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Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_II | Pages 288 - 288
1 May 2006
Cronin J Shannon F Bale E Quinlan W
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Introduction: Urinary retention is a significant complication following hip and knee arthroplasty. Published literature has shown that the insertion of a catheter post-op is associated with an increased incidence of deep joint sepsis, however, pre-operative catheterisation has not.

The International Prostate Symptom Score (IPSS) is an internationally validated scoring system used by Urologists to assess the severity of obstructive urinary symptoms and response to treatment.

The purpose of this study was to quantify the incidence of urinary retention following major joint arthroplasty in an elective orthopaedic unit and to investigate whether a patient’s pre-operative IPSS score could be used to predict the likelihood of post-operative urinary retention.

Patients and Methods: Over a 9 month period, 118 patients were enrolled prospectively into this study. 28 patients were admitted for knee replacement(TKR) and 90 patients for hip replacement (THR). All patients were asked to fill out an IPSS questionnaire form on admission. Demographics including age, mode of anaesthetic, intra-operative blood loss and operative time were recorded. Results: In our study group of 118 patients, 43(36.4%) developed urinary retention postoperatively. 29(32.2%) patients following THR developed urinary retention, whereas 14(50%) of the men who had a TKR developed urinary retention post-op. Of the 25 patients with a pre-operative IPSS score > /=10, 14(56%) went into retention. The mean pre-operative IPSS score was 7.74 for those who went into retention, compared to 5.0 for the other patients (p < 0.05). Type of anaesthesia, blood loss and operative time were non-contributory.

Conclusion: This study shows a high rate of post-operative urinary catheterisation in our patient group. Despite the mean IPSS score being higher in patients requiring catheterisation, our results did not show any conclusive evidence that this scoring system could be used to predict the development of post-operatively urinary retention in patients presenting for hip or knee arthroplasty.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_II | Pages 288 - 288
1 May 2006
Glynn A Bale E McMahon V Keogh P Quinlan W O’Byrne J Kenny P
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Introduction: An arthroplasty database, such as the Swedish Hip Registry, provides a crude means of quality control over the sizable number of prosthetic implants available on the market today. It provides relatively rapid feedback on the performance of orthopaedic devices and surgical techniques, allowing inferior devices and methods to be discontinued. The maintenance of an arthroplasty register is inexpensive and of enormous benefit to the patient. At present, there is no nationwide arthroplasty register in operation in the Republic of Ireland.

Aim: To develop an arthroplasty register which prospectively captures all clinical, radiographic and medical outcome data on patients undergoing surgery in our unit

Materials and methods We are using an existing computer software programme (Bluespier Patient Manager) to capture our information, although our database is stored independently of this.

Data recorded includes medical outcome scores (WOMAC and MOS SF-36), patient data, operative details (including type of prostheses used and operative technique employed), inpatient course, and any postoperative events. For revision procedures, additional data such as location of bony defects (Gruen zones) and acetabular bone loss (Paprosky classification) are also recorded. Follow up in a special Joint Register Clinic is at six months, two years and every five years thereafter for primary procedures. This is reduced to every two years in the case of revision procedures.

To date, a pilot study involving four surgeons has prospectively captured data on 82 patients undergoing both primary and revision procedures in our unit. We aim to enrol all our patients in the register from July 2005, increasing the amount of data collected, which we hope will subsequently benefit patients undergoing hip and knee arthroplasty in the future.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 28 - 28
1 Mar 2006
O Shea K Bale E Murray P
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Introduction: The majority of patients with osteoarthritis of the knee suffer from femorotibial pain with a smaller proportion suffering predominantly patellofemoral symptoms. No clear consensus exists as to the need for patellar resurfacing when performing total knee replacement for patients with symptomatic femorotibial osteoarthritis but without prominent patellofemoral symptomatic and radiographic disease.

Aims: To identify the advantages and disadvantages of both resurfacing and non-resurfacing of the patella during cemented total knee replacement performed for osteoarthritis predominantly of the femorotibial joint. To objectively clarify the rationale for the use of either procedure in clinical practice.

Methods: Prospective randomised double blinded clinical trial. Patients with osteoarthritis of the knee and principally femorotibial symptoms were included. Patients with rheumatoid arthritis, gross deformity of the knee and gross radiological or clinical patellofemoral arthritis were excluded. The implant used was a cemented posterior stabilised AMK (DePuy, Leeds UK) prosthesis. Preoperative American Knee Society Score, SF-36 questionnaire and WOMAC scores were calculated for each patient. These instruments were repeated and combined with clinical and radiological follow up at 3 months, 6 months and 1 year.

