bluuebunny/crossref_metadata_2025_split huggingface dataset:
INCLUSION OF OPEN INJURIES IN AN UPDATED SCHENCK CLASSIFICATION OF KNEE DISLOCATIONS BASED ON A GLOBAL DELPHI CONSENSUS STUDY
Authors: Scheepers Waldo , Held Michael , von Bormann Richard , Wascher Daniel , Richter Dustin , Schenck Robert , Harner Christopher 
Published: August 2023

AbstractIntroductionKnee dislocations (KDs) are complex injuries which are often associated with damage to surrounding soft tissues or neurovascular structures. A classification system for these injuries should be simple and reproducible and allow communication among surgeons for surgical planning and outcome prediction. The aim of this study was to formulate a list of factors, prioritised by high-volume knee surgeons, that should be included in a KD classification system.MethodsA global panel of orthopaedic knee surgery specialists participated in a Delphi process. A list of factors to be included in a KD classification system was formulated by 91 orthopaedic surgeons, which was subsequently prioritised by 27 experts from 6 countries. The items were analysed to find factors that had at least 70% consensus for inclusion in a classification system.ResultsThe four factors that reached consensus agreement and thus deemed critical for inclusion in a classification system were vascular injuries (89%), common peroneal nerve injuries (78%), number of torn ligaments (78%), and open injuries (70%).ConclusionThe wide geographic distribution of participants provides diverse insight and makes the results of the study globally applicable. The most important factors to include in a classification system as determined by the Delphi technique were vascular injuries, common peroneal nerve injuries, number of torn ligaments, and open injuries. The Schenck anatomic classification system most accurately identifies these patient variables with the addition of open injuries. The authors propose to update the Schenck classification system with the inclusion of open injuries as an additional modifier.
ADVICE GIVEN TO CLIMBERS PRIOR TO KNEE ARTHROPLASTY: PATIENT AND SURGEON EXPERIENCE
Authors: Warder Holly , Hall-Thompson Beth , Sanders Tim , Wright Nicholas , Alford Simon , Johnson David 
Published: August 2023

AbstractThe Montgomery ruling advocates patients be informed of ‘material risks’ of a procedure. With no guidelines for patients wishing to return to high activity levels after knee arthroplasty, we explore patient and surgeon perceptions in climbers.Ethical approval was granted by the University of Central Lancashire. Anonymous questionnaires were sent via email and social media to consultant knee arthroplasty surgeons and to climbers/mountaineers across the UK. Consultants were asked about advice given for patients who participate in climbing. Climbers were asked about their experiences of knee arthroplasty and return to activity.Of 33 knee arthroplasty surgeons, 11(33%) were firmly against any return to climbing, 10(30%) counselled against it, and 12(36%) were open to return to previous activity. Of 11(33%) surgeons who do not gather information about levels of climbing, 8 would not provide specific advice regarding risks of returning to sport. Of 28 climbers, only 5(18%) were informed to cease completely, with 11(39%) cautioned against and 12(43%) permitted to return. There was no correlation between the advice received and climbing ability post-operatively, (kappa=0.143,p=0.058), with a substantial agreement between ability 1-year post-operatively and currently, (kappa=0.689,p<0.001).There is a discrepancy between the advice given and received by climbers/mountaineers prior to knee arthroplasty, with ability post-operatively having no relationship to advice given. Climbing is possible at high level with no reported complications following knee arthroplasty. The 1-year time point is predictive of longer-term outcome. This information should help surgeons better inform their patients preoperatively.
JAMES LIND ALLIANCE FIRST-TIME SOFT-TISSUE KNEE INJURIES PRIORITY-SETTING PARTNERSHIP: TOP TEN
Authors: Osmani Humza , Nicolaou Nicolas , Anand Sanjeev , Metcalfe Andrew , McDonnell Stephen 
Published: August 2023

