It is not clear whether anterior knee pain and osteoarthritis
(OA) of the patellofemoral joint (PFJ) are contraindications to
medial unicompartmental knee arthroplasty (UKA). Our aim was to
investigate the long-term outcome of a consecutive series of patients,
some of whom had anterior knee pain and PFJ OA managed with UKA. We assessed the ten-year functional outcomes and 15-year implant
survival of 805 knees (677 patients) following medial mobile-bearing
UKA. The intra-operative status of the PFJ was documented and, with
the exception of bone loss with grooving to the lateral side, neither
the clinical or radiological state of the PFJ nor the presence of
anterior knee pain were considered a contraindication. The impact
of radiographic findings and anterior knee pain was studied in a
subgroup of 100 knees (91 patients).Aims
Patients and Methods
While medial unicompartmental knee arthroplasty (UKA) is indicated
for patients with full-thickness cartilage loss, it is occasionally
used to treat those with partial-thickness loss. The aim of this
study was to investigate the five-year outcomes in a consecutive
series of UKAs used in patients with partial thickness cartilage
loss in the medial compartment of the knee. Between 2002 and 2014, 94 consecutive UKAs were undertaken in
90 patients with partial thickness cartilage loss and followed up
independently for a mean of six years (1 to 13). These patients
had partial thickness cartilage loss either on both femur and tibia
(13 knees), or on either the femur or the tibia, with full thickness
loss on the other surface of the joint (18 and 63 knees respectively).
Using propensity score analysis, these patients were matched 1:2 based
on age, gender and pre-operative Oxford Knee Score (OKS) with knees
with full thickness loss on both the femur and tibia. The functional
outcomes, implant survival and incidence of re-operations were assessed
at one, two and five years post-operatively. A subgroup of 36 knees
in 36 patients with partial thickness cartilage loss, who had pre-operative
MRI scans, was assessed to identify whether there were any factors
identified on MRI that predicted the outcome.Aims
Patients and Methods
The NHS will soon implement 18 week referral to treatment targets. A prospective study was performed whereby from 2004–6, referral letters from General Practitioners suggesting a diagnosis specifically of Morton’s neuroma, resulted in randomised assignment to either direct referral for USI or to the specialist Foot and Ankle outpatient clinic. Patients with less specific referral letters were evaluated in clinic and referred for USI as appropriate. A comparison was made of the sensitivity and specificity of the referral pathways, financial implications and the time to treatment (TTT).
Of 57 patients for whom the GP had diagnosed a MN, 40 (70%) had the diagnosis confirmed on USI (other diagnoses were: 7 NAD, 3 ganglions, 2 bursae, 2 degenerative change, 1 glomus tumour, 1 angioleiomyoma, 1 SOL); this was comparable to the overall number referred to radiology with a suspected MN (69%). In the directly referred group, the mean TTT was 115 days (95%CI = 89 – 141), compared to 241 days (95%CI = 223 – 259) for those patients who went via a Foot and Ankle clinic. P<
0.0001.
The mean wait of this group is within the 18 week government target without any changes to our current radiology protocols. Using this direct referral protocol we saved 29 outpatient appointments; if followed for all eligible patients we would have saved 57 outpatient appointments.
From a retrospective, cohort study of 205 patients diagnosed with full-thickness tears of the rotator cuff, we determined, using ultrasound, the prevalence of such tears in their 129 siblings. Using 150 spouses as controls, the relative risk of full-thickness tears in siblings The significantly increased risk for tears in siblings implies that genetic factors play a major role in the development of full-thickness tears of the rotator cuff.
