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Zimmer Biomet are pleased to support the 2018 BASK Annual Spring Meeting

LCFC, King Power Stadium, Leicester

2018 Annual Spring Meeting – 20th & 21st March(including an ACPA Parallel Meeting)

BRITISH ASSOCIATIONFOR SURGERY OF THE KNEE

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BRITISH ASSOCIATIONFOR SURGERY OF THE KNEE

From the President

It is with great anticipation and pleasure that the BASK Executive and I welcome you all to Leicester for our2018 Spring Meeting.

The Romans created a settlement by the River Soar in AD47 when travelling from Exeter to Lincoln. JewryWall is the sole remnant of the roman town’s public baths. Leicester has better known as the final restingplace of Richard III. Piers Mitchell, Paediatric Orthopaedic Surgeon and Lecturer in Biological Anthropologyat the University of Cambridge, will be telling us how remains under a public car park were verified as beingthose of Richard III.

The conference will be held in the King Power Stadium where Leicester City FC fought an epic battle tobecome Premier League Champions in 2016, against all the odds. Leicester Tigers have won 20 major titles,were European Champions twice and have won a record 10 English Championships.

We are pleased to have the ACPA meeting running in tandem with the BASK meeting. The members ofACPA have arranged their own programme but we welcome any of the ACPA delegates attending any ofthe BASK programme, as our needs and interests are symbiotic.

The Lorden Trickey Lecturer is Wolfgang Klauser, Chief of the Helios Baltic Sea Clinic who will discuss thePrinciples of Revision Knee Surgery. Wolfgang was formerly Chairman of the Knee Dept. and Deputy MedicalDirector of the Endo Klinik, Hamburg from 2005 to 2015.

We have two Instructional Courses covering preventing and treating periprosthetic joint infection, revisiona.c.l. reconstruction and discussing whether we really know how we can improve the outcome of kneearthroplasty surgery.

The Annual Dinner will be held at the National Space Centre in the shadowof Blue Streak and Thor Able rockets and the UK Near Earth ObjectInformation Centre, with entertainment from Jan Ravens, star of BBC DeadRingers (or whoever turns up).

We hope that we have got the balance between free paper sessions,Instructional Courses and invited lectures correct. We look forward to yourfeedback so that we can continue to improve BASK Meetings. Delegateswill be requested to complete an online survey following the meeting inorder to obtain their CPD certificate

We hope that you will enjoy the social and scientific programmes and makethe meeting all it can be in every way possible.

Colin Esler and the BASK Executive

1

2

INDEXPage/s

Presidents Welcome 1

Exhibition Floorplan 3

List of Exhibitors 4

Two day-programme 5-11

Podium Presentations + short poster presentations 12-21

AGM Agenda 22

List of applicants for BASK membership 23

ACPA two-day programme 24-25

Poster Presentations 26-29

E-Posters 30

Introducing the BASK Executive Committee – inside back cover

3

4

Visit our Exhibitors!

The following companies are exhibiting at the 2018 Annual Spring Meeting to showcasetheir products – Please take the time to visit the stands

Company Name Stand Nos

Adler Ortho UK Ltd 14

Arthrex Ltd – (Gold sponsor) 8

Athrodax Healthcare Int. Ltd 34

B. Braun Medical Ltd 4

Biocomposites Ltd 10

British Orthopaedic Association 27

CO.DON AG 26

ConMed UK – (Bronze sponsor) 9

Corin Group 13

DePuy Synthes Int Ltd – (Bronze sponsor) 7

FH Ortho Ltd 11

Hospital Innovations Ltd 2

Ideal Med Ltd (CONFORMIS) 30

Int2Med Ltd 16

Joint Operations (UK) LLP 18

Karl Storz Endoscopy UK Ltd 1

Lima Orthopaedics 23

Link Orthopaedics UK Ltd 35

MatOrtho Ltd 20

Medi UK Ltd 21

Neoligaments 3

NHSBT Tissue and Eye Services 25

Ossur UK Ltd 17

Pentland Medical Ltd 31

Premium Medical Protection 19

Smith & Nephew – (Silver sponsor) 5

Stryker UK Ltd – (Silver sponsor) 22

Thuasne 12

Tissue Regenix Ltd 15

TRB Chemedica (UK) Ltd 29

Trice Medical 28

Zimmer Biomet UK Ltd – (Platinum sponsor) 6

5

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

BASK ANNUAL SPRING MEETING 2018LCFC, King Power Stadium, Leicester

TUESDAY 20th MARCH

08.00 REGISTRATION & COFFEE – Reception Lounge & Walkers Hall within the Exhibition area

09.00 Welcome Introduction – BASK President, Colin Esler (Leicester) – Keith Weller Lounge

Session I – ArthroplastyModerators: Tony Hui (South Tees) & Steve Godsiff (Leicester)

09.10 Free Paper Session:-0085 – PROSPECTIVE RANDOMISED CONTROL STUDY OF THE AGC TOTAL KNEE SYSTEM VERSUS VANGUARD®KNEE SYSTEM: THREE TO FIVE YEAR RESULTSSatish Kannan Rajankulam Ganesan, Manjunathan Sivaprakasam, Kate Weatherly, Kim Miles, Richard Goddard,Adrian Butler-ManuelEast Sussex Healthcare NHS Trust, St Leonards on Sea, United Kingdom.

09.16 0074 – MINIMUM TEN-YEAR SURVIVORSHIP AND PATIENT-REPORTED OUTCOMES OF A SINGLE-RADIUS,CRUCIATE RETAINING TOTAL KNEE ARTHROPLASTYChloe Scott, Katrina Bell, Richard Ng, Deborah MacDonald, James Patton, Richard BurnettRoyal Infirmary of Edinburgh, Edinburgh, United Kingdom.

09.22 0067 – ANALYSIS OF THE ATTUNE TIBIAL BACKSIDE: A COMPARATIVE RETRIEVAL STUDY.Arianna Cerquiglini1, Johann Henckel1, Harry Hothi1, Paul Allen2, James Lewis3, Tim Wilton4, Antti Eskelinen5, Michael T. Hirschmann6, Alister J. Hart1

1University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom. 2PrincessAlexandra NHS Trust, Harlow, United Kingdom. 3Goring Hall Hospital, Goring By Sea, United Kingdom. 4Royal DerbyHospital, Derby, United Kingdom. 5The Coxa Hospital for Joint Replacement, Tampere, Finland. 6University of Baseland Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Basel, Switzerland.

09.28 0001 – ATTUNE HAS IMPROVED SURVIVORSHIP AND CLINICAL OUTCOME OVER PFC SIGMA – A SINGLE SURGEONSERIES OF 1000 TKAS WITH MINIMUM 2 YEARS FOLLOW-UPBenjamin Bloch, Mohammed Shahid, Peter JamesNottingham University Hospitals NHS Trust, Nottingham, United Kingdom.

09.34 Discussion

09.42 0004 – The Rotational Kinematics of Arthritic and Replaced Knees Following Computer-aided Total KneeArthroplastyKamal Deep, Nanjundappa S Harshavardhana, Carlo Menna, Angela Deakin, Frederic PicardGolden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom.

09.48 0024 – OUTCOMES OF ALLOGRAFT MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION (MPFL) IN CHILDREN& ADOLESCENTS WITH JOINT HYPERMOBILITYGautam Reddy, Nisarg Mehta, Nameer Choudhry, Coline Bruce, Nick Barton-HansonAlder Hey Hospital, Liverpool, United Kingdom.

09.54 0057 – Forgotten joint score: comparison between different types of total and unicompartmental kneereplacements – 1,5 and 10 year followJames Corbett, Paul NicolaiWest Suffolk Hospital, Bury St Edmunds, United Kingdom.

10.02 0099 – PATIENT SATISFACTION AND PROMS IN COMPUTER NAVIGATED VS. NON-NAVIGATED TOTAL KNEEREPLACEMENTS(TKR)Kamal Deep1, Kumar Kaushik Dash1, Shivakumar Shankar2, Frederic Picard1, Alistair Ewen1

1Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom. 2Queen’s Hospital, Romford, UnitedKingdom.

10.08 Discussion

This Meeting will be accredited with CME Points

(The abstracts relating to the Free Paper Sessions are stated on pages 12 to 21)

6


10.15 COFFEE – (Walkers Hall & Reception Lounge – Exhibition / Poster & E-Poster Viewing)

Session 2 – Soft Tissue Knee SurgeryModerators: Tawfiq Korim (Leicester) & Alex Dodds (Gloucester)

10.40 Free Paper Session:-0091 – PAEDIATRIC ANTERIOR CRUCIATE LIGAMENT REPAIR WITH INTERNAL BRACE – EARLY RESULTSJohn Dabis, Raghbir Khakha, Mike Risebury, Sam Yasen, Adrian WilsonBasingstoke & North Hampshire NHS Trust, Basingstoke, United Kingdom.

10.46 0049 – SINGLE STAGE ACL REVISION: AN ALGORITHM FOR TREATMENT AND EXPERIENCE OF 106 CASESINCLUDING 34 ELITE ATHLETESNathan White1, Avinash Alva1, Mary Jones1, Simon Ball1,2, Andy Williams1

1Fortius Clinic, London, United Kingdom. 2Chelsea and Westminster Hospital, London, United Kingdom

10.52 0081 – MENISCAL ALLOGRAFT TRANSPLANTATION: DOES SIZE MATTER?Ciara Stevenson, Ahmed Mahmoud, Francois Tudor, Peter MyersBrisbane Orthopaedic Sports Medicine Centre, Brisbane, Australia.

10.58 Discussion

11.04 0100 – MENISCAL ALLOGRAFT TRANSPLANTATION IN THE PAEDIATRIC POPULATION. A CASE SERIESSimon Middleton, Laura Asplin, Ciara Stevenson, Pete Thompson, Tim SpaldingUniversity Hospital Coventry and Warwickshire, Coventry, United Kingdom.

11.10 0064 – INTRAOPERATIVE MOBILISATION OF SYNOVIAL MESENCHYMAL STEM CELLS TO INCREASE THEREGENERATIVE CAPACITY OF THE KNEE USING A NOVEL DEVICEAlam Khalil-Khan1, Anthony Theodorides2, Owen Wall2, Elena Jones1, Dennis McGonagle1, Thomas Baboolal1

1University of Leeds, Leeds, United Kingdom. 2Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom.

11.16 0010 -THE ACCURACY OF PLASMA VISCOSITY LEVELS IN THE DIAGNOSIS OF PROSTHETIC JOINT INFECTION AFTERTOTAL KNEE ARTHROPLASTYAndrel Yoong2, Stefan Bajada1, Patrick Hourigan1, Jonathon Phillips1, Andrew Toms1

1Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter,United Kingdom. 2University of Exeter Medical School, Exeter, United Kingdom.

11.22 Discussion

Richard Parkinson (Wirral) – Introducing

11.30 NJR – National Joint Registry – Peter Howard (Derby)

11.45 NLR – National Ligament Registry – Tim Spalding (Coventry & Warwick)

12.00 UKKOR – David Elson (Gateshead)

12.15 ODEP and beyond compliance – Andrew Porteous (Bristol)

12.30 Your Personal data on display – David Johnson (Stockport)

Colin Esler (Leicester) – Introducing

12.45 Guest Speaker: Piers Mitchell (Peterborough)Presentation ‘Musculoskeletal Disease and Trauma in King Richard III’

13:15 LUNCH – (Walkers Hall & Reception Lounge – Exhibition / Poster & E-Poster Viewing)

Moderator: Prof. Leela Biant (Manchester)Instructional Session 1

Can we improve outcome of knee replacement?

14.00 Does prosthetic designs improve outcome? – Prof. Ritchie Gill (Bath)

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14.20 Surgical philosophies and techniques in TKR – Prof. Andrew Toms (Exeter)

14.40 Patient Selection – how good are we in predicting good or poor results –Paul Baker (Middlesbrough)

15.00 Cementation and fixation – Andrew Porteous (Bristol)

15:20 TEA – (Walkers Hall & Reception Lounge – Exhibition / Poster & E-Poster Viewing)

Moderator: Prof. Andrew Toms (Exeter)Instructional Session 2

Periprosthetic joint infection

15.50 Prevention of infection – Prof. Mike Reed (Northumbria)

16.10 Microbiology and antibiotics – Rhidian Morgan-Jones (Cardiff)

16.30 How to diagnose PJI – Jonathan Phillips (Exeter)

16.50 Surveillance of Surgical Site Infection – Theresa Lamagni (NHS England)

17.10 Discussion

17.15-18.15 AGM – All members of BASK are invited to attend – (Keith Weller Lounge)(AGM agenda on page 22)

19.30pm for 20.15pm – Annual Dinner, ‘The National Space Centre’ LeicesterEntry to the dinner venue is by Ticket ONLY,

(for delegates who have registered to attend the dinner, your ticket is joined to your delegate badge).

8


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

WEDNESDAY 21st MARCH

08.00 am REGISTRATION & COFFEE – Reception Lounge & Walkers Hall within the Exhibition area(Poster & E-Poster viewing)

08.25am Start of 2nd day’s Proceedings – Keith Weller Lounge

Session 3 – Revision ArthroplastyModerators: Robert Ashford (Leicester) & Adil Ajuied (London)

08.30 am Free Paper Session:-0006 – THE EPIDEMIOLOGY OF REVISION TOTAL KNEE AND HIP ARTHROPLASTY IN ENGLAND AND WALES. ACOMPARATIVE ANALYSIS WITH PROJECTIONS FOR THE UNITED STATES. A STUDY USING THE NATIONAL JOINTREGISTRY DATASETBen Waterson1, Amit Patel2, George Pavlou3, Ruben Mujica-Mota4, Andrew Toms1

1Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter,United Kingdom. 2Royal Stoke University Hospital, Stoke, United Kingdom. 3Wrightington Wigan and Leigh NHSTrust, Wigan, United Kingdom. 4University of Exeter, Exeter, United Kingdom.

08.36 0084 – WHY ARE REVISION KNEE REPLACEMENTS FAILING?Sanjeev Agarwarl1, Rakan Kabariti2, D’Jon Lopez2, Rhidian Morgan-Jones2

1University hospital of Wales, Cardiff, United Kingdom. 2University Hospital of Wales, Cardiff, United Kingdom.

08.42 0075 – A RETROSPECTIVE STUDY TO DETERMINE THE ACCURACY OF HOSPITAL REVISION DATA COMPARED TOTHE NATIONAL JOINT REGISTRY FOR PATELLA RESURFACING PROCEDURES FOLLOWING A PRIMARY TOTAL KNEEREPLACEMENT.Irrum Afzal, John Dabis, Roy TwymanSouth West London Elective Orthopaedic Centre, London, United Kingdom.

08.48 0079 – SUCCESSFUL CLINICAL OUTCOME CAN BE ACHIEVED FOLLOWING REVISION OF MEDIALUNICOMPARTMENTAL KNEE ARTHROPLASTYAbtin Alvand1,2, Chin Tat Lim1, Robert Middleton1, Hannah Wilson1, Nicholas Bottomley2, William Jackson2,Andrew Price1

1University of Oxford, Oxford, United Kingdom. 2Nuffield Orthopaedic Centre, Oxford, United Kingdom

08.54 0077 – REVISION OF UNICOMPARTMENTAL TO TOTAL KNEE ARTHROPLASTY: DOES THE UNICOMPARTMENTALIMPLANT (ALL-POLYETHYLENE VERSUS METAL BACKED) IMPACT THE TOTAL KNEE ARTHROPLASTY?Chloe Scott, Matilda Powell-Bowns, Deborah MacDonald, Philip Simpson, Frazer WadeRoyal Infirmary of Edinburgh, Edinburgh, United Kingdom.

09.00 0016 – METAPHYSEAL SLEEVES IN REVISION TOTAL KNEE ARTHROPLASTY AT MIDTERM FOLLOW-UP.Devdatta Neogi, Sanjeev Agarwal, Rhidian Morgan-JonesUniversity Hospital Llandough, Cardiff and Vale University Health Board, Cardiff, United Kingdom

09.06 Discussion

Session 4 – MiscellaneousModerators: Caroline Hing (London) & Urjit Chatterji (Leicester)

09.18 Free Paper Session:-

0025 – MIDTERM OUTCOMES OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION AND STAGED ORSIMULTANEOUS MEDIAL UNICOMPARTMENTAL KNEE REPLACEMENTJames Molloy1, James Kennedy2, Chris Dodd3, David Murray2

1University of Notre Dame, Sydney, Australia. 2University of Oxford, Oxford, United Kingdom. 3Nuffield OrthopaedicCentre, Oxford, United Kingdom

This Meeting will be accredited with CME Points

9


09.24 0015 – MID TO LONG TERM OUTCOMES OF THE AVON PATELLO-FEMORAL JOINT REPLACEMENTSimon Middleton, Andrew Toms, Peter Schranz, Vipul MandaliaExeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter,United Kingdom.

09.30 0104 – SUCCESSFUL CLINICAL RESULTS OF A FOCAL INDIVIDUALISED MINI-METAL IMPLANT FOR FOCALCARTILAGE LESIONS IN THE KNEE.Tim Spalding1, Ciara Stevenson1, Martin Lind2, Karl Eriksson3, Tobias Jung4, Geir Histol5, Pieter Emans6,Johannes Holz7

1University Hospital Coventry, Coventry, United Kingdom. 2Division of Sportstraumatology, Dept.Orthopedics, AarhusUniversity Hospital, Arhus, Denmark. 3Dept.of Orthopedic Surgery, Stockholm South Hospital, Karolinska Institute,Stockholm, Sweden. 4Virchow-Klinikum, Unfallchirurgie & Orthopädie, Sektion Sporttraumatologie & Arthroskopie,Berlin, Germany. 5Dept. Orthopedic Surgery, Vestre Viken, Drammen, Germany. 6Dept. of Orthopedics, MasstrichtUMC, Maastricht, Netherlands. 7OrthoCentrum, Park-Klinik, Manhagen, Hamburg, Germany.

09.36 0007 – DOES COMPLEX REGIONAL PAIN SYNDROME REALLY OCCUR FOLLOWING TOTAL KNEE ARTHROPLASTY? –A PROSPECTIVE STUDY OF 100 PATIENTS USING CURRENT DIAGNOSTIC CRITERIAJonathon Kosy, Simon Middleton, Bradley Ben, Rowenna Stroud, Jonathon Phillips, Andrew TomsExeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter,United Kingdom.

09.42 0039 – CONSENT PLUS – IMPROVING THE CONSENT PROCESS IN ELECTIVE LOWER LIMB ARTHROPLASTYAmit Chandratreya, Paul LeePrincess of Wales Hospital, Bridgend, USA.

09.48 0019 – RATES OF ARTHROSCOPIC KNEE SURGERY ARE DECLINING IN ENGLAND – RESULTS FROM A REVIEW OFTHE NATIONAL HOSPITAL EPISODE STATISTICSSimon Abram, Andrew Judge, David Beard, Andrew PriceNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences. University of Oxford., Oxford,United Kingdom.

09.54 Discussion

10.05 COFFEE – (Walkers Hall & Reception Lounge – Exhibition / Poster & E-Poster Viewing)

Session 5 – Short Poster PresentationsModerators: Prof. Andrew Price (Oxford) & Ram Venkatesh (Leeds)

10.30 Short Poster Session:-0071- CHEMICAL THROMBOPROPHYLAXIS IN PRIMARY JOINT REPLACEMENT – IS IT WORTH THE BLEEDINGBOTHER?’ RISK STRATIFICATION IN JOINT REPLACEMENT IS AS EFFECTIVE, AND SAFER, THAN DRUGS FOR ALL.RESULTS IN 13,472 PATIENTS.Peter Cay, Sukhdeep Gill, Randeep Karwal, Andrea Pearce, Nigel RossiterBasingstoke and North Hampshire Hospital, Basingstoke, United Kingdom.

10.32 Discussion

10.33 0037 – ASIMPLE VISUAL AID INCREASES KNEE FLEXION AFTER A PRIMARY KNEE REPLACEMENTLeonid Kandel, Oriel Ratson, Yoav Mattan, Meir Liebergall, Gurion RivkinHadassah-Hebrew University Medical Center, Jerusalem, Israel.

10.35 Discussion

10.36 0013 – PSYCHOMETRIC ASSESSMENT OF ARTHROSCOPIC SURGEONSJustin Johnson1, David Johnson2

1Musgrove Park Hospital, Taunton, United Kingdom. 2Bristol Orthopaedic Clinic, Bristol, United Kingdom.

10.38 Discussion

10.39 0035 – CANDIDACY AND SURVIVORSHIP FOR MEDIAL-MENISCAL BEARING UNICOMPARTMENTAL KNEEREPLACEMENT BY AGEJames Kennedy1, Stephen Mellon1, Adolph Lombardi2, Keith Berend2, Thomas Hamilton1, David Murray1

1University of Oxford, Oxford, United Kingdom. 2Joint Implant Surgeons, Inc, New Albany, USA.

10.41 Discussion

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10.42 0028 – 1-YEAR OUTCOMES OF MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION WITH TIBIALTUBEROSITY DISTALISATION FOR PATIENTS WITH RECURRENT PATELLOFEMORAL INSTABILITY AND PATELLA ALTAAshley Brown, Gaynor Kanes, Andrew BarnettThe Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom.

10.44 Discussion

10.45 0027 – INTRODUCING DAYCASE SURGERY INTO AN ENHANCED RECOVERY PROGRAMME FORUNICOMPARTMENTAL KNEE REPLACEMENT WITHIN THE NHS SETTING: SUITABLE FOR ALL? THE RESULTS OF ASERVICE IMPROVEMENT PROJECT AND LESSONS LEARNED.Cathy Jenkins1, William Jackson1, Nicholas Bottomley1, Andrew Price1,2, David Murray1,2, Karen Barker1,2

1Nuffield Orthopaedic Centre, Oxford, United Kingdom. 2Nuffield Department of Orthopaedics,Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom.

