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  • British Editorial Society of Bone & Joint Surgery  (9)
  • 1
    Online Resource
    Online Resource
    International consensus on the definition and classification of fibrosis of the knee joint
    British Editorial Society of Bone & Joint Surgery ; 2016
    In:  The Bone & Joint Journal Vol. 98-B, No. 11 ( 2016-11), p. 1479-1488
    Details
    In: The Bone & Joint Journal, British Editorial Society of Bone & Joint Surgery, Vol. 98-B, No. 11 ( 2016-11), p. 1479-1488
    Abstract: The aim of this consensus was to develop a definition of post-operative fibrosis of the knee. Patients and Methods An international panel of experts took part in a formal consensus process composed of a discussion phase and three Delphi rounds. Results Post-operative fibrosis of the knee was defined as a limited range of movement (ROM) in flexion and/or extension, that is not attributable to an osseous or prosthetic block to movement from malaligned, malpositioned or incorrectly sized components, metal hardware, ligament reconstruction, infection (septic arthritis), pain, chronic regional pain syndrome (CRPS) or other specific causes, but due to soft-tissue fibrosis that was not present pre-operatively. Limitation of movement was graded as mild, moderate or severe according to the range of flexion (90° to 100°, 70° to 89°, 〈 70°) or extension deficit (5° to 10°, 11° to 20°, 〉 20°). Recommended investigations to support the diagnosis and a strategy for its management were also agreed. Conclusion 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.
    Type of Medium: Online Resource
    ISSN: 2049-4394 , 2049-4408
    URL: Article
    DOI: 10.1302/0301-620X.98B10.37957
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2016
    detail.hit.zdb_id: 2697480-0
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  • 2
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    Online Resource
    THE OUTCOMES OF A LEARNED CLASSIFICATION MODEL CAN BE USED TO DETERMINE FUNCTIONAL STATUS POST TOTAL KNEE ARTHROPLASTY (TKA) BASED ON WEARABLE SENSOR DATA
    British Editorial Society of Bone & Joint Surgery ; 2023
    In:  Orthopaedic Proceedings Vol. 105-B, No. SUPP_7 ( 2023-4-4), p. 67-67
    Details
    In: Orthopaedic Proceedings, British Editorial Society of Bone & Joint Surgery, Vol. 105-B, No. SUPP_7 ( 2023-4-4), p. 67-67
    Abstract: In a clinical setting, there is a need for simple gait kinematic measurements to facilitate objective unobtrusive patient monitoring. The objective of this study is to determine if a learned classification model's output can be used to monitor a person's recovery status post-TKA. The gait kinematics of 20 asymptomatic and 17 people with TKA were measured using a full-body Xsens model 1 . The experimental group was measured at 6 weeks, 3, 6, and 12 months post-surgery. Joint angles of the ankle, knee, hip, and spine per stride (10 strides) were extracted from the Xsens software (MVN Awinda studio 4.4) 1 . Statistical features for each subject at each evaluation moment were derived from the kinematic time-series data. We normalised the features using standard scaling 2 . We trained a logistic regression (LR) model using L1-regularisation on the 6 weeks post-surgery data2–4. After training, we applied the trained LR- model to the normalised features computed for the subsequent timepoints. The model returns a score between 0 (100% confident the person is an asymptomatic control) and 1 (100% confident this person is a patient). The decision boundary is set at 0.5. The classification accuracy of our LR-model was 94.58%. Our population's probability of belonging to the patient class decreases over time. At 12 months post-TKA, 38% of our patients were classified as asymptomatic.
