Virtual arthroplasty follow-up: five-year data from a district general hospital

Introduction Follow-up after hip and knee arthroplasty is advocated to identify asymptomatic loosening and improve patient satisfaction. There are, however, financial and time implications associated with regular clinic appointments. Assessment through virtual means has been suggested as an alternative. Materials and methods At the West Suffolk Hospital, following arthroplasty surgery of the lower limb, patients are followed-up via a questionnaire at one and five years postoperatively, then subsequently at five-yearly intervals. Patients are recalled based on the outcome of these assessments. Using a locally compiled data base we identified all patients reviewed between 2011 and 2015 using this virtual assessment process and examined their outcomes. Results During the five years of follow-up, 5,380 patients were eligible for assessment. Compliance varied from 77% follow up for hips and 83% for knees. Ten patients were recalled following total hip replacement, eight for x-ray changes and one for a poor satisfaction score. Five went on to undergo revision surgery. Some 56 recalls to clinic following knee arthroplasty were seen; 42 due to a poor Oxford Knee Score, 6 with associated x-ray abnormalities and 6 isolated abnormal x-rays. Five subsequently underwent revision surgery; 30 (54%) were discharged after initial review and 18 (32%) were referred to different subspecialties. As a result of the virtual review process, 4,219 clinic appointments were avoided, with no documented admissions as a result of a missed complication from virtual review. Discussion A virtual arthroplasty clinic significantly reduces the number of patients attending regular follow-up clinics, without compromising safe practice.

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Mid-term results of lateral unicondylar mobile bearing knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.100b1.bjj-2017-0600.r1 ◽

2018 ◽

Vol 100-B (1) ◽

pp. 42-49 ◽

Cited By ~ 30

Author(s):

T. Walker ◽

N. Zahn ◽

T. Bruckner ◽

M. R. Streit ◽

G. Mohr ◽

...

Keyword(s):

At Risk ◽

Los Angeles ◽

Knee Arthroplasty ◽

Revision Surgery ◽

Oxford Knee Score ◽

Mobile Bearing ◽

Dislocation Rate ◽

Number Of Patients ◽

Mid Term Results

Aims The aim of this independent multicentre study was to assess the mid-term results of mobile bearing unicondylar knee arthroplasty (UKA) for isolated lateral osteoarthritis of the knee joint. Patients and Methods We retrospectively evaluated 363 consecutive, lateral UKAs (346 patients) performed using the Oxford domed lateral prosthesis undertaken in three high-volume knee arthroplasty centres between 2006 and 2014. Mean age of the patients at surgery was 65 years (36 to 88) with a mean final follow-up of 37 months (12 to 93) Results A total of 36 (10.5%) patients underwent revision surgery, giving a survival rate of 90.1% at three years (95% confidence intervals (CI) 86.1 to 93.1; number at risk: 155) and 85.0% at five years (95% CI 77.9 to 89.9; number at risk: 43). Dislocation of the mobile bearing occurred in 18 patients (5.6%) at three years (95% CI 1.0 to 16.4; number at risk: 154) and in 20 patients (8.5%) at five years (95% CI 1.0 to 27.0; number at risk: 42). There were no significant differences in the dislocation rate between the participating centres or the surgeons. We were not able to identify an effect of each surgeon’s learning curve on the dislocation rate of the mobile bearing. The clinical outcome in patients without revision surgery at final follow-up was good to excellent, with a mean Oxford knee score of 40.3 (95% CI 39.4 to 41.2), a mean Tegner activity score of 3.2 (95% CI 3.1 to 3.3) and a mean University of California, Los Angeles score of 5.7 (95% CI 5.5 to 5.9). Conclusion Our data, which consists of a high number of patients treated with mobile bearing UKA in the lateral compartment, indicates a high revision rate of 15% at five years with dislocation of the mobile bearing being the main reason for implant failure. Despite the good functional and clinical results and the high patient satisfaction in our study group, we therefore discontinued using mobile-bearing lateral UKA in favour of a fixed-bearing component. Cite this article: Bone Joint J 2018;100-B:42–9.

