Standard of care and outcomes for Māori patients with neck of femur fractures - an Australia & New Zealand Hip Fracture Registry (ANZHFR) study.

Background: This study aimed to compare the demographic differences between Māori and NZ Europeans with neck of femur fracture (NOF), identify any differences in management, surgical and post-op care and outcomes.

Methods: All cases in New Zealand between 2018 and 2020 were collected from the Australia & New Zealand Hip Fracture Registry (ANZHFR). Basic demographics, management factors, and surgical factors were collected.

No Difference in 10-year Clinical or Radiographic Outcomes Between Kinematic and Mechanical Alignment in TKA: A Randomized Trial.

Background: There is continuing debate about the ideal philosophy for component alignment in TKA. However, there are limited long-term functional and radiographic data on randomized comparisons of kinematic alignment versus mechanical alignment.

Questions/purposes: We present the 10-year follow-up findings of a single-center, multisurgeon randomized controlled trial (RCT) comparing these two alignment philosophies in terms of the following questions: (1) Is there a difference in PROM scores? (2) Is there a difference in survivorship free from revision or reoperation for any cause? (3) Is there a difference in survivorship free from radiographic loosening?

Methods: Ninety-nine patients undergoing primary TKA for osteoarthritis were randomized to either the mechanical alignment (n = 50) or kinematic alignment (n = 49) group.

Previous arthroscopy does not decrease survivorship or functional outcomes for unicompartmental knee arthroplasty patients.

Introduction: Arthroscopic procedures for osteoarthritis (OA), in particular arthroscopic meniscectomy, have poorer long-term clinical outcomes compared to those managed non-operatively. In addition, previous arthroscopy is associated with worse outcomes following subsequent total knee arthroplasty (TKA), however there is limited data on the impact on subsequent unicompartmental knee arthroplasty (UKA) outcomes. The aim of the study is to investigate whether patients who had arthroscopy prior to UKA have differences in survivorship or functional outcomes compared to those with no prior arthroscopy.

Validating the capture rate of revisions by the New Zealand ACL Registry: An analysis of all-cause reoperation following primary ACL reconstruction.

Purpose: To validate the New Zealand Anterior Cruciate Ligament (ACL) Registry's capture rate of revisions by cross-referencing Registry data with reoperations data recorded by the Accident Compensation Corporation (ACC) and identify risk factors for all-cause reoperation.

Methods: Primary ACL reconstructions performed between April 2014 and September 2019 were individually matched on a record-by-record basis between the two databases. The ACC database was used to identify patients who underwent a reoperation with manual review of operation notes to identify whether a revision or other procedure was performed.

Accuracy and completeness of registry-reported unicompartmental knee arthroplasty revision.

Introduction: The key outcome of joint registries is revision events, which inform clinical practice and identify poor-performing implants. Registries record revision events and reasons, but accuracy may be limited by a lack of standardized definitions of revision. Our study aims to assess the accuracy and completeness of unicompartmental knee arthroplasty (UKA) revision and indications reported to the New Zealand Joint Registry (NZJR) with independent clinical review.

Clinical and functional outcomes of TKA after HTO or UKA: a New Zealand Joint Registry Study.

Introduction: Surgical options for patients with unicompartmental knee osteoarthritis include high tibial osteotomy (HTO) or unicompartmental knee arthroplasty (UKA). When managing younger patients with a higher chance of further surgery, the outcome of any subsequent conversion to total knee arthroplasty (TKA) also needs to be considered. The aim of this study was to compare implant survivorship and patient-reported outcomes for patients undergoing TKA after previous HTO or UKA, with comparisons for age, gender and comorbidities.

Risk factors for reoperation for arthrofibrosis following primary anterior cruciate ligament reconstruction.

Purpose: The purpose of this study is to identify the rate and risk factors for a reoperation for arthrofibrosis following primary anterior cruciate ligament (ACL) reconstruction.

Methods: Prospective data recorded in the New Zealand ACL Registry were cross-referenced with data from the Accident Compensation Corporation (ACC). Primary ACL reconstructions performed between April 2014 and May 2021 were analysed.

Progressive submaximal effort hamstring muscle endurance is reduced after reconstruction of the anterior cruciate ligament.

