Methods

This was a multicentre registry study from October 2016 to June 2021 that included 861 primary RA-TKA patients who completed at least one pre- and postoperative patient-reported outcome measure (PROM) questionnaire, including Forgotten Joint Score (FJS), Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement (KOOS JR), and pain out of 100 points. The mean age was 67 years (35 to 86), 452 were male (53%), mean BMI was 31.5 kg/m² (19 to 58), and 553 (64%) cemented and 308 (36%) cementless implants.

Introduction

We present a case series of patients that underwent knee ligament reconstruction with graft reinforcement using FibreTape (Arthrex), a 2mm wide non-biodegradable polyethylene tape. Outcomes and safety of this novel technique are reported.

Methods

Data were collected from a prospectively maintained database from 03/2011 to 11/2019. All skeletally mature patients that underwent reinforced knee ligament reconstruction surgery at Basingstoke and North Hampshire Hospital were included. The cohort was interrogated for outcomes including failure, complications, and subjective patient reported outcomes at 6,12 and 24 months postoperatively.

Introduction

MCL injuries often occur concurrently with ACL rupture – most noncontact ACL injuries occur in valgus and external rotation (ER) - and conservative MCL treatment leads to increased rate of ACL reconstruction failure. There has been little work developing effective MCL reconstructions.

Methods

Cadaveric work measured MCL attachments by digitisation and radiographically, relating them to anatomical landmarks. The isometry of the superficial and deep MCL (sMCL and dMCL) and posterior oblique ligament (POL) was measured using fine sutures led to displacement transducers. Contributions to stability (restraint) were measured in a robotic testing system. Two MCL reconstructions were designed and tested: 3-strand reconstruction (sMCL+dMCL+POL), and 2-strand method (sMCL+dMCL) addressing anteromedial rotatory instability (AMRI). The resulting stability was measured in a kinematics test rig, and compared to the ‘anatomic’ sMCL+POL reconstruction of LaPrade.

Introduction

Controversy exists regarding the optimal tibial coronal alignment in total knee arthroplasty. Many believe navigation or robotics are required to set kinematic alignments or to ensure they remain within ‘safe’ limits e.g. maximum 5° varus on the tibia. Given most navigation or robotic systems require the surgeon to identify the ankle malleoli, this study aimed to radiographically analyse standardly used intra-operative landmarks around the ankle, assessing their value in achieving kinematic alignment / setting safety boundaries.

Materials and Methods

Long leg alignment radiographs were analysed independently by two orthopaedic surgeons at two time points, eight weeks apart. Angles were measured between the long axis of the tibia (TB) and: 1. lateral malleolus (TB-LM), 2. lateral border of the talus (TB-LT) and 3. medial aspect of the medial malleolus (TB-MM). Intra- and inter-rater reliabilities were assessed.

Introduction

In recent years, CTA has been an effective training adjunct for orthopaedic procedures. ACLR is a complex procedure with a steep learning curve.

Aim

To design a multimedia CTA learning tool for ACLR using a modified Delphi methodology.

Introduction

Failing total knee replacement management has included isotope bone scan to identify infection or loosening. BASK guidance suggests bone scans have a poor positive predictive value and are not advised. We assessed isotope bone scanning as a negative predictor to exclude loosening or infection in failing total knee replacement.

Methodology

Retrospective review of consecutive bone scans performed to investigate painful total knee replacements for a one-year period (June 2017 to June 2018). 166 bone scans performed. 33 excluded (no notes or scan for other reasons). Demographic information, age of prosthesis, clinic review date, serological markers, results of aspiration and subsequent intraoperative findings also recorded.

Introduction

A revision knee replacement (rKR) network model has been introduced in the UK to improve clinical outcomes for patients and reduce healthcare costs. However, the current practice of different types of surgical unit is not well understood. The aim of this study was to answer: “How complex are rKR cases at a Major Revision Centre (MRC)?”

Methodology

Retrospective cohort study at the Nuffield Orthopaedic Centre, Oxford from 2015 - 2018. Case complexity was classified using the Revision Knee Complexity Classification (RKCC). Referral source, technical details of surgery and hospital admission impact were recorded.

Introduction

The Wells score is commonly used to assess the risk of proximal Deep Vein Thrombosis (DVT) following Knee Arthroplasty (KA). The National Institute for Health and Care Excellence (NICE) guidelines recommend an Ultrasound scan in patients with a Wells score of 2 points or more. We wanted to assess how often this protocol resulted in a scan being done and how many were negative.

Methodology

Details of all postoperative Ultrasound scans performed up to 90 days were audited in a high-volume unit between 1st January 2016 and 31st December 2020. This included all Lower Limb Arthroplasty patients

Introduction

The popularity of all-inside meniscal repair devices has led to a shift away from inside-out meniscus repair without comparative studies to support the change. The aim of this study was to compare the failure rate and time to failure of all-inside and inside-out meniscus repair performed in elite athletes.

Methodology

A retrospective review was performed of all elite athletes who underwent meniscal repair, with a minimum of two-year follow-up between 2013 and 2019. Repairs were classified as all-inside or inside-out according to the repair technique. Failure was defined as undergoing a subsequent surgery to address a persistent meniscal tear.

Introduction

Anxiety and depression are risk factors for poor outcome following knee replacement surgery. The aim of this study was to investigate the prevalence of anxiety and depression before and after primary (pKR) and revision knee replacement (rKR).

Methodology

Retrospective cohort study. 315,720 pKR and 12,727 rKR recruited from the NHS Patient Reported Outcome Measures (PROMs) programme from 2013–2021. Anxiety and depression were defined using: (i) Survey question: “Have you been told by a doctor that you have depression? Yes/No”; (ii) EQ-5D anxiety/depression domain. Rates of EQ-5D anxiety/depression were investigated at baseline and at 6-months following surgery. The prevalence of depression was investigated by patient age and gender.

Introduction

Re-revision knee replacement (RR-KR) is complex surgery, with a significant impact on individual patients and health resource use. The aim of this study was to investigate early patient-relevant outcomes following RR-KR.

Methodology:

206 patients (250 knees) undergoing RR-KR were recruited from a major revision centre between 2015–2018. Patient-relevant outcomes assessed were: implant survivorship, complications (90-days), joint function and quality of life (final follow-up). Risk factors for further revision surgery at 1 year were investigated using multiple logistic regression.

Introduction

In cementless UKR, primary fixation of the tibial component is achieved by press-fitting a keel (i.e. with interference) into a vertical slot cut into the proximal tibia. This may adversely affect the structural integrity of surrounding bone. Early post-operative peri-prosthetic tibial fractures are 7x more common in very small knees, but the aetiology of these fractures is unknown - such sizes are rarely used in the UK but more common in Asian populations. This study explores the effect of keel-related features in fracture risk of these very small tibias.

Method

This in vitro study compares the effect of keel and slot depth (standard vs 33% shallower vs nil) and loading position (anterior/posterior gait range limits: mid-tibia vs 8mm posterior) on fracture load and path. 3D-printed titanium components were implanted using surgical instrumentation/technique, in bone-analogue foam machined to a CT-reconstructed very small tibia which subsequently experienced a peri-prosthetic fracture.

