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Herren AOF, Amin AK, Hall AC. A Disintegrin and Metalloproteinase with Thrombospondin Motifs-4 Levels in Chondrocytes of Different Morphology within Nondegenerate and Early Osteoarthritic Human Femoral Head Cartilage. Cartilage 2023:19476035231176532. [PMID: 37272453 DOI: 10.1177/19476035231176532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- Arthur O F Herren
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Anish K Amin
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Andrew C Hall
- Deanery of Biomedical Sciences, The University of Edinburgh, Edinburgh, UK
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Amin AZ, Amin AK, Abdelkawy MA, Alluhaybi AA, Hashim I. Spectral technique with convergence analysis for solving one and two-dimensional mixed Volterra-Fredholm integral equation. PLoS One 2023; 18:e0283746. [PMID: 37235577 DOI: 10.1371/journal.pone.0283746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/14/2023] [Indexed: 05/28/2023] Open
Abstract
A numerical approach based on shifted Jacobi-Gauss collocation method for solving mixed Volterra-Fredholm integral equations is introduced. The novel technique with shifted Jacobi-Gauss nodes is applied to reduce the mixed Volterra-Fredholm integral equations to a system of algebraic equations that has an easy solved. The present algorithm is extended to solve the one and two-dimensional mixed Volterra-Fredholm integral equations. Convergence analysis for the present method is discussed and confirmed the exponential convergence of the spectral algorithm. Various numerical examples are approached to demonstrate the powerful and accuracy of the technique.
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Affiliation(s)
- A Z Amin
- Department of Mathematical Sciences, Faculty of Science & Technology, Universiti Kebangsaan, Malaysia, Malaysia
| | - A K Amin
- Department of Basic Sciences, Adham University College, Umm AL-Qura University, Makkah, Saudi Arabia
- Department of Mathematics, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| | - M A Abdelkawy
- Department of Mathematics, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
- Department of Mathematics and Statistics, College of Science, Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - A A Alluhaybi
- Department of Basic Sciences, Adham University College, Umm AL-Qura University, Makkah, Saudi Arabia
| | - I Hashim
- Department of Mathematical Sciences, Faculty of Science & Technology, Universiti Kebangsaan, Malaysia, Malaysia
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Carter TH, Heinz N, Duckworth AD, White TO, Amin AK. Management of Lisfranc Injuries: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202304000-00001. [PMID: 37014938 DOI: 10.2106/jbjs.rvw.22.00239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
» There is a spectrum of midtarsal injuries, ranging from mild midfoot sprains to complex Lisfranc fracture-dislocations. » Use of appropriate imaging can reduce patient morbidity, by reducing the number of missed diagnoses and, conversely, avoiding overtreatment. Weight-bearing radiographs are of great value when investigating the so-called subtle Lisfranc injury. » Regardless of the operative strategy, anatomical reduction and stable fixation is a prerequisite for a satisfactory outcome in the management of displaced injuries. » Fixation device removal is less frequently reported after primary arthrodesis compared with open reduction and internal fixation based on 6 published meta-analyses. However, the indications for further surgery are often unclear, and the evidence of the included studies is of typically low quality. Further high-quality prospective randomized trials with robust cost-effectiveness analyses are required in this area. » We have proposed an investigation and treatment algorithm based on the current literature and clinical experience of our trauma center.
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Affiliation(s)
- Thomas H Carter
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nicholas Heinz
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Timothy O White
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Anish K Amin
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Robinson A, Chopra N, Badin AG, Billakanty SR, Cooper K, Fu EY, James J, Murnane V, Swinning J, Stelzer M, Tyler JD, Amin AK. Impact of a dedicated atrial fibrillation clinic on diagnosis-to-ablation time. Heart Rhythm O2 2022; 3:639-646. [PMID: 36589916 PMCID: PMC9795309 DOI: 10.1016/j.hroo.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Outcomes following catheter ablation (CA) for atrial fibrillation (AF) improve as the diagnosis-to-ablation time (DAT) shortens. Use of a protocol-based integrated care model through a dedicated atrial fibrillation clinic (AFC) may serve to standardize treatment pathways and decrease DAT. Objective To evaluate the DAT and clinical characteristics of patients with AF referred from an AFC vs a conventional electrophysiology clinic (EC). Methods Retrospective analysis was completed in consecutive patients undergoing index AF ablation at Riverside Methodist Hospital in 2019 with minimum 1 year follow-up. Patients were categorized based off their CA referral source (AFC vs EC) and where the initial visit following index diagnosis of AF occurred (AFC vs EC). Results A total of 182 patients (mean age 65 years, 64% male) were reviewed. Patients referred from an AFC (21%) had a median DAT of 342 days (interquartile range [IQR], 125-855 days) compared to patients referred from EC (79%) with a median DAT of 813 days (IQR, 241-1444 days; P = .01). Patients with their index visit following AF diagnosis occurring in the AFC (9%) had significantly shorter median DAT (127 days [IQR, 95-188 days]) compared to EC (91%) (789 days [IQR, 253-1503 days]; P = .002). Patients with DAT <1 year had lower AF recurrence than patients with DAT >1 year (P = .04, hazard ratio = 0.58, 95% confidence interval 0.3418-1.000). Conclusion DAT is a modifiable factor that may affect CA outcomes. Significant reductions in DAT were observed in patients evaluated through a dedicated AF clinic.
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Affiliation(s)
- Andrea Robinson
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio,Address reprint requests and correspondence: Ms Andrea Robinson, Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Rd, Columbus, OH 43214.
| | - Nagesh Chopra
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Auroa G. Badin
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Sreedhar R. Billakanty
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Keaira Cooper
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Eugene Y. Fu
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Jennifer James
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Victoria Murnane
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Jill Swinning
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Mitchell Stelzer
- Department of Internal Medicine, OhioHealth Doctors Hospital, Columbus, Ohio
| | - Jaret D. Tyler
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Anish K. Amin
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
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Stelzer M, Blankenship J, Luli J, Kleman JM, Fu EY, Billakanty SR, Chopra N, Badin A, Tyler J, Amin AK. PO-626-08 LEFT ATRIAL APPENDAGE OCCLUSION WITH LEFT ATRIAL FOUR DIMENSIONAL INTRACARDIAC ECHOCARDIOGRAPHY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stelzer M, Robinson A, Billakanty SR, Chopra N, Kleman JM, Blankenship J, Luli J, Badin A, Tyler J, Yakubov S, Amin AK. PO-671-03 LEFT ATRIAL APPENDAGE EARLY EXPERIENCE USING FOUR DIMENSIONAL INTRACARDIAC ECHOCARDIOGRAPHY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Robinson A, Badin A, Billakanty SR, Chopra N, Fu EY, James JL, Kleman JM, Loessin B, Murnane V, Swinning J, Tyler J, Amin AK. PO-627-04 THREE YEAR COST SAVINGS OF AN ACUTE ATRIAL FIBRILLATION PATHWAY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Khan ZA, LaBreck ME, Luli J, Roberts C, Smith A, El-Zein R, Tyler JD, Fu EY, Billakanty SR, Amin AK, Chopra N. Longitudinal QT c Stability and Impact of Baseline Cardiac Rhythm on Discharge Dose in Dofetilide-treated Patients. J Cardiovasc Electrophysiol 2022; 33:1281-1289. [PMID: 35362175 DOI: 10.1111/jce.15483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/03/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dofetilide suppresses AF in a dose-dependent fashion. The protective effect of AF against QTc prolongation induced torsades de pointe and transient post-cardioversion QTc prolongation may result in dofetilide under-dosing during initiation. Thus, the optimal timing of cardioversion for AF patients undergoing dofetilide initiation to optimize discharge dose remains unknown as does the longitudinal stability of QTc . OBJECTIVE To evaluate the impact of baseline rhythm on dofetilide dosing during initiation and assess the longitudinal stability of QTc-all (Bazzett, Fridericia, Framingham, and Hodges) over time. METHODS Medical records of patients who underwent pre-planned dofetilide loading at a tertiary care center between January 2016-2019 were reviewed. RESULTS A total of 198 patients (66±10 years, 32% female, CHADS2 -Vasc 3 [2-4]) presented for dofetilide loading in either AF (59%) or SR (41%). Neither presenting rhythm, nor spontaneous conversion to SR impacted discharge dose. The cumulative dofetilide dose prior to cardioversion moderately correlated (r=0.36; p=0.0001) with discharge dose. Post-cardioversion QTc-all prolongation (p<0.0001) prompted discharge dose reduction (890±224mcg vs 552±199mcg; p<0.0001) in 30% patients. QTc-all in SR prolonged significantly during loading (p<0.0001). All patients displayed QTc-all reduction (p<0.0001) from discharge to short-term (46 [34-65] days) that continued at long-term (360 [296-414] days) follow-ups. The extent of QTc-all reduction over time moderately correlated with discharge QTc-all (r=0.54-0.65; p<0.0001). CONCLUSION Dofetilide initiation prior to cardioversion is equivalent to initiation during SR. Significant QTc reduction proportional to discharge QTc is seen over time in all dofetilide-treated patients. QTc returns to pre-loading baseline during follow-up in patients initiated in SR. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zeryab A Khan
- Department of Internal Medicine, OhioHealth Doctors Hospital, 5100 West Broad Street Columbus, OH, 43228
| | - Megan E LaBreck
- Department of Pharmacy, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214
| | - Jordan Luli
- Department of Internal Medicine, OhioHealth Doctors Hospital, 5100 West Broad Street Columbus, OH, 43228
| | - Chelsea Roberts
- Department of Pharmacy, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214
| | - Alexander Smith
- Department of Internal Medicine, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Rayan El-Zein
- Department of Internal Medicine, OhioHealth Doctors Hospital, 5100 West Broad Street Columbus, OH, 43228
| | - Jaret D Tyler
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Eugene Y Fu
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Sreedhar R Billakanty
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Anish K Amin
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Nagesh Chopra
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
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Smith A, Amin AK, El‐Zein R, Billakanty SR, Chopra N. Relationship between Surpoint Tag Index, a Radiofrequency Ablation lesion quality indicator, and Atrial wall thickness in Cavotricuspid isthmus Ablations exhibiting bidirectional block. J Arrhythm 2021; 38:118-125. [PMID: 35222758 PMCID: PMC8851572 DOI: 10.1002/joa3.12662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/28/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background An RFA lesion quality indicator, Surpoint Tag Index® (TI) incorporates key factors: power, time, and contact force, impacting lesion quality. TI accurately estimates lesion depth in animal studies. However, the relationship between TI and in‐vivo atrial wall thickness in patients exhibiting bidirectional block remains unknown. Objective To describe the relationship between atrial wall thickness and TI in CTI exhibiting bidirectional block. Methods Data from 492 RFA lesions from 25 patients undergoing PVI and CTI ablations in SR with point‐by‐point RF lesions (<45 W) utilizing a Thermocool Smarttouch® SF ablation catheter and CARTO‐3 mapping were retrospectively analyzed. Operators were blinded to TI data and CTI thickness. CTI thickness was obtained using ICE images on Cartosound pre‐ablation. Durable lesions were defined as part of a lesion set exhibiting bidirectional block of >30 min. Results In lesions exhibiting bidirectional block, the thinnest (1–2 mm; 5% lesions) and thickest (8–10 mm; 6% lesions) portions of the CTI correlated with the lowest (429 ± 75) and highest (516 ± 64) TI. The bulk of thickness (2–6 mm; 80%) correlated with a TI of 455 ± 72 (p = 0.001). There was a weak but positive correlation between TI and CTI thickness (r = 0.2; p ≤ 0.01). Examined in sectors, the anterior 1/3rd CTI was the thickest (4.8 ± 1.9 mm) but correlated with a similar TI value (479 ± 75 vs. 471 ± 70; p = 0.34) as the thinner middle 1/3rd (3.8 ± 1.7 mm; p ≤ 0.0001). Conclusion A mean TI value of 455 correlates with bidirectional block across the bulk of CTI with lower and higher values needed for the thinner and thicker portions, respectively. Tissue composition, aside from wall thickness, influences TI values for the creation of the bidirectional block.
