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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_11 | Pages 44 - 44
1 Nov 2022
Khadabadi N Murrell J Selzer G Moores T Hossain F
Full Access

Abstract

Introduction

We aimed to compare the outcomes of elderly patients with periarticular distal femur or supracondylar periprosthetic fractures treated with either open reduction internal fixation or distal femoral replacement.

Methods

A retrospective review of patients over 65 years with AO Type B and C fractures of the distal femur or Su type I and II periprosthetic fractures treated with either a DFR or ORIF was undertaken. Outcomes including Length of Stay, PROMs (Oxford Knee Score and EQ 5D), infection, union, mortality, complication and reoperation rates were assessed. Data on confounding variables were also collected for multivariate analysis. Patients below 65 years and extra articular fractures were excluded.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_2 | Pages 81 - 81
1 Mar 2021
Yaghmour KM Hossain F Konan S
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Abstract

Objective

In this systematic review we aim to compare wound complication rates from Negative Pressure Wound Therapy (NPWT) to dry sterile surgical dressings in primary and revision total knee arthroplasty (TKA).

Methods

A search was performed using PubMed, Embase, Science Direct, and Cochrane Library. Eligible studies included those investigating the use of NPWT in primary and revision TKA. Exclusion criteria included studies investigating NPWT not related to primary or revision TKA; studies in which data relating to NPWT was not accessible; missing data; without an available full text, or not well reported. We also excluded studies with poor scientific methodology. All publications were limited to the English language. Abstracts, case reports, conference presentations, and reviews were excluded. Welch independent sample t-test was used for the statistical analysis.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_2 | Pages 98 - 98
1 Mar 2021
Yaghmour KM Hossain F Konan S
Full Access

Abstract

Objective

In this systematic review we aim to analyse the economical impact of using Negative Pressure Wound Therapy (NPWT) in primary total knee arthroplasty (TKA).

Methods

Four medical electronic databases were searched. Eligible studies included those investigating the costs of NPWT in primary TKA. Exclusion criteria included studies investigating cost of NPWT not related to primary TKA. We also excluded studies with poor scientific methodology. We retrieved and analysed data on dressing costs and hospital length of stay (LOS).


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_1 | Pages 86 - 86
1 Jan 2018
Groen F Hossain F Karim K Witt J
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The purpose of this study was to determine the complications after Bernese periacetabular osteomy (PAO) performed by one experienced surgeon using a minimally invasive modified Smith-Petersen approach.

Between May 2012 and December 2015, 224 periacetabular osteotomies (PAO) in 201 patients were performed. The perioperative complications were retrospectively reviewed after reviewing clinical notes and radiographs. The mean age was 28.8 years with 179 females and 22 males. The most common diagnosis was acetabular dysplasia with some cases of retroversion. The average lateral centre edge (LCE) angle was 16.5°(−18–45) and mean acetabular index (AI) 16.79° (−3–50).

Postoperatively the mean LCE angle was 33.1°(20–51.3) and mean AI 3.0°

(−13.5–16.6). There were no deep infections, no major nerve or vascular injuries and only one allogenic blood transfusion.

Nine superficial wound infections required oral antibiotics and two wounds needed a surgical debridement. There was one pulmonary embolus and one deep vein thrombosis. Nine (4%) cases underwent a subsequent hip arthroscopy and three (1.3%) PAO's were converted to a total hip arthroplasty after a mean follow-up of 22 months (3–50).

Lateral femoral cutaneous nerve dysaesthesia was noted in 64 (28.6%) PAO's. In 55 (24.5%) an iliopsoas injection of local anaesthetic and steroid for persistent iliopsoas irritation during the recovery phase was given.

The minimally invasive modified Smith-Petersen approach is suitable to perform a Bernese periacetabular osteotomy with a low perioperative complication rate. Persistent pain related to iliopsoas is a not uncommon finding and perhaps under-reported in the literature.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_12 | Pages 15 - 15
1 Nov 2015
Aqil A Hossain F Sheikh H Akinbamijo B Whitwell G Aderinto J Kapoor H
Full Access

Introduction

A fractured hip is the commonest cause of injury related death in the UK. Prompt surgery has been found to improve pain scores and reduce the length of hospital stay, risk of decubitus ulcer formation and mortality rates. The hip fracture Best Practice Tariff (BPT) aims to improve these outcomes by financially compensating services, which deliver hip fracture surgery within 36 hours of admission. Ensuring that delays are reserved for patients with conditions which compromise survival, but are responsive to medical optimisation, would facilitate enhanced outcomes and help to achieve the 36-hour target.

