Aims. The primary aim was to assess whether robotic total knee arthroplasty (rTKA) had a greater early knee-specific outcome when compared to manual TKA (mTKA). Secondary aims were to assess whether rTKA was associated with improved expectation fulfilment, health-related quality of life (HRQoL), and patient satisfaction when compared to mTKA. Methods. A randomized controlled trial was undertaken, and patients were randomized to either mTKA or rTKA. The primary objective was functional improvement at six months. Overall, 100 patients were randomized, 50 to each group, of whom 46 rTKA and 41 mTKA patients were available for review at six months following surgery. There were no differences between the two groups. Results. There was no difference between rTKA and mTKA groups at six months according to the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) functional score (mean difference (MD) 3.8 (95% confidence interval (CI) -5.6 to 13.1); p = 0.425). There was a greater improvement in the WOMAC pain score at two months (MD 9.5 (95% CI 0.6 to 18.3); p = 0.037) in the rTKA group, although by six months no significant difference was observed (MD 6.7 (95% CI -3.6 to 17.1); p = 0.198). The rTKA group were more likely to achieve a minimal important change in their WOMAC pain score when compared to the mTKA group at two months (n = 36 (78.3%) vs n = 24 (58.5%); p = 0.047) and at six months (n = 40 (87.0%) vs n = 29 (68.3%); p = 0.036). There was no difference in satisfaction between the rTKA group (97.8%; n = 45/46) and the mTKA group (87.8%; n = 36/41) at six months (p = 0.096). There were no differences in EuroQol five-dimension questionnaire (EQ-5D) utility gain (p ≥ 0.389) or fulfilment of patient expectation (p ≥ 0.054) between the groups. Conclusion. There were no statistically significant or clinically meaningful differences in the change in WOMAC function between mTKA and rTKA at six months. rTKA was associated with a higher likelihood of achieving a clinically important change in knee pain at two and six months, but no differences in knee-specific function, patient satisfaction, health-related quality of life, or expectation fulfilment were observed. Cite this article: Bone Joint J 2023;105-B(9):961–970

Aims. The primary aim of this study was to assess whether pain in the contralateral knee had a clinically significant influence on the outcome of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary aims were to: describe the prevalence of contralateral knee pain; identify if it clinically improves after TKA; and assess whether contralateral knee pain independently influences patient satisfaction with their TKA. Methods. A retrospective cohort of 3,178 primary TKA patients were identified from an arthroplasty database. Patient characteristics, comorbidities, and WOMAC scores were collected preoperatively and one year postoperatively for the index knee. In addition, WOMAC pain scores were also collected for the contralateral knee. Overall patient satisfaction was assessed at one year. Preoperative contralateral knee pain was defined according to the WOMAC score: minimal (> 78 points), mild (59 to 78), moderate (44 to 58), and severe (< 44). Multivariate regression analysis was used to adjust for confounding. Results. According to severity there were 1,425 patients (44.8%) with minimal, 710 (22.3%) with mild, 518 (16.3%) with moderate, and 525 (16.5%) with severe pain in the contralateral knee. Patients in the severe group had a greater clinically significant improvement in their functional WOMAC score (9.8 points; p < 0.001). Only patients in the moderate (22.9 points) and severe (37.8 points) groups had a clinically significant improvement in their contralateral knee pain (p < 0.001), but they were significantly less likely to be satisfied with their TKA (moderate: odds ratio (OR) 0.64, 95% confidence interval (CI) 0.4 to 0.92, p = 0.022; severe: OR 0.57, 95% CI 0.39 to 0.82, p = 0.002). Conclusion. Contralateral knee pain did not impair improvement in the WOMAC score after TKA, and patients with the most severe contralateral knee pain had a clinically significantly greater improvement in their functional outcome. More than half the patients presenting for TKA had mild-to-severe contralateral knee pain, most of whom had a clinically meaningful improvement but were significantly less likely to be satisfied with their TKA. Cite this article: Bone Joint J. 2020;102-B(1):125–131

