondral defects in sheep. Osteochondral defects (5.8×6mm) were created in the medial femoral condyle (MFC) and the lateral trochlea sulcus (LTS) of the stifle joints of 24 sheep. Defects were either left empty or filled with a 6×6mm CG scaffold, either on its own or in combination with PRP or CBMA (n=6). At 6 months the sheep were euthanised, and the repair tissue subjected to mechanical testing, gross morphological analysis, semi quantitative histological scoring and immunohistochemical staining including types I, II and VI collagen.Introduction
Materials and Methods
Unicondylar knee replacements (UKR) may be more effective compared to Total knee replacements (TKR) in unicompartmental arthritis. We report patient outcomes & satisfaction data in an age matched cohort of patients with either a UKR or TKR. A single unit and single surgeon series of patients were recruited. Data was retrospectively collated for 68 patients with more than 24 months follow-up. UKR was undertaken in patients with isolated medial compartment osteoarthritis; stable ACL and less than grade 3 lateral patellar changes of the Outerbridge classification. TKR was undertaken for the rest. The patients were assessed with validated knee scores including the Total Knee Function Questionnaire (TKFQ) which focuses on recreational & sporting outcomes as well as activities of daily living (ADL). Patient satisfaction and perception of knee normality was measured on a visual analogue scale.Introduction
Method
The outcome following arthroscopic anterior cruciate (ACL) reconstruction is dependant on a combination of surgical and non-surgical factors. Technical error is the commonest cause for graft failure, with poor tunnel placement accounting for over 80% of those errors. A routine audit of femoral and tibial tunnel positions following single bundle hamstring arthroscopic ACL reconstruction identified apparent inconsistent positioning of the tibial tunnel in the sagittal plane. Intra-operative fluoroscopy was therefore introduced (when available) to verify tibial guide wire position prior to tunnel reaming. This paper reports a comparison of tibial interference screw position measured on post-operative radiographs with known tunnel position as shown on intra-operative fluoroscopic images in 20 patients undergoing routine primary ACL reconstruction between January and June 2009. Surgery took a mean of 5 minutes longer when intra-operative fluoroscopy was used. In 3/20 patients, fluoroscopy led to re-positioning of the tibial guide wire prior to tunnel reaming. The mean tibial tunnel position as indicated by the tunnel reamer was 41 +/− 2.7 % of the total plateau depth (range 37% to 47%). The mean position projected from the tibial screw on post operative radiographs was 46 +/− 9.2% (range 38% to 76%). A paired t-test showed a significant difference (p = 0.022) between true tunnel position and tibial screw position. 6/20 patients had post operative screw positions that were > 5% more posterior than the known position of the tibial tunnel. The position of the tunnel should be measured at its mid-point where this is evident. On most early radiographic images, the margins of the tunnel are not clear and therefore a line projected from the centre of the screw is used. This audit demonstrates the potential inaccuracy associated with this.
The trochlear groove plays a major role in the mechanics and patho-mechanics of the patellofemoral joint. Our primary goal was to compare normal, osteoarthritic and dysplastic PFJs in terms of angles and distances. Computed tomography scans of 40 normal knees (>55 years old), 9 knees with patellofemoral osteoarthritis (group A) and 12 knees with trochlear dysplasia (group B) were analysed using 3D software. The femurs were orientated using a robust frame of reference. A circle was fitted to the trochlear groove. The novel trochlear axis was defined as a line joining the centres of two spheres fitted to the trochlear surfaces, lateral and medial to the trochlear groove. The relationship between the femoral trochlea and the tibiofemoral joint was measured in term of angles and distances (offsets).T-test for paired samples was used (p<0.05).Introduction
Method