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Affiliation(s)
- Alexander Smith
- Department of Internal Medicine Riverside Methodist Hospital Columbus Ohio USA
| | - Anish K. Amin
- Section of Cardiac Electrophysiology Department of Cardiology OhioHealth Heart and Vascular PhysiciansRiverside Methodist Hospital Columbus Ohio USA
| | - Rayan El‐Zein
- Department of Internal Medicine OhioHealth Doctors Hospital Columbus Ohio USA
| | - Sreedhar R. Billakanty
- Section of Cardiac Electrophysiology Department of Cardiology OhioHealth Heart and Vascular PhysiciansRiverside Methodist Hospital Columbus Ohio USA
| | - Nagesh Chopra
- Section of Cardiac Electrophysiology Department of Cardiology OhioHealth Heart and Vascular PhysiciansRiverside Methodist Hospital Columbus Ohio USA
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Styczynska-Soczka K, Amin AK, Simpson AHW, Hall AC. Optimization and Validation of a Human Ex Vivo Femoral Head Model for Preclinical Cartilage Research and Regenerative Therapies. Cartilage 2021; 13:386S-397S. [PMID: 32567330 PMCID: PMC8721618 DOI: 10.1177/1947603520934534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Articular cartilage is incapable of effective repair following injury or during osteoarthritis. While there have been developments in cartilage repair technologies, there is a need to advance biologically relevant models for preclinical testing of biomaterial and regenerative therapies. This study describes conditions for the effective ex vivo culture of the whole human femoral head. DESIGN Fresh, viable femoral heads were obtained from femoral neck fractures and cultured for up to 10 weeks in (a) Dulbecco's modified Eagle's medium (DMEM); (b) DMEM + mixing; (c) DMEM + 10% human serum (HS); (d) DMEM + 10% HS + mixing. The viability, morphology, volume, and density of fluorescently labelled in situ chondrocytes and cartilage surface roughness were assessed by confocal microscopy. Cartilage histology was studied for glycosaminoglycan content using Alcian blue and collagen content using picrosirius red. RESULTS Chondrocyte viability remained at >95% in DMEM + 10% HS. In DMEM alone, viability remained high for ~4 weeks and then declined. For the other conditions, superficial zone chondrocyte viability fell to <35% at 10 weeks with deeper zones being relatively unaffected. In DMEM + 10% HS at 10 weeks, the number of chondrocytes possessing cytoplasmic processes increased compared with DMEM (P = 0.017). Alcian blue labeling decreased (P = 0.02) and cartilage thinned (P ≤ 0.05); however, there was no change to surface roughness, chondrocyte density, chondrocyte volume, or picrosirius red labeling (P > 0.05). CONCLUSIONS In this ex vivo model, chondrocyte viability was maintained in human femoral heads for up to 10 weeks in culture, a novel finding not previously reported. This human model could prove invaluable for the exploration, development, and assessment of preclinical cartilage repair and regenerative therapies.
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Affiliation(s)
| | - Anish K. Amin
- Department of Trauma and Orthopaedic
Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - A. Hamish W. Simpson
- Department of Trauma and Orthopaedic
Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Andrew C. Hall
- Biomedical Sciences, Edinburgh Medical
School, University of Edinburgh, Edinburgh, Scotland, UK,Andrew C. Hall, Biomedical Sciences,
Edinburgh Medical School, University of Edinburgh, Hugh Robson Building, George
Square, Edinburgh, EH8 9XD, Scotland, UK.
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Stelzer M, Speakman B, Stahl WK, Billakanty SR, Chopra N, Fu EY, Kidwell GA, Kleman JM, Nelson SD, Nichols AJ, Swinning J, Robinson A, Amin AK. B-PO05-047 EVALUATION OF MECHANICAL PLACEMENT, IMPEDANCE, AND LOW VOLTAGE MEASUREMENT COROLLARY STUDY (EMILY STUDY) FOR THE S-ICD. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Swinning J, Sprott K, Reeser T, Amin AK, Basuray A, Castle L, Chopra N, Fu EY, Kidwell GA, Kleman JM, Nelson SD, Nichols AJ, Saha N, Tyler J, Billakanty S, Billakanty SR. B-PO04-187 CARDIAC RESYNCHRONIZATION THERAPY-HEART FAILURE CLINIC: A NOVEL MODEL OF CARE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Khan Z, Labreck M, Luli J, Roberts C, Smith A, El-Zein R, Billakanty SR, Amin AK, Chopra N. B-PO02-146 IMPACT OF DOFETILIDE LOADING DURING ATRIAL FIBRILLATION ON DISCHARGE DOSE AND QTC STABILITY OVER 1-YEAR FOLLOW-UP. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Labreck M, Roberts C, Amin AK, Sherry M, Sullivan D. B-PO03-003 COST COMPARISON OF OUTPATIENT VERSUS INPATIENT SOTALOL LOADING. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Robinson A, Amin AK, Billakanty SR, Fu EY, James J, Kidwell GA, Kleman JM, Murnane V, Nelson SD, Nichols AJ, Smith A, Swinning J, Stelzer M, Tyler J, Chopra N. B-PO04-110 IMPACT OF A DEDICATED ATRIAL FIBRILLATION CLINIC ON DIAGNOSIS-TO-ABLATION TIME. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Styczynska-Soczka K, Amin AK, Hall AC. Cell-associated type I collagen in nondegenerate and degenerate human articular cartilage. J Cell Physiol 2021; 236:7672-7681. [PMID: 34037997 DOI: 10.1002/jcp.30418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/12/2021] [Accepted: 05/08/2021] [Indexed: 12/17/2022]
Abstract
Chondrocytes with abnormal morphology are present in nondegenerate human cartilage suggesting dedifferentiation to a fibroblastic phenotype and production of a mechanically-weakened matrix of unknown composition. We determined the relationship between in situ chondrocyte morphology, chondrocyte clusters, and levels of cell-associated collagen type I. Chondrocyte morphology in fresh femoral head cartilage from 19 patients with femoral neck fracture and collagen type I labelling was identified with Cell TrackerTM fluorescence and immunofluorescence, respectively, in axial/coronal orientations using confocal microscopy with images analysed by ImarisTM . In axial images of grade 0 cartilage, 87 ± 8% were normal chondrocytes with a small (10 ± 6%) abnormal population possessing ≥1 cytoplasmic process. More normal chondrocytes (78 ± 11%) were collagen type I negative than those labelling positively (p < 0.001). For abnormal chondrocytes, 81 ± 14% labelled negatively for collagen type I compared to those labelling positively (19 ± 3%; p = 0.007; N(n)=11(3)). Overall, approximately 9% of the cells in normal cartilage labelled for collagen type I. With degeneration, the percentage of normal chondrocytes decreased (p < 0.001) but increased for abnormal cells (p = 0.036) and clusters (p = 0.003). A larger percentage of normal, abnormal and clustered chondrocytes now demonstrated collagen type I labelling (p = 0.004; p = 0.009; p = 0.001 respectively). Coronal images exhibited increased (p = 0.001) collagen type I labelling in the superficial zone of mildly degenerate cartilage with none in the mid or deep zones. These results show that collagen type I was identified around normal and abnormal chondrocytes in nondegenerate cartilage, which increased with degeneration. This suggested the presence of mechanically weak fibro-cartilaginous repair tissue in otherwise macroscopically nondegenerate human cartilage which progressed with degeneration as occurs in osteoarthritis.
