BASK 2025 Abstracts

Day 1 – Thursday podium presentations

Day 1 – Session 2

Roman Austin, Jens Verhey, Saad Tarabichi, Henry Clarke, Mark Spangehl, Joshua Bingham

Mayo Clinic, Phoenix, USA

Abstract

Introduction: Glucagon-like peptide 1 (GLP-1) receptor agonist use is increasing as a treatment option for obese patients. The rapid weight loss that is associated with GLP-1 agonists use may cause malnutrition and increase risks of post-operative complications in patients undergoing surgery. However, little has been published about the impact of GLP-1 agonists on the outcomes of non-diabetic obese patients undergoing total knee arthroplasty (TKA).

 Methodology: A retrospective query was performed from January 1, 2010 to January 1, 2022 using a national insurance claims database. Patients (BMI>30 kg/m2) undergoing TKA and on GLP-1 agonists (n=5774) were propensity score-matched 1:1 to controls who were not on GLP-1 agonists (n=5774) based on age, sex, BMI, Elixhauser comorbidity index (ECI), and tobacco use. Patients with diabetes mellitus were excluded. 90-day outcomes were evaluated including medical complications, readmission, and reoperation rates. Odds ratios (OR) were generated using regression analyses.

 Results: Patients on GLP-1 agonists had a lower likelihood of receiving a transfusion postoperatively (OR 0.55, 95% CI 0.35–0.89), but no significant differences were observed between groups for deep vein thrombosis, pulmonary embolism, transient ischemic attack, cerebrovascular accident, myocardial infarction, aspiration pneumonia, acute kidney injury, sepsis, or mortality at 90 days. Rates of emergency department visits, readmissions, and 90-day or 2-year surgical complications, including wound dehiscence, hematoma, infection, and revision surgery, were also comparable between the groups (p > 0.05).

Conclusion: GLP-1 agonist use in non-diabetic patients undergoing TKA does not increase the risk of readmissions or major postoperative medical complications. 

HEMANT PANDIT1, David Liu2, Andrew Shimmin3, Guy Ludbrook4, Fathi Abuzgaya5, Sharon Hall6, David Hewitt6, Adam Gridley6

1University of Leeds, Leeds, United Kingdom. 2John Flynn Hospital, Palm Beach, Australia. 3Melbourne Orthopaedic Group, Melbourne, Australia. 4University of Adelaide, Adelaide, Australia. 5University of Toronto, Toronto, Canada. 6Allay Therapeutics, San Jose, USA

Abstract

Introduction: TKR is associated with severe pain post-surgery requiring opioids which have a negative impact on recovery. ATX101, a novel bupivacaine formulation in bio-absorbable polymer achieves controlled-release of bupivacaine locally in the weeks post-surgery. 

Methods: A double-blind RCT assessed safety, pharmacokinetics, and efficacy of ATX-101 to determine dose and endpoint for further studies. ATX101 500mg implants were placed in the pre-selected areas within the joint before TKR wound closure. Bupivacaine/placebo were placed by peri-articular infiltration. All patients received standardised pain relief. Pain-at-rest assessment (0-10 NRS-R) was completed for 30-days. Opioid consumption and functional measures were obtained.  Primary endpoint was area under curve (AUC) of NRS-R from 30-minutes to 8-days censored for opioid use.  

Results: 112 participants: 38 controls and 74 ATX-101 [1000 mg (n=37); 1500 mg (n=37)].  Average age 67.8 years; 56% female, average BMI 31.4.   Plasma bupivacaine concentrations demonstrated controlled release for 21 days: Pain AUC for NRS-R was similar between bupivacaine [112.57 (48.21)] and ATX101 [113.34 (38.22)] for the first 24 hours.   ATX101 was more effective from 24 hours to 8 (p=0.072), 15 (p=0.0404), 22 (p=0.0624), and 30 (p=0.0421) days. ATX101 group consumed 23% less opioid over 30 days and were off opioids sooner (16% vs 3%). ATX101 1500 mg cohort reached 90o flexion quicker and demonstrated better function [Walking and Standing with Aid (D30) (p=0.0174)]. There was less constipation and nausea in ATX101 1500 mg vs. controls.

Conclusions:  ATX101 demonstrated a strong signal for efficacy on pain intensity, reduced opioid consumption and improved clinical outcomes.   

Conor Hennessy1, James Murray2, Andrew Price1, Simon Abram1,2

1University of Oxford, Oxford, United Kingdom. 2University of Bristol, Bristol, United Kingdom

Abstract

INTRODUCTION:

The aim of this study was to estimate a population-specific relative risk of arthroplasty following ACL injury and reconstruction by comparing the rate of arthroplasty in the operated knee to the opposite knee of the same patients.

METHODS:

National Hospital Episode Statistics (HES) data records were cleaned to identify patients undergoing their first ACL reconstruction (ACLr) to the index knee, with no previous or subsequent ACLr to their contralateral knee. Records were analysed to examine arthroplasty free survival of the index native knee which underwent ACLr versus the contralateral knee. 

RESULTS:

A total of 116,672 ACLr procedures were eligible for analysis. At 15 years post ACLr, the rate of arthroplasty on the reconstructed side was 1.6% (95% CI 1.41 to 1.81), versus the contralateral rate of 0.53% (95% CI 0.42 to 0.65). At 20 years post ACLr, the rate of ipsilateral arthroplasty was 4.05% (95% CI 3.4 to 4.7%) versus the contralateral rate of 1.25% (95% CI 0.92 to 1.65%). The overall hazard ratio for knee arthroplasty was 3.10 (95% CI 2.69 to 3.57) in the ACLr knee versus the contralateral knee.

CONCLUSION:

To our knowledge this is the first study to estimate the population-specific relative risk of knee arthroplasty following an ACL injury and reconstruction by using the contralateral knees of the same patients as the control. The relative risk is approximately three-times that of the opposite knee and this is important information that can be shared to better inform patients discussing their long-term prognosis in the clinic.

Saran Gill, Chinmay Gupte

Imperial College London, London, United Kingdom

Abstract

Introduction

Orthopaedic litigation poses a significant financial challenge, accounting for 10.8% of NHS claims in 2023/24 at a cost of £250 million. Despite this impact, comprehensive analyses of litigation trends are scarce. This study aims to examine the trends, causes, and financial impacts associated with litigation, offering actionable insights to enhance clinical practice.

 

Methods

Orthopaedic claims data from NHS Resolution (NHSR) (1996/97–2023/24) were analysed under the Freedom of Information Act. The dataset focused on closed claims with settlements, documenting causes, injury types, and payouts. Broader classifications were applied due to GDPR constraints.

 

Results

Between 1996/97-2023/24, 22,606 claims resulted in 14,702 settlements totalling over £2.2 billion(£1.2 billion in damages). Unnecessary operations and pain were the most common primary injuries(22%, £328.27 million), followed by musculoskeletal injuries(21.4%, £407.53 million), Neurological issues (8%, £254.74 million) and poor outcomes(13%, £129.14 million). Among primary reasons for claims, surgical errors(24%, £309.47 million), followed by failure or delayed treatment(23%, £277.02 million) and decision-making errors(22%, £287.57 million) caused the highest damages. Settlement values peaked in the early 2010s before declining, reflecting changes in clinical practice and risk management.

 

Conclusion

Musculoskeletal injuries, surgical errors, and delayed treatment are leading causes of orthopaedic litigation, highlighting ongoing clinical challenges. While claim volumes and payouts have declined since 2011/12, initiatives like GIRFT, enhanced consent processes, and AI-driven analytics offer potential to improve outcomes and reduce litigation. Continuous quality improvement, multidisciplinary planning, and effective risk management remain essential for addressing these challenges and alleviating financial pressures.

Day 1 – Session 5

Alex Matthews1,2,3,4, William Gray1, Jonathan P Evans2,3, Ruth Knight5, Jonathan T Evans2,3, Sarah Lamb3, Timothy Briggs1,6, Andrew Porteous7, Shiraz Sabah6,4, Abtin Alvand4,8, Andrew Price4,8, Andrew Toms2,3

1Getting It Right First Time programme, NHS England, London, United Kingdom. 2Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom. 3University of Exeter, Exeter, United Kingdom. 4Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom. 5Liverpool Clinical Trials Unit, Liverpool, United Kingdom. 6Royal National Orthopaedic Hospital, Stanmore, London, United Kingdom. 7North Bristol NHS Trust, Bristol, United Kingdom. 8Nuffield Orthopaedic Centre, Oxford, United Kingdom

Abstract

Introduction

Revision knee replacement is rare but increasing. Optimal service delivery models are not known, but it is generally hypothesised that surgical units and surgeons that have higher volume of revision cases report lower levels of re-revision surgery and other adverse outcomes. The aim was to estimate the association of surgical caseload on outcomes following first, single-stage RevKR and to guide future service delivery models.

Methodology

This population-based cohort study used data from several national level registers: the United Kingdom National Joint Registry, Hospital Episode Statistics Admitted Patient Care, National Health Service Patient Reported Outcome Measures (PROMs) and the Civil Registrations of Death. Patients undergoing a first single stage RevKR between 1st January 2009 and 30 June 2019 were included. Patients were split into two cohorts based on indication for revision.  

Results

Of 33,282 first time revision total knee replacements recorded on the NJR, 1,477 patients underwent single stage total RevKRs for infection and 8,695 patients for aseptic reasons. Re-revision was recorded in 235 patients (19.2%) in the infected group compared with 407 patients (5.8%) for the aseptic group. In the infected patient, greater surgical unit volume was associated with a lower risk of re-revision at 2 years. In the aseptic revision patient, a greater surgeon volume was associated with a lower risk of re-revision at 2 years (OR 0.99, 95%CI 0.98 to 0.99).

Conclusion 

Repeat revision may be influenced by revision case volume of the surgeon or surgical unit in the management of first-time revision total knee replacement.

Karolina Mazur1,2, David Deehan1,2, Hannah Paish1, Lee Borthwick1, Nicholas Kalson1,3

1Fibrosis Research Group, Newcastle University, Newcastle-upon-Tyne, United Kingdom. 2Newcastle University Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom. 3Northumbria Healthcare Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom

Abstract

Introduction: Chronic pain following total knee arthroplasty (TKA) is a significant problem affecting 10-20% of patients; however, its aetiology is incompletely understood. We tested the hypotheses that 1) chronic inflammation might drive pain after TKA by examining synovial fluid from painful and pain-free TKA patients and 2) inflammation could be modulated by injection of intra-articular steroid.  

Methodology: Ten patients with painful TKAs and ten with pain-free TKAs were recruited. Painful TKAs (Oxford Knee pain score of <15), underwent clinical, microbiological and radiographic assessment to exclude specific causes of pain. All patients underwent synovial fluid (SF) aspiration. Painful TKAs also had an intra-articular steroid injection followed by a repeat aspiration four weeks later. SF was analysed by MSD ELISA. Differences in samples were tested with Mann-Whitney and paired T-tests. 

Results: We found significant differences in the expression of >10 inflammatory mediators between painful and pain-free SF samples.  Most notably, CRP was significantly elevated in painful SF (330,661 versus 72,984 pg/ml, p=0.0281). Following administration of intra-articular steroid levels of CRP as well as other mediators were significantly reduced (p=0.0256). Pain scores were also reduced at two weeks (11 versus 17, p=<0.05) post steroid.

Conclusion: Here, we report differences in the levels of key inflammatory mediators in patients with unexplained pain post-TKA and demonstrate that intra-articular steroid administration reduces both levels of these mediators and pain. These findings have implications for our understanding of unexplained pain and offer new therapeutic opportunities to target inflammation and pain post-TKA.

Day 2 – Session 12

Imran Ahmed1, Andrew Metcalfe2, BASK Research Comittee3

1University Hospital Coventry and Warwickshire, Coventry, United Kingdom. 2University of Warwick, Coventry, United Kingdom. 3n/a, n/a, United Kingdom

Abstract

Introduction: This study aims to identify the top unanswered research priorities in the field of knee surgery.

Methods: Initial research questions were generated using an online survey sent to all 680 members of the British Association for Surgery of the Knee (BASK). Duplicates were removed and a longlist was generated from this scoping exercise by a panel of 13 experts. A modified Delphi process was used to refine the questions and determine a final list. To rank the final list of questions, each question was scored between one (low importance) and ten (high importance).

Results: This consensus exercise took place between December 2020 and April 2022. A total of 286 clinicians from the BASK membership provided input for the initial scoping exercise, which generated a list of 105 distinct research questions. Following review and prioritisation, a longlist of 51 questions was sent out for two rounds of the Delphi process. A total of 42 clinicians responded to the first round and 24 responded to the second round. A final list of 24 research questions was then ranked by 36 clinicians. The topics included arthroplasty, infection, meniscus, osteotomy, patellofemoral, cartilage, and ligament pathologies. The management of early osteoarthritis was the highest-ranking question.

Conclusion: A Delphi exercise involving the BASK membership has identified the future research priorities in knee surgery. This list of questions will allow clinicians, researchers, and funders to collaborate in order to deliver high-quality research in knee surgery and further advance the care provided to patients with knee pathology.

Simon Abram1,2, Adam Nelson2, Simon Middleton2, Vipul Mandalia2

1University of Bristol, Bristol, United Kingdom. 2Princess Elizabeth Orthopaedic Centre, Exeter, United Kingdom

Abstract

INTRODUCTION:

There have previously been some concerns that an adjustable-loop device could ‘slip’ and lengthen over time in comparison to a fixed-loop device following ACL reconstruction. There has been a clear need for an adequately powered, double-blinded, and randomized study comparing fixed-loop versus adjustable-loop suspensory devices. The GAP study was designed to address this need.

METHODS:

152 patients were recruited and randomized to receive a hamstring ACL reconstruction using either a fixed-loop or variable-loop femoral suspensory device (Stryker G-Lock or ProCinch, respectively) for femoral fixation. The patients and assessors were blinded to the intervention. Knee laxity measurements were taken using the GNRB knee arthrometer from the operated leg and compared to the contralateral leg. 

RESULTS:

At 1-year, 121 patients (62% male; mean age 31) had complete knee laxity assessments (58 fixed-loop; 63 adjustable-loop). At 150N, the operated-knee laxity in the fixed-loop group was 5.51mm (SD 1.40; 95% CI 5.13-5.87) versus 5.61mm (SD 1.39; 95% CI 5.26-5.96) in the adjustable-loop group (P=0.68). At 200N, the operated-knee laxity in the fixed-loop group was 6.94mm (SD 1.54; 95% CI 6.53-7.34) versus 7.02mm (SD 1.53; 95% CI 6.63-7.40) in the adjustable-loop group (P=0.78). There were also no differences by intervention for the relative, between-knee, laxity measurements for patients receiving the fixed-loop versus adjustable-loop device at either 150N or 200N.

CONCLUSION:

No differences were observed in either the absolute or relative (operated vs. non-operated) knee laxity measurements for patients who received the fixed-loop graft fixation device in comparison to patients who received the adjustable-loop device. 

Peter Davies1,2,3, Stephanie O’Brien1,2, Thomas Greensmith1,2, Jay Ebert2, Peter Edwards2, Peter D’Alessandro1,2

1Perth Sports Surgery Fellowship, Perth, Australia. 2Orthopaedic Research Foundation of Western Australia, Perth, Australia. 3RJAH, Oswestry, United Kingdom

Abstract

Introduction: Hamstring harvest for anterior cruciate ligament reconstruction (ACLr) has significant morbidity. Traditional hamstring grafts require dual tendons (DT), but newer techniques allow for a single tendon (ST) graft. Magnetic resonance imaging (MRI) analysis of ACLr grafts has previously been used as a proxy for healing and integration of the graft.   

Methodology: In this blinded prospective randomised controlled trial (RCT) (ACTRN12620000927921) patients were randomised to ST or DT for ACLR. Anaesthetic and surgical techniques were uniform aside from graft technique and tibial fixation. Patients underwent MRI using a single scanner at 6 months and 12 months. MRI signal was measured at multiple regions of interest, with lower signal indicative of better healing and expressed as signal intensity ratio (SIR).

Results: 47 patients were assessed at 6 months post-surgery, and 36 patients were assessed at 12 months. No significant group differences (P>0.05) were observed in demographics (age, sex, height and body mass) or surgical characteristics (concomitant meniscal repairs and tenodeses).   In the ST group, the median SIR was 2.2 (SD 0.9) at 6 months and median 2.4 (SD 0.6) at 12 months.   In the DT group, the median SIR was 2.7 (SD 1.2) at 6 months and median 2.9 (SD 0.8) at 12 months.  The differences between ST and DT groups were significant at 6 months (p=0.02 ) and 12 months (p=0.005) but changes in SIR over time were not significant.

Conclusion: ST harvest resulted in significantly lower graft signal on MRI at 6 and 12 month time points.

Khalis Boksh1,2, Duncan Shepherd1, Daniel Espino1, Christos Plakogiannis3, Arijit Ghosh2, Randeep Aujla2, Michael Hantes4, Tarek Boutefnouchet1,5

1University of Birmingham, Birmingham, United Kingdom. 2University Hospitals of Leicester NHS Trust, Leicester, United Kingdom. 3Kettering General Hospital, Kettering, United Kingdom. 4University of Thessaly, Larissa, Greece. 5University Hospitals of Birmingham NHS Trust, Birmingham, United Kingdom

Abstract

Introduction:  Recent results for single transtibial centralization tunnels (TTC) in combination with single anatomical transtibial pull-through repair (TPR) are promising in extrusion correction and restoring tibiofemoral contact mechanics following medial meniscus posterior root tears (MMPRT). We evaluated to what effect a combination of one or two TPR and one or two TTC tunnels had on these biomechanical parameters. 

 

Methods: Porcine knee joints (n=10) were used to perform one of the following procedures: (1) intact; (2) MMPRT; (3) 1-ATPR + 1-TTC; (4) 2-ATPR + 1-TTC; (5) 1-ATPR + 2-TTC and (6) 2-ATPR + 2-TTC. Contact area and pressure on the medial meniscus and MM extrusion (MME) were evaluated at 30°, 45°, 60° and 90° knee flexions under 200 N compressive load. 

 

Results: MME was significantly reduced with both the 1-ATPR + 2-TTC and 2-ATPR + 2-TTC tunnels in comparison to the 1-ATPR + 1-TTC and 2-ATPR + 1-TTC tunnels at 60° and 90° (p < 0.05). However, extrusion values for all tunnel combinations were within the physiological limit (< 3mm) across all angles. The intact meniscus and 1-ATPR + 1-TTC technique had higher contact area at 60° (p < 0.05) and lower contact pressure at 90° (p < 0.05) compared to the 2-ATPR + 2-TTC technique. 

 

Conclusion: Regardless of the number of ATPR tunnels, a single centralization tunnel best restores extrusion and contact mechanics of the knee to that of the native state. The 1-ATPR + 1-TTC technique is a more pragmatic and less technically demanding approach. Otherwise, all tunnel combinations were similar to one another for contact mechanics and to that of the intact state. 

Adam Ali, Amit Yadav, Anil Gambhir, Peter Kay, George Pavlou

Wrightington, Wigan and Leigh NHS Foundation Trust, Wrightington, United Kingdom

Abstract

Introduction

Manipulation Under Anaesthesia (MUA) is a recognised treatment for improving Maximum Knee Flexion (MKF) after Total Knee Replacement (TKR). However, the efficacy of MUA beyond 6 months, and factors predicting maintenance of MKF, remain unclear.  

Methodology

We reviewed all primary TKRs performed at our institution over a 6 year period that required MUA, had a minimum follow-up of 6 months, and where we could identify MKF pre-TKR, immediately post-TKR, at 6 week follow-up, pre-MUA, immediately post-MUA and at last clinic review. We analysed procedural, temporal and patient factors predicting maintained improvement in MKF, using Kruskal-Wallis and Spearman’s rank correlation analyses, with p<0.05 taken as statistically significant.   

Results

119 patients were identified, with median time from TKR to MUA of 4.2 months and follow-up of 21.8 months. The median initial improvement in MKF was 30 degrees, decreasing to 20 degrees at last follow-up. Analysed by time from TKR to MUA, median improvement in MKF when <3 months, 3-6 months and 6-12 months was 20 degrees, but when >12 months was 10 degrees (p= 0.0113). A large discrepancy between pre-TKR MKF and pre-MUA MKF was associated with the greatest sustained improvement in MKF after MUA (r=-0.34, p=0.00013), with MKF discrepancy at 6 weeks also strongly predicting better outcome (r=-0.21, p=0.025). 

Conclusion 

MUA has similar efficacy whether performed early or up to one year after TKR. A large discrepancy between the pre-TKR MKF and pre-MUA MKF strongly predicts maintained improvement in MKF, with other patient and procedural factors being less important.   

2 Minutes 2 Slides – Day 2 – Session 8 

Thomas Molloy, Benjamin Gompels, Simone Castagno, Stephen McDonnell

University of Cambridge, Cambridgeshire, United Kingdom

Abstract

Introduction

This study focuses on the development of the Cambridge Knee Injury Tool (CamKIT), a novel clinical prediction tool developed as a 12-point scoring tool based on a modified e-Delphi study. 

 

Methodology

 A retrospective cohort evaluation was conducted involving 229 patients presenting to a Major Trauma Centre with acute knee pain over three months. The evaluation extracted data on the 12 scoring tool variables as well as diagnostic and management pathway outcomes. CamKIT scores for the injured and non-injured cohorts were then calculated and evaluated. 

 

Results

The CamKIT yielded a median score of 7.5 (IQR: 6-9) in the injured cohort, compared to a median score of 2 (IQR: 1-4) in the non-injured cohort, with a statistically significant difference (p < 0.0001). When constructed as a three-tier risk stratification tool, the CamKIT produces a sensitivity of 100%, a specificity of 94.3%, a positive predictive value of 89%, and a negative predictive value of 100% for diagnosing clinically significant STKIs. 

 

Conclusion

The CamKIT provides a non-invasive tool that has the potential to streamline the diagnostic process and empower healthcare workers in resource-stretched settings by instilling confidence and promoting accuracy in clinical decision-making. The CamKIT also has the potential to support efficiency in the secondary healthcare setting by enabling more targeted and timely use of specialist resources. This research contributes to the ongoing efforts to enhance patient outcomes and the overall quality of care in managing acute knee injuries.

Samuel King1,2, Tracey Smith3, Charlotte Moses4, Farag Shuweihdi1,5, Bernard Van Duren1, Hemant Pandit1,3, Jeya Palan1,3

1University of Leeds, Leeds, United Kingdom. 2Leeds Teaching Hospitals Trust, Trust, United Kingdom. 3Leeds Teaching Hospitals Trust, Leeds, United Kingdom. 4Hull York Medical School, York, United Kingdom. 5Libyan International University, Benghazi, Libya

Abstract

Introduction:

Increasing demand, long waiting lists and emphasis on cost reduction have contributed to moving post-TKR physiotherapy from face-to-face sessions to self-directed unsupervised home exercises. Physiotherapy adherence with this approach is often poor. Wearable sensor (WS) for remote supervision of physiotherapy is a potential solution as it allows feedback and bespoke care. However, cost- and clinical effectiveness needs to be proven.

 

Methodology:

A 200-participant prospective single-centre RCT compared rehabilitation methods for TKR. Allocation was 1:1 unsupervised exercise standard care (SC) group vs remotely supervised rehabilitation with a WS group (BPMPathway sensor, B.Braun, Melsungen, Germany) including pre-surgery instructions and sensor use for a two-week period. Patients were followed up at six-weeks, six-months and twelve-months post-TKR. Primary outcome was OKS at six months. Secondary outcomes included EQ-5D-5L, KOOS, TUG test, ROM and unplanned interventions.

 

Results:

186 patients have reached the primary end point. The two groups were well-matched and there was no difference between the groups for PROMs, functional measures or complications. Compared with SC, WS participants needed more physiotherapy phone calls  (43.4 vs 25.7minutes,p<0.001), fewer surgeon phone calls (p=0.026), less face-to-face physiotherapy (12.8 vs 31.8minutes,p=0.007) and fewer surgeon (p=0.022) appointments. WS participants with high exercise adherence (>2 exercises/day; 31%) had better early functional recovery (improved TUG and ROM) vs lower adherence groups (10.07 vs 11.72seconds,p=0.044; 110 vs 100degrees,p=0.037 respectively).

 

Conclusion:

Wearable sensors allow remote supervised rehabilitation post-TKR. They reduce face-to-face follow-up, improve adherence and facilitate earlier functional recovery. A multi-centre prospective RCT is needed to confirm these preliminary findings.

Khalis Boksh1,2, Duncan Shepherd1, Daniel Espino1, Arijit Ghosh2, Randeep Aujla2, Michael Hantes3, Tarek Boutefnouchet1

1University of Birmingham, Birmingham, United Kingdom. 2University Hospitals of Leicester NHS Trust, Leicester, United Kingdom. 3University of Thessaly, Larissa, Greece

Abstract

Introduction: We investigated whether the position of the transtibial centralization tunnel following anatomical transtibial pull-through root repair (ATPR) for medial meniscus posterior root tears (MMPRT) affected medial meniscal extrusion (MME) and tibiofemoral contact mechanics.

 

Methods: Porcine knee joints (n=10) were used to perform one of the following procedures: (1) intact; (2) MMPRT; (3) ATPR; (4) ATPR with TTC at the posterior horn apex (TTC-PH); (5) ATPR with TTC midway between the PH and posterior border of medial collateral ligament (MCL) (TTC-MID) and (6) ATPR with TTC behind the MCL (TTC-MCL). Contact area and pressure on the medial meniscus and extrusion were evaluated at 30°, 45°, 60° and 90° knee flexions under 200N compressive force. 

 

Results: ATPR + TTC–PH greatly reduced extrusion compared to both ATPR and ATPR + TTC-MCL at 60° and 90° (p < 0.05). ATPR + TTC-PH improved contact area compared to ATPR at 60° (p = 0.037) and 90° (p = 0.014), and to ATPR + TTC-MCL at 90° (p=0.04). ATPR + TTC-MID improved contact area compared to ATPR at 90° (p = 0.035). ATPR + TTC-PH reduced peak contact pressure compared to ATPR at 45° (p = 0.046) and 60° (p = 0.02), and to ATPR + TTC-MCL at 60° (p = 0.04). The intact meniscus, TTC-PH and TTC-MID repair states performed similarly across all angles for contact mechanics. 

 

Conclusion: Combining ATPR with TTC-PH provides the best biomechanical properties in reducing extrusion and improving contact mechanics following a MMPRT. The ATPR + TTC-MID is an alternative option if the TTC-PH technique is deemed challenging. 

Chetan Khatri1, Ali Ridha1, Jeremy Rodrigues1, Martin Underwood1, Andrew Metcalfe1, Paul Mitchell2

1University of Warwick, Warwick, United Kingdom. 2University of Bristol, Bristol, United Kingdom

Abstract

Introduction: The success of total knee replacements (TKR) are often measured through different domains, such as pain or mobility. Interpreting clinical studies which collect multiple domains can be challenging, as we do not know which are more or less important.

 

Methods: We distributed a Discrete Choice Experiment (DCE) stated preference survey which assessed five domains: early pain (six-weeks), pain (one-year), ability to walk (one-year), functional activities (one-year), risk of reoperation (10 years). People waiting for TKR surgery made choices between hypothetical scenarios of differing recovery trajectories after TKR. We used a multinomial logit model to established the importance of individual factors.

 

Results: 207 people responded and found all five domains to be significantly important when considering TKR (p<0.001). When balancing improvement in pain and mobility attributes against risk of reoperation, participants prioritised having no difficulty in ability to walk (one-year) to be the most important (willing to accept a 25% risk of reoperation at 10 years), followed by pain (one-year, 16% risk of reoperation) and improvement in ability to perform functional tasks of daily living (one-year, 16% risk of reoperation), followed by reduction of early pain (6% of risk of reoperation).

 

Conclusions: The most important outcome was walking at one year. Future clinical trials should consider instruments that measure mobility to be their primary outcome measure. When interpreting existing and future research, these findings can be used to provide clarity when multiple secondary outcomes may provide different or conflicting results.

Amy Firth1, Bernard Van Duren1,2, Jessica Nightingale3, Benjamin Bloch1,3

1Nottingham Elective Orthopaedic Service, Nottingham, United Kingdom. 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom. 3University of Nottingham, Nottingham, United Kingdom

Abstract

Background:
Surgical site infections (SSIs) and prosthetic joint infections (PJI) are a significant complication of lower limb arthroplasty. Disposable surgical gowns are often used due to their perceived superior sterility. This is associated with increased medical waste and a higher carbon footprint than reusable gowns. The Royal College of Surgeons recommend reusable gowns as part of its Green Theatre Checklist. However, clinical outcomes as well as environmental considerations must be taken into account. This study therefore aimed to examine the association between gown type and infection rates in primary hip and knee arthroplasty.

Methods:
Data from 9,239 hip and knee arthroplasties were analysed over a nine-year period and divided into single-use and multiple-use gown groups. Infection was defined as return to theatre due to infection within 12 months. Statistical analyses included descriptive statistics and logistic regression. 

The cohort included 54.4% (n=5,024) primary total knee replacements, 41.4% (n=3,801) male with a mean age of 69.47 years (SD 10.48). Rates of diabetes and COAD were 10.9% (n=1,005) and 3.7% (n=342) respectively. 46.6% (n=4,306) had surgery with disposable gowns.

Results:
The overall SSI rate was 0.96% (n=89). After adjusting for confounders (age, gender, COAD, diabetes, and joint replaced) single-use gowns were associated with a 75% higher infection rate (OR: 1.75, 95% CI: 1.14-2.70, p=0.01) than multiple-use gowns. 

Conclusion:

Disposable theatre gowns in primary arthroplasty are associated with a significantly higher risk of infection than reusable theatre gowns. Reusable gowns can contribute to more environmentally sustainable surgical practices without compromising patient safety.