Aims. Our primary aim was to establish the proportion of female orthopaedic consultants who perform arthroplasty via cases submitted to the
The
Introduction. Despite the increasing numbers of ankle replacements that are being performed there are still limited studies on the survival of ankle replacements and comparisons between different implants. The primary aim of this study is to link NJR data with NHS digital data to determine the true failure rates of ankle replacements. Secondary outcomes include analysis risk factors for failure, patient demographics and outcomes of individual prosthesis. Methods. A data linkage study combined
Electronic Health Records (EHRs) have benefits for hospitals and uptake in the UK is increasing. The
Introduction. The revision rate of unicompartmental knee replacement (UKR) in
Ceramic on ceramic (CoC) bearings in total hip arthroplasty (THA) are commonly used but concerns exist regarding ceramic fracture. This study aims to report the risk of revision for fracture of modern CoC bearings and identify factors that might influence this risk, using data from the
There is paucity of reliable data examining the treatment pathway for hip replacements over the life of the patient in terms of risk of revision and re-revisions. We did a retrospective observational registry-based study of the
Orthopaedic practice is increasingly guided by conclusions drawn from analysis of Joint Registry Data. Analysis of the England and Wales
Hip bearing surfaces materials are typically broadly reported in national registry (metal-on-polyethylene, ceramic-on-ceramic etc). We investigated the revision rates of primary total hip replacement (THR) reported in the
A recent French report suggested that cobalt metal ions released from total hip replacements (THRs) were associated with an increased risk of dilated cardiomyopathy and heart failure. If the association is causal the consequences would be significant given the millions of Orthopaedic procedures in which cobalt-chrome is used annually. We examined whether cobalt-chrome containing THRs were associated with an increased risk of all-cause mortality, heart failure, cancer, and neurodegenerative disorders. Data from the
We investigated the revision rates of primary total hip replacement (THR) reported in the
Background. Method of fixation in THA is a contentious issue, with proponents of either technique citing improved implant survival and outcomes. Current comparisons rely on insufficiently powered studies with short-term follow up or larger poorly controlled registry studies. Patient factors are considered a key variable contributing to the risk of implant failure. One way to overcome this confounder is to compare the survival of cementless and cemented THAs patients who have undergone bilateral THAs with cemented hip on one side and cementless hip on the other. We compared stem survival of patients who have bilateral THA with one cemented stem in one hip and a cementless stem in the contralateral hip in the
Patients need to know the benefits, risks and alternatives to any proposed treatment. Surgeons discussing the risk of a revision procedure becoming necessary, after a hip replacement can draw upon the orthopaedic literature and arthroplasty registries for long-term implant survival. However, early revision is required in a minority of cases. We have investigated the probability for revision hip replacement patients in terms of time-point and indication for revision. Of the 9,411 Primary Total Hip Replacements (THR), undertaken by 22 surgeons, over an eleven-year period, between January 2004 and March 2015, 1.70% (160) were subsequently reported to the
Abstract. Introduction. Component mal-positioning in total hip replacement (THR) and total knee replacement (TKR) can increase the risk of revision for various reasons. Compared to conventional surgery, relatively improved accuracy of implant positioning can be achieved using computer assisted technologies including navigation, patient-specific jigs, and robotic systems. However, it is not known whether application of these technologies has improved prosthesis survival in the real-world. This study aimed to compare risk of revision for all-causes following primary THR and TKR, and revision for dislocation following primary THR performed using computer assisted technologies compared to conventional technique. Methods. We performed an observational study using
Introduction. The
Current advice regarding implant choice is based on estimates of cost-benefit derived from implant survival to an endpoint of revision. Current estimates do not account for many implant failures which are treated with non-revision surgery and may not be accurate. The aim of this study was to estimate survival of major stem implant design groups to an endpoint of reoperation. Primary total hip replacement and linked revision form the
The
At the end of 2018, the NZ Joint Registry introduced a “Surgeon Outlier” policy, whereby each year, if an individual surgeons’ lower 95% confidence interval of their revision rate, measured in revision/100 component years(r/ocys), was above the NZ mean (0.71 r/ocys), that surgeon was required to audit their results with a nominated peer. This study investigates whether outlier surgeons also have high early (1 month and 1 year) revision rates. In 2018, 236 surgeons performed 9,186 total hip arthroplasties in NZ. At the end of 2018, 11 surgeons received notification they were outliers. Results from all surgeons for years 2016, 2017 and 2018 were combined to form the first (pre-notification) time interval, and results from years 2019, 2020 and 2021 were combined to form the second time interval (post-notification). Outlier surgeons performed 2001 total hip replacements in the first time interval and 1947 hips in the second. Early revision rates (1 month and 1 year) of both outlier and nonoutlier surgeons for both time intervals were analysed. Non-outlier surgeons had a consistent mean early revision rate of 0.75% at one month and 1.6% at one year for both time intervals. The 11 outlier surgeons had a higher earlier revision rate of 1.35% at one month and 2.45% at one year for the pre-notification time interval. These values reduced for the post-notification time interval to a revision rate of 1.23% for one month and 2.36% for one year. Poor joint registry results of individual surgeons are often attributed to a poor choice of prosthesis. This study shows early revision rates of outlier surgeons, where prosthesis selection has minimal influence, are also high. A slight improvement in early revision rates of outlier surgeons since introduction of the policy shows it is working.
