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Panteli M.,University of Leeds | Papakostidis C.,G. Hatzikostas General Hospital | Dahabreh Z.,Sydney Orthopaedic Research Institute | Giannoudis P.V.,University of Leeds

Background: To examine the safety and efficacy of topical use of tranexamic acid (TA) in total knee arthroplasty (TKA). Methods: An electronic literature search of PubMed Medline; Ovid Medline; Embase; and the Cochrane Library was performed, identifying studies published in any language from 1966 to February 2013. The studies enrolled adults undergoing a primary TKA, where topical TA was used. Inverse variance statistical method and either a fixed or random effect model, depending on the absence or presence of statistical heterogeneity were used; subgroup analysis was performed when possible. Results: We identified a total of seven eligible reports for analysis. Our meta-analysis indicated that when compared with the control group, topical application of TA limited significantly postoperative drain output (mean difference: -. 268.36. ml), total blood loss (mean difference. = -. 220.08. ml), Hb drop (mean difference. = -. 0.94. g/dL) and lowered the risk of transfusion requirements (risk ratio. = 0.47, 95CI. = 0.26-0.84), without increased risk of thromboembolic events. Sub-group analysis indicated that a higher dose of topical TA (>. 2. g) significantly reduced transfusion requirements. Conclusions: Although the present meta-analysis proved a statistically significant reduction of postoperative blood loss and transfusion requirements with topical use of TA in TKA, the clinical importance of the respective estimates of effect size should be interpreted with caution. Level of evidence: I, II. © 2013 Elsevier B.V. Source

Oussedik S.,University College London | Tsitskaris K.,University College London | Parker D.,Sydney Orthopaedic Research Institute
Arthroscopy - Journal of Arthroscopic and Related Surgery

Purpose We performed a systematic review of the treatment of articular cartilage lesions of the knee by microfracture or autologous chondrocyte implantation to determine the differences in patient outcomes after these procedures. Methods We searched PubMed/Medline, Embase, and The Cochrane Library databases in the period from January 10 through January 20, 2013, and included 34 articles in our qualitative analysis. Results All studies showed improvement in outcome scores in comparison with baseline values, regardless of the treatment modality. The heterogeneity of the results presented in the studies precluded a meta-analysis. Conclusions Microfracture appears to be effective in smaller lesions and is usually associated with a greater proportion of fibrocartilage production, which may have an effect on durability and eventual failure. Autologous chondrocyte implantation is an effective treatment that may result in a greater proportion of hyaline-like tissue at the repair site, which may in turn have a beneficial effect on durability and failure; it appears to be effective in larger lesions. Autologous chondrocyte implantation with periosteum has been shown to be associated with symptomatic cartilage hypertrophy more frequently than autologous chondrocyte implantation with collagen membrane. Matrix-associated autologous chondrocyte implantation is technically less challenging than the other techniques available, and in lesions greater than 4 cm2, it has been shown to be more effective than microfracture. Level of Evidence Level IV, systematic review of Level I-IV studies. © 2015 Arthroscopy Association of North America. Source

Scholes C.J.,Sydney Orthopaedic Research Institute | Scholes C.J.,Queensland University of Technology | McDonald M.D.,Queensland University of Technology | Parker A.W.,Queensland University of Technology
Journal of Biomechanics

Purpose: Evidence concerning the alteration of knee function during landing suffers from a lack of consensus. This uncertainty can be attributed to methodological flaws, particularly in relation to the statistical analysis of variable human movement data. The aim of this study was to compare single-subject and group analyses in detecting changes in knee stiffness and coordination during step landing that occur independent of an experimental intervention. Methods: A group of healthy men (N=12) stepped-down from a knee-high platform for 60 consecutive trials, each trial separated by a 1-minute rest. The magnitude and within-participant variability of sagittal stiffness and coordination of the landing knee were evaluated with both group and single-subject analyses. Results: The group analysis detected significant changes in knee coordination. However, the single-subject analyses detected changes in all dependent variables, which included increases in variability with task repetition. Between-individual variation was also present in the timing, size and direction of alterations. Conclusion: The results have important implications for the interpretation of existing information regarding the adaptation of knee mechanics to interventions such as fatigue, footwear or landing height. It is proposed that a participant's natural variation in knee mechanics should be analysed prior to an intervention in future experiments. © 2012 Elsevier Ltd. Source

Lustig S.,Sydney Orthopaedic Research Institute | Magnussen R.A.,Ohio State University | Dahm D.L.,Mayo Medical School | Parker D.,Sydney Orthopaedic Research Institute
Knee Surgery, Sports Traumatology, Arthroscopy

Purpose: Patellofemoral arthroplasty remains controversial, primarily due to the high failure rates reported with early implants. Numerous case series have been published over the years detailing results of various first- and second-generation implants. The purpose of this work is to summarize results published to date and identify common themes regarding implants, surgical techniques, and indications in order to maximize results of future procedures. Methods: A comprehensive review of the MEDLINE database was carried out to identify all clinical studies related to patellofemoral arthroplasty. Results: First-generation resurfacing implants were associated with relatively high failure rates in the medium term. Second-generation implants, with femoral cuts based on TKA designs have yielded more promising medium-term results. Surgical indications are specific and must be carefully followed to minimize poor results. Short-term complications are generally related to patellar maltracking, while long-term complications are generally related to progression of osteoarthritis in the tibiofemoral joint. Implant loosening and polyethylene wear are rarely reported. Short-term results are favourable for new technology including custom implants and computer navigated surgery. Conclusions: Overall, recent improvements in implant design and surgical techniques have resulted in improvements in short- and medium-term results. More work is required to assess the long-term outcomes of modern implant designs. Level of evidence: IV. © 2012 Springer-Verlag. Source

Lustig S.,Sydney Orthopaedic Research Institute | Lustig S.,University of Lyon | Scholes C.J.,Sydney Orthopaedic Research Institute | Costa A.J.,Sydney Orthopaedic Research Institute | And 2 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy

Purpose: In contrast to radiographic measurements, MRI provides multiple slices of the knee joint in the sagittal plane, making it possible to assess the medial and lateral tibial slope separately. The purpose of this study is to investigate the effect of medial open-wedge high tibial osteotomy (MOWHTO) on bony and meniscal slope in the medial and lateral tibiofemoral compartments. It was hypothesised that greater changes on the medial tibial plateau would be observed compared with the lateral one. Methods: A retrospective analysis of prospectively collected data was performed on pre- and post-operative MRIs from 21 patients (17 men and 4 women; age 52 ± 9 years). Inclusion criteria were varus alignment, medial compartment osteoarthritis and election for a primary MOWHTO. Each patient had a preoperative and a post-operative high-resolution MRI (3Tesla, Magnetom Trio, Siemens AG) at an average follow-up of 2. 1 years. A previously published method was used to measure bony and meniscal slope for each compartment. The difference between pre- and post-operative tibial slope for both compartments was calculated and associated with the amount of frontal correction. Results: There was a significant increase in bony tibial slope in both compartments following MOWHTO. When a change in bony tibial slope was detected in an individual patient, the change was larger in the medial compartment, with the average change also significantly greater (p < 0. 01) in the medial compartment (2. 4° ± 1. 3°) compared with the lateral compartment (0. 9° ± 1. 1°). There was also a significant increase (p < 0. 01) in the lateral tibial meniscal slope of 0. 9° ± 1. 4°, which was equivalent to the change in the bony lateral slope. The amount of frontal correction was not significantly associated with the amount of change in slope. Conclusions: The results suggest that the modification of the bony slope is larger in the medial compartment after MOWHTO, which is likely related to the location of the hinge on the lateral tibial cortex. These findings suggest that consideration of the medial and lateral tibial slope intra-operatively could be important to identify the optimal location of the hinge. However, further studies are required before recommending any modification to the surgical technique, as the potential clinical consequences of tibial slope alterations remain unknown. Level of evidence: IV. © 2012 Springer-Verlag Berlin Heidelberg. Source

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