Colin Howie

Colin Howie
The University of Edinburgh | UoE · Department of Orthopaedic Surgery

About

154
Publications
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5,436
Citations
Additional affiliations
June 2013 - present
The University of Edinburgh
Position
  • Professor

Publications

Publications (154)
Article
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AimsThe aim of this study was to report the meaningful values of the EuroQol five-dimension three-level questionnaire (EQ-5D-3L) and EuroQol visual analogue scale (EQ-VAS) in patients undergoing primary knee arthroplasty (KA).Methods This is a retrospective study of patients undergoing primary KA for osteoarthritis in a university teaching hospital...
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Aims Access to total knee arthroplasty (TKA) is sometimes restricted for patients with severe obesity (BMI ≥ 40 kg/m ² ). This study compares the cost per quality-adjusted life year (QALY) associated with TKA in patients with a BMI above and below 40 kg/m ² to examine whether this is supported. Methods This single-centre study compared 169 consecu...
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Aims Access to total knee arthroplasty (TKA) is sometimes restricted for patients with severe obesity (BMI ≥ 40 kg/m 2). This study compares the cost per quality-adjusted life year (QALY) associated with TKA in patients with a BMI above and below 40 kg/m 2 to examine whether this is supported. Methods This single-centre study compared 169 consecuti...
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Aims Primary aim was to determine survival of a cemented acetabular component with bulk roof autograft with a minimum of 12 years follow-up. The secondary aim was to determine the clinical outcome. Methods A cohort of 62 consecutive patients (74 hips) undergoing cemented total hip arthroplasty with acetabular bulk roof autograft for acetabular dys...
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Aims The primary aim of this study was to assess whether non-fatal postoperative venous thromboembolism (VTE) within six months of surgery influences the knee-specific functional outcome (Oxford Knee Score (OKS)) one year after total knee arthroplasty (TKA). Secondary aims were to assess whether non-fatal postoperative VTE influences generic health...
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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 surg...
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Aims The primary aim was to assess the patient-perceived effect of restrictions imposed due to COVID-19 on rehabilitation following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Secondary aims were to assess perceived restrictions, influence on mental health, and functional outcome compared to patients undergoing surgery without r...
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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: Du...
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Aims the aim of this study was to assess the quality of life of patients on the waiting list for a total hip (thA) or knee arthroplasty (KA) during the CoVID-19 pandemic. secondary aims were to assess whether length of time on the waiting list influenced quality of life and rate of deferral of surgery. Methods During the study period (August and se...
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Aims the aim of this study was to assess the quality of life of patients on the waiting list for a total hip (thA) or knee arthroplasty (KA) during the CoVID-19 pandemic. secondary aims were to assess whether length of time on the waiting list influenced quality of life and rate of deferral of surgery. Methods During the study period (August and se...
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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 clinica...
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Purpose: The primary aim of this study was to assess whether there was a clinically significant difference in the mean Oxford knee score (OKS) between 6 and 12 months after total knee arthroplasty (TKA). The secondary aim was to identify variables associated with a clinically significant change in the OKS between 6 and 12 months. Methods: A retr...
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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 asso...
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Background The primary aim of this study was to assess how expectation fulfilment changes up to 10 years following total hip arthroplasty (THA).Materials and methodsThree hundred and forty-six patients completed an expectation questionnaire (encompassing 18 activities), Oxford hip score (OHS) and Short Form (SF)-12 prior to surgery. At 1 year posto...
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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.
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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 ana...
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Background This study aims to investigate how expectation fulfilment changes up to 10 years following total knee arthroplasty (TKA). Methods Preoperative data was collected for 323 patients undergoing TKA (Hospital for Special Surgery Knee Replacement Expectations survey, Oxford knee score (OKS) and Short Form (SF)-12). Expectation fulfilment, OKS...
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Introduction Single-item questions assessing patient satisfaction following total hip or knee arthroplasty (THA/TKA) provide immediate and comprehensible information. However, they have limited reliability as satisfaction as a concept is influenced by factors unrelated to surgery. The aim of this retrospective study was to evaluate variation in pai...
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Aims: The EuroQol five-dimension (EQ-5D) questionnaire is a widely used multiattribute general health questionnaire where an EQ-5D < 0 defines a state 'worse than death' (WTD). The aim of this study was to determine the proportion of patients awaiting total hip arthroplasty (THA) or total knee arthroplasty (TKA) in a health state WTD and to identi...
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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 ex...
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Objectives To assess a targeted ‘therapy as required’ model of post-discharge outpatient physiotherapy provision. Specifically, we investigated what proportion of patients accessed post-discharge physiotherapy following total hip arthroplasty (THA) and total knee arthroplasty (TKA), whether accessing therapy was associated with post-arthroplasty pa...
