41 results found
Wiik AV, Aqil A, Al-Obaidi B, et al., 2021, The impact of reducing the femoral stem length in total hip arthroplasty during gait, ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, ISSN: 0936-8051
Hastie GR, Collinson SC, Aqil A, et al., 2021, Study to Assess the Rate of Adverse Reaction to Metal Debris in Hip Resurfacing at a Minimum 13-year Follow-up, JOURNAL OF ARTHROPLASTY, Vol: 36, Pages: 1055-1059, ISSN: 0883-5403
Pang C, Aqil A, Mannan A, et al., 2020, Hip fracture patients admitted to hospital on weekends are not at increased risk of 30-day mortality as compared with weekdays, JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY, Vol: 21, ISSN: 1590-9921
Patel B, Aqil A, Riaz O, et al., 2020, The 2nd Metacarpal Cortical Index as a Simple Screening Tool for Osteopenia., J Bone Metab, Vol: 27, Pages: 261-266, ISSN: 2287-6375
BACKGROUND: Osteopenia is a known risk factor for sustaining skeletal fractures. Prevention of fragility fractures has obvious clinical and economic advantages, however screening all patients using a dual energy X-ray absorptiometry (DXA) is controversial not only because of the cost implications but also because it would potentially involve exposing a percentage of normal patients to unnecessary radiation. We wished to assess whether a simple hand X-ray measuring the 2nd metacarpal cortical index (2MCI) could be used as a simple screening tool for identifying patients with osteopenia. METHODS: We retrospectively collected the radiographic data of 206 patients who had a simple radiograph of the hand and a DXA scan within one year of each other from our picture archiving and communication system database. The 2MCI was calculated for all patients. As data was parametric, a Pearson's correlation was performed to assess association between Tscores and 2MCI. Further analysis involved the construction of receiver operating characteristic (ROC) curves to identify a 2MCI index, which would give the most appropriate sensitivity and specificity values for identifying the presence of osteopenia. RESULTS: A statistically significant and moderate correlation between DXA T-scores and 2MCI values was found (r=0.54, n=206, P<0.001). Further ROC curve analysis of normal and osteopenic subjects identified that a 2MCI of 41.5 had a sensitivity of 100% and specificity of 53% for detecting osteopenia. CONCLUSIONS: Our results support the use of the 2MCI as a simple screening tool for identifying patients with osteopenia.
Riaz O, Vanker R, Aslam-Pervez N, et al., 2020, Improving patient and staff safety by minimising radiation exposure during trauma surgery: A simple and validated predictive model, SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, Vol: 18, Pages: 95-99, ISSN: 1479-666X
Aqil A, Shah N, 2020, Diagnosis of the failed total hip replacement., J Clin Orthop Trauma, Vol: 11, Pages: 2-8, ISSN: 0976-5662
Kauser S, Riaz O, Shaw D, et al., 2019, A 10-Year Epidemiology Study of Supracondylar Elbow Fractures in UK Children: Data from an Ethnically Diverse Urban Population, International Surgical Conference of the Association-of-Surgeons-in-Training (ASIT), Publisher: WILEY, Pages: 107-107, ISSN: 0007-1323
Riaz O, Aqil A, Asmar S, et al., 2019, Epsilon-aminocaproic acid versus tranexamic acid in total knee arthroplasty: a meta-analysis study, Journal of Orthopaedics and Traumatology, Vol: 20, ISSN: 1590-9921
INTRODUCTION: Total knee arthroplasty (TKA) surgery can be associated with significant blood loss. Among the problems associated with such blood loss is the need for transfusions of banked blood . Transfusions not only have a financial consequence but also carry a small risk of disease transmission to the patient. Antifibrinolytics have been successfully used to reduce transfusion requirements in elective arthroplasty patients. The objective of this meta-analysis is to determine which of tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) is more effective for reducing peri-operative blood loss, and lessening the need for blood transfusion following knee arthroplasty surgery. MATERIALS AND METHODS: MEDLINE, Embase and CINAHL databases were searched for relevant articles published between January 1980 to January 2018 for the purpose of identifying studies comparing TXA and EACA for TKA surgery. A double-extraction technique was used, and included studies were assessed regarding their methodological quality prior to analysis. Outcomes analysed included blood loss, pre- and post-operative haemoglobin, number of patients requiring transfusion, number of units transfused, operative and tourniquet time, and complications associated with antifibrinolytics. RESULTS: Three studies contributed to the quantitative analysis of 1691 patients, with 743 patients included in the TXA group and 948 in the EACA group. Estimated blood loss was similar between the two groups [95% confidence interval (CI) -0.50, 0.04; Z = 1.69; P = 0.09]. There were no differences between the two groups regarding the percentage of patients requiring transfusion (95% CI 0.14, 4.13; Z = 0.31; P = 0.76). There was no difference in the pre- and post-operative haemoglobin difference between the two groups (95% CI -0.36, 0.24; Z = 0.38; P = 0.70). There was no difference in the average number of transfused units (95%
