Aims Anterior cruciate ligament (ACL) and multiligament knee (MLK) injuries increase the risk of development of knee osteoarthritis and eventual need for total knee arthroplasty (TKA). There are limited data regarding implant use and outcomes in these patients. The aim of this study was to compare the use of constrained implants and outcomes among patients undergoing TKA with a history of prior knee ligament reconstruction (PKLR) versus a matched cohort of patients undergoing TKA with no history of PKLR. Patients and Methods Patients with a history of ACL or MLK reconstruction who underwent TKA between 2007 and 2017 were identified in a single-institution registry. There were 223 patients who met inclusion criteria (188 ACL reconstruction patients, 35 MLK reconstruction patients). A matched cohort, also of 223 patients, was identified based on patient age, body mass index (BMI), sex, and year of surgery. There were 144 male patients and 79 female patients in both cohorts. Mean age at the time of TKA was 57.2 years (31 to 88). Mean BMI was 29.7 kg/m2 (19.5 to 55.7). Results There was a significantly higher use of constrained implants among patients with PKLR (76 of 223, 34.1%) compared with the control group (40 of 223, 17.9%; p < 0.001). Subgroup analysis showed a higher use of constrained implants among patients with prior MLK reconstruction (21 of 35, 60.0%) compared with ACL reconstruction (55 of 188, 29.3%; p < 0.001). Removal of hardware was performed in 69.5% of patients with PKLR. Mean operative time (p < 0.001) and tourniquet time (p < 0.001) were longer in patients with PKLR compared with controls. There were no significant differences in rates of deep vein thrombosis, pulmonary embolism, infection, transfusion, postoperative knee range of movement (ROM), or need for revision surgery. There was no significant difference in preoperative or postoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) scores between groups. Conclusion Results of this study suggest a history of PKLR results in increased use of constrained implants but no difference in postoperative knee ROM, patient-reported outcomes, or incidence of revision surgery. Cite this article: Bone Joint J 2019;101-B(7 Supple C):77–83

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Purpose Accidental dural puncture and post-dural puncture headache are well-known complications of neuraxial anesthesia in parturients. The primary goal of this study was to identify the rate of post-dural puncture headache and epidural blood patch in all parturients who received a neuraxial anesthetic during a ten-year period at an academic tertiary-care medical centre. A secondary goal was to identify any delay in hospital discharge due to a post-dural puncture headache. Methods We conducted a retrospective analysis of all patients who received a neuraxial anesthetic on the labour and delivery unit at Stony Brook Medical Center from 1 January, 2006 to 31 December, 2015. Standardized neuraxial anesthesia equipment was used throughout this period. Chart reviews were conducted on all patients who received a neuraxial anesthetic and had an accidental

Objectives:Clinical diagnosis of femoroacetabular impingement (FAI) and hip instability is determined by accurate history, physical examination, and imaging assessment. Currently, there is no ideal physical examination maneuver and certainly no dynamic method of testing. In this prospective study, we evaluate the Foot Progression Angle Walking (FPAW) test as a novel diagnostic tool that is sensitive and specific for the detection of FAI and hip instability.Methods:A prospective cohort of patients who presented with hip pain underwent FPAW testing in addition to the gold standard assessments for impingement and instability, the Flexion Adduction and Internal Rotation (FADIR) test and the Abduction and External Rotation (ABER) test, respectively. Baseline foot progression angles were initially recorded. Patients were then instructed to walk with foot progression angles: 1) internally rotated (-15º) and 2) externally rotated (+15º). A positive FPAW test was defined by an increase in hip pain with either internal or external rotation. Radiographs and/or magnetic resonance imaging were then used to evaluate for abnormal hip morphology and confirm diagnosis.Results:80 patients (53 Female) with hip pain were evaluated by FPAW testing. Imaging used to assess for hip pathology exhibited FAI (n=48), instability (n=26) and normal anatomic morphology (n=13). Baseline measurements showed a neutral foot progression (64%), out-toeing gait (35%), and in-toeing gait (1%). Analysis of FPAW testing showed a sensitivity of 75% and specificity of 66% for FAI; sensitivity 54% and specificity 61% for instability. A positive predictive value (FAI: 77%; Instability 40%) and negative predictive value (FAI 64%; Instability 73%) were also determined. In comparison, the FADIR test showed a sensitivity and specificity of 96% and 13% for FAI, respectively. Its positive predictive value was 62% while its negative predictive value was 67%. Abduction and external rotation testing showed a sensitivity and specificity of 42% and 96%, respectively for diagnosing instability. Its positive predictive value was 85% and negative predictive value was 78%.Conclusion:FPAW testing was found to be more sensitive and specific for detecting FAI than instability. The higher specificity and positive predictive value of FPAW in comparison to the FADIR test makes it a reliable tool to identify patients with impingement. The FPAW test appears to be an effective tool to reproduce hip pathology in FAI patients during weight-bearing activity and could be a useful adjunct to give further clinical prospective in FAI and hip instability.

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