Adil Ajuied - Academia.edu (original) (raw)

Papers by Adil Ajuied

Journal of Arthritis, 2015

Introduction: Navigated TKA (Total Knee Arthroplasty) has heightened awareness of mal-alignment i... more Introduction: Navigated TKA (Total Knee Arthroplasty) has heightened awareness of mal-alignment in conventional TKA, as well as providing an accurate means of measuring alignment intra-operatively. Debate as to the importance and significance of alignment versus knee balance continues. Aim: To assess cutting error, and examine the hypothesises: • 'Slotted osteotomies are more accurate than non-slotted' • 'Second pass of the saw blade improves the accuracy of osteotomies' Method: Three pairs of fresh frozen human knees were prepared, exposed, and positioned as for primary TKA. Standard cutting guides were used in conjunction with a clinical navigation system, and the error (difference between the achieved resection, and the planned resection) in each osteotomy was measured. A second, tidying, pass of the saw blade was made and the error re-measured. Cutting guides were used with a slotted and un-slotted technique in left and right knees respectively. A single experienced surgeon performed all 96 osteotomies. Results: Slotted tibial osteotomies are significantly more accurate in the sagittal (p=0.01) and coronal (p=0.04) planes. Second pass osteotomies reduce variability in femoral (p=0.07) and tibial (p=0.17) osteotomies. Discussion: The bone cutting process is prone to high levels of random error that can result in implant malalignment, and thus predispose to aseptic loosening. Navigated TKA gives the operating surgeon the opportunity to check each osteotomy, and correct any error where necessary. In conventional TKA the use of dual pass, slotted osteotomies should provide improved accuracy.

Skeletal radiology, 2016

To compare the diagnostic accuracy of magnetic resonance imaging (MRI), 2-dimensional magnetic re... more To compare the diagnostic accuracy of magnetic resonance imaging (MRI), 2-dimensional magnetic resonance arthrogram (MRA) and 3-dimensional isotropic MRA in the diagnosis of rotator cuff tears when performed exclusively at 3-T. A systematic review was undertaken of the Cochrane, MEDLINE and PubMed databases in accordance with the PRISMA guidelines. Studies comparing 3-T MRI or 3-T MRA (index tests) to arthroscopic surgical findings (reference test) were included. Methodological appraisal was performed using QUADAS 2. Pooled sensitivity and specificity were calculated and summary receiver-operating curves generated. Kappa coefficients quantified inter-observer reliability. Fourteen studies comprising 1332 patients were identified for inclusion. Twelve studies were retrospective and there were concerns regarding index test bias and applicability in nine and six studies respectively. Reference test bias was a concern in all studies. Both 3-T MRI and 3-T MRA showed similar excellent dia...

Orthopaedics and Trauma, 2015

Orthopaedics and Trauma, 2015

British Journal of Healthcare Management, 2012

ABSTRACT Statistics regarding aspects of hospital inpatient care are readily available in the pub... more ABSTRACT Statistics regarding aspects of hospital inpatient care are readily available in the public domain. This data is used by policy makers, healthcare commissioners and patients, to compare healthcare providers and inform decision-making. However, by convention these statistics are expressed in the form of the arithmetic mean, which is not an optimal tool for comparing healthcare providers. The authors propose that when comparing lengths of inpatient stay following hospital admissions of elective joint replacement surgery, the geometric mean and mode should be used. These measures are more meaningful to patients, and less sensitive to long stay outliers, which some specialist hospitals are predisposed to due to complexity of case mix, as well as for geographic and socioeconomic reasons. We conducted a comparative cohort study, reviewing prospectively collected length of stay data, for a central London teaching hospital and a Home Counties district general hospital. Our results support the use of the geometric mean and mode over the measures currently used.

JMED Research, 2014

ABSTRACT Anterior Cruciate Ligament (ACL) reconstruction is a well established and widely practic... more ABSTRACT Anterior Cruciate Ligament (ACL) reconstruction is a well established and widely practiced surgical procedure. Wide variation in surgical techniques and postoperative rehabilitation may predispose to early graft failure or sub-optimal functional outcomes. Surgical technique has been investigated extensively. There is little data as to the effect of rehabilitation regimens. This article assesses the current rehabilitation practices after ACL reconstruction within London, UK. Materials and Method: A survey of all NHS (National Health Service) physiotherapy departments that provide rehabilitation for patients undergoing isolated ACL reconstruction in the Greater London area. Results: 38 physiotherapy departments participated in our study. Of these, only 31 (81.6%) had written rehabilitation guidelines. A majority of departments, 31 (81.6%), adopted immediate post-operative full weight bearing. Day surgery ACL reconstruction was performed routinely at 27 (71.0%) units. Braces were used in only 12 (31.6%) departments. Rehabilitation milestones (e.g. return to sports) varied significantly across the study group. Discussion: This survey demonstrates a significant variation in rehabilitation regimens following ACL reconstruction. Current trends are towards day case surgery, immediate weight bearing, and reduced use of bracing. National ligament registries allow for multivariate analysis to identify variables associated with graft failure and sub optimal outcomes. Presently no registries collect data on rehabilitation regimens.

Hip International, 2013

We performed a systematic review to assess whether joint replacement in this very young patient ... more We performed a systematic review to assess whether joint replacement in this very young patient group provides significant functional improvement and whether these procedures are associated with good implant survivorship. The studies included presented the results of 450 THA procedures. All patients showed an improvement in functional score and symptom relief. Uncemented stems showed good integration with no signs of loosening. Cemented implants showed high rates of loosening. This study shows that THA in the very young patient can provide good functional improvement and relief of symptoms and that the more modern uncemented implant designs used with hard-on-hard bearings can be associated with improved implant survival. Long-term studies are necessary to confirm the superiority and improved survivorship of these newer implants.

Orthopaedics and Trauma, 2012

Orthopaedics and Trauma, 2013

ABSTRACT

The Journal of Arthroplasty, 2013

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014

To systematically review and assess the use of the Ligament Advanced Reinforcement System (LARS; ... more To systematically review and assess the use of the Ligament Advanced Reinforcement System (LARS; Surgical Implants and Devices, Arc-sur-Tille, France) for posterior cruciate ligament (PCL) reconstruction. A search of multiple databases was conducted using the following terms: (LARS[All Fields] AND posterior[All Fields]) OR (LARS[All Fields] AND PCL[All Fields]). The methodologic quality of each article was assessed by use of abridged Downs and Black criteria. Fifty-four studies were found from the database search, of which 5 were included in the final review (4 case series and 1 case-control study). One hundred twenty-nine PCL reconstructions with LARS were performed. The mean patient age was 32.2 years, with 89 male and 40 female patients included. The mean follow-up time ranged from 10.5 to 44 months. Lysholm scores improved from a mean of 64.8 preoperatively to 89.8 postoperatively. No patients had International Knee Documentation Committee grade 1 or 2 preoperatively, with 93.0% achieving this postoperatively. Only 1 case of synovitis and 1 case of graft rupture were reported. There is little evidence on the effectiveness of PCL reconstructions using LARS ligaments. What data there are show great promise, with short- and medium-term outcome data appearing favorable to autograft reconstruction. Complication rates are encouragingly low. LARS has great potential for PCL reconstruction. Further studies are needed regarding the use of LARS ligaments during PCL reconstruction, including longer follow-up periods and investigation into the optimal timing for reconstruction. This may be best achieved by way of a multicenter study.

The American Journal of Sports Medicine, 2013

Knee osteoarthritis after anterior cruciate ligament (ACL) injury has previously been reported. H... more Knee osteoarthritis after anterior cruciate ligament (ACL) injury has previously been reported. However, there has been no meta-analysis reporting the development and progression of osteoarthritis. We present the first meta-analysis reporting on the development and progression of osteoarthritis after ACL injury at a minimum mean follow-up of 10 years, using a single and widely accepted radiologic classification, the Kellgren & Lawrence classification. Meta-analysis. Articles were included for systematic review if they reported radiologic findings of ACL-injured knees and controls using the Kellgren & Lawrence classification at a minimum mean follow-up period of 10 years. Appropriate studies were then included for meta-analysis. Nine studies were included for systematic review, of which 6 studies were further included for meta-analysis. One hundred twenty-one of 596 (20.3%) ACL-injured knees had moderate or severe radiologic changes (Kellgren & Lawrence grade III or IV) compared with 23 of 465 (4.9%) uninjured ACL-intact contralateral knees. After ACL injury, irrespective of whether the patients were treated operatively or nonoperatively, the relative risk (RR) of developing even minimal osteoarthritis was 3.89 (P < .00001), while the RR of developing moderate to severe osteoarthritis (grade III and IV) was 3.84 (P < .0004). Nonoperatively treated ACL-injured knees had significantly higher RR (RR, 4.98; P < .00001) of developing any grade of osteoarthritis compared with those treated with reconstructive surgery (RR, 3.62; P < .00001). Investigation of progression to moderate or severe osteoarthritis (grade III or IV only) after 10 years showed that ACL-reconstructed knees had a significantly higher RR (RR, 4.71; P < .00001) compared with…

