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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 36 - 36
1 Jul 2012
Price M Tilley S Pearce A Pandit H Thomas NP
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OBJECTIVE

To examine the short term patient assessed functional results of the Journey BCS ¯(Smith & Nephew) and Triathlon ¯(Stryker Orthopaedics, Mahwah, NJ) total knee replacements when compared to the Scorpio ¯(Stryker) total knee replacement using a multi-surgeon case control design in a single centre.

METHODS

From September 2006 to August 2008 a total of 135 Journey and 97 Triathlon total knee replacements (TKR) were performed. 105 patients with Journey and 90 patients with Triathlon implants were available for follow-up at a minimum of 1 year, with an average of 2 years. Age and sex matched controls were obtained from our pool of patients who had had Scorpio TKR's. The same surgeons using the same approach operated on patients in both groups. All implants were posterior stabilised and all underwent patella resurfacing. All patients were seen pre-operatively and followed up post operatively in a physiotherapist led joint review clinic to assess range of motion (ROM) as well as function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS) and the High Activity Arthroplasty Score (HAAS - used post operatively only).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 53 - 53
1 Mar 2012
Hook S Melton J Wilson AJ Wandless F Thomas NP
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Improved surgical techniques and new fixation methods have revived interest in high tibial osteotomy surgery in recent years. Our aim was to review our first 59 cases. All patients underwent radiological and clinical review including pre and post operative scores.

Mean age at surgery was 43 (22-59) and mean follow up is 22 months.

The mean pre-operative limb alignment was 5.4° varus (range 1°-16°) with correction to 2° valgus (range -1° - 7°).

HTO is known to increase tibial slope and in this series the change in tibial slope from -5.2° (95%CI: -6.36 to -4.07)) to -7.8° (-8.83 to –6.89) was statistically significant. p= 0.0014 (Mann Whitney).

Patellar height is often reduced following opening wedge HTO and this is confirmed in our series. The Blackburne-Peel ratio changed from 0.74 to 0.58 and the Caton-Descamps from 0.83 to 0.7. Both were statistically significant at p<0.0001 and p=0.0001 respectively.

All scores improved post operatively, the knee injury and osteoarthritis outcome (KOOS) from 48 (8-91) to 73 (27-96), the Oxford knee score (OKS) from 25 (3-47) to 37 (9-48), and the EQ5D from 189809 (11221-32333) to 14138 (11111-22233) with the EQ5D VAS improving from 58 to 75. There was no correlation between change in limb alignment, tibial slope or patellar height and any of the scores used.

There were three superficial wound infections, and one non union which was treated with grafting and re fixation. Six patients have had their plate removed.

Improvement in clinical scores in these patients confirms that medial opening wedge HTO is a reliable joint preserving procedure in the short term and our surgical technique is reproducible and consistent with other published series.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 417 - 417
1 Sep 2009
Millington J Pickard R Conn KS Rossiter ND Stranks GJ Britton JM Thomas NP
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It is established good practice that joint replacements should have regular follow-up and for the past seven years at the North Hampshire Hospital a local joint register has been used for this purpose and we compare this with results of the Swedish and UK national registries.

Since March 1999, all primary and revision knee arthroplasties performed at North Hampshire Hospital, Basingstoke have been prospectively recorded onto a database set up by one of the senior authors (JMB). Data from patients entered in the first six years of the register were analysed. All patients have at least one year clinical and radiological review then a minimum of yearly postal follow-up.

As of 31/12/2006, 2854 knee replacement procedures had been performed under the care of 13 consultants. OA was the most common diagnosis in over 75% of knees. 5.2% of patients had died and 4.6% were lost to follow-up. Our revision burden was 3.5% and we had a revision rate of 1.4% for primary total knee replacements. Audit of data for revisions and patello-femoral replacements has enabled us to change our practices. Mean length of stay was 7.2 days for primary total knee arthroplasty versus 4.0 days for unicompartmental knee arthroplasty and 5.4 days for patellofemoral replacement and mean flexion at discharge was 88.4, 93.7 and 88.7 degrees respectively. WOMAC and Oxford scores at 2 years had improved from a mean of 52 and 21 pre-operatively to 74 and 39 respectively for primary total knee arthroplasty. Our costs are estimated at approximately £35 per patient for their lifetime on the register.

Compared to other registries:

Our dataset is more complete and comprehensive

Our costs are less

All patients have a unique identifier (at least 19% of UKNJR data is anonymous)

Our audit loops have been closed


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 410 - 410
1 Sep 2009
Risebury MJ Price M Thomas NP
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To establish the efficacy of a new arthroscopic technique, for the treatment of stiffness after TKR.

Introduction: The usual surgical procedure for stiffness after a total knee replacement is an open arthrolysis, though an arthroscopic procedure can be considered within six months of the index surgery. We have evolved a new procedure of capsulectomy and anterior release which can be used at any time after TKR in patients with a reduced range of movement (ROM).

Methods: 22 patients (10 women and 12 men) underwent arthroscopic capsulectomy and anterior release for the treatment of loss of movement after TKR. The mean age was 62 (range 47–71 yrs). Mean time between TKR and arthrolysis was 27 months (range 3–54). Indication for the arthroscopic procedure was decreased ROM following TKR. Arthroscopy was performed using anteromedial and anterolateral portals. The dense scar tissue was divided and completely excised arthroscopically. ROM was assessed pre-operatively, immediately post-operatively and at 2, 6, 12 weeks, 6 months and 1 year. The Oxford Knee Score (OKS) and American Knee Society Score (AKSS) were used pre-operatively and at 6 months and 1 year post-operatively.

Results: Pre-operatively mean flexion was 50 degrees (Range 20–90°). Post-operatively it was 94.5° (Range 55–125°). At 1 year this was maintained. The mean OKS pre-operatively was 18.4 (range 8–39). At 1 year it was 29.8 (range 9–39). The AKSS (knee and functional components) showed a similar improvement. The mean knee score increased from 47.3 pre-operatively to 71.6 at 1 year. The functional score rose from a mean of 51.3 pre-operatively to 76.9 at 1 year.

Conclusions: Our technique of arthroscopic capsulectomy and anterior release for the treatment of stiffness following TKR is both successful and safe. At 1 year post-operatively the patients have maintained an increased ROM and significantly improved Oxford and American Knee Society Scores.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_III | Pages 321 - 321
1 Nov 2002
Thomas NP Kankate RK
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Chronic medial collateral ligament (MCL) instability is an unusual clinical problem. Due to the unsatisfactory results of advancement procedures or reconstruction using autologous techniques we have devised a new technique using a non-irradiated tendo achilles allograft construct.

Three patients are presented who had symptomatic MCL insufficiency. The laxity was demonstrated clinically (all grade 3) and radiologically using valgus stress views.

The tendo achilles was fashioned into a triangular composite graft consisting of a bone plug (30 x 10 mm) and the tendon. The bone plug was attached to the femur at the anatomical insertion of the MCL using an interference screw and the tendon on the tibia using a multiple suture anchor technique.

The rehabilitation programme consisted of immediate mobilisation and the use of a brace for twelve weeks.

At follow-up (average 12 months) all patients were asymptomatic, had a full range of movements, no increased clinical laxity and no increased radiological laxity to a valgus force at 25 degrees of flexion when compared to the other side.

We conclude that this is an effective technique in the treatment of chronic symptomatic MCL laxity.