Introduction

The optimal alignment technique for total knee replacement (TKR) remains controversial. We previously reported six-month and two-year results of a randomized controlled trial comparing kinematically (KA) versus mechanically (MA) aligned TKR. In the present study, we report 12-year results from this trial.

Methods

The original cohort included 88 TKRs (44 KA using Shape Match patient-specific guides and 44 MA using conventional instrumentation), performed from 2008 to 2009. After IRB approval, the health record of the original 88 patients were queried. Revisions, re-operations, and complications were recorded. The non-deceased patients were contacted via phone. Reoperation and complications were documented via the patient's history. Further, a battery of patient-reported outcome measures (including patient satisfaction, WOMAC, Oxford, KOOS Jr, Forgotten Joint Score, and M-SANE) were obtained.

Introduction

Isolated patellofemoral osteoarthritis accounts for 10% of knee osteoarthritis. Many of these will not require arthroplasty solutions, but for those who are sufficiently symptomatic, patellofemoral joint (PFJ) replacement has been shown to be an effective procedure. The National Joint Registry (NJR) has shown a higher revision rate for this operation, particularly in younger patients (males <55 years 13.3% failure at 5 years, females 9.6%). The aim of this study is to report on the medium-term outcome of the Avon patellofemoral joint arthroplasty in patients under 55 from a non-design centre. There is no other published case series on this young patient cohort.

Methodology

50 Avon PFJ replacements (Stryker, Kalamazoo USA) were undertaken in 46 patients under 55 years old (range 35 – 54, mean 48.8) between 2010 and 2022 for end-stage isolated PFJ arthritis shown on Xray and MRI scan. The outcome measure was all-cause revision rate. This was assessed by review of clinical notes, imaging and NJR data.

Background

Autologous chondrocyte implantation is a NICE approved intervention however it involves the morbidity of two operations, a prolonged rehabilitation and substantial healthcare costs. This study describes a novel, one-step, bone marrow (BM) derived mesenchymal stem cell (MSC) transplantation technique for treating knee osteochondral lesions and presents our prospective clinical study investigating the success of this technique in 206 lesions over a 5 year period.

Methodology

The surgical technique involves harvesting BM from patients’ anterior superior iliac spines, centrifugation to isolate MSCs and seeding into a type 1 collagen scaffold (SyngenitTM Biomatrix). Autologous fibrin glue is used to secure the scaffold into the defect. Inclusion criteria included patients aged 15 – 55 years old with symptomatic osteochondral lesions >1cm2. Exclusion criteria included patients with ligament instability, uncorrected alignment, inflammatory arthropathy and a Body Mass Index >35 kg/m2. Outcome measures included the Modified Cincinnati Knee Rating System (MCKRS), complications and reoperations.

Introduction

A lipohaemarthrosis seen on Horizontal beam lateral X-ray in acute knee injury is often considered predictive of an intra-articular fracture requiring further urgent imaging.

Methodology

We retrospectively searched a five-year X-ray database for the term “lipohaemarthrosis”. We excluded cases if the report concluded “no lipohaemarthrosis” or “lipohaemarthrosis” AND “fracture”. All remaining cases were reviewed by an Orthopaedic Consultant with a special interest in knee injuries (AD) blinded to the report. X-rays were excluded if a fracture was seen, established osteoarthritic change was present, a pre-existing arthroplasty present or no lipohaemarthrosis present. Remaining cases were then studied for any subsequent Radiological or Orthopaedic surgical procedures.

Introduction

This study compared biomechanical and functional parameters of a total knee arthroplasty (TKA) implant (Cemented Zimmer Hi-Flex) against healthy older adults to determine whether knee biomechanics was restored in this patient population.

Methodology

Patients with a primary TKA and healthy adults >55 years old with no musculoskeletal deficits or arthritis participated. Bilateral knee range of motion (RoM) was assessed with a goniometer, then gait patterns were analysed with a 3D motion-capture system. An arthrometer then quantified anterior-posterior laxity of each knee. Statistical analyses were performed in SPSS (α=0.05; required sample size: n=21 per group).

Introduction

The study aims were to demonstrate rates, level, and time taken to RTP in elite sports after ACL reconstruction (ACL-R) and compare football and rugby.