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The effects of patello-femoral arthrosis to the outcome of unicompartmental arthroplasty

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00106 ◽

2017 ◽

Vol 5 (2_suppl2) ◽

pp. 2325967117S0010

Author(s):

Tolga Tüzüner ◽

Ayşe Esin Uygur ◽

Esra Çirçi ◽

Murat Eren ◽

Ziya Demirci

Keyword(s):

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Knee Society Score ◽

Oxford Knee Score ◽

Functional Results ◽

Unicompartmental Knee ◽

Number Of Patients ◽

Significant Difference ◽

Grade 3

Purpose: Unicompartmental knee arthroplasty is developed for the treatment of unicompartment arthrosis. Participation of multi compartments to the disease and patello-femoral arthrosis classically form a contraindication for this surgery. Different opinions were reported in literature on this subject. In this study, the effects of the presence of patello-femoral arthrosis on post-operative clinical and functional outcomes and revision process were investigated. Method: Pre-operative magnetic resonance (MR) images of 52 patients undergone medial unicompartmental knee arthroplasty between the years of 2011-2016 who completed minimum 6 months of follow-up period were evaluated. According to the presence of patello-femoral arthrosis, patients were classified into groups as non-arthrosis, grade 1-2 and grade 3-4. Statistical comparison were performed on knee society score (KSS), functional knee society score (fKSS), Oxford knee score (OKS), visual analog scale (VAS) score and post-operative joint range of motion (ROM) results. Results: 24 of 52 patients had no patello-femoral arthrosis. 13 patients were diagnosed with grade 1-2 and 15 patients were diagnosed with grade 3-4 patello-femoral arthrosis. No statistically significant difference was observed in patello-femoral arthrosis groups in average post-operative KSS, fKSS, OKS, VAS values. No revision proceeding was demonstrated in regression analysis. Conclusion: The results obtained from this study demonstrated that patello-femoral arthrosis has no effect on clinical and functional results. Yet, it is also considered that there is no factor to affect the implant survival rate. Having that said, when the number of patients and relatively short follow-up periods are considered, it is our opinion that new studies are required in this matter. [Figure: see text]

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Subsidence in Collarless Corail Hip Replacement

The Open Orthopaedics Journal ◽

10.2174/1874325001509010194 ◽

2015 ◽

Vol 9 (1) ◽

pp. 194-197 ◽

Cited By ~ 10

Author(s):

Veenesh Selvaratnam ◽

Vishwanath Shetty ◽

Vishal Sahni

Keyword(s):

Rheumatoid Arthritis ◽

Revision Surgery ◽

Hip Replacement ◽

X Rays ◽

Indications For Surgery ◽

Retrospective Case ◽

Female Ratio ◽

X Ray ◽

Male To Female

The purpose of this study was to assess whether subsidence occurs in collarless Corail hip replacement (CCHR) and to ascertain the extent and timing of subsidence if present. Retrospective case notes analysis was performed. Sixty eight patients who had CCHR were identified from our database. Male to female ratio was 32:36. Their mean age was 74.2 years (range 37-95 years). Indications for surgery were osteoarthritis in 64 (94%) patients, rheumatoid arthritis in two (3%) patients and avascular necrosis in two (3%) patients. Subsidence was measured at 6 weeks, 6 months and 1 year post-op compared to initial post-op x-rays. At 6 weeks x-ray 21 patients did not have any subsidence, 18 patients had 1 millimeter (mm) subsidence, 10 patients had 2mms subsidence, 4 patients had 3mms subsidence, 5 patients had 4mms subsidence, 1 patient had 5mms subsidence, 4 patients had 6 mms subsidence and 1 patient each had subsidence of 7mms, 9mms, 11mms, 13mms and 26 mms respectively. When compared with 6 months x-rays only 2 patients had a further subsidence of 2mms while another patient had 3mms subsidence. No further subsidence occurred at 1 year follow up x-rays. One patient had revision surgery due to symptomatic subsidence (29mms) at 6 months follow up. Subsidence does occur in the first 6 weeks in collarless Corail hip replacement, and to a lesser extent until 6 months postoperatively, but does not progress further.

