There is much debate regarding the use of continuous-compartment-pressure-monitoring (CCM) in the diagnosis of acute compartment syndrome (ACS).

We retrospectively reviewed the management of all patients (aged 15 and over) who were admitted with a fracture of the tibial diaphysis, across 3 centres, during 2013–2015. Patient demographics, pre-existing medical problems, initial treatment, subsequent complications, methods of compartment monitoring, and follow-up were all included in the data collection. We separated patients into monitored (MG) and non-monitored groups (NMG), and compared the outcomes of their treatment. Data analysis was performed using SPSS and statistical significance was set as p < 0.05.

287 patients were included in this study (116 NMG vs. 171 MG). There were no significant differences observed in age, sex, previous medical problems, length of stay, AO classification of fracture and post-operative complications between the groups. 21 patients were suspected to have developed ACS (n=8 NMG 6.9percnt;, n=13 MG 7.6percnt;) and were treated with acute decompression fasciotomies. The average time from admission to fasciotomy was 20.3 hours (21.25hrs NMG, 19.5hrs MG p=0.448). There was no significant difference in the average length of hospital stay and documentation of complications at follow up between the 2 groups. There were no reported cases of soft tissue infections associated with the use of CCM.

This study illustrates that CCM does not increase the rate of fasciotomies in this patient group, or reduce the time to fasciotomy significantly. There was no evidence to suggest that use of CCM is associated with superficial or deep infection.

A small proportion of patients have persistent pain after total knee replacement (TKR). The primary aim of this study was to record the prevalence of pain after TKR at specific intervals post-operatively and to ascertain the impact of neuropathic pain. The secondary aim was to establish any predictive factors that could be used to identify patients who were likely to have high levels of pain or neuropathic pain after TKR.

A total of 96 patients were included in the study. Their mean age was 71 years (48 to 89); 54 (56%) were female. The mean follow-up was 46 months (39 to 51). Pre-operative demographic details were recorded including a Visual Analogue Score (VAS) for pain, the Hospital Anxiety and Depression score as well as the painDETECT score for neuropathic pain. Functional outcome was assessed using the Oxford Knee score.

The mean pre-operative VAS was 5.8 (1 to 10); and it improved significantly at all time periods post-operatively (p < 0.001): (from 4.5 at day three to five (1 to 10), 3.2 at six weeks (0 to 9), 2.4 at three months (0 to 7), 2.0 at six months (0 to 9), 1.7 at nine months (0 to 9), 1.5 at one year (0 to 8) and 2.0 at mean 46 months (0 to 10)). There was a high correlation (r > 0.7; p < 0.001) between the mean VAS scores for pain and the mean painDETECT scores at three months, one year and three years post-operatively. There was no correlation between the pre-operative scores and any post-operative scores at any time point.

We report the prevalence of pain and neuropathic pain at various intervals up to three years after TKR. Neuropathic pain is an underestimated problem in patients with pain after TKR. It peaks at between six weeks and three-months post-operatively. However, from these data we were unable to predict which patients are most likely to be affected.

Cite this article: Bone Joint J 2014;96-B:1227–33.

Kinematic alignment has increased in popularity over the last few years in an attempt to improve clinical outcomes following total knee arthroplasty (TKA).

In our unit kinematic alignment has been used with patient-specific cutting guides as part of on-going clinical trials. We performed a retrospective analysis on all the TKA which had been planned to be implanted outside of the mechanical axis (0° ± 3°) based on pre-operative MRI scans and looked at their radiographic and clinical outcomes.

We identified 21 knees which had been implanted as ‘planned outliers’. All had clinical and radiographic follow up to a mean 11.6 months post op. All had a standard long leg alignment radiograph performed at 6 weeks post op to confirm alignment.

All patients had a good improvement in their Oxford Knee Scores with mean improvement from 23 pre-op to 42 at 1 year. Of our patients none had a poor clinical outcome due to the alignment of their TKA, 1 patient had a poor outcome because of a quadriceps rupture which occurred 4 months post-op. There were no post-operative radiographic abnormalities.

In our unit kinematic alignment outside of the mechanical axis is not associated with an increased rate of short term complications.

Introduction

Longstanding complex muliplanar foot deformities represent a significant challenge. The traditional surgical techniques involve excessive dissection and excision of large bony wedges or modifications of the triple fusion to correct the deformity. The majority of the reports in the literature present collective data on different deformity patterns and also mix paediatric and adult patients, even with multiple correction techniques. The aim of this study was to evaluate the clinical, radiological and functional outcomes of the gradual correction of a single common deformity pattern of equino-cavo-varus using a single correction technique of the V-osteotomy and the Ilizarov frame.

Current literature comparing the effect on body mass index (BMI) on the outcome of total hip replacements (THR) is inconclusive. To describe the effect of BMI on THR over the first five years.

