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Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 327 - 327
1 May 2010
Rafiq I Zaki S Kapoor A Rae P
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Introduction: The aim of this study was to determine the outcome of Tomofix plate fixation, in joint retaining surgery, for Medial compartment Osteoarthritis of the knee in young patients

Methods: We report on 33 patients (36 knees) who underwent High tibial osteotomy for unicompartmental osteoarthritis of the knee. The mean age was 39.5 (30–49). There were 20 males and 13 female. All the patients had Medial opening-wedge type Osteotomy using the Tomofix device. The mean duration of follow-up was 48 months (44–60 months). The patients were assessed on the basis of pre and post-operative oxford knee score, knee range of motion, radiological evidence of healing of the osteotomy site and alignment of the knee.

Results: There were no nonunions at the osteotomy site and the medial open-wedge filled-in without any need for bone graft or its substitutes. The mean preoperative oxford knee score was 48 (S.D 4.7 Range 38–54). This improved to a mean score of 22 (S.D 5.9 Range 17–31) after 1 year follow-up. The improvement was significant (pvalue= 0.07). The preoperative average knee flexion was 103.1 (S.D 25.2 Range 10–125) which improved after 1 year follow up to 112 (S.D 15.9 Range 0–140). The mean preoperative Femorotibial angle was 10 degrees varus (range 9–15). The mean postoperative Femorotibial angle was 8 deg valgus (range 6–12). Radiologically, there was no loss of correction during our follow-up. One patient had post-operative DVT.

Conclusion: Our study shows that Tomofix plate fixation in High Tibial osteotomy gives immediate stability, good deformity correction and allows early rehabilitation. The osteotomy gap does not require bone grafting and the correction is maintained. The Short term functional results are encouraging. Longer-term follow-up is however needed to establish its effectiveness in deferring joint replacement surgery in young patients.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 23 - 23
1 Mar 2008
Hockings M Borrill J Rae P
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Patients were followed up retrospectively by a combination of clinical review, mail and telephone questionnaires. The Lysholm knee (LS) and the Tegner activity (TA) scores were recorded.

From July 1991 until February 1999 75 meniscal repairs were carried out in 70 patients by a single surgeon (PJR). The average age of the patients was 26yrs 8 months, 52 male and 18 female. 14 patients (18.6%) were lost to formal follow-up. Lysholm Score (LS) and Tegner Activity (TA) scores were available on 58 repairs for analysis. The average follow-up was 6 yrs 4 months (range 3 yrs 4 months to 10 yrs 9 months), Average scores were LS=89.2, TA before surgery=6.2, TA after surgery=5.7. 9 patients had menisectomy following retear due to further injury. The overall success rate was 86.9%, with 74.1% scoring clinically good or excellent on the Lysholm Score.

There was a trend of improved results for patients over 30 yrs; those with longer tears and lateral repairs did slightly better. Those with ACL laxity had a significantly better result. The time interval to repair following injury did not make a difference. With an overall success rate of 86.9% the authors would recommend this traditional technique in light of the more recent techniques presently in use.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 61 - 61
1 Mar 2008
Hockings M Borrill J Rae P
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The aim of this study was to clinically assess the outcome of arthroscopically assisted inside to outside meniscal repair. Seventy-five meniscal repairs were carried out, the average age was twenty-six year eight months. Average follow up was six years four months, fourteen patients (18.6%) were lost to follow up. The overall success rate was 89.5%, with 78.1% scoring clinically good or excellent on the Lysholm Score. Improved results were shown for patients over thirty years, those with ACL laxity and with longer tears. Delay in repair did not make a difference. Clinically lateral repairs did better. With an overall success rate of 89.5% the authors would recommend this traditional technique.

The purpose of this study was to clinically assess the mid to long-term outcome of arthroscopically assisted inside to outside meniscal repair.

Patients were followed up retrospectively by a combination of clinical review, mail and telephone questionnaires. The Lysholm knee (LS) and the Tegner activity (TA) scores were recorded.

