Hip and knee arthroplasties are very common operations in the UK with over 70000 hip and over 80000 knee arthroplasties taking place in England and Wales in 2011. Fortunately mortality following these operations is rare. However it remains important to understand the incidence and causes of death, in order to manage risk where possible and to inform the consent process.

This study aimed to evaluate the incidence and causes of death within 30 days after undergoing hip or knee arthroplasty in our unit and to highlight possible risk factors.

We looked at 30 day mortality in all patients undergoing hip or knee arthroplasty in our institution between 2005 and 2011. Data on post-operative deaths was derived from the Scottish Arthroplasty Project and correlated with procedural and demographic data from our hospital Patient Administration System (PAS). The notes of all patients who had died within a period of 30 days post-operatively were reviewed to collect data on co-morbid conditions, pre-operative investigations, post-operative thromboprophylaxis and cause of death. All primary and revision knee and hip arthroplasties including bilateral procedures were included. Arthroplasty for trauma was excluded.

A total of 12,243 patients underwent hip or knee arthroplasty within the study period. 59% were female and the mean age was 68 (range 21–91). During this time period the standard protocol was to use aspirin for thromboprophylaxis. Eleven patients died following surgery giving a mortality rate of 0.09%. The most common cause of death was myocardial infarction (7/11 patients).

Our finding of a mortality rate of 0.09% is similar or lower to those found in previous studies. To our knowledge this is the first series of this size looking at mortality from hip and knee arthroplasty within a single centre in the UK.

Objective

To compare clinical parameters associated with medial parapatellar and midvastus approaches for total knee arthroplasty in the early post-operative period.

Background: Thumb carpalmetacarpal joint (CMCJ) osteoarthritis has been treated using various combinations of resection, interposition and replacement arthroplasties. The procedure of choice for various stages of CMCJ osteoarthritis remains controversial. This study compares the short term outcomes of trapeziectomy alone and trapeziectomy with PI2 implantation.

Methods: A cross-sectional observational study involving 33 patients (36 thumbs). 18 thumbs had trapeziectomy alone and 18 had trapeziectomy and PI2 implantation. Underlying indication was osteoarthritis in 35 thumbs and trauma in one thumb. Preoperative radiological assessment using the Eaton and Glickel grading for CMCJ osteoarthritis and clinical review including DASH and SF-36 score was performed at a mean follow-up of 18 months. Preoperative and postoperative pain level was assessed using Visual Analogue Scale (VAS) and satisfaction of the surgery using the Likert 5-point scale.

Results: There were 30 women and 3 men. The average age at follow up was 61 years (range 45 to 75). There was no significant difference between the two groups regarding age, duration of symptoms, and stage of disease, preoperative pain score and handedness. The mean DASH score at follow up was 26.8 for trapeziectomy alone group and 35.4 for the PI2 arthroplasty group. Preoperative to postoperative VAS for pain showed an improvement from fair to excellent in 60% of patients in trapeziectomy alone group and 30% of the patients in the PI2 arthroplasty group. There was no significant difference in the SF-36 scores between the two groups in all health domains. 6 out of 16(38 %) patients in the PI2 group had multiple surgeries mainly due to dislocation or subluxation of the implant. The overall Likert 5-point scale scores were highest for trapeziectomy alone group with 70% very satisfied compared to 40% in the PI2 arthroplasty group.

Conclusion: The early results of pyrocarbon PI2 arthroplasty show a high complication rate compared to simple trapeziectomy. The high rates of subluxation and dislocation observed in the early cohort resulting in multiple surgeries may be attributed to steep learning curve of the surgical technique and creation of a shallow groove for the implant. This may have contributed to the low satisfaction levels observed in PI2 arthroplasty group. Simple trapeziectomy provides satisfactory outcome in more than 80% of the patients.

Introduction: REEF™ is a modular distal locking implant, indicated for use in extensive loosening of femoral stems, peri-prosthetic hip fractures, and tumour surgery requiring distal anchorage to allow resection of the femur proximally. Very little experience with the REEF™ has been reported.

