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ObjectiveThere are few guidelines for clinical trials of interventions for prevention of post-traumatic osteoarthritis (PTOA), reflecting challenges in this area. An international multi-disciplinary expert group including patients was convened to generate points to consider for the design and conduct of interventional studies following acute knee injury.DesignAn evidence review on acute knee injury interventional studies to prevent PTOA was presented to the group, alongside overviews of challenges in this area, including potential targets, biomarkers and imaging. Working groups considered pre-identified key areas: eligibility criteria and outcomes, biomarkers, injury definition and intervention timing including multi-modality interventions. Consensus agreement within the group on points to consider was generated and is reported here after iterative review by all contributors.ResultsThe evidence review identified 37 studies. Study duration and outcomes varied widely and 70% examined surgical interventions. Considerations were grouped into three areas: justification of inclusion criteria including the classification of injury and participant age (as people over 35 may have pre-existing OA); careful consideration in the selection and timing of outcomes or biomarkers; definition of the intervention(s)/comparator(s) and the appropriate time-window for intervention (considerations may be particular to intervention type). Areas for further research included demonstrating the utility of patient-reported outcomes, biomarkers and imaging outcomes from ancillary/cohort studies in this area, and development of surrogate clinical trial endpoints that shorten the duration of clinical trials and are acceptable to regulatory agencies.ConclusionsThese considerations represent the first international consensus on the conduct of interventional studies following acute knee joint trauma.

Aims: The aims were to assess whether joint-specific outcome after total knee arthroplasty (TKA) was influenced by implant design over a 12-year follow-up period, and whether patient-related factors were associated with loss to follow-up and mortality risk., Methods: Long-term follow-up of a randomized controlled trial was undertaken. A total of 212 patients were allocated a Triathlon or a Kinemax TKA. Patients were assessed preoperatively, and one, three, eight, and 12 years postoperatively using the Oxford Knee Score (OKS). Reasons for patient lost to follow-up, mortality, and revision were recorded., Results: A total of 94 patients completed 12-year functional follow-up (62 females, mean age 66 years (43 to 82) at index surgery). There was a clinically significantly greater improvement in the OKS at one year (mean difference (MD) 3.0 (95% CI 0.4 to 5.7); p = 0.027) and three years (MD 4.7 (95% CI 1.9 to 7.5); p = 0.001) for the Triathlon group, but no differences were observed at eight (p = 0.331) or 12 years' (p = 0.181) follow-up. When assessing the OKS in the patients surviving to 12 years, the Triathlon group had a clinically significantly greater improvement in the OKS (marginal mean 3.8 (95% CI 0.2 to 7.4); p = 0.040). Loss to functional follow-up (53%, n = 109/204) was independently associated with older age (p = 0.001). Patient mortality was the major reason (56.4%, n = 62/110) for loss to follow-up. Older age (p < 0.001) and worse preoperative OKS (p = 0.043) were independently associated with increased mortality risk. An age at time of surgery of ≥ 72 years was 75% sensitive and 74% specific for predicting mortality with an area under the curve of 78.1% (95% CI 70.9 to 85.3; p < 0.001)., Conclusion: The Triathlon TKA was associated with clinically meaningful greater improvement in knee-specific outcome when compared to the Kinemax TKA. Loss to follow-up at 12 years was a limitation, and studies planning longer-term functional assessment could limit their cohort to patients aged under 72 years., Competing Interests: N. Clement, D. MacDonald, P. Gaston, and D. Hamilton declare that an unrestricted educational grant for the trial was provided to the University of Edinburgh by Stryker UK, which had no role in the design, collection, analysis and interpretation of the data or in the writing of the article and the decision to submit it. Some of the surgical authors (D. Hamilton and P. Gaston) have previously acted as faculty on Stryker funded educational courses. Although none of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article, benefits have been or will be received but will be directed solely to a research fund, foundation, educational institution, or other non-profit organization with which one or more of the authors are associated. N. Clement is an editorial board member of The Bone & Joint Journal and Bone & Joint Research. D. Hamilton is an editorial board member of The Knee., (© 2024 Clement et al.)

Background: Exercise-based cardiac rehabilitation improves clinical outcomes and quality of life. Technology-enabled delivery of remote cardiac rehabilitation is as effective in improving health outcomes as in-person delivery and has the potential to transform clinical service delivery. However, for the successful translation of research to clinical practice, interventions must be adequately reported in the literature., Methods: Systematic review of MedLine, CINAHL, PubMed and SPORT Discus databases applying PRISMA guidance. Randomised controlled trials of remote or hybrid technology-enabled exercise-based cardiac rehabilitation interventions were included. Completeness of reporting was evaluated against the TIDieR checklist., Results: The search strategy returned 162 articles which, following screening, resulted in 12 randomised trials being included containing data for 1588 participants. No trial fully reported their rehabilitation intervention as per the 12-item TIDieR checklist, with a median score of eight out of 12 categories. Notably, intervention detail, dosage and modification were comparatively poorly reported., Conclusion: Technology-enabled remotely delivered cardiac rehabilitation may be effective at improving cardiovascular fitness; however, the quality of reporting of these interventions in randomised trials is insufficient for replication which has material implications for translation into clinical practice.