Introduction

Higher than expected rates of tibial loosening with the ATTUNE® total knee arthroplasty (TKA) implant has been reported. Component loosening can be associated with the development of radiolucency lines (RLL) and our study aim was to systematically assess the reported rates of these.

Methodology

A systematic search was undertaken using the Cochrane methodology in four online databases. Identified studies were assessed and screened against predetermined inclusion criteria. Meta-analysis was conducted using a random-effects model.

Introduction

There are several imaging-based measurements for patello-femoral height. Available methods rely predominantly on sagittal images. The latter can be misleading with sagittal oblique slices and when the patella is tilted and/or chronically subluxed. In this study we describe a simple method of patellar height measurement using axial MRI overlap.

Materials and methods

A retrospective observational analysis of 97 knees from 251 patients was conducted. Cases were selected following the exclusion of scans with fractures, massive effusion, patello-femoral pathology. Axial patello-trochlear overlap (APTO) was measured on the axial MRI images as follows: (1) Patellar length (P): expressed as the number of axial images showing patellar articular surface (2) Trochlear overlap (T): the number of axial images showing overlap between patellar articular surface and articular surface of lateral trochlea. APTO is the ratio T/P. All measurements were carried out independently and on two separate occasions by 6 raters. As a control conventional patello-trochlear index were measured for all patients by a senior musculoskeletal radiologist.

Introduction

Tibial tubercle osteotomy (TTO) is a complex surgical procedure with a significant risk of complications, which include nonunion and tibial fracture. To determine whether an additional suture tape augmentation can provide better biomechanical stability compared with standard screw fixation.

Methods

Five matched pairs of human cadaveric knees were divided into 2 groups: the first group underwent standard TTO fixation with 2 parallel screws. The second group underwent a novel fixation technique, in which a nonabsorbable suture tape (FiberTape) in a figure-of-8 construct was added to the standard screw fixation. Tubercular fragment migration of >50% of the initial distalization length was defined as clinical failure Tubercular fragment displacement during cyclic loading and pull-to-failure force were recorded and compared between the 2 groups.

Introduction

In 2020, the National Hip Fracture Database (NHFD) was extended to capture data from patients with periprosthetic femoral fractures (PPFF) with plans to include these patients in Best Practice Tarif. We aimed to describe the epidemiology of PPFF in England and Wales, with a particular focus on fractures occurring around the femoral component of knee prostheses.

Methodology

This population-based observational cohort study utilised open-access data available from the NHFD. Patients aged over 60, admitted to an acute hospital in England or Wales with a PPFF, within the period 1st January 2020 to 31st December 2020 were included. The primary outcome was the incidence of PPFF in England and Wales. The secondary outcome was the treatment received.

INTRODUCTION

COVID-19 reduced availability of cross-sectional imaging, prompting the need to clinically justify pre-operative computed tomography (CT) in tibial plateau fractures (TPF). The study purpose was to establish to what extent does a CT alter the pre-operative plan in TPF compared to radiographs. There is a current paucity of evidence assessing its impact on surgical planning

METHODOLOGY

50 consecutive TPF with preoperative CT were assessed by 4 consultant surgeons. Anonymised radiographs were assessed defining the column classification, planned setup, approach, and fixation technique. At a 1-month interval, randomised matched CT scans were assessed and the same data collected. A tibial plateau disruption score (TPDS) was derived for all 4 quadrants (no injury=0,split=1,split/depression=2 and depression=3). Radiograph and CT TPDS were assessed using an unpaired T-test.

Introduction

Spinal local anaesthesia and opioids have long been used as peri-operative analgesia for patients undergoing arthroplasty procedures. However, intrathecal opioids are associated with numerous complications. ERAS^® society guidelines for elective knee replacement (2019) strongly discourage the use of spinal opioids. This study aims to report the impact of low-dose spinal and local infiltrative analgesia on patients undergoing elective knee replacement.

Methodology

Retrospective cohort study of patients undergoing knee replacement under the ERAS protocol over 2 years, at a district general hospital under the care of a single surgeon.

Introduction

Knee osteotomy, both high tibial and distal femoral osteotomy, is a well-recognised treatment for young, active patients with unicompartmental knee osteoarthritis. Osteotomy around the knee is usually performed as an inpatient procedure. The aim of this study was to assess the effectiveness and patient satisfaction of our day-case protocol for knee osteotomy.

Methodology

All patients who underwent day-case knee osteotomy at the study unit, over a three-year period, were reviewed to assess the success of ambulatory care for knee osteotomy. Patients were sent questionnaires to assess functional outcome and patient satisfaction with our day-case process.

Introduction

Medial fix bearing unicompartmental knee replacement (UKR) designs are consider safe and effective implants with many registries data and big cohort series showing excellent survivorship and clinical outcome comparable to that reported for the most expensive and surgically challenging medial UKR mobile bearing designs. However, whether all polyethylene tibial components (all-poly) provided comparable results to metal-backed modular components during medial fix bearing UKR remains unclear. There have been previous suggestions that all-poly tibia UKR implants might show unacceptable higher rates of early failure due to tibial component early loosening especially in high body max index (BMI) patients. This study aims to find out the short and long-term survival rate of all-poly tibia UKR and its relationship with implant thickness and patient demographics including sex, age, ASA and BMI.

Material and Methods

we present the results of a series of 388 medial fixed bearing all-polly tibia UKR done in our institution by a single surgeon between 2007–2019.

Introduction

Distal Femoral Fractures around a Total Knee Replacement have a reported incidence of 0.25–2.3% of primary TKRs. Literature suggests that these fractures have high complication rates such as non union and revision.

Methodology

A retrospective case note review was undertaken of all patients who sustained a distal femoral fracture around a TKR from April 2014-April 2021. Data parameters collected included patient demographics, classification of fracture, management, post op mobility, fracture union and mortality.

Methodology

Prospective single-surgeon case-series evaluating patients undergoing surgery by this technique. 76 cases (mean age of 33.2 years) who had primary ACL reconstruction with BTB or quadriceps tendon with bone block, were divided into 2 matched groups (age, sex and type of graft) of 38 each based on the method of femoral fixation used (interference screw or adjustable cortical suspension). Patients were followed up clinically and using PROMS from NLR with EQ-5D, KOOS, IKDC and Tegner scores. Complications and return to theatre were noted. Paired two-tailed student t-tests and Chi-square tests were employed for statistical analysis.

Results

At a mean follow-up of 82 months, peri-operative mean EQ-5D VAS, EQ-5D Index, KOOS, IKDC and Tegner activity scores showed significant improvement (p<0.05), but no significant difference between the two groups (p>0.05). Mean graft length and diameter was 77mm and 9.3 respectively. Mean interval from injury to surgery was 10.5 months. 18(23.7%) patients had associated meniscal tear with 73.3 % undergoing repair. 10 cases (13.2 %) returned to theatre including, MUA for arthrofibrosis (n=2) and intra-substance graft failure (n=2). 3 cases had to be converted to interference screw fixation due to the tightrope cutting through from the femoral bone block as a result of a technical pitfall.

