Ensuring correct rotation of the femoral component
is a challenging aspect of
Aims. The aim of this study was to evaluate medium-term outcomes and complications of the S-ROM NOILES Rotating Hinge Knee System (DePuy, USA) in revision total knee arthroplasty (rTKA) at a tertiary unit. Methods. A retrospective consecutive study of all patients who underwent a rTKA using this implant from January 2005 to December 2018. Outcome measures included reoperations, revision for any cause, complications, and survivorship. Patients and implant survivorship data were identified through both local hospital electronic databases and linked data from the National Joint Registry/NHS Personal Demographic Service. Kaplan-Meier survival analysis was used at ten years. Results. A total of 89 consecutive patients (89 knees) were included with 47 females (52.8%) and a median age of 74 years (interquartile range 66 to 79). The main indications were aseptic loosening with instability (39.4%; n = 35) and infection (37.1%; n = 33) with the majority of patients managed through two-stage approach. The mean follow-up was 7.4 years (2 to 16). The overall rate of reoperation, for any cause, was 10.1% (n = 9) with a rate of implant revision of 6.7% (n = 6). Only two cases required surgery for
The low contact stress
Isolated
The Oxford medial unicompartmental knee replacement was designed to reproduce normal mobility and forces in the knee, but its detailed effect on the patellofemoral joint has not been studied previously. We have examined the effect on
Abstract. Unicompartment knee replacement (UKR) has been an effective treatment of isolated medial compartment osteoarthritis (OA). There has been several studies which suggest that
We sought to determine the degree of correlation between the condition of the patellar articular cartilage and
Aims. Medial unicompartmental knee arthroplasty (UKA) is associated
with successful outcomes in carefully selected patient cohorts.
We hypothesised that severity and location of
In posterior stabilised total knee replacement
(TKR) a larger femoral component is sometimes selected to manage the
increased flexion gap caused by resection of the posterior cruciate
ligament. However, concerns remain regarding the adverse effect
of the increased anteroposterior dimensions of the femoral component
on the
Aims. This study reports on the medium- to long-term implant survivorship
and patient-reported outcomes for the Avon
Introduction. Autologous chondrocyte implantation presents a viable alternative to microfracture in the repair of damaged articular cartilage of the knee; however, outcomes for patellar lesions have been less encouraging. ChondroCelect (CC) is an innovative, advanced cell therapy product consisting of autologous cartilage cells expanded ex vivo through a highly controlled and consistent manufacturing process. Purpose. To assess the effect of CC in the treatment of
Purpose of the study. To compare the
The aim of this study was to review the early
outcome of the Femoro-Patella Vialla (FPV) joint replacement. A
total of 48 consecutive FPVs were implanted between December 2007
and June 2011. Case-note analysis was performed to evaluate the
indications, operative histology, operative findings, post-operative
complications and reasons for revision. The mean age of the patients
was 63.3 years (48.2 to 81.0) and the mean follow-up was
25.0 months (6.1 to 48.9). Revision was performed in seven (14.6%)
at a mean of 21.7 months, and there was one re-revision. Persistent
pain was observed in three further patients who remain unrevised.
The reasons for revision were pain due to progressive tibiofemoral
disease in five, inflammatory arthritis in one, and patellar fracture following
trauma in one. No failures were related to the implant or the technique.
Trochlear dysplasia was associated with a significantly lower rate
of revision (5.9% vs 35.7%, p = 0.017) and a lower
incidence of revision or persistent pain (11.8% vs 42.9%,
p = 0.045). . Focal patellofemoral osteoarthritis secondary to trochlear dysplasia
should be considered the best indication for
The incidence of significant acute chondral injuries with patella dislocation is around 10–15%. It is accepted that chondral procedures should only be performed in the presence of joint stability. Patients were identified from surgeon/hospital logs. Patient demographics, lesion size and location, surgical procedure, patient reported outcome measures, post-operative MR imaging and complications were recorded. PROMs and patient satisfaction was obtained.Abstract
Introduction
Methodology
Background. The cemented mobile bearing metal backed low contact stress patellofemoral arthroplasty (LCS PFA) is a newer design belonging to the second generation of inlay type implant, based on the more successful knee arthroplasty model. The advantage is the patella can articulate with the trochlear implant as well as the femoral component of a total knee replacement (TKR). Patients. This series is a cohort of 21 patients who underwent 24 (3 bilateral) unicompartmental PFA replacements for isolated patellofemoral osteoarthritis. We have used the mobile bearing LCS PFA in all of them. There were 3 males and 18 females. Average age was 51(40-58) years. The Oxford Knee score was used to assess the results. Results. At the latest follow-up averaging 2.7 (0.5 to 4) years, 9 patients showed excellent improvement in their knee scores, 5 patients showed fair improvement and 7 patients very little. There were 9 revisions in 7 patients either due to mechanical problems or with persistent symptoms. We had 4 patients with mechanical complications who underwent revision and 4 patients had a conversion to TKR. The revision rate at 2 years was 33%. There were no infections or loosening of trochlear implants. Conclusion. The revision rate for this implant seems to be very high and mainly with the patellar implant (at the metal polyethylene interface). The Australian Orthopaedic association annual joint registry report 2008 reported a higher revision rate for the same implant at 5% from a pool of 1057 patients. The young active patient having a
Patellofemoral arthroplasty (PFA) has experienced significant
improvements in implant survivorship with second generation designs.