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Affiliation(s)
| | - Anish K Amin
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew C Hall
- Biomedical Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
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Chen P, Ng N, Snowden G, Mackenzie SP, Nicholson JA, Amin AK. Percutaneous reduction and fixation of low energy Lisfranc injuries results in better outcome compared to open reduction and internal fixation: Results from a matched case-control study with minimum 12 months follow up. Injury 2021; 52:1042-1047. [PMID: 33268080 DOI: 10.1016/j.injury.2020.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Percutaneous fixation of Lisfranc injuries is potentially less invasive to traditional open techniques but evidence of any clinical benefit is lacking. The aim of this study is to compare the clinical outcomes of percutaneous reduction and internal fixation (PRIF) of low energy Lisfranc injuries with a matched, control group of patients treated with ORIF. METHODS Over a seven-year period (2012-2019), 16 consecutive patients with a low energy Lisfranc injury (Myerson B2-type) were treated with PRIF. Patient demographics, injury mechanism and radiological outcomes were recorded within a prospectively maintained database at the institution. This study sample was matched for age, sex and mechanism of injury to a control group of 16 patients with similar low energy Lisfranc injuries (Myerson B2-type) treated with ORIF. Clinical outcome was compared using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and Manchester Oxford Foot Questionnaire (MOXFQ). RESULTS At a mean follow up of 43 months (95% CI 35.6 - 50.4), both the AOFAS and MOXFQ scores were significantly higher in the PRIF group compared to the control ORIF group (AOFAS 89.1vs 76.4, p=0.03; MOXFQ 10.0 vs 27.6, p=0.03). There were no immediate postoperative complications in either group. There was no radiological evidence of midfoot osteoarthritis in the PRIF group, three patients in the ORIF group developed midfoot osteoarthritis (p=0.2). CONCLUSIONS PRIF of low energy Lisfranc injures is a safe, minimally invasive technique and is associated with better mid-term clinical outcomes compared to ORIF.
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Affiliation(s)
- Pengchi Chen
- Royal Infirmary of Edinburgh, Department of Orthopaedic and Trauma Surgery, 51 Little France Crescent, Edinburgh, United Kingdom, EH16 4SA..
| | - Nathan Ng
- Royal Infirmary of Edinburgh, Department of Orthopaedic and Trauma Surgery, 51 Little France Crescent, Edinburgh, United Kingdom, EH16 4SA..
| | - Gordon Snowden
- Royal Infirmary of Edinburgh, Department of Orthopaedic and Trauma Surgery, 51 Little France Crescent, Edinburgh, United Kingdom, EH16 4SA..
| | - Samuel Peter Mackenzie
- Royal Infirmary of Edinburgh, Department of Orthopaedic and Trauma Surgery, 51 Little France Crescent, Edinburgh, United Kingdom, EH16 4SA..
| | - Jamie A Nicholson
- Royal Infirmary of Edinburgh, Department of Orthopaedic and Trauma Surgery, 51 Little France Crescent, Edinburgh, United Kingdom, EH16 4SA..
| | - Anish K Amin
- Royal Infirmary of Edinburgh, Department of Orthopaedic and Trauma Surgery, 51 Little France Crescent, Edinburgh, United Kingdom, EH16 4SA
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18
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El-Zein RS, Shah A, Luli J, Stelzer M, Fu E, Amin AK. Lead Macrodislodgement of a Subcutaneous Implantable Cardioverter-Defibrillator Results in a Reel Problem. JACC Case Rep 2021; 3:523-527. [PMID: 34317572 PMCID: PMC8311011 DOI: 10.1016/j.jaccas.2021.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 06/13/2023]
Abstract
Lead macrodislodgement is a rare complication of cardiac implantable electronic devices associated with patient-related risk factors. This paper outlines a case of reel syndrome secondary to device manipulation 3 months after subcutaneous implantable cardioverter-defibrillator implantation and describes the challenges with lead macrodislodgement diagnosis, mechanisms, and management. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Rayan S. El-Zein
- Department of Internal Medicine, OhioHealth Doctors Hospital, Columbus, Ohio, USA
| | - Ankur Shah
- Department of Cardiology, OhioHealth Doctors Hospital, Columbus, Ohio, USA
| | - Jordan Luli
- Department of Internal Medicine, OhioHealth Doctors Hospital, Columbus, Ohio, USA
| | - Mitchell Stelzer
- Department of Cardiology, OhioHealth Doctors Hospital, Columbus, Ohio, USA
| | - Eugene Fu
- OhioHealth Heart and Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Anish K. Amin
- OhioHealth Heart and Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
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19
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Boström A, Amin AK, Macpherson GJ, Pankaj P, Scott CEH. Hinge location and apical drill holes in opening wedge high tibial osteotomy: A finite element analysis. J Orthop Res 2021; 39:628-636. [PMID: 32352597 DOI: 10.1002/jor.24704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/13/2020] [Accepted: 04/24/2020] [Indexed: 02/04/2023]
Abstract
At the time of medial opening wedge high tibial osteotomy (HTO) to realign the lower limb and offload medial compartment knee osteoarthritis, unwanted fractures can propagate from the osteotomy apex. The aim of this study was to use finite element (FE) analysis to determine the effect of hinge location and apical drill holes on cortical stresses and strains in HTO. A monoplanar medial opening wedge HTO was created above the tibial tuberosity in a composite tibia. Using the FE method, intact lateral hinges of different widths were considered (5, 7.5, and 10 mm). Additional apical drill holes (2, 4, and 6 mm diameters) were then incorporated into the 10 mm hinge model. The primary outcome measure was the maximum principal strain in the cortical bone surrounding the hinge axis. Secondary outcomes included the force required for osteotomy opening, minimum principal strain, and mean cortical bone stresses (maximum principal/minimum principal/von Mises). Larger intact hinges (10 mm) were associated with higher cortical bone maximum principal strain and stress, lower minimum principal strain/stress, and required greater force to open. Lateral cortex strain concentrations were present in all scenarios, but extended to the joint surface with the 10 mm hinge. Apical drill holes reduced the mean cortical bone maximum principal strain adjacent to the hinge axis: 2 mm hole 6% reduction; 4 mm 35% reduction; and 6 mm 55% reduction. Incorporating a 4-mm apical drill hole centered 10 mm from the intact lateral cortex maintains a cortical bone hinge, minimizes cortical bone strains and reduces the force required to open the HTO; thus improving control.