Background

Fracture dislocation of the knee involves disruption of knee ligaments with associated tibial plateau fracture. If these injuries are not evaluated swiftly, can result in a limb-threatening injury. The aim of this study is to look at the clinical outcomes of a single surgeon case series at a major trauma centre.

Methods

Prospectively collected data was analysed for a 5-year period. Primary outcome measures used were International Knee Documented Committee (IKDC) score and Knee Injury & Osteoarthritis Outcome Score (KOOS). The secondary outcome measures include Tegner activity scale, knee range of movements and complications.

Methods

This is a follow-up of a randomized controlled trial, initially involving 32 patients, of whom 19 (nine cemented, ten hybrid) were available for follow-up ten years postoperatively, when further RSA measurements were made. Micromotion of the femoral and tibial components was assessed using model-based RSA software (RSAcore). The clinical outcome was evaluated using the Knee Society Score (KSS), the Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analogue scale (pain and satisfaction).

Introduction

Coronal plane alignment of the knee (CPAK) classification utilises the native arithmetic hip-knee alignment to calculate the constitutional limb alignment and joint line obliquity which is important in pre-operative planning. The objective of this study was to compare the accuracy and reproducibility of measuring the lower limb constitutional alignment with the traditional long leg radiographs versus computed tomography (CT) used for pre-operative planning in robotic-arm assisted TKA.

Methods

Digital long leg radiographs and pre-operative CT scan plans of 42 patients (46 knees) with osteoarthritis undergoing robotic-arm assisted total knee replacement were analysed. The constitutional alignment was established by measuring the medial proximal tibial angle (mPTA), lateral distal femoral angle (LDFA), weight bearing hip knee alignment (WBHKA), arithmetic hip knee alignment (aHKA) and joint line obliquity (JLO). Furthermore, the Coronal Plane Alignment of the Knee (CPAK) classification was utilised to classify the patients based on their coronal knee alignment phenotype.

Introduction

This multi-centre randomised controlled trial evaluated the clinical and cost effectiveness of liposomal bupivacaine for pain and recovery following knee replacement.

Methodology

533patients undergoing primary knee replacement were randomised to receive either liposomal bupivacaine (266mg) plus bupivacaine hydrochloride (100mg) or control (bupivacaine hydrochloride 100mg), administered at the surgical site. The co-primary outcomes were pain visual analogue score (VAS) area under the curve (AUC) 6 to 72hours and the Quality of Recovery 40 (QoR-40) score at 72hours.

Introduction

Inter-prosthetic femoral fractures (IPFF) are fractures occurring between ipsilateral hip and knee implants or fixation devices. In 2020, the National Hip Fracture Database (NHFD) was extended to capture data from patients with peri-prosthetic femoral fractures (PPFF), including those specifically with IPFF. This study aims to describe the epidemiology and treatment of IPFF in England and Wales.

Methodology

This population-based observational cohort study utilised open-access data available from the NHFD. Patients aged over 60, admitted to an acute hospital in England or Wales with an IPFF, within the period 1st January 2020 to 31st December 2020 were included. The primary outcome of this study was the incidence of IPFF in England and Wales. The secondary outcome was the treatment received.

Introduction

COMPOSE describes the demographics, fracture characteristics, management and associated outcomes of knee femoral periprosthetic fractures (KFPPF).

Methods

Multicentre retrospective cohort study conducted 01/01/2018-31/12/2018. Data collected included: patient demographics, social and mobility characteristics, fracture characteristics, management strategy and post-treatment outcomes (length of stay, reoperation, readmission, 30-day and 12-month mortality).

Introduction

The NHS long term plan endorses ‘personalised’, ‘digitally enabled’, ‘out of hospital’ care. Multiagency guidance (CPOC(2021)/NICE(2021)/GIRFT(2021)/NHSX(2021)) advocates an integrated ‘pathway’ approach to information sharing, shared-decision making and patient support. Digital solutions are the vehicle to deliver these agendas.

Methods

In 2018 we developed a digital joint pathway (DJP) spanning the surgical care pathway (prehabilitation to rehabilitation) using the GoWellHealth platform. Patients listed for joint replacement are offered the DJP as routine care. Activity and engagement are monitored using the DJP data library. We sought to evidence our DJP by assessing patient engagement, experience and outcomes (OKS/EQ5D/Readmission).

Background

Performing lateral extra-articular tenodesis (LET) with ACL reconstruction may conflict with the ACLR femoral tunnel.

Methods

12 fresh-frozen cadaveric knees were used: at 120 flexion, an 8mm ACLR femoral tunnel was drilled in the anteromedial bundle position via the anteromedial portal. A modified Lemaire LET was performed using a 1 cm-wide iliotibial band strip left attached to Gerdy's tubercle. The LET femoral fixation point was identified 10mm proximal / 5 mm posterior to the LCL femoral attachment, and a 2.4-mm guide wire was drilled, aiming at 0, 10, 20, or 30 degrees anteriorly in the axial plane, and at 0, 10, or 20 degrees proximally in the coronal plane. The relationship between the LET drilling guide wire and the ACLR femoral tunnel reamer was recorded for each combination. When collision with the femoral tunnel was recorded, the LET wire depth was measured.

Background

Little scientific evidence is available regarding the effect of knee joint line obliquity (JLO).

Methods

10 fresh-frozen human cadaveric knees were axially loaded to 1500 N in a materials testing machine with the joint line tilted 0, 4, 8, and 12 degrees varus and valgus, at 0, and 20 degrees of knee flexion. The mechanical compression axis was aligned to the centre of the tibial plateau. Contact pressures / areas were recorded by sensors inserted between the tibia and femur below the menisci. Changes in relative femoral and tibial position in the coronal plane were obtained by an optical tracking system.

Introduction

Our aim was to investigate trends in the incidence rate and main indication for revision knee replacement (rKR) over the past 15 years in the UK.

Methodology

Cross-sectional study from 2006 - 2020 using data from the National Joint Registry (NJR). Crude incidence rates were calculated using population statistics from the Office for National Statistics.

Background

The incidence of periprosthetic fractures of the femur around a total knee arthroplasty (TKA) is rising and this is owed to the increased longevity that today's TKA implants allow for, as well as an aging population. These injuries are significant as they are related to increased morbidity and mortality.

Methods

We retrospectively reviewed all periprosthetic fractures around a TKA that presented to our NHS Trust between 2011 to 2020. Medical records were reviewed. Treatment, complications and mortality were noted.

Introduction

The outcome of revision anterior cruciate ligament reconstruction (ACL-R) is guarded, particularly their return to sports activities. It is important to know the factors affecting the functional outcomes following a revision ACL-R.

Methods

We analysed results from 39 patients, who underwent a revision ACL reconstruction by a single surgeon and was followed up over a year. Some of them were treated in 2-stage revision while the rest were single-stage revision, depending upon their size of bone tunnel or osteolysis as assessed by pre-operative CT scan.

Introduction

There is a longstanding presumed association between obesity, complications, and revision surgery in primary knee arthroplasty. This has more recently been called into question, particularly in centres where a high volume of arthroplasty is performed. We investigated the correlation between Body Mass Index (BMI), mortality, and revision surgery.

