1
|
A simple technical tip to reduce complications associated with separate pin-site incisions in robotic-assisted total knee arthroplasty. Ann R Coll Surg Engl 2023; 105:672-673. [PMID: 37489528 PMCID: PMC10471434 DOI: 10.1308/rcsann.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 07/26/2023] Open
|
2
|
O014 Oxidised zirconium versus cobalt-chrome femoral heads in total hip arthroplasty: a multi-centre prospective double-blinded randomised controlled trial with 10-years follow-up. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction
This study reports the ten-year polyethylene liner wear rates, incidence of osteolysis, clinical outcomes and complications of a three-arm, multicentre randomised controlled trial comparing Cobalt-Chrome (CoCr) and Oxidised Zirconium (OxZr) femoral heads with ultra-high molecular weight polyethylene (UHMWPE) versus highly cross-linked polyethylene(XLPE) liners in total hip arthroplasty (THA).
Methods
Patients undergoing THA from four institutions were prospectively randomised into three groups. Group A received a CoCrfemoral head and XLPE liner; Group B received an OxZrfemoral head and XLPE liner; and Group C received an OxZr femoral head and UHMWPE liner. Patients and observers recording study outcomes were blinded to the treatment groups at each follow-up interval. The outcomes of 262 study patients were analysed at ten years follow-up after THA.
Results
At ten years follow-up, increased linear wear rates were recorded in group C compared to group A (0.133 ± 0.21 mm/yr vs 0.031 ± 0.07 mm/yr respectively, p<0.001) and group B (0.133 ± 0.21 mm/yr vs 0.022 ± 0.05 mm/yr respectively, p<0.001). Patients in group C were associated with increased risk of osteolysis and aseptic loosening requiring revision surgery compared with group A (7/133 vs 0/133 respectively, p=0.007) and group B (7/133 vs 0/135 respectively, p=0.007).
Conclusion
The use of UHMWPE was associated with progressively increased annual liner wear rates after THA. At ten years follow-up, this translated to UHMWPE leading to an increased incidence of osteolysis and aseptic loosening requiring revision THA, compared with XLPE.
Take-home message
THA using XLPE liners is associated with improved long-term implant survivorship and reduced revision surgery compared with UHMWPE liners at long-term follow-up.
Collapse
|
3
|
Tourniquet use in total knee arthroplasty and the risk of infection: a meta-analysis of randomised controlled trials. J Exp Orthop 2022; 9:62. [PMID: 35776268 PMCID: PMC9249956 DOI: 10.1186/s40634-022-00485-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/12/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose The intra-operative use of tourniquets during Total Knee Arthroplasty (TKA) is common practice. The advantages of tourniquet use include decreased operating time and the creation of a bloodless visualisation field. However, tourniquet use has recently been linked with increased post-operative pain, reduced range of motion, and slower functional recovery. Importantly, there is limited evidence of the effect of tourniquet use on infection risk. The purpose of this systematic review and meta-analysis is to fill this gap in the literature by synthesising data pertaining to the association between tourniquet use and infection risk in TKA. Methods A systematic literature search was performed on Pubmed, Embase, Cochrane and clinicaltrials.gov up to May 2021. Randomized control trials were included, comparing TKA outcomes with and without tourniquet use. The primary outcome was overall infection rate. Secondary outcomes included superficial and deep infection, skin necrosis, skin blistering, DVT rate, and transfusion rate. Results 14 RCTs with 1329 patients were included. The pooled incidence of infection in the tourniquet group (4.0%, 95% CI = 2.7–5.4) was significantly higher compared to the non-tourniquet group (2.0%, 95% CI = 1.1–3.1) with an OR of 1.9 (95% CI = 1.1–3.76, p = 0.03). The length of hospital stay, haemoglobin drop (0.33 95% CI =0.12–0.54), P = 0.002) and transfusion rates (OR of 2.7, 95%CI = 1.4–5.3, P = < 0.01) were higher in the tourniquet group than the non-tourniquet group. The difference in the length of inhospital stay was 0.24 days favouring the non-tourniquet group (95% CI = 0.10–0.38, P = < 0.01). The incidence of skin blistering (OR 2.6, 95% CI = 0.7–9.9, p = 0.17), skin necrosis (OR 3.0, 95% CI = 0.50–19.3, p = 0.25), and DVT rates (OR 1.5, 95% CI = 0.60–3.60, p = 0.36) did not differ between the two groups. Conclusion Quantitative synthesis of the data suggested tourniquet use was associated with an increased overall risk of infection, intraoperative blood loss, need for blood transfusion and longer hospital stay. Findings of this meta-analysis do not support the routine use of tourniquet in TKA and arthroplasty surgeons should consider any potential additional risks associated with its use. Level of evidence meta-analysis, Level II.
