Our aim was to examine the clinical and radiographic outcomes
in 257 consecutive Oxford unicompartmental knee arthroplasties (OUKAs)
(238 patients), five years post-operatively. A retrospective evaluation was undertaken of patients treated
between April 2008 and October 2010 in a regional centre by two
non-designing surgeons with no previous experience of UKAs. The
Oxford Knee Scores (OKSs) were recorded and fluoroscopically aligned
radiographs were assessed post-operatively at one and five years.Aims
Patients and Methods
The aim of this study was to present data on 11 459 patients
who underwent total hip (THA), total knee (TKA) or unicompartmental
knee arthroplasty (UKA) between November 2002 and April 2014 with
aspirin as the primary agent for pharmacological thromboprophylaxis. We analysed the incidence of deep vein thrombosis (DVT) and pulmonary
embolism (PE) then compared the 90-day all-cause mortality with
the corresponding data in the National Joint Registry for England
and Wales (NJR). Aims
Patients and Methods
In an initial randomised controlled trial (RCT)
we segregated 180 patients to one of two knee positions following total
knee replacement (TKR): six hours of knee flexion using either a
jig or knee extension. Outcome measures included post-operative
blood loss, fall in haemoglobin, blood transfusion requirements,
knee range of movement, limb swelling and functional scores. A second
RCT consisted of 420 TKR patients randomised to one of three post-operative
knee positions: flexion for three or six hours post-operatively,
or knee extension. Positioning of the knee in flexion for six hours immediately
after surgery significantly reduced blood loss (p = 0.002). There
were no significant differences in post-operative range of movement,
swelling, pain or outcome scores between the various knee positions
in either study. Post-operative knee flexion may offer a simple
and cost-effective way to reduce blood loss and transfusion requirements
following TKR. We also report a cautionary note regarding the potential risks
of prolonged knee flexion for more than six hours observed during
clinical practice in the intervening period between the two trials,
with 14 of 289 patients (4.7%) reporting lower limb sensory neuropathy
at their three-month review. Cite this article:
The Cementless Oxford Unicompartmental Knee Replacement
(OUKR) was developed to address problems related to cementation,
and has been demonstrated in a randomised study to have similar
clinical outcomes with fewer radiolucencies than observed with the
cemented device. However, before its widespread use it is necessary
to clarify contraindications and assess the complications. This
requires a larger study than any previously published. We present a prospective multicentre series of 1000 cementless
OUKRs in 881 patients at a minimum follow-up of one year. All patients
had radiological assessment aligned to the bone–implant interfaces
and clinical scores. Analysis was performed at a mean of 38.2 months
(19 to 88) following surgery. A total of 17 patients died (comprising
19 knees (1.9%)), none as a result of surgery; there were no tibial
or femoral loosenings. A total of 19 knees (1.9%) had significant
implant-related complications or required revision. Implant survival
at six years was 97.2%, and there was a partial radiolucency at
the bone–implant interface in 72 knees (8.9%), with no complete radiolucencies.
There was no significant increase in complication rate compared
with cemented fixation (p = 0.87), and no specific contraindications
to cementless fixation were identified. Cementless OUKR appears to be safe and reproducible in patients
with end-stage anteromedial osteoarthritis of the knee, with radiological
evidence of improved fixation compared with previous reports using
cemented fixation. Cite this article:
A prospective study of 276 TKA's performed in patients with valgus knee deformity ≥ 10° using a Modified Surgical Technique. Bone cuts were used to balance the valgus knee and soft tissue release was confined to the postero-lateral capsule in severe deformity. The aim was to restore a “functional mechanical axis” as opposed to a “neutral” mechanical axis. All surgeries were performed between Jan2003 and Apr2007, under the care of a single surgeon using an LCS rotating platform. All patients had full length radiographs and outcome scores collected prospectively. The mean coronal alignment of the lower limb was corrected from 15.9°(10-45°) to 3.8°. 94% patients had their coronal alignment restored to = 7°. Sixteen knees with postoperative valgus ≥8° were analysed as a separate group. The mechanical axis deviation was corrected from 52.3mm to 8.8mm. The distal femoral cut was made at 5° valgus in 131 knees(47.5%), 6° in 111 knees(40.2%) and 7° in 24 knees(8.7%).78 knees(28%) were balanced only with bone cuts. 198 knees(72%) had release of posterolateral capsule. 16 knees(5.8%) also had release of IT band. Lateral patellar release was performed in 39 knees (14%) and 23 knees had patella contouring. 93%knees had central patello-femoral alignment postoperatively. One spinout was managed by closed reduction and a second patient had revision of tibial tray for collapse. Patellar subluxation occurred in two patients. The oxford knee score and the American Knee Society clinical score improved from 48.5 to 26 and 21.04 to 86.03 respectively.MATERIALS AND METHODS
