Purpose

To review the outcomes of patients undergoing manipulation under anaesthetic (MUA) after primary total knee arthroplasty (TKA) and predict those that may require such a procedure.

Purpose

To review the outcomes of patients undergoing manipulation under anaesthetic (MUA) after primary total knee arthroplasty (TKA) and predict those that may require such a procedure.

The Patient Evaluation Measure (PEM) was designed at the Derby consensus meeting in 1995. It was validated for Carpal Tunnel Syndrome (CTS) in 2005 (Hobby et al) and was preferable to the DASH score for CTS assessment. We aimed to audit CTS treated by surgical decompression in our unit using the PEM, and to compare our results with the published literature.

Thirty consecutive patients undergoing carpal tunnel decompression were questioned about one hand. Patients completed a preoperative PEM and a postoperative PEM at 3 months.

Mean PEM scores improved from 41.3 to 23.9 (P< 0.001). Individual questions showed statistically significant improvements in mean scores: Feeling in the hand, Cold intolerance, Pain, Dexterity, Movement and Hand in general (all P< 0.001): Work (P< 0.005): ADL (P< 0.01): Movements, Grip and Appearance (P< 0.05). Our results are similar to previously published series, both overall, and for individual questions in the PEM.

Results for Carpal Tunnel Decompression in our unit match those of other units. We found the PEM was easy to use; and effective, both in the assessment of patients with CTS, and for outcome measurement following surgical decompression. Our study supports the idea that the PEM could be used widely as an audit tool, to assist Hand Surgeon and/or Hand Surgery Unit Appraisal.

Aim: To report outcomes of high tibial osteotomies (HTO) in the treatment of patients with symptomatic varus-osteoarthritic knees.

Methods: Fourteen patients had a medial opening wedge HTO between 2001–2008. Twelve were male, mean age 42.2 years (range 33–49). Follow-up range 8–72 (mean 31 months). Six had simultaneous ACL reconstruction (one a revision another part of multiligament reconstruction). X-rays were taken at follow-up at 6, 12, 24, 36 and 52 weeks. Patients had pre- and post-operative KOOS assessment.

Results: All patients achieved a pain free leg with radiological evidence of union at mean 4.7 months (range 3–9). Two major complications occurred in one patient (PE and sensory neuropraxia). Minor complications in three patients: cellulitis, donor site infection, 1cm limb length discrepancy. Six patients required 7 further procedures: 2 arthroscopic chondral debridements, 2 microfractures and 3 arthroplasties. Tibial knee varus angles improved from mean 4.7° to 0.28°. KOOS scores improved in all domains: pain 28.5 to 52.8 (P< 0.01), symptoms 30.4 to 48.2 (P< 0.01), ADL 31.3 to 54.4 (P< 0.05), sport and recreation 2.5 to 7.5 P=0.125 and QOL 4.69 to 17.2 (P< 0.05). Kaplan-Meier survival analysis with failure defined as conversion to TKR shows a survivorship of 78.8% at 3 years.

Conclusions: Young patients with medial compartment osteoarthritis can have improved pain and function after HTO.

Better results are reported in the literature. However, some papers suggest osteotomies have been carried out in relatively asymptomatic patients and others accept significant pain in longer follow-up intervals without their patient cohorts having been offered alternative pain relieving strategies, such as chondral resurfacing or arthroplasty.

Patients require careful counselling that they will not achieve normal function and have a high incidence of need for further intervention.

Leg length discrepancy (LLD) is a recognised complication of total hip arthroplasty. LLDs can cause abnormal weight bearing, leading to increased wear, aseptic loosening of replacement hips and pain. To compensate for LLDs the patient can either flex the knee of the long leg or tilt their pelvis. The aim of this project was to investigate how stance affects static limb loading of patients with leg length discrepancy.

A pedobarograph was used to measure the limb loading of 20 normal volunteers aged 19 to 60. A 2 second recording with both feet on was taken to establish their body weight. Readings were taken of the left foot with the right level, 3.5cm lower (simulating a long left leg) and 3.5cm higher. In each case three readings were taken with the knee flexed and three readings with the knee extended.

When both feet were at the same level, the left limb took 54% of the load.

When the right foot was lower and the left knee flexed, the left leg took 39 % of the load (P < 0.001) (paired t-test). When the left knee was extended the left leg took 49 % of the load (P = 0.074).

With the right foot higher and right knee flexed, the left leg took 65 % of the load (P < 0.001). When the right knee was extended the left leg took 58 % of the load (P = 0.069).

These results show that weight distribution is increased in the simulated shorter limb. Loading is greater when the longer limb is flexed. Tilting the pelvis reduced the load. However this may cause pelvic and spinal problems.

Uneven load distribution is likely to lead to early fatigue when standing and may explain why some post arthroplasty patients with limb length discrepancy have poor outcomes.