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The Bone & Joint Journal
Vol. 100-B, Issue 9 | Pages 1162 - 1167
1 Sep 2018
Metcalfe AJ Ahearn N Hassaballa MA Parsons N Ackroyd CE Murray JR Robinson JR Eldridge JD Porteous AJ

Aims

This study reports on the medium- to long-term implant survivorship and patient-reported outcomes for the Avon patellofemoral joint (PFJ) arthroplasty.

Patients and Methods

A total of 558 Avon PFJ arthroplasties in 431 patients, with minimum two-year follow-up, were identified from a prospective database. Patient-reported outcomes and implant survivorship were analyzed, with follow-up of up to 18 years.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLII | Pages 5 - 5
1 Sep 2012
Gbejuade HO Hassaballa MA Porteous AJ Murray JR Robinson J
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Patients with severe knee instability remain a surgical challenge. Furthermore, in the presence of extensive bone loss, constrained condylar implants may be unsuitable.

Hinged knee replacements have served an important role in the management of such complex knee pathologies.

A combined prospective and retrospective study of 138 consecutive hinge knee arthroplasties (42 primary and 96 revisions) of 8 different models performed in our institution between 2004 and 2010 at a mean follow up of 4.2years.

Outcomes were reviewed and knee scores preoperatively and postoperatively at 1, 2 and 5 years using the American knee scoring system.

The mean preoperative American knee score of 31 improved to 87 postoperatively.

Complication rate was 19%, 15% of which required re-revisions for: loosening (4%), Infection (4%), periprosthetic fracture (3%), Implant fracture (2%), Component disassembly (1%) and dislocation (1%). Overall implant failure rate was 9% and implant survivorship was greater than 80% at 4 years.

In our study, hinge prostheses provided good stability and symptom relief with a lower complication rate compared to some previous studies.

In addition, we believe hinge prostheses can also serve as reasonable alternatives to amputation and arthrodesis in many complex knees cases.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLII | Pages 4 - 4
1 Sep 2012
Gbejuade HO Kamali H Murray JR
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Thromboprophylaxis is of particular interest to the NHS due to the number of deaths from preventable hospital-acquired venous thrombo-embolism, considerable treatment cost and related long-term morbidities.

In compliance with current NICE guidelines, our departmental protocol for chemical thromboprophylaxis changed from aspirin to clexane.

We present a review of the use of both these chemical agents in our hip fracture patients; assessing duration of wound ooze, incidence of symptomatic PE and DVT and thrombocytopaenia.

Prospective study of surgically treated hip fractures patients on chemical thromboprophylaxis postoperatively over a 7 month period.

Of 224 patients reviewed, 110 fitted our inclusion criteria; 78 on Clexane and 32 on aspirin. Mean patient age: 82.6 years(48–100). Mean hospital stay: 30d ays(6–80). Female predominance (3:1). Mean duration of wound ooze: 6.9 days (1–24) for aspirin and 5.6 days (0–15) for clexane. Symptomatic DVTs: 1(3%) for aspirin and 3(3.8%) for clexane. Symptomatic PE: 0 for aspirin and 1(1.3%) for clexane. Thrombocytopenia: 0 for both groups. Mean duration of wound ooze for both groups was approximately 1 week. Low but significant incidence of thrombo-embolism.

Thromboembolism-deterrent-stockings were observed to be unreliable mainly due to skin problems and compliance.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 10 - 10
1 Jul 2012
Robinson JR Singh R Artz N Murray JR Porteous AJ Williams M
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Purpose

The purpose of this study was to determine whether intra-operative identification of osseous ridge anatomy (lateral intercondylar “residents” ridge and lateral bifurcate ridge) could be used to reliably define and reconstruct individuals' native femoral ACL attachments in both single-bundle (SB) and double-bundle (DB) cases.

Methods

Pre-and Post-operative 3D, surface rendered, CT reconstructions of the lateral intercondylar notch were obtained for 15 patients undergoing ACL reconstruction (11 Single bundle, 4 Double-bundle or Isolated bundle augmentations). Morphology of native ACL femoral attachment was defined from ridge anatomy on the pre-operative scans. Centre's of the ACL attachment, AM and PL bundles were recorded using the Bernard grid and Amis' circle methods. During reconstruction soft tissue was carefully removed from the lateral notch wall with RF coblation to preserve and visualise osseous ridge anatomy. For SB reconstructions the femoral tunnel was sited centrally on the lateral bifurcate ridge, equidistant between the lateral intercondylar ridge and posterior cartilage margin. For DB reconstructions tunnels were located either side of the bifurcate ridge, leaving a 2mm bony bridge. Post-operative 3D CTs were obtained within 6 weeks post-op to correlate tunnel positions with pre-op native morphology.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 577 - 577
1 Aug 2008
Murray JR Hogan NA Trezies A Hutchinson J Parish E Read JW Cross MJ
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Background: There is limited evidence on long-term outcome following ACL reconstruction. Concern has been raised that degenerative joint disease is common in the long-term and this may be associated with use of patellar tendon autograft.

Methods: 162 patients underwent single-surgeon arthroscopic ACL reconstruction (1991–1993) were identified from our prospective database. Patient-centred outcome was by Lysholm and Subjective IKDC score, objective outcome measures were clinical examination, arthrometry and X-rays.

Results: 13 year outcome (10–15 years) is known in 115/161 patients (71%). The median subjective scores were 94% (Lysholm) and 90% (IKDC). Ipsilateral graft rupture rate was 4%, with contralateral ACL injury in 8%. Mean manual maximum KT 1000 was 9mm in the grafted knee and 8mm in the contralateral knee. Clinical laxity scores of grade 0 or 1 were found in over 93% patients. Radiographically 66% were normal or near normal (Grade A or B). When compared to the contra-lateral uninjured knee we found no significant difference in the proportion of normal/near normal x-rays (grade A/B) versus abnormal/severe (grade C/D) for the medial, lateral nor patellofemoral compartments. There was no significant difference in the radiological IKDC grades in the medial compartment when compared to the contra-lateral uninjured knee, but there was a difference in the lateral and patellofemoral joints.

Conclusions: At 13 years patellar tendon ACLR provides excellent patient satisfaction, with clinically objective knee stability and low risk of re-rupture. Radiographically degenerative change was seen in 34%. There was no significant side to side difference to the uninjured contralateral medial knee joint, but there was a small but significant difference in the lateral and patellofemoral joints. The lateral joint differences may reflect underlying bone bruising at the time of injury. We do not believe that the patellar tendon autograft is the cause of arthrosis after BTB ACLR.