58 results found
Logishetty K, Edwards TC, Subbiah Ponniah H, et al., 2021, How to prioritize patients and redesign care to safely resume planned surgery during the COVID-19 pandemic., Bone & Joint Open, Vol: 2, Pages: 134-140, ISSN: 2633-1462
AIMS: Restarting planned surgery during the COVID-19 pandemic is a clinical and societal priority, but it is unknown whether it can be done safely and include high-risk or complex cases. We developed a Surgical Prioritization and Allocation Guide (SPAG). Here, we validate its effectiveness and safety in COVID-free sites. METHODS: A multidisciplinary surgical prioritization committee developed the SPAG, incorporating procedural urgency, shared decision-making, patient safety, and biopsychosocial factors; and applied it to 1,142 adult patients awaiting orthopaedic surgery. Patients were stratified into four priority groups and underwent surgery at three COVID-free sites, including one with access to a high dependency unit (HDU) or intensive care unit (ICU) and specialist resources. Safety was assessed by the number of patients requiring inpatient postoperative HDU/ICU admission, contracting COVID-19 within 14 days postoperatively, and mortality within 30 days postoperatively. RESULTS: A total of 1,142 patients were included, 47 declined surgery, and 110 were deemed high-risk or requiring specialist resources. In the ten-week study period, 28 high-risk patients underwent surgery, during which 68% (13/19) of Priority 2 (P2, surgery within one month) patients underwent surgery, and 15% (3/20) of P3 (< three months) and 16% (11/71) of P4 (> three months) groups. Of the 1,032 low-risk patients, 322 patients underwent surgery. Overall, 21 P3 and P4 patients were expedited to 'Urgent' based on biopsychosocial factors identified by the SPAG. During the study period, 91% (19/21) of the Urgent group, 52% (49/95) of P2, 36% (70/196) of P3, and 26% (184/720) of P4 underwent surgery. No patients died or were admitted to HDU/ICU, or contracted COVID-19. CONCLUSION: Our widely generalizable model enabled the restart of planned surgery during the COVID-19 pandemic, without compromising patient safety or excluding high-risk or complex cases. Patients classified as Urgent or P2 w
Raymond AC, Liddle AD, Alvand A, et al., 2021, Clinical Outcome of Free Latissimus Dorsi Flaps for Coverage of Soft Tissue Defects in Multiply Revised Total Knee Arthroplasties, JOURNAL OF ARTHROPLASTY, Vol: 36, Pages: 664-669, ISSN: 0883-5403
Liddle AD, 2020, CORR Insights (R): What Is the Survivorship After Hip Arthroscopy for Femoroacetabular Impingement? A Large-database Study, CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, Vol: 478, Pages: 2274-2276, ISSN: 0009-921X
Carlos Rodriguez-Merchan E, Liddle AD, 2020, Prevention of Periprosthetic Joint Infection in Total Knee Arthroplasty: Main Studies Reported Between November 2017 and January 2020, ARCHIVES OF BONE AND JOINT SURGERY-ABJS, Vol: 8, Pages: 465-469, ISSN: 2345-4644
Davidson DJ, Spratt D, Liddle AD, 2019, Implant materials and prosthetic joint infection: the battle with the biofilm, EFORT Open Reviews, Vol: 4, ISSN: 2058-5241
• Prosthetic joint infection (PJI) is associated with poor clinical outcomes and is expensive to treat.• Although uncommon overall (affecting between 0.5% and 2.2% of cases), PJI is one of the most commonly encountered complications of joint replacement and its incidence is increasing, putting a significant burden on healthcare systems.• Once established, PJI is extremely difficult to eradicate as bacteria exist in biofilms which protect them from antibiotics and the host immune response.• Improved understanding of the microbial pathology in PJI has generated potential new treatment strategies for prevention and eradication of biofilm associated infection including modification of implant surfaces to prevent adhesion of bacteria.• Much research is currently ongoing looking at different implant surface coatings and modifications, and although most of this work has not translated into clinical medicine there has been some early clinical success.