Collapse
|
4
|
Debridement, antibiotics, and implant retention in non-oncological femoral megaprosthesis infections: minimum 5 year follow-up. J Exp Orthop 2022; 9:32. [PMID: 35403987 PMCID: PMC9001793 DOI: 10.1186/s40634-022-00469-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/17/2022] [Indexed: 05/31/2023] Open
Abstract
Purpose Megaprostheses are increasingly utilised outside of the oncological setting, and remain at significant risk of periprosthetic joint infection (PJI). Debridement, antibiotic, and implant retention (DAIR) is an established treatment for PJI, however its use in non-oncological patients with femoral megaprostheses has not been widely reported. There are significant differences in patient physiology, treatment goals, and associated risks between these patient cohorts. Methods We identified 14 patients who underwent DAIR for a PJI of their femoral megaprostheses, between 2000 and 2014, whom had their index procedure secondary to non-oncological indications. Patients were managed as part of a multidisciplinary team, with our standardised surgical technique including exchange of all mobile parts, and subsequent antibiotic therapy for a minimum of 3 months. Patients were followed up for a minimum of 5 years. Results Patients included six proximal femoral replacements, five distal femoral replacements, and three total femoral replacements. No patients were lost to follow-up. There were six males and eight females, with a mean age of 67.2 years, and mean ASA of 2.3. Nine patients (64.3%) successfully cleared their infection following DAIR at a minimum of 5 year follow-up. Five patients (35.7%) required further revision surgery, with four patients cleared of infection. No patients who underwent DAIR alone suffered complications as a result of the procedure. Conclusions The use of DAIR in these complex patients can lead to successful outcomes, but the risk of further revision remains high. The success rate (64.3%) remains on par with other studies evaluating DAIR in megaprostheses and in primary arthroplasty. This study indicates judicious use of DAIR can be an appropriate part of the treatment algorithm. Level of evidence II
Collapse
|
5
|
|
6
|
Day-case unicompartmental knee arthroplasty: a literature review and development of a novel hospital pathway. Ann R Coll Surg Engl 2021; 104:165-173. [PMID: 34323112 DOI: 10.1308/rcsann.2021.0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We have seen unparalleled changes in our healthcare systems globally as a result of the COVID-19 pandemic. As we strive to regenerate our full capacity elective services in order to contest the increasing demand for lower limb arthroplasty, this pandemic has allowed us a rare opportunity to revise and develop novel elective arthroplasty pathways intended to improve patient care and advance healthcare efficiency. We present an extensive evidence-based review of the approaches used to achieve day-case unicompartmental arthroplasty (UKA) as well as the development of a day-case UKA care pathway in a UK NHS institution based on the evidence provided in the literature. METHODS An extensive search of the literature was performed for articles that reported on readmission or complication rates ≥30 days postoperatively following day-case UKA. FINDINGS Fifteen manuscripts reporting the results of day-case UKA, defined as discharged on the same calendar day of surgery, were included in our review. Mean reported complication rates for day-case and inpatient UKA within the follow-up periods were 4.05% and 6.52%, respectively. Mean readmission rates were 2.71% and 4.36% for day-case and inpatient UKA, respectively. The mean rate of successful same-day discharge was 92.45%. CONCLUSION We introduce our institutional Elective Day Surgery Arthroplasty Pathway (EDSAP) founded upon the evidence presented in the literature. Stringent patient selection complimented by a well-defined day-case arthroplasty pathway is fundamental for successful commencement of day-case UKA in the NHS.
Collapse
|
7
|
Abstract
The number of patients requiring hip and knee arthroplasty continues to rise each year. Patients are living longer and expecting to remain active into later life following joint replacement. Developments in computer-assisted surgery and robotic technology may optimise surgical outcomes and patient satisfaction following lower limb arthroplasty. The use of artificial intelligence in healthcare is rapidly growing and has gained momentum in lower limb arthroplasty. This article reviews the use of artificial intelligence and surgical innovation in lower limb arthroplasty, with a particular focus on robotic-assisted surgery in total knee arthroplasty.
