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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_11 | Pages 4 - 4
1 Jun 2016
O'Hare J Langton D Nargol A Joyce T Brewster N Cooke N Jafri A Lord J Duffy P Holland J
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Introduction

Historical studies have reported incidences of taper corrosion in retrieved MoP hips of 20–50%. These studies relied on visual assessments, rather than using modern analytical techniques.

Patients/Materials and Methods

The Northern Retrieval Registry was initiated to routinely analyse all retrieved hips. The volumetric wear rates of retrieved Exeter head tapers were measured using a coordinate measuring machine using validated methods and compared to the available results obtained from an ongoing study of failed MoM prostheses. Power analysis suggested that we would need at least fifty Exeter head tapers to provide significant results. Non-parametric tests were used to assess differences. We have previously identified head diameter/offset/taper angle and taper surface roughness as variables associated with taper wear. The effect of bearing material combination remains unquantified. These design variables were entered into a multiple regression model following log normalisation of taper wear.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 83 - 83
1 Sep 2012
Malviya A Brewster N Weir D Holland J Deehan D
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Purpose

Although classic teaching holds that the least amount of constraint should be implanted, there is very little in the literature to substantiate this. This study attempts to quantify the influence of constraint and various indications upon functional outcome following aseptic first time revision knee arthroplasty. The null hypothesis was that the level of constraint and indication for surgery would not influence the functional outcome following revision knee replacement.

Methods

A single centre prospective study was performed to examine the outcome for 175 consecutive total revision knee replacements performed between 2003 and 2008 with a minimum follow-up of two years. Patient reported outcome data was used to determine the influence of final level of component constraint and its relationship with primary indication for surgery.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 57 - 57
1 Jul 2012
Malviya A Brewster N Weir D Holland J Deehan D
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Introduction

We wished to quantify the influence of constraint and various principal indications upon functional outcome following aseptic first time revision knee arthroplasty.

Methods

In this single centre, prospective study we have looked into the outcome of 175 total revision knee replacement performed between 2003 and 2008 at a minimum follow-up of 1 year. Data was refined to allow for examination exclusively of those cases where the level of constraint was increased from cruciate retaining or cruciate sacrificing knee replacement to either non linked constrained implant (condylar constrained) or linked constrained (rotating hinge) prosthesis.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 286 - 286
1 Jul 2011
Inman D Lingard E Brewster N Deehan D Holland J Mccaskie A Siddique M Gerrand C
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Introduction and Aims: Morbid obesity (BMI> 40) has been shown to cause increased perioperative morbidity and poorer long-term implant survivorship following total knee arthroplasty (TKA). The aim of this study was to determine the impact of morbid obesity on patient-reported outcomes following TKA.

Methods: Patients undergoing primary TKA were invited to complete questionnaires preoperatively and one year after surgery. Questionnaires include the WOMAC and SF-36 health status measures, demographics, self-reported comorbid medical conditions, height and weight. At follow-up, satisfaction with results of TKA is included. Patients were categorised by their preoperative BMI categories as ideal weight (20–25), overweight (> 25–30), obese (> 30–40) or morbidly obese (> 40). We used multivariate analysis to adjust for known significant correlates of WOMAC and SF-36, namely age, gender and comorbid medical conditions. Adjusted mean scores for each assessment were compared by BMI category.

Results: A total of 769 patients were included in the study which included 27 morbidly obese, 280 obese, 314 overweight and 148 ideal weight patients. Morbidly obese patients when compared with non-obese patients had significantly worse preoperative WOMAC pain and function and a trend for worse SF36 scores (Vitality significantly worse, p=0.04). There was no significant difference between the BMI categories at one year for WOMAC or SF-36 scores (trend for the Physical Functioning score to be lower, p=0.052). Morbidly obese patients were all satisfied with pain relief after surgery but were less satisfied with functional results when compared to the non-obese groups.

Discussion: This study shows that morbidly obese patients report significantly worse health status prior to TKA but their post-operative improvement is greater than the non-obese population. Although morbid obesity should not be an absolute contraindication to TKA, patients should be carefully selected balancing the risk of perioperative complications and earlier failure against the demonstrated marked improvement in quality of life.