Little is known about employment following total knee arthroplasty
(TKA). This study aims to identify factors which predict return
to work following TKA in patients of working age in the United Kingdom. We prospectively assessed 289 patients (289 TKAs) aged ≤ 65 years
who underwent TKA between 2010 and 2013. There were 148 women. The
following were recorded pre-operatively: age, gender, body mass
index, social deprivation, comorbidities, indication for surgery,
work status and nature of employment, activity level as assessed by
the University of California, Los Angeles (UCLA) activity score
and Oxford Knee Score (OKS). The intention of patients to return
to work or to retire was not assessed pre-operatively. At a mean
of 3.4 years (2 to 4) post-operatively, the return to work status,
OKS, the EuroQol-5 dimensions (EQ-5D) score, UCLA activity score
and Work, Osteoarthritis and joint-Replacement (WORQ) score were
obtained. Univariate and multivariate analyses were performed.Aims
Patients &
Methods
Computer hexapod assisted orthopaedic surgery (CHAOS), is a method
to achieve the intra-operative correction of long bone deformities
using a hexapod external fixator before definitive internal fixation
with minimally invasive stabilisation techniques. The aims of this study were to determine the reliability of this
method in a consecutive case series of patients undergoing femoral
deformity correction, with a minimum six-month follow-up, to assess
the complications and to define the ideal group of patients for
whom this treatment is appropriate. The medical records and radiographs of all patients who underwent
CHAOS for femoral deformity at our institution between 2005 and
2011 were retrospectively reviewed. Records were available for all
55 consecutive procedures undertaken in 49 patients with a mean
age of 35.6 years (10.9 to 75.3) at the time of surgery.Aims
Patients and Methods
Stress fractures occurring in the pubis and ischium
after peri-acetabular osteotomy (PAO) are not well recognised, with
a reported incidence of 2% to 3%. The purpose of this study was
to analyse the incidence of stress fracture after Bernese PAO under
the care of two high-volume surgeons. The study included 359 patients
(48 men, 311 women) operated on at a mean age of 31.1 years (15
to 56), with a mean follow-up of 26 months (6 to 64). Complete follow-up
radiographs were available for 348 patients, 64 of whom (18.4%)
developed a stress fracture of the inferior pubic ramus, which was
noted at a mean of 9.1 weeks (5 to 55) after surgery. Most (58;
91%) healed. In 40 of the patients with a stress fracture (62.5%),
pubic nonunion also occurred. Those with a stress fracture were
significantly older (mean 33.9 years (16 to 50) Cite this article:
Total hip arthroplasty (THA) has well known subjective benefits,
but little is known objectively about the recovery of mobility in
the early post-operative period. A total of 33 patients aged >
60 years who underwent elective
primary THA had their activity monitored for 30 days post-operatively
using an at-home (Fitbit) ankle accelerometer. Their mean age was
70.7 years (61 to 86); 15 (45.5%) were female. The rate of compliance
and the mean level of activity were determined. Comparisons between subgroups
based on age, body mass index (BMI), surgical approach, and the
destination of the patients when discharged were also performed.Aims
Patients and Methods
Proximal femoral resection (PFR) is a proven
pain-relieving procedure for the management of patients with severe cerebral
palsy and a painful displaced hip. Previous authors have recommended
post-operative traction or immobilisation to prevent a recurrence
of pain due to proximal migration of the femoral stump. We present
a series of 79 PFRs in 63 patients, age 14.7 years (10 to 26; 35
male, 28 female), none of whom had post-operative traction or immobilisation. A total of 71 hips (89.6%) were reported to be pain free or to
have mild pain following surgery. Four children underwent further
resection for persistent pain; of these, three had successful resolution
of pain and one had no benefit. A total of 16 hips (20.2%) showed
radiographic evidence of heterotopic ossification, all of which
had formed within one year of surgery. Four patients had a wound
infection, one of which needed debridement; all recovered fully.
A total of 59 patients (94%) reported improvements in seating and
hygiene. The results are as good as or better than the historical results
of using traction or immobilisation. We recommend that following
PFR, children can be managed without traction or immobilisation,
and can be discharged earlier and with fewer complications. However,
care should be taken with severely dystonic patients, in whom more
extensive femoral resection should be considered in combination
with management of the increased tone. Cite this article:
Malrotation of the femoral component can result in post-operative complications in total knee arthroplasty (TKA), including patellar maltracking. Therefore, we used computational simulation to investigate the influence of femoral malrotation on contact stresses on the polyethylene (PE) insert and on the patellar button as well as on the forces on the collateral ligaments. Validated finite element (FE) models, for internal and external malrotations from 0° to 10° with regard to the neutral position, were developed to evaluate the effect of malrotation on the femoral component in TKA. Femoral malrotation in TKA on the knee joint was simulated in walking stance-phase gait and squat loading conditions.Objectives
Materials and Methods
If patients could recall their physical status
before total hip (THA) or knee arthroplasty (TKA) accurately it
could have valuable applications both clinically and for research.
