ORCID Profile
0000-0002-1572-9529
Current Organisations
Wakefield Orthopaedic Clinic
,
University of Adelaide
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Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.ARTH.2011.03.047
Abstract: Periprosthetic osteolysis is a common cause of revision of total knee arthroplasties (TKAs), with plain anteroposterior and lateral (APL) radiographs being the most common method for screening. The aim of this study was to examine the utility of lesion detection and volume appreciation with APL, paired oblique radiographs, and computed tomography. Defects of different sizes were created in 3 cadaveric knees with a cementless TKA in situ and imaged with APL, oblique, and computed tomography modalities. The resultant images were then shown to 3 arthroplasty surgeons, and the absence or presence of lesions, volume size, and confidence in assessment were recorded. The results suggest that the current practice of APL is inferior for the assessment of periprosthetic osteolysis around TKA.
Publisher: Elsevier BV
Date: 2001
Abstract: Three classifications for assessment of acetabular bone loss were evaluated for their reliability. The 3 systems assessed were the system described by Gross, the system described by Paprosky, and the classification of the American Academy of Orthopaedic Surgeons. In this study, we assessed their reliability based on the preoperative radiographs alone. Intraobserver agreement was measured by evaluating the classifications by the 3 innovators, 3 reconstructive orthopaedic surgeons, and 3 residents. Interobserver agreement was assessed among the reconstructive surgeons and the residents. The unweighted kappa statistic was used to establish levels of agreement. The innovators had better intraobserver agreement than the other 2 groups. Their agreement was only in the moderate range, however. For the noninnovators, intraobserver and interobserver agreement generally was poor for all 3 classifications assessed. Our results indicate that these classifications do not provide statistically reliable information for preoperative assessment of acetabular bone stock loss.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-1996
DOI: 10.1097/00003086-199610000-00041
Abstract: Human immunodeficiency virus infection of a human bone derived cell line was initiated by either cell free virus or with a cell to cell transmission method. The human bone derived cells were examined for 8 weeks, and virus infection was not detected when assessed by microscopy, immunofluorescence, reverse transcriptase activity, or infection of cocultivated human T lymphoid cells susceptible to human immunodeficiency virus. Polymerase chain reaction analysis of human bone derived cells inoculated with the cell to cell infection format showed less than 0.1% infected cells. It is possible that the infected cells detected by polymerase chain reaction were lymphocytes used in the cell to cell infection format. Alternatively, latent infection may have been established in the bone derived cells with no apparent expression of the proviral genome. A large proportion of bone is represented by human bone derived cells, and it is unlikely that bone will contribute to a significant human immunodeficiency virus reservoir in vivo. The blood of bone allograft donors is likely to have a greater virus bioburden than is bone. Methods to sterilize bone should be assessed by their efficacy to inactivate the virus in blood contaminating the graft, and methods to detect human immunodeficiency virus deoxyribonucleic acid in a bone graft may be less sensitive than examining the donor's blood.
Publisher: Wiley
Date: 19-08-2010
DOI: 10.1111/J.1445-2197.2010.05396.X
Abstract: The 'obesity epidemic' is expected to result in an increased incidence of knee osteoarthritis and hence total knee replacements (TKRs). Reviews have demonstrated the conflicting results of TKR for all obese (body mass index (BMI) >30). The aim of this literature review was to specifically evaluate outcomes of TKR in patients with morbid obesity (MO BMI >40). A systematic review of medical databases (PubMed, Medline, Cochrane Library, ScienceDirect) by use of keywords from January 1990 to September 2009 was undertaken. Clinical and functional Knee Society Scores (KSS) improve after TKR for patients with MO. The post-operative functional KSS was, in general, less than in controls. Radiographic analysis was inconclusive because of small study populations and short duration of follow-up. All studies reporting complications noted a greater prevalence in MO patients (10-30%). Of concern was the significantly higher prevalence of deep prosthetic infection (3-9-times that of controls). The morbidly obese also had a significantly higher incidence of wound complications. TKR did not result in weight loss for MO patients, and therefore has no benefit on weight-related medical conditions. Bariatric surgery in MO under 65 years of age has been shown to be a cost-effective and clinically effective method of weight reduction. This surgery also results in significant improvement in weight-related medical conditions, the KSS and knee pain. Given the increase in complications for MO patients after TKR, these patients should be advised to lose weight before surgery and, if suitable, would probably benefit from bariatric surgery.
Publisher: Springer Science and Business Media LLC
Date: 13-01-2016
Publisher: Wiley
Date: 12-07-2016
DOI: 10.1002/JOR.23356
Abstract: A number of different software programs are used to investigate the in vivo wear of polyethylene bearings in total hip arthroplasty. With wear rates below 0.1 mm/year now commonly being reported for highly cross-linked polyethylene (XLPE) components, it is important to identify the accuracy of the methods used to measure such small movements. The aims of this study were to compare the accuracy of current software programs used to measure two-dimensional (2D) femoral head penetration (FHP) and to determine whether the accuracy is influenced by larger femoral heads or by different methods of representing the acetabular component within radiostereometric analysis (RSA). A hip phantom was used to compare known movements of the femoral head within a metal-backed acetabular component to FHP measured radiographically using RSA, Hip Analysis Suite (HAS), PolyWare, Ein Bild Roentgen Analyse (EBRA), and Roentgen Monographic Analysis Tool (ROMAN). RSA was significantly more accurate than the HAS, PolyWare, and ROMAN methods when measuring 2D FHP with a 28 mm femoral head. Femoral head size influenced the accuracy of HAS and ROMAN 2D FHP measurements, EBRA proximal measurements, and RSA measurements in the proximal and anterior direction. The use of different acetabular reference segments did not influence accuracy of RSA measurements. The superior accuracy and reduced variability of RSA wear measurements allow much smaller cohorts to be used in RSA clinical wear studies than those utilizing other software programs. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:988-996, 2017.
