The aim of this study was to document the survivorship and patient reported outcome of the Avon patello-femoral replacement in a consecutive series with follow up of 10 years or more. All cases performed in Bristol from 1996 onwards were prospectively recorded. Follow up was at 1,2,5,7,10,12 and 15 years with the Bristol Patella Score, the Oxford and WOMAC scores and SF12. Implant survival was analysed using the Kaplan-Meier method. There were 323 PFJ replacements (280 individuals). Follow up was available for 286 cases in 250 patients (89% follow up). The 10 year survival rate was 77%, falling to 67% at 15 years. The most common reason for revision was tibio-femoral progression (45/74 revisions), with loosening or polyethylene wear recorded in 8 cases. The best results were seen in the youngest and the oldest patients. Good improvements were seen in PROMs, with the mean OKS improving from 19.5 to 34.1 at 2 years and 32.7 at the 15 years. The Avon patello-femoral knee replacement is a successful long-term treatment for isolated patello-femoral knee osteoarthritis, although further improvements are expected in subsequent series, particularly as indications for surgery have evolved over time.
Total knee arthoplasty (TKA) remains a standard treatment for advanced knee arthritis. The aim of the procedure is to restore function and relieve pain ideally for the rest of patient's life. Patient matched templating (PMT) or patient specific instrumentation (PSI) is a recent development for alignment of TKA components that uses disposable guides. The users of PSI claim it to be the optimum balance of new technology and conventional technique by reducing the complexity of conventional alignment and sizing tools. To assess the clinical and radiological outcome of Primary TKA done with PSI. More than 200 cases of TKA have been done in our unit using PSI and we analysed the radiographic outcome of these cases postoperatively. We also reviewed the clinical outcome of 103 patients with 1 year and 43 patients with 2 year follow-up. Data was collected prospectively: pre-operatively and at 1 year and 2 years post-operatively including Oxford knee score (OKS), WOMAC and American knee society score (AKS). Standard AP and lateral films were done pre-operatively and post-operatively. Mean age was 66 years. There were 56 female and 47 male patients. Mean post-operative angles on standard films were: Alpha = 95.6, Beta = 88.4, Saggittal femur = 3.4 and Saggittal tibia = 90.8. Of the 103 cases with 1 year follow-up, there was significant improvement in all clinical outcome scores. Mean OKS improved from 18 to 39 at 1 year and remained the same at 2 years, WOMAC improved from 40 to 18 in both 1 and 2 years post-op. AKS Total improved from 79 to 173 at 1 year and 170 at 2 years. Performing TKA using PSI is safe and provides good radiological alignment in the coronal and sagittal plane. Significant improvement in outcome scores were seen at one and two year follow up and reached levels that compared favourably with other reported series of TKA outcome from our unit.
It has been reported that some of the local anaesthetic agents possess antimicrobial activity against clinically-significant bacteria. Although bupivacaine exhibits a bacteriostatic effect at concentrations above 0.25% there are concerns that it might interact with some of the other antibiotics administered to patients. Whilst these interactions may be potentially benign, the risk is that they are antagonistic and that local bupivacaine might predispose the patient to a higher risk of infection. Bupivacaine is commonly administered as a local anaesthetic following knee arthroplasy; the purpose of this study was to assess its potential interactions with gentamicin eluting from the cement used to fix the device. A strain of Saphylococcus aureus (29213) with established susceptible Minimal Inhibition Concentration (MIC) and Minimal Bactericidal Concentration (MBC) for gentamicin was used. This organism was inoculated into four types of broth; Mueller-Hinton broth (MH), MH with different concentrations of gentamicin, MH with 0.25% and 0.125% bupivacaine and MH with various combinations of gentamicin and bupivacaine. The broths were incubated at 37C and at 0.5, 1, 2, 3, 6 and 24 hours post inoculation the number of bacteria remaining were counted. From these data kill-curves were generated describing the absolute and individual rates of killing seen with bupivacaine and gentamicin alone and when in combination. Bupivacaine showed a bacteriostatic effect only at concentrations of 0.25% and higher. All concentrations of gentamicin above or equal to the expected MBC showed bactericidal effect. However, in combination with both strengths of Bupivacaine (0.25 and 0.125%) the bacteriocidal effect of gentamicin was seen at a lower concentration and the rate of killing of bacteria was enhanced. Bupivacaine has bacteriostatic effect at concentrations above 0.25% in line with published data. In these experiments we have shown that the use of bupivacaine together with gentamicin does not reduce the bactericidal property of the antibiotic and that the bactericidal effect of gentamicin appears to be enhanced by bupivacaine. This would suggest that the local use of bupivacaine is unlikely to increase the risk of infection in patients undergoing knee arthroplasty and may actually be beneficial.
