1.Comparison of Time Taken in Conventional versus Active Robotic-Assisted Total Knee Arthroplasty
Sanjay Bhalchandra LONDHE ; Santosh SHETTY ; Vijay SHETTY ; Clevio DESOUZA ; Paras BANKA ; Nicholas ANTAO
Clinics in Orthopedic Surgery 2024;16(2):259-264
Background:
Computer- and robotic-assisted total knee replacement procedures have been shown to improve the accuracy of the implant size. It also allows dynamic confirmation of the implant and limb alignment during total knee arthroplasty (TKA). The major inhibition of the arthroplasty surgeon in adapting to the robotic-assisted TKA (RA-TKA) is the extra time spent during the registration process and milling of the bone with the robot. The aim of the study was to ascertain the extra time spent during these 2 steps as compared to the conventional TKA (C-TKA).
Methods:
It is a prospective study involving 30 patients each in the conventional TKA and RA-TKA operated by the same surgical team. The patients were given a choice between the C-TKA and RA-TKA and consecutive 30 cases in each group were studied by an independent observer. In the C-TKA group, the time for the application of appropriate zigs and execution of the bone cuts and soft-tissue release was recorded whereas in the RA-TKA group, the time taken for fixation of the tibial and femoral arrays and bone registration and bone milling with robot and required soft-tissue release was measured.
Results:
The preoperative patient characteristics were the same in both groups. The time taken in the C-TKA and RA-TKA groups was 24.77 ± 1.92 minutes and 25.03 ± 3.27 minutes, respectively, which is statistically insignificant (p = 0.709).
Conclusions
The study findings show that RA-TKA does not take additional time than C-TKA.
2.India-Based Knee Osteoarthritis Evaluation (iKare): A Multi-Centre Cross-Sectional Study on the Management of Knee Pain and Early Osteoarthritis in India.
Parag SANCHETI ; Vijay D SHETTY ; Mandeep S DHILLON ; Sheila A SPRAGUE ; Mohit BHANDARI
Clinics in Orthopedic Surgery 2017;9(3):286-294
BACKGROUND: Access to early knee osteoarthritis treatment in low and middle income nations is often believed to be limited. We conducted a cross-sectional study in India to assess prior access to treatment among patients presenting with knee pain to specialist orthopaedic clinics. METHODS: The multi-centre, cross-sectional study included patients presenting with knee pain at 3 hospitals in India. Patients who met the inclusion criteria and provided informed consent completed a questionnaire designed to assess patient demographics, socioeconomic status, knee pain, treatment method, and patient's knowledge on osteoarthritis (OA). Their orthopaedic surgeons also completed a questionnaire on the severity of patient's OA and their recommended treatments. The impact of demographic characteristics on the prescription of treatment options was analyzed using logistic regression. RESULTS: A total of 714 patients met the eligibility criteria and participated in this study. The majority of patients had been experiencing pain for less than 1 year (64.8%) and had previously been prescribed medications (91.6%), supplements (68.6%), and nonpharmacological (81.9%) treatments to manage their knee OA. Current treatment recommendations included oral medications (83.3%), intra-articular injections (29.8%), and surgical intervention (12.7%). Prescription of oral medications was related to younger age, lack of deformities, and lower Kellgren-Lawrence grades (p < 0.01). Patients treated in private hospital settings were more likely to have been previously treated with medications (range, 84.3% to 92.6%; p < 0.01) and physical treatments (range, 61.8% to 84.8%; p < 0.01) than patients treated at government hospitals. CONCLUSIONS: Contrary to the perception, our findings suggest a similar proportion of early knee OA treatment between India and North America.
Congenital Abnormalities
;
Cross-Sectional Studies*
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Demography
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Hospitals, Private
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Humans
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India*
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Informed Consent
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Injections, Intra-Articular
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Knee*
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Logistic Models
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Methods
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North America
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Osteoarthritis*
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Osteoarthritis, Knee*
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Prescriptions
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Social Class
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Specialization
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Surgeons
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Surveys and Questionnaires
3.Posterior Stabilization of Unstable Sacral Fractures: A Single-Center Experience of Percutaneous Sacroiliac Screw and Lumbopelvic Fixation in 67 Cases
Ajoy Prasad SHETTY ; Karukayil Ramakrishnan RENJITH ; Ramesh PERUMAL ; Sri Vijay ANAND ; Rishi Mugesh KANNA ; Shanmuganathan RAJASEKARAN
Asian Spine Journal 2021;15(5):575-583
Methods:
Out of the 67 patients, 40 and 27 were in the SI and LPF groups, respectively. The electronic medical record for each patient was reviewed, including patient demographic data, mode of trauma, coexisting injuries, neurological status (Gibbon’s four-grade system), Injury Severity Score, time from admission to operative stabilization, type of surgical stabilization, complications, return to the operating room, and treatment outcome measures using Majeed’s functional grading system and Matta’s radiological criteria. The minimum follow-up period was 2 years.
Results:
Noncomminuted longitudinal injuries with normal neurology and acceptable closed reduction have undergone SI screw fixation (n=40). Irreducible, comminuted, or high transverse fractures associated with dysmorphic anatomy or neurodeficit were managed by LPF (n=27). Excellent and good Majeed and Matta scores at 86.57% and 92.54% of the patients, respectively, were postoperatively achieved.
Conclusions
Unstable sacral fractures can be effectively managed with percutaneous SI screw including vertically unstable injuries by paying strict attention to preoperative patient selection whereas LPF can be reserved for comminuted fractures, unacceptable closed reduction, associated neurodeficit, lumbosacral dysmorphism, and high transverse fractures.
4.Impact of Patient Counseling and Socioeconomic Factors on Initiation of Rehabilitation Program in Spinal Cord Injury Patients Presenting to a Tertiary Spine Unit in India
Siddharth Narasimhan AIYER ; Vignesh GUNASEKARAN ; Latha MANI ; Sri Vijay Anand K. S. ; Shanmuganathan RAJASEKARAN ; Ajoy Prasad SHETTY
Asian Spine Journal 2021;15(3):357-364
Prospective case series. This study aimed to investigate the impact of education, financial income, occupation, and patient counseling on the timing of enrolment in a spinal cord injury (SCI) rehabilitation program. A rehabilitation program following SCI is essential to improve functional outcomes. Socioeconomic factors can affect the timing of enrolment to a rehabilitation program. Literature on the effects of socioeconomic factors among patients with SCI in the Indian scenario is limited. A prospective, consecutive analysis of patients with SCI was performed with 1-year follow-up. Assessment of the timing of enrolment to a rehabilitation program was performed using the modified Kuppuswamy socioeconomic scores (MKSS). Patients admitted to the SCI unit (group A), underwent intensive individual, group, and family counseling sessions to encourage early enrolment into a rehabilitation program. Patients presenting directly for rehabilitation (group B) were analyzed for comparison. A total of 153 patients were recruited. Group A was composed of 122 patients who started the rehabilitation program after a mean of 28 days, compared with a mean of 149 days for 31 patients in group B. In group A, 104 patients (85%; mean MKSS, 14.02) and 18 patients (15%; mean MKSS, 15.61) enrolled for rehabilitation <6 weeks and ≥6 weeks, respectively. In group B, 12 patients (39%; mean MKSS, 13.69) and 19 patients (61%; mean MKSS, 12.10) enrolled for rehabilitation <6 weeks and ≥6 weeks, respectively. The total MKSS and scores for education, income, and occupation did not show a significant difference between the two both groups (p>0.05). Early patient counseling in the acute care unit helps in the early enrolment of patients with poor socioeconomic demographic profile to a rehabilitation program.
5.Impact of Patient Counseling and Socioeconomic Factors on Initiation of Rehabilitation Program in Spinal Cord Injury Patients Presenting to a Tertiary Spine Unit in India
Siddharth Narasimhan AIYER ; Vignesh GUNASEKARAN ; Latha MANI ; Sri Vijay Anand K. S. ; Shanmuganathan RAJASEKARAN ; Ajoy Prasad SHETTY
Asian Spine Journal 2021;15(3):357-364
Prospective case series. This study aimed to investigate the impact of education, financial income, occupation, and patient counseling on the timing of enrolment in a spinal cord injury (SCI) rehabilitation program. A rehabilitation program following SCI is essential to improve functional outcomes. Socioeconomic factors can affect the timing of enrolment to a rehabilitation program. Literature on the effects of socioeconomic factors among patients with SCI in the Indian scenario is limited. A prospective, consecutive analysis of patients with SCI was performed with 1-year follow-up. Assessment of the timing of enrolment to a rehabilitation program was performed using the modified Kuppuswamy socioeconomic scores (MKSS). Patients admitted to the SCI unit (group A), underwent intensive individual, group, and family counseling sessions to encourage early enrolment into a rehabilitation program. Patients presenting directly for rehabilitation (group B) were analyzed for comparison. A total of 153 patients were recruited. Group A was composed of 122 patients who started the rehabilitation program after a mean of 28 days, compared with a mean of 149 days for 31 patients in group B. In group A, 104 patients (85%; mean MKSS, 14.02) and 18 patients (15%; mean MKSS, 15.61) enrolled for rehabilitation <6 weeks and ≥6 weeks, respectively. In group B, 12 patients (39%; mean MKSS, 13.69) and 19 patients (61%; mean MKSS, 12.10) enrolled for rehabilitation <6 weeks and ≥6 weeks, respectively. The total MKSS and scores for education, income, and occupation did not show a significant difference between the two both groups (p>0.05). Early patient counseling in the acute care unit helps in the early enrolment of patients with poor socioeconomic demographic profile to a rehabilitation program.
