Aims. Revision total knee arthroplasty (rTKA) is a technically challenging and costly procedure. It is well-documented that primary TKA (pTKA) have better survivorship than rTKA; however, we were unable to identify any studies explicitly investigating previous rTKA as a risk factor for failure following rTKA. The purpose of this study is to compare the outcomes following rTKA between patients undergoing index rTKA and those who had been previously revised. Methods. This retrospective, observational study reviewed patients who underwent unilateral, aseptic rTKA at an academic orthopaedic speciality hospital between June 2011 and April 2020 with > one-year of follow-up. Patients were dichotomized based on whether this was their first revision procedure or not. Patient demographics, surgical factors, postoperative outcomes, and re-revision rates were compared between the groups. Results. A total of 663 cases were identified (486 index rTKAs and 177 multiply revised TKAs). There were no differences in demographics, rTKA type, or indication for revision. Multiply revised patients had significantly longer rTKA operative times (p < 0.001), and were more likely to be discharged to an acute rehabilitation centre (6.2% vs 4.5%) or skilled nursing facility (29.9% vs 17.5%; p = 0.003). Patients who had been multiply revised were also significantly more likely to have subsequent reoperation (18.1% vs 9.5%; p = 0.004) and re-revision (27.1% vs 18.1%; p = 0.013). The number of previous revisions did not correlate with the number of subsequent reoperations (r = 0.038; p = 0.670) or re-revisions (r = −0.102; p = 0.251). Conclusion. Multiply revised TKA had worse outcomes, with higher rates of facility discharge, longer operative times, and greater reoperation and re-revision rates compared to index rTKA. Cite this article: Bone Jt Open 2023;4(5):393–398

Aims. To investigate the impact of consecutive perioperative care transitions on in-hospital recovery of patients who had primary total knee arthroplasty (TKA) over an 11-year period. Methods. This observational cohort study used electronic health record data from all patients undergoing preoperative screening for primary TKA at a Northern Netherlands hospital between 2009 and 2020. In this timeframe, three perioperative care transitions were divided into four periods: Baseline care (Joint Care, n = 171; May 2009 to August 2010), Function-tailored (n = 404; September 2010 to October 2013), Fast-track (n = 721; November 2013 to May 2018), and Prehabilitation (n = 601; June 2018 to December 2020). In-hospital recovery was measured using inpatient recovery of activities (IROA), length of stay (LOS), and discharge to preoperative living situation (PLS). Multivariable regression models were used to analyze the impact of each perioperative care transition on in-hospital recovery. Results. The four periods analyzed involved 1,853 patients (65.9% female (1,221/1,853); mean age 70.1 years (SD 9.0)). IROA improved significantly with each transition: Function-tailored (0.9 days; p < 0.001 (95% confidence interval (CI) -0.32 to -0.15)), Fast-track (0.6 days; p < 0.001 (95% CI -0.25 to -0.16)), and Prehabilitation (0.4 days; p < 0.001 (95% CI -0.18 to -0.10)). LOS decreased significantly in Function-tailored (1.1 days; p = 0.001 (95% CI -0.30 to -0.06)), Fast-track (0.6 days; p < 0.001 (95% CI -0.21 to -0.05)), and Prehabilitation (0.6 days; p < 0.001 (95%CI -0.27 to -0.11)). Discharge to PLS increased in Function-tailored (77%), Fast-track (91.6%), and Prehabilitation (92.6%). Post-hoc analysis indicated a significant increase after the transition to the Fast-track period (p < 0.001 (95% CI 3.19 to 8.00)). Conclusion. This study highlights the positive impact of different perioperative care procedures on in-hospital recovery of patients undergoing primary TKA. Assessing functional recovery, LOS, and discharge towards PLS consistently, provides hospitals with valuable insights into postoperative recovery. This can potentially aid planning and identifying areas for targeted improvements to optimize patient outcomes. Cite this article: Bone Joint J 2024;106-B(6):573–581

