Introduction

There have been concerns regarding the quality of training received by Orthopaedic trainees. There has been a reduction in working hours according to the European working times directive. National targets to reduce surgical waiting lists has increased the workload of consultants, further reducing the trainees' surgical experience. Navigation assisted procedures are successfully used in orthopaedics and provides useful feedback to the surgeon regarding precision of implant placement. We investigated the use of navigation aids as an alternative source of training surgical trainees.

Introduction

Unicondylar knee replacements (UKR) may be more effective compared to Total knee replacements (TKR) in unicompartmental arthritis. We report patient outcomes & satisfaction data in an age matched cohort of patients with either a UKR or TKR.

Purpose: To determine if a multi-modal programme including non-operative measures of physiotherapy and education can improve the symptoms of osteoarthritis of the knee.

Methods/Results: 72 patients with osteoarthritis of the knee confirmed on radiographic or arthroscopic evidence were referred over a 13 month period (April 2007 – May 2008) for a lower limb programme. The programme consisted of 12 classes over 6 weeks of group physiotherapy and included education on osteoarthritis, diet and exercise.

The total number of knees affected was 98. The mean number of compartments affected was 1.2 with the medial and patellofemoral compartment most affected. The mean number of classes attended was 8.3. Pre-intervention, the mean WOMAC score was 64.7 and the mean Oxford knee score was 31.9. Post-intervention at a mean follow up of 12 months (range 7 – 22 months), the mean WOMAC score was 29.4 and the mean Oxford knee score 22.4. The change in scores following intervention was statistically significant (p < 0.05). Of the cohort, 9 patients were subsequently offered or went on to have knee joint arthroplasty.

Conclusions: At 12 months, a multi-modal programme consisting of non-operative interventions has an excellent impact upon osteoarthritis of the knee with improved patient reported scores. This modality should be considered for all patients with mild to moderate osteoarthritis in whom surgical options are not otherwise indicated. Further work is required to see which components most influenced patients’ outcomes, the impact of education and group classes on maintaining physiotherapy exercises in the long term, the benefits conferred even for those patients who subsequently undergo joint arthroplasty, and whether referral to the programme from a primary care setting will lower the number of referrals of knee osteoarthritis to orthopaedic units which are ultimately managed without surgical intervention.

Aim: To ascertain if a medial rotation platform knee replacement design (MRK; Finsbury Orthopaedics) exhibits improved range of motion (ROM) and functional outcome compared to a conventional single radius condylar knee replacement system (PFC Sigma; Depuy) at one year.

Methods: Eighty patients undergoing total knee arthroplasty(TKA) were prospectively randomised and allocated to either receive the MRK or PFC Sigma pros-thesis. Patients were blinded to the choice of implant. Follow-up clinical and radiological evaluations were carried out by a single clinician so as to avoid interob-server error. Validated patient based scores including the Total Knee Function Questionnaire (TKFQ) were used to assess patient function.

Results: The average ROM in the MRK group was 108.53°. In the PFC Sigma group it was 94.16°. Statistical significance was demonstrated between the two groups.

The MRK group showed superior results in the TKFQ score which assesses activities of daily living as well as recreational and sporting activities. The movement and lifestyle component of the TKFQ, and the Knee Society Score were better in the MRK group with statistical significance.

No difference was demonstrated between the two groups with respect to radiological analysis, WOMAC Knee, Oxford Knee and SF-36 scores.

6 out of 40 patients in the MRK group compared to 5 out of 40 patients in the PFC group said that they had forgotten about their TKA at one year.

Conclusions: The medial rotation platform design confers increased ROM at one year with an associated benefit in movement and lifestyle and resultant patient satisfaction.