The clinical success and long-term outcomes of total knee arthroplasty (TKA) depend not only on the accuracy of femoral and tibial components positioning, but also on the restoration of a proper mechanical axis (MA). Coronal and rotational mal-alignment may affect significantly the final result of a knee replacement. Patient specific cutting guides and intra-operative Computer-Assisted Surgery (CAS) have recently been introduced as options to improve implant alignment during TKA. The purpose of this study was to compare the alignment accuracy and implant positioning of Patient Matched technique to CAS system in patients with primary TKA. A cohort of 68 consecutive patients who underwent TKA was enrolled for this study: 34 patients received a TKA using CAS system while 34 patients received a TKA using a MRI-based Patient Matched system. Mechanical axis and kinematics were digitally measured pre- and post-operatively in all knees using the intra-operative navigation system but data were blinded for the operating surgeon in the Patient Matched group. A post-operative CT-scan evaluation was performed in all patients to analyse the prosthetic components alignment (coronal, sagittal and axial alignment according to Perth Protocol from CT-scan). CT-scan measurements were used as landmarks as this tool is considered the gold standard. MA, posterior tibial slope (PTS) and femoral component rotation (FCR) in CAS group were compared to data of Patient Matched group. All patients also underwent a clinical evaluation with Knee Society Score (KSS) and Knee injury and Osteoarthritis Outcome Score (KOOS) at 6 and 12 months of follow up. KSS, KOOS and range of motion were comparable in the two groups after surgery. Operative time was significantly shorter in the Patient Matched group. No differences were found regarding complications rate. Mean angles, respectively for CAS and Patient Matched groups, were the following: MA was 1,7° (SD 0,9°) vs 0.8° (SD 2.1°); PTS was 3.1° (SD 0.9°) vs 3.4° (SD 2.1°); FCR was 1.5° (SD 2.2°) vs 1.36° (DS 1.2°). The outcomes of the CT scan evaluation were the following: MA was 1.5° (SD 0.8°) vs 1.0° (DS 1.5°); PTS was 2.3° (SD 0.8°) vs 3.0° (SD 2.6°); FCR was 0.4° (SD 0.8°) vs 0.2° (SD 0.3°). MA was within 3° of neutral alignment in 94% of patients for CAS group and in 97% of knees for Patient Matched group. After a short follow up, there weren't statistically significant differences between CAS and Patient Matched techniques as regards clinical and functional scores. Both the systems achieved the goal of neutral alignment within 3° of varus and valgus. We only observed greater precision for Patient Matched technique in optimizing femoral component rotation. Actually it is unpredictable if this difference may determine long term effects. Patient Matched technique and CAS for TKA surgery will certainly continue to have an impact in the future. Studies are needed to define which technique is better, in terms of long term results, failure rate and cost-effectiveness

