Limb deformity is usually assessed clinically assisted by long leg alignment radiographs and further imaging modalities (MRI and CT). Often decisions are made based on static imaging and simple gait interpretation in clinic. We have assessed the value of gait lab analysis in surgical decision making comparing surgical planning pre and post gait lab assessment. Patients were identified from the local limb reconstruction database. Patients were reviewed in the outpatient clinic and long leg alignment radiographs and a CT rotational limb profile were performed. A surgical plan was formulated and documented. All patients then underwent a formal gait lab analysis. The gait lab recommendations were then compared to the initial plan.Introduction
Materials & Methods
To compare the results of total knee replacement in a consecutive series of morbidly obese patients (body mass index (BMI) > 40 kg/m2) with a matched group of non-obese (BMI< 30 kg/m2) patients. 41 consecutive total knee replacements performed in morbidly obese patients were matched pre-operatively with 41 total knee replacements performed in non-obese patients for age, sex, diagnosis, type of prosthesis, laterality, knee score and function score components of the Knee Society Score (KSS). All patients were prospectively followed up and the post-operative KSS, radiographs, complications (superficial wound infection, deep joint infection, deep venous thrombosis, peri-operative mortality) and five-year survivorship compared for the two groups. No patients were lost to follow-up (mean follow-up in morbidly obese: 38.5 (range 6-66) months; non-obese: 44 (range 6-67) months).Aim
Methods
Pre-operative co-morbidities such as known coronary artery disease have commonly deemed a patient at ‘high risk’ for primary elective Total Hip Arthroplasty (THA). We prospectively collected data on 1744 patients who underwent primary elective THA between 1998 and 2004. 273 had a history of cardiac disease defined as a previous hospital admission with a diagnosis of angina pectoris or myocardial infarction. 594 patients had hypertension defined as that requiring treatment with antihypertensives. We also had data on pre-operative age, sex and body mass index (BMI). There was no statistically significant increase in early mortality at 3 months with a history of cardiac disease or hypertension and this remained so when adjusting for the other factors in a multivariate analysis. Sex or BMI also did not have a statistically significant effect on the risk of death within 3 months. Increasing age was the only significant risk factor for early mortality (P<0.001). Longer term mortality at 2 and 5 years in relation to these factors was also examined. Statistical analysis revealed that coronary history now showed a highly significant association (P<0.001) with long term mortality, in patients who survived more than 3 months. 95% confidence intervals for percentage mortality at 5 years were 9.7 - 21.7 with a cardiac history compared to 4.8 - 8.8 without a cardiac history. This remained significant (P=0.002) when adjusted for the other factors. Hypertension continued to have no effect, nor did BMI. Age remained a significant risk factor. Females had a slightly lower long term death rate than males, following THA. The overall long term mortality following THA was less than expected from the normal population, even in the subgroup with a coronary history. This study will assist clinicians when advising patients seeking primary elective THA, who have one of these common risk factors.
