Aims. Alternative alignment concepts, including kinematic and restricted kinematic, have been introduced to help improve clinical outcomes following total knee arthroplasty (TKA). The purpose of this study was to evaluate the clinical results, along with
Introduction. Mechanical axis limb alignment in total knee arthroplasty (TKA) has demonstrated excellent long-term survivorship; however,
Introduction. Patient reported outcome measures (PROMs) are increasingly used as quality benchmarks in total joint arthroplasty (TJA). The objective of this study was to investigate whether PROMs correlate with
Introduction.
Aims. The primary aim of this study was to assess whether pain in the contralateral knee had a clinically significant influence on the outcome of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary aims were to: describe the prevalence of contralateral knee pain; identify if it clinically improves after TKA; and assess whether contralateral knee pain independently influences
Aims. While patients with psychological distress have poorer short-term outcomes after total knee arthroplasty (TKA), their longer-term function is unknown. We aimed to 1) assess the influence of preoperative mental health status on long-term functional outcomes, quality of life, and
Osteotomy is recognised treatment for osteoarthritis of the knee. Evidence suggests favourable outcomes when compared to arthroplasty, for younger and more active individuals[1]. Double level osteotomy (DLO) is considered when a single level is insufficient to restore both joint line obliquity and adequate realignment[2]. This paper aims to establish the functional outcomes up to two years post operatively for patients undergoing DLO, using patient reported outcome measures (PROMs). All patients who underwent a DLO at either Lister Hospital, Stevenage, or One Hatfield Hospital, Hertfordshire, between 1st January 2018 and 1st October 2020 were identified. DLO were performed by two specialist consultants, independently or in combination. PROMs including pain scores, health score, Oxford knee score (OKS) and knee injury and osteoarthritis outcome score (KOOS) were recorded pre-operatively and at six month, one and two year post operative intervals.Abstract
Introduction
Methodology
Introduction. Patients who undergo total joint arthroplasty (TJA) are at a high risk for the development of thromboembolic complications. The rate at which venous thromboembolism occurs following TJA has been reported to be between 1.3–9.4%. As a result, the utilization of prophylactic therapies is considered standard of care in this patient population. The primary purpose of the current study was to 1) evaluate
Introduction. The relationship between sagittal component alignment on clinical outcomes has not fully evaluated after TKA. This study evaluated the effect of sagittal alignment of the components on patient function and satisfaction as well as kinematics and kinetics. Methods. This study included 148 primary TKAs with cruciate-substituting prosthesis for primary OA. With post-operative lateral radiograph, femoral component flexion angle (γ) and tibial component posterior slope angle (90-σ) was measured. The patients was classified into multiple groups by every three degrees.
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
A postal questionnaire was sent to 10 000 patients more than one year after their total knee replacement (TKR). They were assessed using the Oxford knee score and were asked whether they were satisfied, unsure or unsatisfied with their TKR. The response rate was 87.4% (8231 of 9417 eligible questionnaires) and a total of 81.8% (6625 of 8095) of patients were satisfied. Multivariable regression modelling showed that patients with higher scores relating to the pain and function elements of the Oxford knee score had a lower level of satisfaction (p <
0.001), and that ongoing pain was a stronger predictor of this. Female gender and a primary diagnosis of osteoarthritis were found to be predictors of lower levels of
In a prospective multicentre study we investigated
variations in pain management used by knee arthroplasty surgeons
in order to compare the differences in pain levels among patients
undergoing total knee replacements (TKR), and to compare the effectiveness
of pain management protocols. The protocols, peri-operative levels
of pain and
Pre-operative variables are increasingly being
used to determine eligibility for total knee replacement (TKR).
