Rehan Gul - Academia.edu (original) (raw)
Papers by Rehan Gul
Acta Orthopaedica Belgica, 2021
The aim of this systematic review was to evaluate the evidence on reservation of Posterior Femora... more The aim of this systematic review was to evaluate the evidence on reservation of Posterior Femoral Condylar Offset (PFCO) and Joint Line (JL) after Revision Total Knee Arthroplasty (RTKA) for im- proved functional outcomes. A comprehensive search of PubMed, Medline, Cochrane, CINAHL, and Embase databases was conducted, with papers published from the inception of the database to October 2020 included. All relevant articles were retrieved, and their bibliographies were hand searched for further references on Posterior condylar offset and revision total knee arthroplasty. The search strategy yielded 28 articles. After duplicate titles were excluded, abstracts and full text were reviewed. Nine studies were assessed for eligibility, four studies were excluded because they did not fully comply with the inclusion criteria. Six articles were finally included in this systematic review. Based on this systematic review restoration of the JL and PFCO in RTKR is associated with a significant imp...
Acta Orthopaedica Belgica, 2021
High-quality and cost-effective health care are highly recommended especially in joint replacemen... more High-quality and cost-effective health care are highly recommended especially in joint replacement surgeries, particularly in total hip arthroplasty. Therefore, it is indispensable for orthopaedic surgeons to spot the potential areas of quality improvement. Evaluating the efficacy of the different ways of skin closure is an unacknowledged topic. We performed this study following both the Preferred Reporting Items for Systematic Reviews and Meta- analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Articles were from any country, written in any language. We included all randomised control trials and retrospective cohort studies undergoing primary total hip arthroplasty who either received staples or subcuticular sutures for skin closure. The primary outcome was the incidence of wound infection. Secondary outcomes included length of stay (LOS), time to skin closure, total cost, and patient’s satisfaction. We included five studies in our cumul...
Midterm results of modern patellofemoral arthroplasty versus total knee arthroplasty for isolated patellofemoral arthritis: systematic review and meta-analysis of comparative studies
Archives of Orthopaedic and Trauma Surgery, 2021
Both Patellofemoral Arthroplasty (PFA) and Total Knee Arthroplasty (TKA) are accepted surgical op... more Both Patellofemoral Arthroplasty (PFA) and Total Knee Arthroplasty (TKA) are accepted surgical options for end-stage isolated patellofemoral osteoarthritis (PFOA). We performed a systematic review and meta-analysis to compare outcomes of PFA and TKA by evaluation of the patient-reported outcome measures (PROMs). We systematically identified publications reporting on patients that underwent either TKA or modern PFA for isolated PFOA. Meta-analysis software was used to screen for potential articles with at least two years’ follow-up. Data were extracted and analysed for all PROMs operating time, postoperative inpatient time, complications and cost. We included five studies in our cumulative meta-analysis and reviewed them using Review Manager V.5.0. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used random-effect models. No significant difference was found between both TKA and PFA in the context of operating time. No significant difference after five years’ follow-up was found between the two treatment options in terms of UCLA score and patient satisfaction. PFA showed significant improvement in WOMAC score at five-year follow-up, less postoperative inpatient time, better cost-effectiveness and significantly less blood loss. PFA seems to be a viable alternative to TKA for treatment of isolated PFOA in appropriately selected patients. PFA showed less postoperative inpatient time and blood loss with similar PROMs to the TKA. Moreover, it is an economically beneficial joint-preserving procedure.
The Journal of Arthroplasty, 2021
Background: Paprosky type IIIa and IIIb acetabular defects remain technically challenging during ... more Background: Paprosky type IIIa and IIIb acetabular defects remain technically challenging during revision hip arthroplasty. Numerous surgical options exist to counter extensive acetabular bone loss with high postoperative complication and revision rates reported. Our aim was to report comprehensive long-term outcomes of our experience with Trabecular Metal (TM) augments for these difficult cases. Methods: 38 patients underwent revision total hip arthroplasty at our institution from 2009 to 2014 where a TM augment was used for acetabular deficiency. Prospective radiographic and Patient-Reported Outcome Measures were recorded and analyzed to a mean of 7.3 years (range: 5.4 to 10.8). Results: No patient was excluded or lost to follow-up. Complications included 3 intraoperative fractures, 1 early infection requiring washout with implant retention, 1 early revision due to allograft resorption, and 6 patients who required late repeat revision surgery: 3 for late infection, 2 for aseptic loosening with augment fracture or dislocation, and 1 for recurrent dislocation. The estimated mean implant survivorship was 8.99 years. 93.5% of augments remaining were well osseointegrated while 97% of the acetabular shells were osseointegrated. Hip center of rotation was restored by a mean of 14 mm inferiorly without significant medialization. Short Form-12 (SF-12) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were significantly reduced postoperatively to a level comparable to the average individual. Conclusion: This long-term study details our experience of TM augments for the most severe acetabular defects. For such cases, no excellent surgical solution exists; in comparison to alternative methods, we advocate that this technique is reasonably safe and effective.
Malignant triton tumour (MTT) of the lung with metastasis to the proximal femur
BMJ Case Reports, 2021
A 65-year-old female patient has a history of malignant triton tumour of the right upper lobe of ... more A 65-year-old female patient has a history of malignant triton tumour of the right upper lobe of the lung. She underwent right upper lobectomy and lymphadenectomy in May 2018. She presented in November 2019 with pathological fracture of the left proximal femur. It was not associated with neurofibromatosis. We decided to do an excisional biopsy of the mass and proximal femoral replacement followed by radiotherapy. Four months later, she presented with local recurrence. We organised a multidisciplinary team between the orthopaedic, histopathology and oncology teams. Then, we decided to treat her with chemotherapy. After 2 months of follow-up, she responded well to the chemotherapy with no further deterioration of her condition.
The Journal of Arthroplasty, 2020
Background: We describe the intraoperative parameters that affect stem subsidence rates in tapere... more Background: We describe the intraoperative parameters that affect stem subsidence rates in tapered modular femoral stems for revision total hip arthroplasty (THA). We also determine the effect of the stem bicortical contact on subsidence rates and whether there is a minimum threshold bicortical contact that must be achieved to avoid the complication of subsidence. Methods: This is a retrospective cohort study consisting of 109 hips in 105 patients (53 males and 52 females) at a minimum of 2 years of follow-up. All revisions were carried out for Paprosky type 3A and 3B femoral deficits. Clinical outcomes included the indication for revision, aseptic re-revision surgery, specifications of the stem inserted, and specifications of the femoral head and acetabular components implanted. Radiographic outcome measures included subsidence (mm) and bicortical contact (mm). Results: Using multivariate regression analysis, 3 parameters were associated with an increased rate of stem subsidence. A reduced bicortical contact distance (P < .001) and a stem length of 155 mm (P < .001) were both associated with higher subsidence rates. We also demonstrated a novel threshold of 20mm bicortical contact which must be achieved to significantly reduce subsidence rates in these modular femoral stems for revision THA. Conclusion: Subsidence rates of modular tapered femoral stems for revision THA can be significantly reduced by increasing the initial bicortical contact of the stem within the diaphysis and the overall length of the femoral stem >155 mm. We describe a minimum threshold bicortical contact distance of 20 mm that should ideally be exceeded to significantly reduce the risk of stem subsidence within the femoral canal.
SICOT-J, 2019
Background: Metal on Metal Hip arthroplasty was commonly used until the last decade. However Hip ... more Background: Metal on Metal Hip arthroplasty was commonly used until the last decade. However Hip Arthroplasty registries of many countries showed increased revision rates of MOM Hips – these high rates of revision caused by trunnionosis, adverse tissue reactions (ALTRs) and Pseudotumor formation. The Case: Our Case is 73 years old gentleman who had left MOM THR in 2008, and was doing fine till the beginning of 2018 when his left leg stuck while getting out of the car. Despite he heard the pop and his leg was shortened and externally rotated, but he was still walking on it for a while. On reviewing him in our orthopedic clinic and after getting the CT-scan showed that he had dislocated femoral head from the stem.
Mesentery and Peritoneum, 2018
Background: Trabecular metal augments are one option when reconstructing bone loss during acetabu... more Background: Trabecular metal augments are one option when reconstructing bone loss during acetabular side revision surgery. Methods: We studied 38 consecutive patients with Paprosky type 3 defects that were revised using a Trabecular Metal shell and one or more augments over a 6-year period. There were 29 Paprosky type 3A defects and 9 Paprosky type 3B defects. The mean age of the patients at time of surgery was 68.2 years (range, 48-84 years). The mean length of follow-up was 36 months (range, 18-74 months). Results: The mean pre-operative SF12 improved from 27.7 before operation to 30.1 at the time of final followup (P=0.001). The mean Western Ontario and McMaster Universities Arthritis Index (WOMAC) score improved from 53 pre-operatively to a mean of 78.8 at final follow-up (P<0.0001). There was evidence of radiographic loosening in seven of the cup-augment constructs. One patient developed a deep infection requiring re-revision. Two patients required revision for aseptic loosening. Conclusions: The use of Trabecular Metal augments in complex acetabular reconstruction is associated with good outcome in the short to medium term.
Foot & Ankle Orthopaedics, 2017
Category: Midfoot/Forefoot Introduction/Purpose: Metatarsophalangeal arthrodesis has usually been... more Category: Midfoot/Forefoot Introduction/Purpose: Metatarsophalangeal arthrodesis has usually been performed using a dorsal plate to immobilize the MTP joint with or without lag screw fixation. Data in the literature is sparse on outcomes of dorsal plate plus lag screw fixation, especially in patients with IMA greater than 15 percent. Our objective was to compare IMA correction outcomes and union rates between dorsal plate only fusions and dorsal plate plus lag screw fixation in patients with IMA greater than 15 percent. Methods: We retrospectively reviewed the charts of 36 patients (39 feet) who underwent first MTP joint arthrodesis for moderate to severe HV deformity between 2011 and 2015. Average age was 61 (range, 39 to 84) years. There were 24 females and 12 males. A single surgeon performed all operations. Joints were immobilized postoperatively using either dorsal locking plate alone or dorsal locking plate with a lag screw. Union (at least 3 bridging cortices) was determined ...
