Gerard Ee - Academia.edu (original) (raw)

Papers by Gerard Ee

Abstract: Meniscal cysts are rare and often are a result of extrusion of synovial fluid through a... more Abstract: Meniscal cysts are rare and often are a result of extrusion of synovial fluid through a tear of the meniscus, resulting in a one-way valve effect of the tear. Arthroscopic partial meniscectomy of the meniscus with intra-articular cyst drainage has become the standard of care. We report a case of an unusually large symptomatic medial meniscal cyst, situated postero-medially and pressing on the posterior cruciate ligament, which was initially clinically misdiagnosed as a Baker’s cyst. The patient had difficulty and pain on squatting. He was successfully treated with arthroscopic debridement and needle decompression; a rarity in literature for such a voluminous perilabral cyst tenting the posterior cruciate ligament. This procedure has the advantage of being able to obtain the cystic fluid for histological and cytological analysis before debridement. This case also highlights the importance of the use of Magnetic Resonance Imaging (MRI) to accurately diagnose a central, poste...

Restoration of the native joint line in total knee arthroplasty is important in restoring ligamen... more Restoration of the native joint line in total knee arthroplasty is important in restoring ligamentous balance and normal knee kinematics. Failure to achieve this could lead to reduced range of motion, patellofemoral maltracking and suboptimal outcomes. The purpose of this study was to analyse the clinical and functional outcome of patients who demonstrated joint line changes after computer-assisted (CAS) total knee arthroplasty (TKA). A prospective study was conducted for 168 patients (168 knees) who underwent CAS TKA by two surgeons at a single institution with an average follow-up of two years. The final change in joint line was calculated from the verified tibial resection, distal and posterior femoral cuts. Group A patients had joint line changes of less than 4mm and Group B patients had joint line changes of more than 4mm. Postoperative Oxford scores, Knee scores, Function scores and SF-36 scores were obtained at six months, one year and two years post-TKA. The final range of m...

Orthopaedic Proceedings, Oct 1, 2012

Restoration of the native joint line in total knee arthroplasty is important in restoring ligamen... more Restoration of the native joint line in total knee arthroplasty is important in restoring ligamentous balance and normal knee kinematics. Failure to achieve this could lead to reduced range of motion, patellofemoral maltracking and suboptimal outcomes. The purpose of this study was to analyse the clinical and functional outcome of patients who demonstrated joint line changes after computer-assisted (CAS) total knee arthroplasty (TKA). A prospective study was conducted for 168 patients (168 knees) who underwent CAS TKA by two surgeons at a single institution with an average follow-up of two years. The final change in joint line was calculated from the verified tibial resection, distal and posterior femoral cuts. Group A patients had joint line changes of less than 4mm and Group B patients had joint line changes of more than 4mm. Postoperative Oxford scores, Knee scores, Function scores and SF-36 scores were obtained at six months, one year and two years post-TKA. The final range of motion and the mechanical alignment were documented. There was significant linear correlation between joint line changes and Oxford scores (p = 0.05) and Function scores (p = 0.05) at six months and Oxford scores alone at two years with increasing joint line changes having poorer outcome scores. Group A compared to Group B patients have better outcomes in terms of Oxford scores (mean 20 vs 27, p = 0.0003), Function scores (mean 69 vs 59, p = 0.03), SF-1 (mean 63 vs 50, p = 0.03), SF-2 (mean 66 vs 43, p = 0.05), SF-5 (mean 75 vs 63, p = 0.04), SF-6 (mean 84 vs 59, p = 0.003), SF-7 (mean 96 vs 83, p = 0.02), SF-8 (mean 84 vs 73, p = 0.006) and total SF-36 scores (mean 603 vs 487, P = 0.003), at six months, and Oxford scores (mean 18 vs 23, p = 0.0007) at two years. In this study, CAS is a useful intra-operative tool for assessing the final joint line in TKA. Outliers in joint line changes of ≥ 4 mm are associated with poorer clinical outcome scores.

