Publications
87 results found
Liddle AD, Judge A, Pandit H, et al., 2015, Adverse outcomes after total and unicompartmental knee replacement in 101330 matched patients: a study of data from the National Joint Registry for England and Wales (vol 384, pg 1437, 2014), LANCET, Vol: 385, Pages: 774-774, ISSN: 0140-6736
- Author Web Link
- Cite
- Citations: 1
Liddle AD, Judge A, Pandit H, et al., 2015, Response to Letter to the Editor: 'Paper validates previous registry unicompartmental knee analyses', OSTEOARTHRITIS AND CARTILAGE, Vol: 23, Pages: 329-330, ISSN: 1063-4584
Liddle AD, Judge A, Pandit H, et al., 2014, Adverse outcomes after total and unicompartmental knee replacement in 101 330 matched patients: a study of data from the National Joint Registry for England and Wales, Lancet, Vol: 384, Pages: 1437-1445, ISSN: 0140-6736
BackgroundTotal knee replacement (TKR) or unicompartmental knee replacement (UKR) are options for end-stage osteoarthritis. However, comparisons between the two procedures are confounded by differences in baseline characteristics of patients undergoing either procedure and by insufficient reporting of endpoints other than revision. We aimed to compare adverse outcomes for each procedure in matched patients.MethodsWith propensity score techniques, we compared matched patients undergoing TKR and UKR in the National Joint Registry for England and Wales. The National Joint Registry started collecting data in April 1, 2003, and is continuing. The last operation date in the extract of data used in our study was Aug 28, 2012. We linked data for multiple potential confounders from the National Health Service Hospital Episode Statistics database. We used regression models to compare outcomes including rates of revision, revision/reoperation, complications, readmission, mortality, and length of stay.Findings25 334 UKRs were matched to 75 996 TKRs on the basis of propensity score. UKRs had worse implant survival both for revision (subhazard ratio [SHR] 2·12, 95% CI 1·99–2·26) and for revision/reoperation (1·38, 1·31–1·44) than TKRs at 8 years. Mortality was significantly higher for TKR at all timepoints than for UKR (30 day: hazard ratio 0·23, 95% CI 0·11–0·50; 8 year: 0·85, 0·79–0·92). Length of stay, complications (including thromboembolism, myocardial infarction, and stroke), and rate of readmission were all higher for TKR than for UKR.InterpretationIn decisions about which procedure to offer, the higher revision/reoperation rate of UKR than of TKR should be balanced against a lower occurrence of complications, readmission, and mortality, together with known benefits for UKR in terms of postoperative function. If 100 patients receiving TKR received UKR instead, the re
, 2014, Determinants of revision and functional outcome following unicompartmental knee replacement, Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society, Vol: 22, Pages: 1241-1250
Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved. OBJECTIVE: Unicompartmental Knee Replacement (UKR) has important advantages over total knee replacement (TKR) but has a higher revision rate. Outcomes vary between centres, suggesting that risk factors for revision may be modifiable with changes to patient selection or operative technique. The objective of this study was to determine factors affecting revision, patient-reported outcome and satisfaction following UKR. METHOD: 25,982 cases from three national databases were analysed. Multilevel multivariable regression models were used to examine the effect of patient and surgical factors on implant survival, patient-reported outcome and satisfaction at 6 months and 8 years following UKR. RESULTS: Of the 25,982 cases, 3862 (14.9%) had pre-operative and 6-month Oxford Knee Scores (OKS). Eight-year survival was 89.1% (95% confidence intervals (CI) 88.3-89.9). OKS increased from 21.9 (SD 7.6) to 37.5 (SD 9.5). Age (Hazard ratio (HR) 0.96 (95% CI 0.96-0.97) per year), male gender (HR 0.86 (95% CI 0.76-0.96)), unit size (HR 0.92 (95% CI 0.86-0.97) per case up to 40 cases/year) and operating surgeon grade (HR 0.78 (95% CI 0.67-0.91) if consultant) predicted improved implant survival. Older patients (≥ 75 years), and those with lower deprivation levels had superior OKS and satisfaction (adjusted mean difference 0.14 (95% CI 0.09-0.20) points per year of age and 0.93 (95% CI 0.60-1.27) per quintile of deprivation). Ethnicity, anxiety and co-morbidities also affected patient-reported outcome. CONCLUSIONS: This study has identified important predictors of revision and patient-reported outcome following UKR. Older patients, who are least likely to be offered UKR, may derive the greatest benefits. Improved understanding of these factors may improve the long-term outcomes of UKR.
