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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_13 | Pages 36 - 36
7 Aug 2023
Matthews S Acton D Tucker A Graham J
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Abstract

Introduction

The Syn-VAR RCT is the first of its kind comparing hamstrings autograft v synthetic neoligament for MPFL reconstruction.

Our aim is to evaluate short and long term patient related outcomes measures (PROMs) following synthetic / autologous MPFL reconstruction in a heterogenous cohort of patients with recurrent patellar instability.

Method

20 patients meeting inclusion criteria were recruited and randomised. Standardised surgery was performed by a single surgeon in Altnagelvin Hospital with data collected over 3 years from 2016. Kujala score was the primary outcome measure with data captured preoperatively and 12 weeks/2 years postoperatively. Secondary outcomes included four other validated scores and complications including Norwich Patellar Instability, Lysholm, IKDC and Banff


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_1 | Pages 29 - 29
1 Feb 2021
Kolessar D Harding J Rudraraju R Hayes D Graham J
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Introduction

Robotic-arm assisted knee arthroplasty (rKA) has been associated with improved clinical, radiographic, and patient-reported outcomes. There is a paucity of literature, however, addressing its cost effectiveness. In the context of an integrated health system with an insurance plan and single source comprehensive data warehouse for electronic health records and claims data, we present an evaluation of healthcare costs and utilization associated with manual knee arthroplasty (mKA) versus rKA. We also examine the influence of rKA technology on surgeons’ practice patterns.

Methods

Practice patterns of KA were assessed 18 months before and after introduction of robotic technology in April 2018. For patients also insured through the system's health plan, inpatient costs (actual costs recorded by health system), 90-day postoperative costs (allowed amounts paid by insurance plan), and 90-day postoperative utilization (length of stay, home health care visits, rehabilitation visits) were compared between mKA and rKA patients, stratified by total (TKA) or unicompartmental (UKA) surgery. Linear regression modeling was used to compare outcomes between the two pairs of groups (mKA vs. rKA, for both UKA and TKA). Log-link function and gamma error distribution was used for costs. All analyses were done using SAS statistical software, with p<0.05 considered statistically significant.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_10 | Pages 13 - 13
1 May 2017
Graham J Heywood J
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Purpose and background

A review of secondary healthcare provision for civilians suffering persistent pain and living in the British Forces Germany (BFG) community was carried out in order to better inform referral from primary care. This population consists mostly of British nationals each with differing linguistic skills and cultural backgrounds. Patients may be referred to Evangelisches Krankenhaus Bielefeld (EvKB) in Germany or to Guys and St Thomas' NHS Foundation Trust (GSTT) in the UK. It was considered important to identify potential language or cultural-related barriers to improve decision making when considering where best to refer for a pain management programme (PMP).

Methods

Clinical visits undertaken at GSTT and EvKB involved observation of clinical activities, collection of documentation and informal staff discussions. Data were organised into common themes and categorised to provide information for written reflective accounts on each visit.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_IV | Pages 440 - 441
1 Apr 2004
Graham J Turner P Johnson D
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Purpose To compare the patient’s experience of anterior cruciate ligament (ACL) reconstruction with previously validated outcome measures.

Methods Forty-five patients who had previously undergone ACL reconstruction performed by a single surgeon at least one year previously were assessed. A mean time of 33 months had elapsed between surgery and assessment. Each assessment included the Modified Lysholm Score, the Tegner Activity Score and the one-legged hop test (OHT). Patient’s subjective assessment included visual analogue scales (VAS) for pain, knee function, achievement of expectations and satisfaction. Correlation of all these items was performed using SPSS.

Results The mean Lysholm score was 90.3, with mean Tegner scores of 6.9 pre-injury, 5.2 currently and 6.3 desired. The mean OHT index was 0.92. The VAS scores (range 0 to 100) were 25 mm for pain, 79 mm for knee function and 77 mm for satisfaction. The VAS score (range −50 to 50) for expectations was 16 mm. Highly significant correlations were found between the Lysholm scores and all VAS scores; all VAS scores with each other; and the discrepancy between the current/desired Tegner scores and satisfaction. Significant correlations were found between age and achievement of expectations; the current Tegner score and achievement of expectations/satisfaction; and the discrepancy between the current/desired Tegner scores and achievement of expectations/time following surgery. There was a poor correlation between the OHT and the other variables in this post-operative population.

Conclusions Patient assessed measures of symptoms and satisfaction following ACL reconstruction correlate well with accepted outcome measures. A discrepancy between current and desired activity levels influence satisfaction following ACL reconstruction to a greater degree than actual activity levels. Patients should therefore be warned pre-operatively of a potential reduction in activity level post-operatively.