Introduction. Neck of femur (NoF) fractures have an inherent 6.5% 30-day mortality as per National hip fracture database(2019). Several studies have demonstrated a higher mortality rate in covid positive NoFs but have been unable to demonstrate whether there are risk factors that contribute to the risk of mortality in this patient group or whether COVID is solely responsible for the higher mortality. Aims. To assess risk factors that are concurrently present in a fracture NoF cohort that may contribute to higher mortality in COVID positive patients. Methods. A cross sectional, retrospective study was performed for a period of 1 year starting from 1st March 2020. All surgically treated neck of femur fracture patients having an isolated intra/extracapsular fracture were included in the study. Data fields recorded- patient demographics, date and time of admission, ward discharge, surgery, mode of surgery (fixation/arthroplasty), prehospital AMTS score, residential status and mobility, ASA grade as per anaesthetist's records, date of death (if deceased), cause of death (as per death certificate/ postmortem / coroner's report). Analysis of mortality was carried out by creating a matched comparison group for each risk factor as well as some combinations. Results. 344 patients were surgically treated for a neck of femur fracture in our DGH during the period of 1st March 2020 to 28th February 2021. 46 patients did not receive a COVID swab (reasons unknown) and were excluded from the study. 35 patients had a COVID-19 RT PCR positive test during their hospital stay and 264 patients remained negative. There were 12 deaths in COVID positive patients (34%) and 53 deaths in COVID negative patients (20%) within the time frame of the study. For each risk factor matched group COVID was seen to confer higher mortality in general. There was no mortality in ASA 1 or 2 patients. Mortality rates in matched groups for age and ASA revealed 23.8% mortality in COVID positive as opposed to 17.3% in COVID negative for ASA 3 and 33.3% mortality in COVID positive vs. 28% in ASA 4. 11 out of the 12 COVID positive patients who died had an AMTS score >6. No correlation was seen between COVID positive deaths and preinjury residential status, type of fracture or surgery offered, or preinjury mobility. The average length of hospital stay was much higher for COVID positive patients (19.5days) as compared to 9.5 days for COVID negative patients. Conclusion. Matched group analysis show that there is a 37.5% increase in COVID positive neck of femur fracture mortality in ASA 3 patients, the same number falls to 17.8% for ASA 4 patients. These figures are much lower compared to other studies in the UK. There is a need to understand the real cause of death in this subset and to improve death certification so that we can differentiate between patients whose mortality is ‘due to’ or ‘With’ COVID

There is no agreement as to the superiority or specific indications for cast treatment, percutaneous pinning or open fracture fixation for Bennett's fractures of the thumb metacarpal. We undertook this study to compare the outcomes of treatment for patients treated for Bennett's fracture in the medium term.

We reviewed 33 patients treated in our unit for a bennett's fracture to the thumb metacarpal with closed reduction and casting. Each patient was matched with a patient treated surgically. Patients were matched for sex, age, Gedda grade of injury and hand dominance. Patients were reviewed at a minimum of 5-years and 66-patients were reviewed in total. Patients were examined clinically and also asked to complete a DASH questionnaire score and the brief Michigan hand questionnaire. Follow up plain radiographs were taken of the thumb and these were reviewed and graded for degenerative change using the Eaton-Littler score.

Sixty-six patients were included in the study, with 33 in the surgical and non-surgical cohorts respectively. The average age was 39 years old. In each cohort, 12/33 were female, 19/33 were right-handed with 25% of individuals injuring their dominant hand. In each coort there were 16 Grade 1 fractures, 4 Grade 2 and 13 Grade 3 fractures. There was no difference between the surgically treated and cast-treatment cohorts of patients when radiographic arthritis, pinch grip, the brief Michigan Hand Questionnaire and pain were assessed at final review. The surgical cohort had significantly lower DASH scores at final follow-up. There was no significant difference in the normalised bMHQ scores.

Our study was unable to demonstrate superiority of either operative or non-operative fracture stabilization. Patients in the surgical cohort reported superior satisfaction and DASH scores but did not demonstrate any superiority in any other objectively measured domain.

The reverse total shoulder replacement (rTSR) has excellent clinical outcomes and prosthesis longevity, and thus, the indications have expanded to a younger age group. The use of a stemless humeral implant has been established in the anatomic TSR; and it is postulated to be safe to use in rTSR, whilst saving humeral bone stock for younger patients. The Lima stemless rTSR is a relatively new implant, with only one paper published on its outcomes.

This is a single-surgeon retrospective matched case control study to assess short term outcomes of primary stemless Lima SMR rTSR with 3D planning and Image Derived Instrumentation (IDI), in comparison to a matched case group with a primary stemmed Lima SMR rTSR with 3D planning and IDI.

Outcomes assessed: ROM, satisfaction score, PROMs, pain scores; and plain radiographs for loosening, loss of position, notching. Complications will be collated. Patients with at least 1 year of follow-up will be assessed.

