The prevalence of Parkinson's disease (PD) is expected to rise however reports of the outcomes of total knee arthroplasty (TKA) in patients with PD in the literature are sparse. We present the first study to compare short to medium term outcomes of TKA in patients with and without PD. We performed a retrospective analysis of data from our regional arthroplasty database. In our PD group 32 TKAs were implanted. In our age-matched control group 33 TKAs were implanted. Mean age at operation was 73 years and the primary indication was osteoarthritis in both groups. Data was collected pre-operatively and at routine 1, 3 and 5 year follow-up attendances. Median in-patient stay was comparable in both groups (P=0.714). Pre-operatively, there were no between-group differences in range of movement, Knee Society Function Score (KSFS), Knee Society Score (KSS) or Pain score taken as an independent variable (P=0.108, 0.079, 0.478 and 0.496). KSS improved in both groups post-operatively with no significant between-group differences (P=0.707). Improvement was maintained to Year 5 (median 30 points pre-operatively and 91 points at Year 5 in PD group). Pain score also improved in both groups. There was no functional improvement following TKA in the PD group. In the controls, an increase in KSFS at Year 1 was followed by a return to pre-operative values at Year 5. Complications in the PD group included 1 case of bilateral quadriceps tendon avulsion and 1 dislocation requiring revision. Patients with PD benefit from excellent pain relief following TKA for at least 5 years after surgery.
Metal on metal hip resurfacing has become popular worldwide for younger patients because of perceived advantages in function and ease of revision, due to bone conservation. Joint Registry data have shown increased risk of early failure, particularly in younger females. There have been few studies comparing the outcome of resurfacing to cemented total hip arthroplasty (THA). 715 Hip Resurfacings (HR) performed between 2000 and 2010 with up to 10 years follow-up were compared with 2210 Exeter cemented Total Hip Arthroplasties (THA) performed for all diagnoses during the same period within our region. Survivorship was recorded using revision for any cause as the end point. Harris Hip Scores were collected pre-operatively and at 1,3,5 and 7 year review. Prospective independent analysis was carried out using Kaplan Meier survivorship, and non-parametric testing to investigate the effect of age (under 55 and over 55) and gender on revision rate and Harris Hip Score.Background
Methods
New methods to reduce inpatient stay, post-operative complications and recovery time are continually being sought in surgery. Many factors affect length of hospital stay, such as, analgesia, patient and surgeon expectations, as well as provision of nursing care and physiotherapy. Development of the use of postoperative local anaesthetic infiltration delivered intra-articularly by a catheter appears to be an effective analgesic method which reduces patient's opioid requirements and allows early physiotherapy without motor blockade of muscles. Our study aimed to explore if the use of local anaesthetic infiltration intra-articularly following joint athroplasty affected the patient's duration of hospitalisation. Looking retrospectively at arthroplasty audit data, we compared two groups of age and sex-matched patients who underwent primary hip arthroplasty (replacement and resurfacing) and knee arthroplasty performed by a single surgeon using the same surgical techniques. The surgeon began to utilize local anesthetic infiltration intra-articularly in 2009. The first group included patients operated on the year prior to the change and the second group were those operated on within a year of the change of practice. There were 103 patients (27 resurfacings, 28 knees, 48 hips) in the local anaesthetic group and 141 patients (48 resurfacings, 36 knees, 64 hips) in the non-local anaesthetic group. The length of stay was investigated for plausible Normality using the Shapiro Wilks statistic. Between-treatment group differences were examined using one-way analysis of variance (ANOVA). Factors observed were, use of local anaesthetic (yes/no), joint (hip/knee) and day of surgery (weekend/not weekend). Between treatment group differences in gender and complications were investigated using Chi-squared methods.Introduction
Methods
The merit of staging bilateral total knee arthroplasties (separate procedures) versus replacing both joints at the same anaesthetic (sequential) is a topic debated in literature. The aim of this study was to evaluate &
compare the clinical outcome in patients who had undergone either bilateral staged or sequential total knee arthroplasties (TKAs). METHODS: Computerized database and medical records of patients who had had bilateral TKAs in the Tayside region between 1984 and 2003 were retrospectively evaluated. Outcome was assessed using Knee Society Score, Pain Score, Function Score and Range of Movement. RESULTS: 438 sequential and 526 staged procedures were evaluated. The sequential group had better function score at 1 and 3 years (P<
0.001). There was no other statistically significant difference in the outcome measures. The mean ages of the sequential and staged study groups were 70.67 and 69.19 years, respectively (P=0.011).
We randomised 24 patients before they had a cemented hemiarthroplasty for hip fracture to receive either thorough or minimal saline lavage of the femoral canal. We then determined the effect in each group on the thromboembolic and cardiopulmonary responses to the pressurised insertion of cement, using transoesophageal echocardiography to show the echogenic embolic response. We found a statistically significant reduction in both the duration of the response and the number of large emboli in patients who had had thorough lavage as compared with the control group with minimal lavage. There was also less disturbance of pulmonary function, as assessed by the change in end-tidal CO2 levels and oxygen saturation, in patients who had thorough lavage. Three patients had a significant fall in blood pressure during cement insertion; all had only minimal lavage. We consider that thorough lavage should be an essential part of the preparation of the proximal femur before cement insertion.
