With up to 40% of patients having patellofemoral joint osteoarthritis (PFJ OA), the two arthroplasty options are to replace solely the patellofemoral joint via patellofemoral arthroplasty (PFA), or the entire knee via total knee arthroplasty (TKA). The aim of this study was to assess postoperative success of second-generation PFAs compared to TKAs for patients treated for PFJ OA using patient-reported outcome measures (PROMs) and domains deemed important by patients following a patient and public involvement meeting. MEDLINE, EMBASE via OVID, CINAHL, and EBSCO were searched from inception to January 2022. Any study addressing surgical treatment of primary patellofemoral joint OA using second generation PFA and TKA in patients aged above 18 years with follow-up data of 30 days were included. Studies relating to OA secondary to trauma were excluded. ROB-2 and ROBINS-I bias tools were used.Aims
Methods
A lipohaemarthrosis seen on Horizontal beam lateral X-ray in acute knee injury is often considered predictive of an intra-articular fracture requiring further urgent imaging. We retrospectively searched a five-year X-ray database for the term “lipohaemarthrosis”. We excluded cases if the report concluded “no lipohaemarthrosis” or “lipohaemarthrosis” AND “fracture”. All remaining cases were reviewed by an Orthopaedic Consultant with a special interest in knee injuries (AD) blinded to the report. X-rays were excluded if a fracture was seen, established osteoarthritic change was present, a pre-existing arthroplasty present or no lipohaemarthrosis present. Remaining cases were then studied for any subsequent Radiological or Orthopaedic surgical procedures.Abstract
Introduction
Methodology
Patella Baja is a known complication of TKR. In this study, we report the effect of the senior author's change of practice from total excision to minimal resection of Hoffa's fat pad on patellar height. Retrospective analysis of a prospective series of TKRs performed or directly supervised by the senior author. Group 1 included 72 patients performed before April 2011 who had complete excision of Hoffa's fat pad to improve exposure during their TKR procedures. Group 2 included 138 patients performed after April 2011 who had the minimum excision of Hoffa's fat pad to allow exposure. There were no other changes in surgical technique, implant choice or rehabilitation protocol during this time. Patellar height was measured using the Caton–Deschamps Index (CDI) on standard lateral radiographs immediately postoperative and at a minimum follow up of 1 year.Abstract
Introduction
Methods
The Coronavirus pandemic mandated an immediate and dramatic change in the delivery of acute trauma services to minimise face-to-face contact. In our hospital, patients presenting to the Emergency Department with a knee injury and no fracture seen on Xrays were referred to a “Virtual Fracture Clinic” (VFC) where Xrays and clinical notes were reviewed by the duty Trauma and Orthopaedic Consultant the following working day. We present the outcomes of 101 consecutive patients managed through this process and deemed to have a “Soft Tissue Knee Injury” with a minimum follow-up of six months. All Xrays were reviewed by a sub-specialist knee surgeon blinded to notes or clinical outcomes. Electronic clinical records were reviewed to determine further clinical appointments, surgical treatment and pending interventions. Of 101 patients, the knee surgeon diagnosed 1 Fracture, 4 Lipo-haemarthroses, 41 significant effusions and 55 patients with normal Xrays. Correlation to urgent surgery was 100% for fracture (1/1), 25% for Lipo-haemarthrosis (1/4), 7.3% for significant effusion (3/41) and 9.1% for normal Xrays (5/55). A further 9.8% (4/41) of the “effusion” group and 7.3% (4/55) of the “normal” group were subsequently listed for non-urgent surgery. Overall 17% (7/41) of “effusion” patients and 16% (9/55) of “normal” patients required surgery. Management plans from VFC varied within groups. Acute “soft-tissue” injuries of the knee in adults cannot be reliably managed via VFC based on X-ray findings. A staged review by an appropriately trained health professional could reduce demand on acute knee surgical clinics and may enhance patient outcomes.Abstract
