bluuebunny/crossref_metadata_2025_split huggingface dataset:
TRAINING AND VALIDITY OF THE MICROSOFT HOLOLENS, AN AUGMENTED REALITY DEVICE, FOR TOTAL KNEE ARTHROPLASTY: A DOUBLE-BLINDED RANDOMIZED CONTROLLED TRIAL
Authors: Kaka Anaiya , Shah Aishwarya , Yunus Azedah , Patel Arpit , Patel Akash 
Published: August 2023

AbstractIntroductionChallenges in surgical training have led to the exploration of technologies such as augmented reality (AR), which present novel approaches to teaching orthopaedic procedures to medical students. The aim of this double-blinded randomised-controlled trial was to compare the validity and training effect of AR to traditional teaching on medical students’ understanding of total knee arthroplasty (TKA).MethodologyTwenty medical students from 7 UK universities were randomised equally to either intervention or control groups. The control received a consultant-led teaching session and the intervention received training via Microsoft HoloLens, where surgeons were able to project virtual information over physical objects. Participants completed written knowledge and practical exams which were assessed by 2 orthopaedic consultants. Training superiority was established via 4 quantitative outcome measures: OSATS scores, a checklist of TKA-specific steps, procedural time, and written exam scores. Qualitative feedback was evaluated using a 5-point Likert scale.ResultsAR training was superior in teaching basic technical proficiency and understanding of TKA, with the intervention group significantly outperforming the control group in 3 metrics [OSATS (38.6%, p=0.021), checklist (33%, p=0.011) and written exam (54.5%, p=0.001)]. Procedural time was equivalent between cohorts (p=0.082). AR was rated as significantly more enjoyable (p=0.044), realistic (p=0.003), easy to understand (p=0.040), and proficient in teaching (p=0.02).ConclusionIn this adequately powered, double-blinded randomised-controlled trial, AR training demonstrated substantially improved translational technical skills and knowledge needed to understand TKA over traditional learning in medical students. Additionally, the results showed face, content, and transfer validity for AR in surgical training.
DOUBLE LEVEL KNEE OSTEOTOMY IN BIFOCAL (FEMUR AND TIBIA) VALGUS MALALIGNED KNEES: WHAT ARE THE OUTCOMES AND LIMB LENGTH DISCREPANCY?
Authors: Mabrouk Ahmed , Ollivier Matthieu , Pioer Charles 
Published: August 2023

AbstractIntroductionDouble-level knee osteotomy (DLO) is a challenging procedure that requires precision in preoperative planning and intraoperative execution to achieve the desired correction. It is indicated in cases of severe varus or valgus deformities where a single-level osteotomy would yield significantly tilted joint line obliquity (JLO).MethodsA single-centre, retrospective analysis of prospectively collected data for 26 patients, who underwent DLO by PSCGs for valgus malaligned knees. Post-operative alignment was evaluated and the delta for different lower limb alignment parameters were calculated; HKA, MPTA, and LDFA. At the two-year follow-up, changes in KOOS sub-scores, UCLA scores, lower limb discrepancy, and mean time to return to work and sport were recorded. All intraoperative and postoperative complications were recorded.ResultsThe postoperative mean ΔHKA was 0.9 ± 0.9°, the mean ΔMPTA was 0.7 ± 0.7°, and the mean ΔLDFA was 0.7 ± 0.8° (all values with p > 0.05). All KOOS subscores’ mean values were improved to an extent two-fold superior to the reported MCID (all with p < 0.0001). There was a significant increase in the UCLA score at the final follow-up (5.4 ± 1.5 preoperatively versus 7.7 ± 1.4, p < 0.01). The mean time to return to sport and work was 4.7 ± 1.1 and 4.3 ± 2.1 months, respectively. There was an improvement in Lower-limb discrepancy preoperative (LLD = 1.3+/−2cm) to postoperative measures (LLD= 0.3 +/− 0.4 cm) p=0.02.ConclusionDLO is effective and safe in achieving accurate correction in bifocal valgus malaligned knees with maintained lower limb length and low complication rate with no compromise of JLO.
OUTCOME OF REVISION PATELLOFEMORAL JOINT REPLACEMENT TO TOTAL KNEE ARTHROPLASTY WHEN COMPARED WITH A MATCHED GROUP OF TOTAL KNEE ARTHROPLASTY OF SAME TOTAL ARTHROPLASTY LIFESPAN
Authors: Jonas Sam , Kumar Abhijeet , White Simon , Agarwal Sanjeev 
Published: August 2023

