The purpose of this study was to compare the outcomes of arthroscopic unilateral surgery and simultaneous bilateral surgery for posterior ankle impingement syndrome (PAIS) in athletes and to evaluate the usefulness of simultaneous bilateral surgery. A total 48 hindfeet of 41 athletes (14 hindfeet of 14 males, 34 hindfeet of 27 females) who underwent arthroscopic surgery for PAIS were studied. Japanese society for surgery of the foot (JSSF) score and visual analogue scale (VAS) were compared before and after surgery, using Wilcoxon signed-rank test. The operation time and the time to return to sports activity were compared in 10 hindfeet of 5 patients who underwent simultaneous bilateral surgery and 38 hindfeet of 36 patients who underwent unilateral surgery, using Wilcoxon rank sum test. Classic ballet was the most common type of sport that caused PAIS (59%, 24/41 athletes). Soccer (10%, 4/41 athletes), baseball (10%, 4/41 athletes), badminton (5%, 2/41 athletes), volleyball (5%, 2/41 athletes), and athletics (5%, 2/41 athletes) followed. The JSSF score improved significantly from 72.7 preoperatively to 98.9 postoperatively in unilateral surgery, and significantly improved from 75.2 preoperatively to 99.0 postoperatively in simultaneous bilateral surgery. VAS significantly decreased from 64.7 preoperatively to 4.8 postoperatively in unilateral surgery, and significantly decreased from 72.7 preoperatively to 1.0 postoperatively in simultaneous bilateral surgery. The operating time was 53.7 minutes on average for unilateral surgery and 101.0 minutes for simultaneous bilateral surgery, significantly longer in bilateral simultaneous surgery. The mean time to return to sports activity was 4.8 weeks for unilateral surgery and 9.6 weeks for simultaneous bilateral surgery, significantly longer in simultaneous bilateral surgery. Both unilateral and simultaneous bilateral surgeries for PAIS in athletes were useful. It should be noted that the operating time and the time to return to sports will be longer. However, considering the 2 times hospitalizations and 2 times surgeries, simultaneous bilateral surgery is one of the treatment options for PAIS

Abstract. Introduction. In patients with bilateral unicompartmental knee osteoarthritis, simultaneous bilateral surgery is cost effective, with both patient-specific and wider socioeconomic benefits. There are concerns however regarding higher complication rates with bilateral knee surgery. This study compares simultaneous bilateral unicompartmental knee arthroplasty (UKA), to single side UKA in terms of complications and outcomes. Methodology. This is a retrospective case-control study of single side medial UKA patients (controls) and simultaneous bilateral medial UKA patients (cases). All patients underwent surgery between 2018 and 2022 by a single surgeon. The two cohorts were compared for perioperative blood loss (PBL), length of stay (LOS), complications (infections, blood clots, wound problems), Oxford Knee Score improvement (OKS) and revision surgery, with a follow-up period of up to 5 years. Results. 64 patients were followed up comprising 55 controls and 9 cases. Average length of stay for controls was 1.55 days and 2.22 days for cases (p=0.03). Average haemoglobin drop was 7.5g/l in controls and 12.8g/l in cases (p=0.04). The OKS improvement was comparable in both groups (p=0.95) with no complications and no revision surgery in either group. Conclusion. The statistically significant differences in PBL and LOS were not clinically relevant. There were no blood transfusions and postoperative haemoglobin was within normal range in more than 60% of cases. Simultaneous bilateral unicompartmental knee arthroplasty is a financially favourable and safe option for patients with bilateral knee medial unicompartmental osteoarthritis

Introduction. A large proportion of patients undergoing total knee arthroplasty (TKA) have severe osteoarthritis in both knees and may consider either simultaneous or staged bilateral TKA. The implications of staged versus simultaneously bilateral TKA for return to work are not well understood. We hypothesized that employed patients who underwent simultaneous bilateral TKA would have significantly fewer days missed from work compared to the sum of days missed from each surgery for patients who underwent staged bilateral TKA. Methods. The prospective arthroplasty registry at Hospital for Special Surgery was utilized. We identified 61 employed patients who had undergone staged bilateral TKA and 152 employed patients who had undergone simultaneous bilateral TKA and had completed the registry's return to work questionnaire. Baseline characteristics and patient reported outcome scores were evaluated. We used a linear regression model, adjusting for potential confounders including age, sex, pre-op BMI, and work type (sedentary, moderate, high activity, or strenuous), to analyze workdays lost after staged versus simultaneous bilateral TKA. Results. Staged patients missed a mean total of 67.9±46.1 days of work across both TKA surgeries, compared to 46.5±29.0 days missed in the simultaneous group (p<0.001). In multivariate mixed regression analysis, adjusted for age, sex, BMI, ASA status, and work type, the staged group missed 16.9±5.7 more days of work compared to the simultaneous group (95%CI 5.8 to 28.1, p=0.003). Compared to sedentary work type, patients with high or strenuous work activity missed 19.4±9.4 (p=0.040) more total work days. Conclusions. Employed patients undergoing simultaneous bilateral TKA missed 17 fewer days of work over the course of their surgical treatment and rehabilitation compared to those undergoing staged bilateral TKA. This information may be useful to surgeons counseling patients with bilateral knee osteoarthritis about staged versus simultaneous bilateral surgery