AbstractIntroductionThe knee is the most commonly injured joint in sporting accidents. They cause substantial disability, time off work and long-term problems. There remains a limited number of high-quality randomised controlled trials assessing first time, acute soft tissue knee injuries. Key areas requiring answers include prevention, diagnosis, treatment, rehabilitation and delivery of care. In association with the James Lind Alliance, this BASK, BOSTAA and BOA supported prioritising exercise was undertaken over a year.MethodologyThe James Lind Alliance methodology was followed. An initial survey invited patients and healthcare professionals to submit their uncertainties regarding soft tissue knee injury prevention, diagnosis, treatment, rehabilitation and delivery of care. Over 1000 questions were submitted. Seventy-four questions were formulated to encompass common concerns. These were checked against best available evidence. Following the interim survey, 27 questions were taken forward to the final workshop in January 2023, where they were discussed, ranked and scored in multiple rounds of prioritisation by groups of healthcare professionals, patients and carers.ResultsThe Top 10 includes prevention, diagnosis, treatment and rehabilitation questions, reflecting the concerns of patients, carers and a wider multidisciplinary team. These will be presented and explained.ConclusionThis validated process has generated an important Top 10, which has been submitted to the National Institute for Health and Care Research. All 27 questions will be published, thus being available for researchers to investigate. The questions in the Top 10 will lead to future high quality research, thus improving patient outcomes.
EARLY TIBIAL FAILURES IN PRIMARY TOTAL KNEE ARTHROPLASTY IN OBESE PATIENTS: ANALYSIS AND IMPLANT CHOICE RECOMMENDATIONS
Authors: Deo Sunny , Jonas Sam , Jhaj Jasmeet 
Published: August 2023

AbstractINTRODUCTIONThe most frequent mode of aseptic failure of primary total knee replacements is tibial baseplate loosening. This is influenced by stresses across the implant-bone interface which can be increased in obese patients leading to potentially higher rates of early failure. The evidence is mixed as to the true effect of elevated BMI (body mass index) on revision rates. We present the experience of early tibial failures in our department and how our implant choices have evolved.METHODOLOGYWe retrospectively reviewed our unit's arthroplasty database and identified all patients who had sustained mechanical tibial failure. Data were collected on patient demographics, operative details of primary and revision operations, components used, alignment pre and post operatively and indication. Complications and further surgery performed were recorded.RESULTS12 patients were identified who had been revised for mechanical tibial failure. All were female, mean age 60 years (46–76). Mean BMI was 11/12 had significant comorbidities and 6/12 had risk factors for reduced bone density (inflammatory arthritis, diabetes, hypothyroid).CONCLUSIONIn our consecutive series of 12 patients who presented with tibial mechanical failure, all were female and had a high BMI with the majority over 40. We recommend that a stemmed tibia construct should be used in female patients with an elevated BMI, particularly if it is over 40.
CO-DESIGNING ACCEPTABLE AND INCLUSIVE APPROACHES TO PUBLIC INVOLVEMENT OF ETHNIC MINORITY COMMUNITIES IN ORTHOPAEDIC RESEARCH
Authors: Jameson Catherine , Wylde Vikki 
Published: August 2023

AbstractIntroductionPeople from ethnic minority backgrounds are underserved in healthcare and research. We co-developed a checklist to promote good practice for inclusive community patient and public involvement (PPI).MethodsWe worked with three community groups in Bristol to develop the checklist – Dhek Bhal (South Asian community), Malcolm X Elders (African Caribbean community) and My Friday Coffee Morning (predominantly Somali women). We worked with group leaders to better understand the needs of the groups. We visited each group at least three times and used informal and open discussions tailored to how each group preferred to work. We paid for community leaders’ time, interpretation and transport where needed, as well as contributing towards activities and catering as suggested by group leaders.ResultsThe checklist covers 4 broad themes:Link building – understand the community, gauge interest in topic, build trust and relationships, visit regularly and return to updatePracticalities – visit the communities in their usual space, understand most appropriate meeting formats, consider translation and transport3. During the meeting – avoid jargon, be informal and flexible, build in social time, provide culturally preferred food4. Giving back – acknowledge the value of people's time, identify preferences for reimbursement, look for opportunities to give backTo complement the checklist, we produced a visual output in the form of an illustration created by a local artist.DiscussionWe hope this checklist will facilitate meaningful involvement of people from underserved communities in all stages of research, including identifying research priorities, co-design, research management and dissemination.
DEPRIVATION, COMPLEXITY, AND MORTALITY IN KNEE ARTHROPLASTY
Authors: Akehurst Harold , Stamatopoulos Alexandros , Deo Sandeep 
Published: August 2023

