Abstract. Introduction. Recent research has questioned the role of arthroscopic meniscectomy in patients with a meniscal tear leading to the development of treatment recommendations for these patients. There is a clear need to understand patient perceptions of living with a meniscal tear in order to plan future research and treatment guidelines. Aims. To explore the experiences and expectations of treatment of young patients with a meniscal tear of the knee. Methodology. Ten participants diagnosed with a meniscal tear were recruited from the METRO cohort study using a purposive sampling strategy. These patients underwent semi-sructured interviews between April and May 2021. Thematic analysis was used to code the transcripts and generate key themes in order to describe the data. Results. Themes identified relate to the broad areas of: the effect of symptoms, the expericne of the clinical consultation and the experience of the treatment modality undertaken. Meniscal tears have a profound impact on pain and many patients experience effects on their family and financial life in addition to physical symptoms. Participants expected the majority of their management to occur in secondary care and most thought surgery would be a definitive treatment, while the effectiveness of physiotherapy could not be guaranteed as it would not fix the physical tear. Conclusion. Patient experience of meniscal tear may not correspond with current available clinical evidence. Clinicians should consider the common misconceptions highlighted in this study when conducting a consultation and pre-empt them to optimally manage patient expectations

Abstract. Introduction. Transforming outpatient services is a key commitment set out in the NHS Long Term Plan, with particular emphasis on digital solutions to reduce outpatient follow-up (FU) by 25%. This study looks at the potential for removing knee arthroscopy FU by providing a bespoke multimedia report for each individual patient, generated using the Synergy™ Surgeon App (Arthrex). Methodology. Single District Hospital using a 3 Phase study. Phase 1 – Assessment of cost and environmental impact of outpatient follow up appointments. Phase 2 – Bench marking of existing pathways and patient experience. Phase 3 – Qualitative assessment of multimedia report feedback of 30 patients. Results. Phase 1 – Impact per year for Trust in released clinician time 135hrs. Cost avoidance £40-£60k. Reduction of the carbon footprint from reduced FU of 3132 KgCo2e2. Phase 2 – Deep dive on 2019 n. 353 procedures. 1206 outpatient appointments required. Average 1.2 post-operative appointments. Phase 3 – 87% of patients who received the e-op report needed no further FU. This compares to only 25% using a traditional post op discussion after surgery. 94% of patients felt the report aided their recovery. Conclusions. Reducing patient FU appointments is crucial to the future of the NHS. Achieving this whilst simultaneously improving the quality of patient communication is achievable as this study has demonstrated. The potential scalability of this project to be applied other arthroscopic procedures is enormous. The study has demonstrated patients are comfortable with modern technology and feel it enhances their understanding whilst decreasing the need for routine post-op FU

Abstract. Introduction. Total knee replacement (TKR) is a successful operation for many patients, however 15–20% of patients experience chronic post-surgical pain (CPSP). Many will experience neuropathic characteristics. We describe the prevalence and patterns of neuropathic pain in a cohort of patients with CPSP three months after TKR. Methodology. Between 2016–2019, 363 patients with troublesome pain, ≤14 on Oxford Knee score pain subscale, at three months after TKR from eight NHS hospitals were recruited into the Support and Treatment After Replacement (STAR) trial. Self-reported neuropathic pain was assessed at three, nine and fifteen months after surgery using painDETECT and Douleur Neuropathique 4 (DN4). Results. At three months post-operative, 53% reported neuropathic pain on painDETECT and 74% on DN4. Half (56%) remained in neuropathic pain over the twelve-month follow-up period, 26% reported improvement, and 9% reported new neuropathic symtpoms or fluctuated in and out of neuropathic pain (9%). Overall mean neuropathic pain scores improved between three and 15 months after TKR. When the painDETECT cut-off score of ≥13(ambiguous/possible) was used, DN4 and painDETECT measures showed similar prevalence rates at each timepoint. Conclusion. Neuropathic pain is common among patients with CPSP at three months after TKR. Although symptoms improved over time, one quarter to one half of our cohort continued to report symptoms at fifteen months. We propose a painDETECT cutoff score of ≥13 be used to identify neuropathic features in the TKR population. Postoperative care should include identification, assessment, and treatment of neuropathic pain in patients with CPSP after TKR

