Gurinder Bedi | Fortis Hospital (original) (raw)
Papers by Gurinder Bedi
Orthopaedic Proceedings, Sep 1, 2005
Introduction and Aims: Our experience with over 200 cases of Avon patellofemoral replacement (PFR... more Introduction and Aims: Our experience with over 200 cases of Avon patellofemoral replacement (PFR) in the elderly with severe arthritis has been satisfactory, so we have extended the indications to younger patients with severe symptoms and various pathologies. Method: Sixty-six knees in 53 patients (10M: 46F) under the age of 55 years (average 47 years) have been treated with an AVON PFR for the following conditions: PATHOLOGY NUMBER of Knees Isolated lateral facet OA 34 Failed realignment 12 Persistent subluxation/dislocation 5 Trochlear dysplasia 5 Pure chondral disease 3 Failed carbon fibre implant 3 Post-patellectomy instability 3 Post-traumatic pain 1 All patients were recorded prospectively and have been regularly reviewed using the modified Oxford, Bartlett & Bristol Knee scoring systems. The mean follow-up of the group is 24 months. Results: No patient has been lost to follow-up, all knee scores improved substantially. Most of the patients retained their range of flexion and the mean range of movement increased from 112 to 122 degrees. Patients with persistent subluxation were the most dramatically improved. There have been no cases of deep infection, loosening or wear. Conclusion: Avon PFR provides a reliable short-term solution to some of the more difficult and disabling problems of the patello-femoral joint as long as demonstrable pathology is present.
Orthopaedic Proceedings, May 1, 2006
Inadequate cementation remains a prime cause of aseptic loosening in Hip Arthroplasties. While go... more Inadequate cementation remains a prime cause of aseptic loosening in Hip Arthroplasties. While good progress has been made in preparation of femoral canal and cement, with newer techniques there are problems with ensuring adequate cement mantle. A distal centraliser available with some prosthesis does aid in better alignment and distal centralisation, but proximal centralisation remains a problem especially with some approaches. We have recently used a new prosthesis CPS (Endoplus) which has a smooth polished double tapered design and also comes with a proximal and distal centraliser. We undertook a study to evaluate the effect of these on cement mantle, stem alignment, centralisation and supero-medial cement thickness. We defined adequate mantle as a thickness of at least 2mm. 75 consecutive cases were included in the study. All cases were done either by or under direct supervision of the senior author using the antero-lateral approach. We found 88% of stem’s aligned within 2 deg. of anatomical axis of the femur. Distal tip of the prosthesis was within 2mm of centre of the medullary canal in 92% in the lateral view and in 95% in AP view. Deficiencies in cement mantle were noted in very few cases, zones 6 & 13 had the highest incidence but even here only 9% of cases had inadequate cementation. We find the centralisers a useful adjunct in cemented hip arthroplasty.
Journal of clinical orthopaedics and trauma, Dec 1, 2011
Orthopedics, Feb 2, 2003
This study evaluated the reliability of three rating systems for total knee arthroplasty. Twenty-... more This study evaluated the reliability of three rating systems for total knee arthroplasty. Twenty-nine patients were assessed by six observers with the American Knee Society Score, the British Orthopaedic Association Score, and the Oxford 12-item questionnaire. The inter- and intraobserver variations were calculated for the American Knee Society Score and the British Orthopaedic Association Score, as was the reproducibility of the Oxford 12-item questionnaire. Components of the scores were evaluated for agreement using Kappa statistics. The British Orthopaedic Association Score had smaller interobserver variation compared to the American Knee Society Score, and the greatest reproducibility of the three systems. This was attributed to the equal weighting of its component variables. The Oxford 12-item questionnaire, a self-administered questionnaire that eliminates interobserver error, emerged as the most reliable system. Observer experience affected the reliability of the American Knee Society Score and the British Orthopaedic Association Score. Subjective variables were more reliable and reproducible than the objective components.
Journal of clinical orthopaedics and trauma, Dec 1, 2012
j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a 3 (2 0 1 2) 7 5 e7 6
Journal of clinical orthopaedics and trauma, Dec 1, 2010
Journal of Arthroscopy and Joint Surgery, Sep 1, 2019
The purpose of the present study was to evaluate the outcome of arthroscopic stabilization of acu... more The purpose of the present study was to evaluate the outcome of arthroscopic stabilization of acute acromio-clavicular joint dislocation using a TightRope device. Material and methods: Between june 2015 to march 2017, 12 patients (9 males and 3 females), aged 39.5 (23e64) years underwent arthroscopic stabilization using a double-button device for acute (2e4 days) acromio-clavicular joint injury, which included acromio-clavicular joint dislocation Rockwood Type III (n ¼ 4), Type IV (n ¼ 5) and Type V (n ¼ 3). Data was collected retrospectively, and clinical assessment on follow-up included the Shoulder Constant Score and Visual Analogue Scale (VAS) for residual pain. Time of return to work was assessed and post-operative complications were recorded. Radiological examination consisted of antero-posterior (Zanca) view of the shoulder, and coraco-clavicular distance before and after surgery. Results: The mean follow-up period was 28.75 (12e38) months, where the Constant Score at final follow-up was 90.4 ± 3.06 and Visual Analogue Scale score was 0.58 (0e1) on activity. The coracoclavicular distance decreased from 20.18 ± 2.84 mm pre-operatively to 10.02 ± 0.39 mmat 6 months and 10.68 ± 0.55 mmat 1 year post-operatively. There were no failures. X-rays did not show acromioclavicular joint arthritis or lysis around the endo-button. There was no tenderness and no evidence of vertical or horizontal instability at the acromio-clavicular joint, but 4 patients had tenderness at the endo-button insertion site. All the patients returned to work after an average of 2.6 (2e4) months. Conclusion: Arthroscopic stabilization of acute acromio-clavicular joint dislocation using a TightRope device is a minimally invasive procedure with decreased post-operative morbidity. It allows early rehabilitation and consistently provides a satisfactory outcome when performed in the acute phase of injury.
Hip International, 2008
The aim of this study was to determine the efficacy and cost-effectiveness of the use of predonat... more The aim of this study was to determine the efficacy and cost-effectiveness of the use of predonation of autologous blood for the periacetabular osteotomy. We carried out a retrospective single surgeon series study looking at patient demographics, intraoperative blood loss, volume of red cells returned (by cell salvage and allogenic/autologous transfusion), and comparing pre-and postoperative haemoglobin levels in those that predonated and those that did not. One hundred and twenty-two procedures were performed on 107 patients between 1996 and 2005. An initial audit (22 procedures) revealed high wastage (45% returned) of allogenic blood. A predonation protocol was initiated and subsequently 100 procedures in 91 patients were performed. In 82 procedures, the patients were eligible for predonation. A total of 226 units of autologous blood were predonated and 92% was used. Only 13 of these patients (16%) required additional allogenic transfusion for unforeseen excessive blood loss intraoperatively. A set protocol for predonation reduces the need for allogenic transfusion and involves minimal wastage. In a procedure which has significant blood loss, we suggest that preoperative autologous donation is a safe and cost effective method of managing blood loss.
Purpose A new design of patello-femoral arthroplasty has been used to treat patients under 55 yea... more Purpose A new design of patello-femoral arthroplasty has been used to treat patients under 55 years suffering severe symptoms from chondral and early arthritic disease of the patello-femoral joint. Materials and Methods and Results Fifty-two patello-femoral arthroplasties were performed in 45 patients under the age of fifty-five years when other treatments had failed. The average age was 48 years (range 36–54 years). Thirty-seven cases had undergone previous surgery for a variety of conditions, and the causes of the disorders were analysed. Results were assessed using pain scores and Bartlett’s and Oxford functional scores. 35 cases were reviewed at 8 months and 22 cases at two years. The median pain score improved from 10/40 points to 35 at two years. The Bartlett score increased from 10/30 points to 27 and the Oxford score from 19/48 points to 35 at two years. The range of movement increased from 114° to 121°. There have been no cases of deep infection, loosening, wear or instabil...
Hip International, 2008
The aim of this study was to determine the efficacy and cost-effectiveness of the use of predonat... more The aim of this study was to determine the efficacy and cost-effectiveness of the use of predonation of autologous blood for the periacetabular osteotomy. We carried out a retrospective single surgeon series study looking at patient demographics, intraoperative blood loss, volume of red cells returned (by cell salvage and allogenic/autologous transfusion), and comparing pre-and postoperative haemoglobin levels in those that predonated and those that did not. One hundred and twenty-two procedures were performed on 107 patients between 1996 and 2005. An initial audit (22 procedures) revealed high wastage (45% returned) of allogenic blood. A predonation protocol was initiated and subsequently 100 procedures in 91 patients were performed. In 82 procedures, the patients were eligible for predonation. A total of 226 units of autologous blood were predonated and 92% was used. Only 13 of these patients (16%) required additional allogenic transfusion for unforeseen excessive blood loss intraoperatively. A set protocol for predonation reduces the need for allogenic transfusion and involves minimal wastage. In a procedure which has significant blood loss, we suggest that preoperative autologous donation is a safe and cost effective method of managing blood loss.
Acta Scientific Orthopaedics
Journal of Arthroscopy and Joint Surgery
Journal of Clinical Orthopaedics and Trauma, 2011
Shoulder injuries are extremely common in sportspeople involved in overhead sports and even in ca... more Shoulder injuries are extremely common in sportspeople involved in overhead sports and even in casual sportspersons. With increasing interest in activities such as tennis, golf, squash, badminton not to mention cricket, many of our colleagues are seeing a lot of these individuals with disabling pains. Many unnecessary investigations are being done where most diagnosis can be made by good clinical examination and knowledge of pathology. Therapy plays a very important part in the rehabilitation of these injuries, although again certain protocols have to be followed. The review will look at some of the common pathologies and also treatment options and also some specific injuries related to few sports.
Journal of Clinical Orthopaedics and Trauma, 2011
Journal of Clinical Orthopaedics and Trauma, 2010
Journal of Clinical Orthopaedics and Trauma, Dec 1, 2012
j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a 3 (2 0 1 2) 7 5 e7 6
Orthopedics, 2003
1. Orthopedics. 2003 Feb;26(2):143-9. Functional rating for knee arthroplasty: comparison of thre... more 1. Orthopedics. 2003 Feb;26(2):143-9. Functional rating for knee arthroplasty: comparison of three scoring systems. Liow RY, Walker K, Wajid MA, Bedi G, Lennox CM. Department of Trauma and Orthopedics, Hartlepool General Hospital, Hartlepool, Cleveland, United Kingdom. ...
Acta Orthopaedica, 2000
We have investigated the reliability of the American Knee Society Score (AKS), a widely used func... more We have investigated the reliability of the American Knee Society Score (AKS), a widely used functional outcome score for knee arthroplasty. 29 subjects were assessed in random order by 6 observers, each patient seen twice by each observer. The interobserver reference intervals were 16 points for the Knee Score (0-100 points) and 21 points for the Function Score (0-100 points). The intraobserver reference intervals were smaller, 11 points and 13 points for the Knee Score and the Function Score, respectively. The presence of arthritis in other joints and general debility did not affect the reliability of the scores. The more experienced observers had greater intraobserver reproducibility. Notably, we found moderate agreement between observers in the subjective variables, while the objective variables produced lower levels of agreement. The high inter- and intraobserver variations of the AKS makes estimation of score change questionable. Reliable use of the AKS would necessitate repeated evaluation by an experienced observer.
Orthopaedic Proceedings, Sep 1, 2005
Introduction and Aims: Our experience with over 200 cases of Avon patellofemoral replacement (PFR... more Introduction and Aims: Our experience with over 200 cases of Avon patellofemoral replacement (PFR) in the elderly with severe arthritis has been satisfactory, so we have extended the indications to younger patients with severe symptoms and various pathologies. Method: Sixty-six knees in 53 patients (10M: 46F) under the age of 55 years (average 47 years) have been treated with an AVON PFR for the following conditions: PATHOLOGY NUMBER of Knees Isolated lateral facet OA 34 Failed realignment 12 Persistent subluxation/dislocation 5 Trochlear dysplasia 5 Pure chondral disease 3 Failed carbon fibre implant 3 Post-patellectomy instability 3 Post-traumatic pain 1 All patients were recorded prospectively and have been regularly reviewed using the modified Oxford, Bartlett & Bristol Knee scoring systems. The mean follow-up of the group is 24 months. Results: No patient has been lost to follow-up, all knee scores improved substantially. Most of the patients retained their range of flexion and the mean range of movement increased from 112 to 122 degrees. Patients with persistent subluxation were the most dramatically improved. There have been no cases of deep infection, loosening or wear. Conclusion: Avon PFR provides a reliable short-term solution to some of the more difficult and disabling problems of the patello-femoral joint as long as demonstrable pathology is present.
Orthopaedic Proceedings, May 1, 2006
Inadequate cementation remains a prime cause of aseptic loosening in Hip Arthroplasties. While go... more Inadequate cementation remains a prime cause of aseptic loosening in Hip Arthroplasties. While good progress has been made in preparation of femoral canal and cement, with newer techniques there are problems with ensuring adequate cement mantle. A distal centraliser available with some prosthesis does aid in better alignment and distal centralisation, but proximal centralisation remains a problem especially with some approaches. We have recently used a new prosthesis CPS (Endoplus) which has a smooth polished double tapered design and also comes with a proximal and distal centraliser. We undertook a study to evaluate the effect of these on cement mantle, stem alignment, centralisation and supero-medial cement thickness. We defined adequate mantle as a thickness of at least 2mm. 75 consecutive cases were included in the study. All cases were done either by or under direct supervision of the senior author using the antero-lateral approach. We found 88% of stem’s aligned within 2 deg. of anatomical axis of the femur. Distal tip of the prosthesis was within 2mm of centre of the medullary canal in 92% in the lateral view and in 95% in AP view. Deficiencies in cement mantle were noted in very few cases, zones 6 & 13 had the highest incidence but even here only 9% of cases had inadequate cementation. We find the centralisers a useful adjunct in cemented hip arthroplasty.
Journal of clinical orthopaedics and trauma, Dec 1, 2011
Orthopedics, Feb 2, 2003
This study evaluated the reliability of three rating systems for total knee arthroplasty. Twenty-... more This study evaluated the reliability of three rating systems for total knee arthroplasty. Twenty-nine patients were assessed by six observers with the American Knee Society Score, the British Orthopaedic Association Score, and the Oxford 12-item questionnaire. The inter- and intraobserver variations were calculated for the American Knee Society Score and the British Orthopaedic Association Score, as was the reproducibility of the Oxford 12-item questionnaire. Components of the scores were evaluated for agreement using Kappa statistics. The British Orthopaedic Association Score had smaller interobserver variation compared to the American Knee Society Score, and the greatest reproducibility of the three systems. This was attributed to the equal weighting of its component variables. The Oxford 12-item questionnaire, a self-administered questionnaire that eliminates interobserver error, emerged as the most reliable system. Observer experience affected the reliability of the American Knee Society Score and the British Orthopaedic Association Score. Subjective variables were more reliable and reproducible than the objective components.