Introduction. Unicompartmental knee replacement (UKR) offers advantages over total knee replacement but has higher revision rates particularly for aseptic loosening. Cementless UKR was introduced in an attempt to address this. We used
Purpose. To establish the reliability of reporting and recording revision hip and knee arthroplasties by comparing data in the
Computer aided Total Hip Arthroplasty (THA) surgery is known to improve implantation precision, but clinical trials have failed to demonstrate an improvement in survivorship or patient reported outcome measures (PROMs). Our aim was to compare the risk of revision, PROMs and satisfaction rates between computer guided and THA implanted without computer guidance. We used the
Total hip arthroplasty has been constantly evolving with technological improvements to achieve the best survival rates. Although the new implants are under closer surveillance through processes such as Beyond Compliance, orthopaedic surgeons generally tend to look out for the latest implants with good short-term results and hope for better long-term results for these. We questioned whether such an assumption or bias is valid. We analysed the data of Kaplan-Meier estimates of cumulative revisions of primary hip replacement by fixation, stem/cup brand and bearing combinations from the NJR 19th Annual Report published in September 2022. We performed a univariate linear regression analysis to predict the 10- and 15-year revision rates for these different hip implant combinations from the 3- and 5-year revision rates. Thirty-seven implant combinations had their 15-year revision rates reported and 67 had the 10-year revision rates. The correlation co-efficients were 0.43 and 0.58 for the 3-year and 5-year revision rates against 15-year revision rates. Only 17% of the variance in 15-year revision rates could be predicted by a linear regression model from the 3-year revision rate and 32% from the 5-year revision rate. Corresponding values for the 10-year revision rates were 46% and 67%. 95% prediction intervals for the 15-year revision rate were +/− 3.1% from the 3-year revision rate and +/− 2.8% from the 5-year revision rate. Corresponding values for the 10-year revision rates were +/− 1.3% and +/− 1%. 19 of 37 implant combinations showed 15-year revision rate of more than 4%. Average 3-year and 5-year revision rates for this cohort was 1.0% and 1.42% compared to 1.4% and 1.9% for the rest and the difference was statistically significant. Although average early revision rates showed small but significant difference between the groups with lower and higher 15-year revision rates, the prediction intervals for 15-year revision rates for individual hips based on their 3-year and 5-year revision rates are very wide. Three- and 5-year revision rates for primary total hip replacements are poor predictors of 15-year revision rates.
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
Background and study aim
Materials and methods
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 National Joint Registry for England, Wales and Northern Ireland
(NJR) has extended its scope to report on hospital, surgeon and
implant performance. Data linkage of the NJR to the London Implant
Retrieval Centre (LIRC) has previously evaluated data quality for
hip primary procedures, but did not assess revision records. We analysed metal-on-metal hip revision procedures performed
between 2003 and 2013. A total of 69 929 revision procedures from
the NJR and 929 revised pairs of components from the LIRC were included.Aims
Methods
Whilst total hip replacement (THR) is generally safe and effective, pre-existing medical conditions, particularly those requiring inpatient admission, may increase the risk of post-operative mortality. Delaying elective surgery may reduce the risk, but it is unclear how long a delay is sufficient. We analysed 958,145 primary THRs performed for solely osteoarthritis April 2003-December 2018, in the NJR linked to Hospital Episodes Statistics to identify inpatient admissions prior to elective THR for 17 conditions making up the Charlson index including myocardial infarction, congestive heart failure, cerebrovascular disease and diabetes. Crude analyses used Kaplan-Meier and adjusted analyses used Cox modelling. Patients were categorised for each co-morbidity into one of four groups: not recorded in previous five-years, recorded between five-years and six-months before THR, recorded six-months to three-months before THR, and recorded between three-months and day before surgery. 90-day mortality was 0.34% (95%CI: 0.33–0.35). In the 432 patients who had an acute MI in the three months before THR, this figure increased to 18.1% (95%CI 14.8, 22.0). Cox models observed 63 times increased hazard of death within 90-days if patients had an acute MI in the 3-months before their THR, compared to patients who had not had an MI in the five years before their THR (HR 63.6 (95%CI 50.8, 79.7)) This association reduced as the time between acute MI and THR increased. For congestive cardiac failure, the hazard in the same scenario was 18-times higher with a similar protective effect of delaying surgery. Linked NJR and HES data demonstrate an association between inpatient admission for acute medical co-morbidities and death within 90-days of THR. This association is greatest in MI, congestive cardiac failure and cerebrovascular disease with smaller associations observed in several other conditions including diabetes. The hazard reduces when longer delays are seen between the admission for acute medical conditions and THR in all diagnoses. This information will help patients with previous medical admissions and surgeons to determine optimal timing for surgery.
Mortality following hip arthroplasty is affected by a large number of confounding variables each of which must be considered to enable valid interpretation. The aim of this study was to establish whether it is possible to determine a true cause-and-effect relationship between the risk of mortality and data that are routinely collected by the NJR and to establish the degree to which variation in the mortality rate could be explained by each variable. Relevant variables available from the 2011 NJR data setwere included in a Cox model. We carried out two analyses: Firstly, we conducted an analysis of data collected from the NJR data set used in preparation of the NJR's 8th Annual Report (2011) looking for an association between the variables collected and the risk of mortality. Secondly, as social deprivation is also known to influence mortalityrates but is not routinely collected as part of the NJR data set, a further analysis was performed which included social deprivation data derived from partial postcodes. Mortality rates in hip arthroplasty patients were lower than in the age matched population across all hip types. Age at surgery, ASA grade, diagnosis, gender, provider type, hip type and lead surgeon grade all had a significant effect on mortality. Schemper's statistic showed that only 18.98% of the variation in mortality was explained by the variables available in the NJR data set. It is inappropriate to use Registry data to study an outcome affected by a multitude of confounding variables when these cannot be adequately accounted for in the available data set.
Prosthetic joint infections (PJI) are a devastating consequence in total hip arthroplasties (THA) with both significant morbidity and sometimes mortality, posing a significant health economic burden. Studies, both clinical and in-vitro have suggested possible reduction in PJI with the use of ceramic bearings. We have investigated the relationship of ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP) or metal-on-polyethylene (MoP) bearing surface in affecting outcome of revision surgery after primary THA using data collected from National Joint Registry for England and Wales, Northern Ireland and the Isle of Man between 2002 and 2016. We used a competing risk regression model to investigate predictors of each revision outcome, such as infection, dislocation, aseptic revision and all cause revisions. The results were adjusted for age, gender, ASA grade, BMI, indication for surgery, intraoperative complications and implant data. We identified 456,457 THA (228,786 MoP, 128,403 CoC and 99,268 CoP). In a multivariable model, the adjusted risk of revision for PJI was lower with CoC (OR-0.748, p<0.001) and CoP (OR-0.775, p<0.001) when compared to MoP bearing. Additionally there was also a significant reduction in the risk of all cause revision for CoC (OR-0.918, p=0.002) and CoP (0.806, p<0.001), bearings as compared with MoP. The protective effect of ceramic bearing was predominantly seen after two years of implantation with a significant (p<0.0001) reduction of revision for PJI in both CoC (by 42.8%) and CoP (by 41.3%) group. Similarly significant effect was seen for aseptic revision beyond two years and overall all cause revision rate beyond two years reduced by 21.6% for CoC and 27.1% for CoP (p<0.001). Within the limits of registry analysis, this study has demonstrated an association between the use of ceramic bearing and lower rates of revision for all cause revisions especially infection and aseptic loosening. This finding supports the use of ceramic bearings in THA.
