Objectives. This study examines variations in knee arthroplasty patient reported outcome measures according to patient age. Methods. We analysed prospectively collected outcome data (OKS, Eq5D, satisfaction, and revision) on 2456 primary knee arthroplasty patients. Patients were stratified into defined age groups (< 55, 55–64, 65–74, 75–84, and ≥85 years). Oxford Knee Score and Eq5D were analysed pre-operatively, and postoperatively at 6 months and 2 years. Absolute scores and post-operative change in scores were calculated and compared between age groups. Satisfaction scores (0–100) were analysed at 6 months post-operatively. Linear, logistic and ordinal regression modelling was used to describe the association between age and outcomes, for continuous, binary and ordinal outcomes, respectively. Kaplan-Meier analysis was performed to describe revision rates at 2 years. Results. Patients aged 65–85 years demonstrated better preoperative status than those aged under 65 (OKS, p=0.03; Eq5D, p=0.048), and over 85 years (OKS, p=0.03). Postoperatively, no significant difference in OKS or Eq5D was observed between age groups. Postoperative change in score showed a linear trend for a greater post-operative change in younger patients at 6-months and 2-years (p< 0.04). Overall satisfaction score was 84.9, but patient satisfaction was significantly lower in those aged < 55 years compared to all other age groups (78.1 Vs. 84.8, p=0.031). Cumulative overall 2-year revision rate was 1.3%. Conclusion. This study demonstrates that good early outcomes, as measured by the OKS and Eq5D, can be anticipated following knee replacement regardless of the patient's age, although younger patients gain greater improvement. However, the lower satisfaction in those aged < 55 years is a concern and suggests that outcome is not fully encapsulated by the OKS and Eq5D alone. This raises the question as to whether the OKS alone is an appropriate measure of pain and function in the younger, more active population

Introduction

The Constant Score (CS) and the Oxford Shoulder Score (OSS) are shoulder scoring systems routinely used in the UK. Patients with Acromio-Clavicular Joint (ACJ) and Sterno-Clavicular Joint (SCJ) injuries and those with clavicle fractures tend to be younger and more active than those with other shoulder pathologies. While the CS takes into account the recreational outcomes for such patients the weighting is very small. We developed the Nottingham Clavicle Score (NCS) specifically for this group of patients.

Aims

This study aims to describe the pre- and postoperative self-reported health and quality of life from a national cohort of patients undergoing elective total conventional hip arthroplasty (THA) and total knee arthroplasty (TKA) in Australia. For context, these data will be compared with patient-reported outcome measures (PROMs) data from other international nation-wide registries.

Aims

To estimate the measurement properties for the Oxford Knee Score (OKS) in patients undergoing revision knee arthroplasty (responsiveness, minimal detectable change (MDC-90), minimal important change (MIC), minimal important difference (MID), internal consistency, construct validity, and interpretability).

Aims

This study aimed to evaluate the association between the sagittal alignment of the femoral component in total knee arthroplasty (TKA) and new Knee Society Score (2011KSS), under the hypothesis that outliers such as the excessive extended or flexed femoral component were related to worse clinical outcomes.

In this study we evaluated whether pre-operative Western Ontario and McMaster Universities (WOMAC) osteoarthritis scores can predict satisfaction following total hip arthroplasty (THA). Prospective data for a cohort of patients undergoing THA from two large academic centres were collected, and pre-operative and one-year post-operative WOMAC scores and a 25-point satisfaction questionnaire were obtained for 446 patients. Satisfaction scores were dichotomised into either improvement or deterioration. Scatter plots and Spearman’s rank correlation coefficient were used to describe the association between pre-operative WOMAC and one-year post-operative WOMAC scores and patient satisfaction. Satisfaction was compared using receiver operating characteristic (ROC) analysis against pre-operative, post-operative and δ WOMAC scores.

We found no relationship between pre-operative WOMAC scores and one-year post-operative WOMAC or satisfaction scores, with Spearman’s rank correlation coefficients of 0.16 and –0.05, respectively. The ROC analysis showed areas under the curve (AUC) of 0.54 (pre-operative WOMAC), 0.67 (post-operative WOMAC) and 0.43 (δ WOMAC), respectively, for an improvement in satisfaction.

We conclude that the pre-operative WOMAC score does not predict the post-operative WOMAC score or patient satisfaction after THA, and that WOMAC scores can therefore not be used to prioritise patient care.

Cite this article: Bone Joint J 2015;97-B:150–3.

We explored the outcome of staged bilateral total knee replacement (TKR) for symmetrical degenerative joint disease and deformity in terms of patient expectations, functional outcome and satisfaction. From 2009 to 2011, 70 consecutive patients (41 female) with a mean age of 71.7 years (43 to 89) underwent 140 staged bilateral TKRs at our institution, with a mean time between operations of 7.8 months (2 to 25). Patients were assessed pre-operatively and at six and 12 months post-operatively using the Short Form-12, Oxford knee score (OKS), expectation questionnaire and satisfaction score. The pre-operative OKS was significantly worse before the first TKR (TKR1), but displayed significantly greater improvement than that observed after the second TKR (TKR2). Expectation level increased from TKR1 to TKR2 in 17% and decreased in 20%. Expectations of pain relief and stair-climbing were less before TKR2; in contrast, expectations of sporting and social activities were greater. Decreased expectations of TKR2 were significantly associated with younger age and high expectations before TKR1. Patient satisfaction was high for both TKR1 (93%) and TKR2 (87%) but did not correlate significantly within individuals. We concluded that satisfaction with one TKR does not necessarily translate to satisfaction following the second.

Cite this article: Bone Joint J 2014;96-B:752–8.

Objectives

To define Patient Acceptable Symptom State (PASS) thresholds for the Oxford hip score (OHS) and Oxford knee score (OKS) at mid-term follow-up.

Pre-operative variables are increasingly being used to determine eligibility for total knee replacement (TKR). This study was undertaken to evaluate the relationships, interactions and predictive capacity of variables available pre- and post-operatively on patient satisfaction following TKR. Using nationally collected patient reported outcome measures and data from the National Joint Registry for England and Wales, we identified 22 798 patients who underwent TKR for osteoarthritis between August 2008 and September 2010. The ability of specific covariates to predict satisfaction was assessed using ordinal logistic regression and structural equational modelling. Only 4959 (22%) of 22 278 patients rated the results of their TKR as ‘excellent’, despite the majority (71%, n = 15 882) perceiving their knee symptoms to be much improved. The strongest predictors of satisfaction were post-operative variables. Satisfaction was significantly and positively related to the perception of symptom improvement (operative success) and the post-operative EuroQol-5D score. While also significant within the models pre-operative variables were less important and had a minimal influence upon post-operative satisfaction. The most robust predictions of satisfaction occurred only when both pre- and post-operative variables were considered together. These findings question the appropriateness of restricting access to care based on arbitrary pre-operative thresholds as these factors have little bearing on post-operative satisfaction.

Cite this article: Bone Joint J 2013;95-B:1359–65.

Patient-reported outcome measures (PROMs) are increasingly being used to assess functional outcome and patient satisfaction. They provide a framework for comparisons between surgical units, and individual surgeons for benchmarking and financial remuneration. Better performance may bring the reward of more customers as patients and commissioners seek out high performers for their elective procedures. Using National Joint Registry (NJR) data linked to PROMs we identified 22 691 primary total knee replacements (TKRs) undertaken for osteoarthritis in England and Wales between August 2008 and February 2011, and identified the surgical factors that influenced the improvements in the Oxford knee score (OKS) and EuroQol-5D (EQ-5D) assessment using multiple regression analysis. After correction for patient factors the only surgical factors that influenced PROMs were implant brand and hospital type (both p < 0.001). However, the effects of surgical factors upon the PROMs were modest compared with patient factors. For both the OKS and the EQ-5D the most important factors influencing the improvement in PROMs were the corresponding pre-operative score and the patient’s general health status. Despite having only a small effect on PROMs, this study has shown that both implant brand and hospital type do influence reported subjective functional scores following TKR. In the current climate of financial austerity, proposed performance-based remuneration and wider patient choice, it would seem unwise to ignore these effects and the influence of a range of additional patient factors.

