Mean Oxford Score Research Articles

Do the porous custom implants have a position consistent with the planning and allow anatomical reconstruction of hip center of rotation in complex acetabular revisions Paprosky III?

IntroductionIn revision total hip arthroplasty (THA), the advent of porous custom-made triflange acetabular implants with 3D scan planning offers a new perspective to improve implantation accuracy and anatomical restoration of the center of rotation (COR). This issue was investigated using CT-scan as the measurement tool, but in limited series (±10 cases) and without investigating the factors that may influence errors in positioning. Therefore we performed a retrospective study aiming to: (1) assess the placement accuracy of such implants with respect to the preoperative planning, (2) examine whether the volume of bone to be resected in order to apply the implant had an impact on this accuracy, (3) assess if errors in position at surgery had any influence on function, complications and survival. HypothesisPreoperative planning could be accurately reproduced when implanting porous custom-made acetabular implants, and that accuracy would decrease in proportion to the volume of bone to be resected MethodTwenty patients undergoing THA revision with porous custom-made acetabular implants were included in this single-center retrospective study. Mean follow-up was 17.9 months ± 9.4 [2–45.1]. Preoperative planning was performed using 3D scanographic modeling. A post-operative CT scan was performed to assess implantation accuracy in terms of orientation and COR restitution. Demographic data, Oxford scores, complications and survival were recorded. ResultsMean deviation from the preoperative planning in inclination, anteversion and rotation were 4.3 ° ± 2.5, 6.1 ° ± 4.7, and 7 ° ± 4.6, respectively. Restoration of the COR showed a mean deviation of 2.1 ± 1.3 mm anteroposteriorly, 2.5 ± 2 mm mediolaterally and 2.2 ± 1.3 mm proximodistally. In total, 45% (9/20) of implants were positioned with perfect restoration of orientation (±10 °) and COR (±5 mm). The mean planned bone resection was 8.1 ± 4.9 cm3, with placement accuracy and COR restitution decreasing significantly when the volume of bone to be resected exceeded 2.7 cm3. One dislocation was found (5%, 1/20). Survival at last follow-up was 100%, the mean Oxford score at follow-up was 31.7 ± 7.9 [16–52], without being influenced by errors in position or COR restitution. ConclusionIn total 45% of the implants restored an orientation and a COR as planned, particularly when the volume of bone to be resected is less than 2.7 cm3. Although these are complex cases with large amounts of bone loss, 3D manufacturing could give us hope of greater precision. The link between better precision and low bone resection volume could be an area to develop with the manufacturer in order to improve results. Level of evidenceIII; diagnostic using CT in transversal retrospective study

Does glenoid version affect the post-operative clinical outcome after repair of posterior labral tear: A retrospective study

IntroductionPosterior shoulder instability and consequent labral tear have been predominantly associated with retroversion of the bony glenoid and chondrolabral version. However, literature concerning the degree of glenoid and chondrolabral version and clinical outcomes following labral repair is scarce. MethodsA retrospective cohort study was undertaken among patients with posterior shoulder instability who had undergone arthroscopic isolated posterior labral repair. The MRI was used to assess the bony and labral variations of the glenoid using the Friedman method and further categorized as either anteverted or retroverted glenoid. American Shoulder and Elbow Surgeons (ASES), Oxford Shoulder Score (OSS), and Single Assessment Numeric Evaluation (SANE) scores were used to evaluate pre- and postoperative clinical outcomes at a minimum follow-up of one year. Results33 shoulder MRIs performed at our institution were available for radiographic analysis. Among the 33 shoulders that underwent posterior shoulder capsulolabral repair, 23 were available for clinical follow-up for at least one year (range, 12–108 months). The mean (±SD) labral version and bony version were −3.98 (±5.68) and −2.83 (±5.20), respectively. The mean (±SD) postoperative ASES, Oxford score, and SANE scores for all participants were 84.04 (±14.14), 43.38 (±3.81), and 78.57 (±17.40), respectively. However, the difference in clinical outcomes in patients with anteverted or retroverted glenoid versions was not statistically significant. ConclusionOur study concludes a strong correlation between posterior glenohumeral instability and higher degree of glenoid retroversion. Nevertheless, variations in the glenoid version appear to have no significant impact on clinical outcomes. Level of studyLevel IV, retrospective cohort.

A novel robot-assisted knee arthroplasty system (ROSA) and 1-year outcome: A single center experience.

Total knee arthroplasty is a successful procedure in the treatment of knee osteoarthritis. Searches in surgical technique have focused surgeons in particular on implant alignment. For this purpose, the use of robot-assisted total knee arthroplasty has become increasingly common in the last 10 years. A total of 46 patients (66 knees) who were operated for knee osteoarthritis with Robotic Surgical Assistant (ROSA, Zimmer-Biomet, Warshaw, Indiana, USA) between 2021 and 2023 were included in the study. Preoperative planning and intraoperative incision time, total surgical time, range of motion and follow-up time recorded. Oxford knee scores and knee society scores (KSS) of the patients were compared before and after surgery. At the last follow-up Forgotten Joint Score and the sagittal and coronal plane alignments were evaluated. Preoperative mean Oxford score of the right knee of the patients was 18.5 ± 3.2, post-surgery mean Oxford score progressed to 43.5 ± 2.2. While the preoperative left knee Oxford score of the patients was 16.9 ± 2.3, the mean left knee Oxford score improved to 43.4 ± 2.2 postoperatively. The mean KSS score of the patients' right knee preoperatively was 49.7 ± 3.5, and progressed to 89.2 ± 4.7 postoperatively. While the preoperative mean left knee KSS score of the patients was 46.5 ± 4.3, the mean KSS score improved to 89.8 ± 3.2 postoperatively. The mean Forgotten Joint Score of the left knee at the last follow-up of the patients was 77.4 ± 3.8, while the mean Forgotten Joint Score of the right knee was 75.4 ± 5.9. The results of ROSA-supported knee arthroplasty found to be functionally successful.

A randomized trial comparing vaginal laser therapy and pelvic floor physical therapy for treating women with stress urinary incontinence.

Female stress urinary incontinence (SUI) is considered a major public health issue. Physical therapy is an important conservative treatment; however, it is primarily limited by poor long-term compliance. Furthermore, surgical treatment entails significant risks. Therefore, new treatment techniques must be identified. To compare the use of laser therapy and pelvic floor (PF) physical therapy for treating postmenopausal women with SUI. This pilot study enrolled 40 women with a clinical and urodynamic diagnosis of SUI who were randomized into two groups: those who received erbium-doped yttrium-aluminum-garnet (Er:YAG) laser therapy implemented over three sessions with a 1-month interval (n = 20) and those who received physical therapy with supervision twice a week for 3 months (n = 20). In total, 16 women completed the treatment in each group. The patients were assessed for PF function using the modified Oxford scale and for pelvic organ prolapse using the Pelvic Organ Prolapse Quantification System. The 1-h pad test and quality of life questionnaires, King's Health Questionnaire (KHQ), and Incontinence Quality of Life (IQOL) were also administered. Patients were re-evaluated at 1, 3, 6, and 12 months after treatment. The mean patient age was 62.7 ± 9.1 and 57.9 ± 6.1 years, median Oxford score at baseline was 3 (2-4.5) and 4 (3-4), mean IQOL score was 79.8 ± 17 and 74.6 ± 18 for physical therapy group (PTG) and laser group (LG), respectively. For the amount of urine leak in the 1-hpad test evaluation, we found significance for the interaction of group and time points only for the Laser intragroup. The cure rate, that is, the rate of reaching an insignificant score in the pad test, at 6 and 12 months was 43.75% and 50% in PTG and 62.5% and 56.25% in the LG, respectively (p > 0.05). IQOL scores demonstrated considerable improvement in both groups (p > 0.05). Upon comparing the initial and follow-up results, the LG showed an improvement at all consultations, whereas the PTG showed improvements at 1, 3, and 6 months but not at 12 months after treatment. KHQ analysis revealed a considerable improvement in the quality of life (QOL) of patients over time, with no substantial difference between the groups. QOL comparison before and after treatment revealed that the vaginal LG improved more consistently in some domains. Only the PTG showed a significant increase in the mean Oxford score from pretreatment to 1 and 3 months after treatment (p < 0.001 and p = 0.002, respectively). However, no statistically significant difference was observed between the groups. Both treatments are safe and have a positive influence on the impact of UI on patients'QOL. The laser caused a greater reduction in the urinary loss, as measured using the weight of pad test, at 6-month and 12-month after treatment without difference with PTG at the end of the follow-up.

