Intro/Purpose. Lateral partial knee replacement is indicated as an alternative to total knee replacement for isolated end stage lateral compartment degenerative joint disease. The purpose of this study is to report the surgical technique and clinical results of a large series of lateral partial knee replacements from two institutions. Methods. A retrospective review identified 205 lateral unicompartmental arthroplasty procedures performed in two practices over a six-year period (Aug 2011 – June 2017). Patients indicated for surgery met specific preoperative clinical and radiographic criteria confirming lateral compartment arthritic disease with a correctable deformity, intact full-thickness medial cartilage, competent anterior cruciate ligament, and minimal disease in the patellofemoral compartment. A single cemented fixed bearing tibial component design was used in all cases specifically designed for lateral compartment anatomy. Results. The average age was 65 years old and 76% were female. Average follow-up in the lateral partials was 1.7 years (range 0.5 years to 6 years). Knee Society Scores improved from 45 (pre-op) to 88 points (post-op). Range of motion improved from 6–115o (pre-op) to 0–122 o (post-op). No knees were revised to a TKA. One knee had an additional medial partial knee placed at 1.1 years post lateral partial knee replacement for medial disease progression. Two knees required an irrigation and debridement for traumatic wound dehiscence. Conclusion. This is the largest series of lateral partial knee replacements reported. Clinical improvements, range of motion, and survivorship were excellent at short-term follow-up. Long-term follow-up is needed for additional understanding of a novel implant designed specifically for the lateral compartment and the survivorship of the unreplaced compartments. We believe the lateral partial knee replacement to be a viable option for isolated lateral compartment disease in approximately 4% of patients

Aims

This study aimed to explore the biological and clinical importance of dysregulated key genes in osteoarthritis (OA) patients at the cartilage level to find potential biomarkers and targets for diagnosing and treating OA.

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.

Objective. To compare the clinical outcomes of bone-patellar tendon-bone (BTB) allografts sterilised through a novel sterilisation system with aseptically processed BTB allografts for Anterior Cruciate Ligament (ACL) reconstruction. The following hypotheses were also tested: (1) the cumulative score of the IKDC is not significantly different in the sterilised treatment group than in the aseptic control group, (2) the proportion of normal laxity in patients, as measured by the KT 2000 arthrometer, is not significantly different in the sterilised group than in the aseptic control group. Methods. A total of 76 patients undergoing ACL reconstruction were randomised into one of two intervention groups, BioCleanse. ¯. -sterilised or Aseptic BTB allografts, at 6 independent investigation sites. Post-op examiners and patients were blinded to graft type. Patients were evaluated at 6 months (44 of the 76), 12 months (20 of the 76), and 24 months (27 of the 76) with KT-2000, IKDC scores, and Flexion and Extension Range of Motion (ROM) analysis. Inclusion criteria included an acute, isolated, unilateral ACL tear and exclusion criteria included prior ACL injury, multiligament reconstruction, and signs of degenerative joint disease. Results. Significant improvement (p<.0001) in IKDC scores was noted in both groups over time. Similarly, a significant improvement (p<.0001) was observed in KT-2000 results over the 24-month period for both groups. There was no difference between graft types at any time point regarding IKDC or KT-2000 scores. There was also no significant difference in active extension ROM between the two groups. Active flexion ROM significantly improved from pre-op to 24 month follow-up (p<.0001) with no difference between groups at any time point. Conclusions. Results indicate that the sterilisation process, BioCleanse. ¯. , does not appear to have an effect on the biomechanics or healing ability of the BTB allograft. BioCleanse. ¯. may provide surgeons with allografts similar to aseptically processed allograft tissue with the benefit of eliminating donor-to-recipient disease transmission

Aims

A significant percentage of patients remain dissatisfied after total knee arthroplasty (TKA). The aim of this study was to determine whether the sequential addition of accelerometer-based navigation for femoral component preparation and sensor-guided ligament balancing improved complication rates, radiological alignment, or patient-reported outcomes (PROMs) compared with a historical control group using conventional instrumentation.

Aims

This study aims to determine the proportion of patients with end-stage knee osteoarthritis (OA) possibly suitable for partial (PKA) or combined partial knee arthroplasty (CPKA) according to patterns of full-thickness cartilage loss and anterior cruciate ligament (ACL) status.

Aims

Approved by the Food and Drug Administration in 2004, the Phase III Oxford Medial Partial Knee is used to treat anteromedial osteoarthritis (AMOA) in patients with an intact anterior cruciate ligament. This unicompartmental knee arthroplasty (UKA) is relatively new in the United States, and therefore long-term American results are lacking.