Method

This was a cohort study of at least 10 years following primary knee arthroplasty from a single high volume arthroplasty unit. Mortality and revision rates were collected from all patients who underwent primary knee arthroplasty between 2009 and 2010. Kaplan Meier analysis was performed.

Introduction

Autologous chondrocyte implantation (ACI) is a common procedure, primarily performed in active, young patients to treat knee pain and functional limitations resulting from cartilage injury. Nevertheless, the functional outcomes of ACI remain poorly understood. Thus, the aim of this systematic review was to evaluate the biomechanical outcomes of ACI.

Methodology

Ovid MEDLINE, Embase, and Web of Science were systematically searched using the terms ‘Knee OR Knee joint AND Autologous chondrocyte implantation OR ACI’. Strict inclusion and exclusion criteria were used to screen publications by title, abstract, and full text. Study quality and bias were assessed by two reviewers. PROSPERO ID: CRD42021238768.

Objectives

To determine the effectiveness of LIA compared to ACB in providing pain relief and reducing opiates usage in hamstring graft ACL reconstructions.

Materials and Methods

In a consecutive series of hamstring graft ACL reconstructions, patients received three different regional and/or anaesthetic techniques for pain relief. Three groups were studied: group 1: general anaesthetic (GA)+ ACB (n=38); group 2: GA + ACB + LIA (n=31) and group 3: GA+LIA (n=36). ACB was given under ultrasound guidance. LIA involved infiltration at skin incision site, capsule, periosteum and in the hamstring harvest tunnel. Analgesic medications were similar between the three groups as per standard multimodal analgesia (MMA). Patients were similar in demographics distribution and surgical technique. The postoperative pain and total morphine requirements were evaluated and recorded. The postoperative pain was assessed using the visual analogue scores (VAS) at 0hrs, 2hrs, 4hrs, weight bearing (WB) and discharge (DC).

Introduction

Risk factors for osteoarthritis include raised BMI and female gender. Whether these two factors influenced synovial gene expression was investigated using a triangulation and modelling strategy which generated 12 datasets of gene expression in synovial tissue from three knee pathologies with matching BMI groups, obese and overweight, and gender distributions.

Methodology

Intra-operative synovial biopsies were immersed in RNAlater at 4oC before storage at -80oC. Total RNA was extracted using RNAeasy with gDNA removal. Following RT- PCR and quality assessment, cDNA was applied to Affymetrix Clariom D microarray gene chips. Bioinformatics analyses were performed. Linear models were prepared in limma with gender and BMI factors incorporated sequentially for each pathology comparison, generating 12 models of probes differentially expressed at FDR p<0.05 and Bayes number, B>0. Data analysis of differently expressed genes utilized Ingenuity Pathway Analysis and Cytoscape with Cluego and Cytohubba plug-ins.

INTRODUCTION

Geniculate nerve blocks (GNB) and ablation (GNA) are increasing in popularity as strategies for the management of knee pain in patients unsuitable for surgical intervention. Typically these simple blocks have been performed by specialists in pain medicine. We present the results of a GNB clinic run by a surgical care practitioner (SCP).

METHODOLOGY

An SCP clinic was created where ultrasound-guided GNBs comprising local anaesthetic and steroid were administered. Patients considered unsuitable for surgery were referred with knee pain by orthopaedic knee surgeons and specialist physiotherapists.

A VAS pain score and an Oxford Knee Score (OKS) were completed prior to and immediately following blockade. Serial VAS diaries were completed. Further OKS were requested at 6 weeks and 6 months. Patients could request GNA at any point during follow-up and their follow-up ceased at this stage.

Introduction

The NHS generates 4–5% of the nation's total carbon emissions and over 500,000 tonnes of waste annually. Up to one-third of waste from orthopaedic procedures are recyclable, with large joint arthroplasties producing more than other subspecialties. However, there is limited evidence demonstrating the principles of sustainability and its benefits within orthopaedic surgery. This study aimed to analyse the environmental impact and sustainable initiatives undertaken within orthopaedic surgery.

Methodology

A systematic review was performed according to PRISMA guidelines. The systematic search was conducted through EMBASE, Medline, and PubMed libraries.

Introduction

Meniscal repair is an accepted surgical option for meniscal tears. However, there remains trepidation with regard to offering such surgery to older patients. We aim to evaluate the outcomes in these such patients.

Methodology

A single surgeons log was used to identify patients who underwent meniscal repair and were over the age of 40. Patients having concurrent anterior cruciate ligament reconstructions were excluded. Demographic data, surgical data and outcomes (pain visual analogue score (VAS); single assessment numerical evaluation (SANE) and knee injury and osteoarthritis outcome joint replacement (KOOS Jr) score) were collected prospectively. Final outcomes were collected between 6–12 months following surgery.

Introduction

Anterolateral procedures can reduce the risk of re-rupture after ACL reconstruction in high risk patients however, this effectiveness has never been evaluated in elite athletes. The purpose of this study was to evaluate the effectiveness of lateral extra-articular tenodesis in reducing revision rates in ACL reconstructions in elite athletes.

Methodology

A consecutive cohort of elite athletes between 2005 and 2018 undergoing ACLR reconstruction with or without modified Lemaire lateral extra-articular tenodesis were analysed. A minimum of 2 years of follow-up was required. The association between the use of LET and ACL graft failure was evaluated with univariate and multivariate logistic regression models.

Introduction

The prevalence of recurrent infection following two-stage exchange arthroplasty following failure of a total knee arthroplasty (TKA) has been reported to be 10% to 25%. There is limited literature available on repeat two stage revisions for TKA infection with only small cohorts and variable success rates.

Methodology

A retrospective cohort study investigating the outcome of two stage revision arthroplasty for treatment of TKA infection was conducted with the aim of identifying factors linked to recurrence of infection. A consecutive cohort of all microbiology intra-operative periprosthetic knee samples from a single revision arthroplasty centre between January 2010 and December 2016 was identified. The final cohort consisted of 658 samples taken during 64 patients undergoing two stage revision knee surgery for infection. Patient demographics, medical and orthopaedic history data including post-operative outcomes and subsequent treatment was obtained from the electronic records system and medical notes.

Introduction

After remodelling, loss of bone density beside the keel of cementless UKR tibial components has been observed as a potential cause of concern. How this affects patient-reported outcomes, and further clinical implications, is unclear. This study aims to assess the effect of cementless UKR implantation on tibial bone density, and to explore its relationship to patient demographics and outcomes.

Method

This prospective study assesses 115 anterior-posterior radiographs from cementless UKR postoperatively and five years after surgery. Grey values from nine regions around each keel were collected and standardised to enable inter-radiograph comparison. Change between the post-operative and 5-year radiographs (indicating bone density) was calculated, and effect on 5-year patient demographics and pain and functional outcomes was assessed. Repeat measurements were performed by two operators to assess reliability.

Introduction

The postoperative inflammatory response may be implicated in the aetiology of patient dissatisfaction following Total Knee Arthroplasty. Robotic-arm assisted TKA has been associated with reduced bone and soft tissue trauma. The objective of this Randomised Controlled Trial was to compare the inflammatory response in conventional Jig-based versus robotic arm-assisted TKA and examine the relationship with patient reported outcome measures and functional outcomes.

