Adenosine, lidocaine, and Mg2+ (ALM) therapy exerts differential immuno-inflammatory responses in males and females early after anterior cruciate ligament (ACL) reconstruction (ACLR). Our aim was to investigate sex-specific effects of ALM therapy on joint tissue repair and recovery 28 days after surgery. Male (n = 21) and female (n = 21) adult Sprague-Dawley rats were randomly divided into ALM or Saline control treatment groups. Three days after ACL rupture, animals underwent ACLR. An ALM or saline intravenous infusion was commenced prior to skin incision, and continued for one hour. An intra-articular bolus of ALM or saline was also administered prior to skin closure. Animals were monitored to 28 days, and joint function, pain, inflammatory markers, histopathology, and tissue repair markers were assessed.Aims
Methods
Uni-compartmental knee replacement (UKR) has become popularised due to quicker recovery times, reduced postoperative pain, and blood loss. The desire to increase bed capacity and reduce costs, while preserving safety and patient satisfaction, has led to increased interest in day-case arthroplasty. This study observes the feasibility of UKR as a day-case procedure and whether this affects short and long-term postoperative outcomes. Between 2018 and 2021, at a single institution and operated by a single orthopaedic surgeon, seventy-seven patients received a UKR on an elective basis. The patients were divided into two groups: ‘day-case’ for those discharged on the same day, and ‘non day-case’ group.Abstract
Introduction
Methodology
Total knee replacement (TKR) in patients with skeletal dysplasia is technically challenging surgery due to deformity, joint contracture, and associated co-morbidities. The aim of this study is to follow up patients with skeletal dysplasia following a TKR. We retrospectively reviewed 22 patients with skeletal dysplasia who underwent 31 TKRs at our institution between 2006 and 2022. Clinical notes, operative records and radiographic data were reviewed.Abstract
Introduction
Methodology
Total knee replacement (TKR) is a successful operation for many patients, however 15–20% of patients experience chronic post-surgical pain (CPSP). Many will experience neuropathic characteristics. We describe the prevalence and patterns of neuropathic pain in a cohort of patients with CPSP three months after TKR. Between 2016–2019, 363 patients with troublesome pain, ≤14 on Oxford Knee score pain subscale, at three months after TKR from eight NHS hospitals were recruited into the Support and Treatment After Replacement (STAR) trial. Self-reported neuropathic pain was assessed at three, nine and fifteen months after surgery using painDETECT and Douleur Neuropathique 4 (DN4).Abstract
Introduction
Methodology
Choosing a hinged implant in the revision knee arthroplasty (rTKA) setting is challenging and limited data on implant performance exists. We present the survivorship and reason for failure in rTKA performed at our institution using the LINK hinge prosthesis, predominantly the cemented modular Endo-Model prosthesis. 260 consecutive revision knee cases performed between 2012 and 2020 were reviewed retrospectively. Mean follow up was 27 months (range 0 to 107). Survivorship was analysed in Stata using a Log Rank test to compare performance in patients stratified according to age (≥80 years old (76 cases), 70–79 years (104 cases) and ≤70 years (80 cases).Abstract
Introduction
Methodology
There is currently very little evidence which can be used to guide surgeons treating skeletally immature patients with suspected meniscal injury. The aim of our modified Delphi study was to develop comprehensive recommendations for the management of isolated meniscal tears in skeletally immature children. An international, two round, modified Delphi consensus was completed. Included ‘experts’ were identified as having an established adult and/or paediatric knee practice and either: 1) Faculty at the international kid's knee meeting, 2) Active member of the complex national paediatric MDT group, or 3) faculty on recognised national course aimed at teaching knee surgeons regarding the management of meniscal lesions. A threshold of 70% was used to identify consensus.Abstract
Introduction
Methodology
Secondary osteonecrosis of the knee affects young population and causes bilateral extensive lesions. Arthroplasty is the last resort in younger population and joint preserving options questionable in pathological bone. Conservative measures have shown failure in multiple studies and hence no gold standard treatment advocated. We aimed at identifying and analysing various treatment options for secondary osteonecrosis with respect to the outcomes and studying features of symptomatic secondary osteonecrosis with regards to demographic pattern, radiological features and causative factors. A systematic review of literature was performed in accordance with the Cochrane handbook for systematic reviews and reported according to the PRISMA guidelines.Abstract
Introduction
Methods