The Exeter V40 femoral stem is the most implanted stem in the NJR for primary THA. In 2004, the 44/00/125 stem was released for use in “cement-in-cement” revision cases. It has however been used ‘off-label’ as a primary stem when, for example, patient anatomy requires a smaller stem with a 44mm offset. We aimed to investigate survival of this stem in comparison to others in the range when used in primary THAs recorded in the NJR. Analyses were performed using a dataset based on that used for the 2020 NJR annual report. Our exposure was the stem; the outcome was all-cause construct revision. Crude analyses were performed using Kaplan-Meier and adjusted using Cox models. The 44/00/125 stem was directly compared to other stems in the Exeter range. We analysed 330,732 primary THAs using the Exeter V40 stem comprising 34.5% of the 958,869 THAs with complete information from the start of the NJR to 31 December 2018. The 44/00/125 stem was implanted in 2,158 primary THAs with 67.5% in female patients and a mean age of 67.8. The 10-year revision estimate for the 44/00/125 stem was 4.9% (95%CI 3.6, 6.8) and in constructs using an Exeter V40 stem was 2.8% (95%CI 2.7, 2.8). Controlling for age, sex and ASA demonstrated an increased overall hazard of revision for constructs using the 44/00/125 stem compared to constructs using other Exeter V40 femoral stems (HR 1.8 (95%CI 1.4, 2.3)). Although the revision estimate is within the NICE 10-year benchmark, survivorship of constructs using the 44/00/125 stem appears to be lower than the rest of the Exeter V40 range. Attempts to control for age, sex and ASA will not take into account confounding by indication i.e. patients with more complex anatomy who may have a higher risk of revision. Surgeons and patients should be reassured by this but should be aware of the observed increased revision estimate and use the stem according to its indications.
THR is one of the most frequently performed operations nationally. A large number of prostheses are available, and the procedure is therefore associated with variation in practice and outcomes. NICE guidelines aim to standardise best practice, and are informed by separate, independent bodies, such as the NJR and ODEP, which monitor data about the implants used and their performance. This study aims to determine whether clinical practice and component use has changed since the publication of NJR data. NJR reports from 2006–2014 were analysed, with record made of the different prostheses used in THR, noting ODEP ratings of components used. Analysis was also performed by component type (i.e. cemented and cementless stems and cups), and combinations of components, according to their frequency of use in a given year. The Kruksal-Wallis test was used for statistical analysis.Introduction
Methods
The role of patellar resurfacing in total knee arthroplasty remains controversial. We questioned the effect of patellar resurfacing on the early and late revision rates after total knee arthroplasty. We analysed the data of cumulative revisions of primary knee replacement from the NJR 19th Annual Report. NJR included secondary patellar resurfacing as a revision. We compared differences in the 3-year and 15-year revision rates between the patellar resurfacing and non-resurfacing for the different combinations of total knee replacements using a paired t-test. We performed subgroup analysis for the five combinations with the highest volumes.Abstract
Introduction
Materials and Methods
Current analysis of unicondylar knee replacements (UKR) by national registries is based on the pooled results of medial and lateral implants. Using data from the National Joint Registry for England and Wales (NJR) we aimed to determine the proportion of lateral UKR implanted, their survival and reason for failure in comparison to medial UKR. By combining information on the side of operation with component details held on the NJR we were able to determine implant laterality (medial vs. lateral) for 32,847 of the 35,624 (92%) UKR registered before December 2010. Kaplan Meier plots, Life tables and Cox' proportion hazards were used to compare the risk of failure for lateral and medial UKRs after adjustment for patient and implant covariates.Background
Methods
This study utilised NJR primary hip data from the 6th Annual Report to determine the rate and indication for revision between cemented, uncemented, hybrid and resurfacing prosthetic groups. Regression analysis was performed to identify the influence of gender and ASA grade on these revision rates. Validity of the data was interrogated by exploring for episodes of misclassification. We identified 2,264 misclassified episodes within the four groups (Misclassification rate 2.7% primary, 4.3% revision procedures). Analysis was performed using the “reclassified dataset”. The Kaplan-Meier revision rates at 3 years were 0.9% (95%CI: 0.8%-1.0%) for cemented prostheses, 1.9% (95%CI: 1.8%-2.0%) for uncemented hips, 1.2% (95%CI: 1.0%-1.4%) for hybrids and 3.0%, (95%CI: 2.7%-3.3%) in the resurfacing group. The trends in revision rates were comparable to those published in the NJR (6th Edn.) with significant differences across all groups (p< 0.0001). Revision rates in the under 55 year age group showed an identical hierarchy with cemented and hybrid arthroplasty having the lowest revision rates. Cox Regression analysis indicated that both the prosthesis group in isolation and the interaction between prosthesis group and ASA grade significantly influenced the rate of failure (p< 0.001). Indications for revision showed significant differences in rates for, pain, aseptic loosening, dislocation and malalignment between prosthesis types (p< 0.001). The indications including Aseptic loosening, pain, malalignment and dislocation all demonstrated similar trends in revision rates between prosthetic groups with cemented hips having the lowest rates followed by ascending rates for hybrid, uncemented and resurfacing groups. The exception being dislocation with resurfacings having the lowest revision rates. This study provides important baseline revision rates by indication for each prosthetic group from which future comparisons can be made. Areas of misclassification within the NJR dataset have been reported back for future annual analysis.Results
Discussion
Total hip replacements (THRs) are performed by surgeons at various stages in their training, with varying levels of senior supervision. There is a balance between protecting training opportunities for the next generation of surgeons, while limiting the exposure of patients to unnecessary risk during the training process. The aim of this study was to examine the association between surgeon grade, the senior supervision of trainees, and the risk of revision following THR. We included 603 474 primary THRs recorded in the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man (NJR) between 2003 and 2016 for an indication of osteoarthritis. Exposures were the grade of the surgeon (consultant or trainee), and whether trainees were supervised by a scrubbed consultant or not. Outcomes were all-cause revision, the indication for revision, and the temporal variation in risk of revision (all up to 10 years). Net failure was calculated using Kaplan-Meier analysis and adjusted analyses used Cox regression and flexible parametric survival analysis (adjusted for patient, operative, and unit level factors). There was no association between surgeon grade and all-cause revision up to 10 years (crude hazard ratio (HR) 0·999, 95% confidence interval (CI) 0.936–1.065; p=0.966); a finding which persisted with adjusted analysis. Adjusted analysis demonstrated an association between trainees operating without supervision by a scrubbed consultant and an increase in all-cause revision (HR 1.100, 95% CI 1.002–1.207; p=0.045). There was an association between the trainee-performed THRs and revision due to instability (crude HR 1.143, 95% CI, 1.007–1.298; p=0.039). However, this was not observed in fully adjusted models, or when trainees were supervised by a scrubbed consultant. Within the current training system in the United Kingdom, trainees achieve comparable outcomes to consultant surgeons when supervised by a scrubbed consultant. Revision rates are higher when trainees are not supervised by a scrubbed consultant but remain within internationally recognised acceptable limits.
With the increasing demand for hip and knee replacement and move towards seven-day services, we examined whether this planned, elective surgery performed at the weekend is associated with a different 30-day mortality versus that performed between Monday and Friday. The study dataset comprised 118,096 joint replacement episodes performed at the weekend and 1,233,882 episodes done on a weekday. We used a Kaplan-Meier framework to examine the 30-day cumulative mortality rate for all elective hip and knee replacements performed in England and Wales and recorded in the NJR between 1st April 2003 and 31st December 2014, with Cox proportional-hazards regression models to assess for time-dependent variation and adjust for identified risk factors for mortality. For hip replacement the cumulative 30-day mortality was 0.15% (95%CI: 0.12–0.19) for patients operated on at the weekend versus 0.20% (0.19–0.21) for patients undergoing surgery during the normal working week. For knee replacement the cumulative 30-day mortality was 0.14% (0.11–0.17) for patients operated on at the weekend versus 0.18% (0.17–0.19) for patients undergoing surgery during the normal working week. The lower mortality associated with weekend operating was most apparent in the later years of the audit (2009 to 2014) and remained after adjustment for any differences in patient age, gender, American Society of Anaesthesiologist grade, surgeon seniority, surgical and anaesthetic practices, and thrombo-prophylaxis choice in weekend versus weekday operated patients. Routine hip and knee replacements performed at the weekend in England and Wales and are not associated with an increased risk of post-operative mortality.
Our previous work presented at BHS revealed a reduced risk of revision for all reasons in THAs using lipped (asymmetric) liners. Some audience members felt that this finding may be due to unaccounted confounders and the hip surgery community remains sceptical. A fully adjusted Cox model was built after exploratory Kaplan-Meier analyses. The following surgical approaches were included in the analysis: Posterior, Hardinge/anterolateral, Other. The variables included in the final Cox model included: Gender, liner asymmetry, age, head composition, stem fixation method, head diameter, indication for implantation and surgical approach. An additional analysis of the 3 most commonly used polyethylene liners with both a flat and asymmetric version was performed. In the fully adjusted Cox model, the use of a flat liner was associated with increased risk of revision for instability (HR: 1.79, 95%CI: 1.52–2.10) and increased risk of revision for all reasons (HR 1.195, 95%CI: 1.104 – 1.293) when compared to THAs utilising flat liners. This finding was upheld in the product specific analysis. When utilising flat liners, the Hardinge/anterolateral approach was associated with a reduced risk of revision for instability compared to the posterior approach (HR 0.56, 95%CI: 0.446 to 0.706). When an asymmetric liner was used, there was no significant difference in the risk of revision for instability between the Hardinge/anterolateral approach and the posterior approach (HR 0.838, 95%CI: 0.633 – 1.110). The use of polyethylene-based bearings gives the surgeon the option to use asymmetric liners. The reduced risk of revision in THAs with asymmetric liners was seen in the analysis of the complete dataset and in the product specific analysis. Our results demonstrate that the posterior approach, when used with asymmetric XLPE liners, is not associated with a higher risk of revision for instability as historical data suggested.
To assess the effect of the bearing surface and head size on the survival of total hip replacements with modern bearing surface combinations. We combined the NJR dataset with polyethylene manufacturing properties as supplied by the manufacturers to sub-divide polyethylene into conventional (PE) and highly crosslinked (XLPE). Cause specific and overall reasons for revisions were analysed using Kaplan-Meier and multi-variate Cox proportional hazard regression survival analyses. The bearing surface analysis was repeated in patients undergoing THR under the age of 55.Aim
Methods
The most appropriate form of chemical thromboprophylaxis following knee replacement is a contentious issue. Most national guidelines recommend the use of low molecular weight Heparin (LMWH) whilst opposing the use of aspirin. We compared thromboembolic events, major haemorrhage and death after knee replacement in patients receiving either aspirin or LMWH. Data from the National Joint Registry for England and Wales was linked to an administrative database of hospital admissions in the English National Health Service. A total of 156 798 patients undergoing knee replacement between April 2003 and September 2008 were included and followed up for 90 days. Multivariable risk modelling was used to estimate odds ratios adjusted for baseline risk factors (AOR). An AOR < 1 indicates that risk rates are lower with LMWH than with aspirin.Background
Methods
A commonly held belief amongst surgeons and patients is that progression of disease (arthritis) to other compartments is a major cause of early failure of UKRs. We analysed the NJR database records of 17,643 primary UKRs performed between April 2003 and April 2009. Where these had been revised the reason for revision was noted.Background
Methods
To assess the effect of different polyethylene modifications on Total Hip Replacement survival. We combined the NJR dataset with polyethylene manufacturing properties as supplied by the manufacturers. Cause specific and overall reasons for revisions were analysed using Kaplan-Meier and multi-variate Cox proportional hazard regression survival analyses. Revision for aseptic loosening was the primary endpoint. Modification variables included resin type, radiation source, multiple cross-linking treatments, cross-linking dose, terminal sterilisation method, terminal sterilisation radiation dose, stabilisation treatment, total radiation dose, and packaging.Aim
Methods
Data was analysed to investigate the relationship between the OKS, satisfaction rate and the background factors. Multivariable logistic regression was performed to establish which factors influenced patient satisfaction.