AbstractINTRODUCTION10% of patients with knee osteoarthritis (OA) have disease confined to the patellofemoral joint (PFJ). The main surgical options are total knee replacement (TKR) and PFJ replacement (PFJR). PFJR has advantages over TKR, including being less invasive, bone preserving, allowing faster recovery and better function and more ‘straight forward’ revision surgery. We aim to compare the clinical results of revised PFJR with primary TKR taking into consideration the survival length of the PFJR.METHODOLOGYTwenty-five patients (21 female) were retrospectively identified from our arthroplasty database who had undergone revision from PFJR to TKR (2006–2019). These patients were then matched with regards to their age at their primary procedure, sex and total arthroplasty life (primary PFJ survival + Revision PFJ time to follow up) up to point of follow-up with a group of primary TKRs implanted at the same point as the primary PFJR.RESULTSMean survival of the PFJs revised were 4.2 years. In the PFJR revision group (mean arthroplasty life 7.8 years) mean Oxford knee score (OKS) at latest follow up was 27.8. In the primary knee group (mean arthroplasty life 7.5 years) mean OKS was 32.4. This difference was not statistically significant. All PFJR revisions were performed using primary prostheses.CONCLUSIONPFJR provides comparable clinical outcome even after revision surgery to TKR as primary TKRs at midterm follow up and should be considered in all patients meeting the selection criteria. Given comparable proms and straight forward revisions, staged arthroplasty to preserve bone-stock is a reasonable choice.
SYSTEMATIC REVIEW AND META-ANALYSIS OF TREATMENT OUTCOMES FOR SECONDARY OSTEONECROSIS OF THE KNEE IN YOUNG ADULTS
Authors: Joseph Vinay , Boktor Joseph , Bajada Stefan , Coupe Ben 
Published: August 2023

AbstractIntroductionSecondary osteonecrosis of the knee affects young population and causes bilateral extensive lesions. Arthroplasty is the last resort in younger population and joint preserving options questionable in pathological bone. Conservative measures have shown failure in multiple studies and hence no gold standard treatment advocated. We aimed at identifying and analysing various treatment options for secondary osteonecrosis with respect to the outcomes and studying features of symptomatic secondary osteonecrosis with regards to demographic pattern, radiological features and causative factors.MethodsA systematic review of literature was performed in accordance with the Cochrane handbook for systematic reviews and reported according to the PRISMA guidelines.ResultsSix studies which included a total of 192 patients with data on 240 knee joints were included in the final review. Follow up period ranged from 1 year to 16 years. The mean age of the patients was 34.7. 3 studies were on arthroplasty and 3 on joint preserving interventions. Majority of patients were in Stage 2 or Stage 4 of osteonecrosis. Steroid induced osteonecrosis was the majority followed by SLE and sickle cell disease. The pooled analysis showed an improvement of pre-operative knee score from 50.47 to 89.21 post-operatively. The pooled effect size for failure rate was 8.7% in joint preserving interventions and 9.2% in joint replacement group.ConclusionJoint preserving techniques with bone marrow aspirate infiltration showed promising functional outcome and to a certain extent reversal of the pathological process. For advanced stages with subchondral collapse cemented arthroplasty showed satisfactory functional outcomes.
IS THE HIGH RATE OF TIBIAL TRAY DEBONDING IN POSTERIOR-STABILIZED NEXGEN TOTAL KNEE ARTHROPLASTY ASSOCIATED WITH BACKSIDE DEFORMATION OF POLYETHYLENE INSERTS?
Authors: Langton David , Bhalekar Rohan , Wells Stephen , Nargol Matthew , Waller Susan , Wildberg Linda , Tilley Simon , Nargol Antoni 
Published: August 2023

