18 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
Wright E, Musbahi O, singh A, et al., 2021, Increased perioperative mortality for femoral neck fractures in patients with coronavirus disease 2019 (COVID-19): experience from the United Kingdom during the first wave of the pandemic, Patient Safety in Surgery, Vol: 15, Pages: 1-8, ISSN: 1754-9493
The coronavirus disease 19 (COVID-19) pandemic has presented modern healthcare with an unprecedented challenge. At the peak of the pandemic, Trauma and Orthopaedic services at our institutions undertook internal restructuring, diverting resources to frontline medical care. Consequently, we sought to assess the impact on the elderly and comorbid patients presenting with femoral neck fractures, with a particular focus on 30-day mortality, length of stay, multidisciplinary team involvement and departmental structuring.MethodA retrospective analysis of patients presenting with femoral neck fractures at three separate West London NHS Trusts was undertaken between March 11, 2020, to April 30, 2020. Length of stay, mortality and adherence to parameters constituting the best care evidence-based practice tariffs were compared between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and negative patients. A similar comparison was also conducted between our cohort and the equivalent period in 2018 using data from the National Hip Fracture Database. ResultsA total of 68 patients presenting with femoral neck fractures were identified, mean age 81 (range 38-98), 73% female. There were 10 confirmed/suspected cases of COVID-19 on admission and a further seven confirmed as inpatients. The 30-day mortality within our cohort was 11.76% compared to 6% nationally in 2018 (p=0.045). Orthogeriatric reviews occurred within 72 hours in 71% of cases compared to 88% in the equivalent 2018 period. Within our cohort, mean length of stay was 17.13 days (SD 5.6, range 8-27days) for SARS-CoV-2 positive patients compared to 10 days (SD 8.7, range 1-53 days) for negative patients (p<0.05). Thirty-two patients (47%) required increased packages of care on discharge or rehabilitation. Conclusions The increase in 30-day mortality for SARS-CoV-2 positive patients presenting with femoral neck fractures is multifactorial, resulting from a combination of the direct effects of COVID-
Wiik AV, Nathwani D, Akhtar A, et al., 2020, The unicompartmental knee is the preferred side in individuals with both a unicompartmental and total knee arthroplasty, Knee Surgery Sports Traumatology Arthroscopy, Vol: 28, Pages: 3193-3199, ISSN: 0942-2056
PurposeTo determine the preferred knee in patients with both one total and one unicompartmental knee arthroplasty.MethodPatients simply with a unicompartmental (UKA) and total knee arthroplasty (TKA) on contralateral sides were retrospectively screened from three senior knee surgeon’s logs over a 15 year period. Patients safe and free from other diseases to affect gait were approached. A total of 16 patients (mean age 70 ± 8) agreed to ground reaction force testing on an instrumented treadmill at a fair pace and incline. A gender-ratio identical group of 16 healthy control subjects (mean age 67 ± 10) and 16 patients with ipsilateral medial knee OA (mean age 66 ± 7) were analysed to compare.ResultsRadiographically the mode preoperative Kellgren–Lawrence knee grade for each side was 3. Postoperatively, the TKA side had a mean coronal femoral component alignment of 7° and a mean tibial coronal alignment of 89° with a mean posterior slope of 5° in the sagittal plane. The UKA side had a mean coronal femoral component alignment of 7° and a mean tibial coronal alignment of 86° with a mean posterior slope of 4° in the sagittal plane. In 7 patients, the TKA was the first procedure, while 6 for the UKA and 3 done simultaneously. Gait analysis demonstrated in both walking conditions the UKA limb was the preferred side through all phases of loading (p < 0.05) and nearer to normal than the TKA limb when compared to healthy controls and patients with knee OA. The greatest difference was observed between the transition of weight acceptance and midstance (p = 0.008), when 22% more load was taken by the UKA side.ConclusionBy using a dynamic metric of an everyday activity, a distinct gait difference between differing arthroplasty types were established. A more natural loading pattern can be achieved with unicompartmentals as compared to total knees.Level o
