The objective of this study was to assess the accuracy of blind placement of caudal epidural needles and the usefulness of the radio-contrast epidurogram. The study involves a prospective case series of 147 consecutive patients with radiological assessment of blind needle placement and epidurogram assessing the accuracy of blind needle placement in caudal epidurals. When the surgical miss rate (26%) and failure of flow of the therapeutic agents (6%) are combined, it can be deduced that up to 32% of nonradiologically guided caudal epidurals may fail to deliver the therapeutic agents to the site of pathology. There was no significant difference in the accuracy of needle placement in adequately trained and experienced middle grade surgeons when compared with consultant surgeons performing these procedures regularly. In conclusion, we recommend radiological guidance and use of epidurogram as the gold standard for the administration of caudal epidurals to increase the likelihood of successful delivery of the therapeutic agents to the site of pathology during the procedure.
We reviewed the outcome of 422 primary cemented Kinemax total knee arthroplasties implanted into 369 patients over a period of five years, from January 1989. The operations were carried out at two NHS district general hospitals and one teaching hospital by 31 surgeons. During the period of review, 49 patients died and ten knees were lost to follow-up (68 knees). The mean Knee Society score improved from 28 before to 89 after surgery, and the mean function score increased from 23 to 79. The range of flexion improved from 92 degrees to 105 degrees. These improvements were maintained throughout the period of study. At the latest review radiolucent lines of 1 mm were seen around 15% of tibial components, 1.4% of patellar components and 9.5% of femoral components. In no case were these changes progressive. Using revision as the endpoint, cumulative survival was 99% after five years and 96.95% after nine years. All revisions were undertaken for deep infection or secondary trauma. Our study has shown that the Kinemax total knee replacement, when carried out with retention of the posterior cruciate ligament by surgeons of varying experience, produces very satisfactory results in the medium term.
Sixty-five patients aged >80 years were compared to 65 patients aged between 60 and 70 years to assess total knee arthroplasty (TKA) outcome using the octogenarian postoperative Knee Society knee and function scores. Knee Society knee scores showed excellent outcomes with no statistically significant difference in the younger cohort (preoperative score, P=.7156; 5-year score, P=.0677). Knee Society function scores also showed good outcomes with no statistically significant difference between the groups (preoperative score, P=.1147; 5-year score, P=A 348). Average length of stay increased by 3 days for octogenarians. Octogenarians had more pre-existing medical conditions and suffered more postoperative confusion. All but 1 patient rated the result as good/excellent. Patients maintained their independence for approximately 3.5 years before requiring more social input. With careful preoperative planning and counseling, TKA is recommended for the octogenarian.
We reviewed the outcome of 422 primary cemented Kinemax total knee arthroplasties implanted into 369 patients over a period of five years, from January 1989. The operations were carried out at two NHS district general hospitals and one teaching hospital by 31 surgeons. During the period of review, 49 patients died and ten knees were lost to follow-up (68 knees). The mean Knee Society score improved from 28 before to 89 after surgery, and the mean function score increased from 23 to 79. The range of flexion improved from 92° to 105°.These improvements were maintained throughout the period of study. At the latest review radiolucent lines of 1 mm were seen around 15% of tibial components, 1.4% of patellar components and 9.5% of femoral components. In no case were these changes progressive. Using revision as the endpoint, cumulative survival was 99% after five years and 96.95% after nine years. All revisions were undertaken for deep infection or secondary trauma.Our study has shown that the Kinemax total knee replacement, when carried out with retention of the posterior cruciate ligament by surgeons of varying experience, produces very satisfactory results in the medium term. The Kinemax Knee System (Howmedica, Rutherford, New Jersey) was introduced into the UK in 1988 after 15 years of research and design development, 1,2 much of which was undertaken at the Brigham and Women's Hospital, Boston, USA. The precursor to the Kinemax knee was the Kinematic, first implanted in 1978, 3 and long-term results for aseptic loosening of the tibial and femoral components were excellent. [4][5][6] There was, however, a rate of revision of 3% for the patellar component and an incidence of fracture of the tibial tray of 1.3%. These results, repeated in two separate institutions, 7-9 were disappointing because of the lower rate of loosening of the patellar component (1.2%) of the Duo-Patella system, the precursor to the Kinematic. 10Walker 11 designed an improved tibial component with better load-bearing properties using computer software based on measurements from human knees, and reverted to the symmetrical femoral component of the Duo-Patella system. 12,13 The Kinemax system evolved further with development of a 'lo-stress insert', which increased the femorotibial contact area and reduced the contact stress by 25% in full extension. 14 It now consists of a standard condylar design, offering options to retain or sacrifice the posterior cruciate ligament and an anatomically symmetrical patellofemoral articulation. 15Previous reports of the long-term outcome of this prosthesis came from the clinical units responsible for its design. These reported few problems with aseptic loosening, wear of polyethylene or patellar subluxation. We now report the results from general hospitals which represent the work of many surgeons in various stages of training. 16 Patients and MethodsBetween January 1989 and April 1994, 422 Kinemax total knee arthroplasties (right 220, left 202) were inserted for severe pain on exercise, night pain and progressi...
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