Outcome of meniscal allograft transplantation related to articular cartilage status: advanced chondral damage should not be a contraindication.

PURPOSE: Advanced chondral damage (bare bone) at presentation is considered a contraindication to meniscal allograft transplantation (MAT), yet there are few other options for young patients where arthroplasty is not appropriate. This study hypothesis is that MAT in patients with advanced chondral damage can obtain good clinical outcomes, equivalent to patients with minimal chondral damage. METHOD: A prospective longitudinal study of 99 consecutive patients who underwent MAT between May 2005 and Feb 2013, with a minimum of 1-year follow-up. Patients were categorised into two groups: 60 in Group A (Good) up to ICRS Chondral grade 3b involving <1 cm(2) and 39 in Group B (Bare) ICRS grade 3b involving >1 cm(2) or worse. Outcomes were assessed by PROMS (KOOS, IKDC, Lysholm, Tegner Activity Scale), with an endpoint of meniscal allograft failure. RESULTS: Mean follow-up was 2.9 years (range 1.1-9.1, SD 1.23), with a similar male to female and lateral to medial ratios between the groups (n.s). The age of Group B was significantly older than Group A (35 vs 29 years, p = 0.002). The status of the articular cartilage at the time of transplant was directly related to the number of years since index meniscectomy [(A) Mean 6.9 years, SD 6.3; (B) 11.9 years, SD 7.4; p = 0.001]. Pre-operatively, patients in Group B had significantly worse pain and functional outcome scores (KOOS p = 0.022, Lysholm p = 0.025, IKDC pain subset p = 0.035). The mean increase PROMs was significant in both groups at 1 year (KOOS p < 0.05, IKDC p < 0.001, Lysholm p < 0.001), and the pain and functional scores were no longer significantly different between groups (n.s.). The outcome measures continued to improve in both groups at 2 and 3 years, with slightly greater improvement in Group A. Failure of the meniscal allograft occurred in 9 patients (A:1, B:8) at a mean time of 1.1 years (SD 0.55). Kaplan-Meier survival at 2 years was 97.9% (A) and 78% (B) (p = 0.002). Logistic regression analysis demonstrated a relationship between survival and chondral grade (p = 0.001) and number of concomitant procedures (p < 0.001). CONCLUSION: Patients with advanced chondral damage should not be excluded from MAT. Though there is a higher initial failure rate, these patients obtain a similar therapeutic benefit to the traditional, ideal patient group. LEVEL OF EVIDENCE: III.

Review of Kinemax total knee replacements performed at the NHS treatment centre, Weston-Super-Mare: five-year results.

As part of the national initiative to reduce waiting times for joint replacement surgery in Wales, the Cardiff and Vale NHS Trust referred 224 patients to the NHS Treatment Centre in Weston-Super-Mare for total knee replacement (TKR). A total of 258 Kinemax TKRs were performed between November 2004 and August 2006. Of these, a total of 199 patients (232 TKRs, 90%) have been followed up for five years. This cohort was compared with 258 consecutive TKRs in 250 patients, performed at Cardiff and Vale Orthopaedic Centre (CAVOC) over a similar time period. The five year cumulative survival rate was 80.6% (95% confidence interval (CI) 74.0 to 86.0) in the Weston-Super-Mare cohort and 95.0% (95% CI 90.2 to 98.2) in the CAVOC cohort with revision for any reason as the endpoint. The relative risk for revision at Weston-Super-Mare compared with CAVOC was 3.88 (p < 0.001). For implants surviving five years, the mean Oxford knee scores (OKS) and mean EuroQol (EQ-5D) scores were similar (OKS: Weston-Super-Mare 29 (2 to 47) vs CAVOC 29.8 (3 to 48), p = 0.61; EQ-5D: Weston-Super-Mare 0.53 (-0.38 to 1.00) vs CAVOC 0.55 (-0.32 to 1.00), p = 0.79). Patients with revised TKRs had significantly lower Oxford knee and EQ-5D scores (p < 0.001). The results show a higher revision rate for patients operated at Weston-Super-Mare Treatment Centre, with a reduction in functional outcome and quality of life after revision. This further confirms that patients moved from one area to another for joint replacement surgery fare poorly.

Review of Kinemax knee arthroplasty performed at the NHS Treatment Centre, Weston-Super-Mare.

As part of the government's initiative to reduce waiting times for major joint surgery in Wales, the Cardiff and Vale NHS Trust sent 224 patients (258 knees) to the NHS Treatment Centre in Weston-Super-Mare for total knee replacement. The Kinemax total knee replacement system was used in all cases. The cumulative survival rate at three years was 79.2% (95% confidence interval (CI) 69.2 to 86.8) using re-operation for any cause as an endpoint and 85.3% (95% CI 75.9 to 91.8) using aseptic revision as an endpoint. This is significantly worse than that recorded in the published literature. These poor results have resulted in a significant impact on our service.