Objective: We report on a single surgeon series of 16 patients who underwent femoral reconstruction using the REEF™ during revision hip arthroplasty (THA).

Methods and Results: This is a retrospective analysis of prospectively collected data on 16 patients (14 females) who underwent revision THA using the REEF™, between 1998 to 2007with a mean follow-up of 16 months (range, 3 to 60).

Indications were peri-prosthetic fractures in 9 cases (Vancouver B1 in one case, B2 in 4 cases and B3 in 4), aseptic loosening with significant bone loss in 3 (Paprosky IIIA in one case, Paprosky IIB in one and Type IV in one), osteolysis (Paprosky IV) secondary to infection in 1, non-union of peri-prosthetic fracture in 2 (Vancouver B2 and B3) and fracture around a spacer in one case.

The mean HHS at 3 months post-operatively was 72 (range, 57 to 76). The median pre-operative/pre-injury University of California, Los Angeles hip rating system (UCLA) was 1. The median UCLA at longest follow-up was 3.5 (range, 1 to 4) with 10 patients having a score greater than 3. Mean time to clinical evidence of implant integration was 4 months (range, 2 to 12). No evidence of subsidence was noted. Four dislocations were seen. No dislocation was seen in the 6 patients who had a Posterior Lip Augmentation Device (PLAD™) inserted at the time of revision THA. One stem fracture occurred requiring revision surgery with a longer REEF™ implant. Two patients died in the immediate post-operative period.

Conclusion: Results of revision THA using the REEF™ implant are encouraging. We recommend the use of the REEF™ with the judicious use of PLAD™ in difficult revision THA.

Introduction: The commonest surgical approach for total knee arthroplasty is medial parapatellar approach. This involves splitting the quadriceps tendon, potentially destabilising the extensor mechanism. The midvastus approach involves splitting the vastus medialis muscle instead of entering the quadriceps tendon, therefore, minimising interruption of the extensor mechanism without compromising the exposure of the knee.

Objective: To compare clinical parameters associated with medial parapatellar and midvastus approaches for total knee arthroplasty in the early postoperative period.

Methods: and Results: We present a prospective observational study of 77 patients undergoing primary total knee arthroplasty using medial parapatellar or midvastus approach (37 midvastus approach, 40 medial parapatellar approach). Ethical approval was obtained for the study. The prosthetic design and physical intervention was standardised in all the patients. The Oxford Knee Score, pain scale, knee flexion, unassisted straight leg raise, standing and walking were compared at 3rd, 5th and 7th day postoperatively, then at 6 weeks and at 3 months. The patients and physiotherapist were blinded to the type of approach used. The average age was 67 years (range 42 to 88). There were 49 women and 39 men. The average hospital stay was 7 days (range 2 to 15). There was statistically significant difference in duration of hospital stay, unassisted straight leg raise and standing at 3 days (p=0.001) all in favour of midvastus approach. There was no statistically significant difference in Oxford Knee Scores, pain scale and range of motion. The average duration to achieving straight leg raise for the midvastus group was 5 days and for the medial parapatellar approach group was 8 days

Conclusion: The study shows that total knee arthroplasty performed through the midvastus approach resulted in less postoperative pain, earlier unassisted straight leg raise and ambulation, therefore, shorter hospital stay as compared to medial parapatellar approach. This may be of benefit to the patients due to less discomfort after surgery and to the healthcare system due to shorter hospital stay for patients.

Purpose: To compare clinical parameters associated with medial parapatellar and midvastus approaches for total knee arthroplasty in the early postoperative period.

Method: We present a prospective observational study of 77 patients undergoing primary total knee arthroplasty using medial parapatellar or midvastus approach (37 midvastus approach, 40 medial parapatellar approach). Ethical approval was obtained for the study. The prosthetic design and physical intervention was standardised in all the patients. The Oxford Knee Score, pain scale, knee flexion, unassisted straight leg raise, standing and walking were compared at 3rd, 5th and 7th day postoperatively, then at 6 weeks and at 3 months. The patients and physiotherapist were blinded to the type of approach used.