Sheikh HQ, Hossain FS, Khan S, et al., 2019, Short-term risk factors for a second hip fracture in a UK population, European Journal of Orthopaedic Surgery and Traumatology, Vol: 29, Pages: 1055-1060, ISSN: 1633-8065
INTRODUCTION: A hip fracture carries significant morbidity and mortality-a second fracture of the contralateral hip carries even higher complications. Most second hip fractures occur within 48 months of the first. The aim of this study was to comprehensively analyse all identifiable variables that may increase the risk of a contralateral hip fracture within this time period. METHODS: We retrospectively analysed 1242 consecutive patients with hip fractures presenting to our institution. All patient-related, surgery-related and inpatient variables were collected from the index admission. We then identified patients with a subsequent contralateral hip fracture in the following 2 years. Univariate and multivariate analyses were performed to identify risk factors associated with a second fracture. RESULTS: A total of 66 patients (5.3%) had a contralateral hip fracture in the 2 years following initial hip fracture. Mean age at first presentation was 81 years, and mean time to second fracture was 305 days. Following multivariate analysis, the patients at highest risk of a second fracture were those with dementia, acute inpatient chest infection, urinary tract infection and multiple comorbidities as measured by the Charlson score. Discharge destination after initial fracture was not associated with the risk of a second fracture. CONCLUSIONS: We have identified a number of discrete risk factors that are associated with a short- to medium-term risk of contralateral hip fracture that may be useful in screening for patients at risk and provide them with focused medical rehabilitation.
Aqil A, Patel S, Wiik A, et al., 2018, Patient-specific guides improve hip arthroplasty surgical accuracy, COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING, Vol: 21, Pages: 579-584, ISSN: 1025-5842
Sheikh HQ, Aqil A, Hossain FS, et al., 2018, There is no weekend effect in hip fracture surgery - A comprehensive analysis of outcomes, SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, Vol: 16, Pages: 259-264, ISSN: 1479-666X
Al-Ashqar M, Aqil A, Phillips H, et al., 2018, There is no 'weekend effecct' in elective orthopaedic surgery, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 100, Pages: 551-555, ISSN: 0035-8843
Wiik AV, Brevadt M, Johal H, et al., 2018, The loading patterns of a short femoral stem in total hip arthroplasty: gait analysis at increasing walking speeds and inclines., Journal of Orthopaedics and Traumatology, Vol: 19, ISSN: 1590-9921
BACKGROUND: The purpose of this study was to examine the gait pattern of total hip arthroplasty (THA) patients with a new short femoral stem at different speeds and inclinations. MATERIALS AND METHODS: A total of 40 unilateral THA patients were tested on an instrumented treadmill. They comprised two groups (shorter stemmed THA n = 20, longer stemmed THA n = 20), both which had the same surgical posterior approach. The shorter femoral stemmed patients were taken from an ongoing hip trial with minimum 12 months postop. The comparative longer THR group with similar disease and severity were taken from a gait database along with a demographically similar group of healthy controls (n = 35). All subjects were tested through their entire range of gait speeds and inclines with ground reaction forces collected. Body weight scaling was applied and a symmetry index to compare the implanted hip to the contralateral normal hip. An analysis of variance with significance set at α = 0.05 was used. RESULTS: The experimental groups were matched demographically and implant groups for patient reported outcome measures and radiological disease. Both THA groups walked slower than controls, but symmetry at all intervals for all groups were not significantly different. Push-off loading was less favourable for both the shorter and longer stemmed THR groups (p < 0.05) depending on speed. CONCLUSIONS: Irrespective of femoral stem length, symmetry for ground reaction forces for both THA groups were returned to a normal range when compared to controls. However individual implant performance showed inferior (p < 0.05) push-off forces and normalised step length in both THR groups when compared to controls. LEVEL OF EVIDENCE: III.
