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

Abstract. Introduction. The NHS long term plan endorses ‘personalised’, ‘digitally enabled’, ‘out of hospital’ care. Multiagency guidance (CPOC(2021)/NICE(2021)/GIRFT(2021)/NHSX(2021)) advocates an integrated ‘pathway’ approach to information sharing, shared-decision making and patient support. Digital solutions are the vehicle to deliver these agendas. Methods. In 2018 we developed a digital joint pathway (DJP) spanning the surgical care pathway (prehabilitation to rehabilitation) using the GoWellHealth platform. Patients listed for joint replacement are offered the DJP as routine care. Activity and engagement are monitored using the DJP data library. We sought to evidence our DJP by assessing patient engagement, experience and outcomes (OKS/EQ5D/Readmission). Results. Engagement. Consecutive cohort of the first 1195 patients registered. Activation rates were >85% and >70% viewed content within the DJP (median=15 access/pt; mean=83 minutes on DJP/pt). Engagement was similar irrespective of age and gender (p=NS). Older patients preferred to access via a computer. Experience. Qualitative interviews (n=14) demonstrated patients felt the DJP impacted positively on their health behaviours and contributed to their recovery. They spoke positively about the use of technology and the accessibility of the DJP. Outcomes. Comparison of patients on the DJP versus those not on the DJP using adjusted regression models demonstrated improved EQ5D=0.070 (95%CI=0.004-0.135,p=0.04), OKS=5.0 (95%CI=2.2-7.8,p<0.001) and readmission rates (3.6% versus 5.6%,p<0.01) for DJP patients. Conclusions. A DJP model for information delivery and patient support, across the entirety of the surgical pathway, is feasible and demonstrates high levels of patient engagement, experience and improved patient outcomes

Improved surgical techniques and new fixation methods have revived interest in high tibial osteotomy surgery in recent years. Our aim was to review our first 59 cases. All patients underwent radiological and clinical review including pre and post operative scores. Mean age at surgery was 43 (22-59) and mean follow up is 22 months. The mean pre-operative limb alignment was 5.4° varus (range 1°-16°) with correction to 2° valgus (range -1° - 7°). HTO is known to increase tibial slope and in this series the change in tibial slope from -5.2° (95%CI: -6.36 to -4.07)) to -7.8° (-8.83 to –6.89) was statistically significant. p= 0.0014 (Mann Whitney). Patellar height is often reduced following opening wedge HTO and this is confirmed in our series. The Blackburne-Peel ratio changed from 0.74 to 0.58 and the Caton-Descamps from 0.83 to 0.7. Both were statistically significant at p<0.0001 and p=0.0001 respectively. All scores improved post operatively, the knee injury and osteoarthritis outcome (KOOS) from 48 (8-91) to 73 (27-96), the Oxford knee score (OKS) from 25 (3-47) to 37 (9-48), and the EQ5D from 189809 (11221-32333) to 14138 (11111-22233) with the EQ5D VAS improving from 58 to 75. There was no correlation between change in limb alignment, tibial slope or patellar height and any of the scores used. There were three superficial wound infections, and one non union which was treated with grafting and re fixation. Six patients have had their plate removed. Improvement in clinical scores in these patients confirms that medial opening wedge HTO is a reliable joint preserving procedure in the short term and our surgical technique is reproducible and consistent with other published series