Results: The average age was 67 years (range 42 to 88). There were 49 women and 39 men. The average hospital stay was 7 days (range 2 to 15). There was statistically significant difference in duration of hospital stay, unassisted straight leg raise and standing at 3 days (p=0.001) all in favour of midvastus approach. There was no statistically significant difference in Oxford Knee Scores, pain scale and range of motion. The average duration to achieving straight leg raise for the midvastus group was 5 days and for the medial parapatellar approach group was 8 days.

Conclusion: The study shows that total knee arthroplasty performed through the midvastus approach resulted in less postoperative pain, earlier unassisted straight leg raise and ambulation, therefore, shorter hospital stay as compared to medial parapatellar approach. This may be of benefit to the patients due to less discomfort after surgery and to the healthcare system due to shorter hospital stay for patients.

Aim: Our aim was to measure plantar foot pressures in normal individuals and to compare them with variations in patients with metatarsalgia.

Methodology: We measured the plantar foot pressures in different parts of the foot in normal subjects of various ages and then compared this with foot pressures of patients with metatarsalgia. For measurement and statistical analysis, the plantar contact of the foot was divided into six anatomical divisions. The foot pressures were measured under the hallux, head of first metatarsal, over heads of second, third and fourth metatarsals, the fifth metatarsal, midfoot and hindfoot. This was measured using the FSCAN insole pedobarograph system (Tekscan, Inc, Boston, MA).

The foot pressures were measured in Kilopascals(Kpa). Independent T-tests was used to compare mean pressure distributions in the six anatomical divisions. We found the mean pressures through the 5th metatarsal head – 217(t=−2.32,p< 0.05) and midfoot 94(t=−3.17, p< 0.05), were significantly higher when compared to pressures in normal subjects (table 1).

Conclusion: We have demonstrated increased pressures transmitted through the outer aspect of the sole of the foot, in patients suffering from metatarsalgia. This can be used further to plan any foot- orthosis or surgery to distribute pressures more evenly across the sole of the foot.

Introduction: The commonest surgical approach for total knee arthroplasty is medial parapatellar approach. This involves splitting the quadriceps tendon, potentially destabilising the extensor mechanism. The midvastus approach involves splitting the vastus medialis muscle instead of entering the quadriceps tendon, therefore, minimising interruption of the extensor mechanism without compromising the exposure of the knee.

Objective: To compare clinical parameters associated with medial parapatellar and midvastus approaches for total knee arthroplasty in the early postoperative period.

Methods and results: We present a prospective observational study of 88 patients undergoing primary total knee arthroplasty using medial parapatellar or midvastus approach (44 in each group). The prosthetic design and physical intervention was standardised in all the patents. The Oxford Knee Score, pain scale, knee flexion, unassisted straight leg raise, standing and walking were compared at 3^rd, 5th and 7^th day postoperatively, then at 6 weeks and at 3 months. The patients and physiotherapist were blinded to the type of approach used. The average age was 67 years (range 42 to 88). There were 49 women and 39 men. The average hospital stay was 7 days (range 2 to 15). There was statistically significant difference in duration of hospital stay, unassisted straight leg raise and standing at 3 days (p=0.001) and pain scale at 5 days, all in favour of midvastus approach. There was no statistically significant difference in Oxford Knee Scores and duration to achieving full flexion and walking. The average duration to achieving straight leg raise for the midvastus group was 5 days and for the medial parapatellar approach group was 8 days

Conclusion: The study shows that total knee arthroplasty performed through the midvastus approach resulted in less postoperative pain, earlier unassisted straight leg raise and ambulation, therefore, shorter hospital stay as compared to medial parapatellar approach. This may be of benefit to the patients due to less discomfort after surgery, and to the healthcare system due to shorter hospital stay for patients.