10.47 Discussion

10.48 0066 – IS MRI USEFUL IN DIAGNOSING INTRA-ARTICULAR KNEE PATHOLOGY IN CHILDREN AND ADOLESCENTS?Stephanie Buchan, Sarah Murgatroyd, Joanna ThomasSouthampton Children’s Hospital, Southampton, United Kingdom.

10.50 Discussion

10.51 0095 – COMBINED INTRAVENOUS AND TOPICAL TRANEXAMIC ACID WITH 30 MINUTES DRAIN CLAMP IS MOREEFFECTIVE THAN SINGLE DOSE TRANEXAMIC ACID, DUAL DOSE INTRAVENOUS TRANEXAMIC ACID OR COMBINEDINTRAVENOUS AND TOPICAL TRANEXAMIC ACID IN REDUCING BLOOD LOSS FOLLOWING TOTAL KNEEREPLACEMENT.Abdelaleem Ragab1, Vinayak Ghanate1, Hatim Cochin2, Shaival Dalal1, Amit Chandratreya1, Rahul Kotwal1

1Princess of Wales Hospital, Bridgend, Wales, United Kingdom. 2Cardiff University, Cardiff, United Kingdom.

10.53 Discussion

10.54 0088 – VALIDATION OF REVISION DATA FOR TOTAL KNEE REPLACEMENTS UNDERTAKEN AT A HIGH VOLUMEORTHOPAEDIC CENTRE USING HOSPITAL AND NATIONAL JOINT REGISTRY DATA.Irrum Afzal, Roy Twyman, Richard FieldSouth West London Elective Orthopaedic Centre, London, United Kingdom.

10.56 Discussion

Moderator: Andrew Porteous (Bristol)

11.00 Update on cartilage repair and cartilage registry – Prof. Leela Biant (Manchester)

11.20 Report from BASK meniscal working group – Prof. Andrew Price (Oxford)

11.40 Travelling fellow’s report – Stephen McDonnell

Colin Esler (Leicester) – Introducing

12.00 ‘Lorden Trickey Lecture’Guest Lecturer:- Dr. Wolfgang Klauser (Helios Baltic Sea Clinic, Germany)Presentation:- Principles of Revision Knee Arthroplasty

12.40 LUNCH – (Walkers Hall & Reception Lounge – Exhibition / Poster & E-Poster Viewing)

Moderator: Guido Guetjens (Derby)Instructional Session 3

13.20 Why and how do ACL grafts fail – Prof. Martin Snow (Birmingham)

13.40 Clinical assessment and investigations – Adil Ajuied (London)

14.00 Surgical planning for revision and graft choice – James Murray (Bristol)

14.20 Pitfalls and tips – Tim Spalding (Coventry Warwick)

11


Moderator: Sanjeev Anand (Leeds)

14.40 NIHR projects – SNAP (ACL) – Prof. David Beard (Oxford)

14.55 BASK research strategies – Prof. Andrew Toms (Exeter)

15.10 TEA – (Walkers Hall & Reception Lounge – Exhibition / Poster & E-Poster Viewing)

Session 6 – Osteotomy and othersModerators: David Elson (Gateshead) & David Johnson (Stockport)

15.30 Free Paper Session:-

0092 – STATIC STRENGTH OF HIGH TIBIAL OSTEOTOMY WITH AND WITHOUT GRAFT MATERIALS: ABIOMECHANICAL STUDYJohn Dabis, James Belsey, Raghbir Khakha, Sam Yasen, Mike Risebury, Adrian WilsonBasingstoke & North Hampshire NHS Trust, Basingstoke, United Kingdom.

15.36 0096 – THE USE OF BONE WEDGE ALLOGRAFT IN HIGH TIBIAL OSTEOTOMY: A PROSPECTIVE STUDY OF PAIN ANDTIME TO UNIONJohn Dabis, Raghbir Khakha, James Belsey, Sam Yasen, Mike Risebury, Adrian WilsonBasingstoke & North Hampshire NHS Trust, Basingstoke, United Kingdom.

15.42 0026 – EFFECT OF BMI ON THE LONG-TERM OUTCOMES OF MEDIAL MENISCAL-BEARING UNICOMPARTMENTALKNEE REPLACEMENTJames Molloy1, James Kennedy2, Chris Dodd3, David Murray2

1University of Notre Dame, Sydney, Australia. 2University of Oxford, Oxford, United Kingdom.3Nuffield Orthopaedic Centre, Oxford, United Kingdom.

15.48 0009 – ALLERGY IN TOTAL KNEE ARTHROPLASTY. A REVIEW OF THE FACTSSimon Middleton, Andrew TomsExeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter,United Kingdom.

15.52 0033 – STUD DESIGN OF SPORTS FOOTWEAR AFFECTS GROUND REACTION FORCES IN CUTTING AND CROSS-CUTTING EXERCISE.Daniel Winson1,2, Dario Cazzola3, Owen Lawrence1, Ian Winson4, Andrew Davies1

1Morriston Hospital, Swansea, United Kingdom. 2University of Bath Sports Medicine Department, Bath, UnitedKingdom. 3University of Bath Applied Biomechanics Suite, Bath, United Kingdom. 4Southmead Hospital, Bristol,United Kingdom

15.58 0078 – RADIOGRAPHIC METHODRobert Keehan1, Amarit Gill2, Lindsay Smith1, Riaz Ahmad1, Jonathan Eldridge3

1Weston General Hospital, Weston super Mare, United Kingdom. 2University of Bristol, Bristol, United Kingdom.3University Hospitals Bristol NHS Trust, Bristol, United Kingdom.

16.04 0046 – 2D/3D EOS IMAGING VERSUS STANDING LONG LEG X-RAY IN LOWER LIMB CLINICAL ASSESSMENT – INTER-OBSERVER AND INTRA-OBSERVER RELIABILITYMelinda YT Hau1, Dipen K Menon1, Ronald Chan2, Kwong Yin Chung2, Wai Wang Chau3, Ki Wai Ho2

1 Kettering General Hospital, United Kingdom, 2Prince of Wales Hospital, Hong Kong, 3Dept of ORT, CUHK, HongKong

16.10 Discussion

16.22 Presentation of Awards for 2018Prizes awarded for the ‘Best 2018 Podium, Poster & E-Poster Presentations’.Golf Trophy

16.30 Closing Remarks – President, Colin Esler (Leicester)

16.45 Close of the ‘2018 BASK Annual Spring Meeting’

12

BASK 2018 Podium PresentationsTuesday 20th March

Free Paper Session 1 – Arthroplasty

0085 – PROSPECTIVE RANDOMISED CONTROL STUDY OF THE AGC TOTALKNEE SYSTEM VERSUS VANGUARD® KNEE SYSTEM: THREE TO FIVE YEARRESULTSSatish Kannan Rajankulam Ganesan, Manjunathan Sivaprakasam,Kate Weatherly, Kim Miles, Richard Goddard, Adrian Butler-ManuelEast Sussex Healthcare NHS Trust, St Leonards on Sea, United Kingdom.

Introduction: The AGC Total Knee System introduced in 1983, has demon-strated excellent long-term survivorship rates of 95.88% at 15 years and92.4% at 30 years. Based on the proven heritage of AGC platform, the Van-guard Knee System was introduced incorporating additional features includ-ing greater modularity. We report three to five-year comparative results ofpatients who underwent TKR using either system.Materials and Methods: A randomised control study was designed recruit-ing 300 patients from November 2011 to July 2014. Patients were followedup post operatively at 6 weeks, 6 months, 1 year and yearly thereafter. Clin-ical and functional assessments including range of movement, HSS KneeScore, Oxford Knee Score(OKS), AKSS and the Noble & Weiss scores wererecorded and statistically analysed.Results: As of September 2017, 230 patients were reviewed at the 3 yearsand 124 patients at the 5-year follow-up. At the 3-year follow-up, there wasno significant difference noted in the Range of movement (Average 0.57°-118.56°(AGC), 0.77°-121.54°(Vanguard)), HSS score (Mean 88.3 vs 86.20, p =0.30), OKS (Mean 37.14 vs 38.81, p = 0.25) and Cumulative AKSS (Mean162.95 vs 168.11, p = 0.32). Similarly, no significant functional differencewas identified between the two groups at the 5 year follow-up.Conclusion: The Vanguard system continues to reproduce the excellentfunctional outcomes of the successful AGC system at the 3-5 year follow-up.The more sensitive Noble & Weiss score analysis is being evaluated to ascer-tain any potential advantages.

0074 – MINIMUM TEN-YEAR SURVIVORSHIP AND PATIENT-REPORTEDOUTCOMES OF A SINGLE-RADIUS, CRUCIATE RETAINING TOTAL KNEEARTHROPLASTYChloe Scott, Katrina Bell, Richard Ng, Deborah MacDonald, James Patton,Richard BurnettRoyal Infirmary of Edinburgh, Edinburgh, United Kingdom.

By utilizing a common flexion-extension-axis, the Triathlon total kneearthroplasty (TKA) was designed to achieve ligament isometry, reduce con-tact stresses, maintain posterior condylar offset and lengthen the quadri-ceps moment arm reducing patellofemoral joint reaction force. We reportthe 10-year survival and patient reported outcomes of the Triathlon TKA ina single independent centre.From 2006-2007, 462 consecutive Triathlon TKAs were implanted in 426patients (mean age 68 (21–89), 290 (62.7%) female) at the study centre.Patellae were not routinely resurfaced. PROMs were assessed preopera-tively and at 1, 5 and 10 years when radiographs were reviewed.At minimum 10 years (10-11.6), 123 patients (128TKAs) had died and 15patients (15TKAs) were lost. Ten-year PROMs were completed by 304/334(91%). OKS score improved most to one year from mean 18.6±7.4 to36.0±10.1 (p<0.001) and was maintained at 33.5 ±9.6 at 10 years when theForgotten Joint Score was 48.5±31.4 and patient satisfaction 88%. Therewere 4 aseptic failures (2 tibial loosening, 2 instability) and 4 septic failuresrequiring revision. Symptomatic aseptic radiographic loosening was presentin 3 cases at 11 years. Four (1%) patellae were secondarily resurfaced.Kaplan–Meier demonstrated 10-year survival of 97.7% (95% CI 96.1-99.3%)for revision for any reason, 99.0% (98.0-100%) for aseptic revision, and99.5% (98.9-100) for aseptic loosening (symptomatic radiographic orrevised).The Triathlon TKA continues to show excellent longer-term results with highimplant survivorship, low rates of aseptic failure, and good patient reportedoutcome scores.

0067 – ANALYSIS OF THE ATTUNE TIBIAL BACKSIDE: A COMPARATIVERETRIEVAL STUDYArianna Cerquiglini1, Johann Henckel1, Harry Hothi1, Paul Allen2, James Lewis3, Tim Wilton4, Antti Eskelinen5, Michael T. Hirschmann6, Alister J. Hart1

1University College London and the Royal National Orthopaedic Hospital,Stanmore, United Kingdom. 2Princess Alexandra NHS Trust, Harlow, UnitedKingdom. 3Goring Hall Hospital, Goring By Sea, United Kingdom. 4RoyalDerby Hospital, Derby, United Kingdom. 5The Coxa Hospital for JointReplacement, Tampere, Finland. 6University of Basel and Department ofOrthopaedic Surgery and Traumatology, Kantonsspital Baselland, Basel,Switzerland.

Introduction: Retrieval analysis of early revisions of Beyond Complianceimplants can help identify common failure mechanisms and improve themonitoring of newly introduced implants. In this study, we (1) compared theamount of cement attachment to the tibial trays of retrieved Attune totalknee replacements (TKRs), with that of another design from the same man-ufacturer (PFC, DePuy).Material and Methods: We examined 6 Attune, 9 titanium PFC Sigma, 5cobalt chromium PFC Sigma and 6 cobalt chromium PFC Sigma Rotating Plat-form implants. We used a peer-reviewed digital imaging method to quantifythe amount of cement attachment to the backside of each tibial tray. Wethen measured (1) the size of tibial tray thickness, tray projections, periph-eral lips and undercuts and (2) surface roughness (Ra) on the backside andkeel of the trays. Statistical analyses were performed to investigate differ-ences between the two designs.Results: There was no evidence of cement attachment on all 6 Attune traysexamined, whilst a median (range) of 36% (0%-66%) of the surface area ofthe backside of the PFC trays showed cement attachment; this differencewas statistically significant, p=0.004. There were significant differencesbetween the design features investigated between the two implant designs(p<0.05).Conclusions: Our retrieval study is the first to compare cement attachmentof the Attune TKR with that of another design. There was no cement attach-ment to any of the Attune tibial trays examined; this common retrieval find-ing may help us understand a mechanism of failure related to componentloosening.

0001 – ATTUNE HAS IMPROVED SURVIVORSHIP AND CLINICAL OUTCOMEOVER PFC SIGMA – A SINGLE SURGEON SERIES OF 1000 TKAS WITHMINIMUM 2 YEARS FOLLOW-UPBenjamin Bloch, Mohammed Shahid, Peter JamesNottingham University Hospitals NHS Trust, Nottingham, United Kingdom.

We set out to review the first 500 Attune TKAs performed in our institution,which now all have a minimum follow-up of over 2 years. The comparisongroup was the senior author’s last 500 PFC Sigma TKAs, meaning that wehave a single surgeon series of 1000 TKAs.We compared the Attune and PFC Sigma, in terms of revision rates, re-oper-ation rates and clinical outcome using Oxford Knee Score. All operationswere performed by or under the supervision of the senior author. Data wasanalysed independently by 2 other authors. Oxford Knee Scores were cap-tured using independent NHS PROMS data.The primary endpoint was revision, defined as removal of the femoral, tibialor patellar components. Re-operation included debridement with exchangeof polyethylene insert, secondary resurfacing of the patella and manipula-tion under anaesthesia.At 2 years, survivorship of the Attune using revision as the endpoint was100%, and 98.7% at 5 years. The PFC Sigma had a survivorship of 98.6% at 2years, and 98.0% at 5 years. This was statistically significant (p=0.02).The Attune group had one revision for infection at 3 years and one for tibialloosening at 4.51 years. Survivorship using re-operation or revision as theendpoint was not statistically significantly different.The average improvement in OKS for Attune was 17.6 points; for PFC Sigmait was 16.At short term follow-up, the Attune has superior survivorship and similarclinical outcome compared to the PFC Sigma.

'Authors of the PODIUM presentations (Free Paper sessions) were invited to submit an E-Poster of their presentation.The E-Posters are displayed on screens within the exhibition area (Walkers Hall & Reception Lounge)'.

You can search and view individual E-Posters using the touch screen in the exhibition area, Walkers Hall.

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0004 – THE ROTATIONAL KINEMATICS OF ARTHRITIC AND REPLACEDKNEES FOLLOWING COMPUTER-AIDED TOTAL KNEE ARTHROPLASTYKamal Deep, Nanjundappa S Harshavardhana, Carlo Menna,Angela Deakin, Frederic PicardGolden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom.

Introduction: Coronal alignment has been studied in normal/arthritic/arthroplasty knees. The rotational kinematics however, are not as clear. Wetherefore studied the rotational kinematics of arthritic and arthroplastyknees following computer-aided total knee arthroplasty(CA-TKA).Methods: Ninety-one (70varus;17valgus;4neutral pre-operative coronalalignment) cruciate retaining CA-TKA performed in 41♂;50♀ constituted thestudy cohort. Computer navigation was used as measurement tool for rota-tion between femur and tibia. Starting from full extension, the changes inrotation during 300;600;900 and full flexion before and after CA-TKA wereevaluated.Results: The mean age and BMI were 66.3±7.8years and 31.2±6.4. Preoper-atively, there was a tendency for all knees to go into internal rotation fromfull extension to 300 flexion (unlocking/Screw home). Beyond 300, there wasreversal of rotation into External rotation between 300-900 for valgus knees(mean:4.50±4.20). The varus knees interestingly rotated externally by only0.60±3.50 between 300-600 and thereafter either remained neutral orrotated internally. Postoperatively both varus and valgus knees rotatedinternally when passively flexed from full extension. There was an increasei n to ta l ra n ge o f ro tat i o n ( Ro R ) fo l l o w i n g T K A i n b o t h va r u s(15.20±7.90to18.30±9.60) and valgus (14.60±5.10to20.60±8.70) knees with nostatistically significant difference between varus vs. valgus knees(p=0.54).Discussion: Varus and valgus arthritic knees had different rotational kine-matics preoperatively, which changed after TKA. The total RoR increasedafter surgery. Further studies are needed to understand the significance ofrotational kinematics to optimize functional outcomes.

0024 – OUTCOMES OF ALLOGRAFT MEDIAL PATELLOFEMORAL LIGAMENTRECONSTRUCTION (MPFL) IN CHILDREN & ADOLESCENTS WITH JOINTHYPERMOBILITYGautam Reddy, Nisarg Mehta, nameer Choudhry, coline Bruce, Nick Barton-HansonAlder Hey Hospital, Liverpool, United Kingdom.

Background: Medial patellofemoral ligament (MPFL) reconstruction is oneof several procedures used to treat patellofemoral instability. Use of allo-graft can preserve native tissue and can be advantageous in patients withconnective tissue disorders or ligamentous laxity. There is limited evidencein the literature regarding functional outcomes of allograft MPFL recon-struction. The aim of this study was to assess the mid-term outcomes ofallograft MPFL reconstruction in a tertiary paediatric orthopaedic centre.Methods: A prospectively collected data was reviewed in all children andadolescents underwent allograft MPFL reconstruction over a 4 year period.The primary outcome measure was the validated Kujala score forpatellofemoral disorders. Secondary outcome measures included complica-tions, redislocation of the patella & return to the theatre.Results: Between 2012 and 2016 one surgeon performed 76 allograft MPFLreconstructions in 57 patients. 19 patients had bilateral surgery. The meanage was 14 (7-17) with a female: male ratio of 3:1 and a mean Beightonscore of 7. 10/57 patients had a syndrome attributing to their hypermobility.Mean follow-up was 3 years (1-4). Nine patients had trochleoplasty as wellalong with allograft MPFL reconstruction. The mean Kujala score was 90 (80-100). The overall complication rate was 11% (9/76). There were two patellafractures. 7 patients required revision surgery for failure (9%). There was nosignificant difference in complications between syndromic and non-syn-dromic patients (p=0.9).Conclusion: This is the first study reporting good mid-term functional out-comes with allograft MPFL reconstruction in children & adolescents withhypermobility, however, long-term follow-up studies are required.

0057 – FORGOTTEN JOINT SCORE: COMPARISON BETWEEN DIFFERENTTYPES OF TOTAL AND UNICOMPARTMENTAL KNEE REPLACEMENTS – 1,5AND 10 YEAR FOLLOWJames Corbett, Paul NicolaiWest Suffolk Hospital, Bury St Edmunds, United Kingdom.

Purpose: The forgotten joint score for knees (FJS-K) is a novel patientreported outcome score that assesses patient awareness of their knee ineveryday life. The aim of this study is to assess the outcomes of differenttypes of knee arthroplasty; both unicompartmental and total knee replace-ments, using the FJS-K.Methods: FJS-K questionnaires for all knee arthroplasty patients undertakenin a single unit were collected 1,5 and 10 years postoperatively. Demo-graphic data, length of hospital stay and implant type were assessed fromthe hospital’s digital patient record system. Data was analysed using PrismGraphPad 7 software.Results: The results of 592 knees were analysed. Unicompartmental kneereplacements had better overall scores than total knee replacements (64.7± 3.30 and 48.9 ± 1.6 respectively, p <0.0001). There was no differencebetween the mean FJS-K for different types of total knee replacements.There was a significant difference in mean FJS-K for the Physica Zimmer Uni-condylar Knee (ZUK) compared to the Oxford unicompartmental kneereplacement (72.7 ± 5.0 and 58.8 ± 4.3, p = 0.036). There was a significantimprovement in mean FJS-K for Genesis II total knee arthroplasty patientsfrom 1 year to 5 years post-operatively (42.1 ± 2.7 and 53.7 ± 2.6 respec-tively, p = 0.0026).Conclusion: The forgotten joint score for knees demonstrate improved out-comes in patients undergoing unicompartmental knee replacements com-pared with total knee replacements, in particular when the Physica ZUK uni-compartmental knee replacement was used. Genesis II total knee replace-ment patients improved from 1 year to 5.

0099 – PATIENT SATISFACTION AND PROMS IN COMPUTER NAVIGATEDVS. NON-NAVIGATED TOTAL KNEE REPLACEMENTS(TKR)Kamal Deep1, Kumar Kaushik Dash1, Shivakumar Shankar2, Frederic Picard1,Alistair Ewen1

1Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom.2Queen’s Hospital, Romford, United Kingdom.

Background: Literature and registry-data show up to 20% dissatisfactionrate for total knee replacements(TKR). We decided to analyse patient satis-faction and PROMs(Oxford Knee Score(OKS)) in our high-volume arthro-plasty unit and also compare between navigated and non-navigated tech-niques.Methods: Following power calculation, we included 229 patients in eachgroup (238 (9 bilateral) knees in navigated, 229 in non-navigated). Same pro-tocols were followed for all. Both groups were similar pre-operatively (Nav-igated:68years(SD9),BMI32.28(SD5.19),OKS:41.55(SD7.45); Non-navi-gated:70 years(SD9),BMI:32.41(SD5.12),OKS:42.6(SD7.25)). Satisfaction wasenquired as very satisfied, satisfied, unsure or dissatisfied.Results: In 238 navigated knees, 227(95.4%) were very satisfied or satisfied,7(2.9%) unsure and 3(1.2%) dissatisfied; while in 229 non-navigated knees,205(89.5%) were very satisfied or satisfied, 15(6.5%) unsure and 9(3.9%)dissatisfied. The navigated group showed better satisfaction (p=0.009, Chi-Square Test) compared to the non-navigated. Even in the non-navigatedgroup, our satisfaction data is similar to high end of the published data.There were no differences in 6-week-OKS between navigated and non-navi-gated groups (Navigated:28.48(sd7.8); conventional:29.51(sd8.1); p=0.44,Analysis of Covariance). The same was also true for range of flexion/exten-sion (p=0.360) and length of hospital stay (p=0.959) in the two groups. Therewas no difference in 6-week-OKS between implant subtypes as well(p=0.25).Conclusion: A modern elective arthroplasty service can deliver high satisfac-tion rates in TKR. Use of computer navigation further improves patient sat-isfaction from the best conventional satisfaction rates.