Objectives

Previous genome-wide association studies (GWAS) have reported significant association of the single nucleotide polymorphism (SNP) rs8044769 in the fat mass and obesity-associated gene (FTO) with osteoarthritis (OA) risk in European populations. However, these findings have not been confirmed in Chinese populations.

Total knee arthroplasty (TKA) is a cost effective and extremely successful operation. As longevity increases, the demand for primary TKA will continue to rise. The success and survivorship of TKAs are dependent on the demographics of the patient, surgical technique and implant-related factors.

Currently the risk of failure of a TKA requiring revision surgery ten years post-operatively is 5%.

The most common indications for revision include aseptic loosening (29.8%), infection (14.8%), and pain (9.5%). Revision surgery poses considerable clinical burdens on patients and financial burdens on healthcare systems.

We present a current concepts review on the epidemiology of failed TKAs using data from worldwide National Joint Registries.

Cite this article: Bone Joint J 2016;98-B(1 Suppl A):105–12.

A national, multi-centre study was designed in which a questionnaire quantifying the degree of patient satisfaction and residual symptoms in patients following total knee replacement (TKR) was administered by an independent, blinded third party survey centre. A total of 90% of patients reported satisfaction with the overall functioning of their knee, but 66% felt their knee to be ‘normal’, with the reported incidence of residual symptoms and functional problems ranging from 33% to 54%. Female patients and patients from low-income households had increased odds of reporting dissatisfaction. Neither the use of contemporary implant designs (gender-specific, high-flex, rotating platform) or custom cutting guides (CCG) with a neutral mechanical axis target improved patient-perceived outcomes. However, use of a CCG to perform a so-called kinematically aligned TKR showed a trend towards more patients reporting their knee to feel ‘normal’ when compared with a so called mechanically aligned TKR

This data shows a degree of dissatisfaction and residual symptoms following TKR, and that several recent modifications in implant design and surgical technique have not improved the current situation.

Cite this article: Bone Joint J 2014;96-B(11 Suppl A):96–100.

Patients with skeletal dysplasia are prone to developing advanced osteoarthritis of the knee requiring total knee replacement (TKR) at a younger age than the general population. TKR in this unique group of patients is a technically demanding procedure owing to the deformity, flexion contracture, generalised hypotonia and ligamentous laxity. We retrospectively reviewed the outcome of 11 TKRs performed in eight patients with skeletal dysplasia at our institution using the Stanmore Modular Individualised Lower Extremity System (SMILES) custom-made rotating-hinge TKR. There were three men and five women with mean age of 57 years (41 to 79). Patients were followed clinically and radiologically for a mean of seven years (3 to 11.5). The mean Knee Society clinical and function scores improved from 24 (14 to 36) and 20 (5 to 40) pre-operatively, respectively, to 68 (28 to 80) and 50 (22 to 74), respectively, at final follow-up. Four complications were recorded, including a patellar fracture following a fall, a tibial peri-prosthetic fracture, persistent anterior knee pain, and aseptic loosening of a femoral component requiring revision. Our results demonstrate that custom primary rotating-hinge TKR in patients with skeletal dysplasia is effective at relieving pain, with a satisfactory range of movement and improved function. It compensates for bony deformity and ligament deficiency and reduces the likelihood of corrective osteotomy. Patellofemoral joint complications are frequent and functional outcome is worse than with primary TKR in the general population.

Autologous chondrocyte implantation (ACI) and mosaicplasty are methods of treating symptomatic articular cartilage defects in the knee. This study represents the first long-term randomised comparison of the two techniques in 100 patients at a minimum follow-up of ten years. The mean age of the patients at the time of surgery was 31.3 years (16 to 49); the mean duration of symptoms pre-operatively was 7.2 years (9 months to 20 years). The lesions were large with the mean size for the ACI group being 440.9 mm² (100 to 1050) and the mosaicplasty group being 399.6 mm² (100 to 2000). Patients had a mean of 1.5 previous operations (0 to 4) to the articular cartilage defect. Patients were assessed using the modified Cincinnati knee score and the Stanmore-Bentley Functional Rating system. The number of patients whose repair had failed at ten years was ten of 58 (17%) in the ACI group and 23 of 42 (55%) in the mosaicplasty group (p < 0.001).

The functional outcome of those patients with a surviving graft was significantly better in patients who underwent ACI compared with mosaicplasty (p = 0.02).