Femoral stem design affects periprosthetic bone mineral density (BMD), which may impact long term survival of cementless implants in total hip arthroplasty (THA). The aim of this study was to examine proximal femoral BMD in three morphologically different uncemented femoral stems designs to investigate whether one particular design resulted in improved preservation of BMDMethods: 119 patients were randomised to receive either a proximally coated dual taper wedge stem, a proximally coated anatomic stem or a fully coated collarless triple tapered stem. All surgeries were performed via the posterior approach with mobilization on the day of surgery. Dual energy x-ray absorptiometry scans (Lunar iDXA, GE Healthcare, Madison, WI) assessed BMD across the seven Gruen zones pre-operatively, and post-operatively at 6-weeks, 1-year, and 2-years and compared to the unoperated contralateral femur as a control. Patient reported outcome measures of pain, function and health were also included at these corresponding follow-ups. BMD increased in zones one (2.5%), two (17.1%), three (13.0%), five (10%) and six (17.9%) for all stems. Greater preservation of BMD was measured on the lateral cortex (zone 2) for both the dual taper wedge and anatomic stems (p = 0.019). The dual taper wedge stem also demonstrated preservation of BMD in the medial calcar (zone 7) whilst the anatomic and triple taper stem declined in this region, however this was not statistically significant (p = 0.059). BMD decreased on average by 2.1% inthe mid-diaphysis region, distal to the stem tip (zone 4) for all implants. All stems performed equivalently at final follow-up in all patient reported outcome measures. This study demonstrated maintenance of femoral BMD in three different cementless femoral stem designs, with all achieving excellent improvements in patient reported outcomes. There was no significant stress shielding observed, however longer follow-up is required to elucidate the impact of this finding on implant survivorship

Background. Studies have compared open reduction internal fixation (ORIF) with fibular nail fixation (FNF) and shown reduced wound complications with minimal difference to PROMS in the short term. Our aim is to compare long-term outcomes for unstable ankle fractures at 10 year follow up. Methods. Patients from a previously conducted RCT were contacted at a minimum of 10 years post intervention at a single study centre. Case notes were reviewed, and patient reported outcome measures acquired at 10 years. Results. Ninety-nine patients were included (48 FNF and 51 ORIF). After 10 years 75% (33/44) of patients in the FNF group required no further follow up versus 81% (39/48) in the ORIF group. Radiographically at 2 years post-injury, there was no statistically significant difference between groups for development of osteoarthritis (p=0.851). There was one tibio-talar fusion in each group secondary to osteoarthritis, but no statistically significant difference in overall re-operation rate (p=0.518). Fifty-one percent (n=50) of patients have so far returned patient reported outcome measures at a minimum of 10 years (Fibular nail n=23, plate fixation n=27). No significant difference was found between groups for the mean scores of Olerud and Molander Ankle Score (FNF 84.78 vs ORIF 84.07; p=0.883), the Manchester-Oxford Foot Questionnaire (MOXFQ) (FNF 89.54 vs ORIF 96.47; p=0.112), Euroqol-5D Index (FNF 0.88 vs ORIF 0.87; p=0.701) and Euroqol-5D Visual Analogue Score (FNF 77.30 vs ORIF 77.52; p=0.859). Conclusion. The current study illustrates that both methods of treatment result in a satisfactory long-term outcome with no difference in late complications or PROM scores at up to 10 years in patients under 65 years old, although the study is currently under powered

Periacetabular osteotomy (PAO) has been established as an effective technique to treat symptomatic hip dysplasia in young patients. Its role in treating borderline dysplasia and acetabular retroversion is evolving. The aim of this study was to:. Examine the prospectively collected outcomes following a minimally invasive PAO in a large cohort of patients. Compare the outcomes of patients with severe dysplasia, borderline dysplasia and acetabular retroversion. This is a single-surgeon review of patients operated in a high-volume centre with prospectively collected data between 2013 and 2020, and minimal followup of six months. PAO was performed using a minimally invasive modified Smith Peterson approach. 387 patients were operated during the study period and 369 eligible patients included in the final analysis. Radiographic parameters were assessed by two authors (GS and KB) with interrater reliability for 25 patients of 84–95% (IntraClass Coefficient). Patient reported outcome measures (i-HOT 12, NAHS, UCLA and EQ-5D) were collected prospectively. Case note review was also performed to collate complication data and blood transfusion rates. Radiological parameters improved significantly after surgery with Lateral centre-edge angle (LCEA) improving by 16.4 degrees and Acetabular index (AI) improved by 15.8 degrees. Patient reported outcome measures showed significant improvement in post-op NAHS, iHOT and EQ5D at 2 years compared to pre-op scores (NAHS=30.45, iHOT=42, EQ5D=0.32, p=0.01). This significance is maintained over 2 years post procedure (p=0.001). There was no significant difference between the three groups (severe dysplasia, borderline dysplasia and acetabular retroversion). Clinical outcomes showed an overall complication rate n=31, 8.3% (Major complication rate: n=3, 0.81%). Non-union rate: n=11, 2.96% of which 3 required fixation (0.81%). Hip arthroscopy post PAO: n=7, 1.9%. Conversion to THR: n=4, 1.1%. Blood transfusion requirement: n=46, 12.5%. No patient developed a major neurovascular injury. In this large single-centre study, patients had radiological and reported outcome improvements following surgery. Overall, there was a low complication rate, providing further evidence of the safety and efficacy of PAO for ameliorating pain and long-lasting results in the management of symptomatic hip dysplasia

The objectives of our study were to compare patient reported outcome measures between manual and robotic-assisted total hip arthroplasty. Between 1st May 2021 and 31st August 2022, 539 consecutive patients who underwent 564 primary total hip arthroplasties were identified from the local registry database. Data were prospectively collected, and included patient demographics, American Society of Anaesthesiologists (ASA) grade, surgical approach, robotic-assistance, Oxford Hip Score (OHS), EQ-5D-3L and EQ-VAS pre-operatively and at twelve months. Robotic-assistance, compared against manual total hip arthroplasty, was associated with an enhanced median (interquartile range) OHS (46 [42 – 48] vs 43 [36 – 47], p-value < 0.001), EQ-5D-3L (5 [5 – 7] vs 6 [5 – 8], p-value 0.002), and EQVAS (90 [75 – 95] vs 80 [70 – 90], p-value 0.003) at twelve months after surgery. Robotic-assistance was confirmed to be an independent predictor of a greater OHS at twelve months on a multivariate linear regression analysis (p-value 0.001). Robotic assistance was superior to manual total hip arthroplasty in enhancing patient reported outcomes at twelve months after surgery

Osteoarthritis (OA) is a disease of the synovial joint with synovial inflammation, capsular contracture, articular cartilage degradation, subchondral sclerosis and osteophyte formation contributing to pain and disability. Transcriptomic datasets have identified genetic loci in hip and knee OA demonstrating joint specificity. A limited number of studies have directly investigated transcriptional changes in shoulder OA. Further, gene expression patterns of periarticular tissues in OA have not been thoroughly investigated. This prospective case control series details transcriptomic expression of shoulder OA by analysing periarticular tissues in patients undergoing shoulder replacement for OA as correlated with a validated patient reported outcome measure of shoulder function, an increasing (clinically worsening) QuickDASH score. We then compared transcriptomic expression profiles in capsular tissue biopsies from the OA group (N=6) as compared to patients undergoing shoulder stabilisation for recurrent instability (the control group, N=26). Results indicated that top ranked genes associated with increasing QuickDASH score across all tissues involved inflammation and response to stress, namely interleukins, chemokines, complement components, nuclear response factors and immediate early response genes. Some of these genes were upregulated, and some downregulated, suggestive of a state of flux between inflammatory and anti-inflammatory signalling pathways. We have also described gene expression pathways in shoulder OA not previously identified in hip and knee OA, as well as novel genes involved in shoulder OA

Background. The literature on the outcome of revision total ankle arthroplasty (TAA) remains limited. We aim to report the clinical and radiological outcomes of revision TAA at a high-volume centre in the UK. Methods. Retrospective review of 28 patients that underwent 29 revision TAA procedures using INBONE II prosthesis. Demographic, radiological, and patient reported outcome measures data were analysed. Results. The mean (range) duration from primary TAA to revision was 87.5 (16–223) months. The main indication for the revision was aseptic loosening of the primary TAA (82.8%). Additional procedures were required in 75.9% of patients. At mean (range) follow-up of 40 (24- 60) months, the infection, re-operation, and implant survival rates were 6.9%, 6.9% and 96.5% respectively. A significant postoperative improvement in the component alignment radiographic measures was observed. Osteolysis, subsidence, loosening and heterotopic ossification rates were comparable to other reports and did not influence the clinical outcome. A significant improvement was observed in the MOXFQ (all domains) and the EQ-5D (three domains) at 24 months postoperatively. Conclusions. Revision TAA using INBONE II was associated with good short-term survival and improvement in the postoperative scores at 2 years. Maintenance of the postoperatively improved alignment was documented at follow up. The relatively high survival rate in this series supports the notion that revision TAA is a satisfactory option for failed primary TAA