Abstract. Background. Orthopaedic training in Southern Africa is largely focused on trauma, although elective procedures, such as knee arthroscopy are increasing. This is especially true in the private sector where most trainees will practice. The primary aim of this study was to assess the arthroscopic competency of orthopaedic trainees in a setting of limited resources. Methods. A prospective observational cohort study was carried out. Orthopaedic trainees of a Southern African university hospital performed basic arthroscopy on a knee model. Their surgical competency was assessed by two surgeons proficient in arthroscopy using the modified Basic Knee Arthroscopy Skill Scoring System (mBAKSSS). Results. A total of 16 trainees (12 male) were included (6 junior and 10 senior trainees). The median age of participants was 36 (34.8, 37). The median mBAKSSS was 28.0 (20.3, 32.5) but showed a large variability (12.0–42.5). The overall reliability was excellent with Cronbach's Alpha of 0.91 and interclass correlation of 0.91 [95% CI 0.75, 0.97]. Conclusions. The average knee arthroscopy proficiency of our trainees is comparable to those of international training programs, but there was great variability with inconsistent skills amongst the trainees. This calls for improved and reproducible arthroscopy training and skills transfer, exposure to procedures and ongoing assessment

Aims. We aimed to assess the reliability and validity of OpenPose, a posture estimation algorithm, for measurement of knee range of motion after total knee arthroplasty (TKA), in comparison to radiography and goniometry. Methods. In this prospective observational study, we analyzed 35 primary TKAs (24 patients) for knee osteoarthritis. We measured the knee angles in flexion and extension using OpenPose, radiography, and goniometry. We assessed the test-retest reliability of each method using intraclass correlation coefficient (1,1). We evaluated the ability to estimate other measurement values from the OpenPose value using linear regression analysis. We used intraclass correlation coefficients (2,1) and Bland–Altman analyses to evaluate the agreement and error between radiography and the other measurements. Results. OpenPose had excellent test-retest reliability (intraclass correlation coefficient (1,1) = 1.000). The R. 2. of all regression models indicated large correlations (0.747 to 0.927). In the flexion position, the intraclass correlation coefficients (2,1) of OpenPose indicated excellent agreement (0.953) with radiography. In the extension position, the intraclass correlation coefficients (2,1) indicated good agreement of OpenPose and radiography (0.815) and moderate agreement of goniometry with radiography (0.593). OpenPose had no systematic error in the flexion position, and a 2.3° fixed error in the extension position, compared to radiography. Conclusion. OpenPose is a reliable and valid tool for measuring flexion and extension positions after TKA. It has better accuracy than goniometry, especially in the extension position. Accurate measurement values can be obtained with low error, high reproducibility, and no contact, independent of the examiner’s skills. Cite this article: Bone Joint Res 2023;12(5):313–320

Abstract. Introduction. Little is known about employment following revision total knee arthroplasty (RTKA). This study aims to describe factors associated with returning to employment in patients of working age who underwent RTKA surgery. Methodology. We performed a retrospective assessment of all patients aged ≤65 who underwent RTKA at our NHS institution between 2006 and 2020. All indications and revision procedures were included. Pre-operative demographics, indication for surgery and Oxford Knee Scores (OKS) were recorded. Postal questionnaires were sent to patients including patient reported outcome measures and departmental questionnaire asking patients about employment status pre- and post-operatively. Results. 132 procedures were performed in 113 patients. Median follow up was 5.5 years (2.4–9.0). Mean age was 58 (5.8) and 50% (57) were male. 62 patients undergoing 74 procedures responded to postal questionnaires and were included in the study. 53% (33) were employed prior to surgery and 61% (38) returned to work at a median of 12 weeks (3–150). Of the 24 who did not return to work, 7 reported intending to return to work. Those patients who returned to work had increased pre-operative OKS (16.9 vs 13.6) and mean improvement (16.5 vs 12.4). Conclusion. This study is limited by small numbers and its observational nature. In this population the majority of patients who wished to return to work after RTKA were able to do so. This provides some reassurance when counselling patients. Prospective studies to better understand the factors that predict return to work will be important with increasing demands from surgery

