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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_9 | Pages 26 - 26
17 Apr 2023
Bhattacharya S
Full Access

Radioprotective gowns are an essential part of operating in orthopaedicse. As we are aware from the evidence, surgeons, and in particular orthopaedic surgeons, are at risk of developing chronic neck and back pain. This is likely a result of the combination of of long operations, heavy equipment, radioprotective gowns and poor ergonomic set up.

Women are a minority in orthopaedics. Amongst trainees there has been an improvement with 20–25% of current trainees are women, however at consultant level this percentage is a lot lower at 5–7%.

Radioprotective gowns worn by trainees are frequently not well fitted and few surgeons have access to bespoke fitted gowns. A questionnaire given to 32 trainees in the region found a significant burden of back pain in trainees and 57% of surgeons felt their gowns were not appropriately fitted. In this study every woman questioned reported back pain as a result of operating and 87% felt the gowns used exacerbated back pain, this figure was 56% in men.

80% of surgeons felt that surgeons would benefit from bespoke fitted gowns, even those that did not themselves have severe back pain. 45% of trainees felt their pain was moderate to severe. In surgery we have the responsibility to protect ourselves and our colleagues from work based injury and illness. Back pain should not be ignored as a symptom and radioprotective gowns is a good place to start.

Overall the majority the gowns exacerbated their back pain during or after procedures, worse in women as described above. We can use this data and do what we can to provide trainees with a range of sizes whilst working in hospitals during their training. Anectodally women sizes were less available in the departments and we can work to improve this and reduce the burden of pain amongst surgeons.


Bone & Joint Open
Vol. 2, Issue 10 | Pages 886 - 892
25 Oct 2021
Jeyaseelan L Sedgwick P El-Daly I Tahmassebi R Pearse M Bhattacharya R Trompeter AJ Bates P

Aims

As the world continues to fight successive waves of COVID-19 variants, we have seen worldwide infections surpass 100 million. London, UK, has been severely affected throughout the pandemic, and the resulting impact on the NHS has been profound. The aim of this study is to evaluate the impact of COVID-19 on theatre productivity across London’s four major trauma centres (MTCs), and to assess how the changes to normal protocols and working patterns impacted trauma theatre efficiency.

Methods

This was a collaborative study across London’s MTCs. A two-month period was selected from 5 March to 5 May 2020. The same two-month period in 2019 was used to provide baseline data for comparison. Demographic information was collected, as well as surgical speciality, procedure, time to surgery, type of anaesthesia, and various time points throughout the patient journey to theatre.


Bone & Joint Research
Vol. 10, Issue 1 | Pages 85 - 95
27 Jan 2021
Akhbari P Jaggard MK Boulangé CL Vaghela U Graça G Bhattacharya R Lindon JC Williams HRT Gupte CM

Aims

The diagnosis of joint infections is an inexact science using combinations of blood inflammatory markers and microscopy, culture, and sensitivity of synovial fluid (SF). There is potential for small molecule metabolites in infected SF to act as infection markers that could improve accuracy and speed of detection. The objective of this study was to use nuclear magnetic resonance (NMR) spectroscopy to identify small molecule differences between infected and noninfected human SF.

Methods

In all, 16 SF samples (eight infected native and prosthetic joints plus eight noninfected joints requiring arthroplasty for end-stage osteoarthritis) were collected from patients. NMR spectroscopy was used to analyze the metabolites present in each sample. Principal component analysis and univariate statistical analysis were undertaken to investigate metabolic differences between the two groups.


Bone & Joint Research
Vol. 9, Issue 3 | Pages 108 - 119
1 Mar 2020
Akhbari P Karamchandani U Jaggard MKJ Graça G Bhattacharya R Lindon JC Williams HRT Gupte CM

Aims

Metabolic profiling is a top-down method of analysis looking at metabolites, which are the intermediate or end products of various cellular pathways. Our primary objective was to perform a systematic review of the published literature to identify metabolites in human synovial fluid (HSF), which have been categorized by metabolic profiling techniques. A secondary objective was to identify any metabolites that may represent potential biomarkers of orthopaedic disease processes.

Methods

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines using the MEDLINE, Embase, PubMed, and Cochrane databases. Studies included were case series, case control series, and cohort studies looking specifically at HSF.


Bone & Joint Research
Vol. 6, Issue 10 | Pages 602 - 609
1 Oct 2017
Jin A Cobb J Hansen U Bhattacharya R Reinhard C Vo N Atwood R Li J Karunaratne A Wiles C Abel R

Objectives

Bisphosphonates (BP) are the first-line treatment for preventing fragility fractures. However, concern regarding their efficacy is growing because bisphosphonate is associated with over-suppression of remodelling and accumulation of microcracks. While dual-energy X-ray absorptiometry (DXA) scanning may show a gain in bone density, the impact of this class of drug on mechanical properties remains unclear. We therefore sought to quantify the mechanical strength of bone treated with BP (oral alendronate), and correlate data with the microarchitecture and density of microcracks in comparison with untreated controls.

Methods

Trabecular bone from hip fracture patients treated with BP (n = 10) was compared with naïve fractured (n = 14) and non-fractured controls (n = 6). Trabecular cores were synchrotron scanned and micro-CT scanned for microstructural analysis, including quantification of bone volume fraction, microarchitecture and microcracks. The specimens were then mechanically tested in compression.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_14 | Pages 8 - 8
1 Dec 2015
Mushtaq N Al Obaidi B Iranpour F Bhattacharya R
Full Access

Introduction

Different techniques for fixation of lateral malleolus have been described. We report our results of using fibula rod for unstable ankle fractures in level one major trauma centre.

Methods

We reviewed the results of 40 ankle fractures (14 open and 26 closed) with significant soft tissue injuries and open fractures that were treated with a fibula rod between 2012 and 2015. The median age of patients was 60 (17–98 years).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 348 - 348
1 Sep 2012
Thomas S Bhattacharya R Saltikov J Kramer D
Full Access

Background

Injury to the ACL is a significant problem and can cause further damage to the internal structures of the knee. ACL injury is associated with injuries to other structures in the knee such as the meniscus and chondral cartilage. Such intra articular injuries pre-dispose the knee to develop arthritis. This injury is usually seen in young and active people usually related to sporting injuries. There is a paucity of literature on the influence of anthropometric features on the hamstring graft obtained in ACL reconstruction, although there are studies on the sex based differences affecting the hamstring graft. This study was undertaken to assess the influence of anthropometric measurements on the graft thickness obtained at ACL reconstruction surgery within the UK population.

Objective

This study was undertaken to assess the influence of anthropometric measurements (body mass index (BMI), height and weight) on the graft thickness obtained at anterior cruciate ligament reconstruction surgery.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 170 - 170
1 Sep 2012
Scott C Bhattacharya R Macdonald D Wade F Nutton R
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Unicompartmental knee replacements (UKRs) have inconsistent and variable survivorships reported in the literature. It has been suggested that many are revised for ongoing pain with no other mode of failure identified. Using a medial UKR with an all-polyethylene non-congruent tibial component from 2004–7, we noted a revision rate of 9/98 cases (9.2%) at a mean of 39 months. Subchondral sclerosis was noted under the tibial component in 3/9 revisions with well fixed implants, and the aim of this study was to investigate this as a mode of failure. 89 UKRs in 77 patients were investigated radiographically (at mean 50 months) and with SF-12 and Oxford Knee scores at mean follow up 55 months. Subjectively 23/89 cases (25%) had sclerosis under the tibial component. We describe a method of quantifying this sclerosis as a greyscale ratio (GSR), which was significantly correlated with presence/absence of sclerosis (p<0.001). Significant predictors of elevated GSR (increasing sclerosis) were female sex (p<0.001) and elevated BMI (P=0.010) on both univariate and multivariate analysis. In turn, elevated GSR was significantly associated with poorer improvement in OKS (p<0.05) at the time of final follow up. We hypothesise that this sclerosis results from repetitive microfracture and adaptive remodelling in the proximal tibia due to increased strain. Finite element analysis is required to investigate this further, but we suggest caution should be employed when considering all polyethylene UKR implants in older women and in those with BMI >35.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 14 - 14
1 Jul 2012
Bhattacharya R Akhtar M Keating J
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Purpose

The aim of the present study was to investigate the relationship between generalised ligament laxity and requirement for revision ACL reconstruction.

Materials and methods

126 patients undergoing primary ACL reconstruction were included in the study along with 35 patients undergoing revision ACL surgery. 62 patients without any knee ligament injury formed an age and sex matched the control group.

The Beighton score was used to quantify the ligamentous laxity in all cases with a score more than 4 classified as having generalised ligamentous laxity. The revision ACL patients were evaluated to identify technical errors at the time of the primary procedure or subsequent traumatic injury that could have contributed to primary graft failure.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 89 - 89
1 Jul 2012
Bhattacharya R Scott C Morris H Wade F Nutton R
Full Access

Purpose

The aim of the present study was to look at survivorship and patient satisfaction of a fixed bearing unicompartmental knee arthroplasty with an all-polyethylene tibial component.

Materials and Methods

We report the survivorship of 91 fixed bearing unicompartmental arthroplasties with all-polyethylene tibial components (Preservation DePuy UK), which were used for medial compartment osteoarthritis in 79 patients between 2004 and 2007. The satisfaction level of patients who had not undergone revision of the implant was also recorded. For comparison, we reviewed 49 mobile bearing unicompartmental arthroplasties (Oxford UKA Biomet UK Ltd), which had been used in 44 patients between 1998 and 2007.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 156 - 156
1 Apr 2012
Bhattacharya D Cooke R Nagaria J
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Thoracic spinal cord herniation is a relatively uncommon syndrome of anterior hemi cord dysfunction. However it has been reported in literature with increasing frequency over the last decade. Since the initial description of this clinical entity by Weitzman et al. in 1974, more than 100 cases have been described.

Although clinical features may vary considerably, as a clinical syndrome it is now widely recognized, and remains a potentially treatable cause of thoracic cord dysfunction.

Anterior spinal or thoracic cord herniation remains an uncommon yet a potentially treatable cause of thoracic myelopathy. Patients usually present in their middle ages, and literature suggests that there is a female predominance. The presenting symptom is usually a Brown Sequard syndrome, although other symptoms suggestive of thoracic cord dysfunction may be present. Although the symptoms are insidious the condition may lead to progressive paraparesis. The herniation is usually through a dural defect, the cause of which open to speculation. Operative treatment is advised, as the outcomes are generally favourable.

As part of a continued focus on this clinical syndrome we describe below a series of 4 patients with thoracic spinal cord hernias that presented to our neurosurgical service over the past 3 years and our experience in the treatment of this condition. Apart from one patient, in whom there possibly was an iatrogenic factor, the rest were all purely idiopathic. All the patients underwent surgical treatment and their outcomes were generally favorable.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 313 - 314
1 Jul 2011
Ahmad M Bajwa A Patil S Bhattacharya R Nanda R Danjoux G Hui A
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Introduction: To quantify the magnitude and incidence of haemodynamic changes that occurs during the fixation of extracapsular proximal femoral fractures when using either intra-medullary or extra-medullary fixation device.

Methods: A prospective group of 31 patients with extra-capsular proximal femoral fractures were randomised to either fixation using an extra-medullary compression hip screw or an intra-medullary hip screw. All patients received a general anaesthetic adhering to a standardised anaesthetic protocol including invasive blood pressure monitoring and arterial blood gas sampling. Trans-oesophageal Doppler probe and monitor was used to record pre-operative hypovolaemia and peri-operative changes in cardiac output, stroke volume and corrected flow time (FTc – a reflection of left ventricular end diastolic pressure) during placement of implants.

Results: 77% of patients were hypovolaemic preoperatively, which was corrected with an average of 439 mls of colloid replacement fluid. Application of the extra-medullary CHS produced no change in haemodynamic function. However on insertion of the IMHS we found a statistically significant reduction in stroke volume, cardiac output and FTc without changes in pulse rate or mean arterial pressure. The changes were transient with normal cardiac function returning by 5 mins post operatively.

Conclusion: The transient fall in cardiac function during insertion of the intramedullary hip screw may be caused by fat embolism entering the venous circulation. As these changes are not detected with standard non-invasive monitoring we would recommend that intramedullary devices be used with caution in elderly patients who tend to have poor physiological reserve.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 356 - 356
1 May 2009
Barton T Gash K Da Costa TM Bhattacharya
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Theatre discipline remains a vital adjunct in the fight against infection in joint replacement surgery. The aim of this audit was to compare local theatre practise in two hospitals with that which is recommended in the literature. Factors assessed included the correct use of the ‘plenum’, the application of hats and masks, the opening of theatre doors intra-operatively, and the number of staff in the theatre.

Results suggest that basic principles and practises of theatre antisepsis are not being adhered to during joint replacement surgery. Suggestions are made as to how theatre behaviour may be improved in order to optimise the operating environment.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 242 - 242
1 May 2009
Thomas S Bhattacharya R Kramer D
Full Access

This study was undertaken to assess the influence of anthropometric measurements on the graft thickness obtained at anterior cruciate ligament reconstruction surgery.

Data from fifty one consecutive patients who had undergone ACL reconstruction by the same surgeon using double loop hamstring grafts were analysed. The body mass index, height and weight of these patients were correlated with the graft thickness obtained during surgery using non parametric tests (Spearman’s correlating coefficient).

There was a statistically significant positive correlation between the body weight and graft thickness (r = 0.32, p=0.02, n= 51). There was however, no correlation between the body mass index and height with the graft thickness.

Anthropometric measurements do not have as much influence on the thickness of the graft as would have been assumed, in ACL reconstruction surgery. Although the body weight has a positive correlation, the body mass index and height do not seem to have any appreciable influence on graft thickness.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 334 - 334
1 Jul 2008
Kumar V Hameed A Bhattacharya R Attar F McMurtry I
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Aim: 1. To assess the role of the CT scan in management of intra-articular fractures of the calcaneum. 2. Does the scan makes any difference to the management decision, obtained from assessing the plain radiograph?.

Methodology: This study involved 24 patients with intra-articular fracture of the calcaneum who had both a plain radiograph and a CT scan as a part of their assessment. Three consultants who were blinded to the actual management and names of the subjects were independently asked to grade the radiographs and CT scans, as operative or non-operative, on different occasions. The data was matched to the actual management and was subjected to statistical analysis.

Results: The data was non-parametric and related. The SIGN test was used to analyse the agreement between the three observers and if the decisions made in each of the groups were significantly different from the actual management. There was no statistically significant difference, between the management decision from the radiographs or CT and the actual management.

The change in management that the CT scan brought about was also assessed for each of the observers using the McNemars test. The CT scan did not make any significant difference to the decision made based on the plain radiographs, on whether to operate or not.

A Cochran Q test used to assess the variability of the decisions, showed that there was more inter-observer variability in decision making, using the CT based assessment (Q=9.50, p=0.009) as compared to plain radiographs (Q=3.84, p=0.14).

Conclusion: We conclude that, the CT scan should only be requested when a decision is made to operate on the fracture, based on plain radiographs. This may help with pre-operative planning of fracture fixation. It does not have to be obtained as a routine to assess all intra-articular fractures of the calcaneum.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_II | Pages 251 - 251
1 May 2006
Bhattacharya R Kumar V Hui A
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Purpose of the study: To determine usefulness of skyline x-ray in diagnosis of patellofemoral osteoarthritis.

Materials and Methods: 50 patients scheduled to undergo knee surgery, had standard antero-posterior, lateral and skyline x-rays of their affected knee. At operation, their patellofemoral joints were graded into two groups according to presence or absence of osteoarthritis. Their lateral and skyline x-rays were also graded into the same two groups, according to presence or absence of patellofemoral osteoarthritis. The two x-ray views were then compared individually against operative findings.

Results: The skyline view had sensitivity of 79% (95% confidence intervals (C.I.) 66% to 93%) and specificity of 80% (95% C.I. 62% to 98%). The lateral view had sensitivity of 82% (95% C.I. 69% to 95%) and specificity of 65% (95% C.I. 44% to 86%).

Conclusion: There was no statistically significant difference between the two x-ray views in terms of sensitivity and specificity in the diagnosis of patellofemoral osteoarthritis of the knee joint. Hence, we cannot recommend the skyline view as a routine radiological investigation in all cases of suspected patellofemoral osteoarthritis.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_II | Pages 166 - 166
1 Apr 2005
Bhattacharya R Jeon I Goodchild L Neumann L Wallace W Rangan A
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Purpose: To analyse preliminary outcomes of a new synthetic ligament used for reconstructing coraco-clavicular ligament in acromio-clavicular joint disruption.

Methods: Patients who underwent acromio-clavicular joint stabilisation using Nottingham Surgilig were followed up at average of 40 months (range 6–80 months) post operation. Apart from clinical and radiological assessment, the Constant-Murley scoring system and the Imatani scores were also used to measure outcome.

Results: Twenty patients underwent this operation and data was available on 19 of them. These patients had their operation after an average of 18 months following injury, during which period they had conservative treatment, except in 2 cases where a Weaver Dunn operation was performed initially.

The mean Constant score was 88 (s.d. 12). The mean Imatani score was 86 (s.d. 16). Most patients were satisfied with the operation (90%). There was one case of rupture through the central portion of the Surgilig, and following extensive laboratory analysis, the ligament has been modified since. One patient had a fracture of his coracoid while lifting heavy weights. In 4 patients there was clinical and radiological evidence of loosening of the screw but only 1 complained of this being a problem.

Conclusion: This is an initial medium term outcome analysis of the Nottingham Surgilig. Our results are promising and justify further use and evaluation of this relatively new technique.