With comparing the early radiographic and clinical outcomes of the stemless rTSR to a similar patient the standard rTSR, we can assess emerging trends or complications of this new device.

41 pairs of stemless and standard rTSRs have been matched, with 1- and 2-year follow up data. Data is currently being collated. Our hypothesis is that there is no clinical or radiographical difference between the Lima stemless rTSR and the traditional Lima stemmed rTSR.

Introduction

Ankle fractures in the elderly have been increasing with an ageing but active population and bring with them specific challenges. Medical co-morbidities, a poor soft tissue envelope and a requirement for early mobilisation to prevent morbidity and mortality, all create potential pitfalls to successful treatment. As a result, different techniques have been employed to try and improve outcomes. Total contact casting, both standard and enhanced open reduction internal fixation, external fixation and most recently tibiotalocalcaneal (TTC) nailing have all been proposed as suitable treatment modalities. Over the past five years popular literature has begun to herald TTC nailing as an appropriate and contemporary solution to the complex problem of high-risk ankle fragility fractures. We sought to assess whether, within our patient cohort, the outcomes seen supported the statement that TTC has equal outcomes to more traditional open reduction internal fixation (ORIF) when used to treat the high-risk ankle fragility fracture.

The purpose of this study was to compare intra-operative, clinical, functional, and patient-reported outcomes following revision anterior cruciate ligament reconstruction (ACL-R) with a matched cohort of primary isolated ACL-R. A secondary purpose was to compare patient-reported outcomes within revision ACL-R based on intra-operative cartilage pathology.

Between January 2010 and August 2017, 396 patients underwent revision ACL-R, and were matched to primary isolated ACL-R patients using sex, age, body mass index (BMI), and Beighton score. Intra-operative assessments including meniscal and chondral pathology, and graft diameter were recorded. Lachman and pivot shift tests were completed independently on each patient at two-years post-operative by a physiotherapist and orthopaedic surgeon. A battery of functional tests was assssed including single-leg Bosu balance, and four single-leg hop tests. The Anterior Cruciate Ligament-Quality of Life Questionnaire (ACL-QOL) was completed pre-operatively and two-years post-operatively.

Descriptive statistics including means (M) and standard deviations (SD), and as appropriate paired t-tests were used to compare between-groups demographics, the degree and frequency of meniscal and chondral pathology, graft diameter, rate of post-operative ACL graft laxity, the surgical failure rate, and ACL-QOL scores. Comparative assessment of operative to non-operative limb performance on the functional tests was used to assess limb symmetry indices (LSI).

Revision ACL-R patients were 52.3% male, mean age 30.7 years (SD=10.2), mean BMI 25.3 kg/m2 (SD=3.79), and mean Beighton score 3.52 (SD=2.51). In the revision group, meniscal (83%) and chondral pathology (57.5%) was significantly more frequent than in the primary group (68.2% and 32.1%) respectively, (p < 0 .05). Mean graft diameter (mm) in the revision ACL-R group for hamstring (M=7.89, SD=0.99), allograft (M=8.42, SD=0.82), and patellar or quadriceps tendon (M=9.56, SD=0.69) was larger than in the primary ACL-R group (M=7.54, SD=0.76, M=8.06, SD=0.55, M=9, SD=1) respectively. The presence of combined positive Lachman and pivot shift tests was significantly more frequent in the revision (21.5%) than primary group (4.89%), (p < 0 .05). Surgical failure rate was higher in the revision (10.3%) than primary group (5.9%).

