The development of standardised, accepted criteria for the diagnosis, classification and grading of the severity of post-operative fibrosis of the knee will facilitate the identification of patients for inclusion in clinical trials, the development of clinical guidelines, and eventually help to inform the management of this difficult condition. Cite this article: Bone Joint J 2016;98-B:1479-88.

This study has shown that patients are adopting lower impact activities to participate in after total hip arthroplasty. The total number of patients performing a sport increases postoperatively but the total amount of sport played decreases. These data will help to counsel patients.

The present study has shown that patients are adopting lower impact activities to participate in after TKA. The total number of patients performing a sport decreases postoperatively and the total amount of sport played decreases. These data will help to counsel patients.

ImportanceThere remains a lack of randomized trials investigating aspirin monotherapy for symptomatic venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA) or total knee arthroplasty (TKA).ObjectiveTo determine whether aspirin was noninferior to enoxaparin in preventing symptomatic VTE after THA or TKA.Design, Setting, and ParticipantsCluster-randomized, crossover, registry-nested trial across 31 hospitals in Australia. Clusters were hospitals performing greater than 250 THA or TKA procedures annually. Patients (aged ≥18 years) undergoing hip or knee arthroplasty procedures were enrolled at each hospital. Patients receiving preoperative anticoagulation or who had a medical contraindication to either study drug were excluded. A total of 9711 eligible patients were enrolled (5675 in the aspirin group and 4036 in the enoxaparin group) between April 20, 2019, and December 18, 2020. Final follow-up occurred on August 14, 2021.InterventionsHospitals were randomized to administer aspirin (100 mg/d) or enoxaparin (40 mg/d) for 35 days after THA and for 14 days after TKA. Crossover occurred after the patient enrollment target had been met for the first group. All 31 hospitals were initially randomized and 16 crossed over prior to trial cessation.Main Outcomes and MeasuresThe primary outcome was symptomatic VTE within 90 days, including pulmonary embolism and deep venous thrombosis (DVT) (above or below the knee). The noninferiority margin was 1%. Six secondary outcomes are reported, including death and major bleeding within 90 days. Analyses were performed by randomization group.ResultsEnrollment was stopped after an interim analysis determined the stopping rule was met, with 9711 patients (median age, 68 years; 56.8% female) of the prespecified 15 562 enrolled (62%). Of these, 9203 (95%) completed the trial. Within 90 days of surgery, symptomatic VTE occurred in 256 patients, including pulmonary embolism (79 cases), above-knee DVT (18 cases), and below-knee DVT (174 cases). The symptomatic VTE rate in the aspirin group was 3.45% and in the enoxaparin group was 1.82% (estimated difference, 1.97%; 95% CI, 0.54%-3.41%). This failed to meet the criterion for noninferiority for aspirin and was significantly superior for enoxaparin (P = .007). Of 6 secondary outcomes, none were significantly better in the enoxaparin group compared with the aspirin group.Conclusions and RelevanceAmong patients undergoing hip or knee arthroplasty for osteoarthritis, aspirin compared with enoxaparin resulted in a significantly higher rate of symptomatic VTE within 90 days, defined as below- or above-knee DVT or pulmonary embolism. These findings may be informed by a cost-effectiveness analysis.Trial RegistrationANZCTR Identifier: ACTRN12618001879257

Few reports have been published about patient-perceived outcomes and return to sport following total knee arthroplasty (TKA) compared with unicompartmental knee arthroplasty (UKA). This article compares the two procedures using self-assessment questionnaires to determine whether there was a difference in patient-perceived Oxford scores, return to sport, and return to work.Patient-perceived outcomes of mini-incision UKA (Oxford; Biomet Inc, Warsaw, Ind) and TKA were retrospectively reviewed at a minimum of 12 months after surgery. A total of 150 patients underwent 183 UKAs (mean age: 71.5 years; standard deviation [SD]: 9.85) and 120 patients underwent 142 TKAs (mean age: 71.53 years; SD: 9.87). Oxford knee questionnaires were used assessing modifi ed Grimby score, sports, and work activities. Mean Oxford knee score (22.17; SD: 9.03) for UKA was superior to TKA (24.5; SD: 9.68) (Pϭ.04) scores. Mean modifi ed Grimby score for UKA (3.89; SD:1.27) was superior to TKA (2.76; SD:1.12) (PϽ.0001). More patients returned to or increased sports following UKA (Pϭ.0003), but no sooner than TKA patients. Patient-perceived Oxford and modifi ed Grimby scores were better and sporting activity was greater following mini-incision UKA compared to TKA.