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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_7 | Pages 6 - 6
1 May 2018
Raut P Chandler H Taranu R Eardley W
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All skeletally immature patients who presented with a supracondylar fracture between 01/09/2013 and 24/11/2015 (n = 50) were used to compare the current management of supra-condylar fractures of the humerus in children to the standards set by the BOAST 11 guidelines. 8.1% did not have full documentation of their neurovascular assessment. 93.9% underwent surgery within 24 hours of presentation. Average time to theatre for neurovascularly compromised patients was 4 hours 46 minutes. 81.8% were managed with 2 K-wires as recommended. Only 39.4% of the patients had their wires removed within 3 – 4 weeks. Only 6.1% had the recommended 2 mm wires. AO recommends the use of 2mm wires if 2 lateral wires are used whereas the BOAST 11 guideline recommends 2mm wires where possible. The results clearly demonstrate a need for further education and awareness of the BOAST 11 guidelines. Of particular interest is the documentation of patients' neurovascular status for appropriate management and for medico-legal purposes. Long term outcome comparison of surgical fixation with 2mm and 1.6mm wires would be useful to support the use of 2mm wires as recommended by the professional consensus in the BOAST 11 guidelines.


The Bone & Joint Journal
Vol. 97-B, Issue 12 | Pages 1657 - 1661
1 Dec 2015
Taranu R Rushton PRP Serrano-Pedraza I Holder L Wallace WA Candal-Couto JJ

Dislocation of the acromioclavicular joint is a relatively common injury and a number of surgical interventions have been described for its treatment. Recently, a synthetic ligament device has become available and been successfully used, however, like other non-native solutions, a compromise must be reached when choosing non-anatomical locations for their placement. This cadaveric study aimed to assess the effect of different clavicular anchorage points for the Lockdown device on the reduction of acromioclavicular joint dislocations, and suggest an optimal location. We also assessed whether further stability is provided using a coracoacromial ligament transfer (a modified Neviaser technique). The acromioclavicular joint was exposed on seven fresh-frozen cadaveric shoulders. The joint was reconstructed using the Lockdown implant using four different clavicular anchorage points and reduction was measured. The coracoacromial ligament was then transferred to the lateral end of the clavicle, and the joint re-assessed. If the Lockdown ligament was secured at the level of the conoid tubercle, the acromioclavicular joint could be reduced anatomically in all cases. If placed medial or 2 cm lateral, the joint was irreducible. If the Lockdown was placed 1 cm lateral to the conoid tubercle, the joint could be reduced with difficulty in four cases. Correct placement of the Lockdown device is crucial to allow anatomical joint reduction. Even when the Lockdown was placed over the conoid tubercle, anterior clavicle displacement remained but this could be controlled using a coracoacromial ligament transfer.

Cite this article: Bone Joint J 2015;97-B:1657–61.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 99 - 99
1 Sep 2012
Lakkol S Taranu R Reddy G Chandra B Friesem T
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Background

The factors that are considered to be associated with successful clinical outcome fallowing cervical arthroplasty surgery are patient selection, absence of facet joint changes and lack of pre-operative kyphosis. Even though many studies have cited the pre-operative demographic details of their patient groups, the effect of associated psychological co-morbidities (Depression/Anxiety), smoking history, gender, social benefits and employment status on the clinical outcome measures have not been reported. The aim of the study was to assess the influence of pre-operative patient characteristics on the clinical outcomes following cervical disc replacement.

Methods

We included 126 patients who underwent single or multiple level cervical arthroplasty in our unit were included in the study. The clinical outcome measures such as Visual Analogue Score for neck pain (VAS-NP) and arm pain (VAS-AP); Neck disability Index (NDI), Hospital depression and anxiety scale and Bodily pain component of Short Form 36 questionnaires (SF-36 P) were recorded pre and post operatively. Statistical analysis was completed using SPSS 16.0 statistical package (SPSS Inc, Chicago, IL).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 278 - 278
1 Sep 2012
Aranganathan S Aranganathan S Lakkol S Taranu R Reddy G Friesem T Kang J
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Introduction

The implantation of DIAM in interspinous space is believed to act as facet joints and provides stability to operated segment by shifting instantaneous axis of rotation forward in lordotic disorders. In this retrospective study, the patients who underwent lumbar surgery with DIAM (Medtronic Sofamor, Danek) spacer implants were followed up with an aim to evaluate the clinical outcomes. To our knowledge, this is the largest series with longest follow up.

