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Browsing by Author "Pandit, Hemant"
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Item Can the use of an inclinometer improve acetabular cup inclination in total hip arthroplasty? A review of the literature(Sage, 2021-09) van Duren, Bernard H.; Royeca, Joseph M.; Cunningham, Conor M.; Lamb, Jonathan N.; Brew, Chris J.; Pandit, Hemant; Medicine, School of MedicineIntroduction: The angle of acetabular (cup) radiographic inclination is an important measurement in total hip arthroplasty (THA) procedures. Abnormal radiographic inclination is associated with dislocation, edge loading and higher failure rates. Consistently achieving a satisfactory radiographic inclination remains a challenge. Inclinometers have been increasingly used over the last decade. This paper reviews the literature to determine whether using an inclinometer improves the accuracy of acetabular cup inclination in THA. Methods: A systematic literature search was performed. The following search terms were used: ('hip' OR 'hip replacement' OR 'hip arthroplasty' OR 'primary hip replacement' OR 'THR' OR 'THA' OR 'Acetabular cup Inclination') AND ('Inclinometer'). Titles and abstracts were screened for relevance. Both radiographic and operative inclination comparisons were included. Results: 7 studies met the inclusion criteria. 2 were randomised control trials with level I evidence, and the remaining studies were cohort studies with level III/IV evidence. 5 were clinical and 2 experimental. In total there were 16 cohorts: 7 using an inclinometer, 6 freehand, and 3 using MAG techniques. All studies comparing radiographic inclination and 1 of 2 studies comparing operative inclination showed an improvement in the attainment of the optimal inclination. Similarly, the use of an inclinometer showed a reduction in the number of outliers when compared to MAG and freehand techniques. Discussion: This review demonstrates that using an inclinometer improved the surgeon's ability to achieve their intended inclination (both operative and radiographic) and reduced the incidence of positioning outside the safe-zone. However, only 2 of the studies were randomised control trials and these resulted in opposing conclusions. Therefore, further studies looking at the use of inclinometers would prove useful in understanding their true benefit.Item Complex regional pain syndrome as a result of total knee arthroplasty: A case report and review of literature(Elsevier, 2019-07-24) Royeca, J. Matthew; Cunningham, Conor M.; Pandit, Hemant; King, Samuel W.; Medicine, School of MedicineTotal knee arthroplasty (TKA) is an effective treatment for patients with end-stage symptomatic knee osteoarthritis. As the aging population grows, the demand for the procedure is projected to increase. While highly successful, TKA has associated risks and complications. Complex regional pain syndrome is one uncommon but debilitating complication that can negatively impact patient satisfaction and quality of life. We present a case of complex regional pain syndrome in the operated leg that resulted in significant functional deficits. Key findings of this case include significant and disproportionate pain in the joint, altered cutaneous sensation around the joint, and decreased range of motion in flexion in the absence of any mechanical issues with the TKA. Because of the debilitating nature of this condition, patients must be fully informed of and realize the risks associated with undergoing a widely appreciated procedure such as TKA.Item Doctor when can I drive? A systematic review and meta-analysis of return to driving after total hip arthroplasty(Sage, 2023) Patel, Purva V.; Giannoudis, Vasileios P.; Palma, Samantha; Guy, Stephen P.; Palan, Jeya; Pandit, Hemant; Van Duren, Bernard H.; Graduate Medical Education, School of MedicineBackground/objective: Advice given to patients on driving resumption after total hip arthroplasty (THA) is inconsistent. Due to a lack of clear guidelines, surgeons' recommendations range between 4-8 weeks after surgery to resume driving. Delays in driving return can have detrimental social and economic impact. However, it is important to ensure patients only resume driving once safe. This study presents a systematic review and meta-analysis of driving simulation studies after THA to establish when patients can safely return to driving postoperatively. Methods: A systematic review and meta-analysis using PRISMA guidelines was undertaken. Titles and abstracts were screened for inclusion, data was extracted, and studies assessed for bias risk. Review Manager, was used for statistical analysis. Values for brake reaction time (BRT) were included for meta-analysis. Results: 14 articles met the inclusion criteria. Of these, 7 measured BRT and were included in the meta-analysis. Pooled means of both right and left THA showed BRT around or above preoperative baseline at 1 week, 2 weeks and 3 weeks, and below baseline at 6 weeks, 12 weeks, 32 weeks and 52 weeks. Of these, the pooled means at 6, 32, and 52 weeks were significant (p < 0.05).Studies not meeting meta-analysis inclusion criteria were included in a qualitative analysis, examining self-reported postoperative driving return times which ranged from 6 days to over a year or in rare cases, never. Majority of