The knee is the most commonly injured joint in sporting accidents. They cause substantial disability, time off work and long-term problems. There remains a limited number of high-quality randomised controlled trials assessing first time, acute soft tissue knee injuries. Key areas requiring answers include prevention, diagnosis, treatment, rehabilitation and delivery of care. In association with the James Lind Alliance, this BASK, BOSTAA and BOA supported prioritising exercise was undertaken over a year. The James Lind Alliance methodology was followed. An initial survey invited patients and healthcare professionals to submit their uncertainties regarding soft tissue knee injury prevention, diagnosis, treatment, rehabilitation and delivery of care. Over 1000 questions were submitted. Seventy-four questions were formulated to encompass common concerns. These were checked against best available evidence. Following the interim survey, 27 questions were taken forward to the final workshop in January 2023, where they were discussed, ranked and scored in multiple rounds of prioritisation by groups of healthcare professionals, patients and carers.Abstract
Introduction
Methodology
Oxidized zirconium (OxZr) has been introduced as an alternative bearing for femoral components in Total Knee Arthroplasty (TKA). It has a ceramic-like zirconium oxide outer layer with a low coefficient of friction. Early studies have found OxZr TKA to have a low incidence of early failure in young high demand patients. Currently no study has reported on the outcome of these implants beyond ten years. The purpose of our study was to present an in-depth 15-year survival analysis of cemented Profix II OxZr TKA.Abstract
Background
Objectives
Mid-flexion instability may cause poor outcomes following TKA. Surgical technique, patient-specific factors, and implant design could all contribute to it, with modelling and fluoroscopy data suggesting the latter may be the root cause. However, current implants all pass the preclinical stability testing standards, making it difficult to understand the effects of implant design on instability. We hypothesized that a more physiological test, analysing functional stability across the range of knee flexion-extension, could delineate the effects of design, independent of surgical technique and patient-specific factors. Using a SIMvitro-controlled six-degree-of-freedom robot, a dynamic stability test was developed, including continuous flexion and reporting data in a trans-epicondylar axis system. 3 femoral geometries were tested: gradually reducing radius, multi-radius and single-radius, with their respective tibial inserts. 710N of compression force (body weight) was applied to the implants as they were flexed from 0–140° with three levels of anterior/posterior (AP) tibial force applied (−90N,0N,90N).Abstract
Introduction
Methods
The aim of this study was to determine which factors affect a professional footballer's return to play performance level after ACL reconstruction (ACL-R). Additionally, to report their playing performance at 2 and 5 years post ACL-R compared to their preinjury performance. A retrospective review of a consecutive series of primary ACL-R undertaken in professional footballers between 2005 and 2019 was undertaken. Performance was determined by the number of minutes played and the league level compared to their pre-injury baseline. Playing time (minutes) was classified as same (within 20%), more, or less playing time for each season compared to the one year prior to surgery.Abstract
Introduction
Methods
Previous research has shown that, notwithstanding ligament healing, properly selected MCL reconstruction can restore normal knee stability after MCL rupture. The hypothesis of this work was that it is possible to restore knee stability (particularly valgus and AMRI) with simplified and/or less-invasive MCL reconstruction methods. Nine unpaired human knees were cleaned of skin and fat, then digitization screws and optical trackers were attached to the femur and tibia. A Polaris stereo camera measured knee kinematics across 0o-100o flexion when the knee was unloaded then with 90N anterior-posterior force, 9Nm varus-valgus moment, 5Nm internal-external rotation, and external+anterior (AMRI) loading. The test was conducted for the following knee conditions: intact, injured: transected superficial and deep MCL (sMCL and dMCL), and five reconstructions: (long sMCL, long sMCL+dMCL, dMCL, short sMCL+dMCL, short sMCL), all based on the medial epicondyle isometric point and using 8mm tape as a graft, with long sMCL 60mm below the joint line (anatomical), short sMCL 30mm, dMCL 10mm (anatomical).Abstract
Introduction
Methods
Osteotomy is recognised treatment for osteoarthritis of the knee. Evidence suggests favourable outcomes when compared to arthroplasty, for younger and more active individuals[1]. Double level osteotomy (DLO) is considered when a single level is insufficient to restore both joint line obliquity and adequate realignment[2]. This paper aims to establish the functional outcomes up to two years post operatively for patients undergoing DLO, using patient reported outcome measures (PROMs). All patients who underwent a DLO at either Lister Hospital, Stevenage, or One Hatfield Hospital, Hertfordshire, between 1st January 2018 and 1st October 2020 were identified. DLO were performed by two specialist consultants, independently or in combination. PROMs including pain scores, health score, Oxford knee score (OKS) and knee injury and osteoarthritis outcome score (KOOS) were recorded pre-operatively and at six month, one and two year post operative intervals.Abstract