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Clinical and radiological outcomes in three-dimensional printing assisted revision total hip and knee arthroplasty: a systematic review

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02646-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Rui Zhang ◽

Jiajun Lin ◽

Fenyong Chen ◽

Wenge Liu ◽

Min Chen

Keyword(s):

3D Printing ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Three Dimensional ◽

Cochrane Library ◽

Control Group ◽

Total Hip ◽

Number Of Patients ◽

Hip And Knee Arthroplasty

Abstract Background This study investigates whether three-dimensional (3D) printing-assisted revision total hip/knee arthroplasty could improve its clinical and radiological outcomes and assess the depth and breadth of research conducted on 3D printing-assisted revision total hip and knee arthroplasty. Methods A literature search was carried out on PubMed, Web of Science, EMBASE, and the Cochrane Library. Only studies that investigated 3D printing-assisted revision total hip and knee arthroplasty were included. The author, publication year, study design, number of patients, patients’ age, the time of follow-up, surgery category, Coleman score, clinical outcomes measured, clinical outcomes conclusion, radiological outcomes measured, and radiological outcomes conclusion were extracted and analyzed. Results Ten articles were included in our review. Three articles investigated the outcome of revision total knee arthroplasty, and seven investigated the outcome of revision total hip arthroplasty. Two papers compared a 3D printing group with a control group, and the other eight reported 3D printing treatment outcomes alone. Nine articles investigated the clinical outcomes of total hip/knee arthroplasty, and eight studied the radiological outcomes of total hip/knee arthroplasty. Conclusion 3D printing is being introduced in revision total hip and knee arthroplasty. Current literature suggests satisfactory clinical and radiological outcomes could be obtained with the assistance of 3D printing. Further long-term follow-up studies are required, particularly focusing on cost-benefit analysis, resource availability, and, importantly, the durability and biomechanics of customized prostheses using 3D printing compared to traditional techniques.

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Adverse Events in the Treatment of Periprosthetic Fractures Around the Knee – a Clinical and Radiological Outcome Analysis

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/s-0043-123831 ◽

2018 ◽

Vol 156 (03) ◽

pp. 287-297 ◽

Cited By ~ 3

Author(s):

Anna Schreiner ◽

Christoph Gonser ◽

Christoph Ihle ◽

Max Zauleck ◽

Tim Klopfer ◽

...

Keyword(s):

Adverse Events ◽

Revision Surgery ◽

Plate Fixation ◽

Oxford Knee Score ◽

Revision Arthroplasty ◽

Periprosthetic Fractures ◽

X Rays ◽

Non Union ◽

Revision Tka

Abstract Background The incidence of periprosthetic fractures associated with total knee arthroplasty (PpFxK) has been reported to be 0.3 – 5.5%. 40% of all cases are related to revision TKA. The most common localisation is the distal femur. Classification is performed according to Rorabeck (RB). RB I – II fractures are usually treated with locked plating and retrograde intramedullary nailing, whereas RB III fractures are an indication for revision arthroplasty using a hinged endoprosthesis. PpFxK of the patella can be classified according to Goldberg and PpFxK of the proximal tibia can be grouped as in Felix. Interprosthetic fractures can be regarded as a special type of PpFx. Due to the increasing numbers of TKA being performed, increasing numbers of adverse events in arthroplasty can be expected. Adverse events in the treatment of PpFxK occur in up to 41% of patients according to the literature and revision is needed in approximately 29% of all cases. Risk factors are age, osteoporosis, infection, malalignment, osteolysis/loosening of the implant and status post revision. Patients A clinical and radiographic follow-up was performed with 50 patients (14 men, 36 women) treated for PpFxK of the femur, tibia and patella between 2011 and 2015 at the department of arthroplasty at a level 1 trauma center in Europe. Results The follow-up of all patients was 68%, with an average of 19.1 ± 14.6 (1 – 49) months between PpFxK and clinical follow-up. 16% of the patients were allocated for further treatment or revision surgery from other hospitals. The patientsʼ median age was 78.0 ± 8.8 (55 – 94) years. Most patients were affected by several orthopaedic and internal medical comorbidities. PpFxK classified as RB II were the most common fractures (60%, n = 30). PpFxK usually occurred 5.0 ± 4.8 (0 – 20) years after index TKA (primary or revision TKA), mostly in patients with CR-retaining endoprosthesis, whereas PpFxK according to Felix occurred significantly earlier and mostly in hinged TKAs. Patients achieved on average a mean Oxford Knee Score of 31.1 ± 9.9 (14 – 46) points. The functional Knee Society Score (KSS) was 52.6 ± 24.4 (20 – 100) and the mean KSS was 58.7 ± 26.8 (0 – 99) points (n = 25). Radiographic evaluation of the RB I – II patients showed frontal and sagittal malalignment in 20.6% of all cases after reduction and plate fixation. The overall rate of surgical adverse events was 50%; 44% of all RB patients needed revision surgery. Adverse events comprised non-union, failure of osteosynthesis, infection, wound healing disorders and re-fractures in the RB II and the Felix subgroup. Conclusion PpFxK are severe injuries and are associated with a high rate of adverse events related to treatment. Patients often have a complex background and a history of revision surgery or periprosthetic joint infection. The treatment of PpFxK should therefore take place at a centre with expertise in traumatology as well as in revision arthroplasty. Preoperative infection diagnostic testing as well as adequate imaging (X-rays and CT) are essential. We furthermore advise early evaluation of revision arthroplasty, especially in elderly patients suffering from PpFxK with insufficient bone quality around the TKA and closeness between fracture and TKA. In the case of plate fixation, it is important to give attention to correct reduction – to prevent non-union, loosening of the implant and failure of the osteosynthesis – as well as to consider double plating.