Abstract. Introduction. Inter-prosthetic femoral fractures (IPFF) are fractures occurring between ipsilateral hip and knee implants or fixation devices. In 2020, the National Hip Fracture Database (NHFD) was extended to capture data from patients with peri-prosthetic femoral fractures (PPFF), including those specifically with IPFF. This study aims to describe the epidemiology and treatment of IPFF in England and Wales. Methodology. This population-based observational cohort study utilised open-access data available from the NHFD. Patients aged over 60, admitted to an acute hospital in England or Wales with an IPFF, within the period 1st January 2020 to 31st December 2020 were included. The primary outcome of this study was the incidence of IPFF in England and Wales. The secondary outcome was the treatment received. Results. Of 2606 patients admitted with PPFF, a total of 133 fractures occurred between ipsilateral hip and knee implants. Internal fixation was performed most frequently, in 87 cases. Revision arthroplasty was performed in 15 cases (hip n=10, knee n=5). A total of 20 patients were managed non-operatively, and three underwent primary arthroplasty (hip n=2, knee n=1). Conclusion. As the proportion of patients living with hip and knee implants continues to increase, it is expected that so too will the incidence of IPFF. This study is the first to estimate the incidence of IPFF in England and Wales. This is likely an underestimate of the true incidence and so we support calls for the prioritisation of further research into the epidemiology, prevention, and management of IPFF

Abstract. Purpose. Unicompartmental knee arthroplasty (UKA) is an effective treatment for late knee osteoarthritis (OA). However, its indications remain controversial. Young age (< 60 years) has been associated with worse outcomes. The goal of this systematic review and meta-analysis is to study the effect of age on UKA outcomes. Methods. The primary objective was to compare the UKA revision rate in young patients with that of old patients, using the age thresholds of 60 and 55 years. Secondary objectives were patient-reported outcome measures (PROMs) and implant design. PubMed, Ovid, Web of Science, Google Scholar, and Cochrane library were searched in June 2021. This review was conducted in accordance with the PRISMA guidelines (PROSPERO registration number: CRD42021248322). Results. A total of 12 observational studies with 6,448 knees were included. A mean MINORS score of 19 was assigned to the review. The mean age of patients was 64.32 years, with follow-up ranging from 0.2 to 15 years. There was no significant difference in revision rate, incident or PROMs between young and old patients in the analysis for each age threshold. Further sub-analysis adjusting for implant type in mobile- and fixed-bearing prostheses also showed similar results between those above and under 60 and 55 years. Conclusion. Young age was not associated with a higher revision rate or lower functional scores. Thus, this review provides evidence that performing UKA at a younger age (< 60 years) should not be considered suboptimal. However, this finding should be applied in context, as other confounding factors need to be explored

Abstract. Introduction. In 2020, the National Hip Fracture Database (NHFD) was extended to capture data from patients with periprosthetic femoral fractures (PPFF) with plans to include these patients in Best Practice Tarif. We aimed to describe the epidemiology of PPFF in England and Wales, with a particular focus on fractures occurring around the femoral component of knee prostheses. Methodology. This population-based observational cohort study utilised open-access data available from the NHFD. Patients aged over 60, admitted to an acute hospital in England or Wales with a PPFF, within the period 1st January 2020 to 31st December 2020 were included. The primary outcome was the incidence of PPFF in England and Wales. The secondary outcome was the treatment received. Results. We identified 2606 patients with PPFF from 135 hospitals. Of these, a total of 578 fractures occurred around the femoral component of a knee implant. These were classified as Vancouver A (epicondylar, n=77), B (involving implant/cement, n=166) and C (proximal to implant/cement, n=335). Internal fixation was the most employed treatment, used in 352 cases. Revision arthroplasty was performed in 80 cases, and 100 were managed non-operatively. Only 28% of operated PPFF went to theatre within 36 hours but nearly 90% had orthogeriatrician review within 72 hours. Conclusion. Eighty six percent of patients with PPFF were treated with non-revision surgery and would not be recorded in the National Joint Registry. In response, we support calls for the prioritisation of further research into the prevention and management of PPFF around the knee

Abstract. Introduction. Knee arthrodesis is one of the treatment options for limb salvage of a failed total knee replacement (TKR) when further revisions were contraindicated. The aim of this study is to determine patient outcomes after knee arthrodesis (KA) following a failed TKR. Methodology. A literature search was conducted for studies published from January 2000 through January 2022 via Medline, Web of Science, Embase and Cochrane databases. Only primary research studies were included with independent extraction of articles by two reviewers. Results were synthesised by narrative review according to PRISMA guidelines, with full tabulation of all included study results. Results. A total of 34 studies with 1,034 patients were included in the review; all were longitudinal observational studies, and none were conducted as randomised controlled trials. Reporting methods were very inconsistent in the included studies, and this heterogeneity led to pooled data totals that varied widely in different categories. The mean follow-up was 3.5 years. Overall, 72.0% (167 of 232) of patients used a walking stick and 12.5% (36 of 287) remained non-ambulatory after KA. Only 7.7% (58 of 752) of patients subsequently underwent above-knee amputation. Conclusion. KA is a potential limb salvage procedure after revision arthroplasties have been attempted in cases of failed TKR. Most patients were able to ambulate both at home and in the community, although with an increased rate of using a walking stick after the operation. However, in the absence of randomised controlled trials, these data may allow for a more accurate counselling and decision making

Abstract. Introduction. There are several imaging-based measurements for patello-femoral height. Available methods rely predominantly on sagittal images. The latter can be misleading with sagittal oblique slices and when the patella is tilted and/or chronically subluxed. In this study we describe a simple method of patellar height measurement using axial MRI overlap. Materials and methods. A retrospective observational analysis of 97 knees from 251 patients was conducted. Cases were selected following the exclusion of scans with fractures, massive effusion, patello-femoral pathology. Axial patello-trochlear overlap (APTO) was measured on the axial MRI images as follows: (1) Patellar length (P): expressed as the number of axial images showing patellar articular surface (2) Trochlear overlap (T): the number of axial images showing overlap between patellar articular surface and articular surface of lateral trochlea. APTO is the ratio T/P. All measurements were carried out independently and on two separate occasions by 6 raters. As a control conventional patello-trochlear index were measured for all patients by a senior musculoskeletal radiologist. Results. The mean APTO value was 36.7 (range 14.2 to 66.6; SD 11.4). There was a positive correlation with patello-trochlear index (Pearson correlation coefficient: 0.76, P < 0.001). Intra-observer reliability was good (ICC: 0.66 95 CI 0.54, 0.76, P < 0.001). Inter-observer reliability was fair (ICC: 0.51, 95 CI 0.41, 0.6, P < 0.001). Conclusion. In the present proof of concept study APTO was a reliable measurement of patellar height and correlated with patella-trochlear indices. The method described can prove valuable in overcoming issues with sagittal image measurements

Aims. Debate remains whether the patella should be resurfaced during total knee replacement (TKR). For non-resurfaced TKRs, we estimated what the revision rate would have been if the patella had been resurfaced, and examined the risk of re-revision following secondary patellar resurfacing. Methods. A retrospective observational study of the National Joint Registry (NJR) was performed. All primary TKRs for osteoarthritis alone performed between 1 April 2003 and 31 December 2016 were eligible (n = 842,072). Patellar resurfacing during TKR was performed in 36% (n = 305,844). The primary outcome was all-cause revision surgery. Secondary outcomes were the number of excess all-cause revisions associated with using TKRs without (versus with) patellar resurfacing, and the risk of re-revision after secondary patellar resurfacing. Results. The cumulative risk of all-cause revision at ten years was higher (p < 0.001) in primary TKRs without patellar resurfacing (3.54% (95% confidence interval (CI) 3.47 to 3.62)) compared to those with resurfacing (3.00% (95% CI 2.91 to 3.11)). Using flexible parametric survival modelling, we estimated one ‘excess’ revision per 189 cases performed where the patella was not resurfaced by ten years (equivalent to 2,842 excess revisions in our cohort). The risk of all-cause re-revision following secondary patellar resurfacing was 4.6 times higher than the risk of revision after primary TKR with patellar resurfacing (at five years from secondary patellar resurfacing, 8.8% vs 1.9%). Conclusion. Performing TKR without patellar resurfacing was associated with an increased risk of revision. Secondary patellar resurfacing led to a high risk of re-revision. This represents a potential substantial healthcare burden that should be considered when forming treatment guidelines and commissioning services. Cite this article: Bone Joint J 2021;103-B(5):864–871