Introduction
Methodology
The anatomic distal femoral locking plate (DF-LCP) has simplified the management of supracondylar femoral fractures with stable knee prostheses. Osteoporosis and comminution seem manageable, but at times, the construct does not permit early mobilization. Considerable soft tissue stripping during open reduction and internal fixation (ORIF) may delay union. Biological plating offsets this disadvantage, minimizing morbidity. Thirty comminuted periprosthetic supracondylar fractures were operated from October 2010 to August 2016. Fifteen (group A) were treated with ORIF, and fifteen (group B) with closed (biological) plating using the anatomical DF-LCP. Post-operatively, standard rehabilitation protocol was followed in all, with hinged-knee-brace supported physiotherapy. Clinico-radiological follow-up was done at 3 months, 6 months, and then yearly (average duration, 30 months), and time to union, complications, failure rates and function were evaluated.Abstract
INTRODUCTION
Materials
Multiligament knee injuries (MLKI) are devastating injuries that can result in significant morbidity and time away from sport. There remains considerable variation in strategies employed for investigation, indications for operative intervention, outcome reporting, and rehabilitation following these injuries. At present no study has yet provided a comprehensive overview evaluating the extent, range, and overall summary of the published literature pertaining to MLKI. Our aim is to perform a methodologically rigorous scoping review, mapping the literature evaluating the diagnosis and management of MLKI. This scoping review will address three aims: firstly, to map the current extent and nature of evidence for diagnosis and management of MLKI; secondly, to summarize and disseminate existing research findings to practitioners; and thirdly, to highlight gaps in current literature. A three-step search strategy as described by accepted methodology will be employed to identify peer-reviewed literature including reviews, technical notes, opinion pieces, and original research. An initial limited search will be performed to determine suitable search terms, followed by an expanded search of four electronic databases (MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Web of Science). Two reviewers will independently screen identified studies for final inclusion.Aims
Methods
Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality. Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality.Aims
Methods
The impact of a diaphyseal femoral deformity on knee alignment varies according to its severity and localization. The aims of this study were to determine a method of assessing the impact of diaphyseal femoral deformities on knee alignment for the varus knee, and to evaluate the reliability and the reproducibility of this method in a large cohort of osteoarthritic patients. All patients who underwent a knee arthroplasty from 2019 to 2021 were included. Exclusion criteria were genu valgus, flexion contracture (> 5°), previous femoral osteotomy or fracture, total hip arthroplasty, and femoral rotational disorder. A total of 205 patients met the inclusion criteria. The mean age was 62.2 years (SD 8.4). The mean BMI was 33.1 kg/m2 (SD 5.5). The radiological measurements were performed twice by two independent reviewers, and included hip knee ankle (HKA) angle, mechanical medial distal femoral angle (mMDFA), anatomical medial distal femoral angle (aMDFA), femoral neck shaft angle (NSA), femoral bowing angle (FBow), the distance between the knee centre and the top of the FBow (DK), and the angle representing the FBow impact on the knee (C’KS angle).Aims
Methods
The tibial component of total knee arthroplasty can either be an all-polyethylene (AP) implant or a metal-backed (MB) implant. This study aims to compare the five-year functional outcomes of AP tibial components to MB components in patients aged over 70 years. Secondary aims are to compare quality of life, implant survivorship, and cost-effectiveness. A group of 130 patients who had received an AP tibial component were matched for demographic factors of age, BMI, American Society of Anesthesiologists (ASA) grade, sex, and preoperative Knee Society Score (KSS) to create a comparison group of 130 patients who received a MB tibial component. Functional outcome was assessed prospectively by KSS, quality of life by 12-Item Short-Form Health Survey questionnaire (SF-12), and range of motion (ROM), and implant survivorships were compared. The SF six-dimension (6D) was used to calculate the incremental cost effectiveness ratio (ICER) for AP compared to MB tibial components using quality-adjusted life year methodology.Aims