Hip international : the journal of clinical and experimental research on hip pathology and therapy, 2017
Total hip arthroplasty (THA) is a very successful procedure. Revision THA is becoming increasingl... more Total hip arthroplasty (THA) is a very successful procedure. Revision THA is becoming increasingly common. Recent developments to improve outcomes include the development of large trabecular metal (TM) acetabular cups and augments. There is a paucity of data on the benefit of these new techniques. A single-centre retrospective review consisting of a radiological review of post-op revision THA anteroposterior pelvis. Data collection was performed using the Irish National Orthopaedic Register (INOR) and from a previous project. We used a technique developed by Fessy et al in 1999 to measure the centre of rotation (COR) of the hip. We then compared our study to that of a study measuring the COR of healthy native hips. 127 revision THA analysed. Native COR calculated by Fessy et al showed a mean horizontal (x) axis 33.6 mm (standard deviation [SD] 5.74) and a vertical (y) axis 16.4 mm (SD 4.67). Non-TM revisions showed a mean x axis of 29 mm (SD 3.9) and y axis 17.9 (SD 5.9). TM Augment...
Journal of Clinical Case Reports, 2015
We present the case of a 43-year-old female with a background history of left Total Hip Replaceme... more We present the case of a 43-year-old female with a background history of left Total Hip Replacement who presented to the clinic with progressively worsening left hip and groin pain over the previous 2 years with sudden deterioration in her mobility over one week. On examination she had a significant pain in the left hip and groin on all hip movements associated with tenderness over the left greater trochanter. An Anterior-Posterior (AP) pelvic radiograph identified an oblique fracture through the proximal third of her Charnley Modular femoral stem. Her primary Total Hip Replacement had been carried out 15 years prior to this presentation for avascular necrosis of the femoral head secondary to Slipped Capital Femoral Epiphysis. A Size 1 Charnley Modular stem was cemented in with a 22.225 mm 9/10+0 Ceramax Head. Her post-op course was uneventful and she was discharged home in a timely manor. She had been pain free in the left hip at all follow-up appointments up to 2 years prior to this presentation. All previous radiographs demonstrated a well positioned prosthesis with no evidence of fracture or loosening. No specific remarks were made about the cement mantle (Figures 1a and 1b). On diagnosis of the broken stem, she was scheduled for a single stage revision. This was carried out through an anterolateral approach with removal of the proximal fragment of the femoral stem. The distal
Coloarticular Fistula Associated with a Pseudotumor After Metal-on-Metal Hip Resurfacing Arthroplasty: A Case Report
JBJS Case Connector, 2013
ABSTRACT Fistula formation between the bowel and an implant following hip arthroplasty is rare1-1... more ABSTRACT Fistula formation between the bowel and an implant following hip arthroplasty is rare1-11. Documented predisposing conditions include pelvic radiation therapy, long-term corticosteroid use, pelvic migration of the hip arthroplasty acetabular component, diverticulitis, and Crohn disease2,4-7,9-13. To our knowledge, we report the first known coloarticular fistula associated with a pseudotumor after a metal-on-metal hip resurfacing arthroplasty. The patient was informed that data concerning the case would be submitted for publication, and she provided consent.
European Journal of Orthopaedic Surgery & Traumatology, 2005
The teardrop fracture of the axis comprises a special entity, characterized by an avulsed fragmen... more The teardrop fracture of the axis comprises a special entity, characterized by an avulsed fragment, of varying size, from the anterior inferior angle of the body of C2. It is extremely rare and differs in many respects from the teardrop fracture of the lower cervical spine, which was originally described by Schneider and Kahn in 1956. Indeed, much of what is written about teardrop fractures relates to lower cervical spine flexion type teardrop fractures. To date there are only 36 reported cases of teardrop fracture of the axis. We present seven cases of a teardrop fracture of the axis treated in the National Spinal Injuries unit at the Mater Miscericordiae University Hospital, Dublin from 1993 to 2003. The mean follow-up time was 6 years. The stability of this fracture has been questioned by certain authors, resulting in disagreement concerning the best choice of treatment to be followed. The radiological, clinical features and functional outcome of patients who have sustained a teardrop fracture of the axis will be described. The mechanism of injury and potential for instability will be compared with teardrop fractures of the lower cervical spine so as to emphasize the importance of recognizing this injury as a separate entity. Keywords Teardrop AE Cervical AE Axis AE Functional AE Outcome Re´sultat fonctionnel apre`s fractures tear-drop de l'axis Mots-cle´s Tear-drop AE Cervical AE Axis AE Fonctionnel AE Re´sultats
European Journal of Orthopaedic Surgery & Traumatology, 2006
We have recently treated two adult patients with significant spinal injuries after using an infla... more We have recently treated two adult patients with significant spinal injuries after using an inflatable 'bouncy castle'. We highlight the risks associated with these devices in the adult age group and review the current literature. We conclude that these devices should carry a clear warning to adults that their use by above-14 is hazardous.
Arthroplastie totale de hanche non cimentée dans le traitement des dysplasies sévères ou des hanches luxées
European Journal of Orthopaedic Surgery & Traumatology, 2004
We present our experience over 6 years with the use of uncemented total hip arthroplasty (THA) fo... more We present our experience over 6 years with the use of uncemented total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) with a mean follow-up of 3 years. In a 6-year period, 26 THAs were performed in 19 patients with Hartofilakidis grades 2 and 3 dislocation of the hips. Out of 19 patients, seven had bilateral dislocations. Uncemented acetabular and femoral components were used in all patients. Patients with a minimum follow-up of 1 year were included in the study. The average age at the time of surgery was 38 (range 20-69) years. Approaches used include trochanteric osteotomy in 14 (54%) patients and a lateral approach in 12 (46%) patients. In addition, subtrochanteric osteotomy was performed in four (15%) patients. A Mallory-head femoral stem was used in 15 (58%) patients; a DDH femoral stem was in nine (35%), and the S-ROM femoral prosthesis in two (8%). A Mallory head acetabular shell was used in all cases, a 22.2-mm chrome cobalt head was used in 18 (69%), and a 28-mm chrome cobalt head was used in eight (31%). The average follow-up was 3 (range 1-6) years. The Harris hip score (HHS) improved in the cohort from a mean preoperative score of 51 to a mean postoperative score of 86 (p<0.05). The mean preoperative SF36v2 score was 42 compared to postoperatively of 67(p<0.05). The complication rate was 11% with nonunion of a subtrochanteric osteotomy in one patient, dislocation in one, and trochanteric bursitis due to fracture of Dall-Miles cables in one. THA for DDH is a technically demanding procedure. This short-term follow-up of THA for DDH using uncemented implants is encouraging for arthrosis secondary to DDH. It provides better function compared to arthrodesis or excision arthroplasty, especially in young individuals. A long-term follow-up is required in order to establish the role of this management strategy. Keywords Cementless AE Total hip arthroplasty AE Developmental dysplasia of the hip Arthroplastie totale de hanche non cimente´e dans le traitement des dysplasies se´ve`res ou des hanches luxe´es
Intraoperative arthrometry in anterior cruciate ligament reconstruction
Acta orthopaedica Belgica, 2005
Arthrometry has an established role in the measurement of knee laxity in anterior cruciate ligame... more Arthrometry has an established role in the measurement of knee laxity in anterior cruciate ligament injury and following reconstruction. The role of routine intraoperative arthrometry in anterior cruciate ligament reconstruction is poorly defined, and this study was designed to test the hypothesis that intraoperative arthrometry provides an objective method of documenting successful knee stabilisation following anterior cruciate ligament reconstruction. A consecutive cohort of 100 patients with unilateral isolated anterior cruciate ligament disruption were prospectively evaluated using a Rolimeter arthrometer. A maximal manual force method was utilised by a single examiner. This allowed for side-to-side comparisons with the uninjured contralateral knee. Analysis of tibial translation was recorded preoperatively with patients both awake and asleep, intraoperatively following anterior cruciate ligament reconstruction, and postoperatively at 2 weeks and 3 months. Statistical analysis w...
Osteochondral fractures in the knee treated with butyl-2-cyanoacrylate glue. A case report
Acta orthopaedica Belgica, 2006
We report a new method of fixation of osteochondral fractures using tissue adhesive butyl-2-cyano... more We report a new method of fixation of osteochondral fractures using tissue adhesive butyl-2-cyanoacrylate. A traumatic osteochondral fracture of the patella and the medial femoral condyle in a 29-year-old male was fixed with butyl-2-cyanoacrylate tissue adhesive. At 6 month follow-up the fractures showed complete healing, the postoperative knee score was 84 and the functional knee score 90 (Knee Society Clinical Rating System).
Journal of orthopaedic surgery (Hong Kong), 2013
A closed reduction technique using a posteriorly inserted intrafocal Kirschner wire for unstable ... more A closed reduction technique using a posteriorly inserted intrafocal Kirschner wire for unstable Gartland type-III supracondylar humeral fractures in children is described. This surgical technique has been used in 7 patients. None had neurovascular complications, and all achieved bone union and had good or excellent functional and cosmetic results.
The outside-in subcutaneous arthroscopically assisted lateral retinacular release: a new technique
Acta orthopaedica Belgica, 2007
Arthroscopic lateral retinacular release in the knee has been used extensively for the treatment ... more Arthroscopic lateral retinacular release in the knee has been used extensively for the treatment of patellar pain and instability. The release can be performed using a number of techniques, but achieving access to the retinaculum can often be difficult, particularly in obese patients. We describe a simple modification of an arthroscopically assisted method, which utilises electrosurgery through a subcutanous channel to perform an outside-in release.
