Aims. Unicompartmental knee arthroplasty (UKA) has a higher risk of revision than
The Oxford knee score (OKS) is a validated and
widely accepted disease-specific patient-reported outcome measure,
but there is limited evidence regarding any long-term trends in
the score. We reviewed 5600 individual OKS questionnaires (1547
patients) from a prospectively-collected knee replacement database,
to determine the trends in OKS over a ten-year period following
total knee replacement. The mean OKS pre-operatively was 19.5 (95%
confidence interval (CI) 18.8 to 20.2). The maximum post-operative
OKS was observed at two years (mean score 34.4 (95% CI 33.7 to 35.2)),
following which a gradual but significant decline was observed through
to the ten-year assessment (mean score 30.1 (95% CI 29.1 to 31.1))
(p <
0.001). A similar trend was observed for most of the individual
OKS components (p <
0.001). Kneeling ability initially improved
in the first year but was then followed by rapid deterioration (p
<
0.001). Pain severity exhibited the greatest improvement, although
residual pain was reported in over two-thirds of patients post-operatively,
and peak improvement in the night pain component did not occur until
year four. Post-operative OKS was lower for women (p <
0.001),
those aged <
60 years (p <
0.003) and those with a body mass
index >
35 kg/m2 (p <
0.014), although similar changes
in scores were observed. This information may assist surgeons in
advising patients of their expected outcomes, as well as providing
a comparative benchmark for evaluating longer-term outcomes following
knee replacement. Cite this article:
The June 2023 Knee Roundup. 360. looks at: Cementless total knee arthroplasty is associated with early aseptic loosening in a large national database; Is cementless total knee arthroplasty safe in females aged over 75 years?; Could novel radiological findings help identify aseptic tibial loosening?; The Attune cementless versus LCS arthroplasty at introduction; Return to work following
The August 2024 Knee Roundup. 360. looks at: Calcification’s role in knee osteoarthritis: implications for surgical decision-making; Lower complication rates and shorter lengths of hospital stay with technology-assisted
Aims. Unicompartmental and
Abstract. Robotic-assisted
The August 2023 Knee Roundup. 360. looks at: Curettage and cementation of giant cell tumour of bone: is arthritis a given?; Anterior knee pain following
We investigated whether an asymmetric extension
gap seen on routine post-operative radiographs after primary total
knee replacement (TKR) is associated with pain at three, six, 12
and 24 months’ follow-up. On radiographs of 277 patients after primary
TKR we measured the distance between the tibial tray and the femoral
condyle on both the medial and lateral sides. A difference was defined
as an asymmetric extension gap. We considered three groups (no asymmetric
gap, medial-opening and lateral-opening gap) and calculated the
associations with the Western Ontario and McMaster Universities
osteoarthritis index pain scores over time. Those with an asymmetric extension gap of ≥ 1.5 mm had a significant
association with pain scores at three months’ follow-up; patients
with a medial-opening extension gap reported more pain and patients
with a lateral-opening extension gap reported less pain (p = 0.036).
This effect was still significant at six months (p = 0.044), but had
lost significance by 12 months (p = 0.924). When adjusting for multiple
cofounders the improvement in pain was more pronounced in patients
with a lateral-opening extension gap than in those with a medial-opening extension
gap at three (p = 0.037) and six months’ (p = 0.027) follow-up. Cite this article:
Postoperative anterior knee pain was evaluated in a consecutive series of 138 knees in 108 patients with rheumatoid arthritis treated by
Aims. Return to sport following undergoing total (TKA) and unicompartmental knee arthroplasty (UKA) has been researched with meta-analyses and systematic reviews of varying quality. The aim of this study is to create an umbrella review to consolidate the data into consensus guidelines for returning to sports following
This study describes 146 primary total knee replacements, either fully or partially coated with hydroxyapatite of which 74 knees in 68 patients were available for clinical and radiological assessment at a mean of 11.2 years (10 to 15). The global failure rate was 1.37% and survival rate with mechanical failure as the end-point was 98.14%. Radiological assessment indicated intimate contact between bone and the hydroxyapatite coating. Over time the hydroxyapatite coating appears to encourage filling of interface gaps remaining after surgery. Our results compare favourably with those of series describing cemented or porous-coated knee replacements, and suggest that fixation with hydroxyapatite is a reliable option in primary total knee replacement.
