The aim of this study was to capture 12-month outcomes from a representative multicentre cohort of patients undergoing total ankle arthroplasty (TAA), describe the pattern of patient-reported outcome measures (PROMs) at 12 months, and identify predictors of these outcome measures. Patients listed for a primary TAA at 19 NHS hospitals between February 2016 and October 2017 were eligible. PROMs data were collected preoperatively and at six and 12 months including: Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ (foot and ankle)) and the EuroQol five-dimension five-level questionnaire (EQ-5D-5L). Radiological pre- and postoperative data included Kellgren-Lawrence score and implant position measurement. This was supplemented by data from the National Joint Registry through record linkage to determine: American Society of Anesthesiologists (ASA) grade at index procedure; indication for surgery, index ankle previous fracture; tibial hind foot alignment; additional surgery at the time of TAA; and implant type. Multivariate regression models assessed outcomes, and the relationship between MOXFQ and EQ-5D-5L outcomes, with patient characteristics.Aims
Methods
Access to joint replacement is being restricted for patients with comorbidities in a number of high-income countries. However, there is little evidence on the impact of comorbidities on outcomes. The purpose of this study was to determine the safety and effectiveness of hip and knee arthroplasty in patients with and without comorbidities. In total, 312,079 hip arthroplasty and 328,753 knee arthroplasty patients were included. A total of 11 common comorbidities were identified in administrative hospital records. Safety risks were measured by assessing length of hospital stay (LOS) and 30-day emergency readmissions and mortality. Effectiveness outcomes were changes in Oxford Hip or Knee Scores (OHS/OKS) (scale from 0 (worst) to 48 (best)) and in health-related quality of life (EQ-5D) (scale from 0 (death) to 1 (full health)) from immediately before, to six months after, surgery. Regression analysis was used to estimate adjusted mean differences (LOS, change in OHS/OKS/EQ-5D) and risk differences (readmissions and mortality).Aims
Methods
The most appropriate form of chemical thromboprophylaxis following knee replacement is a contentious issue. Most national guidelines recommend the use of low molecular weight Heparin (LMWH) whilst opposing the use of aspirin. We compared thromboembolic events, major haemorrhage and death after knee replacement in patients receiving either aspirin or LMWH. Data from the National Joint Registry for England and Wales was linked to an administrative database of hospital admissions in the English National Health Service. A total of 156 798 patients undergoing knee replacement between April 2003 and September 2008 were included and followed up for 90 days. Multivariable risk modelling was used to estimate odds ratios adjusted for baseline risk factors (AOR). An AOR < 1 indicates that risk rates are lower with LMWH than with aspirin.Background
Methods
The aim of the study was to characterise gait in patients with achondroplasia post lengthening. Full kinematic and kinetic lower limb gait analysis was performed at the Sheffield Children's Hospital gait laboratory, Sheffield, using a Vicon system (6 cameras working at 50Hz) and processed using Plug In Gait modelling software. The lengthened Achondroplasia group (n=11, mean age = 24.5 ± 6.1) had previously undergone surgical lengthening of the legs. The lengthened Achondroplasia group was compared to a control group of 11 adult normal subjects.Aim
Patients/Materials and Methods
To examine the effect of limb lengthening on the quality of life of people who have disproportionate short stature (DSS). Thirteen previous patients, completed the SF-36, the Derriford Appearance Scale and participated in face to face semi structured interviews to establish the impact on their physical and social functioning, their present situation including employment, education, housing and leisure activities and their thoughts about whether they felt the treatment had been worthwhile. To increase understanding about the patient and family experience of limb lengthening, participants were asked about their memories of the procedure and the treatment period.Purpose
Method
To examine how patients viewed the outcome of their joint replacement at least one year post surgery. Emphasis was placed on investigating the relative influence of ongoing pain and functional limitation on patient satisfaction. Questionnaire based assessment of the Oxford Knee Score (OKS), patient satisfaction, and need for reoperation in a group of 10,000 patients who had undergone primary unilateral knee replacement between April and December 2003. Questionnaires were linked to the NJR database to provide data on background demographics, clinical parameters and intraoperative surgical information for each patient. Data was analysed to investigate the relationship between the OKS, satisfaction rate and the background factors. Multivariable logistic regression was performed to establish which factors influenced patient satisfaction.Purpose
Method
Data was analysed to investigate the relationship between the OKS, satisfaction rate and the background factors. Multivariable logistic regression was performed to establish which factors influenced patient satisfaction.
Regression modelling showed that patients with higher scores relating to the pain and function elements of the OKS had lower levels of satisfaction (p<
0.001) and that ongoing pain was a stronger predictor of lower levels of satisfaction. Other predictors of lower levels of satisfaction included female gender (p<
0.05), a primary diagnosis of osteoarthritis (p=0.02) and unicondylar replacement (p=0.002). Differences in satisfaction rate were also observed dependent upon age and ASA grade 609 patients (7.4%) had undergone further surgery and 1476 patients (17.9%) indicated another procedure was planned. Both the OKS and satisfaction rates were significantly better in patients who had not suffered complications.