Background Surgical site infection (SSI) ranges from 1.9% to 5.5% in most large series. Minimally... more Background Surgical site infection (SSI) ranges from 1.9% to 5.5% in most large series. Minimally invasive surgery (MIS) has been postulated to reduce SSI rates. Questions/purposes (1) Is MIS associated with a lower incidence of SSI compared with open spinal surgery? (2) Are there other independent risk factors associated with SSI? (3) What bacteria are most common in spinal SSI? Methods Medical records of 2299 patients who underwent transforaminal lumbar interbody fusion, laminectomy, or discectomy were analyzed and selected for a nested case-control analysis. Twenty-seven cases with SSI were matched with 162 control subjects without SSI stratified based on procedure performed within 28 days of the case's date of surgery. Patients were identified from an institutional database at a tertiary care hospital. MIS involved spinal procedures performed through a tubular retractor system. Univariate and multivariate analyses were performed. Results Patients undergoing open spinal surgery were 5.77 times more likely to develop SSI compared with MIS approaches (odds ratio [OR], 5.77; 95% confidence interval [CI], 1.0–32.7; p = 0.048). Also, from the multivariate regression model, diabetes (OR, 4.7; 95% CI, 1.3–17.0; p = 0.018), number of levels operated on (OR, 3.5; 95% CI, 1.6–7.5; p = 0.001), and body mass index (OR, 1.2; 95% CI, 1.0–1.3; p = 0.010) were predictive of an increased risk in SSI. Staphylococcus aureus was most frequently identified, being present in 12 of 21 (52.4%) patients in whom positive cultures were obtained. Four of the 12 patients had methicillin-resistant S aureus infection. Conclusions In our series, MIS has a lower incidence of SSI. The risk factors predictive of SSI should be further evaluated in well-designed prospective trials. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Journal of orthopaedic surgery (Hong Kong)

Pathological fracture is a rare but serious complication of radiotherapy. We report on a 44-year-... more Pathological fracture is a rare but serious complication of radiotherapy. We report on a 44-year-old man who presented with a subtrochanteric femoral fracture 15 years after radiotherapy for a soft-tissue sarcoma in the thigh. We discuss its potential causes, a scoring system to identify high-risk patients for prophylactic intramedullary nailing of the femur, and radiographic signs to identify an impending insufficiency fracture.

BMJ case reports, 2013

A 52-year-old man with cervical spondylosis sustained a hyperextension injury to the neck and sub... more A 52-year-old man with cervical spondylosis sustained a hyperextension injury to the neck and subsequently developed central cord syndrome after 2 weeks. The diagnosis was confirmed clinically and on MRI. During the admission he was febrile from Streptococcus anginosus bacteraemia from a gum infection and was started on penicillin. This resulted in pseudomembranous colitis with abdominal distension and bloody diarrhoea but a lack of expected abdominal complaints. Unfortunately his neurology deteriorated and a repeat MRI showed a discitis at C5-C7 which required a 2-level discectomy, debridement and instrumented fusion. Owing to his spinal cord injury, an abdominal perforation was initially missed owing to the lack of clinical features of an acute abdomen. He underwent a right hemi-colectomy for ascending colon perforation and eventually made a good recovery and was discharged to a spinal rehabilitation unit. By one year follow-up he had returned to full neurological function.

The open orthopaedics journal, 2012

Meniscal cysts are rare and often are a result of extrusion of synovial fluid through a tear of t... more Meniscal cysts are rare and often are a result of extrusion of synovial fluid through a tear of the meniscus, resulting in a one-way valve effect of the tear. Arthroscopic partial meniscectomy of the meniscus with intra-articular cyst drainage has become the standard of care. We report a case of an unusually large symptomatic medial meniscal cyst, situated postero-medially and pressing on the posterior cruciate ligament, which was initially clinically misdiagnosed as a Baker's cyst. The patient had difficulty and pain on squatting. He was successfully treated with arthroscopic debridement and needle decompression; a rarity in literature for such a voluminous perilabral cyst tenting the posterior cruciate ligament. This procedure has the advantage of being able to obtain the cystic fluid for histological and cytological analysis before debridement. This case also highlights the importance of the use of Magnetic Resonance Imaging (MRI) to accurately diagnose a central, posterior k...

Archives of Trauma Research, 2012

I read with great interest the recent manuscript by Siamak Rimaz on “Effect of Gabapentin on Morp... more I read with great interest the recent manuscript by Siamak Rimaz on “Effect of Gabapentin on Morphine Consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study” published in Archives of Trauma Research (1). In ...