Collapse
|
8
|
International dissemination. Bone Joint J 2020; 102-B:805-806. [PMID: 32600146 DOI: 10.1302/0301-620x.102b7.bjj-2020-1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
9
|
|
10
|
Use of preoperative opioids increases duration of hospital stay following elective lower limb arthroplasty. - A snapshot of UK practice. J Orthop 2019; 18:162-165. [PMID: 32021024 DOI: 10.1016/j.jor.2019.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/09/2019] [Accepted: 10/30/2019] [Indexed: 01/28/2023] Open
Abstract
This study is one of the first in the UK where to assess the link between pre-operative opioid use and length of stay or complications. The primary objective was to test our hypothesis; that low dose pre-operative opioids will not lead to an increase in complications and LOS in lower limb arthroplasty patients. 640 records were found and 625 patients were included whom received elective primary or revision surgery. It was found that Pre-operative opioids >12 MED does increase LOS.
Collapse
|
11
|
|
12
|
|
13
|
|
14
|
Preoperative CT-Based Three-Dimensional Templating in Robot-Assisted Total Knee Arthroplasty More Accurately Predicts Implant Sizes than Two-Dimensional Templating. J Knee Surg 2019; 32:642-648. [PMID: 30068010 DOI: 10.1055/s-0038-1666829] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patient dissatisfaction after total knee arthroplasty (TKA) is a concern. Surgical error is a common, avoidable cause of failed TKA. Correct femoral and tibial component sizing improves implant longevity, clinical outcomes, knee balance, and pain scores. We hypothesized that preoperative three-dimensional (3D) templating for robot-assisted TKA (RA-TKA) is more accurate than two-dimensional (2D) digital templating. Prospectively collected data from 31 RA-TKAs were assessed to determine accuracy pertaining to implant sizing and positioning. All cases undergoing RA-TKA undergo preoperative CT-scans as per protocol. Three blinded observers retrospectively templated these knees for TKA using standard radiographs. We compared whether 2D templating was as accurate as CT-guided templating. Postoperative radiographs were then evaluated for sizing and positioning. Intraclass correlation coefficients (ICCs) and the effect of learning curve were assessed. Preoperative femoral component 3D templating and retrospective blinded 2D templating accuracies were 96.6% and 52.9%, respectively (χ 2: 17.965; odds ratio [OR]: 24.957, 3.250-191.661; p < 0.001). Tibial component 3D and 2D templating accuracies were 93.1% and 28.7%, respectively (χ 2: 36.436; OR: 33.480, 7.400-151.481; p < 0.001). ICC for the three radiograph observers was 0.920 (95% confidence interval [CI]: 0.652-0.890; p < 0.001) for the femur and 0.833 (0.717-0.911; p < 0.001) for the tibia, showing excellent agreement. We conclude that preoperative CT-based templating for RA-TKA more accurately predicts the size of implants compared with traditional 2D digital templating. This may improve operating room efficiency and cost containment.
Collapse
|
15
|
|
16
|
International perspectives are important. Bone Joint J 2019; 101-B:353-354. [PMID: 30929486 DOI: 10.1302/0301-620x.101b4.bjj-2019-0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
17
|
|
18
|
|
19
|
Abstract
OBJECTIVES The primary objective of this study was to compare accuracy in restoring the native centre of hip rotation in patients undergoing conventional manual total hip arthroplasty (THA) versus robotic-arm assisted THA. Secondary objectives were to determine differences between these treatment techniques for THA in achieving the planned combined offset, component inclination, component version, and leg-length correction. MATERIALS AND METHODS This prospective cohort study included 50 patients undergoing conventional manual THA and 25 patients receiving robotic-arm assisted THA. Patients undergoing conventional manual THA and robotic-arm assisted THA were well matched for age (mean age, 69.4 years (sd 5.2) vs 67.5 years (sd 5.8) (p = 0.25); body mass index (27.4 kg/m2 (sd 2.1) vs 26.9 kg/m2 (sd 2.2); p = 0.39); and laterality of surgery (right = 28, left = 22 vs right = 12, left = 13; p = 0.78). All operative procedures were undertaken by a single surgeon using the posterior approach. Two independent blinded observers recorded all radiological outcomes of interest using plain radiographs. RESULTS The correlation coefficient was 0.92 (95% confidence interval (CI) 0.88 to 0.95) for intraobserver agreement and 0.88 (95% CI 0.82 to 0.94) for interobserver agreement in all study outcomes. Robotic THA was associated with improved accuracy in restoring the native horizontal (p < 0.001) and vertical (p < 0.001) centres of rotation, and improved preservation of the patient's native combined offset (p < 0.001) compared with conventional THA. Robotic THA improved accuracy in positioning of the acetabular component within the combined safe zones of inclination and anteversion described by Lewinnek et al (p = 0.02) and Callanan et al (p = 0.01) compared with conventional THA. There was no difference between the two treatment groups in achieving the planned leg-length correction (p = 0.10). CONCLUSION Robotic-arm assisted THA was associated with improved accuracy in restoring the native centre of rotation, better preservation of the combined offset, and more precise acetabular component positioning within the safe zones of inclination and anteversion compared with conventional manual THA.