Abstract. Introduction. The NHS long term plan endorses ‘personalised’, ‘digitally enabled’, ‘out of hospital’ care. Multiagency guidance (CPOC(2021)/NICE(2021)/GIRFT(2021)/NHSX(2021)) advocates an integrated ‘pathway’ approach to information sharing, shared-decision making and patient support. Digital solutions are the vehicle to deliver these agendas. Methods. In 2018 we developed a digital joint pathway (DJP) spanning the surgical care pathway (prehabilitation to rehabilitation) using the GoWellHealth platform. Patients listed for joint replacement are offered the DJP as routine care. Activity and engagement are monitored using the DJP data library. We sought to evidence our DJP by assessing patient engagement, experience and outcomes (OKS/EQ5D/Readmission). Results. Engagement. Consecutive cohort of the first 1195 patients registered. Activation rates were >85% and >70% viewed content within the DJP (median=15 access/pt; mean=83 minutes on DJP/pt). Engagement was similar irrespective of age and gender (p=NS). Older patients preferred to access via a computer. Experience. Qualitative interviews (n=14) demonstrated patients felt the DJP impacted positively on their health behaviours and contributed to their recovery. They spoke positively about the use of technology and the accessibility of the DJP. Outcomes. Comparison of patients on the DJP versus those not on the DJP using adjusted regression models demonstrated improved EQ5D=0.070 (95%CI=0.004-0.135,p=0.04), OKS=5.0 (95%CI=2.2-7.8,p<0.001) and readmission rates (3.6% versus 5.6%,p<0.01) for DJP patients. Conclusions. A DJP model for information delivery and patient support, across the entirety of the surgical pathway, is feasible and demonstrates high levels of patient engagement, experience and improved patient outcomes

Abstract. Design. A pragmatic, multicentre, parallel-group, randomised controlled trial to determine whether the intervention is superior to comparator. Setting. 20 NHS Hospitals. Population. NHS patients <60 years with moderate-severe symptomatic knee OA localised to the medial compartment in whom surgical intervention is indicated. Intervention. Surgery with medial opening wedge high tibial osteotomy (HTO) followed by standard postoperative rehabilitation based on local pathways. Comparator. Tailored non-surgical intervention delivered within an NHS physiotherapy department delivered over 6-contact sessions within a period of 4 months. Outcomes. Primary outcome - 24-month Knee Injury and Osteoarthritis Outcome Score (KOOS); Secondary outcomes - OKS, FJS-12, EQ-5D-3L, Pittsburgh Sleep Problem Scale, Return to Work, secondary surgical interventions and complications at 12 and 24 months following randomisation. Health economic evaluation - 24-month within trial analysis, and a decision analytic simulation model to account for the impacts of future knee replacements (and associated revisions), and their timing relative to retirement and employment potential. Process evaluation – to explore trial eligibility, recruitment and retention rates, acceptability of intervention implementation and patient experience of taking part/contextual factors that influence this. Follow up. 12 months and 24 months post-randomisation. Sample size. 224 patients; (90% power, 2-sided p=0.05, equivalent to a sample size of 97 per group). Allowing for 15% loss to follow up, 112 patients will be recruited to each arm of the trial. Project timelines. Start date 1 August 2022, total project duration 60 months including a 9-month, 5-site internal pilot, with a recruitment rate of 0.7 patients/site/month

Abstract. Background. Around 5–15% of patients will experience chronic postoperative pain after total knee replacement (TKR) surgery but the source of the pain is unknown. The aim of this study was to assesses patients six months after TKR using magnetic resonance imaging (MRI) of the knee, pain sensory profiles and assessments of pain catastrophizing thoughts. Methods. Forty-six patients had complete postoperative data and were included. MRI findings were scored according to the MRI Osteoarthritis Knee Score (MOAKS) recommendation for Hoffa synovitis, effusion size and bone marrow lesions. Pain sensory profiles included the assessment of pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM). Pain catastrophizing was assessed using the pain catastrophizing scale (PCS). Clinical pain was evaluated using a visual analog scale (VAS, 0–10cm) and groups of moderate-to-severe (VAS>3) and non-to-mild postoperative pain (VAS≤3) were identified. Results. Patients with moderate-to-severe postoperative pain demonstrated higher grades of Hoffa synovitis (P<0.001) and effusion size (P<0.001), lower PPTs (P=0.039), higher TSP (P=0.001) and lower CPM (P=0.014) when compared to patients with non-to-mild postoperative pain. No differences were found in PCS scores. Linear regression models found TSP (P=0.013), PCS (P<0.001), Hoffa synovitis (P=0.036) and effusion size (P=0.003) as independent parameters contributing to the postoperative pain severity. Conclusion. These finding indicate that chronic postoperative after TKR is a combination of joint-related synovitis and effusion in combination with sensitization of central pain mechanisms and pain catastrophizing thoughts

Aims

This prospective study reports longitudinal, within-patient, patient-reported outcome measures (PROMs) over a 15-year period following cemented single radius total knee arthroplasty (TKA). Secondary aims included reporting PROMs trajectory, 15-year implant survival, and patient attrition from follow-up.

