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Teh HL, Abounouh M, Haibock P, Selvaratnam V, Ganapathy SS, Graichen H. A comprehensive analysis on contributing factors for varus or valgus malposition of femoral stems in uncemented total hip arthroplasty via DAA. J Orthop 2024; 50:42-48. [PMID: 38162260 PMCID: PMC10755486 DOI: 10.1016/j.jor.2023.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024] Open
Abstract
Background Varus or valgus malposition of uncemented femoral stems have been described to have detrimental effects for long term implant survival. Various pre- and intra-OP factors have been suggested to be relevant, one of them being the approach to the hip. The aim was to investigate several pre- and intra-OP factors associated with femoral stem malpositioning in a large series of DAA hips. Methods A series of 400 consecutive patients (416 hips) who underwent navigated (Brainlab) cementless Total Hip Arthroplasty (THA) in 2022 (Corail or Actis stem DePuy Synthes) via a direct anterior approach (DAA) was analyzed. Preoperative data were collected based on patients' demographics, radiographic information [critical trochanteric angle (CTA), centrum collum diaphyseal (CCD) angle, greater trochanter overhang, femoral neck resection angle, femoral neck resection height and Door classification], and these were correlated with the postoperative stem position. Univariable and multivariable linear regression were carried out to determine significant factors that contribute to varus and valgus stem malalignment. Results With the DAA approach, 56.5 % of stems were placed in an optimal neutral position, 38.4 % were in acceptable position of 0.1°-2° varus/valgus and only 5 % had a deviation larger than 2° varus/valgus. The critical trochanteric angle (CTA) was statistically significant in determining varus stem placement whereas centrum collum diaphyseal angle (CCD) was found to affect valgus stem malpositioning. All other factors have shown no relevant effect on stem placement using stepwise regression method. Conclusion In DAA, 95 % of stems were found in a varus/valgus position of 2° or less. In pre-operative measurement, only femoral morphology (e.g. CTA & CCD) were found to be relevant, affecting varus/valgus stem malposition. All other tested modifiable and non-modifiable factors had no significant effect. Therefore, pre-OP templating including measurement of CTA and CCD, intra-operative assessment as well as proper operative techniques are paramount to prevent excessive varus/valgus mal-position of femoral stem in DAA.
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Affiliation(s)
- Hak Lian Teh
- Department of Arthroplasty, General Orthopaedics and Sports Medicine, Asklepios Orthopaedic Hospital Lindenlohe, 92421, Schwandorf, Germany
| | - Mostafa Abounouh
- Department of Arthroplasty, General Orthopaedics and Sports Medicine, Asklepios Orthopaedic Hospital Lindenlohe, 92421, Schwandorf, Germany
| | - Philip Haibock
- Department of Arthroplasty, General Orthopaedics and Sports Medicine, Asklepios Orthopaedic Hospital Lindenlohe, 92421, Schwandorf, Germany
| | - Veenesh Selvaratnam
- Joint Reconstruction Unit, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Heiko Graichen
- Department of Arthroplasty, General Orthopaedics and Sports Medicine, Asklepios Orthopaedic Hospital Lindenlohe, 92421, Schwandorf, Germany
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Teh HL, Selvaratnam V, Low WJ, Kassim AF, Ganapathy SS, Chopra S. Outcomes of Impaction Bone Grafting in the Management of Acetabular Defects with the Use of Uncemented Acetabular Cups: Do Autografts and Irradiated Femoral Head Allografts Integrate? Indian J Orthop 2023; 57:1842-1849. [PMID: 37881276 PMCID: PMC10593662 DOI: 10.1007/s43465-023-00983-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/18/2023] [Indexed: 10/27/2023]
Abstract
Introduction Acetabular impaction bone grafting (AIBG) has been used widely to reconstruct acetabular defects in complex primary and revision cases. The aim of this study was to look at the outcomes AIBG using either frozen irradiated femoral head allografts or autografts with uncemented acetabular cups. Method We retrospectively reviewed 38 patients who had AIBG and uncemented cup reconstruction of the acetabulum performed between 2008 and 2021 for complex primary and revision surgery. Graft incorporation, radiological loosening and cup migration were evaluated in follow-up X-rays. Result There were 24 complex primary and 14 revision total hip arthroplasty. Autografts were used in 10 hips with smaller defects, while 28 hips with larger defects required frozen irradiated femoral head allografts. Using Paprosky classification to evaluate acetabular defects; 8 patients were classified as 2A, 12 as 2B, 7 as 2C, 8 as 3A and 3 as 3B. The Kaplan-Meier survival rate for AIBG with uncemented cups in our series is 89.70% in 10 years. Acetabular cup position was anatomically restored in all autograft AIBG cases and in 25 out of 28 in the allograft group. The mean pre-operative Oxford Hip Score (OHS) was 19 (range 10-24) and post-operative OHS was 39 (range 21-48) (p < 0.001). Conclusions The mid- to long-term results for AIBG and uncemented acetabular cups is good. With newer and more porous uncemented cups especially revision cups, it may serve as an extended indication to achieve solid fixation together with AIBG technique in managing acetabular defects of ≤ 3A.
