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. 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).OBJECTIVE
METHODS
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.
