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
Geniculate nerve blocks (GNB) and ablation (GNA) are increasing in popularity as strategies for the management of knee pain in patients unsuitable for surgical intervention. Typically these simple blocks have been performed by specialists in pain medicine. We present the results of a GNB clinic run by a surgical care practitioner (SCP). An SCP clinic was created where ultrasound-guided GNBs comprising local anaesthetic and steroid were administered. Patients considered unsuitable for surgery were referred with knee pain by orthopaedic knee surgeons and specialist physiotherapists. A VAS pain score and an Oxford Knee Score (OKS) were completed prior to and immediately following blockade. Serial VAS diaries were completed. Further OKS were requested at 6 weeks and 6 months. Patients could request GNA at any point during follow-up and their follow-up ceased at this stage.Abstract
INTRODUCTION
METHODOLOGY
Periprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). Two-stage revision has traditionally been considered the gold standard of treatment for established infection, but increasing evidence is emerging in support of one-stage exchange for selected patients. The objective of this study was to determine the outcomes of single-stage revision TKA for PJI, with mid-term follow-up. A total of 84 patients, with a mean age of 68 years (36 to 92), underwent single-stage revision TKA for confirmed PJI at a single institution between 2006 and 2016. In all, 37 patients (44%) were treated for an infected primary TKA, while the majority presented with infected revisions: 31 had undergone one previous revision (36.9%) and 16 had multiple prior revisions (19.1%). Contraindications to single-stage exchange included systemic sepsis, extensive bone or soft-tissue loss, extensor mechanism failure, or if primary wound closure was unlikely to be achievable. Patients were not excluded for culture-negative PJI or the presence of a sinus.Aims
Methods
To determine the tensile forces across the knee extensor mechanism during walking, in simulated conditions of treatment. Gait analysis of six normal subjects was performed, with full weight bearing unilateral immobilisation of the knee during walking. Measurements were taken without then with a brace, unlocked then locked at 0°, 0-10°, 0-20° and 0-30° of flexion. Mean and maximum knee flexion angles were measured, followed by calculation of the mean and maximum forces across the extensor mechanism during loading, supporting and propulsion phases of gait.Aim
Methods
This study was undertaken to evaluate the early results of a new implant system - the metaphyseal sleeve - in revision total knee replacement. The femoral and tibial metaphyseal sleeves are a modular option designed to deal with metaphyseal bone loss and achieve cementless fixation over a relatively wide area in the metaphysis. Over three years, femoral and/or tibial metaphyseal sleeves were implanted in 104 knees in 103 patients (54 male and 49 female). The clinical notes and radiographs of these patients were reviewed retrospectively. Thirty one patients had revision for infection, 42 for aseptic loosening, and 31 for instability, pain or stiffness. Eighty nine knees were revised as a single stage and 15 were done as two stage procedure. Minimum follow up is 12 months (average 18.5 months).Purpose of the study
Methods
Avascular meniscal tears can be repaired with good clinical outcomes. The mechanical disadvantage and detrimental effect to articular cartilage following meniscectomy has been well documented in the literature. Meniscal repair in the avascular (white on white zone) is controversial and would be deemed inappropriate by many.Hypothesis
Background
Simultaneous bilateral Total Knee Arthroplasty (TKA) has been reported to bring greater patient satisfaction, reduce in-patient stay and recovery, with similar outcomes to single sided or staged TKA, but higher complication rates. No validated selection criteria exist. We report the results of a single surgeon's experience of simultaneous bilateral TKA, using set guidelines for patient selection. A prospectively maintained database of all simultaneous bilateral TKA performed between 2002 and 2008 was retrospectively analysed, supplemented by case-note review. Outcome measures included length of stay, blood loss and transfusion rates, complications and functionality and validated outcome scores. 40 patients were included, 23 male and 17 female, all with osteoarthritis. Mean age was male 64.9 and female 61.3 years. Mean ASA grade was 1.8. All fitted selection criteria. Mean tourniquet time was right 79.1 minutes and left 83.6 minutes. Preoperative mean haemoglobin level was 141.8 g/dl and mean post operative level of 87.3 g/dl. 13 patients received purely autologous blood transfusion, 16 patients purely allogenic and 6 patients received both. There was 1 intraoperative complication (Medial collateral injury), 3 minor post operative complications which recovered prior to discharge. There were no thromboembolic events or deaths. Mean follow-up was 32.7 months (range 3-79 months). Mean in-patient stay was 7.5 days. Mean range of movement at most recent follow up was right 1.0 to 119.1 degrees flexion and left 1.0 to 120.8 degrees flexion. Mean Knee Society Scores pre- versus post-operatively were: 67 knee/62 function versus 90 knee/82 function. Oxford Knee Scores, Pre- versus post-operatively were: 43 versus 35 (Scoring 0-60, lowest best outcome). We demonstrate that with appropriate selection criteria, simultaneous bilateral TKA is safe and successful, giving excellent functional outcomes.