    Type of Medium: Online Resource
    ISSN: 1358-992X , 2049-4416
    URL: Article
    DOI: 10.1302/1358-992X.2023.7.067
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2023
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  • 3
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    Online Resource
    Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty
    British Editorial Society of Bone & Joint Surgery ; 2002
    In:  The Journal of Bone and Joint Surgery Vol. 84, No. 1 ( 2002-1-1), p. 50-53
    Details
    In: The Journal of Bone and Joint Surgery, British Editorial Society of Bone & Joint Surgery, Vol. 84, No. 1 ( 2002-1-1), p. 50-53
    Type of Medium: Online Resource
    ISSN: 0000-0000 , 0301-620X
    URL: Article
    DOI: 10.1302/0301-620X.84B1.12432
    RVK:
    XA 52200.B
    Language: Unknown
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2002
    detail.hit.zdb_id: 2697480-0
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  • 4
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    Arithmetic hip-knee-ankle angle (aHKA): An algorithm for estimating constitutional lower limb alignment in the arthritic patient population
    British Editorial Society of Bone & Joint Surgery ; 2021
    In:  Bone & Joint Open Vol. 2, No. 5 ( 2021-05-01), p. 351-358
    Details
    In: Bone & Joint Open, British Editorial Society of Bone & Joint Surgery, Vol. 2, No. 5 ( 2021-05-01), p. 351-358
    Abstract: Once knee arthritis and deformity have occurred, it is currently not known how to determine a patient’s constitutional (pre-arthritic) limb alignment. The purpose of this study was to describe and validate the arithmetic hip-knee-ankle (aHKA) algorithm as a straightforward method for preoperative planning and intraoperative restoration of the constitutional limb alignment in total knee arthroplasty (TKA). Methods A comparative cross-sectional, radiological study was undertaken of 500 normal knees and 500 arthritic knees undergoing TKA. By definition, the aHKA algorithm subtracts the lateral distal femoral angle (LDFA) from the medial proximal tibial angle (MPTA). The mechanical HKA (mHKA) of the normal group was compared to the mHKA of the arthritic group to examine the difference, specifically related to deformity in the latter. The mHKA and aHKA were then compared in the normal group to assess for differences related to joint line convergence. Lastly, the aHKA of both the normal and arthritic groups were compared to test the hypothesis that the aHKA can estimate the constitutional alignment of the limb by sharing a similar centrality and distribution with the normal population. Results There was a significant difference in means and distributions of the mHKA of the normal group compared to the arthritic group (mean -1.33° (SD 2.34°) vs mean -2.88° (SD 7.39°) respectively; p 〈 0.001). However, there was no significant difference between normal and arthritic groups using the aHKA (mean -0.87° (SD 2.54°) vs mean -0.77° (SD 2.84°) respectively; p = 0.550). There was no significant difference in the MPTA and LDFA between the normal and arthritic groups. Conclusion The arithmetic HKA effectively estimated the constitutional alignment of the lower limb after the onset of arthritis in this cross-sectional population-based analysis. This finding is of significant importance to surgeons aiming to restore the constitutional alignment of the lower limb during TKA. Cite this article: Bone Jt Open 2021;2(5):351–358.
    Type of Medium: Online Resource
    ISSN: 2633-1462
    URL: Article
    DOI: 10.1302/2633-1462.25.BJO-2021-0028.R1
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2021
    detail.hit.zdb_id: 3016366-3
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  • 5
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    Online Resource
    Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty : INFLUENCE OF POSTERIOR CONDYLAR OFFSET
    British Editorial Society of Bone & Joint Surgery ; 2002
    In:  The Journal of Bone and Joint Surgery. British volume Vol. 84-B, No. 1 ( 2002-01), p. 50-53
    Details
    In: The Journal of Bone and Joint Surgery. British volume, British Editorial Society of Bone & Joint Surgery, Vol. 84-B, No. 1 ( 2002-01), p. 50-53
    Abstract: Our purpose was to determine the mechanism which allows the maximum knee flexion in vivo after a posterior-cruciate-ligament (PCL)-retaining total knee arthroplasty. Using three-dimensional computer-aided design videofluoroscopy of deep squatting in 29 patients, we determined that in 72% of knees, direct impingement of the tibial insert posteriorly against the back of the femur was the factor responsible for blocking further flexion. In view of this finding we defined a new parameter termed the ‘posterior condylar offset’. In 150 consecutive arthroplasties of the knee, the magnitude of posterior condylar offset was found to correlate with the final range of flexion.
    Type of Medium: Online Resource
    ISSN: 0301-620X , 2044-5377
    URL: Article
    DOI: 10.1302/0301-620X.84B1.0840050
    RVK:
    XA 52200.B
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2002
    detail.hit.zdb_id: 2697480-0
    detail.hit.zdb_id: 2039886-4
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  • 6
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    Online Resource
    Coronal Plane Alignment of the Knee (CPAK) classification : a new system for describing knee phenotypes
    British Editorial Society of Bone & Joint Surgery ; 2021
    In:  The Bone & Joint Journal Vol. 103-B, No. 2 ( 2021-02-01), p. 329-337
    Details
    In: The Bone & Joint Journal, British Editorial Society of Bone & Joint Surgery, Vol. 103-B, No. 2 ( 2021-02-01), p. 329-337
    Abstract: A comprehensive classification for coronal lower limb alignment with predictive capabilities for knee balance would be beneficial in total knee arthroplasty (TKA). This paper describes the Coronal Plane Alignment of the Knee (CPAK) classification and examines its utility in preoperative soft tissue balance prediction, comparing kinematic alignment (KA) to mechanical alignment (MA). Methods A radiological analysis of 500 healthy and 500 osteoarthritic (OA) knees was used to assess the applicability of the CPAK classification. CPAK comprises nine phenotypes based on the arithmetic HKA (aHKA) that estimates constitutional limb alignment and joint line obliquity (JLO). Intraoperative balance was compared within each phenotype in a cohort of 138 computer-assisted TKAs randomized to KA or MA. Primary outcomes included descriptive analyses of healthy and OA groups per CPAK type, and comparison of balance at 10° of flexion within each type. Secondary outcomes assessed balance at 45° and 90° and bone recuts required to achieve final knee balance within each CPAK type. Results There was similar frequency distribution between healthy and arthritic groups across all CPAK types. The most common categories were Type II (39.2% healthy vs 32.2% OA), Type I (26.4% healthy vs 19.4% OA) and Type V (15.4% healthy vs 14.6% OA). CPAK Types VII, VIII, and IX were rare in both populations. Across all CPAK types, a greater proportion of KA TKAs achieved optimal balance compared to MA. This effect was largest, and statistically significant, in CPAK Types I (100% KA vs 15% MA; p 〈 0.001), Type II (78% KA vs 46% MA; p = 0.018). and Type IV (89% KA vs 0% MA; p 〈 0.001). Conclusion CPAK is a pragmatic, comprehensive classification for coronal knee alignment, based on constitutional alignment and JLO, that can be used in healthy and arthritic knees. CPAK identifies which knee phenotypes may benefit most from KA when optimization of soft tissue balance is prioritized. Further, it will allow for consistency of reporting in future studies. Cite this article: Bone Joint J 2021;103-B(2):329–337.
    Type of Medium: Online Resource
    ISSN: 2049-4394 , 2049-4408
    URL: Article
    DOI: 10.1302/0301-620X.103B2.BJJ-2020-1050.R1
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2021
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  • 7
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    Online Resource
    The arithmetic HKA (aHKA) predicts the constitutional alignment of the arthritic knee compared to the normal contralateral knee : a matched-pairs radiographic study
    British Editorial Society of Bone & Joint Surgery ; 2020
    In:  Bone & Joint Open Vol. 1, No. 7 ( 2020-07), p. 339-345
    Details
    In: Bone & Joint Open, British Editorial Society of Bone & Joint Surgery, Vol. 1, No. 7 ( 2020-07), p. 339-345
    Abstract: An algorithm to determine the constitutional alignment of the lower limb once arthritic deformity has occurred would be of value when undertaking kinematically aligned total knee arthroplasty (TKA). The purpose of this study was to determine if the arithmetic hip-knee-ankle angle (aHKA) algorithm could estimate the constitutional alignment of the lower limb following development of significant arthritis. Methods A matched-pairs radiological study was undertaken comparing the aHKA of an osteoarthritic knee (aHKA-OA) with the mechanical HKA of the contralateral normal knee (mHKA-N). Patients with Grade 3 or 4 Kellgren-Lawrence tibiofemoral osteoarthritis in an arthritic knee undergoing TKA and Grade 0 or 1 osteoarthritis in the contralateral normal knee were included. The aHKA algorithm subtracts the lateral distal femoral angle (LDFA) from the medial proximal tibial angle (MPTA) measured on standing long leg radiographs. The primary outcome was the mean of the paired differences in the aHKA-OA and mHKA-N. Secondary outcomes included comparison of sex-based differences and capacity of the aHKA to determine the constitutional alignment based on degree of deformity. Results A total of 51 radiographs met the inclusion criteria. There was no significant difference between aHKA-OA and mHKA-N, with a mean angular difference of −0.4° (95% SE −0.8° to 0.1°; p = 0.16). There was no significant sex-based difference when comparing aHKA-OA and mHKA-N (mean difference 0.8°; p = 0.11). Knees with deformities of more than 8° had a greater mean difference between aHKA-OA and mHKA-N (1.3°) than those with lesser deformities (-0.1°; p = 0.009). Conclusion This study supports the arithmetic HKA algorithm for prediction of the constitutional alignment once arthritis has developed. The algorithm has similar accuracy between sexes and greater accuracy with lesser degrees of deformity. Cite this article: Bone Joint Open 2020;1-7:339–345.