Seventy-three percent of revision patients completed functional testing. No significant LSI differences were demonstrated between the revision and primary ACL-R groups on any of the functional tests. No statistically significant differences were demonstrated in mean preoperative ACL-QOL scores between the revision (M=28.5/100, SD=13.5) and primary groups (M=28.5/100, SD=14.4). Mean two-year scores demonstrated statistically significant and minimally clinically important differences between the revision (M=61.1/100, SD=20.4) and primary groups (M=76.0/100, SD=18.9), (p < 0 .05). Mean two-year scores for revision patients with repair of the medial (M=59.4/100, SD=21.7) or lateral meniscus (M=59.4/100, SD=23.6), partial medial meniscectomy (M=59.7/100, SD=20), grade three or four osteoarthritis (M=55.9/100, SD=19.5), and medial femoral condyle osteoarthritis (M=59.1/100, SD=18) were lower compared with partial lateral meniscectomy (M=67.1/100, SD=19.1), grade one or two osteoarthritis (M=63.8/100, SD=18.9), and lateral femoral condyle osteoarthritis (M=62, SD=21).

Revision ACL-R patients demonstrated a greater amount of meniscal and chondral pathology at the time of surgery. Two-years post-operative these patients demonstrated higher rates of graft laxity and lower ACL-QOL scores compared with the primary ACL-R group. Higher grade and medial sided osteoarthritis was associated with inferior ACL-QOL scores in revision ACL-R.

Introduction

The Te Whatu Ora Southern catchment area covers the largest geographical region in New Zealand (over 62,000 km2) creating logistical challenges in providing timely access to emergency neck of femur (NOF) fracture surgery. Current Australian and New Zealand guidelines recommend that NoF surgery be performed within 48 hours of presentation. The purpose of this study was to compare the outcomes for patients with NoF fractures who present directly to a referral hospital (Southland Hospital) compared to those are transferred from rural peripheral centres.

Introduction

A subset of patients in cast awaiting fixation of ankle fractures require conversion to delayed external fixation (dEF). We aimed to evaluate the effect of delayed versus planned external fixation (pEF), then identify objective characteristics contributing to need for conversion.

Symptomatic lumbar spinal stenosis is a common entity and increasing in prevalence. Limited evidence is available regarding patient reported outcomes comparing primary vs revision surgery for those undergoing lumbar decompression, with or without fusion. Evidence available suggest a lower rate of improvement in the revision group. The aim of this study was to assess patient reported outcomes in patients undergoing revision decompression, with or without fusion, when compared to primary surgery.

Patient data was collected from the Canadian Spine Outcomes Research Network (CSORN) database. Patients undergoing lumbar decompression without or without fusion were included. Patients under 18, undergoing discectomy, greater than two level decompressions, concomitant cervical or thoracic spine surgery were excluded. Demographic data, smoking status, narcotic use, number of comorbidities as well as individual comorbidities were included in our propensity scores. Patients undergoing primary vs revision decompression were matched in a four:one ratio according to their scores, whilst a separate matched cohort was created for those undergoing primary vs revision decompression and fusion. Continuous data was compared using a two-tailed t-test, whilst categorical variables were assessed using chi-square test.

A total of 555 patients were included, with 444 primary patients matched to 111 revision surgery patients, of which 373 (67%) did not have fusion. Patients undergoing primary decompression with fusion compared to revision patients were more likely to answer yes to “feel better after surgery” (87.8% vs 73.8%, p=0.023), “undergo surgery again” (90.1% vs 76.2%, P=0.021) and “improvement in mental health” (47.7% vs 28.6%, p=0.03) at six months. There was no difference in either of these outcomes at 12 or 24 months. There was no difference between the groups ODI, EQ-5D, SF 12 scores at any time point. Patients undergoing primary vs revision decompression alone showed no difference in PROMs at any time point.

In a matched cohort, there appears to be no difference in improvement in PROMS between patients undergoing primary vs revision decompression, with or without fusion, at two year follow-up. This would suggest similar outcomes can be obtained in revision cases.

Given the high prevalence of psychiatric illness in the total joint arthroplasty (TJA) population, relatively little is known about how these two conditions affect each other. Therefore, the purpose of this study is to evaluate the role of major psychiatric illness on patient specific outcomes after TJA. We hypothesize that patients with major psychiatric illnesses will report inferior outcomes and have more complications after TJA compared to those without any psychiatric illness.