Purpose: The aim of this study is to investigate the cost-effectiveness of revision total knee arthroplasty compared to primary total knee arthroplasty in terms of cost-per-quality-adjusted life year (QALY)., Methods: Data were retrieved for all primary and revision total knee replacement (TKA) procedures performed at a tertiary Swiss hospital between 2006 and 2019. A Markov model was created to evaluate revision risk and we calculated lifetime QALY gain and lifetime procedure costs through individual EuroQol 5 dimension (EQ-5D) scores, hospital costs, national life expectancy tables and standard discounting processes. Cost-per-QALY gain was calculated for primary and revision procedures., Results: EQ-5D data were available for 1343 primary and 103 revision procedures. Significant QALY gains were seen following surgery in all cases. Similar, but significantly more QALYs were gained following primary TKA (PTKA) (5.67 ± 3.98) than following revision TKA (RTKA) (4.67 ± 4.20). Cost-per-QALY was €4686 for PTKA and €10,364 for RTKA. The highest average cost-per-QALY was seen in two-stage RTKA (€12,292), followed by one-stage RTKA (€8982)., Conclusion: RTKA results in a similar QALY gain as PTKA. The costs of achieving health gain are two to three times higher in RTKA, but both procedures are highly cost-effective., Level of Evidence: Economic level II., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background: Although a common injury there is a lack of published primary data to inform clinical management of sports related brachial plexus injuries., Methods: A systematic search was completed in Medline, CINAHL, PubMed, SPORTDiscus and Web of Science databases and Google Scholar from inception to August 2023 according to the PRISMA-ScR guidelines. Methodological quality assessment of included articles was with the Joanna Briggs Institute tool. Studies providing primary data as to the rehabilitative management of diagnosed or suspected brachial plexus injuries sustained when playing contact sports were included., Results: Sixty-five studies were identified and screened, of which, 8 case reports were included, incorporating 10 participants with a mean age of 19.8 (±4.09) years. There was wide heterogeneity in injury severity, injury reporting, physical examination and imaging approaches documented. 9 of 10 participants returned to competitive sports, though follow-up periods also varied widely. Whilst return to play criteria varied between studies, the most consistent indicator was pain-free shoulder range of motion and strength., Conclusions: There is a distinct lack of data available to inform evidence-based rehabilitation management of sports related brachial plexus injury. Only 8 individual case reports contain published data reporting on 10 athletes. Further reporting is critical to inform clinical management., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Armstrong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Although a well-established aspect of healthcare practice, the impact of facemasks on verbal communication is surprisingly ambiguous., Materials and Methods: A systematic search was conducted in APA PSYCHinfo, CINAHL, NHS Knowledge Network, Medline and SPORTDiscus databases from inception to November 2022 according to the PRISMA guidelines. Studies reporting an objective measure of speech understanding in adults, where information was transmitted or received whilst wearing a facemask were included. Risk of bias of included studies was assessed with the Newcastle-Ottawa score., Results: Four hundred and thirty-three studies were identified, of which fifteen were suitable for inclusion, incorporating 350 participants with a median age of 49 (range 19 to 74) years. Wide heterogeneity of test parameters and outcome measurement prohibited pooling of data. 93% (14 of 15) studies reported a deleterious effect of facemasks on speech understanding, and 100% (5 of 5) of the included studies reported attenuation of sound with facemask usage. Background noise added further deleterious effects on speech understanding which was particularly problematic within hearing-impaired populations. Risk of bias in included studies varied but overall was modest., Conclusions: Despite considerable complexity and heterogeneity in outcome measure, 93% (14 of 15) articles suggest respiratory protective equipment negatively affects speech understanding in normal hearing and hearing-impaired adults.

Aims: The primary aim of this study is to assess the survival of the uncemented hydroxyapatite (HA) coated Trident II acetabular component as part of a hybrid total hip arthroplasty (THA) using a cemented Exeter stem. The secondary aims are to assess the complications, joint-specific function, health-related quality of life, and radiological signs of loosening of the acetabular component., Methods: A single-centre, prospective cohort study of 125 implants will be undertaken. Patients undergoing hybrid THA at the study centre will be recruited. Inclusion criteria are patients suitable for the use of the uncemented acetabular component, aged 18 to 75 years, willing and able to comply with the study protocol, and provide informed consent. Exclusion criteria includes patients not meeting study inclusion criteria, inadequate bone stock to support fixation of the prosthesis, a BMI > 40 kg/m 2 , or THA performed for pain relief in those with severely restricted mobility., Results: Implant survival, complications, functional outcomes and radiological assessment up to ten years following index THA (one, two, five, seven, and ten years) will be performed. Functional assessment will include the Oxford Hip Score, Forgotten Joint Score, 12-Item Short Form Health Survey, EuroQol five-dimension health questionnaire, and pain and patient satisfaction. Radiological assessment with assess for acetabula lucent lines, lysis, and loosening according to DeLee and Charnley zones., Conclusion: This study is part of a stepwise introduction of a new device to orthopaedic practice, and careful monitoring of implants should be carried out as part of the Beyond Compliance principles. The results of this study will provide functional, radiological, and survival data to either support the ongoing use of the HA acetabulum or highlight potential limitations of this new implant before wide adoption., Competing Interests: G. J. Macpherson reports consulting fees and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Stryker, unrelated to this study. P. Simpson reports consulting fees from Stryker and DePuy Synthes, unrelated to this study. N. D. Clement is a member of the editorial boards of Bone & Joint Research and The Bone & Joint Journal., (© 2023 Hamilton et al.)

Background: The aim of this study was to perform a cost-utility analysis for total knee arthroplasty (TKA) over a 10-year follow up period., Methods: Two-hundred and twelve patients were randomised to receive either a Kinemax or a Triathlon TKA. Patients were assessed pre-operatively, and at 6 months, and 1, 3, 7 and 10 years postoperatively. The costs of the primary and revision surgery were accounted for. One-year quality-adjusted life year (QALY) gain was used to estimate 10-year gains using the established annual health gain discounts., Results: Forty-eight patients died and eight were revised during the follow up period. Overall QALY gain per patient over the 10-year period was 2.594 and the cost per patient was £6559, which resulted in a cost per QALY of £2761 at 10 years. The Triathlon group had a significantly greater QALY gain compared with the Kinemax (mean difference (MD) 0.53, 95% CI 0.03-1.03, P = 0.02), which resulted in a cost per QALY for the Triathlon group of £2521 compared with £3107 for the Kinemax group at 10 years. The 5% annual discount resulted in a significantly lower QALY gain (MD 0.135, 95% CI 0.201-0.354, P = 0.002), whereas the 3.5% annual discount resulted in non-significant difference in QALY gain compared with the actual gain (MD 0.021, 95% CI -0.084 to 0.077, P = 0.292)., Conclusions: TKA was a cost-effective intervention, and the Triathlon was associated with a greater cost effectiveness at 10 years. The 3.5% annual discounts for QALY gain would seem to be the most accurate, with an underestimation being observed with the 5% discount., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: The primary aim was to assess whether a short (125 millimeter (mm)) stem offered an equivalent hip-specific function compared to the standard (150 mm) stem when used for cemented total hip arthroplasty. Secondary aims were to evaluate health-related quality of life, patient satisfaction, stem height and alignment, as well as radiographic loosenings and complications between the two stems., Methods: A prospective twin-center double-blind randomized control trial was conducted. During a 15-month period, 220 patients undergoing total hip arthroplasty were randomized to either a standard (n = 110) or a short (n = 110) stem. There were no significant (P ≥ .065) differences in preoperative variables between the groups. Functional outcomes and radiographic assessment were undertaken at a mean of 1 and 2 years., Results: There were no differences (P = .428) in hip-specific function according to the mean Oxford hip scores at 1 year (primary endpoint) or at 2 years (P = .622) between the groups. The short stem group had greater varus angulation (0.9 degrees, P = .003) when compared to the standard group and were more likely (odds ratio 2.42, P = .002) to have varus stem alignment beyond one standard deviation from the mean. There were no significant (P ≥ .083) differences in the forgotten joint scores, EuroQol-5-Dimension, EuroQol-visual analogue scale, short form 12, patient satisfaction, complications, stem height, or radiolucent zones at 1 or 2 years between the groups., Conclusion: The cemented short stem used in this study had equivalent hip-specific function, health-related quality of life, and patient satisfaction when compared to the standard stem at mean 2 years post operation. However, the short stem was associated with a greater rate of varus malalignment, which may influence future implant survival., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Robotic-assisted unicompartmental knee arthroplasty (UKA) improves implant accuracy, however whether this translates to patient function is less clear. Various outcomes have been reported but muscle recovery has not been previously investigated., Objective: To explore sequential change in lower limb muscle strength following robotic-assisted UKA with isokinetic dynamometry., Results: 12 participants undergoing rUKA for medial compartment osteoarthritis were assessed pre-operatively, and at 6- and 12-weeks post-operatively. Maximal muscle strength changed over time in both quadriceps (p = 0.006) and hamstrings (p = 0.018) muscle groups. Quadriceps strength reduced from 88.52(39.86)Nm to 74.47(27.58)Nm by 6-weeks (p = 0.026), and then recovered to 90.41(38.76)Nm by 12-weeks (p = 0.018). Hamstring strength reduced from 62.45(23.18)Nm to 54.12(20.49)Nm by 6-weeks (p = 0.016), and then recovered to 55.07(17.99)Nm by 12-weeks (p = 0.028). By 12-weeks quadriceps strength was 70% and hamstrings 83% of the values achieved in the un-operated limb. Substantial improvement was seen in all other measures over time, with sequential positive change in Timed-up-and-go test (p = 0.015), 10 m walk test (p = 0.021), range of knee flexion (p = 0.016) and PROMs (p < 0.025)., (© 2023. The Author(s).)