Regression modelling showed that patients with higher scores relating to the pain and function elements of the OKS had lower levels of satisfaction (p<
0.001) and that ongoing pain was a stronger predictor of lower levels of satisfaction. Other predictors of lower levels of satisfaction included female gender (p<
0.05), a primary diagnosis of osteoarthritis (p=0.02) and unicondylar replacement (p=0.002). Differences in satisfaction rate were also observed dependent upon age and ASA grade 609 patients (7.4%) had undergone further surgery and 1476 patients (17.9%) indicated another procedure was planned. Both the OKS and satisfaction rates were significantly better in patients who had not suffered complications.
National Institute for Health and Clinical Excellence (NICE) guidelines recommend the use of total hip replacement (THR) for displaced intracapsular fractured neck of femur (NOF) in cognitively intact patients who were independently mobile prior to the injury. The National Joint Registry for England and Wales (NJR) has collected data on THRs performed since 2003. This retrospective cohort study explores risk factors independently associated with implant failure and perioperative mortality. NJR data recording a THR performed for acute fractured NOF between 2003 and 2010 were analysed. Cox proportional hazards models were used to analyse the extent to which risk of implant revision was related to specific covariates. Multivariable logistic regression was used to analyse factors affecting 90-day perioperative mortality. Significance was taken as p< 0.01.Introduction
Methods
In order to emulate normal knee kinematics more closely and thereby potentially improve wear characteristics and implant longevity the Medial Pivot type knee replacement geometry was designed. In the current study the clinical and radiographic results of 50 consecutive knee replacements using a Medial Pivot type knee replacement are reported; results are compared to the Australian Orthopaedic Associations National Joint Replacement Registry. The patients' data were crossed checked against the registry to see if they had been revised elsewhere. After a mean follow-up of 9.96 years results show that the Medial Pivot Knee replacement provides good pain relief and functional improvement according to KSS and Womac scores and on subjective patient questionnaires. There was one minor revision; insertion of a patella button at 6.64 years FU. There were no major revisions; all implants appeared to be well fixed on standard radiographic examination. While the revision rate for the Medial Pivot knee according to the Australia Joint Registry results is higher compared to all other types of knee replacements in the registry, and to what is reported in the literature on the medial pivot knee, it is not in the current series. Revision rate was similar to what is reported on in the literature, but after a longer follow-up period. However, long term follow-up is required to draw definitive conclusions on the longevity of this type of implant.
Implants in total hip replacement (THR) are associated with different clinical and cost-effectiveness profiles,. We estimate the costs and outcomes for NHS patients in the year after THR associated with implant bearing materials using linked routinely collected data. We linked NJR primary elective THR patients for osteoarthritis to HES and National PROMs. We estimated health care costs, health-related quality of life indices, and revision risks, in the year after primary and revision THRs overall. We used generalised linear models adjusting for patient and hospital characteristics and estimated 10-year cumulative probability of revision. We imputed utilities using chained equations for half the sample with missing PROMS. We linked 577,973 elective primary THRs and 11,812 subsequent revisions. One year after primary THR, patients with the cemented THRs using cobalt chrome or stainless steel head with HCLPE liner/cup cost the NHS, on average, £13,101 (95%CI £13,080,£13,122), had an average quality-of-life score of 0.788 (95%CI 0.787,0.788), and a 10-year revision probability of 1.9% (95%CI 1.6,2.3). Compared to the reference, patients receiving a cemented THR with delta ceramic head and HCLPE liner/cup, hybrid THR with delta ceramic head and HCLPE liner/cup, and hybrid THR with alumina head and HCLPE liner/cup had lower 1-year costs (-£572 \[95% CI -£775,-£385\], -£346 \[-£501,-£192\], -£371 \[-£574,-£168\] respectively), better quality of life (0.007 \[95% CI 0.003,0.011\], 0.013 \[0.010,0.016\], 0.009 \[0.005,0.013\] respectively), and lower 10-year revision probabilities (1.4% \[1.03,2.0\], 1.5 \[1.3,1.7\], 1.6%\[1.2,2.1\] respectively). Implant bearing materials are associated with varying mean costs and health outcomes after primary THR. Ours is the first study to derive costs and health outcomes from large, linked databases using multiple imputation methods to deal with bias. Our findings are useful for commissioning and procurement decisions and to inform a subsequent cost-effectiveness model with more granular detail on THR implant types.
