Faizal Rayan - Academia.edu (original) (raw)

Papers by Faizal Rayan

Orthopaedic Proceedings, May 1, 2011

Abstract Introduction: Blood transfusion is not uncommon in patients following joint replacement ... more Abstract Introduction: Blood transfusion is not uncommon in patients following joint replacement surgery. However, allogeneic transfusion is associated with potential risks ranging from immune mediated allergic reactions to transmission of blood-borne ...

Colorectal Disease, 2005

Background Patients with inoperable advanced rectal carcinoma require palliation for local sympt... more Background Patients with inoperable advanced rectal carcinoma require palliation for local symptoms. Endoscopic Nd‐Yag laser ablation is a valid palliative treatment option in patients with advanced rectal carcinoma who are poor operative risks due to coexistent multiple comorbidities.Methods All patients who cannot undergo radical surgery due to various factors such as tumour size, poor risk patients, distant metastasis and refusal to undergo surgery were offered palliation with endoscopic Nd‐YAG laser ablation. Indications included troublesome bleeding, local recurrence, mucous discharge and impending obstruction. Patients were admitted on the day of treatment, phosphate enema given for bowel preparation and endoscopic ablation done through a flexible sigmoidoscope under intravenous sedation with midazolam. All patients were discharged the next day after overnight observation. Patients were reviewed every 3 months and laser ablation repeated if deemed necessary.Results Eleven patients (7 males, 4 females; mean age 83.6 years, range 77–90 years) underwent endoscopic laser ablation in a District General Hospital – 8 for rectal carcinoma, 2 for rectosigmoid tumour and 1 for recurrent tubulovillous adenoma. The number of treatment episodes varied from 1 to 12 with symptom free interval from 2 to 18 months between treatment episodes. There were 3 failures, one patient required defunctioning colostomy, one patient was referred for radiotherapy due to persistent symptoms and in one patient laser treatment had to be abandoned due to local extent. There were no immediate post‐treatment complications, but one patient developed incontinence after 5 episodes which might be attributable to tumour infiltration.Discussion Endoscopic laser ablation is a practical and feasible alternative to other palliative treatment modalities in the management of this unfortunate category of patients due to low morbidity and mortality, short hospitalization and low complication rates.

Hip International, Oct 1, 2010

Periprosthetic femoral fractures (PFF) are among the more difficult and expensive complications o... more Periprosthetic femoral fractures (PFF) are among the more difficult and expensive complications of total hip arthroplasty. A rise in the elderly population and increase use of primary hip replacement has led to an escalating incidence. They can occur intra operatively and post operatively. The treatment algorithm defined by the Vancouver classification has universal acceptance. The epidemiology, etiology, classification and the management of periprosthetic femoral fractures in total hip arthroplasty are reviewed.

Orthopaedic Proceedings, Oct 1, 2010

Background: Medial plica syndrome is the most common symptomatic plica. The size and shape of the... more Background: Medial plica syndrome is the most common symptomatic plica. The size and shape of the plica have an important impact on impingement on the femoral condyle and hence, symptoms. The validity of the classification systems of such injuries is essential for prospective studies. The study was designed to assess the reproducibility and reliability of Iino and Jee classification systems of medial plica syndrome. The agreement among multiple surgeons for medial plica syndrome has not been established before.Methods: We validated both classification systems independently from the original authors at our institution. Arthroscopic videos from 30 patients were reviewed by 6 consultant surgeons, 6 registrars and 6 house officers. Intra- and inter-observer reliability and reproducibility were assessed. Each observer scored the videos on two separate occasions and classified the medial plica according to its type (A, B, C and D) for Iino classification and (1, 2, 3 and 4) for Jee classification system.Results...

Orthopaedic Proceedings, Jul 1, 2011

Introduction: The radiographic evaluation of the antero-lateral femoral head is an essential tool... more Introduction: The radiographic evaluation of the antero-lateral femoral head is an essential tool for the assessment of cam type of femoroacetabular impingement. Computerised tomography (CT), magnetic resonance imaging and frog lateral plain radiograph views have all been suggested as imaging options for this type of lesion. The alpha angle is accepted as a reliable indicator of cam type of impingement and this may also be used as an assessment tool for successful operative correction of the cam lesion. The aim of our study was to analyse the reliability of The frog lateral view plain radiographs to analyse the alpha angle in cam femoroacetabular impingement. Patients and Methods: Thirty two patients who presented with femoroacetabular impingement were studied. Interobserver reliability for assessment of alpha angles on frog lateral radiographic view was analysed using intraclass correlation coefficient. The alpha angles measured on frog lateral views using digital templating tools were compared to those measured on CT scans. Results: A high interobserver reliability was noted for the assessment of alpha angles on frog lateral views with a correlation coefficient of 0.83. The average alpha angles measured on frog lateral views was 58.71 degrees (range 32 to 83.3). The average alpha angle measured on CT was 65.11 degrees (range 30 to 102). However, a poor correlation (Spearman r of 0.2) was noted between the measurements using the two systems. Conclusions: Frog lateral plain radiographs are not reliable predictors of alpha angle. Various factors may be responsible for this such as the projection of the radiographs, patient positioning and quality of images. CT imaging may be necessary for accurate measurement of the alpha angle.