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Affiliation(s)
- Hak Lian Teh
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Malaysia
| | - Veenesh Selvaratnam
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Malaysia
- Joint Reconstruction Unit, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Wei Jian Low
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Malaysia
- Joint Reconstruction Unit, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ahmad Fauzey Kassim
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Malaysia
| | - Shubash Shander Ganapathy
- Institute for Public Health, National Institute of Health, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Suresh Chopra
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Malaysia
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Selvaratnam V, Roche A, Narayan B, Giotakis N, Mukhopadhaya S, Aniq H, Nayagam S. Effectiveness of an Antibiotic-impregnated Bioabsorbable Carrier for the Treatment of Chronic Intramedullary and Diffuse Osteomyelitis. Strategies Trauma Limb Reconstr 2023; 18:148-154. [PMID: 38404569 PMCID: PMC10891352 DOI: 10.5005/jp-journals-10080-1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/27/2023] [Indexed: 02/27/2024] Open
Abstract
Aim The surgical management of chronic intramedullary osteomyelitis involves debridement of affected non-viable tissue and the use of antibiotics. Where surgery leaves a cavity, dead-space management is often through antibiotic-impregnated bone cement. These depots of local antibiotics are variable in elution properties and need removal. We review our unit's experience using a bioabsorbable synthetic calcium sulphate to deliver gentamicin as an adjunct in the treatment of osteomyelitis involving the medullary canal. Materials and methods We retrospectively reviewed 34 patients with chronic osteomyelitis who were treated using this method in our institute. Variables recorded included aetiology, previous interventions, diagnostic criteria, radiological features, serology, and microbiology. The Cierny-Mader system was used to classify. Follow-up involved a survival analysis to time to recurrence, clinical and functional assessment (AOFAS-Ankle/IOWA knee/Oxford Hip/DASH scores) and a general health outcome questionnaire (SF36). The primary outcome measure was clinical recurrence of infection. Results There were 24 male and 10 female patients. The mean age at presentation was 47 years (20-67). Clinical, laboratory, radiological, and patient reported outcomes were obtained at a median follow-up of 2.5 years (1.4-6.6 years). The bones involved were the femur (14, 41%), tibia (16, 47%), radius (1, 3%), and humerus (3, 9%). There were 13 cases classified as Cierny-Mader stage IV (diffuse with intramedullary osteomyelitis) and 21 cases as Cierny-Mader stage I. The median Oxford Hip score was 38 (11 patients, range 9-48). The median AOFAS score was 78 (14 patients, range 23-100). The median IOWA knee score was 71 (25 patients, range 22-95). The median DASH score was 33 (2 patients, range 1.7-64.2). There were two recurrences. The treatment success to date is 94%. Conclusion In our series of patients, bioabsorbable carriers of antibiotics appear to be effective adjuncts to surgical treatment of osteomyelitis and were associated with high clinical success rates. How to cite this article Selvaratnam V, Roche A, Narayan B, et al. Effectiveness of an Antibiotic-impregnated Bioabsorbable Carrier for the Treatment of Chronic Intramedullary and Diffuse Osteomyelitis. Strategies Trauma Limb Reconstr 2023;18(3):148-154.
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Affiliation(s)
- Veenesh Selvaratnam
- Joint Reconstruction Unit, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Andrew Roche
- Department of Trauma and Orthopaedic Surgery, Chelsea and Westminster Hospital and The Fortius Clinic, London, United Kingdom
| | - Badri Narayan
- Limb Reconstruction Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Nikolaos Giotakis
- Limb Reconstruction Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Shoumit Mukhopadhaya
- Department of Trauma and Orthopaedic Surgery, Royal Adelaide Hospital, South Australia, Australia
| | - Hifz Aniq
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Selvadurai Nayagam
- Limb Reconstruction Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Shahibullah S, Juhari S, Yahaya F, Yusof NDM, Kassim AF, Chopra S, Selvaratnam V. Outcome of Arthroscopic All-Inside Posterior Cruciate Ligament Reconstruction Using the Posterior Trans-Septal Approach. Indian J Orthop 2023; 57:1134-1138. [PMID: 37383998 PMCID: PMC10293140 DOI: 10.1007/s43465-023-00893-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/10/2023] [Indexed: 06/30/2023]
Abstract
Introduction Posterior Cruciate Ligament (PCL) reconstruction is a complex surgical procedure and often challenging. The newer posterior trans-septal portal technique is thought to make tibial tunnel preparation easier with better visualization of the tibial attachment site. It is also thought to lower the risk of neurovascular injuries. The aim of this study was to evaluate the functional and clinical outcomes of patients who underwent arthroscopic all-inside PCL reconstruction using the posterior trans-septal portal at our institute. Methods This was a retrospective study with prospectively collected data between 2016 and 2020. Data collected were age, gender, types of graft used, range of movement, posterior drawer test grade, KOOS score, Lysholm knee scoring scale, and post-operative complications. All patients underwent pre- and post-operative PCL rehabilitation. Results A total of 36 patients (26 males and 10 females) were identified from our database. The mean age was 35.2 years. Mean time from injury to surgery was 20 months. Mean follow-up was 41.2 months (range, 13-72 months). Twenty cases involved multi-ligament injuries and another 16 patients had isolated PCL injury. Post-operative mean posterior drawer test grade improved from 2.7 to 0.7 (p < 0.001). Knee range of movement was 116.3 degrees pre-operatively and 115.6 degrees postoperatively (p = 0.814). Lysholm knee scoring scale improved from 50.9 to 91.0 (p < 0.001). KOOS score improved from 65.1 to 77.2 (p = 0.196). One patient required manipulation under anesthesia for stiffness. No patients needed any additional surgical procedures. All PCLs were clinically intact at the final follow-up. Conclusion Greater visualization of the PCL tibial attachment minimizes the 'killer turn' giving a huge advantage to this technique. Arthroscopic all-inside PCL reconstruction using the posterior trans-septal portal technique is a safe, reliable and reproducible procedure. From our study, it shows that post-operative clinical and functional outcomes improved significantly.
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Affiliation(s)
- Shahir Shahibullah
- Trauma & Orthopaedic Department, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Kedah Malaysia
| | - Suhari Juhari
- Trauma & Orthopaedic Department, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Kedah Malaysia
| | - Farhan Yahaya
- Trauma & Orthopaedic Department, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Kedah Malaysia
| | - Nur Dini Mohd Yusof
- Trauma & Orthopaedic Department, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Kedah Malaysia
| | - Ahmad Fauzey Kassim
- Trauma & Orthopaedic Department, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Kedah Malaysia
| | - Suresh Chopra
- Trauma & Orthopaedic Department, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Kedah Malaysia
| | - Veenesh Selvaratnam
- Trauma & Orthopaedic Department, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Kedah Malaysia
- Joint Reconstruction Unit, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya Medical Centre, 50603 Kuala Lumpur, Malaysia
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Wong R, Abbas AA, Ayob KA, Nasuruddin H, Selvaratnam V. Custom-Made Articulating Spacer (CUMARS): The Resolution of Periosteal Reaction and Femur Remodelling in Periprosthetic Hip Infection. Cureus 2023; 15:e41669. [PMID: 37575748 PMCID: PMC10412744 DOI: 10.7759/cureus.41669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/15/2023] Open
Abstract
Periprosthetic joint infection (PJI) is one of the most common complications after total hip arthroplasty (THA). Two-stage revision surgery is one of the treatment options for PJI, however, it has been associated with poor patient tolerance, reduced patient mobility, and periarticular tissue contracture leading to difficulty during second-stage reconstruction. The custom-made articulating spacer (CUMARS) was developed to provide an alternative that is better tolerated and to reduce the complexity of second-stage reconstruction. This study details the treatment of a patient with PJI post-THA with significant periosteal reaction using a CUMARS construct, which enabled immediate post-operative weight bearing, eventual eradication of infection, restoration of femoral bone stock, and avoidance of second-stage reconstruction.
