Purpose. Introduce an Integrated Approach for Orthopedic-Sports Medicine Practice and Patient Care Management that. Is built around effective and efficient surgical techniques, and patient care management processes. Integrates Operations and Service Excellence best practices with patient care management processes. Integrates orthopedic care delivery between outpatient clinic, pre-surgery, surgery, inpatient, (acute care) and post acute care settings. Delivers exceptional clinical, patient satisfaction and financial outcomes as validated by independent national healthcare benchmarking organization. Helps position Ortho-Sports medicine services for strategic growth. Is replicable to develop Ortho-Sports Medicine Centers of Excellence. Presentation illustrates the ‘Ten Elements’ approach to implement the Ortho-Sports Medicine Centers of Excellence and demonstrate the effectiveness of the approach with an outcomes study from over 1000 total knee arthroplasty (TKA) procedures. During the presentation, the speakers would share the key clinical, patient satisfaction, and financial outcomes achieved by the implementation of the best practices defined in our ‘Ten Elements’ approach. All performance data elements are collected, validated and analyzed by an independent third party, national healthcare benchmarking company. During the presentation Dr. Bramlett would elaborate on the surgical protocol, and the key differentiating steps in procedure technique from traditional approach that significantly enhances procedure effectiveness, efficiency and lowers the patient complication rate as demonstrated by benchmarking data. Speakers would further present the key elements of Total
In total knee arthroplasty, the aim is to relieve pain and provide a stable, functional knee. Sagittal stability is crucial in enabling a patient to return to functional activities. Knee implants with a medial pivot (MP) design are thought to more accurately reproduce the mechanics of the native joint, and potentially confer greater antero-posterior stability through the range of flexion than some other implant designs. This study aims to compare the sagittal stability of four different total knee arthroplasty implant designs. Method Comparison was made between four different implant designs: medial pivot (MP), two different types of cruciate retaining (CR1 and CR 2) and deep dish (DD). A cohort of 30 Medial Pivot (MP) knees were compared with matched patients from each of the other designs, 10 in each group. Patients were matched for age, body mass index and time to follow up. Clinical examination was carried out by an orthopaedic surgeon blinded to implant type, and sagittal stability was tested using a KT1000 knee arthrometer, applying 67N of force at 30˚ and 90˚.Introduction
Aim
Tranexamic Acid (TA) has been shown to reduce transfusion rates in Total Knee Replacement (TKR) without complication. In our unit it was added to our routine enhanced recovery protocol. No other changes were made to the protocol at this time and as such we sought to examine the effects of TA on wound complication and transfusion rate. All patients undergoing primary TKR over a 12 month period were identified. Notes and online records were reviewed to collate demographics, length of stay, use of TA, thromboprophylaxis, blood transfusion, wound complications and haemoglobin levels. All patients received a Columbus navigated TKR with a tourniquet. Only patients who received 14 days of Dalteparin for thromboprophylaxis were included. 124 patients were included, 72 receiving TA and 52 not. Mean age was 70. Four patients required a blood transfusion all of whom did not receive TA (p = 0.029). Mean change in Hb was 22 without TA and 21 with (p = 0.859). Mean length of stay was 6.83 days without Tranexamic Acid and 5.15 with (p < 0.001). 15% of patients (n=11) of the TA group had a wound complication, with 40% of patients (n=21) in the non TA group (p = 0.003). There was one ultrasound confirmed DVT (non TA group). No patients were diagnosed with pulmonary embolus. In our unit we have demonstrated a significantly lower transfusion rate, wound complication rate and length of stay, without any significant increase in thromboembolic disease with the use of TA in TKR.
To date, there are no clear guidelines from the National Institute of Clinical Excellence or the British Orthopaedic Association regarding the use of Autologous Blood Transfusion (ABT) drains after elective primary Total Knee Replacement (TKR). There is little evidence to comparing specifically the use of ABT drains versus no drain. The majority of local practice is based on current evidence and personal surgical experience. We aim to assess whether the use of ABT drains effects the haemoglobin level at day 1 post-operation and thus alter the requirement for allogenic blood transfusion. In addition we aim to establish whether ABT drains reduce post-operative infection risk and length of hospital stay. Forty-two patients undergoing elective primary TKR in West London between September 2011 and December 2011 were evaluated pre- and post-operatively. Patient records were scrutinised. The patient population was divided into those who received no drain post-operatively and those with an ABT drain where fluid was suctioned out of the knee in a closed system, filtered in a separate compartment and re-transfused into the patient. Twenty-six patients had ABT drains and 4 (15.4%) required an allogenic blood transfusion post-operatively. Sixteen patients received no drain and 5 (31.3%) required allogenic blood. There was no statistical difference between these two groups (p=0.22). There was no statistical difference (p=0.75) in the average day 1 haemoglobin drop between the ABT drain and no drain groups with haemoglobin drops of 2.80 and 2.91 respectively. There was no statistical difference in the length of hospital stay between the 2 groups (p=0.35). There was no statistical difference (p=0.26) in infection rates between the 2 groups (2 in ABT drains Vs. 0 in no drains). Of the 2 patients who experienced complications one had cellulitis and the other had an infected haematoma, which was subsequently washed out. The results identify little benefit in using ABT drains to reduce the requirement for allogenic blood transfusion in the post-operative period following TKR. However, due to small patient numbers transfusion rates of 31.3% in the ABT drain group Vs. 15.4% in the no drain group cannot be ignored. Therefore further studies including larger patient numbers with power calculations are required before a true observation can be identified.
