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Bone & Joint Open
Vol. 5, Issue 11 | Pages 1003 - 1012
8 Nov 2024
Gabr A Fontalis A Robinson J Hage W O'Leary S Spalding T Haddad FS

Aims

The aim of this study was to compare patient-reported outcomes (PROMs) following isolated anterior cruciate ligament reconstruction (ACLR), with those following ACLR and concomitant meniscal resection or repair.

Methods

We reviewed prospectively collected data from the UK National Ligament Registry for patients who underwent primary ACLR between January 2013 and December 2022. Patients were categorized into five groups: isolated ACLR, ACLR with medial meniscus (MM) repair, ACLR with MM resection, ACLR with lateral meniscus (LM) repair, and ACLR with LM resection. Linear regression analysis, with isolated ACLR as the reference, was performed after adjusting for confounders.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 96 - 96
1 Jul 2022
Gabr A Robinson J
Full Access

Abstract

Introduction

The use of MCL “pie-crusting” (selective release of the superficial MCL) to improve arthroscopic access to the posteromedial compartment of the knee for isolated meniscal surgery has been demonstrated. However, there are concerns that MCL pie-crusting with concomitant ACL reconstruction (ACLR) might affect knee stability and outcomes postoperatively. The aim of this study was to compare the functional outcomes between patients who underwent MCL pie-crusting at ACLR with those that did not.

Methods

We performed a retrospective review of prospectively collected data from on the National Ligament Registry. 55 patients (33 male and 22 female) who had MCL pie-crusting(PC group) to address a meniscal lesion at the time of ACLR were compared with 65 patients (38 male and 27 female) who underwent isolated primary ACLR. All procedures were performed by a single surgeon at a tertiary centre between October 2013 and March 2019.


Bone & Joint Open
Vol. 2, Issue 8 | Pages 569 - 575
1 Aug 2021
Bouguennec N Robinson J Douiri A Graveleau N Colombet PD

Aims

MRI has been suggested as an objective method of assessing anterior crucate ligament (ACL) graft “ligamentization” after reconstruction. It has been proposed that the MRI appearances could be used as an indicator of graft maturity and used as part of a return-to-sport assessment. The aim of this study was to evaluate the correlation between MRI graft signal and postoperative functional scores, anterior knee laxity, and patient age at operation.

Methods

A consecutive cohort of 149 patients who had undergone semitendinosus autograft ACL reconstruction, using femoral and tibial adjustable loop fixations, were evaluated retrospectively postoperatively at two years. All underwent MRI analysis of the ACL graft, performed using signal-to-noise quotient (SNQ) and the Howell score. Functional outcome scores (Lysholm, Tegner, International Knee Documentation Committee (IKDC) subjective, and IKDC objective) were obtained and all patients underwent instrumented side-to-side anterior laxity differential laxity testing.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_12 | Pages 28 - 28
1 Oct 2019
Aguilar MB Robinson J Hepinstall M Cooper HJ Deyer TW Ranawat AS Rodriguez JA
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Introduction

The direct anterior approach (DAA) and the posterior approach (PA) are 2 common total hip arthroplasty (THA) exposures. This prospective study quantitatively compared changes in periarticular muscle volume after DAA and PA THA.

Materials

Nineteen patients undergoing THA were recruited from the practices of 3 fellowship-trained hip surgeons. Each surgeon performed a single approach, DAA or PA. Enrolled patients underwent a preoperative MRI of the affected hip and two subsequent postoperative MRIs, averaging 9.6 and 24.3 weeks after surgery. Clinical evaluations were done by Harris Hip Score at each follow-up interval.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_5 | Pages 120 - 120
1 Mar 2017
Shemesh S Robinson J Overley S Moucha C Chen D
Full Access

Intro

Sciatic nerve injury (SNI) is a rare and potentially devastating complication after total hip arthroplasty (THA). Neural monitoring has been found in several studies to be useful in preventing SNI, but can be difficult to practically implement during surgery. In this study, we examine the results of using a handheld nerve stimulator for intraoperative sciatic nerve monitoring during complex THA requiring limb lengthening and/or significant manipulation of the sciatic nerve.

Methods

We retrospectively reviewed a consecutive series of 11 cases (9 patients, 11 hips) with either severe developmental dysplasia of the hip (Crowe 3–4) or other underlying conditions requiring complex hip reconstruction involving significant leg lengthening and/or nerve manipulation. Sciatic nerve function was monitored intra-operatively with a handheld nerve stimulator by obtaining pre- and post-reduction conduction thresholds during component trialling. The results of nerve stimulation were then used to influence intraoperative decision- making (downsizing components, shortening osteotomy).