We prospectively recruited 1,617 patients undergoing primary THR for osteoarthritis and followed them up at 5 years, recording, dislocations, revisions, deep and superficial infections, Harris Hip scores (HHS) and SF-36. A multivariate analysis was performed to identify if BMI is an independent predictor of adverse outcome.

148 (9%) patients had a BMI >35. 6.8% of patients with a BMI >35 had a dislocation by 5 year post op compared with 3.2%BMI 30–34.9, 2% BMI 25–29.9 and 1.5% BMI<25 (p=0.03) Superficial infections 14.2% BMI >35, 4.4% BMI <25. In SF 36 scores only Mental Health and change in health had no significant differences with an increase in BMI having a statistically significant decrease in all other SF scores. HHS had a mean improvement of 45.1 at five years with an expected loss of 0.302 HHS points (95% CI0.440–0.163) per 1 point BMI increase. There was no significant difference in deep infections, mortality <3 months, revision rates or length of stay.

The most significant risk in increasing BMI is the dislocation rate, possibly representing increased technical difficulty in larger patients. Whilst increasing BMI has a reduced HHS and SF16 score, the overall benefit is still positive.

Introduction

In an ageing population the incidence of patients sustaining a neck of femur fracture is likely to rise. Whilst the neck of femur fracture is thought to be a pre-terminal event in many patients, there is little literature following this common fracture beyond 1 year. With improving healthcare and increasing survival rate, it is likely that a proportion of patients live to have subsequent fractures. However little is known about if these occur and what the epidemiology of these fractures are.

We set out to demonstrate the 10-year survivorship of the PFC sigma TKA in a young patient group.

Demographic and clinical outcome data were collected prospectively at 6 months, 18 months, 3 years, 5 years and 8–10 years post surgery.

The data were analysed using Kaplan Meier survival statistics with end point being regarded as death or revision for any reason.

203 patients were found to be < 55 years at the time of surgery. Four patients required revision and four patients died. Another four patients moved away from the region and were excluded from the study.

A total of 224 knees in 199 patients (101 male and 98 females.) 168 patients had a diagnosis of Osteoarthritis and 28 with inflammatory arthritis. Average age 50.6 years range 28–55 years (median 51). Ten-year survivorship in terms of revision 98.2% at ten years 95% confidence interval.

Our results demonstrate that the PFC Sigma knee has an excellent survival rate in young patients over the first 10 years. TKR should not be withheld from patients on the basis of age.

This study reports the first 10-year clinical and radiological follow-up data for the Sigma PFC. The DuPuy Sigma total knee arthroplasty (TKA) is a modification of the well established Press Fit Condylar (PFC) TKA and is used extensively in the UK and worldwide. It is the most commonly used TKA in England and Wales, where it accounts for 34% of all primary TKA.

A total of 235 consecutive Sigma TKAs were performed in 203 patients between October 1998 and October 1999, in our unit. Patients were seen at a specialist nurse led clinic 7 to 10 days before admission and at 6 months, 18 months, 3 years, 5 years and 7-10 years after surgery. Data was recorded prospectively at each clinic visit. Radiographs were obtained at the 5 year and 8-10 year follow-up appointment.

Of 235 knees 171 (147 patients) were alive at 10 years. Twelve were lost to follow up. Nine knees (3.8%) were revised; five for infection and four underwent change of polyethylene insert. Ten-year survival with and end point of revision for any reason was 95.9%, and with and endpoint of revision for aseptic failure was 98.7%. The mean American Knee Society score was 62 at 8-10 years compared with 31 out of 100 pre-operatively. Of 109 radiographs, 47 knees had radiolucent lines but none showed radiological evidence of loosening.

Our results show that the PFC Sigma knee arthroplasty performs well over the first 10 years post implantation.

We set out to demonstrate the 10-year survivorship of the PFC sigma TKA in a young patient group.

Demographic and clinical outcome data were collected prospectively at 6 months, 18 months, 3 years, 5 years and 8-10 years post surgery.

The data were analysed using Kaplan Meier survival statistics with end point being regarded as death or revision for any reason.

203 patients were found to be ≤55 years at the time of surgery. Four patients required revision and four patients died. Another four patients moved away from the region and were excluded from the study.

A total of 224 knees in 199 patients (101 male and 98 females.) 168 patients had a diagnosis of Osteoarthritis and 28 with inflammatory arthritis. Average age 50.6 years range 28-55 years (median 51).

Ten-year survivorship in terms of revision 98.2% at ten years 95% confidence interval.

Our results demonstrate that the PFC Sigma knee has an excellent survival rate in young patients over the first 10 years.

TKR should not be withheld from patients on the basis of age.

Since 2008 the improvised explosive device has been responsible for a significant proportion of injuries sustained whilst on operational duty in Afghanistan. Vehicles have been developed and adapted to offer maximal protection to service personnel. As a result of the decrease in mortality, there has been an increase in the severity of injuries to the lower limb.

Hind-foot injuries are a difficult cohort of injuries to treat successfully. Those that are amenable to reconstruction carry a significant morbidity, which may result in either early or delayed amputation.

