The Aberdeen Weight-Bearing Test (Knee): a new objective test for anterior knee discomfort.

PURPOSE: We present the Aberdeen Weight-Bearing Test (Knee), an objective test specific for anterior knee discomfort assessed via load bearing. We assess its validity by performing it on normal subjects with no knee symptoms and subjects who had undergone anterograde tibial nailing. METHODS: Two scales are placed parallel on the floor with the dials concealed from the subject. The subject then kneels with one knee on each scale. The weight through each knee is recorded at 0, 15, 30, 45, and 60 s. The proportion of total body weight on each leg at each timepoint is calculated, and a ratio calculated from the values. A value of 1 equates to equal weight on each leg. The test was performed on 53 normal subjects and 38 subjects who had undergone tibial nailing. RESULTS: In the normal group, no significant difference in mean ratio of weight distribution (left:right) was seen at any timepoint (mean ratio range = 0.98-0.99, p value range = 0.18-0.64). In the tibial nail group, a difference was observed in mean ratio of weight distribution (injured:uninjured) favouring the uninjured leg, reaching significance at 0, 15, 30, and 45 s (mean ratio range = 0.88-0.94, p value range = 0.01-0.02). At 60 s, the mean ratio was 0.93 (p = 0.09). CONCLUSION: The Aberdeen Weight-Bearing Test (Knee) is an objective, easily reproducible, specific test for anterior knee discomfort. It produces different results in individuals who have undergone anterograde tibial nailing compared to individuals with no knee symptoms.

Total knee arthroplasty for distal femoral fractures in osteoporotic bone: a systematic literature review.

PURPOSE: Distal femoral fractures in the elderly are associated with high morbidity and mortality and their incidence is increasing with an ageing population. Management of these fractures has evolved over recent decades and there is now an accepted recognition of the important role that acute arthroplasty may have in treatment of these fractures. Our purpose was to systematically review the evidence available in the literature for arthroplasty as a treatment option for distal femoral fractures. METHODS: This systematic review was conducted in accordance with the PRISMA reporting guidelines. We searched CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded (until October 2018) for studies and case series. Furthermore, clinical trial registries were searched for ongoing studies. We included all studies or case series that described total knee arthroplasty for distal femoral fractures irrespective of language, publication status, sample size, or follow-up period due to limited studies available in the literature. Exclusion criteria included single patient case reports, isolated tibia fractures, and periprosthetic fractures. Two authors independently identified trials for inclusion and independently extracted the data. Outcome measures included mortality, peri-operative complications (excluding mortality), anaesthetic time, blood loss, time to mobilisation, length of hospital stay, functional scores, radiological loosening, and revision rate. RESULTS: Fourteen papers were included for subsequent quantitative and qualitative synthesis incorporating a total of 181 patients. The highest level of evidence identified was a single cohort study (level III), the remaining 13 papers consisted of multi- or single-centre case series (level IV). The mean mortality rate was 3.34% (range 0-10) at 30 days and 18.4% (range 0-42) at 1 year. The mean revision rate was 3.43% (range 0-25) at 1 year. The mean time to mobilisation was 3.90 days (range 2.5-6) with a mean time to discharge from the acute ward being 16.6 days (range 8-33). CONCLUSIONS: Although there is limited evidence in the literature available, our review suggests that there is a role for acute knee arthroplasty in distal femoral fractures. This mode of treatment has satisfactory mortality and revision rates, and may result in faster time to mobilisation and discharge. There is a need for a higher level of evidence to delineate this issue further.

How effective is microwave ablation for atrial fibrillation during concomitant cardiac surgery?

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether performing microwave ablative procedures during concomitant cardiac surgical procedures is effective for the treatment of atrial fibrillation (AF). In total, 200 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Major exclusion criteria included studies exclusively using bipolar ablation, ambiguous or unspecified ablation technique, other energy modalities and studies with highly variable or undisclosed follow-up time. One study reported that 66% of patients were in sinus rhythm (SR) with follow-ups ranging from 1 to 14 months and suggested that the risk of AF recurrence was significantly increased with a larger left atrial diameter (OR = 1.21, P = 0.02) and an increased duration of preoperative AF (OR = 2.14, P = 0.03). A separate study found no significant difference in the success rate on the basis of the concomitant procedure (coronary artery bypass grafting or mitral valve surgery, P > 0.5). In the only randomized trial identified, microwave ablation delivered significantly inferior SR restoration rates to radiofrequency (RF) ablation at all time points from discharge to 24 months. There is a large degree of heterogeneity in the studies, with patients' characteristics, for example type of AF, and patient management postoperatively, for example administration of anti-arrhythmias, being inconsistent. Of the 12 studies, nine assessed SR at a mean of 6-12 months and found postoperative success rates between 62 and 87%. One study looked at the medium range follow-up of 24 months with SR restoration at 71%. Two studies looked at the long-term follow-up (5 and 5.37 years) with SR restoration at 39 and 61%, respectively. We conclude that microwave ablation, as an intervention for the treatment of AF during concomitant surgery, is not currently recommended on the limited available evidence. This is because the success rates in the longer term are less clear and the only randomized study to date has found inferior outcomes compared with RF-based ablation.