Background. Early mobilization after total joint arthroplasty decreases postoperative complications and optimizes future functional outcomes. The purpose of this study was to evaluate the effectiveness of a supervised patient ambulation program following total joint arthroplasty. Methods. In 2014, our institution initiated a mandatory supervised patient ambulation program termed “No One Walks Alone” (NOWA). The program requires that all patients who mobilize are accompanied by a nurse or physical therapist. Gait belts are worn whenever a patient ambulates. Bed and chair alarms are utilized to alert if a patient tries to ambulate alone. If a patient experiences a fall, he or she is immediately evaluated by the nursing staff, and details regarding the fall and any injury sustained are documented. A retrospective review of patients undergoing total knee or hip arthroplasty between 2011–2017 was conducted. Patients who had surgery between 2011–2013, before the program, were included in the pre-implementation group (N= 3,069) and those having surgery between 2016–2017, after the program started, were included in the post-implementation group (N=3,947). The incidence of patient falls, fall-related complications were compared between groups. Results. The number of patient falls was 23 in the pre-implementation group (0.7%) and 9 in the post-implementation group (0.2%). Fall-related complications occurred in 14 of 23 falls in the pre-implementation group (0.5% overall) and 2 of 9 falls in the post-implementation group (0.05% overall) (p<0.001). Patients who experienced a fall were more likely to have undergone total knee arthroplasty (81.3%) compared to those who did not fall (58%) (p=0.008). Conclusion. A supervised patient ambulation program can be successful at reducing the incidence of patient falls and complications related to falls in the immediate postoperative setting

Aims

The primary objective of this registry-based study was to compare patient-reported outcomes of cementless and cemented medial unicompartmental knee arthroplasty (UKA) during the first postoperative year. The secondary objective was to assess one- and three-year implant survival of both fixation techniques.

Aims

This study aims to determine the rate of and risk factors for total knee arthroplasty (TKA) after operative management of tibial plateau fractures (TPFs) in older adults.

Aims

The aim of this study was to compare the preinjury functional scores with the postinjury preoperative score and postoperative outcome scores following anterior cruciate ligament (ACL) reconstruction surgery (ACLR).

Aims

The rate of day-case total knee arthroplasty (TKA) in the UK is currently approximately 0.5%. Reducing length of stay allows orthopaedic providers to improve efficiency, increase operative throughput, and tackle the rising demand for joint arthroplasty surgery and the COVID-19-related backlog. Here, we report safe delivery of day-case TKA in an NHS trust via inpatient wards with no additional resources.

Aims

Approximately 10% to 20% of knee arthroplasty patients are not satisfied with the result, while a clear indication for revision surgery might not be present. Therapeutic options for these patients, who often lack adequate quadriceps strength, are limited. Therefore, the primary aim of this study was to evaluate the clinical effect of a novel rehabilitation protocol that combines low-load resistance training (LL-RT) with blood flow restriction (BFR).

Aims

Patient dissatisfaction following primary total knee arthroplasty (TKA) with manual jig-based instruments has been reported to be as high as 30%. Robotic-assisted total knee arthroplasty (RA-TKA) has been increasingly used in an effort to improve patient outcomes, however there is a paucity of literature examining patient satisfaction after RA-TKA. This study aims to identify the incidence of patients who were not satisfied following RA-TKA and to determine factors associated with higher levels of dissatisfaction.

