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David W. Murray - One of the best experts on this subject based on the ideXlab platform.
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Ten-year clinical and radiographic results of 1000 cementless Oxford unicompartmental knee replacements
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: H. R. Mohammad, Andrew Judge, Christopher A. Dodd, James A Kennedy, Stephen J. Mellon, David W. MurrayAbstract:PurposeUnicompartmental knee replacement (UKR) has substantial benefits over total knee replacement (TKR) but has higher revision rates. The cementless Oxford UKR was introduced to address this but there are concerns about fixation and tibial plateau fractures. The first long-term study of the device with clinical and radiographic outcomes is reported.MethodsThe first 1000 medial cementless Oxford UKR were prospectively identified and followed up by independent physiotherapists. Survival was calculated using the endpoints reoperation, revision, revision to TKR, major revision requiring revision TKR components and patient mortality. The Oxford Knee Score (OKS), Tegner Activity Score and American Knee Society Score (AKSS) were recorded and radiographs analysed.ResultsThe ten year survival was 96.6% (CI 94.8–97.8), 97.5% (CI 95.7–98.5), 98.9% (CI 97.7–99.4) and 99.6% (CI 98.8–99.9) using reoperation, revision, revision to TKR and major revision as the endpoint, respectively. Commonest causes for revision were bearing dislocation ( n = 7, 0.7%), disease progression ( n = 4, 0.4%) and pain ( n = 2, 0.2%). There was one lateral tibial plateau fracture and one femoral component loosening. At 10 years, the mean OKS was 41.2 (SD 9.8), Tegner 2.8 (SD 1.3), AKSS-O 89.1 (SD 13.0) and AKSS-F 80.4 (SD 14.6). There were no pathological radiolucencies or complete radiolucent lines. There were no implant-related deaths.ConclusionsThe cementless Oxford UKR is a safe procedure with excellent long-term clinical results. Our results suggest that reliable fixation was achieved with only one (0.1%) revision for loosening (femoral), no radiographic evidence of loosening in the remaining cases and no fractures related to implantation.Level of evidenceIII.
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Lateral osteophytes do not represent a contraindication to medial unicompartmental knee arthroplasty: a 15-year follow-up
Knee Surgery Sports Traumatology Arthroscopy, 2017Co-Authors: Thomas W. Hamilton, Stephen J. Mellon, David W. Murray, Rajan Choudhary, Cathy Jenkins, Christopher A. F. Dodd, Hemant G. PanditAbstract:Purpose Lateral osteophytes have been reported to be associated with lateral compartment disease and as such it is unclear whether medial unicompartmental knee arthroplasty should be performed if these are present. Methods Using the OARSI classification system, 0 (no osteophyte) to 3 (large osteophyte), radiographs from a series of cemented meniscal-bearing unicompartmental knee arthroplasty implanted in the setting of full-thickness lateral cartilage where lateral osteophytes were not considered a contraindication were identified and factors associated with the presence and size of lateral osteophytes, and their impact on clinical outcomes and implant survival were assessed. Results Pre-operative radiographs from 458 knees (392 patients), independently followed up for a mean 10.5 years (range 5.3–16.6), were assessed. Lateral osteophytes were present in 62 % of knees with 18 % Scored as Grade 3. Inter-observer reliability was good (kappa = 0.70). The presence and size of lateral osteophytes was associated with younger age at joint replacement ( p = 0.01) and increasing BMI ( p = 0.01). No association was seen with gender, pre-operative status, assessed using the Oxford Knee Score (OKS), American Knee Society (AKSS) Objective or Functional Score, Tegner Activity Score, or size of medial tibial lesion. Subgroup analysis of Grade 3 Osteophytes revealed that these were associated with a greater degree of macroscopic ACL damage. At 10 years there was no difference in function (n.s.), and at 15 years no difference in implant survival or mechanism of failure between groups (n.s.). Subgroup analysis of Grade 3 osteophytes found no significant difference in functional outcome at 10 years or implant survival at 15 years. Conclusion The presence of lateral osteophytes is not a contraindication to medial meniscal-bearing unicompartmental knee arthroplasty. The clinical relevance of this study is that it highlights the importance of an appropriate pre-operative assessment of the lateral compartment as in the setting of full-thickness cartilage at operation lateral osteophytes do not compromise long-term functional outcome or implant survival. Level of evidence IV.
