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Papers by suresh patil

Axial lumbar interbody fusion is a novel percutaneous alternative to common open techniques, such... more Axial lumbar interbody fusion is a novel percutaneous alternative to common open techniques, such as anterior, posterior, and transforaminal lumbar interbody fusion. This minimally invasive technique uses the presacral space to access the L5-S1 and L4-L5 disk space. The goal of this study was to examine outcomes following axial lumbar interbody fusion. The charts of all patients who underwent axial lumbar interbody fusion surgery at our institution between 2006 and 2008 were reviewed. Clinical outcomes included visual analog scale (VAS) and Oswestry Disability Index (ODI). Radiographs were also evaluated for disk space height, L4-L5 and/or L5-S1 Cobb angle, and fusion. Of the 50 patients (32 women, 18 men; mean age, 49.29 years) treated with axial lumbar interbody fusion, 48 had preoperative VAS scores and 16 had preoperative ODI scores available. Complete radiographic data were available at the preoperative, initial postoperative, and final postoperative time points for 46 patients (92%). At last follow-up (average, 12 months), ODI scores were reduced from 46 to 22, and VAS scores were lowered from 8.1 to 3.6. Of the 49 patients with postoperative radiographs, 47 (96%) went on to a solid fusion. There were no significant differences between pre-and postoperative disk space height and lumbar lordosis angle. The most common complications were superficial infection and pseudoarthrosis. Other complications were rectal injury, hematoma, and irritation of a nerve root by a screw. Overall, we found the axial lumbar interbody fusion procedure in combination with pedicle screw placement to have good clinical and radiological outcomes. Axial lumbar interbody fusion is a minimally invasive fusion technique, recently described by Cragg et al, used to approach the L5-S1 and L4-L5 disk space. It is a percutaneous alternative to common open techniques, such as anterior, posterior, and transforaminal lumbar interbody fusion. Although the posterior and transforaminal lumbar interbody fusion procedures can provide circumferential spinal stabilization through a single posterior approach, they involve muscle retraction, ligamentous and osseous dissection, disruption of the annulus, and thecal sac and nerve root retraction, which can lead to cerebrospinal fluid leakage and nerve root injury. Anterior lumbar interbody fusion is also a 1 2 3

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Introduction: Subsidence of cementless femoral stems in total hip arthroplasty (THA) has been ass... more Introduction: Subsidence of cementless femoral stems in total hip arthroplasty (THA) has been associated with poor initial fixation and subsequent risk of aspectic loosening. There is limited literature on how subsidence of cementless, proximally porous coated, tapered wedge femoral stems impacts the patient clinically. The aim of our study was to assess whether subsidence with these stems is associated with a decline in clinical function.

Method: A review of a prospectively collected database of THAs performed by a single surgeon at one institution using two cementless, tapered wedge stem designs from January 2006 to June 2010 was performed. Radiographic analysis using Picture Archiving and Communications System (PACS) was used to identify patients with greater than 1.5 mm of subsidence, and to document osseointegration. Preoperative and postoperative pain and Harris hip scores were recorded; and analyzed to identify if the clinical recovery pattern of the subsidence versus no subsidence groups differed. Protected weight bearing was recommended to all patients with subsidence.

Results: 264 hips were reviewed clinically and radiographically at a mean follow-up of 29 months. 10 hips had subsidence greater than 1.5 mm at last follow up. There were 6 males and 3 females with a mean age of 62.1 years in the subsidence group. Subsidence was noted at the 6 week visits in all 10 patients. Mean Harris Hip scores and pain scores were significantly diminished at 6 weeks in the subsidence group (Mean 67.6) as compared to the none subsidence group (82.2) (Figure 1). The two groups had similar scores preoperatively, at 1 year and 2 years postoperatively. In the subsidence group 9 of 10 hips had no further progression of subsidence, and showed radiographic evidence of osseointegration. Persistent thigh pain was noted in 2 patients in the subsidence group. One underwent successful femoral revision for failure of osseointegration and the other continues to have pain with radiographic signs of osseointegration. All 254 hips in the control group had evidence of osseointegration.

Conclusion: Subsidence of tapered wedge stems which occurs at the 6 week mark may be associated with a transient decline in clinical function. Early modification in the rehabilitation regimen may help improve clinical outcome scores in these patients.