Publisher: BMJ
Date: 30-11-2007
Abstract: To demonstrate the efficacy of intra-articular infliximab in a patient with a persistent monarthritis who had previously had two arthroscopic synovectomies with limited success, and to determine the effect of intra-articular infliximab on synovial membrane pathology Arthroscopic synovial biopsy specimens were collected before and after treatment with intra-articular infliximab. The synovial tissue was stained for a range of inflammatory cell subsets, cell adhesion molecules and cytokines using immunohistochemical techniques and quantified using digital image analysis and a semiquantitative scoring method. Clinical improvement in the knee synovitis was seen after the first two intra-articular infliximab treatments, with a sustained clinical remission lasting for more than 12 months after the third treatment. Significant changes in cellular infiltration and expression of cytokines and cell adhesion molecules occurred as a result of treatment with intra-articular infliximab, with a reduction in some but not all cells in the inflammatory infiltrate, as well as a reduction in the expression of cell adhesion molecules (intercellular adhesion molecule-1 and vascular adhesion molecule-1) and production of cytokines (interleukin 1beta and tumour necrosis factor alpha). Intra-articular infliximab administration is a viable treatment for a persistent monarthritis resistant to other treatment options and can successfully modulate the inflammatory milieu within the synovial membrane.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2010
Publisher: Wiley
Date: 11-2012
DOI: 10.1111/ANS.12000
Abstract: Data from the Australian Better Safer Transfusion programme show that about one-third of patients undergoing hip or knee arthroplasty receive perioperative blood transfusions, placing them at increased risk for adverse clinical outcomes. Other concerns associated with allogeneic blood transfusion include the quality of stored red cell concentrates, the cost of provision of blood and the predicted local demographics, which mean that fewer donors will need to support a greater number of recipients. In view of the multiple challenges associated with allogeneic blood transfusion and its provision, we developed practical management recommendations for perioperative bleeding in joint replacement surgery, based on available evidence and expert consensus opinion, that aim to promote a new, responsible approach to transfusion management. Key recommendations are as follows. Patients' medical health, including haemoglobin and iron levels, needs to be evaluated and optimized preoperatively. Anticoagulant and antiplatelet therapy should be stopped if possible, unless indicated for secondary cardiovascular prevention or coronary stent patency, in which case careful consideration is required. If substantial blood loss is anticipated, intraoperative management with antifibrinolytic agents is recommended for bleeding prophylaxis. Normothermia should be maintained. Pharmacological and non-pharmacological measures are recommended for post-operative thromboprophylaxis. A blood management programme should be instituted for haemodynamically stable patients.
Publisher: Wiley
Date: 15-02-2019
DOI: 10.1111/ANS.15035
Abstract: Total knee replacement (TKR) has been shown to perform differently in patients with rheumatoid arthritis (RA) when compared to osteoarthritis (OA). In this study, we compare the survivorship between these two groups and examine patient and prosthesis factors that impact the revision rate. All RA and OA patients undergoing TKR in Australia from 1 September 1999 to 31 December 2016 were included. Revision rates were assessed using Kaplan-Meier estimates of survivorship. The cumulative percent revision analysed age, gender, prosthesis constraint and revision for infection. There were 541 744 TKR procedures performed including 7542 patients with RA. RA declined as the primary diagnosis from 2.4% of all TKR in 2003 to 0.9% in 2016. Male sex was an independent revision risk in RA patients (hazard ratio (HR) = 1.66, P < 0.001) and OA patients (3.5 years+: HR = 1.09 (1.04-1.15), P < 0.001). Male RA patients had a higher revision rate for infection than females (HR = 3.14, P < 0.001). Females with RA had a lower cumulative percent revision compared to OA females, but males showed no difference between diagnoses. Revision in RA patients was not influenced by age. Compared to OA, RA patients had a decreased revision rate for those aged <65 years, but not for patients aged ≥65 years. The rate of revision after TKR in RA patients is lower than those with OA, but patients with RA are at increased risk of infection, particularly the male group. Prosthesis constraint had no influence on revision rate. Mortality in those undergoing TKR with RA was higher than in those with OA.
Publisher: Wiley
Date: 07-1999
DOI: 10.1046/J.1440-1622.1999.01615.X
Abstract: Bone allograft banks commonly sterilize frozen bone by irradiation. The dose-response relationship for HIV is calculated and the dose required to inactivate the bioburden of virus that may be present in allograft bone is determined. A virus titre experiment is performed using irradiated frozen HIV. The virus is maintained on dry ice (approximately -70 degrees C) and is exposed to a cobalt 60 source with 0-40 kGy irradiation at 5 kGy intervals. Lymphocyte cell cultures are exposed to serial dilutions of the irradiated virus. The virus titre is quantified by cytological changes of HIV infection and p24 immunofluorescence. There is a linear relationship between the virus titre and the radiation dose delivered. The inactivation rate of irradiated virus was 0.1134 log10 tissue culture infective doses 50/mL per kGy (95% confidence intervals, 0.1248-0.1020). The irradiation dose required to inactivate the HIV bioburden in allograft bone is 35 kGy. The irradiation dose required to achieve a sterility assurance level of 10(-6) is 89 kGy. This dose exceeds current recommendations for sterilizing medical products and the current practice of many bone banks. It is concluded that gamma irradiation should be disregarded as a significant virus inactivation method for bone allografts.
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.ARTH.2011.12.002
Abstract: A prospective cohort of 30 patients undergoing primary total hip arthroplasty for treatment of osteoarthritis was enrolled in a study to characterize the migration behavior of a clinically successful cementless stem. At 6 years, the mean subsidence of the stem was 0.63 mm (range, -0.33 to 3.68 mm) the mean rotation into retroversion was 1.41° (range, -1.33° to 7.48°). No stems had additional subsidence of more than 0.25 mm between 6 months and 6 years. The resultant mean subsidence between 2 and 6 years was 0.03 mm, which is below the limit measurable by radiostereometric analysis. The data demonstrate that subsidence of this cementless stem occurs within the first 6 months, after which there is persistent stabilization.
Publisher: Springer Science and Business Media LLC
Date: 20-03-2010
DOI: 10.1007/S00402-010-1092-5
Abstract: Ligament balancing is an established surgical technique in total knee arthroplasty with good clinical results. A similar technique for unicondylar knee arthroplasty was developed. The aim of this study was to asses the outcomes of a unicondylar knee replacement implanted with a ligament tensor. A prospective multicentre study of 168 medial compartment unicondylar knee prosthesis with a minimum follow-up of 2 years. Clinically, the knee society score was recorded. For subjective assessment, the visual analogue scale (VAS) for pain and satisfaction was used. Radiographic analysis was performed to determine radiolucent lines. The surgical technique was based on a ligament-orientated procedure. With this technique, the femoral orientation, flexion/extension gaps and limb alignment is determined with a unique ligament tensor. The total KSS increased from 110.9 +/- 27.5 points preoperative to 176.5 +/- 21.1 points after 24 months. VAS for pain decreased from 6.0 +/- 1.9 preoperative to 2.8 +/- 1.7 after 24 months. VAS for satisfaction increased in the same period from 4.3 +/- 1.9 to 8.9 +/- 1.7. Four tibia implants had thin continuous radiolucent lines. Nine adverse events are reported. One patient died of unrelated causes. Five polyethylene inlays dislocated, one of five dislocated due to a fall. Three unicondylar knee prostheses were revised to a total knee arthroplasty, one because of undiagnosed pain, one for infection and one for femoral component malalignment. We have demonstrated the efficacy of a tension-controlled ligament-balanced surgical technique for unicompartmental knee prosthesis that gives satisfying and reproducible short-term results.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 12-2016
DOI: 10.1302/0301-620X.98B12.37682
Abstract: The increased in vivo resistance to wear of highly crosslinked polyethylene (HXLPE) in total hip arthroplasty (THA) has led to an increased use of larger articulations which have been shown to reduce the incidence of early dislocation. To date, there are few reports of the wear of larger articulations using second generation HXLPE liners. Our prospective cohort study measured the bedding-in and early wear of large (36 mm and 40 mm diameter) articulations involving a second generation X3 HXLPE liner and compared our findings with previous clinical and in vitro studies of the same material. The proximal penetration of the femoral head five years post-operatively was measured for 15 patients using radiostereometric analysis (RSA). The median proximal bedding-in within the first post-operative year was 0.022 mm (interquartile range (IQR) -0.050 to 0.091). The median proximal rate of wear between one and five years was -0.004 mm/year (IQR -0.021 to 0.022). The rates of proximal, medial, 2D or 3D wear between one and five years post-operatively of the X3 HXLPE liner did not increase with larger articulations compared with our previous study of 32 mm articulations. Although reassuring, the use of larger articulations requires continued monitoring to determine whether the low wear observed in the short-term continues to the mid- to long-term. Cite this article: Bone Joint J 2016 -B:1604–10.
Publisher: Wiley
Date: 16-08-2006
DOI: 10.1111/J.1445-2197.2006.03867.X
Abstract: Unicompartmental knee arthroplasty is a popular alternative to total knee replacement in selected patients. Component alignment has not yet been described by computer-assisted tomography (CAT) imaging techniques these have been developed for total knee arthroplasty analysis. The aims of this study were to report two new technologies a new unicompartmental knee arthroplasty system was radiographically assessed with a new CAT scan protocol. In a consecutive cohort study, 60 knees were analysed by the 'UniCAT Protocol'. Patients were implanted with a unicompartmental knee arthroplasty system that uses a unique ligament tensor for femoral component alignment. The uniCAT protocol requires a long anteroposterior and lateral scout scan to measure limb alignment and component orientation. A spiral computer-assisted tomography at the knee is used to measure component rotation. The total scan time was 20 s with a calculated unshielded radiation dose of 1 mSv or less. The mechanical axis had a mean of 2.7 degrees varus. Femoral components were implanted with a mean of 0.37 degrees valgus and 1.3 degrees flexion. Tibial components were implanted with a mean 3.47 degrees varus and 5.1 degrees posterior slope. Femoral components were externally rotated a mean of 3.36 degrees, tibial components were externally rotated 6.59 degrees from the posterior tibia and 5.68 degrees from the transepicondylar axis. The UniCAT protocol uses less radiation than whole-limb spiral scans and is a method that can be used with all modern computer-assisted tomography machines. The coronal and sagital alignment results compare favourably with previous published reports without computer-assisted tomography. Component rotation has not previously been reported and its implications are yet to be defined.
Publisher: SAGE Publications
Date: 11-1994
DOI: 10.1177/036354659402200620
Abstract: We have developed a noninvasive ultrasound tech nique that may be used to differentiate complete and incomplete acute tears of the anterior talofibular liga ment. Direct visualization of the ligament will demon strate the lesion in most cases and can be supple mented by an anterior drawer test with the ligament under direct vision. Seventeen athletes involved in sports and work that put high-demand pressure on their ankles underwent ultrasonic examination of their acute lateral ankle ligament injuries before surgical explora tion. Fourteen scans demonstrating a complete lesion of the anterior talofibular ligament were confirmed at operation. Three scans were equivocal two of these patients had incomplete lesions of their anterior talo fibular ligaments and one patient had a complete tear that was not detected. We have found that the dynamic ultrasound test is a simple and reliable examination. We suggest that this technique is indicated where the extent of an acute lateral ligament injury requires further defi nition. Ankle ultrasonography may reduce the need for ankle arthrography.
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.BONE.2016.04.017
Abstract: Osteocytes are essential regulators of bone homeostasis. However, they are difficult to study due to their location within the bone mineralised matrix. Although several techniques have been published for the isolation of osteocytes from mouse bone, no such technique has been described for human osteocytes. We have therefore developed a protocol for the isolation of osteocytes from human trabecular bone s les acquired during surgery. The cells were digested from the bone matrix by sequential collagenase and ethylenediaminetetraacetic acid (EDTA) digestions and the cells from later digests displayed characteristic dendritic osteocyte morphology when cultured ex vivo. Furthermore, the cells expressed characteristic osteocyte marker genes, such as E11, dentin matrix protein 1 (DMP1), SOST, matrix extracellular phosphoglycoprotein (MEPE) and phosphate regulating endopeptidase homologue, X-linked (PHEX). In addition, genes associated with osteocyte perilacunar remodelling, including matrix metallopeptidase-13 (MMP13), cathepsin K (CTSK) and carbonic anhydrase 2 (CAR2) were expressed. The cells also responded to parathyroid hormone (PTH) by downregulating SOST mRNA expression and to 1α,25-dihydroxyvitamin D3 (1,25D) by upregulating fibroblast growth factor 23 (FGF23) mRNA expression. Therefore, the cells behave in a similar manner to osteocytes in vivo. These cells represent an important tool in enhancing current knowledge in human osteocyte biology.
Publisher: Wiley
Date: 06-2010
Publisher: Springer Science and Business Media LLC
Date: 06-1994
DOI: 10.1007/BF00192474
Publisher: Elsevier BV
Date: 06-2020
Publisher: Wiley
Date: 06-2095
DOI: 10.1111/J.1445-2197.1995.TB00578.X
Abstract: The South Australian Bone Bank had expanded to meet an increased demand for allograft bone. During a 5 year period from 1988 to 1992, 2361 allografts were harvested from 2146 living donors and 30 cadaveric donors. The allografts were screened by contemporary banking techniques which include a social history, donor serum tests for HIV-1, HIV-2, hepatitis B and C, syphilis serology, graft microbiology and histology. Grafts were irradiated with 25 kGy. The majority of grafts were used for arthroplasty or spinal surgery and 99 were used for tumour reconstruction. Of the donated grafts 336 were rejected by the bank. One donor was HIV-positive and two had false positive screens. There were seven donors with positive serology for hepatitis B, eight for hepatitis C and nine for syphilis. Twenty-seven grafts had positive cultures. Bone transplantation is the most frequent non-haematogenous allograft in South Australia and probably nationally. The low incidence of infectious viral disease in the donor population combined with an aggressive discard policy has ensured relative safety of the grafts. The frequency of graft rejection was similar to other bone banks but the incidence of HIV was lower.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.ARTH.2011.05.003
Abstract: Previous surveys of orthopedic surgeons have shown considerable variation in thromboprophylaxis for venous thromboembolism after joint arthroplasty. This survey aimed to determine the current practice among Australian orthopedic surgeons. A questionnaire regarding the duration, reasons, and methods of chemical and mechanical prophylaxis for hip and knee arthroplasty patients was sent to the 1082 surgeons identified 593 (55%) members completed the questionnaire. The survey revealed that 98% of surgeons used chemical thromboprophylaxis, mainly low-molecular-weight heparin (84% hip and 79% knee). Those who use low-molecular-weight heparin were more likely to prescribe anticoagulants in fear of litigation (19.2% vs 10.1%, P = .04) and more likely to rely on protocols or guidelines (32.2% vs 17.2%, P = .004) instead of basing their decision on their own reading (52.4% vs 71.3%, P = .001). Most orthopedic surgeons in our survey have indicated that they would welcome guidelines from their association or college regarding thromboprophylaxis in arthroplasty.
Publisher: Medical Journals Sweden AB
Date: 10-10-2014
Publisher: Springer Science and Business Media LLC
Date: 13-12-2009
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.KNEE.2018.12.003
Abstract: All-polyethylene (AP) tibial components in patients aged greater than 60 years have stable tibial migration patterns and favorable survival rates when compared to identical Metal-backed (MB) designs. Tibial component migration in younger patients has not been reported. The aim of this study was to examine the migration characteristics of patients aged less than 60 years compared to a previous cohort of AP and MB tibial components of identical design in older patients. A prospective consecutive study examined tibial component migration in 21 patients aged less than 60 years undergoing a cemented total knee arthroplasty with an AP tibial component by radiostereometric analysis (RSA) to 24 months. Results were compared to the authors' previous series of 21 patients aged greater than 60 years that were randomized to either an AP or MB tibial component. Both age groups of patients implanted with an AP component had stable migration patterns with no patient having greater than 0.2° rotation or 0.2 mm maximum total point motion. Five of 11 MB tibial components displayed continued migration between one and two years. Subsidence was similar in all groups, whilst maximum total point motion was greater for the MB cohort (0.34 mm, 0.33 mm, 0.61 mm AP 60, MB). Young patients implanted with an AP tibial component had stable tibial migration patterns comparable to older patients with the same AP implant. Regardless of age, AP tibial components were at least as stable as MB tibial components. Level II, Prospective comparative study.