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. Methods. All patients who received a primary, cemented TKA between 2012 and 2017 with a minimum two-year follow-up were included. The implant investigated features an asymmetrical tibial baseplate and shortened keel. Patient demographic details, Knee Society Scores (KSS), component alignment, and the presence of radiolucent lines at final follow-up were recorded. Kaplan-Meier analyses were performed to estimate survivorship. Results. A total of 720 of 754 primary TKAs (95.5%) were included with a mean follow-up of 3.9 years (SD 1.3); 562 (78.1%) were cruciate-retaining and 158 (21.9%) were posterior-stabilized. A total of 11 (1.5%) required reoperation for periprosthetic joint infection and seven (1.0%) for aseptic tibial loosening (five cruciate-retaining, two posterior-stabilized). Loosening occurred at a mean of 3.3 years (0.9 to 6.5). There were no cases of loosening in the 33 patients who received a 14 mm × 30 mm tibial stem extension. All-cause survivorship was 96.6% at three years (95% confidence interval (CI) 95.3% to 98.0%) and 96.2% at five years (95% CI 94.8% to 97.7%). Survivorship with revision for aseptic loosening was 99.6% at three years (95% CI 99.1% to 100.0%) and 99.1% at five years (95% CI 98.4% to 99.9%). Tibial components were in significantly more varus in those with aseptic loosening (mean 3.4° (SD 3.7°) vs 1.3° (SD 2.0°); p = 0.015). There were no other differences in demographic, radiological, or surgical characteristics between revised and non-revised TKAs for aseptic loosening (p = 0.293 to 1.00). Mean KSS improved significantly from 57.3 (SD 9.5) preoperatively to 92.6 (SD 8.9) at the final follow-up (p < 0.001). Conclusion. This is the largest series to date of this design of implant. At short-term follow-up, the rate of aseptic tibial loosening is not overly concerning. Further observation is required to determine if there will be an abnormal rate of loosening at mid- to long-term follow-up. Cite this article: Bone Joint J 2021;103-B(6 Supple A):51–58

Aims. Recent studies have suggested that corticosteroid injections into the knee may harm the joint resulting in cartilage loss and possibly accelerating the progression of osteoarthritis (OA). The aim of this study was to assess whether patients with, or at risk of developing, symptomatic osteoarthritis of the knee who receive intra-articular corticosteroid injections have an increased risk of requiring arthroplasty. Methods. We used data from the Osteoarthritis Initiative (OAI), a multicentre observational cohort study that followed 4,796 patients with, or at risk of developing, osteoarthritis of the knee on an annual basis with follow-up available up to nine years. Increased risk for symptomatic OA was defined as frequent knee symptoms (pain, aching, or stiffness) without radiological evidence of OA and two or more risk factors, while OA was defined by the presence of both femoral osteophytes and frequent symptoms in one or both knees. Missing data were imputed with multiple imputations using chained equations. Time-dependent propensity score matching was performed to match patients at the time of receving their first injection with controls. The effect of corticosteroid injections on the rate of subsequent (total and partial) knee arthroplasty was estimated using Cox proportional-hazards survival analyses. Results. After removing patients lost to follow-up, 3,822 patients remained in the study. A total of 249 (31.3%) of the 796 patients who received corticosteroid injections, and 152 (5.0%) of the 3,026 who did not, had knee arthroplasty. In the matched cohort, Cox proportional-hazards regression resulted in a hazard ratio of 1.57 (95% confidence interval (CI) 1.37 to 1.81; p < 0.001) and each injection increased the absolute risk of arthroplasty by 9.4% at nine years’ follow-up compared with those who did not receive injections. Conclusion. Corticosteroid injections seem to be associated with an increased risk of knee arthroplasty in patients with, or at risk of developing, symptomatic OA of the knee. These findings suggest that a conservative approach regarding the treatment of these patients with corticosteroid injections should be recommended. Cite this article: Bone Joint J 2020;102-B(5):586–592

Introduction. Total knee arthroplasty (TKA) femoral components are known to wear and roughen with clinical use, and reaction to metal is a well-documented complication of TKA. Ceramic materials are resistant to wear and corrosion, but the surface wear of ceramic femoral components in TKA has not been reported. This study measured the changes in roughness and mass lost from cobalt-chromium (CoCr) femoral components tested in a knee simulator, and compared them to those observed in ceramic components. Methods. Six cast CoCr femoral components were tested in a knee simulator bearing against UHMWPE, with high-kinematics/high-load waveforms. Roughness and scratches were measured via optical profilometry. Scratch volume was equated to mass lost from abrasive wear, while nano-particulate wear and corrosion were estimated from the change in the distance of the surface to the depth of the scratches after increasing numbers of cycles. Three magnesia-stabilized zirconia femoral components that had been wear tested to 15 million cycles were compared with the CoCr components. Results. After 500,000 cycles, the CoCr femoral components were visibly scratched and measurably roughened (average roughness Sa = 38.4nm, vs. 22.2nm for never-implanted components; p < 0.0001). The ceramic components were not scratched or roughened (Sa = 18.5nm). The CoCr components had an average of 7.5μg lost due to scratches (0.0018mm. 3. per million cycles). The material lost due to nanoparticulate wear and corrosion was estimated at 1.5μg. Discussion. This study demonstrates rapid loss of CoCr material from wear in TKA, and reports absence of scratching and roughening of ceramic TKA femoral components in simulated wear. This observation suggests a mechanism for the lower polyethylene wear rate against ceramic femoral components, and suggests an advantage in avoiding metal sensitivity

