The aim of this study was to determine the long-term risk of undergoing knee arthroplasty in a cohort of patients with meniscal tears who had undergone arthroscopic partial meniscectomy (APM). A retrospective national cohort of patients with a history of isolated APM was identified over a 20-year period. Patients with prior surgery to the same knee were excluded. The primary outcome was knee arthroplasty. Hazard ratios (HRs) were adjusted by patient age, sex, year of APM, Charlson comorbidity index, regional deprivation, rurality, and ethnicity. Risk of arthroplasty in the index knee was compared with the patient’s contralateral knee (with Aims
Patients and Methods
Of growing concern in arthroplasty is the emergence of atypical infections, particularly For this non-randomized non-blinded study, 101 adult patients scheduled for hip or knee surgery were recruited. For each, four 3 mm dermal punch biopsies were collected after administration of anaesthesia, but prior to antibiotics. Prebiopsy skin preparation consisted of a standardized preoperative 2% chlorhexidine skin cleansing protocol and an additional 70% isopropyl alcohol mechanical skin scrub immediately prior to biopsy collection. Two skin samples 10 cm apart were collected from a location approximating a standard direct anterior skin incision, and two samples 10 cm apart were collected from a lateral skin incision (suitable for posterior, direct-lateral, or anterolateral approaches). Samples were cultured for two weeks using a protocol optimized for Aims
Methods
Although knee osteoarthritis (OA) is diagnosed and monitored radiologically, actual full-thickness cartilage loss (FTCL) has rarely been correlated with radiological classification. This study aims to analyze which classification system correlates best with FTCL and to assess their reliability. A prospective study of 300 consecutive patients undergoing unilateral total knee arthroplasty (TKA) for OA (mean age 69 years (44 to 91; standard deviation (SD) 9.5), 178 (59%) female). Two blinded examiners independently graded preoperative radiographs using five common systems: Kellgren-Lawrence (KL); International Knee Documentation Committee (IKDC); Fairbank; Brandt; and Ahlbäck. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC). Intraoperatively, anterior cruciate ligament (ACL) status and the presence of FTCL in 16 regions of interest were recorded. Radiological classification and FTCL were correlated using the Spearman correlation coefficient.Aims
Methods
Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty with isolated medial or lateral compartment osteoarthritis. However, polyethylene wear can significantly reduce the lifespan of UKA. Different bearing designs and materials for UKA have been developed to change the rate of polyethylene wear. Therefore, the objective of this study is to investigate the effect of insert conformity and material on the predicted wear in mobile-bearing UKA using a previously developed computational wear method. Two different designs were tested with the same femoral component under identical kinematic input: anatomy mimetic design (AMD) and conforming design inserts with different conformity levels. The insert materials were standard or crosslinked ultra-high-molecular-weight polyethylene (UHMWPE). We evaluated the contact pressure, contact area, wear rate, wear depth, and volumetric wear under gait cycle loading conditions.Objectives
Methods
The aim of this study was to determine if the Oxford Knee and Hip Score (OKHS) can accurately predict when a primary knee or hip referral is deemed nonsurgical We retrospectively reviewed pre-consultation OKHS for all consecutive primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) consultations of a single surgeon over three years. The 1436 knees (1016 patients) and 478 hips (388 patients) included were categorized based on the surgeon’s decision into those offered surgery during the first consultation Aims
Patients and Methods
The aim of this study was to give estimates of the incidence of component incompatibility in hip and knee arthroplasty and to test the effect of an online, real-time compatibility check. Intraoperative barcode registration of arthroplasty implants was introduced in Denmark in 2013. We developed a compatibility database and, from May 2017, real-time compatibility checking was implemented and became part of the registration. We defined four classes of component incompatibility: A-I, A-II, B-I, and B-II, depending on an assessment of the level of risk to the patient (A/B), and on whether incompatibility was knowingly accepted (I/II).Aims
Materials and Methods
The purpose of this multicentre observational study was to investigate the association between intraoperative component positioning and soft-tissue balancing on short-term clinical outcomes in patients undergoing robotic-arm assisted unicompartmental knee arthroplasty (UKA). Between 2013 and 2016, 363 patients (395 knees) underwent robotic-arm assisted UKAs at two centres. Pre- and postoperatively, patients were administered Knee Injury and Osteoarthritis Score (KOOS) and Forgotten Joint Score-12 (FJS-12). Results were stratified as “good” and “bad” if KOOS/FJS-12 were more than or equal to 80. Intraoperative, post-implantation robotic data relative to CT-based components placement were collected and classified. Postoperative complications were recorded.Aims
Patients and Methods
Unicompartmental knee arthroplasty (UKA) has
numerous advantages over total knee arthroplasty (TKA) and one disadvantage,
the higher revision rate. The best way to minimize the revision
rate is for surgeons to use UKA for at least 20% of their knee arthroplasties.
To achieve this, they need to learn and apply the appropriate indications
and techniques. This would decrease the revision rate and increase
the number of UKAs which were implanted, which would save money
and patients would benefit from improved outcomes over their lifetime. Cite this article:
During open orthopaedic surgery, joints may be exposed to air, potentially leading to cartilage drying and chondrocyte death, however, the long-term effects of joint drying The patellar groove of anaesthetised rats was exposed (sham-operated), or exposed and then subjected to laminar airflow (0.25m/s; 60 minutes) before wounds were sutured and animals recovered. Animals were monitored for up to eight weeks and then sacrificed. Cartilage and chondrocyte properties were studied by histology and confocal microscopy, respectively.Objectives
Methods
The use of robotics in arthroplasty surgery is expanding rapidly as improvements in the technology evolve. This article examines current evidence to justify the usage of robotics, as well as the future potential in this emerging field.
