Knee arthrodesis (KA) and above knee amputation (AKA) have been used for salvage of failed total knee arthroplasty (TKA) in the setting of periprosthetic joint infection (PJI). The factors that lead to a failed fusion and progression to AKA are not well understood. The purpose of our study was to determine factors associated with failure of a staged fusion for PJI and predictive of progression to AKA. We retrospectively reviewed a single-surgeon series of failed TKA for PJI treated with two-stage KA between 2000 and 2016 with minimum 2-year follow-up. Patient demographics, comorbidities, surgical history, tissue compromise, and radiographic data were recorded. Outcomes were additional surgery, delayed union, Visual Analog Pain scale (VAS) and Western Ontario and McMaster Activity score (WOMAC). No power analysis was performed for this retrospective study. Medians are reported as data were not normally distributed.Aim
Method
Shoulder istability is an increasing problem in the natonal rugby league. Arthroscopic stabilisation has become an acceptable form of treatment for this instability. This study details the results of surgery to 32 elite contact athletes from one NRL club— the North Queensland Cowboys Thirty-two cases of shoulder stabilisation have been performed on the players from the North Queensland Cowboys since 2003. A case series presentation of these procedures and follow up shall be detailed. Thirty-two cases of instability surgery have been performed on North Queensland Elite Rugby League players. Five procedures were open, two bilateral and five for posterior instability. Two recurrences have been seen in the arthroscopically reconstructed group. The first developed a HAGL at his subsequent instability episode and required open repair. The second case was a player with significant ligament instability he eventually underwent bilateral open reconstruction. Arthroscipic stabilisation is an acceptable option for elite rugby league players; recurrence rates are low, range of motion loses are reduced and earlier return to play occurs, when compared to open stabilisation.
Over recent years chondrocyte implantation (MACI) has become a recognised procedure. This paper presents the results of two players in the national rugby league competition who play first grade football and have undergone the procedure. Professional sports medical care can be difficult. Demands from players, the public and coaches are beyond our normal requirements as surgeons. Faced with two high-profile players with career ending focal grade 4 chondral lessions and not responding to our normal treatment methods, I performed chondrocyte implantation (MACI) to deal with this. Both players have responded well to treatment and returned to first grade football The two players in question had focal grade 4 chondral lesions. They had not responded to treatment and had recurrent effusions restricting their ability to play. Player A required a revision acl reconstruction as he was to be away from the game for a year. I treated his chondral lesion with MACI. His effusion settled and he returned to play with no further delays other than those expected from the acl surgery. Encouraged by this result, I performed the second procedure on a very high- profile player who had recurrent pain and effusion and had been treated with arthroscopies with little improvement. Faced with retirement, he opted for the procedure and returned to first grade the following season.
The purpose of study was to investigate kneeling ability after total knee replacement. 100 patients who were at least one year following routine uncemented primary total knee replacement were identified. 32% of patients stated they were able to kneel without significant discomfort. 64 (64%) of patients were actually able to demonstrate kneeling ability without pain or discomfort or with mild discomfort only. 24 (24%) of patients were therefore unable to demonstrate the ability to kneel because of discomfort in the knee. There was no difference in the “kneelers” and “non-kneelers” with regard to overall knee score, range of motion and the presence of patella resurfacing.
We have investigated the ability to kneel after total knee replacement. We asked 75 patients (100 knees) at least six months after routine uncemented primary total knee replacement, to comment on and to demonstrate their ability to kneel. Differences between the perceived and actual ability to kneel were noted. In 32 knees patients stated that they could kneel without significant discomfort. In 54 knees patients avoided kneeling because of uncertainties or recommendations from third parties (doctors, nursing staff, friends, etc). A total of 64 patients was actually able to kneel without discomfort or with mild discomfort only and 12 of the remainder were unable to kneel because of problems which were not related to the knee. Twenty-four patients therefore were unable to kneel because of discomfort in the knee. There was no difference between the ‘kneelers’ and ‘non-kneelers’ with regard to overall knee score, range of movement and the presence of patellar resurfacing.