Background. Unicompartmental knee arthroplasty (UKA) patients with knee partial thickness cartilage loss have inferior functional performance compared to those with full thickness loss. Therefore, the aim of the present study was to investigate on the association between postoperative patients' joint awareness and satisfaction and preoperative radiographic osteoarthritis (OA) Ahlbäck grade in subjects undergoing robotic arm-assisted UKA. Methods. This retrospective observational study includes 675 patients (681 knees) undergoing robotic arm-assisted UKA at two centres between January 2014 and May 2019. Pre-operatively, knee radiographs were performed, and Ahlbäck OA grade was measured by two independent observers. Post-operatively, patients were administered the Forgotten-Joint-Score-12 (FJS-12) and 5-Level-Likert-Scale to assess joint awareness and satisfaction. Postoperative complications and revisions were recorded. Correlations were described between FJS-12, satisfaction and OA grade by means of an adjusted multivariate statistical analysis. Results. A total of 574 patients (580 UKAs) were assessed at a mean follow-up of 3.6 years post-operatively (85.2% follow-up rate; min. 12, max. 75 months). Nine UKAs were revised. Primary or secondary medial knee OA was the preoperative diagnosis in 538 cases, osteonecrosis was present in 42 cases. Cases were divided based on their preoperative Ahlbäck grade in Group A (joint space narrowing, Ahlbäck 1, 279 cases), Group B (joint space obliteration or minor bone attrition, Ahlbäck 2 and 3, 197 cases) and Group C (moderate or severe bone attrition, Ahlbäck 4 and 5, 104 cases). Moderate to severe OA grades (Group B and C) were associated with higher probability of higher postoperative FJS-12 compared to joint space narrowing group (Odds Ratio 1.6 and 1.7, respectively, p<0.05). No associations were described between OA grade and patients' satisfaction. Conclusions. Patients with preoperative joint space obliteration and minor to severe bone attrition have higher probability of a having a forgotten joint after robotic arm-assisted UKA, compared to those without full cartilage thickness loss

Introduction. Previous studies have demonstrated that higher volume hospitals have better outcomes following revision total knee arthroplasty (rTKA), in current literature there are no reports investigating the effect of surgeon volume. The purpose of this study is to investigate if patients of high-volume revision surgeons have better outcomes following rTKA as compared to patients of low volume surgeons. Methods. This retrospective observational analysis examined the rTKA database at a large urban academic medical center for aseptic, unilateral rTKA between January 2016 and March 2019 with at least 1-year of follow-up. Surgeon operative volume during the same time period was evaluated. Surgeons who performed at least 18 aseptic rTKA per year were considered high volume (HV), whereas surgeons who performed fewer than 18 aseptic rTKA per year were considered low volume (LV). Demographics, surgical factors, and post-operative outcomes were collected and compared between the two cohorts. A post-hoc power analysis was conducted for full revisions (1-ß=0.909, α=0.05). Results. 307 cases were identified: 177 performed by LV surgeons and 130 performed by HV surgeons. The only demographic difference was a greater proportion of non-smokers in the LV cohort (59.4% vs. 50.0%; p=0.031). Patients of HV surgeons were more likely to receive a full revision (64.6% vs. 47.5%; p<0.001). For all revisions, HV surgeons had shorter surgical times by about 17 minutes (p=0.010). For the 168 full revisions (84 HV, 84 LV), patients of HV surgeons had shorter hospital stays (2.92±1.62 vs. 3.57±2.69 days; p=0.048), shorter surgical times (131.42±33.86 vs. 171.65±49.88 minutes; p<0.001), lower re-revision rates (7.1% vs. 19.0%; p=0.038), and fewer re-revisions (0.07±0.26 vs. 0.29±0.74 re-revisions; p=0.018). Conclusions. Patients of HV revision surgeons have better outcomes following full rTKA. These findings support the development of revision teams within arthroplasty centers of excellence to offer patients the best possible outcomes following rTKA