Collapse
|
20
|
An assessment of early functional rehabilitation and hospital discharge in conventional versus robotic-arm assisted unicompartmental knee arthroplasty: a prospective cohort study. Bone Joint J 2019; 101-B:24-33. [PMID: 30601042 DOI: 10.1302/0301-620x.101b1.bjj-2018-0564.r2] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The objectives of this study were to compare postoperative pain, analgesia requirements, inpatient functional rehabilitation, time to hospital discharge, and complications in patients undergoing conventional jig-based unicompartmental knee arthroplasty (UKA) versus robotic-arm assisted UKA. PATIENTS AND METHODS This prospective cohort study included 146 patients with symptomatic medial compartment knee osteoarthritis undergoing primary UKA performed by a single surgeon. This included 73 consecutive patients undergoing conventional jig-based mobile bearing UKA, followed by 73 consecutive patients receiving robotic-arm assisted fixed bearing UKA. All surgical procedures were performed using the standard medial parapatellar approach for UKA, and all patients underwent the same postoperative rehabilitation programme. Postoperative pain scores on the numerical rating scale and opiate analgesia consumption were recorded until discharge. Time to attainment of predefined functional rehabilitation outcomes, hospital discharge, and postoperative complications were recorded by independent observers. RESULTS Robotic-arm assisted UKA was associated with reduced postoperative pain (p < 0.001), decreased opiate analgesia requirements (p < 0.001), shorter time to straight leg raise (p < 0.001), decreased number of physiotherapy sessions (p < 0.001), and increased maximum knee flexion at discharge (p < 0.001) compared with conventional jig-based UKA. Mean time to hospital discharge was reduced in robotic UKA compared with conventional UKA (42.5 hours (sd 5.9) vs 71.1 hours (sd 14.6), respectively; p < 0.001). There was no difference in postoperative complications between the two groups within 90 days' follow-up. CONCLUSION Robotic-arm assisted UKA was associated with decreased postoperative pain, reduced opiate analgesia requirements, improved early functional rehabilitation, and shorter time to hospital discharge compared with conventional jig-based UKA.
Collapse
|
21
|
|
22
|
Clinical Orthopaedics and Related Research, The Bone & Joint Journal, the Journal of Orthopaedic Research, and The Journal of Bone and Joint Surgery will not accept clinical research manuscripts previously posted to preprint servers. Bone Joint J 2019; 101-B:1-3. [PMID: 30601050 PMCID: PMC8071585 DOI: 10.1302/0301-620x.101b1.bjj-2018-1289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
23
|
|
24
|
|
25
|
Debridement, antibiotics and implant retention in management of infected total knee arthroplasty: A systematic review. ACTA ACUST UNITED AC 2018. [DOI: 10.1053/j.sart.2019.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
26
|
Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone Joint J 2018; 100-B:930-937. [PMID: 29954217 PMCID: PMC6413767 DOI: 10.1302/0301-620x.100b7.bjj-2017-1449.r1] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aims The objective of this study was to compare early postoperative
functional outcomes and time to hospital discharge between conventional
jig-based total knee arthroplasty (TKA) and robotic-arm assisted
TKA. Patients and Methods This prospective cohort study included 40 consecutive patients
undergoing conventional jig-based TKA followed by 40 consecutive
patients receiving robotic-arm assisted TKA. All surgical procedures
were performed by a single surgeon using the medial parapatellar
approach with identical implant designs and standardized postoperative inpatient
rehabilitation. Inpatient functional outcomes and time to hospital
discharge were collected in all study patients. Results There were no systematic differences in baseline characteristics
between the conventional jig-based TKA and robotic-arm assisted
TKA treatment groups with respect to age (p = 0.32), gender (p =
0.50), body mass index (p = 0.17), American Society of Anesthesiologists
score (p = 0.88), and preoperative haemoglobin level (p = 0.82). Robotic-arm
assisted TKA was associated with reduced postoperative pain (p <
0.001), decreased analgesia requirements (p < 0.001), decreased
reduction in postoperative haemoglobin levels (p < 0.001), shorter
time to straight leg raise (p < 0.001), decreased number of physiotherapy
sessions (p < 0.001) and improved maximum knee flexion at discharge
(p < 0.001) compared with conventional jig-based TKA. Median
time to hospital discharge in robotic-arm assisted TKA was 77 hours
(interquartile range (IQR) 74 to 81) compared with 105 hours (IQR
98 to 126) in conventional jig-based TKA (p < 0.001). Conclusion Robotic-arm assisted TKA was associated with decreased pain,
improved early functional recovery and reduced time to hospital
discharge compared with conventional jig-based TKA. Cite this article: Bone Joint J 2018;100-B:930–7.