This study was undertaken to evaluate the relationships, interactions
and predictive capacity of variables available pre- and post-operatively
on
Purpose. The aim of the present study was to look at survivorship and
To evaluate the role of “top up” intra-articular local anaesthetic injection in patients who have had UKR. 43 patients scheduled to have a cemented Oxford UKR were prospectively recruited and randomised. All patients had the same initial anaesthetic regime of general anaesthesia, femoral nerve block and intra-operative intra-articular infiltration. All patients had a multi-holed epidural catheter placed intra-articularly prior to wound closure. Patients had the same operative technique, post operative rehabilitation and rescue analgesia. An independent, blinded observer recorded post-operative pain scores using a visual analogue score every 6 hours and any rescue analgesia. On the morning after surgery, 22 patients, (Group I), received 20 mls of 0.5% bupivicaine through the catheter whilst 21, (Group II), patients had 20 mls of normal saline by the same observer, after which the catheter was removed. No statistical difference was found in pain scores on the day of operation between the groups. However, patients in Group I had a significantly better pain score initially post top up and at 6 hours (2.4 (0-8) vs 5.7 (2-9), p<0.001). This cohort of patients required less rescue analgesia (p<0.001). In addition, Group I had statistically significant higher patient satisfaction outcome scores after the infiltration, (p<0.001).STUDY PURPOSES
METHOD AND RESULTS
Total knee replacement (TKR) is one of the most
common operations in orthopaedic surgery worldwide. Despite its
scientific reputation as mainly successful, only 81% to 89% of patients
are satisfied with the final result. Our understanding of this discordance
between patient and surgeon satisfaction is limited. In our experience,
focus on five major factors can improve
Previous studies of failure mechanisms leading
to revision total knee replacement (TKR) performed between 1986 and
2000 determined that many failed early, with a disproportionate
amount accounted for by infection and implant-associated factors
including wear, loosening and instability. Since then, efforts have
been made to improve implant performance and instruct surgeons in
best practice. Recently our centre participated in a multi-centre evaluation
of 844 revision TKRs from 2010 to 2011. The purpose was to report
a detailed analysis of failure mechanisms over time and to see if
failure modes have changed over the past 10 to 15 years. Aseptic
loosening was the predominant mechanism of failure (31.2%), followed
by instability (18.7%), infection (16.2%), polyethylene wear (10.0%),
arthrofibrosis (6.9%) and malalignment (6.6%). The mean time to
failure was 5.9 years (ten days to 31 years), 35.3% of all revisions
occurred at less than two years, and 60.2% in the first five years.
With improvements in implant and polyethylene manufacture, polyethylene
wear is no longer a leading cause of failure. Early mechanisms of
failure are primarily technical errors. In addition to improving
implant longevity, industry and surgeons must work together to decrease
these technical errors. All reports on failure of TKR contain patients
with unexplained pain who not infrequently have unmet expectations.
Surgeons must work to achieve realistic patient expectations pre-operatively,
and therefore, improve
Aims. The primary aim was to assess whether robotic total knee arthroplasty (rTKA) had a greater early knee-specific outcome when compared to manual TKA (mTKA). Secondary aims were to assess whether rTKA was associated with improved expectation fulfilment, health-related quality of life (HRQoL), and
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. Methods. From 2006 to 2007, 462 consecutive cemented cruciate-retaining Triathlon TKAs were implanted in 426 patients (mean age 69 years (21 to 89); 290 (62.7%) female). PROMs (12-item Short Form Survey (SF-12), Oxford Knee Score (OKS), and satisfaction) were assessed preoperatively and at one, five, ten, and 15 years. Kaplan-Meier survival and univariate analysis were performed. Results. At 15 years, 28 patients were lost to follow-up (6.1%) and 221 patients (51.9%) had died, with the mean age of the remaining cohort reducing by four years. PROMs response rates among surviving patients were: one-year 63%; five-year 72%; ten-year 94%; and 15-year 59%. OKS and SF-12 scores changed significantly over 15 years (p < 0.001). The mean improvement in OKS was 18.8 (95% confidence (CI) 16.7 to 19.0) at one year. OKS peaked at five years (median 43 years) declining thereafter (p < 0.001), though at 15 years it remained 17.5 better than preoperatively. Age and sex did not alter this trajectory. A quarter of patients experienced a clinically significant decline (≥ 7) in OKS from five to ten years and from ten to 15 years. The SF-12 physical component score displayed a similar trajectory, peaking at one year (p < 0.001).
Aims. The aim was to assess whether robotic-assisted total knee arthroplasty (rTKA) had greater knee-specific outcomes, improved fulfilment of expectations, health-related quality of life (HRQoL), and