British Journal of Surgery

Aim The National Hip Fracture Database (NHFD) encompasses key parameters to reduce mortality and ... more Aim The National Hip Fracture Database (NHFD) encompasses key parameters to reduce mortality and improve care in NOFF patients. Current practice across the NHS incorporates several different inpatient orthogeriatric models. Our quality improvement project sought to improve inpatient care delivered by orthopaedic staff with a geriatric targeted focus. Method An initial audit on 50 patients was conducted and key areas of concern were highlighted. A focussed proforma for daily reviews was implemented which encompassed local and national (NHFD) recommendations and this was re audited for a further 50 patients. Results Documentation of demographics, comoribidites and pre-operative social parameters improved from 70 to 100%. Examination of general health systems improved from 80 to 100%. Identification of nutritional abnormalities improved from 66 to 95%. Documentation of skin condition including wound care and pressure ulcers improved from 55 to 90%. Management of perioperative indwellin...

Introduction: In recent years, there has been a significant advancement in our understanding of f... more Introduction: In recent years, there has been a significant advancement in our understanding of femoro-acetabular impingement and associated labral and chondral pathology. Surgeons worldwide have demonstrated the successful treatment of these lesions via arthroscopic and open techniques. The aim of this study is to validate a simple and reproducible classification system for acetabular chondral lesions. Methods: In our classification system, the acetabulum is first divided into 6 zones as described by Ilizalithurri VM et al [Arthroscopy 24(5) 534–539]. The cartilage is then graded as 0 to 4 as follows: Grade 0 – normal articular cartilage lesions; Grade 1 softening or wave sign; Grade 2 – cleavage lesion; Grade 3 – delamination and Grade 4 -exposed bone. The site of the lesion is further typed as A, B or C based on whether the lesion is 1/3 distance from acetabular rim to cotyloid fossa, 1/3 to 2/3 distance from acetabular rim to cotyloid fossa and > 2/3 distance from acetabular ...

Introduction: The incidence of post-operative peri-prosthetic fractures is increasing. This is a ... more Introduction: The incidence of post-operative peri-prosthetic fractures is increasing. This is a consequence of the larger number of revision cases being undertaken, the increase in the use of cementless implants and a number of patients who develop undetected osteolysis as a result of poor follow up. The Vancouver classification has been shown to be a valid and reliable method for determining the configuration of periprosthetic fractures. This is essential in directing the further management of periprosthetic fractures appropriately. Methods: We have revalidated this classification system independently from the original authors at our institution. The radiographs from 30 patients with peri-prosthetic fractures were reviewed by 6 expert consultant surgeons, 6 non-experts at registrar level and 6 medical students, who had received no specialist training in this area, in order to assess intra and inter-observer reliability and reproducibility. Each observer read the radiographs on 2 s...

British Journal of Surgery, Aug 19, 2022

Aim: The NHS Institute for Innovations and Improvement (NIII) has determined that a £7 million sa... more Aim: The NHS Institute for Innovations and Improvement (NIII) has determined that a £7 million saving can be achieved per trust by improving theatre efficiency. With an increasing influx of admissions and trauma, alongside increasing trends pertaining to the pandemic and winter pressures, it is vital to optimise our patients' journey. Method: The journey of transition from pre-theatre to recovery was mapped and retrospective data on a single weekday theatre trauma list was collected over a one month stretch using ORMIS and 77 patients were identified and analysed. Results: The average case load was found to be 3.7 cases with lowest case load during the end of the week. The average send time for a patient was documented to being 8:45 (range:8:15-9:934) with an average turnaround time being 65 minutes for the first case and 37 minutes for subsequent cases. The average knife-to-skin time was found to be 10:00 for the first case (range:9:21-10:34). The median intercase time (time take from the patient leaving theatre to the next patient entering theatre) was found to be 47 minutes (range:15-49). Conclusions: Causes for delays in theatre flow were largely multifactorial and this impacted the first patient the most leading to a knock-on effect on subsequent patients on the list. With the NIII attributing an efficiency cost of £24.77/minute, there is a lot to be gained by maximising theatre efficiency particularly with current limited resources. A joint surgical and anaesthetic quality improvement project focusing on the golden patient was introduced with a patient focused approach. st Cycle: 30 responses; 36.70% confident/very confident. 2 nd Cycle: 7 responses; 85.70% confident/very confident and know when to refer; Ease of finding equipment remains variable; 71.5% found the guide to be clear/very clear.