Methods

A retrospective review of a consecutive series of ACL-R between 2005 and 2019 was undertaken. Patients were included if they were elite athletes and were a minimum of 2 years post primary autograft ACL-R. The outcomes measured were return to play (RTP), (defined as participation in a professional match or in national/ international level amateur competition), time to RTP after surgery, and RTP level (Tegner score).

Introduction

Patient selection is key to the success of medial unicondylar knee arthroplasty (UKA). Progression of arthritis is the most common indication for revision. Various methods of assessing the lateral compartment have been used including stress radiography, radioisotope bone scanning, MRI, and visualisation at the time of surgery. Arthroscopy is another means of assessing the integrity of the lateral compartment.

Methods

We used per-operative arthroscopy as a means to confirm suitability for UKA in a consecutive series of 279 Oxford medial UKA. This study reports the long-term results of a previously published cohort of knees. Our series of UKA with per-operative arthroscopy (Group 1) was compared to all Oxford UKA (Group 2) and all UKA in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) (Group 3).

Introduction

National BOAST guidelines have been developed to coordinate and improve the standard of care for all patients with problems after knee replacement surgery. Since the inception of these guidelines we wanted to assess the impact of these guidelines on patients and their pathways following their discussions at our weekly revision MDT meetings.

Methodology

Trust casenotes programs, PACS software and MDT notes were evaluated over the past 12 months (January 2022 to December 2022) to collect data for all patients with problematic knee replacements. Current in-patients discussed at MDT were excluded.

Background

Osteochondral allograft (OCA) transplantation is a clinically and cost-effective option for symptomatic cartilage defects. In 2017 we initiated a program for OCA transplantation for complex chondral and osteochondral defects as a UK tertiary referral centre.

Aim

To characterise the complications, re-operation rate, graft survivorship and clinical outcomes of knee OCA transplantation.

Introduction

Knee braces are limited to providing passive support. There is currently no brace available providing both continuous monitoring and active robot-assisted movements of the knee joint. This project aimed to develop a wearable intelligent motorised robotic knee brace to support and monitor rehabilitation for a range of knee conditions including post-surgical rehabilitation. This brace can be used at home providing ambulatory continuous passive movement obviating the need for hospital admissions.

Methodology

A wearable sensing system monitoring knee range of motion was developed to provide remote feedback to clinicians and real-time guidance for patients. A prototype of an exoskeleton providing dynamic motion assistance was developed to help patients complete their exercise goals and strengthen their muscles. The accuracy and reliability of those functions were validated in human participants during exercises including knee flexion/extension (FE) in bed and in chair, sit-to-stand and stand-to-sit.

Introduction

30-day emergency readmission is an indicator of treatment related complication once discharged, resulting in readmission. A board-approved quality improvement pathway was introduced to reduce elective re-admissions.

Method

The pathway involved telephone and email contact details provision to patients for any non-life threatening medical assistance, allowing for initial nurse led management of all issues. A new clinic room available 7 days, and same day ultrasound scanning for DVT studies were introduced. A capability, opportunity and behavior model of change was implemented.

Readmission rates before and six months after implementation were collected from Model Hospital. A database used to document patient communications was interrogated for patient outcomes.

Introduction

Patients presenting with loosening or a fracture between ipsilateral hip and knee replacements provide a unique reconstructive challenge. We present mid-term results of the cement-over megaprosthesis (COM) when managing these complex cases. A COM is cement-linked to the stem of a well-fixed existing implant. We report the largest series to date and show that this may be preferable to total femoral replacement in a cohort of patients who often have significant co-morbidities.

Methodology

A retrospective analysis of patients undergoing COM between 2002–2022 was performed. Primary outcomes were defined as implant survival, displayed with survival analysis. Secondary outcomes included mortality and surgical complications. Functional outcomes included Visual Analogue Score (VAS), EuroQol-5D-3L and Musculoskeletal Tumour Society (MSTS) score at one year post operatively.

Background

Meniscal tears affect 222 per 100,000 of the population and can be managed non-operatively or operatively with an arthroscopic partial meniscectomy (APM), meniscal repair or meniscal transplantation. The purpose of this review is to summarise the outcomes following treatment with a meniscal tear and explore correlations between outcomes.

Methodology

A systematic review was performed of MEDLINE, EMBASE, AMED and the Cochrane Central Register of Controlled Trials to identify prospective studies describing the outcomes of patients with a meniscal tear. Comparisons were made of outcomes between APM and non-operative groups. Outcomes were graphically presented over time for all treatment interventions. Pearson's correlations were calculated between outcome timepoints.

Introduction

Recent research has questioned the role of arthroscopic meniscectomy in patients with a meniscal tear leading to the development of treatment recommendations for these patients. There is a clear need to understand patient perceptions of living with a meniscal tear in order to plan future research and treatment guidelines.

Aims

To explore the experiences and expectations of treatment of young patients with a meniscal tear of the knee

Introduction

In cementless UKR, early post-operative tibial fractures are 7x more common in very small tibias. A smaller keel has been shown to reduce this fracture risk, but its effect on fixation is unassessed. This mechanical study assesses the effect of keel interference and size on sagittal micromotion of the tibial component in physiological loading positions.

Method

A high-resolution Digital Image Correlation setup was developed and validated to an accuracy of 50 micrometres. Variants of tibial components were 3D-printed: standard, no-interference, no-keel, and a new small keel. Components were implanted into bone-analogue foam which was machined to a CT-reconstructed small tibia, using surgical technique. Tibias were loaded to 200N in physiological loading positions: 8mm (step-up) and 15mm (lunge) posterior to midpoint, and micromotion was assessed.

Introduction

Adverse reactions to pain medication and pain can delay discharge after outpatient knee arthroplasty (TKA). Pharmacogenomics is an emerging tool that might help reduce adverse events by tailoring medication use based on known genetic variations in the CYP genes determining drug metabolism. This study was undertaken to evaluate whether pre-operative pharmacogenomic testing could optimize peri-operative pain management in patients undergoing total knee arthroplasty (TKA).

Methods

This prospective, randomized study was performed in adults undergoing primary TKA. Patients in the experimental group underwent pre-operative pharmacogenomic evaluation and medication adjustments. Medications were not optimized for control patients. The Overall Benefit of Analgesic Score (OBAS) at 24 hours post-op was the primary outcome. Postoperative pain scores (VAS scale), total opioid use, time in recovery, and time to discharge were also compared.

Introduction

Knee replacement surgery can greatly improve pain, disability, quality of life and ability to work. Socioeconomic deprivation is associated with multiple poor health outcomes, partly due to reduced access to services, including surgery. We investigated whether deprivation was associated with characteristics at presentation, and outcomes following knee arthroplasty.

Methodology

We linked data from 2358 knee arthroplasty cases with the Index of Multiple Deprivation, and mortality data after mean 7.6 years follow up. A locally developed scoring system was used prospectively to categorise case complexity.

Introduction

There is growing interest in the use of robotic Total Knee Arthroplasty (TKA) to improve accuracy of component positioning. This is the first study to investigate the radiological accuracy of implant component position using the ROSA® knee system with specific reference to Joint Line Height, Tibial Slope, Patella Height and Posterior Condylar Offset. As secondary aims we compared accuracy between image-based and imageless navigation, and between implant designs (Persona versus Vanguard TKA).

Methodology

This was a retrospective review of a prospectively-maintained database of the initial 100 consecutive TKAs performed by a high volume surgeon using the ROSA® knee system. To determine the accuracy of component positioning, the immediate post-operative radiograph was reviewed and compared with the immediate pre-operative radiograph with regards to Joint Line Height, Tibial Slope, Patella Height (using the Insall-Salvati ratio) and Posterior Condylar Offset.

Introduction

The Syn-VAR RCT is the first of its kind comparing hamstrings autograft v synthetic neoligament for MPFL reconstruction.

Our aim is to evaluate short and long term patient related outcomes measures (PROMs) following synthetic / autologous MPFL reconstruction in a heterogenous cohort of patients with recurrent patellar instability.

Method

20 patients meeting inclusion criteria were recruited and randomised. Standardised surgery was performed by a single surgeon in Altnagelvin Hospital with data collected over 3 years from 2016. Kujala score was the primary outcome measure with data captured preoperatively and 12 weeks/2 years postoperatively. Secondary outcomes included four other validated scores and complications including Norwich Patellar Instability, Lysholm, IKDC and Banff