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Affiliation(s)
- Rosalind Wong
- Joint Reconstruction Unit (JRU) National Orthopedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Azlina A Abbas
- Joint Reconstruction Unit (JRU) National Orthopedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Khairul A Ayob
- Joint Reconstruction Unit (JRU) National Orthopedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Haidar Nasuruddin
- Joint Reconstruction Unit (JRU) National Orthopedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Veenesh Selvaratnam
- Joint Reconstruction Unit (JRU) National Orthopedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
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Teh HL, Kassim AF, Chopra S, Selvaratnam V. A Rare Presentation of Patella Button Aseptic Loosening After a Total Knee Replacement Without Evidence of Radiographic Loosening. Cureus 2023; 15:e34665. [PMID: 36909109 PMCID: PMC9997687 DOI: 10.7759/cureus.34665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
Patella resurfacing in total knee replacement (TKR) has been shown to reduce the rate of anterior knee pain, but there are complications from patella resurfacing. A 54-year-old male underwent a left primary TKR with patella resurfacing 15 years ago. He developed spontaneous progressive anterior knee pain for six months. At revision surgery, his patella button was found to be loose. Loosening of a three-peg patella button is rare. A high index of suspicion of patella button loosening should be suspected in patients who present with anterior knee pain after patella resurfacing.
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Affiliation(s)
- Hak Lian Teh
- Exeter Hip Unit and Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter National Health Service Foundation Trust, Exeter, GBR
| | | | - Suresh Chopra
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Alor Setar, MYS
| | - Veenesh Selvaratnam
- National Orthopaedic Centre of Excellence in Research and Learning, Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
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Selvaratnam V, Gunainthran S, Akmal II, Kassim AF. The Modified Spare Piriformis and Internus, Repair Externus Approach for Hip Arthroplasty. Cureus 2023; 15:e34999. [PMID: 36938297 PMCID: PMC10020129 DOI: 10.7759/cureus.34999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
We present the case of an 80-year-old Malaysian gentleman who sustained a displaced intracapsular neck of femur (NOF) fracture and underwent a modified SPAIRE (Sparing Piriformis and Internus, Repair Externus) approach for total hip replacement (THR). The standard approach used in our hospital for THR in NOF fractures is the modified Hardinge approach to the hip. We used this modified SPAIRE approach as this patient lives in a 'Mahjong' center and always sits cross-legged on the floor. Therefore, he is at increased risk of an anterior dislocation. This approach is a modification of the standard SPAIRE approach popularized by the Exeter Hip Unit, United Kingdom. In this report, we describe the modification of the SPAIRE approach that has not been described before and the outcome for this patient.
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Affiliation(s)
- Veenesh Selvaratnam
- Joint Reconstruction Unit (JRU) National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Alor Setar, MYS
- Arthroplasty Unit, Tengku Ampuan Afzan Hospital, Kuantan, MYS
| | | | - Izyan I Akmal
- Arthroplasty Unit, Tengku Ampuan Afzan Hospital, Kuantan, MYS
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Selvaratnam V, Toms AD, Mandalia VI. Robotic Assisted Patellofemoral Joint Replacement: Surgical Technique, Tips and Tricks. Indian J Orthop 2022; 56:2110-2118. [PMID: 36507211 PMCID: PMC9705622 DOI: 10.1007/s43465-022-00746-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/02/2022] [Indexed: 02/04/2023]
Abstract
In this article we wish to provide MAKO robotic knee users a surgical guide including tips and tricks on performing MAKO robotic-assisted patellofemoral joint replacements. The senior authors in this paper from the Exeter Knee Reconstruction Unit, United Kingdom are highly experienced MAKO users who have been performing MAKO assisted Patellofemoral joint replacements since 2017.
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Affiliation(s)
- Veenesh Selvaratnam
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon UK
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Andrew D. Toms
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon UK
| | - Vipul I. Mandalia
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon UK
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Selvaratnam V, Cattell A, Eyres KS, Toms AD, Phillips JRP, Mandalia VI. Robotic-Assisted Patellofemoral Replacement-Correlation of Preoperative Planning with Intraoperative Implant Position and Early Clinical Experience: A Minimum 2-Year Follow-up. J Knee Surg 2022; 35:731-738. [PMID: 33126284 DOI: 10.1055/s-0040-1716848] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patello-femoral arthroplasty (PFA) is successful in a selected group of patients and yields a good functional outcome. Robotic-assisted knee arthroplasty has been shown to provide better implant positioning and alignment. We aim to report our early outcomes and to compare Mako's (Robotic Arm Interactive Orthopaedic System [RIO]) preoperative implant planning position to our intraoperative PFA implant position. Data for this study was prospectively collected for 23 (two bilateral) patients who underwent robotic-assisted PFA between April 2017 and May 2018. All preoperative implant position planning and postoperative actual implant position were recorded. Presence of trochlear dysplasia and functional outcome scores were also collected. There were 17 (two bilateral) female and 6 male patients with a mean age of 66.5 (range: 41-89) years. The mean follow-up period was 30 (range: 24-37) months. Eighteen knees (72%) had evidence of trochlear dysplasia. The anterior trochlear line was on average, 7.71 (range: 3.3-11.3) degrees, internally rotated to the surgical transepicondylar axis and on average 2.9 (range: 0.2-6.5) degrees internally rotated to the posterior condylar line. The preoperative planning range was 4-degree internal to 4-degree external rotation, 4-degree varus to 6-degree valgus, and 7-degree flexion to 3-degree extension. The average difference between preoperative planning and intraoperative implant position was 0.43 degrees for rotation (r = 0.93), 0.99 degrees for varus/valgus (r = 0.29), 1.26 degrees for flexion/extension (r = 0.83), and 0.34 mm for proudness (r = 0.80). Six patients (24%) had a different size component from their preoperative plan (r = 0.98). The mean preoperative Oxford Knee Score (OKS) was 16 and the mean postoperative OKS was 42. No patient had implant-related revision surgery or any radiological evidence of implant loosening at final follow-up. Our early results of robotic PFA are promising. Preoperative Mako planning correlates closely with intraoperative implant positioning. Longer follow-up is needed to assess long-term patient outcomes and implant survivorship.
