The Microbiology of Knee Prosthetic Joint Infection and its Influence on Persistent Infection.

Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a severe complication causing a significant burden. The study aims were to establish the epidemiology of microorganisms in TKA PJI, the rate of persistent infection requiring further surgery, and the risk factors for this. Microbiological specimens between June 2002 and March 2017 at five regional hospital sites were identified with revision TKA procedures in the National Joint Replacement Registry.

Magnetic Resonance Imaging Assessment of Hamstring Graft Healing and Integration 1 and Minimum 2 Years after ACL Reconstruction.

Background: An increase has been seen in the number of studies of anterior cruciate ligament reconstruction (ACLR) that use magnetic resonance imaging (MRI) as an outcome measure and proxy for healing and integration of the reconstruction graft. Despite this, the MRI appearance of a steady-state graft and how long it takes to achieve such an appearance have not yet been established.

Purpose: To establish whether a hamstring tendon autograft for ACLR changes in appearance on MRI scans between 1 and 2 years and whether this change affects a patient's ability to return to sports.

Total Knee Arthroplasty in a Transtibial Amputee.

Introduction: With the diversity of prosthetic components patients with a transtibial amputation can now expect to return to high function. Subsequently, the ipsilateral knee is at risk of developing osteoarthritis with a need for a provision of total knee arthroplasty (TKA).

Case Report: We describe a novel technique for TKA in a transtibial amputee utilizing navigation with a tibial jig.

Adjustable suspension versus hybrid fixation in hamstring autograft anterior cruciate ligament reconstruction.

Background: There has been increased use of adjustable suspensory fixation (ASF) for anterior cruciate ligament reconstruction (ACLR). Potential benefits are the ability to use a shorter graft and to prevent graft displacement and damage. The purpose of this study was to establish the efficacy of this fixation method and assess whether it leads to less tunnel widening, and avoids known complications of screw fixation.

One-Stage Sequential Bilateral Total Knee Arthroplasty: An Effective Treatment for Advanced Bilateral Knee Osteoarthritis Providing High Patient Satisfaction.

Background: The mortality and risks of bilateral total knee arthroplasty (BTKA) have been reported to be far greater than in unilateral total knee arthroplasty (UTKA). This study aimed to determine whether this remains the case using contemporary anesthetic and surgical techniques for one-stage single anesthetic sequential BTKA.

Methods: Two cohorts of 394 patients were created by propensity matching for gender, age, body mass index, American Society of Anesthesiologists grade, and Veterans Rand-12 health survey scores.

Lack of agreement between computer navigation and post-operative 2-dimensional computed tomography (CT) measurements for component and limb alignment in total knee arthroplasty (TKA).

Background: The purpose of this study was to assess the degree of mismatch between intraoperative navigation data using imageless computer navigation and post-operative CT scan measurements with respect to bone cuts, component and limb alignment during TKA.

Methods: Intraoperative navigation data including bone cut verification and overall limb alignment during TKA was compared to postoperative CT measurements of component and limb alignment according to the Perth protocol. The proportion of cases with mismatch between navigation and CT measurements at two and three degree thresholds was identified.

Patient-specific instrumentation for total knee arthroplasty does not match the pre-operative plan as assessed by intra-operative computer-assisted navigation.

Purpose: The introduction of patient-specific instruments (PSI) for guiding bone cuts could increase the incidence of malalignment in primary total knee arthroplasty. The purpose of this study was to assess the agreement between one type of patient-specific instrumentation (Zimmer PSI) and the pre-operative plan with respect to bone cuts and component alignment during TKR using imageless computer navigation.

Methods: A consecutive series of 30 femoral and tibial guides were assessed in-theatre by the same surgeon using computer navigation.

Incidence and severity of complications due to femoral nerve blocks performed for knee surgery.

Background: While single shot femoral nerve blocks and indwelling femoral nerve catheters provide significant peri-operative analgesia, there are small but serious risks of neurovascular complications. We aimed to determine the incidence and characterise the nature of neural complications arising from femoral nerve blocks performed for knee surgery.

Methods: One thousand eight hundred and two patients receiving a femoral nerve block for knee surgery during the study period were screened.

Unsatisfactory accuracy as determined by computer navigation of VISIONAIRE patient-specific instrumentation for total knee arthroplasty.

This investigation evaluated the Smith and Nephew VISIONAIRE patient-specific cutting block (PSCB) system for total knee arthroplasty. A consecutive series of 60 patients was recruited. Intraoperative computer navigation was used to evaluate the accuracy of the cutting blocks in the coronal and sagittal planes for the tibia, as well as rotational plane for the femur.