Al-Ani A, Bence M, Liddle AD, et al., 2019, Admission and treatment at a weekend is not associated with worse outcomes for patients admitted with fractured neck of femur, Trauma, Pages: 146040861878592-146040861878592, ISSN: 1460-4086
Koo K, Liddle AD, Pastides PS, et al., 2019, The Salto total ankle arthroplasty - clinical and radiological outcomes at five years, Foot and Ankle Surgery, Vol: 25, Pages: 523-528, ISSN: 1268-7731
BACKGROUND: Modern designs of total ankle arthroplasty (TAA) have the potential to treat symptomatic ankle OA without adversely affecting ankle biomechanics. We present the mid-term results of a modern, mobile-bearing TAA design. METHODS: TAA was performed in 50 consecutive patients (55 ankles) in an independent, prospective, single-centre series. Implant survival, patient-reported outcome measures (PROMs) and radiographic outcomes are presented at a mean of five years (range 2-10.5years). RESULTS: A total of three patients (four ankles) died and two (two ankles) were lost to follow-up. Three TAAs were revised for aseptic loosening (in two cases) or infection. Two further patients underwent reoperations, one for arthroscopic debridement of anterolateral synovitis and one for grafting of an asymptomatic tibial cyst. With all-cause revision as an endpoint, implant survival was 93.3% at five to ten years (95% CI 80.5%-97.8%). If reoperations are included this falls to 90.2% (95% CI 75.6%-96.3%) at five years. No other patient demonstrated radiographic evidence of loosening or subsidence. PROMs and satisfaction were excellent at latest follow-up. CONCLUSION: At five years, the outcomes for this design of TAA in this series were excellent, and were similar to those of previously published series from the designer centre.
Liddle AD, 2019, CORR Insights (R): No differences in outcomes scores or survivorship of unicompartmental knee arthroplasty between patients younger or older than 55 years of age at minimum 10-year followup, Clinical Orthopaedics and Related Research, Vol: 477, Pages: 1447-1449, ISSN: 0009-921X
Burn E, Sanchez-Santos MT, Pandit HG, et al., 2018, Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis, Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 26, Pages: 1455-1464, ISSN: 0942-2056
PurposeFor patients with medial compartment arthritis who have failed non-operative treatment, either a total knee arthroplasty (TKA) or a unicompartmental knee arthroplasty (UKA) can be undertaken. This analysis considers how the choice between UKA and TKA affects long-term patient-reported outcome measures (PROMs).MethodsThe Knee Arthroplasty Trial (KAT) and a cohort of patients who received a minimally invasive UKA provided data. Propensity score matching was used to identify comparable patients. Oxford Knee Score (OKS), its pain and function components, and the EuroQol 5 Domain (EQ-5D) index, estimated on the basis of OKS responses, were then compared over 10 years following surgery. Mixed-effects regressions for repeated measures were used to estimate the effect of patient characteristics and type of surgery on PROMs.ResultsFive-hundred and ninety UKAs were matched to the same number of TKAs. Receiving UKA rather than TKA was found to be associated with better scores for OKS, including both its pain and function components, and EQ-5D, with the differences expected to grow over time. UKA was also associated with an increased likelihood of patients achieving a successful outcome, with an increased chance of attaining minimally clinically important improvements in both OKS and EQ-5D, and an ‘excellent’ OKS. In addition, for both procedures, patients aged between 60 and 70 and better pre-operative scores were associated with better post-operative outcomes.ConclusionMinimally invasive UKAs performed on patients with the appropriate indications led to better patient-reported pain and function scores than TKAs performed on comparable patients. UKA can lead to better long-term quality of life than TKA and this should be considered alongside risk of revision when choosing between the procedures.Level of evidenceII.