    Type of Medium: Online Resource
    ISSN: 2633-1462
    URL: Article
    DOI: 10.1302/2046-3758.17.BJO-2020-0037.R1
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2020
    detail.hit.zdb_id: 3016366-3
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  • 8
    Online Resource
    Online Resource
    A kinematic comparison of fixed- and mobile-bearing knee replacements
    British Editorial Society of Bone & Joint Surgery ; 2006
    In:  The Journal of Bone and Joint Surgery. British volume Vol. 88-B, No. 8 ( 2006-08), p. 1016-1021
    Details
    In: The Journal of Bone and Joint Surgery. British volume, British Editorial Society of Bone & Joint Surgery, Vol. 88-B, No. 8 ( 2006-08), p. 1016-1021
    Abstract: Mobile-bearing posterior-stabilised knee replacements have been developed as an alternative to the standard fixed- and mobile-bearing designs. However, little is known about the in vivo kinematics of this new group of implants. We investigated 31 patients who had undergone a total knee replacement with a similar prosthetic design but with three different options: fixed-bearing posterior cruciate ligament-retaining, fixed-bearing posterior-stabilised and mobile-bearing posterior-stabilised. To do this we used a three-dimensional to two-dimensional model registration technique. Both the fixed- and mobile-bearing posterior-stabilised configurations used the same femoral component. We found that fixed-bearing posterior stabilised and mobile-bearing posterior-stabilised knee replacements demonstrated similar kinematic patterns, with consistent femoral roll-back during flexion. Mobile-bearing posterior-stabilised knee replacements demonstrated greater and more natural internal rotation of the tibia during flexion than fixed-bearing posterior-stabilised designs. Such rotation occurred at the interface between the insert and tibial tray for mobile-bearing posterior-stabilised designs. However, for fixed-bearing posterior-stabilised designs, rotation occurred at the proximal surface of the bearing. Posterior cruciate ligament-retaining knee replacements demonstrated paradoxical sliding forward of the femur. We conclude that mobile-bearing posterior-stabilised knee replacements reproduce internal rotation of the tibia more closely during flexion than fixed-bearing posterior-stabilised designs. Furthermore, mobile-bearing posterior-stabilised knee replacements demonstrate a unidirectional movement which occurs at the upper and lower sides of the mobile insert. The femur moves in an anteroposterior direction on the upper surface of the insert, whereas the movement at the lower surface is pure rotation. Such unidirectional movement may lead to less wear when compared with the multidirectional movement seen in fixed-bearing posterior-stabilised knee replacements, and should be associated with more evenly applied cam-post stresses.
    Type of Medium: Online Resource
    ISSN: 0301-620X , 2044-5377
    URL: Article
    DOI: 10.1302/0301-620X.88B8.17529
    RVK:
    XA 52200.B
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2006
    detail.hit.zdb_id: 2697480-0
    detail.hit.zdb_id: 2039886-4
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  • 9
    Online Resource
    Online Resource
    The arithmetic HKA (aHKA) predicts the constitutional alignment of the arthritic knee compared to the normal contralateral knee : a matched-pairs radiographic study
    British Editorial Society of Bone & Joint Surgery ; 2020
    In:  Bone & Joint Open Vol. 1, No. 7 ( 2020-07-01), p. 339-345
    Details
    In: Bone & Joint Open, British Editorial Society of Bone & Joint Surgery, Vol. 1, No. 7 ( 2020-07-01), p. 339-345
    Abstract: An algorithm to determine the constitutional alignment of the lower limb once arthritic deformity has occurred would be of value when undertaking kinematically aligned total knee arthroplasty (TKA). The purpose of this study was to determine if the arithmetic hip-knee-ankle angle (aHKA) algorithm could estimate the constitutional alignment of the lower limb following development of significant arthritis. Methods A matched-pairs radiological study was undertaken comparing the aHKA of an osteoarthritic knee (aHKA-OA) with the mechanical HKA of the contralateral normal knee (mHKA-N). Patients with Grade 3 or 4 Kellgren-Lawrence tibiofemoral osteoarthritis in an arthritic knee undergoing TKA and Grade 0 or 1 osteoarthritis in the contralateral normal knee were included. The aHKA algorithm subtracts the lateral distal femoral angle (LDFA) from the medial proximal tibial angle (MPTA) measured on standing long leg radiographs. The primary outcome was the mean of the paired differences in the aHKA-OA and mHKA-N. Secondary outcomes included comparison of sex-based differences and capacity of the aHKA to determine the constitutional alignment based on degree of deformity. Results A total of 51 radiographs met the inclusion criteria. There was no significant difference between aHKA-OA and mHKA-N, with a mean angular difference of −0.4° (95% SE −0.8° to 0.1°; p = 0.16). There was no significant sex-based difference when comparing aHKA-OA and mHKA-N (mean difference 0.8°; p = 0.11). Knees with deformities of more than 8° had a greater mean difference between aHKA-OA and mHKA-N (1.3°) than those with lesser deformities (-0.1°; p = 0.009). Conclusion This study supports the arithmetic HKA algorithm for prediction of the constitutional alignment once arthritis has developed. The algorithm has similar accuracy between sexes and greater accuracy with lesser degrees of deformity. Cite this article: Bone Joint Open 2020;1-7:339–345.
    Type of Medium: Online Resource
    ISSN: 2633-1462
    URL: Article
    DOI: 10.1302/2633-1462.17.BJO-2020-0037.R1
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2020
    detail.hit.zdb_id: 3016366-3
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