ASSESSMENT OF FUNCTIONAL OUTCOME AND COMPLICATIONS OF HIGH ENERGY SCHATZKER TYPE V AND VI PROXIMAL TIBIA FRACTURES MANAGED BY OPEN REDUCTION AND INTERNAL FIXATION

Background:Schatzker Type V and VI tibial fractures are complex injuries and are usually treated with open reduction and internal fixation. Although there are many other treatment methods, there is no gold standard treatment for these fractures. Hence, the present study was undertaken to evaluate outcome and associated complications of open reduction and internal fixation for Schatzker type V and VI proximal tibial fractures. Methodology:This observational study was conducted on 32 patients with Schatzker type V and VI tibial plateau fractures. Patients of age more than 18 years of any gender with these fractures were included. Clinical and radiological assessments were done at 1, 3 and 6 months postoperatively. Oxford Knee Scoring system was used for assessing the functional outcome. Analysis of repeated measurements was done using Generalized Estimating Equations method. A p value &lt;0.05 was taken as statistically significant. Results:The mean of the patients was 44.66 ± 12.31 years. Right side affection was more common. Complete radiological union was achieved in 84.4%, malunion in 12.5% and non-union in 3.1%. Most of the patients achieved union within 15-20 weeks. Knee stiffness (18.8%) was the commonest complication encountered. The mean Oxford score showed a significant improvement from 1 month till 6 months (p&lt;0.05), but we could not find any significant differences in the mean Oxford score between the type V and VI tibial plateau fractures. Excellent and goods results were seen in 43.8% each fair in 9.4% and poor in 3.1%. Conclusion:Open reduction with internal fixation had shown good to excellent results in our study in patients with Schatzker type V and VI tibial plateau fractures with low rate of complications.

THE OUTCOMES OF TOTAL HIP ARTHROPLASTY AS SALVAGE SURGERY FOR FAILED CANNULATED HIP SCREWS

Cannulated hip screws are frequently used in the management of hip fractures. There have been concerns over the failure rate of the technique and the outcomes of those that subsequently require conversion to total hip replacement (THR).This study utilised a database of over 600 cannulated hip screw (CHS) fixations performed over a 14-year period and followed up for a minimum of one year (1-14). We identified 57 cases where a conversion to THR took place (40 females, 17 males, mean age: 71.2 years). Patient demographics, original mechanism of injury, fracture classification, reason for fixation failure, time until arthroplasty, implant type and post-arthroplasty complications were recorded. Clinical outcomes were measured using the Oxford Hip Score.The failure rate of cannulated screw treatment was 9.4% and the mean time from initial fixation to arthroplasty was 15.4 (16.5) months. Thirty six fractures were initially undisplaced and 21 were displaced. As one might expect the displaced cases tended to be younger but this didn't reach statistical significance [66.5(14.3) vs 72.7(13.1), p=0.1]. The commonest causes of failure were non-union (25 cases, 44%) and avascular necrosis (17 cases, 30%). Complications after THR consisted of one leg length discrepancy and one peri-prosthetic fracture. The mean Oxford score pre-arthroplasty was 12.2 (8.4), improving to 38.4 (11.1) at one-year. Although the pre op Oxford scores tended to be lower in patients with undisplaced fractures and higher ASA scores, the improvement was the same whatever the pre-op situation. The one-year Oxford score and the improvement in score are comparable to those seen in the literature for THR in general.In conclusion, CHS has a high success rate and where salvage arthroplasty is required it can provide good clinical outcomes with low complication rates.

Mid-Term Clinical and Radiological Results at a Tertiary Care Hospital in Türkiye: Is Residual Varus Really Important After Mechanically-Aligned Total Knee Arthroplasty?

Traditionally, in total knee arthroplasty (TKA), it is aimed to keep the mechanical axis of the lower extremity neutral (mechanical alignment:3° varus-valgus in thecoronalplane) to improve long-term outcomes. This study aimed to assess the mid-term radiological and clinical results of patients with postoperative residual varus (more than 3° of varus) aftermechanically-aligned TKA. A total of 616 individuals who had undergoneTKAforprimaryknee osteoarthritisbetween 2008 and 2013 in our tertiary care hospital were retrospectively examined.All TKAs were performed with the mechanical alignment strategy.For radiological evaluation, hip-knee-ankle (HKA) angle, knee alignment angle (KAA), mechanical medial proximal tibial angle (mMPTA), knee inclination (KI), joint line orientation angle relative to ground (JLOA-G), posterior tibial slope (PS), joint line convergence angle (JLCA) were measured. Besides, patients' latest radiographs were screened for any clue of aseptic loosening or mechanical failure. Knee Society Score (KSS) (knee and functional subgroups), and Lysholm, Oxford, and Tegner scores were used for clinical evaluation. In addition, knee flexion and extension limitations were assessed. After applying the exclusion criteria, a minimum of five-year follow-up result of 110 patients was demonstrated.There were 101 females (92%) and nine males (8%). The mean follow-up time was 65.8 ± 6.3 months (range: 60.8-75.8 years). The mean age was 65.9 ± 7.7 years (range: 39 to 89 years). Thepreoperative mean mechanical axis angle of the lower extremity was17.3° ± 7.8° (range: 13.4-43.9°), whereas it was 8.3° ± 3.6° (range: 3.2-19.8°) postoperatively.The preoperative mean flexion angle was 90.7° ±23.8° (range: 40-130°), andthe extension limitation was -2.5° ± 7.4° (range: -40-0°), whereas, postoperatively, they were102.8° ± 15.4° (range from 40° to 150°) and -3.7° ± 7.5°(range from -40° to0°), respectively.The latest follow-up's mean KSS knee subgroup was 67 ± 18.4 (range: 12-93), the mean KSS functional subgroup was 74 ± 23.6 (range: 20-100), the mean Lysholm score was 81.7 ± 15.7 (range:25-100), the mean Tegner score was 3.65 ± 0.99 (range: 1-5), the mean Oxford score was 37.4 ± 6.5 (range: 9-48). There was no patient with aseptic loosening or mechanical failure. In the mid-term follow-up of patients with residual varus aftermechanically-alignedTKA, satisfactoryclinicaland radiological results were obtained without aseptic loosening or implant failure.

