Treatment of end-stage anteromedial osteoarthritis (AMOA) of the knee is commonly approached using one of two surgical strategies: medial unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). In this study we aim to investigate if there is any difference in outcome for patients undergoing UKA or TKA, when treated by high-volume surgeons, in high-volume centres, using two different clinical guidelines. The two strategies are ‘UKA whenever possible’ vs TKA for all patients with AMOA. A total of 501 consecutive AMOA patients (301 UKA) operated on between 2013 to 2016 in two high-volume centres were included. Centre One employed clinical guidelines for the treatment of AMOA allowing either UKA or TKA, but encouraged UKA wherever possible. Centre Two used clinical guidelines that treated all patients with a TKA, regardless of wear pattern. TKA patients were included if they had isolated AMOA on preoperative radiographs. Data were collected from both centres’ local databases. The primary outcome measure was change in Oxford Knee Score (OKS), and the proportion of patients achieving the patient-acceptable symptom state (PASS) at one-year follow-up. The data were 1:1 propensity score matched before regression models were used to investigate potential differences.Aims
Methods
Many surgeons choose to perform total knee arthroplasty (TKA) surgery with the aid of a tourniquet. A tourniquet is a device that fits around the leg and restricts blood flow to the limb. There is a need to understand whether tourniquets are safe, and if they benefit, or harm, patients. The aim of this study was to determine the benefits and harms of tourniquet use in TKA surgery. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, and trial registries up to 26 March 2020. We included randomized controlled trials (RCTs), comparing TKA with a tourniquet versus without a tourniquet. Outcomes included: pain, function, serious adverse events (SAEs), blood loss, implant stability, duration of surgery, and length of hospital stay.Aims
Methods
To calculate how the likelihood of obtaining measurable benefit from hip or knee arthroplasty varies with preoperative patient-reported scores. Existing UK data from 222,933 knee and 209,760 hip arthroplasty patients were used to model an individual’s probability of gaining meaningful improvement after surgery based on their preoperative Oxford Knee or Hip Score (OKS/OHS). A clinically meaningful improvement after arthroplasty was defined as ≥ 8 point improvement in OHS, and ≥ 7 in OKS.Aims
Methods
The aim of the British Association for Surgery of the Knee (BASK) Meniscal Consensus Project was to develop an evidence-based treatment guideline for patients with meniscal lesions of the knee. A formal consensus process was undertaken applying nominal group, Delphi, and appropriateness methods. Consensus was first reached on the terminology relating to the definition, investigation, and classification of meniscal lesions. A series of simulated clinical scenarios was then created and the appropriateness of arthroscopic meniscal surgery or nonoperative treatment in each scenario was rated by the group. The process was informed throughout by the latest published, and previously unpublished, clinical and epidemiological evidence. Scenarios were then grouped together based upon the similarity of clinical features and ratings to form the guideline for treatment. Feedback on the draft guideline was sought from the entire membership of BASK before final revisions and approval by the consensus group.Aims
Materials and Methods
The aim of this to study was to compare the previously unreported
long-term survival outcome of the Oxford medial unicompartmental
knee arthroplasty (UKA) performed by trainee surgeons and consultants. We therefore identified a previously unreported cohort of 1084
knees in 947 patients who had a UKA inserted for anteromedial knee
arthritis by consultants and surgeons in training, at a tertiary
arthroplasty centre and performed survival analysis on the group
with revision as the endpoint.Aims
Patients and Methods
The objective of this study was to explore dimensionality of
the Oxford Hip Score (OHS) and examine whether self-reported pain
and functioning can be distinguished in the form of subscales. This was a secondary data analysis of the UK NHS hospital episode
statistics/patient-reported outcome measures dataset containing
pre-operative OHS scores on 97 487 patients who were undergoing
hip replacement surgery. Objective
Methods
To evaluate the role of “top up” intra-articular local anaesthetic injection in patients who have had UKR. 43 patients scheduled to have a cemented Oxford UKR were prospectively recruited and randomised. All patients had the same initial anaesthetic regime of general anaesthesia, femoral nerve block and intra-operative intra-articular infiltration. All patients had a multi-holed epidural catheter placed intra-articularly prior to wound closure. Patients had the same operative technique, post operative rehabilitation and rescue analgesia. An independent, blinded observer recorded post-operative pain scores using a visual analogue score every 6 hours and any rescue analgesia. On the morning after surgery, 22 patients, (Group I), received 20 mls of 0.5% bupivicaine through the catheter whilst 21, (Group II), patients had 20 mls of normal saline by the same observer, after which the catheter was removed. No statistical difference was found in pain scores on the day of operation between the groups. However, patients in Group I had a significantly better pain score initially post top up and at 6 hours (2.4 (0-8) vs 5.7 (2-9), p<0.001). This cohort of patients required less rescue analgesia (p<0.001). In addition, Group I had statistically significant higher patient satisfaction outcome scores after the infiltration, (p<0.001).STUDY PURPOSES