Following in-depth analysis of the market leading brand combinations in which we identified implant influences on risk of revision, we compared revision in patients implanted with different categories of hip replacement in order to find implant with the lowest revision risk, once known flawed options were removed. All patients with osteoarthritis who underwent a hip replacement (2003–2010) using an Exeter-Contemporary (cemented), Corail-Pinnacle (cementless), Exeter-Trident (Hybrid) or a Birmingham Hip resurfacing (BHR) were initially included within the analysis. Operations involving factors that were significant predictors of revision were excluded. Cox proportional hazard models were then used to assess the relative risk of revision for a category of implant (compared with cemented), after adjustment for patient covariates.Introduction
Methods
Recent publications have drawn attention to the fact that some brands of joint replacement may contain variants which perform significantly worse (or better) than their ‘siblings’. As a result, the
The June 2024 Shoulder & Elbow Roundup. 360. looks at: Reverse versus anatomical total shoulder replacement for osteoarthritis? A UK national picture; Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomized controlled trial; acid for rotator cuff repair: a systematic review and meta-analysis of randomized controlled trials; Metal or ceramic humeral head total shoulder arthroplasty: an analysis of data from the
The December 2023 Knee Roundup. 360. looks at: Obesity is associated with greater improvement in patient-reported outcomes following primary total knee arthroplasty; Does mild flexion of the femoral prosthesis in total knee arthroplasty result in better early postoperative outcomes?; Robotic or manual total knee arthroplasty: a randomized controlled trial; Patient-relevant outcomes following first revision total knee arthroplasty, by diagnosis: an analysis of implant survivorship, mortality, serious medical complications, and patient-reported outcome measures using the
Aims. Despite the increasing numbers of ankle arthroplasties, there are limited studies on their survival and comparisons between different implants. The primary aim of this study was to determine the failure rates of primary ankle arthroplasties commonly used in the UK. Methods. A data linkage study combined
Aims. We compared the risks of re-revision and mortality between two-stage revision surgery and single-stage revision surgery among patients with infected primary knee arthroplasty. Methods. Patients with a periprosthetic joint infection (PJI) of their primary knee arthroplasty, initially revised with a single-stage or a two-stage procedure in England and Wales between 2003 and 2014, were identified from the
Aims. The Exeter V40 femoral stem is the most implanted stem in the
Aims. The Oxford Shoulder Score (OSS) is a 12-item measure commonly used for the assessment of shoulder surgeries. This study explores whether computerized adaptive testing (CAT) provides a shortened, individually tailored questionnaire while maintaining test accuracy. Methods. A total of 16,238 preoperative OSS were available in the
Aims. The aim of this study was to evaluate medium- to long-term outcomes and complications of the Stanmore Modular Individualised Lower Extremity System (SMILES) rotating hinge implant in revision total knee arthroplasty (rTKA) at a tertiary unit. It is hypothesized that this fully cemented construct leads to satisfactory clinical outcomes. Methods. A retrospective consecutive study of all patients who underwent a rTKA using the fully cemented SMILES rotating hinge prosthesis between 2005 to 2018. Outcome measures included aseptic loosening, reoperations, revision for any cause, complications, and survivorship. Patients and implant survivorship data were identified through both prospectively collected local hospital electronic databases and linked data from the
Aims. Aseptic loosening is the most common cause of failure following cemented total knee arthroplasty (TKA), and has been linked to poor cementation technique. We aimed to develop a consensus on the optimal technique for component cementation in TKA. Methods. A UK-based, three-round, online modified Delphi Expert Consensus Study was completed focusing on cementation technique in TKA. Experts were identified as having a minimum of five years’ consultant experience in the NHS and fulfilling any one of the following criteria: a ‘high volume’ knee arthroplasty practice (> 150 TKAs per annum) as identified from the
Aims. We compared the risks of re-revision and mortality between two-stage and single-stage revision surgeries among patients with infected primary hip arthroplasty. Methods. Patients with a periprosthetic joint infection (PJI) of their primary arthroplasty revised with single-stage or two-stage procedure in England and Wales between 2003 and 2014 were identified from the
Aims. Our main aim was to describe the trend in the comorbidities of patients undergoing elective total hip arthroplasties (THAs) and knee arthroplasties (KAs) between 1 January 2005 and 31 December 2018 in England. Methods. We combined data from the
Aims. Metal and ceramic humeral head bearing surfaces are available choices in anatomical shoulder arthroplasties. Wear studies have shown superior performance of ceramic heads, however comparison of clinical outcomes according to bearing surface in total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) is limited. This study aimed to compare the rates of revision and reoperation following metal and ceramic humeral head TSA and HA using data from the
Aims. When a total ankle arthroplasty (TAA) fails, it can be converted to a fusion or a revision arthroplasty. Despite the increasing numbers of TAAs being undertaken, there is little information in the literature about the management of patients undergoing fusion following a failed TAA. The primary aim of this study was to analyze the survival of fusions following a failed TAA using a large dataset from the
Aims. A recent report from France suggested an association between the use of cobalt-chrome (CoCr) femoral heads in total hip arthroplasties (THAs) and an increased risk of dilated cardiomyopathy and heart failure. CoCr is a commonly used material in orthopaedic implants. If the reported association is causal, the consequences would be significant given the millions of joint arthroplasties and other orthopaedic procedures in which CoCr is used annually. We examined whether CoCr-containing THAs were associated with an increased risk of all-cause mortality, heart outcomes, cancer, and neurodegenerative disorders in a large national database. Methods. Data from the
Aims. The number of revision total ankle arthroplasties (TAAs) which are undertaken is increasing. Few studies have reported the survival after this procedure. The primary aim of this study was to analyze the survival of revision ankle arthroplasties using large datasets. Secondary aims were to summarize the demographics of the patients, the indications for revision TAA, further operations, and predictors of survival. Methods. The study combined data from the
Aims. The aim of this study was to identify variables associated with time to revision, demographic details associated with revision indication, and type of prosthesis employed, and to describe the survival of hinge knee arthroplasty (HKA) when used for first-time knee revision surgery and factors that were associated with re-revision. Methods. Patient demographic details, BMI, American Society of Anesthesiologists (ASA) grade, indication for revision, surgical approach, surgeon grade, implant type (fixed and rotating), time of revision from primary implantation, and re-revision if undertaken were obtained from the
Aims. Total hip arthroplasties (THAs) are performed by surgeons at various stages in training with varying levels of supervision, but we do not know if this is safe practice with comparable outcomes to consultant-performed THA. Our aim was to examine the association between surgeon grade, the senior supervision of trainees, and the risk of revision following THA. Methods. We performed an observational study using
Aims. The main objective of this study was to examine whether the Oxford Shoulder Score (OSS) demonstrated floor or ceiling effects when used to measure outcomes following shoulder arthroplasty in a large national cohort. Secondary objectives were to assess its pain and function subscales, and to identify independent predictors for patients achieving a postoperative ceiling score following shoulder arthroplasty. Methods. Secondary database analysis of the
Aims. The aim of this study was to determine if uncemented acetabular polyethylene (PE) liner geometry, and lip size, influenced the risk of revision for instability or loosening. Methods. A total of 202,511 primary total hip arthroplasties (THAs) with uncemented acetabular components were identified from the
Aims. The aim of this study was to capture 12-month outcomes from a representative multicentre cohort of patients undergoing total ankle arthroplasty (TAA), describe the pattern of patient-reported outcome measures (PROMs) at 12 months, and identify predictors of these outcome measures. Methods. Patients listed for a primary TAA at 19 NHS hospitals between February 2016 and October 2017 were eligible. PROMs data were collected preoperatively and at six and 12 months including: Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ (foot and ankle)) and the EuroQol five-dimension five-level questionnaire (EQ-5D-5L). Radiological pre- and postoperative data included Kellgren-Lawrence score and implant position measurement. This was supplemented by data from the
Aims. To determine if primary cemented acetabular component geometry (long posterior wall (LPW), hooded, or offset reorientating) influences the risk of revision total hip arthroplasty (THA) for instability or loosening. Methods. The
Aims. The aim of our study was to investigate the effect of asymmetric crosslinked polyethylene liner use on the risk of revision of cementless and hybrid total hip arthroplasties (THAs). Methods. We undertook a registry study combining the
Aims. To determine mortality risk after first revision total hip arthroplasty (THA) for periprosthetic femoral fracture (PFF), and to compare this to mortality risk after primary and first revision THA for other common indications. Methods. The study cohort consisted of THAs recorded in the
Aims. The aim of this study was to estimate the 90-day risk of revision for periprosthetic femoral fracture associated with design features of cementless femoral stems, and to investigate the effect of a collar on this risk using a biomechanical in vitro model. Materials and Methods. A total of 337 647 primary total hip arthroplasties (THAs) from the United Kingdom
Aims. Ceramic-on-ceramic (CoC) bearings in total hip arthroplasty (THA)
are commonly used, but concerns exist regarding ceramic fracture.