Methods
This study aimed to explore the biological and clinical importance of dysregulated key genes in osteoarthritis (OA) patients at the cartilage level to find potential biomarkers and targets for diagnosing and treating OA. Six sets of gene expression profiles were obtained from the Gene Expression Omnibus database. Differential expression analysis, weighted gene coexpression network analysis (WGCNA), and multiple machine-learning algorithms were used to screen crucial genes in osteoarthritic cartilage, and genome enrichment and functional annotation analyses were used to decipher the related categories of gene function. Single-sample gene set enrichment analysis was performed to analyze immune cell infiltration. Correlation analysis was used to explore the relationship among the hub genes and immune cells, as well as markers related to articular cartilage degradation and bone mineralization.Aims
Methods
Classifying trochlear dysplasia (TD) is useful to determine the treatment options for patients suffering from patellofemoral instability (PFI). There is no consensus on which classification system is more reliable and reproducible for the purpose of guiding clinicians’ management of PFI. There are also concerns about the validity of the Dejour Classification (DJC), which is the most widely used classification for TD, having only a fair reliability score. The Oswestry-Bristol Classification (OBC) is a recently proposed system of classification of TD, and the authors report a fair-to-good interobserver agreement and good-to-excellent intraobserver agreement in the assessment of TD. The aim of this study was to compare the reliability and reproducibility of these two classifications. In all, six assessors (four consultants and two registrars) independently evaluated 100 axial MRIs of the patellofemoral joint (PFJ) for TD and classified them according to OBC and DJC. These assessments were again repeated by all raters after four weeks. The inter- and intraobserver reliability scores were calculated using Cohen’s kappa and Cronbach’s α.Aims
Methods
The aim of this study was to report the meaningful values of the EuroQol five-dimension three-level questionnaire (EQ-5D-3L) and EuroQol visual analogue scale (EQ-VAS) in patients undergoing primary knee arthroplasty (KA). This is a retrospective study of patients undergoing primary KA for osteoarthritis in a university teaching hospital (Royal Infirmary of Edinburgh) (1 January 2013 to 31 December 2019). Pre- and postoperative (one-year) data were prospectively collected for 3,181 patients (median age 69.9 years (interquartile range (IQR) 64.2 to 76.1); females, n = 1,745 (54.9%); median BMI 30.1 kg/m2 (IQR 26.6 to 34.2)). The reliability of the EQ-5D-3L was measured using Cronbach’s alpha. Responsiveness was determined by calculating the anchor-based minimal clinically important difference (MCID), the minimal important change (MIC) (cohort and individual), the patient-acceptable symptom state (PASS) predictive of satisfaction, and the minimal detectable change at 90% confidence intervals (MDC-90).Aims
Methods
Implantation of ultra-purified alginate (UPAL) gel is safe and effective in animal osteochondral defect models. This study aimed to examine the applicability of UPAL gel implantation to acellular therapy in humans with cartilage injury. A total of 12 patients (12 knees) with symptomatic, post-traumatic, full-thickness cartilage lesions (1.0 to 4.0 cm2) were included in this study. UPAL gel was implanted into chondral defects after performing bone marrow stimulation technique, and assessed for up to three years postoperatively. The primary outcomes were the feasibility and safety of the procedure. The secondary outcomes were self-assessed clinical scores, arthroscopic scores, tissue biopsies, and MRI-based estimations.Aims
Methods
Knowledge on total knee arthroplasties (TKAs) in patients with a history of poliomyelitis is limited. This study compared implant survivorship and clinical outcomes among affected and unaffected limbs in patients with sequelae of poliomyelitis undergoing TKAs. A retrospective review of our total joint registry identified 94 patients with post-polio syndrome undergoing 116 primary TKAs between January 2000 and December 2019. The mean age was 70 years (33 to 86) with 56% males (n = 65) and a mean BMI of 31 kg/m2 (18 to 49). Rotating hinge TKAs were used in 14 of 63 affected limbs (22%), but not in any of the 53 unaffected limbs. Kaplan-Meier survivorship analyses were completed. The mean follow-up was eight years (2 to 19).Aims
Methods
To identify variables independently associated with same-day discharge (SDD) of patients following revision total knee arthroplasty (rTKA) and to develop machine learning algorithms to predict suitable candidates for outpatient rTKA. Data were obtained from the American College of Surgeons National Quality Improvement Programme (ACS-NSQIP) database from the years 2018 to 2020. Patients with elective, unilateral rTKA procedures and a total hospital length of stay between zero and four days were included. Demographic, preoperative, and intraoperative variables were analyzed. A multivariable logistic regression (MLR) model and various machine learning techniques were compared using area under the curve (AUC), calibration, and decision curve analysis. Important and significant variables were identified from the models.Aims