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_3 | Pages 35 - 35
1 Feb 2017
Bas M Rodriguez J Robinson J Deyer T Cooper J Hepinstall M Ranawat A
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Introduction

Total hip arthroplasty (THA) is a common operation. Different operative approaches have specific benefits and compromises. Soft tissue injury occurs in total hip arthroplasty. This prospective study objectively measured muscle volume changes after direct anterior and posterior approach surgeries.

Methods

Patients undergoing Direct Anterior Approach (DAA) and Posterior Approach (PA) THA were prospectively evaluated. 3 orthopaedic surgeons performed all surgeries. Muscle volumes of all major muscles around the hip were objectively measured using preoperative and 2 different postoperative follow-up MRIs. 2 independent measurers performed all radiographic volume measurements. Repeated-measures ANOVA was used to compare mean muscle volume changes over time. Student's t-test was used to compare muscle volumes between groups at specific time intervals.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_4 | Pages 41 - 41
1 Feb 2017
Kamara E Robinson J Bas M Rodriguez J Hepinstall M
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Background

Acetabulum positioning affects dislocation rates, component impingement, bearing surface wear rates, and need for revision surgery. Novel techniques purport to improve the accuracy and precision of acetabular component position, but may come have significant learning curves. Our aim was to assess whether adopting robotic or fluoroscopic techniques improve acetabulum positioning compared to manual THA during the learning curve.

Methods

Three types of THAs were compared in this retrospective cohort: 1) the first 100 fluoroscopically guided direct anterior THAs (fluoroscopic anterior, FA) done by a posterior surgeon learning the anterior approach, 2) the first 100 robotic assisted posterior THAs done by a surgeon learning robotic assisted surgery (robotic posterior, RP) and 3) the last 100 manual posterior THAs done by each surgeon (total 200 THAs) prior to adoption of novel techniques (manual posterior, MP). Component position was measured on plain radiographs. Radiographic measurements were done by two blinded observers. The percentage of hips within the surgeons' target zone (inclination 30°–50°, anteversion 10°–30°) was calculated, along with the percentage within the safe zone of Lewinnek (inclination 30°–50°; anteversion 5°–25°) and Callanan (inclination 30°–45°; anteversion 5°–25°). Relative risk and absolute risk reduction were calculated. Variances (square of the SDs) were used to describe the variability of cup position.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_2 | Pages 86 - 86
1 Jan 2016
Kamara E Robinson J Hepinstall M Rodriguez J
Full Access

Introduction

Total hip arthroplasty is considered to be one of the most successful orthopaedic interventions. Acetabular component positioning has been shown to affect dislocation rates, component impingement, bearing surface wear rates, and need for revision surgery. The safe zones of acetabular component positioning have previously been described by Lewinnek et al. as 5 to 25 degrees of cup version and 30 to 50 degrees of inclination. Callanan et al. later modified the inclination to 30 to 45 degrees. Our aim was to assess whether THA via robotic assisted posterior approach (PA) improves acetabular component positioning compared to fluoroscopic guided anterior approach THA (AA).

Methods


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_7 | Pages 10 - 10
1 May 2015
Barksfield R Porteous A Robinson J Murray J
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A key theme of the GIRFT project is centralisation of complex orthopaedic procedures to “Specialist Units” and minimum surgeon volumes. We aimed to estimate the effects of implementing minimum unit and surgeon specific volumes upon orthopaedic units within the Severn region.

Practice profiles for surgeons and units were generated using the NJR Surgeon and Hospital Profile Database. Minimum volume thresholds were set at 13 procedures/year for surgeons and 30 procedures/year for units.

Median surgeon volumes were 33 (range 2–180) for primary TKR, 10 (range 2 – 64) for UKR, 2 (range 2 – 41) for PFJR and 5 (range 2–57) for Revision TKR. Amongst 48 surgeons performing UKR, 26 (54%) performed less than 13 procedures per year accounting for 108 (14%) procedures. Amongst 20 surgeons performing PFJR, 19 (95%) performed <13/year, accounting for 56 (58%) of cases. 49 Surgeons performed revision TKR with 24 (49%) performing <13 revisions per annum, accounting 151 (36%) procedures.