RESULTS
Between April 1992 and July 2005, 310 posterior lip augmentation devices were used for the treatment of recurrent dislocation of the hip in 307 patients who had received primary total hip replacements (THRs) using Charnley/Charnley Elite components with a cemented acetabulum. The mean number of dislocations before stabilisation with the device was five (1 to 16) with a mean time to this intervention from the first dislocation of 3.8 years (0 days to 22.5 years). The mean age of the patients at this reconstruction was 75.4 years (39 to 96). A retrospective clinical and radiological review was carried out at a mean follow-up of six years and nine months (4.4 months to 13 years and 7 months). Of the 307 patients, 53 had died at the time of the latest review, with a functioning THR and with the posterior lip augmentation device
We report the result of 46 patients (30 female, 16 male) with periprosthetic femoral fractures who underwent insertion of the Kent Hip Prosthesis. Average age was 73 years (range 43–96years) and follow-up ranged from one to seven years (average, 4 years). The primary implants involved were as follows: Charnley (26), Austin Moore (6), Howse (5), Custom (4), Exeter (1), DHS (1), Thompson (1) and Richards (1). Average time to fracture from insertion of the primary implant ranged from 3 weeks to 20 years (average, 8 years). Forty cases were post-primary implant fractures (38 traumatic, 2 atraumatic) and 6 occurred intraoperatively. Using the Johanssen classification there were 12 type I, 30 type II and two type III fractures. Of the 46 cases, prior to fracture, 42 were living in their own home, 24 were mobile unaided and 20 had thigh and/or groin pain. Thirty-two had a loose stem and/or cup assessed at the time of surgery. Operating time was on average 143 mins (65–235mins). At latest follow-up, 43 were living in their own home, 5 were walking unaided and 10 had ongoing pain. In 34 cases complete union was achieved. There were no cases on non-union. Three patients required revision surgery for broken stems. Three patients sustained wound infections and there were six posterior dislocations. All of the complications were treated satisfactorily. We conclude that the Kent Hip Prosthesis is a useful option in the management of periprosthetic femoral fractures.
In Musgrave Park Hospital, Belfast, younger patients requiring THR were treated by custom-made titanium alloy femoral prosthesis. The identifit hips, which were used initially, were intraoperatively customised by preparing a silicon mould of the endosteal cavity and immediate computer assisted fabrication. The Xpress hips used measurements from preoperative marker x-rays allowing creation of templates and subsequent computer analysis to mill a stem prior to surgery. 7 identifit and 51 Xpress primary uncemented custom THRs were inserted in 50 patients between May 92 and June 96. The average age for the indentifit cases was 47 years (range 24–72) and the Xpress cases 39 years (range 23–51). The Xpress cases were followed up to an average of 47 months (range 12–74 months) and identifit cases to an average of 59 months (range 14–77 months). The indications for arthroplasty were osteoarthrosis in 15 hips, CDH in 14, dysplasia in 11, AVN in 4, rheumatoid arthritis in 3 and other diagnosis in 11. Clinical assessments were made using the Oxford score and the Modified Harris Hip score. The postoperative radiographs were evaluated for subsidence of the prosthesis; and adaptive osseous changes like osteolysis, hypertrophic cortical remodelling, sclerotic radiolucent line formation around the prosthesis and formation of a bone pedestal below the tip of the prosthesis. The average post-op Oxford hip score for those patients not revised was 32.5 /60 (range 12–51). 16 of the 51 Xpress hips underwent revision and 2 were awaiting revision, which is a failure rate of 35.3%. Of the identifit hips 1 out of the 7 was revised (14.3%). Overall 32.8% was the rate of failure. The average duration from primary operation to revision was 47 months for Xpress hips and 90 months for the identifit hips. Of the Xpress hips, revision was done for acetabular component in 1, femoral component in 4, both components in 1, acetabular liner + femoral head in 1 and acetabular liner + femoral component in 9. The 1 revision in the identifit hip was for recurrent dislocation. The reasons for revision in the Xpress hips were dislocation in 2 cases, loose femoral component in 13 cases and infection in 1. Average subsidence of the femoral component was 6mm (range 0–25.9) and this did not have significant correlation with predicting outcome. Pedestal formation (intramedullary formation of bone beneath the tip of the femoral stem) was seen in 87%, sclerotic rediolucent lines were seen in 64%, osteolysis was found in 31% and hypertrophic cortical remodelling was seen in 31%. These also did not reach significance in predicting outcome. Thus even though the idea of an uncemented custom THR is attractive, especially in the younger age group, the failure rate was found to be unacceptably high. On the basis of these data we have discontinued the use of this custom made non-porous uncemented femoral prosthesis.