Methods
In-hospital length of stay (LOS) and discharge dispositions following arthroplasty could act as surrogate measures for improvement in patient pathways, and have major cost saving implications for healthcare providers. With the ever-growing adoption of robotic technology in arthroplasty, it is imperative to evaluate its impact on LOS. The objectives of this study were to compare LOS and discharge dispositions following robotic arm-assisted total knee arthroplasty (RO TKA) and unicompartmental arthroplasty (RO UKA) versus conventional technique (CO TKA and UKA). This large-scale, single-institution study included patients of any age undergoing primary TKA (n = 1,375) or UKA (n = 337) for any cause between May 2019 and January 2023. Data extracted included patient demographics, LOS, need for post anaesthesia care unit (PACU) admission, anaesthesia type, readmission within 30 days, and discharge dispositions. Univariate and multivariate logistic regression models were also employed to identify factors and patient characteristics related to delayed discharge.Aims
Methods
The aim of this study was to assess factors associated with the estimated lifetime risk of revision surgery after primary knee arthroplasty (KA). All patients from the Scottish Arthroplasty Project dataset undergoing primary KA during the period 1 January 1998 to 31 December 2019 were included. The cumulative incidence function for revision and death was calculated up to 20 years. Adjusted analyses used cause-specific Cox regression modelling to determine the influence of patient factors. The lifetime risk was calculated as a percentage for patients aged between 45 and 99 years using multiple-decrement life table methodology.Aims
Methods
Total knee arthroplasty (TKA) may provoke ankle symptoms. The aim of this study was to validate the impact of the preoperative mechanical tibiofemoral angle (mTFA), the talar tilt (TT) on ankle symptoms after TKA, and assess changes in the range of motion (ROM) of the subtalar joint, foot posture, and ankle laxity. Patients who underwent TKA from September 2020 to September 2021 were prospectively included. Inclusion criteria were primary end-stage osteoarthritis (Kellgren-Lawrence stage IV) of the knee. Exclusion criteria were missed follow-up visit, post-traumatic pathologies of the foot, and neurological disorders. Radiological angles measured included the mTFA, hindfoot alignment view angle, and TT. The Foot Function Index (FFI) score was assessed. Gait analyses were conducted to measure mediolateral changes of the gait line and ankle laxity was tested using an ankle arthrometer. All parameters were acquired one week pre- and three months postoperatively.Aims
Methods
The mid-term results of kinematic alignment (KA) for total knee arthroplasty (TKA) using image derived instrumentation (IDI) have not been reported in detail, and questions remain regarding ligamentous stability and revisions. This paper aims to address the following: 1) what is the distribution of alignment of KA TKAs using IDI; 2) is a TKA alignment category associated with increased risk of failure or poor patient outcomes; 3) does extending limb alignment lead to changes in soft-tissue laxity; and 4) what is the five-year survivorship and outcomes of KA TKA using IDI? A prospective, multicentre, trial enrolled 100 patients undergoing KA TKA using IDI, with follow-up to five years. Alignment measures were conducted pre- and postoperatively to assess constitutional alignment and final implant position. Patient-reported outcome measures (PROMs) of pain and function were also included. The Australian Orthopaedic Association National Joint Arthroplasty Registry was used to assess survivorship.Aims
Methods
The aim of this study was to describe the pattern of revision indications for unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) and any change to this pattern for UKA patients over the last 20 years, and to investigate potential associations to changes in surgical practice over time. All primary knee arthroplasty surgeries performed due to primary osteoarthritis and their revisions reported to the Danish Knee Arthroplasty Register from 1997 to 2017 were included. Complex surgeries were excluded. The data was linked to the National Patient Register and the Civil Registration System for comorbidity, mortality, and emigration status. TKAs were propensity score matched 4:1 to UKAs. Revision risks were compared using competing risk Cox proportional hazard regression with a shared γ frailty component.Aims
Methods
