Endoprosthetic replacement (EPR) is an available option for the management of massive bone loss around failed knee implants. The aim of this study was to determine the results of knee EPRs performed for non-tumour indications. Since 2007, 85 EPRs were performed for in a single tertiary centre by seven surgeons. Mean age at surgery was 73.5 years (range:35–95) with infection as the most common indication (49%), followed by aseptic loosening (18%), complex primary replacement (16%), fracture (15%) and mechanical failure (2%). Mean follow up was 4 years (range:1–9). Functional outcome was determined using the Oxford Knee Score (OKS). At follow-up, 21 patients were deceased and 2 lost to follow-up. Complication rate was 19%. Of the 7 infected cases, 6 were treated with DAIR (debridement, antibiotics, and implant retention) and one underwent above knee amputation. Four of the patients undergoing DAIR were cleared of infection and 2 are on long-term antibiotics. Accounting for implant revision, loss to follow-up and those on long-term antibiotics as failures, 5-year survival was 89% with an average OKS of 25 (SD=10). This mid-term study shows that distal femur EPR is a valuable option for the increasing burden of complex revision knee surgery
The burden of peri-prosthetic joint infection (PJI) following hip and knee surgery is increasing. Endoprosthetic replacement (EPR) is an option for management of massive bone loss resulting from infection around failed lower limb implants. To determine clinical outcome of EPRs for treatment of PJI around the hip and knee joint.Introduction
Aims
Restrictions placed on the working hours of doctors have led to increasing time-pressures on surgical training. Consequently, there has been growing interest in developing new techniques to teach and assess technical skills. The primary aim of this study was to determine whether a novel set of visual parameters assessing visuospatial ability, fine motor dexterity and gaze control could objectively distinguish between varying levels of arthroscopic experience. The secondary aim was to evaluate the correlations between these new parameters and previously established technical skill assessment methods. 27 subjects were divided into a “novice” group (n=7), “trainee” group (n=15) and expert group (n=5) based on previous arthroscopic experience. All subjects performed a diagnostic knee arthroscopy task on a simulator. Their performance was assessed using new simple visual parameters that included “prevalence of instrument loss,” “triangulation time” and “prevalence of look downs”. In addition, performance was also evaluated using previously validated technical skill assessment methods (a global rating scale and motion analysis).Introduction
Methods
Motion analysis is a validated method of assessing technical dexterity within surgical skills centers. A more accessible and cost-effective method of skills assessment is to use a global rating scale (GRS). We aimed to perform a validation experiment to compare an arthroscopic GRS against motion analysis for monitoring orthopaedic trainees learning simulated arthroscopic meniscal repairs. An arthroscopic meniscal repair task on a knee simulator was set up in a bioskills laboratory. Nineteen orthopaedic trainees with no experience of meniscal repair were recruited and their performance assessed whilst undertaking a standardized meniscal repair on 12 occasions. An arthroscopic GRS, assessing parameters such as “depth perception,” “bimanual dexterity,” “instrument handling,” and “final product analysis” was used to evaluate technical skill. Performance was assessed blindly by watching video recordings of the arthroscopic tasks. Dexterity analysis was performed using a motion analysis tracking system which measured “time taken,” “total path length of the subject's hands,” and “number of hand movements”.Introduction
Methods
Despite interest, the current rate of day-case anterior cruciate ligament reconstruction (ACLR) in the UK remains low. Although specialised care pathways with standard operating procedures (SOPs) have been effective in reducing length of stay following some surgical procedures, this has not been previously reported for ACLR. We evaluate the effectiveness of SOPs for establishing day-case ACLR in a specialist unit. Fifty patients undergoing ACLR between May and September 2010 were studied prospectively (“study group”). SOPs were designed for pre-operative assessment, anaesthesia, surgical procedure, mobilisation and discharge. We evaluated length of stay, readmission rates, patient satisfaction and compliance to SOPs. A retrospective analysis of 50 patients who underwent ACLR prior to implementation of the day-case pathway was performed (“standard practice group”).Background
Methods