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2014

There is limited literature on the management of neglected healed (fused) bilateral cervical face... more There is limited literature on the management of neglected healed (fused) bilateral cervical facet dislocation. The authors report a case of a middle aged male who developed a bilateral facet dislocation but only sought treatment 14 months post injury when he experienced pain and deformity in the cervical spine. A 42-year-old male was pushed into a 1.2-m pool by accident and hit his head on the bottom. He immediately felt a sharp pain in his neck but was able to get out of the pool by himself and at the emergency department was found to have no neurological deficit. Standard trauma radiographs were performed and a grade 1 anterolisthesis of C4 on C5 was observed without any facet subluxation or dislocation. An emergent Magnetic Resonance Imaging (MRI) of the cervical spine confirmed X-ray results and in addition demonstrated injury to the posterior ligament complex and a broad-based posterior disc bulge. Computed Tomography (CT) scans revealed no facet dislocation or fractures. Unfo...

Singapore Medical Journal, 2014

Knee Surgery, Sports Traumatology, Arthroscopy, 2012

Patellectomized patients may have less satisfactory clinical outcomes following total knee arthro... more Patellectomized patients may have less satisfactory clinical outcomes following total knee arthroplasty due to a decreased extensor mechanism efficiency and potential instability. The literature only reports 3 case series of patients who had a previous patellectomy undergoing a Unicondylar Knee Arthroplasty (UKA) with mixed results. A Minimally Invasive fixed-bearing UKA was performed in a patellectomized patient with excellent postoperative knee stability and clinical outcomes after 5 years. MIS UKA may be a viable option for patellectomized patients with isolated medial compartment osteoarthritis and no preoperative extensor deficiency or instability. Level of evidence IV.

Journal of Spinal Disorders and Techniques, 2013

We conducted a retrospective analysis of a prospectively collected database in a tertiary hospita... more We conducted a retrospective analysis of a prospectively collected database in a tertiary hospital over 10 years. Treatment for vertebral compression fractures remains an area of controversy with respect to timing and type of surgical management. We analysed the clinical outcomes and radiographic measurements of four different modalities of treatment for these fractures. From 2001 to 2011, we analysed a total of 363 patients after failure of 30 days of conservative management. These patients where then further managed either conservatively or with Vertebroplasty (VP), Balloon Kyphoplasty (BK) or Sky Bone Expander (SK). Outcomes were assessed by using Self-Report Measures: Visual Analog Score (VAS), Functional measures, Oswestry Disability Index (ODI) and Short-Form 36 (SF-36); and Physiologic Measures: Pre and Post-operative Radiographs. The outcome measures were assessed for six months for those treated conservatively and up till two years for those treated surgically. Radiographic measurements of the spine were correlated with the clinical outcomes. A total of 62 patients (12.1%) were treated conservatively, 148 (40.8%) with VP, 97 (26.7%) with BK and 56 (15.4%) with SK. We found significant improvements in VAS, ODI and SF-36 scores for all groups after one month follow-up (P<0.05), with the surgical groups demonstrating a greater improvement in pain scores after the 1st post-operative day (P<0.0001) when compared to the conservative group. The improvements in outcomes in those treated surgically were sustained for up to two years with no significant difference (P>0.05) amongst the surgical groups. We also found significant improvement (P<0.005) in anterior vertebral and kyphotic wedge angle after surgical intervention. We have shown that early surgical intervention allows for quicker pain relief compared to conservative treatment, with similar improvements in anterior vertebral height and kyphotic wedge angle between all 3 groups of surgical management.

Journal of Orthopaedic Surgery and Research, 2011

Clinical Orthopaedics and Related Research®, 2013

Surgical site infection (SSI) ranges from 1.9% to 5.5% in most large series. Minimally invasive s... more Surgical site infection (SSI) ranges from 1.9% to 5.5% in most large series. Minimally invasive surgery (MIS) has been postulated to reduce SSI rates. (1) Is MIS associated with a lower incidence of SSI compared with open spinal surgery? (2) Are there other independent risk factors associated with SSI? (3) What bacteria are most common in spinal SSI? Medical records of 2299 patients who underwent transforaminal lumbar interbody fusion, laminectomy, or discectomy were analyzed and selected for a nested case-control analysis. Twenty-seven cases with SSI were matched with 162 control subjects without SSI stratified based on procedure performed within 28 days of the case's date of surgery. Patients were identified from an institutional database at a tertiary care hospital. MIS involved spinal procedures performed through a tubular retractor system. Univariate and multivariate analyses were performed. Patients undergoing open spinal surgery were 5.77 times more likely to develop SSI compared with MIS approaches (odds ratio [OR], 5.77; 95% confidence interval [CI], 1.0-32.7; p = 0.048). Also, from the multivariate regression model, diabetes (OR, 4.7; 95% CI, 1.3-17.0; p = 0.018), number of levels operated on (OR, 3.5; 95% CI, 1.6-7.5; p = 0.001), and body mass index (OR, 1.2; 95% CI, 1.0-1.3; p = 0.010) were predictive of an increased risk in SSI. Staphylococcus aureus was most frequently identified, being present in 12 of 21 (52.4%) patients in whom positive cultures were obtained. Four of the 12 patients had methicillin-resistant S aureus infection. In our series, MIS has a lower incidence of SSI. The risk factors predictive of SSI should be further evaluated in well-designed prospective trials. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The Knee, 2013