Journal of clinical orthopaedics and trauma, Dec 1, 2012
j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a 3 (2 0 1 2) 7 5 e7 6
Journal of clinical orthopaedics and trauma, Dec 1, 2010
Journal of Arthroscopy and Joint Surgery, Sep 1, 2019
The purpose of the present study was to evaluate the outcome of arthroscopic stabilization of acu... more The purpose of the present study was to evaluate the outcome of arthroscopic stabilization of acute acromio-clavicular joint dislocation using a TightRope device. Material and methods: Between june 2015 to march 2017, 12 patients (9 males and 3 females), aged 39.5 (23e64) years underwent arthroscopic stabilization using a double-button device for acute (2e4 days) acromio-clavicular joint injury, which included acromio-clavicular joint dislocation Rockwood Type III (n ¼ 4), Type IV (n ¼ 5) and Type V (n ¼ 3). Data was collected retrospectively, and clinical assessment on follow-up included the Shoulder Constant Score and Visual Analogue Scale (VAS) for residual pain. Time of return to work was assessed and post-operative complications were recorded. Radiological examination consisted of antero-posterior (Zanca) view of the shoulder, and coraco-clavicular distance before and after surgery. Results: The mean follow-up period was 28.75 (12e38) months, where the Constant Score at final follow-up was 90.4 ± 3.06 and Visual Analogue Scale score was 0.58 (0e1) on activity. The coracoclavicular distance decreased from 20.18 ± 2.84 mm pre-operatively to 10.02 ± 0.39 mmat 6 months and 10.68 ± 0.55 mmat 1 year post-operatively. There were no failures. X-rays did not show acromioclavicular joint arthritis or lysis around the endo-button. There was no tenderness and no evidence of vertical or horizontal instability at the acromio-clavicular joint, but 4 patients had tenderness at the endo-button insertion site. All the patients returned to work after an average of 2.6 (2e4) months. Conclusion: Arthroscopic stabilization of acute acromio-clavicular joint dislocation using a TightRope device is a minimally invasive procedure with decreased post-operative morbidity. It allows early rehabilitation and consistently provides a satisfactory outcome when performed in the acute phase of injury.
Hip International, 2008
The aim of this study was to determine the efficacy and cost-effectiveness of the use of predonat... more The aim of this study was to determine the efficacy and cost-effectiveness of the use of predonation of autologous blood for the periacetabular osteotomy. We carried out a retrospective single surgeon series study looking at patient demographics, intraoperative blood loss, volume of red cells returned (by cell salvage and allogenic/autologous transfusion), and comparing pre-and postoperative haemoglobin levels in those that predonated and those that did not. One hundred and twenty-two procedures were performed on 107 patients between 1996 and 2005. An initial audit (22 procedures) revealed high wastage (45% returned) of allogenic blood. A predonation protocol was initiated and subsequently 100 procedures in 91 patients were performed. In 82 procedures, the patients were eligible for predonation. A total of 226 units of autologous blood were predonated and 92% was used. Only 13 of these patients (16%) required additional allogenic transfusion for unforeseen excessive blood loss intraoperatively. A set protocol for predonation reduces the need for allogenic transfusion and involves minimal wastage. In a procedure which has significant blood loss, we suggest that preoperative autologous donation is a safe and cost effective method of managing blood loss.
Purpose A new design of patello-femoral arthroplasty has been used to treat patients under 55 yea... more Purpose A new design of patello-femoral arthroplasty has been used to treat patients under 55 years suffering severe symptoms from chondral and early arthritic disease of the patello-femoral joint. Materials and Methods and Results Fifty-two patello-femoral arthroplasties were performed in 45 patients under the age of fifty-five years when other treatments had failed. The average age was 48 years (range 36–54 years). Thirty-seven cases had undergone previous surgery for a variety of conditions, and the causes of the disorders were analysed. Results were assessed using pain scores and Bartlett’s and Oxford functional scores. 35 cases were reviewed at 8 months and 22 cases at two years. The median pain score improved from 10/40 points to 35 at two years. The Bartlett score increased from 10/30 points to 27 and the Oxford score from 19/48 points to 35 at two years. The range of movement increased from 114° to 121°. There have been no cases of deep infection, loosening, wear or instabil...
Hip International, 2008
The aim of this study was to determine the efficacy and cost-effectiveness of the use of predonat... more The aim of this study was to determine the efficacy and cost-effectiveness of the use of predonation of autologous blood for the periacetabular osteotomy. We carried out a retrospective single surgeon series study looking at patient demographics, intraoperative blood loss, volume of red cells returned (by cell salvage and allogenic/autologous transfusion), and comparing pre-and postoperative haemoglobin levels in those that predonated and those that did not. One hundred and twenty-two procedures were performed on 107 patients between 1996 and 2005. An initial audit (22 procedures) revealed high wastage (45% returned) of allogenic blood. A predonation protocol was initiated and subsequently 100 procedures in 91 patients were performed. In 82 procedures, the patients were eligible for predonation. A total of 226 units of autologous blood were predonated and 92% was used. Only 13 of these patients (16%) required additional allogenic transfusion for unforeseen excessive blood loss intraoperatively. A set protocol for predonation reduces the need for allogenic transfusion and involves minimal wastage. In a procedure which has significant blood loss, we suggest that preoperative autologous donation is a safe and cost effective method of managing blood loss.
Acta Scientific Orthopaedics
Journal of Arthroscopy and Joint Surgery
Journal of Clinical Orthopaedics and Trauma, 2011
Shoulder injuries are extremely common in sportspeople involved in overhead sports and even in ca... more Shoulder injuries are extremely common in sportspeople involved in overhead sports and even in casual sportspersons. With increasing interest in activities such as tennis, golf, squash, badminton not to mention cricket, many of our colleagues are seeing a lot of these individuals with disabling pains. Many unnecessary investigations are being done where most diagnosis can be made by good clinical examination and knowledge of pathology. Therapy plays a very important part in the rehabilitation of these injuries, although again certain protocols have to be followed. The review will look at some of the common pathologies and also treatment options and also some specific injuries related to few sports.
Journal of Clinical Orthopaedics and Trauma, 2011
Journal of Clinical Orthopaedics and Trauma, 2010
Journal of Clinical Orthopaedics and Trauma, Dec 1, 2012
j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a 3 (2 0 1 2) 7 5 e7 6
Orthopedics, 2003
1. Orthopedics. 2003 Feb;26(2):143-9. Functional rating for knee arthroplasty: comparison of thre... more 1. Orthopedics. 2003 Feb;26(2):143-9. Functional rating for knee arthroplasty: comparison of three scoring systems. Liow RY, Walker K, Wajid MA, Bedi G, Lennox CM. Department of Trauma and Orthopedics, Hartlepool General Hospital, Hartlepool, Cleveland, United Kingdom. ...
Acta Orthopaedica, 2000
We have investigated the reliability of the American Knee Society Score (AKS), a widely used func... more We have investigated the reliability of the American Knee Society Score (AKS), a widely used functional outcome score for knee arthroplasty. 29 subjects were assessed in random order by 6 observers, each patient seen twice by each observer. The interobserver reference intervals were 16 points for the Knee Score (0-100 points) and 21 points for the Function Score (0-100 points). The intraobserver reference intervals were smaller, 11 points and 13 points for the Knee Score and the Function Score, respectively. The presence of arthritis in other joints and general debility did not affect the reliability of the scores. The more experienced observers had greater intraobserver reproducibility. Notably, we found moderate agreement between observers in the subjective variables, while the objective variables produced lower levels of agreement. The high inter- and intraobserver variations of the AKS makes estimation of score change questionable. Reliable use of the AKS would necessitate repeated evaluation by an experienced observer.