Introduction: Technological tools that promote the adoption of physical activity to increase individuals' functional ability in knee osteoarthritis (OA) are desired to support lifestyle interventions. However, there is little consensus as to the current use of such supportive interventions for knee OA. The aim of this scoping review is therefore to provide an overview on the current use of technology within lifestyle interventions for individuals with knee OA., Methods: Scoping review as per PRISMA guidance. Structured search of Cochrane Central Register for Controlled Trials, ELSEVIER, IEEExplore, GOOGLE Scholar, MEDLINE, PEDRO, PUBMED, WEB OF SCIENCE from 2010 to 2020 inclusive. Hits were screened by title and abstract and then full text review based on pre-defined criteria. Results were synthesised and pooled by theme for reporting., Results: 2508 papers were identified, and following review, 78 studies included. Papers included interventions for individuals with knee osteoarthritis (n ​= ​31), total or partial knee arthroplasty (n ​= ​20) and developmental work in healthy controls (n ​= ​27). Of the 78 studies, 47 were carried out in laboratory settings and 31 in the field. The identified themes included Movement measurement (n ​= ​24), Tele-rehabilitation (n ​= ​22), Biofeedback (n ​= ​20), Directly applied interventions (n ​= ​3), Virtual or augmented reality (n ​= ​5) and Machine learning (n ​= ​4)., Conclusions: The predominant current use of technology in OA lifestyle interventions is through well-established telecommunication and commercially available activity, joint angle and loading based measurement devices, while integrating new advanced technologies seems a longer-term goal. There is great potential for the engineering and clinical community to use technology to develop systems that offer real-time feedback to patients and clinician as part of rehabilitative interventions to inform treatment., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Home exercise regimes are a well-utilised rehabilitation intervention for many conditions; however, adherence to prescribed programmes remains low. Digital interventions are recommended as an adjunct to face-to-face interventions by the National Health Service in the UK and may offer increased exercise adherence, however the evidence for this is conflicting., Method: A systematic review was undertaken using MEDLINE and CINAHL databases using the PRISMA guidelines. Randomised controlled trials in any clinical population evaluating the adherence to prescribed home exercise interventions with and without additional digital interventions were included. Publication quality was assessed using the Cochrane Risk of Bias tool., Results: The search strategy returned a total of 1336 articles, of which 10 randomised controlled trials containing data for 1117 participants were eligible for inclusion. 565 participants were randomised to receive the interventions, and 552 to the control. Seven of the ten trials reported a significant difference in adherence between the control and intervention groups favouring an additional digital intervention. Three trials reported equivalent findings. These three reported longer-term outcomes, suggesting an interaction between adherence and duration of intervention. There was substantial heterogeneity in outcome assessment metrics used across the trials prohibiting formal meta-analysis. This included studies were of low to moderate quality in terms of risk of bias., Conclusion: The addition of a digital interventions to prescribed home exercise programmes can likely increase exercise adherence in the short term, with longer term effects less certain., (© 2022. The Author(s).)

Background: The purpose of this study was to search for changes in functional outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) between short and medium-term follow-up. Secondary aims included reporting rates of revision surgery and total hip arthroplasty (THA) at medium-term follow-up., Hypothesis: We hypothesised that patients' functional outcomes would improve between short and medium-term follow-up., Patients and Methods: Consecutive patients undergoing hip arthroscopy with a diagnosis of femoroacetabular impingement with labral tears between February 2013 and June 2015 were included. Twelve item international hip outcome tool (iHOT-12) and EuroQol 5D-5L (EQ-5D) scores were collected preoperatively, at short-term and medium-term follow-up. Short-term scores were recorded at a minimum of one year postoperatively and medium-term scores at a minimum of five years postoperatively. Survivorship was assessed with Kaplan-Meier analysis., Results: Short-term outcome data (at median follow-up 1.6 year, Interquartile range [IQR] 1-2.5) was available for 70 of 87 patients (80.5%) and medium-term outcome data (at median follow-up of 6.5 years, IQR 6-7.1) was available for 68 patients (78.2%). Median age at the time of surgery was 31 years (IQR 25-37). The median iHOT-12 scores at short and medium-term follow-up were 72 (IQR 48.75-91.25) and 85.8 (IQR 66.7-96.7) respectively (p<0.001). Medium-term survivorship was 91.2%. Survivorship following labral repair was 94.2%, and 81.3% following labral debridement (p=0.09)., Discussion: Patients undergoing hip arthroscopy for FAI reported continued improvement in iHOT-12 scores between short and medium-term follow-up. Medium-term survivorship following FAI surgery may be greater when the labrum is repaired, although comparisons are limited by their differing indications. Conversion to THA was low with just 4 patients (4.6%) undergoing or being listed for THA at final follow-up., Level of Evidence: IV, Case series., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Aims: Sarcopenia is characterized by a generalized progressive loss of skeletal muscle mass, strength, and physical performance. This systematic review primarily evaluated the effects of sarcopenia on postoperative functional recovery and mortality in patients undergoing orthopaedic surgery, and secondarily assessed the methods used to diagnose and define sarcopenia in the orthopaedic literature., Methods: A systematic search was conducted in MEDLINE, EMBASE, and Google Scholar databases according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies involving sarcopenic patients who underwent defined orthopaedic surgery and recorded postoperative outcomes were included. The quality of the criteria by which a diagnosis of sarcopenia was made was evaluated. The quality of the publication was assessed using Newcastle-Ottawa Scale., Results: A total of 365 studies were identified and screened, 26 full-texts were reviewed, and 19 studies were included in the review. A total of 3,009 patients were included, of whom 2,146 (71%) were female and 863 (29%) were male. The mean age of the patients was 75.1 years (SD 7.1). Five studies included patients who underwent spinal surgery, 13 included hip or knee surgery, and one involved patients who underwent fixation of a distal radial fixation. The mean follow-up was 1.9 years (SD 1.9; 5 days to 5.6 years). There was wide heterogeneity in the measurement tools which were used and the parameters for the diagnosis of sarcopenia in the studies. Sarcopenia was associated with at least one deleterious effect on surgical outcomes in all 19 studies. The postoperative rate of mortality was reported in 11 studies (57.9%) and sarcopenia was associated with poorer survival in 73% (8/11) of these. The outcome was most commonly assessed using the Barthel Index (4/19), and sarcopenic patients recorded lower scores in 75% (3/4) of these. Sarcopenia was defined using the gold-standard three parameters (muscle strength, muscle quantity or quality, and muscle function) in four studies (21%), using two parameters in another four (21%) and one in the remaining 11 (58%). The methodological quality of the studies was moderate to high., Conclusion: There is much heterogeneity in the reporting of the parameters which are used for the diagnosis of sarcopenia, and evaluating the outcome of orthopaedic surgery in sarcopenic patients. However, what data exist suggest that sarcopenia impairs recovery and increases postoperative mortality, especially in patients undergoing emergency surgery. Further research is required to develop processes that allow the accurate diagnosis of sarcopenia in orthopaedics, which may facilitate targeted pre- and postoperative interventions that would improve outcomes. Cite this article: Bone Joint J  2022;104-B(3):321-330.

