Anxiety and depression are risk factors for poor outcome following knee replacement surgery. The aim of this study was to investigate the prevalence of anxiety and depression before and after primary (pKR) and revision knee replacement (rKR). Retrospective cohort study. 315,720 pKR and 12,727 rKR recruited from the NHS Patient Reported Outcome Measures (PROMs) programme from 2013–2021. Anxiety and depression were defined using: (i) Survey question: “Have you been told by a doctor that you have depression? Yes/No”; (ii) EQ-5D anxiety/depression domain. Rates of EQ-5D anxiety/depression were investigated at baseline and at 6-months following surgery. The prevalence of depression was investigated by patient age and gender.Abstract
Introduction
Methodology
This multi-centre randomised controlled trial evaluated the clinical and cost effectiveness of liposomal bupivacaine for pain and recovery following knee replacement. 533patients undergoing primary knee replacement were randomised to receive either liposomal bupivacaine (266mg) plus bupivacaine hydrochloride (100mg) or control (bupivacaine hydrochloride 100mg), administered at the surgical site. The co-primary outcomes were pain visual analogue score (VAS) area under the curve (AUC) 6 to 72hours and the Quality of Recovery 40 (QoR-40) score at 72hours.Abstract
Introduction
Methodology
Our aim was to investigate trends in the incidence rate and main indication for revision knee replacement (rKR) over the past 15 years in the UK. Cross-sectional study from 2006 - 2020 using data from the National Joint Registry (NJR). Crude incidence rates were calculated using population statistics from the Office for National Statistics.Abstract
Introduction
Methodology
Establishing a full-thickness cartilage in the lateral compartment and functionally intact ACL is vital before proceeding with unicompartmental knee replacement (UKR). The aim of this study is to assess whether MRI is a useful adjunct in predicting suitability for UKR, as compared to standard and stress radiographs. We identified 50 patients with a knee found suitable for UKR based on their standard and stress radiographs (full-thickness cartilage on lateral side). These patients underwent an additional cartilage-specific MRI scan to identify the status of ACL and the lateral compartment. The final decision regarding the suitability for UKR was based on the intra-operative observation.INTRODUCTION
METHODS
Late stage medial unicompartmental osteoarthritic disease of the knee can be treated by either Total Knee Replacement (TKR) or Unicompartmental Replacement (UKR). As a precursor to the TOPKAT study this work tested the postulate that individual surgeons show high variation in the choice of treatment for individual patients. Four surgeons representing four different levels of expertise or familiarity with partial knee replacement (UKR design centre knee surgeon, specialist knee surgeon, arthroplasty surgeon and a year six trainee) made a forced choice decision of whether they would perform a TKR or UKR based on the same pre-operative radiographic and clinical data in 140 individual patients. Consistency of decision was also evaluated for each surgeon 3 months later and the effect of additional clinical data was also evaluated. The sample consisted of the 100 patients who had subsequently undergone UKR and 40 who had undergone TKR.Purpose
Method
To examine the clinical characteristics of patients undergoing knee arthroplasty with a pre-operative Oxford Knee Score >34 (‘good’/‘excellent’), and assess the appropriateness of surgical intervention for this group. In the current cost-constrained health economy, justification of surgical intervention is increasingly sought. As a validated disease-specific outcome measure, the pre-operative Oxford Knee Score (OKS) has been suggested as a possible threshold measurement in knee arthroplasty. However, contrary to expectations, analysis of pre-operative OKS in the joint registry population demonstrates a normal distribution curve with a sub-group of high-scoring patients. This suggests that either the baseline OKS does not accurately define surgical threshold, or that patients with a high OKS are inappropriately having knee replacements.Purpose
Background
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. We have analysed pre-operative and post-operative OKS data from 3 large cohorts all undergoing KA, totalling over 3000 patients. In addition we have correlated the OKS to patient satisfaction scores. We have validated our findings using data published from the UK NJR.Purpose
Method
The purpose was to determine if the use of cold irrigation fluid in routine knee arthroscopy leads to a reduction in post operative pain. Some surgeons use cooled irrigation fluid in knee arthroscopy in the hope that it may lead to a reduction in post operative pain and swelling. There is currently no evidence for this, although there is some evidence to support the use of cold therapy post operatively in knee surgery.Purpose
Background
Total knee arthroplasty (TKA) accounts for 84% of all knee replacement surgery in the UK (NJR 2009) despite published epidemiological data showing that single compartment disease is most prevalent. We investigated this incompatibility further by describing the compartmental pattern and stage of cartilage loss of all patients with osteoarthritis (OA) presenting to a specialist knee clinic over one year. All new primary referrals in a calendar year by local General Practitioners to knee clinic at a United Kingdom Hospital were assessed. Tertiary referrals and second opinions were excluded. The final diagnosis after all imaging was recorded and tabulated. The standing AP, lateral and skyline radiographs of all cases of arthritis were scored to assess the pattern of disease.Introduction
Methods
The results of the mobile bearing Oxford unicompartmental knee replacement (UKR) in the lateral compartment have been disappointing with a five year survival of 82%. Therefore, it is recommended that mobile bearings should not be used for lateral UKR. This low survivorship is primarily due to high dislocation rate, all occurring in the first year. A detailed analysis of the causes of bearing dislocation confirmed the elevated lateral tibial joint line to be a contributory factor. A new surgical technique was therefore introduced in which care was taken neither to remove too much bone from distal femur nor to over tighten the knee and thus ensure that the tibial joint line was not elevated. Other modifications to the technique were also introduced including use of a domed tibial component. The aim of this study is to compare the outcome of these iterations: the original series [series I], Series II with improved surgical technique and the domed tibial component [Series III].Introduction
Aim
To assess the incidence of radiolucency in cemented and cementless Oxford unicompartmental knee replacement at two years. Most unicompartmental knee replacements (UKRs) employ cement for fixation of the prosthetic components. The information in the literature about the relative merits of cemented and cementless UKR is contradictory, with some favouring cementless fixation and others favouring cemented fixation. In addition, there is concern about the radiolucency that frequently develops beneath the tibial component with cemented fixation. The exact cause of the occurrence of radiolucency is unknown but it has been hypothesised that it may suggest suboptimal fixation.Purpose of Study
Introduction
Polyethylene particulate wear debris continues to be implicated in the aetiology of aseptic loosening following knee arthroplasty. The Oxford unicompartmental knee arthroplasty employs a spherical femoral component and a fully congruous meniscal bearing to increase contact area and theoretically reduce the potential for polyethylene wear. This study measures the In this The results from this
Before proceeding to longer-term studies, we have studied the early clinical results of a new mobile-bearing total knee prosthesis in comparison with an established fixed-bearing device. Patients requiring bilateral knee replacement consented to have their operations under one anaesthetic using one of each prosthesis. They also agreed to accept the random choice of knee (right or left) and to remain ignorant as to which side had which implant. Outcomes were measured using the American Knee Society Score (AKSS), the Oxford Knee Score (OKS), and determination of the range of movement and pain scores before and at one year after operation. Preoperatively, there was no systematic difference between the right and left knees. One patient died in the perioperative period and one mobile-bearing prosthesis required early revision for dislocation of the meniscal component. At one year the mean AKSS, OKS and pain scores for the new device were slightly better (p <
0.025) than those for the fixed-bearing device. There was no difference in the range of movement. We believe that this is the first controlled, blinded trial to compare early function of a new knee prosthesis with that of a standard implant. It demonstrates a small but significant clinical advantage for the mobile-bearing design.
