Aims

Deprivation underpins many societal and health inequalities. COVID-19 has exacerbated these disparities, with access to planned care falling greatest in the most deprived areas of the UK during 2020. This study aimed to identify the impact of deprivation on patients on growing waiting lists for planned care.

Aims

COVID-19 has compounded a growing waiting list problem, with over 4.5 million patients now waiting for planned elective care in the UK. Views of patients on waiting lists are rarely considered in prioritization. Our primary aim was to understand how to support patients on waiting lists by hearing their experiences, concerns, and expectations. The secondary aim was to capture objective change in disability and coping mechanisms.

Acetabular cup positioning remains a real challenge and component malpositioning after total hip arthroplasty (THA) can lead to increased rates of dislocation and wear. It is a common cause for revision THA. A novel 3D imageless mini-optical navigation system was used during THA to provide accurate, intraoperative, real-time, and non-fluoroscopic data including component positioning to the surgeon. This retrospective comparative single surgeon and single approach study examined acetabular component positioning between traditional mini-posterolateral THA and mini-posterolateral THA using the 3D mini-optical navigation system. A retrospective chart review was conducted of 157 consecutive (78 3D mini-optical navigation and 79 traditional non-navigation methods) THAs performed by the senior author using a mini-posterolateral approach at an ambulatory surgery center and hospital setting. Two independent reviewers analyzed postoperative radiographs in a standardized fashion to measure acetabular component positioning. Demographic, clinical, surgical, and radiographic data were analyzed.

These groups were found to have no statistical difference in age, gender, and BMI (Table I). There was no difference between groups in acetabular components in the Lewinnek safe zone, 31.2% vs 26.6% (p = 0.53). Cup anteversion within the safe zone did not differ, 35.1% vs 40.5% (p = 0.48); while cup inclination within the safe zone differed, with more in the navigation group, 77.9% vs 51.9% (p < 0.01). Change in leg length was significantly different with the navigation group's leg length at 1.9 ± 6.3, less than the traditional at 5.4 ± 7.0 (p < 0.01). There was no difference in mean change in offset between groups (4.5 ± 5.9 vs 6.2 ± 7.9, p = 0.12); navigation, traditional) (Table II). The 3D mini-optical navigation group did have significantly longer operative time (98.4 ± 17.5 vs 89.3 ± 15.5 p < 0.01). Use of the novel 3D Mini-optical Navigation System significantly improved cup inclination compared to traditional methods while increasing operative time.

For any figures or tables, please contact the authors directly.

INTRODUCTION

Component impingement in total hip arthroplasty (THA) can cause implant damage or dislocation. Dual mobility (DM) implants are thought to reduce dislocation risk, but impingement on metal acetabular bearings may cause femoral component notching. We studied the prevalence of (and risk factors for) femoral notching with DM across two institutions.

OBJECTIVE

Post TKR manipulation under anesthesia is required when post operatively patients don't achieve desired range of motion. The rates quoted in various western literature ranges from 1 to 2 %. A knee is considered to be stiff when the patient fails to achieve 60 degrees of flexion. The objective of the study was to find out the differentiating factor responsible for low rate of MUA in Indian post TKR patients as compared to Anglo-Saxon population

Introduction and aim

TKR remains one of the most successful surgeries in orthopedics. Still a sizeable number of patients remain dissatisfied reaching to a level of 30%. Our aim was to examine the excised synovium from the suprapatellar region in all osteoarthritic knees and evaluate the histopathological report to know if in a few cases the unrelenting pain and discomfort could be due to some undiagnosed pathology within the joint.

INTRODUCTION

This study is to determine the response of CRP after TKR surgery, both unilateral and simultaneous bilateral TKR. According to the previously published literature from North America and Europe CRP value peaks on the 1^st and 2^nd post-operative day and then gradually comes down to normal by 6–8 weeks post-operatively.

Introduction

Forgotten knee is the terminology which is used to describe a post TKR patient who is completely unaware of his knee implant. Various factors like age, sex, BMI, pre operative pain, pre operative patella symptoms have been studied to see their cause effect relationship on the achievement of forgotten knee status by the patient. All the published data till to date shows no relationship between thetwo

Tibial shaft fractures co-existing with osteoarthritis can increase the challenges for the orthopedic surgeon. The novel Londhe-Shah technique manages both the problems using one-stage total knee arthroplasty with a long stemmed tibial component which has a good diaphyseal fit. Three osteoarthritis patients with fractures of tibial shaft were treated with this technique and were followed up at 6-weeks, 12-weeks and 1-year (figure 1–3). A complete union of the fractured segment was achieved at follow-up without any adverse events such as infection, damage to the implant, and soft-tissue injury during and after surgery. The American Knee Society Score (AKSS) improved and WOMAC pain and stiffness scores reduced at follow-ups suggesting excellent improvement in functionality and patient satisfaction. One-stage TKR with a long-stem extension of the tibial component to bypass the fracture site mends and stabilises the fracture along with the adverse biomechanics at the fracture site while also correcting the arthritis. The single stage procedure allows early ambulation in six weeks.

For any figures or tables, please contact the authors directly.

A number of studies suggest revision of unicompartmental knee replacement (UKR) to total knee replacement (TKR) is straightforward. We hypothesise that this is not always the case in terms of complexity, cost and clinical outcome.

We identified 23 consecutive patients revised from UKR to TKR by 2 consultant surgeons (2005–2008). These were matched by age, sex and comorbidity to a cohort of primary TKRs (42 patients) performed during the same period. Data were collected regarding demographics, cost (surgical time & implants) and 1 & 5-year follow-up of clinical outcome (OKS) and outpatients attended.

There was no statistically significant difference in cost of implants for revision UKR to TKR vs. primary TKR (p=0.08), however operative time was significantly higher in the revision group. One year mean OKS was significantly higher in the primary TKR group (mean 30 vs. 23 p=0.03), but 5-year follow up showed no significant difference (mean OKS 27 vs. 32 p=0.20). The revision group had statistically significantly greater number of follow-up appointments (mean 6 Vs. 2 p<0.0001).

Revision of UKR to TKR is not a universally straightforward procedure, carrying significant overall cost implications. Clinical outcomes, although significantly different at 1 year are almost the same at 5 years.

Computer assisted total knee arthroplasty has been demonstrated to provide reproducible limb mechanical alignment within three degrees from the neutral mechanical axis. However, restoring proper implant and extremity alignment remains a significant challenge with proximal tibial deficiencies. In this prospective study, we describe the use of computer navigation to quantify the amount of bone loss on the medial or lateral tibial plateau and the use of this data to assess the need for augmentation with metallic tibial wedges.

In this study, we demonstrate that CAS TKR in patients with significant tibial deformities can accurately measure severe tibial deformities, predict tibial augment thickness, and provide excellent mechanical alignment and restore the joint line without excessive bony resection, repeated osteotomies, and repeated augment trialing.

Introduction

Displaced distal radius fractures in children have been treated in above elbow plaster casts since the last century. Cast index has been calculated previously, which is a measure of the sagittal cast width divided by the coronal cast width measurement at the fracture site. This indicates how well the cast was moulded to the contours of the forearm. We retrospectively analysed the cast index in post manipulation radiographs to evaluate its relevance in redisplacement or reangulation of distal forearm fractures.