Restoration of the native joint line in total knee arthroplasty is important in restoring ligamen... more Restoration of the native joint line in total knee arthroplasty is important in restoring ligamentous balance and normal knee kinematics. Failure to achieve this could lead suboptimal outcomes. The purpose of this study was to analyze the clinical and functional outcome of patients who demonstrated joint line changes after computer-assisted (CAS) total knee arthroplasty (TKA). One hundred sixty-eight patients (168 knees) underwent CAS TKA by two surgeons at a single institution with 2 years follow-up. The final change in joint line was calculated from the verified tibial resection and distal femoral cuts. Group A patients had joint line changes of less than 4mm and Group B patients had joint line changes of more than 4mm. Post-operative Oxford scores, Knee scores, Function scores and SF-36 scores were obtained at 6 months and 2 years post TKA. There was significant linear correlation between joint line changes and Oxford scores (P=0.0001), Function scores (P=0.0001) and Knee scores (P=0.0001) at 6 months and Oxford scores (P=0.0001) alone at 2 years with increasing joint line changes having poorer outcome scores. Group A compared to Group B patients demonstrated better Oxford scores (P=0.0001), Function scores (P=0.0001), Knee scores (P=0.0001) and total SF-36 scores (P=0.003) at 6 months as well as better Oxford scores (P=0.0001) and Knee scores (P=0.014) at 2 years. CAS is a useful intra-operative tool for assessing the final joint line in TKA. Outliers in joint line changes of ≥4 mm are associated with poorer clinical outcome scores. Prognostic Study, Level II-1.

Abstract: Meniscal cysts are rare and often are a result of extrusion of synovial fluid through a... more Abstract: Meniscal cysts are rare and often are a result of extrusion of synovial fluid through a tear of the meniscus, resulting in a one-way valve effect of the tear. Arthroscopic partial meniscectomy of the meniscus with intra-articular cyst drainage has become the standard of care. We report a case of an unusually large symptomatic medial meniscal cyst, situated postero-medially and pressing on the posterior cruciate ligament, which was initially clinically misdiagnosed as a Baker’s cyst. The patient had difficulty and pain on squatting. He was successfully treated with arthroscopic debridement and needle decompression; a rarity in literature for such a voluminous perilabral cyst tenting the posterior cruciate ligament. This procedure has the advantage of being able to obtain the cystic fluid for histological and cytological analysis before debridement. This case also highlights the importance of the use of Magnetic Resonance Imaging (MRI) to accurately diagnose a central, poste...

Restoration of the native joint line in total knee arthroplasty is important in restoring ligamen... more Restoration of the native joint line in total knee arthroplasty is important in restoring ligamentous balance and normal knee kinematics. Failure to achieve this could lead to reduced range of motion, patellofemoral maltracking and suboptimal outcomes. The purpose of this study was to analyse the clinical and functional outcome of patients who demonstrated joint line changes after computer-assisted (CAS) total knee arthroplasty (TKA). A prospective study was conducted for 168 patients (168 knees) who underwent CAS TKA by two surgeons at a single institution with an average follow-up of two years. The final change in joint line was calculated from the verified tibial resection, distal and posterior femoral cuts. Group A patients had joint line changes of less than 4mm and Group B patients had joint line changes of more than 4mm. Postoperative Oxford scores, Knee scores, Function scores and SF-36 scores were obtained at six months, one year and two years post-TKA. The final range of m...

