Introduction

Many prosthetic design changes have been introduced in attempt to improve outcomes following TKA; however there is no consensus as to whether these changes confer benefits to patients. This study aimed to assess whether patients treated with a modern implant design had an enhanced patient outcome compared to a traditional model in a double blind randomised controlled trial.

Patient expectations and their fulfilment are an important factor in determining patient-reported outcome and satisfaction of hip (THR) and knee replacement (TKR). The aim of this prospective cohort study was to examine the expectations of patients undergoing THR and TKR, and to identify differences in expectations, predictors of high expectations and the relationship between the fulfilment of expectations and patient-reported outcome measures. During the study period, patients who underwent 346 THRs and 323 TKRs completed an expectation questionnaire, Oxford score and Short-Form 12 (SF-12) score pre-operatively. At one year post-operatively, the Oxford score, SF-12, patient satisfaction and expectation fulfilment were assessed. Univariable and multivariable analysis were performed. Improvements in mobility and daytime pain were the most important expectations in both groups. Expectation level did not differ between THR and TKR. Poor Oxford score, younger age and male gender significantly predicted high pre-operative expectations (p < 0.001). The level of pre-operative expectation was not significantly associated with the fulfilment of expectations or outcome. THR better met the expectations identified as important by patients. TKR failed to meet expectations of kneeling, squatting and stair climbing. High fulfilment of expectation in both THR and TKR was significantly predicted by young age, greater improvements in Oxford score and high pre-operative mental health scores. The fulfilment of expectations was highly correlated with satisfaction.

Introduction

Osteoarthritis continues to be a major cause of pain and disability. The pathological processes leading to the end-stage of joint degeneration remain poorly understood. Advances in radiological imaging have the potential to improve understanding of the structural and functional changes observed in OA. The aim of this study was to describe the microarchitecture of the femoral head in osteoarthritis.

Aim

To investigate the incidence, types and trends in diagnosis of venous thromboembolic events (VTE) in patients undergoing total knee arthroplasty (TKA) over a ten-year period.

There is widespread appreciation amongst orthopaedic surgeons of the importance of thromboprophylaxis. However much of the evidence is based on surrogate outcomes of clinical end-points. This population-based study aims to identify the incidence and trends in venous thromboembolic disease (VTE) following total hip (THR) and knee arthroplasty (TKR) with death or readmission for VTE up to two years following surgery for all patients in Scotland as the primary outcome.

We used the Scottish Morbidity Record (SMR01) system to identify all patients undergoing hip or knee arthroplasty over the ten-year period from 1992 to 2001. Patients undergoing cataract surgery over the same period were identified as a control group. Record linkage for all patients to subsequent SMR01 and Registrar General records provided details of further admissions due to DVT or non-fatal PE and deaths within Scotland up to two years after the operation. The cause of death was determined from the Registrar General Records.

The incidence of VTE (including fatal pulmonary embolism (PE)) three months following primary THR was 2.27% and primary TKR was 1.79%. The incidence of fatal PE within three months of THR was 0.22% and TKR was 0.15%. The majority of events occurred in the interval from hospital discharge to six weeks after surgery. There was no apparent trend over the period. An apparent reduction in the overall mortality within 365 days of surgery appears to be due to a reduction in the incidence of acute myocardial infarct.

The data support the current advice that prophylaxis should be continued for at least six weeks following surgery. Despite increased uptake of prophylaxis regimens and earlier mobilisation, there has been no apparent change in the incidence of symptomatic VTE over the ten-years from 1992 to 2001.

This population-based study investigated the incidence and trends in venous thromboembolic disease after total hip and knee arthroplasty over a ten-year period. Death or readmission for venous thromboembolic disease up to two years after surgery for all patients in Scotland was the primary outcome. The incidence of venous thromboembolic disease, including fatal pulmonary embolism, three months after surgery was 2.27% for primary hip arthroplasty and 1.79% for total knee arthroplasty. The incidence of fatal pulmonary embolism within three months was 0.22% for total hip arthroplasty and 0.15% for total knee arthroplasty. The majority of events occurred after hospital discharge, with no apparent trend over the period. The data support current advice that prophylaxis should be continued for at least six weeks following surgery. Despite the increased use of policies for prophylaxis and earlier mobilisation, there has been no change in the incidence of venous thromboembolic disease.