Liddle AD, Judge A, Pandit H, et al., 2014, Determinants of revision and functional outcome following unicompartmental knee replacement, OSTEOARTHRITIS AND CARTILAGE, Vol: 22, Pages: 1241-1250, ISSN: 1063-4584
- Author Web Link
- Cite
- Citations: 42
Durrani SK, Noble PC, Sampson B, et al., 2014, Changes in blood ion levels after removal of metal-on-metal hip replacements: 16 patients followed for 0-12 months, Acta Orthopaedica, Vol: 85, Pages: 259-265, ISSN: 1745-3674
Background and purpose — In patients with metal-on-metal (MoM) hip prostheses, pain and joint effusions may be associated with elevated blood levels of cobalt and chromium ions. Since little is known about the kinetics of metal ion clearance from the body and the rate of resolution of elevated blood ion levels, we examined the time course of cobalt and chromium ion levels after revision of MoM hip replacements.Patients and methods — We included 16 patients (13 female) who underwent revision of a painful MoM hip (large diameter, modern bearing) without fracture or infection, and who had a minimum of 4 blood metal ion measurements over an average period of 6.1 (0–12) months after revision.Results — Average blood ion concentrations at the time of revision were 22 ppb for chromium and 43 ppb for cobalt. The change in ion levels after revision surgery varied extensively between patients. In many cases, over the second and third months after revision surgery ion levels decreased to 50% of the values measured at revision. Decay of chromium levels occurred more slowly than decay of cobalt levels, with a 9% lag in return to normal levels. The rate of decay of both metals followed second-order (exponential) kinetics more closely than first-order (linear) kinetics.Interpretation — The elimination of cobalt and chromium from the blood of patients who have undergone revision of painful MoM hip arthroplasties follows an exponential decay curve with a half-life of approximately 50 days. Elevated blood levels of cobalt and chromium ions can persist for at least 1 year after revision, especially in patients with high levels of exposure.
Sanchez-Santos MT, Judge A, Batra RN, et al., 2014, A CLINICAL TOOL FOR THE PREDICTION OF PATIENT-REPORTED OUTCOMES AFTER KNEE REPLACEMENT SURGERY, World Congress of the Osteoarthritis-Research-Society-International (OARSI), Publisher: ELSEVIER SCI LTD, Pages: S412-S412, ISSN: 1063-4584
Liddle AD, Pandit HG, Jenkins C, et al., 2014, Valgus subsidence of the tibial component in cementless Oxford unicompartmental knee replacement, BONE & JOINT JOURNAL, Vol: 96B, Pages: 345-349, ISSN: 2049-4394
- Author Web Link
- Cite
- Citations: 21
Leonard HAC, Liddle AD, Burke O, et al., 2014, Single- or Two-stage Revision for Infected Total Hip Arthroplasty? A Systematic Review of the Literature, CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, Vol: 472, Pages: 1036-1042, ISSN: 0009-921X
- Author Web Link
- Cite
- Citations: 122
Liddle AD, Pandit HG, Jenkins C, et al., 2014, Valgus subsidence of the tibial component in cementless Oxford unicompartmental knee replacement, Bone and Joint Journal, Vol: 96 B, Pages: 345-349
The cementless Oxford unicompartmental knee replacement has been demonstrated to have superior fixation on radiographs and a similar early complication rate compared with the cemented version. However, a small number of cases have come to our attention where, after an apparently successful procedure, the tibial component subsides into a valgus position with an increased posterior slope, before becoming well-fixed. We present the clinical and radiological findings of these six patients and describe their natural history and the likely causes. Two underwent revision in the early post-operative period, and in four the implant stabilised and became well-fixed radiologically with a good functional outcome. This situation appears to be avoidable by minor modifications to the operative technique, and it appears that it can be treated conservatively in most patients. © 2014 The British Editorial Society of Bone & Joint Surgery.