Aims. The primary aim of this study was to assess whether patient satisfaction one year after total knee arthroplasty (TKA) changed with longer follow-up. The secondary aims were to identify predictors of satisfaction at one year, persistence of patient dissatisfaction, and late onset dissatisfaction in patients that were originally satisfied at one year. Patients and Methods. A retrospective cohort consisting of 1369 patients undergoing a primary TKA for osteoarthritis that had not undergone revision were identified from an established arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Short Form 12 (SF-12) questionnaire scores were collected preoperatively, and one and five years postoperatively. In addition, patient satisfaction was assessed at one and five years postoperatively. Logistic regression analysis was used to identify independent predictors of satisfaction at one and five years. Results. The overall rate of satisfaction did not change from one (91.7%, n = 1255) to five (90.1%, n = 1234) years (p = 0.16). Approximately half (n = 53/114) of the patients who were dissatisfied at one year became satisfied with their TKA at five years, whereas 6% (n = 74/1255) of those who were satisfied at one year became dissatisfied at five years. At one year, patients with lung disease (p = 0.04), with depression (p = 0.001), with back pain (p <  0.001), undergoing unilateral TKA (p = 0.001), or with a worse preoperative WOMAC pain score (p = 0.04) were more likely to be dissatisfied. Patients with gastric ulceration (p = 0.04) and a worse WOMAC stiffness score (p = 0.047) were at increased risk of persistent dissatisfaction at five years. In contrast, a worse WOMAC pain score (p = 0.01) at one year was a predictor of dissatisfaction in previously satisfied patients at five years. Conclusion. Three groups of dissatisfied patients exist after TKA: ‘early’ dissatisfaction at one year, ‘persistent’ dissatisfaction with longer follow-up, and ‘late’ dissatisfaction developing in previously satisfied patients at one year. All three groups have different independent predictors of satisfaction, and potentially addressing risk factors specific to these groups may improve patient outcome and their satisfaction. Cite this article: Bone Joint J 2018;100-B:161–9

The periacetabular osteotomy(PAO) is an effective common hip-preserving procedure to treat symptomatic acetabular dysplasia of the hip (DDH). The literature regarding truly long-term patient outcomes after PAO remains limited. We sought to evaluate our patient cohort treated by PAO 25 to 33 years ago to identify factors positively and negatively associated with durable therapeutic success. 219 dysplastic hips (183 patients) underwent PAO between August 1991 and December 1999 by a single surgeon. 164 hips in 134 patients were retrospectively evaluated at minimum of 25 years and maximum of 33 years post-operatively. Hips were evaluated using the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) postoperatively. Osteotomy failure was defined as WOMAC pain score of >/=10 or the need for total hip arthroplasty (THA). 7 patients (7 hips) had died - none of whom had THR. 142/176 remaining patients were located. All patients returned questionnaires; some were seen in person with images. Of patients analyzed to date, 109 hips (63%) were asymptomatic/mildly symptomatic with a preserved hip. 58 hips (33%) had undergone THA. 7 preserved hips (5%) were symptomatic (WOMAC>10). Patients with THA were slightly older than asymptomatic patients (54 ± 8 years vs. 50 ± 11 years; p=0.08), as they had been at time of PAO. Most patients were female (83%), with 89% of hip replacement patients being female. 4/58 replaced hips had been revised - 3 for instability and 1 for acetabular loosening. Data collection is ongoing as more patients are located and reviewed. Long-term follow-up of patients is challenging. Review after minimum of 25 years of the Boston cohort treated with PAO after minimum of 25 years dysplasia reveals that most at long-term follow-up report high levels of function, whether or not they had required arthroplasty, although 33% had required interim treatment with THA

Pelvic osteotomies for hip dysplasia results can be variable and depend on the amount of preexisting arthritis. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a technique designed to measure early arthritis, and could be used to select hips that would benefit from a joint-preserving reconstructive procedure. Our objective was to investigate the role of preoperative dGEMRIC in predicting the success of PAO in patients 40 and above. We hypothesized that patients who failed had lower preoperative dGEMRIC index compared to those who did not. Following IRB approval, patients 40 or older who underwent PAO between 1990–2013 and had preoperative dGEMRIC scan and minimum follow-up of 4 years were identified. Patients with prior hip surgeries or any pathologies were removed leading to a total of 70 patients (Age: 44.2 ± 2.9 years old, BMI: 25.7 ± 4.5 Kg/m. 2. ). We only included the first hip undergoing PAO for those with bilateral PAO. Out of 70, 19 had failure defined by the need for total hip replacement or WOMAC pain score of 10 and above within 10 years after index PAO surgery. Articular cartilage was segmented on the 3D pre-operative dGEMRIC scan. The average thickness and dGEMRIC index across the whole articular surface were analyzed. Failed hips had a lower dGEMRIC index by 115 ± 20 ms (P<0.001). All but one failed hips had a dGMERIC index of 400 or less (range: 313 – 479 ms), while all survived hips had a dGMERIC index of greater than 400 (range: 403 – 691 ms). Similar trends were observed when comparing the dGEMRIC index within the 6 subgroups (P<0.01). There were no differences in cartilage thickness (combined femoral head and acetabular cartilage) between the failed and survived hips (p>0.2). Patients with a high dGMERIC index (indicating high GAG content) may have a higher chance of successful outcomes following PAO. Current efforts are underway to develop a multi-modal predictive model to evaluate risk of failure after PAO