Patellofemoral unicompartmental joint replacement is a controversial subject with a relatively small evidence base. Of the 50,000 total knee arthroplasties performed each year in the UK, approximately 10% are performed for predominantly patellofemoral arthritis. There are several patellofemoral unicompartmental prostheses on the market with the National Joint Registry recording 745 such prostheses used in 2007. Most evidence in favour of this procedure comes from experience with the Avon prosthesis (Stryker) predominantly from designer-surgeons. The FPV patellofemoral joint replacement (Wright Medical) has been in use in Europe for several years. The instruments have recently been redesigned and the device marketed in the UK. In 2007 the FPV had 5.9% market share (n=44). We present our early experience with the FPV patellofemoral joint replacement, which to our knowledge, is the first clinical outcome series for this prosthesis. 33 consecutive FPV joint replacements in 29 patients were performed between April 2007 and September 2009 for unicompartmental patellofemoral OA. All cases were performed or directly supervised by the senior author. Results are presented with a minimum follow-up of six months. Oxford and American Knee Society scores (AKSS) were obtained on all patients preoperatively and at subsequent outpatient visits. Mean preoperative AKSS knee score was 49.7 points and postoperative scores at 6 months and 1 year were 82.5 and 86.4 respectively. Mean Oxford score preoperatively was 30.4 (37%) and at 6 months and 1 year were 21.3 (56%) and 11.2 (77%) respectively. There were no complications related to the implant. One knee required a secondary open lateral release due to inadequate balancing at the index procedure. Further medium to long-term follow up data are required, but our initial experience with this device is encouraging.
We report the clinical results of seven consecutive allograft knee ligament reconstructions using Achilles tendon prepared using a chemical treatment process. Results have been disappointing with six clinical failures at short durations of follow-up. All allografts are not the same and the method of tissue preparation may have important consequences for clinical outcomes. Debate regarding the use of allograft or autograft tissue for knee ligament reconstruction continues. A variety of allograft tissues are available from commercial and NHS sources: fresh frozen, freeze dried, irradiated or chemically prepared. There are gaps in the literature with respect to clinical outcomes for these various methods of graft preparation. A recent systematic review indicated similar short-term clinical outcomes for fresh frozen allografts and autografts. The senior author began using allograft Achilles tendon for revision ACL reconstruction or primary multiple ligament reconstruction in 2007. Tissues were obtained from a commercial supplier. These tissues had been harvested in Eastern Europe, transported to the USA and sterilised using a patented “Biocleanse” chemical treatment process. This involves sequential ultrasonic baths of detergent, peroxide and alcohol for fixed periods of time along with pressure and vacuum cycles. Between April 2007 and April 2009, 7 allograft ligament reconstructions were performed in 5 knees. These comprised 5 ACL and 2 LCL reconstructions. At follow up of between 4 months and 2 years, clinical failure of 6 grafts has been observed. We are aware of one previous series of results for ACL reconstructions using chemically sterilised and irradiated allograft tissues. A 45% graft failure rate was reported. We have not been able to identify any clinical outcome studies for grafts prepared using the “Biocleanse” process. Our results have prompted us to change to UK sourced, donor screened allografts, which are fresh frozen after decontamination with 70% ethanol.
A total of 90 patients with an isolated rupture of the anterior cruciate ligament (ACL) had a reconstruction using the ipsilateral patellar tendon secured with round-headed cannulated interference screws. Annual review for five years showed three failures of the graft (two traumatic and one atraumatic); none occurred after two years. Ten patients sustained a rupture of the contralateral ACL. At five years, 69% of those with surviving grafts continued to participate in moderate to strenuous activity. Using the International Knee Documentation Committee assessment, 90% reported their knee as being normal or nearly normal and had a median Lysholm knee score of 96 (64 to 100). Most patients (98%) had a pivot shift of grade 0 with the remaining 2% being grade 1; 90% of the group had a Lachman test of grade 0. The incidence of subsequent meniscectomy was similar in the reconstructed joint to that in the contralateral knee. Radiological examination was normal in 63 of 65 patients. Our study supports the view that reconstruction of the ACL is a reliable technique allowing full rehabilitation of the previously injured knee. In the presence of normal menisci there is a low incidence of osteoarthritic change despite continued participation in sporting activity.
