Aims. This study uses prospective registry data to compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum. Methods. Data on adult patients who underwent arthroscopic labral debridement or repair between 1 January 2012 and 31 July 2019 were extracted from the UK Non-Arthroplasty Hip Registry. Patients who underwent microfracture, osteophyte excision, or a concurrent extra-articular procedure were excluded. The EuroQol five-dimension (EQ-5D) and International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected preoperatively and at six and 12 months post-operatively. Due to concerns over differential questionnaire non-response between the two groups, a combination of random sampling, propensity score matching, and pooled multivariable linear regression models were employed to compare iHOT-12 improvement. Results. A total of 2,025 labral debridements (55%) and 1,659 labral repairs (45%) were identified. Both groups saw significant (p < 0.001) EQ-5D and iHOT-12 gain compared to preoperative scores at 12 months (iHOT-12 improvement: labral repair = +28.7 (95% confidence interval (CI) 26.4 to 30.9), labral debridement = +24.7 (95% CI 22.5 to 27.0)), however there was no significant difference between procedures after multivariable modelling. Overall, 66% of cases achieved the minimum clinically important difference (MCID) and 48% achieved substantial clinical benefit at 12 months. Conclusion. Both labral procedures were successful in significantly improving early functional outcome following hip arthroscopy, regardless of age or sex. Labral repair was associated with superior outcomes in univariable analysis, however there was no significant superiority demonstrated in the multivariable model. Level of evidence: III. Cite this article: Bone Jt Open 2022;3(4):291–301

Aims. The purpose of this study is to evaluate early outcomes with the use of a smartphone-based exercise and educational care management system after total hip arthroplasty (THA) and demonstrate decreased use of in-person physiotherapy (PT). Methods. A multicentre, prospective randomized controlled trial was conducted to evaluate a smartphone-based care platform for primary THA. Patients randomized to the control group (198) received the institution’s standard of care. Those randomized to the treatment group (167) were provided with a smartwatch and smartphone application. PT use, THA complications, readmissions, emergency department/urgent care visits, and physician office visits were evaluated. Outcome scores include the Hip disability and Osteoarthritis Outcome Score (HOOS, JR), health-related quality-of-life EuroQol five-dimension five-level score (EQ-5D-5L), single leg stance (SLS) test, and the Timed Up and Go (TUG) test. Results. The control group was significantly younger by a mean 3.0 years (SD 9.8 for control, 10.4 for treatment group; p = 0.007), but there were no significant differences between groups in BMI, sex, or preoperative diagnosis. Postoperative PT use was significantly lower in the treatment group (34%) than in the control group (55.4%; p = 0.001). There were no statistically significant differences in complications, readmissions, or outpatient visits. The 90-day outcomes showed no significant differences in mean hip flexion between controls (101° (SD 10.8)) and treatment (100° (SD 11.3); p = 0.507) groups. The HOOS, JR scores were not significantly different between control group (73 points (SD 13.8)) and treatment group (73.6 points (SD 13); p = 0.660). Mean 30-day SLS time was 22.9 seconds (SD 19.8) in the control group and 20.7 seconds (SD 19.5) in the treatment group (p = 0.342). Mean TUG time was 11.8 seconds (SD 5.1) for the control group and 11.9 (SD 5) seconds for the treatment group (p = 0.859). Conclusion. The use of the smartphone care management system demonstrated similar early outcomes to those achieved using traditional care models, along with a significant decrease in PT use. Noninferiority was demonstrated with regard to complications, readmissions, and ED and urgent care visits. This technology allows patients to rehabilitate on a more flexible schedule and avoid unnecessary healthcare visits, as well as potentially reducing overall healthcare costs. Cite this article: Bone Joint J 2021;103-B(7 Supple B):91–97

Aims

The Vantage Total Ankle System is a fourth-generation low-profile fixed-bearing implant that has been available since 2016. We aimed to describe our early experience with this implant.

Aims

Recent total knee arthroplasty (TKA) designs have featured more anatomical morphologies and shorter tibial keels. However, several reports have raised concerns about the impact of these modifications on implant longevity. The aim of this study was to report the early performance of a modern, cemented TKA design.

Introduction. Reverse total shoulder replacement is performed for the treatment of rotator cuff arthropathy, massive irreparable cuff tears and failed shoulder hemiarthroplasty with irreparable rotator cuff tears. The aim of this study was to assess the clinical and radiological outcome of single surgeon series of Equinoxe® reverse total shoulder replacement at a district general hospital. Materials/Methods. Consecutive patients who underwent Equinoxe® reverse total shoulder replacement at our unit from Jun 2008 to Dec 2010 were retrospectively reviewed. Indications for surgery, complications and radiological outcomes were assessed. Oxford shoulder score was used to assess the functional outcome. Results. Between Jun 2008 and Dec 2012, forty-one reverse total shoulder replacements were performed by the senior author in 37 patients. Of these, Equinoxe® prostheses were used in 27 operations (26 patients). These included 22 female and 4 male patients. Cuff arthropathy was the commonest preoperative diagnosis (23 patients), followed by proximal humeral fracture non-union (2 patients), failed hemiarthroplasty (one patient) and failed resurfacing (one patient). The mean follow up was 10 months (3 to 17 months). At the time of the study, three patients had died due to unrelated causes, two were not contactable and the remaining 21 patients were analysed. The mean oxford shoulder score was 35.8 (21–48). Nineteen patients (90.5%) graded their outcome a good to excellent while 2 patients (9.5%) graded as poor. Seventeen patients (81%) expressed that they would recommend this operation. One patient (4.7%) had infection and another had dislocation. Overall, there were 3 reoperations (14.3%); first washout, second change of humeral tray and third excision of lateral end of clavicle and reattachment of deltoid. Two patients (9.5%) had small glenoid notching. There was no loosening, neurovascular injury or postoperative haematoma. Conclusion. Early outcome of Equinoxe reverse shoulder replacement is promising. Longer follow-up is required to further assess the outcome

Aims

This study aimed to identify patients receiving total hip arthroplasty (THA) for trauma during the peak of the COVID-19 pandemic in the UK and quantify the risks of contracting SARS-CoV-2 virus, the proportion of patients requiring treatment in an intensive care unit (ICU), and rate of complications including mortality.

Aims: To establish whether pre-existing anxiety and depression negatively impacts symptomatic and functional outcome of knee arthroplasty. Methodology: A prospective study. Ethical approval was obtained prior to the study. Psychological status was assessed using the Hospital Anxiety and Depression Scale; a validated self-assessment tool for detecting anxiety and depression. The Oxford and the American Knee society scores were used to assess the knee status. All scores were documented pre-operatively and at six weeks post-operatively. Results were submitted for independent statistical analysis. Results: 105 consecutive primary knee replacements were included in the study. 39% (41 patients) had abnormal pre-operative anxiety states. This percentage dropped to 28.2% (29 patients) post-operatively (P=0.034). 25.7% (27 patients) had abnormal pre-operative depression states which improved to 15.5% (16 patients) post-operatively (P=0.011). There were high degrees of correlation between abnormal anxiety and depression states both pre-operatively (P< 0.001) and post-operatively (P< 0.001). Patients with abnormal anxiety pre-operatively had worse knee scores both pre-operatively (P=0.17) and post-operatively (P=0.009) than those who did not. Patients with abnormal depression pre-operatively had worse pre-operative Oxford scores (P=0.036), and worse Oxford (p=0.006) and AKSS knee scores post-operatively (0.043). Conclusions: Abnormal anxiety and depression states are common in patients with knee arthritis presenting for knee arthroplasty. These conditions can improve post-operatively. Patients with abnormal pre-operative anxiety and depression do less well following knee arthroplasty than those who do not. Pre-operative psychological assessment is easy to perform and does act as a predictor of early outcome. Further research is needed to assess whether treating these psychological conditions prior to knee arthroplasty improves the outcome or not

Aims

The aim of this study was to compare the clinical outcomes of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) during the first six weeks and at one year postoperatively.

Introduction Intermediate and long-term results following extracapsular fracture neck of femur have been evaluated in the past. However the precise effect of the type and the stability of the fracture on the early outcome is not known. This study evaluates the correlations between type and stability of the fracture, length of stay and predictors of early functional outcome. Methods Ninety-five consecutive cases admitted with intertrochanteric fractures were reviewed retrospectively. Eight patients died during the hospital stay and were excluded from the study. Revision surgery for implant failure was excluded from the study. The medical records were reviewed to determine the pre-operative functional status and the outcome. Radiographs were reviewed by one of the authors to classify the fracture according to AO and Tronzo classification. Statistical analysis was performed using bivariate analysis and multistep logistic regression analysis. Results The factors influencing the post-operative length of stay most were age and AO classification. The factors influencing post-operative mobility were pre-operative mobility, accommodation and presence of complications. The factors predicting post-operative accommodation were pre-injury accommodation and mobility. The mean difference in the pre and post-operative mobility grade was 1.9. The mean difference in the pre and postoperative accommodation grade was 1.31. Conclusions One of the reasons for classification is to predict the prognosis. Our study showed that age and AO classification can predict length of stay in hospital. This can be used to pre-empt the discharge strategy

