The use of technology to assess balance and alignment during total knee surgery can provide an overload of numerical data to the surgeon. Meanwhile, this quantification holds the potential to clarify and guide the surgeon through the surgical decision process when selecting the appropriate bone recut or soft tissue adjustment when balancing a total knee. Therefore, this paper evaluates the potential of deploying supervised machine learning (ML) models to select a surgical correction based on patient-specific intra-operative assessments. Based on a clinical series of 479 primary total knees and 1,305 associated surgical decisions, various ML models were developed. These models identified the indicated surgical decision based on available, intra-operative alignment, and tibiofemoral load data.Aims
Methods
Aims. There are two techniques widely used to determine the rotational
alignment of the components in
Objectives. Numerous complications following
Debate has raged over whether a cruciate retaining
(CR) or a posterior stabilised (PS)
Abnormal sagittal kinematics after
We prospectively reviewed 1000 consecutive patients who underwent a cementless, hydroxyapatite-coated, stemless,
Objectives. Nylon sutures and skin staples are used commonly in
Bicruciate-stabilised
Louis Pasteur once said that: “Fortune favours
the prepared mind.” As one of the great scientists who contributed
to the fight against infection, he emphasised the importance of
being prepared at all times to recognise infection and deal with
it. Despite the many scientific discoveries and technological advances,
such as the advent of antibiotics and the use of sterile techniques,
infection continues to be a problem that haunts orthopaedic surgeons
and inflicts suffering on patients. The medical community has implemented many practices with the
intention of preventing infection and treating it effectively when
it occurs. Although high-level evidence may support some of these
practices, many are based on little to no scientific foundation.
Thus, around the world, there is great variation in practices for
the prevention and management of periprosthetic joint infection. This paper summaries the instigation, conduct and findings of
a recent International Consensus Meeting on Surgical Site and Periprosthetic
Joint Infection. Cite this article:
The routine use of patient reported outcome measures
(PROMs) in evaluating the outcome after arthroplasty by healthcare
organisations reflects a growing recognition of the importance of
patients’ perspectives in improving treatment. Although widely embraced
in the NHS, there are concerns that PROMs are being used beyond
their means due to a poor understanding of their limitations. This paper reviews some of the current challenges in using PROMs
to evaluate
We studied the intra- and interobserver reliability of measurements of the position of the components after
We performed a randomised controlled trial comparing
computer-assisted surgery (CAS) with conventional surgery (CONV)
in
Substantial healthcare resources have been devoted
to computer navigation and patient-specific instrumentation systems
that improve the reproducibility with which neutral mechanical alignment
can be achieved following
Seven stiff
We describe the survivorship of the Medial Rotation
In Scotland, the number of primary total knee replacements performed annually has been increasing steadily. The price of the implant is fixed but the length of hospital stay is variable. We prospectively investigated all patients who underwent primary unilateral
Aims. We conducted a randomised controlled trial to assess the accuracy
of positioning and alignment of the components in total knee arthroplasty
(TKA), comparing those undertaken using standard intramedullary
cutting jigs and those with patient-specific instruments (PSI). Patients and Methods. There were 64 TKAs in the standard group and 69 in the PSI group. The post-operative hip-knee-ankle (HKA) angle and positioning
was investigated using CT scans. Deviation of >
3° from the planned
position was regarded as an outlier. The operating time, Oxford
Knee Scores (OKS) and Short Form-12 (SF-12) scores were recorded. Results. There were 14 HKA-angle outliers (22%) in the standard group
and nine (13%) in the PSI group (p = 0.251). The mean HKA-angle
was 0.5° varus in the standard group and 0.2° varus in the PSI group
(p = 0.492). The accuracy of alignment in the coronal and axial
planes and the proportion of outliers was not different in the two
groups. The femoral component was more flexed (p = 0.035) and there
were significantly more tibial slope outliers (29% versus 13%)
in the PSI group (p = 0.032). Operating time and the median three-month
OKS were similar (p = 0.218 and p = 0.472, respectively). Physical
and mental SF-12 scores were not significantly different at three
months (p = 0.418 and p = 0.267, respectively) or at one year post-operatively
(p = 0.114 and p = 0.569). The median one-year Oxford knee score
was two points higher in the PSI group (p = 0.049). Conclusion. Compared with standard intramedullary jigs, the use of PSI did
not significantly reduce the number of outliers or the mean operating
time, nor did it clinically improve the accuracy of alignment or
the median Oxford Knee Scores. Our data do not support the routine
use of PSI when undertaking
Systemic emboli released during
We have compared the time to recovery of isokinetic
quadriceps strength after
We suggest that different mechanisms underlie joint pain at rest and on movement in osteoarthritis and that separate assessment of these two features with a visual analogue scale (VAS) offers better information about the likely effect of a