In an initial randomised controlled trial (RCT)
we segregated 180 patients to one of two knee positions following total
knee replacement (TKR): six hours of knee flexion using either a
jig or knee extension. Outcome measures included post-operative
blood loss, fall in haemoglobin, blood transfusion requirements,
knee range of movement, limb swelling and functional scores. A second
RCT consisted of 420 TKR patients randomised to one of three post-operative
knee positions: flexion for three or six hours post-operatively,
or knee extension. Positioning of the knee in flexion for six hours immediately
after surgery significantly reduced blood loss (p = 0.002). There
were no significant differences in
The Oxford knee score (OKS) is a validated and
widely accepted disease-specific patient-reported outcome measure,
but there is limited evidence regarding any long-term trends in
the score. We reviewed 5600 individual OKS questionnaires (1547
patients) from a prospectively-collected knee replacement database,
to determine the trends in OKS over a ten-year period following
total knee replacement. The mean OKS pre-operatively was 19.5 (95%
confidence interval (CI) 18.8 to 20.2). The maximum post-operative
OKS was observed at two years (mean score 34.4 (95% CI 33.7 to 35.2)),
following which a gradual but significant decline was observed through
to the ten-year assessment (mean score 30.1 (95% CI 29.1 to 31.1))
(p <
0.001). A similar trend was observed for most of the individual
OKS components (p <
0.001). Kneeling ability initially improved
in the first year but was then followed by rapid deterioration (p
<
0.001). Pain severity exhibited the greatest improvement, although
residual pain was reported in over two-thirds of patients post-operatively,
and peak improvement in the night pain component did not occur until
year four.
The optimal management of the tibial slope in
achieving a high flexion angle in posterior-stabilised (PS) total
knee replacement (TKR) is not well understood, and most studies
evaluating the posterior tibial slope have been conducted on cruciate-retaining
TKRs. We analysed pre- and
We investigated whether the extension gap in total knee replacement (TKR) would be changed when the femoral component was inserted. The extension gap was measured with and without the femoral component in place in 80 patients with varus osteoarthritis undergoing posterior-stabilised TKR. The effect of a
We undertook a prospective, randomised study in order to evaluate the efficacy of clamping the drains after intra-articular injection of saline with 1:500 000 adrenaline compared with
Introduction. The addition of hydroxyapatite in cementless total knee arthroplasty is believed to reduce the time for implant fixation and rehabilitation, reduce the incidence of RLLs and provide long lasting implant stability, through improved osseointegration. We report the results of a prospective, randomised controlled single blinded study comparing the post operative pain, biological fixation and clinical outcomes with the LCS Complete Porocoat and the hydroxyapatite-coated, LCS Complete Duofix mobile-bearing knee systems. Methods. Two hundred and four patients for TKA were prospectively recruited into the study between November 2006 and November 2008. Subjects were randomly assigned to receive the LCS Complete Duofix or LCS Complete Porocoat knee systems. Outcomes including VAS pain scores, American Knee Society scores and Oxford knee scores were performed pre-operatively and at 3 months. X-rays were analysed by an independent reviewer for the presence of radiolucent lines. Results. At no time point from immediately post-operatively to 3 months post-operatively was there a statistically significant difference between groups, in terms of reduction in pain, as measured by the VAS pain score (p=0.9575). American Knee Society and Oxford Knee scores showed similar results between groups. In terms of fixation of the prostheses, radiological analysis revealed a statistical difference between the study groups, Odds Ratio 28.17 (3.670, 216.3), with Duofix having fewer radiolucent lines than Porocoat. 25% of the Porocoat tibias were assessed as not fixated at 3 months whereas only 1% of the Duofix tibias were considered not fixated. There was no significant difference in pain between the fixated and not fixated groups (p=0.293). Conclusions. The addition of hydroxyapatite did not make a significant difference in terms of pain or functional outcomes in the early
Correct positioning and alignment of components during primary total knee replacement (TKR) is widely accepted to be an important predictor of patient satisfaction and implant durability. This retrospective study reports the effect of the
High flexion designs are intended to provide a greater range of knee flexion and possibly improve flexion in stiff knees. This study assessed the effects of two implant designs. A posterior stabilised high flexion mobile bearing (MB) design vs a cruciate retaining standard fixed bearing (FB) design. The aim of this study was to assess whether implant design has an effect on the functional outcome one year after total knee arthroplasty (TKA). Methods. Ninety patients with knee osteoarthritis on the waiting list for unilateral TKA were recruited and randomly allocated to either the MB or FB group. Patients were assessed between one and four weeks before, and one year after TKA. Primary outcome was knee flexion during high flexion activities of daily living such as stair ascending and descending and squatting as measured using gait analysis. Knee flexion in long sitting using a manual goniometer and the WOMAC were also recorded. Two sample t-tests were used to investigate statistical differences between the two groups pre- and postoperatively. Results. Average age was 69 years. Thirty-three received the MB design and 39 the FB design. Age, gender balance and pre-operative flexion (112 and 113 degrees in the FB and MB groups respectively) were the same in both groups. There were no statistically significant differences in
Total knee replacement (TKR) is an effective
method of treating end-stage arthritis of the knee. It is not, however,
a procedure without risk due to a number of factors, one of which
is diabetes mellitus. The purpose of this study was to estimate
the general prevalence of diabetes in patients about to undergo
primary TKR and to determine whether diabetes mellitus adversely
affects the outcome. We conducted a systematic review and meta-analysis
according to the Meta-analysis Of Observational Studies in Epidemiology
(MOOSE) guidelines. The Odds Ratio (OR) and mean difference (MD)
were used to represent the estimate of risk of a specific outcome.
Our results showed the prevalence of diabetes mellitus among patients
undergoing TKR was 12.2%. Patients with diabetes mellitus had an increased
risk of deep infection (OR = 1.61, 95% confidence interval (CI),
1.38 to 1.88), deep vein thrombosis (in Asia, OR = 2.57, 95% CI,
1.58 to 4.20), periprosthetic fracture (OR = 1.89, 95% CI, 1.04
to 3.45), aseptic loosening (OR = 9.36, 95% CI, 4.63 to 18.90),
and a poorer Knee Society function subscore (MD = -5.86, 95% CI,
-10.27 to -1.46). Surgeons should advise patients specifically about
these increased risks when obtaining informed consent and be meticulous about
their peri-operative care. Cite this article:
Total knee arthroplasty (TKA) is known to lead
to a reduction in periprosthetic bone mineral density (BMD). In theory,
this may lead to migration, instability and aseptic loosening of
the prosthetic components. Bisphosphonates inhibit bone resorption
and may reduce this loss in BMD. We hypothesised that treatment
with bisphosphonates and calcium would lead to improved BMD and
clinical outcomes compared with treatment with calcium supplementation
alone following TKA. A total of 26 patients, (nine male and 17 female,
mean age 67 years) were prospectively randomised into two study
groups: alendronate and calcium (bisphosphonate group, n = 14) or calcium
only (control group, n = 12). Dual energy X-ray absorptiometry (DEXA)
measurements were performed post-operatively, and at three months,
six months, one, two, four, and seven years post-operatively. Mean femoral metaphyseal BMD was significantly higher in the
bisphosphonate group compared with controls, up to four years following
surgery in some areas of the femur (p = 0.045). BMD was observed
to increase in the lateral tibial metaphysis in the bisphosphonate
group until seven years (p = 0.002), and was significantly higher than
that observed in the control group throughout (p = 0.024). There
were no significant differences between the groups in the central
femoral metaphyseal, tibial medial metaphyseal or diaphyseal regions
of interest (ROI) of either the femur or tibia. Bisphosphonate treatment after TKA may be of benefit for patients
with poor bone quality. However, further studies with a larger number
of patients are necessary to assess whether this is clinically beneficial. Cite this article:
Purpose. The Oxford Knee Score (OKS) is a validated and widely used PROM that has been successfully used in assessing the outcome of knee arthroplasty (KA). It has been adopted as the nationally agreed outcome measure for this procedure and is now routinely collected. Increasingly, it is being used on an individual patient basis as a pre-operative measure of osteoarthritis and the need for joint replacement, despite not being validated for this use. The aim of this paper is to present evidence that challenges this new role for the OKS. Method. We have analysed pre-operative and
We compared the alignment of 39 total knee replacements implanted using the conventional alignment guide system with 37 implanted using a CT-based navigation system, performed by a single surgeon. The knees were evaluated using full-length weight-bearing anteroposterior radiographs, lateral radiographs and CT scans. The mean hip-knee-ankle angle, coronal femoral component angle and coronal tibial component angle were 181.8° (174.2° to 188.3°), 88.5° (84.0° to 91.8°) and 89.7° (86.3° to 95.1°), respectively for the conventional group and 180.8° (178.2° to 185.1°), 89.3° (85.8° to 92.0°) and 89.9° (88.0° to 93.0°), respectively for the navigated group. The mean sagittal femoral component angle was 85.5° (80.6° to 92.8°) for the conventional group and 89.6° (85.5° to 94.0°) for the navigated group. The mean rotational femoral and tibial component angles were −0.7° (−8.8° to 9.8°) and −3.3° (−16.8° to 5.8°) for the conventional group and −0.6° (−3.5° to 3.0°) and 0.3° (−5.3° to 7.7°) for the navigated group. The ideal angles of all alignments in the navigated group were obtained at significantly higher rates than in the conventional group. Our results demonstrated significant improvements in component positioning with a CT-based navigation system, especially with respect to rotational alignment.