We matched and compared two cohorts of patients undergoing TJA from a prospectively collected database registry, which included those with and without a major psychiatric disorder. Major psychiatric disorder was identified in the registry database by determining if patients had been formally diagnosed with any of the following conditions: bipolar disorder, major personality disorder, chronic mental health diagnoses, depression, or schizophrenia. Primary outcomes of interest included patient specific outcomes measured using the WOMAC or EQ5D. Secondary outcomes included complications, infections, hospital length of stay, 30-day readmission rates and final discharge destination.

In total we included 1828 TJAs (1000 THAs, 828 TKAs). In terms of the primary outcome, both the THA experimental group (37.80 ± 17.91 vs. 40.74 ± 19.3, p=0.023) and TKA experimental group (43.38 ± 18.41 vs 45.45 ± 20.07, p=0.050) had significantly lower preoperative WOMAC scores compared to their respective control groups. At the 3-month period both the THA experimental group (76.74 ± 16.94 vs. 79.16 ± 16.19, p=0.036) and TKA experimental group (71.09 ± 18.64 vs. 75.92 ± 16.22, p=0) again had significantly lower 3-month postoperative WOMAC score. Clinical outcomes at the 1-year mark were similar for both groups in terms of WOMAC and EQ5D. Patients with psychiatric illness were more likely to have increased LOS and non-routine discharge from hospital. In the THA subset, the experimental group had an increased LOS by 1.43 days (p=0.0028), in the TKA subset, the experimental group had an increased LOS by 0.77 days (p= 0.050). In terms of non-routine discharge, the THA experimental group was discharged home 86.9% of the time compared to the control group at 91.8% (p=0.024). In the TKA subset, the experimental group was discharged home 87.6% of the time compared to the control group at 92% (p=0.022). There were no other differences between the two subsets in regards to transfusions, 30-day readmissions, infections, mechanical adverse events, and medical complications.

In conclusion, our results demonstrate that psychiatric illness can result in worse outcomes in the early perioperative period after TJA, although outcomes are equivalent 1 year postoperatively. Patients with psychiatric illness can be expected to gain significant improvements in outcome after surgery that are comparable to a baseline population without psychiatric illness. Nonetheless, patients with psychiatric illness are at increased risk of delayed discharge and non-routine discharge. As such, they may require personalized care post-operatively, and should be counseled accordingly. Based on our results, psychiatric illness should not be an impediment to proceeding with TJA.

While Oxidized Zirconium (OxZr) femoral heads matched with highly cross-linked polyethylene (XLPE) have demonstrated the lowest rate of revision compared to other bearing couples in the Australian National Joint Registry, it has been postulated that these results may, in part, be due to the fact that a single company offers this bearing option with a limited combination of femoral and acetabular prostheses. The purpose of this study was to assess clinical and radiographic outcomes in a matched cohort of total hip replacements (THR) utilizing an identical cementless femoral stem and acetabular component with either an Oxidized Zirconium (OxZr) or Cobalt-Chrome (CoCr) femoral heads at a minimum of 10 years follow-up.

We reviewed our institutional database to identify all patients whom underwent a THR with a single cementless femoral stem, acetabular component, XLPE liner and OxZr femoral head with a minimum of 10 years of follow-up. These were then matched to patients who underwent a THR with identical prosthesis combinations with CoCr femoral head by gender, age and BMI. All patients were prospectively evaluated with WOMAC, SF-12 and Harris Hip Score (HHS) preoperatively and postoperatively at 6 weeks, 3 months, 1 and 2 years and every 2 years thereafter. Charts and radiographs were reviewed to determine the revision rates and survivorship (both all cause and aseptic) at 10 years for both cohorts. Paired analysis was performed to determine if differences exist in patient reported outcomes.