Orthopaedic Proceedings, Oct 1, 2012

Restoration of the native joint line in total knee arthroplasty is important in restoring ligamen... more Restoration of the native joint line in total knee arthroplasty is important in restoring ligamentous balance and normal knee kinematics. Failure to achieve this could lead to reduced range of motion, patellofemoral maltracking and suboptimal outcomes. The purpose of this study was to analyse the clinical and functional outcome of patients who demonstrated joint line changes after computer-assisted (CAS) total knee arthroplasty (TKA). A prospective study was conducted for 168 patients (168 knees) who underwent CAS TKA by two surgeons at a single institution with an average follow-up of two years. The final change in joint line was calculated from the verified tibial resection, distal and posterior femoral cuts. Group A patients had joint line changes of less than 4mm and Group B patients had joint line changes of more than 4mm. Postoperative Oxford scores, Knee scores, Function scores and SF-36 scores were obtained at six months, one year and two years post-TKA. The final range of motion and the mechanical alignment were documented. There was significant linear correlation between joint line changes and Oxford scores (p = 0.05) and Function scores (p = 0.05) at six months and Oxford scores alone at two years with increasing joint line changes having poorer outcome scores. Group A compared to Group B patients have better outcomes in terms of Oxford scores (mean 20 vs 27, p = 0.0003), Function scores (mean 69 vs 59, p = 0.03), SF-1 (mean 63 vs 50, p = 0.03), SF-2 (mean 66 vs 43, p = 0.05), SF-5 (mean 75 vs 63, p = 0.04), SF-6 (mean 84 vs 59, p = 0.003), SF-7 (mean 96 vs 83, p = 0.02), SF-8 (mean 84 vs 73, p = 0.006) and total SF-36 scores (mean 603 vs 487, P = 0.003), at six months, and Oxford scores (mean 18 vs 23, p = 0.0007) at two years. In this study, CAS is a useful intra-operative tool for assessing the final joint line in TKA. Outliers in joint line changes of ≥ 4 mm are associated with poorer clinical outcome scores.

Background Surgical site infection (SSI) ranges from 1.9% to 5.5% in most large series. Minimally... more Background Surgical site infection (SSI) ranges from 1.9% to 5.5% in most large series. Minimally invasive surgery (MIS) has been postulated to reduce SSI rates. Questions/purposes (1) Is MIS associated with a lower incidence of SSI compared with open spinal surgery? (2) Are there other independent risk factors associated with SSI? (3) What bacteria are most common in spinal SSI? Methods Medical records of 2299 patients who underwent transforaminal lumbar interbody fusion, laminectomy, or discectomy were analyzed and selected for a nested case-control analysis. Twenty-seven cases with SSI were matched with 162 control subjects without SSI stratified based on procedure performed within 28 days of the case's date of surgery. Patients were identified from an institutional database at a tertiary care hospital. MIS involved spinal procedures performed through a tubular retractor system. Univariate and multivariate analyses were performed. Results Patients undergoing open spinal surgery were 5.77 times more likely to develop SSI compared with MIS approaches (odds ratio [OR], 5.77; 95% confidence interval [CI], 1.0–32.7; p = 0.048). Also, from the multivariate regression model, diabetes (OR, 4.7; 95% CI, 1.3–17.0; p = 0.018), number of levels operated on (OR, 3.5; 95% CI, 1.6–7.5; p = 0.001), and body mass index (OR, 1.2; 95% CI, 1.0–1.3; p = 0.010) were predictive of an increased risk in SSI. Staphylococcus aureus was most frequently identified, being present in 12 of 21 (52.4%) patients in whom positive cultures were obtained. Four of the 12 patients had methicillin-resistant S aureus infection. Conclusions In our series, MIS has a lower incidence of SSI. The risk factors predictive of SSI should be further evaluated in well-designed prospective trials. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Journal of orthopaedic surgery (Hong Kong)

Pathological fracture is a rare but serious complication of radiotherapy. We report on a 44-year-... more Pathological fracture is a rare but serious complication of radiotherapy. We report on a 44-year-old man who presented with a subtrochanteric femoral fracture 15 years after radiotherapy for a soft-tissue sarcoma in the thigh. We discuss its potential causes, a scoring system to identify high-risk patients for prophylactic intramedullary nailing of the femur, and radiographic signs to identify an impending insufficiency fracture.

