Browsing by Person "Nutton, R. W."

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A prospective randomised double-blind study of functional outcome and range of flexion following total knee replacement with the NexGen standard and high flexion components
(British Editorial Society of Bone and Joint Surgery, 2008-01) Nutton, R. W.; van der Linden, Marietta; Rowe, P. J.; Gaston, P.; Wade, F. A.
Modifications in the design of knee replacements have been proposed in order to maximise flexion. We performed a prospective double-blind randomised controlled trial to compare the functional outcome, including maximum knee flexion, in patients receiving either a standard or a high flexion version of the NexGen legacy posterior stabilised total knee replacement. A total of 56 patients, half of whom received each design, were assessed pre-operatively and at one year after operation using knee scores and analysis of range of movement using electrogoniometry. For both implant designs there was a significant improvement in the function component of the knee scores (p < 0.001) and the maximum range of flexion when walking on the level, ascending and descending a slope or stairs (all p < 0.001), squatting (p = 0.020) and stepping into a bath (p = 0.024). There was no significant difference in outcome, including the maximum knee flexion, between patients receiving the standard and high flexion designs of this implant.
Between-day repeatability of knee kinematics during functional tasks recorded using flexible electrogoniometry
(Elsevier, 2008-08) van der Linden, Marietta; Rowe, P. J.; Nutton, R. W.
The objective of this study was to assess the between-day repeatability of knee kinematics during activities of daily living recorded by electrogoniometry. One rater assessed the peak knee angles and knee excursion of 15 subjects during 13 activities twice with an average of 22 days (range 5-31) between the two assessments. The 15 subjects included four patients one year after total knee replacement (TKR) surgery, five patients before TKR surgery and six age-matched controls. Intra-class correlation coefficients and Bland and Altman coefficient of repeatability were derived to analyse the results. Only the most affected leg of the patients and the right leg of the controls were used for analysis. Different measures of repeatability showed different results. Intra-class correlation coefficients were higher than 0.75 for peak values of all functions except sitting down and rising from a standard chair. However, coefficients of repeatability ranged from 5.6 for the loading response in level walking to 39.8 for stepping out of a bath. Both of these values are higher than clinically significant changes seen after total knee surgery. It was concluded that for a single assessment on individual patients, the functional knee motion as performed in this study did not have sufficient repeatability. However, if the measurements are used to assess the average changes before and after surgery in a group of patients, the assessment of knee motion during activities such as level walking, and slope and stair ascending and descending were found to be sufficiently repeatable.
Does a mobile-bearing, high-flexion design increase knee flexion after total knee replacement?
(British Editorial Society of Bone and Joint Surgery, 2012-08) Nutton, R. W.; Wade, F. A.; Coutts, Fiona; van der Linden, Marietta
This prospective randomised controlled double-blind trial compared two types of PFC Sigma total knee replacement (TKR), differing in three design features aimed at improving flexion. The outcome of a standard fixed-bearing posterior cruciate ligament-preserving design (FB-S) was compared with that of a high-flexion rotating-platform posteriorstabilised design (RP-F) at one year after TKR. The study group of 77 patients with osteoarthritis of the knee comprised 37 men and 40 women, with a mean age of 69 years (44.9 to 84.9). The patients were randomly allocated either to the FB-S or the RP-F group and assessed pre-operatively and at one year postoperatively. The mean post-operative non-weight-bearing flexion was 107 (95% confidence interval (CI) 104 to 110)) for the FB-S group and 113 (95% CI 109 to 117) for the RP-F group, and this difference was statistically significant (p = 0.032). However, weight-bearing range of movement during both level walking and ascending a slope as measured during flexible electrogoniometry was a mean of 4 lower in the RP-F group than in the FB-S group, with 58 (95% CI 56 to 60) versus 54 (95% CI 51 to 57) for level walking (p = 0.019) and 56 (95% CI 54 to 58) versus 52 (95% CI 48 to 56) for ascending a slope (p = 0.044). Further, the mean post-operative pain score of the Western Ontario and McMaster Universities Osteoarthritis Index was significantly higher in the RP-F group (2.5 (95% CI 1.5 to 3.5) versus 4.2 (95% CI 2.9 to 5.5), p = 0.043). Although the RP-F group achieved higher non-weight-bearing knee flexion, patients in this group did not use this during activities of daily living and reported more pain one year after surgery. 2012 British Editorial Society of Bone and Joint Surgery.
Knee kinematics in functional activities seven years after total knee arthroplasty
(Elsevier, 2007-03) van der Linden, Marietta; Rowe, P. J.; Myles, C.; Burnett, R.; Nutton, R. W.
Background. Detailed knowledge of knee kinematics during functional activities is lacking in current studies on the long-term outcome of total knee replacement surgery. The aim of this study was to assess functional knee kinematics using flexible electrogoniometry in patients seven years after unilateral primary total knee arthroplasty for osteoarthritis. Methods. The knee joint functional movement of a cohort of patients (n = 19) with knee osteoarthritis was assessed using electrogoniometry before surgery and 18-24 months and seven years after total knee surgery. The mean age of the patients (11 women and 8 men) at the time of the pre-surgery assessment was 67 years old (SD 8.0). Patient function was also assessed using the Knee Society Score and WOMAC osteoarthritis Index. Findings. The function components of the Knee Society and WOMAC scores were significantly decreased at seven years compared to 18-24 months after surgery (both P < 0.05). However, the majority of the functional knee flexion values derived from electrogoniometry did not decrease. Seven years after surgery, knee excursion during ascending and descending stairs was significantly improved compared to 18-24 months after surgery (both P < 0.01). Interpretation. The finding that functional knee motion continues to improve between 18-24 months and seven years post-surgery is of interest to both patients and those responsible for their treatment planning. Further, it was shown that the WOMAC and Knee Society Scores do not follow the same trends as the patients' functional knee kinematics seven years after total knee replacement surgery.
Preoperative predictors of knee range of motion during stair walking after total knee replacement
(2008-09) van der Linden, Marietta; Roche, Patricia; Rowe, P. J.; Nutton, R. W.
Summary: Hierarchical Multiple Regression was performed on the pre and postoperative measures of 56 patients with end-stage osteoarthritis. Post-operative range of knee motion during stair ascent and descent was predicted by pre-operative measures in different domain blocks. Conclusions: Pre-operative variables predicting post-operative stair walking differ between stair ascent and descent. This has consequences for the treatment of patients waiting for a total knee replacement.
Short Term Recovery of Function following Total Knee Arthroplasty: A Randomised Study of the Medial Parapatellar and Midvastus Approaches
(2014) Nutton, R. W.; Wade, F. A.; Coutts, Fiona; van der Linden, Marietta
This pilot double blind randomised controlled study aimed to investigate whether the midvastus (MV) approach without patellar eversion in total knee arthroplasty (TKA) resulted in improved recovery of function compared to the medial parapatellar (MP) approach. Patients were randomly allocated to either the MV approach or the MP approach. Achievements of inpatient mobility milestones were recorded. Knee kinematics, muscle strength, Timed Up and Go, WOMAC, and daily step count were assessed before and up to six months after surgery. Cohen's effect size