TWENTY-YEAR SURVIVAL OF HIGH TIBIAL OSTEOTOMY

The aim of this study was to determine the long term 20 year survival and outcomes of high tibial osteotomy (HTO).100 consecutive subjects underwent HTO under the care of a single surgeon between 2000 and 2002, consented to participation in a prospective study and completed preoperative WOMAC scores. Subjects were reviewed at 10 years, and again at a minimum of 20 years after surgery. PROMS included further surgery, WOMAC scores, Oxford Knee Score (OHS), KOOS, and EQ-5D, and satisfaction with surgery. 20 year survival was assessed with Kaplan-Meir analysis, and failure defined as proceeding to subsequent knee arthroplasty.The mean age at HTO was 50 years (range 26-66), and 72% were males. The 5, 10, and 20 year survival of the HTO was 88%, 76%, 43% respectively. On multiple regression analysis HTO failure was associated with poor preoperative WOMAC score of 45 or less (HR 3.2, 95% CI 1.7-6.0, p=0.001), age at surgery of 55 or more (HR 2.3, 95% CI 1.3-4.0, p=0.004), and obesity (HR 1.9, 95% CI 1.1-3.4, p=0.023). In patients who met all criteria of preoperative WOMAC score of 45 or less, age &lt;55 years and body mass index of &lt;30 HTO survival was 100%, 94%, and 59% at 5, 10 and 20 years respectively. Of those who had not proceeded to TKA the mean Oxford Score was 40, KOOS Pain score was 91 and KOOS function score was 97. 97% reported they were satisfied with the surgery and 88% would have the same surgery again under the same circumstances.At 20 years after HTO 43% had not proceeded to knee arthroplasty, and were continuing to demonstrate high subjective scores and satisfaction with surgery. HTO survival was higher in those under 55 years, with BMI &lt;30 and baseline WOMAC score of &gt;45 at 59% HTO survival over 20 years. HTO may be considered a viable procedure to delay premature knee arthroplasty in carefully selected subjects.

Functional outcomes of plate fixation in comminuted fractures of olecranon: A case series

Objectives: To report and evaluate the functional outcome of plate fixation in comminuted olecranon fractures (Mayo types IIB and IIIB).Method: 16 patients with comminuted fractures of the olecranon presented to our unit, were operated on with a locking Olecranon plate. Main outcome measurements included radiographic healing, postoperative range of motion, complications, outcome score and patient satisfaction measured at 1 year follow up. Results: Our study included six females and ten males with a mean age of 48(18–67). Nine were Mayo type IIB and seven were Mayo type IIIB. Fourteen patients had no complications post-operatively with good outcomes with a mean oxford score of 44, full rotational ROM and mean flexion arc of 20-130 deg. Two patients had a range of motion between 40-90 deg with full rotational ROM and a mean oxford score of 28. No patients required hardware removal. No non-unions were noted in our series. Conclusion: Plate fixation of complex olecranon fracture is an effective, reliable treatment method with a low risk of non-union. Restoration of a functional flexion arc of movement can be expected with the use of correct technique and early post-op mobilization.

