Medium-term outcomes in single anaesthetic bilateral total knee replacement surgery: a single surgeon series.

BACKGROUND: The lifetime risk of developing symptomatic knee osteoarthritis (OA) is estimated to be 45%, with up to two thirds of patients presenting with bilateral knee symptoms. Patients presenting with end stage bilateral knee OA may benefit from single anaesthetic bilateral total knee replacement (SABTKR). Our study aim was to compare the outcomes of SABTKR with unilateral total knee arthroplasty (TKA) in a single surgeon series over a 20 year period. METHODS: We performed a retrospective review of a single surgeon's data from the New Zealand Joint Registry (NZJR) over a 20-year period from January 1999 to December 2018. This review reports on patient demographics, functional outcomes, revision rates and mortality rates. RESULTS: 1225 total knee replacements were performed by the senior author (995 TKAs and 115 patients underwent SABTKRs) over the 20 year period reviewed. The mean ages of the TKA and SABTKR groups were 67.7 and 66.7 years, respectively. There was 16.9% mortality rate for the TKA group versus 7.8% in SABTKR group. There were no revisions in the SABTKR group versus 17 revisions in the TKA group representing a revision rate of 0.23/100 component years which can be viewed against a 20 year revision rate of 0.48/100 component years (p < 0.05) for all comers in the NZJR. CONCLUSION: This NZJR study demonstrates excellent medium term survival outcomes for selected patients having simultaneous bilateral total knee replacements.

Quadriceps strength deficit associated with rectus fernoris rupture: a case report.

We report a case of rectus femoris rupture of the quadriceps muscles. Isokinetic muscle testing was undertaken at joint angular velocities of 60, 120, 180, 240, and 300 deg s(-1) to establish the knee extensor muscle strength deficits associated with this condition. The mean strength deficit over these joint angular velocities was 16.6%.

Important features associated with acute anterior cruciate ligament injury.

The mechanism of injury and the signs and symptoms associated with initial injury to the anterior cruciate ligament were investigated in 23 subjects. The subjects had injured only their anterior cruciate ligament with no other clinically definable laxity to other major ligamentous structures. The results showed that 70% of subjects had injured their anterior cruciate ligament at footstrike during noncontact situations. In 53% of these subjects the mechanism of injury was internal rotation of the tibia with the knee in slight flexion. A shifting sensation occurring between the tibia and femur was noted by 61% of subjects, while 30% recalled a crack or popping sound at the time of injury. Only 17% of subjects could continue in sports activity immediately following the injury, all with difficulty.

The Morscher Press Fit acetabular component: a nine- to 13-year review.

We reviewed the results at nine to 13 years of 125 total hip replacements in 113 patients using the monoblock uncemented Morscher press-fit acetabular component. The mean age at the time of operation was 56.9 years (36 to 74). The mean clinical follow-up was 11 years (9.7 to 13.5) and the mean radiological follow-up was 9.4 years (7.7 to 13.1). Three hips were revised, one immediately for instability, one for excessive wear and one for deep infection. No revisions were required for aseptic loosening. A total of eight hips (7.0%) had osteolytic lesions greater than 1 cm, in four around the acetabular component (3.5%). One required bone grafting behind a well-fixed implant. The mean wear rate was 0.11 mm/year (0.06 to 0.78) and was significantly higher in components with a steeper abduction angle. Kaplan-Meier survival curves at 13 years showed survival of 96.8% (95% confidence interval 90.2 to 99.0) for revision for any cause and of 95.7% (95% confidence interval 88.6 to 98.4) for any acetabular re-operation.

Video recording in general practice: the patients do mind.

The consent rate for video recording of consultations was examined in a semi-rural training practice in Scotland using a sample of over 1000 patients. An attempt was made to reduce the coercive methods of obtaining consent used in previous studies. In a first study explanatory letters were left in the waiting area - 273 patients returning to reception were asked if they wished to be filmed at a later date - 61 patients (22%) agreed. In a second study 830 patients were handed an explanatory letter asking if they wished to be filmed - 48 patients (6%) volunteered. The overall consent rate for the two studies combined was 10%. The low rate of consent obtained from these patients questions the propriety of using coercive methods.

Change in response with age of human articular cartilage to plasma somatomedin activity.

Normal male articular cartilage (34 specimens, age range 1--30 years) has been examined in vitro for response to somatomedin (SM) activity. Basal 3H-thymidine and 35S-sulfate incorporation both decreased with increasing age of the cartilage donor. However, enhancement of isotope incorporation which was attained on addition of 10% normal plasma (containing IU SM/ml) was greatest in cartilage from adolescents in the age range 12--17 years. The mean enhancement of 3H-thymidine incorporation (expressed as % basal) was as follows: age 1--10 years = 184 +/- 28 (SE), N = 9; 12--17 years = 436 +/- 101 (11); 18--30 years = 231 +/- 49 (8); and for 35S-sulfate incorporation was 1--10 years = 389 +/- 100 (8); 12--17 years = 824 +/- 273 (11); and 18--30 years = 572 +/- 56 (8). The increased response of cartilage in the 12--17 year group suggests that a greater sensitivity to the somatomedins may contribute to the increased skeletal growth during adolesence.

The distribution of radiological joint damage in the rheumatoid hand.

We report a detailed study of the relative distribution of joint damage, as assessed by erosion and joint space scores, in the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the rheumatoid hand. Hand radiographs of 30 patients with erosive rheumatoid arthritis were studied. There was significantly more damage in the dominant hand. The little-finger PIP joints were more damaged and the thumb interphalangeal (IP) joints less damaged than the other PIP joints. The index and middle finger MCP joints were more damaged than the other MCP joints. There was a significant negative correlation between the erosion scores of the PIP and MCP joints of each individual digit, when digits with only minimal damage were excluded. These findings support the concept that joint damage in the rheumatoid hand is greater in those joints that are subjected to greater mechanical stresses, and that in any digital ray the damage is concentrated at either the IPI or MCP joint.

Familial ovarian cancer. How rare is it?

This paper reports an apparently hereditary ovarian carcinoma in the authors' family. A grandmother, her daughter and five granddaughters have been affected. Three of the granddaughters were sisters. The mode of transmission appears to be autosomal dominant, with males capable of being carriers. Present methods of record-keeping make it difficult to link affected females in a family. Further studies are required to find the true incidence of familial ovarian cancer.