6 results found
Uemura K, Boughton O, Logishetty K, et al., 2019, A single-use, size-specific, nylon arthroplasty guide: a preliminary study, Hip International, ISSN: 1120-7000
Jones GG, Logishetty K, Clarke S, et al., 2018, Do patient-specific instruments (PSI) for UKA allow non-expert surgeons to achieve the same saw cut accuracy as expert surgeons?, Archives of Orthopaedic and Trauma Surgery, Vol: 138, Pages: 1601-1608, ISSN: 0936-8051
INTRODUCTION: High-volume unicompartmental knee arthroplasty (UKA) surgeons have lower revision rates, in part due to improved intra-operative component alignment. This study set out to determine whether PSI might allow non-expert surgeons to achieve the same level of accuracy as expert surgeons. MATERIALS AND METHODS: Thirty-four surgical trainees with no prior experience of UKA, and four high-volume UKA surgeons were asked to perform the tibial saw cuts for a medial UKA in a sawbone model using both conventional and patient-specific instrumentation (PSI) with the aim of achieving a specified pre-operative plan. Half the participants in each group started with conventional instrumentation, and half with PSI. CT scans of the 76 cut sawbones were then segmented and reliably orientated in space, before saw cut position in the sagittal, coronal and axial planes was measured, and compared to the pre-operative plan. RESULTS: The compound error (absolute error in the coronal, sagittal and axial planes combined) for experts using conventional instruments was significantly less than that of the trainees (11.6°±4.0° v 7.7° ±2.3º, p = 0.029). PSI improved trainee accuracy to the same level as experts using conventional instruments (compound error 5.5° ±3.4º v 7.7° ±2.3º, p = 0.396) and patient-specific instruments (compound error 5.5° ±3.4º v 7.3° ±4.1º, p = 0.3). PSI did not improve the accuracy of high-volume surgeons (p = 0.3). CONCLUSIONS: In a sawbone model, PSI allowed inexperienced surgeons to achieve more accurate saw cuts, equivalent to expert surgeons, and thus has the potential to reduce revision rates. The next test will be to determine whether these results can be replicated in a clinical trial.
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.
Logishetty K, Western L, Morgan R, et al., 2018, Augmented reality for arthroplasty training - a randomised controlled trial of simulator-based training for acetabular cup orientation skills, Clinical Orthopaedics and Related Research, ISSN: 0009-921X
Background:Accurate implant orientation reduces wear and increases stability in arthroplasty. This is a technically demanding skill. Augmented Reality headsets overlay digital information over the real world. We have developed an enhanced AR headset capable of tracking bony anatomy in relation to an implant. Questions/Purposes:The purpose of this study was to validate this enhanced AR headset in the training simulator setting as determined by (1) quantitative assessments accurately orientating an acetabular component, and (2) a questionnaire regarding the realism of the task, acceptability ofthe technology, and its potential role for surgical training. Methods:Twenty-four novice surgeons voluntarily participated in a simulation trial. Demographics and baseline performance in orientating an acetabular implant to six patient-specific values on the phantom pelvis, were collected prior to training. All participants received standardised educational lectures based around four clinical vignettes on hip surgery to normalise their knowledge. Participants were randomised to two groups, completing four, once-weekly sessions of baseline assessment, training, and re-assessment. One group trained using AR (with live holographic feedback of orientation), and the other received one-on-one tuition from an expert surgeon (ES). The solid-angle error in degrees between the planned and achieved orientations was measured. Participants completed baseline assessments, then training, and then assessment in this fashion after each weekly session, and a validated post-training questionnaire evaluating their experiences. Results:Novice surgeons of similar experience in both groups performed with a similar error prior to training (Baseline ES mean error 16° ± SD 7° compared to AR 14±7°, p>0.05). During training, participants achieved average errors in orientations of 1±1° using AR, and 6±4° when guided by the ES (p<0.001). At fin
Logishetty K, 2017, Adopting and sustaining a Virtual Fracture Clinic model in the District Hospital setting – a quality improvement approach, BMJ Quality Improvement Reports, Vol: 6, ISSN: 2050-1315
Virtual Fracture Clinics (VFCs) are an alternative to the conventional fracture clinics, to manage certain musculoskeletal injuries. This has recently been reported as a safe, cost-effective and efficient care model. As demonstrated at vanguard sites in the United Kingdom, VFCs can enhance patient care by standardising treatment and reducing outpatient appointments.This project demonstrates how a Quality Improvement approach was applied to introduce VFCs in the District General Hospital setting. We demonstrate how undertaking Process Mapping, Driver Diagrams, and Stakeholder Analysis can assist implementation. We discuss Whole Systems Measures applicable to VFCs, to consider how robust and specific data collection can progress this care model.Three Plan-Do-Study-Act cycles led to a change in practice over a 21-month period. Our target for uptake of new patients seen in VFCs within 6 months of starting was set at 50%. It increased from 0% to 56.1% soon after introduction, and plateaued at an average of 56.4% in the six-months before the end of the study period.Careful planning, frequent monitoring, and gathering feedback from a multidisciplinary team of varying seniority, were the important factors in transitioning to, and sustaining, a successful VFC model.
Logishetty K, Jones GG, Cobb JP, 2016, Letter to the Editor: The John Insall Award: no functional benefit after unicompartmental knee arthroplasty performed with patient-specific instrumentation: a randomized trial, Clinical Orthopaedics and Related Research, Vol: 474, Pages: 272-273, ISSN: 1528-1132
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