This is a prospective review of consecutive patients who underwent knee revision surgery using the Legion knee system. Clinical and functional assessments (American Knee Scores-AKS, WOMAC and Oxford knee score-OKS) were carried out preoperatively, one year and 2 years post op. Radiographic evaluation was done at 1 and 2 years included review of standing AP, lateral and skyline views. Figgie's method was used to measure the joint line reproduction. 210 patients underwent revision knee system 103 male: 107 females with a mean age of 66.4 (44–87) yrs. Mean BMI-26.03 (21–50). We had a 2-year follow up for 110 patients. Surgery was carried out at a single centre and performed by Bristol knee specialists. Indications for surgery were aseptic loosening (84), infection (27) instability (47), pain and stiffness (31), progression of disease (6), peri-prosthetic fractures (15) The AKS and WOMAC scores at, 1 year and 2 years follow up showed significant improvements in pain and function. The mean total AKS improved from 75.7/200 pre-operatively to 140.5/200 at 2 yrs. Radiographic assessment showed a mean AP coronal femoral angle of 95.3 degrees (89.6–99.9), coronal tibial angle of 90.1 degrees (88–92). The mean sagittal femoral and tibial angles were 88.4 and 90.4 degrees respectively. The short-term results showed significant improvement in functional and pain scores irrespective of indications for revision surgery. The Legion system has showed good outcome scores that match or beat published series on revisions. It also showed a good ability to restore joint line.
To assess the outcome and complication rate of rotating hinge knee prostheses in our unit. From our knee database we have identified 137 consecutive rotating hinged TKRs (implanted 2004–2010) for severe instability, arthrofibrosis and severe bone loss in either primary or revision arthroplasty. Prospective pre-operative scores and post-operative scores were obtained. 23 had died or were lost to follow-up. This left 114 cases with complete outcome and complication data.Aim
Method
The aim of this study was to study the short to medium term outcome of a contemporary modular revision knee system used in our centre for managing knee revision arthroplasty. Between July 2006 and October 2011, 153 revision cases were done using the Legion revision system. Seventy eight cases completed a 2 years follow up. Preoperative, one and two years follow up scores and radiographic analysis were recorded. Outcome measures included the American Knee Society (AKSS), Oxford (OKS) and WOMAC scores. The American knee society radiographic analysis system was employed to assess assessment standing AP, lateral and skyline views. Figgie's method was used to measure the joint line reproduction. A difference of 5 mm (pre=op/post-op) was deemed satisfactory.Objectives
Methods
To assess the clinical outcome at 1 year of 30 cases of primary TKA performed with PMCB. Data was collected prospectively pre-operatively on over 100 primary TKA's performed with PMCB. Of these cases, 30 have reached a point of 1 year follow-up. Validated outcome measures including American Knee Society score, Oxford Knee Score and WOMAC were completed pre-operatively and at 1 year. Radiographic analysis of alignment was performed.Aim
Method
To assess the process of using patient matched cutting blocks in Primary TKA with respect to: radiology, the proposed engineering plans, the process in theatre and cost effectiveness. Background: Patient matched cutting blocks (PMCB) are the subject of much interest in primary TKA. Our unit has experience of over 100 cases with a single system. We have analysed our initial experience with PMCB. We have compared the sizes of implants used in theatres versus the sizes predicted on the image-generated plans. We have assessed the potential time saving in theatre, during each case and in the turn-around time between cases. We have also looked at the number of trays of instruments used in PMCB versus non-PMCB cases.Aim
Method
To assess the survivorship of unicompartmental replacements (UKR) revised to UKR. Background: Partial revision of UKR, or revision to a further UKR is a rarely performed procedure with some data from the Australian registry suggesting that results are not good, with early revision being required. All revision procedures from initial UKR are prospectively followed and scored as part of our department's knee database. We analysed the 37 cases in our database that showed revision of UKR to UKR. These included cases in the following categories: a) Mobile bearing revised to mobile bearing (n=8) b) Mobile bearing revised to fixed bearing (n=20) c) Fixed bearing revised to fixed bearing (n=9)Aim