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Background: Removal of a well-fixed, cemented acetabular component at the time of revision hip surgery can be complex. It is essential to remove the implant and cement mantle in a timely fashion while preserving bone stock and osseous integrity. The biomechanical properties of polymethylmethacrylate cement and polyethylene can be utilised to aid w...
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Background: Patient-reported outcome scores are the mainstay method for quantifying success following arthroplasty. However, it is unclear when a "successful outcome" is achieved. We calculated threshold values for the Oxford Hip and Knee Score (OHS and OKS) representing achievement of a successful treatment at 12-month follow-up. Methods: Quest...
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PurposeThis study investigated the impact of body mass index (BMI) on improvement in patient outcomes (pain, function, joint awareness, general health and satisfaction) following total knee arthroplasty (TKA). Methods Data were obtained for primary TKAs performed at a single centre over a 12-month period. Data were collected pre-operatively and 12-...
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Background: Aseptic loosening, osteolysis, and infection are the most commonly reported reasons for revision total knee arthroplasty (TKA). This study examined the role of implant design features (e.g. condylar box, pegs) and stems in resisting loosening, and also explored the sensitivity of the implants to a loose surgical fit due to saw blade os...
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Motion at the bone-implant interface, following primary or revision knee arthroplasty, can be detrimental to the long term survival of the implant. This study employs experimentally verified computational models of the distal femur to characterise the relative motion at the bone-implant interface for three different implant types; a posterior stabi...
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Background: Removal of well fixed components can be a complex problem facing an orthopaedic surgeon during revision hip arthroplasty. As the burden of revision hip surgery increases, techniques have been described to enable safe and reliable removal of well fixed components. Removal of well fixed cemented components requires different consideratio...
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Introduction: To assess whether patient satisfaction with their hospital stay influences the early outcome of total knee arthroplasty (TKA). Methods: During a 5-year period patients undergoing primary TKA at the study centre had prospective outcome data recorded (n = 2264). The Oxford knee score (OKS) and the short form (SF)-12 were recorded pre...
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IntroductionReplacement of the metacarpo-phalangeal joints (MCPJ) with silastic Swanson’s implants can help decrease pain, stiffness and allow for improved function in rheumatoid arthritis (RA). There is a lack of patient reported outcome measure (PROM) studies assessing the efficacy of this procedure in RA. The aim of this study was to report any...
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Introduction Treating peri-prosthetic fractures of the humerus can be very challenging, especially when there is poor bone stock and in the presence of adjacent joint prostheses. We discuss the option of a partial humeral replacement as a salvage procedure for such cases with some technical comments. Methods This paper presents a technique which u...
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A fundamental difference between drug trials and surgical trials is that the latter involve a procedure and therefore the patient outcome will depend on a complex interaction between surgeon, patient and the operating environment. With regards to the surgeon’s impact; the outcome will be
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Background: Patient-reported outcome scores gain increasing importance in quantifying clinical success and procedure remuneration. Our aim was to evaluate the impact of comorbidity on joint-specific outcome and general health in patients undergoing elective total hip arthroplasty (THA). Methods: Longitudinal data on THA procedures were used to e...
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PurposeThe primary aim was to compare the early knee-specific functional outcome after articular surface mounted (ASM) navigation with non-navigated TKA. The secondary aims were to compare general physical and mental health improvement, patient satisfaction, and reliability of component alignment in the sagittal and coronal planes between ASM navig...
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Aims: To validate the English language Forgotten Joint Score-12 (FJS-12) as a tool to evaluate the outcome of hip and knee arthroplasty in a United Kingdom population. Patients and methods: All patients undergoing surgery between January and August 2014 were eligible for inclusion. Prospective data were collected from 205 patients undergoing tot...
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Purpose: Due to age-related changes to the material properties and thinning of the cortical bone structure, older patients with osteoporosis may be at greater risk of femoral fracture following total knee arthroplasty. This study investigates whether there is a potential role for stemmed prostheses in such scenarios to help mitigate peri-implant f...
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Background: Patient function is poorly characterized following revision total knee arthroplasty (TKA), although is generally accepted to be inferior to that following primary procedures. Methods: Fifty-three consecutive aseptic revisions to total stabilizer devices were prospectively evaluated, preoperatively and at 6, 26, 52, and 104 weeks post...
Article
Osteoporosis resulting in a reduction in bone stiffness and thinning of the cortex is almost universal in older patients. In this study a novel method to generate computational models of the distal femur which incorporate the effects of ageing and endosteal trabecularisation are presented. Application of this method to pre- and post-knee arthroplas...
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Revision of a cemented femoral stem can be a challenging procedure. We present a series of cases utilising the “In-cement” revision, whereby the same size stem is introduced into the original cement mantle, without additional cementing. It requires a stable cement mantle in the correct version. We describe the technique and present a review of 23 r...