MRI scan for the knee joint has often been regarded to be the non invasive alternative to a diagn... more MRI scan for the knee joint has often been regarded to be the non invasive alternative to a diagnostic arthroscopy. MRI scan is routinely used to support the diagnosis for meniscal or ACL injuries prior to recommending arthroscopic examination and surgery. Identification of meniscal tears can be difficult to interpret and can be observer dependent as well as dependent upon the sensitivity of the scanner. Similar difficulties may exists in clinical examination as well. Our aim was to compare and correlate clinical, MRI and arthroscopic findings in the diagnosis of meniscal and Anterior Cruciate Ligament (ACL) Injuries. This was an observational study of 131 patients over 36 months who had both MRI and arthroscopic surgery. Our study showed clinical examination had better sensitivity (0.86 vs 0.76)and specificity(0.73 v/s 0.52) in comparing to MRI in diagnosis of medial menisceal injuries. similarly +predictive value and −predictive value were higher for clinical examination. whereas ...

Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduct... more Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The management of large bone defects due to trauma, degenerative disease, congenital deformities, and tumor resection remains a complex issue for the orthopaedic reconstructive surgeons. The requirement is for an ideal bone replacement which is osteoconductive, osteoinductive, and osteogenic. Autologous bone grafts are still considered the gold standard for reconstruction of bone defects, but donor site morbidity and size limitations are major concern. The use of bioartificial bone tissues may help to overcome these problems. The reconstruction of large volume defects remains a challenge despite the success of reconstruction of small-to-moderate-sized bone defects using engineered bone tissues. The aim of this paper is to understand the principles of tissue engineering of bone and its clinical applications in reconstructive...

The aim of our study was to determine the usefulness of preoperative digital templating of cement... more The aim of our study was to determine the usefulness of preoperative digital templating of cementless total hip arthroplasty (THA). 60 consecutive cementless THA (synergy stem & reflection cup) were templated digitally by two senior hip arthroplasty fellows (GM, YG) independently. A metallic marker ball of known diameter was used in all images to help scale for magnification. A blinded observer then collated information on the actual implant sizes, size of head component, offset, and level of neck cut intraoperatively. This was used to statistically analyse the correlation (Interclass correlation coefficient) between the digitally templated implant sizes and actual implant sizes used and the reliability of digital templating. A high rate of coincidence between digitally templated estimates and actual implant sizes was noted for both groups of templates. A high intraclass correlation coefficient (ICC) for the acetabular cup, stem and head were noted (ICC of 0.825, 0.794, and 0.884 re...

Radiographic evaluation of the anterolateral femoral head is an essential tool for the assessment... more Radiographic evaluation of the anterolateral femoral head is an essential tool for the assessment of cam type of femoroacetabular impingement. Computerised tomography (CT), magnetic resonance imaging and frog lateral plain radiograph views have all been suggested as imaging options for this type of lesion. Alpha angle is accepted as a reliable indicator of cam type of impingement and this may also be used as an assessment tool for successful operative correction of the cam lesion. The aim of our study was to analyse the reliability of frog lateral view plain radiographs to analyse the alpha angle in cam femoroacetabular impingement. Thirty two patients who presented with femoroac-etabular impingement were studied. Interobserver reliability for assessment of alpha angles on frog lateral radiographic view was analysed using intraclass correlation coefficient. The alpha angles measured on frog lateral views using digital templating tools were compared to those measured on CT scans. A h...

Purpose of study: The diagnosis of meniscal tears is usually based on the patient’s history and o... more Purpose of study: The diagnosis of meniscal tears is usually based on the patient’s history and on specific physical tests. Magnetic resonance imaging (MRI) and arthroscopy is often necessary for diagnosis. Theofilos Karachalios et al. described the new ‘Thessaly test’ and concluded that it could be safely used as a first line screening test for the selection of patients who need arthroscopic meniscal surgery (Ref: J Bone Joint Surg Am. 2005 May; 87(5):955–62). Our objective was to study the role of physical diagnostic tests in screening for meniscal tears and to validate the diagnostic accuracy of the Thessaly test. Methods & Results: We examined 109 patients [(80 male, 29 female), average age 39.11 years, range (16–66)] who presented with a history suggestive of a meniscal tear. Joint line tenderness, McMurray’s test and the Thessaly test were assessed by an independent investigator blinded to any imaging data in all patients. MRI and subsequent arthroscopy results were then colla...