Objective. The purpose of this study was to determine the outcomes of revision ankle replacements, using the Invision implant and impaction allograft for massive talar dome defects following primary ankle replacement failure. Outcomes were assessed in terms of bone graft incorporation; improvement in patient reported outcome measures (PROMs); and survivorship of the revision ankle arthroplasty. Methods. A retrospective review of prospectively collected data identified eleven patients who had massive bone cysts and underwent revision of a failed primary total ankle replacement to the Invision revision system, combined with impaction grafting using morselized femoral head allograft. These revisions occurred at a single high volume ankle arthroplasty centre. Computed tomography (CT) scans were used to assess bone graft incorporation and the Manchester-Oxford Foot Questionnaire (MOXFQ) and EQ-5D scores were used pre and post operatively to assess PROMs. Results. The mean follow up was 18 months (12–48months). In all eleven patients, improvement was reported in the post-operative MOXFQ and EQ-5D scores. CT scans showed bone graft incorporation in all cases. None of the patients have required further surgery and are continue to do well clinically at latest follow up. Conclusions. In the short term, this study confirms revision ankle replacements with the Invision prosthesis and impaction with morselized femoral head allograft is a suitable revision option for primary ankle replacement failure with massive talar bone loss. Long term follow up continues of these complex patients

Abstract. Introduction. Active, middle-aged patients with symptomatic cartilage or osteochondral defects can find themselves in a treatment gap when they have failed conservative measures but are not yet eligible for conventional arthroplasty. Data from various cohort studies suggests that focal knee resurfacing implants such as HemiCAP, UniCAP, Episealer or BioBoly are cost-effective solutions to alleviate pain, improve function and delay or eliminate the need for conventional replacement. A systematic review and meta-analysis were conducted in order to(i) evaluate revision rates and implant survival of focal resurfacing; (ii) explore surgical complications; and (iii) evaluate various patient reported clinical outcome measures. Methodology. PubMED, Cochrane Library and Medline databases were searched in February 2022 for prospective and retrospective cohort studies evaluating any of the available implant types. Data on incidence of revision, complications and various patient reported outcome measures was sourced. Results. A total of 24 unique studies were identified with a total of 1465 enrolled patients. A revision rate of 12.97% over a 5.9 year weighted mean follow-up period was observed across all implant types. However, in one series a Kaplan-Meir survival as high as 92.6% at a 10-year follow-up period was noted. A statistically significant improvement was documented across multiple subjective clinical outcomes scores. There was a low reported incidence of post-operative complications such as aseptic loosening or deep wound infection. Conclusions. Focal femoral resurfacing appears to be a viable treatment option for focal symptomatic chondral lesions in patients beyond biological reconstruction, with low revision rates and high patient satisfaction

Femoroacetabular impingement is a prearthritic deformity frequently associated with early chondral damage. Several techniques exist for restoring larger cartilage defects. While AMIC proved to be an effective treatment in knee and ankle, there are only short-term data available in hip. This study aimed to investigate the mid-term clinical outcome of patients with chondral lesions treated by AMIC and evaluate the quality of repair tissue via MRI. This retrospective, single center study includes 18 patients undergoing surgical hip dislocation for FAI between 2013 and 2016. Inclusion criteria were: cam or pincer-type FAI, femoral or acetabular chondral lesions > 1 cm. 2. , (IRCS III-IV). Due to exclusion criteria and loss-to-follow-up 9 patients (10 hips) could be included. Patient reported outcome measures included Oxford Hip Score (OHS) & Core Outcome Measure Index (COMI)). MRIs were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. None of the patients underwent revision surgery except screw removals from the greater trochanter. Followup data indicate a satisfactory to good hip function at 5 years: PROMS improved from pre- to postop at 5 years: OHS from 38.1 to 43.4, COMI from to 1.8 and UCLA from 4 to 8.1 respectively. MOCART score was 67.5 postoperatively. Subgrouping showed slightly better results for acetabular defects (Ø 69.4) compared femoral defects (Ø 60). Based on the reported mid-term results, we consider AMIC as a valuable treatment option for larger chondral defects of the hip

Multiligament knee injuries (MLKI) are associated with significant morbidity and healthcare requirements. The primary aim of this study is to report the patient reported outcomes measures (PROMs) after reconstructive surgery. Patients undergoing surgery for MLKI between 2014 and 2018 in the single large-volume trauma centre were included. Electronic patient records were reviewed for demographic data, details of surgery and complications. PROMs collected were EQ-5D-5L, Lysholm Knee Score (LKS), UCLA Activity and Sport and patient satisfaction. Thirty-five patients were included. Mean age was 31 years (range 16-66), and 71% were male. The most common mechanism of injury was sports-related (71%). Obesity was present in eight (23%) patients. No vascular injuries were recorded and four patients sustained nerve injuries. PROMs were available for 18 patients (51%) with a median follow up of 4.5 years. Median EQ-5D-5L was 0.78 (IQR 0.14). Median LKS was 84.5 (IQR 21) and there was no correlation with time to surgery (p=0.43). Grade of MLKI did not impact LKS (p=0.09). Fifteen patients (83%) saw a reduction in their activity level. All patients were satisfied with their surgical treatment. Recurrent instability was noted in four patients (11%). Three patients (8%) required further surgery (one revision reconstruction, one meniscectomy, one conversion to a hinged knee replacement. This study demonstrates two groups of patients who sustain MLKI: the sporting population and obese patients. Health related quality of life, functional outcomes and satisfaction are high after surgery. Time to surgery did not impact on functional outcomes

Proximal humerus fracture dislocations are amongst the most severe proximal humerus injuries, presenting a challenging management problem. The aim of this study was to report on the long-term outcomes of the management of proximal humerus fracture dislocations. Patients with a proximal humerus fracture dislocation managed at a Level 1 trauma centre from January 2010 to December 2018 were included. Patients with an isolated tuberosity fracture dislocation or a pathological fracture were excluded. Outcome measures were the Oxford Shoulder Score (OSS), EQ-5D-5L, return to work, and radiological outcomes. Complications recorded included further surgery, loss of position/fixation, non-union/malunion, and avascular necrosis. A total of 69 patients were included with a proximal humerus fracture dislocation in the study period; 48 underwent surgical management and 21 were managed with closed reduction alone. The mean (SD) age of the cohort was 59.7 (±20.4), and 54% were male. Overall patients reported a mean OSS of 39.8 (±10.3), a mean EQ-5D utility score of 0.73 (±0.20), and 78% were able to return to work at a median of 1.2 months. There was a high prevalence of complications in both patients managed operatively or with closed reduction (25% and 38% respectively). In patients undergoing surgical management, 21% required subsequent surgery. Patient reported outcome measures post proximal humerus fracture dislocations do not return to normal population levels. These injuries are associated with a high prevalence of complications regardless of management. Appropriate patient counselling should be undertaken before embarking on definitive management

Meniscal tears are the most common injury in the knee, affecting 66/100,000 people/year. Surgical treatment includes arthroscopic meniscectomy or meniscal repair. Little is known regarding medium-term outcomes following these procedures in isolated meniscal tears. This study aims to quantitatively evaluate patients with meniscal tears, and those who have undergone meniscectomy and meniscal repair using validated patient reported outcome measures (PROMs), further exploring factors which affect surgical outcomes. This observational study screened 334 patients who underwent arthroscopic surgery at South Tyneside Hospital since August 2013. 134 patients with isolated meniscal tears were invited to complete postal PROMs. A combination of patient notes and radiological imaging was used to collect information of interest including age, gender, knee-laterality, injured meniscus, tear pattern, procedure performed, complications, and associated injuries. A total of 115 patients (pre-operative patients with current meniscal tear (n=36), meniscectomy (n=63), meniscal repair (n=16)) were included in the analysis with 96% successful PROM completion. Both meniscectomy and meniscal repairs (mean 55-months follow-up) showed better outcomes than pre-operative patients with meniscal tears. Meniscal repairs demonstrated superior outcomes across all PROMs when compared to meniscectomy, with a greater mean overall KOOS score of 17.2 (p=0.009). Factors including higher pre-operative Kellgren-Lawrence Grade, pre-operative articular cartilage lesions and bilateral meniscectomies were shown to negatively influence outcomes. Both meniscectomy and meniscal repair maintain clinical benefit at mean 55-months follow-up, affirming their use for treatment of meniscal tears. When feasible, meniscal repair should be performed preferentially over meniscectomy in isolated meniscal tears. Identified predictive factors allow adequate treatment stratification in specific patient groups