Acta Orthopaedica Belgica, 2021
The aim of this systematic review was to evaluate the evidence on reservation of Posterior Femora... more The aim of this systematic review was to evaluate the evidence on reservation of Posterior Femoral Condylar Offset (PFCO) and Joint Line (JL) after Revision Total Knee Arthroplasty (RTKA) for im- proved functional outcomes. A comprehensive search of PubMed, Medline, Cochrane, CINAHL, and Embase databases was conducted, with papers published from the inception of the database to October 2020 included. All relevant articles were retrieved, and their bibliographies were hand searched for further references on Posterior condylar offset and revision total knee arthroplasty. The search strategy yielded 28 articles. After duplicate titles were excluded, abstracts and full text were reviewed. Nine studies were assessed for eligibility, four studies were excluded because they did not fully comply with the inclusion criteria. Six articles were finally included in this systematic review. Based on this systematic review restoration of the JL and PFCO in RTKR is associated with a significant imp...
Acta Orthopaedica Belgica, 2021
High-quality and cost-effective health care are highly recommended especially in joint replacemen... more High-quality and cost-effective health care are highly recommended especially in joint replacement surgeries, particularly in total hip arthroplasty. Therefore, it is indispensable for orthopaedic surgeons to spot the potential areas of quality improvement. Evaluating the efficacy of the different ways of skin closure is an unacknowledged topic. We performed this study following both the Preferred Reporting Items for Systematic Reviews and Meta- analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Articles were from any country, written in any language. We included all randomised control trials and retrospective cohort studies undergoing primary total hip arthroplasty who either received staples or subcuticular sutures for skin closure. The primary outcome was the incidence of wound infection. Secondary outcomes included length of stay (LOS), time to skin closure, total cost, and patient’s satisfaction. We included five studies in our cumul...
Midterm results of modern patellofemoral arthroplasty versus total knee arthroplasty for isolated patellofemoral arthritis: systematic review and meta-analysis of comparative studies
Archives of Orthopaedic and Trauma Surgery, 2021
Both Patellofemoral Arthroplasty (PFA) and Total Knee Arthroplasty (TKA) are accepted surgical op... more Both Patellofemoral Arthroplasty (PFA) and Total Knee Arthroplasty (TKA) are accepted surgical options for end-stage isolated patellofemoral osteoarthritis (PFOA). We performed a systematic review and meta-analysis to compare outcomes of PFA and TKA by evaluation of the patient-reported outcome measures (PROMs). We systematically identified publications reporting on patients that underwent either TKA or modern PFA for isolated PFOA. Meta-analysis software was used to screen for potential articles with at least two years’ follow-up. Data were extracted and analysed for all PROMs operating time, postoperative inpatient time, complications and cost. We included five studies in our cumulative meta-analysis and reviewed them using Review Manager V.5.0. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used random-effect models. No significant difference was found between both TKA and PFA in the context of operating time. No significant difference after five years’ follow-up was found between the two treatment options in terms of UCLA score and patient satisfaction. PFA showed significant improvement in WOMAC score at five-year follow-up, less postoperative inpatient time, better cost-effectiveness and significantly less blood loss. PFA seems to be a viable alternative to TKA for treatment of isolated PFOA in appropriately selected patients. PFA showed less postoperative inpatient time and blood loss with similar PROMs to the TKA. Moreover, it is an economically beneficial joint-preserving procedure.
The Journal of Arthroplasty, 2021
Background: Paprosky type IIIa and IIIb acetabular defects remain technically challenging during ... more Background: Paprosky type IIIa and IIIb acetabular defects remain technically challenging during revision hip arthroplasty. Numerous surgical options exist to counter extensive acetabular bone loss with high postoperative complication and revision rates reported. Our aim was to report comprehensive long-term outcomes of our experience with Trabecular Metal (TM) augments for these difficult cases. Methods: 38 patients underwent revision total hip arthroplasty at our institution from 2009 to 2014 where a TM augment was used for acetabular deficiency. Prospective radiographic and Patient-Reported Outcome Measures were recorded and analyzed to a mean of 7.3 years (range: 5.4 to 10.8). Results: No patient was excluded or lost to follow-up. Complications included 3 intraoperative fractures, 1 early infection requiring washout with implant retention, 1 early revision due to allograft resorption, and 6 patients who required late repeat revision surgery: 3 for late infection, 2 for aseptic loosening with augment fracture or dislocation, and 1 for recurrent dislocation. The estimated mean implant survivorship was 8.99 years. 93.5% of augments remaining were well osseointegrated while 97% of the acetabular shells were osseointegrated. Hip center of rotation was restored by a mean of 14 mm inferiorly without significant medialization. Short Form-12 (SF-12) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were significantly reduced postoperatively to a level comparable to the average individual. Conclusion: This long-term study details our experience of TM augments for the most severe acetabular defects. For such cases, no excellent surgical solution exists; in comparison to alternative methods, we advocate that this technique is reasonably safe and effective.