This study evaluated the accuracy of a patient’s recollection one
year after either THA or TKA using the Oxford hip or knee scores
(OHS and OKS). In total, 113 patients (59 THA, 54 TKA) who had completed
the appropriate score pre-operatively were asked to complete the
score again at a mean of 12.4 months (standard deviation ( While there were no significant differences between the actual
and recalled pre-operative scores (OHS mean difference 0.8, A patient’s recollection of pre-operative pain and function is
inaccurate one year after THA or TKA. Cite this article:
We report the use of the distal radius and ulna (DRU) classification
for the prediction of peak growth (PG) and growth cessation (GC)
in 777 patients with idiopathic scoliosis. We compare this classification
with other commonly used parameters of maturity. The following data were extracted from the patients’ records
and radiographs: chronological age, body height (BH), arm span (AS),
date of menarche, Risser sign, DRU grade and status of the phalangeal
and metacarpal physes. The mean rates of growth were recorded according
to each parameter of maturity. PG was defined as the summit of the curve
and GC as the plateau in deceleration of growth. The rates of growth
at PG and GC were used for analysis using receiver operating characteristic
(ROC) curves to determine the strength and cutoff values of the
parameters of growth.Aims
Patients and Methods
In this paper we propose a new classification
of neurogenic peri-articular heterotopic ossification (HO) of the
hip based on three-dimensional (3D) CT, with the aim of improving
pre-operative planning for its excision. A total of 55 patients (73 hips) with clinically significant
HO after either traumatic brain or spinal cord injury were assessed
by 3D-CT scanning, and the results compared with the intra-operative
findings. At operation, the gross pathological anatomy of the HO as identified
by 3D-CT imaging was confirmed as affecting the peri-articular hip
muscles to a greater or lesser extent. We identified seven patterns
of involvement: four basic (anterior, medial, posterior and lateral)
and three mixed (anteromedial, posterolateral and circumferential).
Excellent intra- and inter-observer agreement, with kappa values
>
0.8, confirmed the reproducibility of the classification system. We describe the different surgical approaches used to excise
the HO which were guided by the 3D-CT findings. Resection was always
successful. 3D-CT imaging, complemented in some cases by angiography, allows
the surgeon to define the 3D anatomy of the HO accurately and to
plan its surgical excision with precision. Cite this article:
The Advance Medial-Pivot total knee arthroplasty (TKA) was designed
to reflect contemporary data regarding the kinematics of the knee.
We wished to examine the long-term results obtained with this prosthesis
by extending a previous evaluation. We retrospectively evaluated prospectively collected data from
225 consecutive patients (41 men and 184 women; mean age at surgery
71 years, 52 to 84) who underwent 284 TKAs with a mean follow-up
of 13.4 years (11 to 15). Implant failure, complication rate, clinical (both
subjective and objective) and radiological outcome were assessed.
Pre- and post-operative clinical and radiographic data were available
at regular intervals for all patients. A total of ten patients (4.4%;
ten TKAs) were lost to follow-up.Aims
Patients and Methods
This study compared the long-term results following Salter osteotomy
and Pemberton acetabuloplasty in children with developmental dysplasia
of the hip (DDH). We assessed if there was a greater increase in
pelvic height following the Salter osteotomy, and if this had a
continued effect on pelvic tilt, lumbar curvature or functional outcomes. We reviewed 42 children at more than ten years post-operatively
following a unilateral Salter osteotomy or Pemberton acetabuloplasty.
We measured the increase in pelvic height and the iliac crest tilt
and sacral tilt at the most recent review and at an earlier review
point in the first decade of follow-up. We measured the lumbar Cobb angle
and the Short Form-36 (SF-36) and Harris hip scores were collected
at the most recent review.Aims
Patients and Methods
This study describes the Osseointegration Group of Australia’s
Accelerated Protocol two-stage strategy (OGAAP-1) for the osseointegrated
reconstruction of amputated limbs. We report clinical outcomes in 50 unilateral trans-femoral amputees
with a mean age of 49.4 years (24 to 73), with a minimum one-year
follow-up. Outcome measures included the Questionnaire for persons
with a Trans-Femoral Amputation, the health assessment questionnaire
Short-Form-36 Health Survey, the Amputation Mobility Predictor scores
presented as K-levels, 6 Minute Walk Test and timed up and go tests.
Adverse events included soft-tissue problems, infection, fractures
and failure of the implant.Aims
Patients and Methods
Long-term clinical outcomes for ceramic-on-ceramic (CoC) bearings
are encouraging. However, there is a risk of squeaking. Guidelines
for the orientation of the acetabular component are defined from
static imaging, but the position of the pelvis and thus the acetabular
component during activities associated with edge-loading are likely
to be very different from those measured when the patient is supine.
We assessed the functional orientation of the acetabular component. A total of 18 patients with reproducible squeaking in their CoC
hips during deep flexion were investigated with a control group
of 36 non-squeaking CoC hips. The two groups were matched for the
type of implant, the orientation of the acetabular component when
supine, the size of the femoral head, ligament laxity, maximum hip
flexion and body mass index. Aims
Patients and Methods
The August 2014 Knee Roundup360 looks at: re-admission following total knee replacement; out with the old and in with the new? computer navigation revisited; approach less important in knee replacement; is obesity driving a rise in knee replacements?; knee replacement isn’t cheap in the obese; cruciate substitution doesn’t increase knee flexion; and sonication useful diagnostic aid in two-stage revision.