High complication rates and poor outcomes have been widely reported in patients undergoing revision of large head metal-on-metal arthroplasty. A previous study from our centre showed high rates of dislocation, nerve injury, early cup loosening and pseudotumor recurrence. After noting these issues, we implemented the following changes in surgical protocol in all large head MOM revisions: One: Use of highly porous shells in all cases. Two: Use of largest femoral head possible. Three: Low threshold for use of dual mobility and constrained liners when abductors affected or absent posterior capsule. Four: Use of ceramic head with titanium sleeve in all cases. Five: Partial resection of pseudotumor adjacent to sciatic and femoral nerves. The purpose of the present study is to compare the new surgical protocol above to our previously reported early complications in this group of patients. We specifically looked at (1) complications including reoperations, (2) radiologic outcomes, and (3) functional outcomes. Complication rates after (Group 1), and before (Group 2) modified surgical protocol were compared using Chi-square test, assuming statistical significance p < 0 .05. Major complications occurred in 4 (8.3%) of 48 patients who had modified surgical technique, compared to 12 (38%) of 32 revisions prior to modification (p < 0 .05). Two hips of 48 (4.17%) endured dislocations in Group 1, compared to 9 of 32 (28%) in Group 2 (p < 0 .05). Four patients of 48 had repeat revision in Group 1: 2 for recurrence of pseudotumor, 1 for dislocation, and 1 for infection, compared to 6 patients who had 7 repeat revisions of 32 patients in Group 2: 3 for acetabular loosening, 3 for dislocation, and 1 for recurrence of pseudotumor (p=0.1). None of 48 revisions in Group 1 had acetabular loosening, compared to 4 of 32 in Group 2 (p=0.02). Two patients had nerve injury in Group 2, compared to none in Group 1 (p=0.16). The mean WOMAC pain score was 87.1 of 100 and the function score was 88.4 of 100 in Group 1, compared to a mean WOMAC pain score of 78 of 100 (p=0.6) and a function score of 83 of 100 in Group 2 (p=0.8). Modification of the surgical techniques described in the introduction has resulted in a significant decrease in complications in revision of large head MOM total hips. We continue to use this protocol and recommend it for these difficult cases

Introduction and Objective. An important subset of patients is dissatisfied after total joint arthroplasty (TJA) due to residual functional impairment. This study investigated the assessment of objectively measured step-up performance following TJA, to identify patients with poor functional improvement after surgery, and to predict residual functional impairment during early postoperative rehabilitation. Secondary, longitudinal changes of block step-up (BS) transfers were compared with functional changes of subjective patient reported outcome measures (PROMs) following TJA. Materials and Methods. Patients with end stage hip or knee osteoarthritis (n = 76, m/f = 44/32; mean age = 64.4 standard deviation 9.4 years) were measured preoperatively and 3 and 12 months postoperatively. PROMs were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function subscore. BS transfers were assessed by wearable-derived measures of time. In our cohort, subgroups were formed based on either 1) WOMAC function score or 2) BS performance, isolating the worst performing quartile (impaired) of each measure from the better performing others (non-impaired). Subgroup comparisons were performed with the Man-Whitney-U test and Wilcoxon Signed rank test resp. Responsiveness was calculated by the effect size, correlations with Pearson's correlation coefficient. A regression analysis was conducted to investigate predictors of poor functional outcome. Results. WOMAC function scores were strongly correlated to WOMAC pain scores (Pearson's r=0.67–0.84) and moderately correlated to BS performance (Pearson's r = 0.31–0.54). Prior to surgery, no significant differences for WOMAC function scores and BS performance were found between the impaired and non-impaired subgroups. One year after TJA, our cohort performed significantly better at WOMAC and BS with largest effect size for the non-impaired subgroups (0.62 and 0.43 resp.) At 12 months postop, 56% of patients allocated to the impaired subgroup defined by WOMAC, represented the impaired subgroup defined by BS. Allocation to the impaired subgroup at 3 months postop, raised the odds for belonging to the impaired subgroup at 12 months for WOMAC with an odds ratio=19.14 (67%) and for BS with an odds ratio=4.41 (42%). Conclusions. Assessment of BS performance following TJA reveals residual functional impairment that is not captured by pain-dominated PROMs. Its additional use may help to early identify those patients at risk for a poor outcome