BMJ case reports, 2013

A 52-year-old man with cervical spondylosis sustained a hyperextension injury to the neck and sub... more A 52-year-old man with cervical spondylosis sustained a hyperextension injury to the neck and subsequently developed central cord syndrome after 2 weeks. The diagnosis was confirmed clinically and on MRI. During the admission he was febrile from Streptococcus anginosus bacteraemia from a gum infection and was started on penicillin. This resulted in pseudomembranous colitis with abdominal distension and bloody diarrhoea but a lack of expected abdominal complaints. Unfortunately his neurology deteriorated and a repeat MRI showed a discitis at C5-C7 which required a 2-level discectomy, debridement and instrumented fusion. Owing to his spinal cord injury, an abdominal perforation was initially missed owing to the lack of clinical features of an acute abdomen. He underwent a right hemi-colectomy for ascending colon perforation and eventually made a good recovery and was discharged to a spinal rehabilitation unit. By one year follow-up he had returned to full neurological function.

The open orthopaedics journal, 2012

Meniscal cysts are rare and often are a result of extrusion of synovial fluid through a tear of t... more Meniscal cysts are rare and often are a result of extrusion of synovial fluid through a tear of the meniscus, resulting in a one-way valve effect of the tear. Arthroscopic partial meniscectomy of the meniscus with intra-articular cyst drainage has become the standard of care. We report a case of an unusually large symptomatic medial meniscal cyst, situated postero-medially and pressing on the posterior cruciate ligament, which was initially clinically misdiagnosed as a Baker's cyst. The patient had difficulty and pain on squatting. He was successfully treated with arthroscopic debridement and needle decompression; a rarity in literature for such a voluminous perilabral cyst tenting the posterior cruciate ligament. This procedure has the advantage of being able to obtain the cystic fluid for histological and cytological analysis before debridement. This case also highlights the importance of the use of Magnetic Resonance Imaging (MRI) to accurately diagnose a central, posterior k...

Archives of Trauma Research, 2012

I read with great interest the recent manuscript by Siamak Rimaz on “Effect of Gabapentin on Morp... more I read with great interest the recent manuscript by Siamak Rimaz on “Effect of Gabapentin on Morphine Consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study” published in Archives of Trauma Research (1). In ...

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2014

There is limited literature on the management of neglected healed (fused) bilateral cervical face... more There is limited literature on the management of neglected healed (fused) bilateral cervical facet dislocation. The authors report a case of a middle aged male who developed a bilateral facet dislocation but only sought treatment 14 months post injury when he experienced pain and deformity in the cervical spine. A 42-year-old male was pushed into a 1.2-m pool by accident and hit his head on the bottom. He immediately felt a sharp pain in his neck but was able to get out of the pool by himself and at the emergency department was found to have no neurological deficit. Standard trauma radiographs were performed and a grade 1 anterolisthesis of C4 on C5 was observed without any facet subluxation or dislocation. An emergent Magnetic Resonance Imaging (MRI) of the cervical spine confirmed X-ray results and in addition demonstrated injury to the posterior ligament complex and a broad-based posterior disc bulge. Computed Tomography (CT) scans revealed no facet dislocation or fractures. Unfo...

Singapore Medical Journal, 2014

Knee Surgery, Sports Traumatology, Arthroscopy, 2012

Patellectomized patients may have less satisfactory clinical outcomes following total knee arthro... more Patellectomized patients may have less satisfactory clinical outcomes following total knee arthroplasty due to a decreased extensor mechanism efficiency and potential instability. The literature only reports 3 case series of patients who had a previous patellectomy undergoing a Unicondylar Knee Arthroplasty (UKA) with mixed results. A Minimally Invasive fixed-bearing UKA was performed in a patellectomized patient with excellent postoperative knee stability and clinical outcomes after 5 years. MIS UKA may be a viable option for patellectomized patients with isolated medial compartment osteoarthritis and no preoperative extensor deficiency or instability. Level of evidence IV.

