Worldwide rates of primary and revision total
knee arthroplasty (TKA) are rising due to increased longevity of
the population and the burden of osteoarthritis.
Aims. We have previously reported the mid-term outcomes of
Aims. Stemmed tibial components are frequently used in
Aims. This study aimed to determine outcomes of isolated tibial insert exchange (ITIE) during
Aims. Tibial tubercle osteotomy (TTO) facilitates surgical exposure and protects the extensor mechanism during
Aims. Obtaining solid implant fixation is crucial in
Aims. Tranexamic acid (TXA) is proven to reduce blood loss following total knee arthroplasty (TKA), but there are limited data on the impact of similar dosing regimens in
Aims. Metaphyseal cones with cemented stems are frequently used in
Aims. Metaphyseal fixation during
Aims. Both the femoral and tibial component are usually cemented at
Aims. The aim of this study was to measure the effect of hospital case volume on the survival of
Aims. Single-stage
Aims. It has previously been shown that higher-volume hospitals have better outcomes following
Aims. Porous metaphyseal cones can be used for fixation in
Aims. Varus-valgus constrained (VVC) implants are often used during
We identified 148 patients who had undergone a
Aims. The aim of this study was to establish the results of isolated exchange of the tibial polyethylene insert in
We report a consecutive series of 16
We have previously developed a radiographic technique, the oblique posterior condylar view, for assessment of the posterior aspect of the femoral condyles after total knee arthroplasty. The purpose of this study was to confirm the validity of this radiographic view based upon intra-operative findings at
There has been speculation as to how the outcome of
Aims. Enhanced perioperative protocols have significantly improved patient recovery following primary total knee arthroplasty (TKA). Little has been investigated the effectiveness of these protocols for
Aims. The aim of this study was to compare the outcome of revision
total knee arthroplasty (TKA) with and without proximalisation of
the tibial tubercle in patients with a failed primary TKA who have
pseudo patella baja. Patients and Methods. All revision TKAs, performed between January 2008 and November
2013 at a tertiary referral University Orthopaedic Department were
retrospectively reviewed. Pseudo patella baja was defined using
the modified Insall-Salvati and the Blackburne-Peel ratios. A proximalisation
of the tibial tubercle was performed in 13 patients with pseudo
patella baja who were matched with a control group of 13 patients
for gender, age, height, weight, body mass index, length of surgery
and Blackburne-Peel ratio. Outcome was assessed two years post-operatively
using the Knee Society Score (KSS). Results. The increase in KSS was significantly higher in the osteotomy
group compared with the control group. The outcome was statistically
better in patients in whom proximalisation of >
1 cm had been achieved
compared with those in whom the proximalisation was <
1 cm. Conclusion. In this retrospective case-control study, a proximal transfer
of the tibial tubercle at
The treatment of bony defects of the tibia at the time of
A technique for performing allograft-augmented
Most problems encountered in complex revision
total knee arthroplasty can be managed with the wide range of implant
systems currently available. Modular metaphyseal sleeves, metallic
augments and cones provide stability even with significant bone
loss. Hinged designs substitute for significant ligamentous deficiencies.
Catastrophic failure that precludes successful reconstruction can
be encountered. The alternatives to arthroplasty in such drastic
situations include knee arthrodesis, resection arthroplasty and
amputation. The relative indications for the selection of these
alternatives are recurrent deep infection, immunocompromised host,
and extensive non-reconstructible bone or soft-tissue defects.
Revision knee arthroplasty presents a number
of challenges, not least of which is obtaining solid primary fixation
of implants into host bone. Three anatomical zones exist within
both femur and tibia which can be used to support revision implants.
These consist of the joint surface or epiphysis, the metaphysis
and the diaphysis. The methods by which fixation in each zone can
be obtained are discussed. The authors suggest that solid fixation
should be obtained in at least two of the three zones and emphasise
the importance of pre-operative planning and implant selection. Cite this article:
Little is known about the relative outcomes of revision of unicompartmental
knee arthroplasty (UKA) and high tibial osteotomy (HTO) to total
knee arthroplasty (TKA). The aim of this study is to compare the
outcomes of revision surgery for the two procedures in terms of
complications, re-revision and patient-reported outcome measures (PROMs)
at a minimum of two years follow-up. This study was a retrospective review of data from an institutional
arthroplasty registry for cases performed between 2001 and 2014.