Amongst 16 units performing UKR, 8 (50%) performed <30/year, accounting for 16% overall. Revision TKR was performed in 15 units whilst 8 (53%) performed <30/year, accounting for 62 (15%) cases. We invite discussion of the ramifications of minimum surgeon and unit volumes for Orthopaedic services in the Severn Region.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_5 | Pages 3 - 3
1 Mar 2014
Mihok P Bex C Hassaballa M Robinson J Murray J Porteous A
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Total knee arthoplasty (TKA) remains a standard treatment for advanced knee arthritis. The aim of the procedure is to restore function and relieve pain ideally for the rest of patient's life. Patient matched templating (PMT) or patient specific instrumentation (PSI) is a recent development for alignment of TKA components that uses disposable guides. The users of PSI claim it to be the optimum balance of new technology and conventional technique by reducing the complexity of conventional alignment and sizing tools.

To assess the clinical and radiological outcome of Primary TKA done with PSI.

More than 200 cases of TKA have been done in our unit using PSI and we analysed the radiographic outcome of these cases postoperatively. We also reviewed the clinical outcome of 103 patients with 1 year and 43 patients with 2 year follow-up. Data was collected prospectively: pre-operatively and at 1 year and 2 years post-operatively including Oxford knee score (OKS), WOMAC and American knee society score (AKS). Standard AP and lateral films were done pre-operatively and post-operatively.

Mean age was 66 years. There were 56 female and 47 male patients. Mean post-operative angles on standard films were: Alpha = 95.6, Beta = 88.4, Saggittal femur = 3.4 and Saggittal tibia = 90.8. Of the 103 cases with 1 year follow-up, there was significant improvement in all clinical outcome scores. Mean OKS improved from 18 to 39 at 1 year and remained the same at 2 years, WOMAC improved from 40 to 18 in both 1 and 2 years post-op. AKS Total improved from 79 to 173 at 1 year and 170 at 2 years.

Performing TKA using PSI is safe and provides good radiological alignment in the coronal and sagittal plane. Significant improvement in outcome scores were seen at one and two year follow up and reached levels that compared favourably with other reported series of TKA outcome from our unit.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_5 | Pages 2 - 2
1 Mar 2014
Mihok P Hassaballa M Robinson J Porteous A Bowker K Lovering A Murray J
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It has been reported that some of the local anaesthetic agents possess antimicrobial activity against clinically-significant bacteria. Although bupivacaine exhibits a bacteriostatic effect at concentrations above 0.25% there are concerns that it might interact with some of the other antibiotics administered to patients. Whilst these interactions may be potentially benign, the risk is that they are antagonistic and that local bupivacaine might predispose the patient to a higher risk of infection.

Bupivacaine is commonly administered as a local anaesthetic following knee arthroplasy; the purpose of this study was to assess its potential interactions with gentamicin eluting from the cement used to fix the device.

A strain of Saphylococcus aureus (29213) with established susceptible Minimal Inhibition Concentration (MIC) and Minimal Bactericidal Concentration (MBC) for gentamicin was used. This organism was inoculated into four types of broth; Mueller-Hinton broth (MH), MH with different concentrations of gentamicin, MH with 0.25% and 0.125% bupivacaine and MH with various combinations of gentamicin and bupivacaine. The broths were incubated at 37C and at 0.5, 1, 2, 3, 6 and 24 hours post inoculation the number of bacteria remaining were counted. From these data kill-curves were generated describing the absolute and individual rates of killing seen with bupivacaine and gentamicin alone and when in combination.

Bupivacaine showed a bacteriostatic effect only at concentrations of 0.25% and higher. All concentrations of gentamicin above or equal to the expected MBC showed bactericidal effect. However, in combination with both strengths of Bupivacaine (0.25 and 0.125%) the bacteriocidal effect of gentamicin was seen at a lower concentration and the rate of killing of bacteria was enhanced.

Bupivacaine has bacteriostatic effect at concentrations above 0.25% in line with published data. In these experiments we have shown that the use of bupivacaine together with gentamicin does not reduce the bactericidal property of the antibiotic and that the bactericidal effect of gentamicin appears to be enhanced by bupivacaine. This would suggest that the local use of bupivacaine is unlikely to increase the risk of infection in patients undergoing knee arthroplasty and may actually be beneficial.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_5 | Pages 5 - 5
1 Mar 2014
Hassaballa M Artz N Mihok P Chapman L Robinson J Porteous A Murray J
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This is a prospective review of consecutive patients who underwent knee revision surgery using the Legion knee system.

Clinical and functional assessments (American Knee Scores-AKS, WOMAC and Oxford knee score-OKS) were carried out preoperatively, one year and 2 years post op. Radiographic evaluation was done at 1 and 2 years included review of standing AP, lateral and skyline views. Figgie's method was used to measure the joint line reproduction.

