Numbness around the surgical scar can be a source of discomfort in patients undergoing Total Knee Arthroplasty (TKA). Literature reports wide variation in its prevalence. The consequence of numbness on the functional outcome is not clear. We aimed to investigate the prevalence of numbness, along with factors affecting it, and assess its effect on the outcome of TKA. 258 patients who underwent TKA were included in the prospective cross sectional patient reported outcome measure (PROM) study. Demographic details, approach, length of incision, and the pre-operative and one year post-operative Knee Society Score (KSS) were recorded. A Dundee numbness classification was developed and used for the assessment and localization of numbness using e-Ruler® and Matlab® computer software.Background of study
Materials and methods
Numbness around the surgical scar can be a source of discomfort or dissatisfaction in a proportion of patients undergoing Total Knee Arthroplasty (TKA). Literature reports wide variation in its prevalence and the consequence of numbness on the outcome of TKA is not clear. We aimed to investigate the prevalence of numbness, along with contributing factors, and assess its effect on the functional outcome of TKA. A total of 258 patients were included in this prospective cross sectional patient reported outcome measure study. Demographic details, type and length of incision, and pre-operative and one year post-operative Knee Society Scores (KSS) were recorded and compared. A Dundee knee numbness classification was developed for the assessment of numbness. The prevalence of numbness at one year was 53%, with a female preponderance. Patients above 70 years were less affected. The BMI, laterality and incision length did not affect its occurrence. Discomfort due to numbness was recorded in 8.7% of patients, 75% of which were females. The incision length and numb area positively correlated. The KSS did not correlate with the presence or area of numbness. Our findings indicate a high prevalence of numbness after TKA. Nevertheless, numbness does not affect the functional outcome.
Pigmented Villonodular Synovitis (PVNS) is a rare inflammatory disorder of the synovium, bursa and tendon sheath. The objective of this study was to evaluate the long-term outcomes and morbidity associated with operative management of PVNS of the hand. Histological databases were retrospectively interrogated. All patients between 2003–2008 with confirmed PVNS of the hand were included in the study.Introduction:
Methods:
Endoprosthetic replacement of the proximal femur is common in the management of bone tumours and failed revision arthroplasty. This study seeks to compare those patients undergoing acetabular resurfacing at the time of femoral replacement with those patients where the native acetabulum was preserved. All proximal femoral replacements from 2004 to 2009 with a five year follow up were included. Case files were interrogated to identify those that had either revision surgery or dislocation of the hip.Introduction:
Methods:
Distal femoral replacement is recognised as the optimum treatment for malignant distal femoral tumours. Aseptic loosening is known to be a major cause for failure in these implants. Studies have indicated that the HA coated collar promotes osteointegration and bony in growth. This study compares long term aseptic loosening in implants with HA coated collars to those without in the immature skeleton. To assess the effect of HA coated collars on aseptic loosening in extendable distal femoral replacement prosthesis in the immature skeleton.Introduction:
Objectives:
Recent studies have indicated that healthy and willing patients above 80 years have similar outcomes as younger patients following arthroplasty. We wished to investigate the outcomes in a cohort of patients above 80 years who underwent medial unicompartment knee replacement (UKA). 46 patients (51 knees) with UKA aged 80 or more formed the study group. For comparison rest of the UKA patients in the database were divided into groups according to their age. Patients were reviewed and KSS, complication rates and patient satisfaction information was collected. Revision for any cause was considered an endpoint. Significance was set at < 0.05.Introduction
Material/methods
Although total hip arthroplasty (THA) has been shown to be a cost-effective means of treating hip arthritis, there is some ambiguity within the literature as to its success in those over 80 years of age. With the rapid expansion of this population group and an estimated 40% rise in THA figures expected by 2026, this study aims to review the results of primary THA in the octogenarian population. A series of 510 consecutive cases was obtained from the local arthroplasty database, consisting of all patients aged 80 years and over who underwent primary THA between 1994 and 2004. A control group of 3404 individuals under 80 years was also established using the same database and inclusion criteria. Mean follow-up for the octogenarian group was 5.9 years. Pain scores were comparable five years post-operatively in both groups (P=0.479); in particular 81.5% of octogenarians and 80.2% of the control noted no pain. Pre-operatively, the mean Harris Hip Function and Harris Hip Score were significantly lower in the octogenarian group by 4.3 and 4.2 points (P< 0.001), respectively, and at five years follow-up were also lower by 8.4 and 8.0 points, respectively (P< 0.001). Median hospital stay was three days longer in the elderly population (12 cf 9, P< 0.001). More complications occurred in the octogenarian group (38.1% cf 28.7% of controls, P< 0.001) however fewer cases of revision were noted (1.4% cf 3.8%, P=0.005). Kaplan-Meier analysis found implant survival time to revision to be comparable in both groups (mean 16.4 years in control cf 14.3 years in octogenarian, P=0.17). Patient satisfaction was also similar (97.8% in octogenarians and 98.1% in controls, P=0.741). This study suggests that individuals over 80 years of age have comparable pain improvement and overall satisfaction, low revision rates, reduced functional improvement and are more prone to complications compared to younger patients.
Post-discharge surveillance of surgical site infection is necessary if accurate rates of infection following surgery are to be available. We undertook a prospective study of 376 knee and hip replacements in 366 patients in order to estimate the rate of orthopaedic surgical site infection in the community. The inpatient infection was 3.1% and the post-discharge infection rate was 2.1%. We concluded that the use of telephone interviews of patients to identify the group at highest risk of having a surgical site infection (those who think they have an infection) with rapid follow-up by a professional trained to diagnose infection according to agreed criteria is an effective method of identifying infection after discharge from hospital.