Malignant triton tumour (MTT) of the lung with metastasis to the proximal femur
BMJ Case Reports, 2021
A 65-year-old female patient has a history of malignant triton tumour of the right upper lobe of ... more A 65-year-old female patient has a history of malignant triton tumour of the right upper lobe of the lung. She underwent right upper lobectomy and lymphadenectomy in May 2018. She presented in November 2019 with pathological fracture of the left proximal femur. It was not associated with neurofibromatosis. We decided to do an excisional biopsy of the mass and proximal femoral replacement followed by radiotherapy. Four months later, she presented with local recurrence. We organised a multidisciplinary team between the orthopaedic, histopathology and oncology teams. Then, we decided to treat her with chemotherapy. After 2 months of follow-up, she responded well to the chemotherapy with no further deterioration of her condition.
The Journal of Arthroplasty, 2020
Background: We describe the intraoperative parameters that affect stem subsidence rates in tapere... more Background: We describe the intraoperative parameters that affect stem subsidence rates in tapered modular femoral stems for revision total hip arthroplasty (THA). We also determine the effect of the stem bicortical contact on subsidence rates and whether there is a minimum threshold bicortical contact that must be achieved to avoid the complication of subsidence. Methods: This is a retrospective cohort study consisting of 109 hips in 105 patients (53 males and 52 females) at a minimum of 2 years of follow-up. All revisions were carried out for Paprosky type 3A and 3B femoral deficits. Clinical outcomes included the indication for revision, aseptic re-revision surgery, specifications of the stem inserted, and specifications of the femoral head and acetabular components implanted. Radiographic outcome measures included subsidence (mm) and bicortical contact (mm). Results: Using multivariate regression analysis, 3 parameters were associated with an increased rate of stem subsidence. A reduced bicortical contact distance (P < .001) and a stem length of 155 mm (P < .001) were both associated with higher subsidence rates. We also demonstrated a novel threshold of 20mm bicortical contact which must be achieved to significantly reduce subsidence rates in these modular femoral stems for revision THA. Conclusion: Subsidence rates of modular tapered femoral stems for revision THA can be significantly reduced by increasing the initial bicortical contact of the stem within the diaphysis and the overall length of the femoral stem >155 mm. We describe a minimum threshold bicortical contact distance of 20 mm that should ideally be exceeded to significantly reduce the risk of stem subsidence within the femoral canal.
SICOT-J, 2019
Background: Metal on Metal Hip arthroplasty was commonly used until the last decade. However Hip ... more Background: Metal on Metal Hip arthroplasty was commonly used until the last decade. However Hip Arthroplasty registries of many countries showed increased revision rates of MOM Hips – these high rates of revision caused by trunnionosis, adverse tissue reactions (ALTRs) and Pseudotumor formation. The Case: Our Case is 73 years old gentleman who had left MOM THR in 2008, and was doing fine till the beginning of 2018 when his left leg stuck while getting out of the car. Despite he heard the pop and his leg was shortened and externally rotated, but he was still walking on it for a while. On reviewing him in our orthopedic clinic and after getting the CT-scan showed that he had dislocated femoral head from the stem.
Mesentery and Peritoneum, 2018
Background: Trabecular metal augments are one option when reconstructing bone loss during acetabu... more Background: Trabecular metal augments are one option when reconstructing bone loss during acetabular side revision surgery. Methods: We studied 38 consecutive patients with Paprosky type 3 defects that were revised using a Trabecular Metal shell and one or more augments over a 6-year period. There were 29 Paprosky type 3A defects and 9 Paprosky type 3B defects. The mean age of the patients at time of surgery was 68.2 years (range, 48-84 years). The mean length of follow-up was 36 months (range, 18-74 months). Results: The mean pre-operative SF12 improved from 27.7 before operation to 30.1 at the time of final followup (P=0.001). The mean Western Ontario and McMaster Universities Arthritis Index (WOMAC) score improved from 53 pre-operatively to a mean of 78.8 at final follow-up (P<0.0001). There was evidence of radiographic loosening in seven of the cup-augment constructs. One patient developed a deep infection requiring re-revision. Two patients required revision for aseptic loosening. Conclusions: The use of Trabecular Metal augments in complex acetabular reconstruction is associated with good outcome in the short to medium term.
Foot & Ankle Orthopaedics, 2017
Category: Midfoot/Forefoot Introduction/Purpose: Metatarsophalangeal arthrodesis has usually been... more Category: Midfoot/Forefoot Introduction/Purpose: Metatarsophalangeal arthrodesis has usually been performed using a dorsal plate to immobilize the MTP joint with or without lag screw fixation. Data in the literature is sparse on outcomes of dorsal plate plus lag screw fixation, especially in patients with IMA greater than 15 percent. Our objective was to compare IMA correction outcomes and union rates between dorsal plate only fusions and dorsal plate plus lag screw fixation in patients with IMA greater than 15 percent. Methods: We retrospectively reviewed the charts of 36 patients (39 feet) who underwent first MTP joint arthrodesis for moderate to severe HV deformity between 2011 and 2015. Average age was 61 (range, 39 to 84) years. There were 24 females and 12 males. A single surgeon performed all operations. Joints were immobilized postoperatively using either dorsal locking plate alone or dorsal locking plate with a lag screw. Union (at least 3 bridging cortices) was determined ...