Collapse
|
27
|
|
28
|
|
29
|
Enhanced care pathways have multiple benefits. Bone Joint J 2018; 100-B:413-414. [PMID: 29629593 DOI: 10.1302/0301-620x.100b4.bjj-2018-0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
30
|
|
31
|
Acetabular dysplasia: multiple pathologies and myriad solutions. Bone Joint J 2018; 99-B:705-707. [PMID: 28566387 DOI: 10.1302/0301-620x.99b6.bjj-2017-0491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 11/05/2022]
|
32
|
|
33
|
|
34
|
Abstract
Aims The success of anterior cruciate ligament reconstruction (ACLR) depends on osseointegration at the graft-tunnel interface and intra-articular ligamentization. Our aim was to conduct a systematic review of clinical and preclinical studies that evaluated biological augmentation of graft healing in ACLR. Materials and Methods In all, 1879 studies were identified across three databases. Following assessment against strict criteria, 112 studies were included (20 clinical studies; 92 animal studies). Results Seven categories of biological interventions were identified: growth factors, biomaterials, stem cells, gene therapy, autologous tissue, biophysical/environmental, and pharmaceuticals. The methodological quality of animal studies was moderate in 97%, but only 10% used clinically relevant outcome measures. The most interventions in clinical trials target the graft-tunnel interface and are applied intraoperatively. Platelet-rich plasma is the most studied intervention, but the clinical outcomes are mixed, and the methodological quality of studies was suboptimal. Other biological therapies investigated in clinical trials include: remnant-augmented ACLR; bone substitutes; calcium phosphate-hybridized grafts; extracorporeal shockwave therapy; and adult autologus non-cultivated stem cells. Conclusion There is extensive preclinical research supporting the use of biological therapies to augment ACLR. Further clinical studies that meet the minimum standards of reporting are required to determine whether emerging biological strategies will provide tangible benefits in patients undergoing ACLR. Cite this article: Bone Joint J 2018;100-B:271-84.
Collapse
|
35
|
A new year, but the spectre of metal-on-metal lives on. Bone Joint J 2018; 100-B:1-3. [PMID: 29305442 DOI: 10.1302/0301-620x.100b1.bjj-2017-1462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
36
|
Two-stage revision for the culture-negative infected total hip arthroplasty : A comparative study. Bone Joint J 2018; 100-B:3-8. [PMID: 29292333 PMCID: PMC6424436 DOI: 10.1302/0301-620x.100b1.bjj-2017-0626.r1] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/18/2017] [Indexed: 12/28/2022]
Abstract
Aims Periprosthetic joint infection (PJI) remains a challenging complication
following total hip arthroplasty (THA). It is associated with high
levels of morbidity, mortality and expense. Guidelines and protocols
exist for the management of culture-positive patients. Managing
culture-negative patients with a PJI poses a greater challenge to
surgeons and the wider multidisciplinary team as clear guidance
is lacking. Patients and Methods We aimed to compare the outcomes of treatment for 50 consecutive
culture-negative and 50 consecutive culture-positive patients who
underwent two-stage revision THA for chronic infection with a minimum
follow-up of five years. Results There was no significant difference in the outcomes between the
two groups of patients, with a similar rate of re-infection of 6%,
five years post-operatively. Culture-negative PJIs were associated
with older age, smoking, referral from elsewhere and pre-operative
antibiotic treatment. The samples in the culture-negative patients
were negative before the first stage (aspiration), during the first-stage
(implant removal) and second-stage procedures (re-implantation). Conclusion Adherence to strict protocols for selecting and treating culture-negative
patients with a PJI using the same two-stage revision approach that
we employ for complex culture-positive PJIs is important in order
to achieve control of the infection in this difficult group of patients. Cite this article: Bone Joint J 2018;(1 Supple
A)100-B:3–8.