Background. High complication rates and poor outcomes have been widely reported in patients undergoing revision of large head metal-on-metal arthroplasty. A previous study from our center showed high rates of dislocation, nerve injury, early cup loosening and pseudotumor recurrence. After noting these issues, we implemented the following changes in surgical protocol in all large head MOM revisions: 1. Use of highly porous shells in all cases 2. Use of largest femoral head possible 3. Low threshold for use of dual mobility and constrained liners when abductors affected or absent posterior capsule 4. Use of ceramic head with titanium sleeve in all cases 5. Partial resection of pseudotumor adjacent to sciatic and femoral nerves. Questions/purposes. The purpose of the present study is to compare the new surgical protocol above to our previously reported early complications in this group of patients. We specifically looked at (1) complications including reoperations; (2) radiologic outcomes; and (3) functional outcomes. Complication rates after (Group 1), and before (Group 2) modified surgical protocol were compared using Chi-square test, assuming statistical significance p<0.05. Results. Major complications occurred in 4 (8.3%) of 48 patients who had modified surgical technique, compared to 12 (38%) of 32 revisions prior to modification (p<0.05). Two hips of 48 (4.17%) endured dislocations in Group 1, compared to 9 of 32 (28%) in Group 2 (p<0.05). Four patients of 48 had repeat revision in Group 1: 2 for recurrence of pseudotumor, 1 for dislocation, and 1 for infection, compared to 6 patients who had 7 repeat revisions of 32 patients in Group 2: 3 for acetabular loosening, 3 for dislocation, and 1 for recurrence of pseudotumor (p=0.1). None of 48 revisions in Group 1 had acetabular loosening, compared to 4 of 32 in Group 2 (p=0.02). Two patients had nerve injury in Group 2, compared to none in Group 1 (p=0.16). The mean WOMAC pain score was 87.1 of 100 and the function score was 88.4 of 100 in Group 1, compared to a mean WOMAC pain score of 78 of 100 (p=0.6) and a function score of 83 of 100 in Group 2 (p=0.8). Conclusions. Modification of the surgical techniques described in the introduction has resulted in a significant decrease in complications in revision of large head MOM total hips. We continue to use this protocol and recommend it for these difficult cases. Level of Evidence. Level IV, therapeutic study

Total joint arthroplasty (TJA) is often utilized to improve pain and dysfunction associated with end-stage osteoarthritis. Previous research has suggested that depression may negatively impact patient reported pain and function. The purpose of this study was to determine the effect of pre-operative depressive symptoms, using the Center for Epidemiologic Scale for Depression (CES-D) scale, on patient reported function and pain at one, three and six months following TJA, after controlling for the impact of age, sex, pain, joint replaced, and other comorbidities. This was a secondary analysis of a prospective cohort of 710 patients aged 40 years and older who underwent elective primary TJA in the Edmonton zone. Participants were recruited pre-operatively and reported socio-demographics, comorbid conditions and medications (including depression medications where appropriate), each participant also completed the Western Ontario McMaster (WOMAC) Osteoarthritis Index and the CES-D scale preoperatively. Participants then completed the WOMAC and CES-D scale again at one, three, and six months postoperatively. Risk-adjusted longitudinal data analysis using a linear mixed regression model was performed, controlling for age, sex, joint replaced, chronic pain, comorbidity, social support and employment status. THA participants had a mean age of 65.9±10.1 years and included 175 (57%) female while TKA participants had a mean age of 67.9±10.1 years and included 249 (61%) females. ‘Possible’ depressive symptoms (CES-D score 16–19) were identified in 58 (8.1%) participants while ‘probable’ depressive symptoms (CES-D score ≥20) were identified in 68 (9.6%) participants. The mean WOMAC pain and function scores, when analyzed using the linear mixed regression model, demonstrated improvement from baseline at one, three, and six months (p < 0 .001 for both pain and function models as well as over time). However, in the patients with possible and probable depressive symptoms, WOMAC pain scores were 7.6±1.5 and 11.7±1.3 worse respectively than those without depressive symptoms after controlling for age, sex, joint replaced, chronic pain, comorbidities and social support. Similarly, WOMAC function scores in the patients with possible and probable depressive symptoms were 8.8±1.4 and 14.2±1.2 worse respectively than those without depressive symptoms after controlling for age, sex, joint replaced, comorbidities and employment status. Depressive symptoms negatively affect postoperative pain and function measured using WOMAC scales even after risk adjustment up to six-months post TJA. Screening for depressive symptomology both pre- and postoperatively may provide an opportunity to identify and manage depressive symptoms to improve postoperative pain and function

Total joint arthroplasty (TJA) is often utilized to improve pain and dysfunction associated with end-stage osteoarthritis. Previous research has suggested that depression may negatively impact patient reported pain and function. The purpose of this study was to determine the effect of preoperative depressive symptoms, using the Center for Epidemiologic Scale for Depression (CES-D) scale, on patient reported function and pain at one, three and six months following TJA, after controlling for the impact of age, sex, pain, joint replaced, and other comorbidities. This was a secondary analysis of a prospective cohort of 710 patients aged 40 years and older who underwent elective primary TJA in the Edmonton zone. Participants were recruited pre-operatively and reported socio-demographics, comorbid conditions and medications (including depression medications where appropriate), each participant also completed the Western Ontario McMaster (WOMAC) Osteoarthritis Index and the CES-D scale preoperatively. Participants then completed the WOMAC and CES-D scale again at one, three, and six months postoperatively. Risk-adjusted longitudinal data analysis using a linear mixed regression model was performed, controlling for age, sex, joint replaced, chronic pain, comorbidity, social support and employment status. THA participants had a mean age of 65.9±10.1 years and included 175 (57%) female while TKA participants had a mean age of 67.9±10.1 years and included 249 (61%) females. ‘Possible’ depressive symptoms (CES-D score 16–19) were identified in 58 (8.1%) participants while ‘probable’ depressive symptoms (CES-D score ≥20) were identified in 68 (9.6%) participants. The mean WOMAC pain and function scores, when analyzed using the linear mixed regression model, demonstrated improvement from baseline at one, three, and six months (p < 0 .001 for both pain and function models as well as over time). However, in the patients with possible and probable depressive symptoms, WOMAC pain scores were 7.6±1.5 and 11.7±1.3 worse respectively than those without depressive symptoms after controlling for age, sex, joint replaced, chronic pain, comorbidities and social support. Similarly, WOMAC function scores in the patients with possible and probable depressive symptoms were 8.8±1.4 and 14.2±1.2 worse respectively than those without depressive symptoms after controlling for age, sex, joint replaced, comorbidities and employment status. Depressive symptoms negatively affect postoperative pain and function measured using WOMAC scales even after risk adjustment up to six-months post TJA. Screening for depressive symptomology both pre- and postoperatively may provide an opportunity to identify and manage depressive symptoms to improve postoperative pain and function

This study compared the demographic, clinical and patient-reported outcomes after total hip replacement (THR) and Birmingham Hip Resurfacing (BHR) carried out by a single surgeon. Patients completed a questionnaire that included the WOMAC, SF-36 scores and comorbid medical conditions. Data were collected before operation and one year after. The outcome scores were adjusted for age, gender, comorbid conditions and, at one year, for the pre-operative scores. There were 214 patients with a THR and 132 with a BHR. Patients with a BHR were significantly younger (49 vs 67 years, p < 0.0001), more likely to be male (68% vs 42% of THR, p < 0.0001) and had fewer comorbid conditions (1.3 vs 2.0, p < 0.0001). Before operation there was no difference in WOMAC and SF-36 scores, except for function, in which patients awaiting THR were worse than those awaiting a BHR. At one year patients with a BHR reported significantly better WOMAC pain scores (p = 0.04) and in all SF-36 domains (p < 0.05). Patients undergoing BHR report a significantly greater improvement in general health compared with those with a THR

A prospective cohort of 222 patients who underwent revision hip replacement between April 2001 and March 2004 was evaluated to determine predictors of function, pain and activity level between one and two years post-operatively, and to define quality of life outcomes using validated patient reported outcome tools. Predictive models were developed and proportional odds regression analyses were performed to identify factors that predict quality of life outcomes at one and two years post-operatively. The dependent outcome variables were the Western Ontario and McMaster Osteoarthritis Index (WOMAC) function and pain scores, and University of California Los Angeles activity scores. The independent variables included patient demographics, operative factors, and objective quality of life parameters, including pre-operative WOMAC, and the Short Form-12 mental component score. There was a significant improvement (t-test, p < 0.001) in all patient quality of life scores. In the predictive model, factors predictive of improved function (original regression analyses, p < 0.05) included a higher pre-operative WOMAC function score (p < 0.001), age between 60 and 70 years (p < 0.037), male gender (p = 0.017), lower Charnley class (p < 0.001) and aseptic loosening being the indication for revision (p < 0.003). Using the WOMAC pain score as an outcome variable, factors predictive of improvement included the pre-operative WOMAC function score (p = 0.001), age between 60 and 70 years (p = 0.004), male gender (p = 0.005), lower Charnley class (p = 0.001) and no previous revision procedure (p = 0.023). The pre-operative WOMAC function score (p = 0.001), the indication for the operation (p = 0.007), and the operating surgeon (p = 0.008) were significant predictors of the activity assessment at follow-up. Predictors of quality of life outcomes after revision hip replacement were established. Although some patient-specific and surgery-specific variables were important, age, gender, Charnley class and pre-operative WOMAC function score had the most robust associations with outcome