We recently published a paper comparing the incidence
of adverse outcomes after unicompartmental and total knee arthroplasty
(UKA and TKA). The conclusion of this study, which was in favour
of UKA, was dismissed as “biased” in a review in Cite this article:
The aim of this to study was to compare the previously unreported
long-term survival outcome of the Oxford medial unicompartmental
knee arthroplasty (UKA) performed by trainee surgeons and consultants. We therefore identified a previously unreported cohort of 1084
knees in 947 patients who had a UKA inserted for anteromedial knee
arthritis by consultants and surgeons in training, at a tertiary
arthroplasty centre and performed survival analysis on the group
with revision as the endpoint.Aims
Patients and Methods
Approved by the Food and Drug Administration in 2004, the Phase
III Oxford Medial Partial Knee is used to treat anteromedial osteoarthritis
(AMOA) in patients with an intact anterior cruciate ligament. This
unicompartmental knee arthroplasty (UKA) is relatively new in the
United States, and therefore long-term American results are lacking. This is a single surgeon, retrospective study based on prospectively
collected data, analysing a consecutive series of primary UKAs using
the Phase III mobile-bearing Oxford Knee and Phase III instrumentation. Between July 2004 and December 2006, the senior author (RHE)
carried out a medial UKA in 173 patients (213 knees) for anteromedial
osteoarthritis or avascular necrosis (AVN). A total of 95 patients were men and 78 were women. Their mean
age at surgery was 67 years (38 to 89) and mean body mass index
29.87 kg/m2 (17 to 62). The mean follow-up was ten years (4 to 11).Aims
Patients and Methods
Whether to use total or unicompartmental knee
replacement (TKA/UKA) for end-stage knee osteoarthritis remains controversial.
Although UKA results in a faster recovery, lower rates of morbidity
and mortality and fewer complications, the long-term revision rate
is substantially higher than that for TKA. The effect of each intervention on
patient-reported outcome remains unclear. The aim of this study
was to determine whether six-month patient-reported outcome measures
(PROMs) are better in patients after TKA or UKA, using data from
a large national joint registry (NJR). We carried out a propensity score-matched cohort study which
compared six-month PROMs after TKA and UKA in patients enrolled
in the NJR for England and Wales, and the English national PROM
collection programme. A total of 3519 UKA patients were matched
to 10 557 TKAs. The mean six-month PROMs favoured UKA: the Oxford Knee Score
was 37.7 (95% confidence interval (CI) 37.4 to 38.0) for UKA and
36.1 (95% CI 35.9 to 36.3) for TKA; the mean EuroQol EQ-5D index
was 0.772 (95% CI 0.764 to 0.780) for UKA and 0.751 (95% CI 0.747
to 0.756) for TKA. UKA patients were more likely to achieve excellent
results (odds ratio (OR) 1.59, 95% CI 1.47 to 1.72, p <
0.001)
and to be highly satisfied (OR 1.27, 95% CI 1.17 to 1.39, p <
0.001), and
were less likely to report complications than those who had undergone
TKA. UKA gives better early patient-reported outcomes than TKA; these
differences are most marked for the very best outcomes. Complications
and readmission are more likely after TKA. Although the data presented
reflect the short-term outcome, they suggest that the high revision
rate for UKA may not be because of poorer clinical outcomes. These
factors should inform decision-making in patients eligible for either
procedure. Cite this article:
We scanned 25 left knees in healthy human subjects
using MRI. Multiplanar reconstruction software was used to take
measurements of the inferior and posterior facets of the femoral
condyles and the trochlea. A ‘basic circle’ can be defined which, in the sagittal plane,
fits the posterior and inferior facets of the lateral condyle, the
posterior facet of the medial condyle and the floor of the groove
of the trochlea. It also approximately fits both condyles in the
coronal plane (inferior facets) and the axial plane (posterior facets).
The circle fitting the inferior facet of the medial condyle in the
sagittal plane was consistently 35% larger than the other circles
and was termed the ‘medial inferior circle’. There were strong correlations
between the radii of the circles, the relative positions of the
centres of the condyles, the width of the condyles, the total knee
width and skeletal measurements including height. There was poor
correlation between the radii of the circles and the position of
the trochlea relative to the condyles. In summary, the condyles are approximately spherical except for
the inferior facet medially, which has a larger radius in the sagittal
plane. The size and position of the condyles are consistent and
change with the size of the person. However, the position of the
trochlea is variable even though its radius is similar to that of
the condyles. This information has implications for understanding
anterior knee pain and for the design of knee replacements. Cite this article:
This retrospective study evaluated the midterm clinical and radiographic outcomes of a second-generation total knee replacement system. In a multicentre consecutive series of 1512 patients, 1970 knees were treated with the PFC Sigma knee system (Depuy, Warsaw, Indiana). The patients were reviewed for functional outcome, and underwent independent radiographic evaluation at a mean follow-up of 7.3 years (5 to 10). A total of 40 knees (2%) required revision, 17 (0.9%) for infection. The incidence of osteolysis was 2.2%. The ten-year survival with revision for any cause other than infection as the endpoint was 97.2% (95% CI 95.4 to 99.1). The PFC Sigma knee system appears to provide excellent results in the medium term.