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Towards UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): protocol for an evaluation of the requirements for arthroplasty follow-up, and the production of consensus-based recommendations

BMJ Open ◽

10.1136/bmjopen-2019-031351 ◽

2019 ◽

Vol 9 (6) ◽

pp. e031351

Author(s):

Carolyn J Czoski Murray ◽

Sarah R Kingsbury ◽

Nigel K Arden ◽

Jenny Hewison ◽

Andrew Judge ◽

...

Keyword(s):

Knee Arthroplasty ◽

Revision Surgery ◽

Data Sets ◽

Ageing Population ◽

Follow Up Care ◽

Hip And Knee Arthroplasty ◽

The Uk ◽

Joint Prostheses

IntroductionHip and knee arthroplasties have revolutionised the management of degenerative joint diseases and, due to an ageing population, are becoming increasingly common. Follow-up of joint prostheses is to identify problems in symptomatic or asymptomatic patients due to infection, osteolysis, bone loss or potential periprosthetic fracture, enabling timely intervention to prevent catastrophic failure at a later date. Early revision is usually more straight-forward surgically and less traumatic for the patient. However, routine long-term follow-up is costly and requires considerable clinical time. Therefore, some centres in the UK have curtailed this aspect of primary hip and knee arthroplasty services, doing so without an evidence base that such disinvestment is clinically or cost-effective.MethodsGiven the timeline from joint replacement to revision, conducting a randomised controlled trial (RCT) to determine potential consequences of disinvestment in hip and knee arthroplasty follow-up is not feasible. Furthermore, the low revision rates of modern prostheses, less than 10% at 10 years, would necessitate thousands of patients to adequately power such a study. The huge variation in follow-up practice across the UK also limits the generalisability of an RCT. This study will therefore use a mixed-methods approach to examine the requirements for arthroplasty follow-up and produce evidence-based and consensus-based recommendations as to how, when and on whom follow-up should be conducted. Four interconnected work packages will be completed: (1) a systematic literature review; (2a) analysis of routinely collected National Health Service data from five national data sets to understand when and which patients present for revision surgery; (2b) prospective data regarding how patients currently present for revision surgery; (3) economic modelling to simulate long-term costs and quality-adjusted life years associated with different follow-up care models and (4) a Delphi-consensus process, involving all stakeholders, to develop a policy document which includes a stratification algorithm to determine appropriate follow-up care for an individual patient.Ethics and DisseminationFavourable ethical opinion has been obtained for WP2a (RO-HES) (220520) and WP2B (220316) from the National Research Ethics Committee. Following advice from the Confidentiality Advisory Group (17/CAG/0122), data controllers for the data sets used in WP2a (RO-HES) – NHS Digital and The Phoenix Partnership – confirmed that Section 251 support was not required as no identifiable data was flowing into or out of these parties. Application for approval of WP2a (RO-HES) from the Independent Group Advising on the Release of Data (IGARD) at NHS Digital is in progress (DARS-NIC-147997). Section 251 support (17/CAG/0030) and NHS Digital approval (DARS-NIC-172121-G0Z1H-v0.11) have been obtained for WP2a (NJR-HES-PROMS). ISAC (11_050MnA2R2) approval has been obtained for WP2a (CPRD-HES).