Is femoral nerve block necessary during total knee arthroplasty?: a randomized controlled trial.

There remains a lack of randomized controlled trials comparing methods of perioperative analgesia for total knee arthroplasty. To address this deficiency, a blinded, randomized controlled trial was conducted to compare the use of femoral nerve block (group F) and local anesthetic (group L). A sample of 55 patients who met the inclusion criteria were randomized to either group.

Sagittal placement of the femoral component in total knee arthroplasty predicts knee flexion contracture at one-year follow-up.

Purpose: Flexion contracture has been shown to impair function and reduce satisfaction following total knee arthroplasty (TKA). The aim of this study was to identify modifiable intra-operative variables that predict post-TKA knee extension.

Methods: Data was collected prospectively on 95 patients undergoing total knee arthroplasty, including pre-operative assessment, intra-operative computer assisted surgery (CAS) measurements and functional outcome including range of motion at one year.

Tibial fixation in anterior cruciate ligament reconstruction: a prospective randomized study comparing metal interference screw and staples with a centrally placed polyethylene screw and sheath.

Background: The use of hamstring tendons for anterior cruciate ligament reconstruction has increased in popularity over recent years. However, concerns with the stability of graft fixation on the tibial side remain. Centrally placed interference screw/sheath implants have demonstrated promising results in biomechanical studies.

Articular cartilage changes in patients with osteoarthritis after osteotomy.

Background: High tibial osteotomy (HTO) is a method used to treat medial compartmental osteoarthritis in the knee. The realignment of the knee changes the loading patterns within the joint and may allow for regeneration of articular cartilage. Magnetic resonance imaging methods can be used to assess the quality of the regenerated cartilage.

The accuracy of magnetic resonance imaging scanning and its influence on management decisions in knee surgery.

Purpose: The purpose of our study was to evaluate the impact of preoperative magnetic resonance imaging (MRI) assessment of articular knee pathology on the clinical management of patients presenting with joint line pain.

Methods: A preliminary study on 100 patients was performed to assess the accuracy of specific MRI sequences, using arthroscopy as a gold standard. Six hundred and eighteen consecutive patients with knee symptoms presenting to 2 specialist knee surgeons were then recruited.

Safety of combined use of local anesthetic infiltration and reinfusion drains in total knee arthroplasty.

Injection of local anesthetic during total knee arthroplasty (TKA) has been shown to aid postoperative pain relief. Reinfusion drains have also proven useful in decreasing allogenic blood transfusion. Combined use carries the risk of reinfusion of local anesthetic from drainage bag.

Reliability of bony landmarks for restoration of the joint line in revision knee arthroplasty.

The aim of this study was to determine the reliability of bone landmarks for restoring the joint line in revision knee arthroplasty. The relationship of the femoral epicondyles, the tibial tubercle (TT) and the fibular head (FH) to the joint line was measured on 200 magnetic resonance imaging (MRI, 100 females, 100 males), including assessment on intraobserver and interobserver reliability. MRI scans demonstrating chondral lesions and osteoarthritis were excluded, as were patients with immature skeletons or a history of previous knee surgery.

Posterior cruciate ligament deficiency: biomechanical and biological consequences and the outcomes of conservative treatment. A systematic review.

The objective of the study was to evaluate the biomechanical and biological consequences of posterior cruciate ligament deficiency, determine compensatory mechanisms and assess the efficacy of non-operative treatment. Medline, CINAHL, SPORTdiscus, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews were searched at 30th October 2006 for the terms "PCL" and "posterior cruciate ligament" both independently and including the terms "injury", "deficiency" and "insufficiency". Literature searches identified 598 potentially relevant articles, after exclusions there were 47 articles that fulfilled the inclusion criteria: 30 articles analyzing PCL deficiency and 17 studies on the outcomes for non-operative treatment.

Spinal cord injuries in Australian footballers 1997-2002.

Objective: To review acute spinal cord injuries (ASCIs) in all Australian codes of football (rugby union [RU], rugby league [RL], Australian Rules football [ARF] and soccer) for 1997-2002 and to compare data with those of a 1986-1996 survey.

Design: Retrospective review of hospital records, and structured interviews with injured players.

Participants And Setting: Patients admitted to any of the six Australian spinal cord injury units with a documented football-related ASCI over the period 1997-2002.