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Affiliation(s)
- Veenesh Selvaratnam
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon, England
| | - Andrew Cattell
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon, England
| | - Keith S Eyres
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon, England
| | - Andrew D Toms
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon, England
| | - Jonathan R P Phillips
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon, England
| | - Vipul I Mandalia
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon, England
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Chong S, Ramli N, Juhari Z, Zulkefli E, Phan C, Liew P, Selvaratnam V, Tan S. Janus kinase 2 (JAK2V617F) mutations in patients with splanchnic vein thrombosis, a single centre experience. Pathology 2022. [DOI: 10.1016/j.pathol.2021.12.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chan Y, Selvaratnam V, Manickavasagar T, Shetty V, Sahni V. Liverpool carpal tunnel scoring system to predict nerve conduction study results: A prospective correlation study. World J Orthop 2022; 13:171-177. [PMID: 35317399 PMCID: PMC8891662 DOI: 10.5312/wjo.v13.i2.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/30/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is one of the most common peripheral nerve compressive neuropathies. The clinical symptoms and physical examinations of CTS are widely recognised, however, there is still debate around what is the best approach for assessment of CTS. Clinical assessment is still considered the gold standard, however, controversies do exist regarding the need for investigations such nerve conduction studies (NCS) to aid with management decisions.
AIM To correlate the severity of NCS results to a scoring system which included symptoms, signs and risk factors.
METHODS This was a prospective correlation study. We scored patients’ signs and symptoms using our CTS scoring system. This was then correlated with the findings of the NCS. The scoring system included - four symptoms (2 Katz hand diagrams – one for tingling and one for numbness; nocturnal paresthesia and bilateral symptoms) and four clinical signs (weak thumb abduction test; Tinel’s sign; Phalen sign and hypoalgesia in median nerve territory) and two risk factors (age more than 40 years and female sex). We classified the NCS results to normal, mild, moderate and severe.
RESULTS There were 61 scores in 59 patients. The mean scores for the categories were as follows: 6.75 for normal NCS; 5.50 for mild NCS; 9.17 for moderate NCS and 9 for severe NCS. All scores of 8 or more matched with NCS results of moderate and severe intensity apart from three scores which were greater than seven that had normal NCS. Eta score was 0.822 for the CTS score being the dependent value and the NCS category being the independent variable showing a strong association between the scoring system and the NCS group.
CONCLUSION We feel that this simple scoring system can be used to predict and correlate the severity of NCS in patients with CTS.
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Affiliation(s)
- Yuen Chan
- Department of Trauma and Orthopaedics, Mersey Deanery, Prescot L35 5DR, Merseyside, United Kingdom
| | - Veenesh Selvaratnam
- Department of Trauma and Orthopaedics, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, United Kingdom
| | - Tharjan Manickavasagar
- Department of Trauma and Orthopaedics, Southport and Ormskirk NHS Trust, Southport L39 2AZ, United Kingdom
| | - Vishwanath Shetty
- Department of Trauma and Orthopaedics, Southport and Ormskirk NHS Trust, Southport L39 2AZ, United Kingdom
| | - Vishal Sahni
- Department of Trauma and Orthopaedics, Southport and Ormskirk NHS Trust, Southport L39 2AZ, United Kingdom
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Fishley WG, Selvaratnam V, Whitehouse SL, Kassam AAM, Petheram TG. Cement-in-cement revision of the femur in infected hip arthroplasty in 89 patients across two centres. Bone Joint J 2022; 104-B:212-220. [PMID: 35094572 DOI: 10.1302/0301-620x.104b2.bjj-2021-0598.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision of hip arthroplasty necessitate removal of all bone cement from the femur. In our two centres, we have been using a cement-in-cement technique, leaving the distal femoral bone cement in selected patients for septic hip revision surgery, both for single and the first of two-stage revision procedures. A prerequisite for adoption of this technique is that the surgeon considers the cement mantle to be intimately fixed to bone without an intervening membrane between cement and host bone. We aim to report our experience for this technique. METHODS We have analyzed patients undergoing this cement-in-cement technique for femoral revision in infection, and present a consecutive series of 89 patients. Follow-up was undertaken at a mean of 56.5 months (24.0 to 134.7) for the surviving cases. RESULTS Seven patients (7.9%) required further revision for infection. Ten patients died of causes unrelated to their infection before their two-year review (mean 5.9 months; 0.9 to 18.6). One patient was lost to follow-up at five months after surgery, and two patients died of causes unrelated to their hip shortly after their two-year review was due without attending. Of the remaining patients, 69 remained infection-free at final review. Radiological review confirms the mechanical success of the procedure as previously described in aseptic revision, and postoperative Oxford Hip Scores suggest satisfactory functional outcomes. CONCLUSION In conclusion, we found that retaining a well-fixed femoral cement mantle in the presence of infection and undertaking a cement-in-cement revision was successful in 82 of the patients (92.1%) in our series of 89, both in terms of eradication of infection and component fixation. These results are comparable to other more invasive techniques and offer significant potential benefits to the patient. Cite this article: Bone Joint J 2022;104-B(2):212-220.
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Affiliation(s)
- William G Fishley
- Northumbria Revision Arthroplasty Group, Northumbria Healthcare NHS Foundation Trust, Wansbeck Hospital, Ashington, Tyne and Wear, UK
| | - Veenesh Selvaratnam
- Exeter Hip Unit, Princess Elizabeth Orthpaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Sarah L Whitehouse
- Exeter Hip Unit, Princess Elizabeth Orthpaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, Devon, UK.,Orthopaedic Research Unit, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Al-Amin M Kassam
- Exeter Hip Unit, Princess Elizabeth Orthpaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Timothy G Petheram
- Northumbria Revision Arthroplasty Group, Northumbria Healthcare NHS Foundation Trust, Wansbeck Hospital, Ashington, Tyne and Wear, UK
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Selvaratnam V, Kassam AA, Hubble MJW. A Rare Case of Open 3A VTB2W Periprosthetic Fracture around a Total Hip Arthroplasty. J Orthop Case Rep 2022; 12:68-72. [PMID: 36199927 PMCID: PMC9499062 DOI: 10.13107/jocr.2022.v12.i03.2722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/21/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: The incidence of periprosthetic fracture (PPF) around a total hip arthroplasty (THA) continues to increase with the rise of number of THA performed. We present a rare case of a 73-year-old man who sustained an open periprosthetic femur fracture around a THA. Case Report: This gentleman sustained an open PPF around a fully cemented THA after he lost control and fell off his bicycle. After thorough surgical debridement, internal fixation with double plating was performed and the fracture went on to unite with an excellent patient reported outcome score. To the best of our knowledge, this is the only reported open 3A VTB2W PPF THA in the literature. Conclusion: Open PPF around a THA is a rare and uncommon occurrence. Principles of open fracture management should be continued and we recommend urgent surgery to reduce the risk of post-operative infection. Open VTB2W PPF should be fixed with double plating if the bone cement interface is intact and the fracture can be anatomically reduced. Double plating gives additional rotational stability and allows early weight bearing post-operatively.
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Selvaratnam V, Panchani S, Jones HW, Chitre A, Clayson A, Shah N. Outcomes of acute fix and replace in complex hip posterior fracture dislocations with acetabular fractures : a minimum of 3 years follow-up. Acta Orthop Belg 2021; 87:635-642. [PMID: 35172430 DOI: 10.52628/87.4.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Simultaneous open reduction and internal fixation of acetabular fractures combined with total hip replacement (THR) have some potential advantages over the more traditional approach in specific patient subgroups. The aim of this study was to evaluate the outcomes of patients who had the "fix and replace" construct for complex posterior hip fracture dislocation treated at our tertiary referral pelvic unit. This was a retrospective review of prospectively collected data for patients who underwent this procedure between 2011-2018 with a minimum of 3 year follow up. Data collected were: patient demographics, date of injury, injury pattern, fixation methods, type of implants used and post-operative complications. There were 14 patients with a mean age of 63.2 years (range 43-94 years) who underwent this procedure between 2011-2018. The mean follow up was 58 months. All cases involved a posterior wall fracture and six cases had an associated posterior column involvement. Femoral head autograft was used in 13 patients (93%). Six patients (43%) had their posterior acetabular wall reconstructed with a femoral head autograft. Seven patients had a fully cemented (THR) and the seven others had a hybrid implant. There were no surgical related complications. From our study we can conclude that the acute "fix and replace" construct for complex posterior hip fracture dislocation yields good clinical outcomes in the short and medium term with low complication rate. It is best performed by a surgeon who specialises in both acetabular and hip arthroplasty surgery.
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Abstract
BACKGROUND The cause of recurrent dislocation following primary total hip arthroplasty (THA) is multifactorial. A re-dislocation rate of up-to 34% following revision is reported. The aim of this study was to determine the re-dislocation rates following revision for recurrent THR dislocation. METHODOLOGY Patients who underwent revision for recurrent dislocation between January 2008 and January 2015 were identified. We identified the date and type of primary implant, overall number and reasons for dislocation, revision implant details and complication data. RESULTS Over an 8-year period, 24 patients underwent revision. The median age was 77 (68-85) years, median time to first dislocation was 78 (23-160) months and median number of dislocations was 3 (2-4) with a mean follow-up of 18 months. Socket Mal-Orientation (10) and Abductor deficiency (5) were the main causes of recurrent dislocation. 21 patients (88%) underwent revision of both components, 1 patient underwent isolated cup revision and 2 patients had revision of acetabular component with insertion of a BioBall. There were no dislocations within 90 days of revision surgery. 4 patients had late dislocations (3 recurrent, 1 isolated). There was no significant increase risk of dislocation after revision surgery in the neck of femur group (p = 0.467). CONCLUSIONS We report favourable outcomes for revision of both components for recurrent dislocation with no dislocations within 90 days. The overall late dislocation rate was 16.7%, however, these patients have settled following closed reduction. Due to its multifactorial aetiology, both component revision can be considered in this patient population.
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Affiliation(s)
- Nisarg Mehta
- Wirral University Teaching Hospital NHS Trust, UK
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16
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Chan Y, Selvaratnam V, James L, Nayagam S. Paediatric open tibial fractures. Do children require a modified approach to that advised by the British Orthopaedic Association and British Association of Plastic Reconstructive and Aesthetic Surgeons in the UK? J Pediatr Orthop B 2021; 30:19-24. [PMID: 33252898 DOI: 10.1097/bpb.0000000000000721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
This study reviews the outcomes of paediatric open tibial fractures treated at a level 1 trauma centre using the British Orthopaedic Association/British Association of Plastic Reconstructive and Aesthetic Surgeons standards and compares the results to management in adults. This was a retrospective study of 60 consecutive cases over a 9-year period. The variables recorded include grade of injury, contamination and pattern of fracture. Other data recorded include time at which antibiotics were given, time to index surgery, type of skeletal fixation and time to definitive cover. Outcomes sought were infection rate, time to union, problems with union and any additional unplanned surgery. The mean time to administration of antibiotics was 3.4 h after injury with a range of 0.35-17 h. The mean time to debridement was 13.4 h (range 1-32 h, SD 7.7). The mean time to union was 4.3 months (range 1.3-15 months). There were five cases of deep infection (8.3%) and three cases of superficial infection (5%). There were no significant differences between timings of antibiotic administration, hours to debridement or days to definitive closure between those cases which became infected and those which did not. This retrospective review of a consecutive series of paediatric open tibial fractures shows a close parallel of outcomes to that from adult centres in the UK using the same standards of care. This strengthens the recommendation that, until the availability of data to suggest otherwise, open tibial fractures in children should follow the same recommendations as suggested for adults. The greater healing potential in children, seen in multiple examples of closed long bone fractures, appears to be attenuated in the higher grades of the open tibial fracture.
