Osteotomy is recognised treatment for osteoarthritis of the knee. Evidence suggests favourable outcomes when compared to arthroplasty, for younger and more active individuals[1]. Double level osteotomy (DLO) is considered when a single level is insufficient to restore both joint line obliquity and adequate realignment[2]. This paper aims to establish the functional outcomes up to two years post operatively for patients undergoing DLO, using patient reported outcome measures (PROMs). All patients who underwent a DLO at either Lister Hospital, Stevenage, or One Hatfield Hospital, Hertfordshire, between 1st January 2018 and 1st October 2020 were identified. DLO were performed by two specialist consultants, independently or in combination. PROMs including pain scores, health score, Oxford knee score (OKS) and knee injury and osteoarthritis outcome score (KOOS) were recorded pre-operatively and at six month, one and two year post operative intervals.Abstract
Introduction
Methodology
Osteotomy is a recognised surgical option for the management of unicompartmental knee osteoarthritis. The effectiveness of the surgery is correlated with the accuracy of correction obtained. Overcorrection can potentially lead to excess load through the healthy cartilage resulting in accelerated wear and early failure of surgery. Despite this past studies report this accuracy to be as low as 20% in achieving planned corrections. Assess the effectiveness of adopting modern osteotomy techniques in improving surgical accuracy.Abstract
Introduction
Aim
The approach to Intramedullary (IM) fixation of long bone fractures remains a controversial issue. Early reports demonstrated less favourable results of retrograde nailing as compared with antegrade options due to higher non-union rates. The aim of this audit was to evaluate the outcomes of practice within the Trauma and Orthopaedic department with relation to IM nail fixation of diaphyseal femur fractures. The Trauma database between February 2010 and September 2013 was used to identify all femur IM nailing procedures. Picture Archiving and Communication System (PACS) software was used to classify the fractures according to the Muller AO classification. All 3–2 (Diaphyseal femur fractures) were included in the audit. PACS imaging together with outpatient documentation was evaluated for radiological and clinical outcome.Background
Methodology
Patellofemoral pain and instability can be quantified by using the tibial tuberosity to trochlea groove (TT-TG) distance with more than or equal to 20mm considered pathological requiring surgical correction. Aim of this study is to determine if knee joint rotation angle is predictive of a pathological TT-TG. One hundred limbs were imaged from the pelvis to the foot using Computer Tomography (CT) scans in 50 patients with patellofemoral pain and instability. The TT-TG distance, femoral version, tibial torsion and knee joint rotation angle ((KJRA) were measured. Limbs were separated into pathological and non-pathological TT-TG. Significant differences in the measured angles between the pathological and non-pathological groups were estimated using the t test. The inter- and intraobserver variability of the measurement was performed. Logistic regression analysis was used to find the best combination of rotational angle predictors for a pathological TT-TG.Introduction
Methods
A significant number of patients are affected by localised articular damage that is neither appropriate for traditional arthroplasty, nor for biological repair. A focal resurfacing system utilizing a matched contoured articular prosthetic (HemiCAP®) has been introduced for the treatment of such cases. Independent results on these implants are limited. We retrospectively evaluated the use of this resurfacing system in 14 patients (13 male, one female), mean age 40.3 years (range 28–49) with focal femoral condyle defects. All procedures were performed by the same consultant orthopaedic surgeon. Clinical evaluation consisted of the Knee injury and Osteoarthritis Outcome Score (KOOS) assessment. Radiographic evaluation was conducted independently to look for signs of any migration of the prosthesis or any radiolucency around it. 10 patients were treated on the medial femoral condyle, two on the lateral, and two received bicondylar implants. Average follow-up was 20 months (range 6–42). All but two patients (no improvement) described a good to excellent response of their symptoms. The KOOS score at follow-up was 79.6, compared to 61.2 prior to treatment (p=0.03). No signs of device migration or radiolucency around the device were observed. None of the patients required re-operation, and there were no cases of superficial/deep infection, thromboembolic events or other significant complication. Our short-term results demonstrate that the use of the joint preserving HemiCAP® system provides good pain relief and functional improvement in such patients.