Purpose: The aim was to assess the cost-effectiveness of robotic arm-assisted total hip arthroplasty (rTHA) compared with manual total hip arthroplasty (mTHA) and to assess the influence of annual volume on the relative cost-effectiveness of rTHA., Methods: A database of both rTHA ( n  = 48 performed in a private centre) and mTHA ( n  = 512 performed in the National Health Service) was used. Patient demographics, preoperative Oxford hip score, forgotten joint score, EuroQol 5-dimensional 3-level (EQ-5D), and postoperative EQ-5D were recorded. Two models for incremental cost-effectiveness ratios using cost per quality-adjusted life year (QALY) for rTHA were calculated based on a unit performing 100 rTHAs per year: 10-year follow-up and a lifetime time horizon (remaining life expectancy of a 69-year-old patient)., Results: When adjusting for confounding factors, rTHA was independently associated with a 0.091 ( p =0.029) greater improvement in the EQ-5D compared to mTHA. This resulted in a 10-year time horizon cost per QALY for rTHA of £1,910 relative to mTHA, which increased to £2,349 per QALY when discounted (5%/year). When using the 10-year time horizon cost per QALY was approximately £3,000 for a centre undertaking 50 rTHAs per year and decreased to £1,000 for centre undertaking 200 rTHAs per year. Using a lifetime horizon, the incremental unadjusted cost per QALY gained was £980 and £1432 when discounted (5%/year) for rTHA compared with mTHA., Conclusions: Despite the increased cost associated with rTHA, it was a cost-effective intervention relative to mTHA due to the associated greater health-related quality of health gain, according to the EQ-5D outcome measure., Competing Interests: DFH, PMS, GM, and JTP are educational consultants for Stryker and deliver teaching on instructional courses., (Copyright © 2022 N. D. Clement et al.)

Objective: To determine whether good versus poor outcome trajectories and predictors of poor outcome obtained in a derivation study could be replicated in an independent sample of persons undergoing knee arthroplasty (KA)., Methods: We used data from TRIO-POPULAR, a prospective cohort study of 926 participants who underwent KA in the United Kingdom. The participants were assessed preoperatively and 6-weeks, 6- and 12-months postoperatively. The Oxford Knee Score was the primary outcome and a variety of pre-operative predictors of outcome were selected. The outcome measure and the predictors were selected to most closely align with a previously published derivation study of good versus poor outcome. Confirmatory two-piece latent class growth curve analyses were used to model outcome and regression was used to identify predictors of outcome class., Results: Trajectories for the Oxford Knee Scores from TRIO-POPULAR replicated trajectories for WOMAC Pain and Function scores from the previously published derivation study. Multivariable predictors of poor outcome were pain catastrophizing (odds ratio = 1.125, 95% CI = 1.048, .206, p = 0.001) and comorbidity (odds ratio = 1.134, 95%CI = 1.049, 1.227, p = 0.002. Pain catastrophizing also predicted poor outcome in the derivation study., Conclusions: Good and poor outcome trajectories replicated those found in the previously published derivation study. Our model-based method produces stable outcome trajectories despite using data from different countries and participants with substantively different characteristics. Predictors of poor outcome were somewhat inconsistent between the cross-validation and derivation studies. Pain catastrophizing was the only consistent poor outcome predictor., (Copyright © 2021 Osteoarthritis Research Society International. All rights reserved.)

Purpose: The Forgotten Joint Score (FJS-12) is a valid tool in the evaluation of patients undergoing hip arthroscopy, assessing the unique concept of joint awareness in the setting of a patient's hip pathology. The preoperative burden on patients' mental wellbeing of impaired joint function or symptoms is well established. The purpose of this study was to determine patients' awareness of their hip joint whilst awaiting hip arthroscopy for femoroacetabular impingement, to explore any association between joint awareness and mental health status, and to determine whether this relates to time spent waiting for arthroscopy preoperatively., Methods: A prospective database of patients undergoing hip arthroscopy between January 2018 and November 2020 was analysed. All patients with a diagnosis of femoroacetabular impingement (FAI) undergoing arthroscopic treatment were included. Questionnaires included the FJS-12, twelve item international hip outcome tool (iHOT-12), EuroQol 5D-5L (EQ-5D-5L) and the Tegner activity score. Pearson's correlation coefficient was used to assess relationships between continuous variables., Results: Preoperative functional outcomes were completed by 81 patients (97.5%) prior to undergoing hip arthroscopy. Median preoperative FJS-12 score was 16.67 (IQR 8.33 - 29.68). Forty-four patients reported any level of anxiety/depression preoperatively (54.3%). Preoperative FJS-12 showed a significant negative correlation with worsening mental health status (r = - 0.359, p <  0.001), and a significant positive correlation with EQ-5D-5L (r = 0.445, p <  0.001). The duration of symptoms or time on the waiting list did not correlate with increased joint awareness or worsened mental health., Conclusion: Joint awareness is high when awaiting hip arthroscopy for FAI. Increasing levels of joint awareness correlate with poorer mental health status and poorer quality of life measures, however these parameters do not seem to be associated with increased duration of symptoms prior to surgery or time on the waiting list for surgery., (© 2021. The Author(s).)