We aimed to identify medical conditions associated with patients failing to achieve the 36-hour cut off, and evaluated whether these were justified by calculating their associated mortality risk.

Methods

Prospectively collected data from the National Hip Fracture Database (NHFD) and inpatient hospital records and blood results from a single major trauma centre were obtained. Complete data sets from 1361 patients were available for analysis. Medical conditions contributing to surgical delay beyond the BPPT (Best Practice Tariff Target) 36-hour cut off, were identified and analysed using univariate and multivariate regression analyses, whilst adjusting for covariates. The mortality risk associated with each factor contributing to surgical delay was then calculated using univariate and hierarchical regression techniques.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 188 - 188
1 Sep 2012
Hossain F Rambani R Ribee H Koch L Haddad F
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Introduction

Premature cessation of clopidogrel in certain patients with cardiac conditions is associated with an increased risk of recurrent coronary events. Such patients often present with proximal femoral fractures requiring surgical intervention. Our aim was to ascertain whether it is necessary to stop clopidogrel preoperatively to avoid postoperative complications following hip hemiarthroplasty surgery.

Methods

A retrospective review of 102 patients with ongoing clopidogrel therapy and patients not on clopidogrel who underwent hip hemiarthroplasty for an intracapsular proximal femoral fracture was undertaken. Statistical comparison on pre- and postoperative haemoglobin (Hb), ASA grades, comorbidities, operative times, transfusion requirements, hospital length of stay (LOS), wound infection, haematoma and reoperation rates between the two groups was undertaken.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 439 - 439
1 Sep 2012
El-Husseiny M Patel S Hossain F Haddad F
Full Access

AIM

Failure of a primary anterior cruciate ligament (ACL) reconstruction is associated with poor functional outcomes even after revision surgery. The aim of this study is to identify early predictors for failure, so that it may aid in recognition of at-risk patients.

METHOD

An observational study was conducted of 623 patients undergoing primary ACL reconstruction by a single surgeon over a 72 month period. Patient and procedure related parameters including age, gender, BMI, time to surgery, graft size, fixation methods, meniscal and chondral injuries, meniscal surgery, radiological parameters and post-operative IKDC scores. Logistic regression modeling was employed to identify those factors which were statistically significant for failure.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 90 - 90
1 Mar 2012
Rhee S Hossain F Konan S Ashby E Haddad F
Full Access

Aim

The aim of our study was to assess lateral tracking of the patella with differing designs of Total Knee Arthroplasty (TKA) and compare to that of the native patella.

Method

A modified caliper was used to measure the width and position of the patella relative to the femur at different degrees of knee flexion. The relationship of the patella midpoint to that of the femur was subsequently assessed. Group 1 consisted of 25 native knees. Group 2 consisted of 25 patients with antero-posterior stabilised knee implant with a spherical medial condyle and a deep lateralised patellar groove, and Group 3 consisted of 25 patients with a conventional cam-and-post design with a midline patellar groove. The mean follow-up was 28 months.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 94 - 95
1 May 2011
Hossain F Knott K Patel S Konan S Rayan F Haddad F
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Introduction: Blood transfusion is not uncommon in patients following joint replacement surgery. However, allogeneic transfusion is associated with potential risks ranging from immune mediated allergic reactions to transmission of blood-borne organisms. Furthermore its use has a significant economical impact on healthcare services.

Methods: A retrospective audit of the case notes and haematological records of 196 patients who underwent primary total hip (THR), resurfacing hip (BHR) or total knee replacement (TKR) was carried out. Patients were routinely cross-matched for 2 units of blood if their pre-operative haemoglobin (Hb) levels were < 12g/dL in our cohort. Patient details including age, sex, BMI, comorbidities, and ASA grade were also collected. Surgical parameters such as operation time, tourniquet time (for TKR procedures) and trigger haemoglobin levels (Hb) with timing of transfusion were noted. Statistical analysis was undertaken to identify risk factors for transfusion.

Results: Forty-seven (24%) patients were transfused in our cohort. 78.7% of these patients were appropriately transfused with a trigger Hb of < 8g/dL. Patients transfused with a trigger Hb of > 8g/dL were no different with respect to demographics, procedure type and comorbidities. The average postoperative time interval to transfusion was 2.1 days. Five patients required an intra-operative transfusion. The mean pre-operative Hb levels in transfused and non transfused patients were 12.4 g/dL and 13.5 g/dL respectively. The mean number of units transfused was 2.31. A total of 109 units of blood were used: of these 70 units were cross-matched pre-operatively.

