Patella height measurements in patients with patellofemoral instability: the power to predict patella height indices.

INTRODUCTION: Numerous indices for patella height measurement are described in the literature; however, there is not a universally accepted 'gold standard'. Choice of indices varies depending on personal preference and previous experience, making it difficult to compare results between studies. The aims of this study were to assess the correlation between different patella height indices and generate statistically derived formulae that can be used to predict the value of one patella height ratio when another is known. MATERIALS AND METHODS: Patients with patellofemoral instability were radiologically evaluated using both X-ray and Magnetic Resonance Imaging (MRI) of the knee. Two observers measured six validated patella height indices at two separate time intervals. All measurements were aggregated together and a mean average for each patella height ratio was calculated. These results were then statistically analysed using Pearson product-moment correlation and linear regression tests. RESULTS: Forty-four patients were included in the study. A statistically significant correlation was found between the majority of patella height ratios. On X-ray, the strongest correlation (r = 0.92, p < 0.001) and regression (R2 = 0.85, p < 0.001) coefficients were between the Blackburne-Peel and Caton-Dechamps ratios, with the formula; CD = 0.20 + (0.95xBP). On MRI, the strongest correlation (r = - 0.84, p < 0.001) and regression (R2 = 0.71, p < 0.001) coefficients were between the Patellophyseal index and Patellotrochlear index, with the formula; PP = 1.02-(1.10xPT). CONCLUSION: The formulae produced in this study can predict the value of one patella height ratio when the results of another are known. This could facilitate systematic reviews and meta-analyses by allowing the pooling together of data from many studies.

Impact of age on clinical outcomes in anterior cruciate ligament reconstruction.

BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) is a common procedure for symptomatic ACL injuries. Age is often factored into clinical decision making and can influence the choice of conservative management over surgical intervention. The aim of this study was to investigate the effect of chronological age on the clinical outcome following ACLR. METHOD: Six validated patient-reported outcome measures (PROM) were used to collect pre-operative and post-operative scores from patients with ACL rupture undergoing ACLR. Data were stratified pertaining to the patient's age at the time of surgery to compare the Younger Group (under 40 years) with the Older Group (over 40 years). RESULTS: A total of 45 patients were included in this study. Pre-operatively the Younger Group (n = 32) had significantly better Lysholm (p = 0.016), Tegner (p = 0.001), Knee Injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living (ADL) sub-score (p = 0.003) and International Knee Documentation Committee (IKDC) score (p = 0.014) as compared to the Older Group (n = 13). Post-operatively, there was no significant difference (p > 0.05) between the two groups as all the PROM scores were comparable except for the Tegner score (p = 0.02), where younger patients had higher activity levels. Significant inverse correlations were only found between age and Tegner score (rho = - 0.58, p < 0.001) and KOOS Sport and Recreation sub-score (rho = - 0.33, p = 0.038). CONCLUSION: ACLR is a clinically successful treatment strategy for patients of all ages. Thus, age should not be used in isolation to determine patient suitability.

The prevalence of musculoskeletal presentations in general practice: an epidemiological study.

BACKGROUND: It is estimated that 18.8 million people in the United Kingdom are living with a musculoskeletal (MSK) condition. It is a major cause of morbidity and a significant reason for presentation to primary care. AIM: To determine the prevalence of MSK conditions presenting for consultation in general practice (GP), and how they are managed. DESIGN AND SETTING: Epidemiological study. METHOD: Patient episode consultations were reviewed at an urban community general practice. This involved evaluating morning consultations over a 1-week period from each of January, April, July, and October 2018. This included all the morning consultations from all GPs present. The number of MSK consultations was recorded, and within that the different presentations and their management plan. RESULTS: A total of 545 consultations were reviewed, of which 115 were related to an MSK presentation: an overall prevalence of 21.1%. The commonest MSK presentations related to the lumbosacral spine (18.3%) and the knee joint (17.4%). Re-presentations of an existing condition accounted for 73.9% of all MSK consultations. Steroid injections were administered in 33% of knee related consultations. CONCLUSION: MSK presentations account for a large proportion of GP workload, but there is currently no mandatory training in orthopedics as part of the GP curriculum. Structured MSK education for GPs is important and may reduce the burden of re-presentations. Competency in joint injection is also an important skill for GPs.

It is a well-known fact that musculoskeletal (MSK) conditions are common in the general population. It is less well known just how commonly they present to the general practitioner (GP), and how they are managed in the United Kingdom within the community setting. This article primarily investigates how frequently MSK conditions present to a typical GP surgery in the United Kingdom. It analyses consultations over different weeks of the year in an urban practice in the north east of England. Within the musculoskeletal consultations, multiple variables are analyzed to investigate other trends. By doing so, the article identifies key findings including: the commonest MSK conditions, the different management decisions made by GPs, and how care for patients with MSK conditions might be improved. This article demonstrates that MSK conditions are so common that they are almost certain to be a daily part of the typical working day for a GP. It demonstrates why MSK training should be a priority for GPs, and where that training should be focused to use minimal resources for maximum benefit.

Knee anatomic geometry accurately predicts risk of anterior cruciate ligament rupture.

BACKGROUND: Certain anatomical characteristics of the knee have potential relationships with the risk of anterior cruciate ligament (ACL) rupture. There remains a need for stronger evidence using arthroscopy as well as radiological imaging to accurately clarify these relationships. PURPOSE: To compare the anatomic geometry of the knee joint between patients with and without ACL ruptures. MATERIAL AND METHODS: Case-controlled study of patients with arthroscopically confirmed ACL ruptures (ACL group) compared to patients with arthroscopically confirmed normal ACLs (control group). Magnetic resonance imaging scans were assessed for a total of 14 quantitative radiological variables including medial and lateral tibial slope angles (bone and cartilage measurements), meniscal height, femoral width, intercondylar notch width and tibial depth. RESULTS: A total of 105 patients were included in the study, 55 in the ACL group and 50 in the control group. There was a significant difference (P < 0.05) of most of the radiological measurements between the two groups. There was also a significant difference (P < 0.05) when comparing the variables between sexes. Multiple logistic regression analysis produced a mathematical model utilizing all the radiological measurements with 92.6% classification accuracy in predicating an ACL rupture with the medial tibial slope angle being the strongest predicator variable (odds ratio = 8.97, P = 0.011). CONCLUSION: Greater postero-inferior directed slope measurements of bone and cartilage in both the lateral and medial compartments with a narrower intercondylar notch width increase the risk of ACL rupture. Mathematical modelling can accurately predict the risk of ACL rupture.

Inter- and intra-observer reliability of patellar height measurements in patients with and without patellar instability on plain radiographs and magnetic resonance imaging.

INTRODUCTION: Many patella height indices exist in the literature. There is no single universally accepted radiological assessment for measuring patella height. The aims of this study were to determine which of the commonly used indices can most reliably measure patella height and compare the findings on both plain X-ray and magnetic resonance imaging (MRI) of the knee. METHODS: This case-controlled study compared patients with recurrent patella instability (patella group) to a control group. Two observers measured six validated patella height indices on X-ray and MRI of both groups at two separate time periods. Between-group and within-group statistical analysis was undertaken of the data. The inter- and intra-observer reliability was assessed using the intraclass correlation coefficient (ICC) and the kappa measure of agreement (k). RESULTS: Forty-four patients comprised the patella group and 50 patients the control group. There was a significant difference of most indices between the two groups (p < 0.05). There was a significant difference of most indices between the two imaging modalities (p < 0.05). The Insall-Salvati ratio had the greatest inter-observer reliability for both X-ray and MRI (ICC = 0.79 to 0.97; p < 0.001) (k = 0.50 to 1.00; p < 0.001). CONCLUSION: Patella height indices significantly differ when measured on X-ray as compared to MRI. This may infer that a different set of normative values are required for each radiological modality, which we have proposed in this study. Overall, the Insall-Salvati ratio performed best and shows a high degree of intra- and inter-observer reliability on both X-ray and MRI.

Inter- and intra-observer reliability of radiological grading systems for knee osteoarthritis.