This study aims to report the risk of revision for fracture of modern
CoC bearings and identify factors that might influence this risk,
using data from the
Unicompartmental knee arthroplasty (UKA) has
advantages over total knee arthroplasty but
The mean age of patients undergoing total knee arthroplasty (TKA) has reduced with time. Younger patients have increased expectations following TKA. Aseptic loosening of the tibial component is the most common cause of failure of TKA in the UK. Interest in cementless TKA has re-emerged due to its encouraging results in the younger patient population. We review a large series of tantalum trabecular metal cementless implants in patients who are at the highest risk of revision surgery. A total of 454 consecutive patients who underwent cementless TKA between August 2004 and December 2021 were reviewed. The mean follow-up was ten years. Plain radiographs were analyzed for radiolucent lines. Patients who underwent revision TKA were recorded, and the cause for revision was determined. Data from the National Joint Registry for England, Wales, Northern Island, the Isle of Man and the States of Guernsey (NJR) were compared with our series.Aims
Methods
Cite this article:
Periprosthetic joint infection (PJI) remains an extremely challenging complication. We have focused on this issue more over the last decade than previously, but there are still many unanswered questions. We now have a workable definition that everyone should align to, but we need to continue to focus on identifying the organisms involved. Surgical strategies are evolving and care is becoming more patient-centred. There are some good studies under way. There are, however, still numerous problems to resolve, and the challenge of PJI remains a major one for the orthopaedic community. This annotation provides some up-to-date thoughts about where we are, and the way forward. There is still scope for plenty of research in this area. Cite this article:
Cite this article:
The importance of registries has been brought into focus by recent UK national reports focusing on implant (Cumberlege) and surgeon (Paterson) performance. National arthroplasty registries provide real-time, real-world information about implant, hospital, and surgeon performance and allow case identification in the event of product recall or adverse surgical outcomes. They are a valuable resource for research and service improvement given the volume of data recorded and the longitunidal nature of data collection. This review discusses the current value of registry data as it relates to both clinical practice and research. Cite this article:
The principles of evidence-based medicine (EBM) are the foundation of modern medical practice. Surgeons are familiar with the commonly used statistical techniques to test hypotheses, summarize findings, and provide answers within a specified range of probability. Based on this knowledge, they are able to critically evaluate research before deciding whether or not to adopt the findings into practice. Recently, there has been an increased use of artificial intelligence (AI) to analyze information and derive findings in orthopaedic research. These techniques use a set of statistical tools that are increasingly complex and may be unfamiliar to the orthopaedic surgeon. It is unclear if this shift towards less familiar techniques is widely accepted in the orthopaedic community. This study aimed to provide an exploration of understanding and acceptance of AI use in research among orthopaedic surgeons. Semi-structured in-depth interviews were carried out on a sample of 12 orthopaedic surgeons. Inductive thematic analysis was used to identify key themes.Aims
Methods
The aim of this study was to investigate whether wear and backside deformation of polyethylene (PE) tibial inserts may influence the cement cover of tibial trays of explanted total knee arthroplasties (TKAs). At our retrieval centre, we measured changes in the wear and deformation of PE inserts using coordinate measuring machines and light microscopy. The amount of cement cover on the backside of tibial trays was quantified as a percentage of the total surface. The study involved data from the explanted fixed-bearing components of four widely used contemporary designs of TKA (Attune, NexGen, Press Fit Condylar (PFC), and Triathlon), revised for any indication, and we compared them with components that used previous generations of PE. Regression modelling was used to identify variables related to the amount of cement cover on the retrieved trays.Aims
Methods
Data of high quality are critical for the meaningful interpretation of registry information. The
Unicompartmental knee arthroplasty (UKA) has
numerous advantages over total knee arthroplasty (TKA) and one disadvantage,
the higher revision rate. The best way to minimize the revision
rate is for surgeons to use UKA for at least 20% of their knee arthroplasties.
To achieve this, they need to learn and apply the appropriate indications
and techniques. This would decrease the revision rate and increase
the number of UKAs which were implanted, which would save money
and patients would benefit from improved outcomes over their lifetime. Cite this article:
Aims. This study describes the variation in the annual volumes of revision hip arthroplasty (RHA) undertaken by consultant surgeons nationally, and the rate of accrual of RHA and corresponding primary hip arthroplasty (PHA) volume for new consultants entering practice. Methods.
Aims.