Burn E, Liddle AD, Hamilton TW, et al., 2018, Cost-effectiveness of unicompartmental compared with total knee replacement: A population-based study using data from the National Joint Registry for England and Wales, BMJ Open, Vol: 8, ISSN: 2044-6055
Objectives To assess the value for money of unicompartmental knee replacement (UKR) compared with total knee replacement (TKR).Design A lifetime Markov model provided the framework for the analysis.Setting Data from the National Joint Registry (NJR) for England and Wales primarily informed the analysis.Participants Propensity score matched patients in the NJR who received either a UKR or TKR.Interventions UKR is a less invasive alternative to TKR, where only the compartment affected by osteoarthritis is replaced.Primary outcome measures Incremental quality-adjusted life years (QALYs) and healthcare system costs.Results The provision of UKR is expected to lead to a gain in QALYs compared with TKR for all age and gender subgroups (male: <60 years: 0.12, 60–75 years: 0.20, 75+ years: 0.19; female: <60 years: 0.10, 60–75 years: 0.28, 75+ years: 0.44) and a reduction in costs (male: <60: £−1223, 60–75 years: £−1355, 75+ years: £−2005; female: <60 years: £−601, 60–75 years: £−935, 75+ years: £−1102 per patient over the lifetime). UKR is expected to lead to a reduction in QALYs compared with TKR when performed by surgeons with low UKR utilisation but an increase among those with high utilisation (<10%, median 6%: −0.04, ≥10%, median 27%: 0.26). Regardless of surgeon usage, costs associated with UKR are expected to be lower than those of TKR (<10%: £−127, ≥10%: £−758).Conclusions UKR can be expected to generate better health outcomes and lower lifetime costs than TKR. Surgeon usage of UKR does, however, have a significant impact on the cost-effectiveness of the procedure. To achieve the best results, surgeons need to perform a sufficient proportion of knee replacements as UKR. Low usage surgeons may therefore need to broaden their indications for UKR.
Sanchez-Santos MT, Garriga C, Judge A, et al., 2018, Development and validation of a clinical prediction model for patient-reported pain and function after primary total knee replacement surgery, Scientific Reports, Vol: 8, ISSN: 2045-2322
To develop and validate a clinical prediction model of patient-reported pain and function after undergoing total knee replacement (TKR). We used data of 1,649 patients from the Knee Arthroplasty Trial who received primary TKR across 34 centres in the UK. The external validation included 595 patients from Southampton University Hospital, and Nuffield Orthopaedic Centre (Oxford). The outcome was the Oxford Knee Score (OKS) 12-month after TKR. Pre-operative predictors including patient characteristics and clinical factors were considered. Bootstrap backward linear regression analysis was used. Low pre-operative OKS, living in poor areas, high body mass index, and patient-reported anxiety or depression were associated with worse outcome. The clinical factors associated with worse outcome were worse pre-operative physical status, presence of other conditions affecting mobility and previous knee arthroscopy. Presence of fixed flexion deformity and an absent or damaged pre-operative anterior cruciate ligament (compared with intact) were associated with better outcome. Discrimination and calibration statistics were satisfactory. External validation predicted 21.1% of the variance of outcome. This is the first clinical prediction model for predicting self-reported pain and function 12 months after TKR to be externally validated. It will help to inform to patients regarding expectations of the outcome after knee replacement surgery.
Hexter AT, Hislop SM, Blunn GW, et al., 2018, The effect of bearing surface on risk of periprosthetic joint infection in total hip arthroplasty: A systematic review and meta-analysis, Bone and Joint Journal, Vol: 100B, Pages: 134-142, ISSN: 2049-4394
AimsPeriprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty (THA). Different bearing surface materials have different surface properties and it has been suggested that the choice of bearing surface may influence the risk of PJI after THA. The objective of this meta-analysis was to compare the rate of PJI between metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), and ceramic-on-ceramic (CoC) bearings.Patients and MethodsElectronic databases (Medline, Embase, Cochrane library, Web of Science, and Cumulative Index of Nursing and Allied Health Literature) were searched for comparative randomized and observational studies that reported the incidence of PJI for different bearing surfaces. Two investigators independently reviewed studies for eligibility, evaluated risk of bias, and performed data extraction. Meta-analysis was performed using the Mantel–Haenzel method and random-effects model in accordance with methods of the Cochrane group.ResultsOur search strategy revealed 2272 studies, of which 17 met the inclusion criteria and were analyzed. These comprised 11 randomized controlled trials and six observational studies. The overall quality of included studies was high but the observational studies were at high risk of bias due to inadequate adjustment for confounding factors. The overall cumulative incidence of PJI across all studies was 0.78% (1514/193 378). For each bearing combination, the overall incidence was as follows: MoP 0.85% (1353/158 430); CoP 0.38% (67/17 489); and CoC 0.53% (94/17 459). The meta-analysis showed no significant difference between the three bearing combinations in terms of risk of PJI.ConclusionOn the basis of the clinical studies available, there is no evidence that bearing choice influences the risk of PJI. Future research, including basic science studies and large, adequately controlled registry studies, may be helpful in determining whether implant materials play a role in determining the ri