6.Does Sarcopenia Increase the Risk for Fresh Vertebral Fragility Fractures?: A Case-Control Study
Ashish ANAND ; Ajoy Prasad SHETTY ; K. R. RENJITH ; Sri Vijay Anand K. S. ; Rishi Mugesh KANNA ; Shanmuganathan RAJASEKARAN
Asian Spine Journal 2020;14(1):17-24
Methods:
Fifty-one consecutive patients with vertebral fragility fractures and matched controls without fractures were evaluated for sarcopenia, T-score, body mass index, and presence of preexisting vertebral fractures. Sarcopenia was diagnosed as total psoas cross-sectional area (TPA) 2 standard deviations below normative value from normal young adults and decreased handgrip strength (26 kg for men and 18 kg for women). Univariate and multivariate analyses were performed using the fresh fracture occurrence as the dependent variable.
Results:
Sarcopenia was confirmed in 29.4% and 7.8% of cases and controls (p=0.005), respectively; 56.8% and 13.7% of cases and controls had previous vertebral fractures. Sarcopenia prevalence was greater among those with previous fractures (38% vs. 7.6%; odds ratio, 7.76; p<0.001). TPA was lower among the cases (1,278 mm2 vs. 1,569 mm2 , p=0.001) and those with previous fractures (1,168 mm2 vs. 1,563 mm2 , p<0.001). Handgrip strength was greater among those without previous fractures (19.6 kg vs. 16.3 kg, p=0.05). In multivariate analysis, sarcopenia was not identified as a significant predictor of fresh fractures whereas previous fractures and lower T-score were found to be significant.
Conclusions
Sarcopenia is not an independent risk factor for fresh vertebral fragility fractures in the elderly.
7.In Vertebral Hemangiomas with Neurological Deficit, Is a Less Extensive Approach Adequate
Guna Pratheep K. ; Ajoy Prasad SHETTY ; Sri Vijay Anand K. S. ; Rohit KAVISHWAR ; Rishi Mugesh KANNA ; Shanmuganathan RAJASEKARAN
Asian Spine Journal 2023;17(1):37-46
Methods:
Twenty-one patients who underwent surgery for AVH between 2009 and 2018 were analyzed. Demographic and clinical details of patients were retrieved from hospital information system. Imaging information (i.e., radiography, computed tomography, magnetic resonance imaging) of all patients was accessed and analyzed in picture archiving and communication system. Tumor staging was performed using Enneking and Weinstein–Boriani–Biagini classifications and Spinal Instability Neoplastic Score. At followup, neurological and radiological evaluations were performed.
Results:
Twenty-one patients (13 [61.9%] females and 8 [38.1%] males) were included with a mean age of 44.29 years (range, 14–72 years). All patients in the study had neurological deficit. Back pain was present in 80.9% of patients. Mean duration of symptoms was 4.6 months (range, 1 day to 10 months). Most common lesion location was thoracic spine (n=12), followed by thoracolumbar (D11– L2; n=7) and lumbar (n=2) regions. Ten patients had multiple level lesions. All patients underwent preoperative embolization. Nine patients underwent intralesional spondylectomy with reconstruction; another nine patients underwent stabilization, decompression, and vertebroplasty; three patients underwent decompression and stabilization. Neurology improved in all patients, and only one case of recurrence was noted in a mean follow-up of 55.78±25 months (range, 24–96 months).
Conclusions
In AVH, good clinical and neurological outcomes with low recurrence rates can be achieved using less extensive procedures, such as posterior instrumented decompression with vertebroplasty and intralesional tumor resection.