Publisher: Wiley
Date: 06-2008
DOI: 10.1002/J.2055-2335.2008.TB00821.X
Abstract: Bone cement impregnated with high doses of aminoglycosides is used to treat infection associated with joint arthroplasty. To examine serum tobramycin and creatinine concentrations in patients who received high‐dose tobramycin and vancomycin impregnated bone cement during revision joint arthroplasty. This was a prospective cohort case series of 10 patients aged 58 to 82 years undergoing revision joint arthroplasty with high‐dose tobramycin and vancomycin impregnated bone cement. Serum tobramycin and creatinine concentrations were monitored post surgery. Sterile tobramycin 3.6 g and vancomycin 1.0 g powder was mixed into each 40 g of Palacos bone cement, resulting in total maximum doses of tobramycin 7.2 g and vancomycin 2.0 g. At the time of hospital discharge renal function was unchanged in 9 patients. A 75‐year‐old male patient with preexisting renal impairment developed significant and persistent worsening of his renal function. Bone cement impregnated with high doses of aminoglycosides should be used with caution in patients with a history of renal impairment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-04-2020
DOI: 10.1097/CORR.0000000000001229
Abstract: TKA generally has excellent long-term survivorship. When a new knee system supersedes a previous model, increased survivorship, improved functional performance, or both may be expected, because key areas of design modification are often targeted to address wear, stability, and the patellofemoral articulation. However, not all design changes are beneficial, and to our knowledge, knee arthroplasty has not been systematically evaluated in the context of design changes that occur during the development of new knee arthroplasty systems. Using the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) we performed multiple old-to-new comparisons of frequently used contemporary knee implants to ask: (1) does overall prosthesis survivorship free from revision increase when a new knee prosthesis system is introduced to replace a prior prosthesis system? (2) Has survivorship free from revision improved for the revision indications of wear, instability, and patellofemoral articulation issues, where development efforts have been concentrated? Data from the AOANJRR from September 1999 to December 2017 were used to compare the survivorship of prostheses free from revision at a maximum of 17 years in procedures where a new design model was introduced to replace a prior knee system from the same manufacturer. Only prosthesis systems used in a minimum of 2000 primary TKA procedures for osteoarthritis that had a minimum of 5 years of follow-up were included. Varus-valgus constrained and hinge TKA designs were excluded. Cruciate-retaining, posterior-stabilized, and medial pivot-design knees were considered separately. The new and old prosthesis systems were paired for analysis. Survivorship was calculated with Kaplan Meier estimates and comparisons were performed using the Cox proportional hazards method. Subanalyses according to the three main revision indications were performed, and where possible, analyses were performed based on polyethylene types (highly cross-linked polyethylene and ultra-high-molecular-weight polyethylene), combined and separated. Revision was defined as a reoperation of a previous knee arthroplasty in which one or more of the components was removed, replaced, or added. There were 323,955 TKA procedures and 11 new prosthesis system designs that were introduced to replace an earlier knee system from the same manufacturer. Of these prosthesis system pairs, six were cruciate-retaining prostheses, four were posterior-stabilized designs, and one was a medial pivot design. Six of the 11 knee system pairs showed improved survivorship with the new design, three were no different, and in two, the newer prosthesis systems had a higher rate of revision than the old one did. When revision for wear was analyzed, five prosthesis systems showed improvement, five were no different, and one had a higher rate of revision than the previous system did. There was no improvement in the rate of revision for instability seven new prosthesis systems showed no difference from the previous system and four new prosthesis systems had a higher rate of revision than the previous system did. A subanalysis of revision for patellofemoral complications showed improvement in two comparisons, no difference in six, and a higher revision rate in two one could not be calculated because of an insufficient number of revisions for this reason. It is difficult to predict whether a new system will demonstrate better survival than a previous one, and widespread uptake of a new design before a benefit is shown in robust clinical studies is unwise. Similarly, adoption of a new system for which there is no difference in survivorship from a previous model may be premature because a new device may have associated unknown and unintended consequences. Healthcare policy makers and therapeutic device regulators should similarly be guided by results and seek out peer-reviewed evidence before accepting change to established practice. Surgeons must be aware that implant changes may not translate into better survivorship and must seek compelling evidence of improvement in survival and/or function before changing systems. Level III, therapeutic study.
Publisher: Public Library of Science (PLoS)
Date: 26-09-2019
Publisher: SAGE Publications
Date: 05-2011
Abstract: We studied a prospective cohort of patients in whom gluteal tendon reconstruction was undertaken in association with hip arthroplasty. Over the course of 10 years, 24 patients had gluteal tendon reconstruction performed either at the time of hip arthroplasty or post-operatively, using the Ligament Augment and Reconstruction System (LARS), suture anchors, direct suture to bone, or a combination of these techniques. All patients were assessed clinically and by patient-centred outcome measures, including the hip disability and osteoarthritis score (HOOS). The mean post-operative HOOS was significantly better than pre-operative score (p 0.05). The mean post operative score in the domains of symptoms, pain, activities of daily living (ADL), sports and quality of life (QoL) was 72 (SD 12.8), 73 (SD 15.9), 71 (SD 11.8), 54 (SD 22.6) and 57 (SD 21.76) respectively. There were two failures of gluteal tendon reconstruction which required revision using LARS. One patient died of an unrelated cause. Surgical intervention should be considered in gluteal tendinopathy at the time of hip arthroplasty or when symptoms occur following arthroplasty.
Publisher: Springer Berlin Heidelberg
Date: 2018
Publisher: Elsevier BV
Date: 08-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2012
Publisher: Springer Science and Business Media LLC
Date: 26-10-2019
DOI: 10.1007/S00402-019-03291-8
Abstract: The magnitude and pattern of acceptable long-term migration of cementless femoral stems are not well understood. The Corail hydroxyapatite-coated cementless stem is a clinically successful and commonly used femoral stem with a long-term migration pattern not previously described in the literature. The aim of this study was to assess the long-term migration of the Corail hydroxyapatite-coated cementless stem using radiostereometric analysis (RSA) at 14-year follow-up, thereby establishing a benchmark acceptable long-term migration pattern for hydroxyapatite-coated cementless prostheses. A prospective cohort of 29 patients (30 hips) undergoing primary total hip arthroplasty for primary hip osteoarthritis were enrolled into a study to characterise the migration of the Corail cementless stem. A total of 13 patients (4 males, 9 females) with mean age 82 (range 68-92) underwent repeat RSA radiographs at minimum 10 years post-operation (mean 13.9 years, range 13.3-14.4). Subsidence of the stem was measured and compared to prior measurements taken at 6 months and 1, 2, and 6 years. None of the 13 patients have been revised. The migration at 6 months, 1 year, 2 years, and 6 years has been previously recorded. At mean 14-year follow-up, the cohort mean subsidence of the cementless stem was 0.70 mm (range - 0.06 to 3.61 mm). For each stem followed up at 6 months and 14 years, the mean subsidence over this period was 0.05 mm (range - 0.14 to 0.57 mm). There is no significant difference in mean subsidence at 6 months and 14 years (p = 0.43). The long-term pattern of the subsidence of the Corail femoral stem has not previously been described. Subsidence occurs within the first 6 months, after which there is persistent stabilisation of the implant to 14 years. This study provides a description of a long-term acceptable migration pattern to which new hydroxyapatite-coated cementless prostheses may be compared. II.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 06-2006
DOI: 10.1302/0301-620X.88B6.16822
Abstract: A series of 100 consecutive osteoarthritic patients was randomised to undergo total knee replacement using a Miller-Galante II prosthesis, with or without a cemented polyethylene patellar component. Knee function was evaluated using the American Knee Society score, Western Ontario and McMaster University Osteoarthritis index, specific patellofemoral-related questions and radiographic evaluation until the fourth post-operative year, then via questionnaire until ten years post-operatively. A ten-point difference in the American Knee Society score between the two groups was considered a significant change in knee performance, with α and β levels of 0.05. The mean age of the patients in the resurfaced group was 71 years (53 to 88) and in the non-resurfaced group was 73 years (54 to 86). After ten years 22 patients had died, seven were suffering from dementia, three declined further participation and ten were lost to follow-up. Two patients in the non-resurfaced group subsequently had their patellae resurfaced. In the resurfaced group one patient had an arthroscopic lateral release. There was no significant difference between the two treatment groups: both had a similar deterioration of scores with time, and no further patellofemoral complications were observed in either group. We are unable to recommend routine patellar resurfacing in osteoarthritic patients undergoing total knee replacement on the basis of our findings.
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.ARTH.2017.05.032
Abstract: The bicruciate-stabilized (BCS) knee arthroplasty was developed to replicate normal knee kinematics. We examined the hypothesis that patients with osteoarthritis requiring total knee arthroplasty (TKA) will have better functional outcome and satisfaction with the BCS implant compared with an established posterior cruciate-stabilized implant. This multicenter, randomized, controlled trial compared the clinical outcomes of a BCS implant against an established posterior cruciate-stabilized implant with 2-year follow-up. Of the patients awaiting primary knee arthroplasty for osteoarthritis, 228 were randomized to receive either a posterior-stabilized or BCS implant. Primary outcomes were knee flexion and Oxford Knee Score. Secondary outcomes were rate of complications and adverse events (AEs). Tertiary outcomes included Knee Society Score, University of California, Los Angeles, activity score, Patella scores, EQ-5D, 6-minute walk time, and patient satisfaction. Complete data were recorded for 98 posterior-stabilized implants and 97 BCS implants. Twelve patients had bilateral knee implants. There was no difference between the groups for any of the measures at either 1 or 2 years. At 2 years, knee flexion was 119 ± 0.16 and 120 ± 1.21 degrees for the posterior-stabilized and BCS implants, respectively, (mean, standard error, P = .538) and Oxford Knee Scores were 40.4 ± 0.69 and 40.0 ± 0.67 (P = .828), respectively. There were similar device-related AEs and revisions in each group (AEs 18 vs 22 P = .732 revisions 3 vs 4 P = .618). There was no evidence of clinical superiority of one implant over the other at 2 years.
Publisher: Elsevier BV
Date: 04-2005
DOI: 10.1016/J.KNEE.2004.06.004
Abstract: Arthrofibrosis following total knee replacement (TKR) is a relatively common complication which results in a reduction in knee range of movement and patient dissatisfaction. A retrospective study examined the relationship between anticoagulation with therapeutic warfarin and rates of arthrofibrosis following TKR. Arthrofibrosis was defined as less than 80 degrees of knee flexion 6-8 weeks post-TKR. Patients were warfarinised if they had a history of thrombophilic tendencies or medical conditions necessitating anti-coagulation, rather than as routine thromboprophylaxis. All other patients received thromboprophylaxis using low molecular weight heparin. A total of 728 patients underwent 874 primary TKR between 1993 and 2002 in one centre, performed by four surgeons. Mean age was 68 years (range 48-89 years) and there were 483 female and 391 male knees. Eighty cases were warfarinised post-operatively (53 female, 27 male). Overall, 83 of 874 TKRs (9%) had arthrofibrosis (57 female, 26 male) requiring manipulation under anaesthetic (MUA). In the warfarinised group, 21 knees (26%) had an MUA (15 female, 6 male). This compared to 62 cases (8%) requiring MUA in the non-warfarinised group (42 female, 20 male). There was a statistically significant difference on Fisher's exact testing (P<0.0001) between groups. Following MUA, knee flexion improved in 95% cases to a minimum 95 degrees but 8 cases had a fixed flexion deformity of 5-10 degrees . In conclusion, therapeutic warfarinisation post-TKR leads to a statistically greater chance of the patient developing arthrofibrosis compared to prophylactic low molecular weight heparin and that patients should be counseled appropriately.
Publisher: Springer Science and Business Media LLC
Date: 03-10-2008
Publisher: Oxford University Press (OUP)
Date: 05-2020
DOI: 10.1093/OFID/OFAA068
Abstract: Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. Most observational studies of PJI are retrospective or single-center, and reported management approaches and outcomes vary widely. We hypothesized that there would be substantial heterogeneity in PJI management and that most PJIs would present as late acute infections occurring as a consequence of bloodstream infections. The Prosthetic joint Infection in Australia and New Zealand, Observational (PIANO) study is a prospective study at 27 hospitals. From July 2014 through December 2017, we enrolled all adults with a newly diagnosed PJI of a large joint. We collected data on demographics, microbiology, and surgical and antibiotic management over the first 3 months postpresentation. We enrolled 783 patients (427 knee, 323 hip, 25 shoulder, 6 elbow, and 2 ankle). The mode of presentation was late acute (& days postimplantation and & days of symptoms 351, 45%), followed by early (≤30 days postimplantation 196, 25%) and chronic (& days postimplantation with ≥30 days of symptoms 148, 19%). Debridement, antibiotics, irrigation, and implant retention constituted the commonest initial management approach (565, 72%), but debridement was moderate or less in 142 (25%) and the polyethylene liner was not exchanged in 104 (23%). In contrast to most studies, late acute infection was the most common mode of presentation, likely reflecting hematogenous seeding. Management was heterogeneous, reflecting the poor evidence base and the need for randomized controlled trials.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-01-2021
Publisher: Elsevier BV
Date: 04-1998
DOI: 10.1016/S0030-5898(05)70321-7
Abstract: With the increasing rates and complexity of revision hip and knee arthroplasty, it has become more important than ever to approach the joint in a safe and rational manner. The development of extensile approaches have significantly simplified the removal of solidly fixed components without compromising bone stock. The extended trochanteric osteotomy enables controlled access to the femoral component and is a useful technique for revision of solidly-fixed femoral components. The trochanteric slide allows comprehensive exposure of the acetabulum and femur comparable to trochanteric osteotomy with a diminished risk of trochanteric escape. The vastus slide allows wide exposure of the femoral shaft when using an anterolateral approach. In revision total knee arthroplasty, the extensor mechanism is often at risk of disruption or avulsion, and in most cases, maneuvers that allow wide exposure of the femur and tibia while preserving the extensor mechanism are essential. Such exposures include one of the extensor mechanism reflecting techniques either proximally by rectus snip or patellar turndown, or distally by tibial tubercle osteotomy. Occasionally a femoral peel or epicondylar osteotomy is required. There should be a low threshold to consider one of these specialized approaches during revision hip and knee arthroplasty.
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.KNEE.2017.07.006
Abstract: Although knee replacements have specifically designed patella prostheses that correspond to the geometry of their femoral components, a patella prosthesis that is unmatched to the femoral component may occasionally be inserted. In revision total knee arthroplasty (TKA), an originally resurfaced patella may be left, but the femoral component revised to one that does not match the patella. Few studies have compared the outcome of matched and unmatched patella components in TKA. This study compared the primary or revision TKA outcome of procedures where patella components matched to their femoral counterparts were inserted, with procedures using patella and femoral components that were unmatched. Data on all primary and revision TKA procedures without a patella component or a matched or an unmatched patella component were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Revision surgery was the outcome measure. Cumulative percent revised (CPR) were calculated and Hazard ratios with p values were used to test statistical significance. In primary TKA, there were higher rates of revision where unmatched patella components were used, regardless of implant design. There was no difference in the second revision rates of unmatched versus matched patella component groups. This was evident where delayed resurfacing was carried out, and where the patella prosthesis was left alone but the femoral component was changed. All primary TKA procedures require a patella component corresponding to the femoral component if the patella is resurfaced. Conversely, revision knee arthroplasties are not affected by the use of dissimilar patella and femoral components.
Publisher: Springer Science and Business Media LLC
Date: 30-05-2009
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.ARTH.2009.04.007
Abstract: The long-term survival of 270 Wagner resurfacing hip arthroplasties was determined. Two patients were lost to follow-up. Eleven hips remained unrevised at 15 to 22 years. Survival at 5, 10, and 16 years was 74%, 35%, and 17%, respectively. Survival in patients older than 55 years was better after 5 years than that for patients 55 years or younger (P = .0067). Femoral neck fracture occurred in 2% of the total cohort. Femoral component failure was an early and midterm complication. Acetabular component loosening was the most common reason for revision. The proportion of cases revised for acetabular component failure increased with time. These long-term data in this large series provide important historical results against which the relative benefits of contemporary designs may be evaluated.
Publisher: Elsevier BV
Date: 06-1995
DOI: 10.1016/S0883-5403(05)80176-7
Abstract: A consecutive series of 289 Miller-Galante (Zimmer, Warsaw, IN) total knee arthroplasties were studied, with particular reference to the patellofemoral joint. Sixteen knees were initially excluded the remaining 273 arthroplasties were followed for 14 to 44 months. Thirty patients (11%) had patellofemoral pain. Twenty patients (7.3%) had revision patellofemoral surgery. Fourteen patients had revision surgery for patellar maltracking, of which 10 had resolution of their symptoms, 2 were improved, 1 had no change, and 1 developed a prosthetic infection. Six patients who had no evidence of patellar maltracking had revision surgery with a cemented metal-backed patellar component. Only two of these patients had symptom improvement from their revision surgery. A higher than usual incidence of patellar maltracking (5%) is reported. The first-generation Miller-Galante femoral component may contribute to the relative instability of patellofemoral tracking. Those patients with patellar maltracking were greatly improved by revision surgery the results of revision surgery for anterior knee pain without associated patellar maltracking were disappointing.
Publisher: Copernicus GmbH
Date: 10-11-2022
Abstract: Abstract. Background: Treatment outcomes in studies on prosthetic joint infection are generally assessed using a dichotomous outcome relating to treatment success or failure. These outcome measures neither include patient-centred outcome measures including joint function and quality of life, nor do they account for adverse effects of treatment. A desirability of outcome ranking (DOOR) measure can include these factors and has previously been proposed and validated for other serious infections. We aimed to develop a novel DOOR for prosthetic joint infections (PJIs). Methods: The Delphi method was used to develop a DOOR for PJI research. An international working group of 18 clinicians (orthopaedic surgeons and infectious disease specialists) completed the Delphi process. The final DOOR comprised the dimensions established to be most important by consensus with % of participant agreement. Results: The consensus DOOR comprised four main dimensions. The primary dimension was patient-reported joint function. The secondary dimensions were infection cure and mortality. The final dimension of quality of life was selected as a tie-breaker. Discussion: A desirability of outcome ranking for periprosthetic joint infection has been proposed. It focuses on patient-centric outcome measures of joint function, cure and quality of life. This DOOR provides a multidimensional assessment to comprehensively rank outcomes when comparing treatments for prosthetic joint infection.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-1990
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.ARTH.2013.09.006
Abstract: Our aim was to compare the assessment of periprosthetic osteolysis around total knee arthroplasties using digital images against film-screen images. Simulated osteolytic lesions were created around 3 cadaveric total knee arthroplasties images acquired using fluoroscopic-assisted radiography and Computed Tomography. Three surgeons reviewed the film-screen images (AP/Lateral, Oblique, and Computed Tomography (CAT)) and the same images digitally. Combinations of 2 or more images that included the AP/Lateral views had superior performance in both film-screen and digital imaging to AP/Lateral views alone, except for the digital AP/Lateral/OBL combination. Lesion detection and volume appreciation were superior for film versus digital assessment for most angles. The addition of obliques to assessment using digital imaging improved performance, but film-screen remained superior to digital imaging for assessment of periprosthetic osteolysis.
Publisher: Springer Science and Business Media LLC
Date: 13-06-2001
Abstract: We describe a new technique in which the arthroscope is used to assist the preparation of the cement mantle for cemented revision hip arthroplasty. We present two case reports demonstrating the method and its rationale.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 04-2008
DOI: 10.1302/0301-620X.90B4.20319
Abstract: The Unispacer knee system is a cobalt-chrome self-centring tibial hemiarthroplasty device for use in the treatment of isolated medial compartment osteoarthritis of the knee. The indications for use are similar to those for high tibial osteotomy, but insertion does not require bone cuts or component fixation, and does not compromise future knee replacement surgery. A prospective study of a consecutive series of 18 patients treated with the Unispacer between June 2003 and August 2004 was carried out to determine the early clinical results of this device. The mean age of the patients was 49 years (40 to 57). A total of eight patients (44%) required revision within two years. In two patients revision to a larger spacer was required, and in six conversion to either a unicompartmental or total knee replacement was needed. At the most recent review 12 patients (66.7%) had a Unispacer remaining in situ. The mean modified visual analogue score for these patients at a mean follow-up of 19 months (12 to 26) was 3.0 (0 to 11.5). The mean pain level was 30% that of the mean pre-operative level of 10. The early clinical results using this device have been disappointing. This study demonstrates that use of the Unispacer in isolated medial compartment osteoarthritis is associated with a high rate of revision surgery and provides unpredictable relief of pain.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2010
Publisher: Springer Science and Business Media LLC
Date: 26-06-2004
No related grants have been discovered for David Campbell.