We performed a meta-analysis to evaluate the relative efficacy of regional and general anaesthesia in patients undergoing total hip or knee replacement. A comprehensive search for relevant studies was performed in PubMed (1966 to April 2008), EMBASE (1969 to April 2008) and the Cochrane Library. Only randomised studies comparing regional and general anaesthesia for total hip or knee replacement were included. We identified 21 independent, randomised clinical trials. A random-effects model was used to calculate all effect sizes. Pooled results from these trials showed that regional anaesthesia reduces the operating time (odds ratio (OR) −0.19; 95% confidence interval (CI) −0.33 to −0.05), the need for transfusion (OR 0.45; 95% CI 0.22 to 0.94) and the incidence of thromboembolic disease (deep-vein thrombosis OR 0.45, 95% CI 0.24 to 0.84; pulmonary embolism OR 0.46, 95% CI 0.29 to 0.80). Regional anaesthesia therefore seems to improve the outcome of patients undergoing total hip or knee replacement.
Aims. Accurate identification of the ankle joint centre is critical for estimating tibial coronal alignment in total knee arthroplasty (TKA). The purpose of the current study was to leverage artificial intelligence (AI) to determine the accuracy and effect of using different radiological anatomical landmarks to quantify mechanical alignment in relation to a traditionally defined radiological ankle centre. Methods. Patients with full-limb radiographs from the Osteoarthritis Initiative were included. A sub-cohort of 250 radiographs were annotated for landmarks relevant to
Aims. This systematic review and meta-analysis aimed to compare the influence of patellar resurfacing following cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) on the incidence of anterior knee pain, knee-specific patient-reported outcome measures, complication rates, and reoperation rates. Methods. A systematic review of MEDLINE, PubMed, and Google Scholar was performed to identify randomized controlled trials (RCTs) according to search criteria. Search terms used included: arthroplasty, replacement,
Aims. To assess the incidence of radiological lateral osteoarthritis (OA) at 15 years after medial unicompartmental knee arthroplasty (UKA) and assess the relationship of lateral OA with symptoms and patient characteristics. Methods. Cemented Phase 3 medial Oxford UKA implanted by two surgeons since 1998 for the recommended indications were prospectively followed. A 15-year cumulative revision rate for lateral OA of 5% for this series was previously reported. A total of 163 unrevised
This study compared the outcome of total knee
replacement (TKR) in adult patients with fixed- and mobile-bearing prostheses
during the first post-operative year and at five years’ follow-up,
using gait parameters as a new objective measure. This double-blind
randomised controlled clinical trial included 55 patients with mobile-bearing (n
= 26) and fixed-bearing (n = 29) prostheses of the same design,
evaluated pre-operatively and post-operatively at six weeks, three
months, six months, one year and five years. Each participant undertook
two walking trials of 30 m and completed the EuroQol questionnaire,
Western Ontario and McMaster Universities osteoarthritis index,
Knee Society score, and visual analogue scales for pain and stiffness.
Gait analysis was performed using five miniature angular rate sensors
mounted on the trunk (sacrum), each thigh and calf. The study population
was divided into two groups according to age (≤ 70 years Improvements in most gait parameters at five years’ follow-up
were greater for fixed-bearing TKRs in older patients (>
70 years),
and greater for mobile-bearing TKRs in younger patients (≤ 70 years).
These findings should be confirmed by an extended age controlled
study, as the ideal choice of prosthesis might depend on the age
of the patient at the time of surgery.
Aims. The use of cementless total knee arthroplasty (TKA) components has increased during the past decade. The initial design of cementless metal-backed patellar components had shown high failure rates due to many factors. The aim of this study was to evaluate the clinical results of a second-generation cementless, metal-backed patellar component of a modern design. Methods. This was a retrospective review of 707 primary TKAs in 590 patients from a single institution, using a cementless, metal-backed patellar component with a mean follow-up of 6.9 years (2 to 12). A total of 409 TKAs were performed in 338 females and 298 TKAs in 252 males. The mean age of the patients was 63 years (34 to 87) and their mean BMI was 34.3 kg/m. 2. (18.8 to 64.5). The patients were chosen to undergo a cementless procedure based on age and preoperative radiological and intraoperative bone quality. Outcome was assessed using the
Aims. Micromotion of the polyethylene (PE) inlay may contribute to backside PE wear in addition to articulate wear of total knee arthroplasty (TKA). Using radiostereometric analysis (RSA) with tantalum beads in the PE inlay, we evaluated PE micromotion and its relationship to PE wear. Methods. A total of 23 patients with a mean age of 83 years (77 to 91), were available from a RSA study on cemented TKA with Maxim tibial components (Zimmer Biomet). PE inlay migration, PE wear, tibial component migration, and the anatomical
Aims. The primary aim of this prospective, multicentre study is to describe the rates of returning to golf following hip,
The results of 132 Attenborough total knee replacements after a follow-up period of from four to 10 years are presented. Long-term relief of pain and improvement in stability and walking distance were maintained in over two-thirds. The cumulative survivorship with the prosthesis in situ, little or no pain and no radiological loosening was 65% at six years. Problems with wound healing were common, and there was a complication rate of 20% in primary replacements, including a deep-infection rate of 3.5%. Almost 20% of the prostheses needed revision because of aseptic loosening, and there is evidence of radiological and clinical loosening in a further 7.5%.
1. Seventeen cases of knee injury are described in which the predominant lesion was rupture of the posterior cruciate ligament. Seven were treated conservatively and ten by surgical repair. 2. Most cases occurred in motor cyclists. 3. The extent of the rupture should be determined by examination under anaesthesia. 4. Early surgical repair is indicated for complete rupture. 5. An effective method of repair is described.
1. Strain or rupture of the anterior marginal attachments of the meniscus was observed in approximately 10 per cent of a group of patients operated upon for internal derangement. 2. In about half of these a tear of the body of the meniscus was found and it is probable that this tear may have been the cause of the symptoms. In the remainder no injury to the body of the meniscus was found. 3. Recognition may be difficult and delay in diagnosis may be the cause of degenerative joint changes. 4. The condition should be looked for at operation when the meniscus appears to be intact or when the only lesion appears to be an area of chondromalacia on the weight-bearing surface of the femoral condyle.
There remains a lack of data on the reliability of methods to
estimate tibial coverage achieved during total knee replacement.
In order to address this gap, the intra- and interobserver reliability
of a three-dimensional (3D) digital templating method was assessed
with one symmetric and one asymmetric prosthesis design. A total of 120 template procedures were performed according to
specific rotational and over-hang criteria by three observers at
time zero and again two weeks later. Total and sub-region coverage
were calculated and the reliability of the templating and measurement
method was evaluated.Objectives
Methods
Stress shielding resulting in diminished bone
density following total knee replacement (TKR) may increase the
risk of migration and loosening of the prosthesis. This retrospective
study was designed to quantify the effects of the method of fixation
on peri-prosthetic tibial bone density beneath cemented and uncemented
tibial components of similar design and with similar long-term survival
rates. Standard radiographs taken between two months and 15 years
post-operatively were digitised from a matched group of TKRs using
cemented (n = 67) and uncemented (n = 67) AGC tibial prostheses.
Digital radiograph densitometry was used to quantify changes in
bone density over time. Age, length of follow-up, gender, body mass
index and alignment each significantly influenced the long-term
pattern of peri-prosthetic bone density. Similar long-term changes
in density irrespective of the method of fixation correlated well
with the high rate of survival of this TKR at 20 years, and suggest
that cemented and uncemented fixation are both equally viable. Cite this article: