Introduction: Many patients with DJD of the hip may have co-existent spinal arthritis. This prospective study sought to determine: how hip arthritis commonly presents, the incidence of low back pain- as identified by patients- before and after THA and the correlation between LBP and hip arthritis.

Methods: 344 consecutive patients undergoing THA were recruited prospectively at a single institution. A detailed questionnaire containing diagrams on which the patient could draw out the site of their pain was administered to all patients preoperatively and postoperatively. Detailed clinical, radiographic, and cross sectional imaging of all the patients were reviewed in detail by a hip surgeon, a spine surgeon, and a neurologist.

Results: 170 patients (49.4%) had true LBP which resolved in 63 patients (37%). Of the remaining 107 patients the back pain was of the same intensity following THA in 33 patients (30%) and had decreased in 74 (70%) patients. 22 of the 33 patients with continued LBP were known to have spine pathology. 35 patients developed LBP after THA.18 patients in the latter group were investigated further and 12 were found to have severe previously unrecognized spine pathology.

Discussion: Hip and spine arthritis often co-exist. Majority of patients with ‘back’ pain experience a complete resolution of their pain following THA so long as prior spine pathology did not exist. THA seems to be beneficial in reducing the symptoms even for those with a pre-existent LBP and spine pathology. A number of patients may develop LBP following THA that may relate to unidentified spine pathology. Patients with true LBP may benefit form evaluation of their spine prior to THA.

INTRODUCTION: Range of motion following TKA is a commonly assessed and important outcome parameter. The reported knee ROM is often measured using manual goniometers. The accuracy of goniometer in measuring ROM of the knee is not known. We compared the knee ROM measured with a manual goniometer and compared that to measurements obtained from computer assisted navigation system.

METHODS: This prospective ongoing study has so far recruited 60 patients (71 knees) undergoing TKA by a single surgeon. Measurements of the ROM were performed intraoperatively using a 14 inch 360° Nexgen Baseline® goniometer, validated by physical therapists, and the Stryker knee navigation system^™. Consistent anatomical landmarks were used to obtain flexion and extension measurements. Each goniometer and navigation measurement was performed twice by the same reader.

RESULTS: Goniometer was more inaccurate in measuring the knee ROM than the navigation. There was a 5.07° difference between two measurements obtained with the goniometer compared to a mean discrepancy of 1.15° using the navigation system. Further, the ROM measured by navigation was on average 13.9° larger than that measured by the goniometer. BMI affected the ROM recording obtained by both the goniometer and the navigation system.

DISCUSSION AND CONCLUSION: This study indicates that goniometer is not an accurate tool for measurements of knee ROM as there is a marked discrepancy between two goniometer readings. The navigation system seemed to produce more consistent, but markedly higher, readings than a manual goniometer. Reported results on knee ROM in the literature need to be interpreted with caution and scrutinized for potential inaccuracy of the measuring tool.

Introduction: The safety of simultaneous bilateral knee replacement (BTKA) remains controversial. Some studies have proposed a higher incidence of serious complications, even death, following BTKA whilst others refute the latter. The objective of this meta-analysis was to evaluate the safety of BTKA.

Methods: A computerized literature search was conducted to identify all citations, between 1966 to 2005, concerning BTKA. All the English-language abstracts were obtained. A multistage assessment was then used to identify articles fulfilling the inclusion criteria for the study. All randomized, prospective studies reporting the outcome of BTKA were included. Details of any reported data were extracted and extensive analysis of relevant variables carried out.

Results: 150 published articles pertaining to BTKA were identified of which 18 papers on 27,807 patients (44,684 knees) were included in the meta-analysis.10,734 cases were unilateral TKA, 16,378 were simultaneous BTKA and 458 were staged bilateral TKA with at least 3 months time duration between the surgical procedures. The complications analyzed were DVT, PE, cardiac events and mortality. The incidence of PE (OR=1.8), cardiac complications (OR=2.4), and mortality (OR=2.24) were higher after simultaneous BTKA. The incidence of DVT was LOWER in the group with simultaneous BTKA.

Discussion: Based on the findings of this meta-analysis, simultanous BTKA seems to carry a higher risk of serious cardiac complications, pulmonary complications, and mortality. This procedure should be reserved for the healthy and young patients.