Competing Interests: The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Physical therapy is routinely delivered to patients after discharge from the hospital following knee arthroplasty. Posthospitalization physical therapy is thought to be beneficial, particularly for those patients most at risk of poor outcome, the subgroup with persistent function-limiting pain, despite an apparently successful surgery. Research teams have undertaken 3 large-scale multicenter Phase 3 randomized clinical trials designed specifically for patients at risk of poor outcome following knee arthroplasty. All 3 trials screened for poor outcome risk using different methods and investigated different physical therapist interventions delivered in different ways. Despite the variety of types of physical therapy and mode of delivery, all trials found no effects of the enhanced treatment compared with usual care. In all cases, usual care required a lower dosage of physical therapy compared with the enhanced interventions. This Perspective compares and contrasts the 3 trials, speculates on factors that could explain the no-effect findings, and proposes areas for future study designed to benefit the poor outcome phenotype., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: To contextualize the Forgotten Joint Score (FJS-12) by identifying a patient acceptable symptomatic state (PASS) threshold for patients undergoing hip arthroscopy and to investigate factors which correlated with postoperative FJS-12 score., Methods: All patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) under the care of a single surgeon between January 2018 and November 2019 were prospectively identified and included. Exclusion criteria were Tönnis classification grade 2 or greater. Data (including FJS-12, EuroQol-5 Dimension-5L [EQ-5D-5L], visual analog scale (VAS), and 12-item International Hip Outcome Tool (iHOT-12) scores) were available before surgery and at a minimum of 1 year after surgery. PASS was calculated using an anchor-based approach and receiver operator characteristic curve analysis. Pearson correlation analysis was used to correlate preoperative and postoperative factors with postoperative FJS-12 score., Results: Seventy-seven patients (54 female, 23 male; mean age 30.3 years [standard deviation {SD} 8.2]) were included. Linked longitudinal follow-up data were available for 65 patients (84%) at a mean of 23.8 months (SD 6.4). Six patients required reoperation. Mean postoperative FJS-12 score was 46.5 (SD 33.1) and mean change in score was 27.2 (SD 30.6, P < .001). The PASS threshold for the FJS-12 was 38.5 (sensitivity 80%, specificity 88%), and the area under the curve was 0.852 (95% confidence interval 0.752-0.951). Overall, 53.8% of patients achieved this score. Postoperative FJS-12 score has moderate correlations with preoperative EQ-5D-5L, iHOT-12, and FJS-12 scores, and strong correlations with EQ-5D-5L, iHOT-12 and VAS scores after surgery., Conclusions: We report a postoperative PASS threshold of 38.5 points for the FJS-12 after hip arthroscopy for FAI in a United Kingdom population. This value can act as a quantifiable target for clinicians using the FJS-12 to monitor patient outcomes in practice. FJS-12 has strong correlations with EQ-5D-5L, iHOT-12, and VAS at a minimum 12 months after surgery., Clinical Relevance: We have calculated the patient acceptable symptomatic state of the Forgotten Joint Score to be 38.5 points at short-term follow-up. This can assist clinicians in determining whether surgical interventions related to hip arthroscopy for FAI are meaningful to the patient., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier Inc.)

Aims: Although total knee arthroplasty (TKA) is a highly successful procedure, about 20% of patients remain dissatisfied postoperatively. This proportion is derived from dichotomous models of the assessment of surgical success or failure, which may not reflect the spectrum of outcomes. The aim of this study was to explore differing responses to surgery, and assess whether there are distinct groups of patients with differing patterns of outcome., Methods: This was a secondary analysis of a UK multicentre TKA longitudinal cohort study. We used a group-based trajectory modelling analysis of Oxford Knee Score (OKS) in the first year following surgery with longitudinal data involving five different timepoints and multiple predictor variables. Associations between the derived trajectory groups and categorical baseline variables were assessed, and predictors of trajectory group membership were identified using Poisson regression and multinomial logistic regression, as appropriate. The final model was adjusted for sociodemographic factors (age, sex) and baseline OKS., Results: Data from 731 patients were available for analysis. Three distinct trajectories of outcome were identified: "poor" 14.0%, "modest" 39.1%, and "good" 46.9%. The predicted probability of membership for patients assigned to each trajectory group was high (0.89 to 0.93). Preoperative mental, physical health, and psychosocial factors determined which trajectory is likely to be followed. Poor responders were characterized by a comparatively small number of factors, preoperative expectations of pain and limitations, coping strategies, and a lower baseline physical health status, while the good responders were characterized by a combination of clinical, psychosocial, mental health, and quality of life factors., Conclusion: We identified three distinct response trajectories in patients undergoing TKA. Controlling for baseline score, age, and sex, psychosocial factors such as expectations of pain and limited function and poor coping strategies differentiated the trajectory groups, suggesting a role for preoperative psychosocial support in optimizing the clinical outcome. Cite this article: Bone Joint J  2021;103-B(6):1096-1102.

Purpose: The forgotten joint score-12 (FJS-12) is an outcome questionnaire designed to evaluate joint awareness. The responsiveness and validity of the English language version of the FJS-12 in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) is not known., Methods: Consecutive patients undergoing hip arthroscopy for a diagnosis of FAI were prospectively followed up over a 1 year period. Patients completed preoperative and postoperative FJS-12, EuroQol 5 Dimension (EQ-5D-5L), and the 12-item international hip outcome tool (iHOT-12). We evaluated construct validity with Spearman correlation coefficients for the FJS-12, and responsiveness by way of effect size and ceiling effects., Results: Forty-six patients underwent hip arthroscopy, of which 42 (91%) completed post-operative PROMs at 1 year follow-up. Construct validity was strong with the iHOT-12 (r = 0.87) and also the EQ-5D-5L (r = 0.83). The median postoperative FJS score was 50.2 (IQR 64). The mean change in score for the FJS-12 was 31 points (SD 31) (p < 0.001), with an effect size (Cohen's d) of 1.16. Preoperatively, three patients scored the lowest possible value resulting in a floor effect of 7.1%. Similarly, only three patients (7.1%) scored the best possible score post-operatively., Conclusion: This is the first evaluation of the joint awareness concept in the English language version of the FJS-12 following hip arthroscopy for FAI. The FJS-12 is a valid and responsive tool for the assessment of this cohort of patients., Level of Evidence: II.

