Total knee arthroplasty (TKA) is considered as one of the most successful and cost-effective medical interventions yet it is consistently reported that up to 20% of patients are dissatisfied with their outcomes. Patient satisfaction is correlated with the fulfillment of expectations and an important aspect of this involves good surgeon-patient communication, which itself is a contributor to TKA satisfaction. The purpose of this study was to develop and test a checklist intended to enhance the quality of surgeon-patient communication by optimizing the surgeon's role in helping patients set (or reset) and manage post-TKA expectations that are realistic, achievable, and most importantly, patient-specific.

In this prospective mixed methods study, a communication checklist was developed from the analysis of interviews with patients who were between six weeks and six months post-TKA. Four orthopaedic surgeons then used the checklist to guide discussions with patients about post-operative expectations and outcomes during follow-up visits between six weeks and six months. A visual analogue scale was used to survey two groups of patients on five measures of satisfaction: the standard of care communication group and the intervention group who had received the checklist. The mean scores of the two groups were compared using independent t-tests. The duration of follow-up visits was also tracked to determine if the checklist took significantly more time in practice.

Themes from the qualitative analysis of eight patient interviews incorporated into the checklist included pain management, medication, physiotherapy, and general concerns and questions. The quantitative study comprised 127 participants, 67 in the standard of care communication group and 60 in the checklist group. There were no significant group differences in gender, BMI, comorbidities, post-operative complications, marital or occupational status, however the standard of care group was older by six years (p < .001). The checklist group reported significantly greater satisfaction on four of the five measures of satisfaction: TKA satisfaction and expectations met (p = .017), care and concern shown by the surgeons (p = .011), surgeons' communication ability (p = .008), and satisfaction with time surgeons spent with patients during follow-up visits (p < .001). Satisfaction with the TKA for relieving pain and restoring function was not significant (p = .064). Although the checklist increased the average clinic visit time by only 1 minute, 51 seconds, it was significantly greater (p = .001). The impact of age and gender on satisfaction was explored using a two-way analysis of variance. No significant effects or interactions were observed.

Checklists have been shown to decrease medical errors and improve overall standards of patient care but no published research to date has used a communication checklist to enhance orthopaedic surgeon-patient communication. The present findings indicate that this simple tool can significantly increase patient satisfaction. This has practical significance because patient satisfaction is a metric that is increasingly used as a key performance indicator for surgeons and health care institutions alike. Increased TKA satisfaction will benefit patients, surgeons, and the health care system overall.

The aim was to evaluate the polyethylene wear in an uncemented all polyethylene titanium coated acetabular cup a minimium of ten years post-operatively, and to determine the effect of supine “stress” radiographs on 3-dimensional polyethylene wear, compared with “non-stress” radiographs.

Twenty seven hips in twenty five patients were examined, and standard and stress radiographs were performed. All radiographs were analysed using Polywear 5 auto, to measure 2d, 3d, and volumetric wear. Wear measurements were performed three times to minimise error. Radiographs were analysed for osteolysis.

There were 12 males and 13 females. Eighteen patients had a diagnosis of osteoarthritis.20 patients had a ceramic head and 7 a metal head. There was no association between wear rates and age, weight, diagnosis, Harris hip score or femoral head type. There was no acetabular osteolysis. The average linear wear was 0.11 +/− 0.08 mm/yr. The stress radiographs did not influence the 2D or 3D wear measurements.

This sudy shows a similar wear rate to most published series. The stress radiographs did not influence the wear measurements. The absence of osteolysis is of interest as other uncemented cups have significant osteolysis at ten years.

Introduction and Aims: Polyethylene wear after total hip arthroplasty with an uncemented titanium coated non-modular acetabular component was measured using a computer-assisted technique and correlated with clinical outcomes. Polyethylene wear measurements using post-operative radiographs and recent supine and standing radiographs were compared to see if there was a difference. To date, there is no definitive evidence in the literature that indicates a difference.

Method: Fifty-five patients who had total hip arthroplasties using a non-modular titanium-backed Mathys (Protec, Switzerland) press-fit acetabular component in 1992–1993 were included in this study. Patients who had a revision were excluded. The patients were contacted and reviewed in clinic. Each patient completed an Oxford Hip Score. They also had a cross-table lateral, supine and standing AP radiographs. The radiographs were digitised and analysed using a computer-assisted method (PolyWare) of measuring polyethylene wear. Correlations were sought between the rate of polyethylene wear and clinical outcome using the Oxford Hip Score. Polyethylene wear measurements using supine and standing radiographs were also compared to determine if there was a significant difference.

Results: Early results showed a trend indicating a difference in measured polyethylene wear rates comparing supine and standing radiographs. Previous experience at this institution measuring polyethylene wear using the same computer-assisted technique has shown that leg position has an effect on polyethylene wear measurements; weightbearing radiographs with the leg maximally internally and externally rotated resulted in an increase in polyethylene wear calculation of volumetric wear by 35% as compared to calculations with supine radiographs. A non-cylindrical wear tract was proposed to be the reason for the difference. There is no definitive answer in the literature as to the significance of the effect of supine versus standing radiographs on the measurement of polyethylene wear. Polyethylene wear rate did not seem to be related to clinical outcome as detected by the Oxford hip score.

Conclusion: Early results indicate a difference in polyethylene wear measurement comparing standing and supine radiographs. Polyethylene wear rates using the Mathys acetabular component do not seem to be related to clinical symptoms as detected by the Oxford Hip Score.

Introduction and Aims: In 1999, the serial polyethylene wear of a group of patients with a porous coated anatomic hip (PCA) replacement were reported by Devane et al. Wear was measured using a computer assisted technique where the points were selected manually from a digitised image displayed on a computer screen (method 1). The purpose of this study is to use a new automated method of polyethylene wear measurement (method 2), for analysis of the same serial radiographs of patients which have since been digitised. Results of the two methods are compared.

Method: Twenty-three porous coated anatomic hips (PCA, Howmedica) in 23 patients had serial radiographs performed with a minimum 8.5-year follow-up. A total of 494 anteroposterior (AP) and lateral radiographs were analysed. Assessment of the presence of osteolysis on the longest-term follow-up AP image was made by an independent observer. Correlation of polyethylene wear rate measured by the two different methods, and osteolysis was made.

Results: Using method 1, if a poor quality AP or lateral image was analysed multiple times by the same observer, a poor reproducibility (±0.4 mm) was obtained. Discarding of poor quality radiographs by the user resulted in 74% of the AP images and 68% of the lateral images being measured. It is very likely that a different user would discard different images. Method 2, however, automatically eliminates poor quality images. Method 2 was able to measure 89% of the AP radiographs and 78% of the lateral radiographs. More importantly, if a different user performed the same analysis using the new automated software, the exact same images would be analysed. Results of wear measurements made using method 1 were statistically similar to measurements made using method 2 in 19/24 hips (83%).

7/23 patients demonstrated osteolysis on their images. Wear measurement using method 2 showed statistically greater wear in these patients (69mm/yr vs 35mm/yr, p = 0.003). Wear measurement using method 1 showed only a weak association.

Perhaps most importantly, wear analysis of these patients using method 2, by two separate observers, independent of each other, gave identical results.

Conclusion: With improved accuracy and elimination of user error, measurement of PE wear may now have the ability to make predictions about the long-term survival of a THJR. Clinical decisions may be able to be made based on individual patient measurements.