Method
The gold standard for measuring knee alignment is the lower limb mechanical axis. This is traditionally assessed by weight-bearing full length lower limb X-rays (LLX). CT scanograms (CTS) are however, becoming increasingly popular in view of lower radiation exposure, speed and supine positioning. We assessed the correlation and reproducibility of knee joint coronal alignment using these two imaging modalities. LLX and CTS images were obtained in 24 knees with degenerate joint disease or failed TKR. Hip to ankle mechanical alignment were measured using the PACS software. Coronal knee alignment was assessed from the centre of the knee, measuring the valgus/varus angle relative to the mechanical axis. Measurements were made by two orthopaedic surgeons (Research Fellow and Consultant) on two separate occasions. The mean alignment angles measured by observers 1 and 2 on CTS were 180.29° (SD 6.04) and 180.71° (SD 6.13) respectively, while on LLX were 181.04° (SD7.58) and 181.04° (SD 7.72). The measurements between the two observers were highly correlated for both the CTS (r = 0.97, p < 0.001) and the LLX (r = 0.99, p < 0.001). The angles measured on CTS and LLX were highly correlated (r = 0.826, p < 0.001) with high degree of internal consistency (ICC = 0.804). Malalignment of greater than 5° was seen in 19% of the CTS and 35% of the LLX. There was good correlation between CT scanogram and weight-bearing X-ray measurements in normally-aligned knees. However, as expected, in the malaligned lower limb, the influence of weight-bearing is critical which demonstrates the significance of weight-bearing X-rays.
Patello-femoral arthritis can result in a considerable thinning of the patella. The restoration of an adequate patella thickness is key to the successful outcome of knee arthroplasty. The objectives were (1) to establish a reproducible patella width:thickness index including chondral surface and (2) to investigate whether there is a difference between bone alone and bone/chondral construct thickness as shown by MRI. Forty three MRI scans of young adults, mean age 27 (range 17–38), 34 male and 9 female, were studied. Exclusion criteria included degenerative joint disease, patello-femoral pathology or age under 16/over 40 (102 patients). The bony and chondral thickness of the patella and its width were measured. Inter/intra observer variability was calculated and correlation analysis performed. We found a strong correlation between patella plus cartilage thickness and width (Pearson 0.75, P < 0.001). The mean width:thickness ratio was 1.8 (SD 0.10, 95% CI 1.77–1.83). Without cartilage the ratio was 2.16 (SD 0.15, 95% CI 2.11–2.21), correlation was moderate (Pearson 0.68, P < 0.001). The average patella cartilage thickness was 4.1mm (SD 1.1, 95% CI 3.8–4.5). The narrow confidence intervals for the ratio of patella width:thickness suggest that patella width can be used as a guide to accurate restoration of patella thickness during total knee or patella-femoral replacement. We would recommend a ratio of 1.8:1.
We present a prospective, randomised, single-centre, multi-surgeon, controlled trial comparing minimally invasive (MIS) and standard approach total knee arthroplasty (TKA). 86 patients undergoing 92 total knee replacements were recruited. 46 operations were randomised to the MIS treatment arm, 46 to the standard control arm. Data collected included postoperative blood loss, length of stay and complications. Patients underwent surgery via a quadriceps sparing or standard medial parapatella approach. All operations were performed using MIS instruments and an identical postoperative care pathway. The MIS group had a significantly shorter length of stay (1.4 days, p=0.004) and fewer complications (p=0.003). Demographics, operative time blood loss and radiographic alignment were comparable between the groups. There were no deaths, pulmonary emboli or surgical site infections. 1 patient developed DVT and 1 required revision for pain and failure to regain flexion within 9 months of surgery, both in the control group. Nine percent of MIS patients versus 35% controls suffered a complication delaying discharge, of which 2% and 17% related to surgical site problems respectively. MIS resulted in a shorter admission and fewer complications, whilst achieving satisfactory component alignment. We discuss the potential economic implications.
