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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLI | Pages 40 - 40
1 Sep 2012
Chou D Swamy G Lewis J Badhe N
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Multiple reports suggest good outcome results following unicompartmental knee replacement (UKR). However, several authors report technically difficult revision surgery secondary to osseous defects. We reviewed clinical outcomes following revision total knee replacement for failed UKR and analysed the reasons for failure and the technical aspects of the revision surgery.

Between 2003 and 2009, thirty three revisions from unicompartmental knee replacement to total knee replacement were performed in thirty two patients at a single centre. Demographics, indications for the primary and revision procedures, details of the revised prosthesis including augments and any technical difficulties or complications were noted. Patient assessment included range of motion and the functional status of the affected knee in the form of the Oxford knee score questionnaire. Statistical analysis was performed with the Student t test.

All 33 revision knees were available for prospective clinical and radiological follow-up. The minimum duration of follow-up after revision surgery was 1 year (mean 3 years, range 1 – 7 years). The median interval between the original unicompartmental knee replacements to revision surgery was 19 months (range 2 – 159 months). The predominant cause of failure was aseptic loosening (50%). Other reasons included persistent pain (21%), dislocated meniscus (18%), mal-alignment (7%) and progression of symptomatic osteoarthritis in another compartment (4%). 18 of the 33 revision procedures required additional augments. During the revision surgery, 11 knees required a long tibial stem while 1 required a long femoral stem. 10 knees required medial tibial wedge augmentation; bone graft was used in 6 knees while a metal wedge augment was used in 4 to fill significant osseous defects. At the time of follow-up, range of movement averaged 103 degrees (range 70 – 120). The mean one year Oxford knee score, was 29 compared to 39 for primary total knee replacements performed during the same period in a comparable sample group of patients at our institute (p < 0.001). Three patients continued to have pain and two required re-revision; one for infection and one for loosening.

Aseptic loosening was the commonest mode of failure. Of the UKRs revised to TKRs, 90% were revised within 5 years. The majority of revisions required additional constructs. Oxford Knee Scores after revision surgery were inferior to those for primary TKR. The role of UKR needs to be more clearly defined.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 30 - 30
1 Sep 2012
Al-Atassi T Chou D Boulton C Moran C
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Introduction

Cemented hemiarthroplasty for neck of femur fractures has been advocated over uncemented hemiarthroplasty due to better post-operative recovery and patient satisfaction. However, studies have shown adverse effects of bone cement on the cardio-respiratory system which may lead to higher morbidity and mortality. Therefore, in some institutes, the use of an uncemented prosthesis has been adopted for patients with a high number of co-morbidities. The aim was to compare early mortality rates for cemented vs. uncemented hemiarthroplasties.

Method

Cohort study of displaced intracapsular hip fractures treated with hemiarthroplasty between 1999–2009 at one institute. A total of 3094 hemiarthroplasties performed; out of which 1002(32.4%) were cemented and 2092(67.6%) were uncemented. 48hour and 30day mortality rates for the two groups were compared and a multivariate Cox regression model used to eliminate confounding factors. Significant confounding factor included age, sex, mini mental test score, medical co-morbidities, Nottingham Hip Fracture Score and delay to surgery.