Journal of Spinal Disorders and Techniques, 2013

We conducted a retrospective analysis of a prospectively collected database in a tertiary hospita... more We conducted a retrospective analysis of a prospectively collected database in a tertiary hospital over 10 years. Treatment for vertebral compression fractures remains an area of controversy with respect to timing and type of surgical management. We analysed the clinical outcomes and radiographic measurements of four different modalities of treatment for these fractures. From 2001 to 2011, we analysed a total of 363 patients after failure of 30 days of conservative management. These patients where then further managed either conservatively or with Vertebroplasty (VP), Balloon Kyphoplasty (BK) or Sky Bone Expander (SK). Outcomes were assessed by using Self-Report Measures: Visual Analog Score (VAS), Functional measures, Oswestry Disability Index (ODI) and Short-Form 36 (SF-36); and Physiologic Measures: Pre and Post-operative Radiographs. The outcome measures were assessed for six months for those treated conservatively and up till two years for those treated surgically. Radiographic measurements of the spine were correlated with the clinical outcomes. A total of 62 patients (12.1%) were treated conservatively, 148 (40.8%) with VP, 97 (26.7%) with BK and 56 (15.4%) with SK. We found significant improvements in VAS, ODI and SF-36 scores for all groups after one month follow-up (P<0.05), with the surgical groups demonstrating a greater improvement in pain scores after the 1st post-operative day (P<0.0001) when compared to the conservative group. The improvements in outcomes in those treated surgically were sustained for up to two years with no significant difference (P>0.05) amongst the surgical groups. We also found significant improvement (P<0.005) in anterior vertebral and kyphotic wedge angle after surgical intervention. We have shown that early surgical intervention allows for quicker pain relief compared to conservative treatment, with similar improvements in anterior vertebral height and kyphotic wedge angle between all 3 groups of surgical management.

Journal of Orthopaedic Surgery and Research, 2011

Clinical Orthopaedics and Related Research®, 2013

Surgical site infection (SSI) ranges from 1.9% to 5.5% in most large series. Minimally invasive s... more Surgical site infection (SSI) ranges from 1.9% to 5.5% in most large series. Minimally invasive surgery (MIS) has been postulated to reduce SSI rates. (1) Is MIS associated with a lower incidence of SSI compared with open spinal surgery? (2) Are there other independent risk factors associated with SSI? (3) What bacteria are most common in spinal SSI? Medical records of 2299 patients who underwent transforaminal lumbar interbody fusion, laminectomy, or discectomy were analyzed and selected for a nested case-control analysis. Twenty-seven cases with SSI were matched with 162 control subjects without SSI stratified based on procedure performed within 28 days of the case's date of surgery. Patients were identified from an institutional database at a tertiary care hospital. MIS involved spinal procedures performed through a tubular retractor system. Univariate and multivariate analyses were performed. Patients undergoing open spinal surgery were 5.77 times more likely to develop SSI compared with MIS approaches (odds ratio [OR], 5.77; 95% confidence interval [CI], 1.0-32.7; p = 0.048). Also, from the multivariate regression model, diabetes (OR, 4.7; 95% CI, 1.3-17.0; p = 0.018), number of levels operated on (OR, 3.5; 95% CI, 1.6-7.5; p = 0.001), and body mass index (OR, 1.2; 95% CI, 1.0-1.3; p = 0.010) were predictive of an increased risk in SSI. Staphylococcus aureus was most frequently identified, being present in 12 of 21 (52.4%) patients in whom positive cultures were obtained. Four of the 12 patients had methicillin-resistant S aureus infection. In our series, MIS has a lower incidence of SSI. The risk factors predictive of SSI should be further evaluated in well-designed prospective trials. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The Knee, 2013

Restoration of the native joint line in total knee arthroplasty is important in restoring ligamen... more Restoration of the native joint line in total knee arthroplasty is important in restoring ligamentous balance and normal knee kinematics. Failure to achieve this could lead suboptimal outcomes. The purpose of this study was to analyze the clinical and functional outcome of patients who demonstrated joint line changes after computer-assisted (CAS) total knee arthroplasty (TKA). One hundred sixty-eight patients (168 knees) underwent CAS TKA by two surgeons at a single institution with 2 years follow-up. The final change in joint line was calculated from the verified tibial resection and distal femoral cuts. Group A patients had joint line changes of less than 4mm and Group B patients had joint line changes of more than 4mm. Post-operative Oxford scores, Knee scores, Function scores and SF-36 scores were obtained at 6 months and 2 years post TKA. There was significant linear correlation between joint line changes and Oxford scores (P=0.0001), Function scores (P=0.0001) and Knee scores (P=0.0001) at 6 months and Oxford scores (P=0.0001) alone at 2 years with increasing joint line changes having poorer outcome scores. Group A compared to Group B patients demonstrated better Oxford scores (P=0.0001), Function scores (P=0.0001), Knee scores (P=0.0001) and total SF-36 scores (P=0.003) at 6 months as well as better Oxford scores (P=0.0001) and Knee scores (P=0.014) at 2 years. CAS is a useful intra-operative tool for assessing the final joint line in TKA. Outliers in joint line changes of ≥4 mm are associated with poorer clinical outcome scores. Prognostic Study, Level II-1.