Benedict A. Clift

Oxford Unicompartmental Knee Arthroplasty Versus Age and Gender Matched Total Knee Arthroplasty – Functional Outcome and Survivorship Analysis

We compared the medium-term outcomes of age and gender matched patients with unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). We retrospectively reviewed the pain, function and total knee society scores (KSS) for 602 UKAs and age and gender matched TKAs between 2001 and 2013. Function scores remained significantly better in UKAs from preoperative until 3years follow up. The change of function scores was not significantly different. TKAs performed better than UKAs for pain scores. Total KSS for both groups were not significantly different in the study. Fewer medical complications were reported in UKA group. 6.30% of UKAs and 2.99% of TKAs were revised. The theoretical advantages of UKA were not borne out, other than in immediate postoperative complications.

Do trainee surgeons have an adverse effect on the outcome after total hip arthroplasty?: a ten-year review

AIMS The long-term functional outcome of total hip arthroplasty (THA) performed by trainees is not known. A multicentre retrospective study of 879 THAs was undertaken to investigate any differences in outcome between those performed by trainee surgeons and consultants. PATIENTS AND METHODS A total of 879 patients with a mean age of 69.5 years (37 to 94) were included in the study; 584 THAs (66.4%) were undertaken by consultants, 138 (15.7%) by junior trainees and 148 (16.8%) by senior trainees. Patients were scored using the Harris Hip Score (HHS) pre-operatively and at one, three, five, seven and ten years post-operatively. Surgical outcome, complications and survival were compared between groups. The effect of supervision was determined by comparing supervised and unsupervised trainees. A primary univariate analysis was used to select variables for inclusion in multivariate analysis. RESULTS There was no evidence that the grade of the surgeon had a significant effect on the survival of the patients or the rate of revision (p = 0.987 and 0.405, respectively) up to 12 years post-operatively. There was no significant difference in post-operative functional HHS or total HHS among consultants, junior and seniors up to ten years post-operatively (p = 0.401 and 0.331), respectively. There was no significant difference in hospital stay (p = 0.855) between different grades of surgeons. There was no evidence that the level of supervision had an effect on the survival of the patients or the rate of revision (p = 0.837 and 0.203, respectively) up to 12 years post-operatively. There was no significant difference between supervised and unsupervised trainee groups in post-operative functional HHS or total HHS up to ten years post-operatively (p = 0.213 and 0.322, respectively). There was no significant difference in the mean hospital stay between supervised and unsupervised trainees (p = 0.908). TAKE HOME MESSAGE This study suggests that when trainees are appropriately supervised, they can obtain results comparable with those of their consultant colleagues when performing THA.

Bilateral simultaneous hip replacement versus bilateral sequential hip replacement. A 7-year data review.

The aim of this study was to compare the outcomes of bilateral sequential versus bilateral simultaneous hip replacements, using the collarless polished taper cemented hip prosthesis, in relation to complications, revisions, patient satisfaction rates, and Harris Hip Score. Data were collected by independent practitioners and processed within the University Audit Department. A total of 594 patients were identified as having undergone bilateral hip replacement surgery. Patient satisfaction rates were consistently high in both groups. Harris Hip Scores improvements were similar and reflected a marked improvement in pain and function. The sequential bilateral group experienced an increased length of hospital stay and therefore potential cost implications, which may be offset by the lower incidence of adverse events. Bilateral simultaneous hip replacement remains an important option, for which there is strong supportive evidence.