Total knee arthroplasty (TKA) is a cost effective
and extremely successful operation. As longevity increases, the demand
for primary TKA will continue to rise. The success and survivorship
of TKAs are dependent on the demographics of the patient, surgical
technique and implant-related factors. Currently the risk of failure of a TKA requiring revision surgery
ten years post-operatively is 5%. The most common indications for revision include aseptic loosening
(29.8%), infection (14.8%), and pain (9.5%). Revision surgery poses
considerable clinical burdens on patients and financial burdens
on healthcare systems. We present a current concepts review on the epidemiology of failed
TKAs using data from worldwide National Joint Registries. Cite this article:
In this paper, we will consider the current role
of simultaneous-bilateral TKA. Based on available evidence, it is
our opinion that bilateral one stage TKR is a safe and efficacious treatment
for patients with severe bilateral arthritic knee disease but should
be reserved for selected patients without significant medical comorbidities.
A total of 445 consecutive primary total knee
replacements (TKRs) were followed up prospectively at six and 18 months
and three, six and nine years. Patients were divided into two groups:
non-obese (body mass index (BMI) <
30 kg/m2) and obese
(BMI ≥ 30 kg/m2). The obese group was subdivided into
mildly obese (BMI 30 to 35 kg/m2) and highly obese (BMI ≥ 35
kg/m2) in order to determine the effects of increasing
obesity on outcome. The clinical data analysed included the Knee
Society score, peri-operative complications and implant survival.
There was no difference in the overall complication rates or implant
survival between the two groups. Obesity appears to have a small but significant adverse effect
on clinical outcome, with highly obese patients showing lower function
scores than non-obese patients. However, significant improvements
in outcome are sustained in all groups nine years after TKR. Given
the substantial, sustainable relief of symptoms after TKR and the low
peri-operative complication and revision rates in these two groups,
we have found no reason to limit access to TKR in obese patients.
We report a prospective analysis of clinical
outcome in patients treated with medial patellofemoral ligament
(MPFL) reconstruction using an autologous semitendinosus graft.
The technique includes superolateral portal arthroscopic assessment
before and after graft placement to ensure correct graft tension
and patellar tracking before fixation. Between October 2005 and
October 2010, a total of 201 consecutive patients underwent 219 procedures.
Follow-up is presented for 211 procedures in 193 patients with a
mean age of 26 years (16 to 49), and mean follow-up of 16 months
(6 to 42). Indications were atraumatic recurrent patellar dislocation
in 141 patients, traumatic recurrent dislocation in 50, pain with
subluxation in 14 and a single dislocation with persistent instability
in six. There have been no recurrent dislocations/subluxations.
There was a statistically significant improvement between available pre-
and post-operative outcome scores for 193 patients (all p <
0.001).
Female patients with a history of atraumatic recurrent dislocation
and all patients with history of previous surgery had a significantly
worse outcome (all p <
0.05). The indication for surgery, degree
of dysplasia, associated patella alta, time from primary dislocation
to surgery and evidence of associated cartilage damage at operation
did not result in any significant difference in outcome. This series adds considerably to existing evidence that MPFL
reconstruction is an effective surgical procedure for selected patients
with patellofemoral instability.
This prospective study describes the outcome of the first 1000 phase 3 Oxford medial unicompartmental knee replacements (UKRs) implanted using a minimally invasive surgical approach for the recommended indications by two surgeons and followed up independently. The mean follow-up was 5.6 years (1 to 11) with 547 knees having a minimum follow-up of five years. At five years their mean Oxford knee score was 41.3 ( The incidence of implant-related re-operations was 2.9%; of these 29 re-operations two were revisions requiring revision knee replacement components with stems and wedges, 17 were conversions to a primary total knee replacement, six were open reductions for dislocation of the bearing, three were secondary lateral UKRs and one was revision of a tibial component. The most common reason for further surgical intervention was progression of arthritis in the lateral compartment (0.9%), followed by dislocation of the bearing (0.6%) and revision for unexplained pain (0.6%). If all implant-related re-operations are considered failures, the ten-year survival rate was 96% (95% confidence interval, 92.5 to 99.5). If only revisions requiring revision components are considered failures the ten-year survival rate is 99.8% (confidence interval 99 to 100). This is the largest published series of UKRs implanted through a minimally invasive surgical approach and with ten-year survival data. The survival rates are similar to those obtained with a standard open approach whereas the function is better. This demonstrates the effectiveness and safety of a minimally invasive surgical approach for implanting the Oxford UKR.
We wished to determine whether simultaneous bilateral sequential total knee replacement (TKR) carried increased rates of mortality and complications compared with unilateral TKR in low- and high-risk patients. Our study included 2385 patients who had undergone bilateral sequential TKR under one anaesthetic and 719 who had unilateral TKR. There were no significant pre-operative differences between the groups in terms of age, gender, height, weight, body mass index, diagnosis, comorbidity and duration of follow-up, which was a mean of 10.2 years (5 to 14) in the bilateral and 10.4 years (5 to 14) in the unilateral group. The peri-operative mortality rate (eight patients, 0.3%) of patients who had bilateral sequential TKR was similar to that (five patients, 0.7%) of those undergoing unilateral TKR. In bilateral cases the peri-operative mortality rate (three patients, 0.4%) of patients at high risk was similar to that (five patients, 0.3%) of patients at low risk as it was also in unilateral cases (two patients, 1.0% vs three patients, 0.6%). There was no significant difference (p = 0.735) in either the overall number of major complications between bilateral and unilateral cases or between low- (p = 0.57) and high-risk (p = 0.61) patients. Also, the overall number of minor complications was not significantly different between the bilateral and unilateral group (p = 0.143). Simultaneous bilateral sequential TKR can be offered to patients at low and high risk and has an expected rate of complications similar to that of unilateral TKR.
Systemic emboli released during total knee replacement have been implicated as a cause of
We have compared a new technique of computer-assisted knee arthroplasty with the current conventional jig-based technique in 70 patients randomly allocated to receive either of the methods. Post-operative CT was performed according to the Perth CT Knee Arthroplasty protocol and pre- and post-operative Maquet views of the limb were taken. Intra-operative and