Kinematic 3-D motion analysis of shoulder resurfacing hemiarthroplasty - An objective assessment method.

Shoulder replacement is indicated in the treatment of pain due to osteoarthritis. Few studies have objectively assessed range of motion (RoM) gains at different post-operative time points. This is a prospective 3D motion analysis study to objectively quantify RoM changes at multiple time points following shoulder resurfacing arthroplasty (SRA) for primary gleno-humeral osteoarthritis, comparing it with clinically measured RoM. Clinical assessment, Visual Analog Scale (VAS) pain score, Constant-Morley (CS) and Oxford Shoulder Score (OSS) were recorded. Motion analysis was performed for RoM and three activities of daily living tasks (ADL), pre-operatively and post-operatively at 4 and 12 months. Nineteen shoulders in fifteen patients were included. The mean age was 72 years (range 52-84). There were significant improvements in external and internal rotation, ability to place the hand behind the head and reach the fifth lumbar vertebra, at 4 months on clinical examination and kinematic analysis with no further improvements at 12 months. There was significant improvement in abduction at 4 months with further improvement at 12 months, which was significantly more than noted on clinical assessment. In contrast, kinematic analysis showed a reduction in flexion between 4 and 12 months, while clinically there appeared to be an improvement between these time periods. This is the first study to prospectively utilise objective kinematic 3-D motion analysis in addition to clinical measurements and outcome scores, to investigate the outcome of resurfacing arthroplasty at multiple time points after surgery, providing an understanding into the trends of change in these parameters.

Cemented total hip replacement in patients under 55 years.

Background and purpose - About 86,000 total hip replacements (THR) have been registered in patients under 55 years in the National Joint Registry of England and Wales (NJR). The use of uncemented implants has increased, despite their outcomes not having been proven to be significantly better than cemented implants in this registry. We determined the implant survivorship and functional outcomes of cemented THR in patients under 55 years at a minimum follow-up of 22 years. Patients and methods - 104 hips in 100 patients were included in this prospective study. Functional outcome was assessed using the Harris Hip Score and radiographs were assessed for implant failure and "at risk" of failure. Kaplan-Meier survivorship analysis was performed. Results - 89% of hips showed good to excellent results at final follow-up with a mean Harris Hip Score of 88 at a mean follow-up of 25 years. Revision was performed in 3/104 hips. 14 acetabular components and 4 femoral components were "at risk" of failure. The survivorship at minimum 22 years with revision for any reason as the end-point was 97% (95% CI 95-98). Interpretation - Cemented hip replacements perform well in young patients with good long-term functional and radiographic outcomes.

Acetabulum-Only Revision Total Hip Arthroplasty Is Associated With Good Functional Outcomes and Survivorship.

BACKGROUND: The coexistence of a stable femoral and a loose acetabular component may pose a clinical dilemma for the surgeon. Our study aims at comparing the intermediate functional outcomes and survivorship of acetabulum-only revision total hip arthroplasty (ArTHA) with an age-matched and gender-matched total revision THA (TrTHA) group. METHODS: We retrospectively reviewed prospectively collected data on the pain, function, and total Harris Hip Scores (HHS) and complication profile for ArTHA and TrTHA cohorts from our regional arthroplasty database. Kaplan-Meier survivorship, with the need for repeat revision surgery as the end point, was used for survival analysis. RESULTS: Among 538 cases, there were fewer acute medical complications in ArTHA and a similar dislocation rate for both cohorts. Preoperative HHS for pain, function, and total were better in the ArTHA cohort, but only the function score reached statistical significance. No significant differences in subsequent years for all aspects of HHS, except the function score was significantly better in the ArTHA cohort at year 1. And 10.0% of ArTHAs and 7.8% of TrTHAs had required rerevision. The 5-year survivorship was 90.3% (95% confidence interval ± 2.1%) for the ArTHA cohort and 92.7% (95% confidence interval ± 1.8%) for the TrTHA cohort (P = .394). The ArTHA with posterior approach (n = 118) group had the lowest dislocation rate and the best trend of functional outcomes. CONCLUSION: ArTHA can provide similar functional outcomes and dislocation rate to TrTHA, with an acceptable rerevision rate. The posterior approach in this study was not associated with a significant dislocation rate.

Numbness Around the Total Knee Arthroplasty Surgical Scar: Prevalence and Effect on Functional Outcome.

BACKGROUND: Numbness around the surgical scar can be a source of discomfort or dissatisfaction in a proportion of patients undergoing total knee arthroplasty (TKA). Literature reports wide variation in its prevalence and the consequence of numbness on the outcome of TKA is not clear. We investigated the prevalence of numbness, along with contributing factors, and assessed its effect on the functional outcome of TKA. METHODS: In total, 258 knees were included in this prospective patient-reported outcome measure case-control study. Demographic details, type and length of incision, pre-operative and 1-year post-operative Knee Society Scores were recorded and compared. RESULTS: The prevalence of numbness at 1 year was 53%, with a female preponderance. Patients older than 70 years were less affected. Discomfort due to numbness was recorded in 8.7% of the patients, 75% of which were female. The length of the incision correlated positively with the presence of numbness. The Knee Society Scores did not correlate with the presence or area of numbness. CONCLUSION: Our findings indicate a high prevalence of numbness after TKA. Nevertheless, numbness does not affect the functional outcome.

Oxford unicompartmental knee arthroplasty versus age and gender matched total knee arthroplasty - functional outcome and survivorship analysis.

We compared the medium-term outcomes of age and gender matched patients with unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). We retrospectively reviewed the pain, function and total knee society scores (KSS) for 602 UKAs and age and gender matched TKAs between 2001 and 2013. Function scores remained significantly better in UKAs from preoperative until 3years follow up. The change of function scores was not significantly different. TKAs performed better than UKAs for pain scores. Total KSS for both groups were not significantly different in the study. Fewer medical complications were reported in UKA group. 6.30% of UKAs and 2.99% of TKAs were revised. The theoretical advantages of UKA were not borne out, other than in immediate postoperative complications.

Bilateral simultaneous hip replacement versus bilateral sequential hip replacement. A 7-year data review.

The aim of this study was to compare the outcomes of bilateral sequential versus bilateral simultaneous hip replacements, using the collarless polished taper cemented hip prosthesis, in relation to complications, revisions, patient satisfaction rates, and Harris Hip Score. Data were collected by independent practitioners and processed within the University Audit Department. A total of 594 patients were identified as having undergone bilateral hip replacement surgery. Patient satisfaction rates were consistently high in both groups. Harris Hip Scores improvements were similar and reflected a marked improvement in pain and function. The sequential bilateral group experienced an increased length of hospital stay and therefore potential cost implications, which may be offset by the lower incidence of adverse events. Bilateral simultaneous hip replacement remains an important option, for which there is strong supportive evidence.

Does the Oxford Knee Score complement, concur, or contradict the American Knee Society Score?

The American Knee Society Score (AKSS) and the Oxford Knee Score (OKS) are commonly used outcome assessment tools following total knee arthroplasty. The literature is sparse with regard to direct correlation between the AKSS and the OKS. The present study aimed to elucidate any direct correlation between these two scoring systems. Preoperative and 1-year postoperative AKSS and OKS from 379 patients were analyzed statistically. Regression equations were developed based on curve fit models. The study found a good correlation between the two scoring systems. The OKS can be used as a screening tool to identify which patients need to be assessed clinically in the short term (<2 years) following total knee arthroplasty (TKA). This will have significant cost-benefit implications. It is also possible to predict the AKSS from OKS using mathematical equations developed for this study. This method of predicting the AKSS from the OKS has not previously been described.