INTRODUCTION: Radiographs are the first-line investigation for knee osteoarthritis (OA). Antero-posterior (AP) and Rosenberg views have demonstrated varying sensitivities in detecting severe OA. There is a multitude of radiological grading systems described. The aim of this study was to assess four commonly used grading systems in terms of inter- and intra-observer reliability and correlate the results with patient-reported symptom severity. MATERIALS AND METHODS: This study included 100 patients who had undergone both AP and Rosenberg X-ray views of the knee and evaluated using four radiological grading systems. These included Kellgren & Lawrence (K&L), International Knee Documentation Committee (IKDC), Ahlbäck and Fairbank. Evaluations were performed by two observers, independently, at two separate time points, 8 weeks apart. The data was then statistically analysed and inter- and intra-observer reliability calculated. RESULTS: A significant difference was found between AP and Rosenberg views for all four grading systems (p < 0.001). Both inter- and intra-observer reliability were highest for IKDC (0.79 and 0.86 respectively) and lowest for Fairbank (0.20 and 0.27 respectively). No statistically significant correlation was found between any grading system and the Oxford knee score (OKS). CONCLUSION: IKDC was found to be the most reliable grading system and Fairbank was the least. The Rosenberg view was overall more sensitive at detecting severe OA than the AP view. Radiological findings did not correlate with patient-reported symptoms (OKS).

Clinical outcome measures in anterior cruciate ligament reconstruction: Clinician vs patient completed knee scores.

INTRODUCTION: Clinical outcome measures are important in both the conduct of clinical research and evaluation of knee surgery in every day clinical practice. A wide variety of validated outcome scores are available in the literature. The objective of this study was to investigate if there is a difference between clinician-completed and patient-completed outcome scores in detecting improvement following anterior cruciate ligament (ACL) reconstruction. METHODS: Fifty patients with ACL rupture were prospectively evaluated using nine clinical outcome measures. Five clinician-completed knee scores included Tegner Activity Score, Lysholm Knee Score, Cincinnati Knee Score, International Knee Documentation Committee (IKDC) Objective Knee Score and Tapper and Hoover Meniscal Grading Score. Four patient-completed knee scores included IKDC Subjective Knee Score, Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), Short Form-12 Item Health Survey (SF-12) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Thirty-four of the 50 patients underwent an ACL reconstruction and were reassessed with all nine outcome scores upon their follow-up review 3 months post-operatively. RESULTS: A significant longitudinal improvement was observed of all five clinician-completed knee scores including Tegner (3.3-4.1 (p = 0.006)), Lysholm (71.7-85.3 (p < 0.001)), Cincinnati (62.6-75.9 (p < 0.001)), IKDC Objective (Abnormal to Nearly Normal (p = 0.001)) and Tapper and Hoover (Fair to Good (p < 0.001)). However, none of the four patient-completed knee scores revealed a statistically significant improvement post-operatively. CONCLUSIONS: Results of clinician-completed scores were found to be inconsistent with those of patient-completed instruments. It's important to consider the mode of administering outcome measures either for research or clinical practice as it can have a significant influence on the end results. The use of both a clinician-completed and a patient-completed instrument maybe the more prudent approach to assessing and quantifying ACL injuries and the outcome post-operatively. Ultimately, better methods of objectively evaluating surgical interventions of the knee are required.

Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis: A comparison of clinical and radiological outcomes.

BACKGROUND: Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are well-established operative interventions in the treatment of knee osteoarthritis. However, which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate. Simultaneously, there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes, preoperatively and following HTO or UKA. AIM: To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis: Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this. METHODS: This longitudinal observational study assessed a total of 42 patients that had undergone UKA (n = 23) and HTO (n = 19) to treat medial compartment knee osteoarthritis. Patient-reported outcome measures (PROMs) were collected to evaluate clinical outcome. These included two disease-specific (Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score) and two generic (EQ-5D-5L, Short Form-12) PROMs. The radiographic parameters of knee alignment assessed were the: Hip-knee-ankle angle, mechanical axis deviation and angle of Mikulicz line. RESULTS: Statistical analyses demonstrated significant (P < 0.001), preoperative to postoperative, improvements in the PROM scores of both groups. There were, however, no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group. Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively (P < 0.05). Postoperatively, two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters (hip-knee-ankle angle, mechanical axis deviation) within the HTO group; yet no such associations were observed within the UKA group. CONCLUSION: UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis. Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively; however, a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.

Anthropometric measures of obesity in patients with knee joint pathology: Body surface area versus body mass index.

BACKGROUND: Obesity is quantified using body mass index. Body surface area may provide a superior and more anthropometric method of quantifying obesity in patients with musculoskeletal knee disease. This study compares the effect of weight, height, age and gender on body mass index and body surface area in a population with orthopaedic knee disease. METHODS: An observational cohort study was conducted of patients presenting with musculoskeletal knee disease. Associations between body mass index, body surface area, age, gender, height, weight and operative versus non-operative management were analysed. RESULTS: A total of 151 patients were included. Body surface area was more strongly correlated to weight than body mass index (r = 0.98, p < 0.001 versus r = 0.84, p < 0.001). Body surface area also reflects height which body mass index under presents (r = 0.65, p < 0.001 versus r = -0.08, p = 0.35). Body mass index and body surface area were correlated with one another (r = 0.70, p < 0.001). Age was inversely correlated with body surface area (r = -0.20, p = 0.013) but not body mass index (r = 0.05, p = 0.585). Body mass index did not differ between males and females (30.1 versus 30.9, p = 0.37); however, BSA scores were significantly higher in males than females (2.11 versus 1.91, p < 0.001). Neither body surface area nor body mass index scores influenced operative versus non-operative treatment. CONCLUSION: Body surface area could be a useful alternative to body mass index when considering obesity in patients with musculoskeletal knee pathology. Body surface area better reflects the effects of height, weight, age and gender than body mass index.

Evaluation of comorbidity scoring systems in patients undergoing knee arthroplasty.

BACKGROUND: Ageing populations are increasing the demand for knee arthroplasty. Concurrently, the prevalence of medical comorbidities are rising too. The Self-Administered Comorbidity Questionnaire was developed to provide a patient's assessment of their own comorbidities whereas the American Society of Anesthesiologists grades and the Charlson Comorbidity Index utilise clinical evaluation to objectively measure perioperative morbidity and mortality risk. The primary aim of this study was to compare Self-Administered Comorbidity Questionnaire scores with American Society of Anesthesiologists grades and Charlson Comorbidity Index scores. The secondary aim was to compare Self-Administered Comorbidity Questionnaire scores with knee outcome scores. METHODS: A single centre observational cohort study of patients with knee osteoarthritis undergoing elective knee arthroplasty. Preoperative evaluation included Self-Administered Comorbidity Questionnaire scores, American Society of Anesthesiologists grades, Charlson Comorbidity Index scores and validated patient-reported outcome measures specific to knee surgery. RESULTS: A total of 141 patients were included in this study. Self-Administered Comorbidity Questionnaire scores were directly correlated with American Society of Anesthesiologists grade (rho = 0.37, p < 0.001) and Charlson Comorbidity Index scores (rho = 0.19, p = 0.047). Individual American Society of Anesthesiologists grades had significantly different Self-Administered Comorbidity Questionnaire scores (p = 0.001). Self-Administered Comorbidity Questionnaire scores were specifically associated with hypertension, ischaemic heart disease, chronic obstructive pulmonary disease and the total number of comorbidities, but American Society of Anesthesiologists and Charlson Comorbidity Index scores were associated with more comorbidities. Overall, Self-Administered Comorbidity Questionnaire scores were inversely correlated with patient-reported outcome measure scores. CONCLUSION: Self-Administered Comorbidity Questionnaire scores are associated with increasing comorbidity in patients with symptomatic knee osteoarthritis; however, American Society of Anesthesiologists grades and Charlson Comorbidity Index scores had stronger and more abundant associations with comorbidities and patient-reported outcome measure scores. Self-Administered Comorbidity Questionnaires may complement but not replace current objective assessments of comorbidity when evaluating perioperative risk for knee arthroplasty.

Diagnostic accuracy of ACL tears according to tear morphology.

This retrospective analysis of 182 consecutive patients who underwent anterior cruciate ligament (ACL) reconstruction aimed to assess the clinical examination under anaesthetic and the MRI diagnostic accuracy of arthroscopically-proven, complete ACL ruptures, depending on the morphology of the torn ligament. Patients were then assigned to Group 1 (ACL not reattached) or Group 2 (ACL re-attached abnormally). Of 104 patients (57.1%) in Group 2, 94 (51.7%) had an abnormal re-attachment of the torn ACL to the posterior cruciate ligament (PCL). There was no significant difference between the groups on MRI reporting of a complete ACL tear (p = 0.123) and pivot shift test. On Lachman testing, more patients in Group 1 had an increased laxity compared with Group 2 (p = 0.014); similarly, more patients in Group 1 had an absent endpoint compared with Group 2 (p = 0.008). An ACL-deficient knee with an abnormal re-attachment of the torn ligament appears to be more difficult to diagnose than if there has been no re-attachment.