The February 2023 Knee Roundup. 360. looks at: Machine-learning models: are all complications predictable?; Positive cultures can be safely ignored in revision arthroplasty patients that do not meet the 2018 International Consensus Meeting Criteria; Spinal versus general anaesthesia in contemporary primary total knee arthroplasty; Preoperative pain and early arthritis are associated with poor outcomes in
Aims. Bi-unicondylar arthroplasty (Bi-UKA) is a bone and anterior cruciate ligament (ACL)-preserving alternative to
We reviewed the long-term clinical and radiological
results of 63 uncemented Low Contact Stress (LCS) total knee replacements
(TKRs) in 47 patients with rheumatoid arthritis. The mean age of
the patients at the time of surgery was 69 years (53 to 81). At
a mean follow-up of 22 years (20 to 25), 12 patients were alive
(17 TKRs), 27 had died (36 TKRs), and eight (ten TKRs) were lost
to follow-up. Revision was necessary in seven patients (seven TKRs, 11.1%)
at a mean of 12.1 years (0 to 19) after surgery. In the surviving
ten patients who had not undergone revision (15 TKRs), the mean
Oxford knee score was 30.2 (16 to 41) at a mean follow-up of 19.5
years (15 to 24.7) and mean active flexion was 105° (90° to 150°).
The survival rate was 88.9% at 20 years (56 of 63) and the Kaplan–Meier
survival estimate, without revision, was 80.2% (95% confidence interval
37 to 100) at 25 years. Cite this article:
Aims. Micromotion of the polyethylene (PE) inlay may contribute to backside PE wear in addition to articulate wear of
In the absence of patellar resurfacing, we have
previously shown that the use of electrocautery around the margin of
the patella improved the one-year clinical outcome of total knee
replacement (TKR). In this prospective randomised study we compared
the mean 3.7 year (1.1 to 4.2) clinical outcomes of 300 TKRs performed
with and without electrocautery of the patellar rim: this is an
update of a previous report. The overall prevalence of anterior knee
pain was 32% (95% confidence intervals [CI] 26 to 39), and 26% (95%
CI 18 to 35) in the intervention group compared with 38% (95% CI
29 to 48) in the control group (chi-squared test; p = 0.06). The
overall prevalence of anterior knee pain remained unchanged between
the one-year and 3.7 year follow-up (chi-squared test; p = 0.12). The
mean total Western Ontario McMasters Universities Osteoarthritis
Indices and the American Knee Society knee and function scores at
3.7 years’ follow-up were similar in the intervention and control
groups (repeated measures analysis of variance p = 0.43, p = 0.09
and p = 0.59, respectively). There were no complications. A total
of ten patients (intervention group three, control group seven)
required secondary patellar resurfacing after the first year. Our study suggests that the improved clinical outcome with electrocautery
denervation compared with no electrocautery is not maintained at
a mean of 3.7 years’ follow-up. Cite this article:
Antibiotic impregnated articulating spacers are
used in two-stage revision total knee arthroplasty to deliver local antibiotic
therapy while preserving function. We have observed infection control
in greater than 95% of cases with functional outcomes approaching
those seen in revision for aseptic loosening. Higher failure has
been observed with methicillin resistant organisms.
Aims. Routinely collected patient-reported outcome measures (PROMs) have been useful to quantify and quality-assess provision of total hip arthroplasty (THA) and
We undertook a study in which 138 female patients with a mean age of 71.2 years (51 to 82) received a standard NexGen CR-flex prosthesis in one knee and a gender-specific NexGen CR-flex prosthesis in the other. The mean follow-up period was 3.25 years (3.1 to 3.5). The aspect ratios of the standard and gender-specific prostheses were compared with that of the distal femur. The mean post-operative Knee Society knee scores were 94 (70 to 100) and 93 (70 to 100) points and the function scores were 83 (60 to 100) and 84 (60 to 100) points for the standard implants and the gender-specific designs, respectively. The mean post-operative Western Ontario and McMaster Universities score was 26.4 points (0 to 76). Patient satisfaction, the radiological results and the complication rates were similar in the two groups. In those with a standard prosthesis, the femoral component was closely matched in 80 knees (58.0%), overhung in 14 (10.1%) and undercovered the bone in 44 (31.9%). In those with a gender-specific prosthesis, it was closely matched in 15 knees (10.9%) and undercovered the bone in 123 (89.1%). Since we found no significant differences between the two groups with regard to the clinical and radiological results, patient satisfaction or complication rate, the goal of the design of the gender-specific CR-flex prosthesis to improve the outcome was not achieved in our patients.