Background: Endurance capability in the muscles controlling the knee is poorly understood post anterior cruciate ligament (ACL) reconstruction, despite many sporting activities requiring notable muscle endurance. The hamstring muscles, when active, provide important anatomical support to protect the reconstructed graft. In the absence of good hamstring endurance, fatigue may predispose individuals to re-injury.

Intraosseous regional prophylaxis in total knee arthroplasty.

Prophylactic antibiotics are important in reducing the risk of periprosthetic joint infection (PJI) following total knee arthroplasty. Their effectiveness depends on the choice of antibiotic and the optimum timing of their administration, to ensure adequate tissue concentrations. Cephalosporins are typically used, but an increasing number of resistant organisms are causing PJI, leading to the additional use of vancomycin.

Comparison of Knee Pain and Difficulty With Kneeling Between Patellar Tendon and Hamstring Tendon Autografts After Anterior Cruciate Ligament Reconstruction: A Study From the New Zealand ACL Registry.

Background: The bone-patellar tendon-bone (BTB) autograft is associated with difficulty with kneeling after anterior cruciate ligament (ACL) reconstruction; however, it is unclear whether it results in a more painful or symptomatic knee compared with the hamstring tendon autograft.

Purpose: To identify the rate and risk factors for knee pain and difficulty with kneeling after ACL reconstruction.

Study Design: Cohort study; Level of evidence, 3.

Better post-operative outcomes at 1-year follow-up are associated with lower levels of pre-operative synovitis and higher levels of IL-6 and VEGFA in unicompartmental knee arthroplasty patients.

Purpose: Osteoarthritis (OA) is associated with inflammation, and residual inflammation may influence outcomes following knee arthroplasty. This may be more relevant for patients undergoing unicompartmental knee arthroplasty (UKA) due to larger remaining areas of native tissue. This study aimed to: (1) characterise inflammatory profiles for medial UKA patients and (2) investigate whether inflammation markers are associated with post-operative outcomes.

Meniscal repair failure following concurrent primary anterior cruciate ligament reconstruction: results from the New Zealand ACL Registry.

Purpose: This study aimed to identify the risk factors for meniscal repair failure following concurrent primary anterior cruciate ligament (ACL) reconstruction.

Methods: Prospective data recorded by the New Zealand ACL Registry and the Accident Compensation Corporation were reviewed. Meniscal repairs performed during concurrent primary ACL reconstruction were included.

Success of Debridement, Antibiotics, and Implant Retention in Prosthetic Joint Infection Following Primary Total Knee Arthroplasty: Results From a Prospective Multicenter Study of 189 Cases.

Background: This study aimed to identify the success rate of debridement, antibiotics, and implant retention (DAIR) for prosthetic joint infection (PJI) in a large prospective cohort of patients undergoing total knee arthroplasty (TKA). The ability for different PJI classification systems to predict success was assessed.

Methods: Prospective data recorded in the Prosthetic Joint Infection in Australia and New Zealand Observational study were analyzed.

The Effect of Minor Adjustments to Tibial and Femoral Component Position on Soft Tissue Balance in Robotic Total Knee Arthroplasty.

Background: Ideal goals for alignment and balance in total knee arthroplasty (TKA) remain controversial. We aimed to compare initial alignment and balance using mechanical alignment (MA) and kinematic alignment (KA) techniques and to analyze the percentage of knees that could achieve balance using limited adjustments to component position.

Methods: Prospective data on 331 primary robotic TKAs (115 MAs and 216 KAs) were analyzed.

The Strongest Oxford Knee Score Predictors of Subsequent Revision are "Overall Pain," "Limping When Walking," and "Knee Giving Way".

Background: The Oxford Knee Score (OKS) is used to measure knee arthroplasty outcomes; however, it is unclear which questions are more relevant. Our aims were to (1) identify which OKS question(s) were the strongest predictors of subsequent revision and (2) compare the predictive ability of the "pain" and "function" domains.

Methods: All primary total knee arthroplasties (TKAs) and unicompartmental knee arthroplasties (UKAs) in the New Zealand Joint Registry between 1999 and 2019 with an OKS at 6 months (TKA n = 27,708; UKA n = 8,415), 5 years (TKA n = 11,519; UKA n = 3,365) or 10 years (TKA n = 6,311; UKA n = 1,744) were included.

A comparison of clinical thresholds for revision following total and unicompartmental knee arthroplasty.