Methodology

30 patients with knee osteoarthritis were randomised to either conventional or robotic-arm assisted TKA. Blood samples were collected for up to 28 days post-operatively and intraarticular drain samples at 6 and 24 hours, to ascertain the systemic and local inflammatory responses. The Spearman's correlation was utilised to evaluate the relationship with PROMs and functional outcomes.

Introduction

The demand for total knee arthroplasty (TKA) in older patients is increasing. Current perceptions regarding risks may result in patients inappropriately being denied surgery. This study aimed to evaluate TKA outcomes in patients aged ≥80 compared to a younger cohort.

Methodology

This study retrospectively analysed prospectively collected data from the Scottish Arthroplasty Project. Data were extracted for all patients undergoing primary TKA between 2000 and 2019 in two age groups: 1) ≥80 and 2) 50–79. Hybrid and partial knee replacements and those with incomplete data were excluded. Data were extracted on post-operative complications, infection within 1 year, mortality and revision at any point.

Introduction

The paediatric population present unique challenges to the knee surgeon, particularly when treating recurrent patellofemoral instability(PFI), the management of which is poorly standardised. Through the EPPIC BASK National Trainee Collaborative, we aimed to identify which procedures (and in which combination) are being used to surgically manage recurrent PFI in skeletally immature patients across the UK.

Methods

A retrospective national service evaluation via a trainee collaborative analysing local trust data between 1st January 2014 and 31st December 2019. Data from institutions registered for EPPIC was compiled and compared to the national guidelines for adults.

Purpose

This study aims to compare the clinical and functional outcomes and donor site morbidity of anterior cruciate ligament reconstruction with hamstring tendon autograft and peroneus longus tendon autograft in patients with complete anterior cruciate ligament rupture.

Methods

Patients who underwent ACL reconstruction from February 2018 to July 2019 were randomly allocated into two groups (hamstring and peroneus longus). Functional scores (IKDC and Lysholm scores) and pain intensity by visual analogue score were recorded preoperatively, 3, 6months, 1, and 2 years postoperatively. Donor site morbidities were assessed with thigh circumference measurements in hamstring group and ankle scoring with the American foot and ankle score in peroneus longus group.

Introduction

There are a wide variety of implant brands and types of knee replacement available to surgeons. With time, the options available within many implant brand portfolios has grown, with alternative tibial or femoral components, tibial insert materials or shapes and patella resurfacings.

Aim

To investigate the effect of the expansion of implant brand portfolios, and to establish the potential numbers of compatible implant construct combinations.

Aims

The primary aim of this study was to evaluate the outcomes of fungal knee periprosthetic joint infection following knee arthroplasty. The secondary aim was to evaluate risk factors for acquiring a fungal PJI.

Patients and Methods

This was a retrospective analysis of patients presenting with a confirmed fungal PJI of the knee in two tertiary centres. There were a total of 45 cases. Isolated fungal infections along with mixed bacterial and fungal infections were included. Mean follow up was 40 months (range 3–118).

Background

There is a trend towards minimising length of stay (LOS) after total knee arthroplasty (TKA), as longer LOS is associated with poorer outcomes and higher costs. Patient factors known to influence LOS after TKA include age and ASA grade.

Evidence regarding body mass index (BMI) in particular is conflicting. Some studies find that increased BMI predicts greater LOS, while others find no such relationship. Previous studies have generally not examined socioeconomic status, which may be a confounder. They have generally been conducted outside the UK, and prior to the Covid-19 pandemic.

Methods

We conducted a retrospective cohort study of 1031 primary TKAs performed 01-04-2021 to 31-12-2021, after resumption of elective surgery in our centre. A multivariate regression analysis was performed using a Poisson model over pre-operative variables (BMI, age, gender, ASA grade, index of multiple deprivation, and living arrangement) and peri-operative variables (AM/PM operation, operation side, duration, and day of the week).

INTRODUCTION

This study investigates whether primary knee arthroplasty (KA) restores health-related quality of life (HRQoL) to levels expected in the general population.

METHODOLOGY

This retrospective case-control study utilises two sources: patients undergoing primary KA from a University Teaching hospital; and individual-level data from the Health Survey for England which was used to represent the General Population.

Propensity score matching was used to balance covariates (sex, age and body mass index (BMI)) and facilitate group comparisons. Two matched cohorts with 3029 patients each were obtained for the adjusted analyses (median age 70.3 interquartile range (IQR) 64–77; Female sex 3233 (53.4%); median BMI 29.7 IQR 26.5-33.7). HRQoL was measured using the three-level version of the EuroQol 5-Dimensions’ (EQ-5D-3L) Index and EQ-VAS scores.

Introduction

It is common practice for all patients to have postoperative bloods tests after total knee arthroplasty (TKA). However there have been significant improvement in perioperative care with arthroplasty surgery. As healthcare systems and providers strive towards a more efficient service we must re-consider whether such an intervention is necessary for all patients.

Methodology

This retrospective study included all patients who underwent a primary unilateral TKA at a single tertiary arthroplasty centre during a 1 year period. Electronic medical records of 776 patients were reviewed for patient demographics, length of stay and American Society of Anaesthesiologists grade. Blood tests were examined to investigate the incidence of post operative anaemia requiring transfusion, electrolyte abnormalities that required treatment and the incidence of acute kidney injury.

Introduction

Derby technique for posterolateral corner (PLC) reconstruction uses a doubled gracilis autograft to reconstruct the popliteo-fibular ligament (PFL) and a split biceps tendon transfer to reconstruct the lateral collateral ligament (LCL). We report midterm outcomes of a case series who underwent PLC reconstruction.

Methodology

A retrospective review of 27 patients who underwent PLC reconstruction from 2012 until 2018 was performed (6 females, 21 males, median age 26). Median time interval from injury to primary procedure was 10 months. Outcomes were recorded as per clinical assessment and outcome scores.

Purpose

Recently several authors have suggested a correlation between posterior tibial slope (PTS) and sagittal stability of the knee. However, there is a lack of consensus in the literature relating to measurement, normal values and important values to guide treatment. We performed a systematic literature review looking at PTS and cruciate ligament surgery. Our aim was to define a gold standard measurement technique, determine normal ranges and important values for consideration during cruciate ligament surgery.

Methods

Electronic searches of MEDLINE (PubMed), CINAHL, Cochrane, Embase, ScienceDirect, and NICE in June 2020 were completed. Inclusion criteria were original studies in peer-reviewed English language journals. A quality assessment of included studies was completed using the Methodological Index for Non-Randomized Studies (MINORS) Criteria.

Background

Around 5–15% of patients will experience chronic postoperative pain after total knee replacement (TKR) surgery but the source of the pain is unknown. The aim of this study was to assesses patients six months after TKR using magnetic resonance imaging (MRI) of the knee, pain sensory profiles and assessments of pain catastrophizing thoughts.