Liddle AD, Pandit H, Jenkins C, et al., 2013, Preoperative pain location is a poor predictor of outcome after Oxford unicompartmental knee arthroplasty at 1 and 5 years, KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol: 21, Pages: 2421-2426, ISSN: 0942-2056
- Author Web Link
- Cite
- Citations: 14
Liddle AD, Judge A, Murray DW, et al., 2013, Comment on Chen et al.: Patellar resurfacing versus nonresurfacing in total knee arthroplasty: a meta-analysis of randomised controlled trials, INTERNATIONAL ORTHOPAEDICS, Vol: 37, Pages: 2103-2103, ISSN: 0341-2695
Pandit H, Liddle AD, Kendrick BJL, et al., 2013, Improved Fixation in Cement less Unicompartmental Knee Replacement Five-Year Results of a Randomized Controlled Trial, JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, Vol: 95A, Pages: 1365-1372, ISSN: 0021-9355
- Author Web Link
- Cite
- Citations: 58
Mellon SJ, Liddle AD, Pandit H, 2013, Hip replacement: Landmark surgery in modern medical history, MATURITAS, Vol: 75, Pages: 221-226, ISSN: 0378-5122
- Author Web Link
- Cite
- Citations: 23
Liddle AD, Pandit H, Murray DW, et al., 2013, Cementless Unicondylar Knee Arthroplasty, ORTHOPEDIC CLINICS OF NORTH AMERICA, Vol: 44, Pages: 261-+, ISSN: 0030-5898
- Author Web Link
- Cite
- Citations: 14
Liddle AD, Pegg EC, Pandit H, 2013, Knee replacement for osteoarthritis, MATURITAS, Vol: 75, Pages: 131-136, ISSN: 0378-5122
- Author Web Link
- Cite
- Citations: 26
Liddle AD, Satchithananda K, Henckel J, et al., 2013, Revision of metal-on-metal hip arthroplasty in a tertiary center: A prospective study of 39 hips with between 1 and 4 years of follow-up, Acta Orthopaedica, Vol: 84, Pages: 237-245, ISSN: 1745-3674
Background and purpose Operative findings during revision of metal-on-metal hip arthroplasty (MOMHA) vary widely and can involve massive soft tissue and bone disruption. As a result, planning of theater time and resources is difficult, surgery is challenging, and outcomes are often poor. We describe our experience with revision of MOMHA and provide recommendations for management.Patients and methods We present the findings and outcomes of 39 consecutive MOMHAs (in 35 patients) revised in a tertiary unit (median follow-up time 30 (12–54) months). The patients underwent a preoperative work-up including CT, metal artifact reduction sequence (MARS) MRI, and blood metal ion levels.Results We determined 5 categories of failure. 8 of 39 hips had conventional failure mechanisms including infection and impingement. Of the other 31 hips, 14 showed synovitis without significant disruption of soft tissue; 6 had a cystic pseudotumor with significant soft tissue disruption; 7 had significant osteolysis; and 4 had a solid pseudotumor. Each category of failure had specific surgical hazards that could be addressed preoperatively. There were 2 reoperations and 1 patient (2 hips) died of an unrelated cause. Median Oxford hip score (OHS) was 37 (9–48); median change (ΔOHS) was 17 (–10 to 41) points. ΔOHS was similar in all groups—except those patients with solid pseudotumors and those revised to metal-on-metal bearings, who fared worse.Interpretation Planning in revision MOMHA is aided by knowledge of the different categories of failure to enable choice of appropriate personnel, theater time, and equipment. With this knowledge, satisfactory outcomes can be achieved in revision of metal-on-metal hip arthroplasty.