Stephen J. Mellon - One of the best experts on this subject based on the ideXlab platform.
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Ten-year clinical and radiographic results of 1000 cementless Oxford unicompartmental knee replacements
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: H. R. Mohammad, Andrew Judge, Christopher A. Dodd, James A Kennedy, Stephen J. Mellon, David W. MurrayAbstract:PurposeUnicompartmental knee replacement (UKR) has substantial benefits over total knee replacement (TKR) but has higher revision rates. The cementless Oxford UKR was introduced to address this but there are concerns about fixation and tibial plateau fractures. The first long-term study of the device with clinical and radiographic outcomes is reported.MethodsThe first 1000 medial cementless Oxford UKR were prospectively identified and followed up by independent physiotherapists. Survival was calculated using the endpoints reoperation, revision, revision to TKR, major revision requiring revision TKR components and patient mortality. The Oxford Knee Score (OKS), Tegner Activity Score and American Knee Society Score (AKSS) were recorded and radiographs analysed.ResultsThe ten year survival was 96.6% (CI 94.8–97.8), 97.5% (CI 95.7–98.5), 98.9% (CI 97.7–99.4) and 99.6% (CI 98.8–99.9) using reoperation, revision, revision to TKR and major revision as the endpoint, respectively. Commonest causes for revision were bearing dislocation ( n = 7, 0.7%), disease progression ( n = 4, 0.4%) and pain ( n = 2, 0.2%). There was one lateral tibial plateau fracture and one femoral component loosening. At 10 years, the mean OKS was 41.2 (SD 9.8), Tegner 2.8 (SD 1.3), AKSS-O 89.1 (SD 13.0) and AKSS-F 80.4 (SD 14.6). There were no pathological radiolucencies or complete radiolucent lines. There were no implant-related deaths.ConclusionsThe cementless Oxford UKR is a safe procedure with excellent long-term clinical results. Our results suggest that reliable fixation was achieved with only one (0.1%) revision for loosening (femoral), no radiographic evidence of loosening in the remaining cases and no fractures related to implantation.Level of evidenceIII.
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Lateral osteophytes do not represent a contraindication to medial unicompartmental knee arthroplasty: a 15-year follow-up
Knee Surgery Sports Traumatology Arthroscopy, 2017Co-Authors: Thomas W. Hamilton, Stephen J. Mellon, David W. Murray, Rajan Choudhary, Cathy Jenkins, Christopher A. F. Dodd, Hemant G. PanditAbstract:Purpose Lateral osteophytes have been reported to be associated with lateral compartment disease and as such it is unclear whether medial unicompartmental knee arthroplasty should be performed if these are present. Methods Using the OARSI classification system, 0 (no osteophyte) to 3 (large osteophyte), radiographs from a series of cemented meniscal-bearing unicompartmental knee arthroplasty implanted in the setting of full-thickness lateral cartilage where lateral osteophytes were not considered a contraindication were identified and factors associated with the presence and size of lateral osteophytes, and their impact on clinical outcomes and implant survival were assessed. Results Pre-operative radiographs from 458 knees (392 patients), independently followed up for a mean 10.5 years (range 5.3–16.6), were assessed. Lateral osteophytes were present in 62 % of knees with 18 % Scored as Grade 3. Inter-observer reliability was good (kappa = 0.70). The presence and size of lateral osteophytes was associated with younger age at joint replacement ( p = 0.01) and increasing BMI ( p = 0.01). No association was seen with gender, pre-operative status, assessed using the Oxford Knee Score (OKS), American Knee Society (AKSS) Objective or Functional Score, Tegner Activity Score, or size of medial tibial lesion. Subgroup analysis of Grade 3 Osteophytes revealed that these were associated with a greater degree of macroscopic ACL damage. At 10 years there was no difference in function (n.s.), and at 15 years no difference in implant survival or mechanism of failure between groups (n.s.). Subgroup analysis of Grade 3 osteophytes found no significant difference in functional outcome at 10 years or implant survival at 15 years. Conclusion The presence of lateral osteophytes is not a contraindication to medial meniscal-bearing unicompartmental knee arthroplasty. The clinical relevance of this study is that it highlights the importance of an appropriate pre-operative assessment of the lateral compartment as in the setting of full-thickness cartilage at operation lateral osteophytes do not compromise long-term functional outcome or implant survival. Level of evidence IV.
