The UK and Australian clinical experience of an implantable load absorber was reviewed for knee OA patients who have exhausted conservative care, but are not ideal candidates for HTO or arthroplasty due to age, activity level, obesity, or disinclination. The load absorber was implanted in 58 patients, with the longest duration exceeding two years. Patients included younger OA sufferers (31-68 years), and had a mean BMI > 30kg/m2. Early surgical experience and adverse events with the device were recorded and clinical outcomes using validated patient reported outcomes tools were collected at baseline, post-op, 2 and 6 weeks, and 3, 6, 12 and 24 month timepoints. All patients were successfully implanted with a mean surgical time of 76.4 minutes (range 54-153). After a mean hospital stay of 1.7 days (range 1-3), patients resumed full weight bearing within 1-2 weeks and achieved normal range of motion by 6 weeks. Mean WOMAC pain (0-100 scale) improved from 42.4 to 16.1 (p<0.001); mean WOMAC function (0-100 scale) improved from 42.0 to 14.7 (p<0.001). Most patients reported “no or mild” pain (85%) or “no or mild” functional impairment (90%) at last follow-up (9.5 ± 3.5 months). Patients reported high satisfaction with the implant. Initial UK results mirror the positive Australian experience: reduced pain, improved function, and high satisfaction. Complications arising in the early surgical experience were effectively resolved through revised surgical technique and minor design modifications.Statement of Purpose
Methods and Results
Patellofemoral replacement is an established intervention in selected patients with severe isolated patellofemoral osteoarthritis. FPV (Wright Medical, UK) is a third generation patellofemoral arthroplasty implant and is the second most used after AVON in National Joint Registry for England and Wales. Reports of survivorship and functional of this implant are scarce in literature. Evaluation of functional outcome and survivorship following FPV patellofemoral arthroplasty.Background
Aim
Hyaline cartilage defects are a significant clinical problem for which a plethora of cartilage repair techniques are used. One such technique is cartilage replacement therapy using autologous chondrocyte or mesenchymal stem cell (MSC) implantation (ACI). Mesenchymal stem cells are increasingly being used for these types of repair technique because they are relatively easy to obtain and can be expanded to generate millions of cells. However, implanted MSCs can terminally differentiate and produce osteogenic tissue which is highly undesirable, also, MSCs generally only produce fibrocartilage which does not make biomechanically resilient repair tissue, an attribute that is crucial in high weight-bearing areas. Tissue-specific adult stem cells would be ideal candidates to fill the void, and as we have shown previously in animal model systems [ At present, research focused on isolating tissue-specific stem cells from articular cartilage has met with modest success. Our results demonstrate that using differential adhesion it is possible to easily isolate articular cartilage progenitor populations from human hyaline cartilage and that these cells can be subsequently expanded In conclusion, we propose the identification and characterisation of a novel articular cartilage progenitor population, resident in human cartilage, which will greatly benefit future cell-based cartilage repair therapies.
In recent years tribological development of knee replacement impants has beeen introduced with several benefits. However, concomitant problems were noticed following widespread use. High-flexion total knee replacement (PFC RPF DePuy) has been developed with a view to improve flexion and the design is expected to have a better patello-femoral biomechanics. However, high secondary patella resurfacing rate has been noticed in the current series. We have retrospectively reviewed 119 knees in 96 patients who underwent RPF knee replacement with selective patellar resurfacing from 2006 to 2010 by the senior author. 71 were performed without primary resurfacing while 48 in knees patella was resurfaced primarily due to significant symptomatic arthritic changes. Majority were females (57 versus 39 males). Average follow-up period was 37 (12-62) months. Twelve (16.9%) knees were subjected to secondary resurfacing due to continuing anterior knee pain. Average time from primary total knee replacement to secondary resurfacing was 18 months (8-35). Most of the patients were satisfied following the secondary resurfacing. Mean Oxford Knee Score in the group where the patella was resurfaced primarily was 33.1 (9-48), in the group where the patella was not resurfaced 32.8 (11-47), in the secondary resurfacing group 31.8 (14-43) and in the revision group 20.5 (16-25). RPF knee replacements in our series have a considerably higher rate of secondary patellar resurfacing as compared with published literature. We recommend primary patellar resurfacing of all RPF knee replacements to avoid this problem. Further analysis of the prosthetic design would be beneficial in relation to clinical outcome. No of patients-96 Total no of knee-118 Av age-66.5 Females-57 Males-39 Patella not resurfaced- 73 Resurfaced-45 Revised-10(13.7%) Revision to TKR (TC3) for different reason-3(2.54%) Average time from primary to secondary resurfacing-