Introduction. Recent total knee arthroplasty (TKA) designs have featured more anatomic morphologies and shorter tibial keels. However, several reports have raised concerns regarding the impact of these modifications on implant longevity. This study's purpose is to report the early performance of a modern, cemented TKA design. Methods. All patients who received a primary, cemented TKA from 2012 to 2017 with a minimum two-year follow-up were included. This implant features an asymmetric tibial baseplate and a shortened keel. Patient demographics, Knee Society Scores (KSS), and component alignment were recorded, and Kaplan-Meier survivorship analyses were performed. Results. 720 of 754 primary TKAs (95.5%) were included for analysis (mean follow-up: 3.9 ± 1.3 years; 562 cruciate-retaining, 158 posterior-stabilized). Eleven (1.5%) were revised for periprosthetic infection and seven (1.0%) for aseptic tibial loosening (5 cruciate-retaining, 2 posterior-stabilized). Aseptic loosening occurred at a mean of 3.3 ± 2.0 years. There were no cases of aseptic loosening in 33 patients who received a 14 × 30mm tibial stem extension. All-cause survivorship was 96.6% at 3 years (95% CI: 95.3%–98.0%) and 96.2% at 5 years (95% CI: 94.8%–97.7%). Survivorship for aseptic loosening was 99.6% at 3 years (95% CI: 99.1%–100.0%) and 99.1% at 5 years (CI: 98.4%–99.9%). Tibial component alignment was more varus in aseptic loosening cases (86.6° ± 3.7° vs 88.7° ± 2.0°, p=0.02). There were no other differences in demographic, radiographic, or surgical characteristics between revised and non-revised TKAs for aseptic loosening (p=0.3–1.0). KSS improved from 57.3 pre-operatively to 92.6 post-operatively (p<0.001). Conclusion. This study comprises the largest series to date of this specific implant design. At short-term follow-up, the rate of aseptic tibial loosening is not overly concerning. But, further observation is warranted to determine if there is an abnormal rate of loosening at mid- to long-term follow-up

Aims

This study aims to determine difference in annual rate of early-onset (≤ 90 days) deep surgical site infection (SSI) following primary total knee arthroplasty (TKA) for osteoarthritis, and to identify risk factors that may be associated with infection.

Aims. The purpose of this multicentre observational study was to investigate the association between intraoperative component positioning and soft-tissue balancing on short-term clinical outcomes in patients undergoing robotic-arm assisted unicompartmental knee arthroplasty (UKA). Patients and Methods. Between 2013 and 2016, 363 patients (395 knees) underwent robotic-arm assisted UKAs at two centres. Pre- and postoperatively, patients were administered Knee Injury and Osteoarthritis Score (KOOS) and Forgotten Joint Score-12 (FJS-12). Results were stratified as “good” and “bad” if KOOS/FJS-12 were more than or equal to 80. Intraoperative, post-implantation robotic data relative to CT-based components placement were collected and classified. Postoperative complications were recorded. Results. Following exclusions and losses to follow-up, 334 medial robotic-arm assisted UKAs were assessed at a mean follow-up of 30.0 months (8.0 to 54.9). None of the measured parameters were associated with overall KOOS outcome. Correlations were described between specific KOOS subscales and intraoperative, post-implantation robotic data, and between FJS-12 and femoral component sagittal alignment. Three UKAs were revised, resulting in 99.0% survival at two years (95% confidence interval (CI) 97.9 to 100.0). Conclusion. Although little correlation was found between intraoperative robotic data and overall clinical outcome, surgeons should consider information regarding 3D component placement and soft-tissue balancing to improve patient satisfaction. Reproducible and precise placement of components has been confirmed as essential for satisfactory clinical outcome. Cite this article: Bone Joint J 2019;101-B:435–442

Aims

Total knee arthroplasty (TKA) may provoke ankle symptoms. The aim of this study was to validate the impact of the preoperative mechanical tibiofemoral angle (mTFA), the talar tilt (TT) on ankle symptoms after TKA, and assess changes in the range of motion (ROM) of the subtalar joint, foot posture, and ankle laxity.