The objectives of this study were to compare postoperative pain, analgesia requirements, inpatient functional rehabilitation, time to hospital discharge, and complications in patients undergoing conventional jig-based unicompartmental knee arthroplasty (UKA) This prospective cohort study included 146 patients with symptomatic medial compartment knee osteoarthritis undergoing primary UKA performed by a single surgeon. This included 73 consecutive patients undergoing conventional jig-based mobile bearing UKA, followed by 73 consecutive patients receiving robotic-arm assisted fixed bearing UKA. All surgical procedures were performed using the standard medial parapatellar approach for UKA, and all patients underwent the same postoperative rehabilitation programme. Postoperative pain scores on the numerical rating scale and opiate analgesia consumption were recorded until discharge. Time to attainment of predefined functional rehabilitation outcomes, hospital discharge, and postoperative complications were recorded by independent observers.Aims
Patients and Methods
The aim of this study was to evaluate the risk
factors for dislocation of the bearing after a mobile-bearing Oxford medial
unicompartmental knee replacement (UKR) and to test the hypothesis
that surgical factors, as measured from post-operative radiographs,
are associated with its dislocation From a total of 480 UKRs performed between 2001 and 2012, in
391 patients with a mean age of 66.5 years (45 to 82) (316 female,
75 male), we identified 17 UKRs where bearing dislocation occurred.
The post-operative radiological measurements of the 17 UKRs and
51 matched controls were analysed using conditional logistic regression analysis.
The post-operative radiological measurements included post-operative
change in limb alignment, the position of the femoral and tibial
components, the resection depth of the proximal tibia, and the femoral component-posterior
condyle classification. We concluded that a post-operative decrease in the posterior
tibial slope relative to the pre-operative value was the only significant
determinant of dislocation of the bearing after medial Oxford UKR
(odds ratio 1.881; 95% confidence interval 1.272 to 2.779). A post-operative
posterior tibial slope <
8.45° and a difference between the pre-operative
and post-operative posterior tibial slope of >
2.19° may increase
the risk of dislocation. Cite this article:
Components from 73 failed knee replacements (TKRs) consisting of rotating-platform, mobile-bearing and fixed-bearing implants were examined to assess the patterns of wear. The patterns were divided into low-grade (burnishing, abrasion and cold flow) and high-grade (scratching, pitting/metal embedding and delamination) to assess the severity of the wear of polyethylene. The rotating-platform group had a higher incidence of low-grade wear on the upper surface compared with the fixed-bearing group. By contrast, high-grade wear comprising scratching, pitting and third-body embedding was seen on the lower surface. Linear regression analysis showed a significant correlation of the wear scores between the upper and lower surfaces of the tibial insert (R2 = 0.29, p = 0.04) for the rotating-platform group, but no significant correlation was found for the fixed-bearing counterpart. This suggests that high-grade wear patterns on the upper surface are reduced with the rotating-platform design. However, the incidence of burnishing, pitting/third-body embedding and scratching wear patterns on the lower surface was higher compared with that in the fixed-bearing knee.
Focal femoral inlay resurfacing has been developed
for the treatment of full-thickness chondral defects of the knee. This
technique involves implanting a defect-sized metallic or ceramic
cap that is anchored to the subchondral bone through a screw or
pin. The use of these experimental caps has been advocated in middle-aged
patients who have failed non-operative methods or biological repair
techniques and are deemed unsuitable for conventional arthroplasty
because of their age. This paper outlines the implant design, surgical
technique and biomechanical principles underlying their use. Outcomes
following implantation in both animal and human studies are also reviewed. Cite this article:
A total of 11 patients (12 knees) with stable lesions of osteochondritis dissecans of the knee underwent arthroscopic fixation of the fragments using polylactide bioabsorbable pins. The site of the lesion was the medial femoral condyle in ten knees and the lateral femoral condyle in two. The mean age of the patients was 14.8 years (12 to 16). At a mean follow-up of 32.4 months (13 to 38 months) all fragments had MRI evidence of union. One patient developed early transient synovitis, which resolved with non-steroidal anti-inflammatory medication. All patients returned to sporting activities within eight months of operation and did not require a period of immobilisation.