Hip international : the journal of clinical and experimental research on hip pathology and therapy, 2017
Total hip arthroplasty (THA) is a very successful procedure. Revision THA is becoming increasingl... more Total hip arthroplasty (THA) is a very successful procedure. Revision THA is becoming increasingly common. Recent developments to improve outcomes include the development of large trabecular metal (TM) acetabular cups and augments. There is a paucity of data on the benefit of these new techniques. A single-centre retrospective review consisting of a radiological review of post-op revision THA anteroposterior pelvis. Data collection was performed using the Irish National Orthopaedic Register (INOR) and from a previous project. We used a technique developed by Fessy et al in 1999 to measure the centre of rotation (COR) of the hip. We then compared our study to that of a study measuring the COR of healthy native hips. 127 revision THA analysed. Native COR calculated by Fessy et al showed a mean horizontal (x) axis 33.6 mm (standard deviation [SD] 5.74) and a vertical (y) axis 16.4 mm (SD 4.67). Non-TM revisions showed a mean x axis of 29 mm (SD 3.9) and y axis 17.9 (SD 5.9). TM Augment...
Journal of Clinical Case Reports, 2015
We present the case of a 43-year-old female with a background history of left Total Hip Replaceme... more We present the case of a 43-year-old female with a background history of left Total Hip Replacement who presented to the clinic with progressively worsening left hip and groin pain over the previous 2 years with sudden deterioration in her mobility over one week. On examination she had a significant pain in the left hip and groin on all hip movements associated with tenderness over the left greater trochanter. An Anterior-Posterior (AP) pelvic radiograph identified an oblique fracture through the proximal third of her Charnley Modular femoral stem. Her primary Total Hip Replacement had been carried out 15 years prior to this presentation for avascular necrosis of the femoral head secondary to Slipped Capital Femoral Epiphysis. A Size 1 Charnley Modular stem was cemented in with a 22.225 mm 9/10+0 Ceramax Head. Her post-op course was uneventful and she was discharged home in a timely manor. She had been pain free in the left hip at all follow-up appointments up to 2 years prior to this presentation. All previous radiographs demonstrated a well positioned prosthesis with no evidence of fracture or loosening. No specific remarks were made about the cement mantle (Figures 1a and 1b). On diagnosis of the broken stem, she was scheduled for a single stage revision. This was carried out through an anterolateral approach with removal of the proximal fragment of the femoral stem. The distal
Coloarticular Fistula Associated with a Pseudotumor After Metal-on-Metal Hip Resurfacing Arthroplasty: A Case Report
JBJS Case Connector, 2013
ABSTRACT Fistula formation between the bowel and an implant following hip arthroplasty is rare1-1... more ABSTRACT Fistula formation between the bowel and an implant following hip arthroplasty is rare1-11. Documented predisposing conditions include pelvic radiation therapy, long-term corticosteroid use, pelvic migration of the hip arthroplasty acetabular component, diverticulitis, and Crohn disease2,4-7,9-13. To our knowledge, we report the first known coloarticular fistula associated with a pseudotumor after a metal-on-metal hip resurfacing arthroplasty. The patient was informed that data concerning the case would be submitted for publication, and she provided consent.
European Journal of Orthopaedic Surgery & Traumatology, 2005
The teardrop fracture of the axis comprises a special entity, characterized by an avulsed fragmen... more The teardrop fracture of the axis comprises a special entity, characterized by an avulsed fragment, of varying size, from the anterior inferior angle of the body of C2. It is extremely rare and differs in many respects from the teardrop fracture of the lower cervical spine, which was originally described by Schneider and Kahn in 1956. Indeed, much of what is written about teardrop fractures relates to lower cervical spine flexion type teardrop fractures. To date there are only 36 reported cases of teardrop fracture of the axis. We present seven cases of a teardrop fracture of the axis treated in the National Spinal Injuries unit at the Mater Miscericordiae University Hospital, Dublin from 1993 to 2003. The mean follow-up time was 6 years. The stability of this fracture has been questioned by certain authors, resulting in disagreement concerning the best choice of treatment to be followed. The radiological, clinical features and functional outcome of patients who have sustained a teardrop fracture of the axis will be described. The mechanism of injury and potential for instability will be compared with teardrop fractures of the lower cervical spine so as to emphasize the importance of recognizing this injury as a separate entity. Keywords Teardrop AE Cervical AE Axis AE Functional AE Outcome Re´sultat fonctionnel apre`s fractures tear-drop de l'axis Mots-cle´s Tear-drop AE Cervical AE Axis AE Fonctionnel AE Re´sultats
European Journal of Orthopaedic Surgery & Traumatology, 2006
We have recently treated two adult patients with significant spinal injuries after using an infla... more We have recently treated two adult patients with significant spinal injuries after using an inflatable 'bouncy castle'. We highlight the risks associated with these devices in the adult age group and review the current literature. We conclude that these devices should carry a clear warning to adults that their use by above-14 is hazardous.