Results: 58 patients were recruited into the study, 53 of whom completed follow up and were in included in the analysis. Baseline characteristics were similar in each group. Operating room time was less in the non-resurfaced group (p< 0.05). At 2 years, 3 patients in the non resurfaced group had undergone a revision procedure. There was no difference between the resurfaced and non-resurfaced groups in terms of global functional outcome as measured by SF36 and WOMAC scores at 1 and 2 years post-operatively. The American Knee Society score showed no difference between the two groups (p=0.86) at 1 year post surgery.

Conclusion: There is no significant difference in clinical outcome at 1 and 2 years following surgery vis-à-vis those who did and did not have patellar resurfacing performed during knee replacement for predominantly femorotibial symptomatic osteoarthritis. There was a higher revision rate in the non-resurfaced group. In TKR using a PS AMK prosthesis routine resurfacing of the patella should be performed.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 126 - 126
1 Feb 2004
Street J Flavin R Bale E Murray P
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Pathological conditions of the hip joint may present with variable patterns of pain referral in the lower limb. Literature reports suggest that up to 35% of total hip arthroplasties are performed on patients whose primary compliant is obturator nerve referred “knee pain”. However the effect of varied pain patterns on patient outcome and satisfaction has not previously been examined. This prospective study was undertaken to determine the most common referral patterns of hip pain in patients scheduled to undergo primary total hip replacement and to examine whether initial pain referral pattern predicted ultimate patient outcome. Patients were assessed using the Harris Hip score, SF 36 and WOMAC scoring systems measured preoperatively, at 6 months, 1 and 2 years post operatively.

236 patients were identified with isolated single hip joint disease. Patients who demonstrated multi joint disease, and particularly ipsilateral knee pathology were excluded. Forty-five percent of patients with primary hip disease had pain primarily at or about the knee. There was no difference in preoperative demographics, physical function, social function, perceived general health, Harris Hip score (p=0.74), SF 36 (p=0.66) or WOMAC scores (p=0.81) between the pain pattern groups. Operator status and operative techniques were comparable. At 1 and 2 years postoperatively the groin and thigh pain groups were similar in all respects. However at 6 months, 12 months and 2 years, Harris hip scores (p=0.04, p=0.037, p=0.021) and SF 36 scores (p=0.035, p=0.027, p=0.01) were significantly lower in those patients presenting initially with knee pain. Multivariate regression analysis confirmed that no other confounding variables could account for the observed differences between the groups. These results indicate that, using current outcome measures, patients with “knee pain” who undergo total hip arthroplasty, and in whom ipsilateral knee disease has been excluded, have poorer long-term physical and social function and perceived general health. We believe this is the first report of its kind and suggest that patient and surgeon expectations of the results of total hip arthroplasty should be tailored according to the individual initial pain referral pattern.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 129 - 129
1 Feb 2004
O’Shea K Bale E Murray P
Full Access

Introduction: The majority of patients with osteoarthritis of the knee suffer from femorotibial pain with a smaller proportion suffering predominantly patello-femoral symptoms. No clear consensus exists as to the need for patellar resurfacing when performing total knee replacement for patients with symptomatic femorotibial osteoarthritis but without prominent patello-femoral symptomatic and radiographic disease.

Aims: To identify the advantages and disadvantages of both resurfacing and non-resurfacing of the patella during cemented total knee replacement performed for osteoarthritis predominantly of the femorotibial joint. To objectively clarify the rationale for the use of either procedure in clinical practice.

Methods: Prospective randomized double blinded clinical trail. Patients with osteoarthritis of the knee and principally femorotibial symptoms were included. Patients with rheumatoid arthritis, gross deformity of the knee and gross radiological or clinical patello-femoral arthritis were excluded. The implant used was a cemented posterior stabilized AMK (Depuy, Leeds UK) prosthesis. Pre-operative American Knee Society Score, SF-36 questionnaire and WOMAC scores were calculated for each patient. These instruments were repeated and combined with clinical and radiological follow up at 3 months, 6 months and one year.

Results: 58 patients were recruited into the study, 53 of whom completed follow-up and were included in the analysis. Baseline characteristics were similar in each group. Operating room time was less in the non-resurfaced group (p< 0.05). At one year, no patient in either group had needed to undergo a revision procedure. There was no difference between the resurfaced and non-resurfaced groups in terms of global functional outcome as measured by SF36 and WOMAC scores at one-year post operatively. The American Knee Society score showed no difference between the two groups (p=0.86) at one-year post surgery.

Conclusion: There is no significant difference in clinical outcome at one year following surgery vis-à-vis those who did and did not have patellar resurfacing performed during knee replacement for predominantly femorotibial symptomatic osteoarthritis. Patellar resurfacing as a procedure is not without complications. In patients with osteoarthritis of the knee and predominantly femorotibial disease based on clinical and radiographic findings, we do not advocate the routine use of patellar resurfacing.