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Affiliation(s)
- Anna Boström
- Mechanical Engineering, School of Engineering, The University of Edinburgh, UK
| | - Anish K Amin
- Department of Orthopaedics, Royal Infirmary of Edinburgh, UK
| | | | - Pankaj Pankaj
- School of Engineering, Institute for Bioengineering, The University of Edinburgh, UK
| | - Chloe E H Scott
- Department of Orthopaedics, Royal Infirmary of Edinburgh, UK.,School of Engineering, Institute for Bioengineering, The University of Edinburgh, UK
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20
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Mason PK, Desai A, Ajijola OA, Amin AK, Barbhaiya C, Basil A, DeBiasi R, Dukes J, Fradley M, Ismail H, Jackson L, Mendelson T, Montgomery J, Orencole MP, Syed FF, Wan E, Zilinski J, Singh JP. Integrated electrophysiology care for patients with heart failure: An envisioned future. Heart Rhythm 2021; 18:e51-e63. [PMID: 33065255 DOI: 10.1016/j.hrthm.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/15/2022]
Affiliation(s)
| | - Akshay Desai
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Anish K Amin
- Riverside Methodist Hospital, Upper Arlington, Ohio
| | | | - Anuj Basil
- Temple University, Philadelphia, Pennsylvania
| | - Ralph DeBiasi
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | | | - Larry Jackson
- Duke University Medical Center, Durham, North Carolina
| | - Todd Mendelson
- Pennsylvania Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Jay Montgomery
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Faisal F Syed
- University of North Carolina, Chapel Hill, North Carolina
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21
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Amin AK, Hall AC. Editorial Commentary: Raising the Osmolarity of Arthroscopic Irrigating Solutions May Be Chondroprotective: We Must Be Kind to Joints During Arthroscopy! Arthroscopy 2020; 36:3058-3060. [PMID: 33276892 DOI: 10.1016/j.arthro.2020.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 02/02/2023]
Abstract
The irrigation of joints during arthroscopic procedures typically uses a non-physiological solution. This replaces the natural synovial fluid and rapidly subjects the connective tissues to an alien hypo-osmotic environment in which cartilage cells are far more sensitive to iatrogenic injury. Raising the osmolarity of the irrigating solution may be a simple, safe, and effective chondroprotective strategy.
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22
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El-Zein RS, Amin AK, Billakanty SR, Fu EY, Nichols AJ, Nelson SD, Kleman JM, Kidwell GA, Chopra N. Relationship between right ventricular pacing and non-sustained ventricular arrhythmias in patients with dual-chamber pacemaker and normal range left ventricular ejection fraction. Int J Arrhythm 2020. [DOI: 10.1186/s42444-020-00022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Right ventricular pacing (RVP) increases heart failure, AF, and death rates in pacemaker patients and ventricular arrhythmias (VAs) in defibrillator patients. However, the impact of RVP on VAs burden and its clinical significance in pacemaker patients with normal range LVEF of > 50–55% remains unknown. We sought to evaluate the relationship of RVP and VAs and its clinical impact in a pacemaker patient population.
Methods
Records of 105 patients who underwent denovo dual-chamber pacemaker implant or a generator change (Medtronic™ or Boston Scientific™) for AV block and sinus node disease at a tertiary care center between September 1, 2015, and September 1, 2016, were retrospectively reviewed.
Results
Data from 105 patients (51% females, mean age 76 ± 1 years, mean LVEF 61 ± 0.7%) without history of VAs (98.2%) were reviewed over 1044 ± 23 days. Dependent patients (100% RVP) exhibited the lowest VAs burden when compared to < 100% RVP (isolated PVCs, PVC runs of < 4 beats, and NSVT; p ≤ 0.001). Patients with < 1% RVP also exhibited low VA burden with intermediate RVP (1–99.9%) being most arrhythmogenic for PVC runs (p = 0.04) and for isolated PVCs (p = 0.006). Antiarrhythmics/beta and calcium channel blockers use and stress tests performed to evaluate VAs which were positive requiring intervention did not differ significantly. Burden of > 1/h of PVC runs and increasing PVC runs/h were significantly associated with hospitalization (p = 0.04) and all-cause mortality (p = 0.03), respectively.
Conclusions
In pacemaker patients with normal range LVEF (> 50–55%), 100% RVP is associated with the lowest burden of NSVT. Furthermore, patients with < 1% RVP also exhibit low VA burden; however, intermittent RVP seems to significantly correlate with non-sustained VAs.
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23
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Abstract
Patient: Male, 72-year-old Final Diagnosis: Infective endocarditis Symptoms: Falls • weakness Medication: — Clinical Procedure: Removal of pacemaker Specialty: Cardiology
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Affiliation(s)
- Rayan S El-Zein
- Department of Internal Medicine, Doctors Hospital, Columbus, OH, USA
| | - Mitchell Stelzer
- Division of Cardiology, Department of Internal Medicine, Doctors Hospital, Columbus, OH, USA
| | - John Hatanelas
- Division of Cardiology, Department of Internal Medicine, Doctors Hospital, Columbus, OH, USA
| | - Thomas W Goodlive
- Section of Non-Invasive Cardiology Imaging, Department of Cardiology, Ohio Health Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Anish K Amin
- Section of Cardiac Electrophysiology, Department of Cardiology, Ohio Health Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
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24
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Scott CEH, Holland G, Powell-Bowns MFR, Brennan CM, Gillespie M, Mackenzie SP, Clement ND, Amin AK, White TO, Duckworth AD. Population mobility and adult orthopaedic trauma services during the COVID-19 pandemic: fragility fracture provision remains a priority. Bone Jt Open 2020; 1:182-189. [PMID: 33225287 PMCID: PMC7677724 DOI: 10.1302/2633-1462.16.bjo-2020-0043.r1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims This study aims to define the epidemiology of trauma presenting to a single centre providing all orthopaedic trauma care for a population of ∼ 900,000 over the first 40 days of the COVID-19 pandemic compared to that presenting over the same period one year earlier. The secondary aim was to compare this with population mobility data obtained from Google. Methods A cross-sectional study of consecutive adult (> 13 years) patients with musculoskeletal trauma referred as either in-patients or out-patients over a 40-day period beginning on 5 March 2020, the date of the first reported UK COVID-19 death, was performed. This time period encompassed social distancing measures. This group was compared to a group of patients referred over the same calendar period in 2019 and to publicly available mobility data from Google. Results Orthopaedic trauma referrals reduced by 42% (1,056 compared to 1,820) during the study period, and by 58% (405 compared to 967) following national lockdown. Outpatient referrals reduced by 44%, and inpatient referrals by 36%, and the number of surgeries performed by 36%. The regional incidence of traumatic injury fell from 5.07 (95% confidence interval (CI) 4.79 to 5.35) to 2.94 (95% CI 2.52 to 3.32) per 100,000 population per day. Significant reductions were seen in injuries related to sports and alcohol consumption. No admissions occurred relating to major trauma (Injury Severity Score > 16) or violence against the person. Changes in population mobility and trauma volume from baseline correlated significantly (Pearson's correlation 0.749, 95% CI 0.58 to 0.85, p < 0.001). However, admissions related to fragility fractures remained unchanged compared to the 2019 baseline. Conclusion The profound changes in social behaviour and mobility during the early stages of the COVID-19 pandemic have directly correlated with a significant decrease in orthopaedic trauma referrals, but fragility fractures remained unaffected and provision for these patients should be maintained.Cite this article: Bone Joint Open 2020;1-6:182-189.
