The aim of this study was to assess the quality of life of patients on the waiting list for a total hip (THA) or knee arthroplasty (KA) during the COVID-19 pandemic. Secondary aims were to assess whether length of time on the waiting list influenced quality of life and rate of deferral of surgery. During the study period (August and September 2020) 843 patients (THA n = 394, KA n = 449) from ten centres in the UK reported their EuroQol five dimension (EQ-5D) scores and completed a waiting list questionnaire (2020 group). Patient demographic details, procedure, and date when listed were recorded. Patients scoring less than zero for their EQ-5D score were defined to be in a health state “worse than death” (WTD). Data from a retrospective cohort (January 2014 to September 2017) were used as the control group.Aims
Methods
The diagnosis of joint infections is an inexact science using combinations of blood inflammatory markers and microscopy, culture, and sensitivity of synovial fluid (SF). There is potential for small molecule metabolites in infected SF to act as infection markers that could improve accuracy and speed of detection. The objective of this study was to use nuclear magnetic resonance (NMR) spectroscopy to identify small molecule differences between infected and noninfected human SF. In all, 16 SF samples (eight infected native and prosthetic joints plus eight noninfected joints requiring arthroplasty for end-stage osteoarthritis) were collected from patients. NMR spectroscopy was used to analyze the metabolites present in each sample. Principal component analysis and univariate statistical analysis were undertaken to investigate metabolic differences between the two groups.Aims
Methods
Recent events have highlighted the importance
of implant design for survival and wear-related complications following
metal-on-metal hip resurfacing arthroplasty. The mid-term survival
of the most widely used implant, the Birmingham Hip Resurfacing
(BHR), has been described by its designers. The aim of this study
was to report the ten-year survival and patient-reported functional
outcome of the BHR from an independent centre. In this cohort of 554 patients (646 BHRs) with a mean age of
51.9 years (16.5 to 81.5) followed for a mean of eight years (1
to 12), the survival and patient-reported functional outcome depended
on gender and the size of the implant. In female hips (n = 267)
the ten-year survival was 74% (95% confidence interval (CI) 83 to
91), the ten-year revision rate for pseudotumour was 7%, the mean
Oxford hip score (OHS) was 43 (. sd. 8) and the mean UCLA
activity score was 6.4 (. sd. 2). In male hips (n = 379) the
ten-year survival was 95% (95% CI 92.0 to 97.4), the ten-year revision rate
for pseudotumour was 1.7%, the mean OHS was 45 (. sd. 6) and
the mean UCLA score was 7.6 (. sd. 2). In the most demanding
subgroup, comprising male patients aged <
50 years treated for
primary
This prospective randomised controlled double-blind
trial compared two types of PFC Sigma total knee replacement (TKR),
differing in three design features aimed at improving flexion. The
outcome of a standard fixed-bearing posterior cruciate ligament-preserving
design (FB-S) was compared with that of a high-flexion rotating-platform
posterior-stabilised design (RP-F) at one year after TKR. The study group of 77 patients with
There has been debate about the role of unicompartmental knee replacement in the presence of radiologically identifiable degenerative changes of the patellofemoral joint. We studied 195 knees in 163 patients in whom an Oxford unicompartmental knee replacement had been performed for medial
It has been suggested that a supramalleolar osteotomy can return the load distribution in the ankle joint to normal. However, due to the lack of biomechanical data, this supposition remains empirical. The purpose of this biomechanical study was to determine the effect of simulated supramalleolar varus and valgus alignment on the tibiotalar joint pressure, in order to investigate its relationship to the development of
Bone defects are occasionally encountered during
primary total knee replacement (TKR) and cause difficulty in establishing
a stable well-aligned bone-implant interface. Between March 1999
and November 2005, 59 knees in 43 patients underwent primary TKR
with a metal block augmentation for tibial bone deficiency. In all,
six patients (eight knees) died less than four years post-operatively,
and four patients (five knees) were lost to follow-up leaving 46 knees
in 33 patients available for review at a mean of 78.6 months (62
to 129). The clinical results obtained, including range of movement,
American Knee Society and Oxford knee scores, and the Western Ontario
and McMaster Universities
The purpose of this study was to investigate
whether a gender-specific high-flexion posterior-stabilised (PS)
total knee replacement (TKR) would offer advantages over a high-flex
PS TKR regarding range of movement (ROM), ‘feel’ of the knee, pain
and satisfaction, as well as during activity. A total of 24 female
patients with bilateral
The Mathys Affinis Short is the most frequently used stemless total shoulder prosthesis in the UK. The purpose of this prospective cohort study is to report the survivorship, clinical, and radiological outcomes of the first independent series of the Affinis Short prosthesis. From January 2011 to January 2019, a total of 141 Affinis Short prostheses were implanted in 127 patients by a single surgeon. Mean age at time of surgery was 68 (44 to 89). Minimum one year and maximum eight year follow-up (mean 3.7 years) was analyzed using the Oxford Shoulder Score (OSS) at latest follow-up. Kaplan-Meier survivorship analysis was performed with implant revision as the endpoint. Most recently performed radiographs were reviewed for component radiolucent lines (RLLs) and proximal humeral migration.Aims
Methods
We report the mid- to long-term (mean 20.3 years, 10 to 32.5) results of the Chiari pelvic osteotomy in patients with pre- to advanced stage
Various surgical techniques have been described for total hip arthroplasty (THA) in patients with Crowe type III dislocated hips, who have a large acetabular bone defect. The aim of this study was to evaluate the long-term clinical results of patients in whom anatomical reconstruction of the acetabulum was performed using a cemented acetabular component and autologous bone graft from the femoral neck. A total of 22 patients with Crowe type III dislocated hips underwent 28 THAs using bone graft from the femoral neck between 1979 and 2000. A Charnley cemented acetabular component was placed at the level of the true acetabulum after preparation with bone grafting. All patients were female with a mean age at the time of surgery of 54 years (35 to 68). A total of 18 patients (21 THAs) were followed for a mean of 27.2 years (20 to 33) after the operation.Aims
Methods
We present the clinical results and survivorship
of consecutive 100 Birmingham Hip Resurfacings in 90 patients at
a minimum follow-up of ten years. All procedures were carried out
by an independent surgeon who commenced a prospective study in 1998.