Abstract. Introduction. Anecdotal reports suggest some cementless Oxford Unicompartmental Knee Replacements (OUKRs) have painful early subsidence of the tibial component with valgus rotation and/or posterior tilting. The incidence of subsidence and its association with pain is poorly understood. This radiographic study aimed to evaluate the incidence of tibial subsidence and five-year patient reported outcome measures (PROMs) of a cementless OUKR cohort. Methodology. Cementless OUKRs from a high-volume centre with acceptable post-operative and five-year radiographs were included. Subsidence was determined by measuring the angle of the tibial tray/tibial axis angle and distance between the tibial tray axis and fibula head on anteroposterior and lateral radiographs using a custom MATLAB program. Analysis of 5-year PROMs assessed the relationship between subsidence and pain. Radiographs indicating tibial subsidence were validated by two observers. Results. Radiographs of 94 cementless OUKRs were analysed of which five tibial components had subsided (incidence=5%) with an average of 1.92° varus rotation and 2.97° posterior tilt. Subsidence appeared to occur within the first post-operative year with all tibial components fixed securely at 5 years. Two subsiders had moderate pain (ICOAP=20.5,15.9, AKSS Pain=20,45) and lower Oxford Knee Scores (OKS=26,31) compared to the cohort means (ICOAP=3.91, AKSS Pain=45.9, OKS = 43.6). These two subsiders had BMIs greater than 30. Conclusion. This study found 5% of cementless OUKRs in the cohort underwent tibial subsidence. Subsidence with moderate pain occurred in 2% of cases, and pain may be associated with obesity. A larger study is needed to study subsidence in greater detail

In this study we compare survivorship and patient reported outcome measures in robotically assisted versus conventional Total Hip Arthroplasty (THA). This paper investigates the hypothesis that implant survival and PROMS following THAs performed with robotic assistance were not different to outcomes following conventional THAs. Data included all patients undergoing THA for osteoarthritis between 19 April 2016 and 31 December 2020. Analysis of PROMS outcomes was restricted to those who had completed PROMS data preoperatively and at 6 months postoperatively. There were 157,647 procedures, including 3567 robotically assisted procedures, available for comparison of revision rates. 4557 procedures, including 130 robotically assisted procedures, had PROMS data available. The revision rate of primary THA performed with robotic assistance was not statistically different from THA performed by conventional methods (4 year cumulative percent revision 3.1% v 2.7%; HR = 1.05, p=0.67). The Oxford Hip Score, VAS for pain and the EQ-VAS score for overall health showed no statistically significant difference between the groups. The EQ-5D Utility Score showed an improved score (median score 1 v 0.88; OR = 1.58, p=0.007) for the robotically assisted group compared to the conventional group. Robotic assisted THA was not associated with significant improvement in early revision or joint-specific PROMs. The findings may have been biased, in either direction, by unmeasured patient, surgeon, hospital and prosthesis factors. The findings (including the difference in health-related quality of life) may have also been influenced by lack of blinding. Future research should include methods to minimise these biases

Abstract. Background. Osteochondral allograft (OCA) transplantation is a clinically and cost-effective option for symptomatic cartilage defects. In 2017 we initiated a program for OCA transplantation for complex chondral and osteochondral defects as a UK tertiary referral centre. Aim. To characterise the complications, re-operation rate, graft survivorship and clinical outcomes of knee OCA transplantation. Methodology. Analysis of a prospectively maintained database of patients treated with primary OCA transplantation from 2017 to 2021 with a minimum of one-year follow-up. Patient reported outcome measures (PROMs), complications, re-operations and failures were evaluated. Results. 37 patients with 37 knee OCA procedures were included (mean age 31.6 years [16–49 years]). Mean BMI 26.6 kg/m2 (19.1–35.9 kg/m2). The mean chondral defect size was 3cm2 (1.2–7.3 cm2). Mean duration of follow-up was 3.1 years (1–5.3 years). 16 patients underwent meniscal allograft transplantation (MAT), 6 underwent osteotomy and 4 underwent ligament reconstruction as concurrent procedures. Significant improvements in mean PROMs were noted at 12 months. 16 patients had reoperations of which 5 had more than one surgery. Of these patients 6 were related to OCA (mainly debridement and revision OCA in one patient), and the remainder were related to additional procedures including removal of plate in 2 patients. The overall failure rate was 1 in 37 patients (3%). Conclusions. Early experience of OCA as a treatment option for complex chondral and osteochondral lesions in the knee shows satisfactory results. The reoperation rate is high but at mean follow-up of 3.1 years the survival rate was 97%

Currently, the consensus regarding subscapularis tendon repair during a reverse total shoulder arthroplasty (rTSA) is to do so if it is possible. Repair is thought to decrease the risk of dislocation and improve internal rotation but may also increase stiffness and improvement in internal rotation may be of subclinical benefit. Aim is to retrospectively evaluate the outcomes of rTSA, with or without a subscapularis tendon repair. We completed a retrospective review of 51 participants (25 without and 26 with subscapularis repair) who received rTSR by a single-surgeon using a single-implant. Three patient reported outcome measures (PROM) were assessed pre-operatively and post-operative at twelve months, as well as range of movement (ROM) and plain radiographs. Statistical analysis utilized unpaired t tests for parametric variables and Mann-Whitney U test for nonparametric variables. External Rotation ROM pre-operatively was the only variable with a significance difference (p=0.02) with the subscapularis tendon repaired group having a greater range. Pre- and post-operative abduction (p=0.72 & 0.58), forward flexion (p=0.67 & 0.34), ASES (p=0.0.06 & 0.78), Oxford (p=0.0.27 & 0.73) and post-operative external rotation (p=0.17). Greater external rotation ROM pre-operatively may be indicative of the ability to repair the subscapularis tendon intra-operatively. However, repair does not seem to improve clinical outcome at 12 months. There was no difference of the PROMs and AROMs between the subscapularis repaired and not repaired groups for any of the variables at the pre-operative or 12 month post operative with the exception of the external rotation ROM pre-operatively. We can conclude that from PROM or AROM perspective there is no difference if the tendon is repaired or not in a rTSR and indeed the patients without the repair may have improved outcomes at 12 months

Dual mobility hip arthroplasty utilizes a freely rotating polyethylene liner to protect against dislocation. As liner motion has not been confirmed in vivo, we investigated the liner kinematics in vivo using dynamic radiostereometry. 16 patients with Anatomical Dual Mobility acetabular components were included. Markers were implanted in the liners using a drill guide. Static RSA recordings and patient reported outcome measures were obtained at post-op and 1-year follow-up. Dynamic RSA recordings were obtained at 1-year follow-up during a passive hip movement: abduction/external rotation, adduction/internal rotation (modified FABER-FADIR), to end-range and at 45° hip flexion. Liner- and neck movements were described as anteversion, inclination and rotation. Liner movement during modified FABER-FADIR was detected in 12 of 16 patients. Median (range) absolute liner movements were: anteversion 10° (5–20), inclination 6° (2–12), and rotation 11° (5–48) relative to the cup. Median absolute changes in the resulting liner/neck angle (small articulation) was 28° (12–46) and liner/cup angle (larger articulation) was 6° (4–21). Static RSA showed changes in median (range) liner anteversion from 7° (-12–23) postoperatively to 10° (-3–16) at 1-year follow-up and inclination from 42 (35–66) postoperatively to 59 (46–80) at 1-year follow-up. Liner/neck contact was associated with high initial liner anteversion (p=0.01). The polyethylene liner moves over time. One year after surgery the liner can move with or without liner/neck contact. The majority of movement is in the smaller articulation between head and liner

Purposes of the study and background. Cognitive Functional Therapy (CFT) is a psychologically informed, physiotherapist-led intervention that targets the biopsychosocial complexity of persistent low back pain (LBP). CFT has demonstrated positive outcomes in two randomised controlled trials (RCT) but has not previously been evaluated in the United Kingdom National Health Service (NHS). This study aimed to determine the feasibility of completing a definitive RCT, that will evaluate the clinical and cost-effectiveness of CFT in comparison to usual physiotherapy care (UPC) for people with persistent LBP in the NHS. Methods and results. A two-arm parallel feasibility RCT compared CFT with UPC in participants with persistent LBP. Data concerning study processes, resources, management and patient reported outcome measures (disability, pain intensity, quality of life and psychosocial function) were collected at baseline, three and six-month follow-up, analysed and evaluated in order to establish feasibility. Sixty participants (n=30 CFT and n=30 UPC) were recruited with 71.6% (n=43) retained at six-month follow-up. CFT was delivered to fidelity, relevant and clinically important outcome data were rigorously collected and CFT was tolerated by participants with no safety concerns. The Roland-Morris disability questionnaire was the most suitable primary outcome measure and sample size calculations were completed for a definitive RCT. Intention to treat analysis indicated a signal of effect in favour of CFT with moderate and large between group effect sizes observed across outcome measures at six-month follow-up. Conclusion. It is feasible to conduct a randomised study of CFT in comparison to UPC for NHS patients. A future fully powered clinical and cost effectiveness RCT could be completed. Conflicts of interest: No conflicts of interest. Sources of funding: Chartered Society of Physiotherapy, Physiotherapy Research Foundation

Abstract. Introduction. Little is known about employment following revision total knee arthroplasty (RTKA). This study aims to describe factors associated with returning to employment in patients of working age who underwent RTKA surgery. Methodology. We performed a retrospective assessment of all patients aged ≤65 who underwent RTKA at our NHS institution between 2006 and 2020. All indications and revision procedures were included. Pre-operative demographics, indication for surgery and Oxford Knee Scores (OKS) were recorded. Postal questionnaires were sent to patients including patient reported outcome measures and departmental questionnaire asking patients about employment status pre- and post-operatively. Results. 132 procedures were performed in 113 patients. Median follow up was 5.5 years (2.4–9.0). Mean age was 58 (5.8) and 50% (57) were male. 62 patients undergoing 74 procedures responded to postal questionnaires and were included in the study. 53% (33) were employed prior to surgery and 61% (38) returned to work at a median of 12 weeks (3–150). Of the 24 who did not return to work, 7 reported intending to return to work. Those patients who returned to work had increased pre-operative OKS (16.9 vs 13.6) and mean improvement (16.5 vs 12.4). Conclusion. This study is limited by small numbers and its observational nature. In this population the majority of patients who wished to return to work after RTKA were able to do so. This provides some reassurance when counselling patients. Prospective studies to better understand the factors that predict return to work will be important with increasing demands from surgery

Introduction. By utilising the inherent variability achievable with circular frames, surgeons can manage a wide spectrum of complex injuries, and can deal with deformity at multiple levels, in multiple planes. The aim of this study was to assess functional outcomes utilising patients reported outcome measures (PROMs) of patients being treated with circular (Ilizarov) frame fixation for complex lower limb injuries and assess these results in conjunction with the observed postoperative alignment of the patients’ limbs. Materials & Methods. Cases were identified using a prospectively collected database of adult patients presenting between July 2018 and August 2021. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Score (AOFAS), the 5-level EQ-5D (EQ5D5L), the Lysholm Knee Scoring Scale (LKSS), the Olerud-Molendar Ankle Score (OMAS), and the Tegner Activity Scale (TAS). Postoperative radiographs were analysed for fracture union and to quantify malunion (as described in Dror Paleys Principles of Deformity Correction). Results. The mean AOFAS, EQ5D5L, LKSS and OMAS scores showed an initial drop from pre-op to early time points and then steady increase over the early, mid, late and frame-off time points, with a resultant score higher than pre-op. Malunion was found in 35 (41.7%) patients, 7 patients had a malunion within 5 degrees of normal, 15 from 5–10 degrees of normal, 12 from 10–15 degrees of normal and 2 out with 15 degrees of normal. Conclusions. Circular frame fixation is an attractive option in complex lower limb trauma where alternative fixation methods are unsuitable. Whilst post-operative success to the surgeon might be determined radiographically, patient reported outcomes give a functionally important, objective measure of the success of the surgery to the patient

Abstract. Introduction. Osteotomy is recognised treatment for osteoarthritis of the knee. Evidence suggests favourable outcomes when compared to arthroplasty, for younger and more active individuals[1]. Double level osteotomy (DLO) is considered when a single level is insufficient to restore both joint line obliquity and adequate realignment[2]. This paper aims to establish the functional outcomes up to two years post operatively for patients undergoing DLO, using patient reported outcome measures (PROMs). Methodology. All patients who underwent a DLO at either Lister Hospital, Stevenage, or One Hatfield Hospital, Hertfordshire, between 1st January 2018 and 1st October 2020 were identified. DLO were performed by two specialist consultants, independently or in combination. PROMs including pain scores, health score, Oxford knee score (OKS) and knee injury and osteoarthritis outcome score (KOOS) were recorded pre-operatively and at six month, one and two year post operative intervals. Results. 24 patients underwent DLO; a medial opening wedge high tibial osteotomy and lateral closing wedge distal femoral osteotomy. The cohort comprised 21 males, 3 females with an average age of 54.09 (38–77) years. Preoperative pain scores graded from 0–10 improved from 6.86 to 2.0 at 2 years. OKS improved from 23.94 to 47.88, as did KOOS 43.55 to 87.51, over the same duration. Conclusion. DLO was associated with improvements in pain and functional outcomes, compared to pre-operative levels. In patients for whom arthroplasty may be unfavourable, this provides an alternative to non-operative management, the options for which are frequently exhausted early in the disease process

Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of the spine characterized by a Cobb angle of at least 10 degrees. The goal of surgery is to not only prevent progression but restore sagittal and coronal balance, protecting cardiopulmonary function and improving cosmesis. We reviewed the impact of deformity correction surgery in terms of radiology and patient reported outcome(PROMs). The senior authors prospectively maintained database from 2003 –2022 was retrospectively analysed in terms of pre- and post-operative patient reported outcome measures (SRS 22) as well as radiological parameters. 44 patients with AIS were identified with pre and post op PROMS. The average age at surgery was 15yrs with 84% female. 38% had a Lenke 1 curve and 3 patients had Lenke 6 curves. 73% had posterior surgery. There was a total improvement in SRS 22 scores by 7.8%. Patients reported significant satisfaction with treatment 4.8/5 and improvement in self-image with a change of 0.4 (p<0.001). However, no difference in function, pain and mental health were recorded. Overall, proximal thoracic (PT) curves improved from 24 degrees to 11 degrees (p<0.001), Main thoracic (MT) curve 55 degrees to 19 degrees and Thoracolumbar/Lumbar curves (TL/L) 45 degreesto 11 degrees. Pre-operative flexibility and post-operative correction were 0.40 and 0.41 respectively for PT curve. MT was 0.32 and 0.67. That for TL/L was 0.57 and 0.71 respectively. Surgery yields significant main curve correction correlating with high patient reported satisfaction rate. Although total SRS 22 score yielded 7.8% improvement, sub-analysis of self-image showed the most significant improvement

In an attempt to alleviate symptoms of the disease, patients with knee osteoarthrosis (KOA) frequently alter their gait patterns. Understanding the underlying pathomechanics and identifying KOA phenotypes is essential for improving treatments. We aimed to investigate altered kinematics in patients with KOA to identify subgroups. Sixty-six patients with symptomatic KOA scheduled for total knee arthroplasty and 12 age-matched healthy volunteers with asymptomatic knees were included. We used k-means to separate the patients based on dynamic radiostereometric assessed knee kinematics. Ligament lesions, KOA score, and clinical outcome were assessed by magnetic resonance imaging, radiographs, and patient reported outcome measures, respectively. We identified four clusters that were supported by clinical characteristics. Compared with the healthy group; The flexion group (n=20): revealed increased flexion, greater adduction, and joint narrowing and consisted primarily of patients with medial KOA. The abduction group (n=17): revealed greater abduction, joint narrowing and included primarily patients with lateral KOA. The anterior draw group (n=10): revealed greater anterior draw, external tibial rotation, lateral tibial shift, adduction, and joint narrowing. This group was composed of patients with medial KOA, some degree of anterior cruciate ligament lesion and the greatest KOA score. The external rotation group (n=19): revealed greater external tibial rotation, lateral tibial shift, adduction, and joint narrowing while no anterior draw was observed. This group included primarily patients with medial collateral and posterior cruciate ligament lesions. Patients with KOA can, based on their gait patterns, be classified into four subgroups, which relate to their clinical characteristics. The findings add to our understanding of associations between disease pathology characteristics in the knee and the pathomechanics in patients with KOA. A next step is to investigate if patients in the pathomechanic clusters have different outcomes following total knee arthroplasty

Periprosthetic joint infection is a serious complication of primary total hip replacement (THR) with significant associated morbidity. In acute infection, Debridement, Antibiotics and Implant Retention (DAIR) may be considered. Current national guidelines recommend a DAIR should be performed by “an experienced arthroplasty surgeon┕ but do not specify the need for this to be a revision arthroplasty surgeon. We investigated outcomes in our NHS Trust of DAIR procedures performed by revision and non-revision arthroplasty surgeons. Infection registry data and patient records were analysed for all DAIR procedures of infected primary THRs between 2017 and 2021. Data collected included details of the primary surgery, the presentation with infection, the DAIR procedure and any subsequent complications including return to theatre at any time point. Routinely collected pre- and post-operative patient reported outcome measures (PROMs) were reviewed. 54 periprosthetic joint infections of primary THRs received a DAIR procedure. 41 DAIRs were performed by a revision surgeon and 13 by non-revision surgeons. There was no significant difference in time from primary THR to presentation with infection, time from presentation to DAIR or pre-operative C-reactive protein between the two groups. In 21 (38.9%) patients the DAIR procedure was classed as a treatment failure; 17 patients (31.5%) returned to theatre for further revision surgery, one (2.4%) died related to infection and three (5.6%) had persistent infection but did not receive further surgery. Treatment failure was significantly higher in the non-revision surgeon group (9/13 (69.2%)) than in the revision surgeon group (12/41 (29.3%)) (p = 0.02). Overall, improvement in PROMs after DAIR was seen at both six and 12 months. The overall success rate of DAIR was 61.1% and there was a sustained improvement in PROMs after surgery. However, there was a significant difference in failure rates between revision surgeons and non-revision surgeons