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Affiliation(s)
- Chloe E H Scott
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - George Holland
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Caitlin M Brennan
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matthew Gillespie
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Nick D Clement
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Anish K Amin
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - Tim O White
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - Andrew D Duckworth
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
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25
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Howard TA, Murray IR, Amin AK, Simpson AH, Hall AC. Damage control articular surgery: Maintaining chondrocyte health and minimising iatrogenic injury. Injury 2020; 51 Suppl 2:S83-S89. [PMID: 31685207 DOI: 10.1016/j.injury.2019.10.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
Articular cartilage has limited intrinsic regenerative potential. The maintenance of healthy articular cartilage is essential to prevent joint degeneration and the morbidity associated with arthritis. In this review, we outline the structure and function of healthy articular cartilage. We summarise some of the recent literature outlining the influence of surgical factors on chondrocyte health. These factors include mechanical injury from instrumentation and drilling, drying, and the influence of irrigation fluids, antimicrobial solutions and local anaesthetics. We demonstrate that there is scope for improving cartilage viability at the time of surgery if simple chondroprotective measures are routinely adopted.
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Affiliation(s)
- Thomas A Howard
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 49 Little France Crescent, EH16 4SA, UK
| | - Iain R Murray
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 49 Little France Crescent, EH16 4SA, UK; The University of Edinburgh, UK
| | - Anish K Amin
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 49 Little France Crescent, EH16 4SA, UK; The University of Edinburgh, UK
| | - A Hamish Simpson
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 49 Little France Crescent, EH16 4SA, UK; The University of Edinburgh, UK.
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26
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Chen P, Ng N, Snowden G, Mackenzie SP, Nicholson JA, Amin AK. Rates of Displacement and Patient-Reported Outcomes Following Conservative Treatment of Minimally Displaced Lisfranc Injury. Foot Ankle Int 2020; 41:387-391. [PMID: 31847592 DOI: 10.1177/1071100719895482] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND While surgery is indicated in Lisfranc fracture-dislocations, the natural history and optimal management of minimally displaced injures are unclear. The aim of this study was to define the rate of subsequent displacement and to determine the clinical outcome after conservative treatment of minimally displaced Lisfranc injuries. METHODS Over a 5-year period (2011-2016), 26 consecutive patients with minimally displaced Lisfranc injuries presenting to a single university teaching hospital were identified retrospectively using hospital electronic records. Patient demographics, injury mechanism, and radiological outcomes were recorded. Patient-reported outcome scores (PROMS) were collated at least 1 year postinjury and included the American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score and Manchester Oxford Foot Questionnaire (MOXFQ). RESULTS The rate of displacement was 54% (14/26). The median time to displacement was 18 days (range, 2-141 days). Forty-six percent (12/26) of the Lisfranc injuries remained minimally displaced after 12 weeks of conservative treatment. Initial weightbearing status was not associated with the risk of subsequent displacement (P = .9). At a mean follow-up of 54 months, PROMS were comparable between patients whose injury remained minimally displaced and those that required surgery for further displacement, despite the delay to surgery (AOFAS 78.0 vs 75.9, MOXFQ 24.8 vs 26.3, P > .1). CONCLUSION There was a high rate of displacement after initial conservative management of the minimally displaced Lisfranc injuries. Subsequent surgical management of displaced injuries resulted in outcomes comparable to those that remained minimally displaced. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Pengchi Chen
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Nathan Ng
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Gordon Snowden
- Department of Orthopaedic and Trauma Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Samuel P Mackenzie
- Department of Orthopaedic and Trauma Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jamie A Nicholson
- Department of Orthopaedic and Trauma Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Anish K Amin
- Department of Orthopaedic and Trauma Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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27
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Carter TH, Duckworth AD, Oliver WM, Molyneux SG, Amin AK, White TO. Open Reduction and Internal Fixation of Distal Tibial Pilon Fractures. JBJS Essent Surg Tech 2019; 9:e29. [PMID: 32021729 DOI: 10.2106/jbjs.st.18.00093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Intra-articular fractures of the distal end of the tibia, more commonly referred to as pilon fractures, account for approximately 5% to 7% of all tibial fractures1,2. Type-C fractures present a unique surgical challenge: a total articular fracture contained within a vulnerable soft-tissue envelope. Treatment options include internal fixation3, external fixation with or without limited internal fixation4, and primary ankle arthrodesis2. The management, and particularly the timing, of surgery is often dictated by the patient's general state of health, soft-tissue condition, and fracture comminution as well as the experience of the surgeon. The surgical goals are to reconstruct the articular surface of the plafond, restore limb alignment, and protect the soft-tissue envelope. Since the publication of the seminal paper by Sirkin et al.5 in 1999, it has become orthopaedic orthodoxy to stage the surgery of pilon fractures, adopting a so-called span, scan, and plan approach. We more commonly operate early, and in a recently published retrospective review of 102 type-C pilon fractures in 99 patients, 73 patients (73 fractures; 71.6%) underwent primary internal fixation6. Outcomes were equivalent to the results of a staged protocol: 36 complications in 28 patients (28 fractures; 27.5%), with superficial (n = 9) and deep (n = 9) infection being the most common. Forty-one fractures (40.2%) required at least 1 additional operation, with removal of symptomatic metalwork being the primary indication (n = 30). No patient required an amputation. At a mean follow-up of 6 years, both the mean Foot and Ankle Disability Index (FADI) and mean Foot and Ankle Outcome Score (FAOS) were 76 (range, 0 to 100). Median patient satisfaction was 7 of 10. The results demonstrated a satisfactory outcome following primary internal fixation in appropriately selected patients. This instructional video outlines the surgical technique used. The key steps of the procedure are (1) preoperative planning with assessment of imaging and soft tissues; (2) application of a thigh tourniquet and placement of the patient predominantly in the supine position, unless the fracture configuration requires a prone position; (3) intraoperative use of a spanning external fixator; (4) careful exposure of the distal end of the tibia, dictated by the fracture configuration, with the anterolateral, anteromedial, and direct medial approaches most commonly used, elevating full-thickness tissue flaps wherever possible; (5) fracture reduction and fixation through a joint arthrotomy and fracture windows, allowing visualization of the articular margins, followed by initial Kirschner wire stabilization and definitive lag screw fixation; (6) application of a low-profile, locking or nonlocking plate in either buttress or bridging mode, joining the articular-metaphyseal block to the distal tibial diaphysis; (7) fixation of an associated fibular fracture, typically with intramedullary nailing and removal of the external fixator; (8) layered closure according to surgeon preference; and (9) postoperative protocol, consisting of a removable orthosis with a strict non-weight-bearing restriction for up to 3 months.
