While residual fixed flexion deformity (FFD) in unicompartmental knee arthroplasty (UKA) has been associated with worse functional outcomes, limited evidence exists regarding FFD changes. The objective of this study was to quantify FFD changes in patients with medial unicompartmental knee arthritis undergoing UKA, and investigate any correlation with clinical outcomes. This study included 136 patients undergoing robotic arm-assisted medial UKA between January 2018 and December 2022. The study included 75 males (55.1%) and 61 (44.9%) females, with a mean age of 67.1 years (45 to 90). Patients were divided into three study groups based on the degree of preoperative FFD: ≤ 5°, 5° to ≤ 10°, and > 10°. Intraoperative optical motion capture technology was used to assess pre- and postoperative FFD. Clinical FFD was measured pre- and postoperatively at six weeks and one year following surgery. Preoperative and one-year postoperative Oxford Knee Scores (OKS) were collected.Aims
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Knee arthroscopy can be used for ligamentous repair, reconstruction and to reduce burden of infection. Understanding and feeling confident with knee arthroscopy is therefore a highly important skillset for the orthopaedic surgeon. However, with limited training or experience, furthered by reduced practical education due to COVID-19, this skill can be under-developed amongst trainee surgeons. At a single institution, ten junior doctors (FY1 to CT2), were recruited as a part of a five, two-hour session, training programme utilising the Simbionix® ARTHRO Mentor knee arthroscopy simulator, supplemented alongside educational guidance with a consultant orthopaedic knee surgeon. All students had minimal to no levels of prior arthroscopic experience. Exercises completed included maintaining steadiness, image centring and orientation, probe triangulation, arthroscopic knee examination, removal of loose bodies and meniscectomy. Pre and post experience questionnaires and quantitative repeat analysis on simulation exercises were undertaken to identify levels of improvement.Introduction
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Knee arthroscopy can be used for ligamentous repair, reconstruction and to reduce burden of infection. Understanding and feeling confident with knee arthroscopy is therefore a highly important skillset for the orthopaedic surgeon. However, with limited training or experience, furthered by reduced practical education due to COVID-19, this skill can be under-developed amongst trainee surgeons. At a single institution, ten junior doctors (FY1 to CT2), were recruited as a part of a five, two-hour session, training programme utilising the Simbionix® ARTHRO Mentor knee arthroscopy simulator, supplemented alongside educational guidance with a consultant orthopaedic knee surgeon. All students had minimal to no levels of prior arthroscopic experience. Exercises completed included maintaining steadiness, image centering and orientation, probe triangulation, arthroscopic knee examination, removal of loose bodies, and meniscectomy. Pre and post-experience questionnaires and quantitative repeat analysis on simulation exercises were undertaken to identify levels of improvement.Abstract
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Periprosthetic joint infection (PJI) remains an extremely challenging complication. We have focused on this issue more over the last decade than previously, but there are still many unanswered questions. We now have a workable definition that everyone should align to, but we need to continue to focus on identifying the organisms involved. Surgical strategies are evolving and care is becoming more patient-centred. There are some good studies under way. There are, however, still numerous problems to resolve, and the challenge of PJI remains a major one for the orthopaedic community. This annotation provides some up-to-date thoughts about where we are, and the way forward. There is still scope for plenty of research in this area. Cite this article:
Fractures of the articular surface of the patella or the lateral femoral condyle usually occur following acute dislocation of the patella. This study looked at the radiological and functional outcomes of fixation of osteochondral fractures Twenty-nine patients (18 male, 11 female) sustained osteochondral fractures of the knee following patellar dislocation. All patients had detailed radiographic imaging and MRI scan of the knee preoperatively. An arthroscopic assessment was done, followed by fixation using bio-absorbable pins or headless screws either arthroscopically or mini-open arthrotomy. VMO plication or MPFL repair were done if necessary. MRI scan was done at follow-up to assess for healing of the fixed fragment prior to patient discharge.Abstract