Purpose: The purpose of this work was to evaluate clinical and radiographic factors affecting early outcome of resurfaced hip prostheses in young adults. Material and methods: Among 119 hybrid resurfaced prostheses with a metal-on-metal bearing implanted in patients aged 40 years or less, 94 were retained for analysis at minimum two years follow-up or failure. Mean age was 34.2 years (15–40), 71% of the patients were men and 14% had had a prior hip operation. A risk index (SARI) was developed from the Chandler index. Results: Mean follow-up was three years (2–5). Items of the UCLA score improved: pain 3.1 versus 9.2, walking 5.8 versus 9.4 (p=0.00). Three hips required revision total hip arthroplasty at mean 27 months (2–50) and ten patients had radiographically significant modifications. Comparing these 17 hips with the 47 others, indexes showed 4.7 versus 2.6 for the SARI (p=0.000) and 2.6 versus 2.8 for the Chandler score (p=0.358). There was no correlation with reconstruction mechanics, function, walking or scoring. Valgus implantation of the femoral piece and the lateral lever arm were significantly correlated (r=0.39, p< 0.001). Discussion: If the SARI was > 3, the relative risk of early complications was 12-fold higher than if the SARI was 3. Because of the distinct fixation of the femoral implant, a SARI=2 was attributed when there was a cyst in the femoral head and weight was < 82 kg (lower weight correlated with smaller implant, r=0.60). This index can be used to improve patient selection in order to define the role of arthroplasty resurfacing in the treatment of hip degeneration

Ninety-four hips with a mean patient age 34.2 (range 15– 40) with a metal/metal surface arthroplasty (SA) were reviewed with 71% men and 14% with previous surgery. The Chandler risk index was calculated as well as the SA risk index (SARI). At a mean follow-up three years, three hips were converted at a mean of twenty-seven months (two to fifty), and ten patients had significant radiological changes. Mean SARI for the thirteen problematic hips versus remaining hips was significantly higher, 4.7 and 2.6, respectively (p=0.00). If SARI > 3 the relative risk of early problems is twelve times greater than if SARI ≤3. The purpose of this study was to evaluate the early outcome of a hybrid metal on metal surface arthroplasty of the hip in patients forty years and younger and identify potential risk factors. Surface Arthroplasty Risk Index can help identify patients who may be at increased risk of early failure following metal on metal surface arthroplasty. Proper patient selection and careful surgical technique may minimize early failures with the re-introduction of surface arthroplasty of the hip. Ninety-four hips mean age 34.2 (range 15– 40) with metal/metal surface arthroplasty (SA) were reviewed with 71% men and 14% with previous surgery. The Chandler risk index was calculated and SA risk index (SARI). Mean follow-up three years (range 2–5), three hips were converted at a mean of twenty-seven months (2–50), and ten patients had significant radiological changes. Mean SARI for these thirteen problematic hips versus remaining hips was significantly higher, 4.7 and 2.6, respectively (p=0.00). The mean angle between the prosthesis stem and femoral shaft in the problematic group was significantly smaller than the remaining hips (p=0.03): 133° and 139°, respectively. If SARI > 3 the relative risk of early problems is twelve times greater than if SARI ≤3

Aims

Our aim was to compare kinematic with mechanical alignment in total knee arthroplasty (TKA).

We have investigated whether the pattern of subchondral acetabular cyst formation reflects hip pathology and may provide a prognostic indicator for treatment.

A single surgeon series of sequential hip arthroscopies was reviewed to identify the most recent 200 cases undertaken on a previously un-operated joint with pre-operative plain radiographs and computed tomography or magnetic resonance scan available for review. Also, serial “non-arthritic hip scores” (NAHS) recorded pre-operatively, at 6 weeks and 3 months post-surgery. The acetabular Lateral Centre Edge Angle, the Acetabular Index, the FEAR index and the Kallgren and Lawrence grade were determined. All images were reviewed by two independent assessors and divided into four groups according to acetabular subchondral cyst distribution. NC - No cysts - 74 cases (mean: 40.1 years), SPC - a Single Peripheral Cyst – 58 cases (mean: 43.1 years), SDC - a Solitary Dome Cyst – 32 cases (mean: 33 years) and MC - Multiple Cysts – 36 cases (mean: 42.7 years).

No association was identified between gender and patient reported outcomes.

SDC patients were significantly younger than the other three groups (p <0.001). At three months after surgery, the average increase of the NAHS in the four groups was 25.3, 23.5, 4.2 and 4.9 respectively. Acetabular dysplasia was identified in 72% of the SDC group compared to 18%, 16% and 33% in NC, SPC and MC groups. Degenerative change was identified in 86% of the MC group compared to 18%, 40% and 41% of the NC, SPC and SDC groups.

The early patient reported outcome following hip arthroscopy was significantly affected by the location and number of acetabular subchondral cysts. A Solitary Dome Cyst is indicative of underling hip dysplasia. Multiple Cysts are indicative of degenerative disease. The majority of patients in these groups have poor three-month outcomes after hip arthroscopy.

Aims

Since redesign of the Oxford phase III mobile-bearing unicompartmental knee arthroplasty (UKA) femoral component to a twin-peg design, there has not been a direct comparison to total knee arthroplasty (TKA). Thus, we explored differences between the two cohorts.

The Oxford unicompartmental knee replacement (UKR) is an established treatment option in the management of symptomatic end-stage medial compartmental osteoarthritis (MCOA), which works well in the young and active patient. However, previous studies have shown that it is reliable only in the presence of a functionally intact anterior cruciate ligament (ACL). This review reports the outcomes, at a mean of five years and a maximum of ten years, of 52 consecutive patients with a mean age of 51 years (36 to 57) who underwent staged or simultaneous ACL reconstruction and Oxford UKR. At the last follow-up (with one patient lost to follow-up), the mean Oxford knee score was 41 (sd 6.3; 17 to 48). Two patients required conversion to TKR: one for progression of lateral compartment osteoarthritis and one for infection. Implant survival at five years was 93% (95% CI 83 to 100). All but one patient reported being satisfied with the procedure. The outcome was not significantly influenced by age, gender, femoral or tibial tunnel placement, or whether the procedure was undertaken at one- or two-stages.

In summary, ACL reconstruction and Oxford UKR gives good results in patients with end-stage MCOA secondary to ACL deficiency.

This prospective study assessed the effect of social deprivation on the Oxford hip score at one year after total hip replacement. An analysis of 1312 patients undergoing 1359 primary total hip replacements for symptomatic osteoarthritis was performed over a 35-month period. Social deprivation was assessed using the Carstairs index. Those patients who were most deprived underwent surgery at an earlier age (p = 0.04), had more comorbidities (p = 0.02), increased severity of symptoms at presentation (p = 0.001), and were not as satisfied with their outcome (p = 0.03) compared with more affluent patients. There was a significant improvement in Oxford scores at 12 months relative to pre-operative scores for all socioeconomic categories (p < 0.001). Social deprivation was a significant independent predictor of mean improvement in Oxford scores at 12 months, after adjusting for confounding variables (p = 0.001). Deprivation was also associated with an increased risk of dislocation (odds ratio 5.3, p < 0.001) and mortality at 90 days (odds ratio 3.2, p = 0.02).

Outcome, risk of dislocation and early mortality after a total hip replacement are affected by the socioeconomic status of the patient

Some surgeons are reluctant to perform a reverse total shoulder arthroplasty (RTSA) on both shoulders because of concerns regarding difficulty with activities of daily living post-operatively as a result of limited rotation of the shoulders. Nevertheless, we hypothesised that outcomes and patient satisfaction following bilateral RTSA would be comparable to those following unilateral RTSA. A single-surgeon RTSA registry was reviewed for patients who underwent bilateral staged RTSA with a minimum follow-up of two years. A unilateral RTSA matched control was selected for each shoulder in those patients undergoing bilateral procedures. The Constant–Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Values (SSV), visual analogue scale (VAS) for pain, range of movement and strength were measured pre- and post-operatively. The mean CMS, ASES, SSV, VAS scores, strength and active forward elevation were significantly improved (all p < 0.01) following each operation in those undergoing bilateral procedures. The mean active external rotation (p = 0.63 and p = 0.19) and internal rotation (p = 0.77 and p = 0.24) were not significantly improved. The improvement in the mean ASES score after the first RTSA was greater than the improvement in its control group (p = 0.0039). The improvement in the mean CMS, ASES scores and active forward elevation was significantly less after the second RTSA than in its control group (p = 0.0244, p = 0.0183, and p = 0.0280, respectively). Pain relief and function significantly improved after each RTSA in those undergoing a bilateral procedure.