AbstractIntroductionAt our national explant retrieval unit, we identified an unusual pattern of backside-deformation on polyethylene (PE) inserts of contemporary total-knee-replacements (TKRs). The PE backside's margins were inferiorly deformed in TKRs with central-locking trays. We reported that this backside-deformation appeared to be linked to tray debonding. Moreover, recent studies have shown high-rate of tray debonding in PS NexGen TKRs. Therefore, we hypothesised that backside deformation on PS inserts may be more than on CR inserts.MethodologyWe used peer-reviewed techniques to analyse changes in the bearing (wear rate) and backside surfaces (deformation) of PE inserts using coordinate measuring machines [N=61 NexGen (CR-39 and PS-22) TKRs with non-augmented-trays]. Multiple regression was used to determine which variable had the greatest influence on backside-deformation. The amount of cement cover on trays was quantified as a %of the total surface using Image-J software.ResultsThere was no statistically significant difference (p=0.238) in median (IQR) wear rate of the CR PEs 18 (12–28) mm3/year and PS PEs 14 (8–20) mm3/year. The PE backside-deformation median (IQR) of PS [297(242–333) µm] was significantly higher (p=0.011), when compared with CR [241(161–259) µm]. Multiple regression modelling showed that duration in-vivo (p=0.037), central-clearance between insert and tray (p<0.001) and constraint (p=0.003) were significantly associated with PE backside-deformation. 27(69%) of CR and 20(91%) PS exhibited ≤10% of cement cover on tray.ConclusionThis explant study showed backside-deformation on PS inserts was more than on CR inserts. Therefore, indicating a high-rate of tibial tray debonding in PS compared to CR NexGen TKRs.
LOW READMISSION AND REATTENDANCE RATE FOR 301 CONSECUTIVE DAY-CASE TOTAL KNEE ARTHROPLASTIES DELIVERED IN A NATIONAL HEALTH SERVICE TRUST IN THE UNITED KINGDOM
Authors: Fishley William , Paice Sarah , Iqbal Haaris , Mowat Stephen , Kalson Nicholas , Reed Mike , Partington Paul , Petheram Timothy 
Published: August 2023

AbstractIntroductionThe rate of day-case total knee replacement (TKR) in the UK is currently ~0.5%. Reducing length of stay improves efficiency, increases operative throughput and tackles the rising demand for joint replacement surgery and the COVID-19 related backlog. We report safe delivery of day-case TKR in an NHS Trust via inpatient wards, with no additional resources.MethodologyDay-case TKRs, defined as patients discharged on the same calendar day as surgery, were retrospectively reviewed with a minimum follow-up of six-months. Analysis of hospital and primary care records was performed to determine readmission and reattendance rates. Telephone interviews were conducted to determine patient satisfaction.ResultsBetween 2016 and 2021, 301/7350 (4.1%) TKRs were discharged on the day of surgery. Mean follow-up was 31.4 (6.2–70.0) months. 28 (9.3%) patients attended Accident and Emergency or other acute care settings within 90-days of surgery; six (2.0%) patients were readmitted. No patients underwent a subsequent revision procedure. There were no prosthetic infections. Two patients underwent secondary patella resurfacing, and one patient underwent arthroscopic arthrolysis after previous manipulation under anaesthetic (MUA). Three patients underwent MUA alone. Primary care consultation records, available for 206 patients, showed 16 (7.8%) patients contacted their General Practitioner within two-weeks post-operatively; two (1.0%) were referred to secondary care. 115/121 (95%) patients telephoned stated they would have day-case TKR again.ConclusionDay-case TKR can be safely delivered in the NHS with no additional resources. We found low incidence of contact with primary and secondary care in the post-operative period, and high patient satisfaction.
RETURN TO WORK FOLLOWING REVISION KNEE ARTHROPLASTY IN PATIENTS UNDER 65 YEARS OF AGE
Authors: Reason Lucy , Roberton Andrew , Jonas Sam , Phillips Jonathan 
Published: August 2023

AbstractIntroductionLittle is known about employment following revision total knee arthroplasty (RTKA). This study aims to describe factors associated with returning to employment in patients of working age who underwent RTKA surgery.MethodologyWe performed a retrospective assessment of all patients aged ≤65 who underwent RTKA at our NHS institution between 2006 and 2020. All indications and revision procedures were included. Pre-operative demographics, indication for surgery and Oxford Knee Scores (OKS) were recorded. Postal questionnaires were sent to patients including patient reported outcome measures and departmental questionnaire asking patients about employment status pre- and post-operatively.Results132 procedures were performed in 113 patients. Median follow up was 5.5 years (2.4–9.0). Mean age was 58 (5.8) and 50% (57) were male. 62 patients undergoing 74 procedures responded to postal questionnaires and were included in the study. 53% (33) were employed prior to surgery and 61% (38) returned to work at a median of 12 weeks (3–150). Of the 24 who did not return to work, 7 reported intending to return to work. Those patients who returned to work had increased pre-operative OKS (16.9 vs 13.6) and mean improvement (16.5 vs 12.4).ConclusionThis study is limited by small numbers and its observational nature. In this population the majority of patients who wished to return to work after RTKA were able to do so. This provides some reassurance when counselling patients. Prospective studies to better understand the factors that predict return to work will be important with increasing demands from surgery.
USING THE CAPABILITY, OPPORTUNITY, AND MOTIVATION MODEL OF BEHAVIOUR (COM-B) TO IMPLEMENT A PATHWAY TO REDUCE 30-DAY ELECTIVE EMERGENCY ADMISSIONS
Authors: Wehbe Jad , Womersley Andrew , Jones Samantha , Afzal Irrum , Kader Deiary , Sochart David , Asopa Vipin 
Published: August 2023