Riaz O, Aqil A, Mannan A, et al., 2018, Quadriceps Tendon-Bone or Patellar Tendon-Bone Autografts When Reconstructing the Anterior Cruciate Ligament: A Meta-analysis, CLINICAL JOURNAL OF SPORT MEDICINE, Vol: 28, Pages: 316-324, ISSN: 1050-642X
Aqil A, Kapoor H, Riaz O, 2018, Fractures of proximal humerus open reduction and internal fixation, Fracture Reduction and Fixation Techniques, Editors: Giannoudis, Publisher: Springer International Publishing, Pages: 113-120
Fractures of the proximal humerus are common in the middle age population and usually result from a fall. The fracture may involve the humeral head, lesser tuberosity, greater tuberosity, surgical head or anatomical head of the humerus. Neer’s classification is used to guide treatment and it is based on the number of segments displaced (one to four part fractures). An axillary x-ray is necessary to exclude fracture dislocation. In this chapter the surgical management of proximal humeral fractures is discussed.
Aqil A, Riaz O, Kapoor H, 2018, Sternoclavicular joint dislocations, Fracture Reduction and Fixation Techniques, Editors: Giannoudis, Publisher: Springer International Publishing Group, Pages: 93-96, ISBN: 978-3-319-68627-1
The most common mechanism of sternoclavicular joint (SCJ) dislocation is a fall on the shoulder. Anterior dislocations compare to posterior dislocations are more common. The clinical signs in anterior SJC dislocation are usually both visible and palpable. Posterior SCJ dislocations can be complicated with vascular injury induced by the displaced medial clavicle posteriorly. Early closed reduction is usually successful and stable. In cases where closed reduction is not possible, open reduction and stabilisation must be considered. In this chapter tips and tricks on the management of sternoclavicular joint dislocations are presented.
Aqil A, Hossain F, Sheikh H, et al., 2017, Achieving hip fracture surgery within 36 hours: an investigation of risk factors to surgical delay and recommendations for practice, Orthopaedic Trauma: Diagnosis, operative techniques and management, Editors: Wagner, Publisher: Academic Pages, Pages: 53-53, ISBN: 978-1-9789-2749-0
Riaz O, Aqil A, Sisodia G, et al., 2017, P.F.C Sigma® cruciate retaining fixed-bearing versus mobile-bearing knee arthroplasty: a prospective comparative study with minimum 10-year follow-up., Eur J Orthop Surg Traumatol, Vol: 27, Pages: 1145-1149, ISSN: 1633-8065
AIMS: To prospectively compare long-term clinical and radiological outcomes following a cruciate retaining fixed-bearing (FB) and a mobile-bearing (MB) primary total knee replacement (TKR). METHODS: We prospectively reviewed 113 TKRs in 99 patients (14 bilateral) with a PFC sigma cruciate retaining rotating platform system, at an average follow-up of 11.1 years (range 10-12). Results were contrasted with those from 89 TKRs in 72 patients (17 bilateral) with a PFC sigma cruciate fixed-bearing prosthesis, at an average follow-up of 12.1 years (range 10-14.1). Outcomes collected included pre- and post-operative range of motion, Oxford Knee Scores, complications encountered, as well as radiographical assessments of polyethylene wear. RESULTS: In the MB group, mean Oxford Knee Scores improved from 16 pre-operatively to 42 at final follow-up. The mean range of motion was 115° (75-130). In the FB group, mean Oxford Knee Scores improved from 16.2 pre-operatively to 42.5 at final follow-up. The mean range of motion was 111.2 (80-135) degrees at final follow-up. CONCLUSION: We failed to elicit an objectively demonstrable clinical difference between the MB- and FB-implanted knees. Similarly, radiological benefits of the MB implants with regard to polyethylene wear were not evident at a minimum 10-year follow-up.
Wiik AV, Logishetty K, Boughton O, et al., 2017, Letter to the Editor regarding 'How symmetric are metal-on-metal hip resurfacing patients during gait? Insights for the rehabilitation'., Journal of Biomechanics, Vol: 63, Pages: 203-203, ISSN: 0021-9290
Choudhry MN, Naseem H, Mahmood I, et al., 2017, (in vivoGastrocnemius Muscle) Tendon Ratio in Patients with Cerebral Palsy., Open Orthopaedics Journal, Vol: 11, Pages: 577-582, ISSN: 1874-3250
Background: The position of the gastrocnemius tendon in relation to the leg length may be different in children with cerebral palsy as compared to normal children. The palpation of muscle bellies or previous experience of the operating surgeon is employed to place the surgical incision for lengthening of the gastrocnemius aponeurosis. Inaccurate localisation may cause incorrect incisions and a risk of iatrogenic damage to the vital structures (i.e. sural nerve). Objectives: The aim of our study is to compare gastrocnemius lengthin-vivobetween paretic and unaffected children and create a formula to localise the muscle-tendon junction accurately. Methods: 10 children with di/hemiplegia (range 2-14y) were recruited. None of them had received any conventional medical treatment. An equal number of age/sex matched, typically developing children (range 4-14y) were recruited. Ultrasound scanning of the gastrocnemius muscle at rest was performed to measure the length of gastrocnemius bellies. We also measured the heights and leg lengths in all the children. Results: The gastrocnemius medial muscles were shorter in Cerebral Palsy children when compared to similar aged normal children. In cerebral palsy children, the gastrocnemius muscle and leg ratio ranged between 35 to 50% (average ratio of 45%). Conclusion: Using these figures, we created an average percentage for gastrocnemius muscle length that may be used clinically to identify the tendon for open/endoscopic lengthening and also to make simple and accurate localisation of gastrocnemius muscle-tendon junction for surgical access. This decreases the length of the surgical incision and may reduce the risk of iatrogenic injuries.
Wiik AV, Aqil A, Brevadt M, et al., 2017, Abnormal ground reaction forces lead to a general decline in gait speed in knee osteoarthritis patients., World Journal of Orthopedics, Vol: 8, Pages: 322-328, ISSN: 2218-5836
AIM: To analyse ground reaction forces at higher speeds using another method to be more sensitive in assessing significant gait abnormalities. METHODS: A total of 44 subjects, consisting of 24 knee osteoarthritis (OA) patients and 20 healthy controls were analysed. The knee OA patients were recruited from an orthopaedic clinic that were awaiting knee replacement. All subjects had their gait patterns during stance phase at top walking speed assessed on a validated treadmill instrumented with tandem force plates. Temporal measurements and ground reaction forces (GRFs) along with a novel impulse technique were collected for both limbs and a symmetry ratio was applied to all variables to assess inter-limb asymmetry. All continuous variables for each group were compared using a student t-test and χ(2) analysis for categorical variables with significance set at α = 0.05. Receiver operator characteristics curves were utilised to determine best discriminating ability. RESULTS: The knee OA patients were older (66 ± 7 years vs 53 ± 9 years, P = 0.01) and heavier (body mass index: 31 ± 6 vs 23 ± 7, P < 0.001) but had a similar gender ratio when compared to the control group. Knee OA patients were predictably slower at top walking speed (1.37 ± 0.23 m/s vs 2.00 ± 0.20 m/s, P < 0.0001) with shorter mean step length (79 ± 12 cm vs 99 ± 8 cm, P < 0.0001) and broader gait width (14 ± 5 cm vs 11 ± 3 cm, P = 0.015) than controls without any known lower-limb joint disease. At a matched mean speed (1.37 ± 0.23 vs 1.34 ± 0.07), ground reaction results revealed that push-off forces and impulse were significantly (P < 0.0001) worse (18% and 12% respectively) for the knee OA patients when compared to the controls. Receiver operating characteristic curves analysis demonstrated total impulse to be the best discriminator of asymmetry, with an area under the curve of 0.902, with a cut-off
Arshad R, Riaz O, Aqil A, et al., 2017, Predicting intertrochanteric extension of greater trochanter fractures of the hip on plain radiographs, INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, Vol: 48, Pages: 692-694, ISSN: 0020-1383
Sheikh HQ, Hossain FS, Aqil A, et al., 2017, A Comprehensive Analysis of the Causes and Predictors of 30-Day Mortality Following Hip Fracture Surgery, CLINICS IN ORTHOPEDIC SURGERY, Vol: 9, Pages: 10-18, ISSN: 2005-291X
Aqil A, Wiik A, Zanotto M, et al., 2016, The Effect of Hip Arthroplasty on Osteoarthritic Gait: A Blinded, Prospective and Controlled Gait Study at Fast Walking Speeds, JOURNAL OF ARTHROPLASTY, Vol: 31, Pages: 2337-2341, ISSN: 0883-5403
Masjedi M, Mandalia R, Aqil A, et al., 2016, Validation of the 'FeMorph' software in planning cam osteochondroplasty by incorporating labral morphology, COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING, Vol: 19, Pages: 67-73, ISSN: 1025-5842
Aqil A, Wiik A, Clarke S, et al., 2015, Resurfacing head size and femoral fracture: Are registry conclusions on head size justified?, Eur J Orthop Surg Traumatol, Vol: 25, Pages: 1301-1305, ISSN: 1633-8065
BACKGROUND: Joint registries report that peri-prosthetic fractures are the most common reason for early revision of a hip resurfacing arthroplasty (HRA) and are twice as likely with small implant sizes. However, a national survey found peri-prosthetic fracture to be strongly associated with surgical accuracy. We therefore asked whether the force required to induce a peri-prosthetic fracture: (1) was significantly lower when using smaller implants and (2) correlated to the size of implant used, when surgery was performed accurately. METHODS: To ensure an adequate power, we calculated our sample size from pilot data. Forty-four femurs were tested in two experiments. The first experiment tested femurs with either a small (48 mm) or a large (54 mm) HRA implant. The second involved testing femurs with a range of implant sizes. A rapid prototyped femur-specific guide ensured accurate implantation. Specimens were then vertically loaded in a servo-hydraulic testing machine till fracture. Displacement (mm) and force (N) required for fracture were recorded. RESULTS: A median force of 1081 N was required to fracture specimens implanted with small 48-mm heads, while 1134 N was required when a 54-mm head was used (U = 77, z = -0.054, p = 0.957). Implant head size and force required to fracture were not related, r = 0.12, p = 0.63. CONCLUSIONS: The force required to induce a resurfacing peri-prosthetic fracture was not related to the size of the implant. The increased failure rate seen in all registries is unlikely to be directly the result of this single variable. Correctly performed resurfacing arthroplasty is highly resistant to fracture.
Aqil A, Hossain F, Sheikh H, et al., 2015, Achieving hip fracture surgery within 36 hours: an investigation of risk factors to surgical delay and recommendations for practice, Journal of Orthopaedics and Traumatology, Vol: 17, Pages: 207-213, ISSN: 1590-9999
BACKGROUND: The UK hip fracture best practice tariff (BPT) aims to deliver hip fracture surgery within 36 h of admission. Ensuring that delays are reserved for conditions which compromise survival, but are responsive to medical optimisation, would help to achieve this target. We aimed to identify medical risk factors of surgical delay, and assess their impact on mortality. MATERIALS AND METHODS: Prospectively collected patient data was obtained from the National Hip Fracture Database (NHFD). Medical determinants of surgical delay were identified and analysed using a multivariate regression analysis. The mortality risk associated with each factor contributing to surgical delay was then calculated. RESULTS: A total 1361 patients underwent hip fracture surgery, of which 537 patients (39.5 %) received surgery within 36 h of admission. Following multivariate analyses, only hyponatraemia was deduced to be a significant risk factor for delay RR = 1.24 (95 % CI 1.06-1.44). However, following a validated propensity score matching process, a Pearson chi-square test failed to demonstrate a statistical difference in mortality incidence between the hypo- and normonatraemic patients [χ (2) (1, N = 512) = 0.10, p = 0.757]. CONCLUSIONS: Hip fracture surgery should not be delayed in the presence of non-severe and isolated hyponatraemia. Instead, surgical delay may only be warranted in the presence of medical conditions which contribute to mortality and are optimisable. LEVEL OF EVIDENCE: III.
Brevadt MJ, manning V, wiik A, et al., 2015, The Impact of Stem Length on Function Following Hip Arthroplasty: Are Long Stems Still Required?, International Society for Technology in Arthroplasty
Jones C, Aqil A, Clarke S, et al., 2015, Short uncemented stems allow greater femoral flexibility and may reduce peri-prosthetic fracture risk: a dry bone and cadaveric study, Journal of Orthopaedics and Traumatology, Vol: 16, Pages: 229-235, ISSN: 1590-9921
BackgroundShort femoral stems for uncemented total hip arthroplasty have been introduced as a safe alternative to traditional longer stem designs. However, there has been little biomechanical examination of the effects of stem length on complications of surgery. This study aims to examine the effect of femoral stem length on torsional resistance to peri-prosthetic fracture.Materials and methodsWe tested 16 synthetic and two paired cadaveric femora. Specimens were implanted and then rapidly rotated until fracture to simulate internal rotation on a planted foot, as might occur during stumbling. 3D planning software and custom-printed 3D cutting guides were used to enhance the accuracy and consistency of our stem insertion technique.ResultsSynthetic femora implanted with short stems fractured at a significantly higher torque (27.1 vs. 24.2 Nm, p = 0.03) and angle (30.3° vs. 22.3°, p = 0.002) than those implanted with long stems. Fracture patterns of the two groups were different, but showed remarkable consistency within each group. These characteristic fracture patterns were closely replicated in the pair of cadaveric femora.ConclusionsThis new short-stemmed press-fit femoral component allows more femoral flexibility and confers a higher resistance to peri-prosthetic fracture from torsional forces than long stems.
Aqil A, Sheikh HQ, Masjedi M, et al., 2015, Birmingham Mid-Head Resection Periprosthetic Fracture., CiOS Clinics in Orthopedic Surgery, Vol: 7, Pages: 402-405, ISSN: 2005-4408
Total hip arthroplasty in the young leads to difficult choices in implant selection. Until recently bone conserving options were not available for younger patients with deficient femoral head bone stock. The novel Birmingham Mid-Head Resection (BMHR) device offers the option of bone conserving arthroplasty in spite of deficient femoral head bone stock. Femoral neck fracture is a known complication of standard resurfacing arthroplasty and is the most common reason for revision. It is unknown whether this remains to be the case for the BMHR neck preserving implants. We report a case of a 57-year-old male, who sustained a periprosthetic fracture following surgery with a BMHR arthroplasty. This paper illustrates the first reported case of a BMHR periprosthetic fracture. The fracture pattern is spiral in nature and reaches to the subtrochanteric area. This fracture pattern is different from published cadaveric studies, and clinicians using this implant should be aware of this as revision is likely to require a distally fitting, rather than a metaphyseal fitting stem. We have illustrated the surgical technique to manage this rare complication.
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