Mushtaq N, Liddle AD, Isaac D, et al., 2018, Patient-reported outcomes following single- and multiple-radius total knee replacement: a randomized, controlled trial, Journal of Knee Surgery, Vol: 31, Pages: 87-91, ISSN: 1538-8506
Although single-radius (SR) designs of total knee replacement (TKR) have theoretical benefits, the clinical advantage conferred by such designs is unknown. The aim of this randomized, controlled study was to compare the short-term clinical outcomes of the two design rationales. A total of 105 knees were randomized to receive either a single radius (Scorpio, Stryker; SR Group) or multiple radius (AGC, Zimmer Biomet; MR group) TKR. Patient-reported outcomes (Oxford Knee Score [OKS] and Knee Society Score [KSS]) were collected at 6 weeks, 6 months, and 1 year following surgery. No knees were revised. There was no difference in primary outcomes: OKS was 39.5 (95% confidence interval [CI]: 36.9–42.1) in the SR group and 38.1 (95% CI: 36.0–40.3) in the MR group (p = 0.40). KSS was 168.4 (95% CI: 159.8–177.0) in the SR group; 159.5 (95% CI 150.5–168.5) in the MR group (p = 0.16). There was a small but statistically significant difference in the degree of change of the objective subscale of the KSS, favoring the SR design (p = 0.04), but this is of uncertain clinical relevance. The reported benefits of SR designs do not provide demonstrable functional advantages in the short term.
Burn E, Liddle AD, Hamilton TW, et al., 2017, Choosing between unicompartmental and total knee replacement: what can economic evaluations tell us? A Systematic Review, PharmacoEconomics - Open, Vol: 1, Pages: 241-253, ISSN: 2509-4254
Background and objectivePatients with anteromedial arthritis who require a knee replacement could receive either a unicompartmental knee replacement (UKR) or a total knee replacement (TKR). This review has been undertaken to identify economic evaluations comparing UKR and TKR, evaluate the approaches that were taken in the studies, assess the quality of reporting of these evaluations, and consider what they can tell us about the relative value for money of the procedures.MethodsA search of MEDLINE, EMBASE and the Centre for Reviews and Dissemination National Health Service Economic Evaluation Database was undertaken in January 2016 to identify relevant studies. Study characteristics were described, the quality of reporting and methods assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, and study findings summarised.ResultsTwelve studies satisfied the inclusion criteria. Five were within-study analyses, while another was based on a literature review. The remaining six studies were model-based analyses. All studies were informed by observational data. While methodological approaches varied, studies generally had either limited follow-up, did not fully account for baseline differences in patient characteristics or relied on previous research that did not. The quality of reporting was generally adequate across studies, except for considerations of the settings to which evaluations applied and the generalisability of the results to other decision-making contexts. In the short-term, UKR was generally associated with better health outcomes and lower costs than TKR. Initial cost savings associated with UKR seem to persist over patients’ lifetimes even after accounting for higher rates of revision. For older patients, initial health improvements also appear to be maintained, making UKR the dominant treatment choice. However, for younger patients findings for health outcomes and overall cost effectiveness are mixed, with th
Liddle AD, Carlos Rodriguez-Merchan E, 2017, Evidence-based management of the knee in hemophilia, JBJS Reviews, Vol: 5, ISSN: 2329-9185
» Hemophilia is among the commonest bleeding disordersencountered in orthopaedic practice and results from an Xchromosome-linked failure of coagulation factors VIII (hemophilia A) orIX (hemophilia B).» Morbidity in hemophilia is a result of repeated hemarthroses, and theaim of orthopaedic management is to prevent these, to treat thempromptly, and to address the joint pathology that results.» Both radiosynovectomy and arthroscopic synovectomy are effectivein reducing the degree of synovitis and the number of hemarthroses,although, to our knowledge, there is little evidence that it preventsprogression to end-stage arthritis. There is substantial evidence for thesafety and effectiveness of radiosynovectomy, and this is the first lineof treatment in our practice.» In end-stage disease, total knee arthroplasty is challenging as a resultof severe contractures and is associated with a higher rate ofcomplications such as infection (7% compared with 1% to 2% inosteoarthritis) and need for blood transfusions and a higher revisionrate than that seen in total knee arthroplasty for osteoarthritis.» However, many series of total knee arthroplasty for hemophilia havenow been published, and excellent results can be gained in terms ofpain relief and quality of life.