METHOD AND RESULTS
Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford and the Nuffield Orthopaedic Hospital, Oxford The aim of this study was to use motion analysis to objectively study the learning curve of surgical trainees performing arthroscopic meniscal repair on a training model in a skills laboratory. With improving technology and an appreciation of its likely chondroprotective effects, meniscal repair surgery is becoming more common. It remains a difficult procedure and is not routinely learnt during surgical training.Purpose
Background
Unicompartmental Knee Replacement (UKR) is an appealing alternative to Total Knee Replacement (TKR) when the patient has isolated compartment osteoarthritis (OA). A common observation post-operatively is radiolucency between the tibial tray wall and the bone. In addition, some patients complain of persistent pain following implantation with a UKR; this may be related to elevated bone strains in the tibia. The aim of this study was to investigate the mechanical environment of the tibia bone adjacent to the tray wall, following UKR, to determine whether this region of bone resorbs, and how altering the mechanical environment affects tibia strains. A finite element (FE) model of a cadaver tibia implanted with an Oxford UKR was used in this study, based on a validated model. A single static load, measured in-vivo during a step-up activity was used. There was a 1 mm layer of cement surrounding the keel in the cemented UKR, and the cement filled the cement pocket. In accordance with the operating procedure, no cement was used between the tray wall and bone. For the cementless UKR a layer of titanium filled the cement pocket. An intact tibia was used to compare to the cemented and cementless UKR implanted tibiae. The tibia was sectioned by the tray wall, defining the radiolucency zone (parallel to the vertical tray wall, 2 mm wide with a volume of 782.5 mm3), corresponding to the region on screened x-rays where radiolucencies are observed. Contact mechanics algorithms were used between all contacting surfaces; bonded contact was also introduced between the tray wall and adjacent bone, simulating a mechanical tie between them. Strain energy density (SED), was compared between the intact and implanted tibia for the radiolucency zone. Equivalent strains were compared on the proximal tibia between the intact and implanted tibia models. Forty patients (20 cemented, 20 cementless) who had undergone UKR were randomly selected from a database, and assessed for radiolucency.Introduction
Materials and methods
To identify genes showing altered expression in osteoarthritic (OA) cartilage and synovium. Dkk3, a member of the Dickoppf family of Wnt signalling inhibitors was overexpressed and this work highlights the potential function of Dkk3 in OA. Real-time PCR was used to compare the expression of 270 cytokines, chemokines and their receptors in cartilage and synovium from OA and non-OA patients. Expression of Dkk3 was also measured in ATDC5 cells and in bovine nasal cartilage (BNC) explants treated with inflammatory cytokines. The effect of Dkk3 on hydroxyproline and GAG release was measured in BNC explant cultures. To assess the distribution of Dkk3 in OA cartilage immunohistochemistry was carried out on anteromedial gonarthrosis specimens. The level of Dkk3 in synovial fluid tricompartmental and unicompartmental cartilage lesions was measured using ELISA.Purpose
Methods
Mobile bearing unicompartmental knee replacement (UKR) is an accepted treatment for patients with isolated medial unicompartmental knee osteoarthritis (OA) with a full thickness cartilage loss. The aim of this study was to determine if this recommendation was correct and if the procedure could be used for partial-thickness cartilage loss. 1053 Oxford medial UKRs were studied prospectively. The knees were divided into two groups; partial-thickness cartilage loss (PTCL) group and the full thickness-cartilage loss (FTCL) group. The primary outcome measure was the total Oxford Knee Score (OKS, 0 to 48) at the time of final follow up. The groups were also compared for the change in OKS (?OKS) and the proportion of patients that were considered to have benefited substantially from surgery (?OKS >5).INTRODUCTION
METHODS
This aim of this study was to investigate apoptosis, reactive oxygen species (ROS), and their upstream markers in Anteromedial Gonarthrosis (AMG). Ten resection specimens, from patients undergoing unicompartmental knee replacement for AMG, and ten control specimens, collected from vascular disease patients undergoing above knee amputation, were used. Routine histology and immunohistochemical studies were conducted for Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), Active Caspase 3, Cytochrome C, Active Bax, Bim, 3-Nitrotyrosine and Forkhead box O3A (FOXO 3A).Aim
Methods
Patella alta, Patella type (Wiberg classification), Trochlea sulcus angles for bone and cartilage, The shortest horizontal distance between the most distal part of the vastus medialis obliquis (VMO) muscle to the supra-medial aspect of the patella, Trochlea and patella cartilage thickness (maximum depth), The horizontal distance between the tibial tubercle and the midpoint of the femoral trochlea (TTD), Patella Engagement – represented as the percentage of the patella height that is captured in the trochlea groove when the knee is in full extension, A Discriminant Analysis test for multi-variant analysis was applied to establish the relationship between each bony/soft tissue anatomical variable and the severity/magnitude of patellofemoral subluxation.