Collapse
|
37
|
A functional comparison of medial pivot and condylar knee designs based on patient outcomes and parameters of gait. Bone Joint J 2018; 100-B:76-82. [PMID: 29292344 PMCID: PMC6424433 DOI: 10.1302/0301-620x.100b1.bjj-2017-0605.r1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 07/07/2017] [Indexed: 02/05/2023]
Abstract
Aims The outcome of total knee arthroplasty (TKA) is not always satisfactory.
The purpose of this study was to identify satisfaction and biomechanical
features characterising the gait of patients who had undergone TKA
with either an anatomical single radius design or a medial pivot
design. We hypothesised that the latter would provide superior function. Patients and Methods This is a study of a subset of patients recruited into a prospective
randomised study of a single radius design versus a
medial pivot design, with a minimum follow-up of one year. Outcome
measurements included clinical scores (Knee Society Score (KSS)
and Oxford Knee Score (OKS)) and gait analysis using an instrumented
treadmill. Results There was no statistically significant difference between the
two groups for both the KSS and OKS. There was also no statistical
significance in cadence, walking speed, stride length and stance
time, peak stride, mid support and push-off forces. Conclusion This study corroborates a previous study by the same authors
that showed equally good results in clinical outcome and gait between
the conventional single radius and medial pivot designs under stringent
testing conditions. Cite this article: Bone Joint J 2018;(1 Supple
A)100-B:76–82.
Collapse
|
38
|
70 not out, and the best is yet to come: celebrating 70 years of orthopaedic excellence. Bone Joint J 2017; 99-B:1553-1554. [PMID: 29212673 DOI: 10.1302/0301-620x.99b12.bjj-2017-1254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 11/05/2022]
|
39
|
Vitamin D Deficiency Is Associated With Longer Hospital Stay And Lower Functional outcome After Total Knee Arthroplasty. Acta Orthop Belg 2017; 83:664-670. [PMID: 30423676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
High vitamin D deficiency prevalence has been found in hip and knee osteoarthritis, and a correlation between low vitamin D levels and worse functional outcome after hip arthroplasty was published before. Our goal was to examine the relation between vitamin D levels and outcome after knee arthroplasty on short and long term. In 138 patients with knee replacements preoperative vitamin D levels were recorded. 33 patients were vitamin D deficient (median 32 nmol/l, range 6-40 nmol/l) and 105 patients were vitamin D sufficient (median 65 nmol/l, range 41-177 nmol/l). After correction for confounders, vitamin D deficient patients had significant (p = 0.03) longer hospital stay (+1.0 day, range 0.2-1.6 day), and significant (p = 0.04) worse functional outcome also at long term follow up after eight years (WOMAC : +5.0, range 0.2-9.8). More research is needed to evaluate if rehabilitation and postoperative outcome can be improved by preoperative vitamin D suppletion.
Collapse
|
40
|
Aspirin and the prevention of venous thromboembolism following total joint arthroplasty: commonly asked questions. Bone Joint J 2017; 99-B:1420-1430. [PMID: 29092979 PMCID: PMC5742873 DOI: 10.1302/0301-620x.99b11.bjj-2017-0337.r2] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/19/2017] [Indexed: 12/17/2022]
Abstract
The number of arthroplasties being performed
increases each year. Patients undergoing an arthroplasty are at
risk of venous thromboembolism (VTE) and appropriate prophylaxis
has been recommended. However, the optimal protocol and the best
agent to minimise VTE under these circumstances are not known. Although
many agents may be used, there is a difference in their efficacy
and the risk of bleeding. Thus, the selection of a particular agent relies
on the balance between the desire to minimise VTE and the attempt
to reduce the risk of bleeding, with its undesirable, and occasionally
fatal, consequences. Acetylsalicylic acid (aspirin) is an agent for VTE prophylaxis
following arthroplasty. Many studies have shown its efficacy in
minimising VTE under these circumstances. It is inexpensive and
well-tolerated, and its use does not require routine blood tests.
It is also a ‘milder’ agent and unlikely to result in haematoma
formation, which may increase both the risk of infection and the
need for further surgery. Aspirin is also unlikely to result in persistent
wound drainage, which has been shown to be associated with the use
of agents such as low-molecular-weight heparin (LMWH) and other
more aggressive agents. The main objective of this review was to summarise the current
evidence relating to the efficacy of aspirin as a VTE prophylaxis
following arthroplasty, and to address some of the common questions
about its use. There is convincing evidence that, taking all factors into account,
aspirin is an effective, inexpensive, and safe form of VTE following
arthroplasty in patients without a major risk factor for VTE, such
as previous VTE. Cite this article: Bone Joint J 2017;99-B:1420–30.