AbstractIntroduction30-day emergency readmission is an indicator of treatment related complication once discharged, resulting in readmission. A board-approved quality improvement pathway was introduced to reduce elective re-admissions.MethodThe pathway involved telephone and email contact details provision to patients for any non-life threatening medical assistance, allowing for initial nurse led management of all issues. A new clinic room available 7 days, and same day ultrasound scanning for DVT studies were introduced. A capability, opportunity and behavior model of change was implemented.Readmission rates before and six months after implementation were collected from Model Hospital. A database used to document patient communications was interrogated for patient outcomes.ResultsPrior to implementation, readmission rates following elective primary total knee replacement (TKR) at the 1st business quarter of 2021 (April – June 2021), was 8.7%, (benchmark 3.8%). Following implementation, readmission rates decreased to 4.1% (October – December 2021). 54% of patients making contact were managed with telephone advice. 15% of patients required face-to-face clinic. 32% of those required a same day scan to exclude DVT (1/4).20 out of 684 TKRs performed following protocol introduction were re-admitted within 30 days. Readmissions were 41% surgical, 29% medical. 52% were unaware of the newly implemented protocol. Further improvements have been made to the protocol based on these findings.Implementation of a suitable pathway can significantly reduce re-admission rates in our center and could be used to reduce readmission rates in other national elective treatment centers.
ROSA ROBOTIC ARM SYSTEM RELIABLY RESTORES JOINT LINE HEIGHT, PATELLA HEIGHT, AND POSTERIOR CONDYLAR OFFSET IN TOTAL KNEE ARTHROPLASTY
Authors: Mayne Alistair , Rajgor Harshadkumar , Munasinghe Chathura , Agrawal Yuvraj , Pagkalos Iosif , Davis Edward , Sharma Akash 
Published: August 2023

AbstractIntroductionThere is growing interest in the use of robotic Total Knee Arthroplasty (TKA) to improve accuracy of component positioning. This is the first study to investigate the radiological accuracy of implant component position using the ROSA® knee system with specific reference to Joint Line Height, Tibial Slope, Patella Height and Posterior Condylar Offset. As secondary aims we compared accuracy between image-based and imageless navigation, and between implant designs (Persona versus Vanguard TKA).MethodologyThis was a retrospective review of a prospectively-maintained database of the initial 100 consecutive TKAs performed by a high volume surgeon using the ROSA® knee system. To determine the accuracy of component positioning, the immediate post-operative radiograph was reviewed and compared with the immediate pre-operative radiograph with regards to Joint Line Height, Tibial Slope, Patella Height (using the Insall-Salvati ratio) and Posterior Condylar Offset.ResultsMean age of patients undergoing ROSA TKA was 70 years (range, 55 to 95 years). Mean difference in joint line height between pre and post-operative radiographs was 0.2mm (range −1.5 to +1.8mm, p<0.05), posterior condylar offset mean change 0.16mm (range −1.4 to +1.3mm, p<0.05), tibial slope mean change 0.1 degrees (p<0.05) and patella height mean change 0.02 (range −0.1 to +0.1 p<0.05). No significant differences were found between imageless and image-based groups, or between implant designs (Persona versus Vanguard).ConclusionThis study validates the use of the ROSA® knee system in accurately restoring Joint Line Height, Patella Height and Posterior Condylar Offset.
POSTOPERATIVE OUTCOMES AND FEASIBILITY ANALYSIS OF PERFORMING UNICOMPARTMENTAL KNEE ARTHROPLASTY AS A DAY-CASE PROCEDURE
Authors: Saghir Reyan , Aldridge William , Metcalf David , Jehan Shah , Ng Aaron 
Published: August 2023