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Fracture dislocation of the knee involves disruption of knee ligaments with associated tibial plateau fracture. If these injuries are not evaluated swiftly, can result in a limb-threatening injury. The aim of this study is to look at the clinical outcomes of a single surgeon case series at a major trauma centre. Prospectively collected data was analysed for a 5-year period. Primary outcome measures used were International Knee Documented Committee (IKDC) score and Knee Injury & Osteoarthritis Outcome Score (KOOS). The secondary outcome measures include Tegner activity scale, knee range of movements and complications.Abstract
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Coronal plane alignment of the knee (CPAK) classification utilises the native arithmetic hip-knee alignment to calculate the constitutional limb alignment and joint line obliquity which is important in pre-operative planning. The objective of this study was to compare the accuracy and reproducibility of measuring the lower limb constitutional alignment with the traditional long leg radiographs versus computed tomography (CT) used for pre-operative planning in robotic-arm assisted TKA. Digital long leg radiographs and pre-operative CT scan plans of 42 patients (46 knees) with osteoarthritis undergoing robotic-arm assisted total knee replacement were analysed. The constitutional alignment was established by measuring the medial proximal tibial angle (mPTA), lateral distal femoral angle (LDFA), weight bearing hip knee alignment (WBHKA), arithmetic hip knee alignment (aHKA) and joint line obliquity (JLO). Furthermore, the Coronal Plane Alignment of the Knee (CPAK) classification was utilised to classify the patients based on their coronal knee alignment phenotype.Abstract
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Traumatic knee dislocations are devastating injuries and there is no single best accepted treatment. This study looked at functional outcome of a single surgeon case series of patients who underwent surgical management of their knee dislocation. Eighty-seven patients with knee dislocation were treated at a major trauma centre. Acute surgical repair and reconstruction with fracture fixation within 4 weeks was preferred unless the patient was too unstable (Injury severity score>16). The collaterals were repaired and augmented using a variety of autografts, allografts or synthetic grafts. PCL was primarily braced and reconstructed subsequently, if required. Outcome was collected prospectively using IKDC score, KOOS and Tegner score.Abstract
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Fracture dislocation of the knee involves disruption of two or more knee ligaments with associated tibial plateau fracture. If these injuries are not evaluated swiftly, can result in a limb-threatening injury. The aim of this study is to look at the clinical outcomes of a single surgeon case series at a major trauma centre. Prospectively collected data was analysed for a 5-year period. Primary outcome measures used were International Knee Documented Committee(IKDC) score and Knee Injury & Osteoarthritis Outcome Score(KOOS). The secondary outcome measures include Tegner activity scale, knee range of movements & complications.Abstract
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Traumatic knee dislocations are devastating injuries and there is no single best accepted treatment. Treatment needs to be customised to the patient taking into consideration injury to the knee; associated neurovascular and systemic injuries. This study looked at functional outcome of a single surgeon case series of patients who underwent surgical management of their knee dislocation.Abstract
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Highly porous acetabular components are widely used in revision hip surgery. The purpose of this study is to compare the mid-term survivorship, clinical and radiological outcomes of a hemispherical cup (Stryker Tritanium Revision component) and a peripherally expanded cup (Zimmer TM modular component) in revision hip surgery. Between 2010 and 2017, 30 patients underwent revision hip replacement using a hemispherical cup and 54 patients using a peripherally expanded cup. The surgery was carried out by two arthroplasty surgeons, both fellowship-trained in revision hip surgery. Kaplan-Meier analysis was used to determine the survivorship of the components. Clinical outcomes were measured using the Oxford Hip Score. Radiographs were analysed for the presence of radiolucent lines in the DeLee and Charnley zones.Background
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The Medicines and Healthcare Products Regulatory Agency (MHRA) of the UK have published guidelines for annual follow up of patients with metal on metal hip replacements following widespread concern regarding metallosis We followed up 718 total hip replacements (594 stemmed hips and 124 resurfacing) with metal on metal bearing, implanted between April 1999 and August 2010 in dedicated clinics with clinical and radiological assessment along with assessment of serum metal ions. Survival was calculated using Kaplan Meier analysis.Introduction
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