Generic Cyclosporine in the Treatment of Dry Eye Disease

Objectives: To investigate the efficacy and safety of a generic Cyclosporine 0.05% ophthalmic emulsion in chronic dry eye disease. Materails and Methods: Thirty patients with dry eye disease were included in this observational, prospective study. Patients were examined at baseline, at month -1,-3 and 6 of the study. The following were evaluated at each visit: CDVA (corrected distance visual acuity), corneal and conjunctival staining (Oxford) score, TBUT (tear break-up time), Schirmer-2 score, OSDI (Ocular Surface Disease Index) score, patient’s subjective rating scale of ocular discomfort, daily use of concomittant artificial tears, the researcher's assessment of the global treatment response, and IOP (intraocular pressure). In addition, drug-related side effects were evaluated individually in each examination. When initiating dry eye treatment, cyclosporine was combined with topical loteprednol etabonate 0.5%. Results: There was a statistically significant improvement from baseline in corneal and conjunctival staining (decrease in mean Oxford score), TBUT, Schirmer-2 values, OSDI score, patient’s subjective rating score for ocular discomfort, and mean physician’s subjective assessment of global response to treatment at all follow-up visits (p<0.001). The mean daily use of artifical drops decreased statistically at all time points (<0.001). The most commonly reported adverse events were ocular burning (6.7%), followed by stinging (3.3%), conjunctival hyperemia (3.3%), foreign body sensation (3.3%), and visual disturbance (3.3%). Conclusion: Generic cyclosporine 0.05% ophthalmic emulsion with loteprednol etabonate 0.5% on initiation treatment has well-tolerability and improves subjective and objective measures of dry eye disease.

Intermediate to long term results of stemless metaphyseal reverse shoulder arthroplasty: A five to nine year follow-up

BackgroundShoulder arthroplasty incidence is increasing as is the volume of revision surgeries. Revision surgery is easier if humeral bone stock is preserved with minimal bone defects and osteolysis. This has led to an increased focus on the development of various short stemmed and stemless implants which provides stable fixation whilst preserving humeral bone stock. PurposeTo review the medium to long term clinical and radiological outcomes, complications and survival rates of a stemless reverse shoulder prosthesis. Patients and methodPatients with a minimum follow-up of 60 months following a reverse stemless shoulder arthroplasty were deemed eligible. Clinical and radiological data on twenty-one patients operated between 2009 and 2014 were recorded prospectively. Survivorship and patient recorded symptoms with the end point of revision surgery were recorded. ResultsMean follow-up of 78 months (60–114 months). Mean range of active elevation was 136° (80–170°). Mean range of active abduction and active external rotation was 122° (70–170°) and 47° (10–75°) respectively. Mean Oxford score improved from 12 pre-operatively to 44 at final follow up (p < 0.0001). Mean Constant Murley Score improved from 18 to 72 (p < 0.0001). Mean ADLEIR score of 13 pre-operatively increased to 32 post-operatively (p < 0.0001). Notching was seen in 23.5% of cases and no radiolucent areas were observed around the glenoid component. There were two cases of post traumatic peri-prosthetic fractures that were managed conservatively and one case of deep-seated infection that required a washout. The survivorship at the most recent follow-up was 100%. ConclusionThe advantages of bone preservation with the stemless metaphyseal prosthesis combined with encouraging medium to long term clinical and radiological results are very promising, particularly with the improved post-operative patient satisfaction scores. This is the first study that reports the results with a minimum of 5 year follow-up and has the longest mean follow-up period. Clinical relevanceThe reverse stemless shoulder prosthesis is an effective and reliable option for elective shoulder arthroplasty.

Outcomes of Combined Unicompartmental Knee Replacement and Anterior Cruciate Ligament Reconstruction: A Systematic Review

Abstract Background The incidence of osteoarthritis of the medial compartment after ACL injury has been quoted to range from 33% to 70%. Medial osteoarthritis in ACL deficient knee is a challenge. Patients are mainly young and active. First reports highlighted a higher incidence of complications, in terms of tibial loosening and higher revision rate, when UKA were performed in ACL-deficient knees. They defined ACL deficiency is a contraindication to UKA. Objectives A systematic review and meta-analysis of literature to assess functional outcomes of combined unicompartmental knee arthroplasty with ACL reconstruction and revision rate. Data Sources The following electronic databases were searched up to 2019: PubMed, Google Scholar search engine, JBJS {Journal of bone and joint Surgery}, Cochrane database of systematic reviews, EMBASE and Science Direct. Results A total of 10 studies met the inclusion criteria encompassing 218 patients who were treated with simultaneous ACL reconstruction and unicompartmental knee arthroplasty. The mean age was 49.5 years (range from 36 to 71) with a mean follow-up of 49.3 months (range from 9 to 258). There was an improvement in mean Oxford Score from 29 to 42.5. The mean knee society score improved from 88.3 to 159. Complications reported included tibial inlay dislocation (n = 3), conversion to a total knee arthroplasty (n = 2), infection requiring two-stage revision (n = 2), stiffness requiring manipulation under anaesthesia (n = 1). Average revision rate was 1.8%. Conclusion Literature has strong evidence to support that combined UKA and ACL reconstruction show good functional outcomes and less revision rate. It is a valid treatment option for MOA more in young age group in whom MOA secondary to ACL tear and intact other knee compartments. there is no clinical trial or study suggest that UKA and ACL reconstruction is superior to UKA with tibial slope change or using fixed bearing prosthesis for MOA in ACL deficient knee with instability.