From July 1991 until February 1999 seventy-five meniscal repairs were carried out in seventy patients by a single surgeon (PJR). The average age of the patients was twenty-six year eight months, there were fifty-two male and eighteen female patients. Fourteen patients (18.6%) were lost to formal follow up. Of the seventyfive repairs carried out full data, Lysholm Score (LS) and Tegner Activity (TA) scores were available on fifty-five repairs for analysis. The average follow up was six years four months (range three years four months to ten years nine months), Average scores were LS=87.1, TA before surgery=6.1, TA after surgery=5.5. 9 patients had menisectomy following re-tear due to further injury.

The overall success rate was 89.5%, with 78.1% scoring clinically good or excellent on the Lysholm Score.

In contrast to previous studies improved results were shown for patients over thirty years, those with ACL laxity and those with longer tears. The time interval to repair following injury did not make a difference. In agreement with previous studies, clinically lateral repairs did better.

With an overall success rate of 89.5% the authors would recommend this traditional technique in light of the more recent techniques presently in use.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 292 - 292
1 Mar 2004
Hopgood P Martin C Rae P
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Aim: The aim of this study was to determine the signiþcance of radiolucent lines observed around the MG unicompartmental knee replacement. Method: Weight bearing AP and lateral þlms of 75 knees were reviewed in 56 patients. Each patient had pre-op, post-op and up to date þlms reviewed. On each postoperative þlm the prosthesis was divided into zones. Each zone was observed for evidence of a radiolucent line suggestive of loosening. Results: 75 unicompartmental replacements were performed in 56 patients. The mean follow up was 67.2 months (24–112 months). The femoral component showed no radiolucent lines in any zone in 97% of the knees. 79% of the knees showed no radiolucent lines on the AP view of the tibial component and 71% showed no evidence of radiolucent lines on the lateral view of the tibial component. The most frequent observation was the presence of a radiolucency in zone 1 on both the AP and lateral view of the tibial component. The early appearance of a radiolucency in zone 1 did not progress to aseptic loosening of the implants. Conclusion: The femoral component of the MG implant very rarely shows evidence of radiolucent lines suggestive of loosening. The presence of a radiolucent line in zone 1 of the tibia on the AP or lateral þlm does not lead to early failure of the implant.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 262 - 262
1 Mar 2004
Hopgood P Mitchell S Sochart D Rae P
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Aim: The aim of this research was to assess the difference in the observed tibiofemoral axis between long leg and short AP films of the knee.

Method: 20 patients who were undergoing primary total knee replacement, and had had no previous surgery on the affected limb were x-rayed using the a long leg cassette to include both the hip and ankle joints. A special screen was constructed to obscure all the x-ray except for a field, the size of a standard AP x-ray of the knee. The tibiofemoral angle was measured by two independent observers first on the short film and then on the long leg film.

Results: Our results have shown that the short leg film consistently overestimates the true tibiofemoral angle. Intraobserver correlation is also better when comparing the long leg film rather than the short film.

Conclusion: Measurement of the tibiofemoral or anatomical axis of the knee is best performed using long leg films, as this appears to give more consistent and reproducible results.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 151 - 151
1 Feb 2003
Mitchell S Hopgood P Clayson A Rae P
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To compare the current practice of ACL reconstruction in a District General Hospital against the recently produced BOA best practice guidelines, we have reviewed all ACL reconstructions performed at our institute from 1997 – 2001. We have assessed the interval from injury to reconstruction and the role of pre-operative assessment and education. We have assessed the standard of documentation regarding the in-patient stay and the surgery itself, including the grade of operating surgeon. Post-operatively, we have assessed the position of the grafts radiologically, and whether original levels of sporting activity were regained.

The average time from injury to first consultation in an orthopaedic clinic was 23.6 months. In respect of the admission notes, 77% had the history of injury and symptoms documented, and although all had a general pre-operative cardio-respiratory examination documented, none had evidence of examination of the relevant knee joint. Furthermore, none of the patients had the risks and benefits of the procedure documented at admission, and only one patient had been consented by the operating surgeon. Peri-operatively, all patients received both antibiotics and thromboprophylaxis, although only 21% had daily entries in the notes. The average post-operative follow-up was 9.1 months.

From this audit of our current practice, we have highlighted the following points :-

There is still an unacceptable delay in the diagnosis of ACL rupture.

Documentation must be improved, with regard to admission examination, daily note entries and recording the findings at EUA.

The specific risks and benefits of surgery must be documented either at out-patient assessment or at the time of consent.

Consent is not obtained by the operating surgeon.