Introduction:. Unicompartmental knee arthroplasty (UKA) has been proven to be an effective treatment for degenerative joint disease confined to a single tibiofemoral compartment. Recently, UKAs have been performed with robotic-arm assistance (RAA) devices to build and improve upon previous computer-assisted navigation. As a pilot study, we have analyzed short term outcomes for a series of robotic-arm assisted medial UKAs and compared them to a comparable cohort of traditionally instrumented medial UKAs. Methods:. Ninety-eight fixed-bearing medial UKAs were isolated in our prospective data collection database for short-term analysis for this study. Included patients completed pre and post-operative Short Form 12 version 1 Health Survey (SF12), Western Ontario and McMaster University Outcome Scores (WOMAC), and Knee Society Function Score (KSFS) questionnaires. Forty-eight RAA UKAs were performed using the MAKO RIO system with Restoris implants, and fifty manual UKAs were performed with the Zimmer® Unicompartmental High-Flex Knee System (ZUK). Results:. Both cohorts experienced increased gains in all categories, except for the change in SF12 mental subscore in the MAKO cohort. Only the WOMAC pain subscore at 1 year showed statistically significant differences between the two cohorts, with MAKO subjects experiencing less pain than ZUK subjects (92.4 MAKO vs. 82.0 ZUK, p = 0.03). The SF12 mental score at three months and the change in SF12 mental score from pre-op to 1 year were also statistically significant; however, the pre-op differences between the two groups in the SF 12 mental category were also significantly different. Within the groups that were not significantly different, ZUK subjects experienced greater changes from pre-operative to three months in SF12 mental, all WOMAC subsets, and KSFS, while MAKO subjects had a greater change in SF12 physical subscore. This pattern held true with changes between pre-operative and 1 year, with the exception that MAKO patients experienced a greater positive change in WOMAC pain scores than ZUK patients. Additionally, age and body mass index were not significantly different between cohorts; however, operative time was significantly longer in the MAKO cohort (p < 0.001). Discussion:. These results suggest that despite the lower WOMAC pain scores at one year, the extra expense and operative time required for RAA UKA may not translate into immediate functional gains. These conclusions are however limited due to the short follow-up time period and the randomization of patients. Future studies must also analyze implant alignment, rotation and position in order to fully analyze the operations

Purpose: Obesity is known to be a risk factor for the incidence and progression of prevalent osteoarthritis (OA). The relationship is traditionally believed to be a mechanical effect on weight bearing joints such as the hip and knee, however studies showing a relationship between body mass index (BMI) and OA of non-weight bearing joints, such as the hand, suggest another theory. They suggest that the relationship between obesity and joint degeneration may be a systemic metabolic effect whereby visceral and sub-cutaneous truncal white adipose tissue (WAT) secrete inflammatory mediators that directly influence the pathogenesis of OA. We asked what is the relationship between adiponectin, leptin, and the A/L ratio and patient reported pain in an end stage knee OA joint population. Method: We collected demographic data, Short Form McGill Pain scores, WOMAC pain scores, and synovial fluid (SF) samples from 60 consecutive patients with severe knee OA at the time of joint replacement surgery. Synovial fluid samples were analyzed for leptin and adiponectin using specific ELISA. Non-parametric correlations and linear regression modeling were used to identify the relationship between the adipokines and pain levels. Results: The correlations between the individual adipokines and the pain scales were consistently less than that for the corresponding adipokine ratio. The A/L ratio correlated moderately with the MPQ-SF, (r(58) = − 0.46, p < .01) and the WOMAC pain score, (r(58) = − 0.38, p > .01). Linear regression modeling demonstrated that the A/L ratio was a significant predictor of a greater level of pain on the MPQ-SF(p=0.03, Table 3) but not the WOMAC pain scale(p=0.77, Table 4). Models were adjusted for age, gender, BMI, and medical comorbidity. Conclusion: In conclusion, a greater A/L ratio predicted lower knee OA pain as measured by the MPQ-SF, but not on the WOMAC pain scale. This finding was above that of the individual adipokine levels alone. Some authors have suggested that leptin may have a proin-flammatory role while adiponectin an anti-inflammatory role in synovial joint diseases. Further work to elucidate these pathways may present a target for novel therapeutics in knee OA

