Showing papers by "Gautam M. Shetty published in 2011"

Persistent hindfoot valgus causes lateral deviation of weightbearing axis after total knee arthroplasty.

Abstract: Background The weightbearing axis of the limb goes from the pelvis to the ground and includes the hindfoot. However, the influence of hindfoot alignment on mechanical axis and overall limb alignment after TKA is unclear.

Early complications of medial opening wedge high tibial osteotomy using autologous tricortical iliac bone graft and T-plate fixation.

Abstract: Despite several advantages of medial opening wedge high tibial osteotomy, this procedure has been noted to have a high rate of complications especially with the use of a spacer plate for fixation. We retrospectively evaluated the early complications of 138 medial opening wedge high tibial osteotomies done using autologous tricortical iliac bone graft and T-plate fixation(AO locking compression T-plate, Ti/3H 4.5-5.0 mm, Synthes, Switzerland, Model No. 440.131 in 30 and low-profile locking T-plate and low-profile locking T-plate in 128 patients. At a mean follow-up of 36.8 months (13 to 78), 26 knees (18.8%) developed complications. Complications varied from osteotomy site infection, loss of correction, broken screws and lateral tibial plateau fracture to joint fluid leakage, pseudoaneurysm and iliac bone fractures. Using the "safe zone" technique and penetrating the lateral cortex with Steinmann pins may help to avoid complications such as loss of correction and lateral tibial plateau fractures. The results of this study indicate that medial opening wedge high tibial osteotomy using autologous tricortical iliac bone graft and T-plate fixation may be a technically demanding procedure associated with a moderate rate of complications. However, these complications could be minimized with proper planning, adequate intra-operative precautions and few modifications to avoid technical error.

Optimal bearing surfaces for total hip replacement in the young patient: a meta-analysis

Abstract: Although there is general consensus about the efficacy of total hip replacement (THR) in young patients, the most appropriate bearings in young patients remain highly debated. The three most popular bearings in use include metal-on-polyethylene (MOP), metal-on-metal (MOM) and ceramic-on-ceramic (COC). We conducted a systematic review and meta-analysis of literature to summarise the best available evidence on relative success of the three most popular bearings used in THR in young active patients. Our findings support the use of MOM bearings in the management of the young arthritic hip. These findings, largely based upon observational studies, should be taken in the context of the limitations of such non-randomised study designs.

Postoperative limb alignment and its determinants after minimally invasive Oxford medial unicompartmental knee arthroplasty.

Abstract: One hundred twenty-two consecutive minimally invasive Oxford phase 3 medial unicompartmental knee arthroplasties in 109 patients were evaluated for postoperative limb alignment and the influence of factors such as preoperative limb alignment, age, body mass index, sex, insert thickness, and surgeon's experience. The mean mechanical preoperative hip-knee-ankle (HKA) angle of 172.2° ± 3.1° improved to 177.1° ± 2.9° postoperatively. In 75% of the limbs, the HKA angle was restored to within an acceptable alignment of 177° ± 3°, 14% of the limbs were in excessive varus ( 180°). Only preoperative HKA angle was predictive of postoperative HKA angle. Although most of the limbs had acceptable limb alignment after unicompartmental knee arthroplasty, limbs with more severe preoperative varus deformity had a tendency to remain in excessive varus, and limbs with lesser preoperative varus deformity had a greater tendency to go into valgus postoperatively.

Posterior reattachment of a radial tear in the posterior root of the medial meniscus.

Abstract: The new posterior vertical mattress suture technique is technically easier to perform and provides more secure fixation than the arthroscopic simple or horizontal stitch techniques and may contribute to restoring function of the medial meniscus.