Carlos Rodriguez-Merchan E, Liddle AD, 2017, Pathogenesis and treatment options for hemophilic synovitis, Expert opinion on orphan drugs, Vol: 5, Pages: 173-179, ISSN: 2167-8707
Introduction: Hemophilia is characterized by recurrent bleeding episodes, most commonly in the knees, elbows and ankles. Repeated hemarthroses lead to synovial hypertrophy and a vicious cycle of chronic synovitis arises, leading to destruction of the joint.Areas covered: This article covers the pathogenesis of chronic hemophilic synovitis and its treatment by means of different types of synovectomy.Expert opinion: Both radiosynovectomy (RS) and arthroscopic synovectomy considerably improve the frequency of bleeding episodes. RS is the best option for patients with synovitis unresponsive to a three-month trial of hematological prophylaxis. If the bleeding is refractory to three successive episodes of RS at six monthly intervals, arthroscopic synovectomy is indicated. Open synovectomy should be reserved for adults with elbow synovitis requiring radial head removal and synovectomy in the same surgical session. RS is effective and safe, and particularly helpful in patients with inhibitors as they are at greatest risk of bleeding episodes and have the highest risk of complications of surgery.
Kumar V, Pandit HG, Liddle AD, et al., 2017, Comparison of outcomes after UKA in patients with and without chondrocalcinosis: a matched cohort study, KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol: 25, Pages: 319-324, ISSN: 0942-2056
We recently published a paper comparing the incidence of adverse outcomes after unicompartmental and total knee arthroplasty (UKA and TKA). The conclusion of this study, which was in favour of UKA, was dismissed as “biased” in a review in Bone & Joint 360.Although this study is one of the least biased comparisons of UKA and TKA, this episode highlights the biases that exist both for and against UKA. In this review, we explore the different types of bias, particularly selection, reporting and measurement. We conclude that comparisons between UKA and TKA are open to bias. These biases can be so marked, particularly in comparisons based just on national registry data, that the conclusions can be misleading. For a fair comparison, data from randomised studies or well-matched, prospective observational cohort studies, which include registry data, are required, and multiple outcome measures should be used. The data of this type that already exist suggest that if UKA is used appropriately, compared with TKA, its advantages outweigh its disadvantages.
Liddle AD, 2016, Patellar resurfacing after endoprosthetic replacement for primary or secondary bone tumors, Annals of Translational Medicine, Vol: 4, ISSN: 2305-5839
Pandit H, Spiegelberg B, Clavé A, et al., 2016, Aetiology of lateral progression of arthritis following Oxford medial unicompartmental knee replacement: a case-control study, Musculoskeletal Surgery, Vol: 100, Pages: 97-102, ISSN: 2035-5106
PURPOSE: The aim of this case-control study is to assess for predictive factors that may determine development of lateral compartment progression after Oxford medial unicompartmental knee replacement. METHODS: Twenty-eight patients who were revised as a result of lateral osteoarthritis progression were matched to 52 alive and unrevised patients. Body mass index, intra-operative findings, postoperative leg alignment, meniscal bearing size and histological findings have been analysed. Radiological analysis was carried out on the immediate postoperative radiographs by two blinded observers to assess the severity of arthritis in the lateral compartment. The measurements of the components positions were converted into binary figures as to whether they were inside or outside the recommended limits for analysis. Conditional logistic regression was used to identify important predictors of progression, taking into account the case-control grouping. RESULTS: The results shows that the condition of the lateral compartment is a significant predictor for developing subsequent lateral compartment arthrosis (OR 2.627, p = 0.019). The study showed no relationship between progression of arthritis and component position (OR [0.5-1.18], p [0.21-1]). Nor have it demonstrated that BMI (OR 1.06, p = 0.61), postoperative leg alignment (OR 1.26, p = 0.636), meniscal bearing size (1.32, p = 0.307) or presence of chondrocalcinosis (OR 0.35, p = 0.36) have any association with lateral osteoarthritis progression. CONCLUSIONS: This study showed the importance of excluding radiographic evidence of lateral compartment osteoarthritis on the preoperative radiograph prior to medial unicompartmental knee replacement. We have not been able to show any relationship between progression of arthritis and component position. Level of proof Case-control study, level III.