Patients were assessed clinically using the Western Ontario and
McMaster Universities
Reconstructive acetabular osteotomy is a well established and effective procedure in the treatment of acetabular dysplasia. However, the dysplasia is frequently accompanied by intra-articular pathology such as labral tears. We intended to determine whether a concomitant hip arthroscopy with peri-acetabular rotational osteotomy could identify and treat intra-articular pathology associated with dysplasia and thereby produce a favourable outcome. We prospectively evaluated 43 consecutive hips treated by combined arthroscopy and acetabular osteotomy. Intra-operative arthroscopic examination revealed labral lesions in 38 hips. At a mean follow-up of 74 months (60 to 97) the mean Harris hip score improved from 72.4 to 94.0 (p < 0.001), as did all the radiological parameters (p < 0.001). Complications included penetration of the joint by the osteotome in one patient, a fracture of the posterior column in another and deep-vein thrombosis in one further patient. This combined surgical treatment gave good results in the medium term. We suggest that arthroscopy of the hip can be performed in conjunction with peri-acetabular osteotomy to provide good results in patients with symptomatic dysplasia of the hip, and the arthroscopic treatment of intra-articular pathology may alter the progression of
The purpose of this study was to review the long-term outcomes of a previously reported prospective series of 46 type III acromioclavicular dislocations. These were treated surgically with temporary fixation of the acromioclavicular joint with wires, repair of the acromioclavicular ligaments, and overlapped suture of the deltoid and trapezius muscles. Of the 46 patients, one had died, four could not be traced, and three declined to return for follow-up, leaving 38 patients in the study. There were 36 men and two women, with a mean age at follow-up of 57.3 years (41 to 71). The mean follow-up was 24.2 years (21 to 26). Patients were evaluated using the Imatani and University of California, Los Angeles (UCLA) scoring systems. Their subjective status was assessed using the Disabilities of the Arm, Shoulder and Hand and Simple Shoulder Test questionnaires, and a visual analogue scale for patient satisfaction. The examination included radiographs of the shoulder. At a follow-up of 21 years, the results were satisfactory in 35 (92.1%) patients and unsatisfactory in three (7.9%). In total, 35 patients (92.1%) reported no pain, one slight pain, and two moderate pain. All except two patients had a full range of shoulder movement compared with the opposite side. Unsatisfactory results were the result of early redisplacement in two patients, and
Between June 2001 and November 2008 a modified Dunn osteotomy with a surgical hip dislocation was performed in 30 hips in 28 patients with slipped capital femoral epiphysis. Complications and clinical and radiological outcomes after a mean follow-up of 3.8 years (1.0 to 8.5) were documented. Subjective outcome was assessed using the Harris hip score and the Western Ontario and McMaster Universities
We reviewed the results of 84 total hip replacements performed with a short metaphyseal-fitting anatomical cementless femoral component in 84 unselected consecutive patients with a mean age of 78.9 years (70 to 88). The mean follow-up was 4.6 years (4 to 5). The mean pre-operative Harris hip score was 26 points (0 to 56), which improved to 89 (61 to 100) at the final follow-up. No patient had thigh pain. The mean pre-operative Western Ontario and McMaster Universities
Cementless knee arthroplasty has seen a recent resurgence in popularity due to conceptual advantages, including improved osseointegration providing biological fixation, increased surgical efficiency, and reduced systemic complications associated with cement impaction and wear from cement debris. Increasingly younger and higher demand patients are requiring knee arthroplasty, and as such, there is optimism cementless fixation may improve implant survivorship and functional outcomes. Compared to cemented implants, the National Joint Registry (NJR) currently reports higher revision rates in cementless total knee arthroplasty (TKA), but lower in unicompartmental knee arthroplasty (UKA). However, recent studies are beginning to show excellent outcomes with cementless implants, particularly with UKA which has shown superior performance to cemented varieties. Cementless TKA has yet to show long-term benefit, and currently performs equivalently to cemented in short- to medium-term cohort studies. However, with novel concepts including 3D-printed coatings, robotic-assisted surgery, radiostereometric analysis, and kinematic or functional knee alignment principles, it is hoped they may help improve the outcomes of cementless TKA in the long-term. In addition, though cementless implant costs remain higher due to novel implant coatings, it is speculated cost-effectiveness can be achieved through greater surgical efficiency and potential reduction in revision costs. There is paucity of level one data on long-term outcomes between fixation methods and the cost-effectiveness of modern cementless knee arthroplasty. This review explores recent literature on cementless knee arthroplasty, with regards to clinical outcomes, implant survivorship, complications, and cost-effectiveness; providing a concise update to assist clinicians on implant choice. Cite this article:
The purpose of this prospective, randomised study
was to evaluate the clinical and radiological results comparing the
identical cemented or cementless NexGen total knee prostheses implanted
bilaterally in the same patient. Sequential simultaneous bilateral
total knee replacements were performed in 50 patients (100 knees).
There were 39 women and 11 men with a mean age of 58.4 years (51
to 67) who received a cemented prosthesis in one knee and a cementless
prosthesis in the other. The mean follow-up was 13.6 years (13 to
14). At final review, the mean Knee Society scores (96.2 (82 to
100) versus 97.7 (90 to 100)), the mean Western
Ontario and McMaster Universities