Between April 2000 and December 2002 we performed the minimal invasive medial unicompartmental knee arthroplasty in 36 cases. Our results were evaluated by the HSS knee score. The average follow up time was 24.7 months. We have compared our results to a similar group in age, number and follow up time, who has been operated in the traditional approach.
In total knee arthroplalsties, there are risks of revision surgeries because of aseptic loosening, polyethylene wear, and metal component breakage. The data such as model, type, size, and manufacturing companies are required at the time of revision surgeries. However, it is sometimes difficult to acquire such data due to patient's change of address and the elimination and consolidation of hospitals in the long-term. Therefore, we try to use the Radio Frequency IDentification (RFID) in the total knee joint system. The FerVID family (Fujitsu Co. Ltd., Tokyo, Japan) was prepared as the RFID tag. It was radio-resistant below the dose of 50kGy, which allowed gamma sterilization. The RFID tags were embedded into the anterior side of GUR 1050 UHMWPE inserts and 0.3wt% vitamin E blended UHMWPE. The UHMWPE inserts were manufactured by thecompression molding method at the maximum temperature of 220°C and the maximum compressive force of 245kgf/cm2. The manufactured inserts were implanted in fresh cadaveric knees. The tibial base plate was made of Ti6Al4V. The femoral components were made of Co-Cr-Mo or Ti-6Al-4V. Communication Performance was measured with the interrogator (DOTR-920 MHz-band, Tohoku Systems Support Co. Ltd., Miyagi, Japan). The transmission output was up to 1W. Received Signal Strength Indicator (RSSI) was measured 500 times at 15 mm away from the surface of skin in the extension and 90° flexion of the knee (Fig1).Introduction
Materials and methods
To compare Radiostereometric Analysis (RSA) and subjective outcomes of Total Knee Arthroplasty (TKA) and Total Ankle Arthroplasty (TAA). Twenty-five patients were recruited to receive TKA (Zimmer, NexGen LPS Trabecular Metal Monoblock) and 20 patients were recruited to receive TAA (DePuy, Mobility). The tibial component of the TKA and the tibial component of the TAA were followed for two years with RSA with exams postoperatively at six, 12 and 24 months. At two years, inducible displacement RSA at the knee and ankle was also performed. RSA outcomes measured were translations in the anterior-posterior, medial-lateral and distal-proximal directions of both implants. SF-36 outcome questionnaires were completed preoperatively and at each RSA follow-up with the outcome being the mental component score (MCS) and physical component score (PCS). Analysis of variance statistical testing was used to compare RSA outcomes and subjective outcomes.Purpose
Method
Total Knee Replacement (TKR) is technically demanding, time consuming and has higher complication rates in super obese (BMI>45) patients. Bariatric surgery can be considered for such patients prior to TKR although its effect on complications is unknown. All patients who underwent bariatric surgery and a TKR in the NHS in England between 2005 and 2009 were included. Hospital episode statistics data in the form of OPCS, ICD10 codes were used to establish 90-day DVT, PE and mortality rates (inpatient and outpatient). In addition, readmission to orthopaedics, joint revision and ‘return to theatre for infection’ rates were also established. Code strings for each patient were examined in detail to ensure the correct gastric procedures were selected. Fifty-three patients underwent bariatric surgery then TKR (44-1274 days) (group 1). Thirty-one patients underwent TKR then bariatric surgery (33-1398 days) (group 2).Background
Methods
Orthopaedic surgeons and their patients continue to seek better functional outcomes after total knee replacement, but TKA designs claim characteristic kinematic performance that is rarely assessed in patients. The objectives of this investigation is to determine the in vivo kinematics in knees with Cruciate Retaining TKA using Patient Specific Technology during activities of daily living and to compare the findings with previous studies of kinematics of other CR TKA designs. Four knees were operated by Triathlon CR TKA using Patient Specific Technology and a fluoroscopic measurement technique has been used to provide detailed three-dimensional kinematic assessment of knee arthroplasty function during three motor tasks. 3D fluoroscopic analysis was performed at 4-month follow-up. The range of flexion was 90°(range 5°–95°) during chair-rising, 80°(range 0°–80°) during step up and 100° (range 0°–100°) during leg extension. The corresponding average external rotation of the femur on the tibial base-plate was 7.6° (range +4.3°; +11.9°), 9.5° (+4.0°; 13.5°) and 11.6° (+4.5°; +16.1°). The mean antero-posterior translations between femoral and tibial components during the three motor tasks were +4.7 (−3.7; +1.0), +6.4 (−3.8; +2.6) and +8,4 (−4.9; +3.5) mm on the medial compartment, and −2.5 (−7.1; −9.6), −3.6 (−6.1; −9.7), −2.6 (−7.7; −10.3) mm on the lateral compartment, respectively, with the medial condyle moving progressively anterior with flexion, and the medial condyle moving progressively posterior with flexion. We compared Triathlon CR PSI TKA results from this study with Genesis II CR TKA, with Duracon CR TKA, with Triathlon CR TKA and with the healthy knee kinematics. The results of this study showed no screw home mechanism. The internal rotation of the tibia with knee flexion is close to normal, better than Genesis II, Duracon and Triathlon CR TKA operated with standard surgery. The medial condyle is characterized by the same pattern of the other implants, with a paradoxical anterior translation of 5 mm. The lateral condyle shows a posterior rollback better than Triathlon CR operated with standard surgery. For the first time is demonstrated that the surgical technique can modify the tibio-femoral kinematics.