There has been a new injury pattern to the lower limb, not previously described in the medical literature. This pattern consists of a displaced intra-articular calcaneal fracture, distal third tibial fracture and midfoot injury within the same limb.

We believe the combination of the three injuries form the “unhappy triad of the ankle”. Each of the injuries is individually reconstructable, but the combination of all three primary amputation should be considered as part of the surgical options.

The DuPuy Sigma total knee arthroplasty (TKA) is a modification of the well-established Press Fit Condylar (PFC) TKA and is used extensively in the UK and worldwide. This study reports the first 10-year clinical and radiological follow-up data for the Sigma PFC.

A total of 235 consecutive Sigma TKAs were performed in 203 patients between October 1998 and October 1999, in our unit. Patients were seen at a specialist nurse-led clinic 1 week before admission and at 6 months, 18 months, 3 years, 5 years and 7-10 years after surgery. Data was recorded prospectively at each clinic visit.

Of 235 knees, 171 (147 patients) were alive at 10 years. Twelve were lost to follow up. Eight knees (3.4%) were revised; four for infection and four underwent isolated change of polyethylene insert. Ten-year survival with an end point of revision for any reason was 95.9%, and with an endpoint of revision for aseptic failure was 98.7%. The mean American Knee Society score was 62 at 8-10 years compared with 31 out of 100 pre-operatively.

Our results show that the PFC Sigma knee arthroplasty performs well over the first 10 years post-implantation.

The aim of this study was to compare the long-term outcome from total knee replacement (TKR) in young versus old patients in terms of pain and functional outcome.

We used our arthroplasty database, which recorded prospectively pain and American Knee Society scores at regular intervals over ten years after TKR. The procedures used a modern, cemented resurfacing type cruciate retaining prosthesis. A cohort of young patients (≤55 years) was identified. A control group of patients ≥ 56 was identified, matching for ASA, body mass index and underlying condition. Change over time was analysed using a factorial repeated measures ANOVA test, which allowed for investigation of difference between groups. 40 Knees in 26 patients were identified. 2 patients died prior to follow up, 2 were revised within the study period (1 for infection at 2 years and one for change of poly at 7 years) and a further 4 were lost to follow up. 7 knees could not be matched and were excluded. This left a study group of 24 young and 24 older knees. Pain scores (p=0.025) and American Knee Society “Knee” (p<0.001) and “Function” (p<0.001) scores changed significantly over time. There were however no statistical differences over the 10-year period in pain (p=0.436) and knee performance (0.618) but overall function was higher throughout the period in the younger group (=0.004).

We conclude that Knee replacement in younger patients produces similar outcomes in terms of pain and function compared with older patients and TKR should not be withheld purely on account of age.

The aim of this study was to compare the long-term outcome from total knee replacement (TKR) in young versus old patients in terms of pain and functional outcome.

We used our arthroplasty database which recorded prospectively pain and American Knee Society scores at regular intervals over ten years after TKR. The procedures used a modern, cemented resurfacing type cruciate retaining prosthesis. A cohort of young patients (≤55 years) were identified. A control group of patients > 56 was identified, matching for ASA, body mass index and underlying condition. Change over time was analysed using a factorial repeated measures ANOVA test, which allowed for investigation of difference between groups.

40 Knees in 26 patients were identified. 2 patients died prior to follow up, 2 were revised within the study period. (1 for infection at 2 years and one for change of poly at 7 years) and a further 4 were lost to follow up. 7 knees could not be matched and were excluded. This left a study group of 24 young and 24 older knees.

Pain scores (p=0.025) and American Knee Society “Knee” (p<0.001) and “Function” (p<0.001) scores changed significantly over time. There were however no statistical differences over the 10 year period in pain (p=0.436) and knee performance (0.618) but overall function was higher throughout the period in the younger group (=0.004).

Knee replacement in younger patients produces similar outcomes in terms of pain and function compared with older patients and TKR should not be withheld purely on account of age.

Good perioperative analgesia following Total Knee Replacement facilitates rehabilitation and may reduce hospital stay. A multimodal drug injection has been shown to provide excellent pain control and functional recovery, and was introduced into the operating practice of one Arthroplasty surgeon during his Total Knee Replacements.

We compared the rehabilitation of 27 consecutive patients (group 1) following their Total Knee Replacement under spinal anaesthesia receiving the periarticular infiltration mixture, consisting of levobupivacaine, ketorolac and adrenaline at the end of surgery. Their rehabilitation was compared to group 2, a historical group operated on by the same surgeon before the introduction of the multimodal drug injection. These patients were age and sex matched and had received a Femoral and Sciatic block at the time of their operation.

Patients in group 1 had lower analgesic and anti-emetic requirements than group 2. Group 1 also had a shorter time to Strait Leg raise.

Periarticular multimodal drug injection can improve perioperative analgesia and mobilisation following Total Knee Replacement as well as reducing opioid side effects.