Ali AM, Pandit H, Liddle AD, et al., 2016, Does activity affect the outcome of the Oxford unicompartmental knee replacement?, KNEE, Vol: 23, Pages: 327-330, ISSN: 0968-0160
Liddle AD, Pandit H, Judge A, et al., 2016, Effect of surgical caseload on revision rate following total and unicompartmental knee replacement, Journal of Bone and Joint Surgery: American Volume, Vol: 98, Pages: 1-8, ISSN: 0021-9355
Background: High-volume surgeons attain the best results following unicompartmental knee replacement (UKR), but the exact relationship between caseload and outcome is not clear. It is not known whether this effect is due to patient selection or surgical skill nor whether a similar effect is seen in total knee replacement (TKR). The aim of this study was to quantify the effect of surgical caseload on survival of both TKR and UKR.Methods: This study was based on 459,280 patient records (422,149 TKRs and 37,131 UKRs) from the National Joint Registry for England and Wales. The caseload-outcome relationship was characterized graphically and quantified using regression techniques. Patient selection was compared among high, medium, and low-volume surgeons. Prosthetic survival was compared between UKRs (performed by high, medium, and low-volume surgeons) and matched TKRs.Results: Caseload affected survival of TKR and, more strongly, of UKR. The revision rate following UKR dropped steeply until the volume reached ten cases per year, plateauing at thirty cases. For surgeons performing fewer than ten UKRs per year, the mean eight-year rate of survival of the UKRs was 87.9% (95% confidence interval [CI] = 86.9% to 88.8%) compared with 92.4% (95% CI = 90.9% to 93.6%) for those who performed thirty UKRs or more per year. Analysis of the TKRs showed a linear decrease in revision rate as caseload increased (hazard ratio [HR] for revision = 0.99 [95% CI = 0.98 to 0.99] for every five-case increase in caseload). Surgeons who performed a lower volume of UKRs tended to operate on younger and healthier patients and were more likely to perform revisions to treat loosening and pain. After matching of patients who had undergone UKR with those who had undergone TKR, the surgeons who performed a high volume of UKRs were found to have an eight-year revision/revision rate similar to that seen after TKR (HR for revision or reoperation = 1.10 [95% CI = 0.99 to 1.22] favoring TKR).Conclusions: Th
Rodríguez-Merchán EC, Liddle AD, 2016, Preface, ISBN: 9783319418070
This book offers a comprehensive overview of the basic science and clinical evidence for non-arthroplasty interventions in the adult knee. It aims to cover all aspects of joint-preserving knee surgery, from injectable therapies such as platelet-rich plasma and stem cell therapies to surgical interventions such as meniscal repair and replacement, ligament reconstructions, and osteotomies. Following discussion of clinical assessment and imaging, individual chapters focus on specific clinical problems, including patellofemoral joint disorders, chondral injuries, and bone tumors. For each condition, a thorough overview is provided, describing clinical assessment, management (including surgical and non-surgical methods), and novel therapies. The contributors are experts in their fields from across Europe and are drawn from the worlds of clinical and academic orthopedic surgery. This book is unique in its coverage of the entire span of non-arthroplasty knee surgery and its focus on both clinical and basic science aspects. It will be helpful for knee surgeons and those engaged in research on knee-related topics, but also for students and other physicians involved in the care of patients with disorders of the knee.
Liddle AD, Rodríguez-Merchán EC, 2016, The anterior cruciate ligament, Joint Preservation in the Adult Knee, Pages: 75-90, ISBN: 9783319418070
The anterior cruciate ligament (ACL) is the most common surgically treated ligament rupture in the adult knee. Disruption of the ACL has important consequences for knee kinematics, activities of daily living, return to sport and progression to symptomatic knee osteoarthritis in later life. While reconstructive procedures have good evidence for improving symptoms following ACL rupture, there is no strong evidence that reconstruction prevents osteoarthritis and selection of patients for reconstruction should be made on the basis of their clinical picture. Several controversies persist regarding surgical technique, including the use of single- or double-bundle techniques, the method of fixation and the selection of appropriate graft material. In this chapter, we discuss the natural history of ACL rupture, the evidence base for surgical interventions and the long-term outcomes of ACL reconstruction.