8.Association between anterior corneal astigmatism and posterior corneal astigmatism across age groups:a cross-sectional analysis
Shetty VIJAY ; Haldipurkar S SUHAS ; Dhamankar RITA ; Haldipurkar TANVI ; Pirdankar ONKAR ; Setia Singh MANINDER
International Eye Science 2017;17(11):1993-1999
AIM:To assess the anterior corneal astigmatism (ACA)and posterior corneal astigmatism (PCA) patterns across various age groups.We also evaluated the association between magnitudes and axes of the ACA and PCA across these age groups.METHODS:The present study was a cross-sectional analysis of clinical data of 381 eyes.We converted the clinical astigmatic notation to vector notation for analysis of ACA and PCA.We estimated the correlation between magnitude and axes of the ACA and PCA in the whole population and in four age groups (5-19,20-39,40-59,and ≥ 60y).We used random effects linear regression models for estimating the association between the magnitudes of ACA and PCA.RESULTS:The mean of the magnitude of the ACA (3.59D) and the PCA (0.50D) was highest in children (5 to 9y).Overall,the magnitude of the ACA ranged from 0D to 10.0 Diopters (D) and the magnitude of the PCA ranged from 0 to 3.5 D.There was a significant correlation between the ACA and the PCA in the younger age group (r=0.85,P<0.001).In those 60y or older,the PCA increased by 0.04 units (95% confidence intervals:0.005,0.07;P=0.03) with each unit increase in the ACA,the increase was the smallest in this age group.CONCLUSION:It will be prudent to measure the both the magnitude and axis of the PCA,particularly in those above 60y rather than rely on rule-of-thumb calculations based on ACA parameters for IOL power calculation.
9.Proteomic Signature of Nucleus Pulposus in Fetal Intervertebral Disc
Shanmuganathan RAJASEKARAN ; Dilip Chand Raja SOUNDARARAJAN ; Chitraa TANGAVEL ; Sri Vijay Anand K. S. ; Sharon Miracle NAYAGAM ; Monica Steffi MATCHADO ; Raveendran MUTHURAJAN ; Ajoy Prasad SHETTY ; Rishi Mugesh KANNA ; K. DHARMALINGAM
Asian Spine Journal 2020;14(4):409-420
Methods:
IVDs of nine fetal specimens obtained from medical abortions were used to dissect out the annulus fibrosus and nucleus pulposus under sterile operating conditions. Dissected tissues were transferred to sterile Cryovials and snap frozen in liquid nitrogen before transporting to the research laboratory for protein extraction and further liquid chromatography tandem mass spectrometry (LC-MS/ MS) analysis. Collected data were further analyzed using Gene Functional Classification Tool in DAVID and STRING databases.
Results:
A total of 1,316 proteins were identified through LC-MS/MS analysis of nine fetal IVD tissues. Approximately 247 proteins present in at least four fetal discs were subjected to further bioinformatic analysis. The following 10 clusters of proteins were identified: collagens, ribosomal proteins, small leucine-rich proteins, matrilin and thrombospondin, annexins, protein disulfide isomerase family proteins and peroxiredoxins, tubulins, histones, hemoglobin, and prolyl 4-hydroxylase family proteins.
Conclusions
This study provides fundamental information on the proteome networks involved in the growth and development of healthy fetal discs in humans. Systematic cataloging of proteins involved in various structural and regulatory processes has been performed. Proteins expressed most abundantly (collagen type XIV alpha 1 chain, biglycan, matrilin 1, and thrombospondin 1) in their respective clusters also elucidate the possibility of utilizing these proteins for potential regenerative therapies.
10.Novel Biomarkers of Health and Degeneration in Human Intervertebral Discs: In-depth Proteomic Analysis of Collagen Framework of Fetal, Healthy, Scoliotic, Degenerate, and Herniated Discs
Shanmuganathan RAJASEKARAN ; Dilip Chand Raja SOUNDARARAJAN ; Sharon Miracle NAYAGAM ; Chitraa TANGAVEL ; Muthuraja RAVEENDRAN ; Sri Vijay Anand K S ; Ajoy Prasad SHETTY ; Rishi Mugesh KANNA
Asian Spine Journal 2023;17(1):17-29
Methods:
Forty NP tissues were snap-frozen in liquid nitrogen (–196°C) immediately before being subjected to proteomic and bioinformatic analyses from five different disk phenotypes (eight each).
Results:
Tandem mass spectrometric analysis revealed a total of 1,050 proteins in FDs, 1,809 in ND, 1,487 in SD, 1,859 in DH, and 1,538 in the DD group. Of 28 major collagens reported in the human body, this study identified 24 different collagens with 34 subtypes in NP. Fibril-forming collagens (COL-1, 2, and 11A1) and fibril-associated collagens with interrupted triple helices (COL-9A1, 12A1, and 14A1) were abundantly expressed in FDs, representing their role in the development of NP. Multiplexin (COL-15), a hybrid proteoglycan–collagen molecule, was discovered only in FDs. Degeneration was associated with COL2A1 downregulation and COL-10A1 upregulation.
Conclusions
COL10 was discovered to be a new biomarker for disk degeneration. Besides COL-1 and 2, other important COLs (6, 9, 11, 12, 14, 15) with anabolic potential and abundant expression in the fetal phenotype could be investigated for tissue engineering and novel DDD therapy.