Tibiofemoral alignment is important to determine the rate of
progression of osteoarthritis and implant survival after total knee
arthroplasty (TKA). Normally, surgeons aim for neutral tibiofemoral
alignment following TKA, but this has been questioned in recent
years. The aim of this study was to evaluate whether varus or valgus
alignment indeed leads to increased medial or lateral tibiofemoral
forces during static and dynamic weight-bearing activities. Tibiofemoral contact forces and moments were measured in nine
patients with instrumented knee implants. Medial force ratios were
analysed during nine daily activities, including activities with
single-limb support (e.g. walking) and double-limb support (e.g.
knee bend). Hip-knee-ankle angles in the frontal plane were analysed
using full-leg coronal radiographs. Aims
Patients and Methods
Total knee arthroplasty (TKA) is a cost effective
and extremely successful operation. As longevity increases, the demand
for primary TKA will continue to rise. The success and survivorship
of TKAs are dependent on the demographics of the patient, surgical
technique and implant-related factors. Currently the risk of failure of a TKA requiring revision surgery
ten years post-operatively is 5%. The most common indications for revision include aseptic loosening
(29.8%), infection (14.8%), and pain (9.5%). Revision surgery poses
considerable clinical burdens on patients and financial burdens
on healthcare systems. We present a current concepts review on the epidemiology of failed
TKAs using data from worldwide National Joint Registries. Cite this article:
The number of revision total knee arthroplasties (TKA) that are
performed is expected to increase. However, previous reports of
the causes of failure after TKA are limited in that they report
the causes at specific institutions, which are often dependent on
referral patterns. Our aim was to report the most common indications
for re-operations and revisions in a large series of posterior-stabilised
TKAs undertaken at a single institution, excluding referrals from
elsewhere, which may bias the causes of failure. A total of 5098 TKAs which were undertaken between 2000 and 2012
were included in the study. Re-operations, revisions with modular
component exchange, and revisions with non-modular component replacement
or removal were identified from the medical records. The mean follow-up
was five years (two to 12).Aims
Patients and Methods
Since redesign of the Oxford phase III mobile-bearing unicompartmental
knee arthroplasty (UKA) femoral component to a twin-peg design,
there has not been a direct comparison to total knee arthroplasty
(TKA). Thus, we explored differences between the two cohorts. A total of 168 patients (201 knees) underwent medial UKA with
the Oxford Partial Knee Twin-Peg. These patients were compared with
a randomly selected group of 177 patients (189 knees) with primary
Vanguard TKA. Patient demographics, Knee Society (KS) scores and
range of movement (ROM) were compared between the two cohorts. Additionally,
revision, re-operation and manipulation under anaesthesia rates
were analysed.Aims
Patients and Methods
The October 2015 Hip &
Pelvis Roundup360 looks at: Smoking and complications in arthroplasty; Smoking cessation beneficial in arthroplasty; Intermediate care and arthroplasty; Do we still need cell salvage?; Femoroacetabular impingement in the Japanese population; Trunnionosis or taperosis and geometry; Decontamination for staphylococcus aureus works!; Policeman or opportunity? Quality improvement with registries; Death rates higher in readmission to other hospitals
The cause of dissatisfaction following total
knee arthroplasty (TKA) remains elusive. Much attention has been
focused on static mechanical alignment as a basis for surgical success and
optimising outcomes. More recently, research on both normal and
osteoarthritic knees, as well as kinematically aligned TKAs, has
suggested that other specific and dynamic factors may be more important
than a generic target of 0 ± 3º of a neutral axis. Consideration
of these other variables is necessary to understand ideal targets
and move beyond generic results. Cite this article:
Our aim was to examine the clinical and radiographic outcomes
in 257 consecutive Oxford unicompartmental knee arthroplasties (OUKAs)
(238 patients), five years post-operatively. A retrospective evaluation was undertaken of patients treated
between April 2008 and October 2010 in a regional centre by two
non-designing surgeons with no previous experience of UKAs. The
Oxford Knee Scores (OKSs) were recorded and fluoroscopically aligned
radiographs were assessed post-operatively at one and five years.Aims
Patients and Methods
Normal sagittal spine-pelvis-lower extremity alignment is crucial in humans for maintaining an ergonomic upright standing posture, and pathogenesis in any segment leads to poor balance. The present study aimed to investigate how this sagittal alignment can be affected by severe knee osteoarthritis (KOA), and whether associated changes corresponded with symptoms of lower back pain (LBP) in this patient population. Lateral radiograph films in an upright standing position were obtained from 59 patients with severe KOA and 58 asymptomatic controls free from KOA. Sagittal alignment of the spine, pelvis, hip and proximal femur was quantified by measuring several radiographic parameters. Global balance was accessed according to the relative position of the C7 plumb line to the sacrum and femoral heads. The presence of chronic LBP was documented. Comparisons between the two groups were carried by independent samples Objectives
Methods
The global economy has been facing a financial crisis. Healthcare costs are spiraling, and there is a projected £30 billion health funding gap by 2020 in the UK. What is happening in the UK is a reflection of a global problem. Rationing of healthcare is a topic of much discussion; as unless spending is capped, providing healthcare will become unsustainable. Who decides how money is spent, and which services should be rationed? In this article we aim to discuss the impact that rationing may have on orthopaedic surgery, and we will discuss our own experiences of attempts to ration local services.
Our aim was to prepare a systematic review and meta-analysis
to compare the outcomes of cemented and cementless hemiarthroplasty
of the hip, in elderly patients with a fracture of the femoral neck,
to investigate the mortality, complications, length of stay in hospital,
blood loss, operating time and functional results. A systematic review and meta-analysis was conducted following
the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines on randomised controlled trials (RCTs), studying current
generation designs of stem only. The synthesis of results was done
of pooled data, with a fixed effects or random effects model, based on
heterogeneity.Aims
Materials and Methods
Primary total knee arthroplasty (TKA) is a reliable
procedure with reproducible long-term results. Nevertheless, there
are conditions related to the type of patient or local conditions
of the knee that can make it a difficult procedure. The most common
scenarios that make it difficult are discussed in this review. These
include patients with many previous operations and incisions, and
those with severe coronal deformities, genu recurvatum, a stiff knee,
extra-articular deformities and those who have previously undergone
osteotomy around the knee and those with chronic dislocation of
the patella. Each condition is analysed according to the characteristics of
the patient, the pre-operative planning and the reported outcomes. When approaching the difficult primary TKA surgeons should use
a systematic approach, which begins with the review of the existing
literature for each specific clinical situation. Cite this article:
