Exeter Knee Reconstruction Unit (EKRU)
Permanent URI for this collection
Research outputs from the Exeter Knee Reconstruction Unit at the RD&E.
Browse
Recent Submissions
Item The characteristics and predictors of mortality in periprosthetic fractures around the knee(British Editorial Society of Bone and Joint Journal, 2024-02-01) Nasser, Aahh; Sidhu, M.; Prakash, R.; Mahmood, A.; Osman, K.; Chauhan, G. S.; Nandra, R.; Dewan, V.; Davidson, J.; Al-Azzawi, M.; Smith, C.; Gawad, M.; Palaiologos, I.; Cuthbert, R.; Wignadasan, W.; Banks, D.; Archer, J.; Odeh, A.; Moores, T.; Tahir, M.; Brooks, M.; Biring, G.; Jordan, S.; Elahi, Z.; Shaath, M.; Veettil, M.; De, C.; Handford, C.; Bansal, M.; Bawa, A.; Mattar, A.; Tandra, V.; Daadipour, A.; Taha, A.; Gangoo, S.; Srinivasan, S.; Tarisai, M.; Budair, B.; Subbaraman, K.; Khan, F.; Gomindes, A.; Samuel, A.; Kang, N.; Kapur, K.; Mainwaring, E.; Bridgwater, H.; Lo, A.; Ahmed, U.; Khaleeq, T.; El-Bakoury, A.; Rashed, R.; Hosny, H.; Yarlagadda, R.; Keenan, J.; Hamed, A.; Riemer, B.; Qureshi, A.; Gupta, V.; Waites, M.; Bleibleh, S.; Westacott, D.; Phillips, J.; East, J.; Huntley, D.; Masud, S.; Mirza, Y.; Mishra, S.; Dunlop, D.; Khalefa, M.; Balakumar, B.; Thibbaiah, M.; Payton, O.; Berstock, J.; Deano, K.; Sarraf, K. M.; Logishetty, K.; Lee, G.; Subbiah-Ponniah, H.; Shah, N.; Venkatesan, A.; Cheseldene-Culley, J.; Ayathamattam, J.; Tross, S.; Randhawa, S.; Mohammed, F.; Ali, R.; Bird, J.; Khan, K.; Akhtar, M. A.; Brunt, A.; Roupakiotis, P.; Subramanian, P.; Bua, N.; Hakimi, M.; Bitar, S.; Al Najjar, M.; Radhakrishnan, A.; Gamble, C.; James, A.; Gilmore, C.; Dawson, D.; Sofat, R.; Antar, M.; Raghu, A.; Heaton, S.; Tawfeek, W.; Charles, C.; Burnand, H.; Duffy, S.; Taylor, L.; Magill, L.; Perry, R.; Pettitt, M.; Okoth, K.; Pinkney, T.AIMS: Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality. METHODS: Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality. RESULTS: Out of a total of 1,667 patients in the PPF study database, 420 patients were included. The in-hospital mortality rate was 6.4%. Multivariable analyses suggested that American Society of Anesthesiologists (ASA) grade, history of peripheral vascular disease (PVD), history of rheumatic disease, fracture around a loose implant, and cerebrovascular accident (CVA) during hospital stay were each independently associated with mortality. Each point increase in ASA grade independently correlated with a four-fold greater mortality risk (odds ratio (OR) 4.1 (95% confidence interval (CI) 1.19 to 14.06); p = 0.026). Patients with PVD have a nine-fold increase in mortality risk (OR 9.1 (95% CI 1.25 to 66.47); p = 0.030) and patients with rheumatic disease have a 6.8-fold increase in mortality risk (OR 6.8 (95% CI 1.32 to 34.68); p = 0.022). Patients with a fracture around a loose implant (Unified Classification System (UCS) B2) have a 20-fold increase in mortality, compared to UCS A1 (OR 20.9 (95% CI 1.61 to 271.38); p = 0.020). Mode of management was not a significant predictor of mortality. Patients managed with revision arthroplasty had a significantly longer length of stay (median 16 days; p = 0.029) and higher rates of return to theatre, compared to patients treated nonoperatively or with fixation. CONCLUSION: The mortality rate in PPFs around the knee is similar to that for native distal femur and neck of femur fragility fractures. Patients with certain modifiable risk factors should be optimized. A national PPF database and standardized management guidelines are currently required to understand these complex injuries and to improve patient outcomes.Item Revision total knee replacement finances: a detailed cost-analysis of operative practice at a regional tertiary referral centre(BioMed Central, 2024-01-04) Alexiadis, A.; Reynolds, P.; Al-Mouazzen, L.; Toms, A.; Phillips, J.; Waterson, B.BACKGROUND: The revision knee complexity classification (RKCC) stratifies knee revision operations depending on their level of complexity from simple revisions (R1) to highly complex cases (R3). Current financial codes used for calculation of reimbursement for knee revision services provided at the Trust, rely on patients' comorbidities. However, previous research has demonstrated that this approach may not yield an accurate financial account of knee revision arthroplasty cost. This is a single centre study from a secondary and tertiary revision unit, with work previously presented by the authors demonstrating that the majority of complex revision knee replacement within the region, take place in this unit. The aims of this study were to illustrate the current cost profile and renumeration service currently in place for revision knee and show the differences in cost based on complexity of the operation. METHODS: In this retrospective study, 90 cases who underwent revision knee operations in 2019 were analysed. Data was obtained from a tertiary referral centre where the episodes had occurred. Mean cost, tariff, and subsequent deficit were calculated for the R1, R2 and R3 episodes. RESULTS: R2 and R3 episodes were significantly more expensive than R1 episodes. The increase in cost between R3 and R2 episodes was not significant. The total cost of the revision operations was £1,162,343. Tariffs received for R2 and R3 revision operations were significantly more expensive than R1 operations. However, the increase in tariffs received for R3 operations was not significant in relation to R2 operations. The total amount of tariffs received by the Trust was £ 770,996 generating a net deficit of - £ 391,347. CONCLUSION: Current financial coding for revision knee does not accurately predict costs associated with revision knee surgery. Net deficit varies depending on the RKCC grade of the knee revision episode with more complex operations resulting in a higher mean net deficit. Implementation of the RKCC could prove to be a useful tool in generating an accurate prediction of the cost associated with knee revision surgery.Item Survival of revision ankle arthroplasty(Atypon, 2023-11-01) Jennison, T.; Ukoumunne, O. C.; Lamb, S.; Goldberg, A. J.; Sharpe, I.AIMS: The number of revision total ankle arthroplasties (TAAs) which are undertaken is increasing. Few studies have reported the survival after this procedure. The primary aim of this study was to analyze the survival of revision ankle arthroplasties using large datasets. Secondary aims were to summarize the demographics of the patients, the indications for revision TAA, further operations, and predictors of survival. METHODS: The study combined data from the National Joint Registry and NHS Digital to report the survival of revision TAA. We have previously reported the failure rates and risk factors for failure after TAA, and the outcome of fusion after a failed TAA, using the same methodology. Survival was assessed using life tables and Kaplan Meier graphs. Cox proportional hazards regression models were fitted to compare failure rates. RESULTS: A total of 228 patients underwent revision TAA. The mean follow-up was 2.6 years (SD 2.0). The mean time between the initial procedure and revision was 2.3 years (SD 1.8). The most commonly used implant was the Inbone which was used in 81 patients. A total of 29 (12.7%) failed; nine (3.9%) patients underwent a further revision, 19 (8.3%) underwent a fusion, and one (0.4%) had an amputation. The rate of survival was 95.4% (95% confidence interval (CI) 91.6 to 97.5) at one year, 87.7% (95% CI 81.9 to 91.7; n = 124) at three years and 77.5% (95% CI 66.9 to 85.0; n = 57) at five years. Revision-specific implants had a better survival than when primary implants were used at revision. A total of 50 patients (21.9%) had further surgery; 19 (8.3%) underwent reoperation in the first 12 months. Cox regression models were prepared. In crude analysis the only significant risk factors for failure were the use of cement (hazard ratio (HR) 3.02 (95% CI 1.13 to 8.09)) and the time since the primary procedure (HR 0.67 (95% CI 0.47 to 0.97)). No risk factors for failure were identified in multivariable Cox regression modelling. CONCLUSION: Revision TAAs have good medium term survival and low rates of further surgery. New modular revision implants appear to have improved the survival compared with the use of traditional primary implants at revision.Item Current outcomes of patellofemoral arthroplasty for isolated patellofemoral arthritis - A narrative review(Elsevier, 2023-12-01) Morrison, R.; Mandalia, V.Patellofemoral (PFJ) arthritis can be primary, or secondary to underlying trochlea dysplasia and patellofemoral malalignment. Although primary PFJ osteoarthritis affects an older patient population, just like tibiofemoral arthritis, it is common for younger patients to present with isolated PFJ arthritis secondary to an abnormal PFJ. PFJ arthroplasty (PFJA) has many benefits including being less invasive, associated with lower blood loss, is more cost-effective, and leaves the kinematics of the tibiofemoral joint undisturbed. As a result, there are arguably better functional outcomes associated with PFJA, however the historical revision rate of this procedure is high. Although registry outcome data associated with the first generation of PFJ implants shows a higher revision rate compared to TKA, the comparison of PFJ outcomes with TKA is not always age-matched and there is limited comparison on functional and patient-reported outcomes, something which is more important and relevant in a younger patient cohort. Improvements in implant design, instrumentation, surgical technique, and better patient selection has now resulted in outcomes which are comparable to that of TKA, and in some cases even better. This narrative review outlines the current outcomes of PFJA including highlighting factors which need to be considered in optimising outcomes, as well as discussing advanced techniques of robotic assisted PFJA.Item Return to work following revision knee arthroplasty in patients under 65 years of age: A retrospective study(Elsevier, 2023-10-17) Reason, L. A. R.; Roberton, A.; Jonas, S.; Phillips, J. A.BACKGROUND: Little is known about employment following revision total knee arthroplasty (RTKA). This study aims to describe factors associated with returning to employment in patients of working age who underwent RTKA surgery. METHODS: We performed a retrospective assessment of all patients aged ≤65 who underwent RTKA at our NHS institution between 2006 and 2020. All indications and revision procedures were included. Pre-operative demographics, indication for surgery and Oxford Knee Scores (OKS) were recorded. Postal questionnaires were sent to patients including patient reported outcome measures and a departmental questionnaire asking patients about employment status pre- and post-operatively. RESULTS: 132 procedures were performed in 113 patients. Median follow up was 5.5 years (2.4-9.0). Mean age was 58 (5.8) and 50% (57) were men. 62 patients undergoing 74 procedures responded to postal questionnaires and were included in the study. 53% (33) were employed prior to surgery and 61% (38) returned to work at a median of 12 weeks (3-150). Of the 24 who did not return to work, 7 reported intending to return to work. Those patients who returned to work had increased pre-operative OKS (16.9 vs 13.6) and mean improvement (16.5 vs 12.4). CONCLUSION: This study is limited by small numbers and its observational nature. In this population the majority of patients who wished to return to work after RTKA were able to do so. This provides some reassurance when counselling patients. Prospective studies to better understand the factors that predict return to work will be important with increasing demands from surgery.