Babu S, Singh P, Wiik A, et al., 2019, A comparison of patient-reported outcome measures (PROMs) between short and conventional stem hip replacements: a systematic review and meta-analysis, HIP INTERNATIONAL, Vol: 30, Pages: 513-522, ISSN: 1120-7000
Wiik AV, Lambkin R, Cobb JP, 2019, Gait after Birmingham Hip Resurfacing, The Bone & Joint Journal, Vol: 101-B, Pages: 1423-1430, ISSN: 2049-4394
The aim of this study was to assess the functional gain achieved following hip resurfacing arthroplasty (HRA).Patients and MethodsA total of 28 patients (23 male, five female; mean age, 56 years (25 to 73)) awaiting Birmingham HRA volunteered for this prospective gait study, with an age-matched control group of 26 healthy adults (16 male, ten female; mean age, 56 years (33 to 84)). The Oxford Hip Score (OHS) and gait analysis using an instrumented treadmill were used preoperatively and more than two years postoperatively to measure the functional change attributable to the intervention.ResultsThe mean OHS improved significantly from 27 to 46 points (p < 0.001) at a mean of 29 months (12 to 60) after HRA. The mean metal ion levels at a mean 32 months (13 to 60) postoperatively were 1.71 (0.77 to 4.83) µg/l (ppb) and 1.77 (0.68 to 4.16) µg/l (ppb) for cobalt and chromium, respectively. When compared with healthy controls, preoperative patients overloaded the contralateral good hip, limping significantly. After HRA, patients walked at high speeds, with symmetrical gait, statistically indistinguishable from healthy controls over almost all characteristics. The control group could only be distinguished by an increased push-off force at higher speeds, which may reflect the operative approach.ConclusionPatients undergoing HRA improved their preoperative gait pattern of a significant limp to a symmetrical gait at high speeds and on inclines, almost indistinguishable from normal controls. HRA with an approved device offers substantial functional gains, almost indistinguishable from healthy controls.
Al-Obaidi B, Wiik AV, Bhattacharyya R, et al., 2019, Fibular nails for open and closed ankle fractures: Results from a non-designer level I major trauma centre, Journal of Orthopaedic Surgery, Vol: 27, ISSN: 2309-4990
Aim:To evaluate the outcome of a fibular nail in the treatment of open and closed unstable ankle fractures in a non-designer centre.Methods:In a retrospective cohort study, a total of 39 ankle fractures (14 open and 25 closed) treated with a locking fibular nail were evaluated between 2012 and 2015 in a non-designer level I major trauma centre. Post-operative radiographs were analysed to assess the quality of reduction (McLennan and Ungersma marking system), fracture union and complications. Three patient reported outcome scores (Olerud and Molander score (OMAS), American Association of Orthopaedic Surgeons (AAOS) foot and ankle score and 12-Item Short Form Survey (SF-12)) were collected to obtain an overall measure of the patient’s physical and mental outcome.Results:The adequacy of reduction data was available for 38 of 39 cases; 33 (87%) achieved good, 3 (8%) fair and 2 (5%) poor ratings, based on the McLennan and Ungersma marking system. Thirty-five (12 open and 23 closed) patients were available for initial follow-up. Five (14.3%) of 35 had documented complications (2 of 12 in the open cohort and 3 of 23 in the closed cohort). All fibular fractures treated with the fibular nail went on to unite. Twenty-three (66%) of 35 patients were available at 1-year follow-up for measurement of objective outcome. The combined mean OMAS for both groups was 53.7 (0–85) with statistically better results (59.5 (25–85) vs. 37.3 (0–75)) in favour of the closed versus open injuries, respectively. The mean AAOS score was also statistically better for the closed group than the open, 70.3 (30–95) versus 46.6 (20–77), respectively. The mean SF-12 score (physical component) was 40 (21.6–52.4) in the closed group versus 36.1 (19.4–51.5) in the open group; the mean mental component was 42.5 (26.6–54.3) in the closed group versus 38.8 (28.4–60.5) in the open group, these however were not statistically different.Conclusion:Fibular
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
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.