Patients with severe knee instability and extensive bone loss remain a surgical challenge. In such cases, regular knee implants and constrained condylar implants may not be suitable or have been attempted and failed. Hinged knee replacements have developed an important role in the management of such complex knee cases. They also have an increasingly important role in cases such as rheumatoid arthritis and other cases of severe joint destruction. We present a review of 138 consecutive hinge knee arthroplasties of 8 different Hinge models performed in our unit between 2004 and 2010. Combined prospective and retrospective study of 138 (42 primary and 96 revisions) consecutive cases of Hinge knee replacements at a mean follow up of 4.2 years. Outcomes were recorded and scored using the American knee score preoperatively, 1, 2 and 5 years. Complications, re-revisions, implant failures and survivorship were also assessed.Introduction
Method
The legion knee revision system was designed as a follow and improvement to the Genesis II knee system- allowing for a surgeon directed femoral rotation as opposed to the in-built femoral rotation in the previous system. This is a prospective review of consecutive patients who underwent knee revision surgery using the legion knee system. Clinical and functional assessments were carried out preoperatively, one year and 2 years post op. Radiographic evaluation was done at 1 and 2years follow up. Standard knee scoring systems (American Knee Scores-AKS, and Oxford score were used for the clinical and functional evaluation of these patients. The WOMAC score was also used to assess for pain, stiffness and social function in these patients. The radiographic assessment included review of standing AP, lateral and skyline views. Figgie's method was used to measure the joint line reproduction. A difference of 5 mm (pre = op/post-op) was deemed satisfactory.Introduction
Methods
The aim of this study was to compare the short-term and mid-term outcome of lateral UKRs using a single prosthesis, the AMC Uniglide knee implant. Between 2003 and 2010, seventy lateral unicompartmental knee replacements (mean patient age 63.6±12.7 years) were performed at our unit for isolated lateral compartmental disease. Range of knee motion and functional outcome measures including the American Knee Society (AKSS), Oxford (OKS) and WOMAC scores were recorded from 19 knees at five years' post-operatively and compared to 35 knees at two-years and 53 knees at one-year post-op.Purpose
Methods
Kneeling ability is better in unicompartmental than total knee arthroplasty. There is also an impression that mobile bearing knees achieve better functional outcome than their fixed bearing cousins in unicompartmental and to a lesser extent total joint arthroplasty. In the UK, the market leading unicompartmental replacement is mobile bearing. To analyse kneeling ability after total and unicompartmental knee replacement using mobile and fixed bearing inserts.Introduction
Aim
The aim of this study was to study the short-term outcome of a contemporary modular revision knee system used in our centre for managing Knee revision arthroplasty Preoperative, one and two years follow up scores and radiographic analysis were recorded from 72 consecutive knee revision cases performed between 2006 and 2008. Outcome measures included the American Knee Society (AKSS), Oxford (OKS) and WOMAC scores and range of motion. The radiographic assessment included review of standing AP, lateral and skyline views. Figgie's method was used to measure the joint line reproduction. A difference of 5 mm (pre=op/post-op) was deemed satisfactory.PURPOSE
METHODS
Body Mass Index (BMI) is used to quantify generalised obesity, but does not account for variations in soft tissue distribution. To define an index quantifying the knee soft tissue depth, utilising underlying bony anatomy, and compare with BMI as a measure of individual patient's knee soft tissue envelopes. We performed a practicality and reproducibility study to validate the Bristol Knee Index for future prospective use.Background
Aims
Assessing medium term outcome of medial Uni compartmental replacement and whether there is a difference in outcome between mobile and fixed bearing variants of the same prosthesis. Knee outcome was assessed in 150 patients (81 male, 69 females, mean age 67.0±10.4yrs) undergoing medial UKR knee (Uniglide, Corin Medical, UK) using either fixed or mobile bearing prosthesis between 2002-2007. All operations were performed by members of the Bristol knee group. All patients were scored using the American Knee Score (AKS), Oxford Knee Score (OKS), and WOMAC pre-operatively and at 2-year follow up. The mobile group (n=93) comprised 43 males and 50 females, aged 62.8±8.9yrs. The fixed bearing group (n=57) comprised 38 males and 19 females, aged 74±8.8yrs.Purpose of the study
Methods
To compare minimally invasive (MIS) and standard surgical total knee replacement technique through a prospective, randomised, single-centre, multi-surgeon, controlled trial. Between March 2007 and May 2009, 70 patients undergoing 73 total knee replacements were recruited. 31 operations were randomised to the MIS treatment arm, 42 to the standard control arm. Data were collected for mode of anaesthesia, American Society of Anaesthesiologists' score (ASA), surgical time, Postoperative blood loss within surgical drains, length of stay and complications. Patients underwent surgery via a mini-mid vastus approach or medial parapatella approach (controls). All operations were performedAim
Methods