Orthopaedics and Trauma, 2015

Journal of Arthritis, 2015

Introduction: Navigated TKA (Total Knee Arthroplasty) has heightened awareness of mal-alignment i... more Introduction: Navigated TKA (Total Knee Arthroplasty) has heightened awareness of mal-alignment in conventional TKA, as well as providing an accurate means of measuring alignment intra-operatively. Debate as to the importance and significance of alignment versus knee balance continues. Aim: To assess cutting error, and examine the hypothesises: • 'Slotted osteotomies are more accurate than non-slotted' • 'Second pass of the saw blade improves the accuracy of osteotomies' Method: Three pairs of fresh frozen human knees were prepared, exposed, and positioned as for primary TKA. Standard cutting guides were used in conjunction with a clinical navigation system, and the error (difference between the achieved resection, and the planned resection) in each osteotomy was measured. A second, tidying, pass of the saw blade was made and the error re-measured. Cutting guides were used with a slotted and un-slotted technique in left and right knees respectively. A single experienced surgeon performed all 96 osteotomies. Results: Slotted tibial osteotomies are significantly more accurate in the sagittal (p=0.01) and coronal (p=0.04) planes. Second pass osteotomies reduce variability in femoral (p=0.07) and tibial (p=0.17) osteotomies. Discussion: The bone cutting process is prone to high levels of random error that can result in implant malalignment, and thus predispose to aseptic loosening. Navigated TKA gives the operating surgeon the opportunity to check each osteotomy, and correct any error where necessary. In conventional TKA the use of dual pass, slotted osteotomies should provide improved accuracy.

Skeletal radiology, 2016

To compare the diagnostic accuracy of magnetic resonance imaging (MRI), 2-dimensional magnetic re... more To compare the diagnostic accuracy of magnetic resonance imaging (MRI), 2-dimensional magnetic resonance arthrogram (MRA) and 3-dimensional isotropic MRA in the diagnosis of rotator cuff tears when performed exclusively at 3-T. A systematic review was undertaken of the Cochrane, MEDLINE and PubMed databases in accordance with the PRISMA guidelines. Studies comparing 3-T MRI or 3-T MRA (index tests) to arthroscopic surgical findings (reference test) were included. Methodological appraisal was performed using QUADAS 2. Pooled sensitivity and specificity were calculated and summary receiver-operating curves generated. Kappa coefficients quantified inter-observer reliability. Fourteen studies comprising 1332 patients were identified for inclusion. Twelve studies were retrospective and there were concerns regarding index test bias and applicability in nine and six studies respectively. Reference test bias was a concern in all studies. Both 3-T MRI and 3-T MRA showed similar excellent dia...

Orthopaedics and Trauma, 2015

Orthopaedics and Trauma, 2015

British Journal of Healthcare Management, 2012

ABSTRACT Statistics regarding aspects of hospital inpatient care are readily available in the pub... more ABSTRACT Statistics regarding aspects of hospital inpatient care are readily available in the public domain. This data is used by policy makers, healthcare commissioners and patients, to compare healthcare providers and inform decision-making. However, by convention these statistics are expressed in the form of the arithmetic mean, which is not an optimal tool for comparing healthcare providers. The authors propose that when comparing lengths of inpatient stay following hospital admissions of elective joint replacement surgery, the geometric mean and mode should be used. These measures are more meaningful to patients, and less sensitive to long stay outliers, which some specialist hospitals are predisposed to due to complexity of case mix, as well as for geographic and socioeconomic reasons. We conducted a comparative cohort study, reviewing prospectively collected length of stay data, for a central London teaching hospital and a Home Counties district general hospital. Our results support the use of the geometric mean and mode over the measures currently used.

JMED Research, 2014

ABSTRACT Anterior Cruciate Ligament (ACL) reconstruction is a well established and widely practic... more ABSTRACT Anterior Cruciate Ligament (ACL) reconstruction is a well established and widely practiced surgical procedure. Wide variation in surgical techniques and postoperative rehabilitation may predispose to early graft failure or sub-optimal functional outcomes. Surgical technique has been investigated extensively. There is little data as to the effect of rehabilitation regimens. This article assesses the current rehabilitation practices after ACL reconstruction within London, UK. Materials and Method: A survey of all NHS (National Health Service) physiotherapy departments that provide rehabilitation for patients undergoing isolated ACL reconstruction in the Greater London area. Results: 38 physiotherapy departments participated in our study. Of these, only 31 (81.6%) had written rehabilitation guidelines. A majority of departments, 31 (81.6%), adopted immediate post-operative full weight bearing. Day surgery ACL reconstruction was performed routinely at 27 (71.0%) units. Braces were used in only 12 (31.6%) departments. Rehabilitation milestones (e.g. return to sports) varied significantly across the study group. Discussion: This survey demonstrates a significant variation in rehabilitation regimens following ACL reconstruction. Current trends are towards day case surgery, immediate weight bearing, and reduced use of bracing. National ligament registries allow for multivariate analysis to identify variables associated with graft failure and sub optimal outcomes. Presently no registries collect data on rehabilitation regimens.

