A retrospective medium- to long-term results of 1500 AGC total knee replacements - An independent centre functional follow up and survivorship.

BACKGROUND: The AGC knee is one of the most widely used knee replacements in the world with good survivorship in national joint registries, including the Swedish within which it remains the gold standard of risk. PURPOSE: However, there are few long term survivorship reviews from the centre other than those affiliated with the designer that also offer any insight into functional outcome. In this review, we present the results of one of the largest non-designer, medium- to long term follow-ups of the AGC knee replacement. METHODS: A total of 1538 AGC knees were performed during a 15 year period, of which 902 were followed up by postal or telephone questionnaire using Oxford Knee Scores, Visual Analogue Scores (VASs) of function and pain and survival analysis. RESULTS: 87.5% of patients reported excellent or good functional reports at final follow up and 90.3% reporting excellent or good pain scores. There is a mean survivorship of 95.88% at 15 years from the 1538 knees. 85.7% of patients had an Oxford score of between 12 and 40, with 71.2% scoring between 0 and 30. 65.6% of patients responded with a VAS of 0 or 1 at rest (minimum pain = 0) and 53.9% reported a VAS of 0 or 1 while walking. INTERPRETATION: Our study shows excellent mid to long term results in a large group of patients was achieved using the AGC TKR implanted by a variety of Consultants and trainee surgeons. This review and data from national registries suggest that in terms of both survivorship and function demonstrate the AGC knee replacement still remains the knee that newer designs must be measured against.

Oxford unicompartmental knee arthroplasty: medial pain and functional outcome in the medium term.

BACKGROUND: In our experience results of the Oxford unicompartmental knee replacement have not been as good as had been expected. A common post operative complaint is of persistent medial knee discomfort, it is not clear why this phenomenon occurs and we have attempted to address this in our study. METHODS: 48 patients were retrospectively identified at a mean of 4.5 years (range = 3 to 6 years) following consecutive Oxford medial Unicompartmental Knee arthroplasties for varus anteromedial osteoarthritis. The mean age at implantation was 67 years (range 57-86). Of these 48 patients, 4 had died, 4 had undergone revision of their unicompartmental knee replacements and 2 had been lost to follow up leaving 38 patients with 40 replaced knees available for analysis using the 'new Oxford Knee Score' questionnaire. During assessment patients were asked specifically whether or not they still experienced medial knee discomfort or pain. RESULTS: The mean 'Oxford score' was only 32.7 (range = 16 to 48) and 22 of the 40 knees were uncomfortable or painful medially.The accuracy of component positioning was recorded, using standard post operative xrays, by summing the angulation or displacement of each component in two planes from the ideal position (according to the 'Oxford knee system radiographic criteria'). No correlation was demonstrated between the radiographic scores and the 'Oxford scores', or with the presence or absence of medial knee discomfort or pain. CONCLUSION: In our hands the functional outcome following Oxford Unicompartmental knee replacement was variable, with a high incidence of medial knee discomfort which did not correlate with the postoperative radiographic scores, pre-op arthritis and positioning of the prosthesis.

Long-term follow-up of the surgically corrected clubfoot.

We describe a 17-year follow-up of 44 surgically corrected clubfeet. They were classified preoperatively as mild, moderate or severe and grouped into those operated on before or after 3 months of age. Moderate and severe deformities underwent a posteromedial release after a trial of conservative management. The mean Ponseti score for both groups was 83.9 (good). Severely deformed feet achieved a more favourable result when operated upon before 3 months than those operated later. We conclude that early application of surgery yields better results with severely deformed feet and produces a good functional outcome in the majority of feet.