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Affiliation(s)
- Thomas H Carter
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew D Duckworth
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - William M Oliver
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Samuel G Molyneux
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Anish K Amin
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Timothy O White
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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28
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Chopra N, Amin AK, Gupta A, Fu EY, Nichols AJ, Nelson SD, Kleman JM, Kleman JM, Kidwell GA, Billakanty SR. Clinical Impact of Saline Volume Infused Through Irrigated-Tip Ablation Catheter in Low Acuity Paroxysmal Atrial Fibrillation Ablation Patients. J Atr Fibrillation 2019; 11:2093. [PMID: 31139287 DOI: 10.4022/jafib.2093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/19/2017] [Accepted: 09/14/2018] [Indexed: 11/10/2022]
Abstract
Background Radio-Frequency ablation (RFA) to achieve pulmonary vein isolation (PVI) remains mainstay therapy for symptomatic paroxysmal atrial fibrillation (PAF). The clinical consequences of large saline infusions during AF ablation have not been systematically studied. We utilized the differential flow-rates of the two commercially available ablation catheters (AC): 'ThermoCool' (TCAC) and 'Surround Flow' (SFAC) from Biosense-Webster to evaluate the clinical impact of the saline infused in the immediate post-ablation period. Methods Consecutive charts of PAF patients between 18 and 81 years who underwent RFA procedure at a tertiary care hospital were reviewed. Results Forty-seven patients were included in the study (33Males, 65±11years, LVEF 58±7% and left atrial diameter 44±7.5mm, 23TCAC-use). The saline volume infused through the AC was significantly higher with TCAC vs SFAC use (1277±316vs697±299 ml; p<0.001), with no difference in volume infused from other sources, total procedure or RFA times (p>0.05). This led to significant increase in post-ablation weight gain (96±23 vs 97.5±24kg; p=0.002), furosemide usage (39% vs 0%; p=0.0006), urine production (120±79 vs 63±31ml/hr; p=0.003) and post-RFA potassium reduction (4.4±0.42 vs 4±0.32mmol/l; p<0.001) with TCAC use. Significant post-RFA reduction in magnesium, calcium and creatinine, associated hyperchloremic metabolic acidosis and a modest QTc prolongation were also observed with use of both ACs albeit only moderate to weakly correlated with saline volume infused through the AC. No clinical adverse outcomes were encountered. Conclusions Higher saline-volume infusing AC use in PAF ablation causes significant post-ablation weight gain despite higher furosemide use, larger urine production and associated post-RFA potassium reduction without increasing morbidity in lower acuity patients. Furthermore, an array of post-ablation electrolyte disturbances causes a modest and clinically insignificant QTc prolongation.
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Affiliation(s)
- Nagesh Chopra
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Anish K Amin
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Anand Gupta
- OhioHealth Research and Innovation Institute (OHRI), 3545 Olentangy River Road, Suite 310, Columbus, OH 43214, USA
| | - Eugene Y Fu
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Allan J Nichols
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Steven D Nelson
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - James M Kleman
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - James M Kleman
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Gregory A Kidwell
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Sreedhar R Billakanty
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
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Amin AK, Gold MR, Burke MC, Knight BP, Rajjoub MR, Duffy E, Husby M, Stahl WK, Weiss R. Factors Associated With High-Voltage Impedance and Subcutaneous Implantable Defibrillator Ventricular Fibrillation Conversion Success. Circ Arrhythm Electrophysiol 2019; 12:e006665. [DOI: 10.1161/circep.118.006665] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anish K. Amin
- Riverside Methodist Hospital, Upper Arlington, OH (A.K.A.)
| | | | | | - Bradley P. Knight
- Northwestern University Feinberg School of Medicine, Chicago, IL (B.P.K.)
| | - Moutie R. Rajjoub
- Division of Cardiovascular Medicine, Ohio State University Medical Center, Columbus (M.R.R., R.W.)
| | | | | | | | - Raul Weiss
- Division of Cardiovascular Medicine, Ohio State University Medical Center, Columbus (M.R.R., R.W.)
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Mcqueen M, Woodford LA, Holick E, Wolfer K, Amin AK. Streamlined Surgical Draping Reduces Subcutaneous Implantable Cardioverter-defibrillator Implant Procedure Preparation Time. J Innov Card Rhythm Manag 2018; 9:3244-3246. [PMID: 32477816 PMCID: PMC7252676 DOI: 10.19102/icrm.2018.090705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/06/2018] [Indexed: 11/20/2022] Open
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a proven alternative to transvenous implantable cardioverter-defibrillator systems. One critique of S-ICD use, however, has been the time required for implantation. Here, we discuss the use of an alternative surgical draping technique to reduce preparation time for device implantation.