Post operative analgesia is an important part of Total Knee Arthroplasty (TKA) to facilitate early mobilisation and patient satisfaction. We investigated the effect of periarticular infiltration of the joint with chirocaine local anaesthetic (LA) on the requirement of analgesic in the first 24 hrs period post op. Retrospective analysis of case notes was carried out on 28 patients, who underwent TKA by two different surgeons. They were divided into two groups of 14 each; who did and did not receive the LA infiltration respectively. All patients were given spinal morphine (162 mcg r: 150-200). Analgesic requirement was assessed in terms of the amount of paracetamol, morphine, diclofenac, oxynorm and tramadol administered in 24hrs post op including the operating time.Background
Methods
Many aspects of total knee arthroplasty have
changed since its inception. Modern prosthetic design, better fixation techniques,
improved polyethylene wear characteristics and rehabilitation, have
all contributed to a large change in revision rates. Arthroplasty
patients now expect longevity of their prostheses and demand functional
improvement to match. This has led to a re-examination of the long-held
belief that mechanical alignment is instrumental to a successful
outcome and a focus on restoring healthy joint kinematics. A combination
of kinematic restoration and uncemented, adaptable fixation may
hold the key to future advances. Cite this article:
Background. Surgical wound closure is not the surgeon”s favorite part of the total knee arthroplasty (TKA) surgery however it has vital rule in the success of surgery.
Alignment and soft tissue balance are two of the most important factors that influence early and long term outcome of total knee arthroplasty. Current clinical practice involves the use of plain radiographs for preoperative planning and conventional instrumentation for intra operative alignment. The aim of this study is to assess the Signature. TM. Personalised system using patient specific guides developed from MRI. The Signature. TM. system is used with the Vanguard. R. Complete Knee System. This system is compared with conventional instrumentation and computer assisted navigation with the Vanguard system. Patients were randomised into 3 groups of 50 to either Conventional Instumented Knee, Computer Navigation Assisted Knee Arthroplasty or Signature Personalised
Purpose. Traditional total
Background. Cement restrictors are used for maintaining good filling and pressurization of bone cement during hip and knee arthroplasties. The limitations of certain cement restrictors include the inability to accommodate for large medullary canals particularly in revision procedures. We describe a technique using SurgicelTM (Johnson & Johnson) and SPONGOSTAN™ (Johnson & Johnson) (Fig 1) to form a cement restrictor that can accommodate for large canal diameters and provide excellent pressurisation. Technique. The technique involves the application of SPONGOSTAN™ (Johnson & Johnson) foam onto a SurgicelTM (Johnson & Johnson) mesh which is then rolled onto the SPONGOSTAN™ foam forming a uniform cylindrical structure Figs 2,3. The diameter of the restrictor can be adjusted according to the desired femoral canal diameter through increasing the thickness of the SPONGOSTAN™ (Johnson & Johnson) foam. The restrictor is then inserted into the desired position in the medullary canal where it expands uniformly creating an effective restrictor and bone plug Fig 4. Bone cement is then applied and pressurisation commenced prior to the insertion of the implant Fig5. SPONGOSTAN™ is an absorbable haemostatic sponge intended for haemostatic use by applying to a bleeding surface. It consists of a sterile, water-insoluble, malleable, porcine gelatin absorbable sponge. Surgicel ™ is an absorbable hemostatic agent composed of oxidized regenerated cellulose. It is a sterile, absorbable knitted fabric that is flexible and adheres readily to bleeding surfaces. Both products are routinely used for their haemostatic properties in various surgical disciplines. Discussion. The use of intramedullary plugs in cemented total joint arthroplasty is essential in order to achieve good filling and pressurization in hip and
Total
To evaluate prospectively the mid-term results of the Zimmer Unicondylar
Aim. We aim to compare revision rates and functional outcome scores in between two contemporary total