Welcome to ‘On the Table’ – UPMC Sports Surgery Clinic’s orthopaedic advances podcast hosted by Dr Andy Franklyn-Miller, Consultant Sports & Exercise Medicine Physician at SSC.

The purpose of the podcast is to explore the reasons behind making a decision to operate in common orthopaedic conditions and explore the latest evidence and post-operative strategies.

In Episode Four, we are delighted to speak to Mr Gavin McHugh, Consultant Orthopaedic Surgeon at the UPMC Sports Surgery Clinic.

This episode focuses on the topic of decision making around knee replacement surgery-both unicompartmental knee surgery and total knee replacement.

Shownotes:

02:22
Most people have heard of a total knee replacement, indeed many will know someone personally who had one done, how many do you do a year at SSC?

03:11
We often hear of patients being told to wait till their symptoms get worse or they are ‘too good’ for a replacement – what guides that decision making?

07:22
What role is there for imaging in decision making for joint replacement?

09:23
What is a unicompartmental or partial knee replacement?

14:30
David Beard published in the Lancet, an impressive paper comparing the outcomes of (PKR) and (TKR) for treatment of isolated medial compartment osteoarthritis of the knee in 528 patients (42% female, mean age 65·0 years). Interestingly the TOPKAT’s within-trial cost-effectiveness analysis, PKR was found to be more effective (0·240 additional quality-adjusted life-years, 95% CI 0·046 to 0·434) and less expensive (−£910, −1503 to −317) than TKR during the 5 years of follow-up.

What are the decisions that lead you to a PKR?

17:50
Can you adjust knee alignment with a partial knee replacement?

21:30
How do you manage the contralateral limb during rehabilitation?

23:18
What options in the manufacturer of the joint are there available?

30:22
How often do you need to convert to a total knee replacement?

31:05
What limitations are there in a replaced joint?

33:19
What does the future hold in joint replacement?

Link to the study mentioned in the podcast

Lancet. 2019 Aug 31;394(10200):746-756. doi: 10.1016/S0140-6736(19)31281-4. Epub 2019 Jul 17.
The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial.
Beard DJ1, Davies LJ2, Cook JA3, MacLennan G4, Price A2, Kent S5, Hudson J4, Carr A2, Leal J5, Campbell H5, Fitzpatrick R5, Arden N2, Murray D2, Campbell MK4; TOPKAT Study Group.

About Mr McHugh

Mr Gavin McHugh has personal website www.gavinmchughorthopaedics.com