Comparison of day-case versus inpatient uni-compartmental knee replacement.

BACKGROUND: Uni-compartmental knee replacement (UKR) is an alternative to total knee replacement for patients who have isolated compartment osteoarthritis. Studies have demonstrated that UKR can be safely performed as a day-case procedure without a negative impact on complication rates. The aim of this study was to compare the clinical outcomes between day-case and inpatient UKRs. METHODS: A single surgeon prospective case-controlled study was performed, comparing data between day-case UKRs and inpatient UKRs. This included longitudinal analysis of patient reported outcome measures (PROMs); including the Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score, Short Form 12-item Health Survey, EQ-5D-5L and the Self-administered Comorbidity Questionnaire. Post-operative pain scores (visual analogue scale), unplanned post-operative hospital reattendance rates and complications were also analysed. RESULTS: Overall, 100% of day-case patients were successfully discharged on the same day. Both inpatient (n = 23) and day-case (n = 23) UKRs demonstrated a significant within group longitudinal improvement of PROM scores (p < 0.05) following surgery. However, the post-operative PROM scores were significantly higher in the day-case group as compared to the inpatient group (p < 0.05). Both groups had comparable post-operative pain scores, but the day-case group demonstrated fewer unplanned reattendances and post-operative complications. CONCLUSION: The clinical outcomes of day-case UKR are superior to inpatient UKR. Careful patient selection and a robust multidisciplinary patient pathway are the key components to success of day-case joint replacement surgery. LEVEL OF EVIDENCE: Prospective Case-Control Study, level III.

A Comparison of Tip-Apex Distance at Various Angles of Fixation Devices in Hip Fractures.

Background Intertrochanteric neck of the femur (NOF) fractures are very common, and the majority are fixed using dynamic hip screws (DHS) or intramedullary (IM) nails with a fixed angle. The aim of this study was to assess which angle of fixation has a better tip-apex distance (TAD) on X-ray and lower complication rates. Methods We included patients with intertrochanteric hip fractures fixed using a DHS or an IM nail. We included patients who had complete radiological and clinical records and a minimum follow-up of 24 months. We measured the TAD and recorded the number of implant cutouts, fracture site nonunions, and periprosthetic fractures. Results A total of 107 patients were included, 35 IM nails and 72 DHS. There were four cases of implant cutouts within the DHS group and none in the IM nail group. All four cutout cases were fixed using 135° angle DHS, and two had TAD of more than 25 mm. Multivariable regression analysis revealed that the implant fixation device (p=0.002) and the angle of fixation (p<0.001) are the most important predictors of TAD. Conclusion Smaller angle (130° or 125°) fixation devices allow better positioning of the lag screw and consequently better TAD, which leads to a lower probability of implant cutout in patients undergoing fracture of the neck of the femur surgery.

Arthroscopic Meniscectomy vs Meniscal Repair: Comparison of Clinical Outcomes.

Background Meniscal tears are the most common injury of the knee. Surgical treatment has fallen into contention recently and includes arthroscopic meniscectomy and meniscal repair. The primary aim of this study was to quantitatively evaluate patients with isolated meniscal tears and compare their outcomes with patients who have undergone arthroscopic meniscus surgery. The secondary aim of this study was to compare the clinical outcomes of patients who have undergone arthroscopic meniscectomy with patients who have undergone arthroscopic meniscal repair. Methods This comparative clinical study screened 334 patients to identify subjects who underwent arthroscopic knee surgery for isolated meniscal tears and compare them to patients with symptomatic isolated meniscal tears awaiting surgery using validated patient-reported outcome measures. These included the Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee Subjective Knee Form, Lysholm score, Tegner score, EuroQol-5 Dimension, and the 12-Item Short Form Health Survey. Results A total of 117 patients (Meniscal Tear group (n=36), Meniscectomy group (n=64), and Meniscal Repair group (n=17)) were included in the final data analysis. Both the Meniscectomy group and the Meniscal Repair group (mean 55-month follow-up) showed significantly better clinical outcomes than patients in the Meniscal Tear group (p<0.05). Overall, the Meniscal Repair group demonstrated superior clinical outcomes when compared to the Meniscectomy group (p<0.05). Conclusion Arthroscopic knee surgery showed significant clinical benefit at medium-term follow-up in treating patients with isolated meniscal tears. When feasible, meniscal repair should be performed preferentially over meniscectomy.