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Affiliation(s)
- Yuen Chan
- Alder Hey Children's NHS Trust, Liverpool, Merseyside, UK
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Ellapparadja P, Joseph I, Selvaratnam V. How to Achieve an Accurate Anatomical Femoral Tunnel Technique in ACL Reconstruction in the Early Years of Your Consultancy? Femoral Offset Aimer Technique: Consistent and Reproducible Technique. J Knee Surg 2020; 33:1201-1205. [PMID: 31378859 DOI: 10.1055/s-0039-1692993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Femoral tunnel malposition is the most common reason for failure of primary anterior cruciate ligament reconstruction. There are several methods to identify the anatomical location of femoral footprint. Femoral offset aimer technique is one such technique which is easy to use and reliable. It is an ideal technique for junior and inexperienced surgeons to recreate the femoral tunnel in its anatomical footprint. The senior author (P.E.) has been using this technique for 30 consecutive cases in his first year of independent practice during his consultancy without any major intraoperative complications. The author describes this technique in this article with tips and tricks which will especially guide the junior and inexperienced surgeons to avoid running into intraoperative problems while drilling the femoral tunnel.
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Affiliation(s)
- Pregash Ellapparadja
- Department of Orthopaedics, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, United Kingdom
| | - Ignatius Joseph
- Department of Orthopaedics, Prince Charles Hospital, Merthyr Tydfi
| | - Veenesh Selvaratnam
- Department of Orthopaedics, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, United Kingdom
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Matar HE, Selvaratnam V, Board TN, Purbach B, Porter ML, Kay PR, Shah N. Fractured Femoral Stems in Primary and Revision Hip Arthroplasties Revisited: Wrightington Experience. J Arthroplasty 2020; 35:1344-1350. [PMID: 32014380 DOI: 10.1016/j.arth.2020.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/30/2019] [Accepted: 01/09/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study is to present our experience in managing fractured femoral stems over the last 10 years for both primary and revision stems at our tertiary unit focusing on modes of failure and operative techniques. METHODS This is a retrospective consecutive study of all patients with fractured femoral stems that were operatively managed in our unit between 2008 and 2018. Detailed radiographic evaluation (Paprosky classification) was undertaken and data collected on operative techniques used to extract distal fractured stem fragments. RESULTS Thirty-five patients (35 hips) were included (25 men/10 women) with average age at time of presentation of 68 years (range, 29-93). Average body mass index was 30 (standard deviation, 3.8; range, 22.5-39). There were variety of stems both contemporary and historical, primary and revision cases (15 hips polished tapered cemented stems, 10 hips composite beam and miscellaneous stems, and 10 revision hip stems). The predominant mechanism of failure was fatigue due to cantilever bending in distally fixed stems. Surgical techniques used to extract distal fragment were drilling technique in 2 hips, cortical window in 13 hips, extended trochanteric osteotomy (ETO) in 5 hips, and proximal extraction in 15 hips. CONCLUSION When faced with a contemporary fractured stem, drilling techniques into the distal fragment are unlikely to succeed. If a trochanteric osteotomy had been used at time of index surgery, this could be used again to aid proximal extraction with conventional revision instrumentations. The cortical window technique is useful but surgically demanding technique that is most successful in extracting polished tapered fractured stems particularly when an ETO is not planned for femoral reconstruction. Use of trephines can be useful for removal of longer, uncemented stems. Finally, an ETO might be necessary when other techniques have failed.
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Affiliation(s)
- Hosam E Matar
- Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | | | - Tim N Board
- Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | - Bodo Purbach
- Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | | | - Peter R Kay
- Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | - Nikhil Shah
- Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
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Matar HE, Selvaratnam V, Shah N, Wynn Jones H. Custom triflange revision acetabular components for significant bone defects and pelvic discontinuity: Early UK experience. J Orthop 2020; 21:25-30. [PMID: 32071529 DOI: 10.1016/j.jor.2020.01.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/31/2020] [Indexed: 10/25/2022] Open
Abstract
Aims We report our early experience in acetabular reconstruction for significant bone loss and pelvic discontinuity using custom triflange acetabular components. Patients and methods Retrospective consecutive review of all patients treated at our specialist tertiary unit with significant acetabular defects (Paprosky 3A/3B) and pelvic discontinuity who were reconstructed with custom triflange implants. The primary outcomes were radiographic failure and complications. Results 17 patients (17 hips) were included; 3 males/14 females with a mean age of 72 years (range 61-83). The average follow-up was 3.6 years (2-7 years). Bony defects were Paprosky 3B in 13/17 hips (76%) with pelvic discontinuity encountered in the majority of cases 15/17 hips (88%) and intra-pelvic failed components in 11/17 (64%). At final follow up, no radiographic failures were observed although three patients developed complications (17.6%); haematoma requiring washout out; intra-operative ilium fracture; and recurrent dislocation in one patient. Conclusions Our experience suggest that acceptable outcomes can be achieved with custom implants for this group of challenging patients, although longer follow up is needed to monitor future implants' failure.
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Affiliation(s)
- Hosam E Matar
- Centre for Hip Surgery, Wrightington Hospital, Wigan, WN6 9EP, United Kingdom
| | - Veenesh Selvaratnam
- Centre for Hip Surgery, Wrightington Hospital, Wigan, WN6 9EP, United Kingdom
| | - Nikhil Shah
- Centre for Hip Surgery, Wrightington Hospital, Wigan, WN6 9EP, United Kingdom
| | - Henry Wynn Jones
- Centre for Hip Surgery, Wrightington Hospital, Wigan, WN6 9EP, United Kingdom
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Jain MV, Rajpura A, Kumar VS, Shaw D, Najjar MA, Kalsi NK, Hakimi M, Selvaratnam V, Jackson R, Board TN. Functional outcome of total hip arthroplasty after a previous hip arthroscopy: a retrospective comparative cohort study. Hip Int 2019; 29:363-367. [PMID: 30415576 DOI: 10.1177/1120700018810509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite patients demonstrating significant short-term clinical improvement from a hip arthroscopy (HA), a number of patients progress to significant osteoarthritis of the hip requiring total hip arthroplasty (THA). This study aims to evaluate if there is any difference in the functional outcome of patients undergoing THA after a previous hip arthroscopy compared to patients undergoing THA for primary osteoarthritis of the hip. METHODS Between 2010 and 2013, in a group of 414 patients who underwent hip arthroscopy, we identified 18 patients who underwent a subsequent uncemented THA. These formed the study group. During the same period, 625 patients underwent an uncemented THA performed for primary OA, of which 63 patients were matched to the study group for age, follow-up and implants used. These formed the control group. Pre-op and post-op Oxford Hip Scores (OHS) were recorded for all patients. RESULTS A mean follow-up of 26.5 and 26.3 months was observed in the study and control groups respectively. The median (interquartile ranges) preoperative OHS were 14 (8.25, 17.0) and 18.5 (13.25, 24.75) in the 2 groups. Corresponding postoperative scores were 40 (31.25, 45) and 46 (43, 48). Median difference between the preoperative and postoperative OHS was 27 (19, 31) and 25 (18.25, 31). Adjusting for the pre-treatment scores, the postoperative scores in the study arm were significantly lower than for the control arm with an estimate (SE) of -0.464 (p = 0.012). Post-hoc power analysis showed that the study was sufficiently powered to detect a meaningful difference in scores. CONCLUSION Total hip arthroplasty after hip arthroscopy leads to satisfactory functional outcomes. However, the functional outcome in this group is significantly worse than in a matched cohort of patients undergoing THA for osteoarthritis. There was no difference in the rate of complications between the 2 groups.
