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Bone & Joint Open
Vol. 2, Issue 5 | Pages 330 - 336
21 May 2021
Balakumar B Nandra RS Woffenden H Atkin B Mahmood A Cooper G Cooper J Hindle P

Aims

It is imperative to understand the risks of operating on urgent cases during the COVID-19 (SARS-Cov-2 virus) pandemic for clinical decision-making and medical resource planning. The primary aim was to determine the mortality risk and associated variables when operating on urgent cases during the COVID-19 pandemic. The secondary objective was to assess differences in the outcome of patients treated between sites treating COVID-19 and a separate surgical site.

Methods

The primary outcome measure was 30-day mortality. Secondary measures included complications of surgery, COVID-19 infection, and length of stay. Multiple variables were assessed for their contribution to the 30-day mortality. In total, 433 patients were included with a mean age of 65 years; 45% were male, and 90% were Caucasian.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_11 | Pages 9 - 9
1 Jun 2017
Balakumar B Patel K Madan S
Full Access

Purpose

We share our experience in management of failed in-situ pinning in severe unstable Slipped Capital Femoral Epiphysis (SCFE) by surgical dislocation approach.

Method

A retrospective review of hip database from 2006 to 2013 showed 41 children underwent surgical dislocation for SCFE. We identified seven who had severe slip with failed in-situ pinning.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_11 | Pages 6 - 6
1 Jun 2017
Balakumar B Pincher B Abouel-Enin S Blackey CM Thiagarajah S Madan S
Full Access

Purpose

This study aims to report the radiological corrections achieved and complication profile of Peri-Acetabular Osteotomy (PAO) undertaken through the minimally invasive approach.

Method

106 PAOs were performed in 103 patients, by senior author, using a minimally invasive approach from 2007 to 2015. Pre- and post-operative radiographs were reviewed and the degree of acetabular re-orientation was analysed. Case notes were examined retrospectively to identify haemoglobin levels and complications across two sites.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_11 | Pages 10 - 10
1 Jun 2017
Balakumar B Basheer S Madan S
Full Access

Purpose

This report compares midterm results of open neck osteoplasty + neck osteotomy vs arthroscopic osteoplasty for severe Slipped Capital Femoral Epiphysis (SCFE).

Method

Database from 2006 to 2013 identified 22 patients out of 187 operations for SCFE. 12 underwent Open Neck Osteotomy (ONO) and osteoplasty by Ganz surgical dislocation approach. 10 underwent Arthroscopic Osteoplasty (AO). The mean follow-up for the ONO and AO groups were 59 (46 – 70), 36.1 (33 – 46) months respectively.


The Bone & Joint Journal
Vol. 98-B, Issue 1 | Pages 21 - 27
1 Jan 2016
Basheer SZ Cooper AP Maheshwari R Balakumar B Madan S

Slipped capital femoral epiphysis (SCFE) may lead to symptomatic femoroacetabular impingement (FAI). We report our experience of arthroscopic treatment, including osteochondroplasty, for the sequelae of SCFE.

Data were prospectively collected on patients undergoing arthroscopy of the hip for the sequelae of SCFE between March 2007 and February 2013, including demographic data, radiological assessment of the deformity and other factors that may influence outcome, such as the presence of established avascular necrosis. Patients completed the modified Harris hip score (mHHS) and the non-arthritic hip score (NAHS) before and after surgery.

In total, 18 patients with a mean age of 19 years (13 to 42), were included in the study. All patients presented with pain in the hip and mechanical symptoms, and had evidence of FAI (cam or mixed impingement) on plain radiographs.

The patients underwent arthroscopic osteoplasty of the femoral neck. The mean follow-up was 29 months (23 to 56).

The mean mHHS and NAHS scores improved from 56.2 (27.5 to 100.1) and 52.1 (12.5 to 97.5) pre-operatively to 75.1 (33.8 to 96.8, p = 0.01) and 73.6 (18.8 to 100, p = 0.02) at final follow-up, respectively. Linear regression analysis demonstrated a significant association between poorer outcome scores and increased time to surgery following SCFE (p < 0.05 for all parameters except baseline MHHS).

Symptomatic FAI following (SCFE) may be addressed using arthroscopic techniques, and should be treated promptly to minimise progressive functional impairment and chondrolabral degeneration.

Take home message: Arthroscopy of the hip can be used to treat femoroacetabular impingement successfully following SCFE. However, this should be performed promptly after presentation in order to prevent irreversible progression and poorer clinical outcomes.

Cite this article: Bone Joint J 2016;98-B:21–7.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_23 | Pages 22 - 22
1 May 2013
Balakumar B Madhuri V
Full Access

Purpose

The correction obtained in the coronal plane knee deformity using guided growth was assessed in children with sick physes (Height<1SD of the normal children) to define the limits of this technique in sick physis

Methods

We retrospectively assessed deformity correction following guided growth using 8 plates in children with coronal plane deformity and metabolically abnormal physis- renal rickets in 6 and bone dysplasias (multiple epiphyseal dyspasia, spondyloepiphyseal dysplasia, metaphyseal dysplasia, mesomelic dysplasia, chondrodysplasia punctata) in 10 children aged 2 to 14 years. Lateral distal femoral angle(LDFA) and medial proximal tibia(MPTA) angles were serially assessed after eight plate application as a day care procedure. We noted correction achieved rate of correction, complications and additional surgical procedures. Fischer's exact test and multiple regression analysis was done to assess the effect of modifiers.