Background Patellofemoral arthroplasty is becoming an established treatment for isolated patellofemoral arthritis. Revision to total knee replacement occasionally is required. Lessons learned from patients requiring revision surgery and their subsequent post-revision outcomes are described. Method This study reviewed 49 patellofemoral arthroplasties in 43 patients who had revision to a total knee replacement. These cases were obtained from a cohort of 487 patellofemoral arthroplasties prospectively reviewed between 1989 and 2006. Results The most common reason for revision was progression of arthritis in the tibiofemoral joint (30 knees in 26 patients). Persistent pain from technical error was found in 11 knees (10 patients), and 4 knees in 4 patients had unexplained persistent pain. The revision procedure was straightforward with no technical difficulties. All patients had a primary cemented total knee replacement without requiring bone grafting or prosthetic augmentation. The patients reported significant improvements in the Oxford Knee Score (26/48 points) P = 0.003 and the Bristol Pain Score (25/40 points) P = 0.0001 compared with the scores before patellofemoral arthroplasty. The outcomes were less favorable than expected and were worse than those seen after a successful primary patellofemoral arthroplasty. Conclusion Reasons for patellofemoral arthroplasty failure were identified. Patellofemoral arthroplasty was easy to revise to a primary knee arthroplasty; however, good clinical results could not be guaranteed. These results emphasize the need for careful patient selection and precise surgical technique during the primary operation.
Objectives: Three dimensional (3D) printing technology has many current and future applications in orthopaedics. The objectives of this article are to review published literature regarding applications of 3D technology in orthopaedic surgery with a focus on knee surgery. Methods: A narrative review of the applications of 3D printing technology in orthopaedic practice was achieved by a search of computerised databases, internet and reviewing references of identified publications. Results: There is current widespread use of 3D printing technology in orthopaedics. 3D technology can be used in education, preoperative planning and custom manufacturing. Custom manufacturing applications include surgical guides, prosthetics and implants. Many future applications exist including biological applications. 3D printed models of anatomy have assisted in the education of patients, students, trainees and surgeons. 3D printed models also assist with surgical planning of complex injuries or unusual anatomy. 3D printed surgical guides may simplify surgery, make surgery precise and reduce operative time. Computer models based on MRI or CT scans are utilised to plan surgery and placement of implants. Complex osteotomies can be performed using 3D printed surgical guides. This can be particularly useful around the knee. A 3D printed guide allows pre osteotomy drill holes for the plate fixation and provides an osteotomy guide to allow precise osteotomy. 3D printed surgical guides for knee replacement are widely available. 3D printing has allowed the emergence of custom implants. Custom implants that are patient specific have been particularly used for complex revision arthroplasty or for very difficult cases with altered anatomy. Future applications are likely to include biological 3D printing of cartilage and bone scaffolds. Conclusion: 3D printing in orthopaedic surgery has and will continue to change orthopaedic practice. Its role is to provide safe, reproducible, reliable models with reduced operative time and improves patient outcomes compared to traditional surgical techniques. Long term follow up of the techniques is still required.
ABSTRACTTrochlear dysplasia is common in patients presenting with recurrent patellofemoral instability. Frequently, these patients are young but severely incapacitated. They have often received multiple previous treatments, including extensive physiotherapy and a variety of surgical procedures. Troc
Purpose: To explore participant experiences for people on an arthroplasty waitlist, randomised to an exercise and behaviour-change counselling program (ENHANCE). The ENHANCE program for arthroplasty patients was led by an accredited exercise physiologist who delivered an individually tailored and structured exercise program. Included in the exercise program were up to five in-person counselling sessions, based on the Health Action Process Approach (HAPA) applied specifically to people with osteoarthritis. Nine adults (mean 69.4 years) who were on the waiting list for a total hip or knee arthroplasty and who had completed a 12-week program (ENHANCE) as part of a randomised controlled trial were recruited for this study. Methods: Two focus groups were conducted to explore participant experiences of ENHANCE. Data were analysed using inductive thematic analysis with constructs of the HAPA (motivational and volitional factors) as a framework. Results: We identified three themes (1) ‘The structured program addressed inactivity and improved feelings of wellness and preparation for the operation’. The benefits were not only physical, but psychological and were contextualised in terms of preparation for the upcoming surgery. (2) ‘People as enablers of participation’: Participants identified that the attitude, and skill of the experienced instructor were supportive and motivating, especially in tailoring the intervention. Within the program, the support of the group was considered a positive attribute (3) ‘Improved awareness changed attitudes to self-efficacy and perceived self-control’. Participants described an increased awareness of their condition and a better understanding of health expectations. They felt more control and ownership over their health journey. Conclusion: Goal setting and social support were identified factors in a behaviour-change counselling program, delivered in conjunction with structured exercise that led to a positive experience. Improved psychological and physical health were described. Participants were better prepared for their upcoming surgery, with increased self efficacy and mastery to support long-term physical-activity engagement.
Introduction There is a perception in the orthopaedic community that patients with workers’ compensation claims have a poorer outcome than non-compensation patients. This review aims to identify and quantify the effect of workers’ compensation claims on the outcome of orthopaedic treatment. Methods A systematic review of the literature was performed. Studies of any language published between 1966 and 2002 that compared the outcomes of compensation against a non-compensation group for any orthopaedic treatment were included. Articles with any group less than 20 patients were excluded. Literature searching and data extraction were performed independently by both reviewers and then compared. Differences between reviewers’ findings were resolved by discussion. Measures of region specific objective outcome, where available, were pooled into satisfactory and unsatisfactory groups for comparison. The raw data was used for a meta-analysis. The total number of articles that met the search criteria was 63. Within these articles there were 7,279 patients with workers’ compensation claim and 14,368 patients with no compensation claim. Results No articles found that the workers’ compensation group had better outcomes. Fourteen found no difference between the two groups while 49 articles described a worse outcome in the compensation group. In the 41 papers which had outcome scores available for comparison there were 3,608 compensation patients with outcome scores and the outcome was unsatisfactory in 33.7%. There were 6,607 non-compensation patients with outcome scores and the outcome was unsatisfactory in 15.1% of non-compensation patients. The difference was significant (p Conclusions From reviewing the literature, workers’ compensation patients have a poorer outcome compared to non-compensation patients for the same orthopaedic conditions. A workers’ compensation patient has more than double the risk of having a poor outcome in comparison to the non-compensation patient. More than half of the poor results in the compensation group can be attributed to their compensation status.
Abstract Background The primary objective of the study was to determine if local infiltration anaesthetic ( LIA ) reduced total length of hospital stay in total knee arthroplasty ( TKA ) patients. The study also examined whether LIA improves early pain management, patient satisfaction and range of motion in TKA patients. Methods We conducted a randomized controlled double‐blinded study. Fifty patients undergoing TKA were randomized to receive either placebo or LIA at the time of surgery and on the first day post‐operatively. Pain scores, level of satisfaction and range of motion were recorded preoperatively and post‐operatively. Results There was no statistical difference between the groups for length of stay, post‐operative pain scores, satisfaction scores or range of motion 6 weeks post‐operatively. Conclusion This randomized double‐blinded trial did not demonstrate a decrease in pain or reduction of length of stay due to local infiltration analgesia.
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