header advert
Results 1 - 26 of 26
Results per page:
The Bone & Joint Journal
Vol. 106-B, Issue 1 | Pages 38 - 45
1 Jan 2024
Leal J Mirza B Davies L Fletcher H Stokes J Cook JA Price A Beard DJ

Aims

The aim of this study was to estimate the incremental use of resources, costs, and quality of life outcomes associated with surgical reconstruction compared to rehabilitation for long-standing anterior cruciate ligament (ACL) injury in the NHS, and to estimate its cost-effectiveness.

Methods

A total of 316 patients were recruited and randomly assigned to either surgical reconstruction or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment). Healthcare resource use and health-related quality of life data (EuroQol five-dimension five-level health questionnaire) were collected in the trial at six, 12, and 18 months using self-reported questionnaires and medical records. Using intention-to-treat analysis, differences in costs, and quality-adjusted life years (QALYs) between treatment arms were estimated adjusting for baseline differences and following multiple imputation of missing data. The incremental cost-effectiveness ratio (ICER) was estimated as the difference in costs divided by the difference in QALYs between reconstruction and rehabilitation.


Bone & Joint Open
Vol. 4, Issue 12 | Pages 923 - 931
4 Dec 2023
Mikkelsen M Rasmussen LE Price A Pedersen AB Gromov K Troelsen A

Aims

The aim of this study was to describe the pattern of revision indications for unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) and any change to this pattern for UKA patients over the last 20 years, and to investigate potential associations to changes in surgical practice over time.

Methods

All primary knee arthroplasty surgeries performed due to primary osteoarthritis and their revisions reported to the Danish Knee Arthroplasty Register from 1997 to 2017 were included. Complex surgeries were excluded. The data was linked to the National Patient Register and the Civil Registration System for comorbidity, mortality, and emigration status. TKAs were propensity score matched 4:1 to UKAs. Revision risks were compared using competing risk Cox proportional hazard regression with a shared γ frailty component.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_13 | Pages 88 - 88
7 Aug 2023
Ahmed I Dhaif F Khatri C Parsons N Hutchinson C Price A Staniszewska S Metcalfe A
Full Access

Abstract

Introduction

Recent research has questioned the role of arthroscopic meniscectomy in patients with a meniscal tear leading to the development of treatment recommendations for these patients. There is a clear need to understand patient perceptions of living with a meniscal tear in order to plan future research and treatment guidelines.

Aims

To explore the experiences and expectations of treatment of young patients with a meniscal tear of the knee


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_13 | Pages 87 - 87
7 Aug 2023
Ahmed I Dhaif F Khatri C Parsons N Hutchinson C Staniszewska S Price A Metcalfe A
Full Access

Abstract

Background

Meniscal tears affect 222 per 100,000 of the population and can be managed non-operatively or operatively with an arthroscopic partial meniscectomy (APM), meniscal repair or meniscal transplantation. The purpose of this review is to summarise the outcomes following treatment with a meniscal tear and explore correlations between outcomes.

Methodology

A systematic review was performed of MEDLINE, EMBASE, AMED and the Cochrane Central Register of Controlled Trials to identify prospective studies describing the outcomes of patients with a meniscal tear. Comparisons were made of outcomes between APM and non-operative groups. Outcomes were graphically presented over time for all treatment interventions. Pearson's correlations were calculated between outcome timepoints.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_13 | Pages 89 - 89
7 Aug 2023
Ahmed I Dhaif F Bowes M Parsons N Hutchinson C Staniszewska S Price A Metcalfe A
Full Access

Abstract

Introduction

Previous research has demonstrated no clinically significant benefit of arthroscopic meniscectomy in patients with a meniscal tear, however, patients included in these studies would not meet current treatment recommendations. Prior to further randomised controlled trials (RCTs) research is needed to understand a younger population in more detail.

Aim

To describe the baseline characteristics of patients with a meniscal tear and explore any association between baseline characteristics and outcome.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 34 - 34
1 Jul 2022
Abram S Sabah S Alvand A Price A
Full Access

Abstract

Introduction

The objective of this study was to determine rates of serious adverse events in patients undergoing revision knee arthroplasty with consideration of the indication for revision and compare these with primary knee arthroplasty.

Methodology

Primary and revision arthroplasty procedures were identified in the national Hospital Episode Statistics and were linked by patient and side. A logistic regression model was used to investigate factors associated with 90-day mortality (primary outcome) and secondary serious adverse outcomes. Urgent indications for revision arthroplasty were defined as infection or fracture; other indications (e.g. loosening, instability, wear) were included in the elective cohort.


Abstract

Introduction

Cementless fixation of Oxford Unicompartmental Knee Replacements (UKRs) is an alternative to cemented fixation, however, it is unknown whether cementless fixation is as good long-term. This study aimed to compare primary and long-term fixation of cemented and cementless Oxford UKRs using radiostereometric analysis (RSA).

Methodology

Twenty-nine patients were randomised to receive cemented or cementless Oxford UKRs and followed for ten years. Differences in primary fixation and long-term fixation of the tibial components (inferred from 0/3/6-month and 6-month/1-year/2-year/5-year/10-year migration, respectively) were analysed using RSA and radiolucencies were assessed on radiographs. Migration rates were determined by linear regression and clinical outcomes measured using the Oxford Knee Score (OKS).


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 63 - 63
1 Jul 2022
Sabah S Fritsch LV Price A Alvand A
Full Access

Abstract

Introduction

A revision knee replacement (rKR) network model has been introduced in the UK to improve clinical outcomes for patients and reduce healthcare costs. However, the current practice of different types of surgical unit is not well understood. The aim of this study was to answer: “How complex are rKR cases at a Major Revision Centre (MRC)?”

Methodology

Retrospective cohort study at the Nuffield Orthopaedic Centre, Oxford from 2015 - 2018. Case complexity was classified using the Revision Knee Complexity Classification (RKCC). Referral source, technical details of surgery and hospital admission impact were recorded.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 77 - 77
1 Jul 2022
Sabah S Sina J Alvand A Beard D Price A
Full Access

Abstract

Introduction

Anxiety and depression are risk factors for poor outcome following knee replacement surgery. The aim of this study was to investigate the prevalence of anxiety and depression before and after primary (pKR) and revision knee replacement (rKR).

Methodology

Retrospective cohort study. 315,720 pKR and 12,727 rKR recruited from the NHS Patient Reported Outcome Measures (PROMs) programme from 2013–2021. Anxiety and depression were defined using: (i) Survey question: “Have you been told by a doctor that you have depression? Yes/No”; (ii) EQ-5D anxiety/depression domain. Rates of EQ-5D anxiety/depression were investigated at baseline and at 6-months following surgery. The prevalence of depression was investigated by patient age and gender.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 79 - 79
1 Jul 2022
Fritsch LV Sabah S Xu J Jackson W Merle C Price A Alvand A
Full Access

Abstract

Introduction

Re-revision knee replacement (RR-KR) is complex surgery, with a significant impact on individual patients and health resource use. The aim of this study was to investigate early patient-relevant outcomes following RR-KR.

Methodology:

206 patients (250 knees) undergoing RR-KR were recruited from a major revision centre between 2015–2018. Patient-relevant outcomes assessed were: implant survivorship, complications (90-days), joint function and quality of life (final follow-up). Risk factors for further revision surgery at 1 year were investigated using multiple logistic regression.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 62 - 62
1 Jul 2022
Sabah S Knight R Alvand A Beard D Price A
Full Access

Abstract

Introduction

Our aim was to investigate trends in the incidence rate and main indication for revision knee replacement (rKR) over the past 15 years in the UK.

Methodology

Cross-sectional study from 2006 - 2020 using data from the National Joint Registry (NJR). Crude incidence rates were calculated using population statistics from the Office for National Statistics.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 30 - 30
1 Jul 2022
Middleton R Jackson W Alvand A Bottomley N Price A
Full Access

Abstract

Background

Since 2012 we have routinely used the cementless Oxford medial unicompartmental knee arthroplasty (mUKA), with microplasty instrumentation, in patients with anteromedial osteoarthritis (AMOA) meeting modern indications. We report the 10-year survival of 1000 mUKA with minimum 4-year follow-up.