The primary objective of this study was to compare the five-year tibial component migration and wear between highly crosslinked polyethylene (HXLPE) inserts and conventional polyethylene (PE) inserts of the uncemented Triathlon fixed insert cruciate-retaining total knee arthroplasty (TKA). Secondary objectives included clinical outcomes and patient-reported outcome measures (PROMs). A double-blinded, randomized study was conducted including 96 TKAs. Tibial component migration and insert wear were measured with radiostereometric analysis (RSA) at three, six, 12, 24, and 60 months postoperatively. PROMS were collected preoperatively and at all follow-up timepoints.Aims
Methods
This study aims to identify the top unanswered research priorities in the field of knee surgery using consensus-based methodology. Initial research questions were generated using an online survey sent to all 680 members of the British Association for Surgery of the Knee (BASK). Duplicates were removed and a longlist was generated from this scoping exercise by a panel of 13 experts from across the UK who provided oversight of the process. A modified Delphi process was used to refine the questions and determine a final list. To rank the final list of questions, each question was scored between one (low importance) and ten (high importance) in order to produce the final list.Aims
Methods
Conflicting clinical results are reported for the ATTUNE Total Knee Arthroplasty (TKA). This randomized controlled trial (RCT) evaluated five-year follow-up results comparing cemented ATTUNE and PFC-Sigma cruciate retaining TKAs, analyzing component migration as measured by radiostereometric analysis (RSA), clinical outcomes, patient-reported outcome measures (PROMs), and radiological outcomes. A total of 74 primary TKAs were included in this single-blind RCT. RSA examinations were performed, and PROMs and clinical outcomes were collected immediate postoperatively, and at three, six, 12, 24, and 60 months’ follow-up. Radiolucent lines (RLLs) were measured in standard anteroposterior radiographs at six weeks, and 12 and 60 months postoperatively.Aims
Methods
The aim of this study was to compare the preinjury functional scores with the postinjury preoperative score and postoperative outcome scores following anterior cruciate ligament (ACL) reconstruction surgery (ACLR). We performed a prospective study on patients who underwent primary ACLR by a single surgeon at a single centre between October 2010 and January 2018. Preoperative preinjury scores were collected at time of first assessment after the index injury. Preoperative (pre- and post-injury), one-year, and two-year postoperative functional outcomes were assessed by using the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Score, and Tegner Activity Scale.Aims
Methods
The aims of our systematic review were to assess the Nickel sensitising potential of total knee arthroplasty (TKA), explore the relationship between Nickel hypersensitivity and clinical outcomes, and evaluate the utility of skin patch testing pre- and/or post-operatively. A literature search was performed through EMBASE, Medline and PubMed databases. Articles were screened independently by two investigators. Levels of Evidence were assessed using Oxford CEBM criteria and quality was assessed using MINORS and Cochrane risk-of-bias tools.Abstract
Introduction
Methodology
Cementless total knee arthroplasty (TKA) offers a number of conceptual benefits including osteointegration, bone preservation and reduced aseptic loosening from third body wear. Evidence of equivalence to cemented fixation exists, but the cam-post interaction of posterior-stabilised (PS)-TKA on implant osteointegration remains uncertain. This study aims to assess the survivorship of a single prosthesis PS-TKA. All patients undergoing a PS-TKA using the Triathlon Total Knee System (Stryker Orthopaedics, USA) between 01/01/2010 and 08/04/2019, with exposure to at least 2 years’ risk of revision were identified from the hospital database.Abstract
Introduction
Methodology
To investigate the impact medial opening wedge high tibial osteotomy (MOWHTO) has on the progression of patellofemoral OA, patella height and contact pressure within the patellofemoral joint (PF). A systematic review was conducted in January 2022 according to PRISMA guidelines. Each study was graded as per the MINORS criteria for non-randomised trials. The ICRS cartilage grade of the PF joint at the initial MOWHTO surgery and at second look surgery was compared and relative risk of progression of PF OA was calculated. Evaluation of patella height was assessed by Caton-Deschamps index, Blackburne-Peel index or Insall-Salvati ratio pre and post MOWHTO. Cadaveric studies assessing contact pressures in the PF after MOWHTO were included.Abstract
Introduction
Methods
Whilst short and mid-term activity levels after a Total Knee Replacement (TKR) have been reported in the literature; there is an over simplification of the reporting and longer-term activity levels are unknown. The aim of this study was to map the long-term trajectories of patients’ physical activity levels postoperatively to identify meaningful subgroups and explore associations with preoperative variables. This was a secondary analysis of a single centre longitudinal cohortstudy using group-based trajectory modelling (GBTM) of the University of California, Los Angeles (UCLA) physical activity score over ten years. Multinomial logistic regression models (both adjusted and unadjusted) were used to test associations between preoperative variables and trajectory group membership.Abstract