The debate whether to use cemented or uncemented
components in primary total hip replacement (THR) has not yet been
considered with reference to the cost implications to the National
Health Service. We obtained the number of cemented and uncemented components
implanted in 2009 from the National Joint Registry for England and
Wales. The cost of each component was established. The initial financial
saving if all were cemented was then calculated. Subsequently the
five-year rates of revision for each type of component were reviewed
and the predicted number of revisions at five years for the actual
components used was compared with the predicted number of revisions
for a cemented THR. This was then multiplied by the mean cost of
revision surgery to provide an indication of the savings over the
first five years if all primary THRs were cemented. The saving at primary THR was calculated to be £10 million with
an additional saving during the first five years of between £5 million
and £8.5 million. The use of cemented components in routine primary
THR in the NHS as a whole can be justified on a financial level
but we recognise individual patient factors must be considered when deciding
which components to use.
Aims. The aim of this study was to evaluate medium-term outcomes and complications of the S-ROM NOILES Rotating Hinge Knee System (DePuy, USA) in revision total knee arthroplasty (rTKA) at a tertiary unit. Methods. A retrospective consecutive study of all patients who underwent a rTKA using this implant from January 2005 to December 2018. Outcome measures included reoperations, revision for any cause, complications, and survivorship. Patients and implant survivorship data were identified through both local hospital electronic databases and linked data from the
To determine the risk of total knee replacement (TKR) for primary osteoarthritis (OA) associated with overweight/obesity in the Australian population. This population-based study analyzed 191,723 cases of TKR collected by the Australian Orthopaedic Association
Abstract. Background. Although tantalum is a well recognised implant material used for revision arthroplasty, little is known regarding the use of the same in primary total hip arthroplasty. Methods. A literature search was performed to find all relevant clinical studies until March 2020, which then underwent a further selection criteria. The inclusion criteria was set as follows: Reporting on human patients undergoing primary total hip arthroplasty; Direct comparison between tantalum acetabular cups with conventional acetabular cups. for use in primary total hip arthroplasty; Radiological evaluation (cup migration, osteointegration); Clinical (functional scores, need for subsequent revision, patient-reported outcomes; Post-operative complications; Reporting findings in the English Language. After a thorough search a total of six studies were included in the review. The primary outcome. measures were clinical outcomes, implant migration, change in bone mineral density and rate of revision and infection. Results. Tantalum was found superior to titanium with regards to fewer radiolucencies, survivorship, osteointegration, decreased osteolysis and mechanical loosening. No significant difference in radioisometric analysis, bone mineral density or Harris Hip Score was found. Revision and infection rates were found to be significantly lower in tantalum group at 10 years from pooled data of
Abstract. 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
Patients with Paget's Disease of Bone (PDB) more frequently require total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, controversy remains regarding their outcome. This project aims to evaluate the current literature regarding outcomes following THA and TKA in PDB patients. MEDLINE, EMBASE and Cochrane databases were searched on February 15th, 2022. Inclusion criteria comprised studies evaluating outcomes following THA/TKA in PDB patients. Quality of included studies was assessed using the Newcastle-Ottawa Scale. 19 articles (published between 1976–2022) were included, comprising 58,695 patients (48,766 controls and 10,018 PDB patients), from 209 potentially relevant titles. No study was of high quality. PDB patient pooled mortality was 32.5% at mean 7.8(0.1-20) years following THA and 31.0% at mean 8.5(2-20) years following TKA. PDB patient revision rate was 4.4% at mean 7.2(0-20) years following THA and 2.2% at mean 7.4(2-20) years following TKA. Renal complications, respiratory complications, heterotopic ossification, and surgical site infection were the most common medical and surgical complications. The largest systematic review, to date, evaluating outcomes following THA and TKA in PDB patients. All functional outcome scores improved. PDB patient revision rate was comparable to UK
Abstract. Introduction. Aseptic loosening is the most common cause of failure following cemented total knee arthroplasty (TKA) and this has been linked to poor cementation technique. We aimed to develop a consensus on the optimal technique for component cementation in TKA. Methodology. A UK based, three round, online modified Delphi Expert Consensus Study was completed focussing on cementation technique in TKA. Experts were identified as having a minimum of 5 years Consultant experience in the NHS and fulfilling any one of the following three criteria:. · A ‘high volume’ knee arthroplasty practice (>150 TKA per annum) as identified from the
Introduction. A key outcome measured by
Total hip replacement (THR) is one of the most common and cost-effective elective surgical procedures. In the National Health Service (NHS) of England and Wales a myriad of implants for THR are offered at a variety of locally negotiated prices. This study aims to estimate the total burden of elective THR to the NHS, expenditure on implants, and different scenarios of cost changes if implant selection changed for different patient groups. Using
Clinical commissioning groups (CCG) have been replaced with ICBs that will bring together NHS and social care for the local population. ICBs are allocating contracts for long waiters for total hip replacements (THR) to hospitals that have achieved pre-covid volumes of THR, THR volumes undertaken by hospitals in 2022 should be at 2019 levels or more. Purpose of this study was to identify whether NHS hospitals in England are at a disadvantage in procuring ICB contracts for THR. THR volumes for NHS and independent sector (IND) hospitals from January 2012 to November 2022 were identified via
This study evaluates the association between consultant and hospital volume and the risk of re-revision and 90-day mortality following first-time revision of primary hip replacement for aseptic loosening. We conducted a cohort study of first-time, single-stage revision hip replacements (RHR) performed for aseptic loosening and recorded in the
Introduction. This is a multi-centre, prospective, observational study of 503 INFINITY fixed bearing total ankle arthroplasties. We report the minimum two-year results of this prosthesis which was introduced to the UK Market in 2014 and is now the most used ankle arthroplasty in the
Abstract. 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. Results. We identified 2606 patients with PPFF from 135 hospitals. Of these, a total of 578 fractures occurred around the femoral component of a knee implant. These were classified as Vancouver A (epicondylar, n=77), B (involving implant/cement, n=166) and C (proximal to implant/cement, n=335). Internal fixation was the most employed treatment, used in 352 cases. Revision arthroplasty was performed in 80 cases, and 100 were managed non-operatively. Only 28% of operated PPFF went to theatre within 36 hours but nearly 90% had orthogeriatrician review within 72 hours. Conclusion. Eighty six percent of patients with PPFF were treated with non-revision surgery and would not be recorded in the
Abstract. 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.
Abstract. 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