Patient education programmes prior to hip and knee arthroplasty reduce anxiety and create realistic expectations. While traditionally delivered in-person, the Covid-19 pandemic has necessitated change to remote delivery. We describe a ‘Virtual Joint School’ (VJS) model introduced at Ysbyty Gwynedd, and present patient feedback to it.

Eligible patients first viewed online educational videos created by our Multi-Disciplinary Team (MDT); and then attended an interactive virtual session where knowledge was reinforced. Each session was attended by 8–10 patients along with a relative/friend; and was hosted by the MDT consisting of nurses, physiotherapists, occupational therapists, and a former patient who provided personal insight. Feedback on the VJS was obtained prospectively using an electronic questionnaire.

From July 2022 to February 2023, 267 patients attended the VJS; of which 117 (44%) responded to the questionnaire. Among them, 87% found the pre-learning videos helpful and comprehensible, 92% felt their concerns were adequately addressed, 96% felt they had sufficient opportunity to ask questions and 96% were happy with the level of confidentiality involved. While 83% felt they received sufficient support from the health board to access the virtual session, 63% also took support from family/friends to attend it. Only 15% felt that they would have preferred a face-to-face format. Finally, by having ‘virtual’ sessions, each patient saved, on average, 38 miles and 62 minutes travel (10,070 miles and 274 hours saved for 267 patients).

Based on the overwhelmingly positive feedback, we recommend implementation of such ‘Virtual Joint Schools’ at other arthroplasty centres as well.

Abstract

The final alignment of Patient Specific Instrumentation (PSI) TKA relies on the accuracy and the correct placement of the 3-D moulds, precision of saw cuts, soft tissue balancing and cementing technique. We aimed to compare the predicted alignment between PSI and Articulated Surface Mounted (ASM) computer navigation. Eight consecutive patients underwent knee replacement using MRI based PSI (Zimmer) with planning of 0º femoral and tibial mechanical alignment. After placing the conventional cutting blocks over the pins (placed according to PSI), the predicted alignment of cuts was verified with ASM navigation. PSI technique was used regardless of navigation values and alignment was compared.

Good correlation was found for tibial cuts (maximum variation: coronal plane – 1º, sagittal plane – 2º) and femoral cuts in the sagittal plane (maximum variation 2º). However, in two patients the coronal plane variation in femur was > 2º (3º and 4º respectively). Navigation predicted combined final alignment of 5º valgus and 4º valgus in these patients. However, long leg standing x-rays revealed neutral and 1º valgus alignment in those two patients respectively, matching closely with PSI prediction. Final alignment in long-leg standing x-rays were independently reported by a musculoskeletal radiologist. Six knees were in neutral mechanical alignment (including the 2 navigation predicted outliers). The remaining 2 knees had a maximum deviation of 2 degrees from neutral. We conclude that there was overall good correlation between PSI and navigation. Even in cases where navigation predicted more than 3º combined varus/valgus alignment, PSI prediction was more accurate on long leg views.

Patient specific instrumentation (PSI) is the latest advancement in total knee arthroplasty (TKA), which claims to improve alignment, simplify the surgical process, forecasts the component size and reduces the operating time. We discuss our experience of preoperative planning using default settings and making changes where necessary.

We analysed prospectively collected data in 100 consecutive PSI knee replacements (Zimmer®) performed in our institute during the period February to August 2012. All patients underwent MRI scans of the ipsilateral hip, knee and ankle joints. From the images, Materialise® (Leuven, Belgium) provided 3D model of the knee on which preoperative planning was done using PSI software. All default plans were checked and appropriate changes were made before the senior author approved final plan for preparation of patient specific moulds.

We made 636 changes (6.36 changes per knee) preoperatively from the default settings. In only 4% of the patients, the primary cuts needed revision. Thus in 96% of the cases, the primary cuts allowed optimal alignment and gap balancing with appropriate soft tissue release. Our preoperative planning predicted 99% of femoral and 98% of tibial component sizes definitively implanted.

Our results show the importance of the surgeon's input in approving preoperative planning with this technique.

Aim

To determine the outcome, the need for revision surgery, quality of life (QOL) of patients and the financial implications of instability following successful closed reduction of dislocation after primary total hip arthroplasty (THA).