Liddle AD, Pandit H, O'Brien S, et al., 2013, Cementless fixation in Oxford unicompartmental knee replacement A MULTICENTRE STUDY OF 1000 KNEES, BONE & JOINT JOURNAL, Vol: 95B, Pages: 181-187, ISSN: 2049-4394
- Author Web Link
- Cite
- Citations: 67
Liddle AD, Pandit H, Murray DW, et al., 2012, Unicompartmental knee arthroplasty: state of the art and future developments, Archivio di Ortopedia e Reumatologia, Vol: 123, Pages: 31-33, ISSN: 0390-7368
Liddle AD, Abram S, Iyer S, et al., 2012, prosthetic joint infection associated with undiagnosed colonic malignancy, KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol: 20, Pages: 1069-1070, ISSN: 0942-2056
- Author Web Link
- Cite
- Citations: 5
Hart AJ, Satchithananda K, Liddle AD, et al., 2012, Pseudotumors in Association with Well-Functioning Metal-on-Metal Hip Prostheses A Case-Control Study Using Three-Dimensional Computed Tomography and Magnetic Resonance Imaging, JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, Vol: 94A, Pages: 317-325, ISSN: 0021-9355
- Author Web Link
- Cite
- Citations: 232
Nanidis TG, Majed A, Liddle AD, et al., 2010, Conservative versus Operative Management of Complex Proximal Humeral Fractures: A Meta-analysis, Shoulder and Elbow, Vol: 2, Pages: 166-174, ISSN: 1758-5732
Background: The optimal management of complex proximal humeral fractures is debatable. The present study uses meta-analytical techniques to compare conservative and operative management of proximal humeral fractures with respect to morbidity and functional outcomes. Methods: Studies published between 1970 and 2007 comparing conservative and operative treatment of proximal humeral fractures were included. The end points evaluated were morbidity and functional outcomes. A random effects model was used and sensitivity analysis was performed to account for bias in patient selection. Results: Ten studies matched the selection criteria, reporting on 486 patients. Two hundred and nineteen (45%) were managed conservatively, 174 (36%) underwent operative fixation and 93 (19%) underwent hemiarthroplasty. Mean follow-up ranged from 6 months to 156 months. No significant difference was demonstrated in post-treatment Constant scores (weighted mean difference = 1.62, –7.12, 10.36), rate of avascular necrosis [odds ratio (OR) = 0.92, confidence interval (CI) = 0.37–2.30] ongoing pain or non-union (OR = 1.28, CI = 0.11–15.46) between the groups. These findings remained consistent when considering studies matched for three- and four-part fractures and fracture dislocations. Conclusion: On the basis of available comparative data, there is no demonstrable difference in outcomes between fractures managed surgically or conservatively. There is a need for large, randomised trials to guide management of these fractures.
Liddle AD, Imbuldeniya AM, Hunt DM, 2008, Transphyseal reconstruction of the anterior cruciate ligament in prepubescent children, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, Vol: 90B, Pages: 1317-1322, ISSN: 0301-620X
- Author Web Link
- Cite
- Citations: 61
Liddle AD, Rosenfeld PF, 2008, Locked second metatarsal head fracture: A case report, FOOT & ANKLE INTERNATIONAL, Vol: 29, Pages: 1054-1056, ISSN: 1071-1007
- Author Web Link
- Cite
- Citations: 4
Liddle AD, Anderson DR, Mishra PK, 2008, Intrapericardial teratoma presenting in fetal life: intrauterine diagnosis and neonatal management., Congenit Heart Dis, Vol: 3, Pages: 449-451
Intrapericardial teratoma is a rare and often fatal germ-cell tumor of neonates. It is usually histologically benign but may cause death in utero by hydrops fetalis or by pericardial tamponade in the early days of life. The etiology of these tumors is uncertain, but resection appears to be curative. However, these tumours present a challenge in terms of prenatal management. The prevention or adequate management of hydrops fetalis is essential for the gestation to proceed to term, at which point it can be managed successfully with surgical resection. We present a case of intrapericardial teratoma, diagnosed in utero on ultrasound screening and managed both prenatally by laser decompression in utero and surgically in the first days of life.
Munz Y, Almoudaris AM, Moorthy K, et al., 2007, Curriculum-based solo virtual reality training for laparoscopic intracorporeal knot tying: objective assessment of the transfer of skill from virtual reality to reality, AMERICAN JOURNAL OF SURGERY, Vol: 193, Pages: 774-783, ISSN: 0002-9610
- Author Web Link
- Cite
- Citations: 85
Liddle AD, Davies AH, 2007, Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices, PHLEBOLOGY, Vol: 22, Pages: 100-104, ISSN: 0268-3555
- Author Web Link
- Cite
- Citations: 59
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.