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The Bone & Joint Journal
Vol. 105-B, Issue 8 | Pages 895 - 904
1 Aug 2023
Smith TO Dainty J Loveday DT Toms A Goldberg AJ Watts L Pennington MW Dawson J van der Meulen J MacGregor AJ

Aims

The aim of this study was to capture 12-month outcomes from a representative multicentre cohort of patients undergoing total ankle arthroplasty (TAA), describe the pattern of patient-reported outcome measures (PROMs) at 12 months, and identify predictors of these outcome measures.

Methods

Patients listed for a primary TAA at 19 NHS hospitals between February 2016 and October 2017 were eligible. PROMs data were collected preoperatively and at six and 12 months including: Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ (foot and ankle)) and the EuroQol five-dimension five-level questionnaire (EQ-5D-5L). Radiological pre- and postoperative data included Kellgren-Lawrence score and implant position measurement. This was supplemented by data from the National Joint Registry through record linkage to determine: American Society of Anesthesiologists (ASA) grade at index procedure; indication for surgery, index ankle previous fracture; tibial hind foot alignment; additional surgery at the time of TAA; and implant type. Multivariate regression models assessed outcomes, and the relationship between MOXFQ and EQ-5D-5L outcomes, with patient characteristics.


The Bone & Joint Journal
Vol. 103-B, Issue 6 | Pages 1111 - 1118
1 Jun 2021
Dainty JR Smith TO Clark EM Whitehouse MR Price AJ MacGregor AJ

Aims

To determine the trajectories of patient reported pain and functional disability over five years following total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Methods

A prospective, longitudinal cohort sub-study within the National Joint Registry (NJR) was undertaken. In all, 20,089 patients who underwent primary THA and 22,489 who underwent primary TKA between 2009 and 2010 were sent Oxford Hip Score (OHS) and Oxford Knee Score (OKS) questionnaires at six months, and one, three, and five years postoperatively. OHS and OKS were disaggregated into pain and function subscales. A k-means clustering procedure assigned each patient to a longitudinal trajectory group for pain and function. Ordinal regression was used to predict trajectory group membership using baseline OHS and OKS score, age, BMI, index of multiple deprivation, sex, ethnicity, geographical location, and American Society of Anesthesiologists grade.


The Bone & Joint Journal
Vol. 98-B, Issue 9 | Pages 1160 - 1166
1 Sep 2016
Smith TO Aboelmagd T Hing CB MacGregor A

Aims

Our aim was to determine whether, based on the current literature, bariatric surgery prior to total hip (THA) or total knee arthroplasty (TKA) reduces the complication rates and improves the outcome following arthroplasty in obese patients.

Methods

A systematic literature search was undertaken of published and unpublished databases on the 5 November 2015. All papers reporting studies comparing obese patients who had undergone bariatric surgery prior to arthroplasty, or not, were included. Each study was assessed using the Downs and Black appraisal tool. A meta-analysis of risk ratios (RR) and 95% confidence intervals (CI) was performed to determine the incidence of complications including wound infection, deep vein thrombosis (DVT), pulmonary embolism (PE), revision surgery and mortality.


The Bone & Joint Journal
Vol. 98-B, Issue 4 | Pages 452 - 460
1 Apr 2016
Mahmoud SSS Pearse EO Smith TO Hing CB

Aims

The optimal management of intracapsular fractures of the femoral neck in independently mobile patients remains open to debate. Successful fixation obviates the limitations of arthroplasty for this group of patients. However, with fixation failure rates as high as 30%, the outcome of revision surgery to salvage total hip arthroplasty (THA) must be considered. We carried out a systematic review to compare the outcomes of salvage THA and primary THA for intracapsular fractures of the femoral neck.

Patients and Methods

We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) compliant systematic review, using the PubMed, EMBASE and Cochrane libraries databases. A meta-analysis was performed where possible, and a narrative synthesis when a meta-analysis was not possible.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVIII | Pages 61 - 61
1 May 2012
Smith TO Nichols R Donell ST Hing CB
Full Access

Hip resurfacing procedures have gained increasing popularity for younger, higher demand patients with degenerative hip pathologies. However, with concerns regarding revision rates and possible adverse metal hypersensitivity reactions with metal-on-metal articulations, some authors have questioned the hypothesised superiority of hip resurfacing over total hip arthroplasty. The purpose of this meta-analysis was to compare the clinical and radiological outcomes and complication rates of these two procedures.

A systematic review was undertaken of all published and unpublished research up to January 2010. The primary search was of the databases Medline, CINAHL, AMED and EMBASE, searched via Ovid using MeSH terms and Boolian operators ‘hip’ AND ‘replacement’ OR ‘arthroplasty’ AND ‘resurfacing’. A secondary search of unpublished literature was conducted using the databases SIGLE, the National Technical Information Service, the National Research Register (UK), the British Library's Integrated Catalogue and Current Controlled Trials databases using the same search terms as the primary search. All included studies were critically appraised with the CASP appraisal tool.

