british association for surgery of the knee...british association for surgery of the knee from the...

(British Orthopaedic Sports Trauma & Arthroscopy Association & Arthroplasty Care Practitioners Association)

Zimmer Biomet are pleased to support the2016 BASK Annual Spring Meeting

The ACC Liverpool

2016 Annual Spring Meeting – 30th & 31st March(Parallel sessions by BOSTAA & ACPA)

BRITISH ASSOCIATIONFOR SURGERY OF THE KNEE

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oxfordpartialknee.com

1. Price AJ, Svard U. 2011 Jan;469(1): 174-9.

©2016 Zimmer Biomet. All pictures product names and trademarks herein are the property of Zimmer Biomet, or its affiliates. This material is intended for health care professionals only. For indications, contraindications and risk information, please see the package insert and visit www.zimmerbiomet.com. Not intended for distribution in France.

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BRITISH ASSOCIATIONFOR SURGERY OF THE KNEE

From the President

I warmly welcome you all to Liverpool for BASK’s 2016 spring meeting. Merseyside is my adopted home and I live just across theRiver Mersey on the Wirral. Liverpool represents one of the finest conference venues in the country. Many of you, I am sure,will have been to meetings at the ACC before. It provides everything from first class auditoria, plenty of room to circulate andnetwork, excellent facilities for healthcare companies to exhibit and local hotels, restaurants and bars to rest and socialise.

We welcome two affiliated societies who join us this year, BOSTAA and ACCPA. These two societies will be running some parallelsessions with our meeting. All delegates are free to circulate between the meeting rooms as you wish.

This year we have had a slight change in emphasis in the format of the meeting. In response to the feedback that we have re-ceived from our recent meetings, we have more instructional lectures and rather fewer free papers. We have sessions on pae-diatric knee injuries and periprosthetic fractures delivered by nationally recognised experts in their fields. As well as our usualmix of themed free papers we have as our guest, BOA president, Tim Wilton who will talk to us and receive questions from del-egates. We are also most honoured to receive Clare Marx, orthopaedic knee surgeon and president of the Royal College of Sur-geons who will also speak to us. We warmly welcome both to our meeting.

BOSTAA have organised a series of debates on sports topics which will prove to be stimulating and controversial.

We also have our customary registries session, not only focusing on the NJR but also the growing NLR and UKKOR. Building onthe interest generated with the mock trial that we ran for the first time in Telford, we are running another medico legal sessionwith Michael Foy, orthopaedic surgeon and medico legal expert and William Poole, a clinical negligence barrister who will speakon selected topics.

The Lorden Trickey lecture this year will be delivered by Dr Robert Barrack from Washington University St Louis Missouri, USA.Robert who is an internationally renowned knee and hip surgeon, will address us on the “Total Knee Replacement. The Patient’sPerspective”. We are most honoured that he has accepted our invitation to join with us in Liverpool.

The golf outing was held at the Royal Liverpool Golf Club on Tuesday 29 March, hosted as always by BASK stalwart John Ireland,John remains a canny golfer and I for one won’t be betting against him lifting the trophy! Our annual dinner this year is beingheld at Liverpool Town Hall and the venue is splendid. It is one of the finest Victorian buildings in Europe and the dining roomexhibits two magnificent chandeliers. The after dinner entertainment is provided by Frank Cognoscenti who will sing our favouriteFrank Sinatra songs to musical accompaniment. For those of you who like to sing (and I know there are few!) you may wish tobrush up on the lyrics of “New York, New York” and “I Did it my Way”. We have again invited master of ceremonies, Pete Emmett.I know Pete from my association with Everton Football Club and he has the added advantage of being a fellow Yorkshireman.He will keep us entertained between courses!

Delegates will be requested to complete an online survey after the meeting so that we can solicit feedback and it will also enableyou to obtain your CPD certificate. Thanks to David Johnson, our webmaster for coordinating that.

In my second year as president I owe an enormous thank you to the rest of the hard workingBASK exec without whom this meeting would not take place. My last vote of thanks goes toHazel Choules, our events manager who really does a wonderful job of organisation and sheensures smooth running of the conference and social programme.

It is my wish that you all enjoy yourselves. Welcome all of you to Liverpool and the scientificmeeting.

Richard Parkinson and the BASK Executive

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INDEX

Page/s

Presidents Welcome 1

Top Score - Golden Ticket - 500 Words Meets Top Gun (stand no.28) 2

“Cadaveric Demonstration” by Arthrex (stand no.8) 4

Exhibition Floorplan (Hall 2a) 5

List of Exhibitors 6

BASK Programme 7-11

BASK Podium Presentations 12-18

BASK AGM Agenda 19

BASK Applications for Membership 20

BOSTAA Programme 21-23

BOSTAA Podium Presentations 24-27

ACPA Programme 28-29

BASK Poster Presentations 30-36

BASK E-Poster Presentations 37

“SAVE-THE-DATE”

BASK – ANNUAL SPRING MEETING

28-29 MARCH 2017 – STCC, SOUTHPORT

© Arthrex Ltd, 2016. All rights reserved.

Live Demonstrations BASK 2016Wednesday, March 30, 2016 | Room 4a | ACC Convention Centre, Liverpool

Award-Winning Medical Education Rolling into LiverpoolSurgical Demonstrations and Discussion Presentations Focusing On:

Meniscal Repair Mr Rob Gilbert | Wrightington, UK

Meniscal Root Avulsion Mr Rob Gilbert | Wrightington, UK

AnteroLateral Stabilisation of the Knee Mr Adrian Wilson | Basingstoke, UK

All delivered in crystal clear SynergyUHD4 to the comfort of your seat. Arrive early to avoid disappointment.

The Arthrex MobileLab received a Special Commendation for Innovation 2013

British Orthopaedic Association

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Visit our Exhibitors!The following companies are exhibiting at the 2016 Annual Conference to showcase theirproducts and services.

Company Name Stand NosAdler Ortho UK Ltd 37Amplitude Clinical 11Aquilant Orthopaedics 16Arthrex Ltd 8B. Braun Medical Ltd 3Biocomposites Ltd 26British Orthopaedic Association 33ConforMIS UK Ltd 6Corin Ltd 44DePuy Synthes Ltd 39Episurf Medical 1Exactech UK Ltd 30Freelance Surgical Ltd 34Game Ready UK 21Hospital Innovations 12Int2Med Ltd 27Joint Operations 22JRI Orthopaedics Ltd 31Karl Storz Endoscopy (UK) Ltd 2Lima Orthopaedics UK 23Mathys Orthopaedics Ltd 40MatOrtho Ltd 14Medacta UK Limited 15Medi UK Ltd 5Mircroport Orthopedics 10Neoligaments / Xiros 4NHSBT Tissue & Eye Services 9Ossur UK 7Promedics Orthopaedics Ltd 24Smith & Nephew 20Sobi - ChondroCelect 32Stryker UK Ltd 17Syncera - Smith & Nephew 19VirtaMed 28Zimmer Biomet Ltd 13Medical Billing & Collection 41NJR / National Joint Registry 42TopKAT 43

Please take the time to visit the stands

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(The abstracts relating to the Free Paper Sessions are stated on pages 12 to 18)

Please note: Filming, recording or photography during the two-dayMeeting is Strictly Prohibited unless by prior agreement withthe Executive Committee

BASK ANNUAL SPRING MEETING 2016THE ACC, LIVERPOOL

WEDNESDAY 30TH MARCH

08.00 REGISTRATION & COFFEE – Hall 2, Exhibition area

09.15 INTRODUCTION – Richard Parkinson, President and Tony Hui, Honorary Secretary – Room 3

Moderators:Richard Parkinson & Simon Roberts

09.20 Risks outweigh the benefits of knee arthroscopy in middle aged or olderAgree – Andy CarrDisagree – Ian Corry

09.40 Acute Isolated ACL tear – Primary surgery is on the riseAgree – Amer KhanDisagree – Fares Haddad

Session IColin Esler & Leela Biant

10.00 Free Paper Session:-0115 – A MULTICENTRE RANDOMISED STUDY COMPARING TOTAL OR PARTIAL KNEEREPLACEMENT – ONE YEAR RESULTS OF THE TOPKAT TRIALDavid Beard1, Andrew Price1, Loretta Davies1, Jonathan Cook1, Graeme MacLennan2,Marion Campbell2, Andrew Carr1, Ray Fitzpatrick1, Helen Campbell1, Nigel Arden1, Helen Doll1, TOPKAT study group1,David Murray1

1University of Oxford, Oxford, UK, 2University of Aberdeen, Aberdeen, UK

10.06 0001 – IS THERE A RELATIONSHIP BETWEEN OUTCOME FOLLOWING TOTAL KNEE REPLACEMENT (TKR) ANDHOSPITAL CLINICAL PRACTICES / BEHAVIOUR: AN ANALYSIS OF NATIONALLY AVAILABLE DATA FOR NHS TRUSTS INENGLAND AND WALES?Moez Zeiton, David JohnsonStockport NHS Foundation Trust, Stockport, UK

10.12 0062 – LEARNING CURVE WITH A NEW PRIMARY TKA IMPLANT: A WORLDWIDE PERSPECTIVE WITH MORE THAN2000 PATIENTSIvan Brenkel1, Chong Chang7, Mark Clatworthy2, William Hamilton3, James Howard10, John-Paul Whittaker5, StephenKantor4, James Lesko8, Ryan Nunley9, Peter Verdonk6, Verdonna Huey8

1Queen Margaret Hospital, Dunfermline, UK, 2Auckland Bone & Joint Surgery, Auckland, New Zealand,3Anderson Orthopaedic Clinic, Alexandria, USA, 4Dartmouth Hitchcock Medical Center, Lebanon, NH, USA,5Robert Jones & Agnes Hunt Orthopaedic Hospital, Owestry, UK, 6Monica Camputs O.L.V. Middelares Hospital,Antwerp, Belgium, 7SMG-Seoul National University Boramae Medical Center, Seoul, Republic of Korea, 8DePuySynthes Joint Reconstruction, Warsaw, IN, USA, 9Washington University School Medicine, St Louis, MO, USA,10University of Western Ontario, London, Ontario, Canada

10.18 0075 – IN VIVO KINEMATICS FOR CUSTOMIZED VS. TRADITIONAL TKA DESIGNS: A MOBILE FLUOROSCOPY STUDYIan Zeller1, Adrija Sharma1, Bradley Meccia1, Harold Cates2, William Kurtz3, Mathew Anderle1, Richard Komistek1

1University of Tennessee, Knoxville,TN, USA, 2Tennessee Orthopedic Clinic, Knoxville,TN, USA, 3Tennessee OrthopedicAlliance, Nashville, TN, USA

10.24 Discussion

10.30 COFFEE – (Hall 2 Lower Level – Exhibition / Posters & E-Posters)

This Meeting will be accredited with CME Points

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Session 2Moderators: David Johnson & Tony Hui

10.50 Free Paper Session:-0124 – THE ALL POLY TIBIAL COMPONENT IN TOTAL KNEE ARTHROPLASTY: MEDIUM TERM RESULTEmad Mallick, Tawfiq Korim, Deepu Sethi, Steven Godsiff, Colin Esler University Hospital Leicester, Leicester, UK

10.56 0008 – METAL BACKED VERSUS ALL-POLYETHYLENE UNICOMPARTMENTAL KNEE ARTHROPLASTY: THE EFFECT OFIMPLANT THICKNESS ON PROXIMAL TIBIAL STRAIN IN A VALIDATED FINITE ELEMENT MODELChloe Scott1, Mark Eaton2, Richard Nutton3, Frazer Wade3, Sam Evans2, Pankaj Pankaj1

1University of Edinburgh, Edinburgh, UK, 2Cardiff University, Cardiff, UK, 3Royal Infirmary of Edinburgh, Edinburgh,UK

11.02 0016 – EARLY RESULTS OF FIXED BEARING MEDIAL UNICOMPARTMENTAL KNEEREPLACEMENT USING A CEMENTED ALL POLYETHYLENE TIBIAL COMPONENT.Munier Hossain, Kim Howard, Richard ParkinsonWirral University Teaching hospital NHS foundation trust, Liverpool, UK

11.08 Discussion

11.14 0019 – NO DIFFERENCE IN TWO-YEAR FUNCTIONAL OUTCOMES USING KINEMATIC VERSUS MECHANICALALIGNMENT IN TKA – A RANDOMIZED CONTROLLED CLINICAL TRIALSimon Young1, Matthew Walker1, Ali Bayan1, Toby Briant-Evans3, Paul Pavlou2, Bill Farrington1

1North Shore Hospital, Aukland, New Zealand, 2Royal Bournemouth Hospital, Bournemouth, UK, 3North Hampshire Hospital, Basingstoke, UK

11.20 0029 – RANDOMISED CONTROL TRIAL: THE FUNCTIONAL BENEFITS OF RETAINING THE INFRAPETELLAR FAT PAD INA TOTAL KNEE REPLACEMENTAnthony Howard2, Moez Ballal1, Matthew Cartwright3, Alasdair Santini1, Andrew Philipson1, Jo Banks1

1RLBUHT, Liverpool, UK, 2Academic Unit, Leeds General Infirmary, Leeds, UK, 3Southport and Ormskirk NHS Trust,Ormskirk, UK

11.26 0127 – THE INCIDENCE AND IMPACT OF ARTHROSCOPY IN THE YEAR BEFORE TOTAL KNEE ARTHROPLASTYSimon Barton, George McLauchlan, Stephen CantyLancashire Teaching Hospitals NHS Trust, Lancashire, UK

11.32 Discussion

11.40 NJR/National Joint Registry – Martyn Porter, NJR Medical DirectorPeter Howard, Chair, Surgeon Outlier & Implant Scrutiny Committee

12.00 ODEP for Knees – Keith Tucker

12.25 Guest Speaker: Tim Wilton, President of the BOAPresentation”Outlook from the BOA Office”

13:00 LUNCH – (Hall 2 Lower Level – Exhibition / Posters & E-Posters)

14.00 Guest Speaker: Clare Marx – President of the RCS EngPresentation “View from the Centre”

14.40 Paediatric Session;Paul Gibb – Juvenile ACL InjuriesFergal Monsell – Physeal InjuriesJonathan Eldridge – Patellofemoral Instability

15:40 TEA – (Hall 2 Lower Level – Exhibition / Posters & E-Posters)

16.00 Medicolegal SessionMike Foy - Common Medico legal pitfalls for the orthopaedic surgeonWilliam Poole – Montgomery and consent issues

17.30 – 18.30 AGM – All members of BASK are invited to attend – Room 3 (AGM Agenda on page 19)

17:30 – 18.30 Arthrex – “Cadaveric Demonstration” – Live Link in Room 4a from the Mobile Surgical Unit“Limited spaces available” – Please visit Arthrex on their Stand no.8 to request an invitation.

19.30pm for 20.15pm – Annual Dinner, ‘TOWN HALL’ Liverpool. Entrance by Ticket ONLY.

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Please note: Filming, recording or photography during the two-dayMeeting is Strictly Prohibited unless by prior agreement withthe Executive Committee.

THURSDAY 31st MARCHDay-Two – BASK 2016 Annual Meeting – ACC LiverpoolWelcome to Day 2


08.30 Start of 2nd day’s Proceedings – Room 3

Session 3Moderators: Andrew Porteous & Adil Ajuied

08.40 Free Paper Session:-0073 – PROPHYLACTIC ANTIBIOTICS IN ELECTIVE HIP AND KNEE ARTHROPLASTY – AN ANALYSIS OF ORGANISMSREPORTED TO CAUSE INFECTION AND A NATIONAL SURVEY OF CLINICAL PRACTICECraig Hickson1, David Metcalfe2, Suzanne Elgohari3, Tamsin Oswald4, James Masters6, Monika Rymaszewska5, Mike Reed4, Andrew Sprowson6

1Leicester Royal Infirmary, Leicester, UK, 2Center for Surgery and Public Health, Harvard Medical School, Boston,USA, 3Department of Healthcare Associated Infections & Antimicrobial Resistance, Public Health England, London,UK, 4Northumbria Healthcare NHS Foundation Trust, Northumberland, UK, 5Wansbeck Hospital, Northumberland,UK, 6Warwick Orthopaedics, Coventry, UK

08.46 0104 – CORONAL KNEE ALIGNMENT: RELIABILITY OF WEIGHTBEARING & NON-WEIGHTBEARING SHORT VS LONGLEG RADIOGRAPHSSam Yasen, Zakk Borton, David Elson, Ed Britton, Mike Risebury, Adrian WilsonHampshire Hospitals NHS Trust, Basingstoke, UK

08.52 0098 – PREDICTING DISSATISFACTION FOLLOWING TOTAL KNEE REPLACEMENT IN PATIENTS UNDER 55 YEARS OFAGEChloe Scott, William Oliver, Deborah MacDonald, Frazer Wade, Matthew Moran, Steffen BreuschRoyal Infirmary of Edinburgh, Edinburgh, UK

08.58 Discussion

09.04 0041 – EXPERIENCES USING A REVISION ARTHROPLASTY NETWORK: A REVIEW OF THE FIRST 250 CASESBenjamin Bloch, Martin Raglan, Andrew Manktelow, Peter JamesNottingham University Hospitals NHS Trust, Nottingham, UK

09.10 0056 – ONE STAGE REVISION KNEE ARTHROPLASTY- MEAN 5 YEARS RESULTS FROM A TERTIARY CARE CENTRERahul kakar, Nima Razii, Rhidian Morgan-JonesLlandough Hospital, Cardiff, UK

09.16 0043 – TWO STAGE DEBRIDEMENT WITH ANTIBIOTIC CEMENT BEADS AND PROSTHESIS RETENTION FOR ACUTEPERIPROSTHETIC INFECTIONS AFTER KNEE ARTHROPLASTYMatthew Niesen, Mark Spangehl, Henry Clarke, Adam Schwartz, Christopher BeauchampMayo Clinic, Phoenix, Arizona, USA

09.22 Discussion

Session 4Moderators: Robert Barrack & Andrew Price

09.28 Free Paper Session:-0156 – PATIENT REPORTED OUTCOME FOLLOWING TOTAL KNEE ARTHROPLASTY; DOES ETHNICITY INFLUENCE THEOUTCOME?Mehdi Suzangar, James Kennedy, Urjit Chatterji, Colin EslerUniversity Hospitals of Leicester NHS Trust, Leicester, UK

09.34 0028 – THE GOOD AND BAD OF KNEE REPLACEMENT – COMBINING TRANSITION, SATISFACTION AND PROM DATATO DEFINE PATIENT OUTCOME AFTER TKAAnqi Gao, Abtin Alvand, William Jackson, Nicholas Bottomley, David Beard, Andrew PriceUniversity of Oxford, Oxford, Oxfordshire, UK

This Meeting will be accredited with CME Points

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09.40 0025 – DOES PRE-OPERATIVE ANXIETY AND DEPRESSION AFFECT PATIENT OUTCOME AFTER PRIMARY KNEEREPLACEMENT ARHTROPLASTY?Andrew Jones, Tim James, Andrew DaviesMorriston Hospital, Swansea, Wales, UK

09.46 Discussion

09.52 0091 – PREDICTING CHRONIC POSTOPERATIVE PAIN BY ASSESSING CENTRAL SENSITIZATION IN PATIENTSUNDERGOING TKR SURGERY: A PRELIMINARY FUNCTIONAL BRAIN MRI STUDY AT 3-TESLA.Thomas Kurien1, Diane Reckziegel2, William Cottam2, Kristian Petersen3, Richard Pearson1, Lars Arendt-Nielsen3,Thomas Graven-Nielsen4, Dorothee Auer2, Brigitte Scammell1

1Academic Division of Trauma and Orthopaedics, Queen’s Medical Centre, Arthritis Research UK Pain Centre, TheUniversity of Nottingham, Nottingham, UK, 2Academic Radiology, Arthritis Research UK Pain Centre, The Universityof Nottingham, Nottingham, UK, 3SMI, Aalborg University, Aalborg, Denmark, 4Centre forNeuroplasticity and Pain,Aalborg University, Aalborg, Denmark

09.58 0033 – IDENTIFYING PRE-OPERATIVE NEUROPATHIC PAIN AS A MARKER OF POOR OUTCOME FOLLOWING KNEEREPLACEMENT SURGERY.Anushka Soni1, Nick Bottomley3, William Jackson3, Irene Tracey2, M. Kassim Javaid1, Andrew Price1

1Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology andMusculoskeletal Sciences, Oxford, UK, 2Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB),University of Oxford, Oxford, UK, 3The Knee Service, Nuffield Orthopaedic Centre, Oxford, UK

10.04 0052 – UNEXPLAINED PAIN FOLLOWING TOTAL KNEE ARTHROPLASTY- IS ROTATIONAL MALALIGNMENT THEPROBLEM?Simon Young2, Mark Spangehl1, Henry Clarke1

1Mayo Clinic, Phoenix, Arizona, USA, 2University of Auckland, Auckland, New Zealand

10.10 Discussion


10.50 Guest Speaker: Peter Giannoudis – Periprosthetic Fractures

11.20 Registry Session – UKNLR – Sean O’LearyUKKOR – David Elson

12.00 ‘Lorden Trickey Lecture’Guest Lecturer:- Dr. Robert Barrack (USA)Presentation:- “Total knee replacement – the patient’s perspective”

12.45 LUNCH – (Hall 2 Lower Level – Exhibition / Posters & E-Posters)

13.30 Presentation of Awards for 2016Presidential Award for “Best Podium Presentation for 2015 – 2016”Prizes awarded for the ‘Best 2016 Podium, Poster & E-Poster Presentations’.Golf Trophy

13.50 Report from Travelling / Research Fellows

14.10 Debate and Focus on Meniscal allograft transplantationModerator: Simon RobertsACI is a waste of moneyAgree – Rhidian ThomasDisagree – Leela Biant

14.30 Focus on meniscal allograft:Meniscal allograft transplantation in 2016: Where are we now? Tim SpaldingReflections on long term outcome data Katherine Van Der Straeten

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Session 5Moderators: Sanjeev Anand & Richard Parkinson

14.50 Free Paper Session:-00146 – KNEE ARTHROPLASTY IN PATIENTS PREVIOUSLY TREATED WITH AUTOLOGOUS CHONDROCYTEIMPLANTATIONEmile Schutgens, Daud Chou, George Bentley, John Skinner, Timothy BriggsRoyal National Orthopaedic Hospital, Stanmore, UK

14.56 0023 – RETURNING TO WORK AFTER JOURNEY II TOTAL KNEE REPLACEMENTAnn Avery, Joanne Banks, John Davidson, Andrew Phillipson, Jill Pope & Alasdair Santini.The Lower Limb Arthroplasty Unit,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK

15.02 0078 – A DOUBLE BLIND, RANDOMISED, CONTROLLED COMPARATIVE STUDY OF THE DEPUY PFC SIGMA AND CR150TOTAL KNEE REPLACEMENTS.Anthony Redmond1, Graham Chapman1, Richard Wilkins1, Todd Stewart1, Derrick White1, Elizabeth Hensor1,Ramakrishnan Venkatesh2

1University of Leeds, Leeds, UK, 2Leeds Teaching Hospitals NHS Trust, Leeds, UK

15.08 Discussion

15.14 0106 – TRENDS IN THE OXFORD KNEE SCORE FOLLOWING MEDIAL-OPENING WEDGE HIGH TIBIAL OSTEOTOMY &THE IMPACT OF KELLGREN-LAWRENCE GRADESam Yasen1, Harry Palmer1, David Elson1, Matt Dawson3, Chris Wilson2, Adrian Wilson1

1Hampshire Hospitals NHS Trust, Basingstoke, UK, 2Cardiff & Vale University Health Board, Cardiff, UK, 3NorthCumbria University Hospitals NHS Trust, Carlisle, UK

15.20 0158 – OXFORD DOMED LATERAL PARTIAL KNEE REPLACEMENT: UPTO 10 YEAR FOLLOW-UP. AN INDEPENDENTSINGLE SURGEON SERIESSimon Newman, Helen Alsop, Justin CobbImperial College London, London, UK

15.26 Discussion

15.30 0144 – VIRTUAL CLINIC FOLLOW-UP OF HIP AND KNEE REPLACEMENT: A PATIENT SURVEYLaura McArthur, Gabriel Fieraru, Dan WilliamsRoyal Cornwall Hospitals NHS Trust, Cornwall, UK

15.36 0142 – VIRTUAL CLINIC FOLLOW-UP OF PRIMARY JOINT REPLACEMENT PATIENTSWilliam Reeve, Laura McArthur, Dan WilliamsRoyal Cornwall Hospitals NHS Trust, Cornwall, UK

15.42 0143 – THE INFLUENCE OF DESIGN OF PATIENT SPECIFIC INSTRUMENTATION ON ACCURACY OF PLACEMENT INUNICOMPARTMENTAL KNEE REPLACEMENTSimon Newman, Susannah Clarke, Simon Harris, Justin CobbImperial College London, London, UK

15.48 Discussion

15.55 Closing Remarks – President, Richard Parkinson

16.10 Close of 2016 BASK Annual Spring Meeting(Tea & coffee in the Foyer Area upper level by session rooms)

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BASK 2016 Podium PresentationsWEDNESDAY 30th March – Free Papers

10:00am – Session 1Moderators: Colin Esler & Leela Biant

0115 – A MULTICENTRE RANDOMISED STUDY COMPARING TOTAL ORPARTIAL KNEE REPLACEMENT – ONE YEAR RESULTS OF THE TOPKAT TRIALDavid Beard1, Andrew Price1, Loretta Davies1, Jonathan Cook1, GraemeMacLennan2, Marion Campbell2, Andrew Carr1, Ray Fitzpatrick1, HelenCampbell1, Nigel Arden1, Helen Doll1, TOPKAT study group .1, David Murray1

1University of Oxford, Oxford, UK, 2University of Aberdeen, Aberdeen, UK

Background: Early (one year) follow up results are presented for TOPKAT, amulti-centre randomised trial assessing the clinical and cost effectiveness ofPartial Knee Replacement (PKR) compared to Total Knee Replacement (TKR)in patients with antero-medial osteoarthritis of the knee.Method: 528 patients were recruited from 27 sites and randomised to TKRor PKR. The primary outcome was the Oxford Knee Score (OKS), collected at2 months, 1 year and annually to 5 years. Secondary outcomes includedcomplications and re-operation, activity scores, cost-effectiveness, andpatient satisfaction.Results: Baseline variables between groups were balanced. At 1 year OKSresult was 1.9 points ([95%CI, 0.2 to 3.6 p=0.029) in favour of PKR. Second-ary outcomes mostly reflected the same pattern. 89% of PKR patientsreported they would have the operation again compared with 77% of TKRpatients (<0.001). There were 9 events for readmission in the PKR group(including 2 bearing revisions and 2 MUAs) and 15 events in the TKR groupwith 6 MUAs for stiffness. A composite outcome variable for failure showedthat 11% of PKR’s failed compared to 15% in the TKR group (a relative risk of0.72 [95% CI 0.46, 1.11] in favour of the PKR group.Conclusions: Both operations had good early outcome. There was no evi-dence (at one year) that TKR was superior to PKR. Several separate out-comes showed a difference in favour of PKR, though some were of uncertainclinical significance. Longer term results from TOPKAT are now required.

0001 – IS THERE A RELATIONSHIP BETWEEN OUTCOME FOLLOWINGTOTAL KNEE REPLACEMENT (TKR) AND HOSPITAL CLINICAL PRACTICES /BEHAVIOUR: AN ANALYSIS OF NATIONALLY AVAILABLE DATA FOR NHSTRUSTS IN ENGLAND AND WALES?Moez Zeiton, David JohnsonStockport NHS Foundation Trust, Stockport, UK

Introduction GIRFT data suggests wide variation in T&O practice, with littlework explaining the causes.Aim Compare nationally available data on clinical practice/behaviour withpublished outcomes in TKR.Methods TKR data on all NHS Trusts was obtained for Oxford knee scoreimprovement (OKS), 1&5 year NJR revision rates (1yrRev/5yrRev) and 90-day mortality. For each measure the ratio between the best 10% was com-pared with the worst for data from: NJR; HES; PHSO; NHSLA; GMC survey;BASK.Results Comparison of best/worst results within each measure showed aratio of OKS 0.76x (difference 4.46 points); 1yrRev x9.2; 5yrRev x6.9; mortal-ity x3.78. When comparing measures: 1yrRev was related to OKS x1.96,5yrRev x1.41; 5yrRev was related to OKS x1.67, 1yrRev x1.81. TKR volumewas related to 1yrRev with 40% more performed in the best. All measureswere related to: NJR not known consent rate, OKS x2.88; 1yrRev x1.29,5yrRev x1.54, mortality x4.13; and NHSLA orthopaedic claims, OKS x1.25,1yrRev x1.25, 5yrRev x1.38, mortality x1.34. Other relationships were:length of stay and OKS x1.37; readmissions and OKS x1.45, 1yrRev x1.28;accepted PHSO Trust complaints and 1yrRev x4.53, 5yrRev x5.11; GMCtrainee survey and OKS/mortality. BASK 2015 attendance/surgeon review ofNJR/PROMS data were related to better OKS/1yrRev results. Enhancedrecovery programme use was related to a better 1yrRev.Conclusion The difference between best/worst performers for each meas-ure is large. Outcomes are related to other measures of practice, teachingand engagement in submitting/reviewing data. Different strategies to tacklethese areas are needed to improve patient care.

0062 – LEARNING CURVE WITH A NEW PRIMARY TKA IMPLANT: AWORLDWIDE PERSPECTIVE WITH MORE THAN 2000 PATIENTSIvan Brenkel1, Chong Chang7, Mark Clatworthy2, William Hamilton3, JamesHoward10, John-Paul Whittaker5, Stephen Kantor4, James Lesko8, RyanNunley9, Peter Verdonk6, Verdonna Huey8

1Queen Margaret Hospital, Dunfermline, UK, 2Auckland Bone & JointSurgery, Auckland, New Zealand, 3Anderson Orthopaedic Clinic, Alexandria,USA, 4Dartmouth Hitchcock Medical Center, Lebanon, NH,USA, 5RobertJones & Agnes Hunt Orthopaedic Hospital, Owestry, UK, 6Monica CamputsO.L.V. Middelares Hospital, Antwerp, Belgium, 7SMG-Seoul NationalUniversity Boramae Medical Center, Seoul, Republic of Korea, 8DePuySynthes Joint Reconstruction, Warsaw, IN, USA, 9Washington UniversitySchool Medicine, St Louis, MO, USA, 10University of Western Ontario,London, Ontario, Canada

Materials & Methods: From November 2012 to July 2015, 2369 primaryTKAs were enrolled in two studies (50 sites in 14 countries) with a new kneesystem (NEW-TKA). The NEW-TKAs were compared to 843 primary TKAsfrom three manufacturers (CA-TKA) with the same configurations as theNEW-TKA. Demographics for NEW-TKA and CA-TKA were similar. Operativetimes, clinical outcomes and a series of patient reported outcomes werecompared between the first 10 New-TKA subjects for each surgeon (definedas learning curve cases N=520) and all later subjects (N=1849).Results: Mean (SD) surgical time for NEW-TKA learning curve cases was 79.1(24.3) minutes; later reduced to 73.6 (24.3) (p=0.002). Beyond 10 cases,there was continued reduction in NEW-TKA surgical time (R-Squared =0.031); on par with the mean (SD) 71.9 (21.6) for CA-TKA (p=0.078).PROM outcomes for NEW-TKA learning curve cases were not statistically dif-ferent from later cases at less than 1 year or later when adjusted for relevantcovariates (p-values > 0.01). PROM outcomes for NEW-TKA vs. CA-TKAunder the same covariate adjustments showed a trend favoring KOOS ADL,Symptoms, and Sport and Recreation subscores at minimum 1 year (p-val-ues < 0.01).The intraoperative operative site complications were 1.3% for the NEW-TKAlearning curve cases; similar to the 0.6% rate for historical CA-TKA (p=0.231).The 0.6% intraoperative complication rate for NEW-TKA later cases was con-sistent with learning curve cases (p=0.158).Discussion: This study found surgeon learning curve with this new primaryTKA system does not adversely affect patient short-term outcomes andcomplication rates.

0075 – IN VIVO KINEMATICS FOR CUSTOMIZED VS. TRADITIONAL TKADESIGNS: A MOBILE FLUOROSCOPY STUDYIan Zeller1, Adrija Sharma1, Bradley Meccia1, Harold Cates2, William Kurtz3,Mathew Anderle1, Richard Komistek1

1University of Tennessee, Knoxville,TN, USA, 2Tennessee Orthopedic Clinic,Knoxville,TN, USA, 3Tennessee Orthopedic Alliance, Nashville, TN, USA

Introduction: Recently, patient specific posterior cruciate retaining (PCR)total knee arthroplasty (TKA) have been individually made replicating thepatient’s femur and tibia geometry. The objective of this study was to deter-mine the in vivo kinematics for subjects having a either a traditional, off-the-shelf (OTS) TKA or a customized, individually made (CIM) TKA.Methods: In vivo kinematics for 108 subjects, 44 having the CIM-PCR-TKAand 64 having one of three standard OTS-PCR-TKA designs, were assessed.A mobile fluoroscopic system was used to observe subjects during a weight-bearing deep knee bend (DKB), Chair Rise and Normal Gait. All the subjectswere implanted by one of two surgeons and were considered clinically suc-cessful (HSS Score>90).Results: During the DKB, CIM-TKA subjects experienced -3.3 (-5.0 to -14.3SD=2.8) mm of lateral condyle posterior femoral rollback (PFR) compared to-2.6 (2.4 to -9.7 SD=3.1) mm, -0.7 (6.0 to -6.5 SD=3.6) mm and -1.2 (5.7 to -8.1 SD=3.9) for subjects having the three OTS-TKA designs. Subjects havinga CIM-TKA achieved 105° of weight-bearing knee flexion, while subjects hav-ing an OTS-TKA achieved 100°, 97° and 102°, respectively. These trends weresimilar during Chair Rise.Discussion: All CIM-TKA subjects experienced directionally normal posteriorfemoral rollback patterns of the lateral condyle while 19-28% of OTS-TKAsubjects experienced lateral motion paradoxical to the normal knee pattern.In general the CIM-TKA demonstrated a larger range of motion (p=0.05) withtranslation and rotation patterns more closely resembling the normal knee.CIM-TKAs demonstrated less variability between patients, particularly withrespect to condyle translation.

Authors of the Podium Presentations have submitted an E-Poster of their presentation which can be viewed on the screens within the exhibition area (Hall 2a)

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10:50 – Session 2Moderators: David Johnson & Tony Hui

0124 – THE ALL POLY TIBIAL COMPONENT IN TOTAL KNEE ARTHROPLASTY:MEDIUM TERM RESULTEmad Mallick, Tawfiq Korim, Deepu Sethi, Steven Godsiff, Colin EslerUniversity Hospital Leicester, Leicester, UK

Introduction: The all polyethylene tibial (APT) component may be equiva-lent or better than a metal backed tibial (MBT) component and is cheaper.There are no medium or long term UK studies comparing the 2 tibial com-ponents.Objectives: To analyse the revision rates in a large UK unit, comparing theAPT to the MBT after a minimum of 5 yearMethods: We obtained data from the Trent arthroplasty register of all thetotal knee replacements performed at University Hospital Leicesterbetween years 2007 to 2009. We evaluated the all radiographs to categorisethem into APT/MBTand also to determine the technical aspects of surgeryincluding alignment, excess cement etc, and if any revision surgery wasundertaken. We cross checked the national data base to ensure no TKRundergoing revision was missed.Results: There were 3337 TKRs; 2869 were MBT and 468 were APTs.In the latter group, there were 300 females and 168 males with a medianage of 75 years. The median age in the MBT was 69 years. The median fol-low-up was 75.8 months.There was significantly more revisions in the MBT group compared to theAPT (1.9% vs 0.6%, p=0.05, Fishers exact test). The APT were revised forpatella dislocation (1), infection (1) and loosening (1). Aseptic loosening wasthe commonest reason for revision in the MBT.Conclusions: Mid term results show lower revision rate of APT as comparedto cemented modular implants. We advocate implantation of APT due to itscomparable survival and cost effectiveness

0008 – METAL BACKED VERSUS ALL-POLYETHYLENE UNICOMPARTMENTALKNEE ARTHROPLASTY: THE EFFECT OF IMPLANT THICKNESS ON PROxIMALTIBIAL STRAIN IN A VALIDATED FINITE ELEMENT MODELChloe Scott1, Mark Eaton2, Richard Nutton3, Frazer Wade3, Sam Evans2,Pankaj Pankaj1

1University of Edinburgh, Edinburgh, UK, 2Cardiff University, Cardiff, UK,3Royal Infirmary of Edinburgh, Edinburgh, UK

Unicompartmental knee replacements (UKRs) are an attractive option fortreating medial compartment osteoarthritis, but 25-40% of revisions areperformed for unexplained pain possibly secondary to elevated proximaltibial bone strain. This study investigates the effect of tibial componentmetal backing and polyethylene thickness on cancellous bone strain in afinite element model (FEM) of a cemented fixed bearing medial UKR, vali-dated using acoustic emission (AE). Ten composite tibias implanted with all-polyethylene (AP) and metal backed (MB) tibial components were loaded to2500N. Cancellous microdamage was measured using AE. FEMs were cre-ated and validated and polyethylene thickness was varied 6-10mm. The vol-ume of cancellous bone exposed to <-3000 and <-7000 minimum principalmicrostrain (compressive, µ�) and >3000 and >7000 maximum principalmicrostrain (tensile) was measured. Linear regression analysis showed goodcorrelation between AE data and FEM predicted volume of cancellous bonewith compressive strain <-3000µ�: correlation coefficients (R= 0.947, R2 =0.847), standard error of the estimate (12.6 AE hits) and percentage error(12.5%) (p<0.001). Cancellous bone strains were higher in AP implants for allstrain variables at all loads. Strain patterns differed between implants: MBlateral edge concentrations; and AP concentrations at keel, peg and at theregion of load application. AP implants had 2.2 (10mm) to 3.2 (6mm) timesthe volume of cancellous bone compressively strained <-7000µ� than MBimplants. Altering MB polyethylene insert thickness had no effect. Theseresults suggest caution should be used with all-polyethylene UKR implantsespecially in large or active patients where loads are higher.

0016 – EARLY RESULTS OF FIxED BEARING MEDIAL UNICOMPARTMENTALKNEE REPLACEMENT USING A CEMENTED ALL POLYETHYLENE TIBIALCOMPONENTMunier Hossain, Kim Howard, Richard ParkinsonWirral University Teaching hospital NHS foundation trust, Liverpool, UK

Objective: The objective of this study was to evaluate the early results of afixed bearing medial UKR performed using a cemented all polyethylene(UHMWPE) tibial component.Methods: We retrospectively reviewed the medical records and radiographsof 138 consecutive UKR performed between September 2009 and July 2014.All cases were performed by the senior author.Results: There were 78 males and 60 females. Mean age was 65 (range 40-87). Follow up ranged from 12-72 months. 2 patients died. 14 (8.70%) werelost to follow up. The mean body mass index was 30 (range 21-49). Therewere no clinically significant venous thrombo-embolism events. There wereno intraoperative complications or deep infections. 1 patient developed apostoperative pain syndrome and associated stiffness requiring manipula-tion under anaesthesia. 105 patients (86%) were highly satisfied or satisfiedwith surgery. 17 patients (14.31%) were not satisfied following surgery, 10of whom (8.19%) had unexplained pain. There were 3 revisions (2.17%), 1for a progressive radiolucency and 1 was revised unsuccessfully by anothersurgeon for unexplained pain that persisted after revision. 1 patient awaitsrevision for progression of patello-femoral arthritis. A radiolucent line wasobserved beneath the tibial base plate in 3 further patients who remainunder surveillance. The cumulative probability of survival at 5 years was97.41% ( 95% CI 92.72%- 99.23%).Conclusions: Using an all UHMWPE tibial component resulted in a cost sav-ing of 33,810 GBP (245 GBPper case) compared to the more commonly usedmodular tibial design without adversely affecting the clinical outcome.

0019 – NO DIFFERENCE IN TWO-YEAR FUNCTIONAL OUTCOMES USINGKINEMATIC VERSUS MECHANICAL ALIGNMENT IN TKA – A RANDOMIZEDCONTROLLED CLINICAL TRIALSimon Young1, Matthew Walker1, Ali Bayan1, Toby Briant-Evans3, PaulPavlou2, Bill Farrington1

1North Shore Hospital, Aukland, New Zealand, 2Royal BournemouthHospital, Bournemouth, UK, 3North Hampshire Hospital, Basingstoke, UK

Neutral mechanical alignment (MA) in total knee arthroplasty (TKA) aims toposition femoral and tibial components perpendicular to the mechanicalaxis of the limb. In contrast, Kinematic Alignment (KA) matches implant posi-tion to the pre-arthritic anatomy of the individual patient, with the aim ofimproving functional outcome.Question: Are two-year patient-reported outcome scores enhanced inpatients with KA compared to MA technique?Methods: Ninety-nine primary TKAs were randomized to either MA (n=50)or KA (n=49) groups. In the KA group, patient specific cutting-blocks weremanufactured using individual pre-operative MRI data. In the MA group,computer navigation was used to ensure neutral mechanical alignmentaccuracy. Post-operative alignment was assessed with CT scan, and func-tional scores were assessed pre-operatively and at 6 weeks, 6 months, 1 and2 years post-operatively.Results: There was no difference in 2-year change scores (post-op minuspre-op score) in KA versus MA patients for the Oxford Knee Score (21.9 vs20.0, p=0.4), Western Ontario and McMaster Universities score (38.3 vs35.1, p=0.32), or Forgotten Joint score (29.2 vs 26.7, p=0.8). Post-operativehip-knee-ankle axis was similar between groups (KA 0.4° vs MA 0.7° varus),but in the KA group the tibial component was in mean 2.1° more varus thanthe MA group (95% CI 1.0°-3.2°, p=0.0003) and the femoral component in1.4° more valgus (95% CI 0.55°-2.3° p=0.003). Complication rates were sim-ilar between groups.Conclusion: We found no difference in two-year patient reported outcomescores in TKAs implanted using the KA versus MA technique.

0029 – RANDOMISED CONTROL TRIAL: THE FUNCTIONAL BENEFITS OFRETAINING THE INFRAPETELLAR FAT PAD IN A TOTAL KNEE REPLACEMENTAnthony Howard2, Moez Ballal1, Matthew Cartwright3, Alasdair Santini1,Andrew Philipson1, Jo Banks1

1RLBUHT, Liverpool, UK, 2Academic Unit, Leeds General Infirmary, Leeds, UK,3Southport and Ormskirk NHS Trust, Ormskirk, UK

Introduction: This is a randomised control study to analyse whether theexcision of the intrapatellar fat pad (Hoffa’s fat pad) during a Total KneeReplacement, alters the post-operative pain and/or function.


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Method: Patients listed for a primary total knee replacement forosteoarthritis (OA) were recruited. The operating surgeons agreed a strictstandardised protocol on the extent of soft tissue dissection. The patientsundertook Oxford Knee Score, KOOS Score, Lysholm Score, Kujala Score, andVisual Pain Scale preoperatively at 3 months, 3 months postoperatively andat 12 months postoperatively.Results: 46 patients were recruited, the two groups had similar demograph-ics, Fat Pad Removed Patients average age 67(54-85), female:male ratio of1:1.3 and the Fat Pad Retained Patients 68(51-82) with a ratio 1:1. Further,the two groups of patients had a similar preoperative function and pain.Across the measures employed, at 3 months Postoperatively there was nosignificant difference in the two groups. However, at 12 months followingthe Total Knee Replacement, those patients who had retained their infrap-atellar fat pad across the measures performed more favourably. There weresignificant differences in the KOOS Score (p=0.022) between the two groups.Discussion & Conclusion: This study is the first to consider the functionaloutcomes in relation to the removal of the infrapatellar fat pad during a pri-mary knee replacement. The results demonstrate that at 12 months there isa significant difference, using the KOOS Score as a measure, in the patientswho retained their infrapatellar fat during a primary total knee replacement.

0127 – THE INCIDENCE AND IMPACT OF ARTHROSCOPY IN THE YEARBEFORE TOTAL KNEE ARTHROPLASTYSimon Barton, George McLauchlan, Stephen CantyLancashire Teaching Hospitals NHS Trust, Lancashire, UK

Introduction: Prior knee surgery and arthroscopy is known to increase com-plications and re-operations in subsequent total knee replacement (TKR).National guidelines recommend a 1-year conversion rate <10% for kneearthroscopy to arthroplasty.Aims: To establish if arthroscopy in the year before TKR impacts uponpatient rated outcome measures.Methods: A retrospective review of theatre and clinical records identified allpatients undergoing TKR within a year of arthroscopy (2009 – 2013). Oxfordknee score (OKS) data was then compared with a published cohort fromsame department (1708 patients).Results: 187 patients were identified who underwent TKR within a year ofarthroscopy; 112 females / 75 males; mean age 64 (SD 10); mean BMI 31.4(SD 4.6). There was no significant difference between groups with respect tosex, age, BMI, or pre-operative OKS.103/187 patients underwent TKR within 6 months of arthroscopy. 43patients had TKR within 4 months of arthroscopy.Patients undergoing TKR within 6 months of arthroscopy had a significantreduction in OKS (32.8 vs 35.3, P<0.005). Subgroup analysis demonstratedthat those undergoing TKR within 4 months of arthroscopy had both a clin-ically and statistically significant reduction in OKS (31.5, P<0.005). There wasno significant difference in OKS when TKR was performed >6 months afterarthroscopy (35.3).The re-operation rate was 14% in the arthroscopy group, with a revision rateof 3.8% (vs 1.6%, published cohort).Conclusions: TKR should not be performed within 6 months of arthroscopy,and current national guidelines suggesting an acceptable 10% conversionrate may need revisiting.

BASK 2016 Podium PresentationsTHUSDAY 31st March – Free Papers

8.40am – Session 3Moderators: Andrew Porteous & Adil Ajuied

0073 – PROPHYLACTIC ANTIBIOTICS IN ELECTIVE HIP AND KNEEARTHROPLASTY – AN ANALYSIS OF ORGANISMS REPORTED TO CAUSEINFECTION AND A NATIONAL SURVEY OF CLINICAL PRACTICECraig Hickson1, David Metcalfe2, Suzanne Elgohari3, Tamsin Oswald4, JamesMasters6, Monika Rymaszewska5, Mike Reed4, Andrew Sprowson6

1Leicester Royal Infirmary, Leicester, UK, 2Center for Surgery and PublicHealth, Harvard Medical School, Boston, USA, 3Department of HealthcareAssociated Infections & Antimicrobial Resistance, Public Health England,London, UK, 4Northumbria Healthcare NHS Foundation Trust,Northumberland, UK, 5Wansbeck Hospital, Northumberland, UK, 6WarwickOrthopaedics, Coventry, UK

Objectives: To investigate regional variations in the organisms reported ascausing peri-prosthetic infections and to report on prophylaxis regimens

currently in use across England.Methods: Analysis of data routinely collected by Public Health England’s(PHE) national surgical site infection database on elective primary hip andknee arthroplasty procedures between April 2010 and March 2013 to inves-tigate regional variations in causative organism. A separate national surveyof 145 hospital trusts (groups of hospitals under local management) in Eng-land routinely performing primary hip and/or knee arthroplasty was carriedout by standardised email questionnaire.Results: Analysis of 189 858 elective primary hip and knee arthroplasty pro-cedures and 1116 surgical site infections found statistically significant varia-tions for some causative organism between regions. There was a 100%response rate to the prophylaxis questionnaire that showed substantial vari-ation between individual trust guidelines. A number of regimens currentlyin use are inconsistent with the best available evidence.Analysis of 189 858 elective primary hip and knee arthroplasty proceduresand 1116 surgical site infections found statistically significant variations forsome causative organism between regions. There was a 100% response rateto the prophylaxis questionnaire that showed substantial variation betweenindividual trust guidelines. A number of regimens currently in use are incon-sistent with the best available evidence.Conclusions: The approach towards antibiotic prophylaxis in elective arthro-plasty nationwide reveals substantial variation without clear justification.Only seven causative organisms are responsible for 89% of infections affect-ing primary hip and knee arthroplasty, which cannot justify such widespreadvariation between prophylactic antibiotic policies.

0104 – CORONAL KNEE ALIGNMENT: RELIABILITY OF WEIGHTBEARING &NON-WEIGHTBEARING SHORT VS LONG LEG RADIOGRAPHSSam Yasen, Zakk Borton, David Elson, Ed Britton, Mike Risebury, AdrianWilsonHampshire Hospitals NHS Trust, Basingstoke, UK

Introduction: Realignment osteotomy has become an accepted surgical pro-cedure for the management of unicompartmental knee arthritis. It requirespreoperative planning which can be performed using weightbearing (WB)and non-weightbearing (NWB) knee radiographs, ‘long-leg’ alignment radi-ographs, and CT scannograms. We compare the accuracy of WB and NWBknee radiographs taken on a standard short leg film, against ‘long-leg’ (LL)radiographs, which are routinely performed at our institute.Methods: Coronal plane knee alignment was assessed on 30 consecutivepatients with WB knee films taken prior to long-leg alignment views, and 30with NWB radiographs and LL films. Inclusion criteria were that radiographswere performed no greater than 6 months apart, were of a joint which sub-sequently underwent osteotomy, and that the short-leg views had sufficientexposure to allow the axis to be measured by a validated technique.Results: The short leg WB films differed from LL views by a mean of 1.79degrees (95% CI: 1.35-2.24); and the NWB films against the LL views by 2.88degrees (95% CI:1.92-3.83). Neither of these reached statistical significance,p=0.35 and p=0.21 respectively. However, the magnitude of the deviationbetween short and long leg radiographs differed significantly between WBand NWB films, p<0.05.Conclusion: There is a significant difference in the reliability of WB versusNWB films in measuring coronal plane knee alignment. This raises concernsif CT scannograms (which are non-weightbearing) are used for preoperativeplanning. There was an observed difference between short and long legradiographs but this did not reach statistical significance.

0098 – PREDICTING DISSATISFACTION FOLLOWING TOTAL KNEEREPLACEMENT IN PATIENTS UNDER 55 YEARS OF AGE.Chloe Scott, William Oliver, Deborah MacDonald, Frazer Wade, MatthewMoran, Steffen BreuschRoyal Infirmary of Edinburgh, Edinburgh, UK

The aim of this study was to identify predictors of dissatisfaction followingTKR in patients younger than 55 of age. We assessed 177 TKRs (157 consec-utive patients) implanted from 2008 to 2013. Data was collected on age, sex,implant, indication for surgery, BMI, range of motion, and prior knee surgeryin addition to the Oxford Knee Score (OKS) and SF-12. Post-operative dataincluded knee range of motion, complications, and OKS, SF-12 and satisfac-tion measures at one year. Overall 75.1% (133/177) patients were satisfiedor very satisfied; 24.9% (44/177) of patients were unsure or dissatisfied. Sig-nificant predictors of dissatisfaction were: worse preoperative OKS (satisfied17.7 ± 6.6 Vs dissatisfied 14.4 ± 6.1, p=0.004 T-test); indication for surgery(p=0.010, Chi squared) – primary osteoarthritis (OA) 19.3% dissatisfied(11/57), secondary OA with previous menisectomies (open n=2) 40.6%


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(13/32), secondary OA in multiply (>3) operated knee 41.7% (5/12), OA insuper-obesity (BMI>40) 30.5% (7/23), post-traumatic OA 44.4% (4/9), sec-ondary OA following other knee surgery 28.6% (2/7), and inflammatoryarthropathy 5.4% (2/37); presence of a complication (18/30 p<0.001, Chisquared); patient reported stiffness (9/12 dissatisfied, p<0.001 Chi squared);superficial wound infections (4/4 dissatisfied, p<0.001 Fisher’s exact); objec-tive flexion of <90 degrees (7/10 dissatisfied, p=0.007 Chi squared); andpoor improvement in OKS (18.2 ± 8.8 satisfied Vs 5.3 ± 7.5, p<0.001 MannWhitney U Test).Satisfaction is worst in patients with post traumatic OA and those who haveundergone previous knee surgeries, including arthroscopic menisectomies,and in patients who suffer complications.

0041 – ExPERIENCES USING A REVISION ARTHROPLASTY NETWORK: A REVIEW OF THE FIRST 250 CASESBenjamin Bloch, Martin Raglan, Andrew Manktelow, Peter JamesNottingham University Hospitals NHS Trust, Nottingham, UK

Between 2005 and 2010, the number of UK revision knee arthroplasties roseby 92.1%. This number is predicted to rise by 332% by 2030.NHS England invited bids to run a pilot revision network. Nottingham Elec-tive Orthopaedic Service (NEOS) was successful and the East Midlands Spe-cialist Orthopaedic Network (EMSON) runs on a ‘hub-and-spoke’ model.All patients within the EMSON area requiring revision arthroplasty are dis-cussed at a weekly meeting, chaired by a revision hip and knee surgeon andattended by arthroplasty surgeons and an orthopaedic microbiologist.Other specialties are available as required.EMSON discussions and a proposed management plan are recorded, signedand returned as a permanent record in the patient’s notes.255 arthroplasties in 253 patients have been discussed. 124 have related toknee arthroplasties. 47% of cases had a recommendation to change themanagement plan. Several of these changes have been significant. 4% ofcases have been transferred to NUH for surgery. 35% of cases required extraloan kit, predominantly in the spoke hospitals.Although we have not seen many patients transferred to NEOS, we haveseen a 20% increase in tertiary referrals. Surgeons taking part in EMSONhave expressed their satisfaction with the support received from EMSON.Discussing these complex cases supports revision surgeons in the region andis likely to improve patient care. We note a high number of changes to themanagement plan and an increase in direct referrals to NEOS. EMSON hasbeen well received and we recommend this approach to other regions.

0056 – ONE STAGE REVISION KNEE ARTHROPLASTY- MEAN 5 YEARSRESULTS FROM A TERTIARY CARE CENTRERahul kakar, Nima Razii, Rhidian Morgan-JonesLlandough Hospital, Cardiff, UK

Periprosthetic joint infection is one of the major cause for morbidity afterTKR. Although it is rare < 1% incidence, for the patients, it’s a major cause ofmorbidity and has significant psychological, emotional and financial impact.Two stage- techniques remain the ‘gold standard’ in most of the centres,however on critically reviewing the available literature there is no clear evi-dence if one is better than other. There are major advantage of one stagerevision with reduced hospital stay, reduced cost and higher patient satisfac-tion.We reviewed 107 consecutive patients, operated by a single surgeon, in ourhospital from 2008 to 2013. Each was treated by a defined debridementprotocol and an immediate one-stage performed (not a 2-in-1 protocol).Reconstruction and fixation was by a predominantly uncemented method. 5recurrences (8%) were noted, with the remaining 92% infection free at 2-5years.Revision TKR for infection in a Single-stage, performed by a high volumerevision surgeon is therefore equivalent to the best outcomes of 2-stageprotocols

0043 – TWO STAGE DEBRIDEMENT WITH ANTIBIOTIC CEMENT BEADS ANDPROSTHESIS RETENTION FOR ACUTE PERIPROSTHETIC INFECTIONS AFTERKNEE ARTHROPLASTYMatthew Niesen, Mark Spangehl, Henry Clarke, Adam Schwartz,Christopher BeauchampMayo Clinic, Phoenix, Arizona, USA

Purpose: Debridement with prosthesis retention is one treatment option inacute peri-prosthetic joint infection (APJI). However, failure rates for singlestage debridement have been reported to be as high as 60-80%. This studysought to determine the success of an alternative two stage debridementusing antibiotic impregnated cement beads.Methods: 44 patients (25 men, 19 women; average age of 65.7 years)underwent a 2 stage debridement protocol for APJI with less than 4 weeksof symptoms following total knee arthroplasty between 2002 and 2014. Allpatients met the Musculoskeletal Infection Society criteria for APJI. The pro-tocol included: 1) initial debridement with placement of high dose antibioticbeads; 2) repeat debridement at an average of 5.1 days with removal ofantibiotic beads and exchange of modular parts; and 3) 6 week course of IVantibiotics. Patients were classified as successfully treated if they did notrequire re-operation for infection and had no evidence of infection clinically.Results: 38 of the 44 patients (86.4%) with an APJI following knee arthro-plasty were successfully treated at a mean follow-up of 43.6 months (range,12-155 months). Patients treated successfully underwent the first debride-ment at a mean of 4.1 days after onset of symptoms, versus 11.2 days inthose who failed (p=0.011). Conclusions: Patients with acute prosthetic infections after knee arthro-plasty can be successfully treated, using a two-stage debridement protocolwith prosthesis retention and high dose antibiotic beads. The 86% successrate is better than historic series using a single stage protocol.

09.36 – Session 4Moderator: Robert Barrack & Andrew Price

0156 PATIENT REPORTED OUTCOME FOLLOWING TOTAL KNEEARTHROPLASTY; DOES ETHNICITY INFLUENCE THE OUTCOME?Mehdi Suzangar, James Kennedy, Urjit Chatterji, Colin EslerUniversity Hospitals of Leicester NHS Trust, Leicester, UK

Background and Hypothesis: Current literature suggests that ethnicity maybe a significant factor in determining patient reported outcomes for kneearthroplasty. There is a paucity of literature related to patients from differ-ent ethnic groups who have their surgery in the U.K.We hypothesized that patients’ ethnicity, whether as an independent factoror as a factor secondary to differences such as attitudes towards postoper-ative pain and rehabilitation, can affect patient reported satisfaction.Methods: We performed a retrospective analysis of the prospectively col-lected data from the Trent & Wales Arthroplasty Register. All registeredpatients were mailed a validated self-reported outcome form 1 year aftertheir arthroplasty surgery. The patients were asked whether they werepleased with the outcome of their surgery (yes/no/unsure). We examinedthe responses from patients who had their bilateral staged primary TKA inLeicester between 1990 and 2007.Results: Total number of TKA analysed: 2639 (1636 from first TKA and 1003from their contralateral TKA). Overall self-reported satisfaction (pleasure)was 87.7% and 87.2% for the first and second sides respectively.A Fisher’s exact test indicated a significant difference among ethnic groups(p=0.03) for the first operation but not for the second operation (p=0.9).Logistic regression was performed which suggested that patients withIndian ethnicity were significantly less satisfied compared to patients withBritish ethnicity (coefficient=-0.68, p=0.02, 95%CI -1.25 to -0.11).Discussion: Our data suggests that when offering and consenting patientsfor knee arthroplasty surgery, the discussion should also take into accounteach patients ethnic origin, cultural needs.

0028 – THE GOOD AND BAD OF KNEE REPLACEMENT – COMBININGTRANSITION, SATISFACTION AND PROM DATA TO DEFINE PATIENTOUTCOME AFTER TKAAnqi Gao, Abtin Alvand, William Jackson, Nicholas Bottomley, David Beard,Andrew PriceUniversity of Oxford, Oxford, Oxfordshire, UK

Background: Outcome of total knee arthroplasty (TKA) can be assessedusing the Oxford Knee Score (OKS) in conjunction with two anchor questionsaddressing patients’ ‘satisfaction’ and perceived ‘transition’ of symptoms


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compared to pre-operation. The aim of this study was to determine the rela-tionship between ‘satisfaction’ and ‘transition’ ratings, and develop ananchor-based approach to evaluate outcome following TKA.Methods: This study used the 2012-2013 TKA PROMs dataset (n=40,622),which were prospectively collected through the NHS PROMs program. Thetwo anchor questions were combined in a step-wise fashion to create analgorithm for overall assessment of TKA outcome. Based on their responsesto the anchors, patients were categorized into three outcome groups –“good”, “intermediate” and “bad”. Outcome category-specific effect size wascalculated based on OKS change.Results: There was a significant positive correlation between ‘satisfaction’and ‘transition’ (R-squared=0.507, p<0.001). 82% of patients had a goodoutcome with a large effect size of 2.37 (95% CI (2.35, 2.39)). 7% improvedby a smaller amount and felt dissatisfied despite an effect size of 1.21 (95%CI (1.15, 1.27)). 11% experienced a poor outcome characterised by a smalleffect size of 0.27 (95% CI (0.22, 0.31)).Conclusion: This anchor-based tool for assessing TKA outcome is potentiallymore meaningful to patients. Our study highlights a dilemma within kneearthroplasty where 82% of patients recognise a large improvement in qual-ity of life following TKA; 7% improve, but not to the extent that makes themsatisfied; 11% do not report improvement (i.e. have a bad outcome).

0025 – DOES PRE-OPERATIVE ANxIETY AND DEPRESSION AFFECT PATIENTOUTCOME AFTER PRIMARY KNEE REPLACEMENT ARHTROPLASTY?Andrew Jones, Tim James, Andrew DaviesMorriston Hospital, Swansea, Wales, UK

Chronic pain is associated with psychological distress, most commonly man-ifested as anxiety and depression. We prospectively investigated the anxietyand depression levels of a cohort of 104 patients undergoing a total of 107primary knee arthroplasty procedures and the outcomes they achieved at 6weeks, 1 year and 7 years post operatively. The Hospital Anxiety and Depres-sion Scale was used to record psychological status. Oxford Knee Score andAmerican Knee Society Score were used to record the functional status pre-operatively and at all follow up time points.46 (44%) of the patients had an abnormal pre-operative anxiety and/ordepression score. Mean anxiety and depression scores improved at 6 weeksand 1 year follow up, but then deteriorated slightly after 7 years, albeit notback to baseline. Knee scores showed similar patterns over time. Regardlessof pre-operative psychological status, mean scores improved at 6 weeks andfurther improved at 1 year post op. They then showed slight deteriorationat 7 years, but remained significantly better than pre-op.Psychological distress is common in our patients pre-operatively. Improve-ments in knee pain and function as a result of surgery correlate well withlower levels of psychological distress post-operatively. Knee replacementsurgery positively influences all of the outcome measures studied ratherthan recovery being negatively influenced by pre-operative states. Kneereplacement arthroplasty is not contra-indicated by pre-operative psycho-logical distress. Successful knee replacement improves knee pain and func-tion, as well as symptoms of anxiety and depression. These improvementspersist for many years after the surgery.

0091 – PREDICTING CHRONIC POSTOPERATIVE PAIN BY ASSESSINGCENTRAL SENSITIZATION IN PATIENTS UNDERGOING TKR SURGERY: APRELIMINARY FUNCTIONAL BRAIN MRI STUDY AT 3-TESLA.Thomas Kurien1, Diane Reckziegel2, William Cottam2, Kristian Petersen3,Richard Pearson1, Lars Arendt-Nielsen3, Thomas Graven-Nielsen4, DorotheeAuer2, Brigitte Scammell1

1Academic Division of Trauma and Orthopaedics, Queen’s Medical Centre,Arthritis Research UK Pain Centre, The University of Nottingham,Nottingham, UK, 2Academic Radiology, Arthritis Research UK Pain Centre,The University of Nottingham, Nottingham, UK, 3SMI, Aalborg University,Aalborg, Denmark, 4Centre for Neuroplasticity and Pain, Aalborg University,Aalborg, Denmark

Purpose: Temporal summation of pain (TSP), the perception of increasinglyaugmented pain evoked by repetitive noxious stimuli is a measure of centralsensitization. TSP has shown to predict chronic postoperative pain aftertotal knee replacement surgery (TKR). This study aimed to assess the feasi-bility of methods needed for fMRI assessment during temporal summationof pain in healthy individuals and knee OA patients using a cuff pressurealgometry.Methods: Three patients with chronic knee osteoarthritis pain waiting TKRsurgery and five healthy volunteers underwent an fMRI scan at 3-Tesla. Fiveruns of 10 x 1 second pressure stimuli (temporal summation of pain) during

fMRI were achieved using cuff inflation applied on the calf muscle ipsilateralto the most affected knee or the left side in healthy volunteers. The painintensity increase during repeated stimulations was assessed on a numericalrating scale. Two models were used to define the pattern of brain activation,1) averaged across noxious stimuli, and 2) the differential activation compar-ing the 1st vs. 10th stimulus (at TSP).Results: Cuff stimuli provoked brain activity across the 10 stimuli in knownpain processing areas. TSP related brain activity in the chronic OA patientsdisplayed higher signal within the subgenual anterior cingulate compared tohealthy volunteers.Conclusions: These results indicate that enhanced temporal summation ofpain in chronic knee OA pain may be linked with augmented responses inemotional brain circuitry. This may have implications for understanding cen-tral sensitization to improve clinical outcomes for patients with knee OAundergoing TKR surgery.

0033 – IDENTIFYING PRE-OPERATIVE NEUROPATHIC PAIN AS A MARKEROF POOR OUTCOME FOLLOWING KNEE REPLACEMENT SURGERY.Anushka Soni1, Nick Bottomley3, William Jackson3, Irene Tracey2, M. KassimJavaid1, Andrew Price1

1Oxford NIHR Musculoskeletal Biomedical Research Unit, NuffieldDepartment of Orthopaedics, Rheumatology and Musculoskeletal Sciences,Oxford, UK, 2Centre for Functional Magnetic Resonance Imaging of theBrain (FMRIB), University of Oxford, Oxford, UK, 3The Knee Service, NuffieldOrthopaedic Centre, Oxford, UKPurpose: A subgroup of patients with knee osteoarthritis (KOA) have neuro-pathic pain, which may be associated with suboptimal response to arthro-plasty and persistent post-surgical pain (PPSP). This study compares the out-come following arthroplasty in patients with and without neuropathic painpre-operatively.Methods: Patients with KOA, awaiting arthroplasty, were recruited. Themodified PainDETECT score was used to identify nociceptive (<13), unclear(13-18) and neuropathic pain (>18), and was the predictor variable. OxfordKnee Score (OKS) was the primary outcome variable. Regression modelingwas used to test the difference in OKS for each pain group, adjusting for age,sex and BMI. The analyses were replicated in a larger, independent, valida-tion cohort.Results: 120 patients were recruited to the study cohort:63 (52.5%) hadnociceptive pain;32 (26.7%) had unclear pain; and 25 (20.8%) had likely neu-ropathic pain. The validation cohort comprised 384 patients with pre-oper-ative and 12-month post-operative data. In the study cohort, patients withneuropathic pain had significantly worse OKS at baseline compared to thenociceptive group: (20.5 (7.3) versus 13.1 (5.5), p<0.001). This persisted 2months post-operatively: OKS 32.0 (18.0-41.0) versus 39.0 (29.0-43.0),p<0.05. The validation cohort showed that 12-months post-operative OKSwas significantly worse in the neuropathic group: 37.0 (25.0-43.0) versus42.0 (35.0-46.0), p<0.001, and that PPSP was more common in the neuro-pathic group: OR (95% CI) 3.0 (1.6-5.8), p<0.001.Conclusion: Neuropathic pain is associated with significantly worse out-come at 2 and 12-months post-operatively, and may be improved by theutilisation of targeted therapy pre, peri and post-operatively.

0052 – UNExPLAINED PAIN FOLLOWING TOTAL KNEE ARTHROPLASTY- ISROTATIONAL MALALIGNMENT THE PROBLEM?Simon Young2, Mark Spangehl1, Henry Clarke1

1Mayo Clinic, Phoenix, Arizona, USA, 2University of Auckland, Auckland, NewZealand

Introduction: Tibial and femoral component malrotation have been sug-gested to cause pain following total knee arthroplasty (TKA). The aim of thisstudy was to compare component rotation in TKA patients with unexplainedpain to a control group with well-functioning TKAs.Methods: 71 patients presenting with unexplained pain following primaryTKA were included in this retrospective, comparative study. Patients with anidentifiable reason for pain, or with initially well-functioning TKAs wereexcluded. A control group of 41 patients with well-functioning TKAs alsounderwent CT scans. Femoral component rotation was measured relative tothe trnas-epicondylar axis, and tibial component rotation relative to themedial third of the tibial tubercle using previously validated methods.Results: We found no difference in femoral component rotation betweenthe two groups (mean 0.6° vs 1.0° external rotation (ER), p=0.4), and no dif-ference in tibial component rotation (mean 11.2° vs 9.5° internalrotation(IR), p=0.3). Furthermore, 59% of patients in the painful group hadtibial component rotation >9°IR versus 49% in the control group; 6% ofpatients in the painful group and 2% in the control group had femoral com-


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ponent rotation >3°IR. There was no difference in coronal alignmentbetween groups (mean 1.3° vs 0.5° varus, p=0.23).Conclusions: In this the largest study to date on component rotation in TKA,we found no differences in tibial or femoral component malalignment inpainful versus well functioning TKAs. Tibial component IR is a common find-ing in well-functioning TKAs and its significance when evaluating the painfulTKA should be interpreted with caution.

14:50 – Session 5Moderators: Sanjeev Anand & Richard Parkinson

0146 – KNEE ARTHROPLASTY IN PATIENTS PREVIOUSLY TREATED WITHAUTOLOGOUS CHONDROCYTE IMPLANTATIONEmile Schutgens, Daud Chou, George Bentley, John Skinner, Timothy BriggsRoyal National Orthopaedic Hospital, Stanmore, UK

Autologous chondrocyte implantation and matrix assisted chondrocyteimplantation (ACI/MACI) are well-established methods of treating sympto-matic osteochondral defects in the knees of young patients. Despiteadvances in this technique, there remains a failure rate.Overall, ACI/MACI can be seen as a method of delaying the need for jointarthroplasty. Controversy remains, as ACI/MACI may in some way influencethe functional outcomes of these patients after eventual joint arthroplasty.This study assesses the clinical outcomes of knee arthroplasty in patientswho have previously been treated with ACI/MACI.A retrospective analysis was performed of 41 patients (mean age 38, range21 – 56) treated with knee arthroplasty following a failed ACI/MACI (24/17)procedure.Knee arthroplasty was carried out at 60 months (13 – 129) after the initialACI/MACI. Patients were followed for 11 years (6 – 21). 22% went on to haverevision surgery of their arthroplasty. At most recent follow-up, patientsscored 50 points (8 – 99) on the modified Cincinnati knee questionnaire, 2.4points (1 – 4) on the Bentley/Stanmore knee score, and 4.4 (0.5 – 10) on theVAS score.58% of patients retrospectively considered that, in a similar situation now,they would elect for primary knee arthroplasty instead of ACI.Our study demonstrates generally poor results for knee arthroplasty inpatients previously treated with ACI/MACI.There is no reported assessment of this group in the literature and the impli-cations for future management require further Investigation.

0023 – RETURNING TO WORK AFTER JOURNEY II TOTAL KNEEREPLACEMENTAnn Avery, Joanne Banks, John Davidson, Andrew Phillipson, Jill Pope &Alasdair Santini.The Lower Limb Arthroplasty Unit,Royal Liverpool and BroadgreenUniversity Hospitals NHS Trust, Liverpool, UK

Introduction: With increasing numbers of patients undergoing TKR at ayounger age (NJR 2014) and a rise in state pension age to 67 years, manymay have surgery whilst in employment. Information regarding if and whenthey return to work may be of value in the shared decision making process.Method: We prospectively assessed the first 100 patients to receive a Jour-ney II TKR between July 2013 and July 2014, analysing pre- and post-op out-come scores, intensity of work and return to employment.Results: Twenty-seven were employed pre-operatively with 25 returning tothe same job post-operatively at a mean time of 13.9 weeks. Ten, eight andnine were employed in heavy, medium and light work respectively, with thetwo not returning both in heavy employment. Those in light work returnedearlier at 12.0 weeks. No patient not working pre-operatively re-com-menced work post-operatively. In both employed and not employed groups,there was significant improvement in SF-12 (physical), WOMAC and Oxfordscores post-operatively but a non-significant drop in SF-12 (mental) score.Those in employment had significantly better pre-operative SF-12 (mental),WOMAC and Oxford scores than those not in employment but whilst bothgroups improved, those returning to employment maintained significantlybetter scores.Conclusion: Almost all patients return to the same employment after a Jour-ney II TKR at an average of 13.9 weeks. Employed patients have better pre-operative scores; whilst both groups improve, those in employment gainhigher post-operative scores. This information may help with the shareddecision making process for these patients.

0078 -A DOUBLE BLIND, RANDOMISED, CONTROLLED COMPARATIVESTUDY OF THE DEPUY PFC SIGMA AND CR150 TOTAL KNEEREPLACEMENTS.Anthony Redmond1, Graham Chapman1, Richard Wilkins1, Todd Stewart1,Derrick White1, Elizabeth Hensor1, Ramakrishnan Venkatesh2

1University of Leeds, Leeds, UK, 2Leeds Teaching Hospitals NHS Trust, Leeds,UK

Introduction: In 2010 DePuy Synthes introduced the PFC Sigma CR150 kneeimplant with modified posterior geometry postulated to permit greaterknee flexion. This study aimed to compare the functional performance ofthe standard PFC Sigma with the ‘high flexion’ CR150 12 months post-oper-atively.Methods: Patients undergoing unilateral knee replacement were ran-domised by sealed envelope allocation to receive one of the implants. Allpatients had a normal native contralateral knee with good function. Fullwritten consent was provided and ethical approval received.The primary outcome was maximum active knee flexion 12 months post-operation, measured using electromagnetic motion tracking. Secondaryoutcomes included i) force through the operated and non-operated limbduring sit-to-stand, ii) gait velocity and iii) PROMS- Oxford knee score (OKS),KOOS and EQ5D questionnaires.Results: 34/36 patients completed 12 month follow-up. The mean (SD) flex-ion in the operated limb was 89.5° (18.0) in the PFC Sigma group and 86.4°(15.2) in the CR150 group (mean diff=-3.12°, 90% CI -13.0° to 6.7°). Sit-to-stand normalised maximum force through the operated knee was 4.58(0.55) and 4.83 (0.83) N/Kg respectively. Gait velocity was 0.92 (0.28) and1.12 (0.29) m/sec. The median (IQR) 12 month OKS was 41.5 (21.0) and 39.0(9.0), KOOS ADL scores were 82.4 (52.2) and 88.2 (23.5) and EQ5D VASscores were 69.0 (28.5) and 85.0 (15.0)Conclusions: Mean flexion at 12 months was marginally lower (-3.1°,p=0.595) in the CR150 group but the CR150 performed slightly better over arange of functional measures.0106 – TRENDS IN THE OxFORD KNEE SCORE FOLLOWING MEDIAL-OPENING WEDGE HIGH TIBIAL OSTEOTOMY & THE IMPACT OFKELLGREN-LAWRENCE GRADESam Yasen1, Harry Palmer1, David Elson1, Matt Dawson3, Chris Wilson2,Adrian Wilson1

1Hampshire Hospitals NHS Trust, Basingstoke, UK, 2Cardiff & Vale UniversityHealth Board, Cardiff, UK, 3North Cumbria University Hospitals NHS Trust,Carlisle, UK

Background: Outcomes following medial opening wedge high tibialosteotomy (HTO) have been demonstrated to show significant improvementpostoperatively. Trends in the change to outcome scores over time, and theimpact of preoperative severity of arthritis, as documented by the radi-ographic Kellgren-Lawrence (KL) grade, have not previously been examined.Methods: A series of 528 medial opening wedge HTOs were performed atthree participating centres (Basingstoke, Cardiff and Carlisle), between June2001 and June 2014 with a follow up of 6 months to 12.2 years. Our localosteotomy database was interrogated for postoperative outcomes scoresand correlated against preoperative KL grade. Changes in the Oxford KneeScore (OKS) at six months, one year, two years, three years and four yearspost-operatively were examined using statistical one-way ANOVA testing.Results: (1) Medial-opening wedge HTO significantly improves OKS post-operatively (N=371, p=0.000) with a mean improvement of 11.5 points. (2)Subsequent changes after six months do not return a statistically significantresult: one year (N=228, p=0.071), two years (N=159, p=0.861), three years(N=131, p=0.806) and four years (N=88, p=0.553). (3) There is no significantrelationship between OKS and KL grade at all time points: six months(N=219, p=0.146), one year (N=194, p=0.320), two years (N=131, p=0.937),three years (N=101, p=0.935) and four years (N=62, p=0.536).Conclusion: Improvement in OKS is independent of severity of KL grade atall time points postoperatively in medial opening wedge HTO. Outcomescores improve by 6 months irrespective of preoperative severity of arthri-tis, following which improvements are not statistically significant.

0158 – OxFORD DOMED LATERAL PARTIAL KNEE REPLACEMENT: UPTO 10YEAR FOLLOW-UP. AN INDEPENDENT SINGLE SURGEON SERIESSimon Newman, Helen Alsop, Justin CobbImperial College London, London, UK

Introduction: The Oxford Domed Lateral Partial Knee Replacement(ODLPKR) was designed with a convex tibial surface and mobile biconcavepolyethylene bearing to overcome the unacceptable dislocation rate associ-ated with the use of the Oxford Partial Knee Replacement in the lateral com-partment. We present the first up to 10 year results from an independent,


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single surgeon practice.Methods: Between 2005 and 2009 the senior author performed 64 ODLPKRon 58 patients for isolated lateral compartment osteoarthritis with a func-tionally intact anterior cruciate ligament (ACL). Patients were reviewed inthe clinic or contacted by telephone to determine the status of their implantand their level of function using the Oxford Knee Score (OKS).Results: The status of 61 of the 64 knees was confirmed with a mean followup period of 80.6 months (range 24-120 months). Five patients had diedwith no further surgery performed. Three patients had dementia and wereunable to complete the OKS but had not undergone further surgery. Onepatient sustained a bearing dislocation on two occasions following fallsnecessitating open reductions. Two patients underwent conversion to totalknee replacement, one for septic arthritis and one for pain. Five furtherpatients reported further operations: one bearing exchange for instability,two medial partial replacements, one ACL reconstruction and onearthroscopy for haemarthrosis. Mean OKS was 24 (range 9-36) pre-opera-tively and 40 (10-48) at final follow-up.Conclusion: The ODLPKR offers an effective treatment for lateral compart-ment osteoarthritis. Bearing dislocation does not appear to be a significantissue with this implant.

0144 – VIRTUAL CLINIC FOLLOW-UP OF HIP AND KNEE REPLACEMENT: A PATIENT SURVEYLaura McArthur, Gabriel Fieraru, Dan WilliamsRoyal Cornwall Hospitals NHS Trust, Cornwall, UK

Background: With support from the Health Foundation, we established avirtual clinic service to follow up hip and knee replacement patients- seewww.youtube.com/watch?v=0jcbytfSook. Here we report the results of apatient survey.Method: Consecutive patients who used the virtual clinic between Februaryand June 2015 (n=113) were invited to complete an online questionnaire viaSurveyMonkey about their experience of the new service; 46 (41%) com-pleted the survey.Results: 79% of patients thoughts the care was either very good or good.70% took less than ten minutes to complete the online assessment and therest (30%) completed it within twenty minutes. 70% found the virtual clinicpathway easier than attending a face-to-face appointment, 9% found itmuch harder. All of the respondents reported having an x-ray at a locationof their choice, of which 100% reported the date convenient and 98% thetime convenient. All users rated the clarity of the instructions to access thevirtual clinic as acceptable with 90% rating it as good or very good. 40% ofpatients saved travel costs and 22% saved on parking fees. 33% of patientsmissed the personal interaction but only 12% of people wouldn’t have a vir-tual clinic appointment instead of a face-to-face appointment in the future.Discussion: Patient service users found this new service effective, quick andeasy but missed the personal interaction.Conclusion: Virtual clinic follow up might not suit everyone but could con-tribute to robust, cost-effective follow up in line with BOA guidelines.

0142 – VIRTUAL CLINIC FOLLOW-UP OF PRIMARY JOINT REPLACEMENTPATIENTSWilliam Reeve, Laura McArthur, Dan WilliamsRoyal Cornwall Hospitals NHS Trust, Cornwall, UK

Background: BOA guidelines recommend follow up of each of the 160,000hip and knee joint replacement patients performed each year at one, sevenand every subsequent three years following surgery. Traditionally carriedout via a face-to-face appointment checking a set of questions and an x-rayfilm, it costs £50 million to follow up just one year of hip replacementpatients. With support from the Health Foundation, we aimed to improvethe efficiency of this high volume system using web based technology to col-lect patient reported outcomes and digital x-ray films, without compromis-ing quality or patient acceptability.Method: We report the headline statistics of a virtual clinic service thatreplaces two face-to-face appointments with five virtual clinic appoint-ments; see www.youtube.com/watch?v=0jcbytfSookResults: Three hundred patients were followed up in a virtual clinic duringthe first 11 months of the new service with 520 additional patients choosingthe new service for their future follow up. There was a 0% DNA rate withhigh levels of patient satisfaction. However, only 21% of slots were filled anduse varied from 6 to 54% across our surgical teams.Discussion: A CQUIN to the value of £216,000 is in place to support the newservice into its second year. Further work is required to standardise follow-up practice across all surgical teams and ensure appropriate training is avail-

able to everyone involved to optimise the use of this innovation.Conclusion: Early data from this new service is encouraging with high levelsof patient satisfaction and pro-active commissioner support.

0143 – THE INFLUENCE OF DESIGN OF PATIENT SPECIFICINSTRUMENTATION ON ACCURACY OF PLACEMENT INUNICOMPARTMENTAL KNEE REPLACEMENTSimon Newman, Susannah Clarke, Simon Harris, Justin CobbImperial College London, London, UK

Introduction: The influence of guide design on the accuracy of placement ofPatient Specific Instrumentation has received little attention.Methods: A standard anatomy tibial Sawbone was selected for use in thestudy and a computed tomography scan obtained to facilitate the produc-tion of PSI. A control PSI guide with similar dimensions to the Oxford Phase3 UKR tibial guide was produced, contoured to the anterior tibial surfacewith multiple studs on the tibial contact surface. Five variants of this guidewere designed to assess the impact of design features on accuracy. Allguides were designed with an appendage that facilitated direct attachmentto a navigation machine. 36 volunteers were recruited to place each guideon the tibia. The navigation machine recorded deviations from the plan inrespect of proximal-distal and medial-lateral translations as well as rotationaround all three axes.Results: Contact points in greater than one plane led to a trend for increas-ing accuracy and precision of PSI guide placement with respect to rotationalalignment, this achieved statistical significance relative to the control guidewith a guide that included articular and distal contact points (p=0.009). Nosignificant differences were found with respect to translation. Changes incontact area within the same plane and the use of smooth or studded con-tact points made no significant difference to accuracy.Conclusions: PSI guide design significantly impacts on the accuracy of place-ment. PSI guides for UKR should endeavour to include widely separated ref-erence points in different planes to maximise rotational accuracy.


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British Association for Surgery of the KneeANNUAL GENERAL MEETING

Wednesday 30th March 2016 – Liverpool

1. Apologies

2. Minutes of BASK AGM, Telford 2015

3. Presidents Report

4. National Registries – NLR + UKKOR Sean O’Leary

5. Research Committee A Price

6. Education Report A Porteous

7. Webmasters Report D Johnson

8. Treasurers Report L Biant

9. ‘The Knee’ Report C Hing

10. Secretaries Report – Elections to BASK Executive

a Election of new members T Hui

11. Future Meetings

a BOA Belfast

a BASK Spring Meeting 2017 Southport

12. Any other business

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Pooler Archbold

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ospital BelfastM

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ember)

Benjamin Bloch

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The British Orthopaedic Sports Trauma& Arthroscopy Association

BOSTAA @ BASK 30th March 2016, Liverpool ACC

Start End Time Time8.00 Registration & Coffee

9.15 Welcome / Introduction

9.20 BASK & BOSTAA combined session - Room 3BOSTAA Debate

Chairs: Simon Roberts & Richard Parkinson

9.20 Risks outweigh the benefits of knee arthroscopy in middle aged or olderAgree – Andy CarrDisagree – Ian Corry

9.40 Acute isolated ACL tear – Primary surgery is on the riseAgree – Amer KhanDisagree – Fares Haddad

10.00 BASK Free paper session

10.00 A Multicentre Randomised Trial comparing total or partial knee

10.06 Is there a relationship between outcome of TKR + hospital practice

10.12 Learning curve with a new primary TKR implant

10.18 In vivo kinematics of for customised vs traditional TKR designs

10.24 Discussion

10.30 Coffee Break

10.50 12.30 BOSTAA Keynote Lecture and Free Papers - Room 4aChairs: Panos Thomas and Fares Haddad

Duration DiscussionMinutes Minutes

10.50 15 5 Keynote LectureFares Haddad The evaluation of outcomes after knee surgery

11.10 10 2 The ACL Blue Book Panos Thomas & Sanjeev Anand

11.22 Sports -Mini -Oral Poster Presentations

11.22 2 - The effect of knee arthroscopy on c-reactive protein and erythrocyte sedimentation rateAndrew Hannah, Graeme Hancock, James Stoddard, Paul Sutton (0035)

11.25 2 - The Risus study: rugby injury surveillance in ulster schools: knee injuries 2014-2015 Pooler Archbold, David Milligan, Gavin Heyes, Alan Rankin, Chris Bleakley, Richard Nicholas, RogerWilson, Lynsey Henderson, Micheal Webb (0010)

11.28 2 - Is there any difference in unplanned admission for daycase anterior cruciate ligamentreconstruction with femoral vs saphenous nerve blocks?Charlotte Angel, Michael Rodger, Andrew Cattell, David Isaac, Michael Hockings (0030)

11.30 Sports- Free Paper Session


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11.32 6 2 The magnetic resonance imaging appearance of the anterolateral ligament of the kneeJonathan Kosy, Rahul Anaspure, Vipul Mandalia (0013)

11.40 6 2 Cell Viability and Density in Open vs Arthroscopic Autologous Chrondrocyte ImplantationLeela Biant, Michiel Simons, Trudi Gillespie, Michael McNicholas (0058)

11.48 6 2 An evaluation of the effectiveness of medial patellofemoral ligament reconstruction using ananatomical tunnel siteKars Valkering, Aysha Rajeev, Nick Caplan, Willem Tuinebreijer, Deiary Kader (0006)

11.56 6 2 Meniscal allograft transplantation provides good survivorship and outcomes: an analysis of 132casesBenjamin Bloch, Nick Smith, Laura Asplin, Tim Spalding (0042)

12.04 6 2 Anterior cruciate ligament injury and the risk of primary total knee replacement for osteoarthritis:a matched case control study using the clinical practice research datalinkTanvir Khan, Abtin Alvand, David Culliford, Andrew Judge, Daniel Prieto-Alhambra, Brigitte Scammell,Nigel Arden, Andrew Price (0097)

12.12 6 2 Pigmented villonodular synovitis of the knee: a retrospective analysis of 214 cases at a tertiaryreferral centreKavi Patel, Anil Haldar, Richard Carrington, Rob Pollock, Stephen Cannon, John Skinner, TimothyBriggs, William Aston (0034)

12.20 6 2 Meniscal scaffold mid-term outcomesIoannis Pengas, Nick Smith, Ben Parkinson, Laura Asplin, Pete Thompson, Tim Spalding (0161)

12.30 Tim Wilton – BOA President ‘Outlook from the BOA Offices’

13.00 Lunch Break

14.00 Clare Marx – President of RCS Eng.

14.30 Instructional course lecture: – Room 4aChairs: Deiary Kader and Richard Nicholas

14.30 8 2 Panos Gikas: 10 things to avoid when treating Chondral lesions

14.40 8 2 James Robinson: 10 things to avoid when treating Meniscal Lesions

14.50 8 2 Mike Carmont: 10 things to avoid when treating Tendinopathy

15.00 8 2 Tony Hui: 10 things to avoid when treating ACL instability

15.10 8 2 Rahul Patel: 10 things to avoid when treating PCL instability

15.20 8 2 Simon Ball: 10 things to avoid when treating Multiligament Instability

15.30 8 2 Deiary Kader: 10 things to avoid when treating Patellar instability

15.40 Coffee Break

16.00 BOSTAA Keynote Lecture and Sports Free Papers – Room 4aChairs: Mike Carmont and Michael Dobson

16.00 Keynote LectureAndy WilliamsThe Key Success in ACL Reconstruction: Addressing peripheral Lesions

Sports- Mini -Oral Poster Presentations

16.21 2 - Combined Anterior Cruciate Ligament Reconstruction (ACL) with Knee Realignment Osteotomy –Results up to Five YearsSam Yasen, James Smith, Ed Britton, Harry Palmer, Mike Risebury, Adrian Wilson (0108)


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16.24 2 - The use of extra articular stabilisation in primary ACL surgery in a high demand athletic populationwith high grade pivot shift test; a cohort studySujith Konan, Yusuf Mirza, Albert Ngu, Fares Haddad (0145)

16.27 2 - Lateral intercondylar ridge: is it a reliable landmark for femoral ACL insertion?: an anatomicalstudyRahul Bhattacharyya, Andrew Ker, Quentin Fogg, Simon Spencer, Jibu Joseph (0087)

16.30 2 - A retrospective multicentre review of chondrotissue® use for chondral injury in the kneeMorgan Bayley, Angus Robertson, Robert Yate (0102)

16.34 Sports Free Paper Session – Room 4a

16.34 6 2 Algorithmic approach to revision ACL reconstruction: mid term outcomesS Konan, YH Mirza, RJ Tansey, FS Haddad (0125)

16.42 6 2 Biotribology of osteochondral grafts in the kneePhilippa Bowland, John Fisher, Eileen Ingham, Louise Jennings (0072)

16.50 6 2 A series of cases of foreign body reaction and synovitis after soft tissue knee reconstruction usingLARS ligament.Mike Rodger, Andrew Lee (0026)

16.58 6 2 Comparative clinical study of autograft vs synthetic graft patellofemoral ligament (MPFL)reconstructionsPaul Y F Lee, Abhishek Sharma, Amit Chandratreya (0101)

17.06 6 2 Are xenograft Tendons a Viable Alternative for Knee Ligament Reconstruction? A BiomechanicalStudy of Bovine Tendons Treated with a Novel Processing MethodHenry Colaco, Breck Lord, Zameer Shah, Diane Back, Andrew Davies, Andrew Amis, Adil Ajuied(0089)

17.14 6 2 Can balance be improved with a simple home based training programme? A prospectiverandomised controlled trialAngela McGowan, Laura Derbyshire, Lee Herrington, David Johnson (0048)

17.22 6 2 The use of the macintosh procedure in revision acl reconstruction surgery; early to mid termresults: a cohort studyS Konan, YH Mirza, AWT Ngu, FS Haddad (0157)

END OF BOSTAA PROGRAM

17.30 BASK AGM – Room 3 – All Members of BASK are invited to attend

17.30 Arthrex - "Cadaveric Demonstration" Live link in Room 4a - Limited spaces availablePlease visit Arthrex on their stand no. 8 to request an invitation

19.30 BASK Association Dinner – Town Hall, Liverpool – Entrance by ticket only

BOSTAA 31st March 2016 – Room 3

14.10 BOSTAA ACI Debate & Focus on meniscal allograft transplantation - Room 3Chair: Simon Roberts

ACI is a waste of moneyAgree – Rhidian ThomasDisagree – Leela Biant

14.30 Focus on meniscal allograft:Meniscal allograft transplantation in 2016: Where are we now? Tim SpaldingReflections on long term outcome data Katherine Van Der Straeten


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BOSTAA Poster & Podium PresentationsWEDNESDAY 30th March10.50 to 12.30 (Morning)

Sports – Mini Oral Poster Presentations

0035 – THE EFFECT OF KNEE ARTHROSCOPY ON C-REACTIVE PROTEINAND ERYTHROCYTE SEDIMENTATION RATEAndrew Hannah, Graeme Hancock, James Stoddard, Paul SuttonNorthern General Hospital, Sheffield, South Yorkshire, UK

0010 – The RISUS study: Rugby injury surveillance in Ulster Schools: KneeInjuries 2014-2015Pooler Archbold1, David Milligan1, Gavin Heyes1, Alan Rankin4, ChrisBleakley2, Richard Nicholas1, Roger Wilson1, Lynsey Henderson1, MichealWebb3

1Royal Victoria Hospital, Belfast, UK, 2University of Ulster, Jordanstown, UK,3Ulster Rugby, Belfast, UK, 4BUPA Clinic, Belfast, UK

0030 – IS THERE ANY DIFFERENCE IN UNPLANNED ADMISSION FORDAYCASE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION (ACL) WITHFEMORAL VS SAPHENOUS NERVE BLCOKS?Charlotte Angel1, Michael Rodger1, Andrew Cattell2, David Isaac1, MichaelHockings1

1Torbay Hospital, Torquay, UK, 2Robert Jones and Agnes Hunt OrthopaedicHospital, Oswestry, UK

Sports – Free Paper Session

0013 – THE MAGNETIC RESONANCE IMAGING APPEARANCE OF THEANTEROLATERAL LIGAMENT OF THE KNEEJonathan Kosy, Rahul Anaspure, Vipul MandaliaRoyal Devon and Exeter Hospital, Exeter, UK

Objective: Previous studies, using magnetic resonance imaging (MRI) tocharacterise the anterolateral ligament (ALL), have been inconsistent. Ourstudy aimed to define the normal appearance of this structure as a baselineto further work on injury patterns.Materials and Methods: Following approval from an Institutional ReviewBoard, 154 consecutive, retrospective cases were studied. In each case 1.5TMRI studies were reviewed by a consultant musculoskeletal radiologist. Fol-lowing exclusions (lateral compartment or cruciate injury and patientsunder 16 years) 100 MRIs (98 patients; 63 males: 35 females; mean age45.3 years (range 16-85)) were studied.Results: The ALL was clearly seen in 94.0% of the cases with the wholelength visualised in 57.0% of the cases. This was similar to previous descrip-tions with a thickness of 1.75 ± 0.57mm. The tibial insertion (7.64 ±1.26mm below the joint-line) and meniscal attachment were demonstratedin all cases where the ligament was seen. The femoral origin was seen aris-ing from the lateral epicondyle in 57.0% of cases but, when not seen, abroad expansion of the ligament towards the iliotibial band was observed.Four distinct variations of meniscal attachment (complete, central, bipolarand inferior-only) were identified.Conclusion: In the majority of studies, of the uninjured knee, the tibial andmeniscal portions of the ALL are clearly seen. Attachment to the lateralmeniscus is a consistent finding with anatomical variation described by oursubclassification. The femoral origin is more difficult to visualise and existsas a broadened expansion in many patients.

0058 – CELL VIABILITY AND DENSITY IN OPEN VS ARTHROSCOPICAUTOLOGOUS CHRONDROCYTE IMPLANTATIONLeela Biant1, Michiel Simons1, Trudi Gillespie1, Michael McNicholas2

1University of Edinburgh, Edinburgh, UK, 2University of Liverpool, Liverpool,UK

Background: Autologous chondrocyte implantation (ACI) is an establishedcartilage repair technique. Cell viability is reduced by handling and manip-ulation of the implant. It is technically more challenging to perform ade-

quate lesion debridement and implantation of cell-membrane constructsarthroscopically. Arthroscopic ACI has the theoretical advantages of quickerrehabilitation and avoiding drying damage to remaining cartilage.Aim: To assess the number and viability of cells on ACI membranes whenthe constructs are implanted via mini-arthrotomy vs arthroscopically.Method: Sixteen 2x2 femoral condyle articular cartilage defects were cre-ated in young cadaver knees. Eight cadaver ACI surgeries were performedvia mini-arthrotomy and 8 completed arthroscopically by two experiencedcartilage repair surgeons using membranes loaded with human reference-line cells. Knees were opened and the retrieved membranes stained with 5-chloromethylfluoresceindiacetate (stains cytoplasm of live cells) and pro-pidium iodide (stains nuclei of dead cells). Samples were imaged using Con-focal Laser Scanning Microscopy in 5 consistent zones to assess cell viabilityand density.Results: The open surgery had significantly shorter duration. There weresignificantly more cells and more viable cells on the membranes implantedby via mini-arthrotomy.At the membrane edge (where integration to host cartilage must occur)there were fewer dead cells on the constructs delivered by the open tech-nique.Conclusion: There more cells, more viable cells and a shorter duration ofsurgery when ACI is performed via mini-arthrotomy than arthroscopically.The absolute number of cells required to effect cartilage repair is unknown.

0006 – AN EVALUATION OF THE EFFECTIVENESS OF MEDIALPATELLOFEMORAL LIGAMENT RECONSTRUCTION USING ANANATOMICAL TUNNEL SITEKars Valkering5, Aysha Rajeev2, Nick Caplan3, Willem Tuinebreijer4, Deiary Kader1

1South West London Elective Orthopaedic Centre, Epsom, Surrey, UK,2Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK, 3Faculty ofHealth and Life Sciences, Northumbria University, Newcastle upon Tyne,Tyne and Wear, UK, 4Red Cross Hospital, Beverwijk, The Netherlands,5Orthopedium, Delft, The Netherlands

Purpose: Medial patellofemoral ligament (MPFL) reconstruction for recur-rent patellar instability has gained popularity and anatomical and biome-chanical studies have recently altered our operative techniques. The aim ofthis study is to report the clinical outcome of this new anatomical MPFLreconstructive technique and investigate whether correlating factors canbe identified.Methods: Between April 2009 and November 2012, a total of 31 consecu-tive patients underwent MPFL reconstruction using an autologous gracilisgraft and anatomical tunnel placement. Pre- and post-operative data werecollected as a part of routine clinical practice. The preoperative assessmentincluded a rotational profile CT scan of the lower extremity according to theLyon protocol with TT-TG distance measurement. Outcomes were evalu-ated with the Kujala and Norwich patella instability (NPI) scores preopera-tively and at follow-up (1.5-5.1 years).Results: A significant improvement of both the Kujala (p<0.001) and NPI(p=0.012) scores was recorded. A medium and large negative correlationwere found between TT-TG distance and Kujala score improvement (rho=-0.482, p=0.020) and NPI score improvement (rho=-0.829, p=0.042), respec-tively. Multiple regression analysis identified TT-TG distance, Beightonscore and BMI as factors explaining the variance of Kujala score improve-ment.Conclusion: Anatomical MPFL reconstruction with the gracilis autograft forpatellar instability results in good outcome. With a precise preoperativework-up, factors can be identified that may guide selecting the optimaloperative strategy and improve counseling of the patient.

0042 – MENISCAL ALLOGRAFT TRANSPLANTATION PROVIDES GOODSURVIVORSHIP AND OUTCOMES: AN ANALYSIS OF 132 CASES Benjamin Bloch1, Nick Smith2, Laura Asplin2, Tim Spalding2

1Nottingham University Hospitals NHS Trust, Nottingham, UK,2University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK

Pain following a meniscectomy is a recognised problem, particularly inyoung patients. Meniscectomy also predisposes patients to developing OAand increases the risk of requiring a TKR compared to the non-meniscec-tomised knee.Meniscal Allograft Transplantation (MAT) is a recognised surgical techniqueto restore function and relieve pain in the meniscal deficient knee. We pres-ent the clinical outcomes and survivorship of 132 MATs with at least 1 yearfollow-up (range 1-10).


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Of the 132 MATs, 70 had good chondral surfaces. 52 patients had an iso-lated MAT (Group A), 9 had MAT + HTO (Group B), 9 had MAT + ACLR (GroupC). Of those patients with poor chondral surfaces, 31 had bare bone on 1surface (Group D) and 28 had bare bone on both surface (Group E).All groups had improvements in their KOOS, IKDC and Tegner scores whichis maintained at 5 years.Survivorship of the whole group was 80% at 7 years. Survivorship was sig-nificantly reduced in Groups D & E. Cox regression analysis showed that car-tilage grade was the only significant predictor of failure. The overall adverseevent/reoperation rate was 27%.MAT has good patient-reported outcomes at minimum 1 year, but survivor-ship is improved if chondral surfaces are intact. We would recommendearly referral of symptomatic patients with meniscal deficiency.

0097 – ANTERIOR CRUCIATE LIGAMENT (ACL) INJURY AND THE RISK OFPRIMARY TOTAL KNEE REPLACEMENT FOR OSTEOARTHRITIS: A MATCHEDCASE CONTROL STUDY USING THE CLINICAL PRACTICE RESEARCHDATALINKTanvir Khan2, Abtin Alvand1, David Culliford3, Andrew Judge1, Daniel Prieto-Alhambra1, Brigitte Scammell2, Nigel Arden1, Andrew Price1

1University of Oxford, Oxford, UK, 2University of Nottingham, Nottingham,UK, 3University of Southampton, Southampton, UK

Background: There is an established association between ACL rupture andan increased risk of knee osteoarthritis (OA) 10-20 years following injury.However, there is limited evidence of the progression to end-stage OA postACL rupture. The aim of this study was to investigate whether ACL injury(ACLi) increases the risk of developing end-stage OA requiring Total KneeReplacement (TKR).Methods: A matched case-control study of all TKRs performed in the UKbetween 1991 and 2011 and recorded in the CPRD was undertaken. TheCPRD contains longitudinal data on approximately 3.6 million patients fromover 480 general practices. Two controls (control group) were selected foreach case of TKR (case group) matched on age, sex and general practice.Individuals with inflammatory arthritis were excluded. The odds of havingTKR for individuals with a CPRD-recorded diagnosis of ACLi were comparedwith those without ACLi using chi-squared analysis and conditional logisticregression. This was adjusted for BMI, previous fractures around the kneeand meniscal injury.Results: In the 20-year period, 50867 individuals had a TKR recorded on theCPRD (104,481 controls). 162 individuals in the case group had an ACLicompared to 41 controls (p<0.05). The adjusted odds ratio of having a TKRafter ACLi was 8.36 (95% confidence interval: 5.02-13.92) compared tothose without ACLi.Discussion: This study demonstrates that ACL injury is a significant risk fac-tor for developing end-stage OA, using TKR as a surrogate marker. Futurework should determine the effect of ACL reconstruction on risk of develop-ing end-stage OA.

0034 – PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEE: ARETROSPECTIVE ANALYSIS OF 214 CASES AT A TERTIARY REFERRALCENTREKavi Patel, Anil Haldar, Richard Carrington, Rob Pollock, Stephen Cannon,John Skinner, Timothy Briggs, William AstonThe Royal National Orthopaedic Hospital, Stanmore, UK

Introduction: Pigmented villonodular synovitis (PVNS) is a rare, locallyaggressive disease of the synovium with a significant rate of recurrence. Wepresent the largest single-centre experience of knee PVNS in the literature.Aims: To evaluate our centre’s experience in the management of kneePVNS.Methods: Retrospective data collection of consecutive cases of knee PVNSfrom 2002 – 2015.Results: 214 cases of knee PVNS were identified, with histological diagno-sis, which represented 53.4% of all PVNS at our centre. 100 were localisedPVNS (LPVNS), 114 diffuse PVNS (DPVNS) and 2 malignant villonodular syn-ovitis. 188 were primary cases and 26 had already been treated at anotherinstitution.Knee PVNS was more common in females, mean age of 39. The most com-mon location of LPVNS was Hoffa’s pad. Following surgery, 47.6% had recur-rence with DPVNS as opposed to 8.6% with LPVNS. In LPVNS, there was nodifference in recurrence between open and arthroscopic synovectomy(8.7% vs 9.1%, P > 0.05). However, in DPVNS, there was a statistically signif-icant higher risk of recurrence with arthroscopic compared to open syn-ovectomy (83.3% vs 45.2%, P = 0.027). Sixteen patients went on to have

TKR. The surgical complication rate was 9.7% and 62% were pain free withfull range of motion at follow-up.Conclusion: PVNS can be difficult to treat and affects the knee in more thanhalf of cases. We found a higher risk of recurrence with arthroscopic treat-ment of DPVNS, compared to open synovectomy. We would recommendopen synovectomy for the treatment of DPVNS.

0161 – PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEE: ARETROSPECTIVE ANALYSIS OF 214 CASES AT A TERTIARY REFERRALCENTREKavi Patel, Anil Haldar, Richard Carrington, Rob Pollock, Stephen Cannon,John Skinner, Timothy Briggs, William AstonThe Royal National Orthopaedic Hospital, Stanmore, UK

Introduction: Pigmented villonodular synovitis (PVNS) is a rare, locallyaggressive disease of the synovium with a significant rate of recurrence. Wepresent the largest single-centre experience of knee PVNS in the literature.Aims: To evaluate our centre’s experience in the management of kneePVNS.Methods: Retrospective data collection of consecutive cases of knee PVNSfrom 2002 – 2015.Results: 214 cases of knee PVNS were identified, with histological diagno-sis, which represented 53.4% of all PVNS at our centre. 100 were localisedPVNS (LPVNS), 114 diffuse PVNS (DPVNS) and 2 malignant villonodular syn-ovitis. 188 were primary cases and 26 had already been treated at anotherinstitution.Knee PVNS was more common in females, mean age of 39. The most com-mon location of LPVNS was Hoffa’s pad. Following surgery, 47.6% had recur-rence with DPVNS as opposed to 8.6% with LPVNS. In LPVNS, there was nodifference in recurrence between open and arthroscopic synovectomy(8.7% vs 9.1%, P > 0.05). However, in DPVNS, there was a statistically signif-icant higher risk of recurrence with arthroscopic compared to open syn-ovectomy (83.3% vs 45.2%, P = 0.027). Sixteen patients went on to haveTKR. The surgical complication rate was 9.7% and 62% were pain free withfull range of motion at follow-up.Conclusion: PVNS can be difficult to treat and affects the knee in more thanhalf of cases. We found a higher risk of recurrence with arthroscopic treat-ment of DPVNS, compared to open synovectomy. We would recommendopen synovectomy for the treatment of DPVNS.Meniscal scaffolds improve and maintain patient reported outcomes at 5years. Further work should be aimed at identification of the ideal patientfor optimal long term outcome and the effect on chondroprotection.Acknowledgements: Many thanks to Harry Palmer for his statistical input.


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WEDNESDAY 30th March16.21 to 17.30 (Afternoon)

Sports – Mini Oral Poster Presentations

0108 – COMBINED ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION(ACL) WITH KNEE REALIGNMENT OSTEOTOMY – RESULTS UP TO FIVEYEARSSam Yasen, James Smith, Ed Britton, Harry Palmer, Mike Risebury, AdrianWilsonHampshire Hospitals NHS Trust, Basingstoke, UK

0145 – THE USE OF ExTRA ARTICULAR STABILISATION IN PRIMARY ACLSURGERY IN A HIGH DEMAND ATHLETIC POPULATION WITH HIGH GRADEPIVOT SHIFT TEST; A COHORT STUDYSujith Konan, Yusuf Mirza, Albert Ngu, Fares HaddadUniversity College Hospital, London, UK

0087 – LATERAL INTERCONDYLAR RIDGE: IS IT A RELIABLE LANDMARKFOR FEMORAL ACL INSERTION? : AN ANATOMICAL STUDYRahul Bhattacharyya2, Andrew Ker2, Quentin Fogg1, Simon Spencer2, Jibu Joseph3

1Department of Human Anatomy, University of Glasgow, Glasgow, UK,2Queen Elizabeth University Hospital, Glasgow, UK,3Royal Alexandra Hospital, Paisley, UK

0102 – A RETROSPECTIVE MULTICENTRE REVIEW OF CHONDROTISSUE®USE FOR CHONDRAL INJURY IN THE KNEEMorgan Bayley1, Angus Robertson2, Robert Yate1

1Glangwili Hospital, Carmarthen, UK, 2University Hospital of Wales, Cardiff,UK

Sports – Free Paper Session

0125 – ALGORITHMIC APPROACH TO REVISION ACLRECONSTRUCTION:MID TERM OUTCOMES S Konan, YH Mirza, RJ Tansey, FS HaddadUniversity College Hospital, London, UK

Introduction: The aim of this study is to report our mid-term revision ACLoutcomes undertaken in a consecutive series of patients using a standard-ised protocol.Methods: We reviewed a consecutive series of 100 revision ACL (96patients, 40 female, mean 32 years [18 – 38]) at minimum 2 year follow up(2 to 8 years). The choice of revision was based on an established clinicaalgorithm.Results: Sixty-two cases (ACL group) were revised to optimal femoral tun-nel positions from previously non-conventional tunnel positions. Fifteenalso required new tibial tunnels. Thirty-three cases (ACL+ group) weretreated with ACL reconstruction along with extra-articular augmentation(McIntosh technique). In 10 of these cases, surgery had to be staged withinitial bone grafting of tunnel. The indication to undertake extra-articularaugmentation was for one of the following reasons; failed ACL reconstruc-tion despite acceptable tunnel positions, technique and rehabilitation; highdemand athletes at high risk of failure; clinical signs of hyperlaxity.In 5cases, with persistent symptoms of instability despite intact graft isolatedextra-articular augmentation was undertaken. Concomitant ligament repairor reconstruction was necessary in 28 cases. At minimum 2-year follow upwe report 2 clinical revisions in the ACL group and 1 in the isolated extraarticular augmentation group (97% survival). 87% returned to pre-morbidTegner activity level. The remainder dropped activity level by one point.Conclusion: In our series of revision ACLs for instability, we have demon-strated a high success rate using an algorithmic approach.

0072 – BIOTRIBOLOGY OF OSTEOCHONDRAL GRAFTS IN THE KNEEPhilippa Bowland, John Fisher, Eileen Ingham, Louise JenningsUniversity of Leeds, Leeds, UK

Introduction: In order to deliver successful osteochondral grafts to thepatient, there is the requirement to develop preclinical test methods incor-porating functional tribological simulations to assess the performance ofgrafts in the natural knee. The study aimed to investigate the effects of graftimplantation on the local tribology of the joint using a simple geometry tri-bological model.Method: The coefficient of friction and wear of 12 mm diameter porcineosteochondral pins reciprocating against bovine osteochondral plates wasdetermined. Negative controls consisted of intact osteochondral pins andplates. Positive control groups included a 6 mm stainless steel pin insertedcentrally in the plate flush with the cartilage surface (n=6) and 1mm proud(n=6). Test groups included 6 mm diameter cartilage defects (n=6) andporcine xenografts (n=6) inserted centrally. Samples were tested at a stressof 1MPa initially for 3 hours as a negative control, and then as either, a pos-itive control test or a test group for a further 3 hours. Wear was analysedusing an Alicona InfiniteFocus scanner.Results: Significant cartilage damage was observed in the positive controlgroups, wear was significantly lower in negative controls than all testgroups and moderate in the cartilage defect and xenograft groups.Increased friction only correlated with increased wear in the second posi-tive control group (steel pins 1mm proud).Discussion: Analysis of wear following implantation of osteochondral graftsand defects indicated that the local biotribology was altered, possiblyattributable to differences in contact areas and edge effects.

0026 – A SERIES OF CASES OF FOREIGN BODY REACTION AND SYNOVITISAFTER SOFT TISSUE KNEE RECONSTRUCTION USING LARS LIGAMENTMike Rodger, Andrew LeeRoyal Cornwall Hospital, Cornwall, UK

A patient in his thirties developed synovitis with grade 4 chondrolysis anda stiff knee with a fixed flexion deformity between three and six years fol-lowing PLC and PCL reconstruction using LARS (Ligament Augmentation andReconstruction System, Corin). There was histologic evidence of foreignbody reaction, the knee was painful, swollen and stiff.We did not use any further LARS ligaments for soft tissue reconstructionsof the kneein our practice. We commenced a recall programme for all 83patients patients who underwent a soft tissue knee reconstruction usingLARS. Of those contacted, 41 replied (49%) and 16 patients had symptoms(19%) and were investigated further with XRay, MRI and arthroscopy asindicated.We discovered a total of four patients had histologically proven synovitiswith foreign body reactions (5%), three of whom had life-changing sympto-matic pain, swelling and stiffness with degenerate changes (3.6%). Thesepatients had undergone various reconstructions, including a) PLC only, b)ACL and PCL, c) PCL and PLC and d) ACL, PCL and PLC. A further single caseof massive bone cyst formation was noted, following PCL reconstructionusing LARS (1.2%). Histology is awaited in one further case.

0101 – COMPARATIVE CLINICAL STUDY OF AUTOGRAFT VS SYNTHETICGRAFT PATELLOFEMORAL LIGAMENT (MPFL) RECONSTRUCTIONSPaul Y F Lee3, Abhishek Sharma2, Amit Chandratreya1

1Princess of Wales Hospital, Bridgend, UK, 2Cardiff University, Cardiff, UK,3WelshBone, Wales, UK

MPFL reconstruction using synthetic tape can reduce donor site mobilitycompared to using the hamstring tendon. The purpose of this study is toevaluate clinical results between the autologous gracilis tendon (GT) recon-struction to fibretape (Arthex) for MPFL reconstruction with the same sur-gical technique. 44 consecutive patients (50 knees) presenting with objec-tive patella-femoral instability underwent a MPFL reconstruction, isolatedor associated with other surgical procedures for PF stabilization. Two PEEKbone anchors were used to secure the graft to the patella and a single PEEKinterference screw was used for the femur. Autologous GT was used for thefirst 22 patients, 27 knees. In the following 22 patients, 23 knees Fibretapesynthetic graft was used as graft. All patients were clinically and radiologi-cally evaluated, Kujala score, Bartlett score, Modified Tegner activity ratingscale, SF 12 score and Lysholm score were used to assess clinicaloutcome.The average follow-up in the GT group were 2.8 years, 8 male and14 female with mean age of 22; in the synthetic group the average follow-up were 1.3 years, 7 male and 15 female with mean age of 21. No recur-


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rence of dislocation was observed in either group of patients. The overallsatisfaction rate was 98%. There were significant improvements (p<0.05) inall patient’s reported outcome measures in both groups but no significantdifference between groups. 2 patients (3 knees) had superficial infection inthe GT group. Synthetic Fibretape offered the same patient outcome withbiological GT graft, without donor site morbidity.

0089 – ARE xENOGRAFT TENDONS A VIABLE ALTERNATIVE FOR KNEELIGAMENT RECONSTRUCTION? A BIOMECHANICAL STUDY OF BOVINETENDONS TREATED WITH A NOVEL PROCESSING METHOD Henry Colaco1, Breck Lord2, Zameer Shah1, Diane Back1, Andrew Davies1,Andrew Amis2, Adil Ajuied1

1Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK,2Imperial College, London, UK

Introduction: This study aims to test the time-zero in vitro biomechanicalproperties of bovine xenograft tendons treated with a novel proprietarylow-temperature sterilisation process used to process allograft tendons.Methods: Three groups of tendons (n=42) were tested: 15 BioCleanse®bovine (BCB), 15 fresh frozen unprocessed bovine extensor tendons (FFB),and 12 processed human allograft tibialis anterior tendons (BCA). Cross-sectional area (CSA) was measured using an alginate impression technique,and tendons were mounted in cryogenic clamps to an Instron® 5565 Mate-rials Testing System. The 5-stage static loading protocol involved 10N pre-load for 1min, steady ramp to 500N over 10s, maintenance at 500N tomeasure creep, then ramp to failure at 10mm/s.Results: BCB tendons displayed a higher ultimate tensile strength, withequivalent ultimate failure load, creep, and modulus of elasticity whencompared to the FFB tendons (p<0.05). BCB tendons had an equivalentcross-sectional area to the BCA tendons whilst exhibiting a greater failureload, ultimate tensile strength, less creep and a higher modulus of elasticity(p<0.05). CSA was a better predictor of ultimate failure load in the BCB(R2=0.77) than FFB (R2=0.286) and BCA (R2=0.220) tendon groups.ConclusionsThe BioCleanse® process does not adversely affect the time-zero biome-chanical properties of bovine xenograft tendons. Processed bovinexenograft tendons exhibit superior biomechanical characteristics whencompared with processed human allograft tibialis anterior tendons.Our findings demonstrate favourable time-zero biomechanical characteris-tics of BioCleanse® processed bovine tendons supporting further investiga-tion of their application as xenograft in human knee ligament reconstruc-tive surgery.

0048 – CAN BALANCE BE IMPROVED WITH A SIMPLE HOME BASEDTRAINING PROGRAMME? A PROSPECTIVE RANDOMISED CONTROLLEDTRIAL.Angela McGowan1, Laura Derbyshire1, Lee Herrington2, David Johnson1

1Stockport NHS Foundation Trust, Stockport, UK, 2University of Salford,Salford, UK

Introduction: Knee injuries are associated with disability/degenerativechange. Access to balance training is important in preventing injuries, butis restricted for amateur sportspeople.Aim: Compare the effectiveness of 3 home-based balance training pro-grammes.Methods: Healthy individuals were recruited. Each had an initial balanceassessment measuring BiodexSD Postural Stability Index (PSI) / Limits ofStability Test (LOS); and Star Excursion Balance Test (SEBT). Participantswere randomised to a control group or one of three interventions (physio-therapist taught exercises; home-exercise sheet; Nintendo®WiiTM/WiiTMFitbalance board). After 6 weeks the balance assessment was repeated by anassessor blinded to the allocation.Results: Of 185 randomised, 157 completed the study; 41 males / 116females; mean age 43.4 years (range 19-75); mean BMI 25.1 (range 18.1-39.9). There was no significant difference between groups with respect tosex, age, BMI, or Tegner/UCLA activity scores. All measures improved(p<0.01) in the intervention groups combined and in the controls. Exceptfor PSI, improvement was greater in the intervention groups combinedcompared to the controls (SEBT p<0.01). All individual groups improved(p<0.01) for all assessments, except PSI in the home-exercise sheet group.The physiotherapist taught exercise group gained greatest improvement forPSI (vs exercise sheet p=0.026) and SEBT (vs control p<0.001); with the Nin-tendo® group improving vs control (p=0.048) for SEBT. Discussion: A home-based balance training programme can improve bal-ance. Results are best in a taught programme, but can be achieved other

ways. Our study paves the way for a study into injury prevention in amateursports.

0157 – THE USE OF THE MACINTOSH PROCEDURE IN REVISION ACLRECONSTRUCTION SURGERY; EARLY TO MID TERM RESULTS: A COHORTSTUDY S Konan, YH Mirza, AWT Ngu, FS HaddadUniversity College Hospital, London, UK

Introduction: The Macintosh extra-articular augmentation procedureforms an important tool in the armamentarium of the surgeon faced withthe patient with failed ACL reconstruction . We describe an age and sexmatched cohort study of the early to medium term follow up of the use ofthe Macintosh procedure as part of revision ACL surgery.Methodology: 159 patients were identified,over a 10 year period from2000 to 2013. 53 patients underwent revision ACL and Macintosh augmen-tation whilst a further 106 matched controls underwent revision ACL recon-struction alone. All had failed ACL reconstruction with pivot shift phenom-enon upon clinical examination. 127 patients (80% ) underwent allograftreconstruction, 24 patients (15%) underwent autograft reconstructionusing hamstring tendon harvest and 8 patients (5%) BTB.All had clinical andfunctional outcomes including the modified Lysholm and Tegner scoringsystem.Results: At minimum follow up 2 years (range 2 to 13) , all returned to activ-ities within 1 Tegner scale. There was no positive pivot shift phenomenonon clinical examination in any patient. 98% (n=51) of with Macintosh aug-mentation reported instability to be “never” or “rare” upon Lysholm Tegnerscoring compared to 89% (n=94) of those without Lysholm Tegner scoreswere good or excellent in 83% (n=88) controls compared to 95%, (n=50) ofthose undergoing the Macintosh procedure.Conclusion: The Macintosh procedure forms an important adjunct in theprevention of anterolateral instability in revision ACL surgery with patientsreporting good scores at 2 years.


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ACPA ANNUAL MEETINGWEDNESDAY 30TH MARCH THURSDAY 31ST MARCH 2016

VENUE: ACC, LIVERPOOLPROGRAMME

WEDNESDAY 30TH MARCH AM

8.00 Registration and Coffee

9.20 BASK – Room 3

10.00 ACPA Welcome and Introduction – Room 4bComplex Patient session: Chair Cathy Armstrong

10.10 10.30 Managing joint replacement in patients with AlkaptonuriaMr J S Davidson

10.30 10.50 Coffee

ACPA Complex Patients Session continued – Room 4b

10.50 11.10 The consent process with patients who have learning difficulties: A case study.Mr S Kalra

11.10 11.30 The role of the Therapists with patients who have learning difficulties: continuation of a case study.

11.30 12.00 The role of the Independent Mental Capacity Advocate with patients who have learning difficultiesJeanette Abendstern

12.00 12.25 Ankle ArthroplastyTariq Karim

12.25 13.00 BASK: Tim Wilton BOA President

13.00 14.00 Lunch

WEDNESDAY 3OTH: MARCH PM

14.00 BASK – Room 3Clare Marx: President RCS Eng

14.40 ACPA Competency session: Chair Jill Pope – Room 4b

14.40 Developing Clinical Reasoning Skills to Manage Complex problemsDenise Prescott

15.10 Using the Competency Tools: the Wrightington ExperienceNeil Crabtree and Keiran Goode

15.30 Competency Workshop

15.40 Tea

16.00 BASK – Room 3Medicolegal session

17.30 18.30 Arthrex “Cadaveric Demonstration” – Live Link in Room 4aLimited spaces available – Please visit Arthrex on their stand no.8 to request an invitation.

19.30 Association Dinner – Town Hall, Liverpool – Entrance by ticket only

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THURSDAY 31ST MARCH AM

9.00 ACPA – Room 4bImproving Patient Satisfaction session Chair: Claire-Louise Sandell

9.00 Proms: the Liverpool ExperienceDr Cathy Armstrong

9.30 Picking WinnersDr Paul Jermin

10.00 ACPA AGM

10.20 Coffee

10.50 BASKPeter Giannoudis: Periprosthetic Fractures

11.20 ACPACase studiesClose of ACPA meeting

12.00 BASK – Room 3Lordon Trickey lecture: Robert Barrack

12.45 Lunch

13.30 BASK meeting programme – Room 3

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The Poster Presentations are displayed on poster boards in the exhibition area (Hall2) a number of the authors have also submitted E-Posters of their posterpresentation, these are displayed as eposters on the screens within the exhibition area (Hall 2).

You can also search and view individual eposters using the touch screens in the middle of the exhibition area.

0004 – FUNCTIONAL OUTCOME SCORES CAN BE USED AS ASURROGATE FOR RETURN OF QUADRICEPS FUNCTIONFOLLOWING ACL RECONSTRUCTIONAndrew Legg, Siddharth Shah, Fazal AliChesterfield Royal Hospital, Chesterfield, UK

Objectives: Return of isometric quadriceps function has beenshown to predict functional outcome following ACL reconstruction.The aim of this study was to identify if a functional outcome scorecould be used as a surrogate for quadriceps function, and if pre-operative quadriceps isometric strength had an impact on ACLreconstruction functional outcome.Method: A prospective cohort study of 30 patients undergoing pri-mary ACL reconstruction had pre-operative quadriceps and ham-string isometric strength, power and endurance measurements ofthe injured and uninjured limb. This was then re-measured at aminimum of 12 months post-operatively following a standard ACLphysiotherapy rehabilitation protocol being completed. Functionalquestionnaires (KOOS and Tegner) were also completed pre-oper-ative and at a minimum of 12 months post-operatively.Results: 67% (20 out of 30) of patients had complete sets of data.There was a strong correlation between isometric quadricepsindex strength with both KOOS and Tegner scores (p = 0.017 and p= 0.013), and quadriceps power (p < 0.033 and 0.032). There wasno correlation between endurance and the functional outcomescores (p = 0.566 and p = 0.885); or between pre-operative andpost-operative quadriceps isometric strength and functionalscores.Conclusion: KOOS and Tegner functional outcome scores can beused as surrogate for return of quadriceps function, and thereforecan be used as part of the decision making process of when apatient is able to return to sport. However, neither functionalquadriceps scores or isometric strength measurements can be asubstitute for function return to sport testing.

0007 – AUTULOGOUS CONDITIONED PLASMA (ACP) INJECTIONFOR GRADE3 AND GRADE4 OSTEOCHONDRAL DEFECTS OF KNEEIN YOUNG PATIENTSChristopher Ghazala, Shankar Kashyap, Aysha RajeevQueen Elizabeth Hospital, Gateshead, UK

Introduction: Osteochondral defects in the knee in young patientsare a difficult condition to treat. Autologous conditioned plasma(ACP), a platelet concentrate made of autogenous blood, has beenused to improve bone and soft tissue defect healing.The aim of the study is to prospectively assess the clinical and func-tional outcomes in younger age group with grade 3& 4 osteochon-dral defects in the knee.Materials and Methods: Sixty patients who had demonstrableosteochondral defects were included The plasma is prepared usingArthrex kit. The plasma which is separated is injected in to theaffected knee under local anaesthesia as a day patient. Thepatients were assessed by senior physiotherapist pre and postinjection with Kujala, Oxford and Lysholm outcome measures after6 months and one year. The severity of pain was measured usingVAS.Results: There were 38 males and 32 females. The age groupranged from 24 to 42 years (average 33.1).The average preopera-tive scores for Kujala, Oxford and Lysholm were59, 31 and 65respectively. VAS was between 7 and 9 .70% of the patients had animproved clinical functional outcome at 6months (Kujala-77Oxford-43, Lysholm-92).The VAS improved between 5 and 6after injection.At one year 52% of the patents had a lower scoresbelow 50 for Kujala, moderate to severe joint function with Oxfordscores and poor Lysholm score,Conclusion: The use of ACP injection in young patients with osteo-chondral defects of the knee gives relief of symptoms andimproves function in the short term.

0009 – ExTENSOR MECHANISM INJURIES: TO USS OR MRI THATIS THE QUESTIONEllen Martin, Adelle Fishlock, James NewmanMid Yorkshire Hospitals NHS Trust, Wakefield, UK

Introduction: Ultrasound is a quick and readily accessible investi-gation that is routinely used for the diagnosis of extensor mecha-nism injuries of the knee. Anecdotally, within the orthopaediccommunity it is felt that there is a poor correlation between ultra-sound reports and intra-operative findings for both patella tendonand quadriceps tendon injuries.Methods: Data from 2013-2015 was retrospectively reviewed. Allpatients who had an ultrasound examination of their extensormechanism prior to surgical exploration were included. Ultrasoundreports and intra-operative findings were compared.Results: Thirty-seven patients were included (11 patella tendons,26 quadriceps tendons). Ultrasound was 100% accurate in diagnos-ing complete patella tendon ruptures. For quadriceps injury, ultra-sound was 73% accurate for diagnosing complete tears and 54%accurate for partial tears. The overall accuracy of ultrasound forquadriceps injuries was 57.7%. Three patients had ultrasound evi-dence of quadriceps tendon injury, yet no injury was found intra-operatively. There was little difference in the accuracy of reportingin Sonographers versus Radiologists, with an accuracy of 71% and62% respectively.Conclusions: Ultrasound is an accurate method of diagnosing

patella tendon injuries. However, it is not an accurate method ofdiagnosing quadriceps tendon injuries. Hence, this could lead toeither exposure of patients to undue surgical risk, or undertreatinga potentially very serious injury. Therefore, we suggest MRI as afirst line investigation for quadriceps injury.

0012 – NUMBNESS AROUND THE TOTAL KNEE ARTHROPLASTYSURGICAL SCAR: ITS PREVALENCE AND EFFECT ON THEOUTCOMEManish Kiran, Avinash Parthasarathy, Arpit Jariwala, LindaJohnstonUniversity of Dundee, Dundee, UK

Background of study: Numbness around the surgical scar can be asource of discomfort in patients undergoing Total Knee Arthro-plasty (TKA). Literature reports wide variation in its prevalence.The consequence of numbness on the functional outcome is notclear. We aimed to investigate the prevalence of numbness, alongwith factors affecting it, and assess its effect on the outcome ofTKA.Materials and methods: 258 patients who underwent TKA wereincluded in the prospective cross sectional patient reported out-come measure (PROM) study. Demographic details, approach,length of incision, and the pre-operative and one year post-opera-tive Knee Society Score (KSS) were recorded. A Dundee numbnessclassification was developed and used for the assessment andlocalization of numbness using e-Ruler® and Matlab® computersoftware.Results: The prevalence of numbness at one year review was 53%,with a significant female preponderance. Midline incision was pre-dominantly used for TKA. The incision length and numbness areapositively correlated. Oblique incision was more prone for numb-ness. Discomfort due to numbness was noted in 8.7% of patientsand correlated with the numbness area. The KSS and its compo-nents did not correlate with the presence or the area of numbness.Conclusion: Our findings indicate high prevalence of numbnessafter TKA. However, numbness did not affect the functional out-come.

0017 – THE FAILING MEDIAL COMPARTMENT IN THE VARUSKNEE AND ITS ASSOCIATION WITH CAM DEFORMITY OF THE HIPJonathan Palmer1, Antony Palmer1, Luke Jones1, Sujin Kang1,Nicholas Bottomley2, William Jackson2, Cameron Brown1, AndrewPaul Monk1, David Beard1, Kassim Javaid1, Sion Glyn-Jones1,Andrew Price1

1University of Oxford, Oxford, UK, 2Nuffield Orthopaedic Centre,Oxford, UK

Background: The knee service at the Nuffield Orthopaedic Centrehas been offering a neutralising medial opening wedge high tibialosteotomy (HTO) to a group of patients presenting with earlymedial osteoarthritis of the knee and genu varum. During develop-ment of this practice an association was observed between thisphenotype of osteoarthritis and the presence of CAM deformity atthe hip. The objective of this study is:To establish whether this group have a high incidence of CAMdeformity in the hip (defined by an increased alpha angle)Methods: A retrospective case-controlled study. All patients whounderwent HTO since 2011 were identified (n=30). Comparatorgroups were used in order to establish whether meaningful obser-vations were being made:Control group: The spouses of a high-risk osteoarthritis cohortrecruited for a different study at our unit (n=20)Pre-arthroplasty group: Patients who have undergone uni-com-partmental arthroplasty (UKA) for antero-medial osteoarthritis(n=20)All patients had standing bilateral full-length radiographs availablefor analysis using in house developed Matlab®-based software forhip measurements and MediCAD® for lower limb alignment meas-urements.Results: A total of 140 limbs from 70 gender-matched subjectswere studied. The HTO group had a significantly greater meanalpha angle than both the pre-arthroplasty (p=0.01) and controlgroups (p=0.007).Conclusions: The results of this study confirm that our HTO grouphave a significantly greater incidence of CAM lesions. This groupdemonstrate independent predictors for progression of OA in boththe hip and the knee. To our knowledge this is a novel observation.

0018 – CLINICIAL OUTCOMES OF TIBIAL TUBERCLE TRANSFERFOR ANTERIOR KNEE PAIN AND PATELLO-FEMORAL INSTABILITYSYED.F.F GUL, P. Y. F Lee, Andrew P DaviesMorriston hospital, ABMU health board, Swansea ,Wales, UK

Anterior knee pain and patellofemoral instability have a multi-fac-torial aetiology and are therefore difficult to treat. A variety of sur-gical treatment options have been proposed for such patients. Tib-ial tubercle transfer is one such option and has been describedusing different surgical techniques. There is however a paucity ofliterature regarding the procedure itself and its clinical outcomes.Purpose: This study describes the clinical efficacy and outcome ofa Tibial Tubercle Transfer (TTT).Study Design: Case seriesMethods: 86 consecutive patients who underwent TTT for anterior

Poster Presentationsknee pain and/or patellofemoral instability were studied prospec-tively. All patients received the same rehabilitation protocol post-operatively. Clinical outcome was measured using the Kujala kneescore pre-operatively and at follow-up. Patients were also asked torate their satisfaction with the procedure. Mean duration of followup was 1.7 years (6 months to 3 years).Results: 94% of patients were satisfied with their decision toundergo the operation at the latest follow up. The mean Kujalascore pre-operatively was 46 points with a Standard deviation (SD)of 14.35. At 6 months the mean Kujala score had improved to 70points with a standard deviation of 20.25. Patients with patella-femoral instability alone showed greater improvement of Kujalascores compared to patients with anterior knee pain alone or painplus instability.Conclusion: Our experience suggests that tibial tubercle transferprovides a safe and effective surgical treatment option for patientswith anterior knee pain and patellofemoral instability. Patientswith patellofemoral instability pre-operatively derived the mostbenefit.

0020 – MAGNETIC RESONANCE IMAGING (MRI) EVALUATION OFRECURRENT PATELLAR INSTABILITYMuhammad Adeel Akhtar, Brent Ascherl, Ian Curzon, SheamusFitzgerald, Anthony HuiJames Cook University Hospital, Middlesbrough, UK

Introduction: MRI scan is used to evaluate the status of MPFL andtrochlear dysplasia following recurrent patellar instability. Our aimwas to study the MRI findings in patients undergoing MPFL recon-struction.Material and Methods: The MRI scans of 19 patients undergoingMPFL reconstruction were reviewed by 3 consultant radiologist toassess the Medial patellofemoral ligament(MPFL),trochlear dyspla-sia,patellar tilt and patella alta. The inter-observer agreement fordifferent findings on the MRI scan was assessed by using Kappatest.Results: The mean age for 10 female(53%)and 9 male(47%)patients was 21 years(range 13-33). MPFL was identified in allpatients by all three observers. MPFL was found to be intact in 12patients (63%),lax in 1 patient(5%)and torn in 6 patients(32%).Thekappa value for MPFL status was 0.57.MPFL rupture site waspatella in 5 patients(83%)and both patella and femur in 1patient(17%)with a kappa value of 0.66.Trochlear dysplasia wasnoted in 16 patients(84%)with a kappa value of 0.26. 6patients(32%)had patellar tilt on MRI scan with a kappa value of0.57 for inter-observer variability. The mean Insall-Salvati ratio was1.3(range 1.1-1.6) .The patel la a lta was noted in 12/18patients(67%)with a kappa value of 0.93.Conclusions: Trochlear dysplasia was present in 84% patients andpatella alta was noted in 67% cases. There was poor inter-observeragreement for MRI findings for MPFL status(kappa 0.57),trochleardysplasia(kappa 0.26)and patellar tilt(kappa 0.57).The highestinter-observer agreement was for patella alta with a kappa value of0.93.We believe that MRI findings alone cannot be used as thedefinitive diagnostic test for patellar instability.0021 – MAGNETIC RESONANCE IMAGING (MRI) AND OUTCOMESIN ADOLESCENTS UNDERGOING PATELLAR STABILIZATION FORRECURRENT PATELLAR INSTABILITYMuhammad Adeel Akhtar, Firas Yaish, Anthony HuiJames Cook University Hospital, Middlesbrough, UK

Introduction: Our aim was to study the MRI findings and outcomesfollowing surgery for patellar instability in adolescents.Material and Methods: 10 patients undergoing patellar stabiliza-tion under the age of 18 years were identified. Demographicdetails,MRI findings,type of stabilization,length of follow up,leglength discrepancy,malalignment and further instability were stud-ied.Results: The mean age for 6 females and 4 males was 16years(range 13-18).1 patient had bilateral patellar stabilization.There were 8(72%)Medial patellofemoral ligament (MPFL) recon-struction and 3 patients (28%)had MPFL reconstruction andTrochleoplasty.The growth plate was open in 2 patients(20%)andclosed in 8(80%)on preoperative x-rays.7 patients had preoperative MRI scans which showed an intactMPFL in 4(57%),torn in 2(29%) and lax in 1 patient(14%).MPFL wastorn from patella and from both patella and femoral sites in 1pat ient each.6 pat ients(86%)had trochlear dysplas ia ,1patient(14%)had patella tilt and 1 patient(14%)had patella alta onMRI scan evaluation. The mean Insall-Salvati ratio was 1.24(range1.1-1.6).The mean follow up was 21 months(range 5-42).At the lastfollow up there were no further episodes of patellar instability,leglength discrepancy or patellar malalignment.Conclusions: We studied the MRI findings and outcomes followingpatellar stabilization in adolescents with patellar instability.Trochlear dysplasia was a common finding in 86% patients.3patients(28%)required Trochleoplasty along with MPFL reconstruc-tion for patellar stabilization. There were no further episodes ofpatellar instability. We recommend MPFL reconstruction+/-Trochleoplasty in symptomatic adolescents with patellar instabilityas we believe it is safe to breach the epiphysial plate during MPFLreconstruction and this did not lead to growth arrest.

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0024 – THE INCIDENCE OF ANTEROLATERAL LIGAMENT INJURYIN ASSOCIATION WITH ANTERIOR CRUCIATE LIGAMENTRUPTURE ON PREOPERATIVE MAGNETIC RESONANCE IMAGINGJonathan Kosy, Rahul Anaspure, Vipul MandaliaRoyal Devon and Exeter Hopsital, Exeter, Devon, UK

Magnetic resonance imaging (MRI) is a reliable method to imagethe anterolateral ligament (ALL). Injury (either intra-substance oras an avulsion) is thought to be related to rotational instability.Identification of this injury may help to reduce instability followingACL reconstruction.Following Institutional Review Board approval we performed a ret-rospective study of 192 preoperative MRI scans (identified from aprospective ACL reconstruction database). 1.5T MRI studies wereexamined by a consultant musculoskeletal radiologist. Exclusionswere patients under 16 years or incomplete imaging. This left 152scans (152 patients; 100 males: 52 females; mean age 30.4 years(range 16-51)) for analysis. Injury to the ALL was identified aseither complete rupture, localised oedema or an avulsion fracture.The visualised ALL had similar anatomy to published results in theuninjured knee (Thickness = 1.97 ± 0.55mm). Both the tibial attach-ment and meniscal portion of the ligament were identifiable in92.7% of cases. However the femoral origin was less clearlydefined and seen in only 56.3% of scans. Injury to the ALL wasdemonstrated in 18.5% of cases (11.8% rupture, 6.0% oedema,0.7% fracture).We found that the ALL was clearly identifiable in the majority ofMRI studies of the injured knee. However injury occurs in less thanone-fifth of cases of ACL rupture. Therefore the relationshipbetween this injury and clinical findings, including high-gradepivot-shift, requires further study and the indications for recon-struction must be further defined. However evidence of MRI evi-dence of ALL injury may aid the selection of appropriate cases.

0031 – AN ACTIVE DISCHARGE POLICY AFTER KNEEARTHROSCOPY AND MENISCECTOMY IS APPROPRIATE AND TIMEEFFICIENTJonathan Wright, Andraay Leung, Emma Leighton, Tom NunnRoyal Alexandr Hospital, Paisley, Renfrewshire, UK

Orthopaedic departments around the United Kingdom perform alarge number of knee arthroscopies per year. We examined a singlesurgeon cohort to determine whether an active discharge policyfollowing knee arthroscopy is appropriate and time efficient.386 patients who had knee arthroscopies, with a minimum of 6months’ follow-up were identified. Operation notes and comput-erised databases were examined to determine the intraoperativefindings, interventions performed, follow-up arrangements andwhether any unexpected clinic returns occurred. We excludedpatients who had meniscal repairs or microfractures, as theynecessitate follow-up in clinic.The mean follow-up period was 530 days. The commonest inter-vention performed was partial meniscal debridement (n=316,81.9%). There were 3 complete meniscectomies (0.8%). 67 proce-dures (17.4%) were diagnostic, or involved minor debridement ofdegenerative tissue.Unless clinically indicated, 277 (71.8%) were discharged at thepoint of surgery with printed recovery and rehabilitation informa-tion and details of how to arrange follow-up, should it be required.There were subsequently 35 (9.1%) self-arranged returns at amean of 49 days postoperatively. Using Cox-Regression analysis,we did not identify any factors, including intraoperative findings ofosteoarthritis and procedure performed, associated with unex-pected returns.242 patients remain successfully discharged at the point of surgery.Compared with the scenario in which each patient receives onefollow-up clinic appointment, this equates to a saving of 13.5 con-sultant sessions (with definitions from the BOA Consultant Advi-sory Book recommendations).We have shown that an active discharge policy post kneearthroscopy and meniscectomy can be safe, efficient, and poten-tially cost saving

0032 – DAY OF SURGERY DISCHARGE FOLLOWINGUNICOMPARTMENTAL KNEE ARTHROPLASTY WITHIN THE UKNATIONAL HEALTH SERVICEBen Bradley, Simon Middleton, Niel Davis, Mary Stocker, MichaelHockings, David IsaacTorbay Hospital, Torbay and South Devon NHS Foundation Trust,Devon, UK

Outpatient unicompartmental knee arthroplasty (UKA) has beensuccessfully performed in the North American healthcare system.Despite differences in healthcare structure and financial environ-ment, we hypothesized that it would be possible to replicate thissuccess and perform UKA surgery with safe day of surgery (DoS)discharge within the confines of the NHS. Outpatient UKA has notbeen reported in any other centres within the UK. We report onour experience of implementing a pathway to allow safe DoS dis-charge following UKA. Data was prospectively collected on 72patients who underwent planned outpatient UKA over a 4 yearperiod in our Trust. We achieved an 85% DoS discharge rate withhigh patient satisfaction scores. The most common reason forfailed DoS discharge (4 patients) was logistical, with patients hav-ing their surgery too late in the day. Other reasons included inabil-ity to mobilize safely (3), pain (2) and wound problems (1). Theaverage length of stay for failed discharges was 1.2 nights (range 1-3). Over the same time period 58 patients underwent planned in-patient UKA as they were deemed not appropriate for the DoS dis-

charge pathway, however 3 of these patients were safely dis-charged on the DoS. This study demonstrates that patients can besafely discharged on the DoS following UKA with high patient sat-isfaction. This offers obvious financial and bed-planning benefits toHealthcare Trusts. It also offers potential advantages of reducedperi-operative complications and improved patient outcomescores. We are the first unit in the UK NHS to demonstrate this.

0038 – KNEE ARTHRODESIS WITH A LONG INTRAMEDULLARYNAIL FOR LIMB SALVAGE FOLLOWING COMPLEx INFECTION OFPRIMARY OR REVISION TOTAL KNEE ARTHROPLASTY, OR FAILEDKNEE ARTHRODESISNima Razii1, Ammar Abbas2, Rahul Kakar1, Sanjeev Agarwal1,Rhidian Morgan-Jones1

1Cardiff and Vale Orthopaedic Centre, Cardiff, UK, 2WishawGeneral Hospital, Wishaw, UK

Background: Periprosthetic infection following total knee arthro-plasty (TKA) is a devastating complication, which is not always sat-isfactorily resolved by revision surgery. Arthrodesis is a salvagealternative to above-knee amputation or permanent resectionarthroplasty. Fixation options include internal compression plating,external fixation, and intramedullary nails.Methods: We retrospectively reviewed twelve consecutive cases(9 males, 3 females; mean age, 67 years) of knee arthrodesis witha long intramedullary nail, performed at our institution between2003 and 2014, as a salvage procedure. The mean follow up was 33months. Desired outcomes were the ability to mobilise withoutpain, solid radiographic fusion, and the eradication of infection.Results: Eleven patients (92%) demonstrated stable fusion, tenpatients (83%) were ambulatory without pain, and ten patients(83%) remained without infection at most recent follow up. Eightpatients achieved union at an average of 12 months; threerequired repeat procedures, achieving union at an average of 9months. There was a significant difference (P < 0.01) between thenumbers of previous operations amongst the eight patients whoinitially achieved union following surgery (mean, 3.25) and threewho subsequently required repeat procedures (mean, 8.33).Conclusions: In contrast to similar studies, our preference was fora single-stage protocol where possible, although comparableambulatory and fusion rates were observed. Arthrodesis with along intramedullary nail can alleviate pain and allow early mobili-sation in patients with bone loss and complex periprosthetic infec-tions, but numerous previous attempts at revision arthroplasty andco-morbidities may hinder its efficacy as a definitive salvage proce-dure.

0039 – ABSOLUTE OxFORD KNEE SCORES ARE INFLUENCED BYLEVELS OF PSYCHOLOGICAL DISTRESSAndrew Jones, Tim James, Andrew DaviesMorriston Hospital, Swansea, UK

The Oxford Knee Score (OKS) has become the benchmark self-assessment score for knee pain and function in patients withosteoarthritis. Chronic pain, the main symptom of osteoarthritis, isknown to be associated with psychological distress, most com-monly presenting as anxiety / depression which can alter percep-tion of severity of physical symptoms. The Hospital Anxiety andDepression score (HADS) is an established tool to quantify psycho-logical distress. We aimed to investigate the correlation betweenanxiety / depression and the OKS.We prospectively investigated the OKS and HADS scores of a cohortof 104 patients undergoing a total of 107 primary knee arthro-plasty procedures pre-operatively and at 6 weeks, 1 year and 7years post operatively.46 (44%) of our patients had abnormal anxiety and/or depressionscores pre-operatively. This was associated with a worse pre-opOKS compared to those with normal HADS scores (33 vs 31 points).As the severity of anxiety and/or depression increased, so did theOKS (mean 36 points). Although both HADS and OKS scoresimproved significantly post operatively in all groups, the associa-tion of worse HADS and OKS scores persisted at all time points.Our study has shown that OKS and HADS scores are linked. Sincethese are self-assessments and psychological distress tends to neg-atively influence perception of physical symptoms, this is perhapsnot surprising. The use of threshold scores for management deci-sions is inappropriate as psychological factors will influenceabsolute OKS scores. Similar symptoms are perceived and scoreddifferently by patients depending on their psychological status.

0046 – ROPIVACAINE PLASMA LEVELS FOLLOWING HIGH-DOSELOCAL INFILTRATION ANALGESIA FOR TOTAL KNEEARTHROPLASTYAlistair Brydone1, R Souvatzoglou1, M Abbas2, DG Watson2, F Picard1, AM Gill1

1Golden Jubilee National Hospital, Glasgow, UK,2University of Strathclyde, Glasgow, UK

Total and free plasma concentrations of ropivacaine were meas-ured following high-volume, high-dose local infiltration analgesiain 28 patients aged 65 years or over undergoing unilateralcemented total knee arthroplasty for osteoarthritis. Patientsreceived local infiltration of ropivacaine 400 mg followed by a 480mg dose infused at 20 mg.h(-1) through an intra-articular catheter.Total and free plasma levels of ropivacaine were measured at 5, 10,15, 20, 25, and 30 min, then 1, 4, 12, and 24 hrs after release of thepneumatic surgical tourniquet. Patients were monitored for symp-toms and signs of local anaesthetic toxicity at intervals and cardiac

rhythm was monitored continuously. Total levels of plasma ropiva-caine varied from 0.147 to 3.093 μg.ml(-1) (mean (SD) 1.105(0.518) μg.ml(-1) ). Free levels of plasma ropivacaine varied from0.001 to 0.104 μg.ml(-1) (mean (SD) 0.037 (0.020) μg.ml(-1) ). Sixsamples had total plasma ropivacaine levels greater than the toxicthreshold of 2.2 μg.ml(-1) . No samples reached the toxic thresholdfor free venous ropivacaine concentration. We conclude that theuse of high-dose ropivacaine infiltration and catheter infusion fortotal knee arthroplasty in an elderly population does not result infree plasma ropivacaine levels previously associated with toxicitybut that raised total plasma levels may be observed.

0047 – CLINICAL COMPARISON OF ARTHROSCOPIC VERSUS OPENAUTOLOGOUS, MATRIx-INDUCED CHONDROGENESIS (AMIC) FORCARTILAGE REPAIR IN THE KNEEJustus GilleUniversity of Schleswig Holstein, Luebeck, Germany

Purpose: Autologous Matrix Induced Chondrogenesis (AMIC) is aninnovative treatment for localized full-thickness cartilage defects.This study was performed to review and compare the outcome ofAMIC in an open versus an arthroscopic technique.Methods and Materials: Within the context of clinical follow-up,30 patients were evaluated 1 and 2 years after the index proce-dure. While surgery was performed in 20 cases in an open proce-dure (group 1), 10 patients (group 2) were treated with an arthro-scopic technique.Results: No differences were seen comparing base line data (e.g.age, defect size) of group 1 and 2.The majority of patients was satisfied with the postoperative out-come, reporting a significant decrease of pain (VAS group 1/group2: preop. 5.8/4.6, 1 year postop. 2.9/2.5, 2 years postop. 2.2/1.2).Significant improvement of the Lysholm score was observed asearly as 12 months after AMIC and further increased values werenotable up to 24 months postoperatively (group 1/group 2: preop.44.8/52.5, 1 year postop. 76.8/82.5, 2 year postop. 80.3/83.5).Analyzing the subgroups of the KOOS score of group 1 and 2reveales comparable results with significant increases of the val-ues.No significant differences were seen comparing group 1 and 2.Conclusions: This is the first study comparing the outcome of AMICin an open or arthroscopic technique. In the recent series we didnot see a significant difference comparing the open and arthro-scopic technique at mid-term follow-up. In conclusion, both tech-niques should be considered as alternative treatment options.

0050 – 12 YEAR SURVIVAL ANALYSIS OF OxIDISED ZIRCONIUMTOTAL KNEE REPLACEMENTS PERFORMED IN PATIENTS UNDER50 YEARS OF AGEAlexander W. Glover, Alasdair J.A. Santini, John S. Davidson, Jill A. PopeThe Royal Liverpool and Broadgreen University Hospitals NHSTrust, Liverpool, UK

Background: Oxidised zirconium has the wear properties ofceramic with the breakage resistance of metal. This results in lesswear and is of benefit to young, high demand patients. We reportthe short to mid-term survival of 103 Profix zirconium total kneereplacements performed in patients under 50 years of age at timeof surgery.Methods: Data was collected prospectively and survival analysisundertaken with strict end points used. SF12 and WOMAC scoreswere recorded at pre-operatively and at 3 months, 1 year, 3 yearsand 5 years.Results: The average age at operation was 43.21 years (range 20-50) with a mean follow-up of 8.56 years (range 5-15). No patientsdied with one patient lost to follow up after 7 years review. Themean WOMAC score improved from 53 to 29, and the mean SF12physical component improved from 29 to 36. The five year sur-vivorship for implant related complications was 99.03% (95% CI94.64 – 100.0) due to tibial component aseptic loosening at year 1.Re-operation for any cause at five years including stiffness was94.09% (95% CI 88.69-98.11). Thirty-three patients were at leastten years post-operative at the time of analysis, with no asepticloosening of either component giving 10 year femoral componentsurvival of 100% and all cause revision of 95.4%. The only zirco-nium femoral failure was at 12 years.Conclusions: Our data shows excellent mid-term survivorship ofoxidised zirconium total knee replacements in young, high demandpatients.

0051 – OUTCOMES OF DEBRIDEMENT, ANTIBIOTICS ANDIMPLANT RETENTION (DAIR) PROCEDURE IN ACUTEPERIPROSTHETIC JOINT INFECTION (PJI)Sieh Yen Heng1, Sanjeev Agarwal2

1Cardiff University, Cardiff, UK, 2Cardiff University, Cardiff, UK

Introduction: Periprosthetic joint infection (PJI) is one of the mostserious complications of joint arthroplasty. One treatment optionis debridement, antibiotics and implant retention (DAIR) proce-dure. Our study aims to investigate the efficacy of DAIR in total hip(THA) and total knee (TKA) arthroplasties and the factors thatmight contribute to its success.Materials and method: We conducted a retrospective study on 14patients who underwent DAIR at Llandough Hospital. All patientswere reviewed for at least 12 months. Patient demographics,symptom duration, type of pathogen, medical co-morbidities andthe presence of a history of previous PJI were recorded.

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Results: We recorded an overall success rate of 37.5%. Failureswere associated with history of previous PJI, chronic infection,longer duration of symptoms, diabetes mellitus and chronic renalfailure. Type of pathogen was not associated with failure.Conclusion: Our data demonstrated a low success rate of DAIR. Itis however a worthwhile procedure to help avoid expensive andcomplicated revision surgery in this group of patients.

0053 – FUNCTIONAL OUTCOMES FOR ACL GRAFT PLACEMENTUSING A TRANSTIBIAL OR ANTEROMEDIAL PORTAL TECHNIQUE –A PROSPECTIVE COMPARATIVE STUDYOsman Riaz, Fahad Hossain, Asim SiddiquiCalderdale and Huddersfield NHS Foundation Trust, Huddersfield,West Yorkshire, UKBackground: Contemporary methods of anatomic ACL reconstruc-tion (ACLR) using anteromedial portal (AMP) femoral drilling tech-niques have been advocated due to perceived benefits of betterrotational and translational stability of the knee while proponentsof the longer established transtibial (TT) technique have histori-cally managed good outcomes using the established technique.This study aimed to ascertain if there was any difference in patientreported functional outcomes between the two techniques ofACLR.Methods: Prospectively collected data from a single surgeon seriesof 132 patients subjected to arthroscopic ACLR using either a TT(n= 51) or AMP (n=81) technique was undertaken. Functional out-come measured using the Lysholm score and hop test at 12 monthswas compared between the two techniques using an ANCOVAanalysis after correcting for preoperative scores, age and presenceof concomitant injuries.Results: No difference with respect to age, gender and preopera-tive Lysholm scores between the two groups. The mean pre-oper-ative Lysholm score improved from 50.7 (TT) and 52.4 (AMP) to86.7 and 85.6 respectively. After accounting for all confoundingvariables there was no difference in Lysholm scores and hop test at12 months between the two techniques. The presence of concomi-tant chondral injury (p <0.005) and preoperative Lysholm scores(p<0.0001) were the most important determinants of postopera-tive functionConclusion: There is no difference in functional outcomes whencomparing the TT technique to more anatomic methods of ACLR.Pre injury activity levels and the presence of secondary chondralinjuries are the most significant determinants of functional out-come after ACLR.

0060 – INTRODUCTION OF THE MICROPLASTYINSTRUMENTATION SYETEM FOR UNICOMPARTMENTAL KNEEARTHROPLASTY – IS IT SAFE? DOES IT WORK?Abtin Alvand, Reza Mafi, Hannah Wilson, Cameron Brown, DavidBeard, Nicholas Bottomley, William Jackson, Andrew PriceUniversity of Oxford, Oxford, UK

Background: The ‘Microplasty’ instrumentation for implantation ofthe Oxford unicompartmental knee arthroplasty (UKA) aims tosimplify the surgical technique, reduce outliers, improve compo-nent positioning, and avoid large tibial bone resections. This studyaimed to evaluate component positioning and functional outcomefor the initial series of UKAs performed using this system.Methods: The first 91 medial UKAs performed by two experiencedknee surgeons using this system were compared with a precedingcohort of 84 UKAs performed by the same surgeons using the tra-ditional ‘Phase 3’ instrumentation. Post-operative radiographswere analysed to determine accuracy of component positioningand depth of tibial bone resection. One-year functional outcomewas determined using the Oxford Knee Score (OKS).Results: There were no intra-operative complications in eithercohort. Similar implant positioning was achieved in both cohortsexcept varus/valgus aligment of the femoral component for whichthe Microplasty cohort had significantly lower number of outliers(1% for Microplasty compared with 4% in Phase 3; p<0.05). Tibialplateau resection depth was significantly lower in the Microplastycohort (p<0.05). Mean OKS improvement in the Microplasty cohortwas 18.7 (9.3) compared with a marginally lower improvement of18.2 (10.9) in the Phase 3 cohort (p<0.05).Conclusions: This study demonstrates that experienced UKA sur-geons can safely switch over to the Microplasty instrumentationwithout compromising implant positioning and functional out-come. A further advantage appears to be the more conservativeresection of the tibial plateau using the Microplasty instrumenta-tion. This is likely to benefit trainees and less experienced UKA sur-geons.

0061 – CEMENTLESS OxFORD UNICOMPARTMENTAL KNEEARTHROPLASTY – IS INCOMPLETE SEATING OF THE TIBIALCOMPONENT AT IMPLANTATION A PROBLEM? Hannah Wilson, Abtin Alvand, Reza Mafi, David Beard, NicholasBottomley, William Jackson, Andrew PriceUniversity of Oxford, Oxford, UK

Background: Clinical observation following implantation of theOxford cementless medial unicompartmental knee arthroplasty(UKA) indicates that not all tibial components are fully seated atthe time of surgery. This ‘lift-off’ phenomenon can be seen on ini-tial post-operative radiographs as an elevation of the lateral edgeof the tibial component. The objective of this study was to deter-mine functional and radiographic outcome of incompletely seatedcementless UKAs.Methods: 420 consecutive cementless medial UKAs performed for

osteoarthritis between January 2012-August 2014 were reviewed.Cases with ‘lift-off’ of the tibial component were identified andmatched for age and sex to a control group. Outcome was deter-mined at one year by assessing radiographs, Oxford Knee Score(OKS), re-operation and revision rates.Results: 90 (21.4%) cases demonstrated ‘lift-off’ of the tibial com-ponent. Radiographic assessment revealed that all such cases hadsettled to a stable position by a maximum of one year. There wereno revisions of cases with tibial component ‘lift-off’. There werethree wound infections requiring open washout. Mean OKSimproved from 20.6 (range 0-32) pre-operatively to 41.5 (27-48)post-operatively in the ‘lift-off’ group, and 21.2 (8-38) to 38.6 (12-47) in the control group. There was no significant difference in themean improvement in OKS between the two groups (p=0.274).Conclusion: Incomplete seating of the tibial component with thecurrent Oxford cementless UKA system can be expected in approx-imately 20% of cases. However, this resolves without any interven-tion by a maximum of one year and has no effect on clinical out-come.

0065 – THE MYTH OF SURGICAL STERILITY: BACTERIALCONTAMINATION OF KNEE ARTHROPLASTY DRAPESScott Parker, Thomas Key, Harriet Hughes, Simon WhiteCardiff and Vale NHS Trust, Cardiff, UK

The majority of peri-prosthetic joint infection occurring within 1year of surgery is due to introduction of microbes at the time ofsurgery. Lavage of total knee replacement leaves a pool of fluid onthe surgical drapes. This fluid could be a direct source of woundcontamination via suction catheter tip, gloves or instruments.Twenty patients undergoing total knee arthroplasty had a sampleof drape fluid sent for standard and enrichment culture. The sur-gery took place in a laminar low theatre with scrub teams in togas(Stryker). Normal saline was used as the wash. 20mls fluid wastaken via syringe and transferred to blood culture bottles in theatrepost-operatively.Ten samples (50%) showed bacterial contamination, of these 55%were one organism and 45% polymicrobial. Coagulase negativestaphylococcus (CNS) occurred in 90% positive samples, followedby moraxella (20%) and MSSA (10%). Organisms grown includedskin, nasal, respiratory and environmental pathogens, all but onepreviously documented as causing septic arthritis.The major contaminant found in our study, CNS, is a skin commen-sal. This could be from increasing resistance to skin preparations ora decline in theatre infection control procedures secondary toeither cost or staff behaviour. Fluid collecting in the drapes is asource of potential contamination. All aspects of infection controlprotocol need continual re-assessment. Surgeons cannot assumethat skin preparation and peri-operative antibiotics will eradicatebacterial contamination. It is all our responsibility to implementbest infection control practice in the operating room.

0066 – MORPHINE SULPHATE (SLOW REALEASE) IS NOTEQUIVALENT TO OxYCODONE (MODIFIED RELEASE) INENHANCED RECOVERY KNEE ARTHROPLASTY SURGERYScott Parker, Thomas Key, Abi Ved, Mark Forster, Simon WhiteCardiff and Vale NHS Trust, Cardiff, UK

Enhanced recovery knee arthroplasty (ERAS) has shown improve-ments in patient satisfaction, length of stay and clinical outcomeswith multi-modal analgesia a central component. Oxycontin is theopiate of choice but is often substituted due to perceived cost ben-efits. We are not aware of any papers comparing analgesia in ERASoutcomes.This prospective study looked at consecutive cases for surgeonsundertaking knee arthroplasty using same ERAS pathway. InitiallySurgeon 1 prescribed oxycontin post-operatively. Surgeon 2 pre-scribed morphine sulphate. The initial results showed reduced painscores and length of stay for the oxycontin group. In phase 2 bothsurgeons prescribed oxycontin. Surgeon 1 continued to be moni-tored as a control.Results showed Surgeon 2 had a reduction in pain scores aftermoving to prescribing oxycontin, significant on day 3 post-opera-tively (p 0.02) matching Surgeon 1. On comparison of all 4 groupsthe MST group had higher pain scores, significant on day 3 post-op(p 0.035). The MST group lost 8 days physiotherapy due to paincompared to none for oxycontin groups. There was a reduction inenemas required for constipation. The LOS did not reduce signifi-cantly for Surgeon 2 and remained higher than Surgeon 1.Pain scores were lower for patients treated with oxycontin irre-spective of surgeon. This became significant on day 3 post-opera-tively. The choice of analgesia should not be a secondary consider-ation. During this study period, the length of stay did not changesignificantly suggesting other factors may be more important suchas social factors and time of surgery.

0067 – ExPERIMENTAL WEAR SIMULATION OF AN ALL-POLYMERKNEE IMPLANT UNDER DIFFERENT ENVIRONMENTALCONDITIONSRaelene Cowie1, Adam Briscoe2, John Fisher1, Louise Jennings1

1Institute of Medical and Biological Engineering, University ofLeeds, Leeds, UK, 2Invibio Biomaterials Solutions, Lancashire, UK

Introduction: PEEK Optima shows promise as an alternativearthroplasty bearing material due to its biocompatibility andpotentially low wear rates. The aim of this study was to investigatethe wear of an all-polymer PEEK-on-polyethylene knee replace-ment in a knee simulator under different environmental conditions

and to compare the wear to a conventional metal-on-polyethyleneimplant.Methods: PEEK Optima femorals (Invibio Biomaterials Solutions,UK) and cobalt chrome femorals of similar initial surface topogra-phy and geometry were tested against all-polyethylene tibials in aknee simulator under kinematics to represent a high demandpatient [1]. N=3 of each implant was tested at room temperaturefor 5 million cycles (MC) and n=3 at elevated temperature (33°C)for 10MC using 25% bovine serum as a lubricant. The wear of thetibials was assessed. Results and Discussion: The wear of the implants was low againstboth femoral materials (<5mm3/MC) and testing at elevated tem-perature further lowered wear rate for both material types. Thiswas attributed to test artefacts caused by denaturation of the pro-tein based lubricant. In the more rigorous room temperature test,there was no significant difference in wear rate between the differ-ent femoral materials (p=0.27). Scratching was observed on thePEEK implants however, this did not influence the wear rate whichremained constant over a 10MC test.Conclusion: PEEK Optima shows promise as an alternative bearingmaterial to cobalt chrome in a metal free knee implant. Environ-mental conditions such as lubricant temperature influence thewear of materials.[1] McEwen 2005 JBiomech 38(2):357-365

0068 – THE INFLUENCE OF CALCIUM SULPHATE BONE VOIDFILLERS ON THE WEAR OF TOTAL KNEE REPLACEMENTSRaelene Cowie1, Sean Aiken2, John Cooper2, Louise Jennings1

1Institute of Medical and Biological Engineering, University ofLeeds, Leeds, UK, 2Biocomposites Ltd, Keele, UK

Introduction: Calcium sulphate bone void fillers (CS-BVFs) areincreasingly being used for dead space management in infectedarthroplasty revision surgery. The potential for CS-BVFs to becometrapped in the articulating surface and accelerate wear of totalknee replacements (TKR) is a concern. The aim of this study was toinvestigate the influence of third body damage caused by CS-BVFson the wear of TKRs.Method: To simulate third body damage, 5cc of CS-BVF beads (Bio-composites Ltd) were trapped between the articulating surfaces ofa TKR in a knee joint simulator and run dry for 60cycles beforeadding lubricant to the test and running for 115,000cycles to rep-resent the 6 weeks the BVFs are in the body prior to their resorp-tion. 3 million cycles of wear simulation was then carried outagainst these potentially damaged femorals with the wear of theUHMWPE tibials compared to negative controls (no damage tofemorals) and positive controls (femorals scratched with a dia-mond stylus ) with N=6 for all groups.Results/Discussion: The wear rate of the CS-BVF group was equiv-alent (p>0.05) to that of the negative control. The wear of the pos-itive control group was significantly (p<0.05) higher than the nega-tive control showing damage of sufficient magnitude to thefemoral component can increase wear. Conclusion: This study demonstrated a methodology for simulat-ing third body damage in TKRs and showed that when CS-BVFs areused close to the articulating surfaces of TKRs, they may not influ-ence wear nor be detrimental to the longevity of the implant.

0070 – THE CHALLENGE OF MULTIPLE REVISION SURGERY: APILOT STUDYZohra Shaikh, Jerome Davidson, Emile Schutgens, John Skinner,Jonathan Miles, Richard Carrington, Rob Pollock, Panos Gikas,William Aston, Tim BriggsRoyal National Orthopaedic Hospital, Greater London, UK

Background: Since 2003 the National Joint Registry estimate17,000 revision knee replacements have been performed. A rise inprimary and revision knee arthroplasty has increased the burdenon re-revision surgery; with little known about this cohort ofpatients.Method: Pilot study reviewing 50 multiple revision knee replace-ments (≥2 completed revision cycles), where the final procedurewas performed at our institution (Tertiary centre); between 2003-2014.Results: First revision was performed for ongoing pain in 20(40%)cases, loosening in 17(34%) cases, infection in 6(12%) cases andinstability or stiffness in 7(14%) cases.Second revision: loosening 20(40%), infection 16(32%), ongoingpain 9(18%) and instability/stiffness in 5(10%).Third revision: infection 10(56%), loosening 5(28%), pain 2(11%)and instability/stiffness in 1(5%).Fourth revision: infection 6(60%), loose 2(20%) and instability in2(20%).Fifth revision surgery performed for infection and resulted inamputation.Main reasons for first revision surgery in this multiple revisioncohort were: loosening and pain. However the burden of infectionincreases as the number of revision procedures does (first 12% to60% fourth revision).Multiple revision surgery required use of complex implants (>50%);with 19 constrained, 6 distal femoral replacements, 1 arthrodesis.8 amputations were performed for infection.Conclusion: This initial dataset will form the basis for a compre-hensive review of multiple revision knee replacements performedat our institution. Early data indicates: increasing infection burden,with the need for complex implants in multiple revisions. Wewould advocate treatment of this difficult group to take place inunits with access to infection MDTs and complex on-shelf inventoryfor joint reconstruction.

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0071 – IS THERE A CLINICAL ADVANTAGE IN ROUTINEBANDAGING POST TOTAL KNEE REPLACEMENT?David Gamble, Angela Deakin, Nickolas OhlyOrthopaedic department, Golden Jubilee National Hospital,Glasgow, UK

Firm circumferential bandaging following knee replacement sur-gery has been thought to reduce bleeding into the joint by a tam-ponade effect thereby reducing knee swelling and improving painand early function. The aim of this audit was to ascertain if band-aging had any clinical benefit following knee replacement surgery.Patients undergoing total knee replacement over a three monthperiod from March 2015 under the care of four surgeons wereincluded. Two surgeons used a bandage post-operatively as part oftheir standard care and two did not. Data collected included demo-graphics, inpatient data (length of stay (LOS), haemoglobin drop,day of mobilisation) and six week follow-up data (Oxford KneeScore (OKS, 0 to 48), RoM, wound problems).118 patients were included, 63 in the bandaged and 55 in the nobandage group. The groups had similar demographics (bandagedgiven first): mean age 67 vs 69; female 62% vs 66%; mean BMI 32.7vs 30.9. Clinical outcomes were similar between groups (bandagedgiven first): mean LOS 3.3 vs 3.6 days; mean Hb drop 16.6 vs 16.0g/L; patients mobilised on operative day 59% vs 53%; mean sixweek OKS: 31 vs 30; mean RoM at six weeks 2-96.7° vs 1.8-93.9°;wound problems 5 vs 4 patients.This audit found no clinically relevant difference between the twogroups. We therefore consider that there may be no advantage inroutinely using wool and crepe bandaging post-operatively. Thismay potentially lead to cost savings without clinical risk to thepatient.

0076 – IN VIVO KINEMATICS FOR CUSTOMIZED, PATIENT-SPECIFICVS. TWO GENERATIONS OF TRADITIONAL TKA DURING VARIOUSACTIVITIESIan Zeller1, Adrija Sharma1, Bradley Meccia1, Harold Cates2,William Kurtz3, Mathew Anderle1, Richard Komistek1

1University of Tennessee, Knoxville,TN, USA, 2Tennessee OrthopedicClinic, Knoxville, TN, USA, 3Tennessee Orthopedic Alliance,Nashville, TN, USA

Introduction: The objective of this study is to compare in vivo kine-matics of posterior cruciate retaining (PCR) total knee arthroplasty(TKA) subjects implanted with one of two consecutive designs of atraditional, off-the-shelf (OTS) TKA or a customized-individually-made (CIM) TKA replicating individual femur and tibia geometries.Methods: In vivo kinematics for 65 clinically successful patients, 25CIM-PCR-TKA, 15 OTS-PCR-TKA of a legacy design and 25 OTS-PCR-TKA of a modern design, both currently on the market, wereassessed using mobile fluoroscopy and 2D-3D registration duringweight-bearing deep-knee-bend (DKB), chair-rise, and gait activi-ties.Results: During DKB, CIM patients experienced 3.99mm of femoralrollback vs. 1.17mm (p=0.05 vs CIM) and 2.06mm (p=0.129) for thelegacy and modern design OTS subjects respectively. The CIM-TKA’s demonstrated 6.25° of axial rotation compared to 4.41(p=0.35) and 1.54° (p=0.005) for the legacy and modern designOTS-PCR-TKAs. On average, CIM subjects experienced similarweight-bear ing f lex ion to the modern des ign OTS-TKA(103°vs105°), compared to 95° for legacy design OTS-TKA subjects.Discussion: During DKB, CIM subjects experienced greater lateralcondyle femoral rollback and axial rotation. OTS subjects experi-enced entirely external femoral rotation, different from normalknee motion, whereas CIM subjects experienced a change frominternal to external rotation throughout the DKB, consistent withnormal knee motion. Additionally, patients with a CIM-TKA experi-enced significantly higher rollback than the legacy design andhigher rotation than the modern design.Significance: While kinematic variability was observed betweensubjects in all the groups, the CIM-PCR-TKA subjects demonstratekinematics patterns more closely resembling the normal knee.

0077 – REVISION KNEE ARTHOPLASTY: INFECTION DIAGNOSIS; ISASPIRATION USEFUL?Ahmed Fadulelmola, Akmal Turaev, Ajay Radhakrishnan, Hajime Nagai, Peter KayWWL NHS foundation, Wigan, UK

Introduction: A total of 5,783 knee revision procedures werereported in the UK last year. 1317 (23%) had been revised becauseof infection. The diagnosis and management of infected total kneearthoplasty (TKA) present substantial clinical and financial burden.Routine use of pre-operative knee aspiration is a controversial sub-ject with reported sensitivities from 50%-93%.Objectives: The study was planned to see if there is any justifica-tion to the added cost and logistic for the preoperative knee aspi-ration before revision knee arthoppalsty in cases of suspectedinfectionMethods: Retrospective analysis of data of patients who had revi-sion total knee arthroplasty from Wrightington hospital in 2013and 2014. The data were collected from electronic patient records,case notes and microbiology register. Out of a total of 189 patients,108 patients had pre-operative joint aspiration.Results: 21 (11.1%) patients had positive criteria of prosthetic jointinfection that managed by 4-6 weeks of antibiotics. 29 (15.3%)patients had single positive intra-operative samples. Coagulasenegative staph aureus (CNS) was found to be the commonest causeof infection. Joint aspiration Pre-operatively showed very poor sen-sitivity (23. 07%), but high specificity (98.78%). Its positive predic-

tive value was 85.71% while negative predictive value was 80.20%.Conclusion: 11% of the revisions TKAs were due to infection. Jointaspiration Pre-operatively showed very poor sensitivity (23. 07%),but high specificity (98.78%). Combination of clinical judgment andinvestigations is the main method to guide pre-operative planningfor management of suspected infected TKA.

0080 – EARLY OUTCOMES WITH A NEW PRIMARY TOTAL KNEEARTHROPLASTY (TKA) SYSTEM VS. CONTEMPORARY TKA:INTERIM RESULTS OF TWO WORLDWIDE, MULTI-CENTERPROSPECTIVE STUDIESIvan Brenkel1, William Hamilton3, Stephen Kantor4, MarkClatworthy5, Kimberly Dwyer6, James Lesko6, Sam Himden6,Anthony Gibbon2

1Queen Margaret Hospital, Dunfermline, Fife, UK, 2York TeachingHospital, York, North Yorkshire, UK, 3Anderson Orthopaedic Clinic,Alexandria, Virginia, USA, 4New London Hospital, New London,New Hampshire, USA, 5Auckland Bone & Joint Surgery, Auckland,New Zealand, 6DePuy Synthes Joint Reconstruction, Warsaw,Indiana, USA

The purpose of this study was to evaluate whether a new TKA(NEW-TKA) improved patient reported outcomes vs. currentlyavailable products (CA-TKA).From October 2011-March 2015, 22 investigators prospectivelyenrolled 843 patients implanted with CA-TKA, and betweenNovember 2012 and May 2015, they enrolled 1137 patients withNEW-TKA. Demographics were similar. Operative times, clinicaloutcomes, patient report outcomes (PROMs), and complicationswere compared. Outcomes were covariate adjusted and the first10 NEW-TKA subjects for each surgeon were excluded (211 sub-jects) as learning curve cases.Follow-up at less than 1-year and 1-year for CA-TKA was 815 and724, and for NEW-TKA was 838 and 467. Less than 1 year meanoutcomes were similar for CA-TKA vs. NEW-TKA, except for PKIPstability and satisfaction, both of which were better for NEW-TKA(p=0.008 and p<0.001, respectively). The following mean out-comes were statistically better for NEW-TKA vs. CA-TKA at mini-mum 1 year: KOOS (ADL: 88.9 vs. 85.7, p<0.001; Symptom: 81.9 vs.78.3, p<0.001; Sport/Rec: 62.6 vs. 56.5, p<0.001; Pain: 88.2 vs.84.8, p<0.001; QOL: 73.3 vs. 70.3, p=0.023), WOMAC (Pain: 90.2vs. 87.5, p=0.002; Stiffness: 80.2 vs. 76.8, p=0.003; Function: 88.9vs. 85.7, p<0.001), New OKS (41.7 vs. 40.4, p<0.001), and PKIP(Overall: 74.5 vs. 71.7, p=0.011; Confidence: 8.4 vs. 8.0, p=0.003;Stability: 8.6 vs. 8.3, p=0.011; Satisfaction: 8.2 vs. 7.9, p=0.020). NoPROMs were better for CA-TKA vs. NEW-TKA.NEW-TKA had improved outcomes across a broad range of PROMscompared to currently available TKA implant designs. Longer fol-low-up is ongoing.

0082 – IMPROVED KNEE FUNCTION AND OBJECTIVE KNEE SCOREDISTRIBUTION WITH CUSTOMIZED VS. OFF-THE-SHELF TKAIMPLANTMary O’Connor1, Mark Visk2, Robert Tait3, Francisco Borja4, Alexvan der Ven4, Christopher Cannova5, Edward Rossario6, DavidMack7

1Yale School of Medicine, Connecticut, USA, 2Orthopedic Specialtiesof Spartanburg, South Carolina, USA, 3Orthopedic Institute ofHenderson, Nevada, USA, 4Baptist Hospital of Miami, Florida, USA,5Suburban Hospital, Maryland, USA, 6Saint Lucie Medical Center,Florida, USA, 7North Cypress Hospital, Texas, USA

Introduction: The objective of this study was to compare patient-reported outcomes and blinded functional tests for patientsimplanted with either a Customized, Individually Made TKR (CIM)or Off-The-Shelf (OTS) TKR.Methods: 314 patients with either CIM or OTS TKA were enrolledat 7 centres, with blinded functional evaluation. No significant dif-ferences existed between the groups in terms of (BMI, sex, lateral-ity) except duration since surgery which was shorter for CIM(p<0.01) and age which was younger for the OTS group (p=0.04).Collected data included 2011 KSS, KOOS, 8m Walk (WALK), Timed-Up-and-Go (TUG), Timed-Up-and-Down-Stairs (TUDS) and Aggre-gated Locomotor Function score (ALF=Walk+TUG+TUDS).Results: CIM patients exhibited higher scores versus OTS patientsfor 3/4 KSS domains. In the objective domain patients with CIM-TKR were 1.5 times more likely to experience an excellent/goodoutcome and OTS-TKR were 2.5 times more likely to experience apoor outcome. Analysis of functional data revealed that patientswith CIM-TKR demonstrated faster functional times versus OTS-TKA across multiple functional activities: WALK (CIM 10.6secs vsOTS 11.6secs, p=0.02), TUG (CIM 8.0secs vs OTS 8.6secs, p=0.09)and TUDS (CIM 7.6secs vs OTS 8.6secs; p=0.09). Patients with CIM-TKA exhibited significantly higher ALF scores (CIM 26.3secs vs28.5secs,p=0.04) versus OTS-TKR patients.Discussion: Results from this multi-center study show that patientswith CIM-TKR exhibit improved functional outcomes compared topatients with OTS-TKRs. Specifically, patients with CIM-TKR walkstatistically significantly faster than patients with OTS-TKR. Theprobability to have a poor objective KSS outcome score is 2.5 timesgreater for OTS-TKR compared to CIM-TKR patients.

0083 – THE PIVOT SHIFT TEST MODELLED BY CATASTROPHETHEORY CORRESPONDS TO A CUSP CATASTROPHEShameem Sampath1, Loren Cobb2, Raoul Grasman3

1The Bluespot Knee Clinic, Manchester, UK, 2The University ofColorado, Denver, USA, 3The University of Amsterdam,Amsterdam, The Netherlands

25 parameters have been used to describe the Pivot shift test.These have generally measured antero-posterior translation, accel-eration and rotation. The mathematical relationship betweenthem has not been clarified. However, it is acknowledged that it isthe sudden acceleration of anterior- posterior movement resultingfrom a very small change in flexion during the test that is of clinicalsignificance.A sudden change in state resulting from a small change in a param-eter is characteristic of systems that can be modelled using catas-trophe theory.The aim of this study is to determine whether thepivot shift can be modelled accurately using catastrophe theory,and if so, to determine what subset of catastrophe type best fitsthe measurements.The pivot shift test was performed on 50 ante-rior cruciate ligament (ACL) deficient knees by a single surgeonprior to navigated ACL reconstructionInternal/external rotation,flexion/extension and antero-posterior translation were recordedusing the navigation software. Analysis was done using the Cusppackage for the R statistical systemThe Pivot Shift in the ACL defi-cient knee was successfully modelled as a Cusp Catastrophe. Thefitted model clearly reproduces the sudden acceleration of ante-rior-posterior movement as flexion crosses the singularity, and allestimated parameters were significant at the p < 0.01 level. Basedon this model, there are at least three subcategories of kneebehaviour as revealed by the Pivot shift testModelling as a Cuspcatastrophe may enable true evidence based decisions as to whichstabilisation procedures should be done for “ACL deficient” knees.

0085 – THE JOURNEY BICRUCIATE KNEE REPLACEMENT: DESIGNMODIFICATIONS YIELD ExCELLENT EARLY FUNCTIONAL RESULTS.Lazaros Oikonomidis, Jill Pope, John Davidson, Joanne Banks,Andrew Phillipson, Alasdair SantiniThe Lower Limb Arthroplasty Unit, Royal Liverpool & BroadgreenUniversity NHS Trust, Liverpool, UK

Introduction: The Journey I total knee replacement (bicruciatesubstituting implant) was designed to improve knee kinematicsand patient satisfaction but had a number of recorded complica-tions. With the Journey II modifications were made, includingincreasing the height of cam, which reduced these whilst maintain-ing high function. We analysed the outcomes of the two knees in aconsecutive case series.Patients and methods: 386 knee replacements were performedand available data for 216 Journey I (J1) and 101 Journey II (J2)knees were assessed. Thirty-one patellae were primarily resur-faced in J1 with 62 in J2 and were separately analysed. A compar-ative statistical analysis was undertaken at one year, assessingnumerous factors including pain, functional activity, range ofmovement, stability, and SF-12, WOMAC and Oxford scores.Results: Whilst both replacements demonstrated excellent post-operative function, Journey II performed better than Journey I withfewer complications. In both groups, patella resurfacing improvedpatella-femoral pain (p=0.03) with J2 demonstrating betterimprovement in patella-femoral pain (p=0.02) and rest pain(p=0.03). J2 needed less walking support (p=0.02), had better mus-cle strength (p=0.004), bigger improvement in Oxford score(p=0.02) but not statistically better with regard to flexion improve-ment, SF-12 and WOMAC scores. There were three dislocations ofthe cam in J1 with none in J2. Stiffness requiring intervention andthe requirement for secondary patella resurfacing was reduced inJ2.Conclusions: Journey II has better short term clinical outcomescompared to Journey I with eradication of dislocation and reduc-tion in other complications. Best results are achieved with patellaresurfacing.

0086 – LONG-TERM US OF UNLOADER KNEE BRACE CAN REDUCETHE NEED FOR ARTHROPLASTY AND IMPROVE RETURN TOWORKPaul Y F Lee3, Emerald Storey2, Vicky Smith1, Haf Widdet1, AmitChandratreya1

1Princess of Wales Hospital, Bridgend, UK, 2Cardiff University,Cardiff, UK, 3WelshBone, Wales, UK

Offloading Knee Braces can provide good short-term pain relief forsome patients with unicompartmental osteoarthritis. Their cost isrelatively small compared to surgical interventions. However, therehas not been any study reporting their long-term use. Prospectivedata was collected for 60 consecutive patients between 2007-2009, after conservative management they were offered anoffloading brace (Unloader, Ossur) while waiting for surgery.Patient reported outcome measures and radiological assessmentswere performed yearly and the primary end point was surgicalintervention. All patients were reviewed; the mean follow up was6.5 years, mean age 51. At final follow up, 22 out of 60 patients didnot require surgery; there was no significant radiological progres-sion of disease. 68% of patients were able to return to work or pre-vious level of activity while using the offloading brace. Multiregres-sion analysis suggests that body weight, social economical status,gender did not collate with the surgical interventions. Incorrect fit-ting is the most common problem associated with the use of theknee brace and is collated with surgical intervention. UnloaderBraces can reduce the number of patient undergoes knee replace-

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ment and promote patients’ return to work prior to surgery.Patients tolerating the use of brace for more than 2 years wereunlikely to require surgical intervention. A specialist nurse led clinicis recommended at 3 month to ensure brace fitting correctly,which could further reduce the rate of conversion to surgery; Wenow run a Nurse –Led Brace fitting clinic, which is a first and onlyfor Wales.

0090 – 3D PATIENT IMAGING HELPS UNDERSTAND WEARPATTERNS IN RETRIEVED KNEE REPLACEMENTSJohann Henckel1, Harry Hothi1, Ariana Cerquiglini1, Shiraz Sabah1,Michael Hirschmann2, John Skinner1, Alister Hart1

1Institute of Orthopaedics and Musculoskeletal Science, Stanmore,UK, 2Kantonsspital Baselland, Bruderholz, Switzerland

Introduction: Malalignment contributes to 2.8% of knee revisionsyet malpositioning of the knee implant can also lead to pain inpatients. The current study considers the use of 3D imaging of theimplant pre-revision and correlates rotation of the implant withwear in retrieved polyethylene inserts of the knee replacements.Methods: Patients with painful knee replacements were investi-gated using a diagnostic algorithm which included 3D computedtomography (CT) images. Measurements of internal/external rota-tion of both the femoral and tibial implants were made. The tibialpolyethylene inserts that were revised (n=10) were macroscopi-cally examined. Reason for revision in these instances includedmalpositioning (x3), instability (x4) and loosening (x3).Results: 6 of the revised components showed combined internalrotation (1 to 10°) and 4 were externally rotated (1-8°). In 6 cases,the direction of rotation of the tibial component was also the com-bined rotation. Five of the implants showed large rotation (greaterthan 9°) of either the tibial or femoral component. In all instances,increased external rotation was accompanied with increased lat-eral wear and internal rotation with medial wear.Discussion: Combining retrieval analysis with high quality imagingcan offer clues as to the factors leading to revision. The currentstudy suggests that rotation can lead to differences in the wear ofthe condyles with external rotation leading to greater levels of lat-eral wear. Malpositioning may, therefore, contribute to other rea-sons for revision and be a greater problem than initially assumed.

0095 – MUCOID DEGENERATION OF THE ANTERIOR CRUCIATELIGAMENT (ACL): FURTHER CLINICAL AND RADIOLOGICALCHARACTERISATION OF THE ‘CELERY STALK’ ACLCharis Demetriou, Jaimie Roberts, Andrew Hotchen, Dennis Edwards, Joel MeltonCambridge University Hospitals, Cambridge, UK

Mucoid deposition within the ACL is an uncommon cause of kneepain causing characteristic striation of the ligament (resemblingcelery stalk). The authors set out to further characterise the condi-tion and understand the natural history.A PACS system query from a consecutive series of MRI scans of theknee over an 18mnth period generated a list of 408 scans contain-ing search terms relevant to mucoid degeneration of ACL. All scanswere reviewed and 31 cases of mucoid degeneration within theACL were identified. The case notes were retrieved and analysed inan attempt to characterise the clinical, radiologic and surgical find-ings.Clinical presentation confirmed consistent features of occasionallysevere, dull aching pain which was often experienced posteriorly inthe knee (60%) with pain/limitation of deep flexion (58%). Somecomplained of limitation of extension (19%). Instability was lesscommon (4/31). Mechanical features were unusual. There was ahistory of trauma in 5/31. The radiological findings on MRI scan(T2/PDFS) demonstrated str iated mucoid s ignal from athickened/engorged ACL giving a classic ‘Celery stalk’ appearancewith an AP ACL dimension averaging 16.5mm (11.6-21.6). Thenotch width index was 0.265 (average range 0.23-0.31). There wasevidence of degenerate change in 17/31. All 7 patients treatedwith arthroscopic partial debridement had complete resolution ofpain. 2/7 patients required delayed reconstruction of ACL due toinstability.The condition has characteristic recognisable clinical and radiolog-ical features consistent with a notch impingement syndrome. Thepain responds well to arthroscopic debridement. Simultaneousreconstruction of ACL should be considered.

0096 – HIGH RATES OF COMPLICATION IN NCB- LOCKING PLATEFIxATION OF PERIPROSTHETIC DISTAL FEMUR FRACTURES INELDERLY POPULATION WITH TOTAL KNEE ARTHROPLASTIES ‘ARETROSPECTIVE CONSECUTIVE CASE SERIES STUDY’Mahmoud Rahuna, Amin Kheiran, Urjit ChatterjiNHS, Leicester, UK

Background: The reduction and fixation of periperosthetic distalfemur fractures is a challenging surgical procedure particularly in afrail and aged population. Locking plates have emerged as one ofthe treatment options.Patients and methods: 21 patients, aged 68 and older withfemoral periprosthetic TKA fractures that had NCB plate fixationbetween July 2012 and February 2015,were reviewed. Fracturemorphologies were closed Su type I-III with well fixed prosthesis.Data collection included mortality rate, ASA grade, time to union,length of hospital stay, weight bearing status and complications.Results: The mean time to radiological union was 141 days; rangewas 93- 268. Two patients had died in the post-operative period

secondary to hospital acquired pneumonia. Implant related com-plications occurred in 4 patients leading to surgical revision. Twowere revised to distal femoral replacements due to non-union. Theincidence of deep wound infections necessitating washout was13%. The mean time to discharge was 43 days; range 28-64. Totalweight-bearing was achieved at a mean of 4.7 months (range, 2.4-11 months). The majority of complications occurred in those withASA III or IV patients.Conclusion: There is a significant incidence of morbidity, mortalityand reoperation in this group of patients. The time to dischargefrom hospital and to reach full weight bearing status and union canbe protracted. The large majority of fractures do eventually unite.

0099 – RETURN TO EMPLOYMENT FOLLOWING MEDIALUNICOMPARTMENTAL KNEE REPLACEMENTSheba Basheer, Shankar Thiagarajah, Fazal AliChesterfield Royal Hospital, Chesterfield, North Derbyshire, UK

Knee osteoarthrosis (OA) in patients of working age may lead toloss of employment and diminished quality of life. Medial unicom-partmental knee arthroplasty (UKA) has become popular as atreatment for symptomatic medial OA. Studies have demonstratedthat UKA is less invasive than total knee arthroplasty and results inan improved range of knee motion. However there is minimal datareviewing the impact of UKA on return to employment and type ofwork performed.Our study aims to establish the effect of medial UKA on employ-ment status of patients in a consecutive single surgeon series.We identified patients under the age of 60 years undergoingmedial UKA by the senior author over a 27 month period. A postalquestionnaire regarding occupational status and function was sentto patients postoperatively.We identified 37 patients who underwent 39 cemented medialUKA. Six were excluded as they were not contactable for follow-up.Median age was 51 years (range: 43 – 57 years). Twenty-fivepatients were employed prior to surgery, and post-operatively 22(88%) returned to work.The majority (86%) of patients who returned to work did so within6 months of surgery. We found no association between type ofpre-operative occupation and likelihood of return to employment;however 18% of patients required a change in intensity of work inorder to facilitate this. Neither gender nor age at surgery was asso-ciated with likelihood of return to employment. None of thepatients who were unemployed prior to medial UKA were able togain employment following surgery.

0107 – DOES THE GRADE OF SURGEON FOR PRIMARY TOTALKNEE REPLACEMENT HAVE AN EFFECT ON THE SUBSEQUENTREVISION?Mark Forster, Sangeev Agrawal, Adel Ghandour, Khitish Mohanty,Rhidian Morgan-Jones, Angus Robertson, Simon White, RhysWilliams, Chris WilsonCardiff & Vale University Health Board, Cardiff, UK

There is a learning curve to total knee replacement (TKR) but thereis also the need to train the next generation of knee surgeons. Theaim of this study was to assess the impact of surgeon grade of theprimary TKR on the subsequent revision TKR.All revisions linked by the NJR to a primary knee replacement per-formed in our unit were assessed by at least 2 Consultant Knee Sur-geons. Case notes and radiographs were reviewed from before theprimary knee replacement until the latest follow up.For the purposes of this study only cemented TKRs were included.Partial replacements, revisions performed elsewhere, secondarypatella resurfacings, insert changes and revision procedures whereno implants were removed were excluded.The study group included 68 cemented TKRs. Overall, 21/68 (31%)were felt to be potentially avoidable by the peer review. The pri-mary TKR was performed by a consultant in 38 cases with 6/38(16%) felt to be potentially avoidable. This increased to 40% (2/5)if the case was performed by a middle grade (Specialist Registrar orAssociate Specialist) supervised by a scrubbed Consultant and 61%(11/18) if the case was performed by an unsupervised middlegrade. No operation notes relating to the primary TKR were avail-able in 7 cases.Given these findings we feel that middle grade surgeons shouldnot be left to perform TKR without consultant supervision. We con-tinue to actively train our middle grade surgeons but feel that closesupervision is essential to try to prevent avoidable issues.

0109 – DOES REVISION KNEE REPLACEMENT REALLY WORK? ANANALYSIS OF OxFORD KNEE SCORESSarang Kasture, Walid Elnahal, Mo Hassaballa, James Murray,James Robinson, Andrew PorteousAvon Orthopaedic centre, Southmead hospital, Bristol, UK

Background and Aim: Revision knee arthroplasty patients’ out-come is reported in the literature to be inferior to that of primarysurgery.Minimum clinically important difference (MCID) for Oxford kneescore (OKS) is reported between 3 and 5 points improvement while11 points change is associated with high patients’ satisfaction.This study aims to investigate subjective outcome improvementfrom preoperative to one year following revision knee arthroplastyusing OKS.Patients and Methods: Prospectively collected data from patientsthat underwent revision knee arthroplasty from January 2009 tillAugust 2014 was analysed. Absolute scores and change in (OKS)

from preoperative to one year postoperatively were assessed.Results: 149 patients were included in the study. Reasons for revi-sion: Aseptic loosening (35.6%), Infection (18.9%), Instability(15.5%), Malalignment (14.8%), Pain and stiffness (4%), peri-pros-thetic facture (2%) and progression of OA (9%).The mean pre-operative Oxford score was 14 (+/- 6.9) and postop-eratively 29 at one year. The mean improvement of OKS was at 1-year was 15 (+/-11.1). 66 % of patients showed ≥11 pointsimprovement score while 83% showed improvement greater thanthe MCID. Aseptic loosening and arthritis progression patientsshowed the best absolute score at 31 and the best improvement of18 points. 25 patients were undergoing second or greater revisionand only 48% improved ≥11 points.Conclusion: Revision knee arthroplasty provides a clinically impor-tant improvement for 83% of patients. Improvement in OKS wasgreatest in first revisions. Most patients (66%) obtained a greaterthan 11 point improvement in OKS compatible with high patientsatisfaction.

0110 – ANTERIOR CRUCIATE LIGAMENT (ACL) REPAIR –RATIONALE, TECHNIQUE AND EARLY RESULTSSam Yasen, Melissa Mahoney, Duncan Avis, Bhushan Sabnis, Ed Britton, Adrian WilsonHampshire Hospitals NHS Trust, Basingstoke, UK

Introduction: ACL repair as opposed to reconstruction has under-gone a recent resurgence in interest with advances in imaging,arthroscopic techniques and patient rehabilitation. Patient selec-tion is important – the ideal patient being one that has an acuteinjury (<6 weeks) and good quality ACL remnant with detachmentfrom its femoral insertion.Technique: The ACL remnant is mobilised with minimal tissuedebridement. If it is of sufficient quality, its proximal end is lassoedwith a locking suture. The femoral socket position is identified anda 2.5mm tunnel is made through the lateral femoral condyle. Thisis used to retrieve the suture attached to the ACL remnant andapproximate it to its insertion point. A further 2.5mm tibial tunnelis made exiting the ACL tibial footprint which allows internal brac-ing using a 2.5mm FibreTape alongside the repaired ACL. The rem-nant is tensioned using a suspensory fixation tightrope against thelateral femoral cortex, and the FibreTape is secured and tensionedat the tibial end using a 4.75mm SwiveLock device. Post-operativerehabilitation is no different to ACL reconstruction.Results: Fourteen ACL repairs have been performed to date with>6 months follow up. Preoperative KOOS averaged 48, Lysholm 47,Tegner 1.9; improving to 73, 73 and 3.3 at 6 months, and 87, 89,5.3 at 1 year, which are similar to outcomes recorded in our stan-dard ACL reconstruction patients. Range of movement maintained.No complications to date.Conclusion: Early results suggest no detriment to outcome withACL repair in select individuals compared to ACL reconstruction.

0114 – THROMBOEMBOLISM EVENTS FOLLOWING ANTERIORCRUCIATE LIGAMENT RECONSTRUCTION: IS CHEMICALPROPHYLAxIS REALLY NOT NEEDED?Adnan Saithna, Robert Jordan, Edward GeeSouthport & Ormskirk NHS Trust, Merseyside, UK

Introduction: Recent publications report a surprisingly high venousthromboembolism (VTE) rate after anterior cruciate ligament (ACL)reconstruction. This study aims to investigate whether the rate isdifferent if pharmacological prophylaxis is used and to also to doc-ument the rate of associated adverse events.Methods: A systematic review of the literature was conducted(protocol registered with PROSPERO database). Data was pooledfrom primary research articles reporting VTE rates in patientsundergoing ACL reconstruction. Studies were evaluated using theGRADE critical appraisal tool.Results: Eight studies were identified for inclusion (n=996). Allexcept one (randomized trial) scored GRADE 2C indicating signifi-cant weaknesses. 85.9% of the pooled population received nothromboprophylaxis peri-operatively, whilst the rest receivedenoxaparin. The incidence of asymptomatic DVT was higher inthose not receiving thromboprophylaxis (9.7%) compared to thosedid (2.9%). A major limitation was that the rate of symptomaticDVT was not explicitly reported by all authors (4% following nothromboprophylaxis in two studies, unknown rate with chemicalprophylaxis). No statistically significant increased risk of bleedingcomplications was seen when prophylaxis was used (p=0.595).Conclusions: Recent literature suggests a much higher rate of VTEthan previously reported in large observational series. The existingevidence all has significant limitations which prevent a clear under-standing of the rate of symptomatic VTE with and without chemi-cal thromboprophylaxis. However, the only randomized controlledstudy supports a role for it and therefore there is clearly a need forfurther high quality research in order to provide a robust scientificbasis for clinical guidelines.

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0116 – USING STANDARD OPERATING PROCEDURES TO IMPROVEPATIENT SATISFACTION AND SUCCESS OF DAY CASEUNICOMPARTMENTAL KNEE REPLACEMENTJakob Van Oldenrijk1, Julian Foote1, William Jackson1, AbtinAlvand2, Saket Tibrewal1, Paul Monk2, Nicholas Bottomley1, RachelBarr1, Hannah Rivers1, Victoria Millar1, Hannah Wilson1, DavidBeard2, Andrew Price2

1Nuffield Orthopaedic Centre, Oxford University Hospitals, NHSFoundation Trust, Oxford, Oxfordshire, UK, 2University of Oxford,Oxford, Oxfordshire, UK

Background: Standard Operating Procedures (SOPs) may help toovercome some of the challenges during the implementation ofDay Case Unicompartmental Knee Replacement (DC-UKR). Weaimed to assess patient experience after DC-UKR and compliancewith SOPs and their effect on the success of DC-UKR.Methods: 30 patients, 9 men and 9 women (mean 67 years (51-82)), were selected for this pilot study that evaluated DC-UKR. 21received a medial UKR, 8 patients a lateral UKR and 1 patient atotal knee replacement (TKR). SOPs were defined for every step ofthe clinical process. The primary outcome was patient experiencemeasured with The Surgical Satisfaction Questionnaire (SSQ-8) andthe Outcomes and Experiences Questionnaire (OEQ) at 3 monthsfollow-up. In addition compliance with these SOPs, along withlength of stay, readmission rates and reasons for day case failurewere assessed.Results: Of the 30 patients, 18 (60%) were successfully dischargedon the day of surgery. One day case patient was readmitted 2 dayspost-operatively due to pain. The 12 failed day case patients stayedfor a mean duration of 2.1 days (1-5).Out of all day case SSQ responses, 86% were (highly) satisfied,although 3% were unsatisfied. Patients rating of their experiencewere excellent (82%), very good (12%) or fair (6%). 87% of patientswere discharged on the day of surgery when all SOPs were fol-lowed and 33% where they were not.Conclusion: Using SOPs we were able to complete successfullyday-case UKR in 60% of patients selected with high levels of satis-faction.

0117 – HYPERExTENSION INJURIES OF THE KNEE: DO PATTERNSOF BONE BRUISING CORRELATE WITH INJURY SEVERITY?Adam Ali, Janani Kumaraguru, Vivek Gulati, Benjamin Roberton,Charles GibbonsChelsea and Westminster Hospital, London, UK

Aim: to correlate patterns of bony injury with damage to soft tis-sue structures following knee hyperextension.Methods: Retrospective search of Picture Archiving and Communi-cation System (PACS) for all knee MRIs and associated radiographswith a report containing the word ‘hyperextension’, from June2008- April 2015. Clinical details were obtained from local data-bases.Results: We identified 30 patients with an MRI following kneehyperextension (19M, 11F; median age= 30 years, time from injuryto MRI= 27 days). The most common abnormality was anterome-dial tibial plateau (MTP) oedema (14 knees)- 3 of these had anassociated tibial plateau fracture; in 8 cases there was concomitantoedema on the anteromedial femoral condyle (MFC). Of 10 kneeswith MFC oedema, 8 displayed a sign on the lateral radiograph (the‘double sulcus’ sign) that has not been previously described. 11 outof 30 knees had ACL injury. Of 8 knees with MFC impaction visibleon the plain radiograph, 5 had ACL injury with 2 having concomi-tant PCL injury. 11 out of 30 knees had anterolateral tibial plateau(LTP) oedema; 8 out of 10 with PCL injury had LTP oedema. Signif-icant injury to the posterolateral corner was associated with ‘kiss-ing’ MTP/MFC oedema. Meniscal injury was not associated withspecific patterns of bony oedema.Conclusions: The most common pattern of bone bruising followingknee hyperextension is MTP/MFC oedema. LTP oedema is associ-ated with PCL injury. 8 out of 10 patients with MFC oedema dis-played the radiographic ‘double sulcus’ sign, and 5 of these 8 hadACL injury.

0118 – MINIMALLY INVASIVE SURGERY (MIS) TOTAL KNEEREPLACEMENT, 5 YEARS FOLLOW UPOlivia Unwin2, Mo Hassaballa1, James Murray1, Andrew Porteous1

1Avon orthopaedic centre, Southmead hospital, Bristol, UK,2Faculty of Medicine, Bristol University, Bristol, UK

Introduction and Aim: Minimally invasive surgery for total kneearthroplasty has been under debate in the literature for someyears. This study reports the results of medium term follow up(mean 6 years) from a prospective randomised control trail com-paring MIS-TKA with the standard approach.Patients and Methods: Using standard knee score questionnaires(OKS, WOMAC, AKSS), we collected patient reported outcomemeasures (PROMs) regarding pain and function by post. 65patients completed the questionnaires (32 in MIS group, 33 in con-trol group).Results: There was no significant difference between MIS and con-trol TKA groups for absolute scores or change in scores from pre-operative to medium term follow up in all three PROMs. Mean MISand control group improvement was: AKSS 53.13 and 51.27(p=0.7644), OKS 15.38 and 16.24 (no p=0.2341) or WOMAC 15.56and 15.60 (p=0.9900) respectively. The Oxford and WOMAC scoresfor MIS group were 34.9 and 22.9 while it was 33.1 and 23.9 for thecontrol group. Revisions between groups; there were 2 revisions inthe MIS-TKA group and 1 in the control group.Discussion: Our study showed no significant difference between

MIS-TKA and standard techniques according to patients reportedoutcome in medium term follow up.

0121 – SAME DAY MOBILISATION IS ASSOCIATED WITH REDUCEDLENGTH OF STAY IN A PRIMARY ARTHROPLASTY ENHANCEDRECOVERY PROGRAMMEHarold Akehurst, Alex Vaughan, Hari Arunachalam, Bessie Ayres,Cathryn Eitel, Madhu RaoWestern Sussex Hospitals NHS Trust, Western Sussex, UK

Introduction: Early mobilisation is often incorporated intoEnhanced Recovery Programmes (ERP). The ability of ERP toreduce length of stay improving patient experience and cost-effi-ciency has been demonstrated, but the impact of same-day mobil-isation remains to be conclusively shown. Significant implicationsmay include planning of services and resources.Methods: Data were prospectively collected for all patientsenrolled into our ERP between January 2013 and April 2015. Multi-Disciplinary Teams were involved in preoperative counselling, peri-operative management, early mobilisation and safe discharge.Day of mobilisation was condensed into categories, whose charac-teristics were compared using suitable tests of means and associa-tion. The relationship between day of mobilisation and length ofstay was analysed using Kaplan-Meier plotting and the log-ranktest.Results: 2705 patients participated in our ERP (1316 THR, 1389TKR). Day of mobilisation was positively skewed (range 0-6 days,median 1), with 666 (24.6%), 1837 (67.9%) and 154 (5.7%) patientsmobilising day 0, 1, and 2 or more respectively. Significant differ-ences in age (p = 0.003) and operation (p < 0.0001) were foundbetween these groups.Length of stay was also positively skewed (range 1-57 days, median4). Median length of stay for patients mobilising on days 0, 1, and2 or more were 2, 3 and 4 days respectively (p < 0.0001).Discussion: This analysis of large cohort of primary arthroplastypatients provides strong evidence of the association between earlymobilisation and early discharge. Patient experience and cost-effi-ciency might be maximised by incorporating same-day mobilisa-tion into enhanced recovery programmes.

0123 – A MATCHED-PAIR ANALYSIS OF SYSTEMIC VSCOMBINATION REGIMEN OF TRANExAMIC ACIDADMINISTRATION IN TOTAL KNEE ARTHROPLASTY.Munier Hossain, Susan Gardner, Safdar Ralston, Robert HarveyWirral University Teaching hospital NHS foundation trust, Wirral,UK

Objective: Tranexamic acid (TXA) has been used to reduce bloodloss and transfusion requirements in total knee arthroplasty (TKA).We have used systemic TXA (SP) after TKA. Following evidencebased review we implemented a combined protocol (CP) of sys-temic and topical TXA administration. The objective of this studywas to undertake a prospective matched-pair analysis of the CPagainst SP.Methods: Between January –June 2015 patients undergoing TKAhad systemic 1gm of TXA (SP) on induction. From August onwardsall patients underwent a combined protocol (CP) of 1gm of sys-temic TXA on induction and 1gm of topical TXA injected after clo-sure of the capsule. All patients underwent TKA under Total Intra-venous Anaesthesia (TIVA) without a tourniquet and post-opera-tively had a combination of mechanical and chemical anti-throm-botic prophylaxis. We prospectively collected data on patientdemographics, surgical details, pre and post op haemoglobin (Hb),length of stay (LOS), transfusion requirements, wound complica-tions, symptomatic thromboembolism and re-admission.Results: 35 consecutive patients were included in each arm. Thegroups were similar in their pre-operative characteristics. No onerequired blood transfusion and there was no case of symptomaticthromboembolism. There was no major wound complication andno difference in blood loss or LOS.Variables SP CPAge 71 (48-88) 68 (50-88)Gender 32 Female 28 FemaleBMI 31 (23-41) 30 (23-43)ASA II IIPre-op Hb 133 (88-166) 137 (103-169)Post-op Hb 109 (86-132) 113 (85-145)LOS 4 (2-8) 3.6 (2-11)Conclusion: Combined protocol proved to be safe and effective inTKA.

0128 – IN AN ERA OF ADVANCED TECHNOLOGY DO PATIENTSSTILL WANT TO ATTEND OUTPATIENT CLINICS ?Marius Calciu, Mark ForsterCardiff and Vale University Hospitals, cardiff, UK

Background: In today’s NHS, the pressure to accommodate newreferral/assessments and follow-up reviews is increasing. Anymodality to offload the number of clinical appointments safely andprofessionally would enable a significant improvement in the qual-ity and quantity of outpatient clinics. The technology creates newpossibilities of communication through telephone and emails. Thisstudy looks at the patient’s preference to opt between the tradi-tional clinical appointment and virtual clinic.Methods: 95 patients attending knee clinic at one site were askedto complete a questionnaire comprised of 11 items focused onidentifying their attitudes towards the implementation of virtualclinic as a modality to streamline clinics in the future. The study

looked at the patient’s possibility to access a phone or e-mail, theirpreference to be contacted and assessed over the phone orthrough e-mail or to attend a face-to-face consultation.Results: Out of 95 participants in the study, 50 were women and 45men.The age range was 17 to 85 years (mean age 56.5). 67% regularlyaccess an e-mail and 89% have a phone. 92% agreed to be con-tacted by phone, with 58% at any time. 58% accepted to be con-tacted via e-mail but only 17% wanted an email consultation. 13%of the patients consider that the consultation could be done byphone but only 7% would prefer assessment by phone.Conclusion: Despite the easy access to modern communicationmethods the large majority of the patients still prefer face to faceappointments, with no difference between age group patients.

0130 – POST-OPERATIVE CONTROL OF WEDGE DISTANCE USINGA DISTRACTION NAIL INCREASES SURGICAL ACCURACY IN HIGHTIBIAL OSTEOTOMYPregash Ellapparadja, Lewis C Bennett, David W Elson, Matt J DawsonCumberland Infirmary, Carlisle, UK

Medial Opening Wedge High Tibial Osteotomy (MOW HTO) is anestablished treatment of mono-compartmental osteoarthritis inyounger active patients. Success is dependent upon correctionaccuracy, with improved longevity when alignment targets areachieved. Significant under-correction or over-correction may leadto poor clinical outcomes. Pre-op planning is mandatory but doesnot necessarily translate into accurate execution. Currentlyosseous wedge distances are fixed on table with devices which donot allow post-operative correction. So the achieved correctionmust be accepted or revised. A novel nailing device which containsa magnet controlled motor, facilitates post-op distraction and hasbeen engineered for trial application to MOW HTO. This prospec-tive case series includes 11 cases undergoing MOW HTO, Mean agewas 52.5 (Range 45-60), ten males, one female. Long leg alignmentradiographs were performed weight bearing, with patellae centredforward and a calibration marker ball. Bespoke corrections wereplanned using Minacci technique and PACS digital annotation.Nails were inserted through a medial para-patellar approach sub-sequently bi-planar osteotomy was performed through a separateoblique incision. Distraction was initiated after a latent period of 5-10 days with follow up at 2, 4, 6 and 12 weeks. The distraction wasadjusted towards the intended target over the initial 3 visits. Allcases in this series achieved corrections within 2.5% of theintended target. This novel device allows post-operative adjust-ment and subsequently increases surgical accuracy in high tibialosteotomy

0137 – ExTENSOR ACTIVATION TEST (EAT): A NEW CLINICAL TESTFOR QUADRICEPS TENDON RUPTUREMahbub Alam, Alexi Iliadis, Michael Goldring, Saadallah MortadaBHR University Hospitals NHS Trust, London, UK

Introduction: Quadriceps tendon ruptures are common. Howevermisdiagnosis or diagnostic delay occurs in 37-69% of cases.Objectives: To describe and validate the Extensor Activation Test(EAT) for the assessment of the integrity of the quadriceps tendon.Methods: The EAT has 3 parts. 1) With the knee extended andrelaxed quadriceps relaxed, the patella is mo-bile. 2) On quadri-ceps contraction the patella visibly mobilises into the femoralnotch. 3) With con-traction maintained the patella mobility isrechecked. Unlike in normal quadriceps, with complete quadricepsrupture the patella does not move into the groove and remainsmobile.The investigation was performed by the four authors. There were10 subjects (20 knees). 4 patients had unilateral quadriceps rup-ture. 6 patients had an unrelated unilateral knee injury with anintact extensor mechanism. Each author examined the 10 patientsusing the EAT without examining for straight leg raising or palpat-ing for a gap. After 60 minutes the patients were moved aroundand the process repeated with the examiners in reverse order.Diagnosis were confirmed by MRI and sur-gery.Results: All 4 investigators correctly identified the 4 quadricepsruptures on both occasions giving a sensitivi-ty of 100%. 1 investi-gator thought an intact quadriceps tendon was EAT positive on oneoccasion in a patient with recurrent patella dislocation of thatknee, otherwise all knees with an intact quadriceps tendon werereported as being EAT negative, giving a specificity of 97%.Conclusion: EAT is a simple and quick bedside diagnostic clinicaltest with a high sensitivity and specificity.

0139 – HIGH TIBIAL OSTEOTOMY IN THE TREATMENT OF KNEEOSTEOARTHRITIS IN YOUNG WORKING ADULTSCezary Kocialkowski, Alex Dodds, Harminder GosalCheltenham General Hospital, Cheltenham, UK

Introduction: Surgical treatment options for isolated medial com-partment knee osteoarthritis include high tibial osteotomy, uni-compartmental knee replacement and total knee replacement.High tibial osteotomy may help to delay the need for joint replace-ment surgery and to enable patients to continue to lead an activelifestyle.Methods: We assessed the outcomes of 41 patients who under-went medial opening wedge high tibial osteotomy for the treat-ment of medial compartment knee osteoarthritis, in our depart-ment, over a period of 8 years. Patients were sent an employmentquestionnaire including the Workplace Activity Limitation Scale to

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determine work related outcomes as well as the EQ-5D quality oflife questionnaire.Results: The average age of patients was 44 years, 85% of patientswere male and 81% were ASA grade 1. Prior to surgery 92% ofpatients were in full time employment and all of these patientsreturned to full time employment after surgery. 46% of patientswere involved in manual labour and the average time taken forpatients to return to work was 2.8 months. The average WALSscore was 5.6 and the average EQ-5D score was 0.8. The averagevisual analogue scale for overall quality of life 77.Conclusions: Medial opening wedge high tibial osteotomy is a reli-able treatment option for young working adults with medial com-partment knee osteoarthritis. Our results indicate that the vastmajority of patients are able to to return to regular employment,even if in manual labour, without significant impairment in theirworking ability or overall quality of life.

0140 – USING PATIENT SPECIFIC INSTRUMENTATION TOIMPROVE ACCURACY IN LATERAL UNICOMPARTMENTAL KNEEREPLACEMENT BY NOVICE SURGEONSJustin Ng, Simon Newman, Susannah Clarke, Simon Harris, Justin CobbImperial College London, London, UK

Introduction: Lateral unicompartmental knee arthroplasty (LUKA)is a valuable procedure for patients with isolated lateral compart-ment disease. However the procedure’s technically demandingnature have limited its practice.A potential means of making the LUKA more attractive to surgeonsis patient specific instrumentation (PSI). This involves the use ofcustomised cutting guides, which should theoretically simplify theLUKA and allow inexperienced surgeons to more accurately followa preoperative plan.Methods: 12 novice LUKA surgeons performed two LUKAs each onsynthetic dry bone models. They were instructed to create theirresections according to a preoperative plan and each surgeon com-pleted the procedure once with conventional equipment and oncewith PSI. 3D representations of the achieved LUKAs were then cre-ated to allow a comparison of plan adherence between the twosets of instrumentation. This was measured in terms of compoundrotational and translational error, as well as the degree of displace-ment across each of the six degrees of freedom.Results: PSI led to lower mean compound rotational and transla-tional errors in both the femoral and tibial LUKA implants. Howeveronly the improvement in compound rotational error of the femoralimplant achieved statistical significance (p = 0.004).PSI was also associated with visibly narrower standard deviationsin implant displacement across the six degrees of freedom, sug-gesting a greater precision than conventional instrumentation.Conclusions: PSI appears to improve the ability of novice LUKA sur-geons to adhere to a preoperative plan.

0141 – PREDICTING MORTALITY RATES IN DISTAL FEMORALREPLACEMENTS FOR FRACTURE AND PERIPROSTHETICFRACTURE IN THE ELDERLYMark Dahill, Alister Trezies, Neil Bradbury, Harvey SandhuRoyal United Hospital, Bath, UK

Non-reconstructable distal femoral fractures pose significant man-agement dilemmas. Factors predicting outcome in this patientpopulation are not reported in the literature. Mortality rates of 22to 82% are quoted in small series with varying follow up times, rais-ing the question of clinical and cost effectiveness.A series of ten consecutive patients from September 2012 to April2015 were reviewed. Five cases of periprosthetic fracture and 5cases of unreconstructable fracture were treated with distalfemoral replacement. Mean age was 81 years and one-year mor-tality was 50%. Time to death ranged from 0 to 338 days, with 3patients dying in the first month. Treatment was in a busy traumasetting with a seven day orthogeriatric service.Mean operative time was 104 minutes, with all operations per-formed by one of two specialist knee consultants. No single pre-operative biochemical or physiological parameter correlated withmortality outcome. All patients treated with distal femoral replace-ment were independently mobile however there was a preponder-ance of housebound patients in the mortality group. The positivepredictive value of being housebound for predicting mortality was100% (NPV= 83%). When stage three chronic kidney disease, orworse, was included in the analysis, PPV was 100% and NPV roseto 100%. No other variable or comorbidity raised predictive values.There are no clear guidelines regarding decision making in thesecases and physiological and comorbid considerations are only sup-portive. Our series suggests outdoor function may be an importantdeterminant in these patients, however further evaluation in theliterature is required.

0152 – DO THE ACCEPTED ANATOMICAL LANDMARKS REALLYHELP IN ALIGNING A TOTAL KNEE REPLACEMENT? – ANOBSERVATIONAL STUDYMunier Hossain, Robert Harvey, Susan GardnerWirral University Teaching Hospitals NHS Trust, Wirral, UK

Anatomical landmarks are utilised as part of prostheses positioningin total knee replacement (TKR) surgery. Rotational alignment ofthe femoral component is often determined by using posteriorfemoral condyles, transepicondylar axis (TEA) and Whiteside’s linein isolation or together. Whiteside’s line is described to be at 90degrees to TEA and TEA to be in 3 degrees external rotation in rela-

tion to the posterior femoral condylar axis in most knees, exceptvalgus joints. The distal femoral valgus angle is often estimated tobe between 5 and 7 degrees. Femoral malrotation and malalign-ment of prostheses can be a significant factor in joint instabilityand patient dissatisfaction after TKR.Methods 124 patients had radiological assessment with CT scanson the TruMatch® system and subsequently had total kneereplacement (PFC Sigma®) were included in the study. The anatom-ical assessment and the instrumentation produced thereafter wastherefore patient specific.Results We observed that 50% of patients had a distal femoral val-gus angle outside the conventionally accepted 5 to 7 degrees(range 2-11 degrees). 11% of patients had TEA perpendicular toWhiteside’s line (range 82 – 96 degrees). In 18% of patients, TEAwas 3 degrees externally rotated to posterior femoral condyles(range 1-9 degrees). Males had larger posterior tibial slopes com-pared to females.Conclusion Gold standard anatomical landmarks and geometricalaxes do not necessarily lie within the standard prescribed limits. Itis important for a operating surgeon to appreciate these variationswhile adjusting femoral rotation and avoiding implant malposition-ing

0154 – OUTCOME OF REVISION KNEE ARTHROPLASTY SURGERYUSING THE RT PLUS HINGED PROSTHESISKristina Scott2, Mo Hassaballa1, James Murray1, Andrew Porteous2

1Avon Orthopaedic centre, Southmead hospital, Bristol, UK,2Faculty of medicine, Bristol university, Bristol, UKAim: To report the minimum 2yr outcome of revision knee arthro-plasty using the RT Plus rotating hinge.Patients and methods: We reviewed prospectively collected dataon 85 revision cases performed with the RT Plus Rotating Hingeprosthesis between 2008 and 2014. Demographic data, time sinceprimary surgery, the American Knee Society scores (AKS) pre andpost-operatively at 1 and 2 years were analysed.Results: Mean age was 74.4 years. 50 females and 35 males. Theprosthesis was used in 70 first-time revision cases and in 15 multi-ply-revised cases (2 to 5 revisions).The indications included aseptic loosening (20), instability (33),infection (31), periprosthetic fracture (1).Mean AKSS preoperatively for all revisions was 65/200 andimproved to 133/200 and 131/200 at 1 and 2 years respectively.The first-time revisions improved from 61/200 pre-operatively to138 at both 1 and 2 years whereas the multiply revised casesimproved from 72/200 pre-operatively to 114/200 and 113/200 at1 and 2 years respectively. The aseptic loosening group showed thebest improvement from 62/200 pre-operatively to 154/200 at 1year and 137/200 at 2 years.Conclusion: Despite this cohort comprising of complex revisionscases with gross instability, the RT Plus Rotating Hinge providedsafe and clinically effective treatment with significant clinicalimprovement at 12 months maintained at 2 years. First-time revi-sion cases (R1) showed better outcome than multiply revised (R2-5) patients.”

0159 – SWITCHING TO THE UK NATIONAL LIGAMENT REGISTRY –IS DATA COLLECTION IMPROVED WHEN COMPARED WITH A DIYDATABASE?Alexander Riddell, Waheeb Al-Azzani, Andrew DaviesMorriston Hospital, Swansea, UK

The UK national ligament registry (UKNLR) was launched in the2013 meeting and uses an online platform to gather patientreported outcome measures (PROMs) in patients undergoing pri-mary anterior cruciate ligament (ACL) reconstruction. It follows atrend of introducing national registries with an ultimate aim of aid-ing clinicians in treatment of patients. Online collection of PROMsrelies on patients responding to e-mailed requests to completeonline forms at different time points and may be subject to attri-tion bias.The senior author has maintained his own PROMs database since2010 with Tegner and Lysholm scores gathered prospectively pre-operative and at six months post-operative. In August 2014 thesenior author adopted the UKNLR. We report the rate of data cap-ture using the ‘DIY’ database and compare this with the UKNLR todate.77 patients underwent primary ACL reconstruction between Janu-ary 2010 and August 2014 and were included on the DIY database.PROMs were recorded pre-operatively in 98.7% (76/77) and post-operatively in 49.4% (38/77). 35 patients have currently beenincluded on the UKNLR with pre-operative PROMs recorded in77.1% (27/35). Post-operative scores have been completed by47.0% (8/17) at six months and 36.4% (4/11) at one year.The UKNLR is an important new tool that should allow the nationalcapture of PROMs data for ACL reconstruction. Our experience isthat without personal prompting, data capture is incomplete pre-operatively and falls rapidly over time. E-mail prompts alone seemto be insufficient and this may need to be addressed if the registryis to succeed.

0163 – DIAGNOSTIC EFFICACY OF 3.0 TESLA MRI FOR KNEEINJURIES USING ARTHROSCOPY AS A REFERENCE STANDARD- AMETA-ANALYSISChristian Smith1, Adil Ajuied1, Ciaran McGarvey1, Diane Back1, Rus-sell Houghton1, Andrew Davies2

1Guy’s and St Thomas’s NHS Foundation Trust, London, UK, 2FortiusClinic, London, UK

Purpose: To assess the evidence for the diagnostic efficacy of 3Tesla (T) MRI imaging for meniscal and ACL pathology in the kneeusing arthroscopy as a reference, comparing results to a previousmeta-analysis assessing 1.5T MRI.Methods: The online Cochrane Library, Medline and PubMed data-bases were searched using the following term: MRI AND ((3 ORthree) AND (Tesla OR T)) AND Knee AND arthroscopy AND (menisc*OR ligament). Patient demographics, patient characteristics, MRIscan details and diagnostic results were investigated. Methologicalquality of included studies was assessed using the revised QualityAssessment of Diagnostic Accuracy Studies tool (QUADAS-2).Where applicable, studies were meta-analysed and compared to aprevious meta-analysis utilising 1.5T MRI.Results: 101 studies were identified by the search strategy. 13studies were included in the review. All studies were level 1b,except for one level 2b study. All included studies had highmethodological integrity and low risk of bias using the QUADAS-2tool. 1197 patients were included, with a mean age of 41.9 years.10 studies were eligible for meta-analysis. Medial meniscal pathol-ogy sensitivity: 0.94 (95% CI: 0.91- 0.96), specificity: 0.79 (95% CI:0.75-0.83). Lateral meniscal pathology sensitivity: 0.81 (95% CI:0.75-0.85), specificity: 0.87 (95% CI: 0.84-0.89). ACL pathology sen-sitivity:0.92 (95% CI: 0.83-0.96), specificity: 0.99 (95% CI: 0.96-1.00). Lateral meniscal specificity was significantly lower for 3.0Tscans compared to 1.5T scans (p=0.0013).Conclusions: This study doesn’t provide evidence that 3.0T scan-ners have superior diagnostic efficacy for meniscal damage andACL integrity when compared to 1.5T machines.

37

0002 – TOURNIQUET USE IN TKR: A POTENTIAL PREDICTOR OF POSTOPERATIVE PAIN SCORES INMALES AND FEMALESFeisal Ali Shah2, Zulfiqar Haider1, Bushra Kamal2, Rudy Appodo1, Neil Bradbury1, Amir Qureshi2,Umer Butt1.1Circle Bath Hospital, Bath, UK, 2University Hospital Southampton, Southampton, UK

0003 – IS IT SAFE TO OFFER AN OUT-OF-HOURS PRIMARY TOTAL KNEE ARTHROPLASTY SERVICE TOOUR PATIENTS?Amit Thakrar1, Lambros Athanatos1, Parminder Jeer1.1East Kent Hospitals University NHS Foundation Trust, Margate, Kent, UK

0015 – KNEE OSTEOARTHRITIS FUNCTIONAL CLASSIFICATION SCHEME - VALIDATION OF TIMEDEPENDENT TREATMENT EFFECT. ONE YEAR FOLLOW-UP OF 518 PATIENTSAmir Herman1, Amit Mor2, Ganit Segal2, Nachshon Shazar1, Yiftah Beer3, Nahum Halperin3, RonenDebi4, Avi Elbaz2.1Department of Orthopaedic Surgery Sheba medical center, Tel-Hashomer, Israel, 2AposTherapyResearch Group, Herzliya, Israel, 3Department of Orthopaedic Surgery, Assaf HaRofeh MedicalCenter, Zerifin, Israel, 4Department of Orthopaedic Surgery Barzilay Medical Center, Ashkelon, Israel

0022 – AVAILABILITY OF TOTAL KNEE ARTHROPLASTY IMPLANTS FOR METAL HYPERSENSITIVITYPATIENTSSanil Ajwani1, Charalambos Charalambous2.1Orthopaedic Department, Blackpool Teaching Hospitals NHS Trust, Blackpool, UK, 2School ofMedicine and Dentistry, University of Central Lancashire, Preston, UK, 3Institute of Inflammation andRepair, School of Medical and Human Sciences, University of Manchester, Manchester, UK

0027 – How does Obesity affect Total Knee Arthroplasties? Richard Elston1, Claire Barnsley1, Ellie Granger1, Emily Stickler1, Lauran Noel1, Alice Huffman1, RussMachin1, George Dixon1.1University of Bristol, Bristol, Avon, UK

0036 – A REVIEW OF 90 DAY MORTALITY FOLLOWING PRIMARY KNEE ARTHROPLASTY AT TORBAYHOSPITALSimon Middleton1, David Isaac1, Mike Hockings1.1Torbay and South Devon NHS foundation trust, Torbay, Devon, UK

0049 – DIY DATABASE VS UKKOR FOR PATIENTS REPORTED OUTCOME SCORES AFTER OSTEOTOMYWaheeb A K Al-Azzani1, Alexander Riddell1, Andrew P Davies2.1Morriston Hospital, Swansea, UK, 2Cardiff University, Cardiff, UK

0054 – THE USE OF METAPHYSEAL SLEEVES IN REVISION KNEE SURGERYSohail Nisar1, Osman Riaz1, Jan Marciniak1, Graham Walsh1.1Huddersfield Royal Infirmary, Huddersfield, UK

0055 – THE ‘APPLE CORE’ CEMENT SPACER FOR THE MANAGEMENT OF MASSIVE BONE LOSS IN ATWO-STAGE PROTOCOL FOR INFECTED TOTAL KNEE ARTHROPLASTYRahul kakar1, Nima Razii1.Rhidian Morgan-Jones1, 1Llandough Hospital, Cardiff, UK

0057 – Outcome of the first 500 cases of a new total knee replacement implant Benjamin Bloch1, Peter James0, 1Nottingham University Hospitals NHS Trust, Nottingham, UK

0059 – IS BI-CRUCIATE RETAINING TOTAL KNEE ARTHROPLASTY THE ANSWER? FUNCTIONALOUTCOME RESULTS OF A NON-DESIGN CENTRE PILOT STUDY Abtin Alvand1, Hannah Wilson1, Reza Mafi1, David Beard1, Nicholas Bottomley1, William Jackson1,Andrew Price1.1University of Oxford, Oxford, UK

0063 – SURGICAL TRAINING: WHAT FACTORS ACCOUNT FOR LOST TRAINING IN THEATRE?Scott Parker1, Thomas Key1, Gareth Roberts1, Alun John1, Simon White1.1Cardiff and Vale NHS Trust, Cardiff, UK

0064 – THEATRE DOOR OPENING AS A MARKER OF THEATRE DISCIPLINE AND INFECTIONCONTROL: ARE STANDARDS SLIPPING?Llywela Davies1, Lee Sanders-Crook1, Scott Parker2, Gareth Roberts2, Thomas Key2, Harriet Hughes2,Simon White2.1Cardiff University, Cardiff, UK, 2Cardiff and Vale NHS Trust, Cardiff, UK

0069 – OUTCOMES AND EVIDENCE OF A LEARNING EFFECT WITH THE OxFORD PHASE 3 UKR: ASINGLE SURGEON SERIESJames Berwin1, Jehan Butts1, Simon Newman1, Charles Gibbons1.1Chelsea and Westminster Hospital, London, UK

0074 – PATIENT REPORTED OUTCOMES IN PRIMARY TOTAL KNEE ARTHROPLASTY (TKA) AMONGCURRENTLY AVAILABLE PRODUCTS: A LARGE SAMPLE PROSPECTIVE WORLDWIDE STUDYIvan Brenkel1, William Hamilton3, Stephen Kantor4, Mark Clatworthy5, Kimberly Dwyer6, James Lesko6, Sam Himden6, Anthony Gibbon2.1Queen Margaret Hospital, Dunfermline, Fife, UK, 2York Teaching Hospital, York, North Yorkshire, UK,3Anderson Orthopaedic Clinic, Alexandria, Virginia, USA, 4New London Hospital, New London, NewHampshire, USA, 5Auckland Bone & Joint Surgery, Auckland, New Zealand, 6DePuy Synthes JointReconstruction, Warsaw, Indiana, USA

0079 – CLINICAL OUTCOMES AFTER A CUSTOMIZED, INDIVIDUALLY MADE UNICONDYLAR KNEEREPLACEMENTDinesh Nathwani1.1The London Clinic, London, UK

0081 – CUSTOMIZED, INDIVIDUALLY MADE BI-COMPARTMENTAL KNEE REPLACEMENT: APROSPECTIVE, MULTICENTER STUDY OF CLINICAL OUTCOMESJohannes Beckmann1, Andre Steinert2, Bryan Huber3, Deryk Jones4, Franz KÖck5, Matthias Buhs6,Michael Kang7, Rolston Lindsey8.1Sport Klinik Stuttgart, Stuttgart, Germany, 2Orthopaedische Universitaets Klinik Konig-Ludwig-Haus,Würzburg, Germany, 3Copley Hospital, Morrisville, VT, USA, 4Ochsner Baptist Medical Center,Louisiana, USA, 5MedArtes Gemeinschaftspraxis und Privatklinik, Neutraubling, Germany, 6COVZ ·Gemeinschaftspraxis, Quickborn, Germany, 7Saint Francis Hospital, New York, USA, 8Henry CountyCenter for Orthopedics Surgery and Sports Medicine, Indiana, USA

0084 – CUSTOMIZED INDIVIDUALLY MADE TOTAL KNEE ARTHROPLASTY OUTCOMES.Bryan Huber1, Robert Tait2, William Kurtz3, Todd Swanson4, Gregory Martin5, Ian Dickey6, DavidMack7, Joseph Burkhardt8, Terry Clyburn9.1Copley Hospital, Vermont, USA, 2Orthopedic Institute of Henderson, Nevada, USA, 3TennesseeOrthopaedic Alliance, Tennessee, USA, 4Desert Orthopaedic Center, Nevada, USA, 5JFK MedicalCenter, Florida, USA, 6Eastern Maine Medical Center, Maine, USA, 7North Cypress Hospital, Texas,USA, 8Southern Michigan Orthopaedics, Michigan, USA, 9Memorial Hermann Texas Medical Center,Texas, USA

0088 – ADDUCTOR CANAL BLOCK – HOW EFFECTIVE IS IT FOR TOTAL KNEE ARTHROPLASTY?Rahul Bhattacharyya1, Emma Murphy1, Mark Jenkinson1, Graeme Hilditch1, Brian Rooney1.1Queen Elizabeth University Hospital, Glasgow, UK

0093 – SYSTEMATIC REVIEW OF ASPIRIN FOR VENOUS THROMBOPROPHYLAxIS IN TOTAL KNEEARTHROPLASTYDaniel Wilson1, William Poole1, Sandeep Chauhan1, Benedict Rogers1.1Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

0105 – WARFARIN THERAPY AND LENGTH OF STAY IN ELECTIVE TOTAL KNEE ARTHROPLASTYJuliet Clutton1, Sieuming Ng1, Richard Byrne2, Simon White2.1University Hospital of Wales, Cardiff, UK, 2University Hospital of Llandough, Cardiff, UK

0111 – SLOPE CHANGING ANTERIOR TIBIAL OSTEOTOMY USING BIOLOGICAL PLATINGSam Yasen1, Michael Dean1, David Elson1, Ed Britton1, Bhushan Sabnis1, Adrian Wilson1.1Hampshire Hospitals NHS Trust, Basingstoke, UK

0112 – OUTCOMES OF NAVIGATED HIGH TIBIAL OSTEOTOMY: A REVIEW OF 61 KNEES Antonios Papadopoulos1, Manal Siddiqui1, Angela H Deakin1, Frederic Picard1.1Golden Jubilee National Hospital, Glasgow, UK, 2Biomedical Engineering Department StrathclydeUniversity, Glasgow, UK

0113 – PATIENT PERSPECTIVE AND OUTCOME OF SECONDARY PATELLAR OPERATION AFTER TOTALKNEE REPLACEMENTShreedhar Aranganathan1, Aled Rhys Evans0.1Royal Gwent Hospital, Newport, UK

0119 – UNDERSTANDING THE DIFFERENCE IN LENGTH OF STAY BETWEEN PRIMARYARTHROPLASTIES OF THE HIP AND KNEEHarold Akehurst1, Alex Vaughan1, Hari Arunachalam1, Bessie Ayres1, Cathryn Eitel1, Madhu Rao1.1Western Sussex Hospitals NHS Trust, Western Sussex, UK

0120 – HAS THE INTRODUCTION OF AN ENHANCED RECOVERY PROGRAMME IMPROVED PATIENTREPORTED OUTCOME MEASURES FOR PATIENTS UNDERGOING A TOTAL KNEE REPLACEMENT?Thomas Marks1, John Moorehead2, James Fountain2, Cronan Kerin2.1School of Medicine, University of Liverpool, Liverpool, Merseyside, UK, 2Department of OrthopaedicSurgery, University Hospital Aintree, Liverpool, Merseyside, UK

0122 – AN UNUSUAL CASE OF METAL FATIGUE FRACTURE IN A DEPUYTM TCIII REVISION KNEEARTHROPLASTYSunil Panchani1, Tim Board0.1Wrightington Hospital, Wigan, UK

0126 – THE EFFECT OF FEMORO-TIBIAL COMPONENT SIZE MISMATCH ON OUTCOME IN PRIMARYTOTAL KNEE ARTHROPLASTYJames Gill1, Paul Nicolai0.1West Suffolk Hospital, Bury St Edmunds, Suffolk, UK

0132 – Mid term results of patellofemoral arthroplasty using Journey® implantRammohan Raghavendra1, Paul Lee2, Randy Guro1, Amit Chandratreya1.1Princess of wales hospital, Bridgend, UK, 2wales deanery, cardiff, UK

0133 – A LOW RATE OF ALLOGENIC BLOOD TRANSFUSION CAN BE ACHIEVED IN TOTAL KNEEARTHROPLASTYMarieanne Smith1, Angela.H Deakin1, Andrew. W.G Kinninmonth1, Niall. A Munro1, Martin Sarungi1.1Golden Jubilee National Hospital, West Dunbartonshire, UK

0136 – EARLY ExPERIENCE OF REMOTE RANGE OF MOTION ASSESSMENT FOLLOWING TOTAL KNEEARTHROPLASTY Findlay Welsh1, Fiona Macbeth1, Frederic Picard1.1Golden Jubilee National Hospital, Clydebank, UK

0138 – WHY ARE WE MEASURING CRP POST-OPERATIVELY IN ADULT ORTHOPAEDIC PATIENTS? S Parker1, O Blocker1, J Glasbey1, R Whitham1, A Johanson1, A Ghandour1.1Cardiff and Vale NHS Trust, Cardiff, UK

0147 – BLOOD LOSS AFTER UNICOMPARTMENTAL KNEE REPLACEMENT: DO WE NEED TO REPEATGROUP AND SAVE BLOOD DAMPLING PRIOR TO SURGERY?Shahrukh ahamd1, Mohammed Bhutta0.1Pennine Acute NHS Trust, Manchester, UK

0148 – AN EVALUATION OF SERVICE USER AND PROVIDER ExPERIENCE OF A VIRTUAL CLINICPATHWAY Gabriel Fieraru1, Laura McArthur1, Jo Palmer1, Jennifer Wingham2, Dan Williams1.1Royal Cornwall Hospitals NHS Trust, Cornwall, UK, 2University of Exeter, Devon, UK

0149 – FEMORAL COMPONENT ROTATION IN THE ATTUNE TKR, BALANCED TECHNIQUE ANDMEASURED RESECTION INSTRUMENTATIONRobert Harvey1, Munier Hossain2.1Spire Murrayfield, Wirral, UK, 2Wirral University Teaching Hospitals NHS Trust, Wirral, UK

0150 – EFFECT OF TOURNIQUET FREE UNICOMPARTMENTAL KNEE ON DAY CASE ARTHROPLASTYSURGERY RATE AND BLOOD LOSSSharukh Ahmad1, Mohammed Bhutta0.1Pennine Acute NHS Trust, Manchester, UK

0151 – A RETRIEVAL ANALYSIS OF TOTAL KNEE REPLACEMENT PROSTHESES WITH OxIDISEDZIRCONIUM FEMORAL COMPONENTS Emma Kennard1, Susan C. Scholes1, Raj Gangadharan2, David Weir2, Jim Holland2, David Deehan2,Thomas J. Joyce1.1Newcastle University, Newcastle-upon-Tyne, UK, 2Freeman Hospital, Newcastle-upon-Tyne, UK

0153 – DAY CASE UNICOMPARTMENTAL KNEE REPLACEMENT: EFFICACY AND SAFETYAzhar Din1, Bilal Chaudry1, Mohammed Bhutta1.1Pennine Acute NHS Trust, Manchester, UK

0160 – TOTAL KNEE REPLACEMENT IN PATIENTS UNDER 55 WITH PRIMARY OR POST-TRAUMATICOSTEOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSISCiaran McGarvey1, Ziad Harb1, Christian Smith1, Diane Back1, Andrew Davies2, Adil Ajuied1.1Guy’s and St Thomas’ NHS Foundation Trust, London, UK, 2Fortius Clinic, London, UK

0162 – INTRODUCING DAY-CASE HIGH TIBIAL OSTEOTOMY: THE PATIENT ExPERIENCE Samuel Hart1, Sandy Wood2, James Murray2.1University of Bristol, Bristol, UK, 2Avon Orthopaedics Centre, Bristol, UK

The E-Posters are displayed on screens within the exhibition area (Hall2), you can search and view individual eposters using the touch screens in the centre of the exhibition area.

E-Posters – Titles and Authors

Sessions will include:

BOA Annual Congress 2016

Clinical Leadership & Engagement

congress.boa.ac.uk #BOAAC

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©2016 Zimmer Biomet

Persona® Knee System

The Personalized Knee

Component shapes based on patient anatomy is another way that the Persona Knee System allows for a no compromise approach to total knee replacement.

• Improved balancing options 1 with 2 mm femoral increments and 1 mm articular surface increments

• Improved fit with 21 distinct profiles of standard and narrow components 2

• Persona Natural Tibial® Component designed to facilitate 92% bone coverage with proper rotation, according to one study3

For more information on the Persona Knee System, call your Zimmer Biomet Sales Representative or visit zimmerbiomet.com.

1. Versus lower fidelity systems

2. Versus single M/L implant families

3. Dai, et al., ORS 2013, San Antonio, TX, Influence of Ethnicity on

Coverage of the Tibia in Total Knee Arthroplasty

oach to total knee rapprersonathat the P

eplacement. oach to total knee rKnee System allows for a no comprersona

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ow componentsnarroved fit with 21 distinct prImpr•

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ding to one otation, accor Component designed to facilitate

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ementsements and 1 mm articular surface incral with 2 mm femor

or visit zimmerbiomet.com.Zimmer Biomet Sales ReprFor more information on the Persona Knee System,

or visit zimmerbiomet.com.esentative Zimmer Biomet Sales Repr

For more information on the Persona Knee System,

call your For more information on the Persona Knee System,


Dai, et al., ORS 2013, San Antonio, TX, Influence of Ethnicity on 3.

Versus single M/L implant families2.

Versus lower fidelity systems 1.


Dai, et al., ORS 2013, San Antonio, TX, Influence of Ethnicity on

Versus single M/L implant families

Versus lower fidelity systems

Dai, et al., ORS 2013, San Antonio, TX, Influence of Ethnicity on

©2016 Zimmer Biomet

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Mr Richard ParkinsonPresident

Mr Tony HuiHonorary Secretary

Ms Leela BiantHonorary Treasurer

Adil Aijuied Mr William Jackson Mr Colin EslerPresident Elect

Ms Caroline HingKnee Editor

Mr Sean O’LearyNLR Chair

Sanjeev Anand

Mr Andrew PorteousEducation

Professor Andrew PriceResearch

Mr David JohnsonWebmaster

Contact Details: – British Association for Surgery of the Kneeat the Royal College of Surgeons35 – 43 Lincoln’s Inn Fields

London WC2A 3PEHazel Choules: [email protected]

Tel: 020 7406 1763 www.baskonline.com

This programme has been sponsored by

BRITISH ASSOCIATION FOR SURGERY OF THE KNEEBASK Executive Committee 2016 – 2017

The ACC Liverpool

British Association for Surgery of the Knee2016 Annual Spring Meeting

This programme has been sponsored by

british association for surgery of the knee...british association for surgery of the knee from the...

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