Methods

Forty-six patients had complete postoperative data and were included. MRI findings were scored according to the MRI Osteoarthritis Knee Score (MOAKS) recommendation for Hoffa synovitis, effusion size and bone marrow lesions. Pain sensory profiles included the assessment of pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM). Pain catastrophizing was assessed using the pain catastrophizing scale (PCS). Clinical pain was evaluated using a visual analog scale (VAS, 0–10cm) and groups of moderate-to-severe (VAS>3) and non-to-mild postoperative pain (VAS≤3) were identified.

Introduction

To compare the efficacy of adductor canal blocks (ACB) and periarticular anesthetic injections (PAI) with bupivacaine in total knee arthroplasty.

Methods

90 patients undergoing primary total knee arthroplasty under spinal anesthesia were randomized to 1 of 3 groups: ACB alone (15 mL of 0.5% bupivacaine), PAI alone (50 mL of 0.25% bupivacaine with epinephrine) and ACB + PAI. Primary outcome in this study was the visual analog scale (VAS) pain score in the immediate postoperative period. Secondary outcomes included postoperative opioid use, activity level during physiotheraphy, length of hospital stay and ROM.

Introduction

Traumatic knee dislocations are devastating injuries and there is no single best accepted treatment. This study looked at functional outcome of a single surgeon case series of patients who underwent surgical management of their knee dislocation.

Methods

Eighty-seven patients with knee dislocation were treated at a major trauma centre. Acute surgical repair and reconstruction with fracture fixation within 4 weeks was preferred unless the patient was too unstable (Injury severity score>16). The collaterals were repaired and augmented using a variety of autografts, allografts or synthetic grafts. PCL was primarily braced and reconstructed subsequently, if required. Outcome was collected prospectively using IKDC score, KOOS and Tegner score.

Introduction

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.

Aim

Assess the effectiveness of adopting modern osteotomy techniques in improving surgical accuracy.

Introduction

Anterior cruciate ligament reconstruction (ACLR) can be performed with a number of different autografts including all soft tissue quadriceps autograft. (QT). QT has several advantages including decreased donor site morbidity, reduced anterior knee pain and comparable revision rates compared to other autografts. The primary aim of this review was to assess all complications of QT in adult population.

Methodology

A systematic review of the literature was conducted on in accordance with the PRISMA guidelines using the online databases Medline and EMBASE. Clinical studies or reporting on soft tissue QT were included and appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool.

Design

A pragmatic, multicentre, parallel-group, randomised controlled trial to determine whether the intervention is superior to comparator

Setting

20 NHS Hospitals

INTRODUCTION

A paucity of literature exists regarding efficacy of lateral unloader bracing in treatment for pathologies effecting the lateral compartment of the knee.

We evaluate patient outcomes following customised lateral unloader bracing (cLUB) in treatment of lateral compartment osteoarthritis (LCOA), lateral tibial plateau fractures (LTPF) and spontaneous osteonecrosis of knee (SONK).

METHODS

Institutional study approval was obtained. All patients undergoing cLUB between January 2013 and January 2021 were included, and prospectively followed-up. Visual Analogue Scales (VAS), Oxford Knee Scores (OKS) and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were assessed at brace fitting and final follow-up. Brace compliance, complications and surgical interventions were also collected. Statistical analysis utilised paired t-test.

Introduction

It is increasingly evident that synovium may play a larger role in the aetiology of osteoarthritis. We compared gene expression in whole tissue synovial biopsies from end-stage knee osteoarthritis and knee trauma patients with that of their paired explant cultures to determine how accurately cultured cells represent holistic synovial function.

Methodology

Synovial tissue biopsies were taken from 16 arthroplasty patients and 8 tibial plateau fracture patients with no osteoarthritis. Pairs of whole tissue fragments were either immediately immersed in RNAlater Stabilisation Solution at 4o C before transfer to -80o C storage until RNA extraction; or weighed, minced and cultured at 500mg tissues/5ml media in a humidified incubator at 37oC, 5% CO2. After sub-culturing total RNA was extracted using RNAeasy Plus Mini Kit with gDNA removal. Following RT-PCR and quality assessment, cDNA was applied to Affymetrix Clariom D microarray gene chips. Bioinformatics analyses were performed.

Methods

15 patients post TKA with severe arthrofibrosis and mean ROM 71° were recruited, (three cases had previously failed manipulation under anaesthetic (MUA). Patients received 8 weeks standard physiotherapy, then treatment with the STAK at home for 8 weeks. ROM, extension, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Scores (OKS) were collected at various time-points.

Results

Following standard physiotherapy there were small improvements in ROM (8°) (p<0.01), but no significant improvements in extension, OKS or WOMAC (p=0.39). Following the STAK treatment all outcomes significantly improved (p<0.01). STAK group; mean ROM (21° versus 8°, p < 0.001), extension 9° versus 2° (p < 0.01), WOMAC (18 points versus 3, p < 0.01), and OKS (8 points versus 4, p<0.01). No patients suffered any complications relating to the STAK.

Background

Since 2012 we have routinely used the cementless Oxford medial unicompartmental knee arthroplasty (mUKA), with microplasty instrumentation, in patients with anteromedial osteoarthritis (AMOA) meeting modern indications. We report the 10-year survival of 1000 mUKA with minimum 4-year follow-up.

Methods

National Joint Registry (NJR) surgeon reports were interrogated for each senior author to identify the first 1,000 mUKAs performed for osteoarthritis. A minimum of 4 years follow-up was required. There was no loss to follow-up. The NJR status of each knee was established. For each mUKA revision the indication and mechanism of failure was determined using local patient records. The 10-year implant survival was calculated using life-table analysis.

Aims

Ceramic coatings in total knee arthroplasty have been introduced with the aim of reducing wear and consequently improving implant survivorship. We studied both cobalt-chrome-molybdenum and ceramic-coated components of the same implant design from a single centre to identify if the ceramic coating conferred any benefit at mid-term review.

Patients and Methods

We identified 1641 Columbus TKAs (Aesculap AG, Tüttlingen, Germany) from a prospectively collected arthroplasty database. 983 were traditional CoCrMo and 659 had the AS ceramic coating. Patients were followed up until death or revision of the implant.

Introduction

Cryocompression therapy after knee surgery is widely utilised for post-operative rehabilitation. Skin temperature should be reduced to 10–15°C to maximise the therapeutic benefits while avoiding risks of adverse events. Some cryocompression devices offer control over the temperature of the ice-water circulated through a cuff. The degree to which this corresponds to the achieved skin temperature during a treatment is unknown.

Methods

30 healthy participants volunteered for this prospective randomised crossover trial involving the use of a cryocompression device. Each underwent a 30-minute test in all of five conditions: A, B, C, D and Control. Conditions corresponded to device temperature settings of 6, 8, 10, 12°C and no ice-water circulation, respectively. Skin temperature was measured prior to the cuff being applied, then every 5 minutes during a test.

Aim

End-stage arthropathy is a well-known complication of haemophilia, with recurrent haemarthroses leading to joint destruction, deformity, pain, and stiffness. In the knee, this is often treated with total knee arthroplasty (TKA), which can be more challenging in patients with haemophilia (PwH) and associated with poorer outcomes. We conducted a systematic literature review and meta-analysis to determine implant survivorship, functional outcomes and complication rates.