Methods

National Joint Registry (NJR) surgeon reports were interrogated for each senior author to identify the first 1,000 mUKAs performed for osteoarthritis. A minimum of 4 years follow-up was required. There was no loss to follow-up. The NJR status of each knee was established. For each mUKA revision the indication and mechanism of failure was determined using local patient records. The 10-year implant survival was calculated using life-table analysis.


The Bone & Joint Journal
Vol. 100-B, Issue 12 | Pages 1572 - 1578
1 Dec 2018
Middleton R Wilson HA Alvand A Abram SGF Bottomley N Jackson W Price A

Aims

Our unit was identified as a negative outlier in the national patient-reported outcome measures (PROMs) programme, which has significant funding implications. As a centre that carries out a high volume of unicompartmental knee arthroplasty (UKA), our objectives were: 1) to determine whether the PROMs programme included primary UKA when calculating the gain in Oxford Knee Score (OKS); and 2) to determine the impact of excluding primary UKA on calculated OKS gains for primary knee arthroplasty.

Materials and Methods

National PROMs data from England (2012 to 2016) were analyzed. Inclusion of UKA cases in the national PROMs programme was determined using clinical codes. Local OKS gain was calculated for UKA and TKA and compared with the published PROMs results for 2012/13.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 92 - 92
1 Jul 2012
Mehmood S Batta V Gulati A Pandit H Bottomley N Gil H Beard D Dodd C Jackson W Murray D Price A
Full Access

INTRODUCTION

Establishing a full-thickness cartilage in the lateral compartment and functionally intact ACL is vital before proceeding with unicompartmental knee replacement (UKR). The aim of this study is to assess whether MRI is a useful adjunct in predicting suitability for UKR, as compared to standard and stress radiographs.

METHODS

We identified 50 patients with a knee found suitable for UKR based on their standard and stress radiographs (full-thickness cartilage on lateral side). These patients underwent an additional cartilage-specific MRI scan to identify the status of ACL and the lateral compartment. The final decision regarding the suitability for UKR was based on the intra-operative observation.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 71 - 71
1 Jul 2012
Beard D Holt M Mullins M Massa E Malek S Price A
Full Access

Purpose

Late stage medial unicompartmental osteoarthritic disease of the knee can be treated by either Total Knee Replacement (TKR) or Unicompartmental Replacement (UKR). As a precursor to the TOPKAT study this work tested the postulate that individual surgeons show high variation in the choice of treatment for individual patients.

Method

Four surgeons representing four different levels of expertise or familiarity with partial knee replacement (UKR design centre knee surgeon, specialist knee surgeon, arthroplasty surgeon and a year six trainee) made a forced choice decision of whether they would perform a TKR or UKR based on the same pre-operative radiographic and clinical data in 140 individual patients. Consistency of decision was also evaluated for each surgeon 3 months later and the effect of additional clinical data was also evaluated. The sample consisted of the 100 patients who had subsequently undergone UKR and 40 who had undergone TKR.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 107 - 107
1 Jul 2012
Williams D Beard D Arden N Field R Price A
Full Access

Purpose

To examine the clinical characteristics of patients undergoing knee arthroplasty with a pre-operative Oxford Knee Score >34 (‘good’/‘excellent’), and assess the appropriateness of surgical intervention for this group.

Background

In the current cost-constrained health economy, justification of surgical intervention is increasingly sought. As a validated disease-specific outcome measure, the pre-operative Oxford Knee Score (OKS) has been suggested as a possible threshold measurement in knee arthroplasty. However, contrary to expectations, analysis of pre-operative OKS in the joint registry population demonstrates a normal distribution curve with a sub-group of high-scoring patients. This suggests that either the baseline OKS does not accurately define surgical threshold, or that patients with a high OKS are inappropriately having knee replacements.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 43 - 43
1 Jul 2012
Price A Jackson W Field R Judge A Carr A Arden N Murray D Dawson J Beard D
Full Access

Purpose

The Oxford Knee Score (OKS) is a validated and widely used PROM that has been successfully used in assessing the outcome of knee arthroplasty (KA). It has been adopted as the nationally agreed outcome measure for this procedure and is now routinely collected. Increasingly, it is being used on an individual patient basis as a pre-operative measure of osteoarthritis and the need for joint replacement, despite not being validated for this use. The aim of this paper is to present evidence that challenges this new role for the OKS.

