Deep joint infection is one of the most dreaded complications of total joint arthroplasty, and urinary tract infections (UTI) are generally believed to be a source for haematogenous seeding of the prosthetic joint. Although patients are often screened for UTI there appears to be minimal evidence on the management of asymptomatic bacteriuria, or for those patients who perform intermittent self-catheterisation prior to joint arthroplasty. This study aims to address this.

We performed an online and postal survey of the British Association for the Surgery of the Knee membership to provide a consensus from a body of professionals. Of the respondents 75% performed 50 or more joint arthroplasty surgery over a 12 month period. For all surgeons, 71.4% provided antibiotic cover for the insertion and withdrawal of urinary catheters. However, only 19% were aware of National guidelines, compared to 76.2% for local guidelines which were more likely to be followed. Two thirds of surgeons would treat asymptomatic bacteriuria prior to surgery, yet 70% of these surgeons were unable to cite evidence for this decision. Similarly, the management of patients requiring intermittent self-catherisation produced a heterogenous response.

Our study suggests there is a lack of consensus and/or awareness amongst specialist knee surgeons for the management of asymptomatic urinary bacteriuria in patients prior to knee surgery. We believe a minimum standard of care be defined by the society to protect both patient and surgeon.

Aims: To determine the anthropometric measurements of bony landmarks in the knee using MR scans and so assist revision knee surgeons in prostheses placement.

Methods: We analysed 100 MR scans of patients aged 16–50 (50 male, 50 female) which were performed for meniscal pathology, patellar dislocation and ACL injury. Those over the age of 50 or with symptoms suggestive of general osteoarthritis, or where the epiphyses had not yet fused were excluded. All measurements recorded were to the level of joint line and are shown below.

Results: (Tables removed)

Conclusions: To ensure near normal knee mechanics are achieved during revision knee surgery the joint line should be within 5mm of the original. Our study provides mean values for the distance from various bony landmarks to the joint line in non-arthritic knees on MR scan. The use of the medial epicondyle value as a sole reference will place the joint line within 5mm in 88% of males and 96% of females. Use of multiple landmarks further increases accuracy. The final position of the joint will depend on trialling prostheses.

Introduction: With the introduction of out-patient waiting time targets, there has been increasing pressure on clinics to accommodate both new referrals and follow-up patients. Departments have found it increasingly difficult to continue long-term follow-up of patients post arthroplasty.

We have piloted a new system of purely therapist led clinics and assessed this with an anonymous patient survey.

Method: Since 2005 and following a training program for the therapists involved, 110 arthroplasty patients have passed through the new clinics. They are seen at 6 weeks, 6 and 12 months and then 3, 5 and 10 years. Their ROM, stability and XRAY findings are documented and each patient completes Oxford Knee, SF 12 and WOMAC scores. If there are problems at any stage they are seen in the surgeon led clinic.

Results: 69% of patients responded to the survey and in general they were very satisfied with the new system. 75% felt that been seen by the therapist alone still fully addressed their needs with 79% having an overall impression of either excellent or very good. The patients rated the therapists professionalism, assessment and information delivery as good to excellent in over 80%.

Conclusion: We feel that with the introduction of this new system, we will be able to continue long-term follow-up of all our patients post arthroplasty. With their regular assessments and scoring we will be able to monitor the success of their replacements and theoretically identify early any problems.

Aim: To review results and complications of revision knee replacements.

Materials and Methods: We retrospectively reviewed 41 cases of cemented revision knee arthroplasty in 39 patients (15 male, 24 female) performed between 1993 and 2003. Data regarding clinical and functional outcomes and complications was recorded.

Results: Mean age at index (revision) operation was 67.8 years (32 to 86) and mean follow-up was 6.8 years (1.5 to 12). Average time to revision was 80 months (9 months to 23 years).

The indication for revision was aseptic loosening in 16 cases, and deep sepsis in 13 cases, (12 were done in 2 stages). Others included polyethylene wear in 4 knees, instability in 2, and 1 each of peri-prosthetic fracture, implant breakage and pain of undetermined origin. 3 revisions were performed for failed Link Lubinus patello-femoral replacement. Mean interval between staged procedures for sepsis was 2 months.

Reconstruction was performed using the Kinemax Revision system with the use of augments and stems. The modular rotating hinge was used in 4 cases. Surgical exposure included additional lateral release in 7 cases, tibial tubercle osteotomy in 4 and quadriceps snip in one.

Complications: Included 1 post-operative death due to haematemesis and 2 non-fatal cardiac complications. 1 patient was re-revised for aseptic loosening at 3.5 years, 1 needed an above knee amputation for intractable sepsis after multiple failed reconstructions and 1 is awaiting patellar revision.

At latest review, 7 patients had died due to unrelated causes with a pain free functioning knee prosthesis. Of the remaining 31, 26 patients had none or minimal pain. 21 were independently mobile with a satisfactory range of motion.10 patients needed a walking stick.

Conclusion: Revision total knee replacement can give satisfactory results in the short to medium term, although the complication rate can be significant. The procedure should be performed in specialist units. Revision in 2 stages for sepsis resulted in satisfactory control of infection in our study.

Aims: Outside of specialist centres, follow up data on knee arthroplasties beyond 3 years is seldom available. We have devised a simple and cost effective tool to enable the average District general Orthopaedic department to assess their long-term outcomes following knee replacements. Methods: 130 patients underwent a total knee arthroplasty in 1997 at Bolton. A simple questionnaire (which could be completed in person or over the telephone) was dispatched to all of the 115 patients still alive. Questions referred to the patientñs satisfaction with their operation, their mobility, visual analogue score for their pain and any complications that had occurred. Results: Within two weeks there were 95(83%) meaningful returns and a further 8(7%) were completed over the telephone. 12(10%) were lost to follow up. Of the 103 questionnaires completed 80(78%) patients were completely satisþed with their joint. 23(22%) patients experienced problems Ð 13 had signiþcant pain (greater than 50% on VAS), 5 thromboembolisms, 4 infections (2 joint, 2 wound) and 1 complained of a shorter leg. Conclusions: With this questionnaire we have quickly and cheaply identiþed our 5-year status for knee arthroplasty. We thus propose it is a useful audit tool for a department such as ours. In addition it may have the potential to identify those patients who would beneþt from hospital review at þve years and thus could be recalled.