Isolated patellofemoral joint(PFJ) osteoarthritis affects approximately 10% of patients aged over 40 years and treatment remains controversial. Our aim was to evaluate long term functional and radiological outcomes following PFJ arthorplasty with the Femoro Patella Vialli (FPV) prosthesis as this evidence is lacking in literature. A retrospective review of prospectively collected PROMS in patients undergoing Patellofemoral arthroplasty. Single centre trial. Between 2004 and 2008, 101 FPV patellofemoral arthroplasties were performed in 80 patients with isolated patellofemoral joint osteoarthritis. Data was collected as a part of routine follow-up for up to 6 years and additional long term data was collected at 16 years.Abstract
Introduction
Methodology
The outcome of revision anterior cruciate ligament reconstruction (ACL-R) is guarded, particularly their return to sports activities. It is important to know the factors affecting the functional outcomes following a revision ACL-R. We analysed results from 39 patients, who underwent a revision ACL reconstruction by a single surgeon and was followed up over a year. Some of them were treated in 2-stage revision while the rest were single-stage revision, depending upon their size of bone tunnel or osteolysis as assessed by pre-operative CT scan.Abstract
Introduction
Methods
The use of MCL “pie-crusting” (selective release of the superficial MCL) to improve arthroscopic access to the posteromedial compartment of the knee for isolated meniscal surgery has been demonstrated. However, there are concerns that MCL pie-crusting with concomitant ACL reconstruction (ACLR) might affect knee stability and outcomes postoperatively. The aim of this study was to compare the functional outcomes between patients who underwent MCL pie-crusting at ACLR with those that did not. We performed a retrospective review of prospectively collected data from on the National Ligament Registry. 55 patients (33 male and 22 female) who had MCL pie-crusting(PC group) to address a meniscal lesion at the time of ACLR were compared with 65 patients (38 male and 27 female) who underwent isolated primary ACLR. All procedures were performed by a single surgeon at a tertiary centre between October 2013 and March 2019.Abstract
Introduction
Methods
Unicompartment knee replacement (UKR) has been an effective treatment of isolated medial compartment osteoarthritis (OA). There has been several studies which suggest that patellofemoral (PFJ) wear may not be a relative contraindication for UKR with no statistical difference in failure rates. There is currently conflicting evidence on the role of BMI. We will review if BMI and PFJ wear impacts on the post operative functional scores following UKR. A retrospective review of a prospectively collected database was performed. Data was collected between 26/6/2014 and 25/8/2022. 159 UKR procedures were identified. BMI and PFJ cartilage wear were collected. Oxford knee scores (OKS) were collected at > 2 years. PFJ wear was split into International Cartilage Research Society (ICRS) grades I&II and III&IV. 159 UKR procedures were identified, of these 115 had 2 year follow up. There were 77 who had OKS recorded at 2 years. For PFJ wear there was no statistical difference in the median OKS at 2 years 45 vs 43.5 (p=0.408). Assessing the BMI the median was 29kg/m2, range 20–43kg/m2. Spearman's rank was performed to assess the correlation between BMI and >2 year OKS, this demonstrated a moderately negative correlation p(df)=−0.339 (CI 95% −0.538, −0.104) p=0.004. There is no statistically significant difference in >2 year OKS following UKR regardless of PFJ wear. There is a moderately negative correlation between BMI and >2 year OKS which was significant p=0.004. Therefore BMI is a more important consideration when counselling patients for UKR.Abstract
End-stage arthropathy is a well-known complication of haemophilia, with recurrent haemarthroses leading to joint destruction, deformity, pain, and stiffness. In the knee, this is often treated with total knee arthroplasty (TKA), which can be more challenging in patients with haemophilia (PwH) and associated with poorer outcomes. We conducted a systematic literature review and meta-analysis to determine implant survivorship, functional outcomes and complication rates. A systematic review was conducted using MEDLINE, EMBASE, and PubMed for studies reporting TKA outcomes with Kaplan-Meier survivorship in PwH (PROSPERO registered). Meta-analysis was performed for survivorship and outcomes, and the results were compared to outcomes from the National Joint Registry (NJR).Abstract
Aim
Method
Re-revision knee replacement (RR-KR) is complex surgery, with a significant impact on individual patients and health resource use. The aim of this study was to investigate early patient-relevant outcomes following RR-KR. 206 patients (250 knees) undergoing RR-KR were recruited from a major revision centre between 2015–2018. Patient-relevant outcomes assessed were: implant survivorship, complications (90-days), joint function and quality of life (final follow-up). Risk factors for further revision surgery at 1 year were investigated using multiple logistic regression.Abstract
Introduction
Methodology:
Total Knee Arthroplasty (TKA) has been demonstrated to drastically improve a patient's quality of life. The outcomes following TKA are often reported by subjective patient reported outcome measurements (PROMs). However, there are few objective outcome measures following TKA, limiting the amount of information physicians can use to effectively guide a patient's recovery, especially in the first 3 weeks. Newly developed knee sensors have been able to ameliorate this problem by providing the physician with previously unobtainable objective data. Our study aims to evaluate the use of a wearable knee sensor device to measure functional outcomes (range of motion and steps) in real time. 29 patients who underwent primary, unilateral TKA were recruited for this IRB approved study. Patients were instructed how to use the device and associated mobile phone application preoperatively (Figure 1) and provided knee sensors to wear postoperatively (Figure 2). Patients wore the device for 3 weeks postoperatively to allow for data collection. The device recorded range of motion, number of steps, and percentage of physical therapy exercises completed. Patients were grouped by gender, age (<69 or >=70 years old), and BMI (<30 and >=30 kg/m2) for analysis of functional outcome measurements (maximum flexion, minimum extension, and number of steps). Unpaired two-sample t-tests were used to analyze differences between the groups.Introduction
Methods
The postoperative inflammatory response may be implicated in the aetiology of patient dissatisfaction following Total Knee Arthroplasty. Robotic-arm assisted TKA has been associated with reduced bone and soft tissue trauma. The objective of this Randomised Controlled Trial was to compare the inflammatory response in conventional Jig-based versus robotic arm-assisted TKA and examine the relationship with patient reported outcome measures and functional outcomes. 30 patients with knee osteoarthritis were randomised to either conventional or robotic-arm assisted TKA. Blood samples were collected for up to 28 days post-operatively and intraarticular drain samples at 6 and 24 hours, to ascertain the systemic and local inflammatory responses. The Spearman's correlation was utilised to evaluate the relationship with PROMs and functional outcomes.Abstract
Introduction
Methodology
Identifying knee osteoarthritis patient phenotypes is relevant to assessing treatment efficacy. Biomechanical variability has not been applied to phenotyping, yet features may be related to outcomes of total knee arthroplasty (TKA), an inherently mechanical surgery. This study aimed to i) identify biomechanical phenotypes among TKA candidates based on demographic and gait mechanic similarities, and ii) compare objective gait improvements between phenotypes post-TKA. TKA patients underwent 3D gait analysis one-week pre (n=134) and one-year post-TKA (n=105). Principal component analysis was applied to frontal and sagittal knee angle and moment gait waveforms, extracting major patterns of variability. Demographics (age, sex, BMI), gait speed, and frontal and sagittal pre-TKA angle and moment principal component (PC) scores previously found to differentiate sex, osteoarthritis (OA) severity, and symptoms of TKA recipients were standardized (mean=0, SD=1, [134×15]) to perform multidimensional scaling and machine learning based hierarchical clustering. Final clusters were validated by examining inter-cluster differences at baseline and gait changes (PostPCscore–PrePCscore) by k-way Chi-Squared, and ANOVA tests.Introduction
Methods
The application of artificial intelligence (A.I) using patient reported outcomes (PROs) to predict benefits, risks, benefits and likelihood of improvement following surgery presents a new frontier in shared decision-making. The purpose of this study was to assess the impact of an A.I-enabled decision aid versus patient education alone on decision quality in patients with knee OA considering total knee replacement (TKR). Secondarily we assess impact on shared decision-making, patient satisfaction, functional outcomes, consultation time, TKR rates and treatment concordance. We performed a randomized controlled trial involving 130 new adult patients with OA-related knee pain. Patients were randomized to receive the decision aid (intervention group, n=65) or educational material only (control group, n=65) along with usual care. Both cohorts completed patient surveys including PROs at baseline and between 6–12 weeks following initial evaluation or TKR. Statistical analysis included linear mixed effect models, Mann-Whitney U tests to assess for differences between groups and Fisher's exact test to evaluate variations in surgical rates and treatment concordance.Introduction
Methods
We prospectively followed 171 patients who underwent
bilateral unicompartmental knee replacement (UKR) over a period
of two years. Of these, 124 (72.5%) underwent a simultaneous bilateral
procedure and 47 (27.5%) underwent a staged procedure. The mean
cumulative operating time and length of hospital stay were both
shorter in the simultaneous group, by 22.5 minutes (p <
0.001)
and three days (p <
0.001), respectively. The mean reduction
in haemoglobin level post-operatively was greater by 0.15 g/dl in
the simultaneous group (p = 0.023), but this did not translate into
a significant increase in the number of patients requiring blood
transfusion (p = 1.000). The mean hospital cost was lower by $8892
in the simultaneous group (p <
0.001). There was no significant
difference in the rate of complications between the groups, and
at two-year follow-up there was no difference in the outcomes between
the two groups. We conclude that simultaneous bilateral UKR can be recommended
as an appropriate treatment for patients with bilateral medial compartment
osteoarthritis of the knee. Cite this article:
