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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_13 | Pages 6 - 6
7 Aug 2023
Hampton M Balachandar V Charalambous C Sutton P
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Abstract

Introduction

Aseptic loosening is the most common cause of failure following cemented total knee arthroplasty (TKA) and this has been linked to poor cementation technique. We aimed to develop a consensus on the optimal technique for component cementation in TKA.

Methodology

A UK based, three round, online modified Delphi Expert Consensus Study was completed focussing on cementation technique in TKA. Experts were identified as having a minimum of 5 years Consultant experience in the NHS and fulfilling any one of the following three criteria:

· A ‘high volume’ knee arthroplasty practice (>150 TKA per annum) as identified from the National joint registry (NJR).

· A senior author of at least 5 peer reviewed articles related to TKA in the previous 5 years

· A named trainer for a post CCT fellowship in TKA.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 40 - 40
1 Jul 2022
Prodromidis A Chloros G Thivaios G Sutton P Veysi V Giannoudis P Charalambous C
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Abstract

Introduction

Higher than expected rates of tibial loosening with the ATTUNE® total knee arthroplasty (TKA) implant has been reported. Component loosening can be associated with the development of radiolucency lines (RLL) and our study aim was to systematically assess the reported rates of these.

Methodology

A systematic search was undertaken using the Cochrane methodology in four online databases. Identified studies were assessed and screened against predetermined inclusion criteria. Meta-analysis was conducted using a random-effects model.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 39 - 39
1 Jul 2022
Prodromidis A Charalambous C Moran E Venkatesh R Pandit H
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Abstract

Introduction

This study aimed to assess the effect of PRP on knee articular cartilage content (thickness and/or volume) and establish if there is a correlation between changes in cartilage and clinical outcomes in patients with knee osteoarthritis.

Methodology

A systematic review was performed following the Cochrane methodology. Studies were included if they reported on cartilage content with MRI or Ultrasound before and after the injection. A random-effects model meta-analysis was performed.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_16 | Pages 23 - 23
1 Dec 2015
Kursumovic K Charalambous C
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No consensus exists regarding the optimal graft choice between allogenic and autologous graft. Incidence of septic arthritis following ACL reconstruction is rare but may dependent on the graft type. Our meta-analysis assesses the difference in incidence of septic arthritis after ACL reconstruction across three groups of grafts: hamstring autografts, bone patellar tendon bone (BPTB) autografts and allografts of any type.

A literature search was performed without language restriction on PubMed and EMBASE databases. We identified 245 infected ACL grafts across 15 included studies that provided a breakdown of infection incidence by graft type. A meta-analysis was performed using a random-effects model to estimate the overall infection rates and those for different graft types. Summary risk ratios and 95% confidence intervals (CIs) were calculated and reported for each outcome. Publication bias with respect to infection rates was estimated using a funnel plot.

Our meta-analysis shows an overall ACL graft infection rate of 0.6% (CI 0.3% – 1.3%). The incidence was highest in autologous hamstring grafts at 1.1% at (CI 0.8% – 1.6%). That of allografts and autologous BPTB grafts was similar at 0.5% (CI 0.2%–1.0%) and 0.4% (CI 0.2% – 0.7%), respectively. Full breakdown of the meta-analysis results by study and graft type is reported in Figure 1.

Septic arthritis after ACL reconstruction remains a rare (<1%) but a serious complication. Allograft rates of infection were not higher than those the autografts, contrary to the theoretical concerns. Therefore a higher infection risk should not be cited as a reason for not using it. The reason for the apparently higher infection rate with hamstring autografts is unclear and requires further research. The results of our meta-analysis may aid informed discussions between surgeons and patients about the risk of infection after ACL reconstructive surgery and graft choice.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 119 - 119
1 Jul 2014
Razak A Ebinesan A Charalambous C
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Summary Statement

Routine metal allergy screening prior to joint arthroplasty is not essential and the use of cobalt chromium or stainless steel implants is recommended regardless of the patient's metal allergy status.

Introduction

This study was undertaken to obtain a consensus amongst joint arthroplasty experts with regards to metal allergy screening prior to joint arthroplasty and the choice of implant in patients with potential metal allergy.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 505 - 505
1 Sep 2012
Wall A Wall A Hassan S Charalambous C
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Approximately 30000 total knee replacements are performed annually in the UK. Standard practice is to obtain a radiograph during the initial post-operative period. We performed a retrospective review of 638 total knee replacements and found no significant complications were visible on post-operative radiographs. There were 4 cases of mild femoral notching. Cessation of initial radiographs could save the NHS two million pounds annually. We suggest check radiographs in the initial post-operative period are unnecessary and waste valuable resources which could be distributed elsewhere.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 294 - 294
1 Jul 2011
Mulgrew E Sahu A Charalambous C Ravenscroft M
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Purpose: Tension band wiring is the most common surgical procedure for fixation of fractures of the Olecranon, but it is associated with high rate of metal work complications and implant failure leading to re-operation.

Method: We present a new fixation technique for olecranon fractures that avoids reoperation to remove hardware as compared with the standard fixation technique with Kirschner wires and tension band wiring as advocated by the AO technique. We describe fixation of displaced transverse and oblique olecranon fractures with anchor sutures, each of which has two pairs of suture strands. Prior to the insertion of the anchor sutures, the fracture is reduced through a standard open approach

Results: Twelve patients have been treated with this technique so far, with a mean follow-up of 6 months. The mean age of the patients was 46.7 years (range 14–75 yrs). We have followed all these patients till union of the fractures. No immediate complications have been noted. Radiographic results are good, with no loss of reduction.

Conclusion: This technique avoids the need for reop-eration for hardware removal without compromising the quality of reduction. It may be argued that anchor sutures may cost more than tension band wiring which is a very low cost procedure. At the same time, we should also consider the future cost involved because of reoperation rate and morbidity. Our newly described technique would be particularly useful in dealing with olecranon fractures in children where it is undesirable to cross the physeal plate by metal work. It would also be of great value in dealing with intra articular distal humeral fractures where fixation is planned initially but conversion to total elbow replacement becomes essential intra-operatively. In such cases an olecranon osteotomy can be fixed by this technique, even in presence of a total elbow replacement.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 413 - 414
1 Jul 2010
Abiddin Z Howard K Charalambous C Sutton P Parkinson R
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We report our experience with LCS Patellofemoral joint replacement. Between September 2003 and November 2007, 66 consecutive patients were reviewed retrospectively who underwent LCS patellofemoral joint replacement. There were 13 males and 51 females with a mean age of 61.6 years (range 43–78). The average follow-up was 22 months (range 11–51 months). To assess the outcome, revision for any cause was taken as the end point for this study.

A total of 14 (21.2%) revision operations were carried out at an average of 15.6 months (range 8–29 months) from the initial operation. The reasons for revision were mal-tracking of patella (3), dislocated patellar button (2), persistent unexplained pain (5) and progression of arthritis (4). Amongst the remaining 52 patients, 8 are still experiencing pain and not entirely satisfied with the procedure. 42 patients (63%) have a satisfactory outcome so far. All of them who underwent revision to a total knee replacement were satisfied with their outcome with relief in their symptoms. Revision to a total knee replacement is not a straightforward procedure, especially removing the metal backed patellar component.

The revision rate of over 21% is unacceptably high to recommend the procedure as a routine. Based on our experience, we conclude that LCS patellofemoral replacement should be used with caution.


The Journal of Bone & Joint Surgery British Volume
Vol. 84-B, Issue 7 | Pages 1086 - 1087
1 Sep 2002
CHARALAMBOUS C ELLIS D