Publications

2006

Complex regional pain syndrome complicating total knee arthroplasty

Burns, A. W. R., Parker, D. A., Coolican, M. R. J. and Rajaratnam, K. (2006). "Complex regional pain syndrome complicating total knee arthroplasty." Journal of Orthopaedic Surgery 14(3): 280.

To compare the long-term outcome of patients diagnosed with complex regional pain syndrome-type 1 (CRPS-1) after total knee arthroplasty (TKA) with those of uncomplicated TKA knees and preoperative osteoarthritic knees. Medical records of 1280 patients who underwent TKA for osteoarthritis were retrospectively reviewed; 8 were diagnosed as having symptoms and signs consistent with CRPS after TKA. Patients with primary inflammatory arthritis, signs of component loosening, malpositioning, or of infected arthroplasty were excluded. No patient had signs of CRPS prior to operative intervention. The 8 patients were compared with 2 groups of age- and sex-matched controls: uncomplicated TKA knees and preoperative osteoarthritic knees. Patients were followed up for a mean of 54 (range, 13-111) months and their range of movement, Western Ontario and McMaster Universities Osteoarthritis Index, SF-36 questionnaire scores, and Knee Society scores were assessed and compared. After appropriate treatment, most CRPS complicated patients had similar scores on SF-36, Western Ontario and McMaster Universities Osteoarthritis Index, and Knee Society scores when compared with uncomplicated TKA patients. Scores for CRPS complicated patients were significantly improved when compared with preoperative osteoarthritic patients. The incidence of CRPS after TKA was 0.7%. When managed early, patients complicated with CRPS after TKA have a similar prognosis to patients with uncomplicated TKA.

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2005

Spinal cord injuries in Australian footballers 1997-2002

Carmody, D. J., Taylor, T. K., Parker, D. A., Coolican, M. R. and Cumming, R. G. (2005). "Spinal cord injuries in Australian footballers 1997-2002." Medical Journal of Australia 182(11): 561.

OBJECTIVE: To review acute spinal cord injuries (ASCIs) in all Australian codes of football (rugby union [RU], rugby league [RL], Australian Rules football [ARF] and soccer) for 1997-2002 and to compare data with those of a 1986-1996 survey. DESIGN: Retrospective review of hospital records, and structured interviews with injured players. PARTICIPANTS AND SETTING: Patients admitted to any of the six Australian spinal cord injury units with a documented football-related ASCI over the period 1997-2002. OUTCOME MEASURES: Average annual incidence of ASCIs per 100,000 players in the different codes, final Frankel grading of injuries, and wheelchair status. RESULTS: Fifty-two footballers (45 adult men and seven schoolboys) suffered ASCIs between 1997 and 2002. The average annual incidence of ASCIs per 100,000 players was 3.2 for RU, 1.5 for RL, 0.5 for ARF and 0.2 for soccer. While there has been little change in incidence since the 1986-1996 survey, there has been a trend towards less severe injuries in RU and RL, but not in ARF. There have been no scrum injuries in RL since 1996, when the scrum stopped being contested. Seven injuries occurred in RU scrums, six at the moment of engagement of the opposing teams. The incidence of 2-on-1 and "gang" tackles (involving multiple tacklers) in RL is disturbing. Overall, 39% of injured players became permanently wheelchair-dependent. CONCLUSIONS: There continues to be good reason to revise the laws of scrum engagement in RU. The laws relating to multiple tacklers in RL should be examined. The insurance cover for injured players is grossly inadequate. The longstanding need for a registry of spinal cord injuries for all football codes regrettably remains unmet.

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2004

Medial compartmental knee arthroplasty with the Miller-Galante prosthesis

Naudie, D., Guerin, J., Parker, D. A., Bourne, R. and Rorabeck, H. (2004). "Medial compartmental knee arthroplasty with the Miller-Galante prosthesis." Journal of Bone and Joint Surgery 86: 1931-1935.

Unicompartmental knee arthroplasty has become a popular treatment alternative for osteoarthritis that is confined to the medial part of the knee. Excellent intermediate-term results recently have been reported in assosciation with the Miller-Galante unicompartmental implant. The purpose of the present study was to report on out longer-term experience with the Miller-Galante unicompartmental knee replacement. Methods: We evaluated the results of 113 medial unicompartmental knee arthroplasties that had been performed with the use of the Miller-Galante implant in 84 patients between 1989 and 2000. The mean age of the patients at the time of surgery was 68 years. Forty-five patients were men and thirty-nine were women. Thirteen patients (sixteen knees) died at a mean of seven years after the index arthroplasty. No patient was lost to follow-up. The remaining seventy-one patients (ninety-seven knees) were followed for a mean of ten years and were evaluated with use of the Knee Society Clinical Rating System. Results: Eleven knees were revised at a mean of four years after the index procedure. The mean Knee Society and function scores for the sixty-one patients (eighty-six knees) who were living and had not had a revision improved from 48 and 53 points preoperatively to 93 and 80 points at the time of the most recent evaluation. The five and ten year rates of survival were 94% and 90% respectively, with revision to tricompartmental knee arthroplasty as the end point and 93% and 86%, respectively, with revision or radiographic loosening as the endpoint. Conclusions: The Miller-Galante medial unicompartmental knee arthroplasty provided excellent pain relief and restoration of function in carefully selected patients and demonstrated durable implant survival at ten years.

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2003

Extensor Mechanism Failure Associated With Total Knee Arthroplasty: Prevention and Management

Parker, D. A., Dunbar, M. J. and Rorabeck, C. H. (2003). "Extensor Mechanism Failure Associated With Total Knee Arthroplasty: Prevention and Management." Journal of the American Acadamy of Orthopedic Surgeons 11(4): 238-247.

Extensor mechanism complications are the most commonly reported reasons for revision surgery after total knee arthroplasty and are a frequent source of postoperative morbidity. Patellofemoral instability is the most commonly reported extensor mechanism complication and has multiple etiologies, including prosthetic malalignment and soft tissue imbalance. Patellar fracture or rupture of either the quadriceps or patellar tendon can cause catastrophic disruption of the extensor mechanism. Although some stable fractures can be successfully managed nonsurgically, displaced fractures or tendon rupture often lead to poor results. Other complications include patellar clunk and soft-tissue adhesions, prosthetic wear or loosening, and osteonecrosis. Increased understanding of implant alignment, rotation, and soft-tissue balance, as well as improved design of the trochlear groove of femoral implants and patellar components, has resulted in a decline in extensor mechanism complications. Appropriate prosthetic selection and meticulous surgical technique remain the keys to avoiding unsatisfactory results and revision surgery.

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