A 15 to 17-year follow-up of the Kinemax total knee replacement.

BACKGROUND: There is a paucity of long-term data concerning the pre- and postoperative patient reported function of total knee replacement. The aim of this study was to determine the mortality, implant survivorship, patient reported function and satisfaction in a cohort of 114 patients, from a single centre, who received a Kinemax total knee replacement more than 15 years ago. METHODS: Patients completed a questionnaire incorporating validated disease- and joint-specific scores, patient satisfaction and overall health preoperatively, at three months, one year, two years and a minimum of 15 years following surgery. NHS National Strategic Tracing Service, hospital and primary care records were used to establish mortality and for implant survivorship in deceased patients. RESULTS: Forty five patients were alive at final follow-up. The survivorship of the cohort with revision of the TKR as the endpoint was 84%. Four cases were revised for wear, three for loosening and one for peri-prosthetic fracture. There was a significant improvement in WOMAC Pain, Function and Stiffness Scores, Oxford Knee Score and Self-Administered Patient Satisfaction Scale between pre-operative and all post-operative time points, although patient satisfaction had decreased significantly by the time of final follow-up. CONCLUSION: In this cohort, the Kinemax TKR showed survivorship of 84% at 16.3 years with functional scores demonstrating a high level of patient satisfaction at all follow-up time points. LEVEL OF EVIDENCE: 2 - Prospective Cohort Study.

Clinical Anatomy and Assessment of the Elbow.

BACKGROUND: The elbow is a complex synovial hinge joint comprising of three articulations. Satisfactory function and stability are provided by bony and soft tissue stabilising structures. Injuries around the elbow joint are common. METHODS: A literature search was performed and the authors' personal experiences reported. RESULTS: The article discusses the osseous and ligamentous anatomy around the elbow joint and their relevance when assessing and managing elbow injuries. CONCLUSION: Knowledge of the intricate anatomy around the elbow joint is essential to successfully assessing and managing elbow injuries and restoring good function.

The Assessment and Management of Simple Elbow Dislocations.

BACKGROUND: Simple elbow dislocations are a commonly seen joint dislocation involving a sequential disruption of the soft tissue stabilisers without a significant associated fracture. METHODS: A selective literature search was performed and personal surgical experiences are reported. RESULTS: The majority of these injuries can be treated with expedient closed reduction, with the intact bony congruency of the elbow joint conferring early stability. Early mobilisation after reduction results in a faster recovery with good functional outcomes. Surgical intervention for persistent instability or stiffness is uncommonly required. Although, early surgical ligamentous repair has been considered, the current evidence does not demonstrate any long-term benefits compared to non-operative treatment. CONCLUSION: The majority of simple elbow dislocations can be successfully managed non-operatively with good reliable outcomes. Careful follow up is essential, however, to identify patients that may occasionally develop persistent instability or stiffness and require intervention.

A review of outcomes and modes of presentation following liner dissociation from Harris-Galante uncemented acetabular components.

PURPOSE: Dissociation of the polyethylene liner is a known failure mechanism of the Harris Galante I and II uncemented acetabular components. The outcomes of revision surgery for this indication and the influence of time to diagnosis are not well described. METHODS: We report a series of 29 cases revised due to this failure mechanism. The median time from primary to revision surgery was 13 years. RESULTS: At a median of 4 years follow-up, the mean OHS was 34 (range 6-48) but results were poorer (mean 29; range 6-45) when the diagnosis and revision was delayed compared to when it was not (mean 39; range 20-48). A large proportion of our patients (n = 14) presented with sudden onset of symptoms with or without trauma. Osteolysis was common in this series but the cup was well fixed in 20/29 cases. There was macroscopic damage to the shell in all cases. CONCLUSIONS: In our experience, prompt revision of liner dissociation optimises outcomes in this group of patients and radiology reporting alone is not sufficient to identify these cases.