Bilateral RTSA is thus a reasonable form of treatment for patients with severe bilateral rotator cuff deficiency, although inferior results may be seen after the second procedure compared with the first.

Cite this article: Bone Joint J 2013;95-B:1232–8.

There is a known association between femoroacetabular impingement and osteoarthritis of the hip. What is not known is whether arthroscopic excision of an impingement lesion can significantly improve a patient’s symptoms.

This study compares the results of hip arthroscopy for cam-type femoracetabular impingement in two groups of patients at one year. The study group comprised 24 patients (24 hips) with cam-type femoroacetabular impingement who underwent arthroscopic debridement with excision of their impingement lesion (osteoplasty). The control group comprised 47 patients (47 hips) who had arthroscopic debridement without excision of the impingement lesion. In both groups, the presence of femoroacetabular impingement was confirmed on pre-operative plain radiographs. The modified Harris hip score was used for evaluation pre-operatively and at one-year. Non-parametric tests were used for statistical analysis.

A tendency towards a higher median post-operative modified Harris hip score was observed in the study group compared with the control group (83 vs 77, p = 0.11). There was a significantly higher proportion of patients in the osteoplasty group with excellent/good results compared with the controls (83% vs 60%, p = 0.043). Additional symptomatic improvement may be obtained after hip arthroscopy for femoroacetabular impingement by the inclusion of femoral osteoplasty.

The purpose of this study is to audit the early clinical outcomes of a consecutive series of hip arthroscopies performed by one surgeon.

Pre-operative WOMAC and Non Arthritic Hip scores were performed on the patients. All patients had MRI arthrograms. These were correlated with the clinical findings at the time of surgery. Postoperatively all complications were recorded and at one year post surgery the pre-operative scores were repeated.

There are 37 consecutive cases. 15 males and 22 females. Average age 39 years. 76% of cases were accident related. The average length of symptoms pre-operatively was 21 months. There were 2 false negative MRI arthrograms and one false positive. The surgical treatment included debridement of 18 labral tears and 10 labral tears associated with an articular cartilage defect. The average traction time was 39 minutes. The complications were minor and all have resolved.

There are many indications for hip arthroscopy however the outcomes of labral debridement are not clearly defined. This paper attempts to measure the success of arthroscopic labral debridement in a consecutive series of patients. The clinical symptoms and MRI arthrograms seem to have a good correlation with the arthroscopic findings. The short term results of this treatment are encouraging as is the low morbidity associated with the surgery itself.

We undertook a comparative audit of 171 consecutive Hip and Knee Arthroplasties performed by an overseas team at an Independent Hospital (Group 1) between August 2005 and December 2005 and compared them to a corresponding number performed by all grades of surgeons at the local NHS Trust (Group 2). We examined patient selection criteria such as BMI and ASA grade and compared the early radiological outcome, complication rate, length of hospital stay and the patient satisfaction rate between the two groups. We found that patients in Group 1 had a lower average BMI (27.13) and a better ASA grade (95% grade 1 and 2) as compared to Group 2 (BMI - 29.69 and 80% ASA Grade 1 and 2). The average hospital stay was 6.1 days in Group 1 and 8 days in Group 2. Only 74% of the patients in Group 1 were completely satisfied with their treatment outcome as compared to 91% in Group 2. (Trent Arthroplasty Questionnaire). There were 7 early dislocations (9.1%) in Group 1 (76 THRs), two requiring revision, as compared to one in Group 2 (1.3%, 84 THRs). Three other patients from Group 1 (TKRs) required a revision procedure within the first year. There was an increased incidence of adverse features (mal-alignment and mal-positioning of components) on the post operative X rays of patients in Group 1 as compared to Group 2 leading to adverse clinical events. 11 patients (95TKRs) showed substantial femoral notching in Group 1 as compared to 3 in Group 2. This study shows that patients selected for surgery by the overseas team were the fitter of the two groups, but had a significantly higher complication rate and a much lower satisfaction rate. The study underlines the potential risks of commissioning work to overseas teams in order to reduce waiting times