Does resurfacing of asymptomatic full-thickness localized articular defects of the trochlea influence the outcome following unicompartmental knee arthroplasty of the medial compartment?: A retrospective cohort study with minimum seven-year follow-up.

BACKGROUND: Patellofemoral joint (PFJ) degeneration has been found not to affect outcome following medial unicompartmental knee arthroplasty (UKA). However, PFJ disease occasionally presents as isolated trochlear cartilage lesions, with little available evidence regarding treatment options or necessity. We evaluated the effectiveness of concomitant trochlear resurfacing in patients undergoing medial UKA with asymptomatic trochlear lesions. METHODS: We included 60 patients undergoing medial UKA with an associated full thickness lesion of the trochlea. A fixed bearing UKA implant (PKR™, Stryker, Warsaw, IND) was used in all cases. In 30 patients, trochlear lesions were resurfaced with a HemiCAP® PF Classic (HemiCAP® PFC) implant (Arthrosurface, Franklin, MA). Outcome measures included VAS-, KOOS-, WOMAC-, SF-36 scores and radiological assessment. RESULTS: Average length of follow-up was 97.4 months (range: 88-106 months). Both groups showed significant improvement for all clinical scores post-operatively compared to pre-operatively (p < 0.001 for all). The UKA group showed a better VAS score at all follow-up moments (p < 0.01 for all), but no differences were found between both groups at all time points for other outcome measures. None of the HemiCAP® PFC implants needed to be revised within the timeframe of the study. CONCLUSIONS: In this retrospective cohort study, we found a 100% survivorship of the HemiCAP® PFC implant at an average eight-year follow-up. However, no clinical benefits were found in performing trochlear resurfacing in conjunction with medial UKA for asymptomatic end-stage trochlear cartilage lesions. Therefore, these lesions can be safely ignored when performing a medial UKA.

Wearable Sensor-Based Exercise Biofeedback for Orthopaedic Rehabilitation: A Mixed Methods User Evaluation of a Prototype System.

The majority of wearable sensor-based biofeedback systems used in exercise rehabilitation lack end-user evaluation as part of the development process. This study sought to evaluate an exemplar sensor-based biofeedback system, investigating the feasibility, usability, perceived impact and user experience of using the platform. Fifteen patients participated in the study having recently undergone knee replacement surgery. Participants were provided with the system for two weeks at home, completing a semi-structured interview alongside the System Usability Scale (SUS) and user version of the Mobile Application Rating Scale (uMARS). The analysis from the SUS (mean = 90.8 [SD = 7.8]) suggests a high degree of usability, supported by qualitative findings. The mean adherence rate was 79% with participants reporting a largely positive user experience, suggesting it offers additional support with the rehabilitation regime. Overall quality from the mean uMARS score was 4.1 out of 5 (SD = 0.39), however a number of bugs and inaccuracies were highlighted along with suggestions for additional features to enhance engagement. This study has shown that patients perceive value in the use of wearable sensor-based biofeedback systems and has highlighted the benefit of user-evaluation during the design process, illustrated the need for real-world accuracy validation, and supports the ongoing development of such systems.

Clinician perceptions of a prototype wearable exercise biofeedback system for orthopaedic rehabilitation: a qualitative exploration.

OBJECTIVES: This study explores the opinions of orthopaedic healthcare professionals regarding the opportunities and challenges of using wearable technology in rehabilitation. It continues to assess the perceived impact of an exemplar exercise biofeedback system that incorporates wearable sensing, involving the clinician in the user-centred design process, a valuable step in ensuring ease of implementation, sustained engagement and clinical relevance. DESIGN: This is a qualitative study consisting of one-to-one semi-structured interviews, including a demonstration of a prototype wearable exercise biofeedback system. Interviews were audio-recorded and transcribed, with thematic analysis conducted of all transcripts. SETTING: The study was conducted in the orthopaedic department of an acute private hospital. PARTICIPANTS: Ten clinicians from a multidisciplinary team of healthcare professionals involved in the orthopaedic rehabilitation pathway participated in the study. RESULTS: Participants reported that there is currently a challenge in gathering timely and objective data for the monitoring of patients in orthopaedic rehabilitation. While there are challenges in ensuring reliability and engagement of biofeedback systems, clinicians perceive significant value in the use of wearable biofeedback systems such as the exemplar demonstrated for use following total knee replacement. CONCLUSIONS: Clinicians see an opportunity for wearable technology to continuously track data in real-time, and feel that feedback provided to users regarding exercise technique and adherence can further support the patient at home, although there are clear design and implementation challenges relating to ensuring technical accuracy and tailoring rehabilitation to the individual. There was perceived value in the prototype system demonstrated to participants which supports the ongoing development of such exercise biofeedback platforms.

Long-term performance of exteriorized femoral stem after cortical perforation in revision cemented total hip replacement.

This is the first published report of a long-term, fourteen years close annual follow-up of a patient who underwent revision total hip replacement with per-operative anterior cortical perforation of femur while undertaking cemented femoral stem insertion. This patient has complete satisfaction in terms of clinical and radiological outcome. This patient has been walking full weight bearing on her operated leg after 3 months of her surgery. We advocate for the need of paying meticulous attention to observe this complication on operative table and to proceed with controlled stem insertion where doubt exist. Such patients may require a vigilant regular annual follow-up to observe their clinical and radiological status and an expectant approach may be adopted unless patient becomes symptomatic.

Exsanguinators and tourniquets: do we need to change our practice?

PURPOSE: Exsanguinators and tourniquets are regularly used in orthopaedic theatres. A good understanding of their application and contraindications must be ensured to prevent injury to limb or life. However, the level of staff understanding is not well documented. The aims of this study were to assess knowledge of their use between theatre personnel and assess their sterility at our institution. METHODS: A previously published questionnaire was distributed to various orthopaedic theatre personnel responsible for exsanguinator and tourniquet application. Microbiology culture and sensitivity swabs were also taken. RESULTS: Mean questionnaire score for all participants was 30.9%. None of the 74 participants scored more than 49% in the questionnaire. Exsanguinators grew more positive cultures than the tourniquets. CONCLUSIONS: Exsanguinators and tourniquets are used widely in the field of orthopaedics. Lack of their understanding amongst operating theatre personnel involved with their use strongly supports the need for providing and ensuring adequate education to provide the best patient care. In consideration of our findings, we propose a solution addressing these issues.

The effect of pre-existing ischaemic heart disease on renal dysfunction in cardiac transplant recipients.

Renal dysfunction is a recognized complication of cardiac transplantation and can impact on the life expectancy of an already fragile population. A large proportion of these patients require transplantation because of the consequences of ischaemic heart disease (IHD) which, in turn, is often associated with ischaemic nephropathy. We studied the effect of IHD, diagnosed prior to transplantation, on the renal function of recipients who survived more than 6months after surgery. Of the 168 patients transplanted in a single centre over 15 years, 132 were included in the study. Renal dysfunction was defined as a serum creatinine consistently above 200 micromol/L (2.26 mg/dL). Analysis confirmed that IHD was an independent risk factor for developing renal impairment. In transplant recipients with IHD, closer monitoring is warranted to detect and prevent renal dysfunction or to retard its progression.