This study reports on the first 150 consecutive
Oxford cementless unicompartmental knee arthroplasties (UKA) performed
in an independent centre (126 patients). All eligible patients had
functional scores (Oxford knee score and high activity arthroplasty
score) recorded pre-operatively and at two- and five-years of follow-up. Fluoroscopically
aligned radiographs were taken at five years and analysed for any
evidence of radiolucent lines (RLLs), subsidence or loosening. The
mean age of the cohort was 63.6 years (39 to 86) with 81 (53.1%)
males. Excellent functional scores were maintained at five years
and there were no progressive RLLs demonstrated on radiographs.
Two patients underwent revision to a total knee arthroplasty giving
a revision rate of 0.23/100 (95% confidence interval 0.03 to 0.84)
component years with overall component survivorship of 98.7% at
five years. There were a further four patients who underwent further
surgery on the same knee, two underwent bearing exchanges for dislocation
and two underwent lateral UKAs for disease progression. This was
a marked improvement from other UKAs reported in New Zealand Joint
Registry data and supports the designing centre’s early results. Cite this article:
We explored the trends over time and the geographical
variation in the use of subacromial decompression and rotator cuff
repair in 152 local health areas (Primary Care Trusts) across England.
The diagnostic and procedure codes of patients undergoing certain
elective shoulder operations between 2000/2001 and 2009/2010 were extracted
from the Hospital Episode Statistics database. They were grouped
as 1) subacromial decompression only, 2) subacromial decompression
with rotator cuff repair, and 3) rotator cuff repair only. The number of patients undergoing subacromial decompression alone
rose by 746.4% from 2523 in 2000/2001 (5.2/100 000 (95% confidence
interval (CI) 5.0 to 5.4) to 21 355 in 2009/2010 (40.2/100 000 (95%
CI 39.7 to 40.8)). Operations for rotator cuff repair alone peaked
in 2008/2009 (4.7/100 000 (95% CI 4.5 to 4.8)) and declined considerably
in 2009/2010 (2.6/100 000 (95% CI 2.5 to 2.7)). Given the lack of evidence for the effectiveness of these operations
and the significant increase in the number of procedures being performed
in England and elsewhere, there is an urgent need for well-designed
clinical trials to determine evidence of clinical effectiveness. Cite this article: Bone Joint J 2014;96-B:70–4.
We studied the bone mineral density (BMD) and
the bone mineral content (BMC) of the proximal tibia in patients with
a well-functioning uncemented Oxford medial compartment arthroplasty
using the Lunar iDXA bone densitometer. Our hypothesis was that
there would be decreased BMD and BMC adjacent to the tibial base
plate and increased BMD and BMC at the tip of the keel. There were 79 consecutive patients (33 men, 46 women) with a
mean age of 65 years (44 to 84) with a minimum two-year follow-up
(mean 2.6 years (2.0 to 5.0)) after unilateral arthroplasty, who
were scanned using a validated standard protocol where seven regions
of interest (ROI) were examined and compared with the contralateral
normal knee. All had well-functioning knees with a mean Oxford knee
score of 43 (14 to 48) and mean Knee Society function score of 90
(20 to 100), showing a correlation with the increasing scores and
higher BMC and BMD values in ROI 2 in the non-implanted knee relative
to the implanted knee (p = 0.013 and p = 0.015, respectively). The absolute and percentage changes in BMD and BMC were decreased
in all ROIs in the implanted knee compared with the non-implanted
knee, but this did not reach statistical significance. Bone loss
was markedly less than reported losses with total knee replacement. There was no significant association with side, although there
was a tendency for the BMC to decrease with age in men. The BMC
was less in the implanted side relative to the non-implanted side
in men compared with women in ROI 2 (p = 0.027), ROI 3 (p = 0.049)
and ROI 4 (p = 0.029). The uncemented Oxford medial compartment arthroplasty appears
to allow relative preservation of the BMC and BMD of the proximal
tibia, suggesting that the implant acts more physiologically than
total knee replacement. Peri-prosthetic bone loss is an important
factor in assessing long-term implant stability and survival, and
the results of this study are encouraging for the long-term outcome
of this arthroplasty. Cite this article:
