The mean age of patients undergoing total knee arthroplasty (TKA) has reduced with time. Younger patients have increased expectations following TKA. Aseptic loosening of the tibial component is the most common cause of failure of TKA in the UK. Interest in cementless TKA has re-emerged due to its encouraging results in the younger patient population. We review a large series of tantalum trabecular metal cementless implants in patients who are at the highest risk of revision surgery. 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.Aims
Methods
Surgery in patients with high body mass index (BMI) is more technically challenging and associated with increased complications post-operatively. Inferior clinical and functional mid-term results for high BMI patients undergoing high tibial osteotomy (HTO) relative to normal weight patients have been reported. This study discusses the clinical, radiological and functional outcomes of HTO surgery in patients with a high BMI. This is a retrospective study on patients undergoing HTO surgery using the Tomofix anatomical MHT plate between 2017 and 2022, with follow-up period of up to 5 years. The cohort was divided: non-obese (BMI <30 kg/m2) and obese (BMI>30 kg/m2). Pre and post operative functional scores were collected: Oxford Knee Score (OKS), EuroQol-5D and Tegner. Complications, plate survivorship and Mikulicz point recorded.Abstract
Introduction
Method
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
Porous metaphyseal cones are increasingly used for fixation in revision total knee arthroplasty (RTKA). Both cemented shorter length stems and longer diaphyseal engaging stems are currently utilized with metaphyseal cones with no clear evidence of superiority. The purpose of this study was to evaluate our experience with 3D printed titanium metaphyseal cones with both short cemented and longer cementless stems from a clinical and radiographic perspective. In total 136 3D printed titanium metaphyseal cones were implanted. The mean patient age was 63 and 48% were female. The mean BMI was 33 and the mean ASA class was 2.5. There were 42 femoral cones in which 28 cemented and 14 cementless stems were utilized. There were 94 tibial cones in which 67 cemented and 27 cementless stems were utilized. The choice for stem fixation was surgeon dependent and in general cones were utilized for AORI type 2 and 3 bone defects on the femur and tibia. The most common fixation scenario was short cemented stems on both the femur and tibia followed by cemented stem fixation on the tibia and cementless fixation on the femur. Clinical data such as revision, complication, and PRO was collected at last follow-up (minimum follow-up 1 year). Radiographic analysis included cone bony ingrowth and coronal and sagittal alignment on long-standing radiographs. Descriptive statistics were used to compare demographics between patients who had malalignment (HKA beyond +/− 3 degrees and flexion/extension beyond +/− 3 degrees). Adjusted logistic regression models were run to assess malalignment risk by stem type.Introduction
Methods
Recent studies of novel healthcare episode payment models, such as the Bundled Payments for Care Improvement (BPCI) initiative, have demonstrated pathways for improving value. However, these models may not provide appropriate payments for patients with significant medical comorbidities or complications. The objective of this study was to identify risk factors for exceeding our institution's target payment, the so-called “bundle busters.” After receiving an exemption from the Institutional Review Board, we queried our institutional data warehouse for all patients (n=412) that underwent total joint arthroplasty (TJA) of the hip (n=192), knee (n=207), or ankle (n=13), and qualified for our institution's bundled payments model during the study time period (July 2015 – May 2017). Patients with medical conditions that were not well controlled or were potentially optimizable were all sent for preoperative medical optimization prior to surgery. For each 90-day episode, patient characteristics, medical comorbidities, perioperative data, and payments from the Centers for Medicare and Medicaid Services (CMS) were obtained. Episodes where Medicare payments exceeded the target payment were considered “busters”. The busters were older, and had higher comorbidity scores (all, p<0.01). Variables were summarized using descriptive statistics and risk ratios were calculated using a modified Poisson regression analysis.Introduction
Methods