Method

We have analysed pre-operative and post-operative OKS data from 3 large cohorts all undergoing KA, totalling over 3000 patients. In addition we have correlated the OKS to patient satisfaction scores. We have validated our findings using data published from the UK NJR.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 64 - 64
1 Jul 2012
Al-Ali S Khan T Jackson W Beard D Price A
Full Access

Purpose

The purpose was to determine if the use of cold irrigation fluid in routine knee arthroscopy leads to a reduction in post operative pain.

Background

Some surgeons use cooled irrigation fluid in knee arthroscopy in the hope that it may lead to a reduction in post operative pain and swelling. There is currently no evidence for this, although there is some evidence to support the use of cold therapy post operatively in knee surgery.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 70 - 70
1 Jul 2012
Erturan G Neely J Richards N Price A Jackson W Khan T
Full Access

A feasibility study of the use of an MRI based patient specific knee arthroplasty system within the NHS.

Introducing new technologies within a public funded health system can be challenging. We assess the use and potential benefit of customised jigs for knee arthroplasty. Outcomes assessed were safety and accuracy of implantation.

Eight knee replacements using custom jigs were compared to 11 conventionally instrumented replacements matched to surgeon and operative day. Parameters measured include tourniquet time; drain output; hospital stay; adjusted change in haemoglobin; complications; and component position on post-operative long-leg alignment films

None of the parameters observed demonstrated a statistically significant difference from the conventional arthroplasty group. No complications were seen in either group. No significant differences were seen in alignment.

Our early experiences show that this technology appears safe and allows accurate implantation of the prosthesis. There was a trend for decreased stay and blood loss. The health economic benefits of navigational arthroplasty have been demonstrated in other studies and come from the lack of instrumentation of the intramedullary canal. MRI based patient specific instrumentation is considered technically easier and more convenient than intra-operative navigation. A larger study is planned to assess the health economic implications of adopting this new technology.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 25 - 25
1 Mar 2012
Pandit H Jenkins C Gill H Beard D Price A Dodd C Murray D
Full Access

Introduction

The results of the mobile bearing Oxford unicompartmental knee replacement (UKR) in the lateral compartment have been disappointing with a five year survival of 82%. Therefore, it is recommended that mobile bearings should not be used for lateral UKR. This low survivorship is primarily due to high dislocation rate, all occurring in the first year. A detailed analysis of the causes of bearing dislocation confirmed the elevated lateral tibial joint line to be a contributory factor. A new surgical technique was therefore introduced in which care was taken neither to remove too much bone from distal femur nor to over tighten the knee and thus ensure that the tibial joint line was not elevated. Other modifications to the technique were also introduced including use of a domed tibial component.

Aim

The aim of this study is to compare the outcome of these iterations: the original series [series I], Series II with improved surgical technique and the domed tibial component [Series III].


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 19 - 19
1 Mar 2012
Bottomley N Kendrick B Ferguson J Al-Ali S Dodd C Murray D Beard D Price A
Full Access

Introduction

Total knee arthroplasty (TKA) accounts for 84% of all knee replacement surgery in the UK (NJR 2009) despite published epidemiological data showing that single compartment disease is most prevalent. We investigated this incompatibility further by describing the compartmental pattern and stage of cartilage loss of all patients with osteoarthritis (OA) presenting to a specialist knee clinic over one year.

Methods

All new primary referrals in a calendar year by local General Practitioners to knee clinic at a United Kingdom Hospital were assessed. Tertiary referrals and second opinions were excluded. The final diagnosis after all imaging was recorded and tabulated. The standing AP, lateral and skyline radiographs of all cases of arthritis were scored to assess the pattern of disease.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 32 - 32
1 Mar 2012
Kendrick B Simpson D Bottomley N Kaptein B Garling E Gill H Dodd C Murray D Price A
Full Access

Purpose of study

To investigate the linear penetration rate of the polyethylene bearing in unicompartmental knee arthroplasty at twenty years.