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Affiliation(s)
- Mikhil V Jain
- 1 Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Asim Rajpura
- 1 Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Debbie Shaw
- 1 Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Navjit K Kalsi
- 1 Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Mounir Hakimi
- 1 Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | | | - Tim N Board
- 1 Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
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Mehta NJ, Goldsmith T, Lacey A, Reddy G, Selvaratnam V, Ramakrishnan M. Outcomes of Intramedullary Nailing with Cerclage Wiring in Subtrochanteric Femoral Fractures. Strategies Trauma Limb Reconstr 2019; 14:29-33. [PMID: 32559265 PMCID: PMC7001599 DOI: 10.5005/jp-journals-10080-1423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims The aim of this study was to compare the outcomes of closed reduction against open reduction with cerclage wires in patients with subtrochanteric fractures treated with intramedullary nailing (IMN). Materials and methods We identified 141 patients who had an IMN over a 4-year period. They were classified into three groups based on fracture pattern and whether open or closed reduction was performed. Type I was a transverse fracture, type II, a spiral fracture with an intact posterior and medial wall in the proximal fragment, and a type III fracture without intact posterior or medial walls. The primary outcome measure was a revision surgery for implant failure. Secondary outcome measures were related to fracture reduction and radiological union scores of the hip (RUSH). Results There were 35 patients who had a type I fracture, 26 patients with a type II fracture, and 80 patients with a type III fracture. The mean follow-up was 7 months. Closed reduction in type III fractures was associated with a significantly increased risk of mechanical complications (p = 0.005) and unplanned returns to theatre for implant failure (p = 0.04) as compared to open reduction. Open reduction in type III fractures was associated with a significantly higher mean RUSH scores (p = 0.0006). There was no significant difference in mean operative time between open and closed reduction in type III fractures (p = 0.12). Conclusion We recommend open reduction with cerclage wiring in type III subtrochanteric fractures in order to reduce the risk of implant failure, nonunion, and need for further surgery. How to cite this article Mehta NJ, Goldsmith T, Lacey A, et al. Outcomes of Intramedullary Nailing with Cerclage Wiring in Subtrochanteric Femoral Fractures. Strategies Trauma Limb Reconstr 2019;14(1):29–33.
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Chan Y, Selvaratnam V, Raut V. Thirty-day mortality following total knee arthroplasty over 7 years at a tertiary referral centre of orthopaedic excellence. J Clin Orthop Trauma 2018; 9:51-53. [PMID: 29628684 PMCID: PMC5884056 DOI: 10.1016/j.jcot.2017.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/26/2017] [Accepted: 11/30/2017] [Indexed: 11/30/2022] Open
Abstract
Total Knee Arthroplasty (TKA) is one of the most successful orthopaedic procedures. Around 100,000 TKAs are performed yearly in the United Kingdom. The aim of this study was to report the mortality rate within 30 days after a TKA in an Orthopaedic Centre of Excellence. We reviewed prospectively collected data of 7067 TKAs performed between April 2009-November 2016. All mortalities within 30 days of a TKA were recorded. Data such as age, sex, ASA, comorbidities and cause of death was recorded. There were 14 (0.198%) deaths within 30 days of TKA. There were eight male patients and six female patients who died. No statistical difference was demonstrated between gender. (p = 0.37). The mean age was 77.9 years (66-94 years). Means days to death from post-op were 9.6 days (2-30 days). One patient was ASA 1, six patients were ASA 2, six patients were ASA 3 and one patient did not have an ASA recorded. There was no statistical difference between the difference ASA groups. (p = 0.27). Cause of death documented was as follow: acute left ventricular failure-3; myocardial infarction-2; pneumonia-2; pulmonary oedema-1; gastrointestinal bleed-1 and multiorgan failure-1. Four patients did not have their cause of death recorded. The 30-day mortality rate after TKA in our institute is low and is comparable to other institutes. This emphasizes that primary TKA is a safe procedure. The predominant cause of perioperative mortality is cardiopulmonary disease.
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Affiliation(s)
- Yuen Chan
- Mersey Deanery, United Kingdom,Corresponding author.
| | | | - Videsh Raut
- Wrightington Hospital NHS Foundation Trust, United Kingdom
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Khoder A, Sever M, Palanicawandar R, Pello O, Loaiza S, Bray E, Bradshaw A, Uddin S, Atta M, Selvaratnam V, Sevillano B, Monsalvo S, Altaf S, Innes A, Lozano S, Pavlu J, Auner H, Apperley J, Olavarria E, Kanfer E. Plerixafor effectively rescues biosimilar G-CSF-alone-based stem cell mobilisation failures. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mehta N, Selvaratnam V, Giotakis N, Narayan B. Is device-assisted reduction prior to semi-extended intramedullary nailing of distal tibial fractures necessary? Injury 2017; 48:506-510. [PMID: 28011071 DOI: 10.1016/j.injury.2016.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/06/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Traditional methods of nailing distal tibial fractures have an unacceptable risk of mal-alignment due to difficulty in obtaining and maintaining reduction intra-operatively. Methods to obtain and maintain reduction when nailing these fractures, and therefore reducing the risk of Mal-alignment include modified external fixators, distractors and commercial reduction tools. Semi-extended intramedullary nailing of distal tibial fractures via a supra-patellar approach is now being used more commonly. The aim of this study was to assess whether a commercial reduction device (Staffordshire Orthopaedic Reduction Machine - STORM, Intelligent Orthopaedics, Stafffordshire, UK) is necessary to reduce the risk of mal-alignment in patients undergoing semi-extended nailing for distal tibial fractures. METHODOLOGY A case-control study was conducted in 20 patients who had STORM-assisted reduction of distal tibial fractures prior to intramedullary nailing and 20 controls without STORM. The control group was matched for age, sex, fracture type (AO/OTA), ASA and gender. All patients had an intramedullary nail (IMN) using the semi-extended system. Primary outcome measures were coronal and sagittal mal-alignment. Secondary outcome measure was unplanned return to theatre for complications and problems with fracture healing. RESULTS There was no difference in post-operative mal-alignment in both groups. There was no significant difference in time to union in both groups Both groups had equal number of patients requiring unplanned return to theatre. The STORM group was associated with a significantly increased operative time [p=0.007, 130.3min (SD 49.4) STORM vs 95.6 mins (SD 22.9) Control]. CONCLUSION Intraoperative use of STORM significantly increases operative time with no difference in outcome. The superior orthogonal views and manual control obtained during semi-extended nailing via a supra-patellar approach obviate the need for additional methods: of intraoperative reduction for this fracture group.