Collapse
|
41
|
Established dogma should be challenged. Bone Joint J 2017; 99-B:1409-1410. [PMID: 29092976 DOI: 10.1302/0301-620x.99b11.bjj-2017-1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 11/05/2022]
|
42
|
The reform of methods of payment for orthopaedic services. Bone Joint J 2017; 99-B:1265-1266. [PMID: 28963145 DOI: 10.1302/0301-620x.99b10.bjj-2017-1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 11/05/2022]
|
43
|
Prosthetic Joint Infections and Cost Analysis? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 971:93-100. [PMID: 28321829 DOI: 10.1007/5584_2016_155] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Prosthetic joint infection is a devastating complication of arthroplasty surgery that can lead to debilitating morbidity for the patient and significant expense for the healthcare system. With the continual rise of arthroplasty cases worldwide every year, the revision load for infection is becoming a greater financial burden on healthcare budgets. Prevention of infection has to be the key to reducing this burden. For treatment, it is critical for us to collect quality data that can guide future management strategies to minimise healthcare costs and morbidity / mortality for patients. There has been a management shift in many countries to a less expensive 1-stage strategy and in selective cases to the use of debridement, antibiotics and implant retention. These appear very attractive options on many levels, not least cost. However, with a consensus on the definition of joint infection only clarified in 2011, there is still the need for high quality cost analysis data to be collected on how the use of these different methods could impact the healthcare expenditure of countries around the world. With a projected spend on revision for infection at US$1.62 billion in the US alone, this data is vital and urgently needed.
Collapse
|
44
|
The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J 2017; 99-B:732-740. [PMID: 28566391 DOI: 10.1302/0301-620x.99b6.38053] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 12/12/2016] [Indexed: 02/06/2023]
Abstract
AIMS The most effective surgical approach for total hip arthroplasty (THA) remains controversial. The direct anterior approach may be associated with a reduced risk of dislocation, faster recovery, reduced pain and fewer surgical complications. This systematic review aims to evaluate the current evidence for the use of this approach in THA. MATERIALS AND METHODS Following the Cochrane collaboration, an extensive literature search of PubMed, Medline, Embase and OvidSP was conducted. Randomised controlled trials, comparative studies, and cohort studies were included. Outcomes included the length of the incision, blood loss, operating time, length of stay, complications, and gait analysis. RESULTS A total of 42 studies met the inclusion criteria. Most were of medium to low quality. There was no difference between the direct anterior, anterolateral or posterior approaches with regards to length of stay and gait analysis. Papers comparing the length of the incision found similar lengths compared with the lateral approach, and conflicting results when comparing the direct anterior and posterior approaches. Most studies found the mean operating time to be significantly longer when the direct anterior approach was used, with a steep learning curve reported by many. Many authors used validated scores including the Harris hip score, and the Western Ontario and McMaster Universities Arthritis Index. These mean scores were better following the use of the direct anterior approach for the first six weeks post-operatively. Subsequently there was no difference between these scores and those for the posterior approach. CONCLUSION There is little evidence for improved kinematics or better long-term outcomes following the use of the direct anterior approach for THA. There is a steep learning curve with similar rates of complications, length of stay and outcomes. Well-designed, multi-centre, prospective randomised controlled trials are required to provide evidence as to whether the direct anterior approach is better than the lateral or posterior approaches when undertaking THA. Cite this article: Bone JointJ 2017;99-B:732-40.