Introduction. Knee arthroplasty (KA) is a highly effective surgical procedure. However, research suggests that a considerable number of patients continue to experience substantial pain and functional loss following surgical recovery. We aimed to estimate pain and function outcome trajectories for persons undergoing KA depicting the outcome, the relationship between the pain and function trajectory types, and pre-surgery predictors of trajectory type (i.e., good versus poor). Methods. Participants included 384 patients who took part in the Knee Arthroplasty Skills Training (KASTPain) clinical trial. Pain and function was assessed at 2-week pre- and 2-, 6-, and 12-month post-surgery using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Function Scales. Piecewise latent class growth models were used to estimate pain and function trajectories. Dumenci's latent kappa was used to estimate the chance-corrected agreement between pain and function trajectory types. Pre-surgery variables were used to predict trajectory types. Results. There was strong evidence for two trajectory types, labeled as good and poor, for both WOMAC pain and function scores. Model estimated rates of the poor trajectory type were 18% for both pain and function. Dumenci's latent kappa between pain and function trajectory types was 0.71 (95% CI: 0.61 – 0.80). Most pre-surgery variables were not significant predictors of the trajectory types. Conclusions. Among adults with moderate to severe pain catastrophizing undergoing KA, approximately one-fifth of patients continue to have persistent pain, poor function, or both, which is similar to the rate of poor reported outcomes in the TKA population overall. Although the poor pain and function trajectory types tend to go together within persons, a significant number of patients experience either poor pain or function but not both, suggesting heterogeneity among persons who do not fully benefit from KA. For figures, tables, or references, please contact authors directly

Aims

Treatment of end-stage anteromedial osteoarthritis (AMOA) of the knee is commonly approached using one of two surgical strategies: medial unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). In this study we aim to investigate if there is any difference in outcome for patients undergoing UKA or TKA, when treated by high-volume surgeons, in high-volume centres, using two different clinical guidelines. The two strategies are ‘UKA whenever possible’ vs TKA for all patients with AMOA.

Background. Optimal perioperative fluid management has not been established in patients undergoing orthopaedic surgical procedures. Our purpose was to investigate the effects of perioperative fluid management on patients experiencing TKA. Methods. One hundred thirty patients who met inclusion criteria undergoing primary unilateral TKA were prospectively randomized into traditional (TFG) vs. oral (OFG) perioperative fluid management groups. The TFG had a predetermined (4L) amount of intravenous fluids (IVF) administered in the perioperative period. The OFG began drinking a minimum of three, 20-ounces servings of clear fluids daily for three days prior to surgery. This cohort also drank 10-ounces of clear fluids 4 hours prior to surgery. Perioperative IVF were discontinued when the patient began oral intake or when the total amount of IVF reached 500mL. Outcome measures included: body-weight (BW) fluctuations, knee motion, leg girth, bioelectrical impendence, quadriceps activation, functional outcomes testing, KOOS JR, VR-12, laboratory values, vital signs, patient satisfaction, pain scores, and adverse events. Results. The TFG had increased BW the evening of surgery (7.0±4.3 vs. 3.0±3.9, p=0.000), post-operative day (POD) #1 (9.1±4.3 vs. 4.7±3.9, p=0.000), and POD #2 (6.2±5.0 vs. 4.4±4.0, p=0.032). Bioelectrical impedance showed less limb edema in the OFG (4.2±29.7 vs. 17.8±30.3, p=0.000) on POD#1. Urine specific gravity differences were seen preoperatively between groups (OFG, more hydrated, p=0.002). Systolic blood pressure decrease from baseline was greater in the OFG upon arrival to the floor (19.4±13.5 vs. 10.6±12.8, p=0.000) and 8 (23.4±13.3 vs. 17.0±12.9, p=0.006) and 16 (25.8±13.8 vs. 25.8±13.8, p=0.046) hours after floor arrival. The TFG had more UOP on POD#1 (3369mL±1343mL vs. 2435mL±1151mL). Conclusions. Oral fluid intake with IVF restriction in the perioperative period after TKA may offer short-term benefits with swelling and BW fluctuations. The authors continue to limit perioperative IVFs and encourage patient initiated fluid intake. For figures, tables, or references, please contact authors directly

Aims

Access to total knee arthroplasty (TKA) is sometimes restricted for patients with severe obesity (BMI ≥ 40 kg/m²). This study compares the cost per quality-adjusted life year (QALY) associated with TKA in patients with a BMI above and below 40 kg/m² to examine whether this is supported.

Aims

Single-shot adductor canal block (ACB) after total knee arthroplasty (TKA) for postoperative analgesia is a common modality. Patients can experience breakthrough pain when the effect of ACB wears off. Local anaesthetic infusion through an intra-articular catheter (IAC) can help manage breakthrough pain after TKA. We hypothesized that combined ACB with ropivacaine infusion through IAC is associated with better pain relief compared to ACB used alone.

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.