Background

In the United Kingdom (UK), the fastest growing population demographic is the over 85 years of age, but despite this, outcomes achieved in the octogenarian population with a Unicompartmental Knee Replacement (UKR) are underrepresented in the literature. The Elective Orthopaedic Centre, Epsom, has an established patient reported outcome measures (PROMs) programme into which all patients are routinely enrolled. We aim to investigate the outcome of medial UKR using the oxford phase 3 implant in octogenarians.

Introduction

Rupture of the anterior cruciate ligament (ACL) is a common injury and often presents with a typical injury pattern. Historic literature has shown that the accuracy of diagnosis of ACL ruptures is poor at the initial medical consultation despite the history of injury strongly suggesting an ACL injury. The aims of this study were to determine: if the accuracy of diagnosis of ACL ruptures at initial presentation has improved over the last decade; grade of medical staff at initial and subsequent consultations; the mechanism of injury; and the subsequent delay in diagnosis and definitive treatment.

Introduction: Rupture of the anterior cruciate ligament (ACL) is a common injury and often presents with a typical injury pattern. Historic literature has shown that the accuracy of diagnosis of ACL ruptures is poor at the initial medical consultation despite the history of injury strongly suggesting an ACL injury. The aims of this study were to determine: if the accuracy of diagnosis of ACL ruptures at initial presentation has improved over the last decade; grade of medical staff at initial and subsequent consultations; the mechanism of injury; and the subsequent delay in diagnosis and definitive treatment.

Materials and Methods: One hundred and thirty two consecutive patients who underwent ACL reconstruction between January 2005 and January 2009 were analysed using prospective collected data. The mean age of the patients was 29 years (12–57). Sixteen patients were excluded due to chronic ACL injury (15).

Results: One hundred and sixteen patients (117 ACL ruptures) were included in the analysis. A typical injury pattern was documented in 87 (75%) of cases. The most common sporting activities associated with an ACL injury were football (35.3%), skiing (21.6%), rugby (10.3%) and other (32.8%). The vast majority of patients (68.1%) sought medical attention within 1 week from time of injury. The diagnosis of an ACL rupture was made in 33 cases (28%) at the initial medical consultation. The diagnosis was made in 13 (11%) of cases with the use of MRI and 6 (5%) cases at arthroscopy. The most common diagnoses made in cases of failed ACL rupture diagnosis were medial meniscal tear (10.3%), medial collateral ligament injury (7.8%) and none (33.6%). The mean time to diagnosis was 21 weeks (0–192) and the mean time to ACL reconstruction was 44 weeks (1–240).

Conclusions: Despite a typical mechanism of injury leading to ACL rupture the rate of initial diagnosis remains poor. This often leads to an unnecessary delay in diagnosis and subsequent treatment. Possible reasons for this are discussed.

Study Purposes: A retrospective study to assess patient’s height as a predictor for sizing the femoral component of the Phase 3 Oxford Unicompartmental Knee replacement.

Methods and Results: 118 patients post oxford uni-compartmental knee replacement were identified from the elective orthopaedic unit. Their post-operative radiographs were reviewed by 3 independent orthopaedic surgeons according to the Oxford Group criteria, measuring the femoral component fit. Patients were allocated to two cohorts: patients with ill-fitting prostheses and well fitting prosthesis.

Patient’s height and size of femoral component used at time of surgery was recorded. The results showed a positive correlation between the patient’s height and a well fitting femoral prosthesis.

Conclusions: Current templates with the Oxford Phase Three system may not provide accurate guide to the correct femoral prosthesis size for a patient. Recent studies have highlighted the wide range of magnifications used in computerised X-ray systems leading to variance with templating. Other studies have shown large inter-observer variability when sizing the femoral component. A variable as simple as patient height may offer a more accurate guide for choosing the size of the femoral component.

We have demonstrated that the height of a patient can be a used to guide and assist in the sizing of the femoral component of the Oxford uni-compartmental knee replacement. This study may also have implications for the sizing of other prostheses currently in use.

The purpose of the study was to investigate the outcome of re-operations performed at this district general hospital on total knee replacements over a period of nine and a half years: we also compare the reasons for re-operation as well as their timing.

Total knee replacements performed at this hospital and other centres requiring re-operation involving an open procedure were included in this study (total number =58). Patients were assessed both before and after re-operation using the knee society score. Data was recorded with respect to the type of original pros-thesis, reason for and time to re-operation as well as the nature of the re-operation procedure itself.

Pre- and post-operative knee society scores showed a mean improvement of 20 with respect to the function scores and 65 with respect to knee scores. 50% of re-operations were for aseptic loosening with a further 25% each for infection and instability.

In conclusion, re-operation for total knee replacement is shown to have had a satisfactory outcome in most cases. The results for revision surgery using a two stage procedure, in the treatment of infected total knee replacements, showed this to be very effective.

Aims: A prospective study of the long term fixation of an all- polyethylene acetabular component with a 2mm rim for cement pressurisation, and methylmethac-rylate spacer beads for optimal cement mantle thickness. Methods: A consecutive series of 1348 hip arthroplasty patients aged between 23 and 94 (average 68 years) has been prospectively studied between 1993 and 2002. The cemented Ultima (De Puy) stem and cup were used via an anterolateral approach by 6 surgeons in a District General Hospital. Clinical and radiological assessment was at 0, 2, 5, 6, 7 and 8 years. Detailed assessment of the cup has been carried out to determine cases of clinical or radiological failure, quality of cement fixation to bone, and the profile of the cement mantle. Results: 875 patients have been followed up for a minimum of 2 years, 52 for a minimum of 8 years. The cumulative survival rate of the cup using revision for aseptic loosening as an endpoint at 8 years was 98% and using radiological evidence of loosening as an endpoint was 96%. There were no cases with less than 2 mm of cement mantle thickness and good quality bone cement interface was seen in all on the initial postoperative films indicating adequate pressurisation. Conclusions: The design of the Ultima polyethylene cup has been successful in achieving good cement pressurisation during implantation, an even cement mantle thickness, and clinical success rates which compare favourably with other cemented acetabular components.

Twenty-two knees with osteochondritis dissecans diagnosed before skeletal maturity were followed prospectively into middle age: 32% had radiographic evidence of moderate or severe osteoarthritis at an average follow-up of 33.6 years; only half had a good or excellent functional result. We found that osteoarthritis was more likely to occur if the defect was large or affected the lateral femoral condyle.

We measured the blood loss during and after hip replacement in two groups of women, each consisting of 10 patients. In one group the lumbar plexus was infiltrated with bupivacaine, in the other it was not. The group in whom the plexus was blocked had significantly less blood loss.