How accurate are orthopaedic surgeons in visually estimating lower limb alignment

Abstract: This study aimed to determine the accuracy and reliability of visual estimation of limb alignment and knee flexion by orthopaedic surgeons when compared to recordings done by computed navigation. Orthopaedic surgeons attending a national conference were asked to place a lower limb synthetic bone model in 6 positions of the knee in the coronal and sagittal planes. These were simultaneously quantified and recorded by a computer navigation system. In the sagittal plane, 44%, 54% and 60% of the surgeons deviated by more than 5 degrees when positioning the knee in 0 degrees flexion, 10 degrees flexion and 90 degrees flexion respectively. In the coronal plane, 15%, 12% and 8% of the surgeons deviated by more than 5 degrees when positioning the knee in 0 degrees varus/valgus, 5 degrees varus and 5 degrees valgus respectively. Only 25% of the surgeons could position the knee both within 3 degrees of neutral varus/valgus and within 5 degrees of neutral flexion. Accuracy of visual estimation was not different when surgeons were compared based on time since residency, experience with TKA and experience with computer-assisted TKA. Visual estimation of knee alignment in both the sagittal and coronal plane is prone to error and may lead to inaccurate limb alignment during procedures such as TKA.

Resurrection of the case report

Abstract: Typically, a case report intends to share a surgeon’s anecdotal experience of an unusualpresentation of a disease or an unusual outcome or complication of treatment. Apart from its interesting and entertaining value, case reports aim to enrich the diagnosticand management skills of the surgeon. However, an increasing number of orthopaedicjournals have now significantly reduced the acceptance rate for case reports andnumerous others have adopted the policy of not publishing case reports. Apart fromadding to the workload of reviewers and editors who already have to deal with thesoaring number of online submission of original articles, case reports have been deemed as lacking scientific merit and very low on the evidence pyramid. So why a journal solely dedicated to case reports? First, a case report or a technicalnote is a perfect opportunity for orthopaedic residents or consultants who are not wellversed with medical writing to take their first step towards research and publication. The editors believe that this first, relatively simple step of publishing a case report ortechnical note will go on to encourage further interest in research and publication.Second, case reports although considered low on the evidence pyramid act as instruments for hypothesis generation which may point towards a direction for furtherresearch. Third, a rare disease presentation or rare outcomes of treatment act as anexception to the generally accepted rules and norms which will help to broaden theperspective of surgeons. Finally, technical notes will help provide effect solutions tocommon problems encountered during diagnosis and management of a disease. Another aspect of Case reports is their individualism. Most literature is a collective workof grouping together of cases based on specific criterias and then describing amanagement strategy and results for that particular group of cases. Every case may not fulfil the criteria or may have additional compounding factors and thus the managementand results both may vary from case to case. Case reports essentially describe management strategies for such cases which deviate significantly from the norm and cannot be grouped together. Case Reports represent a watershed between Evidence based Orthopaedics and Practise Based Orthopaedics. Many clinical scenarios do not have enough literature to answer specific questions and many results from literature do not yield perfect conclusions applicable to particular clinical scenarios. The Journal of Orthopaedic Case Reports (JOCR) initiated by the Indian Orthopaedic Research Group (IORG) aims to promote collaboration between Evidence and PractiseBased Orthopaedics. Case reports published in this Journal will provide a commonground where both Literature review and Practical experience will be seen to play abalanced role to decide on effective and optimal treatment of the patient. We feel that this description of clinical scenarios and related literature will also synthesise a strong message which will help in generating hypothesis. The Journal will provide a platform for orthopaedic surgeons to publish case reports and technical notes which will convey a relevant and useful clinical message. Apart from single case reports, JOCR also aims to publish peer-reviewed case series and technical notes. The editors hope that JOCR will contribute to quality, peer-reviewed orthopaedic literature and achieve all its goal sover the coming years.

Alignment of computer-assisted total knee arthroplasty in patients with altered hip center.

Abstract: This study aimed to determine limb and component alignment after computer-assisted total knee arthroplasty in 30 patients (32 limbs) with an altered hip center due to a prior hip implant or deformed femoral head. There were no outliers greater than ±3° in the postoperative coronal alignment of the limb and the femoral component in relation to the altered hip center. Two limbs (8%) were more than ±3° for coronal alignment of the femoral component in relation to the anatomical hip center and 96% of limbs had less than 2° deviation in relation to the altered hip center. Computer-navigated total knee arthroplasty results in accurate restoration of lower limb and component alignment in patients with prior hip implants or deformed femoral heads where accurate restoration of alignment may be challenging due to altered hip center.