British Journal of Surgery, 2021

A service evaluation audit highlighted significant variation in our practice as regards catheteri... more A service evaluation audit highlighted significant variation in our practice as regards catheterisation in NOF patients. A pilot protocol was developed with real time data monitoring to see if we could improve our patients’ pathway. The protocol focussed on early catheterisation, monitoring the condition of patients’ skin, documentation around catheter care and removal instructions and surveillance for urinary tract infection rates (UTI) 150 patients were included in the pilot. There was a reduction by more than 50% of patients assessed as having at risk or broken skin. 94.5% of patients were catheterised out of theatres (previously only 4%) saving an average of 14 minutes of theatre time per case. Delays in catheter removal after documented request reduced by 2 days and our UTI rates were relatively unchanged (3.3% compared to 2.7%). Documentation significantly improved. We also noted that overall length of stay was reduced by 2 days. Standardising our care pathway has improved our...

HIP International, 2010

The aim of our study was to determine the usefulness of preoperative digital templating of Birmin... more The aim of our study was to determine the usefulness of preoperative digital templating of Birmingham hip resurfacing (BHR). This prospective cohort of 30 consecutive Birmingham hip resurfacings was templated digitally by two senior hip arthroplasty fellows (GM, JG) independently. A blinded observer then collated information on the actual implant sizes intraoperatively and used this to statistically analyse the correlation (Interclass correlation coefficient) between the digitally templated implant sizes and the actual implant sizes used. A significantly high rate of coincidence between digitally templated estimates and the actual implant sizes was noted for both groups of templates. The Intra class correlation coefficient (ICC) for the acetabular cup in the two groups were 0.798, p=0.013 and 0.870, p=0.0001. For the femoral component, the ICC values in the two groups were 0.888, p=0.005 and 0.784, p=0.003. Similarly a high reliability of digital templating was noted for both acetab...

The Journal of bone and joint surgery. British volume, 2011

There have been considerable recent advances in the understanding and management of femoroacetabu... more There have been considerable recent advances in the understanding and management of femoroacetabular impingement and associated labral and chondral pathology. We have developed a classification system for acetabular chondral lesions. In our system, we use the six acetabular zones previously described by Ilizaliturri et al. The cartilage is then graded on a scale of 0 to 4 as follows: grade 0, normal articular cartilage lesions; grade 1, softening or wave sign; grade 2, cleavage lesion; grade 3, delamination; and grade 4, exposed bone. The site of the lesion is further classed as A, B or C based on whether the lesion is less than one-third of the distance from the acetabular rim to the cotyloid fossa, one-third to two-thirds of the same distance and greater than two-thirds of the distance, respectively. In order to validate the classification system, six surgeons graded ten video recordings of hip arthroscopy. Our findings showed a high intra-observer reliability of the classificatio...

Stem cells international, 2012

The management of large bone defects due to trauma, degenerative disease, congenital deformities,... more The management of large bone defects due to trauma, degenerative disease, congenital deformities, and tumor resection remains a complex issue for the orthopaedic reconstructive surgeons. The requirement is for an ideal bone replacement which is osteoconductive, osteoinductive, and osteogenic. Autologous bone grafts are still considered the gold standard for reconstruction of bone defects, but donor site morbidity and size limitations are major concern. The use of bioartificial bone tissues may help to overcome these problems. The reconstruction of large volume defects remains a challenge despite the success of reconstruction of small-to-moderate-sized bone defects using engineered bone tissues. The aim of this paper is to understand the principles of tissue engineering of bone and its clinical applications in reconstructive surgery.

Journal of Pediatric Orthopaedics B, 2009

The aim of this study was to present the functional results of treatment of neglected clubfoot in... more The aim of this study was to present the functional results of treatment of neglected clubfoot in children with Moebius syndrome. A prospective analysis of seven patients with Moebius syndrome who had corrective surgery for clubfoot deformity was performed. Functional result using a modified American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire at an average follow-up of 58 months was analysed. Five children were able to have their foot flat on the ground. Additional corrective surgery was required in eight feet. Our experience of treating neglected clubfoot deformity in children with Moebius syndrome shows that correction of the deformity allows them to have a reasonable independent living.