Unicompartmental knee arthroplasty (UKA) has higher revision rates than total knee arthroplasty (TKA). As revision of UKA may be less technically demanding than revision TKA, UKA patients with poor functional outcomes may be more likely to be offered revision than TKA patients with similar outcomes. The aim of this study was to compare clinical thresholds for revisions between TKA and UKA using revision incidence and patient-reported outcomes, in a large, matched cohort at early, mid-, and late-term follow-up.

Similar Survivorship but Different Revision Reasons for Uncemented Mobile-Bearing and Cemented Fixed-Bearing Medial UKA: A Long-Term Population-Based Cohort Study of 2,015 Patients.

Background: Long-term survivorship and accurate characterization of revision reasons in unicompartmental knee arthroplasty (UKA) are limited by a lack of long-term data and standardized definitions of revision. The aim of this study was to identify survivorship, risk factors, and reasons for revision in a large cohort of medial UKAs with long-term follow-up (up to 20 years).

Methods: Patient, implant, and revision details for 2,015 primary medial UKAs (mean follow-up, 8 years) were recorded following systematic clinical and radiographic review.

The Impact of Sex on the Outcomes of Prosthetic Joint Infection Treatment with Debridement, Antibiotics and Implant Retention: A Systematic Review and Individual Patient Data Meta-analysis.

Background: The influence of sex on the failure of débridement antibiotics and implant retention (DAIR) for treating prosthetic joint infection (PJI) is important for decision-making, patient counseling, and equitable health care. However, very few studies in the orthopaedic literature conduct sex-specific analyses.

Aim: The primary aim was to determine whether sex influences treatment success after DAIR.

Associations of the Oxford Knee Score and knee arthroplasty revision at long-term follow-up.

Background: Self-reported outcome measures are increasingly being collected for healthcare evaluation therefore it is prudent to understand their associations with patient outcomes. Our aims were to investigate: (1) if Oxford Knee Score (OKS) is associated with impending revision at long-term (5 and 10 years) follow-up, and (2) if decreased OKS at subsequent follow-ups is associated with higher risk of revision.

Patients And Methods: All total knee (TKAs) and unicompartmental knee arthroplasties (UKAs) between 1999 and 2019 in the New Zealand Joint Registry with an OKS at 6 months (TKA n = 27 708, UKA n = 8415), 5 years (TKA n = 11 519, UKA n = 3365) or 10 years (TKA n = 6311, UKA n = 1744) were included.

Comparative Study of ACL Reconstruction With Hamstring Versus Patellar Tendon Graft in Young Women: A Cohort Study From the New Zealand ACL Registry.

Background: Young female athletes are a specific population that is at high risk of primary anterior cruciate ligament (ACL) rupture and subsequent graft failure. Despite large numbers of ACL reconstructions being carried out in young women, there is limited analysis of outcomes in this group, leading to low levels of evidence for graft choice.

Purpose: To assess the effect of graft choice on ACL reconstruction failure rates among young women in New Zealand.

Safety and efficacy of intraosseous ropivacaine in lower extremity (SORE) study.

Background: Day stay surgery for anterior cruciate ligament (ACL) reconstructions is an increasingly common practice and has driven clinicians to develop postoperative pain regimes that allow same day mobilization and a safe and timely discharge. There is a paucity of literature surrounding the use of intraosseous (IO) ropivacaine used as a Bier's block to provide both intraoperative and postoperative analgesia in lower limb surgery.

Methods: This patient blinded, pilot study randomized 15 patients undergoing ACL reconstruction to receive either IO ropivacaine 1.

The Knee-Fix study: study protocol for a randomised controlled trial evaluating cemented and cementless components in total knee arthroplasty.

Background: Total knee arthroplasty (TKA) is an effective procedure for patients with a variety of knee conditions. The main cause of aseptic TKA failure is implant loosening, which has been linked to poor cement mantle quality. Cementless components were introduced to offer better longer-term biological fixation through osseointegration; however, early designs led to increased rate of revision due to a lack of initial press-fit and bony ingrowth.

A desirability of outcome ranking (DOOR) for periprosthetic joint infection - a Delphi analysis.

: Treatment outcomes in studies on prosthetic joint infection are generally assessed using a dichotomous outcome relating to treatment success or failure. These outcome measures neither include patient-centred outcome measures including joint function and quality of life, nor do they account for adverse effects of treatment. A desirability of outcome ranking (DOOR) measure can include these factors and has previously been proposed and validated for other serious infections.