Cryocompression therapy is a non-invasive and non-pharmacological modality used in managing acute post-operative inflammation and pain. A prospective, randomised controlled trial (RCT) was undertaken to evaluate the effectiveness of a post-operative cryocompression protocol using the Game Ready™ (GR) device versus usual care on recovery following total knee arthroplasty (TKA). A single centre RCT was conducted with 70 TKAs (68 patients) randomised to a 2-week intervention period consisting of treatment with GR cryocompression (n=33, 33.3% males) or a usual care protocol of ice with static compression using tubigrip (n=35, 54.3% males).
Aims. There are comparatively few randomized studies evaluating knee arthroplasty prostheses, and fewer still that report longer-term functional outcomes. The aim of this study was to evaluate mid-term outcomes of an existing implant trial cohort to document changing patient function over time following total knee arthroplasty using longitudinal analytical techniques and to determine whether implant design chosen at time of surgery influenced these outcomes. Methods. A mid-term follow-up of the remaining 125 patients from a randomized cohort of total knee arthroplasty patients (initially comprising 212 recruited patients), comparing modern (Triathlon) and traditional (Kinemax) prostheses was undertaken. Functional outcomes were assessed with the Oxford Knee Score (OKS),
Computer navigation systems enable precise measurement and intra- operative
Objective. To determine differences in fracture stability and functional outcome between synthetic bone graft and allograft/autograft with internal fixation of tibia plateau metaphyseal defects. Patient & Methods. Between 2007- 2008, 84 consecutive cases of internal fixation of tibia plateaux were identified from our theater logbook. 29 patients required additional autologous, allogenic bone graft, or synthetic bone graft substitute to ensure fracture stability. 5 patients were excluded due to lost to follow up leaving a cohort of 24 patients. Hydroxyapatite calcium carbonate synthetic bone graft was utilised in 14 patients (6 male and 8 female). Allograft/autograft were utilised in the remaining 10 patients (6 male and 4 female). All 24 patients had closed fractures, classified using the AO and Schatzker classification. Roentograms at presentation, post-operatively and regular follow-up till 12 months were analysed for maintenance of reduction, early and late subsidence of the articular surface. Functional outcomes such as
Methods and materials: Between August 2000 and August 2002, 28 patients, average age of 78 years (range 62 to 94 years), with distal femoral fractures (33A1 – 17, 33A2 – 1, 33C1 – 6, 33C2 – 4) were treated with DFN. All the patients had sustained the injury following a simple fall. Periprosthetic fractures were excluded from this study. Two fractures required additional procedures in the form of circleage wires. Nailing was performed through a midline mini arthrotomy. Post operative protocol was to mobilise the patient weight bearing as tolerated. Results: All fractures healed without the need for secondary procedures. Average period of follow up was 8.5 months. Average hospital stay was 18 days (range 10 to 34). Post operative mobility returned to pre operative state in 15 patients. Three patients died within 3 months due to unrelated medical causes. There was no incidence of extension lag or malunion.
When managing malignant bone tumours in the distal femur with limb salvage, resection and reconstruction with a distal femoral replacement (DFR) conventionally entails prosthetic replacement of the knee joint. In younger patients it is desirable to try to preserve the knee joint. We now use a new Joint-Sparing distal femoral prosthesis in those cases where it is possible to resect the tumour and preserve the femoral condyles. Purpose of study: To look at our early results with knee joint preserving DFR’s. Methods: Between June 2001 and March 2004 the prosthesis was implanted in 8 patients (5 males and 3 females) aged between 8 and 24 years at the time of surgery. The diagnosis was osteosarcoma in 6 cases and chondrosarcoma in 2 cases. All patients were followed regularly and
Unicompartmental knee replacement (UKR) is technically challenging, but has the advantage over total knee replacement (TKR) of conserving bone and ligaments, preserving
Introduction: The emergence of Independent Sector Treatment Centres (ISTCs) in the UK for the provision of elective orthopaedic services began in 2002–3. Within our trust the bulk of elective orthopaedic surgery is performed in an ISTC however there is a small but significant cohort of patients who are deemed not suitable for treatment at the ISTC. Patients with a BMI (body mass index) ≥40 or an ASA (American society of anaesthesiologists) grade of 3 or more are automatically rejected. With increasing levels of obesity and an aging population the size of the reject cohort is going to rise. These patients are then returned to the NHS to be placed on a new (complex elective) waiting list for their surgery. The aim of this study was to assess the early outcomes and complications following primary knee arthroplasty on our high risk patients. Methods: A retrospective review of a consecutive series of 214 primary knee arthroplasties in patients rejected from the ISTC was performed. Data (demographics, ASA grade, BMI, length of stay, complications,
Introduction To assess five-year survivorship and clinical outcome following unicompartmental knee replacement (UKR) and total knee replacement (TKR) in pre-operatively matched patient groups. Methods From a prospective database of over 600 patients undergoing knee replacement for osteoarthritis, 70 primary Oxford UKRs (62 patients) were matched pre-operatively with 70 primary PFC TKRs (68 patients) for age, sex, body mass index,