Objective. To evaluate the clinical and functional outcomes obtained by combination of high-flexion Freedom® Total Knee System (TKS) and mini-subvastus approach in total knee replacement patients. Method. This is a retrospective, observational, real world study conducted at Mumbai in India from 2011 to 2016. All patients who were above the age of 18 and operated for total knee replacement (TKR) with mini-subvastus approach using Freedom (Maxx Medical) by the senior author were included. The Implant survivorship was the survey endpoint; primary endpoint was range of motion (ROM); and secondary endpoints were AKSS (American Knee Society Score) and WOMAC (Western Ontario and McMaster Universities Osteoarthritis) scores collected pre- and post-operatively. Results. 184 patients with 242 knees (126 unilateral and 58 bilateral) were operated with high-flexion TKS. Average age of patients was 70 ± 6.2 years. The mean ROM increased from 99.4°±10.44° (50°-120°) preoperatively to 116.78°±8.18° (88°–140°) postoperatively (p<0.001). Clinical and functional AKSS scores improved from 60.83±5.12 to 91.16±2.19 (p<0.001) and 65.35±3.52 to 99.13±4.61 (p<0.001) respectively. There average WOMAC pain scores improved from 12.12±1.72 to 0.066±0.37 (<0.0001). Moreover, post-operative WOMAC stiffness and function scores depicted significant improvement from 4.43±0.97 to 0.03±0.26 (p<0.0001) and 0.03±0.26 to 0.18±1.21 (p<0.0001) respectively at a mean follow-up of 3.71 ± 0.98 years. Implant survivorship was 100%. Conclusion. High-flexion Freedom® TKS demonstrated a satisfactory clinical and functional improvements including high flexion when operated by the mini-subvastus approach at a mean FU of 4 years

Aims

Despite new technologies for total knee arthroplasty (TKA), approximately 20% of patients are dissatisfied. A major reason for dissatisfaction and revision surgery after TKA is persistent pain. The radiological grade of osteoarthritis (OA) preoperatively has been investigated as a predictor of the outcome after TKA, with conflicting results. The aim of this study was to determine if there is a difference in the intensity of pain 12 months after TKA in relation to the preoperative radiological grade of OA alone, and the combination of the intensity of preoperative pain and radiological grade of OA.

The aim of this study was to determine the outcomes and survivorship of the Triathlon knee replacement at 7 years after surgery. A cohort of 266 patients receiving a Triathlon knee replacement were assessed before surgery and at 3 months, 1 year, 2 years, 3 years, 5 years and 7 years post-operation. Patient-reported outcomes were assessed using the WOMAC, KOOS Knee-Related Quality of Life scale, Satisfaction Scale and questions on kneeling ability and whether they regretted having the operation. Data on survivorship was collected from self-report and medical records. At 7 years after surgery, 32 patients were deceased, and 17 patients were withdrawn. Of the 217 patients remaining in the study, 164 (76%) returned a completed study questionnaire. At 7 years after surgery, 92% of patients reported an improvement in their WOMAC Pain score greater than the minimally clinically important improvement (defined as improvement of ≥9 points from before surgery) and 82% reported this in their WOMAC Function score (defined as improvement of ≥12 points). Knee-related quality of life was good, with a mean score of 66.8 (SD 26.0) (0–100 scale, worst to best). A high percentage of patients (89%) were somewhat or very satisfied with their outcome at 7 years. Survivorship with revision as the endpoint was 96.4% (95% CI 93.2–98.1%) at 7 years post-operation. Five percent of patients regretted having their operation and 68% reported much difficulty or an inability to kneel. In conclusion, this study observed good long-term patient outcomes and survivorship of the Triathlon knee replacement

INTRODUCTION. To test whether there are differences in postoperative mechanical and component alignment, and in functional results, between conventional, navigated and patient-specific total knee arthroplasties in a low-volume centre?. MATERIAL AND METHODS. Retrospective cohort study of 391 patients who received conventional, navigated or patient- specific primary cemented TKA in a low-volume hospital. RESULTS. The risk of mechanical alignment outliers was 89% lower in the navigated group compared to the conventional TKA group. There was a 63% lower risk of femoral component malalignment and a 66% lower risk of tibial component malalignment in the navigated group. No significant reduction in the risk of malalignment was seen in the patient-specific group. Total WOMAC and Oxford scores were no different between the three techniques. The patient-specific group reported better WOMAC pain scores. PSI TKA was 33% more expensive than conventional TKA and 28% more expensive than Navigated TKA. DISCUSSION. Navigated TKA improved alignment, but neither navigated nor patient-specific TKA improved functional outcomes. Patient-specific TKA was more expensive, with little additional benefit. Clinical relevance: The routine use of patient-specific instrumentation in low-volume centers is not supported by the currently available data

