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Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_4 | Pages 1 - 1
1 Feb 2017
Guggi T Leunig M Rienmüller A
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Dedication to quality has a longstanding tradition within the Schulthess Clinic. Pioneering documentation Maurice E. Müller initiated an International Documentation & Evaluation System (IDES) in the era of hip replacement becoming an increasingly wide spread and standardized procedure. Starting in 1984, IDES was used to document each and every hip replacement and as of 1995 also for every knee arthroplasty performed. Norbert Gschwend became the driving authority in the clinic for standardizing documentation and regular long term follow-up intervals for all patients.

With increasing interest in patient reported outcomes (PROMs) a shift took place in the basic conception and electronic means (iPads) were introduced in 2012 to let patients complete their part of questionnaires, i.e. EQ-5D, OHS, OKS, UCLA & WOMAC while the clinical part was addressed in the same manner using HHS & KSS.

Optimizing user experience while answering routine questions and allowing for the physician to quickly enter required data without the numbing experience of ever same paper forms largely increased the return on information. This approach also guarantees for complete data sets, often a problem when using pen and paper.

Using these modern tools in combination with a refined recall procedure, we today show follow-up rates of well over 90% in the first post-operative years vs rates of 80% or less prior to introduction.

As of late 2012 the Swiss implant registry for knees & hips was introduced and here again we today use iPads with an app specifically designed to quickly document and register all operations on a daily base, reducing the chore of using paper or web based on line options from 3 to 10 minutes per operation to a mere 20 seconds, fully plausibilized and in this way never returned for corrections.

Pooling this data allows not only for generalized and stringent quality control but also facilitates spotting aberrant trends in the sense of an early warning system within our clinic with regard to procedures and implants.

Pioneering this approach to facilitate & perfect all documentation related procedures we aspire towards an elevated quality level in reporting to help sustain & guarantee patient satisfaction despite the high day-by-day volume.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_7 | Pages 9 - 9
1 May 2016
Adravanti P Guggi T D'Anchise R Dwyer K Lesko J Kape J
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INTRODUCTION

There is ongoing debate about the possible advantages of unicompartmental (UNI) knee replacement versus total knee replacement (TKR), such as for young, active patients. The purpose of this study was to investigate functional, radiographic, and device survivorship outcomes of UNI knee replacement with a newer generation UNI through 2-years post-op.

METHODS

A retrospective review of 188 cemented, fixed bearing unicompartmental (UNI) knee replacements implanted between January 2009 and June 2012 at 3 centers. The purpose of this study was to evaluate the survivorship, reasons for revision, radiographic and clinical results. A chart review was performed to collect demographics, operative details, American Knee Society (AKS) scores and adverse events (AE) through 2-years post-op. Kaplan-Meier (KM) device survivorship rates for the partial knee construct were estimated for post-op years in which at least 40 subjects had later follow-up. The definition of revision was the removal of any component for any reason, and device survivorship was the lack of revision. The time variable was the time to revision if the knee had been revised, or the time to last clinical follow-up or death if the knee had not been revised.

The average follow-up was 2.03 years (SD=0.4). The mean age was 64 years (SD=10.5), 56% of the patients were 65 years or younger, mean BMI was 27.5 kg/m2 (SD=4.9), 60% of patients were women, and 89% had a diagnosis of OA (9.6% had AVN). Data were collected through April 2015.