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Affiliation(s)
- Nisarg Mehta
- Core Surgical Trainee (CT2) in Trauma & Orthopaedics Surgery, Royal Liverpool & Broadgreen Teaching Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom.
| | - Veenesh Selvaratnam
- Core Surgical Trainee (CT2) in Trauma & Orthopaedics Surgery, Royal Liverpool & Broadgreen Teaching Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
| | - Nikolaos Giotakis
- Core Surgical Trainee (CT2) in Trauma & Orthopaedics Surgery, Royal Liverpool & Broadgreen Teaching Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
| | - Badri Narayan
- Core Surgical Trainee (CT2) in Trauma & Orthopaedics Surgery, Royal Liverpool & Broadgreen Teaching Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
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Chan Y, Selvaratnam V, Garg N. Toxic shock syndrome post open reduction and Kirschner wire fixation of a humeral lateral condyle fracture. BMJ Case Rep 2015; 2015:bcr-2015-210090. [PMID: 26264942 DOI: 10.1136/bcr-2015-210090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Use of Kirschner wires (K-wires) is the most common method of fracture stabilisation in lateral condyle fracture fixation in children. We report a case of toxic shock syndrome (TSS) following an open reduction and internal fixation using K-wires for a humeral lateral condyle fracture in a 5-year-old girl. TSS is a toxin-mediated multisystem illness. It typically presents with shock and it is most often attributed to toxin-producing strains of Staphylococcus aureus and Streptococcus pyogenes. It can lead to multiorgan failure and, ultimately, death. It is important to be aware of TSS, as it can present within any setting. Patients often have non-specific symptoms and their condition can worsen rapidly. TSS postorthopaedic surgery is rare; however, due to the serious nature of this disease, it is important to promptly recognise and diagnose TSS, and to ensure appropriate treatment is started without delay.
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Affiliation(s)
- Yuen Chan
- Department of Trauma and Orthopaedics, Alder Hey NHS Foundation Trust, Liverpool, UK
| | - Veenesh Selvaratnam
- Department of Trauma and Orthopaedics, Alder Hey NHS Foundation Trust, Liverpool, UK
| | - Neeraj Garg
- Department of Trauma and Orthopaedics, Alder Hey NHS Foundation Trust, Liverpool, UK
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Abstract
The purpose of this study was to assess whether subsidence occurs in collarless Corail hip replacement (CCHR) and to ascertain the extent and timing of subsidence if present. Retrospective case notes analysis was performed. Sixty eight patients who had CCHR were identified from our database. Male to female ratio was 32:36. Their mean age was 74.2 years (range 37-95 years). Indications for surgery were osteoarthritis in 64 (94%) patients, rheumatoid arthritis in two (3%) patients and avascular necrosis in two (3%) patients. Subsidence was measured at 6 weeks, 6 months and 1 year post-op compared to initial post-op x-rays. At 6 weeks x-ray 21 patients did not have any subsidence, 18 patients had 1 millimeter (mm) subsidence, 10 patients had 2mms subsidence, 4 patients had 3mms subsidence, 5 patients had 4mms subsidence, 1 patient had 5mms subsidence, 4 patients had 6 mms subsidence and 1 patient each had subsidence of 7mms, 9mms, 11mms, 13mms and 26 mms respectively. When compared with 6 months x-rays only 2 patients had a further subsidence of 2mms while another patient had 3mms subsidence. No further subsidence occurred at 1 year follow up x-rays. One patient had revision surgery due to symptomatic subsidence (29mms) at 6 months follow up. Subsidence does occur in the first 6 weeks in collarless Corail hip replacement, and to a lesser extent until 6 months postoperatively, but does not progress further.
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Affiliation(s)
| | | | - Vishal Sahni
- Southport & Ormskirk NHS Hospital Trust, Liverpool, L1 8LP, UK
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27
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Abstract
Developmental dysplasia of the hip (DDH) is a common paediatric orthopaedic problem. There are various options for treatment dependent on the age and presentation. In closed and open reduction of DDH, we use a hip spica cast for immobilisation after the procedure. We present an unusual case of fungal growth on a hip spica. A 7-month-old girl presented to our institution with clusters of yellowish-white outgrowths resembling mushrooms from her spica. To the best of our knowledge, this is the first reported case of fungal growth on a hip spica following DDH treatment. It is of utmost importance to be aware of any growth on a hip spica, as this requires a prompt change of spica to avoid further complications. We recommend that the integrity of the spica and the skin be checked at regular intervals in patients with a hip spica.
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Affiliation(s)
- Yuen Chan
- Department of Trauma and Orthopaedics, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Veenesh Selvaratnam
- Department of Trauma and Orthopaedics, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Neeraj Garg
- Department of Trauma and Orthopaedics, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
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28
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Javed S, Selvaratnam V, Babori A, Wigfield C. Circumferential encasement of the spinal cord in a patient with rheumatoid arthritis. Br J Neurosurg 2011; 25:308-9. [DOI: 10.3109/02688697.2010.536275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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29
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Manikandan R, Selvaratnam V, Philip J, Hanlon A, Machin DG, Williamson M. Evaluation of Flow Characteristics of 3-Way Catheters. J Urol 2009; 181:1922-5. [PMID: 19237172 DOI: 10.1016/j.juro.2008.11.094] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Indexed: 11/18/2022]
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