Introduction

The Phase 1 Oxford medial UKR was introduced in 1978 as a design against wear, with a fully congruous articulation. In 1987 the Phase 2 implant was introduced with new instrumentation and changes to the bearing shape. We have previously shown a linear penetration rate (LPR) of 0.02 mm/year at ten years in Phase 2, but that higher penetration rates can be seen with impingement. The aim of this study was to determine the 20 year in-vivo LPR of the Oxford UKR, using Roentgen Stereophotogrammetric Analysis (RSA).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 34 - 34
1 Mar 2012
Ferguson J Pandit H Price A Marks B Gill H Murray D Dodd C
Full Access

Introduction

Obesity has been considered a relative contra-indication in unicompartmental knee arthroplasty (UKA) due to fear of high wear rates, loosening and tibial collapse. The aim of this study was to investigate the impact of high body mass index (BMI) on ten-year survivorship and five-year functional outcome after Oxford UKA, a fully congruous mobile bearing design with large contact area and low wear rate.

Methods

This prospective study examines a consecutive series of 595 knees (mean age 66 years, range: 33-88) undergoing Oxford UKA with a minimum 5-year follow-up. Patients were divided into three groups; Group I (Normal body weight), BMI <25 (n=171), Group II (overweight), BMI 25- 30 (n=264), and Group III (Obese), BMI ≥30 (n=160). The survivorship and functional outcome (as assessed by change in Oxford Knee Score [DeltaOKS]) and Knee Society Score (KSS) for all three groups were compared.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 31 - 31
1 Mar 2012
Kendrick B Pandit H Jenkins C Beard D Gill H Price A Dodd C Murray D
Full Access

Purpose of Study

To assess the incidence of radiolucency in cemented and cementless Oxford unicompartmental knee replacement at two years.

Introduction

Most unicompartmental knee replacements (UKRs) employ cement for fixation of the prosthetic components. The information in the literature about the relative merits of cemented and cementless UKR is contradictory, with some favouring cementless fixation and others favouring cemented fixation. In addition, there is concern about the radiolucency that frequently develops beneath the tibial component with cemented fixation. The exact cause of the occurrence of radiolucency is unknown but it has been hypothesised that it may suggest suboptimal fixation.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 27 - 27
1 Mar 2012
Pandit H Jenkins C Weston-Simons S Ferguson J Popat BM Gibbons M Price A Gill H Dodd C Murray D
Full Access

Introduction

Kozinn and Scott have made recommendations about contra-indications for unicompartmental knee replacement (UKR). They suggest that patients younger than 60, weight > 82 kilograms, patients with exposed bone in patella-femoral compartment or patients who are physically active/perform heavy labour should not be offered a UKR. In addition, chondrocalcinosis is a contra-indication. These strict selection criteria are based on the experience with fixed bearing UKAs and are more intuitive than evidence based. The Oxford UKR has a fully congruous mobile bearing and has been shown to have minimal wear. Over the past 25 years, the Oxford Group has followed a standardised protocol for patient selection for UKR. We ignore patella-femoral joint pathology, chondrocalcinosis, patient's age, weight and activity level when deciding the suitability for UKR.

Methods

Using the standardised indications, more than 1100 Oxford UKRs have been performed to date over the last 10 years. These patients are assessed pre-operatively and at regular intervals post-operatively in a dedicated research clinic. We present the results of these consecutive cases. Patients were classified into two groups: group I (satisfy Kozinn-Scott recommendations) and group II (outside recommendations).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 77 - 77
1 Mar 2012
James AR Dean B Moore E Whitwell D Price A Gibbons C
Full Access

Aim

A case series with functional and radiographic outcomes, of modular endoprosthetic distal femoral replacement in complex cases of periprosthetic fracture.

Method

Sixteen cases were identified of endoprosthetic replacement (EPR) from the bone and soft tissue cancer implant registry. A retrospective review was undertaken.