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Free Paper Session 2 – Soft Tissue Knee Surgery

0091 – PAEDIATRIC ANTERIOR CRUCIATE LIGAMENT REPAIR WITHINTERNAL BRACE – EARLY RESULTSJohn Dabis, Raghbir Khakha, Mike Risebury, Sam Yasen, Adrian WilsonBasingstoke & North Hampshire NHS Trust, Basingstoke, United Kingdom.

Introduction: There is a high failure and recurrence rate, up-to 20%, inpatients under the age of 18 years undergoing ACL reconstruction. Non-operative treatment will result in persistent instability resulting in chondral/meniscal injuries. There are increasing concerns of growth plate disturbancewith trans-physeal techniques and issues with relatively small diametergrafts in Tanner 1 and 2 patients, which are inadequate. With advancinginstrumentation, such as 3.5 mm tunnel drilling, repair and subsequentpreservation of the native ACL has become a viable option. The minimallyinvasive approach of arthroscopic primary ACL repair retains the native liga-ment. We present our early two-year results.Methods: Fifteen patients (aged 6 to 16 years) with complete proximal ACLruptures underwent direct arthroscopic ACL repair reinforced by a tempo-rary internal brace. Patient reported outcome measures were collected at 6months, 1-year and 2-years post operatively.Results: Seven patients completed data at 1-year, 8 patients completed dataat 2-years post-operatively. Examination, second-look arthroscopy, andimaging at 3 months confirmed knee stability and complete ACL healing inall cases. There were neither any failures nor complications and no growthdisturbance was noted beyond 2 years. Outcome scores (KOOS-Child,Lysholm and Tegner) pre- and post-operatively demonstrated statisticallysignificant improvements following surgery with p<0.00001.Conclusion: ACL repair in young children using this technique negates therequirement and potential morbidity of graft harvest and demonstrates thepotential for excellent outcome as an attractive alternative to ACL recon-struction, where an adequate ACL remnant permits direct repair.

0049 – SINGLE STAGE ACL REVISION: AN ALGORITHM FOR TREATMENTAND EXPERIENCE OF 106 CASES INCLUDING 34 ELITE ATHLETESNathan White1, Avinash Alva1, Mary Jones1, Simon Ball1,2, Andy Williams1

1Fortius Clinic, London, United Kingdom. 2Chelsea and Westminster Hospi-tal, London, United Kingdom.

Revision ACL reconstruction is a major undertaking. While there is undoubt-edly a role for 2 stage revision surgery, staged revision has disadvantages forthe patient when compared to single stage surgery. Despite this, little hasbeen published examining the outcome following single stage revision. Thesenior author’s practice is to perform single stage surgery wherever possi-ble. We present an algorithm for treatment and document experience usingthe method described, with a minimum of two years follow up.A review of single stage revision ACL surgery was undertaken. Patient fileswere reviewed, and telephone or postal survey undertaken. The outcome ofthe elite athlete subgroup was further supplemented through publicly avail-able information and direct contact.106 single stage procedures were undertaken, at an average follow up of 4.9years (2-9.2y). For comparison, 2x 2-stage reconstructions were performedduring this time. 84 were male, with an average age of 27.8 years. 34 proce-dures were performed in 32 elite athletes. 29 returned to play at elite level.In 44% of cases the femoral tunnel was repositioned. 90% of patients hadmeniscal or chondral damage. A lateral tenodesis was performed in 80% ofcases. There were 4 re-ruptures, 2 of which were revised. There were 17reoperations, and one deep infection at an adjacent osteotomy site.In this series, single stage ACL revision achieved good medium term results,with low failure rate. We believe single stage revision presents an attractiveoption in selected cases, which may otherwise have been considered forstaged surgery.

0081 – MENISCAL ALLOGRAFT TRANSPLANTATION: DOES SIZE MATTER?Ciara Stevenson, Ahmed Mahmoud, Francois Tudor, Peter MyersBrisbane Orthopaedic Sports Medicine Centre, Brisbane, Australia.

Purpose: To assess long-term survivorship of meniscal allograft transplanta-tion (MAT) and determine the effect that pre-operative sizing has upon func-tional outcome and mechanical survivorship.Methods: A prospectively collected database including patients receivingMAT from 2001 to 2017 was analysed. Data includes demographic informa-tion; meniscal sizing measurements, complications and patient reported

outcome measures (PROM’s). All allografts were sized using the Pollardtechnique.Results: 73 transplants were performed in 67 patients; mean age at trans-plant was 34 years (range 14-52 years). The mean follow-up was 75 months(6.25 years). Mechanical survival at 5 and 10yrs was 96% and 89.4% respec-tively. There was statistically significant improvements in all PROM’s; meanLysholm score improved by 17.5 points, mean IKDC improved by 13.3 points,mean OKS improved by 5.6 points and the Tegner by 0.9 points. 41 MAT’swere undersized for width (range 1-11mm). 7 MAT’s were undersized forlength (range 1-4mm). There was a negative correlation between width andlength I.e. If a graft was undersized in width it was oversized in length toreplicate the circumference of the native meniscus.There was no statistically significant difference in mechanical survivorship orclinical outcomes between undersized, matched or oversized grafts. How-ever, subgroup analysis demonstrated increased failure of allografts under-sized by more than 5mm in width.Conclusions: MAT is an effective treatment to improve function and allevi-ate pain with excellent survivorship in this series. Accepting an allograft thatis more than 5mm smaller in width than pre-operative templating increasesthe likelihood of clinical and mechanical failure.

0100 – MENISCAL ALLOGRAFT TRANSPLANTATION IN THE PAEDIATRICPOPULATION. A CASE SERIESSimon Middleton, Laura Asplin, Ciara stevenson, Pete Thompson, Tim SpaldingUniversity Hospital Coventry and Warwickshire, Coventry, United Kingdom.

Purpose: Symptomatic paediatric patients following meniscal resection forinjury or discoid meniscus are a challenging group. Meniscus Allograft trans-plantation (MAT) is an effective treatment in adults but there is scant datain paediatric patients with questions on timing, indications and outcomes.We aim to report on a specific series of paediatric MAT.Methods: Patients aged 18 or under at the time of MAT were analysed fromour prospective MAT database of 250 patients.Results: 18 patients were included, 11 female and 7 male patients. Meanage 16 (range 9-18), 11 right knee, 7 lateral. The average wait (time of listingto transplant) was 10 months (range 4-22 months). Additional procedureswere 1 high tibial osteotomy, 1 ACL reconstruction, 1 MACI graft and 3microfracture procedures. Mean follow up is 3.3 years (range of 0.7 to 7.0),15 have follow up of over 1 year (average 3.8 range 1.2 to 7.0).Preop IKDC score was 39.2 indicating severe symptoms and mean durationfrom initial injury to MAT was 43 months (range 11- 120) Mean post op IKDCwas 69 at 1 year. All modalities of the KOOS increased from baseline. Therewere no cases of graft failure, four required secondary surgical interventionand no cases of superficial or deep infection.Conclusion: Meniscal allograft transplant in children when performed in thepresence of high level of symptoms and functional limitations can result insustained clinical improvement. MAT should be considered as an importantearly option for symptomatic meniscal deficiency in paediatric patients.

0064 – INTRAOPERATIVE MOBILISATION OF SYNOVIAL MESENCHYMALSTEM CELLS TO INCREASE THE REGENERATIVE CAPACITY OF THE KNEEUSING A NOVEL DEVICEAlam Khalil-Khan1, Anthony Theodorides2, Owen Wall2, Elena Jones1, Dennis McGonagle1, Thomas Baboolal1

1University of Leeds, Leeds, United Kingdom. 2Leeds Teaching Hospital NHSTrust, Leeds, United Kingdom.

Introduction: The joint contains populations of mesenchymal stem cells(MSCs) that may contribute to cartilage repair. Irrigation during arthroscopylikely removes these MSCs. The purpose of this study was to develop a noveldevice with an abrasive surface to safely mobilise MSCs from the synovium.The long-term aim, to utilise native synovial MSCs in single-stage repairstrategies.Methods: Joint fluid MSC number, phenotype and functionality wasassessed pre- and post-synovial mobilisation in subjects undergoing kneearthroscopy. Adhesion between mobilised MSCs and fibrin was also evalu-ated to ascertain whether mobilised MSCs might concentrate at site ofbleeding.Results: Irrigation during arthroscopy depleted synovial fluid MSCs (4-folddecrease, n=15). MSCs numbers were significantly higher when cells weremobilised from the synovium with our purpose made device compared to a



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cytology brush (median of 5,763 and 54 colonies respectively, p=0.001,n=15). The mobilised cellular fraction contained MSCs with proliferativepotential and trilineage differentiation for bone, cartilage and fat and cul-tured daughter cells exhibited the ISCT defined MSC phenotype. Mobilisedsynovial MSCs also adhered to various clots in vitro, supporting a role forintegration into microfracture sites or targeted repair using fibrin base scaf-fold. The device was simple and convenient to use and not associated withany complications.Conclusions: Numbers of functional MSCs can be greatly increased duringarthroscopy using our purpose made device. Opening up the prospect ofsingle stage stem cell procedures for cartilage and other joint defects withsynovial derived MSCs that can be undertaken during many arthroscopicprocedures.

0010 – THE ACCURACY OF PLASMA VISCOSITY LEVELS IN THE DIAGNOSISOF PROSTHETIC JOINT INFECTION AFTER TOTAL KNEE ARTHROPLASTYAndrel Yoong2, Stefan Bajada1, Patrick Hourigan1, Jonathon Phillips1,Andrew Toms1

1Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre,Royal Devon and Exeter Hospital, Exeter, United Kingdom. 2University ofExeter Medical School, Exeter, United Kingdom.

Background: The incidence of prosthetic joint infection (PJI) following totalknee arthroplasty (TKA) ranges from 1.1% – 12.4%. Haematological screen-ing for infection via the ESR is commonly used and reported in the literature,but a more cost-effective alternative is plasma viscosity (PV). This studysought to investigate the value of PV in the diagnosis of PJI after TKA and toidentify the optimal levels of PV to aid diagnosis in conjunction with CRP.Methods: 310 patients who underwent revision for a painful knee replace-ment were evaluated. 102 patients were infected, 208 patients were not.Serum investigations including ESR, CRP and PV were analysed usingreceiver observer curves and optimal cut-off points identified.Results: There was a strong correlation between PV and both ESR (Pearson’sr=0.735, P<0.001) and CRP (Pearson’s r=0.712, P<0.001). The area undercurve (AUC) was 0.814 for PV and 0.812 for ESR. The lower bound of the 90%confidence interval of the difference in AUC between PV and ESR is -0.065.This is greater than the non-inferiority margin of -0.10 indicating non-inferi-ority of PV in PJI as compared to ESR.A PV value of >=1.81 had the best efficiency of 81.4%. Combining this witha CRP >=13.5 in an AND-AND approach yielded the highest specificity of97.9% and positive likelihood ratio of 22.7. Sensitivity was 47.9% and a neg-ative likelihood ratio of 0.53.Conclusion: PV is an adequate test to aid in the diagnosis and exclusion ofinfection in PJI after TKA.

BASK 2018 Podium PresentationsWednesday 21st March

Free Paper Session 3 – Revision Arthroplasty

0006 – THE EPIDEMIOLOGY OF REVISION TOTAL KNEE AND HIPARTHROPLASTY IN ENGLAND AND WALES. A COMPARATIVE ANALYSISWITH PROJECTIONS FOR THE UNITED STATES. A STUDY USING THENATIONAL JOINT REGISTRY DATASETBen Waterson1, Amit Patel2, George Pavlou3, Ruben Mujica-Mota4, Andrew Toms1

1Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre,Royal Devon and Exeter Hospital, Exeter, United Kingdom. 2Royal StokeUniversity Hospital, Stoke, United Kingdom. 3Wrightington Wigan andLeigh NHS Trust, Wigan, United Kingdom. 4University of Exeter, Exeter,United Kingdom.

Introduction: Total knee arthroplasty (TKA) and total hip arthroplasty (THA)are recognised and proven interventions for patients with advanced arthri-tis. Studies to date have demonstrated a steady increase in the requirementfor primary and revision procedures. Projected estimates made for theUnited States show that by 2030 the demand for primary TKA will grow by673% and for revision TKA by 601% from the level in 2005. For THA the pro-jected estimates are 174% and 137% for primary and revision surgery,respectively. The purpose of this study was to see if those predictions were

similar for England and Wales.Materials and Methods: Data from the National Joint Registry and theOffice of National Statistics for England and Wales was analysed.Results: Analysis suggests that by 2030, the volume of primary and revisionTKAs will have increased by 117 % and 332%, respectively between 2012and 2030. The data for the United States translates to a 306% cumulativerate of increase between 2012 and 2030 for revision surgery, which is similarto our predictions for England and Wales.The predictions from the United States for primary TKA were similar to ourupper limit projections. For THA, we predicted an increase of 134% and 31%for primary and revision hip surgery, respectively.Conclusions: Our model highlights the economic burden of arthroplasty inthe future in England and Wales as a real and unaddressed problem. Thiswill have significant implications for the provision of health care and thefuture management of orthopaedic services.

0084 – WHY ARE REVISION KNEE REPLACEMENTS FAILING?SANJEEV AGARWAL1, Rakan Kabariti2, D’Jon Lopez2, Rhidian Morgan-Jones2

1University hospital of Wales, Cardiff, United Kingdom. 2University Hospitalof Wales, Cardiff, United Kingdom.

The number of knee revisions worldwide has been increasing steadily. Whilebeing complex and expensive operations, a high percentage of knee revi-sions fail early. We retrospectively evaluated 95 patients following knee revi-sion surgery, who underwent further knee revision operation. The cause offailure was infection in 29.5%, followed by aseptic loosening in 27.5%, insta-bility in 11.4%, persistent stiffness in 9.5%, ongoing pain in 6.6%, extensormechanism problems in 4.7% and one patient was re-revised for suspectedmetal allergy. 63% of knee revision failures were within the first 30 monthsafter surgery. Improving outcomes for infection management and improvedfixation methods will help reduce failed knee revisions.

0075 – A RETROSPECTIVE STUDY TO DETERMINE THE ACCURACY OFHOSPITAL REVISION DATA COMPARED TO THE NATIONAL JOINT REGISTRYFOR PATELLA RESURFACING PROCEDURES FOLLOWING A PRIMARY TOTALKNEE REPLACEMENTIrrum Afzal, John Dabis, Roy TwymanSouth West London Elective Orthopaedic Centre, London, United Kingdom.

As per the National Joint Registry (NJR) guidelines a Patella Resurfacing (PR)following a Primary Total Knee Replacement (TKR) must be recorded as arevision procedure to the registry. The accuracy of recording a PR as revisionprocedure following a TKR remains uncertain as no original implants areremoved or replaced.Over an 11-year period, 23 surgeons performed 12,635 primary TKRs at onehospital. 37 of these primary TKRs were reported to the NJR as revised. 14of the 137 underwent a PR following a TKR and were accurately reported tothe NJR. The remaining 123 were revised for other clinical reasons. Furtheranalysis of hospital revision data using a hospital electronic system identi-fied all the revision procedures performed by the same cohort of surgeons.Local patient electronic medical records and NJR records were linked usinghospital number in order to identify the accuracy in reporting revision data.88 PR operations following a primary TKR were recorded on the hospitalelectronic system. 74 of these PR procedures were identified as not beingreported to the NJR as revisions. PR following a TKR was underreported tothe NJR. As a result the percentage of reported revisions following a primaryTKR at this hospital should increase from 1.08% to 1.66% for an 11-year fol-low-up period. This result was found to be statistically significant, p <0.0001.In order to improve both knee arthroplasty surgery and NJR data quality, itis crucial that accurate data is recorded to the NJR.

0079 – SUCCESSFUL CLINICAL OUTCOME CAN BE ACHIEVED FOLLOWINGREVISION OF MEDIAL UNICOMPARTMENTAL KNEE ARTHROPLASTYAbtin Alvand1,2, Chin Tat Lim1, Robert Middleton1, Hannah Wilson1, NicholasBottomley2, William Jackson2, Andrew Price1

1University of Oxford, Oxford, United Kingdom. 2Nuffield OrthopaedicCentre, Oxford, United Kingdom.

Aim: The purpose of this study was to determine functional outcome afterrevision of failed medial unicompartmental knee arthroplasty (UKA) and



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technical aspects of reconstructive surgery.Methods: Revisions performed for failed medial UKA by two surgeonsbetween 2006 and 2015 were identified. Demographics, indication for revi-sion, prosthesis used (augments, stems, polyethylene bearing thickness,level of constraint), complications and functional outcome (assessed usingthe Oxford Knee Score [OKS] and Activity and Participation Questionnaire[APQ]) at minimum 2-year follow-up were recorded. Revision using stems,augments or hinged prostheses was classified as ‘complex’.Results: There were 44 UKA revisions with a mean age at primary surgery of63.9 years (range: 32.0-84.2). Mean time from primary UKA to revision sur-gery was 6.3 years (range:1.3-15.1). A lateral UKA was added in 20%, cruci-ate retaining TKA used in 36%, posterior stabilised TKA in 36%, and hingedprosthesis in 8%. Complex revision TKA was required in 20%. The complica-tion rate was 11%. No patients receiving an additional lateral UKA sufferedpost-operative complications. At follow-up, mean OKS was 31.6 (range:9–38) and mean APQ score was 11.9 (range:0–32).Conclusions: This study suggests that acceptable clinical outcomes can beachieved after revision of failed UKA. In 80% of cases a standard primaryTKA or lateral UKA was performed without the need for stems, augments orhinged prostheses. The overall complication rate was acceptable at 11% andthe revision rate was low. Functional results demonstrates that an accept-able clinical outcome can be achieved.

0077 – REVISION OF UNICOMPARTMENTAL TO TOTAL KNEEARTHROPLASTY: DOES THE UNICOMPARTMENTAL IMPLANT (ALL-POLYETHYLENE VERSUS METAL BACKED) IMPACT THE TOTAL KNEEARTHROPLASTY?Chloe Scott, Matilda Powell-Bowns, Deborah MacDonald, Philip Simpson,Frazer WadeRoyal Infirmary of Edinburgh, Edinburgh, United Kingdom.

The aim of this study was to investigate differences in implant requirement,outcomes and re-revision when TKA was performed following UKAs with all-polyethylene (AP) compared to metal-backed (MB) tibial components.Retrospective study of 60 UKAs converted to 60 TKAs at mean 7.3 years (0.1to 17) after implantation in 55 patients (mean age 64 (49-83), 44% male): 44MB and 16 AP. TKA implant requirement was investigated in addition tomode of failure, Oxford Knee Score and TKA survival at mean 5.4 years (0.5to 17).Progression of osteoarthritis was the commonest mode of failure in MBUKAs (p=0.03) and unexplained pain in AP (p=0.011) where revision was ear-lier (4.8±3.2 Vs 8.2±4.5, p=0.012). In 56/60 (93%) cases, unconstrained TKAimplants were used. The use of standard cruciate-retaining TKAs withoutaugments/stems was more likely following AP (10/14, 71%) compared toMB UKA (12/38, 32%, p=0.013). MB UKA implants were associated withgreater relative bony resection (p=0.005), more tibial stem use (p=0.04), andmore use of cruciate substituting polyethylene (p=0.05). Seven were re-revised giving 7-year TKA survival: MB UKA 70.3 (47.0 to 93.6 95%CI); andAP UKA 87.5 (64.6 to 100 95%CI) (p=0.191).Metal backed UKA implants increase the chances of a complex revisionrequiring tibial stems and cruciate substitution, but reduce the chances ofearly revision compared to all-polyethylene UKA which often fail early withpain. There is a trend towards worse TKA survival following metal-backedUKAs predominantly due to tibial sided failures.

0016 – METAPHYSEAL SLEEVES IN REVISION TOTAL KNEE ARTHROPLASTYAT MIDTERM FOLLOW-UPDevdatta Neogi, Sanjeev Agarwal, Rhidian Morgan-JonesUniversity Hospital Llandough, Cardiff and Vale University Health Board,Cardiff, United Kingdom.

Introduction: Stepped porous titanium metaphyseal sleeves may provide anoption for not only reconstruction but also enhanced fixation in managingchallenging bone defects in revision total knee aArthroplasty (RTKA). Wereport our results of RTKA using metaphyseal sleeves with minimum 7 yearsfollow-up. Materials: Between January 2007 and December 2009,103patients, 54 male and 49 female who underwent RTKA in our centre werefollowed up prospectively as part of this study with clinical and radiographicassessment. Revision data for patients who did not attend the follow-upstudy were accessed through Clinical Portal. Statistical analysis was doneusing SPSS Version 21.0. Results: The mean age of patients was 74.7 years(range 58-92). 64 patients had radiological assessment at minimum 7 yearsfollow up. Mean follow-up was 95.7 (range, 88-115) months. From the orig-

inal cohort 15 patients had died from unrelated causes. During the follow upperiod, there were 23 re-revisions. Indication for re-revision was asepticloosening in 7, stiffness in 6 patients, infection in 5, instability in 3 andsevere pain in 2 patients. Radiographically, all unrevised sleeves as wellthose patients who had re-revisions from stiffness and instability were well-fixed without any evidence of loosening. OKS in patients without re-revi-sions was 28.5 (SD12.2; 4 to 48). On EQ-5D the quality of life index was 57.9.Conclusion: At mid-term follow up, metaphyseal sleeves demonstratedurable clinical results and radiographic fixation and offers the potential forsuccessful long-term structural support in complex knee reconstruction forboth septic and aseptic indications.

Free Paper Session 4 – Miscellaneous

0025 – MIDTERM OUTCOMES OF ANTERIOR CRUCIATE LIGAMENTRECONSTRUCTION AND STAGED OR SIMULTANEOUS MEDIALUNICOMPARTMENTAL KNEE REPLACEMENTJames Molloy1, James Kennedy2, Chris Dodd3, David Murray2

1University of Notre Dame, Sydney, Australia. 2University of Oxford, Oxford,United Kingdom. 3Nuffield Orthopaedic Centre, Oxford, United Kingdom.

Intro: Meniscal-bearing unicompartmental knee replacement (UKR)requires a functionally intact anterior cruciate ligament (ACL), and bone-on-bone anteromedial osteoarthritis. Occasionally patients meet the indica-tions, but with a previously reconstructed ACL, or are ACL deficient. The aimof this study was to describe midterm outcomes, and compare functionaloutcomes to those with an intact ACL.Methods: We identified knees with staged or simultaneous ACL reconstruc-tion and medial UKR from a prospectively followed designer UKR cohort,and describe mean Oxford Knee Score (OKS), mean Tegner activity score andKaplan-Meier survival estimates. We matched these knees to ACL intactknees.Results: Seventy-six consecutive UKR with staged or simultaneous ACLreconstruction were identified with mean 6 year follow up (range 1-15).There was significant improvement in OKS and Tegner score with surgery. Atmost recent follow up, OKS was 41.0 (SD 8), and Tegner score 3.6 (SD 1).There were three revisions occurring at a mean of 5 years post operatively.One due to deep infection in a diabetic patient, and two due to lateral dis-ease progression. The 5, 10 and 15 year survival estimates were 97% (n atrisk = 45; 95% CI 93-100), 92.1% (at risk 12; 83-100), and 92.1% (at risk 2; 83-100). There was no difference in OKS or Tegner score compared to ACL intactknees.Discussion: These results demonstrate excellent midterm function and sur-vival of selected patients who have undergone ACL reconstruction andmedial UKR. In addition, their function was similar to those with intact ACLs.

0015 – MID TO LONG TERM OUTCOMES OF THE AVON PATELLO-FEMORALJOINT REPLACEMENTSimon Middleton, Andrew Toms, Peter Schranz, Vipul MandaliaExeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre,Royal Devon and Exeter Hospital, Exeter, United Kingdom.

Introduction: Avon patello-femoral joint replacement (PFJR) is a well-estab-lished treatment for the treatment of isolated PFJ osteo-arthritis. The aimsof this study are to evaluate the results, outcome and survivorship of thefirst PFJR performed in Exeter and to assess radiographic progression ofarthritis in the other compartments of the knee.Materials and Methods: Review of patient generated outcome question-naires, x-rays, notes and up to date follow up of patients who underwentAvon PFJR in our Unit between 2003 and 2014.Results: 103 PFJR implanted in 85 patients (28 male, 57 female) with meanage 59 years. Mean follow-up 5.6 years. Total revision rate: 9.7% (9 PFJR’swere converted to total knee replacement for disease progression and onefemoral component exchanged for malpositioning). Mean time to revi-sion:2.9 years (range 1-6), with no cases revised for infection or loosening.90% survival at 5 years and 85% at 10 years. Mean post op OKS 36 (range 7-48). 90% of the patients were satisfied with results of surgery. Radiologicalprogression of disease noted in 21 patients (28.3%)- 18 by 1 point on Kell-gren and Lawrence Score.Conclusions: We believe this to be the largest study of the Avon PFJR out-side of Bristol. Our results show good symptomatic relief as assessed bypatient acceptable symptom state (OKS≥36) for the vast majority ofpatients. Conversion to TKR does not represent failure of the index opera-



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tion. The majority of radiographic progression is mild. We continue toemploy this surgical option in selected cases.

0104 – SUCCESSFUL CLINICAL RESULTS OF A FOCAL INDIVIDUALISED MINI-METAL IMPLANT FOR FOCAL CARTILAGE LESIONS IN THE KNEE.Tim Spalding1, Ciara Stevenson1, Martin Lind2, Karl Eriksson3, Tobias Jung4,Geir Histol5, Pieter Emans6, Johannes Holz7

1University Hospital Coventry, Coventry, United Kingdom. 2Division ofSportstraumatology, Dept.Orthopedics, Aarhus University Hospital, Arhus,Denmark. 3Dept.of Orthopedic Surgery, Stockholm South Hospital,Karolinska Institut, Stockholm, Sweden. 4Virchow-Klinikum, Unfallchirurgie& Orthopädie, Sektion Sporttraumatologie & Arthroskopie, Berlin,Germany. 5Dept. Orthopedic Surgery, Vestre Viken, Drammen, Germany.6Dept. of Orthopedics, Masstricht UMC, Maastricht, Netherlands.7OrthoCentrum, Park-Klinik, Manhagen, Hamburg, Germany.

Objectives: Patients in the “gap age” 35-60 years old, with focal cartilagelesions are often considered too young for an arthroplasty and too old forbiologic repair. We report prospective results of patients undergoing treat-ment for chondral defects using a patient specific mini-metal implant.Methods: 61 (20 men, 41 women) with focal cartilage lesion ICRS grade 3 or4 underwent partial resurfacing with a 2nd generation individualized metal-lic implant. Mean age was 49 (27-67) years with mean BMI of 28. 86% hadfailed previous cartilage surgery. Prospective clinical data using VAS andKOOS outcome. Detailed specific MRI data was used to manufactureimplants and guide instruments by a CAD/CAM process. Implants and guideinstruments were patient specific and made to fit the unique knee anatomyof each individual knee. Implants were uncemented and made of chrome-cobalt, double coated with hydroxyapatite on top of Titanium.Results: Mean preoperative aggregated KOOS was 36. This improved to 52at 3 months, 60 at 6 months, 64 at 12 months and 66 at 24 months (n=19).The VAS score improved from 64 preoperatively to 29 at 12 and 24 months.There was one revision in this group after 16 months due to infection.Conclusions: The study shows excellent early clinical results in the treat-ment of focal full thickness symptomatic cartilage lesions on the femoralcondyles or trochlea with a second-generation patient specific metalimplant and cutting guides. Adherence to strict indications has allowed forhigh patient reported scores and low early revision rate.

0007 – DOES COMPLEX REGIONAL PAIN SYNDROME REALLY OCCURFOLLOWING TOTAL KNEE ARTHROPLASTY? – A PROSPECTIVE STUDY OF100 PATIENTS USING CURRENT DIAGNOSTIC CRITERIAJonathon Kosy, Simon Middleton, Bradley Ben, Rowenna Stroud,Jonathon Phillips, Andrew TomsExeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre,Royal Devon and Exeter Hospital, Exeter, United Kingdom.

Introduction: Complex Regional Pain Syndrome (CRPS) has been reported tooccur in up to 21% of patients following total knee arthroplasty (TKA). It issuggested that this is a common cause for continuing post-operative pain.The diagnostic criteria behind these reports however, are outdated. Thisstudy aimed to identify cases of CRPS using the updated internationallyaccepted criteria, whilst investigating areas where misdiagnosis may be pos-sible.Materials and Methods: We prospectively assessed data from a consecutiveseries of 100 primary TKA patients 6 weeks following TKA. Symptoms andsigns of CRPS were assessed in those patients with excessive pain (visualanalogue scale score > 4/10) using the Budapest Diagnostic Criteria and inline with this, an alternative diagnosis was sought that may explain the painand exclude a diagnosis of CRPS. In those patients without an explanationfor an alternative source of pain, an assessment of neuropathic pain wasconducted using the painDETECT questionnaire.Results: No cases of CRPS were identified according to the updatedBudapest criteria. According to the previous Orlando Criteria, 8 patients mayhave been diagnosed with CRPS. 6 of these patients with unexplained exces-sive pain levels had evidence of neuropathic pain. Reassessment of thosepatients with excessive pain 3 months following TKA showed resolution in allbut 2 patients without the need to restrict physiotherapy or institute addi-tional opiate analgesia.Conclusions: Using updated diagnostic criteria, CRPS should be considereda rare diagnosis following TKA. Assessment of more common causes such asneuropathic pain should be made.

0039 – CONSENT PLUS – IMPROVING THE CONSENT PROCESS IN ELECTIVELOWER LIMB ARTHROPLASTYAmit Chandratreya, Paul LeePrincess of Wales Hospital, Bridgend, USA.

Consent PLUS is an easy to use web based programme which introduces adocumented checkpoint to the consent process in hip and knee replace-ment surgery. It enables reproducible high-quality bite-sized informationdelivery to patients and their families in an optimal environment. It utilisesthe flip classroom principle to facilitate dialogue between doctors andpatients. More importantly it generates physical documentation to showpatients’ knowledge and understanding of the material risks; to produce atruly informed consent.1106 users completed the Consent PLUS process over 28 hospitals acrossthe UK. 98.1% of users were satisfied with Consent PLUS. It significantlyincreased users’ self-rated knowledge by 29%, independent of age group,prior knowledge or check-point scores.We were able to validate our data set with user self-rated scores before andafter they used Consent PLUS. It demonstrated Consent PLUS can increasepatients’ self-perceived knowledge by 30%, independent of their age group.Over the past 12 months, 1106 users completed the Consent PLUS onlinesystem and reached the certification stage. 60% of users accessed the sys-tem via desktop computers, 23% via tablet and 17% via mobile phone. 55consultant surgeons and 28 hospitals have been registered into the system.In conclusion, based on 1106 users’ data, Consent PLUS can facilitate infor-mation delivery and improve patients’ understanding of the risks of surgeryand its implications subjectively and objectively. Consent PLUS is a tooldesigned to enhance and facilitate the consent process, not to replace thecurrent consent forms.

0019 – RATES OF ARTHROSCOPIC KNEE SURGERY ARE DECLINING INENGLAND – RESULTS FROM A REVIEW OF THE NATIONAL HOSPITALEPISODE STATISTICSSimon Abram, Andrew Judge, David Beard, Andrew PriceNuffield Department of Orthopaedics, Rheumatology and MusculoskeletalSciences. University of Oxford., Oxford, United Kingdom.

Aim: The purpose of this study was to determine the trends and regionalvariation in the rate of arthroscopic knee surgery performed in England from1997-2017.Methods: National hospital episode statistic (HES) data on all kneearthroscopy procedures performed in England between 1997/98 and2016/17 was acquired from NHS Digital and analysed.Results: Through 1997-2017, 2,134,995 knee arthroscopies were per-formed. Nationally, the age and gender standardised rate of kneearthroscopy increased from a low of 159/100,000 population in 1997/98 topeak at mean 245/100,000 from 2008-2011 before declining steadily to182/100,000 in 2016/17. The rate of arthroscopic partial meniscectomy(APM) increased steadily from a low of 51/100,000 in 1997/98 to a peak atmean 147/100,000 through 2010-2014, before declining to 120/100,000 in2016/17. In the over 60 age group, 478,632 knee arthroscopies were per-formed and the rate increased from a low of 131/100,000 in 1997/98 to apeak of mean 278/100,000 in 2008-2011 before declining gradually to167/100,000 in 2016/17. The rate of APM increased from a low of36/100,000 in 1997/98 to a peak at mean 185/100,000 through 2010-2014,before declining to 134/100,000 in 2016/17. There was considerable geo-graphic variation.Conclusions: National data suggests that rates of arthroscopic knee surgeryhave declined considerably from previous peak levels, indicating a change inpractice in response to published trial evidence. Nevertheless, considerableregional variation persists and rates are higher in England than thosereported in some other countries. The ‘appropriate’ rate of arthroscopicknee surgery for the population is, however, unknown.



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Free Paper Session 5 – ‘SHORT POSTER PRESENTATIONS’

0071 – CHEMICAL THROMBOPROPHYLAXIS IN PRIMARY JOINTREPLACEMENT – IS IT WORTH THE BLEEDING BOTHER?’ RISKSTRATIFICATION IN JOINT REPLACEMENT IS AS EFFECTIVE, AND SAFER,THAN DRUGS FOR ALL. RESULTS IN 13,472 PATIENTSPeter Cay, Sukhdeep Gill, Randeep Karwal, Andrea Pearce, Nigel RossiterBasingstoke and North Hampshire Hospital, Basingstoke, United Kingdom.

Background: Retrospective analysis of over 13,000 primary hip and kneereplacements in a single DGH from 1999-2016.Methods: Patients were stratified prior to admission as high or low risk.Prior to 2012 low risk patients only had mechanical prophylaxis (Footpumps). After 2012 patients had a selection of VTE prophylaxis includingNOACs, aspirin, LMWH, warfarin and mechanical onlyResults: Foot pumps alone had a 0.67% DVT risk and a 0.44% PE risk, similarto low risk patients on aspirin prophylaxis (DVT 0.38%, PE 0.38%) after a pri-mary hip replacement. Foot pumps alone had a 0.81% DVT risk and a 0.57%PE risk, similar to low risk patients on aspirin prophylaxis (DVT 0.42%, PE0.57%) after a primary knee replacement.Conclusion: Risk stratification may be enough to identify patients who areat low enough risk post arthroplasty to not require any form of chemicalprophylaxis.

0037 – A SIMPLE VISUAL AID INCREASES KNEE FLEXION AFTER A PRIMARYKNEE REPLACEMENTLeonid Kandel, Oriel Ratson, Yoav Mattan, Meir Liebergall, Gurion RivkinHadassah-Hebrew University Medical Center, Jerusalem, Israel.

Knee flexion is a very important functional outcome after primary kneereplacement. During the first weeks after the surgery, patients are encour-aged to increase the range of motion of the knee. However, pain and anxietymay preclude the patient from exercising. “Doctor, it is too painful, some-thing has to be wrong in there” is a common statement. We studied if a sim-ple visual aid can improve the knee flexion.After power analysis, 60 patients were prospectively recruited, 29 in controland 31 in intervention group. Both groups received identical postoperativetreatment, both in hospital and after the discharge. In intervention group,patients received a laminated A4 color photo of their postoperative flexion,with their initials written on their thigh. Patients were encouraged to keepthe photo at the bedside and to look at it every time they are in pain or anx-ious about their surgery. Knee flexion was measured preoperatively and 6weeks after the procedure, using a smartphone application.The two groups were similar in age, gender and BMI. There was no differ-ence in preoperative knee flexion. 6 weeks after the surgery, the averageflexion in the intervention group was 105 degrees and in the control group– 95 degrees (p=0.03).A photo of postoperative knee flexion, taken while under anaesthesia,shows the patient his optimal – and possible – knee flexion. In this study itimproved the knee flexion, probably by reducing the anxiety and allowingmore exercising. More similar interventions are needed to improve differentaspects of outcome.

0013 – PSYCHOMETRIC ASSESSMENT OF ARTHROSCOPIC SURGEONSJustin Johnson1, David Johnson2

1Musgrove Park Hospital, Taunton, United Kingdom. 2Bristol OrthopaedicClinic, Bristol, United Kingdom.

Arthroscopic and minimally invasive surgery demands spatial manipulationand visualization skills commonly associated with dyslexia.The UK Clinical Aptitude Test (UKCAT) is a higher academic qualification usedfor UK Medical School entry since 2006. We assessed the psychometric apti-tude scores of two groups of postgraduate experts with widely differing skillsets. An online questionnaire of questions and psychometric tests from theUKCAT were used to compare the performance in a group of Consultantarthroscopic orthopaedic surgeons and a group of established general prac-titioners.The Orthopaedic Surgeons had an incidence of dyslexic traits in 33%, a his-tory of 25% special needs training in school, 42% were slow to read as chil-dren, 50% reported adult spelling problems, 33% found oral examinationsbetter, 25% had dyslexic children. This compared to 0% of these problems inthe GP group. Dyslexic individuals scored much lower on the UKCAT test, asdid candidates whose first language was not English. The UKCAT test showedthat the GP’s significantly outscored the arthroscopic surgeons in the UKCAT

test results in all categories except confidence of decision making when cor-rect. Some of these parameters reached statistical significance at the p<0.05level. The scores suggest that 33% of the arthroscopic surgeons may nothave achieved the level necessary for entry to medical school.The current reliance on the UKCAT as a higher level of academic and apti-tude testing for medical school entry may exclude those with the psychome-tric skills which are ideally suited for minimally invasive surgeons.

0035 – CANDIDACY AND SURVIVORSHIP FOR MEDIAL-MENISCAL BEARINGUNICOMPARTMENTAL KNEE REPLACEMENT BY AGEJames Kennedy1, Stephen Mellon1, Adolph Lombardi2, Keith Berend2,Thomas Hamilton1, David Murray1

1University of Oxford, Oxford, United Kingdom. 2Joint Implant Surgeons,Inc, New Albany, USA.

Introduction: About 50% of knees are candidates for unicompartmentalknee replacement (UKR), but it is unclear how candidacy is affected by age.Methods: Preoperative radiographs from 457 consecutive knees replaced atan independent centre were reviewed. A radiographic decision aid, vali-dated for medial meniscal-bearing UKR, determined candidacy for agegroups <50, 50 to <60, 60 to <70, 70 to <80, and 80+.Results: Overall 49% of knees were appropriate for UKR. Candidacydecreased with age (p = 0.004), being 74% (CI 32), 53% (CI 18), 46% (CI 15),41% (CI 19), and 43% (CI 31) respectively. In all groups lateral osteoarthritiswas the leading reason UKR was not appropriate. To improve power, sur-vivorship was examined with cutoffs <60, 60 to <75, and 75+. 92% of kneesidentified as appropriate for UKR were treated with UKR and in these 5 yearimplant survival was not related to age (p=0.54), and was 98.6% (CI 10),98.8% (CI 8) and 100% respectively.Conclusion: Candidacy decreased with age, being 74% in those <50 and 43%in those 80+. The proportion of patients appropriate for UKR that aretreated by UKR, based on National Joint Registry data, also decreases withage being one-third in those <60 and only one-tenth in those over 80. UKRhas lower morbidity and mortality compared to TKR, and in this series norevisions in those 75+, thus it is arguably the eldest patients that have themost to gain with UKR yet are the most underutilised.

0028 – 1-YEAR OUTCOMES OF MEDIAL PATELLOFEMORAL LIGAMENTRECONSTRUCTION WITH TIBIAL TUBEROSITY DISTALISATION FORPATIENTS WITH RECURRENT PATELLOFEMORAL INSTABILITY AND PATELLAALTAAshley Brown, Gaynor Kanes, Andrew BarnettThe Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UnitedKingdom.

Introduction: Recurrent patellofemoral instability represents a challengingcondition to treat. Two of the most common risk factors for this conditionare trochlear dysplasia and patellar alta. In carefully selected patients, sur-gery can restore stability and improve clinical function. We report on theoutcomes of medial patellofemoral ligament (MPFL) reconstruction in com-bination with tibial tuberosity distalisation (TTD) for patients withpatellofemoral instability and patella alta.Methods: MPFL reconstruction with TTD was undertaken for patients withrecurrent patellofemoral instability and radiographic evidence of patella altabetween August 2013 and December 2016. Patients were evaluated pre-and post- operatively with standard scoring systems. Patients with severetrochlear dysplasia were excluded.Results: Twenty-four consecutive MPFL reconstruction and TTD procedureswere undertaken in 20 patients (6 male, 14 female), with a mean age of 22.8years (16 – 31), and 1-year follow-up. Four patients underwent bilateral pro-cedures (sequential). Three (12%) had no trochlear dysplasia, 11 (46%) milddysplasia, and 10 (42%) moderate. Mean operative time was 82 minutes.Mean Kujala and IKDC scores improved from 62.1 pre-operatively to 82.7 at1 year post-operatively (p<0.05), and 48.7 to 73.4 (p<0.05), respectively. Norecurrence of instability occurred during the 1 year follow up period. One(4%) patient developed post-operative stiffness, requiring a manipulationunder anaesthetic at 6 months post-operatively.Conclusions: In carefully selected patients with patellofemoral instabilityand patella alta, MPFL reconstruction and TTD is a safe and effective treat-ment.



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0027 – INTRODUCING DAYCASE SURGERY INTO AN ENHANCED RECOVERYPROGRAMME FOR UNICOMPARTMENTAL KNEE REPLACEMENT WITHINTHE NHS SETTING: SUITABLE FOR ALL? THE RESULTS OF A SERVICEIMPROVEMENT PROJECT AND LESSONS LEARNEDCathy Jenkins1, William Jackson1, Nicholas Bottomley1, Andrew Price1,2,David Murray1,2, Karen Barker1,2

1Nuffield Orthopaedic Centre, Oxford, United Kingdom. 2NuffieldDepartment of Orthopaedics, Rheumatology and Musculoskeletal Sciences,Oxford, United Kingdom.

Aim: The emphasis within the NHS is to safely reduce the time patientsspend in hospital and perform more operations as daycases or short stay.Our aim was to introduce a new pathway with an innovative rehabilitationprotocol, delaying knee flexion, to reduce the length of stay (LOS) for all uni-compartmental knee replacements (UKRs) This gave the opportunity for asmany patients as possible to be managed as daycases with an option totransfer to an enhanced recovery pathway if they were not discharged byday 1.Patients and Methods:In September 2016 an innovative daycase pathwaywas introduced. Eleven orthopaedic consultants and their teams performed436 primary unilateral UKRs in the 12 months to August 2017.Results:130 patients (30%) went home on the day of surgery, 180 (41%) onday 1 and 126 (29%) stayed in 2 or more days (range 2-28 days). The averageLOS reduced from 2.6 to 1.5 days (median of 1 day). The pathway was safeand acceptable to patients. Average flexion was 109° (60-135) at 6 weekswith no MUAs. A saving of 480 bed days and £144,000 was made in 12months.Conclusion: Many components of traditional clinical care were alteredallowing adoption of this pathway. We feel the important factors were theconsistent team message and patient education, delayed knee flexion andphysiotherapists working late evening shifts. The changes we achieved werethe result of marginal improvements in all areas of the pathway, rather thanany one major change.

0066 – IS MRI USEFUL IN DIAGNOSING INTRA-ARTICULAR KNEEPATHOLOGY IN CHILDREN AND ADOLESCENTS?Stephanie Buchan, Sarah Murgatroyd, Joanna ThomasSouthampton Children’s Hospital, Southampton, United Kingdom.

Introduction: Evidence reviewing the accuracy of MRI for knee pathology inchildren and adolescents is limited. This study aims to compare the intra-operative findings with MRI reports to identify the accuracy of MRI in diag-nosing knee pathology in children and adolescents and conclude if MRI aidsmanagement.Method: Over a 12-month period, all patients under 18 years of age whounderwent arthroscopic knee surgery were identified from theatre records.The surgical operation notes and corresponding pre-operative MRI reportswere analysed and compared.Results: Of the 96 patients who underwent knee arthroscopy during thistime, 90 had MRI scans reported by a consultant musculoskeletal radiologistand were included in our study. The MRI and arthroscopy findings correlatedin 52 cases. The sensitivity of MRI investigation was 58%, specificity 50% andaccuracy 57%. Anterior cruciate ligament (ACL) injuries specifically werepoorly identified on MRI. Of 37 patients who had an ACL rupture atarthroscopy and were reconstructed, 19 were correctly identified on MRI,resulting in a sensitivity of 51% for MRI diagnosed ACL ruptures. One patienthad an MRI reported tear that was normal at arthroscopy. Overall accuracyfor MRI to identify an ACL injury was 79%. On review of MRI scans post-oper-atively with a consultant paediatric musculoskeletal radiologist and consult-ant paediatric orthopaedic surgeon (senior author) the arthroscopic findingswere not obvious on the MRI scan.Conclusion: Clinicians should not be falsely reassured by a normal MRI scanand in the presence of ongoing knee symptoms should consider kneearthroscopy.

0095 – COMBINED INTRAVENOUS AND TOPICAL TRANEXAMIC ACID WITH30 MINUTES DRAIN CLAMP IS MORE EFFECTIVE THAN SINGLE DOSETRANEXAMIC ACID, DUAL DOSE INTRAVENOUS TRANEXAMIC ACID ORCOMBINED INTRAVENOUS AND TOPICAL TRANEXAMIC ACID INREDUCING BLOOD LOSS FOLLOWING TOTAL KNEE REPLACEMENTAbdelaleem Ragab1, Vinayak Ghanate1, Hatim Cochin2, Shaival Dalal1, Amit Chandratreya1, Rahul Kotwal1

1Princess of Wales Hospital, Bridgend, Wales, United Kingdom. 2Cardiff University, Cardiff, United Kingdom.

Introduction: Tranexamic acid is thought to play an important role in reduc-ing blood loss in patients undergoing total knee replacement (TKR). Its useis variable and there is debate as to what is the most optimal route and dosefor its use in TKR.Aim: To compare differing practices of four surgeons to determine the mosteffective dose and mode of use of tranexamic acid administration to reduceblood loss during TKR.Methods: Prospective cohort study. 4 groups of patients who underwentprimary TKR for osteoarthritis with 4 surgeons. Group 1 (n=22) received 1gmintravenous tranexamic acid at induction. Group 2 (n=22) received 1gmintravenous at induction and 1 gram intravenous before skin closure. Group3 (n=22) received 1gm intravenous at induction and 1gm intra-articular top-ically during closure and a drain was used, clamped for 30 minutes. Group 4(n=11) same as group 3 but without a drain. Drop in haemoglobin level post-operatively and the need for blood transfusion was assessed.Results: None of the patients needed blood transfusion post operatively.Groups 1 & 2 showed significant drop of haemoglobin (mean Hb drop 23.78,22.14 respectively) in relation to the other two groups, p value 0.013. Group3 (mean Hb drop 13.32) showed significant less drop of haemoglobin thangroup 4 (mean Hb drop 17.5) with p value 0.047.Conclusion: Combined intravenous and intra-articular tranexamic acid witha drain clamped for 30 minutes was the most effective regimen in reducingperioperative blood loss in our cohort of patients undergoing TKR.

0088 – VALIDATION OF REVISION DATA FOR TOTAL KNEE REPLACEMENTSUNDERTAKEN AT A HIGH VOLUME ORTHOPAEDIC CENTRE USINGHOSPITAL AND NATIONAL JOINT REGISTRY DATAIrrum Afzal, Roy Twyman, Richard FieldSouth West London Elective Orthopaedic Centre, London, United Kingdom.

The National Joint Registry (NJR) provides a powerful tool to monitorimplant survivorship and the influence of different surgical strategies. Wereport the frequency of incorrect K2 revision data, inputted by a high vol-ume orthopaedic centre, over eleven years.Of 12,635 primary Total Knee Replacements (TKR) undertaken by 23 sur-geons, with available NJR consultant outcome publication data, 1.08% (137)were subsequently reported to the NJR as revised. Review of ‘reason forrevision’ was undertaken using imaging studies (x-rays, CT, MRI and isotopescans), pathology, histology, microbiology and electronic medical records.Discrepancies in reporting to the NJR were identified for 28 (20.4%) cases.The most frequent discrepancies were in the reporting of infection, progres-sive arthritis,malalignment and ‘other’. Infection was under-reported to the NJR by3.65%. The ‘reason for revision’ data is recorded to the NJR with findings atthe time of surgery. It is some days before microbiology reports becomeavailable and source data had not been updated. Progressive arthritis andmalignment were under-reported by 6.56% and 3.65% respectively. 3.65%of the revised cases were reported as ‘other’. Retrospective review allowedall these cases to be reclassified to the most appropriate ‘reason for revision’category.Local scrutiny, review and validation of K1 and K2 data is vital to optimisethe value of the NJR. If the 20% wrong data entry at a highly organised insti-tution is replicated throughout the United Kingdom, a formal process to val-idate K1 and K2 data should be considered.



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0002 – A SYSTEMATIC REVIEW OF LONG TERM PATIENT REPORTEDOUTCOMES FOR THE TREATMENT OF ANTERIOR CRUCIATE LIGAMENTINJURIES IN THE SKELETALLY IMMATURE.Christopher Buckle, Andrew WainwrightNuffield Department of Orthopaedics, Rheumatology and MusculoskeletalSciences, Oxford, United Kingdom.

Purpose: To systematically review the available literature regarding out-comes for the treatment of ACL injuries in the skeletally immature at skeletalmaturity or >5 years after surgery.Methodology: A systematic search was performed of seven online data-bases for literature reporting patient reported outcomes for the treatmentof ACL injuries in the skeletally immature. A systematic review of this litera-ture was performed examining the outcomes and their association withskeletal immaturity and treatment techniques.Results: 18 articles reported the outcomes of 375 subjects. The mean age atsurgery ranged from 10.3 to 15 years old. Average follow up ranged from 36to 163 months. 10 studies followed up subjects until skeletal maturity. Theranges for outcome scores for surgical treatments were found to be:Lysholm 84.6-100, Tegner 6-8.7, IKDC 84-97. No differences in outcomescores were seen between extra- or trans-physeal surgery, however, resultsfor non-surgical treatments were worse. Higher incidences of limb lengthdiscrepancy (n=2) and malalignment (n=1) were seen with transphyseal sur-gery. A higher incidence of persistent instability was seen with transphysealsurgery.Conclusions: The results of this systematic review have found the long-termpatient reported outcomes of ACL reconstruction in the skeletally immatureto be good. They compare favourably to the natural history of the condition.However, the results of modern non-surgical treatments and ligament repairtechniques needs to be further evaluated. Both transphyseal and extraphy-seal reconstructive techniques produced good outcomes, but a trend ofmore persistent instability was seen in the transphyseal group.

Free Paper Session 6- Osteotomy and others

0092 – STATIC STRENGTH OF HIGH TIBIAL OSTEOTOMY WITH ANDWITHOUT GRAFT MATERIALS: A BIOMECHANICAL STUDYJohn Dabis, James Belsey, Raghbir Khakha, Sam Yasen, Mike Risebury,Adrian WilsonBasingstoke & North Hampshire NHS Trust, Basingstoke, United Kingdom.

Objectives: The purpose of this study was to investigate the use of differentgraft materials during medial opening wedge high tibial osteotomy(MOWHTO), and their effects on construct strength and stability.Methods: A 10 mm biplanar MOWHTO was performed on 15 artificial tibiae.In the resultant osteotomy gap, an allograft wedge (n=5), or pairs of syn-thetic β-tricalciumphosphate wedges (n=5) were inserted prior to plate fix-ation. An additional control group (n=5) with no inserted wedge was alsoincluded in the study. All osteotomies were secured using an internal fixatorplate with a monoaxial locking system. Static compression was applied, fol-lowing a ramp protocol (0.1 mm/s), perpendicular to the tibial plateau ofeach specimen, until failure of the osteotomy construct. Failure was thepoint at which there was a fracture of the lateral cortex. Maximum force,horizontal and vertical displacement, valgus malrotation of the tibial head,and specimen stiffness were calculated.Results: The synthetic group failed at 6.25 kN, the allograft group at 6.04 kN,and the control group at 4.46 kN. The most valgus malrotation of the tibialhead was observed in the allograft group (2.6˚). The allograft group showedhigh stiffness on the medial side of the tibial head as well as the highest stiff-ness on the lateral side.Conclusions: The use of graft materials in MOWHTO results in superior bio-mechanical properties as compared to the use of no graft. Synthetic graftsprovide the highest mechanical strength to a MOWHTO. Allograft wedgesalso provide mechanical strength to MOWHTO.

0096 – THE USE OF BONE WEDGE ALLOGRAFT IN HIGH TIBIALOSTEOTOMY: A PROSPECTIVE STUDY OF PAIN AND TIME TO UNIONJohn Dabis, Raghbir Khakha, James Belsey, Sam Yasen, Mike Risebury, AdrianWilsonBasingstoke & North Hampshire NHS Trust, Basingstoke, United Kingdom.

Introduction: Medial opening wedge high tibial osteotomy (HTO) is com-monly used to treat patients with medial osteoarthritis secondary to varus

malalignment. It has traditionally been associated with high pain scores,complications with union and hardware prominence. Modern techniqueshave improved clinical outcomes, however, pain and swelling remains anissue for some patients.Aims: To identify whether the use of a cancellous bone wedge allograftimproves clinical outcomes and time to union.Methods: A prospective cohort study with three interventions wasdesigned. Group 1 received an HTO using a Tomofix plate (Depuy-Synthes)with no bone graft. Group 2 received a Tomofix plate with bone graft. Group3 received a low profile Activmotion plate (Newclip Technics) with bonegraft. Power was set at 80% with p<0.05, requiring 28 patients in each arm.Patient outcome scores including KOOS, OKS, EQ-5D and APQ scores werecollected pre-operatively and 12 weeks. Opiod use and pain scores weremeasured in the first 48 hours post-operatively, with repeat scores at weeks3,6,9 and 12. Signs of union were assessed radiologically at 3 months.Results: There was a significant reduction in pain scores, opiod use andswelling in groups using bone graft in the immediate post-operative periodup to 6 weeks, compared to those without (p<0.05). These scores becameequivocal at 12 weeks. There were no associated complications using allo-graft.Conclusion: Bone wedge allograft can be safely used in high tibialosteotomy surgery with the benefits of reduction of pain and swelling in theimmediate post-operative period.

0026 – EFFECT OF BMI ON THE LONG-TERM OUTCOMES OF MEDIALMENISCAL-BEARING UNICOMPARTMENTAL KNEE REPLACEMENTJames Molloy1, James Kennedy2, Chris Dodd3, David Murray2

1University of Notre Dame, Sydney, Australia. 2University of Oxford, Oxford,United Kingdom. 3Nuffield Orthopaedic Centre, Oxford, United Kingdom.

Background: Obesity is considered a contraindication for unicompartmentalknee replacement (UKR), and this has seen rationing of arthroplasty in theUnited Kingdom based on body mass index (BMI). The aim of this study wasto assess the effect of BMI on long term functional and survival outcomes ofmedial UKR.Methods: A prospectively followed cohort of 1000 consecutive medialmeniscal-bearing UKR with mean ten year follow up was divided intogroups: BMI <25 kg/m2, 25 to <30, 30 to <35 and 35+. At ten years, meanOxford Knee Score (OKS) was compared with a Kruskall-Wallis test, andKaplan-Meier survival estimates compared with a log rank test.Results: Heavier patient groupings were younger and had worse preopera-tive OKS. All groups had a significant improvement in OKS with surgery. Atten years the OKS from lightest to heaviest group were 41 (SD 8), 41 (8), 37(8), and 40 (8) (p=0.001). The 35+ group experienced the greatest overallincrease in OKS. Ten year survival from lightest to heaviest group was 91.5%(95% CI 86-96), 94.5% (92-97), 93.8% (90-98) and 92.6% (87-99). These dif-ferences were not significant (p=0.54). Disease progression was not associ-ated with BMI (p=0.52).Conclusions: There were significant differences in OKS, though there did notappear to be a trend with increasing BMI, and the heaviest group had thebiggest improvement. There was no difference in implant survival. Theseresults suggest BMI does not impact outcome, and should not be consid-ered a contra-indication to medial meniscal-bearing UKR

0009 – ALLERGY IN TOTAL KNEE ARTHROPLASTY. A REVIEW OF THE FACTSSimon Middleton, Andrew TomsExeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre,Royal Devon and Exeter Hospital, Exeter, United Kingdom.

Introduction: The possibility of allergy in total knee arthroplasty (TKA) is anissue that has become increasingly prominent over the last few years. 10 to48% of the population are reported to be sensitive to metal. We examinedthe literature and explored potential mechanisms of allergy to identify if anyclear relationship between allergy and TKA exists.Methods: Literature search using Medline and PubMed for articles with spe-cific reference to allergy or hypersensitivity in TKA.Results: More than 100 papers were identified, reduced to 56 relevantpapers on abstract review and these formed the basis of our opinion.True allergy is an IgE mediated reaction and does not occur in response tometal implants. However, type IV hypersensitivity is not antibody mediatedbut a T-cell lymphocyte mediated reaction taking a few days to occur inpatients who have previously been sensitised to the allergen. Metal parti-cles on their own do not stimulate the immune system but must cross react



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with proteins. The cellular mechanism for this exists.Criteria to diagnose an implant failure as a result of allergy are extensive,ultimately relying on resolution of symptoms after revision as well as appro-priate local tissue reaction.Conclusion: On the basis of current evidence pre- operative screening formetal hypersensitivity is not needed as evidence is lacking to support thathypersensitivity as an allergic process to TKA exists or is a problem. There isno current proven benefit to novel hypoallergenic implants and we continueto use standard implants in all patients.

0033 – STUD DESIGN OF SPORTS FOOTWEAR AFFECTS GROUNDREACTION FORCES IN CUTTING AND CROSS-CUTTING EXERCISEDaniel Winson1,2, Dario Cazzola3, Owen Lawrence1, Ian Winson4, Andrew Davies1

1Morriston Hospital, Swansea, United Kingdom. 2University of Bath SportsMedicine Department, Bath, United Kingdom. 3University of Bath AppliedBiomechanics Suite, Bath, United Kingdom. 4Southmead Hospital, Bristol,United Kingdom.

Non-contact Anterior Cruciate Ligament injury can occur during cutting andcross-cutting movements in sport. The nature of the playing surface (grassvs 4G) affects ground reaction forces through the lower limb, but the impactof boot stud design and arrangement is unknown. One theory is that bootswith a ‘blade’ stud design resist sideways slipping of the planted foot to agreater degree than boots with a rounded stud. Increased lateral forcesmight predispose to greater risk of injury using such designs. This biome-chanical study directly measures ground reaction forces using two differentdesigns of rugby boot. The study was conducted on a 4G artificial grass sur-face rather than in a biomechanics laboratory in order to replicate genuinesporting conditions more accurately.Ground reaction forces on the foot were measured using Tekscan in-shoepressure plates in 20 rugby players. Each player was asked to complete anagility course to measure acceleration, cutting and cross-cutting in the twodifferent designs of rugby boot. The two boots used were the CanteburyPhoenix Club 8 Stud boot and the Cantebury Speed Club Blade boot.Results are produced as colour-coded force maps and pressure graphs forboth feet as the athletes performed the test course. Ground reaction forcesduring cutting and cross-cutting were higher when wearing the blade designcompared to the traditional stud design. Increased lateral forces could the-oretically increase risk of ACL injury in athletes. Further clinical studies willbe required to assess this correlation in the sporting population.

0078 – ASSESSMENT OF THE TIBIAL TUBEROSITY-TROCHLEAR GROOVEDISTANCE IN TROCHLEAR DYSPLASIA- A NEW RADIOGRAPHIC METHODRobert Keehan1, Amarit Gill2, Lindsay Smith1, Riaz Ahmad1, Jonathan Eldridge3

1Weston General Hospital, Weston super Mare, United Kingdom. 2Univer-sity of Bristol, Bristol, United Kingdom. 3University Hospitals Bristol NHSTrust, Bristol, United Kingdom.

Introduction: The tibial tuberosity trochlea groove distance (TTTG) is animportant radiological measurement in patellofemoral instability (PFI). Avalue ≥20mm is considered an indication for tubercle medialisation.Trochlear dysplasia is a common finding in PFI, in which the TTTG can be dif-ficult or impossible to assess. We present a new measurement based on thefemoral epicondyles as an alternative to the TTTG which potentially resolvesthese difficulties.Methods: We reviewed 30 consecutive MRIs, excluding 61 with sulcusangles ≥ 135°, patella tendon insertions which were not demonstrated, orartefact. On axial images we located the mid inter-epicondylar line trochleaintersection (MIELTI), and compared it to the deepest point of the trochleargroove. Three researchers measured the TTTG and the TTMIELTI for all 30knees. One remeasured after 6 weeks.Results: – The intraclass correlation coefficient (ICC) test demonstratedgood to excellent correlation, inter-observer reliability, and intra-observerrepeatability of TTTG and TTMIELTI.Discussion: The primary advantage of the TTMIELTI is that it can be usedirrespective of the degree of dysplasia. Study weaknesses include the num-ber of exclusions and the lack of formal measurements of knee extension.The sample size is relatively small but produced significant results, which arelikely to reflect the consistency of the anatomical relationship between theepicondyles and the deepest part of the trochlear groove.

Conclusions: We conclude that the TTMIELTI is a reliable alternative to theTTTG in normal knees. Re-assessment in dysplastic knees would be of ben-efit to establish its usefulness in the clinical setting.

0046 – 2D/3D EOS IMAGING VERSUS STANDING LONG LEG X-RAY INLOWER LIMB CLINICAL ASSESSMENT – INTER-OBSERVER AND INTRA-OBSERVER RELIABILITYMelinda YT Hau1, Dipen K Menon1, Ronald Chan2, Kwong Yin Chung2, Wai Wang Chau3, Ki Wai Ho2

1 Kettering General Hospital, United Kingdom, 2Prince of Wales Hospital,Hong Kong, 3Dept of ORT, CUHK, Hong Kong

Background: X-ray imaging is widely used as gold standard for assessinglower limb conditions, such as arthritis, and for pre-operative planning. Newlow-radiation-dose EOS imaging system enables weight-bearing 3D imagingso it accounts for limb deformities and aids accurate pre-operative planning.The objective is to measure lower limb angles from EOS images to deter-mine its accuracy and repeatability compared with standing x-rays.Method: Over 1 year patients with end-stage osteoarthritis were recruitedfrom preoperative clinics. 40 long leg 2D EOS, 3D EOS images and x-ray radi-ographs were measured independently by 4 observers (2D EOS and x-ray:fAMA, mLDFA, aLDFA, MPTA, LDTA; 3D EOS: femur and tibia length,varus/valgus, fAMA, mLDFA, and MPTA). All observers repeated the meas-urements on 2D EOS and x-ray imaging.Results: T-test and Bland-Altman (BA) analysis comparing 2D EOS with x-rayimaging showed no statistical difference in measurements, apart from MPTA(85.20 vs. 86.14, p=0.04). T-test comparing 3D EOS with 2D EOS imagingshowed no significant difference in all angles (p>0.05). T-test comparing 3DEOS with x-ray radiographs measurements showed no significant differencein fAMA and mLDFA, apart from measuring MPTA (84.50±3.07 vs.86.27±4.02, p=0.03). Inter-observer ICC for 2D EOS and x-ray was 0.99 and0.99 respectively. The intra-observer ICC for 2D EOS and x-ray was 1.00 and1.00 respectively. Both modalities have excellent repeatability and repro-ducibility.Conclusion: This study has shown EOS imaging system as a valid alternativemethod of imaging lower limbs for alignment, measurements and preoper-ative arthroplasty planning.



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British Association for Surgery of the KneeANNUAL GENERAL MEETING

Tuesday 20th March 2018 - Leicester

Agenda

1. Apologies

2. Minutes of BASK AGM, Southport 2017 Tony Hui

3. President’s Report Colin Esler

4. Research Committee Andrew Toms

5. Education Report Andrew Porteous

6. Webmaster’s Report Ram Venkatesh

7. Treasurer’s Report Leela Biant

8. ‘The Knee’ Report Caroline Hing

9. Coding, tariff and GAPI David Johnson

10. Secretary’s Report Tony Hui

a. Election to BASK Executive

b. Election of new members

11. Any other business

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24

ACPA CONFERENCE PARALLEL TO BASK ANNUAL SPRING MEETING

LCFC, King Power Stadium, Leicester

20th – 21st March 2018

The APCA Meeting will be held in Premier Lounge 2, located on the 2nd floor of the LCFC

Tuesday 20th March

08.00 REGISTRATION & COFFEE – Reception Lounge & Walkers Hall within the Exhibition Area

09.00 WELCOME & INTRODUCTION – BASK President, Colin Esler (Leicester) – Keith Weller Lounge

09.30 WELCOME & INTRODUCTION TO MAIN ACPA PROGRAMME – Clare-Louise Sandell, ACPA Presi-dent, Premier Lounge 2, Second Floor

09.40 GiRFT – THE ROLE OF THE ARTHROPLASTY PRACTITIONER IN VALIDATING DATA – Mr Tim Wilton,Consultant Orthopaedic Surgeon, Royal Derby Hospital, Derby, UK

10.15 COFFEE – (Walkers Hall & Reception Lounge – Exhibition/Poster & E-Poster Viewing)

10.45 HEALTH LITERACY & NUMERACY – AN INTRODUCTORY AND INSTRUCTIONAL SESSION ON KEYCONCEPTS FOR ENHANCING PATIENT CENTRED COMMUNICATION AND CONSENT – Ms MaxineDennis, Operations Director, Community Health & Learning Foundation, Loughborough, UK

12.45 MAIN BASK PROGRAMME – GUEST SPEAKER: Piers Mitchell (Peterborough) Presentation ‘Musculoskeletal Disease and Trauma in King Richard III’

13.15 LUNCH – (Walkers Hall & Reception Lounge – Exhibition/Poster & E-Poster Viewing)

14.00 MAIN BASK PROGRAMME – INSTRUCTIONAL SESSION 1 – Can we improve outcome of knee re-placement?

15.20 TEA – (Walkers Hall & Reception Lounge – Exhibition/Poster & E-Poster Viewing)

15.50 MAIN BASK PROGRAMME – INSTRUCTIONAL SESSION 2- Periprosthetic Joint Infection

17.15 – 18.15 ACPA AGM & DRINKS RECEPTION

19.30 arrival drinks for 20.15 seating for dinner – Annual BASK Dinner, ‘The National Space Centre’ Leicester.There will be an alternative ACPA dinner – venue to be confirmed.

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The APCA Meeting will be held in Premier Lounge 2, located on the 2nd floor of the LCFC

Wednesday 21st March

08.00 REGISTRATION & COFFEE – Reception Lounge & Walkers Hall within the Exhibition Area (Poster &E-Poster Viewing)

09.00 CLINICAL PEARLS SESSION 1 – FOOT AND ANKLE – Mr Stephen Milner, Consultant Foot and AnkleSurgeon, Royal Derby Hospital, Derby, UK

09.30 CLINICAL PEARLS SESSION 2 – SHOULDER AND ELBOW REPLACEMENT, INCLUDING OUTCOMEMEASUREMENT AND DATABASE CREATION – Ms Marie Morgan, Clinical Specialist Physiotherapistand Upper Limb Arthroplasty Practitioner, Royal Derby Hospital, Derby, UK

10.05 COFFEE – (Walkers Hall & Reception Lounge – Exhibition/Poster & E-Poster Viewing)

10.40 CLINICAL PEARLS SESSION 3 – RADIOLOGY: BACK TO BASICS – Dr Michael Khoo, Consultant Radi-ologist, Royal National Orthopaedic Hospital, Stanmore, UK

12.00 MAIN BASK PROGRAMME – Lorden Trickey Lecture- Principles of Revision Knee Arthroplasty, DrWolfgang Klauser, Helios Baltic Sea Clinic, Germany

12.40 LUNCH – (Walkers Hall & Reception Lounge – Exhibition/Poster & E-Poster Viewing)

13.20 ACPA OPEN FORUM AND NETWORKING SESSION – Chaired by Sharon Ferndinadus, OrthopaedicNurse Specialist, Chapel Allerton Hospital, UK

15.00 ACPA MEETING ENDS AND CLOSING REMARKS

15.10 COFFEE – (Walkers Hall & Reception Lounge – Exhibition /Poster & E-Poster Viewing)

15.30 MAIN BASK PROGRAMME

16.30 Closing Remarks– President, Colin Esler (Leicester)

16.45 Close of the ‘2018 BASK Annual Spring Meeting’

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'The Poster Presentations are displayed on poster boards in the exhibition areas, Walkers Hall & Reception Lounge'.Authors of the POSTER presentations (Free Paper sessions) were invited to submit an E-Poster of their presentation.

The E-Posters are displayed on screens within the exhibition area (Walkers Hall & Reception Lounge).You can search and view individual E-Posters using the touch screen in the exhibition area, Walkers Hall.

0005 – A VALIDATION STUDY OF THE ARABIC VERSION OF THEOXFORD KNEE SCORE FOR USE IN END STAGE KNEEOSTEOARTHRITISBodor Bin sheeha1,2, Anita Williams1, David Sands (DS) Johnson3,4,AHMAD BIN NASSER5, Malcolm Granat1, Richard Jones1

1University of Salford, Manchester, United Kingdom. 2PrincessNora bint Abdul Rahman University, Riyadh, Saudi Arabia.3Stockport NHS Foundation Trust, Manchester, United Kingdom.4Honorary Professor, University of Salford., Manchester, UnitedKingdom. 5King Khalid University Hospital, Riyadh, Saudi Arabia.

The Oxford knee score (OKS) is a reliable, valid and responsiveassessment tool for knee osteoarthritis patients, but the Arabicversion (OKS-Ar) is not fully validated. Published works are limitedto male patients, with no assessment of responsiveness followingtotal knee arthroplasty (TKA).Aim Assess the reliability and validity of OKS-Ar in male and femaleknee osteoarthritis patients, and responsiveness post-TKA.Methods One hundred patients awaiting TKA completed the OKS-Ar, the Arabic version of the Knee Osteoarthritis Outcome Score(KOOS-Ar) and a Visual Analogue Scale for Pain. Repeated ques-tionnaires were administered 7–10 days later and 6 months post-TKA.Results All questionnaires were completed by 80 females and 20male participants. Their mean age was 60 ± 7 years and 69 ± 8years, respectively.Reliability OKS-Ar had ICC= 0.96–0.98. Bland-Altman’s limits ofagreement revealed no significant bias. Test and re-test meanscores had no significant difference and a highly significant Spear-man’s rho. Cronbach’s α was 0.98, signifying internal consistency.There was no floor or ceiling effect pre-TKA, and post-TKA ceilingeffect was only 2%.Validity OKS-Ar’s pain was strongly positively correlated withKOOS-Ar’s, and moderately correlated with symptoms. OKS-Ar’sfunction was strongly positively correlated with KOOS-Ar’s ADL andmoderately positively correlated correlation with its QoL. A statis-tically significant median improvement of 20 points for OKS-Ar wasobserved 6 months post-TKA (p< 0.005), z=8.68.Conclusion Our results are aligned with the original English OKSand other validated translations. OKS-Ar can be used with Arabic-speaking individuals with end-stage knee osteoarthritis.

0008 – CORONAL ALIGNMENT IN KINEMATIC TOTAL KNEEARTHROPLASTY – THE 4 YEAR RESULTS OF THE OUTLIERS.Robert Petretta1, Parnell Keling2, Keith Eyres2, Vipul Mandalia2,Andrew Toms2

1University of Vancouver, Vancouver, Canada. 2Exeter KneeReconstruction Unit, Princess Elizabeth Orthopaedic Centre, RoyalDevon and Exeter Hospital, Exeter, United Kingdom.

Introduction: Kinematically Aligned Total Knee Arthroplasty (KA –TKA) aims to restore normal knee function by achieving pre-arthritic constitutional alignment and restoring the axis of rotation.As such, planned prosthesis alignment can sometimes lie outsideneutral mechanical alignment (MA) of 0 ± 3°. This study aimed toassess the mid-term functional and radiological outcomes of agroup of KA-TKA patients whose planned alignment lay outside thisperceived acceptable alignment and to determine the incidence ofcatastrophic failure.Materials and Methods: 24 patients (25 knees) were seen pre-operatively and at 6 weeks, 6 months, 1 and 4 years post opera-tively. Radiographs were assessed for loosening, change in posi-tion, catastrophic failure and alignment. Clinical outcome wasassessed using the older version of the Oxford Knee Score (lowerscore indicating a better outcome).Results: Mean clinical follow up post-operatively was 4 years andmean radiological follow up 3.5 years.12 knees had a varus alignment (HKA > 3°: mean 6°), 9 had a valgusalignment (HKA < -3°: mean -7.6°) and 4 had neutral alignment(HKA 0 ± 3°-mean 180°).The pre-operative mean Oxford score for all patients was 42 whichimproved to 21, 23 and 15 for the varus, valgus and neutral groupsrespectively. (Difference not statistically significant).There were no mid-term catastrophic failures nor radiographicsigns of significant loosening of the components in any sub-group.Conclusion: TKA placed outside of neutral alignment 0 ± 3° haveshown good mid-term clinical and radiological outcomes.

0011 – THE FIXED BEARING STRYKER TRIATHLON PARTIAL KNEEREPLACEMENT- A MULTI-SURGEON, SINGLE CENTRE COHORTSTUDY WITH MEAN FOLLOW UP OF 4.5 YEARSSimon Middleton, Peter Schranz, Vipul Mandalia, Andrew TomsExeter Knee Reconstruction Unit, Princess Elizabeth OrthopaedicCentre, Royal Devon and Exeter Hospital, Exeter, United Kingdom.

Introduction: Fixed bearing cemented partial knee replacements(PKR) are both increasing in market share and out- performingmobile bearing options in registry data. The Stryker Triathlon PKRwas first implanted in Exeter in 2009.Materials and Methods: Analysis of a database which includedmedical notes, radiographs and prospectively collected pre-opera-tive and post-operative Oxford Knee Score (OKS) questionnaires ofpatients who underwent PKR using the Triathlon prosthesis.Results: 129 Stryker Triathlon PKR were implanted in 115 patientsbetween April 2009 and March 2015. Mean age of the patients was65.5 years. Mean follow up was 4.5 years. 2 patients weredeceased with PKR implants still insitu. Of the remaining 127implants, 11 have been revised (8.6%): 6 for disease progression, 2for infection, 2 for aseptic loosening and 1 for mal-alignment.

Mean time to revision was 1.7 years. The mean average increase inOKS was 19 points (range 2-41): from a mean average pre op scoreof 21 (range 5-38). Implant survivorship with revision for any rea-son as the end-point at 7.5 years was 90%.Conclusions: This review of all the Triathlon PKR cases performedin our Unit provides evidence that the implants and procedures areeffective and safe. It is the largest review that has been undertakenof this implant. Reviews such as this can used to better informpatients of what they can expect from PKR surgery hopefully lead-ing to greater satisfaction.We continue to use the Triathlon PKR as our implant of choice forisolated medial compartment osteo-arthritis.

0012 – THE MODULAR LINK HINGE KNEE. MINIMUM 3 YEARFOLLOW UPJonathon Phillips, Keith Eyres, Andrew TomsExeter Knee Reconstruction Unit, Princess Elizabeth OrthopaedicCentre, Royal Devon and Exeter Hospital, Exeter, United Kingdom.

Introduction: Using a prospective database analysis of PROMS andradiological outcomes we report upon a consecutive series of com-plex Link hinge patients at greater than 3 years follow up. Opera-tions were performed May 2012 to 2014.Materials and Methods: An independent researcher reviewed themedical records and radiological outcomes of all cases.Results 69 patients were identified with a minimum 3 years followup. Mean age 72 years, 64% female. The main indication for usingthe Link prosthesis was revision surgery for instability (51%),among other indications such as infection (10%), stiffness (10%)and periprosthetic fracture (9%). 95mm modular stems were usedfor the majority of cases (77% in tibia, 69% in femur). Distalfemoral replacements were used in 23% of cases.At final follow up at a minimum of three years, four cases hadundergone revision surgery. One case was revised for recurrence ofinfection, one femoral loosening occurred, one tibial looseningoccurred and there was one case of bushing failure leading toinstability. The survivorship of the Modular Link Hinge at our insti-tution in a complex case mix with a minimum three years follow upis 94%.Conclusion: We have identified good survivorship rates and havefound this a reliable and versatile implant to use in revision kneesurgery.

0014 – IS SLEEP DISTURBANCE A PROBLEM FOR PATIENTS AFTERTOTAL KNEE REPLACEMENT?Hoade Lucy1, Alexandra MacMillan2, Patrick Hourigan2, Robert Petretta3, Andrew Toms2

1University of Exeter Medical School, Exeter, United Kingdom.2Exeter Knee Reconstruction Unit, Princess Elizabeth OrthopaedicCentre, Royal Devon and Exeter Hospital, Exeter, United Kingdom.3University of Vancouver, Vancouver, Canada.

Background: Sleep disturbance has been reported by patients fol-lowing Total Knee Replacement (TKR) but little is written aboutthis.Hypothesis: Sleep quality decreases following TKR surgery.AIMS: To assess the presence and extent of sleep disturbance fol-lowing TKR surgery, to identify contributing factors, and to evalu-ate how long it takes for quality of sleep to recover.Materials and methods: Sleep quality and factors affecting sleepwere assessed in a prospective cohort of 11 patients undergoingprimary TKR in our Unit. All completed The Pittsburgh Sleep Qual-ity Index (PSQI) and the pain DETECT questionnaire pre-opera-tively, then at 2, 6 and 12 weeks post-operatively. Pre-operativeand post-operative data was compared.Results: The majority of TKR patients were classified as havingpoor quality of sleep both before (81.8%, n=9) and after surgery(100%, n=11). Sleep quality had deteriorated by 2 weeks after sur-gery (12.6±2.8) compared to pre-operative results (8.3±3.3,p=0.02) and remained so 6 weeks after surgery (11.0±3.4, p=0.07),with PSQI scores returning to near pre-operative values after 3months. (8.5±3.6, p=0.92). Pain was the greatest contributing fac-tor.Conclusions: The majority of patients were classified as havingpoor quality of sleep before, and for up to 3 months following TKRsurgery. There was a significant increase in sleep disturbance 2weeks after TKR, and in most severe reported pain but not in aver-age pain ratings. A further larger scale study to further investigatepain-related factors such as use of analgesics and pain characteris-tics is required.

0018 – THE LATELLA 2 DEVICE: A NOVEL DEVICE FOR THETREATMENT OF MEDIAL KNEE PAINAndrew Davies, Matthew DoddMorriston Hospital, Swansea, United Kingdom.

The ‘Treatment Gap’ describes the lack of treatment options forpatients who have reduced medial joint space and pain but are notyet ready for long bone osteotomy or replacement arthroplasty.The Latella 2 device is a one-piece, fixed, spoon-shaped devicedesigned to be attached to the lateral aspect of the femur distally,deep to the ileo-tibial band. It elevates the lateral structures andhence creates a moment-arm to relatively lateralise forces acrossthe knee in the coronal plane. This has the effect of off-loading themedial compartment. The joint is not opened and the device couldbe removed in future. We were part of a multi-centre clinical trialof the device.We implanted five Latella devices into five patients between

December 2015 and August 2016. Patients underwent generalanaesthesia and implantation with image intensifier guidance. Allwent home the same day and all reported immediate relief of theirmedial knee pain. There have been no complications. As part ofthe research protocol all patients have been exhaustively reviewedat numerous time points. The device has been well tolerated andhas not resulted in any loss of knee flexion or anterior knee pain.Knee scores improved immediately and patient satisfaction is high.Pain relief has been sustained at two years for the three patientswho have reached that milestone. One patient has had recurrenceof symptoms at 15 months post surgery.The Latella 2 potentially offers a new treatment option to fill the‘Treatment Gap’ that exists at present.

0020 – INTRAOSSEOUS REGIONAL PROPHYLAXIS WITHVANCOMYCIN PROVIDES HIGHER TIDDUE CONCENTRATIONS INOBESE PATIENTS IN TOTAL KNEE ARTHROPLASTY: ARANDOMIZED TRIALHenry Clarke1, Seung Joon Chin2, Grant Moore3, Mei Zhang3,4,Mark Spangehl1, Simon Young2

1Mayo Clinic, Phoenix, USA. 2University of Auckland, Auckland,New Zealand. 3Canterbury Health Laboratories, Christchurch, NewZealand. 4University of Otago-Christchurch, Christchurch, NewZealand.

Introduction: In obese patients, larger doses of prophylactic van-comycin, based on body weight, are required to reach therapeuticconcentrations. This increases the risk of systemic adverse effects.Low-dose vancomycin delivered via intraosseous regional adminis-tration (IORA) mitigates these factors, and produces tissue concen-trations 6-10 times greater than intravenous (IV) administration innon-obese patients. This study compared tissue concentrations ofvancomycin administered via IORA versus IV administration in pri-mary TKA.Methods: Twenty-two patients with a body mass index >35 under-going TKA were randomized into two groups. The IV group received15mg/kg (maximum of 2g) of systemic IV prophylactic vancomycinover a one to two hour infusion, timed to finish immediately priorto surgery. The IORA group received 500mg vancomycin in 150mlsaline as a bolus injection into a tibial intraosseous cannula, belowan inflated thigh tourniquet, immediately before skin incision. Sub-cutaneous fat and bone samples were taken at defined intervals.Tissue antibiotic concentrations were measured using liquid chro-matography.Results: The mean BMI was 41.1 (range 37-52) in the IORA groupand 40.1 (range 35-52) in the IV group. The overall mean tissuevancomycin concentration in subcutaneous fat was 39.3ug/g in theIORA group and 4.4ug/g in the IV group; mean tissue concentra-tions in bone were 34.4ug/g in the IORA group and 6.1ug/g in theIV group (all p<0.05).Conclusions: Vancomycin administered by IORA produced tissueconcentrations 6-8 times higher than IV administration in obesepatients undergoing TKA, achieving appropriate prophylactic levelsin all patients.

0029 – ALL INSIDE RECONSTRUCTION OF THE PCL: EXPERIENCEAND CLINICAL OUTCOMESAlex Riddell, Scott Mercer, Matthew Dodd, Andrew DaviesMorriston Hospital, Swansea, United Kingdom.

Reconstruction of the Posterior Cruciate Ligament (PCL) usinghamstring autograft has been practiced for over a decade. Thetechnique involves passage of the graft from anterior to posteriorthrough a tibial tunnel to exit within the tibial footprint. The graftis then drawn back anteriorly through the knee before beingpassed into a femoral tunnel which runs obliquely from anterior toposterior. The graft negotiates two tight angles over bony tunneledges and this can compromise results in some cases. The tech-nique is challenging and time consuming even in experienced sur-gical hands.The advent of ‘all inside’ cruciate ligament reconstruction usingshort sockets reamed from within the knee outwards brings theadvantages of being able to orient the femoral socket more trans-versely, a thicker graft from a single hamstring harvest and easiergraft passage into the sockets.The senior author has performed eight PCL reconstructions usingthe traditional tunnel technique and six using the all-inside tech-nique. Tourniquet times including graft harvest and preparationfell from a mean of 88 minutes (range 65-112) to 66 minutes (range59-73). Hamstring graft diameter increased from median 8.0 to 8.5mm. There were no complications in either group.Clinical outcomes were prospectively measured using Tegner andLysholm scores pre-injury, pre-surgery and 1 year post-surgery.There were two clinical failures in the traditional group, none inthe all-inside group.All inside PCL reconstruction is technically less demanding andoffers at least equivalent clinical results, with shorter tourniquettimes, in this series.

0036 – A REGIONAL MDT SERVICE FOR THE MANAGEMENT OFINFECTED NATIVE AND TOTAL KNEE REPLACEMENTS:DEVELOPMENT AND RESULTS OF AN ESTABLISHED SERVICEFady Awad, Nicola Fine, Jonathon Phillips, Andrew TomsExeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital,Exeter, United Kingdom.

Introduction: Native and prosthetic joint infections pose a major

Poster Presentations 2018

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therapeutic challenge to clinicians. Management of these condi-tions can be complex, often involving different healthcare profes-sionals from several speciality teams.Methods: A multidisciplinary service was set up in Exeter in 2015to manage patients presenting with native and prosthetic kneeinfections. The team consists of orthopaedic surgeons, plastic sur-geons, microbiologists and physiotherapists. Using a hub andspoke design, as recently recommended by GIRFT, patients fromacross the South West Peninsula are discussed in the MDT meet-ings and management plans are formulated with input from differ-ent teams. We report on the results of all patients discussed at theMDT over the last two years.Results: 106 patients were managed through the MDT (20 nativeknees, 59 total knee replacements (TKR) and 27 revision TKR). Ofthe native knees, over half grew Staphylococcus (55%) and 85% ofpatients were managed with a washout and antibiotics. A widevariety of organisms were cultured in the infected TKR patients and36% were managed with revision knee surgery. One third of refer-rals came from regional centres. A similarly wide spectrum oforganisms was observed in the infected revision TKR patients and37% of patients were managed with revision surgery. A quarter ofthese referrals came from regional centres.Conclusion: We report on a model of care for managing infectednative and prosthetic knee infections that involves a multidiscipli-nary approach to management. This ensures optimal care in allcases.

0041 – MULTI-LIGAMENT KNEE INJURIES. 9 YEAR EXPERIENCEFROM A SINGLE UK MAJOR TRAUMA CENTRE (MTC)Thomas Wood, Ryan Wong, Lior Laver, Tim Spalding, Peter ThompsonUHCW, Coventry, United Kingdom.

Introduction: We present the experience from a single UK Majortrauma centre over a 9 year period (01/08/2007- 31/07/2016) inmulti-ligament knee injuries, with a minimum follow-up of 12months.Methods: We conducted a retrospective review of prospectivelycollected data on the electronic patient records (EPR) to identify allcases of multi-ligament knee injuries over the study period. Wethen contacted the patients the confirm the patient demographics,mechanism and injury and outcome following the injury, measuredusing the Lysholm score and the Tegner activity level pre-injury andpost-injury.Results: We identified 61 patients over a 9 year period that hadbeen treated for a multi-ligament knee injury at our institution.The mean age was 31 (range 14-65), sex distribution was 45 male:16 female patients. 7 cases (11%) were assocated with vascularinjury, 11 cases (18%) with nerve injury and 20 cases (32%) with afracture.42 patients were able to be contacted to obtain PROMs and satis-faction scores. The mean lysholm score was 81 (range 18- 100)which represents a fair knee function score. Pre injury tegner activ-ity level was 6.1 compared with a post-injury level of 4.3. The post-surgery SANE score was 72.3. Variation in outcome was demon-strated in certain groups, although only age was statistically signif-icant (p= 0.039).Conclusion: Multi-ligament knee injuries are very significantinjuries, often sustained in association with other injuries, andcommonly require either damage-control surgery, delayed surgeryor both to manage these complex injuries.

0045 – DOES PHYSICAL ACTIVITY CHANGE FOLLOWING TOTALKNEE ARTHROPLASTY?Bodor Bin sheeha1,2, Anita Williams1, David Sands (DS) Johnson3,4,AHMAD BIN NASSER5, Malcolm Granat1, Richard Jones1

1University of Salford, Manchester, United Kingdom. 2PrincessNora bint Abdul Rahman University, Riyadh, Saudi Arabia.3Stockport NHS Foundation Trust, Manchester, United Kingdom.4Honorary Professor, University of Salford., Manchester, UnitedKingdom. 5King Khalid University Hospital, Riyadh, Saudi Arabia.

An improvement in physical activity (PA) is often expected bypatient’s following total knee arthroplasty (TKA). However, fewstudies have used objective methods to investigate such changes.Aim: To explore changes in PA following TKA using an objectiveassessment tool.Methods: A total of 33 patients waiting for TKA were recruitedfrom our population. ActivPAL activity monitors were worn bypatients for a period of 7 days both before surgery and 6 monthsfollowing TKA. The patients completed the Oxford Knee Score(OKS) and Knee Osteoarthritis Outcome Score (KOOS).Results: The 27 females and 6 male patients had mean ages of 59years and 76 years, respectively.Six months post-TKA, the sedentary time showed a non-significantreduction, while mean standing and upright times showed non-sig-nificant increases. There was a significant increase in stepping timeof 11.5 (95%CI 7.3-15.6) minutes per day following surgery, with acorresponding median increase in number of steps taken per dayof 471steps. A statistically significant median improvement of 20points for OKS, 44 points for KOOS pain, 42 for KOOS symptomsand 48 points for KOOS ADL subscale were observed 6 monthspost-TKA.Conclusion: This is the first study to explore post-TKA activity levelsin detail. As expected the PROMS, which assess mainly pain relatedsymptoms, improved. However, there was only a modest improve-ment in PA, which only affected step time and counts. Our studyconfirms at this early stage post-operatively that TKA improvespain but not necessarily to the same degree activity levels.

0063 – IS EARLY PAIN A PREDICTOR OF OUTCOME INUNICOMPARTMENTAL KNEE ARTHROPLASTY?Ruaraidh Fowler1, Alisdair Gilmour2,1, Iona Donelly1, Mark Blyth2,1

1University of Glasgow, Glasgow, United Kingdom. 2NHS GreaterGlasgow and Clyde, Glasgow, United Kingdom.

In unicompartmental knee arthroplasty (UKA) persistent pain is amajor contributor to the high revision rate, when compared toTotal Knee Arthroplasty. Few studies have been published examin-ing the role immediate post-operative pain and any effect on thelong-term outcome of UKA. The aim of this study was to investigatethe relationship between early post-operative pain and longer-term outcome.Data from the Glasgow Royal Infirmary MAKO RCT dataset wasused. Comprehensive pain diary data were available for 75 partici-pants. Pain scores during the first 3 days post-op, at 3 months, 1and 2 years were compared, alongside the American Knee SocietyScore (AKSS), Oxford Knee Score (OKS) and Forgotten Joint Score(FJS).The majority of patients experienced their peak pain on day 2 post-op. Over the two years post-operatively, mean pain scoresdecreased. Although certain patients’ pain scores remained high.There was no significant relationship between day 2 pain scoresand those at 3 months, 1 or 2 years. There was no relationshipbetween day 2 pain scores and AKSS, OKS and FJS at 3 months, 1 or2 years.In this patient group, there does not appear to be a significant rela-tionship between early pain and outcome at 3 months, 1 or 2years. However, there is a small group of patients for whom earlypost-operative pain scores were high and remained high. There-fore, further investigation is required to assess if interventions toreduce immediate post-operative pain, may have any benefit inreducing persistent pain.

0065 – DOES DIABETES AFFECT OUTCOME OF KNEEARTHROPLASTY IN PATIENTS?Debashis Dass1, Davindra Bachu2, Lisa Canty1, Richard Roach1

1Princess Royal Hospital, Telford, United Kingdom. 2StokeUniveristy Hospital, Stoke, United Kingdom.

Background: Studies have previously shown that diabetic patientswho undergo total knee arthroplasty have increased pain andpoorer functional outcome post operatively. However, conflictingstudies have shown that this is not the case. The purpose of thisstudy was to estimate the prevalence of diabetes in the localpatient cohort and determine whether it adversely affects out-come.Methodology/Principle Findings: The study was based within asingle unit, with 461 consecutive patients under a single consultantsurgeon. Data was collected prospectively over 10 years and kepton an internal arthroplasty database. Demographics and co-mor-bidity data was collated. The results showed the prevalence of dia-betes mellitus among patients undergoing knee arthroplasty as15.8%. Patients with diabetes mellitus had an increased length ofstay (8.6 days vs 6.9 days). However, there was no significant differ-ence in the pre-operative oxford knee scores between diabetic andnon-diabetic patients (14.9 vs 15.5 ns) and post-operative oxfordknee scores (36.6 vs 36.5 ns) at 1-year.Conclusions: In our cohort of patients who underwent kneearthroplasty, diabetes mellitus is associated with an increasedlength of stay in hospital. We were unable to ascertain as to whythis may be the case and needs further study.This cohort includesthe introduction of enhanced recovery. It is reassuring to knowthat at 1-year post knee arthroplasty patients with diabetes melli-tus do as well as patients without diabetes.

0082 – HOW RELIABLE IS THE POLLARD TECHNIQUE FOR PRE-OPERATIVE MENISCAL SIZING? A SNAPSHOT STUDY OF THEAUSTRALIAN MENISCAL TRANPLANT STUDY GROUPCiara Stevenson1, Ahmed Mahmoud2, Peter Myers1

1Brisbane Orthopaedic Sports Medicine Centre, Brisbane,Australia. 2Brisbane Orthopaedic Sports Medicine CentreMedicineCentre, Brisbane, Australia.

Purpose: The Pollard technique is commonly used for pre-opera-tive sizing in meniscal allograft transplantation. The aim of thisstudy was to assess the inter-observer reliability among ConsultantOrthopaedic Surgeons with a specialist interest in meniscal trans-plant.Method: We performed a spontaneous snap shot study at theMeniscal Transplant Study session of the Australian Knee Society in2017. Each surgeon was provided with anonymised anteroposte-rior and lateral radiographs of a patient currently awaiting a medialmeniscal transplant. The radiographs included an Australian 5 centcoin (19mm diameter) for calibration. A ruler and pencil were pro-vided and each surgeon asked to calculate the dimensions of theallograft they would require.Results: 14 surgeons participated in this study. On the AP radi-ograph, coin diameter and medial compartment width were calcu-lated, whilst on the lateral radiograph, coin diameter and medialcompartment length. Ultimately Anteroposterior and Medial-Lat-eral allograft dimensions were calculated.12 out of 14 surgeons completed both coin and compartmentmeasurements on both radiographs. We ran an interclass correla-tion (ICC) between each set of measurements to assess agree-ment.Coin diameter on both AP and Lateral radiographs had excellentcorrelation between surgeons. However, measurements for medialcompartment width ranged from 23mm-33mm and length from29mm-44mm.Ultimate calculations of meniscal allograft dimensions variedgreatly among surgeons producing a correlation of 0.348, whichprovides a less than poor inter-observer reliability.

Conclusions: The Pollard technique for meniscal allograft sizing hasa low inter-observer reliability between Consultant Orthopaedicsurgeons with a specialist interest in this field.

0083 – RETURN TO ACTIVITY AND SPORTING FUNCTIONFOLLOWING OPENING WEDGE HIGH TIBIAL VERSUSUNICOMPARTMENTAL KNEE ARTHROPLASTYTimothy Woodacre1,2, Martha Ricketts2, Andrew Toms1, Michael Hockings2

1Royal Devon and Exeter Hospital, Exeter, United Kingdom. 2Torbay Hospital, Torquay, United Kingdom.

Background: Opening wedge high tibial osteotomy (OWHTO) is atreatment option for young patients with isolated medial compart-ment osteoarthritis. We investigate the impact of OWHTO onpatient activity levels and sporting function comparative to uni-compartmental knee arthroplasty (UKA).Methods: This is a retrospective comparative case-series involving3 regional hospitals. Data collection was via recognised patient-reported outcomes, comparing pre-morbid, pre-operative andpost-operative function.Results: Seventy five patients underwent OWHTO; mean age of46.8, M:F ratio 6.5:1 and mean BMI of 29.1. Patients significantlyimproved pre to post-operatively, with a mean improvement inVAS of 4.5/10, KOS-SAS of 0.62/2 and Tegner of 1.4/10 (p<0.01).23% of patients regained complete pre-morbid activity levels,including competitive sporting function. 6% percent of patientsdeteriorated in function, all of whom experienced operative com-plications. 27 patients underwent UKA; mean age of 53.1, M:F ratio1:2, and mean BMI of 30.3. These also experienced significant preto post-operative improvements in VAS of 6/10, KOS-SAS 0.68/2and Tegner 0.6/10 (p<0.01). 18% of patients regained pre-morbidactivity levels, including recreational sporting function, but to anaverage lower level of function than patients undergoing OWHTO.Neither implant nor patient BMI had significant effect on outcome.Discussion: Opening wedge high tibial osteotomy can improveactivity levels and sporting function in patients under 60. Premor-bid activity levels, including high level sports function can beachieved, although this is not the norm. UKA can also improveactivity levels but in a different patient population and to a lowerlevel of sports function.

0086 – OXFORD UNICOMPARTMENTAL KNEE ARTHROPLASTY: 10-YEAR RESULTS FROM AN INDEPENDENT CENTRESatish Kannan Rajankulam Ganesan, Manjunathan Sivaprakasam,Jerome Davidson, Kim Miles, Kate Weatherly, Adrian Butler-ManuelEast Sussex Healthcare NHS Trust, St Leonards on Sea, UnitedKingdom.

Introduction: The Oxford unicompartmental arthroplasty contin-ues to be the commonest unicondylar replacement performed inthe United Kingdom with over 54,000 joints registered in theNational Joint Registry. While designer surgeons have reportedlarge series with 10-year survivorship of over 94%, few long termindependent studies have been published. We present from anindependent centre, the 10-year survivorship and functionalresults in a large series of 544 patients with a mean follow-up of8.42 years (range 5 to 17 years).Materials and Methods: A prospective longitudinal case study wasdesigned, recruiting 833 consecutive patients undergoing Oxfordunicompartmental arthroplasty from February 1999. Patientdemographics, preoperative and postoperative functional scoresincluding Hospital for Special Surgery(HSS) Knee Score, OxfordKnee Score(OKS) and American Knee Society Score(AKSS) wasrecorded and statistically analysed.Results: 558 patients with a minimum 5-year follow-up of whom215 had a minimum 10-year follow-up were included in the analy-sis. We report a 10-year survivorship of 89.7%. At the time of lastfollow-up, there was a significant improvement range of move-ment (Mean Preop 3.41°-114° to 1.14°-123.45°), HSS knee score(from mean preop 59.06 to 84.83, p value <0.0001), OKS (mean22.89 to 35.90, p value <0.0001), and AKSS (93.03 to 155.23, pvalue <0.0001).Conclusion: The results indicate excellent results with good sur-vivorship can be achieved in independent centers and supports thecontinuing use of Oxford unicompartmental arthroplasty whereappropriately indicated.

0089 – FOLLOW-UP STUDY OF 141 PATELLO-FEMORAL JOINTARTHROPLASTIES UNDERTAKEN AT A SINGLE CENTREPeter Cay, Harry Beale, Louise McMenemy, Sukhdeep Gill, Nigel RossiterBasingstoke and North Hampshire Hospital, Basingstoke, UnitedKingdom.

Isolated patellofemoral joint arthritis can be problematic to treat.Patellofemoral joint arthroplasty (PFA) presents one operativesolution avoiding total arthroplasty surgery in a traditionallyyounger, high demand population.We present a retrospective analysis of all PFA operations under-taken at a single centre with at least 1 year follow up.Our retrospective analysis revealed 141 replacements undertakenon 122 patients (Female 100: Male 22) with an average follow upof 59 months (Range 12-157 months). Median age was 59 years(range 35-87 years) representing a younger patient populationcompared to the average age of 65-74 years for Total KneeReplacements (TKR) reported in the literature. There were 8deaths for unrelated reasons, 17 patients were either lost to ordeclined follow up. 22 required revision to TKR for ongoing painand trauma, consistent with a revision rate of up to 19% in the lit-

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erature. Statistically, if the initial operation was completed by atrainee it was more likely to require revision. Preoperative films (99patients) were assessed for trochlea dysplasia and patients withshallow or flat trochlea (49 patients) had a lower rate of revision toTKR (10.2%). Patella height was also examined (83 patients) how-ever no statistical correlation was seen regarding revision rates.This study of PFA reported concludes that for carefully selectedpatients PFA represents a management option for consideration.Those undergoing PFA are of a younger age on average than TKR.The learning curve in operative technique requires careful consid-eration of the grade of surgeon undertaking the operation.

0090 – PAEDIATRIC CRUCIATE LIGAMENT RECONSTRUCTIONUSING PARENTALLY DONATED HAMSTRING ALLOGRAFTJohn Dabis, David Rawaf, Raghbir Khakha, Sam Yasen, Adrian WilsonBasingstoke & North Hampshire Hospital, Basingstoke, UnitedKingdom.

Introduction: There is an increasing incidence of cruciate ligamentinjuries in the paediatric population and these represent a signifi-cant management challenge. Graft rupture rates in surgicallyreconstructed patients are significantly higher than in an adultcohort. Graft options are more limited due to inadequate size ofhamstrings autograft, while allograft is associated with unaccept-ably high failure. One solution is to use live parentally donatedhamstring allograft. This is now an accepted treatment modality inAustralia but has not become commonplace in the UK.Method: Children presenting with a cruciate-deficient knee andsymptomatic instability were considered for reconstruction usingparentally donated tissue. A transphyseal surgical technique on thetibia was employed, and either an extraphyseal or transphysealapproach on the femur was taken depending on the Tanner Stageof the patient. Patients were evaluated pre and postoperativelywith subjective scoring indices and clinical examination. Objectivemeasurement of laxity was performed using the KT1000 arthrom-eter when patient size permitted.Results: 6 patients underwent anterior cruciate ligament recon-struction and 1 patient underwent a posterior cruciate reconstruc-tion with a mean age 11.25 years (10-12) and mean follow-up of13.75 months (3-38). Clinically and statistically significant increasesin all scoring indices at all postoperative time points were demon-strated. In cases when KT assessment was feasible, side-to-side dif-ference was under 2mm. No reported complications or failureswere recorded.Conclusion: Adequate graft size can be achieved using parentallydonated hamstring allograft in paediatric cruciate ligament recon-struction. Early follow-up suggests excellent patient outcomes withno earlier failures reported.

0093 – MINIMALLY INVASIVE SURGERY (MIS) IN KNEEOSTEOTOMY ACHIEVES EQUIVALENT RADIOLOGICAL OUTCOMESTO TRADITIONAL OPEN APPROACHESJohn Dabis, James Belsey, Raghbir Khakha, Sam Yasen, Mike Risebury, Adrian WilsonBasingstoke & North Hampshire NHS Trust, Basingstoke, UnitedKingdom.

Introduction: Coronal plane knee realignment can be achievedwith opening or closing wedge techniques on the medial or lateralside of the distal femur or proximal tibia. The workhorse proce-dures are medial opening wedge (MOW) high tibial osteotomy(HTO) and medial closing wedge (MCW) distal femoral osteotomy(DFO). Traditional approaches for these involve large incisions withsignificant associated morbidity. Minimally invasive approachesare increasingly used in our institution.Aim: To establish whether MIS approaches influence radiologicaloutcomes or complication rate.Methods: Our prospectively maintained research database wasinterrogated for all MOW HTOs and MCW DFOs between July 2015and June 2016. Patients in group 1 underwent osteotomy utilisinga standard surgical approach, while patients in group 2 received anMIS approach. Radiological outcome data was assessed usingunpaired T-tests. Perioperative complication rate up to 3 monthsfollow up was assessed using Fisher’s exact test.Results: There were 40 knees in group 1 and 46 in group 2. No sig-nificant demographic differences existed between the two groups.Mean correction wedge size was 7.9 mm (range 3-17 mm) andthere was no significant difference between the two groups(p>0.05). Accuracy of radiological correction as determined byachieved Mickulitz point versus target correction showed no differ-ence between the two groups (p>0.05). No difference in overallcomplication rate or of soft tissue complications seen between thetwo groups.Conclusions: Osteotomy around the knee can safely be undertakenutilising minimally invasive approaches with no increase in compli-cation rate or detriment in radiological outcomes.

0094 – QUADRICEPS TENDON-BONE OR PATELLAR TENDON-BONE AUTOGRAFTS WHEN RECONSTRUCTING THE ANTERIORCRUCIATE LIGAMENT: A META-ANALYSISOsman Riaz1, Adeel Aqil1, Fahad Hossain1, Gautam Chakrabarty2,Graham Radcliffe1

1Bradford Royal Infirmary, Bradford, United Kingdom.2Huddersfield Royal Infirmary, Huddersfield, United Kingdom.

We aimed to quantitatively assess the outcomes of studies, com-paring the use of Bone-patellar tendon-bone (BPTB) and thequadriceps tendon-bone (QTB) autografts when reconstructing theanterior cruciate ligament (ACL).MEDLINE, Embase, and CINAHL databases were searched for rele-

vant articles published comparing BPTB and QTB autografts for ACLreconstruction. Outcomes analyzed were graft failure rates, objec-tive and subjective stability assessments, as well as the presenceand severity of donor site morbidity.Five studies contributed to the quantitative analysis of 806patients. Graft failure rates were similar between the 2 groups[odds ratio (OR) = 0.61; confidence interval (CI) = 0.17-2.15; Z =0.78, P = 0.44]. No significant differences between the 2 groupswhen testing anteroposterior stability using an arthrometer (stan-dardized mean difference = 0.07; CI = -0.12-0.25; Z = 0.70, P =0.48). At 1 year postoperatively, there was no difference in the per-centage of patients with a positive pivot shift test between the 2groups (OR = 1.0; CI = 0.85-1.18; Z = 0.01, P = 0.99). However, sig-nificantly less patients had graft site pain 1 year after surgery in theQTB group (OR = 0.10; CI = 0.02-0.43; Z = 3.12, P = 0.002). Similarly,fewer patients reported moderate to severe pain while kneeling, inthe QTB group (OR = 0.16; CI = 0.07-0.37; Z = 4.26, P < 0.001).This study demonstrates comparable survival rates and joint stabil-ity when BPTB and QTB grafts are used. However, fewer adversedonor site symptoms are evident with QTB grafts.

0097 – MIDBUNDLE FEMORAL POSITIONING IN SINGLE BUNDLEACL RECONSTRUCTION INCREASES GRAFT FAILURE COMPAREDTO STANDARD ANATOMIC RECONSTRUCTIONJohn Dabis, Zakk Borton, Sam Yasen, Raghbir Khakha,Mike Risebury, Adrian WilsonBasingstoke & North Hampshire NHS Trust, Basingstoke, UnitedKingdom.

Introduction: Traditional techniques for ACL reconstruction (ACLR)often yield non-anatomical graft placement. Such positioning failsto control rotational laxity and can result in a persistent pivot glidepostoperatively. This has driven a move towards anatomic recon-struction. Some authors advocate placing the femoral tunnel in themidbundle position (MB), whilst others suggest a point within thefootprint of the anteromedial bundle fibres (AM). At our institutionboth techniques have been utilised reflecting trends in surgicalpractice at the time.Methods: Our local prospectively maintained database was inter-rogated. All primary ACLRs performed using the single-bundleTransLateral all-inside technique were included. This involves aquadrupled hamstring graft secured with two adjustable loop sus-pensory fixation devices. A minimum follow-up of 24 months wasset. The failure rate of the MB and AM cohorts was comparedusing a one-tailed Fishers exact test.Results: 272 ACLRs meeting the inclusion criteria were identified.Mean follow-up was 47.7 months (24-72).There were 110 knees inthe MB group and 162 in the AM group. There were 8 (7.3%) fail-ures in the MB group and 3 (1.9%) in the AM group (p=0.0287). Thedifference remained significant when performing sub-analysesexcluding cases using an allograft (n=256, p=0.0355), and whenonly considering cases using quadrupled semitendinosus autograft(n=239, p=0.0355).Conclusion: Data from this case series suggests that positioningthe femoral socket within the footprint of the anteromedial bundlemay reduce risk of rupture versus those placed at the midbundleposition when performing anatomic single-bundle ACL reconstruc-tion.

0102 – 7 YEAR SURVIVAL OF THE ALL POLYETHYLENE TIBIA INTHE PROFIX TOTAL KNEE REPLACEMENT – A SINGLE CENTRESERIES OF OVER A 1000 PATIENTSDavid Selvan, Alasdair Santini, Jill Pope, John DavidsonRoyal Liverpool and Broadgreen University Hospitals NHS trust,Liverpool, United Kingdom.

Introduction: We are presenting the 7 year survival analysis datafor the Profix TKR with an all polyethylene tibial component fromour unit.Methods: We undertook a systematic survival analysis on theprospective data for 1092 consecutive patients undergoing a TKRwith an all polyethylene tibia. We gathered data on demographics,Range of movement (ROM), muscle strength, pain scores, SF12 andWOMAC scores.Results: The 7-year survival rate for failure of the all-polyethylenecomponent was 96.96%, using any re-operation as the end point.If aseptic loosening was chosen as the end point, the survival ratewas 98.57%. All the aseptic loosenings were on the tibial side.Improved ROM was noted however maximum final flexion wasreduced compared to pre-operative data. Muscle strengthimproved and was maintained by one grade at 7 years. The post oppain scores, SF12-Ph, SF12-M and WOMAC scores all improvedcompared to the pre-operative scores.Conclusion: To our knowledge, this is the largest single centreseries in the world to assess the survival of the Profix all-polyethyl-ene tibial base system. The results demonstrate good longevitywith excellent function at 7 years when compared to the MBT sys-tem but can provide potential cost savings. Our survival results arecomparable to the published NJR data.