Introduction. The aim of this study was to identify the effects of first MTPJ arthritis, ankle arthritis and hallux valgus on patient reported outcomes, and to assess the efficacy of surgery. Methods. Patients who underwent first MTPJ fusion, ankle fusion or hallux valgus correction from July 2013 to October 2014 were included in the study. Exclusion criteria included revision or simultaneous bilateral surgery, inflammatory arthropathy, or arthritis of a proximal joint awaiting arthroplasty. Subjects completed the Manchester-Oxford Foot Questionnaire (MOX-FQ), EQ-5D index, and EQ-5D health scale on presentation and at least six months post-operatively. Between group statistical analysis was carried out using one-way ANOVA, pre- and post-operative scores were compared using a paired t-test. Results. Eighty-two patients completed pre-operative questionnaires. Seventy-four (22 male, 52 female) of these (90%) completed post-operative questionnaires at a median of 10 months (range 6–17 months). The median age was 64 years (range 36–85 years). Pre-operative MOX-FQ and EQ-5D scores differed significantly between the groups (both p< 0.001) with ankle fusion patients reporting the worst scores and hallux valgus patients the best. Post-operative MOX-FQ and EQ-5D did not differ between groups (p=0.52, p=0.06 respectively). MOX-FQ significantly improved in all groups from pre-operatively (MTPJ p=0.0001; Ankle p=0.0002; Hallux Valgus p< 0.0001). EQ-5D only statistically improved following surgery for arthritic conditions (MTPJ p< 0.001; ankle p< 0.001; Hallux valgus p=0.06). The EQ-5D health scale did not show any differences between the groups either pre- or post-operatively, nor between pre- and post-op scores for each type of surgery. Conclusions. MOX-FQ and EQ-5D scores differ between patients with different foot and ankle pathologies. Both scores significantly improve following surgery for arthritic conditions, but only the more specific MOX-FQ improves following hallux valgus correction. These results will be of benefit when consenting patients pre-operatively, and potentially for prioritisation of healthcare provision

The purpose of this study was to investigate the safety and outcome of bilateral simultaneous ACL reconstruction. In patients presenting with an ACL-deficient knee, 2 – 4% have bilateral ACL deficiency. A staged or simultaneous approach can be adopted when the patient requires reconstructive surgery for both knees. We report a case series of 8 patients (6 male, 2 female, average age 30.4 years) who underwent bilateral simultaneous ACL reconstruction. Simultaneous or bilateral ACL reconstruction using ipsilateral patella tendon graft has been reported as a safe procedure with outcome and complication rate no different to unilateral procedures. Considerable cost savings of simultaneous over staged procedures have also been described. There are no case series in the published literature that describe the use of hamstring tendon autograft for bilateral simultaneous ACL reconstruction. We used two camera stack systems and instrument sets to allow for simultaneous bilateral surgery by two surgical teams. Quadrupled hamstring tendon graft was used in 4 patients although in one patient patella tendon graft was used on the second side due to poor quality of hamstring tendons. Patella tendon graft was also used in a further 4 patients. At two weeks all patients were able to discard crutches and were independent in mobility. There was no difference in outcome at one year between those patients undergoing bilateral simultaneous ACL reconstruction in comparison to the outcomes of unilateral ACL reconstruction with respect to Lysholm, Tegner and IKDC scores. The mean follow up period was 2.3 years. Our results demonstrate that bilateral simultaneous ACL reconstruction is safe and cost effective. A simultaneous approach also has the benefit of reducing the overall period of rehabilitation required by the patient. We report good short-term functional outcome but no long-term data is yet available

Introduction: Pain is one of the most important outcome measures that contributes to patient dissatisfaction following total knee arthroplasty (TKA) and unexplained pain poses a difficult problem to manage. This paper focuses on a group of patients with unexplained knee pain post arthroplasty to identify any predictors of a poor pain outcome. Methods: A prospective study of 622 primary TKAs performed on 512 patients using cemented press fit condylar prosthesis was the basis to examine a group of patients that reported moderate or severe pain at 5 years. Demographic and operative variables as well as American Knee Society Scores were collected prospectively. Data was available for 462 knees at 5 years. After exclusion of patients with mild pain, two groups were generated; 374 with no pain and 28 with moderate or severe unexplained pain. Univariate linear analysis was performed to identify possible predictors of poor outcome and this was further refined using multiple regression analysis to remove the effect of confounding factors. Results: Comparison of the pain and no pain group found the following to be significant predictors of poor outcome: Staged approach to bilateral disease when compared to simultaneous bilateral surgery (13% vs 2%, P< 0.01), age below 60 (17% vs 7%, P< 0.01) and performing lateral release (13% vs 5%, P< 0.01). Other factors which had no predictive effect were gender, body mass index, operating surgeon, patella component, instability and range of motion. Conclusions: Avoiding surgery in patients aged below 60 and performing simultaneous bilateral TKA instead of a staged approach to bilateral disease, should aid selection of patients for improved outcome in terms of pain. Good surgical technique to avoid lateral release is also recommended to improve outcome