Background. The Manchester-Oxford Foot Questionnaire (MOxFQ) is a condition specific patient reported outcome measure (PROM) for foot and ankle surgery. It consists of 16 items across three subscales measuring distinct, but related traits: walking/standing ability, pain, and social interaction. Although it is the most used foot and ankle PROM in the UK, initial MOxFQ validation involved analysis of only 100 individuals undergoing hallux valgus surgery. This project aimed to establish whether an individual's response to the MOxFQ varies with anatomical region of disease (measurement invariance), and to explore structural validity of the factor structure (subscale items) of the MOxFQ. Methods. This was a single-centre, prospective cohort study involving 6640 patients (mean age 52, range 10–90 years) presenting with a wide range of foot and ankle pathologies between 2013 and 2021. Firstly, to assess whether the MOxFQ responses vary by anatomical region of foot and ankle disease, we performed multi-group confirmatory factor analysis. Secondly, to assess the structural validity of the subscale items, exploratory and confirmatory factor analyses were performed. Results. Measurement invariance by pathology was confirmed suggesting the same model can be used across all foot and ankle anatomical regions. Exploratory factor analysis demonstrated a 2–3 factor model, and suggested that item 13 (inability to carry out my work/everyday activities) and item 14 (inability to undertake social/recreational activities) loaded more positively onto the walking/standing subscale than their original social interaction subscale. Conclusions. This large-cohort study supports the current widespread use of the MOxFQ across a broad range of foot and ankle pathologies. Items 13 and 14 might be better moved from the “social interaction” to the “walking/standing” subscale and this may have future implications for deriving/analysing subscale scores

There is little known about how patient socioeconomic status impacts clinical outcomes in hip preservation surgery. The aim of this study was to evaluate the relationship between indices of multiple deprivation, funding provider (NHS Funded or Private Funded) and clinical outcomes following surgery for femoroacetabular impingement (FAI). The study analysed the data of 5590 patients recorded in the NAHR who underwent primary hip arthroscopic treatment for FAI between November 2013 and July 2023. Records were matched to the UK National index of multiple deprivation using the lower layer super output area. Using iHOT12 score, patient reported outcome measures were analysed at base line and 1 year following surgery. 2358 records were matched to LLSOA deciles. Between the lowest (most deprived) 3 deciles and the highest (least deprived) the average baseline iHOT12 score was 28.98 (n=366) and 35.33 (n=821). The proportion of patients receiving treatment through NHS funding compared to independent funding for the most deprived, 292 (90%) 37 (10%) respectively compared to the least deprived 515 (70%) and 244 (30%) respectively. At 1year, iHOT12 scores for each group were 51.64 (29.1 SD) compared to 61.5 (28.06 SD) respectively. The study demonstrates that patients from lower socioeconomic backgrounds had poorer baseline and one-year post-surgery iHOT12 scores compared to those from higher socioeconomic strata. Furthermore, a higher reliance on NHS funding was observed among the most deprived, while more affluent patients predominantly opted for private funding. These findings underscore the significant influence of socioeconomic status on both the quality of healthcare received and recovery outcomes in hip preservation surgery, calling attention to the need for more equitable healthcare solutions

Background. The effect of hallux valgus (HV) on health-related quality of life (HRQOL) and the relationship between radiographic severity of deformity and patient reported outcome measures (PROMs) is poorly understood. The aim of this study was to compare the HRQOL of female patients with HV to the UK population. The secondary aim was to assess the correlation between PROMs, including HRQOL, with radiographic severity of deformity. Methods. Weight bearing radiographic data (hallux valgus (HVA) angle; intermetatarsal (IM) angle) were measured in consecutive female patients presenting with HV. Each patient prospectively completed the Euroqol EQ-5D-5L questionnaire (EQ-5D), Visual Analogue Scale for Pain (VAS-Pain) and Manchester Oxford Foot Questionnaire (MOXFQ). Data were stratified into age ranges and compared with an EQ-5D United Kingdom general population reference dataset. Pearson R correlation values were calculated for the PROMs and radiographic deformity. Results. Between July 2015 and March 2020, 425 consecutive female patients presented with HV for consideration for surgery. EQ-5D-5L data were prospectively collected for 396 of these patients (93.2%). Females less than 65 years with HV had a statistically significantly worse quality of life compared with females of the same age group in the general population. Above the age of 65, there was no statistically significant difference in EQ-5D-5L Index score between the two groups. There was no correlation between radiographic HV deformity and HRQOL measures or MOXFQ scores. Conclusion. Female patients presenting with HV deformity have a significantly reduced quality of life compared with the UK general population. The radiographic severity of deformity did not correlate with HRQOL measures or foot and ankle specific PROMs. Foot and ankle specific clinical PROMs moderately correlate with HRQOL and may be a better marker of the negative effect of symptomatic hallux valgus deformity on quality of life

Abstract. Customised individually made implants(CIM) total knee arthroplasty(TKA) are custom-made to better fit patients native anatomy and aim to improve outcomes which can be variable with conventional off-the-shelf(OTS). A systematic review and meta-analysis was conducted searching the MEDLINE and Embase databases. Studies reporting on patient reported outcome measures, clinical or radiological outcomes were included. 23 studies satisfied the search criteria (case-control studies14, case series8, cross-sectional studies1). There were 2,856(CIM) and 1,877(OTS) implants. The overall revision-rate was higher in CIM 5.9%vs3.7%OTS [OR 1.46(95% CI 0.82–2.62)]. MUA was higher in the CIM group 2.2%vs.1.1%OTS [OR 2.95(95% CI 0.95–9.13)] and overall complications rate was also higher in the CIM group 5% vs. 4.5%OTS [OR 1.45(95% CI 0.53–3.96)]. LOS was significantly shorter in the CIM group 2.9 days vs. 3.5 days [MD −0.51(95% CI −0.82–0.20)]. Pooled analysis for KSS showed no difference between CIM and OTS groups(Knee=90.5 vs. 90.6 [MD-0.27,(95% CI −4.27–3.73)] and Function=86.1 vs. 90.6[MD 1.51 (95% CI −3.69–6.70)] component of the scores. There was no significant difference in post-operative ROM between CIM and OTS groups 117.3° vs. 115.0° [MD 0.02,(95% CI −1.70–1.74)]. CIM TKAs has theoretical benefits over OTS TKAs however in this review they were associated with higher complication, MUA and revision rates with no difference in outcome scores and no improvement in target alignment. The findings of this review does not support the use of CIM over OTS prosthesis in total knee arthroplasty

Background. Prospective study to compare patient reported outcome measures (PROM) for sacroiliac joint (SIJ) fusion using HA-coated screw (HACS) vs triangular titanium dowel (TTD). First study of its kind in English literature. Methods. 40 patients underwent percutaneous SIJ stabilisation using HACS and TTD was used in 70 patients. Patients were followed up closely and outcome scores were collected prospectively. PROMs were collected preoperatively and 12 months after surgery. Short Form (SF)-36, Oswestry Disability Index, EuroQol-5D-5L and Majeed Pelvic Scores were collected. Shapiro-wilk test was used to determine normality of data. Mann-whitney U test was used to compared non-parametric data and Independent sample T test for parametric data. Results. 33 patients in HACS group and 61 in TTD group completed follow-up. There was no significant difference in all preoperative PROMs in both groups hence the data was considered comparable. All postoperative PROMs were significantly higher in the TTD group. In the HACS group, 21 patients (63%) had lysis around the screw and a sub-group analysis showed that improvement in PROMs was significantly less in patients with lysis around the screw. 4 patients with lysis around the screw were offered revision due to ongoing pain. Revision was successful in only 1 patient. In TTD group only 5 patients (8.2 %) patients had radiological evidence of lysis. Relative risk of developing lysis was 6.7 times higher in HACS group. Conclusion. Percutaneous SIJ fixation procedure has been shown to have good clinical outcomes and TTD leads to significantly better patient reported outcomes compared to HACS. There is a 6.7 time higher risk of lysis with use of HACS and lysis is a risk factor for poor outcomes