Yingfang Ao - One of the best experts on this subject based on the ideXlab platform.
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Translation, Validation and Cross-Cultural Adaptation of a Simplified-Chinese Version of the Tegner Activity Score in Chinese Patients with Anterior Cruciate Ligament Injury.
PLOS ONE, 2016Co-Authors: Hongshi Huang, Dongxia Zhang, Yanfang Jiang, Jie Yang, Tao Feng, Xi Gong, Jianquan Wang, Yingfang AoAbstract:Aims To translate the English version of Tegner Activity Score into a Simplified-Chinese version (Tegner-C) and evaluate its psychometric properties. Methods Tegner-C was cross-culturally adapted according to established guidelines. The validity and reliability of Tegner-C were assessed in 78 participants, with 19–20 participants in each of the four groups: before anterior cruciate ligament reconstruction (pre-ACLR) group, 2–3 months after ACLR group, 3–12 months after ACLR group, and healthy control group. Each participant was asked to complete the Tegner-C and Chinese version of International Knee Documentation Committee Subjective Knee Form (IKDC-SKF-C) twice, with an interval of 5±2 days. Intra-class correlation coefficient (ICC2, 1) was used to assess the reliability and Spearman’s rank correlation was used for construct validity. Results The ICC2,1 was higher than 0.90 for all groups except in the pre-ACLR group, for which the ICC2,1 was 0.71 (0.41, 0.87) (All with p
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translation validation and cross cultural adaptation of a simplified chinese version of the Tegner Activity Score in chinese patients with anterior cruciate ligament injury
PLOS ONE, 2016Co-Authors: Hongshi Huang, Dongxia Zhang, Yanfang Jiang, Jie Yang, Tao Feng, Xi Gong, Jianquan Wang, Yingfang AoAbstract:Aims To translate the English version of Tegner Activity Score into a Simplified-Chinese version (Tegner-C) and evaluate its psychometric properties. Methods Tegner-C was cross-culturally adapted according to established guidelines. The validity and reliability of Tegner-C were assessed in 78 participants, with 19–20 participants in each of the four groups: before anterior cruciate ligament reconstruction (pre-ACLR) group, 2–3 months after ACLR group, 3–12 months after ACLR group, and healthy control group. Each participant was asked to complete the Tegner-C and Chinese version of International Knee Documentation Committee Subjective Knee Form (IKDC-SKF-C) twice, with an interval of 5±2 days. Intra-class correlation coefficient (ICC2, 1) was used to assess the reliability and Spearman’s rank correlation was used for construct validity. Results The ICC2,1 was higher than 0.90 for all groups except in the pre-ACLR group, for which the ICC2,1 was 0.71 (0.41, 0.87) (All with p<0.001). The absolute reliability as evaluated by the smallest detectable change was 0.43, 2.12, 0.89, and 0.44 for the healthy control group, pre-ACLR group, 2–3 months after ACLR group, and 3–12 months after ACLR group, respectively. Neither a ceiling effect nor a floor effect was observed for any group. Significant difference was observed for both Tegner-C and IKDC-SKF-C Scores between the control and the other three groups (all with p<0.001), and between pre-ACLR and the 2–3 months after ACLR group (p<0.001). Conclusions Tegner-C demonstrated comparable psychometric properties to the original English version and thus is reliable and valid for Chinese-speaking patients with ACL injury.
Hemant G. Pandit - One of the best experts on this subject based on the ideXlab platform.