0106 – THE OUTCOMES OF TOTAL KNEE REPLACEMENT INMORBIDLY OBESE PATIENTS: A SYSTEMATIC REVIEW OF THELITERATURELouis Boyce1, Anoop Prasad2, Matt Barrett1, Steve Millington2,Sebastian Dawson-Bowling2, Sammy Hanna2

1Barts and The London School of Medicine and Dentistry, London,United Kingdom. 2Royal London Hospital, London, UnitedKingdom.

Introduction: The increasing prevalence of obesity has led to anincrease in total knee replacements (TKRs) being undertaken inhigher body mass index (BMI) patients. TKR in morbidly obese

patients are more challenging due to anatomical factors andpatient co-morbidities. The long-terms results in this patient groupis unclear. This systematic review aims to evaluate the long-termrevision rates and functional outcomes of TKRs in morbidly obeseand non-morbidly obese patients.Methods: A search of PubMed, EMBASE and PubMed Central wasconducted to identify studies that reported revision rates in acohort of morbidly obese (MO) patients (BMI ≥ 40 kg/m2) thatunderwent primary TKA, compared to non-morbidly obese (NMO)patients (BMI < 40 kg/m2). Secondary outcomes included KneeSociety Objective Scores (KSS) between the two groups.Results: Eleven studies were included in this review. There were570 TKRs in MO patients and 6191 TKRs in NMO patients, averageBMI values were 44.8 kg/m2 and 26.7 kg/m2 respectively. Theaverage follow-up time was 4.9 years (range: 0.5 to 14.1) and 5.2years (range: 0.5 to 13.2) respectively, with a revision rate of 8%and 2% respectively. Pre- and post-operative Knee Society Objec-tive Scores (KSS) were poorer in MO patients, however, KSSimprovement was comparable between groups.Conclusions: This review suggests a slightly increased revision ratefollowing primary TKA in MO patients, however, these patientshave a functional recovery comparable to the NMO group. MOpatients should be fully informed of these issues prior to undergo-ing TKR.

0111 – THE ZIMMER-BIOMET PERSONA TOTAL KNEEREPLACEMENT: EARLY RESULTSWai Huang Teng, Fahd Mahmood, David Wallace, Jason Roberts,Jon ClarkeGolden Jubilee National Hospital, Glasgow, United Kingdom.

The Zimmer-Biomet Persona total knee replacement (TKR) isdesigned to maximise anatomical accuracy. As the system is new tomarket, there is a paucity of patient outcome data. We presentearly results of the system, particularly relevant in light of initia-tives such as Beyond Compliance.This was an observational prospective cohort study of patientsundergoing Persona TKR in our high volume arthroplasty unit.Cases were undertaken consecutively over 2 years by two sur-geons. Electronic patient records were reviewed to obtain patientreported outcomes preoperatively, at 6 weeks and 1 year postop-eratively. Postoperative range of movement, complications andpatient satisfaction were recorded. Preoperative and postopera-tive mechanical alignment was measured from long leg radi-ographs.206 cruciate retaining TKRs were identified. 200 (96.9%) patientshad data available at 6 weeks and 92 (47.9%) at 1 year. Mean agewas 66.9 years. Mean Oxford score was 42.2 preoperatively, 30.4at 6 weeks and 22.4 at 1 year, a significant (p<0.0005) improve-ment. Improvements were noted across all domains of the EQ5D.At 1 year, mean extension was 0.30° and mean flexion 104.7°.Mean alignment was 4.36° varus preoperatively and 0.95° varuspostoperatively. 85.1% of patients were found to be ‘very satisfied’with the outcome of their TKR at 1 year; 5.3% were ‘dissatisfied.’No deep infections were reported.As an evaluating centre for this implant, we demonstrate promis-ing early patient satisfaction and alignment. Increased length offollow up will provide further data to demonstrate whether themanufacturer’s stated aims are realised.

0115 – AUGMENTATION OF PATELLA TENDON REPAIR WITHINTERNAL BRACING: A NOVEL TECHNIQUE FOR PRIMARY REPAIRShahnawaz khan, Kiran Diwani, Henry AtkinsonNorth Middlessex Hospital, london, United Kingdom.

Background: Primary patella tendon repair is traditionally per-formed with the use of transosseous tunnels or suture anchorrepair. These techniques are associated with lengthy immobilisa-tion and loss of strength, with risks of re-rupture. We Describe anovel technique of augmenting primary suture repair with internalbracing permitting early post-operative mobilisation and rehabili-tation.Surgical Technique and rehabilitation: Midline incision allowingexposure of patella tendon rupture. Krakow suture with Fiberwireharnessing the tendon and to repair retinacular tissues. 2 centralswivelocks are used to dock primary repair. The repair is internallybraced with fibretape strands linking the proximal tibia to patella.These are docked with 2 lateral patella swivelocks. Patients areallowed full immediate weight bearing in a knee brace for 6 weeks.Free unrestricted range of motion is permitted from weeks 2-6.Immediate quads activation with straight leg exercises. At 6 weeksreturn to unassisted ambulation and low impact activities. At 3months a return to sports.Results: 11 unilateral repairs were performed. Ages 27-49 (mean39). With average follow-up of 18 months. No wound complica-tions were noted with no re-ruptures at the last review. Within 6months patients had regained full extension with no lag, 2 patientslacked terminal flexion limited at 140 degrees. At 6 months allpatients had returned to pre-morbid activities including impactsports. There was no clinically significant reduction in strength.Conclusion: We describe a novel technique of internally bracingacute primary repair of patella tendons. This facilitates an acceler-ated rehabilitation and reduces immobilisation related morbidity.

29



0116 – OUTCOME OF TOTAL KNEE ARTHROPLASTY IN PATIENTSWITH POLIOMYELITISAnoop Prasad1, Jaimee Hui Shan Tan2, Manoj Ramachandran1,Sebastian Dawson-Bowling1, Steven Millington1, Pramod Achan1,Sammy Hanna1

1Barts Health Royal London Hospital, London, United Kingdom.2Barts and The London School of Medicine and Dentistry, London,United Kingdom.

Purpose: Total knee arthroplasty (TKA) in patients affected bypoliomyelitis is technically challenging owing to abnormal anatom-ical features including articular and metaphyseal angular deformi-ties, external rotation of the tibia, excessive valgus alignment,bone loss, narrowness of the femoral and tibial canals, impairedquadriceps strength, flexion contractures, genu recurvatum andligamentous laxity. Little information is available regarding theresults and complications of TKA in this challenging group ofpatients.Methods: We carried out a systematic review of the literature todetermine the functional outcome, complications and revisionrates of TKA in patients with poliomyelitis-affected knees. Six stud-ies including 82 knees were reviewed. The mean patient age was63 years (45 to 85) and follow-up was 5.5 years (0.5 to 13).Results: All studies reported significant improvement in knee func-tion following TKA. There were 6 failures requiring revision in 82cases (7%) occurring at a mean of 6.2 years (0.4 to 12). Reasons forrevision were aseptic loosening (17%, n=1), infection (33%, n=2),periprosthetic fracture (17%, n=1), and instability (33%, n=2).Thirty-six knees had a degree of recurvatum pre-operatively (44%)(range 5-30 degrees). Ten of these knees (28%) developed recur-rent recurvatum post-operatively.Conclusion: The findings support the use of TKA in patients withpoliomyelitis-affected knees. Post-operative functional outcome issimilar to other patients; however, the revision rate is higher.Quadriceps muscle power appears to be an important prognosticfactor for functional outcome, and the use of constrained implantdesigns is recommended in patients with less than antigravityquadriceps strength.

0117 – TIBIAL TUBERCLE POSITION: A NOVEL PARAMETER TODEFINE PATELLOFEMORAL SYMPTOMSAtanu Bhattacharjee, Miriam Fahmy, Andrew P DaviesMorriston Hospital, Swansea, United Kingdom.

Background: The lateralised tibial tubercle(TT) is one of the con-tributors of patellar instability. Measurement of tibial tuberosity-trochlear groove distance provides no information about the posi-tion of the tibial tubercle.Aim: Study of the tibial tubercle position (TTP) in patients withsymptomatic patellofemoral (PF) maltracking is compared withpatients having no patellofemoral symptoms.Methods: MRI scans of 48 knees treated with tibial tubercleosteotomy(TTO) for PF symptoms and 20 knees with acute injuriesbut no PF symptoms (control group) are analysed.TTP is the ratio of the horizontal distance from the perpendiculardrawn from the midpoint of the PT attachment to the maximumhorizontal width of the tibia on the axial scan. The sagittal imagecorresponds to the most proximal part of the patellar tendonattachment on tuberosity with precise definition of PT on axialimage.Results: An independent sample t-test showed a significant differ-ence (p<0.001) of the TTP between two groups. Mean (SD) TTP inpatients with PF symptoms was 27(+/-8.6) (95% CI 24.6-29.3), andthe control group was 35.4 (+/- 6.3) (95%CI 32.4-38.2). In controlgroup, 19 /20 knees (95%) had TTP > 29 however only 19 /48 (29%)had TTP>29 in the group with PF symptoms implying a high inci-dence of lateralised tubercle in PF maltracking.Conclusion: TTP can be used to define lateralisation of tibial tuber-cle in patients with PF symptoms. TTP can also be used as an objec-tive measure for PF maltracking in symptomatic patients andpotentially used to guide treatment.

0121 – MEDIAL ROTATION KNEE RANDOMISED CONTROLLEDTRIAL: ALL-POLYETHYLENE VS METAL-BACKED TIBIALCOMPONENTS. A COST EVALUATION.Simon Lewthwaite, Niall GrahamThe Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry,United Kingdom.

In this prospective, randomised and blinded, multi-centre study wehave examined the patient level costing for a single centre subgroup of patients.50 patients at the lead centre for the study had the cost of theirinpatient episodes reviewed.There were 25 metal backed tibias and 25 all poly tibias.The total cost saving to the health care organisation of using an allpoly tibia was 920GBP per case. Only 395GBP of this saving wasdirectly attributable to implant cost saving.We examine the potential causes for this cost differential and thebenefits of this implant design in the financially challenging envi-ronment for healthcare.

30

0001 – ATTUNE HAS IMPROVED SURVIVORSHIP AND CLINICAL OUTCOME OVER PFC SIGMA – ASINGLE SURGEON SERIES OF 1000 TKAS WITH MINIMUM 2 YEARS FOLLOW-UPBenjamin Bloch, Mohammed Shahid, Peter James Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom

0002 – A SYSTEMATIC REVIEW OF LONG TERM PATIENT REPORTED OUTCOMES FOR THETREATMENT OF ANTERIOR CRUCIATE LIGAMENT INJURIES IN THE SKELETALLY IMMATURE.Christopher Buckle, Andrew Wainwright Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UnitedKingdom.

0005 – A VALIDATION STUDY OF THE ARABIC VERSION OF THE OXFORD KNEE SCORE FOR USE INEND STAGE KNEE OSTEOARTHRITISBodor Bin sheeha1,2, Anita Williams1, David Sands (DS) Johnson3,4, AHMAD BIN NASSER5, MalcolmGranat1, Richard Jones1

1University of Salford, Manchester, United Kingdom. 2Princess Nora bint Abdul Rahman University,Riyadh, Saudi Arabia. 3Stockport NHS Foundation Trust, Manchester, United Kingdom. 4HonoraryProfessor, University of Salford., Manchester, United Kingdom. 5King Khalid University Hospital,Riyadh, Saudi Arabia.

0016 – METAPHYSEAL SLEEVES IN REVISION TOTAL KNEE ARTHROPLASTY AT MIDTERM FOLLOW-UP.Devdatta Neogi, Sanjeev Agarwal, Rhidian Morgan-Jones University Hospital Llandough, Cardiff and Vale University Health Board, Cardiff, United Kingdom.

0024 – OUTCOMES OF ALLOGRAFT MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION(MPFL) IN CHILDREN & ADOLESCENTS WITH JOINT HYPERMOBILITYGautam Reddy, Nisarg Mehta, nameer Choudhry, coline Bruce, Nick Barton-Hanson Alder Hey Hospital, Liverpool, United Kingdom.

0027 – INTRODUCING DAYCASE SURGERY INTO AN ENHANCED RECOVERY PROGRAMME FORUNICOMPARTMENTAL KNEE REPLACEMENT WITHIN THE NHS SETTING: SUITABLE FOR ALL? THERESULTS OF A SERVICE IMPROVEMENT PROJECT AND LESSONS LEARNED.Cathy Jenkins1, William Jackson1, Nicholas Bottomley1, Andrew Price1,2, David Murray1,2, KarenBarker1,2

1Nuffield Orthopaedic Centre, Oxford, United Kingdom. 2Nuffield Department of Orthopaedics,Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom.

0028 – 1-YEAR OUTCOMES OF MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION WITHTIBIAL TUBEROSITY DISTALISATION FOR PATIENTS WITH RECURRENT PATELLOFEMORALINSTABILITY AND PATELLA ALTAAshley Brown, Gaynor Kanes, Andrew Barnett The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom

0033 – STUD DESIGN OF SPORTS FOOTWEAR AFFECTS GROUND REACTION FORCES IN CUTTINGAND CROSS-CUTTING EXERCISE.Daniel Winson1,2, Dario Cazzola3, Owen Lawrence1, Ian Winson4, Andrew Davies1

1Morriston Hospital, Swansea, United Kingdom. 2University of Bath Sports Medicine Department,Bath, United Kingdom. 3University of Bath Applied Biomechanics Suite, Bath, United Kingdom.4Southmead Hospital, Bristol, United Kingdom.

0045 – DOES PHYSICAL ACTIVITY CHANGE FOLLOWING TOTAL KNEE ARTHROPLASTY?Bodor Bin sheeha1,2, Anita Williams1, David Sands (DS) Johnson3,4, AHMAD BIN NASSER5, MalcolmGranat1, Richard Jones1

1University of Salford, Manchester, United Kingdom. 2Princess Nora bint Abdul Rahman University,Riyadh, Saudi Arabia. 3Stockport NHS Foundation Trust, Manchester, United Kingdom. 4HonoraryProfessor, University of Salford., Manchester, United Kingdom. 5King Khalid University Hospital,Riyadh, Saudi Arabia.

0046 – 2D/3D EOS IMAGING VERSUS STANDING LONG LEG X-RAY IN LOWER LIMB CLINICALASSESSMENT – INTER-OBSERVER AND INTRA-OBSERVER RELIABILITYMelinda YT Hau1, Dipen K Menon1, Ronald Chan2, Kwong Yin Chung2, Wai Wang Chau3, Ki Wai Ho2

1 Kettering General Hospital, United Kingdom, 2Prince of Wales Hospital, Hong Kong, 3Dept of ORT,CUHK, Hong Kong

0057 – FORGOTTEN JOINT SCORE: COMPARISON BETWEEN DIFFERENT TYPES OF TOTAL ANDUNICOMPARTMENTAL KNEE REPLACEMENTS – 1,5 AND 10 YEAR FOLLOWJames Corbett, Paul Nicolai West Suffolk Hospital, Bury St Edmunds, United Kingdom

0064 – INTRAOPERATIVE MOBILISATION OF SYNOVIAL MESENCHYMAL STEM CELLS TO INCREASETHE REGENERATIVE CAPACITY OF THE KNEE USING A NOVEL DEVICEAlam Khalil-Khan1, Anthony Theodorides2, Owen Wall2, Elena Jones1, Dennis McGonagle1, ThomasBaboolal1

1University of Leeds, Leeds, United Kingdom. 2Leeds Teaching Hospital NHS Trust, Leeds, UnitedKingdom.

0066 – IS MRI USEFUL IN DIAGNOSING INTRA-ARTICULAR KNEE PATHOLOGY IN CHILDREN ANDADOLESCENTS?Stephanie Buchan, Sarah Murgatroyd, Joanna Thomas Southampton Children’s Hospital, Southampton, United Kingdom.

0071 – CHEMICAL THROMBOPROPHYLAXIS IN PRIMARY JOINT REPLACEMENT – IS IT WORTH THEBLEEDING BOTHER?’ RISK STRATIFICATION IN JOINT REPLACEMENT IS AS EFFECTIVE, AND SAFER,THAN DRUGS FOR ALL. RESULTS IN 13,472 PATIENTSPeter Cay, Sukhdeep Gill, Randeep Karwal, Andrea Pearce, Nigel Rossiter Basingstoke and North Hampshire Hospital, Basingstoke, United Kingdom.

0075 - A RETROSPECTIVE STUDY TO DETERMINE THE ACCURACY OF HOSPITAL REVISION DATACOMPARED TO THE NATIONAL JOINT REGISTRY FOR PATELLA RESURFACING PROCEDURESFOLLOWING A PRIMARY TOTAL KNEE REPLACEMENTIrrum Afzal, John Dabis, Roy TwymanSouth West London Elective Orthopaedic Centre, London, United Kingdom.

0082 – HOW RELIABLE IS THE POLLARD TECHNIQUE FOR PRE-OPERATIVE MENISCAL SIZING? ASNAPSHOT STUDY OF THE AUSTRALIAN MENISCAL TRANPLANT STUDY GROUPCiara Stevenson1, Ahmed Mahmoud2, Peter Myers1

1Brisbane Orthopaedic Sports Medicine Centre, Brisbane, Australia. 2Brisbane Orthopaedic SportsMedicine CentreMedicine Centre, Brisbane, Australia.

0095 – COMBINED INTRAVENOUS AND TOPICAL TRANEXAMIC ACID WITH 30 MINUTES DRAINCLAMP IS MORE EFFECTIVE THAN SINGLE DOSE TRANEXAMIC ACID, DUAL DOSE INTRAVENOUSTRANEXAMIC ACID OR COMBINED INTRAVENOUS AND TOPICAL TRANEXAMIC ACID IN REDUCINGBLOOD LOSS FOLLOWING TOTAL KNEE REPLACEMENT.Abdelaleem Ragab1, Vinayak Ghanate1, Hatim Cochin2, Shaival Dalal1, Amit Chandratreya1, RahulKotwal1

1Princess of Wales Hospital, Bridgend, Wales, United Kingdom. 2Cardiff University, Cardiff, UnitedKingdom.

0099 - PATIENT SATISFACTION AND PROMS IN COMPUTER NAVIGATED VS. NON-NAVIGATED TOTALKNEE REPLACEMENTS(TKR)Kamal Deep1, Kumar Kaushik Dash1, Shivakumar Shankar2, Frederic Picard1, Alistair Ewen1

1Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom. 2Queen's Hospital, Romford, United Kingdom.

0102 – 7 YEAR SURVIVAL OF THE ALL POLYETHYLENE TIBIA IN THE PROFIX TOTAL KNEEREPLACEMENT – A SINGLE CENTRE SERIES OF OVER A 1000 PATIENTSDavid Selvan, Alasdair Santini, Jill Pope, John Davidson Royal Liverpool and Broadgreen University Hospitals NHS trust, Liverpool, United Kingdom.

0106 – THE OUTCOMES OF TOTAL KNEE REPLACEMENT IN MORBIDLY OBESE PATIENTS: ASYSTEMATIC REVIEW OF THE LITERATURELouis Boyce1, Anoop Prasad2, Matt Barrett1, Steve Millington2, Sebastian Dawson-Bowling2, SammyHanna2

1Barts and The London School of Medicine and Dentistry, London, United Kingdom. 2Royal LondonHospital, London, United Kingdom.

0111 – THE ZIMMER-BIOMET PERSONA TOTAL KNEE REPLACEMENT: EARLY RESULTSWai Huang Teng, Fahd Mahmood, David Wallace, Jason Roberts, Jon Clarke Golden Jubilee National Hospital, Glasgow, United Kingdom.

0116 – OUTCOME OF TOTAL KNEE ARTHROPLASTY IN PATIENTS WITH POLIOMYELITISAnoop Prasad1, Jaimee Hui Shan Tan2, Manoj Ramachandran1, Sebastian Dawson-Bowling1,Steven Millington1, Pramod Achan1, Sammy Hanna1

1Barts Health Royal London Hospital, London, United Kingdom. 2Barts and The London School ofMedicine and Dentistry, London, United Kingdom.

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Zimmer Biomet is the leading company in PKA1 with over 40 years’ experience, o�ering a comprehensive range of anatomic and innovative solutions.

All content herein is protected by copyright, trademarks and other intellectual property rights, as applicable, owned by or licensed to Zimmer Biomet or its a�liates unless otherwise indicated, and must not be redistributed, duplicated or disclosed, in whole or in part, without the express written consent of Zimmer Biomet. This material is intended for health care professionals. Distribution to any other recipient is prohibited. For product information, including indications, contraindications, warnings, precautions, potential adverse e�ects and patient counseling information, see the package insert and www.zimmerbiomet.com. Check for country product clearances and reference product specific instructions for use. ©2018 Zimmer Biomet

Gender Solutions® Patello-Femoral Joint Systemdesigned to address the anatomic di�erences among men and women

Persona® Partial Knee the next era in personalization in fixed bearing partial knee design

1. Data on file at Zimmer Biomet. Based on Market Analysis and Registry Data, gathered September 2017. 2. Price AJ, Svard U. Clin Orthop Relat Res. 2011 Jan;469(1):174–9. 3. Pandit et al. Bone Joint J 2015;97-B:1493–1500.

Oxford® Partial Knee Systemthe most widely used1 and clinically proven2,3 partial knee in the world

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BRITISH ASSOCIATION FOR SURGERY OF THE KNEE€¦ · Hospital, Derby, United Kingdom. 5The Coxa Hospital for Joint Replacement, Tampere, Finland. 6University of Basel and Department