210 patients underwent revision knee system 103 male: 107 females with a mean age of 66.4 (44–87) yrs. Mean BMI-26.03 (21–50). We had a 2-year follow up for 110 patients. Surgery was carried out at a single centre and performed by Bristol knee specialists.

Indications for surgery were aseptic loosening (84), infection (27) instability (47), pain and stiffness (31), progression of disease (6), peri-prosthetic fractures (15)

The AKS and WOMAC scores at, 1 year and 2 years follow up showed significant improvements in pain and function. The mean total AKS improved from 75.7/200 pre-operatively to 140.5/200 at 2 yrs. Radiographic assessment showed a mean AP coronal femoral angle of 95.3 degrees (89.6–99.9), coronal tibial angle of 90.1 degrees (88–92). The mean sagittal femoral and tibial angles were 88.4 and 90.4 degrees respectively.

The short-term results showed significant improvement in functional and pain scores irrespective of indications for revision surgery. The Legion system has showed good outcome scores that match or beat published series on revisions. It also showed a good ability to restore joint line.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 497 - 497
1 Dec 2013
Rathod P Deshmukh A Robinson J Stirton J Rodriguez J
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Introduction

Acetabular component position is an important determinant of stability, wear and impingement following total hip arthroplasty (THA). Its optimum position and size in direct anterior approach (DAA) THA has not been clearly described in previous studies. Our aim was to study the evolution of the same with reference to stability and impingement as a part of a single surgeon's learning curve.

Methods

Clinical and radiographic records of first 300 consecutive DAA THAs performed by a single surgeon from April 2009 to April 2011 were reviewed from a prospective database at a single center. Radiographic analysis was done by two observers to determine acetabular inclination and anteversion on 6 week postoperative standing radiographs. Native femoral head size, measured on preoperative radiographs after adjusting for magnification, was used to calculate the native acetabular cup size. The study population was divided into three groups; Group A– 1st 100 DAA THA cases, Group B – 2nd 100 and Group C – 3rd 100 corresponding to the use of intraoperative anterior stability assessment (Group B and C) and change in the cup size strategy (Group C). The incidence of instability and psoas impingement (PI) –related groin pain at 2 year follow-up was determined for the three groups. Statistical analysis was done to see if there were differences in these clinical and radiographic outcome measures in the three groups.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 503 - 503
1 Dec 2013
Robinson J Rathod P Stirton J Cooper J Ranawat A Rodriguez J
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The aim was to study the evolution of radiographic patterns of osteointegration of tapered wedge stems and determine if there is correlation with bony morphology and initial stem fit.

We reviewed primary total hip replacements performed by two surgeons using a single cementless tapered wedge design and that had a complete series of radiographs (defined as preoperative, 6 weeks, 1 year and 5 or more years).

Signs of bony remodeling were recorded at each Gruen zone. Calcar remodeling, changes in cortical thickness, evidence of subsidence and pedestal formation were recorded (Figure 1).

57 hips (50 patients) were available for analysis with a mean follow up of 5.03 years. Mean changes in cortical thickness were positive in zones 2(7.51) and 6(5.36) and negative in zones 1(−7.53) and 7(−13.51). Radiolucent lines were found in gruen zones 3,4(39%), and 5. Femoral neck cancellization was seen in zone 7 in 8 patients (14%) in year 1 and 36 (63%) by year 5.

Correlations were seen with proximal canal fill and radiolucent lines at zones 3 (0.278; p0.36) and 5 (0.258; p 0.05) and with distal canal fill and hypertrophy of the cortex in zone 3 (0.429; p0.001) and 5.

Cortical hypertrophy around the midstem, lack of radiolucent lines around the proximal stem and cancellization of the calcar are all radiographic patterns which occur routinely. A positive correlation with distal canal fill and hypertrophy of zones 3 and 5 was noted.

There was no significant correlation with preoperative boney morphology or initial stem fit proximally.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 552 - 552
1 Dec 2013
Robinson J Tarwala R Rathod P Rodriguez J
Full Access

Introduction:

The incidence of heterotrophic ossification after primary total hip arthoplasty (THA) has been reported to be between 8 to 90%. The incidence is higher in lateral approach because of extensive muscular trauma associated with it. There exists limited data on the incidence of heterotrophic ossification after direct anterior approach (DAA) THA. The purpose of this study was to assess the incidence of heterotrophic ossification after THA via the direct anterior approach and the influence of surgical technique and chemoprophylaxis.

