We reviewed the outcome of 146 Insall-Burstein II
Aims. Treatment of end-stage anteromedial osteoarthritis (AMOA) of the knee is commonly approached using one of two surgical strategies: medial unicompartmental knee arthroplasty (UKA) or
Aims. Tranexamic acid (TXA) is now commonly used in major surgical operations including orthopaedics. The TRAC-24 randomized control trial (RCT) aimed to assess if an additional 24 hours of TXA postoperatively in primary total hip (THA) and
We describe a method of audit of a type of
In this study we randomised 140 patients who
were due to undergo primary total knee arthroplasty (TKA) to have the
procedure performed using either patient-specific cutting guides
(PSCG) or conventional instrumentation (CI). The primary outcome measure was the mechanical axis, as measured
at three months on a standing long-leg radiograph by the hip–knee–ankle
(HKA) angle. This was undertaken by an independent observer who
was blinded to the instrumentation. Secondary outcome measures were
component positioning, operating time, Knee Society and Oxford knee
scores, blood loss and length of hospital stay. A total of 126 patients (67 in the CI group and 59 in the PSCG
group) had complete clinical and radiological data. There were 88
females and 52 males with a mean age of 69.3 years (47 to 84) and
a mean BMI of 28.6 kg/m2 (20.2 to 40.8). The mean HKA
angle was 178.9° (172.5 to 183.4) in the CI group and 178.2° (172.4
to 183.4) in the PSCG group (p = 0.34). Outliers were identified
in 22 of 67 knees (32.8%) in the CI group and 19 of 59 knees (32.2%)
in the PSCG group (p = 0.99). There was no significant difference
in the clinical results (p = 0.95 and 0.59, respectively). Operating time,
blood loss and length of hospital stay were not significantly reduced
(p = 0.09, 0.58 and 0.50, respectively) when using PSCG. The use of PSCG in primary TKA did not reduce the proportion
of outliers as measured by post-operative coronal alignment. Cite this article:
Patellofemoral complications are common after
total knee replacement (TKR). Leaving the patellar unsurfaced after
TKR may lead to complications such as anterior knee pain, and re-operation
to surface it. Complications after patellar resurfacing include
patellar fracture, aseptic loosening, patellar instability, polyethylene
wear, patellar clunk and osteonecrosis. Historically, patellar complications
account for one of the larger proportions of causes of failure in
TKR, however, with contemporary implant designs, complication rates
have decreased. Most remaining failures relate to patellofemoral
tracking. Understanding the causes of patellofemoral maltracking
is essential to prevent these complications as well as manage them
when they occur. Cite this article:
Aims. The aim of this study was to describe the pattern of revision indications for unicompartmental knee arthroplasty (UKA) and
Aims. The COVID-19 pandemic has caused unprecedented disruption to elective orthopaedic services. The primary objective of this study was to examine changes in functional scores in patients awaiting total hip arthroplasty (THA),
We analysed the long-term results with a mean follow-up of 10.2 years, of 66
Aims. To examine whether natural language processing (NLP) using a clinically based large language model (LLM) could be used to predict patient selection for total hip or
Aims. The aim of this study was to evaluate the healthcare costs and benefits of enoxaparin compared to aspirin in the prevention of symptomatic venous thromboembolism (VTE) after total hip arthroplasty (THA) or
We studied the quality of fixation of the tibial component using radiostereometric analysis (RSA) in 40 patients who had undergone a cemented Freeman-Samuelson
The administration of heparin during operation has been reported to enhance the efficacy of thromboprophylaxis in patients undergoing total hip replacement. We have performed a small pilot study in which intraoperative doses of heparin were given in addition to the usual postoperative thromboprophylaxis with enoxaparin in 32 patients undergoing
The October 2023 Knee Roundup. 360. looks at: Cementless total knee arthroplasty is associated with more revisions within a year; Kinematically and mechanically aligned
We have evaluated prospectively the incidence and location of deep-vein thrombosis (DVT), the risk factors for pulmonary embolism, and the natural history of thrombosis after
The February 2024 Knee Roundup. 360. looks at: Do patients with hypoallergenic
We conducted a systematic review and meta-analysis
of randomised controlled trials evaluating the effect of tranexamic
acid (TXA) upon blood loss and transfusion in primary total knee
replacement. The review used the generic evaluation tool designed
by the Cochrane Bone, Joint and Muscle Trauma Group. A total of
19 trials were eligible: 18 used intravenous administration, one
also evaluated oral dosing and one trial evaluated topical use.
TXA led to a significant reduction in the proportion of patients
requiring blood transfusion (risk ratio (RR) 2.56, 95% confidence
interval (CI) 2.1 to 3.1, p <
0.001; heterogeneity I2 =
75%; 14 trials, 824 patients). Using TXA also reduced total blood
loss by a mean of 591 ml (95% CI 536 to 647, p <
0.001; I2 =
78%; nine trials, 763 patients). The clinical interpretation of
these findings is limited by substantial heterogeneity. However,
subgroup analysis of high-dose (>
4 g) TXA showed a plausible consistent
reduction in blood transfusion requirements (RR 5.33; 95% CI 2.44
to 11.65, p <
0.001; I2 = 0%), a finding that should
be confirmed by a further well-designed trial. The current evidence
from trials does not support an increased risk of deep-vein thrombosis
(13 trials, 801 patients) or pulmonary embolism (18 trials, 971
patients) due to TXA administration.
The long-term functional result of exposed
Although the vast majority of patients that undergo
total knee replacement have satisfactory outcomes with a generally
low complication rate, occasionally a patient will be encountered
that has had multiple failed surgeries, and now reaches a crossroad
as to whether limb salvage will be acceptable or not. Cite this article: