Background Pre-operative planning and templating is a crucial prerequisite for total hip arthropl... more Background Pre-operative planning and templating is a crucial prerequisite for total hip arthroplasty (THA). Recently, the use of digital radiography has allowed templating to be digitalised instead of traditional methods involving the use of radiograph transparencies. The primary aim of this study was to compare the accuracy in correction of leg length discrepancy (LLD) and restoring femoral offset in patients undergoing THA for primary osteoarthritis with pre-operative digital templating (PDT) versus conventional planning without digital templating. Methods This retrospective cohort study compared two groups of patients who underwent THA for primary osteoarthritis. During the period of the year 2020, 56 patients underwent THA with pre-operative digital templating and 50 patients without digital templating. Two independent blinded observers recorded all radiological data. Results The digital templated and non-digital templated cohorts were matched for variables including age (mean = 71.8 years vs 70.9 years), pre-operative LLD (-4.9mm vs-5.2mm) and pre-operative offset (41.2mm vs 43.7mm). PDT resulted in correction of LLD to <5mm compared to the contralateral hip in 76.8% of cases, 5-10mm in 21.4% and >10mm in one case (1.8%). The non-digital templated cohort had a LLD of <5mm in 50% of cases, 5-10mm in 28% and >10mm in 22%. Chi-square testing demonstrated these results to be statistically significant (p = 0.002). The mean pre-operative offset in the digital templated group was 40mm and 46mm post-operatively. The non-digital templated cohort had a mean pre-operative offset of 42mm and 36mm post-operatively. Independent t-testing revealed statistical significance of these results (p = 0.05). Conclusion PDT leads to an increased likelihood of restoring LLD to <5mm and a significantly increased likelihood of preventing lengthening >10mm. PDT also significantly increases the chance of restoring femoral offset to match the pre-operative native hip. Decreased offset is seen predominantly in the non-digitally templated patients.
Cartilage is frequently damaged and shows little or no capacity for repair. Injuries that extend ... more Cartilage is frequently damaged and shows little or no capacity for repair. Injuries that extend to the subchondral level show some capacity for repair due to the release of bone marrow derived mesenchymal stem cells. This technique is employed in techniques like the microfracture but they are only appropriate for smaller cartilage defects. Autologous Chondrocyte Implantation (ACI) and Matrix-carried Autologous Chondrocyte Implantation (MACI) are currently used in clinical practice to treat larger full thickness chondral defects in the knee with similar results. MACI does however have a number of advantages including its amenability to be performed arthroscopically or through a more limited approach without requiring arthrotomy. More definitive studies showing the long-term effects of the two cell-based treatments and comparing them are however awaited. There are a small number of studies using mesenchymal stem cells and further in vitro and in vivo studies are needed before this tr...
Purpose. We report a series of 58 patients with metastatic bone disease treated with resection an... more Purpose. We report a series of 58 patients with metastatic bone disease treated with resection and endoprosthetic reconstruction over a five-year period at our institution. Introduction. The recent advances in adjuvant and neoadjuvant therapy in cancer treatment have resulted in improved prognosis of patients with bone metastases. Most patients who have either an actual or impending pathological fracture should have operative stabilisation or reconstruction. Endoprosthetic reconstructions are indicated in patients with extensive bone loss, failed conventional reconstructions, and selected isolated metastases. Methods and Results. We identified all patients who were diagnosed with metastatic disease to bone between 1999 and 2003. One hundred and seventy-one patients were diagnosed with bone metastases. Metastatic breast and renal cancer accounted for 84 lesions (49%). Fifty-eight patients with isolated bone metastasis to the appendicular skeleton had an endoprosthetic reconstruction....
Total Knee Replacement is used to treat pain, stiffness and reduced range of movement. It has bee... more Total Knee Replacement is used to treat pain, stiffness and reduced range of movement. It has been estimated that a minimum of 90 degrees of range of motion in the knee is required for normal activities of daily living. In this article we demonstrate a technical note with a small patient series about the methods of treating knee stiffness after Total Knee Replacement.
Anterior knee pain is a common presenting complaint, and in many cases no identifiable cause can ... more Anterior knee pain is a common presenting complaint, and in many cases no identifiable cause can be found. In these circumstances it is commonly known as anterior knee pain syndrome or patellofemoral pain syndrome. The management for this condition is most commonly non-operative. Treatment strategies include physiotherapy, pharmacotherapy, orthoses and combinations of the above. There are many described methods in the literature with a wide spectrum of outcomes, which in itself is testimony to the lack of any generally accepted gold standard of care for these patients. It is thus unclear to the health care professional treating these patients which is the best treatment to offer. In this review we aim to summarise historical and most up to date literature on the subject and in so doing allow the health care professional pick whichever treatment strategy they feel most beneficial and also provide a guide for appropriate patient education.
Journal of Bone and Joint Surgery - British Volume, 2009
Smoking is known to have an adverse effect on wound healing and musculoskeletal conditions. This ... more Smoking is known to have an adverse effect on wound healing and musculoskeletal conditions. This case-controlled study looked at whether smoking has a deleterious effect in the outcome of autologous chondrocyte implantation for the treatment of full thickness chondral defects of the knee. The mean Modified Cincinatti Knee score was statistically significantly lower in smokers (n = 48) than in non-smokers (n = 66) both before and after surgery (p &lt; 0.05). Smokers experienced significantly less improvement in the knee score two years after surgery (p &lt; 0.05). Graft failures were only seen in smokers (p = 0.016). There was a strong negative correlation between the number of cigarettes smoked and the outcome following surgery (Pearson&#39;s correlation coefficient -0.65, p = 0.004). These results suggest that patients who smoke have worse pre-operative function and obtain less benefit from this procedure than non-smokers. The counselling of patients undergoing autologous chondrocyte implantation should include smoking, not only as a general cardiopulmonary risk but also because poorer results can be expected in smokers following this procedure.
Journal of Bone and Joint Surgery - British Volume, 2008
We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with ... more We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with failed total hip replacement and severe proximal femoral bone loss by revision using a distal fix/proximal wrap prosthesis. The mean follow-up was for 55.3 months (25 to 126). The mean number of previous operations was 2.2 (1 to 4). The mean Oxford hip score decreased from 46.2 (38 to 60) to 28.5 (17 to 42) (paired t-test, p &amp;amp;amp;amp;lt; 0.001) and the mean Harris Hip score increased from 30.4 (3 to 57.7) to 71.7 (44 to 99.7) (paired t-test, p &amp;amp;amp;amp;lt; 0.001). There were two dislocations, and in three patients we failed to eradicate previous infection. None required revision of the femoral stem. This technique allows instant distal fixation while promoting biological integration and restoration of bone stock. In the short term, the functional outcome is encouraging and the complication rates acceptable in this difficult group of patients.
Radiographs of 33 patients who had an expandable prosthesis inserted after tumor resection in the... more Radiographs of 33 patients who had an expandable prosthesis inserted after tumor resection in the distal femur were evaluated. We hypothesized that, when a sleeve was present, there was greater stem migration and cortical reaction. The thickness of medial and lateral cortices of the tibia was measured at 6 months and on the last follow-up radiograph. The distance from the edge of the prosthesis to the cortical edge was also compared. When a sleeve was present, there was greater stem migration (P b .001) and a greater increase in lateral cortical thickness (P b .001). There was a higher revision rate when a sleeve was used, but this was not statistically significant. There was no difference in function according to the Toronto Extremity Salvage Score (TESS) between the 2 groups. This is the first study to demonstrate that the presence of a polyethylene sleeve is associated with a tendency for the tibial prosthesis to migrate laterally and cause a greater sclerotic reaction.
Chondromalacia patella is a distinct clinical entity of abnormal softening of the articular carti... more Chondromalacia patella is a distinct clinical entity of abnormal softening of the articular cartilage of the patella, which results in chronic retropatellar pain. Its aetiology is still unclear but the process is thought to be a due to trauma to superficial chondrocytes resulting in a proteolytic enzymic breakdown of the matrix. Our aim was to assess the effectiveness of autologous chondrocyte implantation on patients with a proven symptomatic retropatellar lesion who had at least one failed conventional marrow-stimulating therapy. We performed chondrocyte implantation on 48 patients: 25 received autologous chondrocyte implantation with a type I/III membrane (ACI-C) method (Geistlich Biomaterials, Wolhusen, Switzerland), and 23 received the Matrix-assisted Chondrocyte Implantation (MACI) technique (Genzyme, Kastrup, Denmark). Over a mean follow-up period of 40.3 months, there was a statistically significant improvement in subjective pain scoring using the visual analogue scale (VAS) and objective functional scores using the Modified Cincinnati Rating System (MCS) in both groups. Chondromalacia patellae lesions responded well to chondrocyte implantation. Better results occurred with MACI than with ACI-C. Excellent and good results were achieved in 40% of ACI-C patients and 57% of MACI patients, but success of chondrocyte implantation was greater with medial/odd-facet lesions. Given that the MACI procedure is technically easier and less time consuming, we consider it to be useful for treating patients with symptomatic chondral defects secondary to chondromalacia patellae.
As our population demographics change, osteoarthritis and cartilage defects are becoming more pre... more As our population demographics change, osteoarthritis and cartilage defects are becoming more prevalent. The discovery of stems cells and their ability for indefinite regeneration has revolutionised the way cartilage problems are viewed. Tissue engineering has been shown to be the ideal way of repairing articular cartilage lesions, i.e. back to native tissue. Cartilage is an ideal tissue engineering target as it is avascular, aneural and alymphatic. The two main types of stem cells being investigated in chondrogenesis are embryological and mesenchymal stem cells. Research into embryological stem cells has been surrounded by controversy because of ethical, religious and social concerns. We discuss the use of embryological and mesenchymal stem cells in cartilage repair and the various factors involved in the differentiation into chondrocytes. We also discuss commonly used mesenchymal stem cell markers and their limitations.
We conducted a prospective study to evaluate the long-term results after Corin C-Fit uncemented t... more We conducted a prospective study to evaluate the long-term results after Corin C-Fit uncemented total hip arthroplasty in young patients with hydroxyapatite or porous coated components. We prospectively followed 36 patients (38 hips) who had Corin C-Fit uncemented total hip arthroplasties by eight experienced consultant surgeons at two centres. The acetabular and femoral components were hydroxyapatite or porous coated. The overall 10-year survival rate for the Corin C-Fit arthroplasty was 43%. The 10-year survivorship for the femoral implant was 56% and for the acetabular component 59%. The evidence presented in this study suggests that the Corin C-Fit uncemented total hip arthroplasty has one of the highest mid- and long-term failure rates for both femoral and acetabular components in the literature. We believe this implant should not be used and patients who have had this form of total hip arthroplasty should be kept under regular review.
As our population changes osteoarthritis and cartilage defects are becoming more prevalent. The d... more As our population changes osteoarthritis and cartilage defects are becoming more prevalent. The discovery of stems cells and their ability for indefinite regeneration has revolutionised the way cartilage problems are viewed. Tissue engineering has been shown to be the ideal way of repairing articular cartilage lesions, i.e. back to native tissue. The two main types of stem cells being investigated in chondrogenesis are embryological and mesenchymal stem cells. Research into embryological stem cells has been surrounded by controversy because of tumour formation and damaging embryos during the harvest of cells. We discuss the use of embryological and mesenchymal stem cells in cartilage repair and the various factors involved in the differentiation into chondrocytes.
Background Pre-operative planning and templating is a crucial prerequisite for total hip arthropl... more Background Pre-operative planning and templating is a crucial prerequisite for total hip arthroplasty (THA). Recently, the use of digital radiography has allowed templating to be digitalised instead of traditional methods involving the use of radiograph transparencies. The primary aim of this study was to compare the accuracy in correction of leg length discrepancy (LLD) and restoring femoral offset in patients undergoing THA for primary osteoarthritis with pre-operative digital templating (PDT) versus conventional planning without digital templating. Methods This retrospective cohort study compared two groups of patients who underwent THA for primary osteoarthritis. During the period of the year 2020, 56 patients underwent THA with pre-operative digital templating and 50 patients without digital templating. Two independent blinded observers recorded all radiological data. Results The digital templated and non-digital templated cohorts were matched for variables including age (mean = 71.8 years vs 70.9 years), pre-operative LLD (-4.9mm vs-5.2mm) and pre-operative offset (41.2mm vs 43.7mm). PDT resulted in correction of LLD to <5mm compared to the contralateral hip in 76.8% of cases, 5-10mm in 21.4% and >10mm in one case (1.8%). The non-digital templated cohort had a LLD of <5mm in 50% of cases, 5-10mm in 28% and >10mm in 22%. Chi-square testing demonstrated these results to be statistically significant (p = 0.002). The mean pre-operative offset in the digital templated group was 40mm and 46mm post-operatively. The non-digital templated cohort had a mean pre-operative offset of 42mm and 36mm post-operatively. Independent t-testing revealed statistical significance of these results (p = 0.05). Conclusion PDT leads to an increased likelihood of restoring LLD to <5mm and a significantly increased likelihood of preventing lengthening >10mm. PDT also significantly increases the chance of restoring femoral offset to match the pre-operative native hip. Decreased offset is seen predominantly in the non-digitally templated patients.
Cartilage is frequently damaged and shows little or no capacity for repair. Injuries that extend ... more Cartilage is frequently damaged and shows little or no capacity for repair. Injuries that extend to the subchondral level show some capacity for repair due to the release of bone marrow derived mesenchymal stem cells. This technique is employed in techniques like the microfracture but they are only appropriate for smaller cartilage defects. Autologous Chondrocyte Implantation (ACI) and Matrix-carried Autologous Chondrocyte Implantation (MACI) are currently used in clinical practice to treat larger full thickness chondral defects in the knee with similar results. MACI does however have a number of advantages including its amenability to be performed arthroscopically or through a more limited approach without requiring arthrotomy. More definitive studies showing the long-term effects of the two cell-based treatments and comparing them are however awaited. There are a small number of studies using mesenchymal stem cells and further in vitro and in vivo studies are needed before this tr...
Purpose. We report a series of 58 patients with metastatic bone disease treated with resection an... more Purpose. We report a series of 58 patients with metastatic bone disease treated with resection and endoprosthetic reconstruction over a five-year period at our institution. Introduction. The recent advances in adjuvant and neoadjuvant therapy in cancer treatment have resulted in improved prognosis of patients with bone metastases. Most patients who have either an actual or impending pathological fracture should have operative stabilisation or reconstruction. Endoprosthetic reconstructions are indicated in patients with extensive bone loss, failed conventional reconstructions, and selected isolated metastases. Methods and Results. We identified all patients who were diagnosed with metastatic disease to bone between 1999 and 2003. One hundred and seventy-one patients were diagnosed with bone metastases. Metastatic breast and renal cancer accounted for 84 lesions (49%). Fifty-eight patients with isolated bone metastasis to the appendicular skeleton had an endoprosthetic reconstruction....
Total Knee Replacement is used to treat pain, stiffness and reduced range of movement. It has bee... more Total Knee Replacement is used to treat pain, stiffness and reduced range of movement. It has been estimated that a minimum of 90 degrees of range of motion in the knee is required for normal activities of daily living. In this article we demonstrate a technical note with a small patient series about the methods of treating knee stiffness after Total Knee Replacement.
Anterior knee pain is a common presenting complaint, and in many cases no identifiable cause can ... more Anterior knee pain is a common presenting complaint, and in many cases no identifiable cause can be found. In these circumstances it is commonly known as anterior knee pain syndrome or patellofemoral pain syndrome. The management for this condition is most commonly non-operative. Treatment strategies include physiotherapy, pharmacotherapy, orthoses and combinations of the above. There are many described methods in the literature with a wide spectrum of outcomes, which in itself is testimony to the lack of any generally accepted gold standard of care for these patients. It is thus unclear to the health care professional treating these patients which is the best treatment to offer. In this review we aim to summarise historical and most up to date literature on the subject and in so doing allow the health care professional pick whichever treatment strategy they feel most beneficial and also provide a guide for appropriate patient education.
Journal of Bone and Joint Surgery - British Volume, 2009
Smoking is known to have an adverse effect on wound healing and musculoskeletal conditions. This ... more Smoking is known to have an adverse effect on wound healing and musculoskeletal conditions. This case-controlled study looked at whether smoking has a deleterious effect in the outcome of autologous chondrocyte implantation for the treatment of full thickness chondral defects of the knee. The mean Modified Cincinatti Knee score was statistically significantly lower in smokers (n = 48) than in non-smokers (n = 66) both before and after surgery (p &lt; 0.05). Smokers experienced significantly less improvement in the knee score two years after surgery (p &lt; 0.05). Graft failures were only seen in smokers (p = 0.016). There was a strong negative correlation between the number of cigarettes smoked and the outcome following surgery (Pearson&#39;s correlation coefficient -0.65, p = 0.004). These results suggest that patients who smoke have worse pre-operative function and obtain less benefit from this procedure than non-smokers. The counselling of patients undergoing autologous chondrocyte implantation should include smoking, not only as a general cardiopulmonary risk but also because poorer results can be expected in smokers following this procedure.
Journal of Bone and Joint Surgery - British Volume, 2008
We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with ... more We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with failed total hip replacement and severe proximal femoral bone loss by revision using a distal fix/proximal wrap prosthesis. The mean follow-up was for 55.3 months (25 to 126). The mean number of previous operations was 2.2 (1 to 4). The mean Oxford hip score decreased from 46.2 (38 to 60) to 28.5 (17 to 42) (paired t-test, p &amp;amp;amp;amp;lt; 0.001) and the mean Harris Hip score increased from 30.4 (3 to 57.7) to 71.7 (44 to 99.7) (paired t-test, p &amp;amp;amp;amp;lt; 0.001). There were two dislocations, and in three patients we failed to eradicate previous infection. None required revision of the femoral stem. This technique allows instant distal fixation while promoting biological integration and restoration of bone stock. In the short term, the functional outcome is encouraging and the complication rates acceptable in this difficult group of patients.
Radiographs of 33 patients who had an expandable prosthesis inserted after tumor resection in the... more Radiographs of 33 patients who had an expandable prosthesis inserted after tumor resection in the distal femur were evaluated. We hypothesized that, when a sleeve was present, there was greater stem migration and cortical reaction. The thickness of medial and lateral cortices of the tibia was measured at 6 months and on the last follow-up radiograph. The distance from the edge of the prosthesis to the cortical edge was also compared. When a sleeve was present, there was greater stem migration (P b .001) and a greater increase in lateral cortical thickness (P b .001). There was a higher revision rate when a sleeve was used, but this was not statistically significant. There was no difference in function according to the Toronto Extremity Salvage Score (TESS) between the 2 groups. This is the first study to demonstrate that the presence of a polyethylene sleeve is associated with a tendency for the tibial prosthesis to migrate laterally and cause a greater sclerotic reaction.
Chondromalacia patella is a distinct clinical entity of abnormal softening of the articular carti... more Chondromalacia patella is a distinct clinical entity of abnormal softening of the articular cartilage of the patella, which results in chronic retropatellar pain. Its aetiology is still unclear but the process is thought to be a due to trauma to superficial chondrocytes resulting in a proteolytic enzymic breakdown of the matrix. Our aim was to assess the effectiveness of autologous chondrocyte implantation on patients with a proven symptomatic retropatellar lesion who had at least one failed conventional marrow-stimulating therapy. We performed chondrocyte implantation on 48 patients: 25 received autologous chondrocyte implantation with a type I/III membrane (ACI-C) method (Geistlich Biomaterials, Wolhusen, Switzerland), and 23 received the Matrix-assisted Chondrocyte Implantation (MACI) technique (Genzyme, Kastrup, Denmark). Over a mean follow-up period of 40.3 months, there was a statistically significant improvement in subjective pain scoring using the visual analogue scale (VAS) and objective functional scores using the Modified Cincinnati Rating System (MCS) in both groups. Chondromalacia patellae lesions responded well to chondrocyte implantation. Better results occurred with MACI than with ACI-C. Excellent and good results were achieved in 40% of ACI-C patients and 57% of MACI patients, but success of chondrocyte implantation was greater with medial/odd-facet lesions. Given that the MACI procedure is technically easier and less time consuming, we consider it to be useful for treating patients with symptomatic chondral defects secondary to chondromalacia patellae.
As our population demographics change, osteoarthritis and cartilage defects are becoming more pre... more As our population demographics change, osteoarthritis and cartilage defects are becoming more prevalent. The discovery of stems cells and their ability for indefinite regeneration has revolutionised the way cartilage problems are viewed. Tissue engineering has been shown to be the ideal way of repairing articular cartilage lesions, i.e. back to native tissue. Cartilage is an ideal tissue engineering target as it is avascular, aneural and alymphatic. The two main types of stem cells being investigated in chondrogenesis are embryological and mesenchymal stem cells. Research into embryological stem cells has been surrounded by controversy because of ethical, religious and social concerns. We discuss the use of embryological and mesenchymal stem cells in cartilage repair and the various factors involved in the differentiation into chondrocytes. We also discuss commonly used mesenchymal stem cell markers and their limitations.
We conducted a prospective study to evaluate the long-term results after Corin C-Fit uncemented t... more We conducted a prospective study to evaluate the long-term results after Corin C-Fit uncemented total hip arthroplasty in young patients with hydroxyapatite or porous coated components. We prospectively followed 36 patients (38 hips) who had Corin C-Fit uncemented total hip arthroplasties by eight experienced consultant surgeons at two centres. The acetabular and femoral components were hydroxyapatite or porous coated. The overall 10-year survival rate for the Corin C-Fit arthroplasty was 43%. The 10-year survivorship for the femoral implant was 56% and for the acetabular component 59%. The evidence presented in this study suggests that the Corin C-Fit uncemented total hip arthroplasty has one of the highest mid- and long-term failure rates for both femoral and acetabular components in the literature. We believe this implant should not be used and patients who have had this form of total hip arthroplasty should be kept under regular review.
As our population changes osteoarthritis and cartilage defects are becoming more prevalent. The d... more As our population changes osteoarthritis and cartilage defects are becoming more prevalent. The discovery of stems cells and their ability for indefinite regeneration has revolutionised the way cartilage problems are viewed. Tissue engineering has been shown to be the ideal way of repairing articular cartilage lesions, i.e. back to native tissue. The two main types of stem cells being investigated in chondrogenesis are embryological and mesenchymal stem cells. Research into embryological stem cells has been surrounded by controversy because of tumour formation and damaging embryos during the harvest of cells. We discuss the use of embryological and mesenchymal stem cells in cartilage repair and the various factors involved in the differentiation into chondrocytes.
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Papers by Parag Jaiswal