There were 208 OxZr THRs identified which were matched with 208 CoCr THRs. There was no difference in average age (OxZr, 54.58 years, CoCr, 54.75 years), gender (OxZr 47.6% female, CoCr 47.6% female), and average body max index (OxZr, 31.36 kg/m2, CoCr, 31.12 kg/m2) between the two cohorts. There were no significant differences preoperatively in any of the outcome scores between the two groups (WOMAC (p=0.449), SF-12 (p=0.379), HHS(p=0.3718)). Both the SF12 (p=0.446) and the WOMAC (p=0.278) were similar between the two groups, however the OxZr THR cohort had slightly better HHS compared to the CoCr THR cohort (92.6 vs. 89.7, p=0.039). With revision for any reason as the end point, there was no significant difference in 10 years survivorship between groups (OxZr 98.5%, CoCr 96.6%, p=0.08). Similarly, aseptic revisions demonstrated comparable survivorship rates at 10 year between the OxZr (99.5%) and CoCr groups (97.6%)(p=0.15).

Both THR cohorts demonstrated outstanding survivorship and improvement in patient reported outcomes. The only difference was a slightly better HHS score for the OxZr cohort which may represent selection bias, where OxZr implants were perhaps implanted in more active patients. Implant survivorship was excellent and not dissimilar for both the OxZr and CoCr groups at 10 years. Therefore, with respect to implant longevity at the end of the first decade, there appears to be no clear advantage of OxZr heads compared to CoCr heads when paired with XLPE for patients with similar demographics. Further follow-up into the second and third decade may be required to demonstrate if a difference does exist.

The purpose of this study was to define the risk and incidence of eventual ankle arthroplasty or fusion after documented ankle fracture in a large cohort, and compare that rate to matched healthy patients from the general population.

The Ontario health insurance plan (OHIP) physician billing database, Institute for Clinical Evaluative Sciences (ICES) Physician Database, the Canadian Institute for Health Information (CIHI) databases, Discharge Abstract Database (DAD) and Same Day Surgery (SDS) were used to identify patients treated surgically and non-surgically for ankle fractures. Each patient was matched to four individuals from the general population (13.5 million) with no documented prior treatment for ankle fracture, according to age, sex, income, and urban/rural residence. Fusion and replacement incidence was compared using time-to-event analysis (Kaplan-Meier). A Cox Proportional Hazards model was used to explore the influence of patient, provider and surgical factors on time to surgery.

We identified 45,444 (58.8% female, mean age 48.7 years) and 140, 629 (53.9% female, mean age 47.1 years) patients who had undergone open reduction internal fixation (ORIF) or non-operative management of an ankle fracture (NOA), respectively. Among ORIF patients, n=237 (0.5%) and n=69 (0.15%) patients underwent fusion or arthroplasty after a median 2.8 and 6.9 years, respectively. Among non-operatively treated ankle fractures, n=198 (0.14%) and n=36 (0.03%) patients underwent fusion or arthroplasty after a median of 3.2 and 5.6 years, respectively. Surgical treatment (vs. non-operatively treated fracture), older age, greater co-morbidity and a history of infection post fracture significantly increased the risk of eventual fusion or arthroplasty (HR 3.6 (3.1–4.3), p < 0 .001, HR 1.01 (1.01–1.02), p=0.009, HR 1.2 (1.1–1.3), p < 0 .001, HR 11.3 (6.8–18.7), p < 0 .001, respectively). Compared to matched controls, the risk of fusion/arthroplasty was not independent of time, following an exponential decay pattern. ORIF patient risk was 20 times greater than the general population in the first three years post-ORIF, and approached the risk of non-operatively treated patients (HR 4.5 (95CI: 3.5–5.8), p < 0 .0001) by approximately 14 years out from injury on time and comorbidity adjusted KM curves.