Material Methods

Patients who underwent lumbar surgery (discectomy and decompression) with concomitant placement of DIAM spacer within a 36-months period were included. A total of 52 patients including equal number of male (n=26) and female (n=26), were followed up for 12 to 45 months (Mean: 22 months).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 100 - 100
1 Sep 2012
Lakkol S Aranganathan S Reddy G Taranu R Friesem T
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Introduction

In the last decade, single level cervical arthroplasty has proven its efficacy as one of the surgical treatment option for for patients suffering from cervical degenerative disc disease. Recent published reports on multilevel cervical arthroplasty using single implants have shown statistically significant results when compared to single level surgery. The aim of this study is to compare the clinical outcomes of multilevel cervical arthroplasty to single level cervical arthroplasty, when more than one type of implants were used.

Methods

This is a prospective study of consecutive patients who presented to our unit in between June 2006 and November 2009. The maximum follow-up period was 51 months (mean=18 months). Several types of cervical arthroplasty devices have been used in this study. The clinical outcome measures such as Visual Analogue Score for neck pain (VAS-NP) and arm pain (VAS-AP); Neck disability Index (NDI) and the Bodily pain component of Short Form 36 questionnaires were recorded pre and post operatively. After confirming the normality of the data appropriate parametric (paired t-test) were used to assess the statistical significance (p< 0.05) between pre and post-operative values. Two sample T-test was used to assess the significance between the differences in mean scores between each group.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 6 - 6
1 Jun 2012
Taranu R Lakkol S Aranganathan S Bhatia CK Reddy G Friesem T
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Introduction

This study aims to evaluate the impact of associated psychological co-morbidities (Depression/Anxiety), smoking history, gender, work benefits and employment status on the clinical outcome following anterior cervical disc replacement (ACDR).

Materials and Methods

We included in our study 100 patients who underwent ACDR in our Spinal Unit (between May 2006 – May 2010). We used as clinical outcome measures: Visual Analogue Score for neck pain (VAS-NP) and arm pain (VAS-AP), Neck Disability Index (NDI) and Bodily Pain (SF36-BP) component of the Short Form 36 questionnaire. Statistics were obtained using SPSS 16.0 for Windows (SPSS Inc, Chicago, IL). Independent sample t-test for normally distributed data and Man-Whitney U test for non-parametric data were used. Statistical significance was designated at p < 0.05.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 89 - 89
1 Jun 2012
Lakkol S Lingutla K Taranu R Kang J Reddy G Friesem T
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Background

We present the results of a single centre, prospective study to evaluate the clinical and radiographic outcomes of anterior cervical decompression and replacement (ACDR) using the NuNec(tm) Cervical Arthroplasty System (Pioneer Surgical Technology, Marquette, Mich., USA).

Methodology and Results

36 patients with radiculopathy/myelopathy, who failed to respond to conservative measures, were included. Pain and function were evaluated by Visual Analogue score for Neck pain (VAS-NP) and Arm pain (VAS-AP), Neck disability index (NDI) and SF-36 questionnaires. Radiological assessments include assessing overall range of movement (ROM) and at functional segment unit (FSU). Statistical analysis was completed using SPSS 16.0 statistical package (SPSS Inc, Chicago, IL). Appropriate parametric (A paired t-test) and non parametric tests (Wilcoxon signed-rank test) were used to assess the statistical significance (p<0.05).

The average age at operation was 51 years (range 35 - 77years). 8 patients received ACDR at one-level, 15 had 2-level surgery, 12 had 3-level surgery and 1 had a 4-level surgery. At the time of final follow-up (Mean 14.25 months, Range 12- 22.5 months) the mean NDI improved from 49.35; to 33.78 (p< 0.001). There statistically significant improvement note in VAS-NP (Post-op3.65, Pre-op:8.16, p<0.001), VAS-AP (Post-op:3.12, Pre-op:7.32, p<0.001) and SF-36BP (pre-op:29.15, post-op:37.18, p<0.002). The overall global ROM movement was preserved (pre-op:46.80±10.52, post-op:45.04±11.53) and an improvement in ROM at FSU was observed (pre-op:16.60±8.50, post-op:20.22±12.22) at final follow–up.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 36 - 36
1 Jun 2012
Lakkol S Taranu R Lingutla K Hadgaonkar S Krishna M Bhatia C
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Introduction

We present our experience of 22 patients with low grade degenerative lumbar spondylolysthesis with stenosis (21 Grade I and 1 Grade II) who were treated using new stabilization systems {Scient'x IsoBar TTL Dynamic Rod Stabilization and the Inlign™ Multi-Axial pedicle Screws (Disc Motion Technologies - DMT)}.

Methodology and Results

The pain intensity was evaluated using the Visual Analogue Score for back pain (VAS-BP) and leg pain (VAS-LP) and functional outcomes using Oswestry Disability Score (ODS). Overall improvement in general patient's health was assessed using the Bodily Pain (SF36-BP) component of the SF -36 questionnaires. Data was analysed with the SPSS 16.0 for Windows (SPSS Inc, Chicago, IL). Statistical significance was designated at p < 0.05 and appropriate parametric (Paired sample t-test) and non parametric tests (Wilcoxon signed-rank test) were used.

There were 3 male and 19 female patients and average age at operation was 68.95 years (57-79 years). The average duration of follow up was 16.18 months (8-37 months). Most common level of surgery was L4/5 (n=18). Decompression and instrumentation involved 1 level (7 cases), 2 levels (9 cases), 3 levels (1 case) and 4 levels (5 cases). There was statistically significant improvement in all clinical outcomes. The ODS improved from 49.45 ±14.35 pre-operatively to 22.91 ± 6.38 post operatively (p< 0.001). There was statistically significant improvement noted in VAS-BP (p< 0.001), VAS-LP (p<0.001) and SF36-BP (p=0.002).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 90 - 90
1 Jun 2012
Lakkol S Taranu R Raju P Trewhella M Dennis R Reddy G Friesem T
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Aim

The purpose of this study is to compare the pre and post-operative magnetic resonance image clarity of titanium and PEEK based cervical arthroplasty devices at the level of implantation and adjacent level discs.

Methodology and Results

This is a prospective, blinded, randomised study on imaging of cervical arthroplasty devices. The pre and postoperative MRI images of 16 patients who underwent cervical arthroplasty using Prestige LP(r) (Medtronic Sofamor Danek) and NuNec(tm) Cervical Arthroplasty System (Pioneer Surgical Technology, Marquette, Mich., USA) were assessed. Two independent radiologists who were blinded and provided with a sets of random images to score using a four point Jarvick grading system. Statistical analysis was completed using SPSS 16.0 statistical package (SPSS Inc, Chicago, IL) and analysis included comparing MR image quality before and after cervical arthroplasty at the operated and adjacent levels, and in between two types of implant.

The pre-operative MR image quality at operated and adjacent levels was excellent in both groups. In the post-operative images, the adjacent level visualisation was adequate in both groups without much difference in average scores. However, at operated level, the quality of MR images in the NuNec group (PEEK on PEEK articulating disc) was excellent and clear visualisation of the cord, central canal, foramen and disc.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 11 | Pages 1518 - 1523
1 Nov 2011
Lakkol S Bhatia C Taranu R Pollock R Hadgaonkar S Krishna M

Recurrence of back or leg pain after discectomy is a well-recognised problem with an incidence of up to 28%. Once conservative measures have failed, several surgical options are available and have been tried with varying degrees of success. In this study, 42 patients with recurrent symptoms after discectomy underwent less invasive posterior lumbar interbody fusion (LI-PLIF). Clinical outcome was measured using the Oswestry Disability Index (ODI), Short Form 36 (SF-36) questionnaires and visual analogue scales for back (VAS-BP) and leg pain (VAS-LP). There was a statistically significant improvement in all outcome measures (p < 0.001). The debate around which procedure is the most effective for these patients remains controversial.

Our results show that LI-PLIF is as effective as any other surgical procedure. However, given that it is less invasive, we feel that it should be considered as the preferred option.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 194 - 194
1 May 2011
Kasis A Taranu R Marshman L Friesem T
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Introduction: There is an increasing interest in the concept of motion preservation in cervical disc degeneration surgery. There is still a controversy regarding the effect of posterior placement of the disc on the segmental motion of the treated level.

The objective of this study is to assess the effect (if any) of posterior placement of the LP Prestige disc on the motion.

To our knowledge this is the first study to assess the relation of posterior placement on the motion.

Material and Methods: We retrospectively reviewed 186 prosthesis implanted in 130 patients who underwent an LP Prestige cervical disc replacement and decompression. The distance between the posterior edge of the lower plate of the LP Prestige disc and the posterior wall of the corresponding vertebra was measured. The measurement was performed on a digitalized lateral view x-rays. The posterior placement measurement was correlated to the range of motion of the device on the same level and also on the level above and bellow.

Results: The average age was 46.7 years (range 33–66). The mean posterior placement was 2.96 mm (range 0–6 mm). Range of motion (full flexion to full extension) of the prosthesis was 9.41 degrees (range 0.2–22). Average followup was 2.3 years.

Statistical analysis showed no statistical significant correlation between the posterior placement of the disc and the motion of disc (flexion to extension, flexion to neural and neutral to extension). The p value was 0.259, 0.379 and 0.623 respectively. There was no correlation between the placement of the disc and the motion of the level above and bellow the operated level.

Conclusion: We conclude from our study that there is no correlation between the posterior placement of the Prestige LP and the segmental motion of the prosthesis and the level above and bellow.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 194 - 194
1 May 2011
Kasis A Taranu R Marshman L Friesem T
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Introduction: Cervical disc replacement has emerged as an alternative to the gold standard ACDF in ordered to preserve the motion of the cervical spine, and reduce the risk of adjacent degenerative changes. However, little data actually exists to support or refute the effect of symptoms chronicity on TDA for the treatment of degenerative cervical spine.

Material and Methods: We prospectively investigated 130 consecutive patients who have undergone a Prestige LP cervical disc replacement for degenerative disease causing chronic neck pain and radiculopathy.

The pre and post-operative NDI, SF-36, Visual Analogue Score (VAS), HDS and HAS were recorded.

Results: There were 130 patients in total. There were 66 males and 64 females, with an mean age at surgery was 51.12 +/− 0.84. Seventy five patients had one level disc replacement, and 56 had 2 levels.

The mean follow up was 28+/−0.35 months, and the mean duration of symptoms was 34.46 +/−3.8 months. Mean length of stay 1.75+/−0.11 (1–4)

There was no correlation between the DOS and any of the functional outcome:

Improvement Neck disability index (r=−0.181, p=0.134)

Improvement in HDS (r=−0.126, p=0.296)

Improvement in HAS (r=0.00, p=0.99)

Improvement in SF-36 bodily pain (r=−0.011, p=0.925)

Improvement in SF-26 mental health (r=0.042, p=0.324)

Improvement in VAS neck pain (r=−0.0120, p=0.324)

Improvement in VAS arm pain (r=0.0178, p=0.141)

Dividing the DOS into more or less than 12 months shows significant improvement only in the NDI: less than 12 months DOS (31.85±3.209) and in patients with more than 12 months DOS (19.71±2.164), p=0.002

While there was no statistical difference in the other outcomes.

Dividing the DOS into more or less than 24 months showed significant improvement the out come in patients with less than 24 months in the following outcomes:

Improvement in NDI: less than 24 months (27.35±2.714), more thank 24 months (19.72+2.435), p=0.04

Improvement in VAS arm pain: less than 24 months (4.6000±0.34446), more than 24 months (2.7414±3.7236), p=0.001

Improvement in hospital depression score: less than 24 months (5.37±0.589), more than 24 months (3.60±0.47), p-0.023

Improvement in hospital anxiety score: less than 24 months (4.28±0.49), more than 24 months (2.45±0.48), p=0.009

While there was no significant difference in the other outcomes

Dividing the DOS into less or more than 36 months showed no statistical difference in any of the outcome,

That was also the case when the DOS was divided into more or less than 48 months.

Conclusion: Duration of symptoms of more that 24 months was associated with less favorable outcome, that was evident in improvement in NDI, HDS, HAS and VAS arm pain. Patients should be counseled when they present with DOS more than 24 months.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 369 - 369
1 Jul 2010
Torres P Taranu R Quinby J
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The aims of this study were to compare the outcome of epiphysiodesis in patients with limb length discrepancy (LLD) as a result of cerebral palsy with those as a result of other causes in order to test our hypothesis that the hemiplegic / monoplegic limb may respond differently to epiphysiodesis, to evaluate the accuracy of the Moseley method and evaluate whether there is any difference between the outcomes of left or right hemiplegic limbs with LLD bearing in mind that the left hand is used for bone age calculations.

We reviewed the case notes and radiographs of 34 children who had undergone epiphysiodesis for the management of LLD by the same surgeon, using the Moseley method between February 1999 and May 2005 to final follow up at skeletal maturity. Of the 34 patients, 9 had a LLD as a result of cerebral palsy (4-Left, 5-Right) and 25 as a result of other causes. In the cerebral palsy group the mean residual LLD was 0.59cm and in the other group it was 1.18cm. Both groups were similar in terms of age and sex distribution. There was no demonstrable statistically significant difference in outcome between the 2 groups (unpaired T test, P=0.734). The Moseley method appeared accurate and there was no difference demonstrated in the outcome between left and right hemiplegic LLD.

We conclude that the Moseley method is reliable. We have not found any evidence that the hemiplegic limb behaves any differently. We have not demonstrated any difference in the outcome of left or right hemiplegic limbs.