Introduction

Transforming outpatient services is a key commitment set out in the NHS Long Term Plan, with particular emphasis on digital solutions to reduce outpatient follow-up (FU) by 25%. This study looks at the potential for removing knee arthroscopy FU by providing a bespoke multimedia report for each individual patient, generated using the Synergy™ Surgeon App (Arthrex)

Methodology

Single District Hospital using a 3 Phase study

Phase 1 – Assessment of cost and environmental impact of outpatient follow up appointments

Phase 2 – Bench marking of existing pathways and patient experience.

Phase 3 – Qualitative assessment of multimedia report feedback of 30 patients

Introduction

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).

Methodology

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.

Introduction

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.

Methods

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.

INTRODUCTION

The most frequent mode of aseptic failure of primary total knee replacements is tibial baseplate loosening. This is influenced by stresses across the implant-bone interface which can be increased in obese patients leading to potentially higher rates of early failure. The evidence is mixed as to the true effect of elevated BMI (body mass index) on revision rates. We present the experience of early tibial failures in our department and how our implant choices have evolved.

METHODOLOGY

We retrospectively reviewed our unit's arthroplasty database and identified all patients who had sustained mechanical tibial failure. Data were collected on patient demographics, operative details of primary and revision operations, components used, alignment pre and post operatively and indication. Complications and further surgery performed were recorded.

Introduction

The Oxford Unicompartmental Knee Replacement's (OUKR's) fully-congruent design minimises polyethylene wear. Consequently, wear is a rare failure mechanism. Phase-3 OUKR linear wear at 5 years was higher than previous OUKR phases, but very low compared to fixed-bearing UKRs. This study aimed to measure OUKR bearing wear at 10 years and investigate factors that may affect wear.

Methodology

Bearing thickness for 39 OUKRs from a randomised study was calculated using radiostereometric analysis at regular intervals up to 10 years. Data for 39 and 29 OUKRs was available at 5 and 10 years, respectively. As creep occurs early, wear rate was calculated using linear regression between 6 months and 10 years. Relationships between wear and patient factors, fixation method, Oxford Knee Score (OKS), bearing position, and component position were analysed.

Introduction

Little is known about employment following revision total knee arthroplasty (RTKA). This study aims to describe factors associated with returning to employment in patients of working age who underwent RTKA surgery.

Methodology

We performed a retrospective assessment of all patients aged ≤65 who underwent RTKA at our NHS institution between 2006 and 2020. All indications and revision procedures were included. Pre-operative demographics, indication for surgery and Oxford Knee Scores (OKS) were recorded. Postal questionnaires were sent to patients including patient reported outcome measures and departmental questionnaire asking patients about employment status pre- and post-operatively.

Introduction

Augmentation of meniscus repairs with fibrin clot may enhance the healing capacity. Pulling the clot into the tear with a suture ensures that it stays in position. This paper aims to assess the outcome of this technique.

Methods

52 patients over 4 years undergoing suture repair of a meniscus tear with blood clot augmentation were collected from a prospective database. Follow up included outcome scores and a questionnaire. Failure was defined as pain or further surgery secondary to meniscal pathology.

Purpose

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.

Materials and Methods

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.

Introduction

People from ethnic minority backgrounds are underserved in healthcare and research. We co-developed a checklist to promote good practice for inclusive community patient and public involvement (PPI).

Methods

We worked with three community groups in Bristol to develop the checklist – Dhek Bhal (South Asian community), Malcolm X Elders (African Caribbean community) and My Friday Coffee Morning (predominantly Somali women). We worked with group leaders to better understand the needs of the groups. We visited each group at least three times and used informal and open discussions tailored to how each group preferred to work. We paid for community leaders’ time, interpretation and transport where needed, as well as contributing towards activities and catering as suggested by group leaders.

Methods

A retrospective cohort study was undertaken of 700 primary MA TKAs (643 patients) performed between 2014 and 2017. Lateral distal femoral and medial proximal tibial angles were measured pre- and postoperatively to calculate the arithmetic hip-knee-ankle angle (aHKA), JLO, and Coronal Plane Alignment of the Knee (CPAK) phenotypes. The primary outcome was the magnitude and direction of aHKA, JLO, and CPAK alterations.