Arthroplastie totale de hanche non cimentée dans le traitement des dysplasies sévères ou des hanches luxées
European Journal of Orthopaedic Surgery & Traumatology, 2004
We present our experience over 6 years with the use of uncemented total hip arthroplasty (THA) fo... more We present our experience over 6 years with the use of uncemented total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) with a mean follow-up of 3 years. In a 6-year period, 26 THAs were performed in 19 patients with Hartofilakidis grades 2 and 3 dislocation of the hips. Out of 19 patients, seven had bilateral dislocations. Uncemented acetabular and femoral components were used in all patients. Patients with a minimum follow-up of 1 year were included in the study. The average age at the time of surgery was 38 (range 20-69) years. Approaches used include trochanteric osteotomy in 14 (54%) patients and a lateral approach in 12 (46%) patients. In addition, subtrochanteric osteotomy was performed in four (15%) patients. A Mallory-head femoral stem was used in 15 (58%) patients; a DDH femoral stem was in nine (35%), and the S-ROM femoral prosthesis in two (8%). A Mallory head acetabular shell was used in all cases, a 22.2-mm chrome cobalt head was used in 18 (69%), and a 28-mm chrome cobalt head was used in eight (31%). The average follow-up was 3 (range 1-6) years. The Harris hip score (HHS) improved in the cohort from a mean preoperative score of 51 to a mean postoperative score of 86 (p<0.05). The mean preoperative SF36v2 score was 42 compared to postoperatively of 67(p<0.05). The complication rate was 11% with nonunion of a subtrochanteric osteotomy in one patient, dislocation in one, and trochanteric bursitis due to fracture of Dall-Miles cables in one. THA for DDH is a technically demanding procedure. This short-term follow-up of THA for DDH using uncemented implants is encouraging for arthrosis secondary to DDH. It provides better function compared to arthrodesis or excision arthroplasty, especially in young individuals. A long-term follow-up is required in order to establish the role of this management strategy. Keywords Cementless AE Total hip arthroplasty AE Developmental dysplasia of the hip Arthroplastie totale de hanche non cimente´e dans le traitement des dysplasies se´ve`res ou des hanches luxe´es
Intraoperative arthrometry in anterior cruciate ligament reconstruction
Acta orthopaedica Belgica, 2005
Arthrometry has an established role in the measurement of knee laxity in anterior cruciate ligame... more Arthrometry has an established role in the measurement of knee laxity in anterior cruciate ligament injury and following reconstruction. The role of routine intraoperative arthrometry in anterior cruciate ligament reconstruction is poorly defined, and this study was designed to test the hypothesis that intraoperative arthrometry provides an objective method of documenting successful knee stabilisation following anterior cruciate ligament reconstruction. A consecutive cohort of 100 patients with unilateral isolated anterior cruciate ligament disruption were prospectively evaluated using a Rolimeter arthrometer. A maximal manual force method was utilised by a single examiner. This allowed for side-to-side comparisons with the uninjured contralateral knee. Analysis of tibial translation was recorded preoperatively with patients both awake and asleep, intraoperatively following anterior cruciate ligament reconstruction, and postoperatively at 2 weeks and 3 months. Statistical analysis w...
Osteochondral fractures in the knee treated with butyl-2-cyanoacrylate glue. A case report
Acta orthopaedica Belgica, 2006
We report a new method of fixation of osteochondral fractures using tissue adhesive butyl-2-cyano... more We report a new method of fixation of osteochondral fractures using tissue adhesive butyl-2-cyanoacrylate. A traumatic osteochondral fracture of the patella and the medial femoral condyle in a 29-year-old male was fixed with butyl-2-cyanoacrylate tissue adhesive. At 6 month follow-up the fractures showed complete healing, the postoperative knee score was 84 and the functional knee score 90 (Knee Society Clinical Rating System).
Journal of orthopaedic surgery (Hong Kong), 2013
A closed reduction technique using a posteriorly inserted intrafocal Kirschner wire for unstable ... more A closed reduction technique using a posteriorly inserted intrafocal Kirschner wire for unstable Gartland type-III supracondylar humeral fractures in children is described. This surgical technique has been used in 7 patients. None had neurovascular complications, and all achieved bone union and had good or excellent functional and cosmetic results.
The outside-in subcutaneous arthroscopically assisted lateral retinacular release: a new technique
Acta orthopaedica Belgica, 2007
Arthroscopic lateral retinacular release in the knee has been used extensively for the treatment ... more Arthroscopic lateral retinacular release in the knee has been used extensively for the treatment of patellar pain and instability. The release can be performed using a number of techniques, but achieving access to the retinaculum can often be difficult, particularly in obese patients. We describe a simple modification of an arthroscopically assisted method, which utilises electrosurgery through a subcutanous channel to perform an outside-in release.