A total of 292 patients were identified, of which 217 had a revision
of HTO to TKA, and 75 had revision of UKA to TKA. While mean follow-up
was longer for the HTO group compared with the UKA group, patient
demographics (age, body mass index and Charlson co-morbidity index)
and PROMs (Short Form-36, Oxford Knee Score, Knee Society Score,
both objective and functional) were similar in the two groups prior
to revision surgery. Outcomes included the rate of complications
and
re-operation, PROMS and patient-reported satisfaction at six months
and two years post-operatively. We also compared the duration of
surgery and the need for revision implants in the two groups. Aims
Patients and Methods
The management of bone loss in revision replacement of the knee remains a challenge despite an array of options available to the surgeon. Bone loss may occur as a result of the original disease, the design of the prosthesis, the mechanism of failure or technical error at initial surgery. The aim of revision surgery is to relieve pain and improve function while addressing the mechanism of failure in order to reconstruct a stable platform with transfer of load to the host bone. Methods of reconstruction include the use of cement, modular metal augmentation of prostheses, custom-made, tumour-type or hinged implants and bone grafting. The published results of the surgical techniques are summarised and a guide for the management of bone defects in revision surgery of the knee is presented.
Aims. In the last decade, perioperative advancements have expanded the use of outpatient primary total knee arthroplasty (TKA). Despite this, there remains limited data on expedited discharge after
Aims. The aim of this study was to determine the prevalence of depressive and anxiety disorders prior to total hip (THA) and total knee arthroplasty (TKA) and to assess their impact on the rates of any infection, revision, or reoperation. Methods. Between January 2000 and March 2019, 21,469 primary and revision arthroplasties (10,011 THAs; 11,458 TKAs), which were undertaken in 15,504 patients at a single academic medical centre, were identified from a 27-county linked electronic medical record (EMR) system. Depressive and anxiety disorders were identified by diagnoses in the EMR or by using a natural language processing program with subsequent validation from review of the medical records. Patients with mental health diagnoses other than anxiety or depression were excluded. Results. Depressive and/or anxiety disorders were common before THA and TKA, with a prevalence of 30% in those who underwent primary THA, 33% in those who underwent revision THA, 32% in those who underwent primary TKA, and 35% in those who underwent
Aims. Tibial cones are often utilized in
Aims. The purpose of this study was to assess mid-term survivorship following primary total knee arthroplasty (TKA) with Optetrak Logic components and identify the most common revision indications at a single institution. Methods. We identified a retrospective cohort of 7,941 Optetrak primary TKAs performed from January 2010 to December 2018. We reviewed the intraoperative findings of 369 TKAs that required
Aims.
Aims.
Aims. With an ageing population of patients who are infected with hepatitis C virus (HCV), the demand for total knee arthroplasty (TKA) in this high-risk group continues to grow. It has previously been shown that HCV infection predisposes to poor outcomes following TKA. However, there is little information about the outcome of TKA in patients with HCV who have been treated successfully. The purpose of this study was to compare the outcomes of TKA in untreated HCV patients and those with HCV who have been successfully treated and have a serologically confirmed remission. Patients and Methods. A retrospective review of all patients diagnosed with HCV who underwent primary TKA between November 2011 and April 2018 was conducted. HCV patients were divided into two groups: 1) those whose HCV was cured (HCV-C); and 2) those in whom it was untreated (HCV-UT). All variables including demographics, HCV infection characteristics, surgical details, and postoperative medical and surgical outcomes were evaluated. There were 64 patients (70 TKAs) in the HCV-C group and 63 patients (71 TKAs) in the HCV-UT cohort. The mean age at the time of surgery was 63.0 years (. sd. 7.5; 44 to 79) in the HCV-C group and 61.7 years (. sd. 6.9; 47 to 88) in the HCV-UT group. Results. HCV-UT patients had a significantly longer mean hospital stay (3.4 days vs 2.9 days; p = 0.04), were more likely to be transferred to the intensive care unit (14.1% vs 4.3%; p = 0.04), and were significantly more often discharged to a post-acute care facility (39.4% vs 14.3%; p < 0.01). HCV-UT patients had significantly more postoperative infections (15.5% vs 4.3%; p = 0.03), surgical complications (21.1% vs 7.1%; p = 0.02), and