Proprioception Analysis following Anterior Cruciate Ligament Reconstruction using Stabilometry: A Prospective, Longitudinal Study.

Objective Commonly used methods for measuring proprioception have resulted in conflicting reports regarding knee proprioception with anterior cruciate ligament (ACL) rupture and the influence of ACL reconstruction. Methods One hundred subjects (50 patients with radiologically and arthroscopically confirmed unilateral ACL rupture and 50 normal controls) were assessed with regards to proprioception using dynamic single-leg stance postural stabilometry. Instrumented knee ligament laxity and knee outcome scores were also measured. Of the 50 patients in the ACL group, 34 underwent reconstruction and were reassessed postoperatively. Results There was a significant proprioceptive deficiency in the ACL group compared with their contralateral knee ( p < 0.001) and to the control group ( p = 0.01). There was a significant improvement in knee proprioception following ACL reconstruction compared to preoperative findings ( p = 0.003). There was no correlation between ligament laxity measurements and outcome scores. A significant correlation was found preoperatively between outcome scores and proprioception measurements. This correlation was not found post-operatively. Pre-operative proprioception testing had a significant correlation (r = 0.46) with post-operative proprioception ( p = 0.006). Conclusion Patients with an ACL rupture had a proprioceptive deficit which improved following ligament reconstruction. Knee outcome scores had a better correlation with proprioception than ligament laxity. Proprioception may be a superior objective measure than ligament laxity in quantifying functional knee deficits and outcomes in patients with ACL ruptures. Level of Evidence III Therapeutic Study; Prospective Longitudinal Case-Control Study.

Comparison of clinical outcomes between total hip replacement and total knee replacement.

BACKGROUND: Total hip replacements (THR) and total knee replacements (TKR) are effective treatments for severe osteoarthritis (OA). Some studies suggest clinical outcomes following THR are superior to TKR, the reason for which remains unknown. This study compares clinical outcomes between THR and TKR. AIM: To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures (PROMs). METHODS: A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre- and post-operatively. RESULTS: A total of 131 patients were included in the study which comprised the THR group (68 patients) and the TKR group (63 patients). Both groups demonstrated significant post-operative improvements in all PROM scores (P < 0.001). There were no significant differences in post-operative PROM scores between the two groups: Hip and Knee Osteoarthritis Outcome scores (P = 0.140), Western Ontario and McMaster Universities Osteoarthritis Index pain (P = 0.297) stiffness (P = 0.309) and function (P = 0.945), Oxford Hip and Knee Score (P = 0.076), EuroQol-5D index (P = 0.386) and Short-Form 12-item survey physical component score (P = 0.106). Subgroup analyses showed no significant difference (P > 0.05) between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference (P > 0.05) between cemented and uncemented fixation in the THR group. Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR. CONCLUSION: Contrary to some literature, THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs. The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome. Obesity had a greater influence on the outcome following TKR than that of THR.

Clinical efficacy of bisphosphonates and monoclonal antibodies on bone mineral density following skeletal fractures.

Background: Bisphosphonates and monoclonal antibodies are drugs primarily developed to inhibit osteoclast-mediated bone resorption and are used to treat an array of skeletal pathologies. Their use is aimed at increasing bone health and therefore reducing fracture risks. The aim of this study was to evaluate the effectiveness of bone protection therapy on improving bone mineral density (BMD) in patients following a fracture. Methods: Inclusion criteria consisted of patients who sustained a skeletal fracture and were subsequently commenced on bone protection therapy. Dual-energy X-ray Absorptiometry (DEXA) scans were performed at baseline and following a consented period of drug therapy. Bone health data included T-Scores, Z-Scores, FRAX Major, FRAX Hip and BMD. The clinical effectiveness of four bisphosphonates (alendronate, risedronate, pamidronate and zoledronate) and one monoclonal antibody (denosumab) were evaluated. Results: A total of 100 patients were included in the study. Overall, bone protection therapy significantly improved Z-score Hip, Z-score Spine, T-score Spine and BMD Spine (p < 0.05). There was a marked difference between drug therapies. Denosumab and zoledronate were associated with the greatest treatment effect size. Alendronate only improved Z-score Spine and Z-score Hip (p < 0.05). Pamidronate and risedronate did not demonstrate any statistically significant improvement across any DEXA parameter. Conclusion: Overall, bisphosphonates/monoclonal antibodies confer beneficial effects on bone health as measured by DEXA scans in patients following skeletal fractures. However, the magnitude of improvement varies among the commonly used drugs. Alendronate, zoledronate and denosumab were associated with greatest therapeutic benefit. Bone protection therapy did not improve fracture risk of patients (FRAX scores).