Method:

A consecutive series of four hundred two primary uncemented direct anterior approach total hip arthoplasties in 378 patients were reviewed for incidence of heterotrophic ossification. In the first 200 total hip arthoplasties an anterior capsulectomy (Group 1) was done for exposure while in the subsequent 202 total hip arthoplasties a capsulotomy (Group 2) followed by complete release of supero-lateral flap of from its attachement to the gluteus minimus muscle and trochanter was performed (Figure 1). Group 1 received warfarin for thromboprophylaxis; while aspirin (thromboprophylaxis) and celecoxib (pain) was used in group 2. Heterotrophic ossification was classified according to Brooker's classification on plain radiographs.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 502 - 502
1 Dec 2013
Robinson J Patil S Rathod P Rodriguez J
Full Access

Introduction:

Subsidence of cementless femoral stems in total hip arthroplasty (THA) has been associated with poor initial fixation and subsequent risk of aspectic loosening. There is limited literature on how subsidence of cementless, proximally porous coated, tapered wedge femoral stems impacts the patient clinically. The aim of our study was to assess whether subsidence with these stems is associated with a decline in clinical function.

Method:

A review of a prospectively collected database of THAs performed by a single surgeon at one institution using two cementless, tapered wedge stem designs from January 2006 to June 2010 was performed. Radiographic analysis using Picture Archiving and Communications System (PACS) was used to identify patients with greater than 1.5 mm of subsidence, and to document osseointegration. Preoperative and postoperative pain and Harris hip scores were recorded; and analyzed to identify if the clinical recovery pattern of the subsidence versus no subsidence groups differed. Protected weight bearing was recommended to all patients with subsidence.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_18 | Pages 18 - 18
1 Apr 2013
Lancaster S Robinson J Spalding T Brown C
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There is increasing interest in the placement of the femoral and tibial tunnels for anterior cruciate ligament (ACL) reconstruction, with a trend towards a more anatomically accurate reconstruction. Non-anatomical reconstruction of the ACL has been suggested to be one of the major causes of osteoarthritis in the knee following ACL rupture.

Knee surgeons from an international community were invited to demonstrate their method for arthroscopic ACL tunnel placement in an ACL deficient cadaveric knee. These positions were recorded with image intensification and compared with the native ACL insertion sites, which had previously been recorded with image intensification, before the ACL had been resected.

Some clear trends were observed; the use of three tunnel placement techniques (anatomic ridges, ‘ruler method’ and use of image intensification) was associated with most accurate position of the femoral tunnel in the centre of the native ACL femoral insertion site. The choice of arthroscopy portals also affected tunnel placement.

There is considerable variation in ACL reconstruction tunnel placement amongst experienced knee surgeons. This study provides useful information as to which tunnel placement methods are associated with the most anatomically accurate ACL reconstruction.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_14 | Pages 43 - 43
1 Mar 2013
Porteous A Murray J Robinson J Hassaballa M
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Objectives

The aim of this study was to study the short to medium term outcome of a contemporary modular revision knee system used in our centre for managing knee revision arthroplasty.

Methods

Between July 2006 and October 2011, 153 revision cases were done using the Legion revision system. Seventy eight cases completed a 2 years follow up. Preoperative, one and two years follow up scores and radiographic analysis were recorded. Outcome measures included the American Knee Society (AKSS), Oxford (OKS) and WOMAC scores. The American knee society radiographic analysis system was employed to assess assessment standing AP, lateral and skyline views. Figgie's method was used to measure the joint line reproduction. A difference of 5 mm (pre=op/post-op) was deemed satisfactory.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_14 | Pages 33 - 33
1 Mar 2013
Porteous A Murray J Robinson J Hassaballa M
Full Access

Aim

To assess the clinical outcome at 1 year of 30 cases of primary TKA performed with PMCB.

Method

Data was collected prospectively pre-operatively on over 100 primary TKA's performed with PMCB. Of these cases, 30 have reached a point of 1 year follow-up. Validated outcome measures including American Knee Society score, Oxford Knee Score and WOMAC were completed pre-operatively and at 1 year. Radiographic analysis of alignment was performed.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_14 | Pages 31 - 31
1 Mar 2013
Porteous A Murray J Robinson J Hassaballa M
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Aim

To assess the process of using patient matched cutting blocks in Primary TKA with respect to: radiology, the proposed engineering plans, the process in theatre and cost effectiveness. Background: Patient matched cutting blocks (PMCB) are the subject of much interest in primary TKA. Our unit has experience of over 100 cases with a single system.

Method

We have analysed our initial experience with PMCB. We have compared the sizes of implants used in theatres versus the sizes predicted on the image-generated plans. We have assessed the potential time saving in theatre, during each case and in the turn-around time between cases. We have also looked at the number of trays of instruments used in PMCB versus non-PMCB cases.