Rates of fusion/arthroplasty are very low after ORIF and non-operative treatment of an ankle fracture in the general population of a public healthcare system. Utilization patterns suggest fusion is more common earlier, and arthroplasty remote, which may be a factor of patient age, injury severity, and complications from initial injury/surgery. Patients who underwent ORIF have >20 times the risk of fusion/arthroplasty in the short-term, however, the risk decreases over time eventually approaching that of non-operatively treated patients (∼4.5x the general population) when compared to non-fractured controls.

Introduction

Patient matched instrumentation (PMI) have been proposed the accuracy of bone cuts through custom cutting blocks and provide the proper alignment of total knee arthroplasty (TKA). On the other hand, there are some reports that the introduction of PMI for guiding bone cuts could increase the incidence of malalignment in primary TKA. Recent comparisons between patient-specific cutting guides and quantitative assessments of postoperative alignment have revealed the presence of outliers with respect to coronal alignment. The purpose of this study was to assess the implanted component alignment post-operatively between one type of MRI based PMI (Visionaire; Smith & Nephew, Inc, Memphis, Tenn) and conventional surgical instrumentation (CI) using radiographs and CT scan.

Eligible patients were randomly allocated to PMI or standard intramedullary jigs. Smith and Nephew's patient specific cutting blocks (Visionaire) were used for PMI. Postoperative component positioning was investigated using the ‘Perth CT protocol’. Deviation of more than 3° from the recommended position was regarded as an outlier. Exact Mann-Whitney U test was used to compare component positioning and difference in proportion of outliers was calculated using Chi Squared analysis.

Fifty-five knees were enrolled in the standard instrumentation group and fifty-two knees in the PMI group.

Coronal femoral alignment was 0.7 ± 1.9° (standard) vs 0.5 ± 1.6° (PMI) (P=0.33). Outliers 9.4% vs 7.4% (P=0.71). Coronal tibial alignment was 0.4 ± 1.5° (standard) vs 0.6 ± 1.4° (PMI) (P=0.56). Outliers 1.9% vs 1.9% (P=0.99). Sagittal femoral alignment was 0.6 ± 1.5° (standard) vs 1.3 ± 1.9° (PMI) (P=0.07). Outliers 3.8% vs 13.2% (P=0.09). Tibial slope was 1.7 ± 1.9 ° (standard) vs 1.8 ± 2.7° (PMI) (P=0.88). Outliers 13.2% vs 24.1% (P=0.15). External rotation of femoral component was 0.6 ± 1.4° (standard) vs 0.2 ± 1.8° (PMI) (P=0.14). Outliers: 3.8% vs 5.6% (P=0.66).

Compared to standard intramedullary jigs, patient matched instrumentation does not improve component positioning or reduce alignment outliers.

Aim

To assess the accuracy of predicted and actual cut alignment from PMCB versus intra-operative computer navigation.

Introduction

Hip resurfacing is a bone sparing approach to treating arthritis in younger or more active patients. Accurate positioning of the femoral component in the hip resurfacing procedure is essential for the success of the operation [1-2]. An alignment guide assisting the operator in accurately positioning the resurfacing implant may increases the success rate of the operation. This study focuses on the effectiveness of a CT based resurfacing alignment guide, shown in Figure 1.

Aim

To compare the results of total knee replacement in a consecutive series of morbidly obese patients (body mass index (BMI) > 40 kg/m²) with a matched group of non-obese (BMI< 30 kg/m²) patients.

A comparative study on CT- and MRI-based patient specific matched guides (PSG) from the same manufacturer for the implantation of total knee arthroplasty (TKA) has not been undertaken.

A total of 64 knees operated with CT based PSG was divided into two groups, with (n=32, CT^HK) or without (n=32, CT^NA) a history of a knee operation, and matched with a control group operated with MRI based PSG(n=64). Alignment of the biomechanical axis of the leg (HKA angle) and accuracy of individual implant alignment were measured on digital long-standing AP and sagittal radiographs. HKA and implant angles <3° deviation of the preoperative planned alignment were defined as correct. Peroperative implant size, OR time (min) and blood loss (ml) were compared.