Wiik AV, Patel P, Bovis J, et al., 2018, Use of ketamine sedation for the management of displaced paediatric forearm fractures, World Journal of Orthopedics, Vol: 9, Pages: 50-57, ISSN: 2218-5836
AIMTo determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department.METHODSFollowing an agreed interdepartmental protocol, fractures of the radius and ulna (moderately to severely displaced) in children between the age of 2 and 16 years old, presenting within a specified 4 mo period, were manipulated in our paediatric emergency department. Verbal and written consent was obtained prior to procedural sedation to ensure parents were informed and satisfied to have ketamine. A single attempt at manipulation was performed. Pre and post manipulation radiographs were requested and assessed to ensure adequacy of reduction. Parental satisfaction surveys were collected after the procedure to assess the perceived quality of treatment. After closed reduction and cast immobilisation, patients were then followed-up in the paediatric outpatient fracture clinic and functional outcomes measured prospectively. A cost analysis compared to more formal manipulation under a general anaesthetic was also undertaken.RESULTSDuring the 4 mo period of study, 10 closed, moderate to severely displaced fractures were identified and treated in the paediatric emergency department using our ketamine sedation protocol. These included fractures of the growth plate (3), fractures of both radius and ulna (6) and a single isolated proximal radius fracture. The mean time from administration of ketamine until completion of the moulded plaster was 20 min. The mean time interval from sedation to full recovery was 74 min. We had no cases of unacceptable fracture reduction and no patients required any further manipulation, either in fracture clinic or under a more formal general anaesthetic. There were no serious adverse events in relation to the use of ketamine. Parents, patients and clinicians reported extremely favourable outcomes using this technique. Furthermore, compared to using a manipulation under general anaesthes
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
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
Jones G, Kotti M, Wiik A, et al., 2016, Gait comparison of unicompartmental and total knee arthroplasties with healthy controls, Bone & Joint Journal, Vol: 98-B, Pages: 16-21, ISSN: 2049-4394
Aims:To compare the gait of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) patients with healthy controls, usinga machine learning approach.Patients:145 participants (121 healthy controls, 12 cruciate retaining TKA patients, and 12 mobile bearing UKA patients) were recruited. The TKAand UKA patients were a minimum of 12 months post-op, and matched for pattern and severity of arthrosis, age, and BMI.Methods:Participants walked on an instrumented treadmill until their maximum walking speed was reached. Temporospatial gait parameters, andvertical ground reaction force data was captured at each speed. Oxford knee scores (OKS) were also collected. An ensemble of treesalgorithm was used to analyse the data: 27 gait variables were used to train classification trees for each speed, with a binary outputprediction of whether these variables were derived from a UKA or TKA patient. Healthy control gait data was then tested by the decisiontrees at each speed and a final classification (UKA or TKA) reached for each subject in a majority voting manner over all gait cycles andspeeds. Top walking speed was also recorded.Results:92% of the healthy controls were classified by the decision tree as a UKA, 5% as a TKA, and 3% were unclassified. There was nosignificant difference in OKS between the UKA and TKA patients (p=0.077). Top walking speed in TKA patients (1.6 m/s [1.3-2.1]) wassignificantly lower than that of both the UKA group (2.2 m/s [1.8-2.7]) and healthy controls (2.2 m/s [1.5-2.7]) (p<0.001).Conclusion:UKA results in a more physiological gait compared to TKA, and a higher top walking speed. This difference in function was not detectedby the OKS.
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
Brevadt MJ, manning VL, 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
Wiik AV, Aqil A, Tankard S, et al., 2015, Downhill walking gait pattern discriminates between types of knee arthroplasty: improved physiological knee functionality in UKA versus TKA, KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol: 23, Pages: 1748-1755, ISSN: 0942-2056
Atallah L, Wiik A, Lo B, et al., 2014, Gait asymmetry detection in older adults using a light ear-worn sensor, PHYSIOLOGICAL MEASUREMENT, Vol: 35, Pages: N29-N40, ISSN: 0967-3334
Wiik AV, Manning V, Strachan RK, et al., 2013, Unicompartmental knee arthroplasty enables near normal gait at higher speeds, unlike total knee arthroplasty, Journal of Arthroplasty, Vol: 28, Pages: 176-178, ISSN: 0883-5403
Top walking speed (TWS) was used to compare UKA with TKA. Two groups of 23 patients, well matched for age, gender, height and weight and radiological severity were recruited based on high functional scores, more than twelve months post UKA or TKA. These were compared with 14 preop patients and 14 normal controls. Their gait was measured at increasing speeds on a treadmill instrumented with force plates. Both arthroplasty groups were significantly faster than the preop OA group. TKA patients walked substantially faster than any previously reported series of knee arthroplasties. UKA patients walked 10% faster than TKA, although not as fast as the normal controls. Stride length was 5% greater and stance time 7% shorter following UKA — both much closer to normal than TKA. Unlike TKA, UKA enables a near normal gait one year after surgery.
Atallah L, Wiik A, Jones GG, et al., 2012, Validation of an ear-worn sensor for gait monitoring using a force-plate instrumented treadmill, GAIT & POSTURE, Vol: 35, Pages: 674-676, ISSN: 0966-6362
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