Femoral stem design affects periprosthetic bone mineral density (BMD), which may impact long term survival of cementless implants in total hip arthroplasty (THA). The aim of this study was to examine proximal femoral BMD in three morphologically different uncemented femoral stems designs to investigate whether one particular design resulted in improved preservation of BMD. 119 patients were randomized to receive either a proximally coated dual taper wedge stem, a proximally coated anatomic stem or a fully coated collarless triple tapered stem. Dual energy x-ray absorptiometry scans (Lunar iDXA, GE Healthcare, Madison, WI) assessed BMD across the seven Gruen zones pre-operatively, and post-operatively at 6-weeks, 1-year, and 2-years comparing the unoperated contralateral femur as a control. BMD increased in zones one (2.5%), two (17.1%), three (13.0%), five (10%) and six (17.9%) for all stems. Greater preservation of BMD was measured on the lateral cortex (zone 2) for both the dual taper wedge and anatomic stems (p = 0.019). The dual taper wedge stem also demonstrated preservation of BMD in the medial calcar (zone 7) whilst the anatomic and triple taper stem declined in this region, however this was not statistically significant (p = 0.059). BMD decreased on average by 2.1% in the mid-diaphysis region, distal to the stem tip (zone 4) for all implants. All stems performed equivalently at final follow-up in all patient reported outcome measures. Implant design was shown to impact BMD changes. All stems preserved bone at the metaphyseal level in early follow-up, which theoretically indicates favorable implant fixation. There was no significant stress shielding observed, however longer follow-up is required to elucidate the impact of this finding on implant survivorship

Introduction. Open fractures are complex injuries associated with substantial morbidity. These injuries are associated with harm to both physical and emotional health as well as preclusion of work, social, and leisure activities. Patient reported outcome measures (PROMs) and health related quality of life are critical indicators of successful rehabilitation following open fracture treatment. This study aimed to measure the PROMs for patients with open lower limb fractures and investigate the relationship with injury severity. Materials & Methods. A retrospective cohort study was performed at a single major trauma centre in the UK. All adult patients with an open lower limb fracture were eligible for inclusion. Patients were identified through a search of a local Open Fracture Database. Epidemiological, clinical, and fracture classification data were obtained by reviewing case notes. Lower Extremity Function Scale (LEFS) and EQ5-D were used as PROMs and measured by a postal questionnaire, alongside return to employment data. Results. A total of 73 patients responded to the questionnaire. Median LEFS was 42 (IQR 26.5 – 59.5), and median EQ5-D was 0.69 (IQR 0.48 – 0.89). There was no significant association between open fracture classification and PROMs. Over 40% of patients reported a change in employment due to their injury. Those who changed jobs had a statistically significant reduction in the EQ5-D of 0.12 (p = 0.021); no significant difference existed in LEFS. Conclusions. This study demonstrates the devastating functional impact of open fractures. This cohort of open injuries reported lower functional and quality-of-life measures compared to population norms. Injury classification was not a valuable predictor of PROMs. A substantial proportion of patients were forced to change employment due to their injury, and these patients reported a significantly lower quality of life. Further work is required to understand the factors contributing to open fracture PROMs

Periacetabular osteotomy (PAO) is an established treatment for developmental hip dysplasia (DDH) in young adults and can also be utilised in the management of femoroacetabular impingement (FAI) with acetabular retroversion. This study used a national registry to assess the outcomes of PAO for DDH and FAI. PAOs recorded in the UK Non-Arthroplasty Hip Registry between 2012 and November 2022 were identified along with recorded patient and surgical characteristics. Cases were grouped according to the primary pathology (DDH or FAI). Patient reported outcome measures (PROMs) captured included the International Hip Outcome Tool (iHOT)-12 (primary outcome) and the EuroQol-5 Dimensions (EQ-5D) index preoperatively and at 6 months, 1, 2, and 5 years post-operatively. 1,087 PAOs were identified; 995 for DDH (91%), 98 for FAI (9%). Most patients (91%) were female. The DDH group were significantly older (mean 31.7 years) than the FAI group (25.4 years) but had similar body mass index (mean 25.7kg/m2). Overall, significant (all p<0.0001) iHOT-12 and EQ-5D improvement (delta) vs baseline pre-operative scores were achieved at 6 months (mean iHOT-12 improvement +27.4 (95%CI 25.3 to 29.5); n=515) and maintained out to 5 years (+30.0 (21.4 to 38.6); n=44 [9.8% of those eligible for follow-up at 5 years]), at which point 71% and 55% of patients continued to demonstrate a score improvement greater than or equal to the minimum clinically important difference (≥13 points) and substantial clinical benefit (≥28 points) for iHOT-12 respectively. This study demonstrates excellent functional outcomes following PAO undertaken for DDH and FAI in the short to medium term in a large national registry

Most hip replacements are performed in an in-patient setting; however, there has been a shift in recent years in Canada towards doing more on an outpatient basis. In 2021–2022, 15.6% of hip replacements were performed as day surgeries compared to 0.7% in 2018–2019. This analysis will assess patient reported outcome measures of patients who had inpatient versus outpatient hip replacement surgery between 2018 and 2021. We analysed a retrospective sample of 4917 adult patients who had an elective primary unilateral hip replacement. Preoperative and three-month postoperative PROMs were completed - the Oxford Hip Score, EQD5L and patient satisfaction with the outcome were recorded. Patients who had an outpatient procedure were matched 1:1 with patients who are admitted to hospital for surgery based on age, sex and pre-COVID versus the COVID (March 15, 2020 as the start). Preoperative PROMs and Charlson Comorbidity Index were collected. T-tests and chi-square tests were used to assess the differences. The inpatient group on average was older, female and had a lower preoperative PROMs score and more comorbidities than the outpatient group. With cohort matching the sample consisted of 1244 patients. The inpatient and outpatient groups have similar Oxford scores, postoperative EQ-5D-5L scores and the proportion satisfied with their surgical results. The Oxford postoperative score was slightly higher in the outpatient group compared to the inpatient group; however, this is not clinically significant. We observed that outpatient protocols have no difference in patient satisfaction, self-reported functional outcomes and self-reported health-related quality of life three months after a hip replacement. Day surgery protocols represented potential solution to the challenges caused by the expected increase in demand for hip replacements. Our results demonstrated that patients do well clinically with day surgery procedures and there does not appear to be any detrimental effect on PROMs

Aims. Management of intra-articular calcaneal fractures remains a debated topic in orthopaedics, with operative fixation often held in reserve due to concerns regarding perioperative morbidity and potential complications. The purpose of this study was to identify the characteristics of patients who developed surgical complications to inform the future stratification of patients best suited to operative treatment for intra-articular calcaneal fractures and those in whom surgery was highly likely to produce an equivocal functional outcome with potential post-operative complications. Methods. All patients who underwent open reduction and internal fixation of calcaneal fractures utilizing the Sinus Tarsi approach between March 2014 and July 2018 were identified using theatre records. Patient imaging was used to assess pre- and post-operative fracture geometry with Computed Tomography (CT) used for pre-operative planning. Each patient's clinical presentation was established through retrospective analysis of medical records. Patients provided verbal consent to participation and patient reported outcome measures were recorded using the Maryland Foot Score. Results. Fifty-eight intra-articular calcaneal fractures (fifty-three patients including five bilateral, mean age = 46.91 years) were included. Forty-nine patients were injured as a result of a fall from a height (92.4%). Mean time from presentation to surgery was 3.23 days (range 0–21). Mean Maryland Foot score was found to be 77.6 (+/− 16.22) in forty-five patients. Five patients (9.4%) had wound complications; two superficial (3.7%) and three deep (5.6%). Conclusion. Intra-articular fractures of the calcaneus should be considered for surgical intervention in order to improve long-term functional outcomes. The Sinus Tarsi approach provides the potential to decrease the operative complication rate whilst maintaining adequate fixation, however, the decision to surgically manage these fractures should be carefully balanced against the risk of post-operative complications. This increased risk of complication associated with smoking may tip the balance against benefit from surgical management

To compare the long-term outcomes of fibular nailing and plate fixation for unstable ankle fractures in a cohort of patients under the age of 65 years. Patients from a previously conducted randomized control trial comparing fibular nailing and plate fixation were contacted at a minimum of 10 years post intervention at a single study centre. Short term data were collected prospectively and long-term data were collected retrospectively using an electronic patient record software. Ninety-nine patients from one trauma centre were included (48 fibular nails and 51 plate fixations). Groups were matched for gender (p = 0.579), age (p = 0.811), body mass index (BMI)(p = 0.925), smoking status (p = 0.209), alcohol status (p = 0.679) and injury type (p = 0.674). Radiographically at an average of 2 years post-injury, there was no statistically significant difference between groups for development of osteoarthritis (p = 0.851). Both groups had 1 tibio-talar fusion (2% of both groups) secondary to osteoarthritis with no statistically significant difference in overall re-operation rate between groups identified (p = 0.518,). Forty-five percent (n=42) of patients had so far returned patient reported outcome measures at a minimum of 10 years (Fibular nail n=19, plate fixation n=23). No significant difference was found between groups at 10 years for the Olerud and Molander Ankle Score (p = 0.990), the Manchester-Oxford Foot Questionnaire (p = 0.288), Euroqol-5D Index (p = 0.828) and Euroqol-5D Visual Analogue Score (p = 0.769). The current study illustrates no difference between fibular nail fixation and plate fixation at a long-term follow up of 10 years in patients under 65 years old, although the study is currently under powered