The average HKA angle in the CT^HK group (177.0, 170.5 to 181.5, p=0.016) and mean varus-valgus alignment of the tibia component in the MRI group (90.6, 85.6 to 94.1, p=0.003) were statistically significant different. None of the outcome on the frontal femoral and lateral tibial component were statistically significant different. Percentage <3° deviation of the preoperative planned femoral flexion-extension alignment was better in the MRI group (84%, p=0.002), compared to the CT^HK and CT^NA group (respectively 30% and 42%). Average operation time was statistically significant shorter in favour of the MRI group (53.1, 34 to 80, p≤0.00), compared to the CT^HK(70.8, 44 to 114) and CT^NA group (59.2, 41 to 78).

There is discrepancy between CT and MRI based PSG from the same manufacture because of patients who were not suitable for MRI due to history of a knee operation in the past. Whether these differences are clinically relevant is questionable. Future research needs to emphasise whether one of these two modalities, MRI or CT is superior compared to the other.

There has recently been a proliferation of image-based knee arthroplasty systems which utilize pre-operative radiological analysis of a patient's anatomy to identify the bone cuts required to correct their mechanical alignment. The aim of this was to assess the accuracy of one such system (Visionaire™, Smith and Nephew Inc.©)

Eleven cadavers were imaged using the Smith and Nephew Visionaire® MRI protocol to enable the production of cutting blocks individualized to the various specimens. These cutting blocks were then used to perform knee replacements on all cadavers. Post-operatively the validated Perth CT protocol was used to assess the position and rotational profile of each implant. These measurements were then compared to the pre-operative plan in order to assess the accuracy of implant placement.

Relative to the pre-operative target parameters, the femoral components were aligned in a mean 0.048° valgus (95% CI – 0.36° to 1.32°) with 1.8° extension (95% CI −0.1° to 4.5°) and externally rotated by a mean 0.66° (95% CI 1.08° internal rotation to 2.4° external rotation.) The tibial components were in a mean 0.29° of varus (95% CI – 0.68° to 1.27°) with a posterior tibial slope of 90.5° (95% CI 89.6° to 92.6°) and internally rotated by a mean 1.7° (range 10.1° internal rotation to 1.1° external rotation.)

The findings of our study suggest that the Visionaire system can produce accurate coronal implant alignment. The saggital and rotational alignment was not as reliable although these parameters may have been more prone to adverse influence by the limitations of the cadaveric model. Patient-matched knee arthroplasty technology offers significant potential benefits to both patient and surgeon and warrants further clinical investigation.

The aim of this study was to compare the long-term outcome from total knee replacement (TKR) in young versus old patients in terms of pain and functional outcome.

We used our arthroplasty database which recorded prospectively pain and American Knee Society scores at regular intervals over ten years after TKR. The procedures used a modern, cemented resurfacing type cruciate retaining prosthesis. A cohort of young patients (< 55 years) were identified. A control group of patients ≥ 56 was identified, matching for ASA, body mass index and underlying condition. Change over time was analysed using a factorial repeated measures ANOVA test, which allowed for investigation of difference between groups.

40 Knees in 26 patients were identified. 2 patients died prior to follow up, 2 were revised within the study period. (1 for infection at 2 years and one for change of poly at 7 years) and a further 4 were lost to follow up. 7 knees could not be matched and were excluded. This left a study group of 24 young and 24 older knees.

Pain scores (p=0.025) and American Knee Society “Knee” (p<0.001) and “Function” (p<0.001) scores changed significantly over time. There were however no statistical differences over the 10 year period in pain (p=0.436) and knee performance (0.618) but overall function was higher throughout the period in the younger group (=0.004).

Knee replacement in younger patients produces similar outcomes in terms of pain and function compared with older patients and TKR should not be withheld purely on account of age.