Method

A systematic review was conducted using MEDLINE, EMBASE, and PubMed for studies reporting TKA outcomes with Kaplan-Meier survivorship in PwH (PROSPERO registered). Meta-analysis was performed for survivorship and outcomes, and the results were compared to outcomes from the National Joint Registry (NJR).

Introduction

This study aimed to assess the effect of PRP on knee articular cartilage content (thickness and/or volume) and establish if there is a correlation between changes in cartilage and clinical outcomes in patients with knee osteoarthritis.

Methodology

A systematic review was performed following the Cochrane methodology. Studies were included if they reported on cartilage content with MRI or Ultrasound before and after the injection. A random-effects model meta-analysis was performed.

Introduction

The incidence of significant acute chondral injuries with patella dislocation is around 10–15%. It is accepted that chondral procedures should only be performed in the presence of joint stability.

Methodology

Patients were identified from surgeon/hospital logs. Patient demographics, lesion size and location, surgical procedure, patient reported outcome measures, post-operative MR imaging and complications were recorded. PROMs and patient satisfaction was obtained.

Introduction

High posterior tibial slope (PTS) has been recognised as a risk factor for anterior cruciate ligament rupture and graft failure. This prospective randomised study looked at intra-operative findings of concomitant intra-articular meniscal and chondral injuries during a planned ACL reconstruction.

Material and Methods

Prospective data was collected as part of a randomised trial for ACL reconstruction techniques. Intra-operative data was collected and these findings were compared with the PTS measured on plain radiograph by a single person twice through a standardised technique and intra-observer analysis was performed.

Introduction

With respect to survivorship following total knee arthroplasty (TKA), joint registries consistently demonstrate higher revision rates for both sexes in those less than 55 years. The current study analyses the survivorship of 500 cementless TKAs performed in this age group in a high-volume primary joint unit where cementless TKA has traditionally been used for the majority of patients.

Methods

This was a retrospective review of 500 consecutive TKAs performed in patients under the age of 55 between March 1994 and April 2017. The primary outcome measure for the study was all-cause revision. Secondary outcome measures included clinical, functional and radiological outcomes.

Introduction

All-tissue quadriceps tendon (QT) is becoming an increasingly popular alternative to hamstrings tendon (HT) and bone-tendon-bone (BTB) autograft for anterior cruciate ligament (ACL) reconstruction. The relatively short graft length however dictates that one, or both, ends rely on suture fixation. The strength of this construct is therefore extremely important. This study evaluates whether the use of a novel fixation technique can improve the tensile properties of the construct compared to a Krackow suture, and a looped tendon (suture free) gold standard.

Methods

Eighteen porcine flexor tendons were tested, across three groups; suture-tape Krackow, looped tendon, and the novel ‘strain suture’. Biomechanical testing simulated the different stages of ACL graft preparation and loading (60N preload for 10 minutes, 10 cycles from 10N to 75N, and 1000 cycles from 100N to 400N). Elongation and load to failure were recorded, and stiffness calculated for each construct.

Introduction

Mako robotic assisted knee arthroplasty requires a planning CT scan within 8 weeks of surgery according to the supplier's protocol. This is often impractical, therefore we evaluated whether CT scans remain valid for an extended period.

Methodology

Patients undergoing Mako partial (PKA) and total (TKA) knee arthroplasty were identified from our hospital database. The hospital PACS system was used to define the time interval between the initial planning CT scan and surgery, and whether further imaging was required prior to surgery.

Introduction

MRI has been increasingly used as an outcome measure and proxy for healing and integration after ACL reconstruction (ACLR). Despite this, it has not yet been established what a steady state graft MRI appearance is.

Methodology

MRI and clinical outcome measures were prospectively taken at 1 and minimum 2 years after hamstring autograft ACLR. MRI graft signal was measured using novel reconstructions both parallel and perpendicular to the graft, with lower signal indicative of better healing and expressed as the signal intensity ratio (SIR), and tunnel apertures analysed.

Introduction

Elite athletes sustaining a graft re-rupture after ACL reconstruction (ACL-R) undergo revision reconstruction to enable their return to elite sport. The aim of this study was to determine the rate of return to play (RTP) and competition levels at 2 and 5 years post revision ACL-R.

Methodology

A consecutive series of revision ACL-R in elite athletes undertaken by the senior author between 2009 and 2019 was retrospectively reviewed. Outcome measures were RTP rates and competition level.

Introduction

OtisMed Shape Match ® patient specific implant cutting jigs were designed to place TKA in kinematic alignment (KA) rather than traditional mechanical alignment (MA). This product was withdrawn from the market in 2013.

It has been hypothesised that KA might lead to early implant failure. Initial evidence has not supported this.

We present 10 year outcome data for the largest single centre cohort to date.

Methodology

Between 2010 and 2013, 127 Shape Match® TKAs were implanted in 119 individuals.

Retrospective review of long leg post-operative radiographs assessed femoral mechanical anatomical angle (FMA), tibial mechanical angle (TMA), hip-knee-ankle angle (HKA), posterior tibial slope (PTS) and femoral component flexion.

Oxford Knee Scores (OKS), revision and further surgery rates were reviewed.

Background

Prosthetic joint infection (PJI) is a significant cause of morbidity and mortality following knee replacement surgery. Identifying the causative agent(s) and their antibiotic sensitivities is critical in determining the choice of treatment methods used and the likelihood of successful eradication. This study aimed to investigate:

Methods

We identified consecutive patients passing through our knee infection Multi-Disciplinary Team meeting between December 2014 and March 2020. Data was collated data retrospectively using electronic records. Statistical analysis was performed using Stata (Timberlake, February 2020)

Introduction

Articular cartilage degradation is a defining feature of osteoarthritis. Synovium is a reactive tissue with synovial villae, neoangiogenesis and intimal hyperplasia common to many joint pathologies. The consequences of cartilage debris in osteoarthritis impacting the synovial intima is not well understood. We analysed the immunohistology of synovium from 16 patients with osteoarthritis and 17 patients undergoing knee surgery for non-arthritic pathologies. This data was integrated with imaging and functional scores to correlate synovitis in osteoarthritis.

Methodology

Formalin-fixed paraffin embedded synovial biopsy sections were cut in serial sequence and processed for routine staining (H&E or CD3, CD68, CD20, Vimentin, vWF and PCNA IHC) using standardised Dako monoclonal mouse anti-human antibodies. Digital images scanned at x20 were evaluated for fragments of cartilage and aggregates of inflammatory cells. Clinical data (gender, BMI, KL grade, WOMAC & SF-12 scores) was aligned with histopathological data.

Introduction

Synovitis impacts osteoarthritis symptomatology and progression. The transcription factors controlling synovial gene expression have not been described. This study analyses gene expression in synovium samples from 16 patients with osteoarthritis with 9 undergoing arthroscopic and 8 knee trauma surgery for non-arthritic pathologies.