Introduction. The commonest causes of revision of Unicompartmental Knee Replacement (UKR) in National Registers are loosening and pain. Cementless UKR was introduced to address loosening and was found, in small randomised studies, to have better radiographic fixation than Cemented UKR. Although non-significant these studies also suggested the clinical outcome was better with cementless. The aim of this larger study was to compare the pain and function of cementless and cemented UKR at five years. Methods. 263 Cemented and 266 Cementless UKR of identical design, implanted by four high volume surgeons for the same indications, were reviewed by independent physiotherapists at five years. Revision, re-operation, Oxford Knee Score (OKS), American Knee Society score (AKSS) and EQ-5D were assessed. Two pain specific scores were also used: Pain Detect (PD) and Intermittent and Constant Osteoarthritis Pain (ICOAP). The pain scores were normalised onto a scale of 0 to 100 with 100 being the best. The cemented cohort was mainly implanted before the cementless, although there was considerable overlap. To explore whether differences were due to progressive improvement in surgical practice with time each cohort was divided into early and late subgroups. Results. Pre-operatively there were no differences between the devices in patient demographics or scores. At 5 years there were no differences in revision rate (0.8%), re-operation rate (2.2%) or medical complication rate (4%). The Cementless had significantly (p<0.05) better OKS (43 v 41), AKSS and EQ5D. There were significantly (p=0.03) fewer cementless cases with unexplained pain (2.3% v 6%). The cementless had significantly (p<0.002), less ‘strongest’ (84 v 76) and ‘average’ (90 v 85) pain as assessed by PD and less chronic (97 v 92) and intermittent (93 v 86) pain as assessed by ICOAP. Subgroup analysis found no significant differences in outcome between the early and late subgroups within the cohorts, whereas there were significant differences in outcomes between the late subgroup of the cemented cohort and the early subgroup of the cementless cohort. Discussion and Conclusion. Almost all outcome scores were significantly better following cementless compared to cemented UKR, suggesting that the cementless is better than cemented. However, as the cemented cases were mainly implanted before the cementless, it could be the difference was due to other factors, such as surgical technique or rehabilitation, that improved with time. This is unlikely to be the case as there were no differences between the early and late subgroups within the cohorts whereas there were differences between the late subgroup of the cemented cohort and the early subgroup of the cementless cohort which were implanted at a similar time. Although the functional scores following cementless are significantly better than cemented, the differences are similar to or smaller than the minimally clinical important difference (MCID) for these scores. In contrast there is significantly less pain following the cementless and the differences tended to be greater than the MCID. This suggests that Cementless UKR is associated with appreciably less pain and slightly better function than Cemented UKR. For figures, tables, or references, please contact authors directly

Purpose. To review the Five year survivorship of Kinnemax TKA performed at the NHS Treatment Cantre, Weston-Super-Mare (WSM), and compare it to a similar cohort from our institution. Introduction. As part of the government's initiative to reduce waiting times for major joint surgery in Wales, the Cardiff and Vale NHS Trust (CAVOC) sent 224 patients (258 knees) to the NHS Treatment Centre in Weston-Super-Mare (WSM) for total knee arthroplasty. Controversy remains as to the unexpectedly high revision rates previously seen. Method. Between April 2004 and January 2006, 224 patients (258 TKAs) were performed at WSM. 90% have been followed up to five years. The WSM Cohort was compared to a similar cohort of 260 consecutive TKAs from CAVOC over a similar time period (2004/5) performed by a number of surgeons. Oxford Knee Score, EQ5D, VAS for pain, re-operation and overall satisfaction were obtained. Statistical testing was performed with chi-squared tests using SPSS v16.0 (a=0.05). Results. Mean age in years at date of operation was 68 (36-85) from WSM and 70 (41 to 87) fromCAVOC. The 5 year cumulative survival rate using ‘revision any cause’ as the endpoint, was 79.9% (95% CI 72.46 to 85.9) in the WSM cohort and 96.4% (95%CI 94.1 to 99.1) in the CAVOC cohort. The relative risk for revision at the ISTC as opposed to the referring centre was 3.76 (p<0.001). The mean Oxford Knee Score was 27.5 (range 2-48) for the WSM cohort. The average, non-revised, oxford knee score for the WSM cohort lower than expected at 29. This is lower than other published series of primary TKA. Conclusion. This is the first published five year survivorship for total knee arthroplasty performed at a first generation ISTC in the UK. Revision rates, functional outcomes, and overall health status results are below expected when compared to a similar cohort from a standard NHS Orthopaedic Unit

Aims

The primary objective of this study was to compare migration of the cemented ATTUNE fixed bearing cruciate retaining tibial component with the cemented Press-Fit Condylar (PFC)-sigma fixed bearing cruciate retaining tibial component. The secondary objectives included comparing clinical and radiological outcomes and Patient Reported Outcome Measures (PROMs).

Aims

Responsiveness to clinically important change is a key feature of any outcome measure. Throughout Europe, health-related quality of life following total knee arthroplasty (TKA) is routinely measured with EuroQol five-dimension (EQ-5D) questionnaires. The Patient-Reported Outcomes Measurement Information System 10-Question Short-Form (PROMIS-10 Global Health) score is a new general heath outcome tool which is thought to offer greater responsiveness. Our aim was to compare these two tools.

Aims

A pragmatic, single-centre, double-blind randomized clinical trial was conducted in a NHS teaching hospital to evaluate whether there is a difference in functional knee scores, quality-of-life outcome assessments, and complications at one-year after intervention between total knee arthroplasty (TKA) and patellofemoral arthroplasty (PFA) in patients with severe isolated patellofemoral arthritis.

We present a comparison of patient-reported outcomes (PROMs) in relation to patient age, in patients who had received a total (TKR) or unicompartmental knee replacement (UKR). The outcome was evaluated using the Oxford knee score (OKS), EuroQol (EQ-5D) and satisfaction scores. Patients aged 65 to 84 years demonstrated better pre-operative function scores than those aged < 65 years (OKS, p = 0.03; EQ-5D, p = 0.048) and those aged ≥ 85 years (OKS, p = 0.03). Post-operative scores were comparable across age groups, but a linear trend for greater post-operative improvement in OKS and EQ-5D was seen with decreasing age (p < 0.033). The overall mean satisfaction score at six months was 84.9, but those aged <  55 years exhibited a lower mean level of satisfaction (78.3) compared with all other age groups (all p < 0.031). The cumulative overall two-year revision rate was 1.3%. This study demonstrates that good early outcomes, as measured by the OKS and EQ-5D, 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 EQ-5D evaluation, and raises the question whether the OKS alone is an appropriate measure of pain and function in younger, more active individuals.

Cite this article: Bone Joint J 2013;95-B:38–44.

Partial knee arthroplasty (PKA), either medial or lateral unicompartmental knee artroplasty (UKA) or patellofemoral arthroplasty (PFA) are a good option in suitable patients and have the advantages of reduced operative trauma, preservation of both cruciate ligaments and bone stock, and restoration of normal kinematics within the knee joint. However, questions remain concerning long-term survival. The goal of this review article was to present the long-term results of medial and lateral UKA, PFA and combined compartmental arthroplasty for multicompartmental disease. Medium- and long-term studies suggest reasonable outcomes at ten years with survival greater than 95% in UKA performed for medial osteoarthritis or osteonecrosis, and similarly for lateral UKA, particularly when fixed-bearing implants are used. Disappointing long-term outcomes have been observed with the first generation of patellofemoral implants, as well as early Bi-Uni (ie, combined medial and lateral UKA) or Bicompartmental (combined UKA and PFA) implants due to design and fixation issues. Promising short- and med-term results with the newer generations of PFAs and bicompartmental arthroplasties will require long-term confirmation.

Cite this article: Bone Joint J 2015;97-B(10 Suppl A):9–15.

Objectives

Subtotal or total meniscectomy in the medial or lateral compartment of the knee results in a high risk of future osteoarthritis. Meniscal allograft transplantation has been performed for over thirty years with the scientifically plausible hypothesis that it functions in a similar way to a native meniscus. It is thought that a meniscal allograft transplant has a chondroprotective effect, reducing symptoms and the long-term risk of osteoarthritis. However, this hypothesis has never been tested in a high-quality study on human participants. This study aims to address this shortfall by performing a pilot randomised controlled trial within the context of a comprehensive cohort study design.

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.