While patients with psychological distress have poorer short-term outcomes after total knee arthroplasty (TKA), their longer-term function is unknown. We aimed to 1) assess the influence of preoperative mental health status on long-term functional outcomes, quality of life, and patient satisfaction; and 2) analyze the change in mental health after TKA, in a cohort of patients with no history of mental health disorder, with a minimum of ten years’ follow-up. Prospectively collected data of 122 patients undergoing primary unilateral TKA in 2006 were reviewed. Patients were assessed pre- and postoperatively at two and ten years using the Knee Society Knee Score (KSKS) and Function Score (KSFS); Oxford Knee Score (OKS); and the Mental (MCS) and Physical Component Summary (PCS) which were derived from the 36-Item Short-Form Health Survey questionnaire (SF-36). Patients were stratified into those with psychological distress (MCS < 50, n = 51) and those without (MCS ≥ 50, n = 71). Multiple regression was used to control for age, sex, BMI, Charlson Comorbidity Index (CCI), and baseline scores. The rate of expectation fulfilment and satisfaction was compared between patients with low and high MCS.Aims
Methods
Patient-specific instrumentation (PSI) is a novel technique in total knee arthroplasty (TKA) which potentially permits more accurate alignment of the components; however, there is no consensus in literature regarding the accuracy and reliability of PSI as many studies have shown controversial and inconsistent results of various PSI systems. A 24-month follow-up study was carried out to compare perioperative clinical outcomes, radiological limb alignment and component positioning, as well as functional outcomes following TKA between PSI and conventional instrumentation (CI). During September 2011 and August 2012, 90 consecutive patients were scheduled to undergo unilateral TKA with either PSI or CI. TruMatch® Personalised Solutions was used in this study, and a senior surgeon performed all operations. Patients were clinically assessed before, 6-month and 24-month after surgery.Objective
Methods
Failures in total knee arthroplasty (TKA) have been associated with overall lower limb malalignment and component malposition. Although traditional computer navigation systems improve component placement, they require fixation of the femoral and tibial reference arrays for software recognition using anchoring pins. This increases the risk of bony fracture, pin sites infection and osteomyelitis. This study aims to evaluate the accuracy of a new hand held navigation system (BrainLAB® Dash® Navigation system) that will avoid these complications.Introduction
Aim
Restoration of the native joint line in total knee arthroplasty is important in restoring ligamentous balance and normal knee kinematics. Failure to achieve this could lead to reduced range of motion, patellofemoral maltracking and suboptimal outcomes. The purpose of this study was to analyse the clinical and functional outcome of patients who demonstrated joint line changes after computer-assisted (CAS) total knee arthroplasty (TKA). A prospective study was conducted for 168 patients (168 knees) who underwent CAS TKA by two surgeons at a single institution with an average follow-up of two years. The final change in joint line was calculated from the verified tibial resection, distal and posterior femoral cuts. Group A patients had joint line changes of less than 4mm and Group B patients had joint line changes of more than 4mm. Postoperative Oxford scores, Knee scores, Function scores and SF-36 scores were obtained at six months, one year and two years post-TKA. The final range of motion and the mechanical alignment were documented. There was significant linear correlation between joint line changes and Oxford scores (p = 0.05) and Function scores (p = 0.05) at six months and Oxford scores alone at two years with increasing joint line changes having poorer outcome scores. Group A compared to Group B patients have better outcomes in terms of Oxford scores (mean 20 vs 27, p = 0.0003), Function scores (mean 69 vs 59, p = 0.03), SF-1 (mean 63 vs 50, p = 0.03), SF-2 (mean 66 vs 43, p = 0.05), SF-5 (mean 75 vs 63, p = 0.04), SF-6 (mean 84 vs 59, p = 0.003), SF-7 (mean 96 vs 83, p = 0.02), SF-8 (mean 84 vs 73, p = 0.006) and total SF-36 scores (mean 603 vs 487, P = 0.003), at six months, and Oxford scores (mean 18 vs 23, p = 0.0007) at two years. In this study, CAS is a useful intra-operative tool for assessing the final joint line in TKA. Outliers in joint line changes of ≥ 4 mm are associated with poorer clinical outcome scores.
We have performed a prospective double-blind, randomised controlled trial over two years to evaluate the efficacy and safety of an intra-operative peri-articular injection of triamcinolone acetonide in patients undergoing medial unicondylar knee replacement. We randomised 90 patients into two equal groups. The study group received an injection of triamcinolone acetonide, bupivacaine, and epinephrine into the peri-articular tissues at the end of the operation. The control group received the same injection mixture but without the addition of triamcinolone. The peri-operative analgesic regimen was standardised. The study group reported a significant reduction in pain (p = 0.014 at 12 hours, p = 0.031 at 18 hours and p = 0.031 at 24 hours) and had a better range of movement (p = 0.023 at three months). There was no significant difference in the rate of infection and no incidence of tendon rupture in either group. The addition of corticosteroid to the peri-articular injection after unicondylar knee replacement had both immediate and short-term benefits in terms of relief from pain, and rehabilitation with no increased risk of infection.