Methodology

Intra-operative synovial biopsies were immersed in RNAlater at 4oC before storage at -80oC. Total RNA was extracted using RNAeasy. After purification, RT-PCR and quality assessment, cDNA was applied to Affymetrix Clariom D microarray gene chips. Bioinformatics analyses were performed. Linear models were prepared in limma with gender and BMI factors incorporated sequentially for each pathology comparison, generating 12 models of probes differentially expressed at FDR p<0.05 and Bayes number, B>0. Data analysis of differently expressed genes utilized Ingenuity Pathway Analysis and Cytoscape with Cluego and Cytohubba plug-ins.

Methods

A retrospective cohort of 5,857 patients was used to create the prediction models, and a second cohort of 721 patients from a different centre was used to validate the models, all of whom underwent TKA. Patient characteristics, BMI, OKS, and EQ-5D-3L were collected preoperatively and one year postoperatively. Generalized linear regression was used to formulate the prediction models.

Methods

A retrospective, single-surgeon review was carried out of all of the NexGen Legacy Posterior Stabilized (LPS) TKAs performed in this institute. The specific model used for the index procedures was the NexGen Complete Knee System (Legacy Knee-Posterior Stabilized LPS-Flex Articular Surface, LPS-Flex Femoral Component Option, and Stemmed Nonaugmentable Tibial Component Option).

Methods

From January 2008 to December 2010, 266 TKAs were performed in 169 patients with HBV (HBV group). A total of 169 propensity score–matched patients without HBV were chosen for the control group in a one-to-one ratio. Then, the clinical outcomes, mortalities, implant survival rates, and complications of TKA in the two groups were compared. The mean follow-up periods were 11.7 years (10.5 to 13.4) in the HBV group and 11.8 years (11.5 to 12.4) in the control group.

Methods

Incidence of revision and mortality for all primary UKAs performed from 1999 to 2019 (n = 13,481) was obtained from the New Zealand Joint Registry (NZJR). Lifetime risk of revision was calculated for patients and stratified by age, sex, and American Society of Anesthesiologists (ASA) grade.

Methods

We report factors that affect outcome on 526 patients undergoing MAT across two sites (one in the UK and one in Italy). Outcomes of interest were the Knee injury and Osteoarthritis Outcome Score four (KOOS4) at two years and failure rates. We performed multiple regression analysis to examine for factors affecting KOOS, and Cox proportional hazards models for survivorship.

Methods

A double-blinded, randomized placebo-controlled trial was performed with three groups receiving either placebo injections (Normal Saline), one PRP injection followed by two placebo injections, or three PRP injections. Each injection was given one week apart. Outcomes were prospectively collected prior to intervention and then at six weeks, three months, six months, and 12 months post-intervention. Primary outcome measures were Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQol five-dimension five-level index (EQ-5D-5L). Secondary outcomes included visual analogue scale for pain and patient subjective assessment of the injections.

Methods

A total of 501 consecutive AMOA patients (301 UKA) operated on between 2013 to 2016 in two high-volume centres were included. Centre One employed clinical guidelines for the treatment of AMOA allowing either UKA or TKA, but encouraged UKA wherever possible. Centre Two used clinical guidelines that treated all patients with a TKA, regardless of wear pattern. TKA patients were included if they had isolated AMOA on preoperative radiographs. Data were collected from both centres’ local databases. The primary outcome measure was change in Oxford Knee Score (OKS), and the proportion of patients achieving the patient-acceptable symptom state (PASS) at one-year follow-up. The data were 1:1 propensity score matched before regression models were used to investigate potential differences.

Methods

De-identified individual-level data on all revision knee arthroplasties performed in Australia from 2007 to 2017 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population data and life tables were obtained from the Australian Bureau of Statistics. The lifetime risk of revision surgery was calculated for each year using a standardized formula. Separate calculations were undertaken for males and females.

Methods

A multicentre randomized trial compared the outcomes of sensor balancing (SB) with manual balancing (MB) in 250 patients (285 TKAs). The primary outcome measure was the mean difference in the four Knee injury and Osteoarthritis Outcome Score subscales (ΔKOOS₄) in the two groups, comparing the preoperative and two-year scores. Secondary outcomes included intraoperative balance data, additional patient-reported outcome measures (PROMs), and functional measures.

Methods

A retrospective study was conducted on 1,061 TKAs performed from January 2016 to December 2019 with an image-based robotic-assisted system. Demographic data included age, sex, height, and weight. The femoral and tibial mechanical axis and the osteophyte volume were calculated from CT scans. These inputs were used to develop a predictive model aimed to predict operating time based on demographic data only, and demographic and 3D patient anatomy data.

Methods

A tibial component with (group S: Attune S+) and without (group A: Attune) additional cement pockets was implanted in 15 fresh-frozen human leg pairs. The relative motion was determined under dynamic loading (extension-flexion 20° to 50°, load-level 1,200 to 2,100 N) with subsequent determination of the maximum pull-out force. In addition, the cement mantle was analyzed radiologically for possible defects, the tibia base cement adhesion, and preoperative bone mineral density (BMD).

Methods

Radiostereometric analysis (RSA) data over a two-year period were available for 419 successful primary TKAs (267 cemented and 152 uncemented in 257 female and 162 male patients). Longitudinal analysis of data using marginal models was performed to examine the associations of patient factors (age, sex, BMI, smoking status) and implant factors (cemented or uncemented, the size of the implant) with maximum total point motion (MTPM) migration. Analyses were also performed on subgroups based on sex and fixation.

Methods

This single-centre study compared 169 consecutive patients with severe obesity (BMI ≥ 40 kg/m²) (mean age 65.2 years (40 to 87); mean BMI 44.2 kg/m² (40 to 66); 129/169 female) undergoing unilateral TKA to a propensity score matched (age, sex, preoperative Oxford Knee Score (OKS)) cohort with a BMI < 40 kg/m² in a 1:1 ratio. Demographic data, comorbidities, and complications to one year were recorded. Preoperative and one-year patient-reported outcome measures (PROMs) were completed: EuroQol five-dimension three-level questionnaire (EQ-5D-3L), OKS, pain, and satisfaction. Using national life expectancy data with obesity correction and the 2020 NHS National Tariff, QALYs (discounted at 3.5%), and direct medical costs accrued over a patient’s lifetime, were calculated. Probabilistic sensitivity analysis (PSA) was used to model variation in cost/QALY for each cohort across 1,000 simulations.

Methods

A total of 76 patients (34 bi-UKA and 42 TKA patients) were analyzed in a prospective, single-centre, randomized controlled trial. Flat ground shod gait analysis was performed preoperatively and one year postoperatively. Knee flexion moment was calculated from motion capture markers and force plates. The same setup determined proprioception outcomes during a joint position sense test and one-leg standing. Surgery allocation, surgeon, and secondary outcomes were analyzed for prediction of the primary outcome from a binary regression model.

Methods

We performed a retrospective review of 75 patients from a single institution who underwent DFA for non-neoplastic indications, including aseptic loosening or mechanical failure of a previous prosthesis (n = 25), periprosthetic joint infection (PJI) (n = 23), and native or periprosthetic distal femur fracture or nonunion (n = 27). Patients with less than 24 months’ follow-up were excluded. We collected patient demographic data, complications, and reoperations. Reoperation for implant failure was used to calculate implant survivorship.