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Aim: To compare the mortality and morbidity and post op complication in high risk Intertrochanter... more Aim: To compare the mortality and morbidity and post op complication in high
risk Intertrochanteric fractures treated by cemented bipolar and internal fixation.
Material and methods: Thirty five selected patients matched for age, sex,
weight, fracture type and preop ASA grade-III were treated by primary bipolar
arthroplasty (Group A) from January 2002 to June 2005. All patients were
operated by the same surgeon. Bipolar implants were cemented (tapered design,
2nd generation cemented technique, standard length) and trochanteric
comminution was circlage to restore abductor mechanism The results of this
group of patients were compared with thirty nine patients treated with Internal
Fixation (Group B) by Dynamic Hip Screw and side plate with appropriate
reduction and fixation.The comparison was done with emphasis on perioperative
mortality and morbidity in terms of day of full weight bearing, pressure sore,
pulmonary complication.
Discussion and result: The Bipolar Arthroplasty (Group A) was able to full
weight bear significantly earlier than the Internal Fixation (Group B)
patients. Rehabilitation was easier and faster and post op morbidity like pressure
sore pulmonary complication was significantly low (P<0.05). The mortality in
cemented bipolar group (5/35) was significantly lower than internal fixation group
(12/39) (P<0.05).
Conclusion: Statistically Mortality and morbidity in bipolar Arthroplasty (Group
A) was significantly lower compared to internal fixation (Group B). Bipolar
Arthroplasty may be a better alternative treatment for osteoporotic unstable
Intertrochanteric fractures in elderly morbid patients

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Two-stage reimplantation, with interval antibiotic-impregnated cement spacer, is the preferred tr... more Two-stage reimplantation, with interval antibiotic-impregnated cement spacer, is the preferred treatment of prosthetic knee joint infections. In medically compromised hosts with prior failed surgeries, the outcomes are poor. Articulating spacers in such patients render the knee unstable; static spacers have risks of dislocation and extensor mechanism injury. We examined 58 infected total knee arthroplasties with extensive bone and soft tissue loss, treated with resection arthroplasty and intramedullary tibiofemoral rod and antibiotic-laden cement spacer. Thirty-seven patients underwent delayed reimplantation. Most patients (83.8%) were free from recurrent infection at mean follow-up of 29.4 months. Reinfection occurred in 16.2%, which required debridement. Twenty-one patients with poor operative risks remained with the spacer for 11.4 months. All patients, during spacer phase, had brace-free ambulation with simulated tibiofemoral fusion, without bone loss or loss of limb length

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Various navigation systems are available to aid pedicle screw placement. The O-arm replaces the n... more Various navigation systems are available to aid pedicle screw placement. The O-arm replaces the need for fluoroscopy and generates a 3-dimensional volumetric dataset that can be viewed as transverse, coronal, and sagittal images of the spine, similar to computed tomography (CT) scanning. The dataset can be downloaded to the Stealth system (Medtronic Navigation, Louisville, Colorado) for real-time intraoperative navigation.The main objectives of the current study were to assess (1) accuracy of pedicle screw placement using the O-arm/Stealth system, and (2) time for draping, positioning of the O-arm, and screw placement. Of 188 screws (25 patients), 116 had adequate images for analysis. The average time for O-arm draping was 3.5 minutes. Initial O-arm positioning was 6.1 minutes, and final positioning was 4.9 minutes. Mean time for screw placement, including O-arm draping and positioning and array attachment, was 8.1 minutes per screw. Mean time for screw placement alone was 5.9 minutes per screw. Screw placements on final O-arm images were on average 3.14 mm deeper than on the snapshot navigation images. Three screws (2.6%) breached the medial cortex, and 3 screws (2.6%) were misaligned and did not follow the pilot hole trajectory.The use of the O-arm/Stealth system was associated with a low rate of pedicle screw misalignment. The time to place screws was less than previously reported with CT navigation, but longer than conventional techniques. It is important to be aware of the potential discrepancy between snapshot navigation images and actual screw placement on final O-arm images. Our findings suggest that final screw positions may be deeper than awl positions appear on navigation images.

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