Background: Clinical studies of Collagen Hydrolysate have suggested efficacy in decreasing symptoms and increasing joint function. Therefore a large multi-center, randomized, double-blind, placebo-controlled trial including 389 patients with osteoarthritis (OA) of the knee was performed with 6 centers in the United States (US), 3 in the United Kingdom (UK) and 11 in Germany (GER). Patients randomly received either identically packaged 10g Pharmaceutical Collagen Hydrolysate (PCH) or 12g lactose (placebo) for 24 weeks. Centers were used as strata for randomization. Acetaminophen (ACET) rescue up to 4g/day was allowed. Primary efficacy parameters were the differences of the WOMAC pain score, the WOMAC physical function score and the Patient Global Evaluation that were measured at the beginning and the end of the study period. No statistically significant differences between treatment groups were observed for the total study population. However, when individual countries were analyzed, a statistically significant treatment advantage of PCH over placebo was observed in all 3 primary efficacy endpoints in Germany (adjusted p-value < 0.05), but neither in the US nor the UK. Purpose: To analyse country differences of the 3 primary endpoints using univariate and multivariate statistical methods. Methods: Since the randomization was done within the centers, the randomization is still valid for a by country analysis. Firstly, the success of the randomization was investigated. Secondly, the influences of certain factors on the effect of the treatment were exploratorily analyzed for each primary efficacy endpoint by a univariate analysis. Thirdly, a multivariate linear regression analysis (for the two continuous primary efficacy endpoints WOMAC pain score and WOMAC physical function score) or a logistic regression (for the discrete primary efficacy endpoint Patient Global Evaluation) was performed. Results: Randomization – No differences of age, gender, and race were determined between the treatment groups in all countries. Univariate analysis – Effects of the placebo, drop-out rate, protocol violations, ACET consumption, and baseline differences in all primary efficacy endpoints show significant differences between Germany and the USA. Multivariate analysis – The drop-out rate was the prognostic factors with the highest effect for all primary efficacy endpoints. Furthermore treatment, country, baseline differences, and ACET intake were also significant prognostic factors. Conclusions:. Although a unique study protocol for all countries was used, the outcomes of PCH compared to placebo were different between the three countries. In multi-national studies strategies for controlling possible cultural influences have to be developed. Results of studies carried out in one country should only be cautiously transferred into another country

Introduction. Deaths due to overdose involving opioids have nearly quadrupled in USA in the last 20 years. Several published studies have shown that preoperative opioid use independently predicts perioperative complications in total joint arthroplasty. Our objectives were to (1) assess preoperative opioid consumption in patients undergoing total hip arthroplasty (THA) and (2) to determine how preoperative opioid use affects patient oriented outcomes (POO's) and hip scores before and after THA. Methods. 54 primary THA by a single surgeon were reviewed. A new patient questionnaire was administered to document preoperative opioid consumption (type, dosage and length of use); preoperatively and postoperatively POO's measurements [visual analog scale (VAS), QWB-7, SF-36, and WOMAC] and hip scores were recorded. Patients were stratified into two groups: (1) Opioid Users and (2) Non-Opioid Users. Oral morphine equivalents (OME) were calculated for opioid using patients using standard methodology. Results. 22.2% of the patients were using opioids prior to THA. Among these, 16.6% had tried more than 1 drug. Dosage was self-reported in 33.3% and length of usage only in 8.3%. Mean OME was 13.3mg (range: 6mg–32mg) among users. After adjusting for covariates (gender), opioid users reported worse significant outcomes before surgery for the SF-36 general health (69 vs 80.7; p=0.02), SF-36 role emotional (75.7 vs 99.1; p=0.002), and SF-36 mental health (64 vs 79.7; p=0.005). After surgery even though significant improvements were seen in both groups, opioid users reported significantly worse WOMAC pain scores (1.4 vs 0.3; p=0.03) than non-opioid users. Conclusions. Almost a quarter of the patients in our community undergoing THA, use opioid medications prior to surgery. Opioid users came to surgery with more pain and less function and had worse outcomes. Documentation on the use of opioids in self-administered questionnaire was poor at best. Quantification of OME may help the surgeons with a cutoff point for referral to detoxification before surgery. A significant effort needs to be made in order to measure and manage opioids prior to THA