Aims. The aim of this study was to identify predictors of return to
work (RTW) after revision lower limb arthroplasty in patients of
working age in the United Kingdom. Patients and Methods. We assessed 55 patients aged ≤ 65 years after revision total
hip arthroplasty (THA). There were 43 women and 12 men with a mean
age of 54 years (23 to 65). We also reviewed 30 patients after revision
total knee arthroplasty (TKA). There were 14 women and 16 men with
a mean age of 58 years (48 to 64). Preoperatively, age, gender,
body mass index, social deprivation, mode of failure, length of
primary implant survival, work status and nature, activity level
(University of California, Los Angeles (UCLA) score), and Oxford
Hip and Knee Scores were recorded. Postoperatively, RTW status,
Oxford Hip and Knee Scores, EuroQol-5D (EQ-5D), UCLA score, and
Work, Osteoarthritis and Joint-Replacement Questionnaire (WORQ)
scores were obtained. Univariate and multivariate analysis was performed. Results. Overall, 95% (52/55) of patients were working before their revision
THA. Afterwards, 33% (17/52) RTW by one year, 48% (25/52) had retired,
and 19% (10/52) were receiving welfare benefit. RTW was associated
with age, postoperative Oxford Hip Score, early THA failure (less
than two years), mode of failure dislocation, and contralateral
revision (p < 0.05). No patient returned to work after revision
for dislocation. Only age remained a significant factor on multivariate
analysis (p = 0.003), with 79% (11/14) of those less than 50 years
of age returning to work, compared with 16% (6/38) of those aged
fifty years or over. Before
Aims. Unicompartmental knee arthroplasty (UKA) has higher revision rates than total knee arthroplasty (TKA). As revision of UKA may be less technically demanding than
Aims. The prevalence of ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) is rising in concert with life expectancy, putting more patients at risk for interprosthetic femur fractures (IPFFs). Our study aimed to assess treatment methodologies, implant survivorship, and IPFF clinical outcomes. Methods. A total of 76 patients treated for an IPFF from February 1985 to April 2018 were reviewed. Prior to fracture, at the hip/knee sites respectively, 46 femora had primary/primary, 21 had revision/primary, three had primary/revision, and six had revision/revision components. Mean age and BMI were 74 years (33 to 99) and 30 kg/m. 2. (21 to 46), respectively. Mean follow-up after fracture treatment was seven years (2 to 24). Results. Overall, 59 fractures were classified as Vancouver C (Unified Classification System (UCS) D), 17 were Vancouver B (UCS B). In total, 57 patients (75%) were treated with open reduction and internal fixation (ORIF); three developed nonunion, three developed periprosthetic joint infection, and two developed aseptic loosening. In all, 18 patients (24%) underwent revision arthroplasty including 13 revision THAs, four distal femoral arthroplasties (DFAs), and one
Aims. In patients with a “dry” aspiration during the investigation of prosthetic joint infection (PJI), saline lavage is commonly used to obtain a sample for analysis. The aim of this study was to investigate prospectively the impact of saline lavage on synovial fluid analysis in revision arthroplasty. Methods. Patients undergoing revision hip (THA) or knee arthroplasty (TKA) for any septic or aseptic indication were enrolled. Intraoperatively, prior to arthrotomy, the maximum amount of fluid possible was aspirated to simulate a dry tap (pre-lavage) followed by the injection with 20 ml of normal saline and re-aspiration (post-lavage). Pre- and post-lavage synovial white blood cell (WBC) count, percent polymorphonuclear cells (%PMN), and cultures were compared. Results. A total of 78 patients had data available for analysis; 17 underwent revision THA and 61 underwent
Aims. Patients with flexion instability after total knee arthroplasty
(TKA) often present with a recurrent effusion, which may be a haemarthrosis.
While the radiographic factors contributing to flexion instability
have been elucidated, the clinical diagnosis remains challenging.
Our aim, in this study, was to determine the mean white cell count
and differential profile in pre-operative aspirations of synovial
fluid in a consecutive series of patients undergoing revision TKA
for flexion instability. Patients and Methods. Between 2000 and 2010, 60 patients undergoing aseptic revision
TKA for flexion instability were identified. The results of the
pre-operative aspiration of synovial fluid were available for 53
patients (88%). These patients were 1:2 matched to 106 patients
who underwent aseptic TKA for indications other than flexion instability.