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PRIMARY TOTAL KNEE ARTHROPLASTY FOR SEVERE VALGUS DEFORMITY: A 2YEAR FOLLOW-UP STUDY AT HASAN SADIKIN HOSPITAL

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00060 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0006

Author(s):

K. A. M. Luthfi ◽

D. Mulyadi ◽

F.A. Tanjung

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Oxford Knee Score ◽

Primary Total Knee Arthroplasty ◽

Valgus Deformity ◽

X Rays ◽

Femorotibial Angle ◽

Total Knee ◽

Primary Total Knee

Valgus deformity (VD) accounts for only 10% of total knee arthroplasties (TKAs), but is frequently considered the most challenging to manage. The aim of this study was to review outcome of primary total knee arthroplasty for severe valgus deformity at Hasan Sadikin Hospital, Bandung. Methods: From January 2015 and December 2017 consecutive patients undergoing unconstrained primary total knee arthroplasty with severe VD, grade II and III were enrolled in a prospective observational cohort study. Preoperatively, at 6 weeks, and 2 years after surgery, patients completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), and the Knee Society Score (KSS, 2011, modified version). Femorotibial angle were measured on the frontal standing X-rays. Results and Discussions: There were twenty-four patients (18 women, 6 men) with mean age of 66 years (55 - 80). The knee range of motion improved from a mean of 71 degrees preoperatively to a mean of 95 degrees. KOOS Quality of life had increased significantly 6 weeks – 2 years after surgery. KOOS pain mean score was 40.3 points before surgery and increased significantly to 86.6 at two year follow up. OKS mean score increased from 22.1 to 41.8 two years after surgery. KSS 2011 mean objective score increased from 22 to 96 and mean function score increased from 32 to 81 two years after surgery. The mean femorotibial angle were improved from valgus 32.72º±9.68º pre-operation to 4.89º±0.90º post-operation (P <0.001). Conclusion: Primary total knee arthroplasty can be effective and safe for severe valgus deformity and the clinical results up to two years after surgery are promising. As our results show, if proper ligament balancing techniques are used and proper ligament balance is attained, the knee may not require the use of a more constrained components.

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Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty

Medicina ◽

10.3390/medicina57020188 ◽

2021 ◽

Vol 57 (2) ◽

pp. 188

Author(s):

Daniel C. Santana ◽

Matthew J. Hadad ◽

Ahmed Emara ◽

Alison K. Klika ◽

Wael Barsoum ◽

...

Keyword(s):

Knee Arthroplasty ◽

Perioperative Management ◽

Recent Literature ◽

Patient Specific ◽

Antithrombotic Agents ◽

Coronary Syndrome ◽

Risk Of Bleeding ◽

Post Operative Period ◽

Number Of Patients ◽

Hip And Knee Arthroplasty

Total hip and knee arthroplasty are common major orthopedic operations being performed on an increasing number of patients. Many patients undergoing total joint arthroplasty (TJA) are on chronic antithrombotic agents due to other medical conditions, such as atrial fibrillation or acute coronary syndrome. Given the risk of bleeding associated with TJAs, as well as the risk of thromboembolic events in the post-operative period, the management of chronic antithrombotic agents perioperatively is critical to achieving successful outcomes in arthroplasty. In this review, we provide a concise overview of society guidelines regarding the perioperative management of chronic antithrombotic agents in the setting of elective TJAs and summarize the recent literature that may inform future guidelines. Ultimately, antithrombotic regimen management should be patient-specific, in consultation with cardiology, internal medicine, hematology, and other physicians who play an essential role in perioperative care.

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Classification of Fresh Fractures of the Lunate

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_88_90180-5 ◽

1988 ◽

Vol 13 (4) ◽

pp. 458-462

Author(s):

H. TEISEN ◽

J. HJARBAEK

Keyword(s):

Vascular Anatomy ◽

X Rays ◽

Lunate Bone ◽

X Ray

The X-rays of 17 patients with fresh fractures of the lunate bone have been reviewed. The fractures were classified according to their radiological appearances and according to the vascular anatomy of the lunate. A long term X-ray follow-up examination was performed.

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