Purpose: Our aim was to measure plantar foot pressures in normal individuals and to compare them with variations in patients with metatarsalgia

Methods: This was a case control study. We measured the plantar foot pressures in different parts of the foot in normal subjects of various ages and then compared this with foot pressures of patients with metatarsalgia. For measurement and statistical analysis, the plantar contact of the foot was divided into six anatomical divisions. The foot pressures were measured under the hallux, head of first metatarsal, over heads of second, third and fourth metatarsals, the fifth metatarsal, midfoot and hindfoot. This was measured using the FSCAN insole pedobarograph system (Tekscan, Inc, Boston, MA

Results: The foot pressures were measured in Kilopascals(Kpa). Independent T-tests was used to compare mean pressure distributions in the six anatomical divisions. We found the mean pressures through the 5th metatarsal head – 217(t=−2.32,p< 0.05) and midfoot 94(t=−3.17, p< 0.05), were significantly higher when compared to pressures in normal subjects ( table 1).

Conclusions: We have demonstrated increased pressures transmitted through the outer aspect of the sole of the foot, in patients suffering from metatarsalgia. This can be used further to plan any foot- orthosis or surgery to distribute pressures more evenly across the sole of the foot.

Introduction Plantar foot pressure measurements using pressure distribution instruments is a standard tool for diagnostic and therapeutic interventions. Foot pressure studies have measured pressure distributions in patients with various conditions such as rheumatoid arthritis, diabetes and obesity . Pressure studies in metatarsalgia and Hallux rigidus, to our knowledge, has not been reported previously. Our aim was to measure plantar foot pressures in normal individuals and to compare them with variations in patients with metatarsalgia and Hallux rigidus. This data may enable us to identify areas of abnormal pressure distributions and thus plan foot-orthosis or surgical intervention.

Materials and Methods This was a case control study. We measured the plantar foot pressures in different parts of the foot in normal subjects of various ages and then compared this with foot pressures of patients with metatarsalgia and hallux rigidus. For measurement and statistical analysis, the plantar contact of the foot was divided into six anatomical divisions. The foot pressures were measured under the hallux, head of first metatarsal, over heads of second, third and fourth metatarsals, the fifth metatarsal, midfoot and hindfoot. This was measured using the FSCAN insole pedobarograph system (Tekscan, Inc, Boston, MA).

Results The foot pressures were measured in Kilopascals(Kpa). Independent T-tests was used to compare mean pressure distributions in the six anatomical divisions. Comparing normal with metatarsalgia, the mean pressures through the 5th metatarsal head 217(t=−2.32,p< 0.05) and midfoot 94(t=−3.17, p< 0.05), were significantly higher when compared to pressures in normal subjects. In patients with hallux rigidus, the mean pressures through the hallux 314 (t=−3.62, p< 0.01) and mid-foot 140 (t=-5.11, p< 0.01), were significantly higher, as compared to pressures in normal subjects.

Discussion Metatarsalgia is a condition that presents with pain under the region of the 2nd to 4th metatarsal heads. Hence, the normal response of the body would be to avoid putting increased pressure through this region, thus causing increased pressures to be transmitted through other parts of the foot. The foot pressures through the hallux and midfoot were higher in patients with hallux rigidus (compared to normal). This results in pressure imbalances and thus may contribute to pain, deformity and abnormal gait. Our study, confirms this, the mean plantar foot pressures were higher under the 5th metatarsal head and the midsole as compared to normal subjects. This could be explained by the tendency to walk on the outer aspect of the sole to avoid the painful area. Thus, any foot orthosis or surgery should aim to redistribute these forces.

Conclusion We have demonstrated increased pressures transmitted through the outer aspect of the sole of the foot, in patients suffering from metatarsalgia. The pressures through the Hallux and midfoot were higher in oatients with hallux rigidus. This information can be used further to plan any foot-orthosis or surgery to distribute pressures more evenly across the sole of the foot.