The mean age of the patients at
Aims. Aseptic loosening of the tibial component is a frequent cause of failure in primary total knee arthroplasty (TKA). Management options include an isolated tibial revision or full component revision. A full component revision is frequently selected by surgeons unfamiliar with the existing implant or who simply wish to “start again”. This option adds morbidity compared with an isolated tibial revision. While isolated tibial revision has a lower morbidity, it is technically more challenging due to difficulties with exposure and maintaining prosthetic stability. This study was designed to compare these two reconstructive options. Methods. Patients undergoing
Aims. The aim of this study was to evaluate the ability of a machine-learning algorithm to diagnose prosthetic loosening from preoperative radiographs and to investigate the inputs that might improve its performance. Methods. A group of 697 patients underwent a first-time revision of a total hip (THA) or total knee arthroplasty (TKA) at our institution between 2012 and 2018. Preoperative anteroposterior (AP) and lateral radiographs, and historical and comorbidity information were collected from their electronic records. Each patient was defined as having loose or fixed components based on the operation notes. We trained a series of convolutional neural network (CNN) models to predict a diagnosis of loosening at the time of surgery from the preoperative radiographs. We then added historical data about the patients to the best performing model to create a final model and tested it on an independent dataset. Results. The convolutional neural network we built performed well when detecting loosening from radiographs alone. The first model built de novo with only the radiological image as input had an accuracy of 70%. The final model, which was built by fine-tuning a publicly available model named DenseNet, combining the AP and lateral radiographs, and incorporating information from the patient’s history, had an accuracy, sensitivity, and specificity of 88.3%, 70.2%, and 95.6% on the independent test dataset. It performed better for cases of revision THA with an accuracy of 90.1%, than for cases of
Aims. The aim of this study was to assess the effects of transferring patients to a specialized arthroplasty centre between the first and second stages (interstage) of prosthetic joint infection (PJI) of the knee. Patients and Methods. A search of our institutional database was performed to identify patients having undergone two-stage
Nonagenarians (aged 90 to 99 years) have experienced the fastest percent decile population growth in the USA recently, with a consequent increase in the prevalence of nonagenarians living with joint arthroplasties. As such, the number of revision total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) in nonagenarians is expected to increase. We aimed to determine the mortality rate, implant survivorship, and complications of nonagenarians undergoing aseptic revision THAs and revision TKAs. Our institutional total joint registry was used to identify 96 nonagenarians who underwent 97 aseptic revisions (78 hips and 19 knees) between 1997 and 2018. The most common indications were aseptic loosening and periprosthetic fracture for both revision THAs and revision TKAs. Mean age at revision was 92 years (90 to 98), mean BMI was 27 kg/m2 (16 to 47), and 67% (n = 65) were female. Mean time between primary and revision was 18 years (SD 9). Kaplan-Meier survival was used for patient mortality, and compared to age- and sex-matched control populations. Reoperation risk was assessed using cumulative incidence with death as a competing risk. Mean follow-up was five years.Aims
Methods
Aims. The aim of this study was to evaluate the surface damage, the density of crosslinking, and oxidation in retrieved antioxidant-stabilized highly crosslinked polyethylene (A-XLPE) tibial inserts from total knee arthroplasty (TKA), and to compare the results with a matched cohort of standard remelted highly crosslinked polyethylene (XLPE) inserts. Materials and Methods. A total of 19 A-XLPE tibial inserts were retrieved during
The aim of this study was to identify variables associated with time to revision, demographic details associated with revision indication, and type of prosthesis employed, and to describe the survival of hinge knee arthroplasty (HKA) when used for first-time knee revision surgery and factors that were associated with re-revision. Patient demographic details, BMI, American Society of Anesthesiologists (ASA) grade, indication for revision, surgical approach, surgeon grade, implant type (fixed and rotating), time of revision from primary implantation, and re-revision if undertaken were obtained from the National Joint Registry data for England, Wales, Northern Ireland, and the Isle of Man over an 18-year period (2003 to 2021).Aims
Methods
Aims. The number of