A ceramic-on-ceramic hip resurfacing implant (cHRA) was developed and introduced in an MHRA-approved clinical investigation to provide a non metallic alternative hip resurfacing product. This study aimed to examine function and physical activity levels of patients with a cHRA implant using subjective and objective measures both before and 12 months following surgery in comparison with age and gender matched healthy controls. Eighty-two unilateral cHRA patients consented to this study as part of a larger prospective, non-randomised, clinical investigation. In addition to their patient reported outcome measures (PROMs), self- reported measures of physical activity levels and gait analysis were undertaken both pre- operatively (1.5 weeks) and post operatively (52 weeks). This data was then compared to data from a group of 43 age gender and BMI matched group of healthy controls. Kinetics and kinematics were recorded using an instrumented treadmill and 3D Motion Capture. Statistical parametric mapping was used for analysis. cHRA improved the median Harris Hip Score from 63 to 100, Oxford Hip score from 27 to 48 and the MET from 5.7 to 10.3. cHRA improved top walking speed (5.75km vs 7.27km/hr), achieved a more symmetrical ground reaction force profile, (Symmetry Index value: 10.6% vs 0.9%) and increased hip range of motion (ROM) (31.7° vs 45.9°). Postoperative data was not statistically distinguishable from the healthy controls in any domain. This gait study sought to document the function of a novel ceramic hip resurfacing, using those features of gait commonly used to describe the shortcomings of hip arthroplasty. These features were captured before and 12 months following surgery. Preoperatively the gait patterns were typical for OA patients, while at 1 year postoperatively, this selected group of patients had gait patterns that were hard to distinguish from healthy controls despite an extended posterior approach. Applications for regulatory approval have been submitted

Most previous studies investigating autograft options (quadriceps, hamstring, bone-patella-tendon-bone) in primary anterior cruciate ligament (ACL) reconstruction are confounded by concomitant knee injuries. This study aims to investigate the differences in patient reported outcome measures and revision rates for quadriceps tendon in comparison with hamstring tendon and bone-patella-tendon-bone autografts. We use a cohort of patients who have had primary ACL reconstruction without concomitant knee injuries. All patients from the New Zealand ACL Registry who underwent a primary arthroscopic ACL reconstruction with minimum 2 year follow-up were considered for the study. Patients who had associated ipsilateral knee injuries, previous knee surgery, or open procedures were excluded. The primary outcome was Knee Injury and Osteoarthritis Outcome Score (KOOS) and MARX scores at 2 years post-surgery. Secondary outcomes were all-cause revision and time to revision with a total follow-up period of 8 years (time since inception of the registry). 2581 patients were included in the study; 1917 hamstring tendon, 557 bone-patella-tendon-bone, and 107 quadriceps tendon. At 2 years, no significant difference in MARX scores were found between the three groups (2y mean score; 7.36 hamstring, 7.85 bone-patella-tendon-bone, 8.05 quadriceps, P = 0.195). Further, no significant difference in KOOS scores were found between the three groups; with the exception of hamstring performing better than bone-patella-tendon-bone in the KOOS sports and recreation sub-score (2y mean score; 79.2 hamstring, 73.9 bone-patella-tendon-bone, P < 0.001). Similar revision rates were reported between all autograft groups (mean revision rate per 100 component years; 1.05 hamstring, 0.80 bone-patella-tendon-bone, 1.68 quadriceps, P = 0.083). Autograft revision rates were independent of age and gender variables. Quadriceps tendon is a comparable autograft choice to the status quo for primary ACL reconstruction without concomitant knee injury. Further research is required to quantify the long-term outcomes for quadriceps tendon use

Total hip arthroplasty (THA) is often performed in symptomatic patients with developmental dysplasia of the hip (DDH) who do not qualify for periacetabular osteotomy (PAO). The impact of osteoarthritis (OA) severity on postoperative outcomes in DDH patients who undergo THA is not well described. We hypothesized that DDH patients who undergo THA with mild OA have slower initial recovery postoperatively, but similar one-year patient reported outcome measures (PROMs) when compared to DDH patients with severe OA. We performed a retrospective review at a single academic institution over a six-year period of patients with DDH who underwent primary THA and compared them to patients without DDH who underwent THA. Within the DDH cohort, we compared PROMs stratified by DDH severity and OA severity. Diagnosis of DDH was verified using radiographic lateral center edge angle (LCEA). Minimum one-year follow-up was required. PROMs were collected through one-year postoperatively. Logistic and linear regression models were used adjusting for age, sex, body mass index, and Charlson Comorbidity Index. 263 patients with DDH were compared to 1,225 THA patients without DDH. No significant differences were found in postoperative PROMs or revision rates (p=0.49). When stratified by DDH severity, patients with LCEA<10° had worse preoperative pain (p=0.01), mental health (p<0.01) and physical function (p=0.03) scores but no significant difference in postoperative PROMs. Within the DDH group, when stratified by OA severity, patients with Grade 3 Tonnis score had worse preoperative pain (p=0.04) but no significant difference in postoperative PROMs. Recovery curves in DDH patients based upon severity of DDH and OA were not significantly different at 2-weeks, 6-weeks and 1-year. DDH patients who have mild OA have similar recovery curves compared to those with severe OA. THA is reasonable in symptomatic DDH patients who have mild arthritis and do not qualify for PAO

Cryocompression therapy is a non-invasive and non-pharmacological modality used in managing acute post-operative inflammation and pain. A prospective, randomised controlled trial (RCT) was undertaken to evaluate the effectiveness of a post-operative cryocompression protocol using the Game Ready™ (GR) device versus usual care on recovery following total knee arthroplasty (TKA). A single centre RCT was conducted with 70 TKAs (68 patients) randomised to a 2-week intervention period consisting of treatment with GR cryocompression (n=33, 33.3% males) or a usual care protocol of ice with static compression using tubigrip (n=35, 54.3% males). Knee range of movement (ROM) (flexion and extension), a visual analogue pain score (VAS) and limb circumference were documented at day 1, 2 and 14, as well as 6 and 12 weeks post-surgery. ROM was also recorded at day 90, while medication use and length of hospital stay were documented. Patient reported outcome measures (PROMs) including the KOOS and patient satisfaction questionnaire were employed. The GR group demonstrated 2.3° more (p=0.05) knee extension ROM overall, as well as 2. 8° more at day 1 (p=0.048), 3.8° at day 14 (p=0.007) and 5.4° at 3 months (p=0.017). There were no group differences (p>0.05) observed in pain (VAS), flexion ROM, limb circumference, opioid use or other PROMs. Across the full cohort, higher pain levels resulted in increased opioid intake (p=0.002), older patients used significantly less opioids (p<0.001) and males reported significantly less pain (VAS) than females (p=0.048). Using GR following TKA is a safe, non-invasive tool that can be used to aid in the post-operative recovery period. Patients using the GR cryocompression device gained significantly more extension ROM compared to the conventional ice with compression group, despite no other group differences

Abstract. Introduction. In revision knee arthroplasty, rotating hinge implants (RHK) have been considered to result in higher complication rates and lower survivorship when compared to constrained condylar implants (CCK). The aims of this study were to compare patient reported outcome measures (PROMs), complication rates and survivorship of RHK and CCK used in revision arthroplasty at a single, high volume elective orthopaedic centre with previously validated bespoke database. Methodology. One hundred and eight patients who underwent revision knee arthroplasty with either CCK or RHK and matched our inclusion criteria were identified. EQ5D, Health State and Oxford Knee Scores were collected pre-operatively and at 1 year post-operatively. Complication data was collected at 6 weeks, 6 months, 1 year and 2 years post-operatively. NJR data was interrogated, in addition to our own database, to investigate implant survival. Results. There was no statistically significant difference between RHK and CCK in implant survival at two to twelve years of follow up. In addition, we observed no statistically significant difference in the PROMs scores and complication rates of the two implants. Conclusion. This study shows that both the RHK and CCK remain viable options in revision arthroplasty, the implant survival and complication rate were comparable. We recommend prospective randomised control trials with long-term follow up to further investigate the use of CCK and RHK implants in revision knee arthroplasty