Evaluation of dry eye and Meibomian gland dysfunction in female androgenetic alopecia patients.

To evaluate dry eye tests and Meibomian gland functions in female androgenetic alopecia patients. Twenty left eyes of 20 female androgenetic alopecia patients (Group 1) and 20 left eyes of 20 healthy female volunteers (Group 2) were enrolled in the study. The presence of dry eye was evaluated with Schirmer 1 test, invasive tear film break-up time (T-BUT), Oxford scale scoring and Ocular Surface Disease Index (OSDI) score assessments. Evaluation of upper and lower eyelid Meibomian glands was performed using infrared filter of a slit-lamp biomicroscope, and the drop out ratio was scored for each eyelid. The mean ages of Group 1 and Group 2 were 48.3 ± 6.6 (range, 38-58) and 49.8 ± 5.4 (range, 38-59) years, respectively (P = 0.437). Mean T-BUT was statistically significantly lower in Group 1 (P = 0.013); mean OSDI score was significantly higher in Group 1 (P = 0.049). Mean Schirmer 1 score was lower and mean Oxford score was higher in Group 1, but the differences were not statistically significant (P = 0.291, P = 0.088, respectively). In addition, upper, lower and total meiboscores were significantly higher in Group 1 (P = 0.007, P = 0.003, P = 0.002, respectively). Alterations in sex hormones play a role in the pathogenesis of both female androgenetic alopecia and Meibomian gland dysfunction. Significant differences were detected in the results of dry eye tests and Meibomian gland dropout ratios between subjects with female androgenetic alopecia and healthy control subjects. For this reason, female androgenetic alopecia patients should be examined for dry eye and Meibomian gland dysfunction and should be treated to prevent serious consequences.

Revision knee arthroplasty: Can good outcomes be achieved at lower volumes?

BackgroundThe National Joint Registry (NJR) demonstrates a re-revision rate for primary knee arthroplasty of 14.2% at 7 years. The 2015 Getting it Right First Time (GIRFT) report highlighted that 58% of surgeons undertaking revision knee arthroplasty (RKA) performed fewer than five cases per year. It has been suggested that revision cases be centralised in specialist centres with a multidisciplinary team (MDT) approach. Such a hub and spoke or cluster models may still require revision surgery to be performed at relatively low volume units. MethodsAn analysis of RKA surgery performed in a four surgeon, lower volume revision knee unit over 10 years to December 2016 was undertaken. The effect of the introduction of a MDT was reviewed. The minimum follow up was two years. The primary outcome measure was re-revision. Hospital data as well as individual surgeon NJR reports were used to ensure all re-revisions were accounted for. Outcome scores were available for 68% of cases. ResultsThere were 192 RKAs performed in 187 patients at a mean (stdev) of 6.3 (5.4) years from the index procedure. The mean age at surgery was 68.2 (10.9) years. Twenty nine (15.5%) patients had died at the time of final review. Twelve (6.3%) cases required a further revision procedure. The commonest complication was stiffness requiring MUA. The overall 7 year survivorship was 94.9% (95% CI 90.2–97.3). The mean Oxford score at 5.4 years was 30.4 (10.4). ConclusionsRKA can be reliably performed at lower volume centres with appropriate MDT systems in place.

Place du NIBUT automatisé dans l’évaluation multimodale de la surface oculaire dans le syndrome sec avec le Lacrydiag

Dry eye disease is a very frequent condition with a significant impact on patients' quality of life. The most common clinical sign is fluorescein break up time (BUT). Recently, non-invasive measurement of BUT (NIBUT) by Placido disc analysis has been proposed to replace FBUT. We performed an automated NIBUT analysis using Lacrydiag and compared the values obtained with other typical dry eye criteria. A retrospective study was carried out in the Bicêtre ophthalmology department from July 1 through October 30. Dry eye patients over 18 years of age with Oxford scores>1 and OSDI scores>22 were included. They underwent slit lamp examination to determine fluorescein BUT, Oxford and Arita MGD scores. On the same day, they were tested with the Lacrydiag to assess NIBUT, tear lake height and meibography. OSDI and Schirmer's testing were performed on the date of examination. In this study, only patients' right eyes were included. The correlation between NIBUT and OSDI, Schirmer's testing and tear lake height was analyzed by Pearson's test. The correlation between NIBUT and fluorescein BUT was analysed by both Pearson and Bland-Altman statistical tests. Thirty right eyes (21 women, 9 men) were included. The mean age was 62.3 years (SD 16.0), mean OSDI 49.4 (SD=20.1), mean Oxford score 3.33 (SD 2.1), mean NIBUT 6.91sec (SD 3.4), and mean FBUT 3.6sec (SD 1.8). The NIBUT and FBUT were significantly correlated (R=0.139; P=0.042), with an even more significant concordance (r=0.55; P=0.001) on Bland-Altman graphic analysis, but the mean NIBUT was 2.7 seconds higher than the FBUT (P=0.001 on Bland-Altman analysis). In addition, NIBUT was correlated with the Oxford score (R=0.156; P=0.031), but not with Schirmer I score (R=0.120; P=0.061), OSDI score (R=0.018; P=0.48), tear lake height (R=0.04; P=0.148), or Arita meibomian gland dysfunction score (R=0; P=0.933). NIBUT is a possible alternative to FBUT for the measurement of tear film stability, with the advantage of lack of dependence on the amount of fluorescein instilled. In addition, modern imaging methods allow for automated, and thus reproducible, measurement. However, its role in the diagnostic tool kit remains to be precisely defined, especially given its weak correlation with other markers of dry eye and its significant difference from FBUT. The definitive diagnosis of dry eye thus remains based on the combined analysis of signs and symptoms.

Association between pre-operative anxiety and/or depression and outcomes following total hip or knee arthroplasty.

While elective primary total hip (THA) and knee (TKA) arthroplasty are effective procedures for addressing the symptoms associated with advanced osteoarthritis, there is evidence to suggest that patient anxiety and depression are linked to poorer outcomes following surgery. A secondary analysis of prospectively-collected data of people undergoing primary elective THA or TKA for osteoarthritis across 19 hospitals was performed. We assessed outcomes at 1 year post-surgery for people with and without medically treated anxiety and/or depression at the time of surgery (A/D and no-A/D). We used unadjusted and adjusted analyses to compare improvement in Oxford Hip or Knee Scores, the incidences of major post-operative complications, satisfaction and index joint improvement by A/D status. 15.2% (254/1669) of patients were identified with anxiety and/or depression at time of surgery. In the unadjusted analysis, the A/D group had greater mean Oxford score improvement by 2.1 points (95% CI 0.8 to 3.4, p = 0.001), increased major complications (OR 1.39, 95% CI 1.05 to 1.85, p = 0.02), were less likely to report a "much better" global improvement for index joint (OR 0.56, 95% CI 0.38 to 0.83, p = 0.003), and there was no statistically significant difference in the rate of satisfaction with the results of surgery (OR 0.64, 95% CI 0.37 to 1.10, p = 0.10). The adjusted analysis found no significant associations between A/D vs. no-A/D and any of the reported outcomes. After adjustment for confounding variables, people with anxiety and/or depression pre-operatively, compared to those without, have similar outcomes following hip or knee arthroplasty.

Oxford partial knee replacement by microplasty instrumentation: Indian evidence

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; There is increasing evidence in support of unicondylar knee replacement (UKR) as a superior surgical modality in a select group of patients of osteoarthritis knee. Oxford knee is one type of UKR with fully congruent, mobile bearing designed to minimize wear. This prospective study describes 5-year results of partial medial compartment knee replacement in 92 Indian cases by microplasty instrumentation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; All 92 cases were operated by a single surgeon. Mean follow up was 5 years. In all cases oxford mobile bearing medial unicondylar knee prosthesis was implanted using minimally invasive surgical technique and the cases followed up.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean oxford score at the end of 5 year was 43. Patient satisfaction index at the end of 5 year was 98%. Mean maximum flexion was 125 degrees. Incidence of revision was 1.9. No deep or superficial infections were encountered. Average hospital stay was 3 days.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There are variations in Indian patients as per size of implants, stay and similarities regarding less blood loss, improved oxford knee score, good range of motion, less morbidity, higher postoperative patient satisfaction and early getting back to work. Oxford partial knee replacement by microplasty instrumentation done in carefully selected patients with proper surgical technique gives excellent functional outcome and superior patient satisfaction.&lt;/p&gt;

Similar functional outcome using single anterior portal and standard two portals technique in recurrent dislocation of shoulder