Abstract. Multidisciplinary team (MDT) meetings in orthopaedic surgery are evolving. The goals include patient optimisation, surgical planning and discharge arrangements, individually on a patient specific basis. In line with British Association Surgery of the Knee and GIRFT guidelines, we report our regional experience on the implementation and evolution of our regional Revision Knee Arthroplasty MDT. We undertook a retrospective review of the process, cases discussed and quality assurance conducted in the weekly MDT. Since implementation of the MDT meeting in January 2019, 550 patients with painful joint replacements have been discussed. In May 2021, we formalised our ‘terms of reference’ and ‘standard operating procedures’ which are adhered to by the consultants operating within the network, all of whom attend the meeting. A proforma has been developed and is completed for all cases capturing all pertinent information. All cases are graded according to R1, R2, or R3 complexity scale. Since its inception, the MDT has looked at all
Abstract. Introduction. Anecdotal reports suggest some cementless Oxford Unicompartmental Knee Replacements (OUKRs) have painful early subsidence of the tibial component with valgus rotation and/or posterior tilting. The incidence of subsidence and its association with pain is poorly understood. This radiographic study aimed to evaluate the incidence of tibial subsidence and five-year patient reported outcome measures (PROMs) of a cementless OUKR cohort. Methodology. Cementless OUKRs from a high-volume centre with acceptable
Abstract. INTRODUCTION. This study aimed to examine how physical activity and health-related quality of life (HRQoL) evolved over the first year after total knee replacement (TKR) for patients with and without
Abstract. Introduction. There is growing interest in the use of robotic Total Knee Arthroplasty (TKA) to improve accuracy of component positioning. This is the first study to investigate the radiological accuracy of implant component position using the ROSA® knee system with specific reference to Joint Line Height, Tibial Slope, Patella Height and Posterior Condylar Offset. As secondary aims we compared accuracy between image-based and imageless navigation, and between implant designs (Persona versus Vanguard TKA). Methodology. This was a retrospective review of a prospectively-maintained database of the initial 100 consecutive TKAs performed by a high volume surgeon using the ROSA® knee system. To determine the accuracy of component positioning, the immediate
Abstract. Introduction. Patella Baja is a known complication of TKR. In this study, we report the effect of the senior author's change of practice from total excision to minimal resection of Hoffa's fat pad on patellar height. Methods. Retrospective analysis of a prospective series of TKRs performed or directly supervised by the senior author. Group 1 included 72 patients performed before April 2011 who had complete excision of Hoffa's fat pad to improve exposure during their TKR procedures. Group 2 included 138 patients performed after April 2011 who had the minimum excision of Hoffa's fat pad to allow exposure. There were no other changes in surgical technique, implant choice or rehabilitation protocol during this time. Patellar height was measured using the Caton–Deschamps Index (CDI) on standard lateral radiographs immediately postoperative and at a minimum follow up of 1 year. Results. Group 1 included 28 males, 44 females with mean age 68.36 years. The mean CDI in this group changed from 0.54 immediately post-operatively to 0.46 at minimum one year follow-up (P=0.001) indicating progressive Patella Baja. Group 2 included 56 males, 82 females with mean age 65 years. The mean CDI changed from 0.67 immediately
Abstract. Patient Reported Outcome Measures (PROMs) can be completed using paper and postal services (pPROMS) or via computer, tablet or smartphone (ePROMs). We have investigated whether there are differences in scores depending on the method of PROMs acquisition for the Oxford Knee (OKS) and the EQ-5D scores, at one and two years post operatively. Patient demographics, mode of preferred data collection and pre-and
Abstract. Introduction. It is common practice for all patients to have postoperative bloods tests after total knee arthroplasty (TKA). However there have been significant improvement in perioperative care with arthroplasty surgery. As healthcare systems and providers strive towards a more efficient service we must re-consider whether such an intervention is necessary for all patients. Methodology. This retrospective study included all patients who underwent a primary unilateral TKA at a single tertiary arthroplasty centre during a 1 year period. Electronic medical records of 776 patients were reviewed for patient demographics, length of stay and American Society of Anaesthesiologists grade. Blood tests were examined to investigate the incidence of post operative anaemia requiring transfusion, electrolyte abnormalities that required treatment and the incidence of acute kidney injury. Results. Average length of stay in hospital was 4.3 days. Pre-operative (R=-0.22) &
Abstract. Introduction. The demand for total knee arthroplasty (TKA) in older patients is increasing. Current perceptions regarding risks may result in patients inappropriately being denied surgery. This study aimed to evaluate TKA outcomes in patients aged ≥80 compared to a younger cohort. Methodology. This study retrospectively analysed prospectively collected data from the Scottish Arthroplasty Project. Data were extracted for all patients undergoing primary TKA between 2000 and 2019 in two age groups: 1) ≥80 and 2) 50–79. Hybrid and partial knee replacements and those with incomplete data were excluded. Data were extracted on