patients (n = 960) self-reported driving return within approximately 6 weeks (pooling of mean values 32.9 days). Conclusions: The mean return to driving time recommended in the literature was 4.5 weeks. Based upon BRT meta-analysis, a return to baseline braking performance was noted at 6 weeks postoperatively. However, driving is a complex skill, and patient recommendation should be individualised based on factors such as vehicle transmission type, THA technique, surgical side, medication and comorbidities.Item Late-onset fibrodysplasia ossificans progressiva with atypical presentation: A case report(Elsevier, 2019-07-19) Cunningham, Conor M.; Royeca, J. Matthew; King, Samuel W.; Pandit, Hemant; Medicine, School of MedicineFribrodysplasia ossificans progressiva (FOP) is a rare genetic disease characterized by progressive heterotopic ossification of connective tissues, episodic flare-ups and bilateral deformities of the great toe (hallux valgus). As faulty tissue repair processes progressively calcify tissue, patients suffer from swelling and limited mobility in that area. We present a case of a 66-year-old woman who had initially presented at age 54 without the hallux valgus deformity or classic-type flare-ups. As there is currently no cure for FOP, management is mainly symptom control. Physicians should still consider FOP if imaging indicates progressive heterotopic ossification in the absence of hallux valgus in an older patient.Item Patients Generally May Return to Driving 4 Weeks After Hip Arthroscopy and 6 Weeks After Knee Arthroscopy: A Systematic Review and Meta-analysis(Elsevier, 2021-10-06) Palma, Samantha; Giannoudis, Vasileios; Patel, Purva; Palan, Jeya; Guy, Stephen; Pandit, Hemant; Van Duren, Bernard; Medicine, School of MedicinePurpose: To consolidate the evidence from the available literature and undertake a meta-analysis to provide a reference for physicians to make evidence-based recommendations to their patients regarding the return to driving after hip or knee arthroscopic procedures. Methods: A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The OVID, Embase, and Cochrane databases were searched through June 2020 for articles containing keywords and/or MeSH (Medical Subject Headings) terms "hip arthroscopy" and "knee arthroscopy" in conjunction with "total brake response time" or "reaction time" in the context of automobile driving. A title review and full article review were performed to assess quality and select relevant articles. A meta-analysis of qualifying articles was undertaken. Results: Eight studies met the inclusion criteria for meta-analysis of brake reaction time (BRT). Meta-analysis of all knee BRTs showed times slower than or equal to baseline BRTs through 5 weeks, with a trend of improving BRTs from 6 to 10 weeks (weeks 8 and 10 were significant, P < .05). Among all hip BRTs, week 2 showed times slower than baseline BRTs, but after week 4, a trend toward faster BRTs was observed through week 8 (week 8 was significant, P < .05). Conclusions: BRTs met baseline or control values and continued to improve after 6 weeks after knee arthroscopy and after 4 weeks after hip arthroscopy. On the basis of these results, it would be safe to recommend a return to driving at 6 weeks after knee arthroscopic procedures and 4 weeks after hip arthroscopic procedures. Clinical relevance: These results can be used by surgeons to base their recommendations on to provide guidance for their patients on the resumption of driving. Although BRT is an important aspect of driving ability, there are additional factors that need to be taken into consideration when making these recommendations, including cessation of opioid analgesics, strength of the surgical limb, and range of motion.Item Periprosthetic femoral fractures following total hip and total knee arthroplasty(Elsevier, 2018-11) King, Samuel W.; Lamb, Jonathan N.; Cage, Emily S.; Pandit, Hemant; Graduate Medical Education, School of MedicineTotal joint arthroplasties are increasing worldwide in both frequency and prevalence. When successful, they offer great improvements in quality of life. However, fractures around implants are often difficult to manage and require prolonged inpatient stays in tertiary hospitals. Management may differ between surgeons, but most patients will be managed surgically if mobility or joint stability is threatened. Those affected are often at higher risk from surgery, are frailer and at higher risk of mortality and a lifelong reduction in mobility. The incidence of these fractures is increasing, and patients should appreciate the risk and implications of this recognised complication of joint arthroplasty.Item Vertebroplasty: For whom and when(Elsevier, 2018) Ranade, Manjiri; Geeraert, Ruben; Pandit, Hemant; Medicine, School of MedicineVertebral compression fractures (VCF) are the most common type of fragility fracture, with about 1.4 million people affected annually, worldwide [1]. The risk of VCF increases with age, up to 25% in women and 18% in men by age 75 according to the European Vertebral Osteoporosis Study (EVOS) [2]. VCF can result in severe and disabling back pain, especially in elderly patients. Patients may experience significant morbidity and decreased quality of life, are at higher risk of chronic back pain and have increased mortality rates [3].