Hip International, 2013

We performed a systematic review to assess whether joint replacement in this very young patient ... more We performed a systematic review to assess whether joint replacement in this very young patient group provides significant functional improvement and whether these procedures are associated with good implant survivorship. The studies included presented the results of 450 THA procedures. All patients showed an improvement in functional score and symptom relief. Uncemented stems showed good integration with no signs of loosening. Cemented implants showed high rates of loosening. This study shows that THA in the very young patient can provide good functional improvement and relief of symptoms and that the more modern uncemented implant designs used with hard-on-hard bearings can be associated with improved implant survival. Long-term studies are necessary to confirm the superiority and improved survivorship of these newer implants.

Orthopaedics and Trauma, 2012

Orthopaedics and Trauma, 2013

ABSTRACT

The Journal of Arthroplasty, 2013

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014

To systematically review and assess the use of the Ligament Advanced Reinforcement System (LARS; ... more To systematically review and assess the use of the Ligament Advanced Reinforcement System (LARS; Surgical Implants and Devices, Arc-sur-Tille, France) for posterior cruciate ligament (PCL) reconstruction. A search of multiple databases was conducted using the following terms: (LARS[All Fields] AND posterior[All Fields]) OR (LARS[All Fields] AND PCL[All Fields]). The methodologic quality of each article was assessed by use of abridged Downs and Black criteria. Fifty-four studies were found from the database search, of which 5 were included in the final review (4 case series and 1 case-control study). One hundred twenty-nine PCL reconstructions with LARS were performed. The mean patient age was 32.2 years, with 89 male and 40 female patients included. The mean follow-up time ranged from 10.5 to 44 months. Lysholm scores improved from a mean of 64.8 preoperatively to 89.8 postoperatively. No patients had International Knee Documentation Committee grade 1 or 2 preoperatively, with 93.0% achieving this postoperatively. Only 1 case of synovitis and 1 case of graft rupture were reported. There is little evidence on the effectiveness of PCL reconstructions using LARS ligaments. What data there are show great promise, with short- and medium-term outcome data appearing favorable to autograft reconstruction. Complication rates are encouragingly low. LARS has great potential for PCL reconstruction. Further studies are needed regarding the use of LARS ligaments during PCL reconstruction, including longer follow-up periods and investigation into the optimal timing for reconstruction. This may be best achieved by way of a multicenter study.

The American Journal of Sports Medicine, 2013

Knee osteoarthritis after anterior cruciate ligament (ACL) injury has previously been reported. H... more Knee osteoarthritis after anterior cruciate ligament (ACL) injury has previously been reported. However, there has been no meta-analysis reporting the development and progression of osteoarthritis. We present the first meta-analysis reporting on the development and progression of osteoarthritis after ACL injury at a minimum mean follow-up of 10 years, using a single and widely accepted radiologic classification, the Kellgren & Lawrence classification. Meta-analysis. Articles were included for systematic review if they reported radiologic findings of ACL-injured knees and controls using the Kellgren & Lawrence classification at a minimum mean follow-up period of 10 years. Appropriate studies were then included for meta-analysis. Nine studies were included for systematic review, of which 6 studies were further included for meta-analysis. One hundred twenty-one of 596 (20.3%) ACL-injured knees had moderate or severe radiologic changes (Kellgren & Lawrence grade III or IV) compared with 23 of 465 (4.9%) uninjured ACL-intact contralateral knees. After ACL injury, irrespective of whether the patients were treated operatively or nonoperatively, the relative risk (RR) of developing even minimal osteoarthritis was 3.89 (P < .00001), while the RR of developing moderate to severe osteoarthritis (grade III and IV) was 3.84 (P < .0004). Nonoperatively treated ACL-injured knees had significantly higher RR (RR, 4.98; P < .00001) of developing any grade of osteoarthritis compared with those treated with reconstructive surgery (RR, 3.62; P < .00001). Investigation of progression to moderate or severe osteoarthritis (grade III or IV only) after 10 years showed that ACL-reconstructed knees had a significantly higher RR (RR, 4.71; P < .00001) compared with…

Orthopaedics and Trauma, 2015