Total knee arthroplasty (TKA) is an established
and successful procedure. However, the design of prostheses continues
to be modified in an attempt to optimise the functional outcome
of the patient. . The aim of this study was to determine if patient outcome after
TKA was influenced by the design of the prosthesis used. A total of 212 patients (mean age 69; 43 to 92; 131 female (62%),
81 male (32%)) were enrolled in a single centre double-blind trial
and randomised to receive either a Kinemax (group 1) or a Triathlon
(group 2) TKA. . Patients were assessed pre-operatively, at six weeks, six months,
one year and three years after surgery. The outcome assessments
used were the Oxford
Viscosupplementation with hyaluronic acid (HA) is an established intervention for pain control in patients with mild to moderate osteoarthritis (OA) of the hip and knee. It is highly concentrated at the surface of the articular cartilage and the superficial layers of the synovial membrane. In the synovial fluid, HA acts as both a lubricant and a shock absorber. Due to the meshwork it forms with aqueous solutions, it acts as a semi-permeable barrier regulating metabolic exchanges between cartilage and the synovial fluid, and a viscoelastic shield around synoviocytes and adjacent nerve endings. Through its molecular size HA hinders the free movement of lytic enzymes and inflammatory mediators, and enhances chondrocyte metabolism. Osteoarthritis is associated with a decrease in concentration and average molecular weight of native HA in synovial fluid. The mechanism of action of administered intra-articular HA is not completely understood, but as its clinical benefit exceeds its intra-articular presence, it is thought to perhaps induce native biosynthesis of HA and other extracellular matrix components and in particular suppress the inflammatory response and inhibit substance P, in addition to contributing to shock absorption by means of its viscoelastic properties. Problems include inconvenience, expense and the logistical problems associated with multiple injections, injection technique and level of skill required by the administering physician, variable clinical response and adverse reactions. In this independent, prospective, randomized trial, we compare efficacy and complications associated with treatment 100 athletes (112 knees) using durolaneTM and synvisc oneTM using the Visual Analogue Score, SF-36 V2 questionaire, and Oxford
Aims: To assess the results of Anterior Cruciate Ligament (ACL) reconstruction at a minimum of two years follow-up, using the Rolimeter [AIRCAST, Europe] as an adjunct to routine knee examination and subjective scoring systems. Methods: The Warrington Knee Injury database was initiated in June 2001 and data from all knee ligament injuries has been collected prospectively, from preoperative status through to all follow up assessments. Inclusion criteria for our study were, all ACL reconstructions performed by the senior author with minimum 24 months follow up; other ligaments being intact and presence of a normal contralateral knee. 50 patients satisfied the inclusion criteria. There were 41 males and 9 females in ages ranging from 17 to 51 (mean 30.6 years), with no significant difference in age between sexes. Hamstring grafts were used in 29 knees and Bone-Patellar tendon – Bone (BPTB) grafts in 21. Knee laxity was measured using the Rolimeter with IKDC knee examination and functional assessments using the Lysholm, IKDC and KOOS scoring systems. Results: 20/21 of patients with BPTB grafts (95.2%) and 26/29 of patients with Hamstring grafts (89.7%) achieved normal or near normal knee laxity compared to their opposite
The interest in unicompartmental knee arthroplasty (UKA) for
medial osteoarthritis has increased rapidly but the long-term follow-up
of the Oxford UKAs has yet to be analysed in non-designer centres.
We have examined our ten- to 15-year clinical and radiological follow-up
data for the Oxford Phase III UKAs. Between January 1999 and January 2005 a total of 138 consecutive
Oxford Phase III arthroplasties were performed by a single surgeon
in 129 patients for medial compartment osteoarthritis (71 right
and 67 left knees, mean age 72.0 years (47 to 91), mean body mass
index 28.2 (20.7 to 52.2)). Both clinical data and radiographs were
prospectively recorded and obtained at intervals. Of the 129 patients,
32 patients (32 knees) died, ten patients (12 knees) were not able
to take part in the final clinical and radiological assessment due
to physical and mental conditions, but via telephone interview it
was confirmed that none of these ten patients (12 knees) had a revision
of the knee arthroplasty. One patient (two knees) was lost to follow-up.Aims
Patients and Methods
The June 2015 Knee Roundup360 looks at: Cruciate substituting
Effective analgesia after total knee arthroplasty (TKA) improves
patient satisfaction, mobility and expedites discharge. This study
assessed whether continuous femoral nerve infusion (CFNI) was superior
to a single-shot femoral nerve block in primary TKA surgery completed
under subarachnoid blockade including morphine. We performed an adequately powered, prospective, randomised,
placebo-controlled trial comparing CFNI of 0.125% bupivacaine Objectives
Methods
The October 2014 Research Roundup360 looks at: unpicking syndesmotic injuries: CT scans evaluated; surgical scrub suits and sterility in theatre; continuous passive motion and knee injuries; whether pain at night is melatonin related;