Collapse
|
45
|
|
46
|
Raising the bar. Bone Joint J 2017; 99-B:417-418. [PMID: 28385927 DOI: 10.1302/0301-620x.99b4.bjj-2017-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/13/2017] [Indexed: 11/05/2022]
|
47
|
|
48
|
|
49
|
Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture? Bone Joint J 2017; 99-B:50-59. [PMID: 28042119 DOI: 10.1302/0301-620x.99b1.bjj-2016-0220.r1] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/27/2016] [Indexed: 11/05/2022]
Abstract
AIMS Periprosthetic femoral fractures (PFF) following total hip arthroplasty (THA) are devastating complications that are associated with functional limitations and increased overall mortality. Although cementless implants have been associated with an increased risk of PFF, the precise contribution of implant geometry and design on the risk of both intra-operative and post-operative PFF remains poorly investigated. A systematic review was performed to aggregate all of the PFF literature with specific attention to the femoral implant used. PATIENTS AND METHODS A systematic search strategy of several journal databases and recent proceedings from the American Academy of Orthopaedic Surgeons was performed. Clinical articles were included for analysis if sufficient implant description was provided. All articles were reviewed by two reviewers. A review of fundamental investigations of implant load-to-failure was performed, with the intent of identifying similar conclusions from the clinical and fundamental literature. RESULTS In total 596 articles were initially identified, with 34 being eligible for analysis. Aggregate analysis of 1691 PFFs in 342 719 primary THAs revealed a significantly higher number of PFFs with cementless femoral implants (p < 0.001). Single-wedge and double-wedge (fit-and-fill) femoral implants were associated with a threefold increase in PFF rates (p < 0.001) compared with anatomical, fully coated and tapered/rounded stems. Within cemented stems, loaded-taper (Exeter) stems were associated with more PFFs than composite-beam (Charnley) stems (p = 0.004). Review of the fundamental literature revealed very few studies comparing cementless component designs. CONCLUSION Very few studies within the PFF literature provide detailed implant information. Cementless implants, specifically those of single-wedge and double-wedge, have the highest PFF rates in the literature, with most investigations recommending against their use in older patients with osteoporotic bone. This review illustrates the need for registries and future PFF studies to record implant name and information for future analysis. Furthermore, future biomechanical investigations comparing modern implants are needed to clarify the precise contribution of implant design to PFF risk. Cite this article: Bone Joint J 2017;99-B(1 Supple A):50-9.
Collapse
|
50
|
Does location of patellofemoral chondral lesion influence outcome after Oxford medial compartmental knee arthroplasty? Bone Joint J 2017; 98-B:11-15. [PMID: 27694510 PMCID: PMC5047133 DOI: 10.1302/0301-620x.98b10.bjj-2016-0403.r1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 11/15/2022]
Abstract
Aims Medial unicompartmental knee arthroplasty (UKA) is associated
with successful outcomes in carefully selected patient cohorts.
We hypothesised that severity and location of patellofemoral cartilage
lesions significantly influences functional outcome after Oxford
medial compartmental knee arthroplasty. Patients and Methods We reviewed 100 consecutive UKAs at minimum eight-year follow-up
(96 to 132). A single surgeon performed all procedures. Patients
were selected based on clinical and plain radiographic assessment.
All patients had end-stage medial compartment osteoarthritis (OA)
with sparing of the lateral compartment and intact anterior cruciate ligaments.
None of the patients had end-stage patellofemoral OA, but patients
with anterior knee pain or partial thickness chondral loss were
not excluded. There were 57 male and 43 female patients. The mean
age at surgery was 69 years (41 to 82). At surgery the joint was
carefully inspected for patellofemoral chondral loss and this was documented
based on severity of cartilage loss (0 to 4 Outerbridge grading)
and topographic location (medial, lateral, central, and superior
or inferior). Functional scores collected included Oxford Knee Score
(OKS), patient satisfaction scale and University College Hospital
(UCH) knee score. Intraclass correlation was used to compare chondral
damage to outcomes. Results All patients documented significant improvement in pain and improved
functional scores at mid-term follow-up. There were four revisions
(mean 2.9 years, 2 to 4; standard deviation (sd) 0.9) in
this cohort, three for tibial loosening and one for femoral loosening.
There was one infection that was treated with debridement and insert exchange.
The mean OKS improved from 23.2 (sd 7.1) to 39.1 (sd 6.9);
p < 0.001. The cohort with central and lateral grade 3 patellofemoral
OA documented lower mean satisfaction with pain (90, sd 11.8)
and function (87.5, sd 10.3) on the patient satisfaction
scale. On the UCH scale, patients reported significantly decreased
mean overall scores (7.3, sd 1.2 vs 9, sd 2.3)
as well as stair climb task (3.5, sd 0.3 vs 5, sd 0.1)
when cartilage lesions were located centrally or laterally on the
PFJ. Patients with medial chondral PFJ lesions behave similar to
patients with no chondral lesions. Conclusion Topographical location and severity of cartilage damage of the
patella can significantly influence function after successful Oxford
medial UKA. Surgeons should factor this in when making their operative
decision, and undertake to counsel patients appropriately. Cite this article: Bone Joint J 2016;98-B(10
Suppl B):11–15.
Collapse
|