AbstractIntroductionKnee replacement surgery can greatly improve pain, disability, quality of life and ability to work. Socioeconomic deprivation is associated with multiple poor health outcomes, partly due to reduced access to services, including surgery. We investigated whether deprivation was associated with characteristics at presentation, and outcomes following knee arthroplasty.MethodologyWe linked data from 2358 knee arthroplasty cases with the Index of Multiple Deprivation, and mortality data after mean 7.6 years follow up. A locally developed scoring system was used prospectively to categorise case complexity.ResultsMost patients were from more affluent areas. Deprivation was associated with younger age, and increasing case complexity. There was a significant association between case complexity and mortality, while an independent association between deprivation and mortality could not be confirmed.ConclusionHealth inequalities may impact presentations and outcomes in knee arthroplasty. Patients from areas of socioeconomic deprivation present more complex cases, which may be a result of associated comorbidity and delayed presentation due to impaired access. As knee arthroplasty can improve disability and ability to work, its availability in deprived areas can play a role in the alleviation of health inequality.
ROSA VERSUS MAKO: COMPARING SURGICAL ACCURACY IN ROBOTIC TOTAL KNEE ARTHROPLASTY
Authors: Mayne Alistair , Rajgor Harshadkumar , Munasinghe Chathura , Agrawal Yuvraj , Pagkalos Iosif , Davis Edward , Sharma Akash 
Published: August 2023

AbstractIntroductionThere is increasing adoption of robotic surgical technology in Total Knee Arthroplasty - The ROSA® knee system can be used in either image-based mode (using pre-operative calibrated radiographs) or imageless modes (using intra-operative bony registration). The Mako knee system is an image-based system (using a pre-operative CT scan). This study aimed to compare surgical accuracy between the ROSA and Mako systems with specific reference to Joint Line Height, Patella Height and Posterior Condylar Offset.MethodologyThis was a retrospective review of a prospectively-maintained database of the initial 100 consecutive ROSA TKAs and the initial 50 consecutive Mako TKAs performed by two high volume surgeons. To determine the accuracy of component positioning, the immediate post-operative radiograph was reviewed and compared with the immediate pre-operative radiograph. Patella height was assessed using the Insall-Salvati ratio.ResultsThere was no significant difference between ROSA TKA and Mako TKA with regards to restoration of joint line height, ROSA mean 0.2mm versus Mako mean 0.3mm (p<0.05), posterior condylar offset, ROSA mean 0.16mm versus Mako mean 0.3mm (p<0.05), and patella height, ROSA mean 0.02 versus Mako mean 0.03 (p<0.05)ConclusionThis study is the first study to compare the accuracy of the ROSA and MAKO knee systems in total knee arthroplasty. Both systems are highly accurate in restoring native posterior condylar offset, joint line height, and patella height in TKA with no significant difference demonstrated between the two robotic systems.
ARE OBESITY AND AGE CONTRAINDICATIONS TO HIGH TIBIAL OSTEOTOMY IN MEDIAL COMPARTMENT OSTEOARTHRITIS?
Authors: Myatt Darren , Marshall Morgan , Franklin Marieta , Robb Curtis 
Published: August 2023

AbstractHigh tibial osteotomy (HTO) is a well-recognised procedure to address medial compartment osteoarthritis (OA). There remains dispute on the impact of pre-operative patient factors on patient related outcome measures (PROMS).Does BMI and age affect > 2 year and > 5 year oxford knee scores (OKS) and Knee injury and osteoarthritis outcome scores (KOOS).A retrospective review of a prospectively collected database was performed. Timeframe was 26/6/2014 and 25/8/2022. BMI and age were recorded. OKS and KOOS were collected at > 2 years and > 5 years.There were 81 procedures included, of these 50 had OKS and KOOS scores at > 2 years and 35 at > 5 years. Median BMI was 28.5kg/m2, range was 18.6–40.8kg/m2. Spearman's rank for >2 year OKS was p(df)=−0.210 p=0.157, > 5 year OKS p(df)=−0.215 p=0.230. For > 2 year and > 5 year KOOS subscales there were no statistically significant associations on Spearman's rank.For age, median age was 52.5, range 26–71 years old. OKS at >2 year p(df)=0.068 p=0.664, OKS >5 years p(df)=0.065 p= 0.709. For >2 year and > 5 year KOOS subscales there were no statistically significant associations on Spearman's rank.There were no adverse outcome in patients up-to the age of 71. There were no statistically significant Spearman's rank correlations between PROMS and OKS/KOOS scores. This supports recent KOG consensus statement highlighting physiological age importance vs chronological age. Of note there were more negative associations in the BMI group compared with age.
SYNTHETIC VERSUS AUTOLOGOUS RECONSTRUCTION (SYN-VAR) RANDOMIZED CONTROLLED TRIAL OF THE MEDIAL PATELLOFEMORAL LIGAMENT
Authors: Matthews Scott , Acton Danny , Tucker Adam , Graham John 
Published: August 2023

AbstractIntroductionThe Syn-VAR RCT is the first of its kind comparing hamstrings autograft v synthetic neoligament for MPFL reconstruction.Our aim is to evaluate short and long term patient related outcomes measures (PROMs) following synthetic / autologous MPFL reconstruction in a heterogenous cohort of patients with recurrent patellar instability.Method20 patients meeting inclusion criteria were recruited and randomised. Standardised surgery was performed by a single surgeon in Altnagelvin Hospital with data collected over 3 years from 2016. Kujala score was the primary outcome measure with data captured preoperatively and 12 weeks/2 years postoperatively. Secondary outcomes included four other validated scores and complications including Norwich Patellar Instability, Lysholm, IKDC and BanffResults20 patients with an average age of 19 included 9 females and 11 males. At 12 weeks and 2 years Kujala improvement in the hamstring group was 18 and 32 (both p<0.05) compared to the synthetic group where the increase was 2 and 20 (p<0.05). All secondary score improvements at 2 years were significant (p<0.05) with no difference in any score at all time intervals when comparing both groups (p<0.05).DiscussionOur RCT validates the non-inferiority of synthetic MPFL reconstruction as a treatment for restoring patellar stability in a small heterogenous group with positive long term data and minimal morbidity. With no hamstring harvesting offering a reduction in theatre time with this offers a safe, efficient and viable alternative with reduced morbidity.
OUTCOME AFTER AVON PATELLOFEMORAL JOINT REPLACEMENT IN PATIENTS UNDER 55 YEARS OLD: LOW REVISION RATE AT MID-TERM FOLLOW-UP FROM AN INDEPENDENT CENTRE
Authors: Hainsworth Louis , Lankester Ben 
Published: August 2023

AbstractIntroductionIsolated patellofemoral osteoarthritis accounts for 10% of knee osteoarthritis. Many of these will not require arthroplasty solutions, but for those who are sufficiently symptomatic, patellofemoral joint (PFJ) replacement has been shown to be an effective procedure. The National Joint Registry (NJR) has shown a higher revision rate for this operation, particularly in younger patients (males <55 years 13.3% failure at 5 years, females 9.6%). The aim of this study is to report on the medium-term outcome of the Avon patellofemoral joint arthroplasty in patients under 55 from a non-design centre. There is no other published case series on this young patient cohort.Methodology50 Avon PFJ replacements (Stryker, Kalamazoo USA) were undertaken in 46 patients under 55 years old (range 35 – 54, mean 48.8) between 2010 and 2022 for end-stage isolated PFJ arthritis shown on Xray and MRI scan. The outcome measure was all-cause revision rate. This was assessed by review of clinical notes, imaging and NJR data.ResultsThe mean follow up was 5.8 years (range 6 months to 12.9 years). Only one patient had a revision procedure (for progressive osteoarthritis) which was 3 years after the primary procedure. This patient has had no further surgery. The implant survival rate was 97.2% at 5 years and 97.2% at 10 years.ConclusionThis study shows that patellofemoral joint replacement with the Avon prosthesis can give a satisfactory revision rate in the medium term in patients under 55 if carefully selected.
BONE MARROW-DERIVED STEM CELL TRANSPLANTATION FOR OSTEOCHONDRAL DEFECTS OF THE KNEE: A PROSPECTIVE CLINICAL STUDY
Authors: Al-Jabri Talal , Bentley George , McCulloch Robert , Miles Jonathan , Carrington Richard , Shearman Alexander , Donaldson James , Jayadev Chethan 
Published: August 2023

AbstractBackgroundAutologous chondrocyte implantation is a NICE approved intervention however it involves the morbidity of two operations, a prolonged rehabilitation and substantial healthcare costs. This study describes a novel, one-step, bone marrow (BM) derived mesenchymal stem cell (MSC) transplantation technique for treating knee osteochondral lesions and presents our prospective clinical study investigating the success of this technique in 206 lesions over a 5 year period.MethodologyThe surgical technique involves harvesting BM from patients’ anterior superior iliac spines, centrifugation to isolate MSCs and seeding into a type 1 collagen scaffold (SyngenitTM Biomatrix). Autologous fibrin glue is used to secure the scaffold into the defect. Inclusion criteria included patients aged 15 – 55 years old with symptomatic osteochondral lesions >1cm2. Exclusion criteria included patients with ligament instability, uncorrected alignment, inflammatory arthropathy and a Body Mass Index >35 kg/m2. Outcome measures included the Modified Cincinnati Knee Rating System (MCKRS), complications and reoperations.ResultsMean MCKR scores showed statistically significant improvements compared to pre-operative scores at 6 months 58.79 ± 3.5 and 1 year postoperatively 63.82 ± 3.93 with further improvements at 2 years and 5 years which did not reach statistical significance. Survival rates were 97.9%, 94% and 93.2% at 1, 2 and 5 years. Multiple regression analysis identified previous cartilage surgery, microfracture and age as factors affecting MCKRS scores (p < 0.029, 0.001 and 0.030, respectively).ConclusionsOne-step BM derived stem cell transplantation demonstrates satisfactory outcomes over a 5 year period.
PREVALENCE AND PATTERNS OF NEUROPATHIC PAIN IN A COHORT OF PATIENTS WITH CHRONIC POST-SURGICAL PAIN AFTER TOTAL KNEE ARTHROPLASTY
Authors: Bertram Wendy , Howells Nick , White Simon , Sanderson Emily , Wylde Vikki , Lenguerrand Erik , Gooberman-Hill Rachael , Bruce Julie 
Published: August 2023

AbstractIntroductionTotal knee replacement (TKR) is a successful operation for many patients, however 15–20% of patients experience chronic post-surgical pain (CPSP). Many will experience neuropathic characteristics.We describe the prevalence and patterns of neuropathic pain in a cohort of patients with CPSP three months after TKR.MethodologyBetween 2016–2019, 363 patients with troublesome pain, ≤14 on Oxford Knee score pain subscale, at three months after TKR from eight NHS hospitals were recruited into the Support and Treatment After Replacement (STAR) trial. Self-reported neuropathic pain was assessed at three, nine and fifteen months after surgery using painDETECT and Douleur Neuropathique 4 (DN4).ResultsAt three months post-operative, 53% reported neuropathic pain on painDETECT and 74% on DN4. Half (56%) remained in neuropathic pain over the twelve-month follow-up period, 26% reported improvement, and 9% reported new neuropathic symtpoms or fluctuated in and out of neuropathic pain (9%). Overall mean neuropathic pain scores improved between three and 15 months after TKR. When the painDETECT cut-off score of ≥13(ambiguous/possible) was used, DN4 and painDETECT measures showed similar prevalence rates at each timepoint.ConclusionNeuropathic pain is common among patients with CPSP at three months after TKR. Although symptoms improved over time, one quarter to one half of our cohort continued to report symptoms at fifteen months. We propose a painDETECT cutoff score of ≥13 be used to identify neuropathic features in the TKR population. Postoperative care should include identification, assessment, and treatment of neuropathic pain in patients with CPSP after TKR.
HIGH RATE OF LOOSENING OF ENDOLINK MODULAR HINGE KNEE ARTHROPLASTY IN PATIENTS UNDER 70 YEARS OLD
Authors: Reason Lucy , Jonas Sam , Evans Jonathan T , Eyres Keith S , Toms Andrew D , Kalson Nicholas S , Phillips Jonathan RA 
Published: August 2023

AbstractIntroductionChoosing a hinged implant in the revision knee arthroplasty (rTKA) setting is challenging and limited data on implant performance exists. We present the survivorship and reason for failure in rTKA performed at our institution using the LINK hinge prosthesis, predominantly the cemented modular Endo-Model prosthesis.Methodology260 consecutive revision knee cases performed between 2012 and 2020 were reviewed retrospectively. Mean follow up was 27 months (range 0 to 107). Survivorship was analysed in Stata using a Log Rank test to compare performance in patients stratified according to age (≥80 years old (76 cases), 70–79 years (104 cases) and ≤70 years (80 cases).Results53 patients died and 48/207 (23%) cases in 40 patients underwent re-revision. Reasons for re-revision were aseptic loosening (21), infection (12), instability (4), extensor failure (1), stiffness (1), fracture (1) and other (8). Loosening was seen in the femur (8), tibia (5), and both the femur and tibia (8). Sub-group analysis of patients according to age showed a significantly higher failure rate in younger patients (6 failures (8%) in patients ≥80, 27 failures (26%) in 70–79 and 15 (19%) in ≤70 (p = 0.02). Failure in patients ≤70 was predominantly due to aseptic loosening (8/15).ConclusionHere we report a significantly higher rate of LINK hinge prostheses failure in patients <70 undergoing rTKA. Consent should consider the risk of re-revision in this patient group.