The aims of this study were to assess mapping models to predict the three-level version of EuroQoL five-dimension utility index (EQ-5D-3L) from the Oxford Knee Score (OKS) and validate these before and after total knee arthroplasty (TKA). A retrospective cohort of 5,857 patients was used to create the prediction models, and a second cohort of 721 patients from a different centre was used to validate the models, all of whom underwent TKA. Patient characteristics, BMI, OKS, and EQ-5D-3L were collected preoperatively and one year postoperatively. Generalized linear regression was used to formulate the prediction models.Aims
Methods
In the late 1980's Michael Freeman conceived the idea that knee replacement would most closely replicate the natural knee joint, if the medial Tibio-Femoral articulation was configured as a “ball-in-socket”. Over the last three decades, medial rotation and medial pivot designs have proved successful in clinical use. Freeman's final iteration of the medial ball-in-socket concept was the Medial Sphere knee. We report the three-year survivorship, clinical outcomes, patient reported outcome measures (PROMs) and radiographic analysis of this implant in a multi-centre, multi-surgeon, prospective observational study. Patients awaiting total knee replacement were recruited by four centres. They had no medical contraindication to surgery, were able to provide informed consent and were available for follow-up. Primary outcome was implant survival at six months, one, two, three and five years. Secondary outcomes were patient reported outcome measures: Oxford Knee Score (OKS), Euroqol (EQ-5D), International Knee Society Score (IKSS), IKSS Functional score and Health State score, complications and radiographic outcomes. Radiographic analysis was undertaken using the TraumaCad software and data analysis was undertaken using SPSS.Background
Methods
Lumbar paraspinal muscle dysfunction and low back pain are strongly correlated. Muscle atrophy is common in LBP and is recognised by MRI scan. Corticosteroid injections and physical rehabilitation programs are advocated for treatment of LBP. The purpose is to evaluate efficacy of specific lumbar multifidus muscle retraining exercises and perifacet multifidus injections in treatment of Low Back Pain (LBP) and referred leg pain. 63 patients with non-specific LBP, with or without leg pain, were randomised to three treatment groups. MR images of paraspinal muscle and the atrophy classified. A-Control group, standard physiotherapy for 10 weeks. B-Multifidus rehabilitation program for 10 weeks. C-Perifacet injection (multifidus injection) with methylprednisolone. ODI was primary outcome measure and the SF-36, modified Zung Depression Index and others were secondary outcome measures.Purpose
Method
There are about 63,000 primary total knee replacements done annually in England and Wales. One of the biggest challenges of modern NHS is to ensure high quality care for the patients. A reduced length of stay in the hospital following primary total knee replacements could be the key factor in significant cost reduction. The aim of the study was to assess the efficacy of our rapid recovery programme following total knee replacements in terms of reducing length of stay, morbidity, complications, and readmissions rates. A prospective study of 252 patients who underwent primary total knee replacement for a period of one year between October 2006 to 2007 were included in the programme. There were 123 (49%) males and 129 (51%)females. The average age was 71 (range-53 to 86). The average BMI was 30 (range-22 to 46). The median ASA grade was 2 (range-1 to 4). There were no exclusion criteria. The programme included pre-operative education of patient and relatives, standardised operation protocols, infection control, pain management, continuous motivation by nursing staff and physiotherapists in the ward as well as intensive rehabilitation by a community based physiotherapy team in patient’s own environment. The patients were discharged when they had achieved the ward physiotherapy requirements. The average length of stay was 5.2 days. The complications encountered during inpatient stay was wound discharge(43), surgical site infection(1), DVT (1), pneumonia(1).12 patients needed post operative blood transfusion. The readmissions rate was 4%. Deep infection was noted in 4 patients, DVT(1), pulmonary embolism(1)and 3 patients had medical complications. In conclusion the rapid recovery programme following total knee replacement is an efficient method of speeding the recovery and reducing the length of hospital stay after primary knee replacements. It is useful for the modern NHS to achieve a balance between financial savings and a consistent, responsive and high-quality care for patients.
