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The Bone & Joint Journal
Vol. 98-B, Issue 10 | Pages 1360 - 1368
1 Oct 2016
Waterson HB Clement ND Eyres KS Mandalia VI Toms AD

Aims

Our aim was to compare kinematic with mechanical alignment in total knee arthroplasty (TKA).

Patients and Methods

We performed a prospective blinded randomised controlled trial to compare the functional outcome of patients undergoing TKA in mechanical alignment (MA) with those in kinematic alignment (KA). A total of 71 patients undergoing TKA were randomised to either kinematic (n = 36) or mechanical alignment (n = 35). Pre- and post-operative hip-knee-ankle radiographs were analysed. The knee injury and osteoarthritis outcome score (KOOS), American Knee Society Score, Short Form-36, Euro-Qol (EQ-5D), range of movement (ROM), two minute walk, and timed up and go tests were assessed pre-operatively and at six weeks, three and six months and one year post-operatively.


Bone & Joint 360
Vol. 4, Issue 6 | Pages 2 - 5
1 Dec 2015
Dodd L Sharpe I Mandalia VI Toms AD Phillips JRA

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.1 This has prompted a drive for efficiency in healthcare provision in the UK, and in 2012, the Health and Social Care Act was introduced, heralding a fundamental change to the structure of the National Health Service, especially in the way that healthcare is funded in England.2

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.3 We also seek to inform and educate the general orthopaedic community on this topic.


Bone & Joint 360
Vol. 3, Issue 3 | Pages 2 - 8
1 Jun 2014
Phillips JRA Waterson HB Searle DJ Mandalia VI Toms AD

This is the second of a series of reviews of registries. This review looks specifically at worldwide registry data that have been collected on knee arthroplasty, what we have learned from their reports, and what the limitations are as to what we currently know.


Bone & Joint 360
Vol. 3, Issue 3 | Pages 9 - 13
1 Jun 2014
Waterson HB Philips JRA Mandalia VI Toms AD

Mechanical alignment has been a fundamental tenet of total knee arthroplasty (TKA) since modern knee replacement surgery was developed in the 1970s. The objective of mechanical alignment was to infer the greatest biomechanical advantage to the implant to prevent early loosening and failure. Over the last 40 years a great deal of innovation in TKA technology has been focusing on how to more accurately achieve mechanical alignment. Recently the concept of mechanical alignment has been challenged, and other alignment philosophies are being explored with the intention of trying to improve patient outcomes following TKA.

This article examines the evolution of the mechanical alignment concept and whether there are any viable alternatives.