Aims: The aim of this study was to identify the minimal clinically important difference (MCID), minimal important change (MIC), minimal detectable change (MDC), and patient-acceptable symptom state (PASS) threshold in the Forgotten Joint Score (FJS) according to patient satisfaction six months following total knee arthroplasty (TKA)., Methods: During a one-year period 484 patients underwent a primary TKA and completed preoperative and six-month FJS and OKS. At six months patients were asked, "How satisfied are you with your operated knee?" Their response was recorded as: very satisfied, satisfied, neutral, dissatisfied, or very dissatisfied. The difference between patients recording neutral (n = 44) and satisfied (n = 153) was used to define the MCID. MIC for a cohort was defined as the change in the FJS for those patients declaring their outcome as satisfied, whereas receiver operating characteristic curve analysis was used to determine the MIC for an individual and the PASS threshold. Distribution-based methodology was used to calculate the MDC., Results: Using satisfaction as the anchor question, the MCID for the FJS was 16.6 (95% confidence interval (CIs) 8.9 to 24.3; p < 0.001) and when adjusting for confounding this decreased to 13.7 points (95% CI 4.8 to 22.5; p < 0.001). The MIC for the FJS for a cohort of patients was 17.7 points and for an individual patient was 10 points. The MDC90 for the FGS was 12 points; where 90% of patients scoring more than this will have experienced a real change that is beyond measurement error. The PASS was defined as 22 points or more in the postoperative FJS., Conclusion: The estimates for MCID and MIC can be used to assess whether there is clinical difference between two groups and whether a cohort/patient has had a meaningful change in their FJS, respectively. The MDC90 of 12 points suggests a value lower than this may fall within measurement error. A postoperative FJS of 22 or more was predictive of achieving PASS. Cite this article: Bone Joint J  2021;103-B(5):846-854.

Background: Definition and clinical diagnosis of instability in TKA is challenging. Sensitive and objective biomechanical tools to aid diagnosis are currently lacking. This proof-of-concept study evaluates the use of pressure mat analyses to identify abnormal biomechanical loading patterns associated with TKA instability within an outpatient clinical setting., Methods: Twenty participants were examined: 10 patients with suspected unilateral TKA instability and 10 healthy controls. Participants underwent bilateral stance and gait tests measuring time and limb loading pressure parameters. Gait was divided into three phases: heel strike, mid-foot and toe off. Pressure recordings are expressed relative to bodyweight. Between-limb loading discrepancies were calculated in TKA patients and controls, and these differences were then compared between groups. Statistical significance was accepted at p < 0.05., Results: TKA patients consistentlyoffloadedpressure away from the operated limb, whereas healthy controls exhibited more even limb loading throughout bilateral stance (p < 0.05). TKA patients exhibited greater discrepancy in overall step contact time between limbs (-0.09 s ± 0.16 s; p = 0.016) compared to controls (0.06 s ± 0.08 s; p = 0.04). Post-hoc tests showed significant between-group differences during midfoot (-0.04 s ± 0.07 s; p = 0.03) and toe-off (0.05 s ± 0.14 s; p = 0.013). Between-group differences in limb loading discrepancy were evident at heel strike (-9.24% ± 2.11%; p = 0.0166) and toe-off (-10.34% ± 5.51%; p = 0.0496)., Discussion: Pedobarographic measurements demonstrated differences in mechanical loading patterns in patients with TKA instability compared to healthy controls during functional tasks and warrants further investigation. This may prove to be a useful clinical diagnostic tool in identifying patients that would benefit from revision surgery or physical therapy., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflicts of interest., (Copyright © 2021. Published by Elsevier B.V.)

Aims: The primary aim of this study was to compare the hip-specific functional outcome of robotic assisted total hip arthroplasty (rTHA) with manual total hip arthroplasty (mTHA) in patients with osteoarthritis (OA). Secondary aims were to compare general health improvement, patient satisfaction, and radiological component position and restoration of leg length between rTHA and mTHA., Methods: A total of 40 patients undergoing rTHA were propensity score matched to 80 patients undergoing mTHA for OA. Patients were matched for age, sex, and preoperative function. The Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and EuroQol five-dimension questionnaire (EQ-5D) were collected pre- and postoperatively (mean 10 months (SD 2.2) in rTHA group and 12 months (SD 0.3) in mTHA group). In addition, patient satisfaction was collected postoperatively. Component accuracy was assessed using Lewinnek and Callanan safe zones, and restoration of leg length were assessed radiologically., Results: There were no significant differences in the preoperative demographics (p ≥ 0.781) or function (p ≥ 0.383) between the groups. The postoperative OHS (difference 2.5, 95% confidence interval (CI) 0.1 to 4.8; p = 0.038) and FJS (difference 21.1, 95% CI 10.7 to 31.5; p < 0.001) were significantly greater in the rTHA group when compared with the mTHA group. However, only the FJS was clinically significantly greater. There was no difference in the postoperative EQ-5D (difference 0.017, 95% CI -0.042 to 0.077; p = 0.562) between the two groups. No patients were dissatisfied in the rTHA group whereas six were dissatisfied in the mTHA group, but this was not significant (p = 0.176). rTHA was associated with an overall greater rate of component positioning in a safe zone (p ≤ 0.003) and restoration of leg length (p < 0.001)., Conclusion: Patients undergoing rTHA had a greater hip-specific functional outcome when compared to mTHA, which may be related to improved component positioning and restoration of leg length. However, there was no difference in their postoperative generic health or rate of satisfaction. Cite this article: Bone Joint Res 2021;10(1):22-30.

Patient-reported outcomes measures form the backbone of outcomes evaluation in orthopaedics, with most of the literature now relying on these scoring tools to measure change in patient health status. This patient-reported information is increasingly collected routinely by orthopaedic providers but use of the data is typically restricted to academic research. Developments in electronic data capture and the outcome tools themselves now allow use of this data as part of the clinical consultation. This review evaluates the role of patient reported outcomes data as a tool to enhance daily orthopaedic clinical practice, and documents how develop-ments in electronic outcome measures, computer-adaptive questionnaire design and instant graphical display of questionnaire can facilitate enhanced patient-clinician shared decision making., Competing Interests: Conflict-of-interest statement: The authors declare no conflicts of interest., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)

MicroRNAs (miRNAs) are a class of small non-coding RNAs that have emerged as potential predictive, prognostic, and therapeutic biomarkers, relevant to many pathophysiological conditions including limb immobilization, osteoarthritis, sarcopenia, and cachexia. Impaired musculoskeletal homeostasis leads to distinct muscle atrophies. Understanding miRNA involvement in the molecular mechanisms underpinning conditions such as muscle wasting may be critical to developing new strategies to improve patient management. MicroRNAs are powerful post-transcriptional regulators of gene expression in muscle and, importantly, are also detectable in the circulation. MicroRNAs are established modulators of muscle satellite stem cell activation, proliferation, and differentiation, however, there have been limited human studies that investigate miRNAs in muscle wasting. This narrative review summarizes the current knowledge as to the role of miRNAs in the skeletal muscle differentiation and atrophy, synthesizing the findings of published data. Cite this article: Bone Joint Res 2020;9(11):798-807.

