To identify the degree of morphological change achievable following the Bereiter trochleoplasty and to establish whether these results are comparable with functional outcomes. Seventeen consecutive patients (19 knees) with patellar instability secondary to trochlear dysplasia underwent trochleoplasty, of which 12 knees (12 patients) were radiologically evaluated pre- and post surgery using axial CT and MRI imaging. Their mean age at time of surgery was 28.1 years (15 to 44). The mean follow-up was 2.2 years (0.5 to 5). The following four radiological outcomes were used: trochlear depth (TD), transverse patellar shift (TPS), lateral patellar inclination angle (LPIA) and sulcus angle (SA). All knees were assessed post-operatively using MRI. The axial CT images were reformatted which allowed for direct comparison with MRI. Each knee was radiologically evaluated twice by a senior musculoskeletal radiology consultant to increase data accuracy and assess for intra-observer reliability using the intraclass correlation coefficient (ICC). Functional outcomes consisted of the KOOS, Lysholm, Kujala and Tegner scores.Purpose of Study
Methods
To identify the early functional outcomes, survivorship and complications associated with the Corin Uniglide Unicompartmental Knee Replacement (UKRs) from an independent centre. A prospective consecutive case series of sixty Uniglide UKRs was carried out in fifty-one patients between January 2006 and March 2009. The data collected included:
Primary outcome measures: Pre- and post-operative American Knee Society Score (AKSS), Oxford Knee Scores (OKS), WOMAC Survivorship Secondary outcome measures: X-ray error scores assessing component position Complications No cases were lost to follow-up. Mean follow-up time was 19 months (12 to 36months) and mean age was 66 years (39 to 78 years). Kaplan-Meier Survivorship showed 95% survival at 3 years (CI:6.4). All functional outcomes showed significant improvement p <0.05. There were two revisions within the first year, which were the main complications, secondary to aseptic tibial loosening and collapse of the posteromedial tibia. The x-ray error score identified the most common error as the femoral flexion/extension angle followed by the anterior/posterior fit.Purpose of Study
Methods and Results
Therefore, thirty-two patients (50 PFAs) were included; nine males and 23 females. Seventeen patients had bilateral PFA. The mean age of the patients was 65.8 years (SD 9.2). Follow-up averaged at 5.34years (range 2.1–10.2years) (SD2.64). The Oxford Knee Scores in this population showed a bimodal distribution. One group centred around 35 and the other around 60. The median Oxford knee score was 42.5 (IQR 34.25 to 54.25). Two sample t-test analysis of the population, divided as those above and below an OKS of 42, showed that follow-up time and age, did not differ between the groups (p=0.325, p=0.255 respectively). The quality of life outcome scores were significantly lower for bilateral compared to unilateral patients, with median scores of 50 and 72.5 respectively (p=0.03829). The cumulative survival at 5years for those with minimum 5 year follow-up (32 out of 50 PFA) was 100%. Three knees in total were revised. One patient developed bilateral tibiofemoral osteoarthritis, requiring revision to total knee replacement (TKA) at seven and 10 years. Another had persistent anterior knee pain and was converted to a TKA.
Between May 1998 and May 2007 we carried out 50 Avon patellofemoral joint replacements in 32 patients with isolated patellofemoral osteoarthritis. There were no revisions in the first five years, giving a cumulative survival of 100% for those with a minimum follow-up of five years. The mean follow-up was 5.3 years (2.1 to 10.2). The median Oxford knee score was 30.5 (interquartile range 22.25 to 42.25). In patients with bilateral replacements the median Euroqol General health score was 50 which was significantly lower than that of 75 in those with a unilateral replacement (p = 0.047). The main complication was progression of disease, which was identified radiologically in 11 knees (22%). This highlights the need for accurate selection of patients. Our findings suggest that the Avon prosthesis survives well and gives a satisfactory functional outcome in the medium term.
The POMS is the only published method for prospectively describing complications associated with major surgery. It comprises a 9-point survey and provides a generic measure of short term post-operative outcome. Data is simple and quick to collect and easily learnt. No additional tests are required for data collection.