AbstractIntroductionUni-compartmental knee replacement (UKR) has become popularised due to quicker recovery times, reduced postoperative pain, and blood loss. The desire to increase bed capacity and reduce costs, while preserving safety and patient satisfaction, has led to increased interest in day-case arthroplasty. This study observes the feasibility of UKR as a day-case procedure and whether this affects short and long-term postoperative outcomes.MethodologyBetween 2018 and 2021, at a single institution and operated by a single orthopaedic surgeon, seventy-seven patients received a UKR on an elective basis. The patients were divided into two groups: ‘day-case’ for those discharged on the same day, and ‘non day-case’ group.Results31 patients were identified as day case procedures with the remaining 46 requiring between one to three days before discharge. Mean age, sex, modal ASA score, BMI, Charlson co-morbidity index, and pre-op oxford knee score showed no statistically significant difference between the two groups (p>0.05). No significant difference between the post-op oxford knee score at 1 year was found for patients treated and discharged as a day case procedure (37.8 +/− 6.88) and those who remained as an inpatient postoperatively (37.8 +/− 10.7); t(df) = −0.0007, p=0.994. No patients in either group suffered any complications beyond the peri-operative period. 30-day and 90-day readmission rates were equal.ConclusionsWith no significant differences in post-op knee scores, complication, and readmission rates, we feel UKR can be performed as a viable day case procedure in a planned elective setting. This will result in significant cost savings.
TOTAL KNEE ARTHROPLASTY IN PATIENTS WITH SKELETAL DYSPLASIA
Authors: Mudiganty Srikanth , Jayadev Chethan , Carrington Richard , Miles Jonathan , Donaldson James , Mcculloch Robert 
Published: August 2023

AbstractIntroductionTotal knee replacement (TKR) in patients with skeletal dysplasia is technically challenging surgery due to deformity, joint contracture, and associated co-morbidities. The aim of this study is to follow up patients with skeletal dysplasia following a TKR.MethodologyWe retrospectively reviewed 22 patients with skeletal dysplasia who underwent 31 TKRs at our institution between 2006 and 2022. Clinical notes, operative records and radiographic data were reviewed.ResultsAchondroplasia was the most common skeletal dysplasia (8), followed by Chondrodysplasia punctata (7) and Spondyloepiphyseal dysplasia (5). There were fourteen men and eight women with mean age of 51 years (28 to 73). The average height of patients was 1.4 metres (1.16–1.75) and the mean weight was 64.8 Kg (34.3–100). The mean follow up duration was 68.32 months (1–161). Three patients died during follow up. Custom implants were required in twelve patients (38.71%). Custom jigs were utilised in six patients and two patients underwent robotic assisted surgery. Hinged TKR was used in seventeen patients (54.84%), posterior stabilised TKR in nine patients (29.03%), and cruciate retaining TKR in five patients (16.13%). One patient underwent a patella resurfacing for persistent anterior knee pain and another had an intra-operative medial tibial plateau fracture which was managed with fixation. No revisions occurred during the follow up period.ConclusionDespite the technical challenges and complexity of TKR within this unique patient group, we demonstrate good implant survivorship during the study period. Cross sectional imaging is recommended preoperatively for precise planning and templating.
DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION IS SUCCESSFUL IN THE MANAGEMENT OF ACUTELY INFECTED UNICOMPARTMENTAL KNEE ARTHROPLASTY: A CASE SERIES
Authors: Al-Jabri Talal , Brivio Angela , Martin Jurgen , Barrett David , Maffulli Nicola 
Published: August 2023

AbstractBackgroundInfections are rare and poorly studied complications of unicompartmental knee athroplasty (UKA) surgery. They are significantly less common compared to infections after total knee arthroplasties (TKAs). Optimal management of periprosthetic joint infections (PJIs) after a UKA is not clearly defined in the literature. We present the results of a multicentre retrospective series of UKA PJIs treated with Debridement, Antibiotics and Implant Retention (DAIR).MethodologyPatients presenting between January 2016 and December 2019 with early UKA infection were identified at three specialist centres using the Musculoskeletal Infection Society (MSIS) criteria. All patients underwent a standardized treatment protocol consisting of the DAIR procedure and antibiotic therapy comprising two weeks of intravenous (IV) antibiotics followed by six weeks of oral therapy. The main outcome measure was overall survivorship free from reoperation for infection.ResultsA total of 3225 UKAs (2793 (86.2%) medial and 432 (13.8%) lateral UKAs) were performed between January 2016 and December 2019. Nineteen patients had early infections necessitating DAIR. The mean follow-up period was 32.5 months. DAIR showed an overall survivorship free from septic reoperation of 84.2%, with an overall survivorship free from all-cause reoperation of 78.95%. The most common bacteria were Coagulase-negative Staphylococci, Staphylococcus aureus and Group B Streptococci. Three patients required a second DAIR procedure but remained free from re-infection at follow-up obviating the need for more demanding, staged revision surgery.ConclusionsIn infected UKAs, the DAIR procedure produces a high rate of success, with a high survivorship of the implant.