Background: College-level American football injury data are routinely collected; however, data relating to American football injuries at universities in the United Kingdom have never been reported., Purpose: To describe the epidemiology of UK university American football injuries., Study Design: Descriptive epidemiology study., Methods: An online survey tool was used to collect the injury data of 410 players from 56 UK university teams who participated in the 2014-2015 British Universities and College Sports American football season. Survey data were collected from January to February 2016 and were analyzed to determine the incidence and patterns of injury., Results: Overall, 710 injuries and 204 concussions were self-reported among the 410 participants, of which 334 (81.5%) were injured and 131 (32.0%) experienced concussion symptoms. The rate of injury per 100 athlete-seasons was greater in defensive players (195.3) than offensive players (155.1). The most common injuries were knee and ankle ligament injuries. Most injuries were classified as severe (time loss of >4 weeks)., Conclusion: UK university American football injuries differ markedly from those reported for US colleges. UK university players appear to have less playing experience, greater concussion risks, more severe injuries, and a greater proportion of injuries in defensive players versus offensive players., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Aims: Responsiveness and ceiling effects are key properties of an outcome score. No such data have been reported for the original English version of the International Hip Outcome Tool 12 (iHOT-12) at a follow-up of more than four months. The aim of this study was to identify the responsiveness and ceiling effects of the English version iHOT-12 in a series of patients undergoing hip arthroscopy for intra-articular hip pathology at a minimum of one year postoperatively., Methods: A total of 171 consecutive patients undergoing hip arthroscopy with a diagnosis of femoroacetabular impingement (FAI) under the care of a single surgeon between January 2013 and March 2017 were included. iHOT-12 and EuroQol 5D-5L (EQ-5D-5L) scores were available pre- and postoperatively. Effect size and ceiling effects for the iHOT-12 were calculated with subgroup analysis., Results: A total of 122 patients (71.3%) completed postoperative PROMs scores with median follow-up of 24.3 months (interquartile range (IQR) 17.2 to 33.5). The median total cohort iHOT-12 score improved significantly from 31.0 (IQR 20 to 58) preoperatively to 72.5 (IQR 47 to 90) postoperatively (p < 0.001). The effect size (Cohen's d) was 1.59. In all, 33 patients (27%) scored within ten points (10%) of the maximum score and 38 patients (31.1%) scored within the previously reported minimal clinically important difference (MCID) of the maximum score. Furthermore, nine (47%) male patients aged < 30 years scored within 10% of the maximum score and ten (53%) scored within the previously reported MCID of the maximum score., Conclusion: There is a previously unreported ceiling effect of the iHOT-12 at a minimum one-year follow-up which is particularly marked in young, male patients following hip arthroscopy for FAI. This tool may not have the maximum measurement required to capture the true outcome following this procedure. Cite this article: Bone Joint J 2020;102-B(8):1010-1015.

Background: Around 20% of revision knee arthroplasty procedures are carried out for a diagnosis of instability. Clinical evaluation of instability is primarily through physical stress testing of knee ligamentous laxity and joint space opening. It is assumed that increased knee ligament laxity is associated with instability of the knee and, by association, reduced physical function. The range of knee ligament laxity in asymptomatic patients with total knee arthroplasty has however not been reported, nor has the association with measures of physical outcomes., Methods: Patients who reported being happy with the outcomes of TKA and denied any feelings of knee instability were evaluated at routine follow-up clinicas. Knee ligamentous stability was evaluated seperately by 2 blinded assessors in both coronal and saggital planes. Assessors classified the ligamentous stability as 'tight', 'neutrol' or 'loose'. Clinical outcome was evaluated by Oxford Knee Score, patient satisfaction metric, timed performance test, range of motion and lower limb power. Analysis of variance was employed to evaluate variables between groups with post hoc pairwise comparisons., Results: In total, 42 patients were evaluated. Mean time since index surgery was 46 (SD 8) months. In the coronal plane, 11 (26.2%) were categorised as 'tight', 22 (52.4%) as 'neutral' and 9 (21.4%) as 'loose'. In the sagittal plane, 15 (35.7%) were categorised as 'tight', 17 (40.5%) as 'neutral' and 10 (23.8%) as 'loose'. There were no between-group differences in outcomes: Oxford Knee Score, range of motion, lower limb power, timed functional assessment score or in satisfaction response in either plane (p = 0.05)., Conclusions: We found a range of ligamentous laxity in asymptomatic patients satisfied with the outcome of their knee arthroplasty, and no association between knee laxity and physical ability.

Background: Total knee arthroplasty (TKA) is an effective treatment for end-stage osteoarthritis. Patient reported-outcome measures (PROMs) capture the patients' perception of the success of an intervention. The minimal important difference (MID) is an important characteristic of the PROM, which helps to interpret results. The aim of this study was to identify the MID for the Forgotten Joint Score-12 (FJS-12) and Western Ontario and McMaster Universities (WOMAC) osteoarthritis index., Methods: Data were collected in a prospective cohort study. Patients were asked to complete the FJS-12, WOMAC osteoarthritis index and transition items evaluating change over time to determine the MID. We employed an anchor-based methodology relating score change to the response categories of the transition items using both binary logistic regression and receiver operating characteristic (ROC) analysis., Results: Data from 199 patients were analysed. Mean age was 72.3 years, 58% were women. Employing binary logistic regression the MID for the FJS-12 was 10.8 points, for the WOMAC pain score 7.5 points and for the WOMAC function score 7.2 points. ROC analyses found a MID of 13.0 points for the FJS-12, 12.5 points for WOMAC pain and 14.7 points for WOMAC function., Conclusion: We report MIDs for the FJS-12 and the WOMAC Pain and Function scales in a TKA patient cohort, which can be used to interpret meaningful differences in score. In line with previous research, we found more advanced statistical methods to result in smaller MID estimates for both scores., Trial Registration: Written consent for this study was obtained from all participants and ethical approval was granted by the local ethics committee (Ethikkommission St. Gallen; EKSG 14/973; Registered 03 July 2014; http://www.sg.ch/home/gesundheit/ethikkommission.html).

Purpose: The clinical benefits of total knee arthroplasty (TKA) are well defined, but little attention has been paid to the cross-cultural variation. The objective of this study was to compare case mix and outcomes following TKA in Swiss and Scottish patients., Methods: Data from local registries at a Swiss and a Scottish orthopaedic hospital were extracted to evaluate: (A) age, sex, body mass index (BMI), self-reported health status (EQ-5D), and joint awareness (Forgotten Joint Score-12 (FJS-12)) at pre-surgery, (B) improvement in EQ-5D and FJS-12 scores from pre-surgery to 1 year, and (C) patient satisfaction at 1 year., Results: Data from 2075 Swiss and 994 Scottish TKA patients were available from the local registries. Swiss and Scottish patients differed in age (69.3 vs 68.8 years, p = 0.046), sex ratio (62.9% vs 56.9% women, p = 0.002) and BMI (29.6 vs 30.9, p < 0.001). At pre-surgery, FJS-12 scores were comparable (Swiss 12.1 vs Scottish 10.9, n.s.), but EQ-5D scores were better in Swiss patients (0.52 vs 0.40, p < 0.001). Post-operative improvement was greater in Switzerland for the FJS-12 (+ 55.1 vs + 32.2, p < 0.001), but not for the EQ-5D (+ 0.31 vs + 0.29, n.s.). The satisfaction rate was similar in both groups (88.3% vs 89.6%, n.s.)., Conclusion: Subtle cross-cultural variation was evident in TKA case-mix factors between the two countries. Satisfaction and improvement in health status were similar, while improvement in joint-specific outcome was notably greater in Switzerland. Understanding cross-cultural variability of the outcome has important implications when interpreting study and registry data from other countries and when counselling a patient in daily practice., Level of Evidence: Retrospective cohort, Level III.