Univariate analysis established a significant relationship between the need for postoperative transfusion and preoperative Hb levels (p< 0.0001), length of surgery (p=0.01), age (p=0.03), history of respiratory disease (p=0.028) and hypertension (p=0.01). There was no significant relationship with respect to ASA grade and procedure type. Multivariate logistic regression analysis revealed pre-operative Hb (p< 0.0001) and age (p=0.015) as the strongest predictors of the need for post-operative transfusion. There is a strong correlation between length of surgery and time interval to transfusion (p=0.037).

Conclusion: Utilisation rates of blood products after primary hip and knee arthroplasty procedures exceed that of what is available from pre-operative cross-matching. In our institution more than 20% of patients may have been transfused inappropriately based upon local guidelines. The decision to cross-match blood pre-operatively for elective arthroplasty procedures should be re-evaluated in light of both patient age and pre-operative Hb levels. Postoperative monitoring of Hb levels should be undertaken early in patients with a prolonged duration of surgery.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 175 - 175
1 May 2011
Patel S Hossain F El-Husseiny M Haddad F
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Introduction: Rupture of the anterior cruciate ligament (ACL) is a serious injury associated with symptomatic instability of the knee. There is an increasing trend for confirmation of diagnosis with magnetic resonance imaging (MRI) before proceeding to reconstruction. The overall sensitivity and specificity of diagnosis using this modality is more than 95%. It is however observer-dependent. We have developed a simple 4 point recognition card to increase the pick-up rate of this injury for professionals without specific radiological training such as orthopaedic trainees. The aim of this study was to determine how much improvement could be achieved using this card and whether any change was sustained.

Methods: 20 participants (orthopaedic trainees surgeons and medical students) were shown 20 MRI scans of the knee (10 with complete ACL ruptures and 10 with normal ACLs) and asked which scans were demonstrative of ACL pathology. Each participant was then randomly allocated to either having verbal teaching in the standard fashion about detection of ACL injuries [Group 1] or given written cards detailing a 4 point recognition plan for recognising ACL injuries on MRI [Group 2]. A repeat test of MRI scans was performed on each participant immediately after the teaching session and at 3 weeks.

Results: The mean time taken to teach Group A was 14 mins and Group B was 11 mins (p < 0.05). The mean number of correct diagnoses was 2.7/10 in Group A and 3.1/10 in Group B pre-intervention (p > 0.05). Immediately following intervention, there were 6.1 correct diagnoses in Group A and 8.2 in Group B (p < 0.05). At 3 weeks, there were 3.4 correct diagnoses in Group A and 7.9 in Group B (p < 0.05). The difference in number of correct diagnoses at 3 weeks compared to immediately following intervention was significant in Group A (p < 0.05), but not in Group B (p > 0.05).

Conclusions: The results support the use of the 4 point recognition card as to tool for increasing the pick-up of ACL injuries on MRI. It offers advantages over standard teaching Methods: since it takes less time to teach and the necessary information is retained to a greater degree than with traditional teaching methods.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 212 - 212
1 May 2011
Patel S Haddad F Soler JA Tahmassebi J Wardle N Hossain F
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Introduction: The bearing surface of total hip arthroplasty (THA) is a key factor in implant survivorship. Ceramic bearings have enhanced wear properties though are prone to fracture and thus Oxinium has been developed as an alternative. The aim of our study was to compare the its wear properties against cobalt-chrome which is currently the most widely used femoral head bearing surface in THA.

Methods: We prospectively randomized 270 consecutive patients undergoing THA at one institution into three groups: Groups I, II and III. Group I received a cobalt-chrome femoral head and cross-linked poly-ethylene (XLPE) liner; Group II received an oxinium femoral head and ultrahigh molecular weight polyeth-ylene (UHMWPE) liner; Group III received an oxinium femoral head and cross-linked polyethylene liner. 32 mm heads were used in all the cases. Patients were longitidunally followed up with clinical evaluation and standardised radiographs of the pelvis and hip. Using DICOMeasure software, we calculated the linear and volumetric wear rate for each group to determine if a difference existed.

Results: The demographics and comorbid conditions were similar between the groups. The survivorship of all components was 100% in all groups at 2 years. No patients were lost to follow-up. After the first 6 months of creep, the rate of linear wear over 2 years was 0.16mm for Group I, 0.10mm for Group II, and 0.06mm for Group III. ANOVA testing demonstrates statistical significance between the groups (P < 0.05).

Discussion and Conclusion: Our results demonstrate that the wear rate using 32mm Oxinium heads is significantly lower than that for cobalt-chrome heads and this effect is dramatically enhanced when used in combination with highly cross linked polyethylene.