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Lateral osteophytes do not represent a contraindication to medial unicompartmental knee arthroplasty: a 15-year follow-up
Knee Surgery Sports Traumatology Arthroscopy, 2017Co-Authors: Thomas W. Hamilton, Stephen J. Mellon, David W. Murray, Rajan Choudhary, Cathy Jenkins, Christopher A. F. Dodd, Hemant G. PanditAbstract:Purpose Lateral osteophytes have been reported to be associated with lateral compartment disease and as such it is unclear whether medial unicompartmental knee arthroplasty should be performed if these are present. Methods Using the OARSI classification system, 0 (no osteophyte) to 3 (large osteophyte), radiographs from a series of cemented meniscal-bearing unicompartmental knee arthroplasty implanted in the setting of full-thickness lateral cartilage where lateral osteophytes were not considered a contraindication were identified and factors associated with the presence and size of lateral osteophytes, and their impact on clinical outcomes and implant survival were assessed. Results Pre-operative radiographs from 458 knees (392 patients), independently followed up for a mean 10.5 years (range 5.3–16.6), were assessed. Lateral osteophytes were present in 62 % of knees with 18 % Scored as Grade 3. Inter-observer reliability was good (kappa = 0.70). The presence and size of lateral osteophytes was associated with younger age at joint replacement ( p = 0.01) and increasing BMI ( p = 0.01). No association was seen with gender, pre-operative status, assessed using the Oxford Knee Score (OKS), American Knee Society (AKSS) Objective or Functional Score, Tegner Activity Score, or size of medial tibial lesion. Subgroup analysis of Grade 3 Osteophytes revealed that these were associated with a greater degree of macroscopic ACL damage. At 10 years there was no difference in function (n.s.), and at 15 years no difference in implant survival or mechanism of failure between groups (n.s.). Subgroup analysis of Grade 3 osteophytes found no significant difference in functional outcome at 10 years or implant survival at 15 years. Conclusion The presence of lateral osteophytes is not a contraindication to medial meniscal-bearing unicompartmental knee arthroplasty. The clinical relevance of this study is that it highlights the importance of an appropriate pre-operative assessment of the lateral compartment as in the setting of full-thickness cartilage at operation lateral osteophytes do not compromise long-term functional outcome or implant survival. Level of evidence IV.
D W Murray - One of the best experts on this subject based on the ideXlab platform.
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minimally invasive oxford phase 3 unicompartmental knee replacement results of 1000 cases
Journal of Bone and Joint Surgery-british Volume, 2011Co-Authors: H Pandit, C Jenkins, H S Gill, Karen Barker, C A F Dodd, D W MurrayAbstract:This prospective study describes the outcome of the first 1000 phase 3 Oxford medial unicompartmental knee replacements (UKRs) implanted using a minimally invasive surgical approach for the recommended indications by two surgeons and followed up independently. The mean follow-up was 5.6 years (1 to 11) with 547 knees having a minimum follow-up of five years. At five years their mean Oxford knee Score was 41.3 (sd 7.2), the mean American Knee Society Objective Score 86.4 (sd 13.4), mean American Knee Society Functional Score 86.1 (sd 16.6), mean Tegner Activity Score 2.8 (sd 1.1). For the entire cohort, the mean maximum flexion was 130° at the time of final review. The incidence of implant-related re-operations was 2.9%; of these 29 re-operations two were revisions requiring revision knee replacement components with stems and wedges, 17 were conversions to a primary total knee replacement, six were open reductions for dislocation of the bearing, three were secondary lateral UKRs and one was revision of a tibial component. The most common reason for further surgical intervention was progression of arthritis in the lateral compartment (0.9%), followed by dislocation of the bearing (0.6%) and revision for unexplained pain (0.6%). If all implant-related re-operations are considered failures, the ten-year survival rate was 96% (95% confidence interval, 92.5 to 99.5). If only revisions requiring revision components are considered failures the ten-year survival rate is 99.8% (confidence interval 99 to 100). This is the largest published series of UKRs implanted through a minimally invasive surgical approach and with ten-year survival data. The survival rates are similar to those obtained with a standard open approach whereas the function is better. This demonstrates the effectiveness and safety of a minimally invasive surgical approach for implanting the Oxford UKR.