Patient reported outcome measures in anterior cruciate ligament rupture and reconstruction: The significance of outcome score prediction.

BACKGROUND: Numerous anterior cruciate ligament (ACL) clinical outcome measures exist. However, the result of one score does not equate to the findings of another even when evaluating the same patient group. AIM: To investigate if statistically derived formulae can be used to predict the outcome of one knee scoring system when the result of another is known in patients with ACL rupture before and after reconstruction. METHODS: Fifty patients with ACL rupture were evaluated using nine clinical outcome measures. These included Tegner Activity Score, Lysholm Knee Score, Cincinnati Knee Score, International Knee Documentation Committee (IKDC) Objective Knee Score, Tapper and Hoover Meniscal Grading Score, IKDC Subjective Knee Score, Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), Short Form-12 Item Health Survey and Knee Injury and Osteoarthritis Outcome Score. Thirty-four patients underwent an ACL reconstruction and were reassessed post-operatively. RESULTS: The mean total of each of the nine outcome scores appreciably differed from each other. Significant correlations and regressions were found between most of the outcome scores and were stronger post-operatively. The strongest correlation was found between Cincinnati and KOS-ADLS (r = 0.91, P < 0.001). The strongest regression formula was also found between Cincinnati and KOS-ADLS (R 2 = 0.84, P < 0.001). CONCLUSION: The formulae produced from this study can be used to predict the outcome of one knee score when the results of the other are known. These formulae could facilitate the conduct of systematic reviews and meta-analysis in studies relating to ACL injuries by allowing the pooling of substantially more data.

Clinical Outcome Measures in Arthroscopic Meniscectomy: Clinician versus Patient Completed Knee Scores.

Objective The aim of the present study was to investigate the difference between clinician-completed and patient-completed outcome scores in detecting improvement following arthroscopic meniscectomy in patients with meniscal tears of the knee. Methods Thirty-four patients with meniscal tears were prospectively assessed using 9 clinical outcome measures. The five clinician-completed knee scores included the Tegner Activity Score, the Lysholm Knee Score, the Cincinnati Knee Score, the International Knee Documentation Committee (IKDC) Examination Knee Score, and the Tapper and Hoover Meniscal Grading Score. The four patient-completed knee scores included the IKDC Subjective Knee Score, the Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), the Short Form-12 Item Health Survey (SF-12), and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Twenty-nine of the 34 patients underwent an arthroscopic meniscectomy and were reassessed with all 9 outcome scores upon their follow-up review. Results A significant longitudinal improvement was observed in 4 of the 5 clinician-completed scores (Tegner [ p < 0.001], Lysholm [ p = 0.004], Cincinnati [p = 0.002] and Tapper and Hoover [ p < 0.001], but not in the IKDC Examination [ p = 0.332]. However, the IKDC Subjective score ( p = 0.021) was the only patient-completed score to demonstrate significant improvement postoperatively. Conclusion Overall, clinician-completed scoring systems were found to be inconsistent with those of patient-completed instruments. The mode of administering outcome measures can have a significant influence on the outcome results both for research and for clinical practice. A combination of both a clinician-completed with a patient-completed instrument may be a more balanced approach to assessing and quantifying meniscus tears and the outcome following arthroscopic meniscectomy.

Conservative treatment of knee osteoarthritis: A review of the literature.

Knee osteoarthritis (KOA) is a common chronic debilitating disease with an estimated prevalence of 23.9% in the general adult population. The condition is characterised by joint pain, functional impairment and significant reduction in quality of life. Management for KOA can generally be divided into conservative (non-operative) and surgical (operative) measures. Conservative management broadly compromises pharmacological and non-pharmacological options and is conventionally the first line treatment to avoid or delay the need for surgical management. The aim of this study is to provide an overview of the current recommendations, efficacy and safety profile of different conservative treatments through a review of the literature.