This has renewed interest in PFA as an alternative to total knee
arthroplasty (TKA) for younger active patients with isolated patellofemoral
osteoarthritis (PF OA). We analysed the cost-effectiveness of PFA We used a Markov transition state model to compare cost-effectiveness
between PFA and TKA. Simulated patients were aged 60 (base case)
and 50 years. Lifetime costs (2015 United States dollars), quality-adjusted
life year (QALY) gains and incremental cost-effectiveness ratio
(ICER) were calculated from a healthcare payer perspective. Annual rates
of revision were derived from the National Joint Registry for England,
Wales, Northern Ireland and the Isle of Man. Deterministic and probabilistic
sensitivity analysis was performed for all parameters against a
$50 000/QALY willingness to pay. Aims
Patients and Methods
Isolated patellofemoral osteoarthritis can be a disabling disease. When conservative treatment fails, surgical options can be unpredictable and may be considered too aggressive for middle-aged and active people. We analysed the clinical and radiological results of a new coronal osteotomy involving thinning of the patella in a selected group of patients with isolated patellofemoral osteoarthritis. Since 1991, 31 patients (35 knees) have been treated, of whom 34 were available for follow-up at a mean of 9.1 years. The Knee Society Score, the Patellar score and the Short-form-36 questionnaire were used for clinical evaluation. We also examined the radiological features to confirm bone consolidation and assess the progression of osteoarthritis. A significant improvement in the functional scores and radiological parameters was noted. All patients except one were satisfied with the operation. Radiological progression of the patellofemoral osteoarthritis was slowed but radiological femorotibial osteoarthritis progressed in 23 (65%) cases, with a total knee replacement becoming necessary in four cases without technical problems in resurfacing the patella. We compared the results with other forms of surgical treatment reported in the literature. This treatment offers good clinical and radiological results, presenting an alternative method of managing patellofemoral osteoarthritis.
The primary aim of this study was to compare the knee-specific functional outcome of patellofemoral arthroplasty with total knee arthroplasty (TKA) in the management of patients with patellofemoral osteoarthritis. A total of 54 consecutive Avon patellofemoral arthroplasties were identified and propensity-score-matched to a group of 54 patients undergoing a TKA with patellar resurfacing for patellofemoral osteoarthritis. The Oxford Knee Score (OKS), the 12-Item Short-Form Health Survey (SF-12), and patient satisfaction were collected at a mean follow up of 9.2 years (8 to 15). Survival was defined by revision or intention to revise.Aims
Patients and Methods
Trochlear dysplasia is a developmental condition characterised by an abnormally flat or dome-shaped trochlea and is an important contributory factor to patellofemoral instability and recurrent dislocation. We studied prospectively a series of 54 consecutive patients (59 knees) with patellofemoral instability secondary to trochlear dysplasia, who were treated by a trochleoplasty by a single surgeon between June 2002 and June 2007. Pre- and post-operative scores were assessed by the patients and a satisfaction questionnaire was completed. Of the 54 patients (59 knees) in the series, 39 (44 knees) were female and 15 (15 knees) were male. Their mean age at surgery was 21 years and 6 months (14 years 4 months to 33 years 11 months). In 40 patients (42 knees) the mean follow-up was for 24 months (12 to 58). One patient was unable to attend for follow-up. An analysis of the results of those patients followed up for at least 12 months showed a statistically significant improvement in outcome (p <
0.001 for all scores). Overall, 50 patients (92.6%) were satisfied with the outcome of their procedure. The early results of trochleoplasty are encouraging in this challenging group of patients.