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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 71 - 71
1 Jul 2012
Beard D Holt M Mullins M Massa E Malek S Price A
Full Access

Purpose

Late stage medial unicompartmental osteoarthritic disease of the knee can be treated by either Total Knee Replacement (TKR) or Unicompartmental Replacement (UKR). As a precursor to the TOPKAT study this work tested the postulate that individual surgeons show high variation in the choice of treatment for individual patients.

Method

Four surgeons representing four different levels of expertise or familiarity with partial knee replacement (UKR design centre knee surgeon, specialist knee surgeon, arthroplasty surgeon and a year six trainee) made a forced choice decision of whether they would perform a TKR or UKR based on the same pre-operative radiographic and clinical data in 140 individual patients. Consistency of decision was also evaluated for each surgeon 3 months later and the effect of additional clinical data was also evaluated. The sample consisted of the 100 patients who had subsequently undergone UKR and 40 who had undergone TKR.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXV | Pages 148 - 148
1 Jun 2012
Mofidi A Badaja S Holt M Davies A
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The aim of this study was to assess the increase in the anterior diameter of the knee and the impact of this increase on the range of motion and function of the knee.

Twenty-eight patients (34 knees) who underwent Patello-femoral replacement with FPV (Wright Medical) prosthesis between 2005 and 2009 who were identified retrospectively and analyzed using chart and radiological review. Oxford and AKSS knee-scores were gathered prospectively pre-operative and at follow-up.

Trochlear height was measured using lateral radiograph. Trochlear height was compared pre and postoperatively. Patellar height was also measured in preoperative and postoperative skyline view and was compared. The range of movement at six weeks and the Oxford and American knee society knee scores at six months postoperatively were noted. Association between increased anterior height and improved range of motion was studied.

All but three-knees regained full knee extension. Postoperative mean range of flexion of the knee joint was 116 degrees. The mean Oxford knee and the mean American Knee Society Knee Scores significantly improved post-operatively

The trochlear height was increased by 4mms. Patellar height was also increased by 3 mms resulting in average total increase of 7 mms in the anterior-posterior diameter of the knee. We found no relationship between range of motion of the knee and the increase in the anterior-posterior diameter. We found a negative correlation between increase in the antero-posterior and preoperative trochlear and patellar height.

We conclude that FPV Patello-femoral replacement results in correct anatomical reconstruction of the trochlear height rather than ‘overstuffing’ of the patellofemoral joint which can lead to stiffness and failure of resolution of pain post-operatively. This should in turn result in durable improvements in pain and function.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 25 - 25
1 Mar 2008
Langston A James S Holt M
Full Access

The South Wales Air ambulance is a charity-funded helicopter service that started functioning on 1 April 2001. There are 10 staff involved in the running of the service, including pilot and paramedics. The territory covered is the South and Mid-Wales regions. The service costs on average £500 per flight and the net cost per year is approximately £750,000.

A retrospective study was performed to evaluate the extent and appropriateness of the air-ambulance call-outs over a 12-month period. The guidelines for call-out are based on medical and non-medical criteria. During this period the helicopter made 315 sorties. On 159 occasions the helicopter was stood down once airborne or following landing at the scene. £80,000 has been spent on non-patient -carrying call-outs. Of the 156 patient-carrying sorties 70% were transferred to Mor-riston Hospital, Swansea. 67% of these patients were categorised as trauma patients. Transfer distance averaged just 15 miles (range 2.6-41.2 miles). The majority of trauma cases were categorised as spinal soft tissue injuries or soft tissue injuries. 52% of patients were discharged by A& E staff without requiring orthopaedic assessment. 59% of trauma transfers were deemed to be inappropriate for helicopter transfer by the senior author.

Our study concludes that the air-ambulance is used inappropriately in at least 50% of the call-outs. The call-out criteria require amending and should place more emphasis on pick-up location rather than the nature of the casualty. It is not used cost effectively and is not always clinically effective.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_I | Pages 46 - 46
1 Mar 2005
Morgan D Evans A holt M
Full Access

Aims: Musculo-skeletal complaints comprise a significant proportion of General Practitioner workload. The aim of this study was to assess whether the training of GP’s is satisfactory given their exposure to orthopaedics and trauma in practice.

Methods: A postal questionnaire was sent to 200 local General Practitioners requesting information on their training in musculo-skeletal conditions.

Results: The response rate was 58%. The reported estimated proportion of musculo-skeletal problems varied between 10% and 60 %. Only 33% of General Practitioners had any formal post graduate training in trauma and orthopaedics. Experience in the related specialities of rheumatology was 12% and A+E 69%. 35% of responding General Practitioners reported a specialist interest in musculo-skeletal conditions although less than 2% have any postgraduate qualifications in this area.

Only 23% of GP’s thought that their training in orthopaedics and trauma was adequate .85% felt that they would benefit from further training. 80% of these felt that clinical teaching would be the best way to achieve this.

Conclusions: Musculo-skeletal problems comprise a significant proportion of General Practice workload. Despite this fact formal training in trauma and orthopaedics received by GP’s is minimal. 77% of GP’s feel that their training in the treatment of musculo-skeletal conditions is inadequate and 85% would like further training.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 176 - 176
1 Feb 2003
Servant C Bradbury N Holt M Cross M
Full Access

Arthrofibrosis following ACL reconstruction prevents the patient from regaining full knee movement postoperatively.

Our aim was to determine whether acute reconstruction (performed within 3 weeks of injury) is associated with an increased risk of arthrofibrosis compared with chronic reconstruction (performed more than 8 weeks after injury).

We performed a prospective study of 114 patients who underwent a patellar tendon ACL reconstruction: 62 patients underwent acute reconstruction and 52 patients underwent chronic reconstruction. All patients were operated on by a single surgeon using a standardised arthroscopic technique and accelerated rehabilitation programme. All patients were assessed independently by an experienced physiotherapist at an average of 7 months post-operatively. Range of motion, stability, muscle strength and functional scores were measured.

There was no significant difference in the incidence of arthrofibrosis between the acute and chronic groups. Flexion of less than 125° or a loss of extension of more than 10° occurred in 8 (12.9%) of the acute group and in 9 (17.3%) of the chronic group.

All knees were clinically stable, but the mean KT1000 difference was 1.21mm in the acute group and 1.89mm in the chronic group (p< 0.05). There were no significant differences in muscle strength or functional scores between the two groups.

There were significantly more meniscal injuries (65% versus 31%) and chondral lesions (31% versus 18%) in the chronic group.

Acute ACL reconstruction is not associated with an increased risk of arthrofibrosis. However, it is associated with increased stability and less meniscal and chondral pathology. This study suggests that the optimum time for ACL reconstruction is within the first 3 weeks after injury.