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Objective It is generally accepted that the patients’ hospital experience can influence their overall satisfaction with the outcome of lower limb arthroplasty; however, little is known about the factors that shape the hospital experience. The aim of this study was to develop an understanding of what patients like and do not like about their hospita...
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Objectives: To assess the responsiveness and ceiling/floor effects of the Forgotten Joint Score -12 and to compare these with that of the more widely used Oxford Hip Score (OHS) in patients six and 12 months after primary total hip arthroplasty. Methods: We prospectively collected data at six and 12 months following total hip arthroplasty from 1...
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The “correct” rates of discretional interventions are difficult to define. However, David Hamilton and Colin Howie point out that discrepancies in usage of knee arthroscopy within the UK suggest the organisation of the care pathway may be an important determinant Osteoarthritis of the knee can result in joint pain and reduced physical function. Tr...
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Patellar instability is a condition with multifactorial aetiology, potentially involving soft tissue characteristics, the bony anatomy of the patella, femur and tibia, and alignment of the lower limb. The shape of the distal femur and patellofemoral joint has been frequently studied using plain orthogonal and skyline radiographs. We investigated a...
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The Oxford Hip and Knee Scores (OHS, OKS) have been demonstrated to vary according to age and gender, making it difficult to compare results in cohorts with different demographics. The aim of this paper was to calculate reference values for different patient groups and highlight the concept of normative reference data to contextualise an individual...
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Worldwide rates of primary and revision total knee arthroplasty (TKA) are rising due to increased longevity of the population and the burden of osteoarthritis. Revision TKA is a technically demanding procedure generating outcomes which are reported to be inferior to those of primary knee arthroplasty, and with a higher risk of complication. Overall...
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Modular prostheses are increasingly applied in complex revision knee arthroplasty scenarios due to the greater intraoperative flexibility they provide to the surgeon, e.g. accurate placement of stem in canal while maintaining a good fit distally for complex femoral geometry. However, growing evidence indicates that these modular devices often fail...
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Total knee arthroplasty (TKA) is an established and successful procedure. However, the design of prostheses continues to be modified in an attempt to optimise the functional outcome of the patient. The aim of this study was to determine if patient outcome after TKA was influenced by the design of the prosthesis used. A total of 212 patients (mean a...
Article
Total knee arthroplasty (TKA) is an established and successful procedure. However, the design of prostheses continues to be modified in an attempt to optimise the functional outcome of the patient. The aim of this study was to determine if patient outcome after TKA was influenced by the design of the prosthesis used. A total of 212 patients (mean a...
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Instability is the reason for revision of a primary total knee replacement (TKR) in 20% of patients. To date, the diagnosis of instability has been based on the patient’s symptoms and a subjective clinical assessment. We assessed whether a measured standardised forced leg extension could be used to quantify instability. A total of 25 patients (11 m...
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Patients with complex periprosthetic fracture patterns of the femur may ultimately require amputation. Some authors have described the use of mega-endoprostheses as a salvage procedure. This study reports functional outcome, complications, and implant and patient survival after total femoral replacement (TFR) for salvage of periprosthetic fracture...
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Satisfaction with care is important to both patients and to those who pay for it. The Net Promoter Score (NPS), widely used in the service industries, has been introduced into the NHS as the ‘friends and family test’; an overarching measure of patient satisfaction. It assesses the likelihood of the patient recommending the healthcare received to an...
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The Triathlon single-radius total knee arthroplasty (TKA) was used in 11 % of primary procedures in England and Wales in 2011 making it the third most common prosthesis implanted. To date, there has been no independent report of survivorship or outcome for this implant. The aim of this study was to report the 5-year survival and patient-reported ou...
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Professor Cobb’s comments are broadly in line with our intention when we suggested that registry data should be interpreted cautiously.1 2 Such data demonstrate efficacy (the outcome in general use) well, but not the effect …
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Objectives Following the election of the Labour government in 1997, policies were developed in England to reduce waiting times for NHS treatment with commitments to reduce health inequalities. Similar policies were adopted in Scotland but with less emphasis on the use of the private sector to deliver NHS treatments than in England. This study uses...
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To report the functional outcome, implant survival, and patient mortality after mega prosthetic distal femoral arthroplasty according to the surgical indication. A prospective database was compiled for 45 consecutive patients undergoing distal femoral arthroplasty, of which 26 had fractures of the distal femur (group 1) and 19 underwent revision of...
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The aim of this study was to investigate the relationships between personality and joint-specific function, general physical and general mental health in patients undergoing total hip (THA) and knee arthroplasty (TKA). One hundred and eighty-four patients undergoing THA and 205 undergoing TKA were assessed using the Eysneck Personality Questionnair...