Aims: The primary aim of the study was to compare the knee-specific functional outcome of robotic unicompartmental knee arthroplasty (rUKA) with manual total knee arthroplasty (mTKA) for the management of isolated medial compartment osteoarthritis. Secondary aims were to compare length of hospital stay, general health improvement, and satisfaction between rUKA and mTKA., Methods: A powered (1:3 ratio) cohort study was performed. A total of 30 patients undergoing rUKA were propensity score matched to 90 patients undergoing mTKA for isolated medial compartment arthritis. Patients were matched for age, sex, body mass index (BMI), and preoperative function. The Oxford Knee Score (OKS) and EuroQol five-dimension questionnaire (EQ-5D) were collected preoperatively and six months postoperatively. The Forgotten Joint Score (FJS) and patient satisfaction were collected six months postoperatively. Length of hospital stay was also recorded., Results: There were no significant differences in the preoperative demographics (p ⩾ 0.150) or function (p ⩾ 0.230) between the groups. The six-month OKS was significantly greater in the rUKA group when compared with the mTKA group (difference 7.7, p < 0.001). There was also a greater six-month postoperative EQ-5D (difference 0.148, p = 0.002) and FJS (difference 24.2, p < 0.001) for the rUKA when compared to the mTKA. No patient was dissatisfied in the rUKA group and five (6%) were dissatisfied in the mTKA, but this was not significant (p = 0.210). Length of stay was significantly (p < 0.001) shorter in the rUKA group (median two days, interquartile range (IQR) 1 to 3) compared to the mTKA (median four days, IQR 3 to 5)., Conclusion: Patients with isolated medial compartment arthritis had a greater knee-specific functional outcome and generic health with a shorter length of hospital stay after rUKA when compared to mTKA.Cite this article: Bone Joint Res 2019;9(1):15-22., Competing Interests: Conflict of interest statement: D. F. Hamilton, A. Bell, P. Simpson, G. Macpherson, and J. T. Patton report institutional grants (paid to The Royal Infirmary of Edinburgh) from Stryker, related to this study. D. F. Hamilton, P. Simpson, G. Macpherson, and J. T. Patton also report personal payment for lectures and institutional grants (paid to The Royal Infirmary of Edinburgh) from Stryker, not related to this study. P. Simpson, G. Macpherson, and J. T. Patton report personal consultancy fees and payments for development of educational presentations from Stryker, not related to this study., (© 2020 Author(s) et al.)

After publication of our article [1] we have been notified that two of the author names have been mistakenly removed from the authorship list: Colin R. Howie and Nicholas D. Clement.

Aims: There are comparatively few randomized studies evaluating knee arthroplasty prostheses, and fewer still that report longer-term functional outcomes. The aim of this study was to evaluate mid-term outcomes of an existing implant trial cohort to document changing patient function over time following total knee arthroplasty using longitudinal analytical techniques and to determine whether implant design chosen at time of surgery influenced these outcomes., Methods: A mid-term follow-up of the remaining 125 patients from a randomized cohort of total knee arthroplasty patients (initially comprising 212 recruited patients), comparing modern (Triathlon) and traditional (Kinemax) prostheses was undertaken. Functional outcomes were assessed with the Oxford Knee Score (OKS), knee range of movement, pain numerical rating scales, lower limb power output, timed functional assessment battery, and satisfaction survey. Data were linked to earlier assessment timepoints, and analyzed by repeated measures analysis of variance (ANOVA) mixed models, incorporating longitudinal change over all assessment timepoints., Results: The mean follow-up of the 125 patients was 8.12 years (7.3 to 9.4). There was a reduction in all assessment parameters relative to earlier assessments. Longitudinal models highlight changes over time in all parameters and demonstrate large effect sizes. Significant between-group differences were seen in measures of knee flexion (medium-effect size), lower limb power output (large-effect size), and report of worst daily pain experienced (large-effect size) favouring the Triathlon group. No longitudinal between-group differences were observed in mean OKS, average daily pain report, or timed performance test. Satisfaction with outcome in surviving patients at eight years was 90.5% (57/63) in the Triathlon group and 82.8% (48/58) in the Kinemax group, with no statistical difference between groups (p = 0.321)., Conclusion: At a mean 8.12 years, this mid-term follow-up of a randomized controlled trial cohort highlights a general reduction in measures of patient function with patient age and follow-up duration, and a comparative preservation of function based on implant received at time of surgery. Cite this article: Bone Joint J 2020;102-B(4):434-441.

Background: Patients' pre-operative health and physical function is known to influence their post-operative outcomes. In patients with knee osteoarthritis, pharmacological and non-pharmacological options are often not optimised prior to joint replacement. This results in some patients undergoing surgery when they are not as fit as they could be. The aim of this study is to assess the feasibility and acceptability of a pre-operative package of non-operative care versus standard care prior to joint replacement., Methods/design: This is a multicentre, randomised controlled feasibility trial of patients undergoing primary total knee replacement for osteoarthritis. Sixty patients will be recruited and randomised (2:1) to intervention or standard care arms. Data will be collected at baseline (before the start of the intervention), around the end of the intervention period and a minimum of 90 days after the planned date of surgery. Adherence will be reviewed each week during the intervention period (by telephone or in person). Participants will be randomised to a pre-operative package of non-operative care or standard care. The non-operative care will consist of (1) a weight-loss programme, (2) a set of exercises, (3) provision of advice on analgesia use and (4) provision of insoles. The intervention will be started as soon as possible after patients have been added to the waiting list for joint replacement surgery to take advantage of the incentive for behavioural change that this will create. The primary outcomes of this study are feasibility outcomes which will indicate whether the intervention and study protocol is feasible and acceptable and whether a full-scale effectiveness trial is warranted. The following will be measured and used to inform study feasibility: rate of recruitment, rate of retention at 90-day follow-up review after planned surgery date, and adherence to the intervention estimated through review questionnaires and weight change (for those receiving the weight-loss aspect of intervention). In addition the following information will be assessed qualitatively: analysis of qualitative interviews exploring acceptability, feasibility, adherence and possible barriers to implementing the intervention, and acceptability of the different outcome measures., Discussion: The aims of the study specifically relate to testing the feasibility and acceptability of the proposed effectiveness trial intervention and the feasibility of the trial methods. This study forms the important first step in developing and assessing whether the intervention has the potential to be assessed in a future fully powered effectiveness trial. The findings will also be used to refine the design of the effectiveness trial., Trial Registration: ISRCTN registry, ID: ISRCTN96684272. Registered on 18 April 2018.