PurposeRecurrent dislocation of shoulder (RDS) is a common injury in high demand professionals, like athletes and military personnel. The treatment for the patients with Bankart lesion is the arthroscopic repair. This present study compares the outcomes of two different techniques of arthroscopic Bankart repair i.e. a standard two anterior portals technique and a single anterior portal technique in patients with RDS. MethodsPatients with traumatic RDS met the inclusion criteria were managed with Bankart repair using either two anterior portals (Group A) or a single anterior portal (Group B) technique. Patients were evaluated before the intervention and at the mean follow-up of approximately two years using Rowe score, Oxford shoulder score and Tegner activity scale. ResultsThe mean age of the patients in Groups A (n = 34) and B (n = 37) was 29.64 years and 29.05 years respectively (p = 0.66). The dominant shoulder was involved in 27 patients in Group A and 22 patients in Group B (p = 0.069). The operative time in Group A and B was 68.52 min and 46.35 min, respectively (p < 0.001). The complications at follow-up, the mean Rowe score and Oxford score improved significantly in both groups compared with the pre-operative values. However, the final outcome scores were not significantly different between the both groups. The median Tegner's score preoperatively and at follow-up was 7 and 6, respectively in Groups A and B. ConclusionsSingle anterior portal technique is an effective treatment modality, yielding a similar outcome as two anterior portals technique in the management of RDS.

Clinical profile of patients undergoing bilateral total knee replacement at a tertiary care hospital

During standing, the joint reaction force increases with increasing knee flexion as the force vectors of quadriceps and patellar tendons become more parallel to the joint reaction force. It has been calculated, patella-femoral joint reaction forces is of 2-5 times body weight during activities of daily living; during squatting to 120 degree of knee flexion, the joint reaction force may be as high as 7-8 times body weight. During knee flexion, the patella makes a rolling or gliding motion along the femoral articulating surface. This study was conducted in Department of Orthopaedics, twenty patients who Consented (12 female and 8 male) and underwent SBTKR for tricompatrmental arthritis of knee using a posterior stabilized type of knee prosthesis, were assessed functionally using knee society score and oxford knee score. In the present study Knee society score and oxford scores were assessed in patients post operatively after simultaneous bilateral total knee replacement at 3 months, 6 months and 12 months. it was observed that the mean KSS score right knee improved from 132.9 at 3 months to 144.57 at 6 month and 159.86 at 12 months. Mean KSS score left knee improved from 133.7 at 3 months to 145.29 at 6 month and 161.1 at 12 months. Mean oxford score improved from 32.4 at 3 months to 36.76 at 6 month and 40.38 at 12 months.

Long-term comparative study of large-diameter metal-on-metal bearings: Resurfacing versus total arthroplasty with large-diameter Durom™ bearing

IntroductionShort-term results in total hip arthroplasty (THA) with large-diameter metal-on-metal (MoM) bearings were encouraging, but high failure rates have been reported in the long term, notably implicating corrosion due to modularity. Several studies compared resurfacing (to which modularity does not apply) versus large-diameter MoM THA; but, to our knowledge, none compared the same bearing in the two situations with more than 10 years’ follow-up. We therefore conducted a retrospective case-control study, using a single cup model (Durom™, Zimmer, Warsaw, USA) for both resurfacing (R) and large-diameter THA, to determine the role of modularity in failure of large-diameter MoM bearings. The study compared (1) metallic ion levels, and (2) survival, functional scores and complications rates between R and THA. HypothesisLarge-diameter MoM bearing failure implicates not bearing wear but head-neck junction modularity in larger-diameter MoM THA. Material and methodEighty-three THAs and 90 Rs were included between February 2004 and March 2006. All patients had clinical and radiologic follow-up with chromium (Cr) and cobalt (Co) ion blood assay. ResultsIn the THA group, 24 of the 83 patients (28.9%) underwent revision for adverse reaction to metal debris (ARMD), versus none in the R group. Ten-year all-cause survival was significantly better in R (97.7%; 95% CI, 96.2–99.2) than THA (67.1%; 95% CI, 60.9–73.3). Median blood ion level was higher in THA (with a difference between Co and Cr: 5.75μg/L (range, 3.82–19.2) versus 1.75μg/L (range, 1.34–2.94) respectively) than in R (no difference: 0.89μg/L (range, 0.67–2.89) and 1.07μg/L (range, 0.67–1.65) respectively). In the THA group, there were positive correlations between Co and Cr elevation and implant revision (both p<0.0001). Co/Cr ratio was significantly higher in THA (2.57) than R (0.88) (p<0.0001), and higher again in the 24 cases of THA revision (4.67). There was no significant difference in mean PMA score (THA: 17.08±1.82 (range, 7–18); R: 17.50±0.74 (range, 15–18)), whereas mean Oxford score was better in R (14.32±2.5 (range, 12–24)) than THA (18.17±8.05 (range, 12–42)) (p=0.02). DiscussionThe present study confirmed the incontrovertible implication of modularity in failure of large-diameter MoM THA, by analyzing the same bearing in THA and in resurfacing. Trunnionosis was observed in the 24 cases of revision, with the THA adaptation ring inducing serious metallic ion release (with dissociated Co/Cr ratio), accounting for the high rate of revision. Level of evidenceIII, case-control study.