In total, 46 studies were identified from 1124 citations. These included 3799 hip resurfacings and 3282 total hip arthroplasties. On meta-analysis, functional outcomes for subjects following hip resurfacing were better than or the same as subjects with a total hip arthroplasty, with significantly higher WOMAC score (Mean Difference (MD)=−2.41; 95% Confidence Interval (CI): −3.88, −0.94; p=0.001), and significantly better Harris Hip Score (range of motion component) (MD=−0.05; 95% CI: (−0.07, −0.03; p<0.0001) and overall Harris Hip Score (MD=2.51; 95% CI: 1.24, 3.77; p=0.0001) in the hip resurfacing compared to total hip arthroplasty cohorts. However, there were significantly greater incidences of heterotopic ossification (Risk Ratio (RR)=1.62; 95% CI: 1.23, 2.14; p=0.006), aseptic loosening (RR=3.07; 95% CI:1.11, 8.50;p=0.03) and revision surgery (RR=1.72; 95% CI: 1.20, 2.45; p=0.003) with hip resurfacing compared to total hip arthroplasty. The evidence-base presented with a number of methodological inadequacies such as the limited use of power calculations and poor or absent blinding of both patients and assessors, potentially giving rise to assessor bias. In respect to these factors, the current evidence-base, whilst substantial in its size, may be questioned in respect to its quality in determining superiority of hip resurfacing over total hip arthroplasty.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 6 | Pages 777 - 781
1 Jun 2011
Kalra S Smith TO Berko B Walton NP

The Oxford unicompartmental knee replacement gives good results in patients with symptomatic osteoarthritis of the medial compartment. Previous studies have suggested that the presence of radiolucent lines (RLLs) does not reflect a poor outcome in such patients. However, the reliability and validity of this assessment have not been determined. Our aim was to assess the intra- and interobserver reliability and the sensitivity and specificity of the assessment of RLLs around both tibial and femoral components using standard radiographs.

Two reviewers assessed the radiographs of 45 patients who had loosening of the tibial or femoral component confirmed at revision surgery and compared them with those of a series of 45 asymptomatic patients matched for age and gender.

The results suggested that, using standard radiographs, tibial RLLs were 63.6% sensitive and 94.4% specific and femoral RLLs 63.9% sensitive and 72.7% specific for loosening. Overall intra- and interobserver reliability was highly variable, but zonal analysis showed that lucency at the tip of the femoral peg was significantly associated with loosening of the femoral component.

Fluoroscopically guided radiographs may improve the zonal reliability of the assessment of RLLs, but further independent and comparative studies are required. In the meantime, the innocence of the physiological RLLs detected by standard radiographs should be viewed with caution.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 4 | Pages 476 - 478
1 Apr 2011
Kang S Smith TO De Rover WBS Walton NP

There has been debate about the role of unicompartmental knee replacement in the presence of radiologically identifiable degenerative changes of the patellofemoral joint. We studied 195 knees in 163 patients in whom an Oxford unicompartmental knee replacement had been performed for medial osteoarthritis between January 2004 and July 2007. The mean age of the patients was 66 years (51 to 93). The degree of degenerative change of the patellofemoral joint was assessed using Jones’ criteria. Functional outcome was assessed at a mean of 3.4 years (2 to 7) post-operatively, using the Oxford knee score and the Short-form 12 score.

Degenerative changes of the patellofemoral joint were seen pre-operatively in 125 knees (64%) on the skyline radiographs. There was no statistically significant difference in the Oxford knee or Short-form 12 scores between those patients who had patellofemoral osteoarthritis pre-operatively and those who did not (p = 0.22 and 0.54, respectively).

These results support the opinion expressed at the designer’s hospital that degenerative changes of the patellofemoral joint in isolation should not be considered to be a contraindication to medial Oxford unicompartmental knee replacement.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 426 - 427
1 Sep 2009
Smith TO Davies L Donell S
Full Access

Aim: To systematically review the present evidence-base, assessing the clinical and radiological outcomes following trochleoplasty for trochlear dysplasia.

Methods: An electronic literature search was performed using the AMED, British Nursing Index, CINAHL, Cochrane, EMBASE, ovid Medline, Physiotherapy Evidence Database, PsycINFO, Pubmed and Zetoc databases from their inception to August 2007. Reference lists of identified papers and a hand search of specialist knee journals was also undertaken. All English language, human subject clinical studies, detailing the clinical and/or radiological outcomes of patellar instability patients following a trochleoplasty were included. Two independent reviewers appraised each paper using the CASP tool.

Results: Six papers comprising of 117 trochleoplasty procedures on 99 patients were reviewed. Clinically and radiologically, trochleoplasty was shown to be a safe and effective procedure to correct patellar instability in trochlear dysplasia patients. However, the CASP tool identified that the evidence-base reviewed presented with a number of methodological limitations. These included: limited use of inferential statistics; not applying reliable outcome measurements; poor description of patient recruitment; and evaluating small samples.

Conclusion: Although trochleoplasty may be an effective procedure to correct patellar instability in trochlear dysplasia patients, further study is recommended to assess longer-term outcomes using well-designed studies.