Methods

Patients scheduled for primary TKA were included in a single-centre, prospective, three-armed, blinded randomized trial (n = 216; 72 per group). After intraoperative confirmation of posterior cruciate ligament (PCL) integrity, patients were randomly allocated to receive a CR, AS, or PS design from the same TKA system. Insertion of an AS or PS design required PCL resection. The primary outcome was the mean score of all five subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS) at two-year follow-up. Secondary outcomes included all KOOS subscales, Oxford Knee Score, EuroQol five-dimension health questionnaire, EuroQol visual analogue scale, range of motion (ROM), and willingness to undergo the operation again. Patient satisfaction was also assessed.

Methods

A total of 23 patients with a mean age of 83 years (77 to 91), were available from a RSA study on cemented TKA with Maxim tibial components (Zimmer Biomet). PE inlay migration, PE wear, tibial component migration, and the anatomical knee axis were evaluated on weightbearing stereoradiographs. PE inlay wear was measured as the deepest penetration of the femoral component into the PE inlay.

Methods

A total of 454 consecutive patients who underwent cementless TKA between August 2004 and December 2021 were reviewed. The mean follow-up was ten years. Plain radiographs were analyzed for radiolucent lines. Patients who underwent revision TKA were recorded, and the cause for revision was determined. Data from the National Joint Registry for England, Wales, Northern Island, the Isle of Man and the States of Guernsey (NJR) were compared with our series.

Methods

Patient-reported outcome measure (PROM) data measuring knee health were obtained from the NHS PROMs dataset and Total or Partial Knee Arthroplasty Trial (TOPKAT). Assumptions for common scale modelling were tested. A graded response model (fitted to OKS item responses in the NHS PROMs dataset) was used as an anchor to calibrate paired HAAS items from the TOPKAT dataset. Information curves for the combined OKS-HAAS model were plotted. Bland-Altman analysis was used to compare common scale scores derived from OKS and HAAS items. A conversion table was developed to map between HAAS, OKS, and the common scale.

Methods

A retrospective consecutive study of all patients who underwent a rTKA using the fully cemented SMILES rotating hinge prosthesis between 2005 to 2018. Outcome measures included aseptic loosening, reoperations, revision for any cause, complications, and survivorship. Patients and implant survivorship data were identified through both prospectively collected local hospital electronic databases and linked data from the National Joint Registry/NHS Personal Demographic Service. Kaplan-Meier survival analysis was used at ten years.

Methods

Male (n = 21) and female (n = 21) adult Sprague-Dawley rats were randomly divided into ALM or Saline control treatment groups. Three days after ACL rupture, animals underwent ACLR. An ALM or saline intravenous infusion was commenced prior to skin incision, and continued for one hour. An intra-articular bolus of ALM or saline was also administered prior to skin closure. Animals were monitored to 28 days, and joint function, pain, inflammatory markers, histopathology, and tissue repair markers were assessed.

Methods

This retrospective, observational study reviewed patients who underwent unilateral, aseptic rTKA at an academic orthopaedic speciality hospital between June 2011 and April 2020 with > one-year of follow-up. Patients were dichotomized based on whether this was their first revision procedure or not. Patient demographics, surgical factors, postoperative outcomes, and re-revision rates were compared between the groups.

Introduction

Uni-compartmental knee replacement (UKR) has become popularised due to quicker recovery times, reduced postoperative pain, and blood loss. The desire to increase bed capacity and reduce costs, while preserving safety and patient satisfaction, has led to increased interest in day-case arthroplasty. This study observes the feasibility of UKR as a day-case procedure and whether this affects short and long-term postoperative outcomes.

Methodology

Between 2018 and 2021, at a single institution and operated by a single orthopaedic surgeon, seventy-seven patients received a UKR on an elective basis. The patients were divided into two groups: ‘day-case’ for those discharged on the same day, and ‘non day-case’ group.

Introduction

Total knee replacement (TKR) in patients with skeletal dysplasia is technically challenging surgery due to deformity, joint contracture, and associated co-morbidities. The aim of this study is to follow up patients with skeletal dysplasia following a TKR.

Methodology

We retrospectively reviewed 22 patients with skeletal dysplasia who underwent 31 TKRs at our institution between 2006 and 2022. Clinical notes, operative records and radiographic data were reviewed.