Aims
Methods
Knee arthrodesis is one of the treatment options for limb salvage of a failed total knee replacement (TKR) when further revisions were contraindicated. The aim of this study is to determine patient outcomes after knee arthrodesis (KA) following a failed TKR. A literature search was conducted for studies published from January 2000 through January 2022 via Medline, Web of Science, Embase and Cochrane databases. Only primary research studies were included with independent extraction of articles by two reviewers. Results were synthesised by narrative review according to PRISMA guidelines, with full tabulation of all included study results.Abstract
Introduction
Methodology
The objective of this study was to determine rates of serious adverse events in patients undergoing revision knee arthroplasty with consideration of the indication for revision and compare these with primary knee arthroplasty. Primary and revision arthroplasty procedures were identified in the national Hospital Episode Statistics and were linked by patient and side. A logistic regression model was used to investigate factors associated with 90-day mortality (primary outcome) and secondary serious adverse outcomes. Urgent indications for revision arthroplasty were defined as infection or fracture; other indications (e.g. loosening, instability, wear) were included in the elective cohort.Abstract
Introduction
Methodology
The association between body mass index (BMI) and venous thromboembolism (VTE) is well studied, but remains unclear in the literature. We aimed to determine whether morbid obesity (BMI≥40) was associated with increased risk of VTE following total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA), compared to those of BMI<40. Between January 2016 and December 2020, our institution performed 4506 TKAs and 449 UKAs. 450 (9.1%) patients had a BMI≥40. CT pulmonary angiography (CTPA) for suspected pulmonary embolism (PE) and ultrasound scan for suspected proximal deep vein thrombosis (DVT) were recorded up to 90 days post-operatively.Abstract
Aims
Methods
In revision knee arthroplasty, rotating hinge implants (RHK) have been considered to result in higher complication rates and lower survivorship when compared to constrained condylar implants (CCK). The aims of this study were to compare patient reported outcome measures (PROMs), complication rates and survivorship of RHK and CCK used in revision arthroplasty at a single, high volume elective orthopaedic centre with previously validated bespoke database. One hundred and eight patients who underwent revision knee arthroplasty with either CCK or RHK and matched our inclusion criteria were identified. EQ5D, Health State and Oxford Knee Scores were collected pre-operatively and at 1 year post-operatively. Complication data was collected at 6 weeks, 6 months, 1 year and 2 years post-operatively. NJR data was interrogated, in addition to our own database, to investigate implant survival.Abstract
Introduction
Methodology
Fractures of the articular surface of the patella or the lateral femoral condyle usually occur following acute dislocation of the patella. This study looked at the radiological and functional outcomes of fixation of osteochondral fractures Twenty-nine patients (18 male, 11 female) sustained osteochondral fractures of the knee following patellar dislocation. All patients had detailed radiographic imaging and MRI scan of the knee preoperatively. An arthroscopic assessment was done, followed by fixation using bio-absorbable pins or headless screws either arthroscopically or mini-open arthrotomy. VMO plication or MPFL repair were done if necessary. MRI scan was done at follow-up to assess for healing of the fixed fragment prior to patient discharge.Abstract
Introduction
Methods
The number of total knee replacements (TKRs) performed continues to increase and is marked in patients under the age of 60. Increased number of younger patients raises concerns about potentially increased rates of implant failure or revision. Previous studies used small cohorts with only short to medium term follow-up. This study is the largest of its kind reporting long term outcomes and clinical survivorship of patients 50 years or less undergoing TKR. This is a retrospective cohort study using data from the Scottish Arthroplasty Project. A total of 3727 patients 50 years or less undergoing TKR between 2000 and 2019. Data was also collected for the same time period on patients aged 50–79 years undergoing TKR for comparison.Abstract
Introduction
Methods