Liddle AD, Rodríguez-Merchán EC, 2016, Tendon injuries of the knee, Joint Preservation in the Adult Knee, Pages: 55-63, ISBN: 9783319418070
Tendon injuries are common in the knee. The most commonly affected structure is the extensor mechanism. The main pathologies are tendonitis of the patella and ruptures of the patellar and quadriceps tendons, although other tendonopathies have rarely been described around the knee. Patellar tendinopathy can be difficult to treat, but the mainstay of treatment is physiotherapy, with injectable and surgical treatment reserved for recalcitrant cases. The diagnosis of quadriceps and patellar tendon ruptures requires a high index of suspicion and thorough history-taking to assess for medical comorbidities that may predispose patients to tendon degeneration. Radiographic assessment with plain films supplemented by ultrasonography (US) and magnetic resonance imaging (MRI) when the diagnosis is equivocal further aids diagnosis, however, advanced imaging is often unnecessary in patients with functional extensor mechanism defi- cits. Acute repair is preferred, and transpatellar bone tunnels serve as the primary form of fixation when the tendon rupture occurs at the patellar insertion, with or without augmentation depending on surgeon preference. Chronic tears are special cases requiring reconstructions with allograft, synthetic grafts or autograft. Rehabilitation protocols generally allow immediate weight-bearing with the knee locked in extension and crutch support. Limited arc motion is started early with active flexion and passive extension and then advanced progressively, followed by full active range of motion and strengthening. Complications are few but include quadriceps atrophy, heterotopic ossification, infection, stiffness and rerupture. Outcomes are excellent if repair is done acutely, with poorer outcomes associated with delayed repair.
Murray DW, Liddle AD, Dodd CAF, et al., 2015, Unicompartmental knee arthroplasty: is the glass half full or half empty? (vol 97, pg 3, 2015), BONE & JOINT JOURNAL, Vol: 97B, Pages: 1732-1732, ISSN: 2049-4394
Liddle AD, Pandit H, Judge A, et al., 2015, Optimal usage of unicompartmental knee arthroplasty, BONE & JOINT JOURNAL, Vol: 97B, Pages: 1506-1511, ISSN: 2049-4394
Murray DW, Liddle AD, Dodd CAF, et al., 2015, Unicompartmental knee arthroplasty: is the glass half full or half empty?, Bone and Joint Journal, Vol: 97-B, Pages: 3-8, ISSN: 2049-4394
There is a large amount of evidence available about the relative merits of unicompartmental and total knee arthroplasty (UKA and TKA). Based on the same evidence, different people draw different conclusions and as a result, there is great variability in the usage of UKA.The revision rate of UKA is much higher than TKA and so some surgeons conclude that UKA should not be performed. Other surgeons believe that the main reason for the high revision rate is that UKA is easy to revise and, therefore, the threshold for revision is low. They also believe that UKA has many advantages over TKA such as a faster recovery, lower morbidity and mortality and better function. They therefore conclude that UKA should be undertaken whenever appropriate.The solution to this argument is to minimise the revision rate of UKA, thereby addressing the main disadvantage of UKA. The evidence suggests that this will be achieved if surgeons use UKA for at least 20% of their knee arthroplasties and use implants that are appropriate for these broad indications.
Liddle AD, Carlos Rodriguez-Merchan E, 2015, Platelet-Rich Plasma in the Treatment of Patellar Tendinopathy: A Systematic Review, AMERICAN JOURNAL OF SPORTS MEDICINE, Vol: 43, Pages: 2583-2590, ISSN: 0363-5465
Liddle AD, Pandit H, Judge A, et al., 2015, Patient-reported outcomes after total and unicompartmental knee arthroplasty A STUDY OF 14 076 MATCHED PATIENTS FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND AND WALES, BONE & JOINT JOURNAL, Vol: 97B, Pages: 793-801, ISSN: 2049-4394
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