This is the first study to establish that patella engagement is related to PFJ subluxation showing that the lower the percentage engagement of the patella in the trochlea, the greater the severity/magnitude of patellofemoral subluxation. The finding provides greater insight into the aetiology and understanding of the mechanism of symptomatic PFJ subluxation.
Anteromedial Osteoarthritis of the Knee (AMOA) is a distinct phenotype of OA. Within this pattern of disease, the anterior third of the medial tibial plateau exhibits full thickness cartilage loss. The middle third has damaged partial thickness cartilage, and the posterior third has retained cartilage, which is seen on macroscopic visual assessment to be normal. This study investigates the molecular features of progressive severities of cartilage damage within this phenotype. Ten medial tibial plateau specimens were collected from patients undergoing unicompartmental knee replacements. The cartilage within the area of macroscopic damage was divided into equal thirds: T1(most damaged), to T3 (least damaged). The area of macroscopically undamaged cartilage was taken as a 4th sample, N. The specimens were prepared for histological (Safranin-O) and immunohistochemical analysis (Type I and II Collagen, proliferation and apoptosis). Immunoassays were undertaken for Collagens I and II and GAG content. Real time PCR compared gene expression between areas T and N. There was a decrease in OARSI grade across the four areas, with progressively less fibrillation between areas T1, T2 and T3. Area N had a grade of 0 (normal). The GAG immunoassay showed decreased levels with increasing severity of cartilage damage (p<
0.0001). Proliferation and apoptosis, as expected, were increased in the more damaged areas. There was no significant difference in the Collagen II content or gene expression between areas. The Collagen I immunohistochemistry showed increased staining within chondrocyte pericellular areas in the undamaged region (N) and immunoassays showed that the Collagen I content of this macroscopically and histologically normal cartilage, was significantly higher than the damaged areas (p<
0.0001). Furthermore, real time PCR showed a significant increase in Collagen I expression in the macroscopically normal areas compared to the damaged areas (p=0.04). We conclude that in this phenotype the Collagen I increase, in areas of macroscopically and histologically normal cartilage, may represent very early changes of the cartilage matrix within the osteoarthritic disease process. This may be able to be used as an assay of early disease and as a therapeutic target for disease modification or treatment.
24 ± 5, 22 ± 10, and 22 ± 9 and for Objective-AKSS were 84 ± 12, 82 ± 15 and 91 ± 11 respectively. The frequency of five year radiolucency for the groups A, B, and C were 42%, 35%, and 45% respectively.
patients’ pre-operative demographics for age, weight, height, BMI, intra-operative variables such as the operating surgeon (n=2), insert and component sizes, post-operative varus/valgus deformity, and clinical outcome, assessed by the change in Oxford knee (OKS) and Tegner (TS) scores, from before surgery to five-year post-operatively.
We found no significant relationship between physiological RL, pre-operative demographics, intra-operative variables and clinical outcome scores in this study. Tibial RL remains a common finding following the Oxford UKA yet we do not know why it occurs but in the medium term, clinical outcome is not influenced by RL. In particular, it is not a sign of loosening. Physiological RL can therefore be ignored even if associated with adverse symptoms following the Oxford UKA.
The cartilage within the area of macroscopic damage was divided into equal thirds: T1(most damaged), to T3 (least damaged). The area of macroscopically undamaged cartilage was taken as a 4th sample, N. The specimens were prepared for histological (Safranin-O and H&
E staining) and immunohistochemical analysis (Type I and II Collagen, proliferation and apoptosis). Immunoassays were undertaken for Collagens I and II and GAG content. Real time PCR compared gene expression between areas T and N.
The GAG immunoassay showed decreased levels with increasing severity of cartilage damage (ANOVA P<
0.0001). There was no significant difference in the Collagen II content or gene expression between areas. The Collagen I immunohistochemistry showed increased staining within chondrocyte pericellular areas in the undamaged region (N) and immunoassays showed that the Collagen I content of this macroscopically and histologically normal cartilage, was significantly higher than the damaged areas (ANOVA P<
0.0001). Furthermore, real time PCR showed that there was a significant difference in Collagen I expression between the damaged and macroscopically normal areas (p=0.04).