The use of MCL “pie-crusting” (selective release of the superficial MCL) to improve arthroscopic access to the posteromedial compartment of the knee for isolated meniscal surgery has been demonstrated. However, there are concerns that MCL pie-crusting with concomitant ACL reconstruction (ACLR) might affect knee stability and outcomes postoperatively. The aim of this study was to compare the functional outcomes between patients who underwent MCL pie-crusting at ACLR with those that did not. We performed a retrospective review of prospectively collected data from on the National Ligament Registry. 55 patients (33 male and 22 female) who had MCL pie-crusting(PC group) to address a meniscal lesion at the time of ACLR were compared with 65 patients (38 male and 27 female) who underwent isolated primary ACLR. All procedures were performed by a single surgeon at a tertiary centre between October 2013 and March 2019.Abstract
Introduction
Methods
Patella Baja is a known complication of TKR. In this study, we report the effect of the senior author's change of practice from total excision to minimal resection of Hoffa's fat pad on patellar height. Retrospective analysis of a prospective series of TKRs performed or directly supervised by the senior author. Group 1 included 72 patients performed before April 2011 who had complete excision of Hoffa's fat pad to improve exposure during their TKR procedures. Group 2 included 138 patients performed after April 2011 who had the minimum excision of Hoffa's fat pad to allow exposure. There were no other changes in surgical technique, implant choice or rehabilitation protocol during this time. Patellar height was measured using the Caton–Deschamps Index (CDI) on standard lateral radiographs immediately postoperative and at a minimum follow up of 1 year.Abstract
Introduction
Methods
Unicompartmental knee arthroplasty (UKA) is an effective treatment for late knee osteoarthritis (OA). However, its indications remain controversial. Young age (< 60 years) has been associated with worse outcomes. The goal of this systematic review and meta-analysis is to study the effect of age on UKA outcomes. The primary objective was to compare the UKA revision rate in young patients with that of old patients, using the age thresholds of 60 and 55 years. Secondary objectives were patient-reported outcome measures (PROMs) and implant design. PubMed, Ovid, Web of Science, Google Scholar, and Cochrane library were searched in June 2021. This review was conducted in accordance with the PRISMA guidelines (PROSPERO registration number: CRD42021248322).Abstract
Purpose
Methods
Periprosthetic joint infection (PJI) is a common cause of revision total knee surgery. Although debridement and implant retention (DAIR) has lower success rates in the chronic setting, it is an accepted treatment for acute PJI. There are two broad DAIR strategies: single debridement or a planned double debridement performed days apart. The purpose of this study is to evaluate the cost-effectiveness of single versus double DAIR with antibiotic beads for acute PJI in total knee arthroplasty (TKA). A decision tree using single or double DAIR as treatment strategies for acute PJI was constructed. Quality Adjusted Life Years (QALYs) and costs associated with the two treatment arms were calculated. Treatment success rates, failure rates, and mortality rates were derived from the literature. Medical costs were derived from both the literature and Medicare data. A cost-effectiveness plane was constructed from multiple Monte Carlo trials. A sensitivity analysis identified parameters most influencing the optimal strategy decision.Abstract
Introduction
Methodology
Cementless fixation of Oxford Unicompartmental Knee Replacements (UKRs) is an alternative to cemented fixation, however, it is unknown whether cementless fixation is as good long-term. This study aimed to compare primary and long-term fixation of cemented and cementless Oxford UKRs using radiostereometric analysis (RSA). Twenty-nine patients were randomised to receive cemented or cementless Oxford UKRs and followed for ten years. Differences in primary fixation and long-term fixation of the tibial components (inferred from 0/3/6-month and 6-month/1-year/2-year/5-year/10-year migration, respectively) were analysed using RSA and radiolucencies were assessed on radiographs. Migration rates were determined by linear regression and clinical outcomes measured using the Oxford Knee Score (OKS).Abstract
Introduction
Methodology
The UK National Joint Registry(NJR) has not reported total knee replacement (TKR)survivorship based on design philosophy alone, unlike its international counterparts. We report outcomes of implant survivorship based on design philosophy using data from NJR's 2020 annual report. All TKR implants with an identifiable design philosophy from NJR data were included. Cumulative revision data for cruciate-retaining(CR), posterior stabilised(PS), mobile-bearing(MB) design philosophies was derived from merged NJR data. Cumulative revision data for individual brands of implants with the medial pivot(MP) philosophy were used to calculate overall survivorship for this design philosophy. The all-cause revision was used as the endpoint and calculated to 15 years follow-up with Kaplan-Meier curves.Abstract
Introduction
Methodology
The aim of this study was to report patient and clinical outcomes following robotic-assisted total knee arthroplasty (RA-TKA) at multiple institutions with a minimum two-year follow-up. 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.Aims
Methods