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Affiliation(s)
- Marcy Mcqueen
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart & Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Lori A Woodford
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart & Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Eric Holick
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart & Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Kevin Wolfer
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart & Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Anish K Amin
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart & Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
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Amin AK, Billakanty SR, Chopra N, Fu EY, Nichols AJ, Kleman JM, Kidwell GA. Premature ventricular contraction-induced polymorphic ventricular tachycardia after leadless pacemaker implantation: A unique adverse effect of leadless pacing. HeartRhythm Case Rep 2018; 4:180-183. [PMID: 29915713 PMCID: PMC6003784 DOI: 10.1016/j.hrcr.2018.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Anish K Amin
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Sreedhar R Billakanty
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Nagesh Chopra
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Eugene Y Fu
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Allan J Nichols
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - James M Kleman
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Gregory A Kidwell
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
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Karim A, Amin AK, Hall AC. The clustering and morphology of chondrocytes in normal and mildly degenerate human femoral head cartilage studied by confocal laser scanning microscopy. J Anat 2017; 232:686-698. [PMID: 29283191 DOI: 10.1111/joa.12768] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 01/22/2023] Open
Abstract
Chondrocytes are the major cell type present in hyaline cartilage and they play a crucial role in maintaining the mechanical resilience of the tissue through a balance of the synthesis and breakdown of extracellular matrix macromolecules. Histological assessment of cartilage suggests that articular chondrocytes in situ typically occur singly and demonstrate a rounded/elliptical morphology. However, there are suggestions that their grouping and fine shape is more complex and that these change with cartilage degeneration as occurs in osteoarthritis. In the present study we have used confocal laser scanning microscopy and fluorescently labelled in situ human chondrocytes and advanced imaging software to visualise chondrocyte clustering and detailed morphology within grade-0 (non-degenerate) and grade-1 (mildly degenerate) cartilage from human femoral heads. Graded human cartilage explants were incubated with 5-chloromethylfluorescein diacetate and propidium iodide to identify the morphology and viability, respectively, of in situ chondrocytes within superficial, mid- and deep zones. In grade-0 cartilage, the analysis of confocal microscope images showed that although the majority of chondrocytes were single and morphologically normal, clusters (i.e. three or more chondrocytes within the enclosed lacunar space) were occasionally observed in the superficial zone, and 15-25% of the cell population exhibited at least one cytoplasmic process of ~ 5 μm in length. With degeneration, cluster number increased (~ 50%) but not significantly; however, the number of cells/cluster (P < 0.001) and the percentage of cells forming clusters increased (P = 0.0013). In the superficial zone but not the mid- or deep zones, the volume of clusters and average volume of chondrocytes in clusters increased (P < 0.001 and P < 0.05, respectively). The percentage of chondrocytes with processes, the number of processes/cell and the length of processes/cell increased in the superficial zone of grade-1 cartilage (P = 0.0098, P = 0.02 and P < 0.001, respectively). Processes were categorised based on length (L0 - no cytoplasmic processes; L1 < 5 μm; 5 < L2 ≤ 10 μm; 10 < L3 ≤ 15 μm; L4 > 15 μm). With cartilage degeneration, for chondrocytes in all zones, there was a significant decrease (P = 0.015) in the percentage of chondrocytes with 'normal' morphology (i.e. L0), with no change in the percentage of cells with L1 processes; however, there were significant increases in the other categories. In grade-0 cartilage, chondrocyte clustering and morphological abnormalities occurred and with degeneration these were exacerbated, particularly in the superficial zone. Chondrocyte clustering and abnormal morphology are associated with aberrant matrix metabolism, suggesting that these early changes to chondrocyte properties may be associated with cartilage degeneration.
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Affiliation(s)
- Asima Karim
- Centre for Integrative Physiology, Deanery of Biomedical Sciences, University of Edinburgh, Edinburgh, UK
| | - Anish K Amin
- Department of Orthopaedic and Trauma Surgery, University of Edinburgh, Edinburgh, UK
| | - Andrew C Hall
- Centre for Integrative Physiology, Deanery of Biomedical Sciences, University of Edinburgh, Edinburgh, UK
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Paterson SI, Eltawil NM, Simpson AHRW, Amin AK, Hall AC. Drying of open animal joints in vivo subsequently causes cartilage degeneration. Bone Joint Res 2016; 5:137-44. [PMID: 27114348 PMCID: PMC4921049 DOI: 10.1302/2046-3758.54.2000594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/26/2016] [Indexed: 02/03/2023] Open
Abstract
Objectives During open orthopaedic surgery, joints may be exposed to air, potentially leading to cartilage drying and chondrocyte death, however, the long-term effects of joint drying in vivo are poorly understood. We used an animal model to investigate the subsequent effects of joint drying on cartilage and chondrocytes. Methods The patellar groove of anaesthetised rats was exposed (sham-operated), or exposed and then subjected to laminar airflow (0.25m/s; 60 minutes) before wounds were sutured and animals recovered. Animals were monitored for up to eight weeks and then sacrificed. Cartilage and chondrocyte properties were studied by histology and confocal microscopy, respectively. Results Joint drying caused extensive chondrocyte death within the superficial regions of cartilage. Histology of dried cartilage demonstrated a loss of surface integrity at four weeks, fibrillations at eight weeks, and an increased modified Mankin score (p < 0.001). Cartilage thickness increased (p < 0.001), whereas chondrocyte density decreased at four weeks (p < 0.001), but then increased towards sham-operated levels (p < 0.01) at eight weeks. By week eight, chondrocyte pairing/clustering and cell volume increased (p < 0.05; p < 0.001, respectively). Conclusions These in vivo results demonstrated for the first time that as a result of laminar airflow, cartilage degeneration occurred which has characteristics similar to those seen in early osteoarthritis. Maintenance of adequate cartilage hydration during open orthopaedic surgery is therefore of paramount importance. Cite this article: Dr A. Hall. Drying of open animal joints in vivo subsequently causes cartilage degeneration. Bone Joint Res 2016;5:137–144. DOI: 10.1302/2046-3758.54.2000594.
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Affiliation(s)
- S I Paterson
- Centre for Integrative Physiology, University of Edinburgh, Deanery of Biomedical Sciences, Hugh Robson Building, George Square, Edinburgh EH8 9XD, UK
| | - N M Eltawil
- Centre for Integrative Physiology, University of Edinburgh, Deanery of Biomedical Sciences, Hugh Robson Building, George Square, Edinburgh EH8 9XD, UK
| | - A H R W Simpson
- Department of Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK
| | - A K Amin
- Department of Orthopaedic and Trauma Surgery, University of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - A C Hall
- Centre for Integrative Physiology, University of Edinburgh, Deanery of Biomedical Sciences, Hugh Robson Building, George Square, Edinburgh EH8 9XD, UK
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Paterson SI, Amin AK, Hall AC. Airflow accelerates bovine and human articular cartilage drying and chondrocyte death. Osteoarthritis Cartilage 2015; 23:257-65. [PMID: 25463263 DOI: 10.1016/j.joca.2014.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 10/08/2014] [Accepted: 10/13/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Exposure of articular cartilage to static air results in changes to the extracellular matrix (ECM) and stimulates chondrocyte death, which may cause joint degeneration. However during open orthopaedic surgery, cartilage is often exposed to laminar airflow, which may exacerbate these damaging effects. We compared drying in static and moving air in terms of cartilage appearance, hydration and chondrocyte viability, and tested the ability of saline-saturated gauze to limit the detrimental effects of air exposure. DESIGN Articular cartilage from bovine metatarsophalangeal joints (N = 50) and human femoral heads (N = 6) was exposed for 90 min to (1) static air (2) airflow (up to 0.34 m/s), or (3) airflow (0.18 m/s), covered with gauze. Following air exposure, cartilage was also rehydrated (0.9% saline; 120 min) to determine the reversibility of drying effects. The influence of airflow was assessed by studying macroscopic appearance, and quantifying superficial zone (SZ) chondrocyte viability and cartilage hydration. RESULTS Airflow caused advanced changes to cartilage appearance, accelerated chondrocyte death, and increased dehydration compared to static air. These effects were prevented if cartilage was covered by saline-saturated gauze. Cartilage rehydration reversed macroscopic changes associated with drying but the chondrocyte death was not altered. Chondrocytes at the cut edge of cartilage were more sensitive to drying compared to cells distant from the edge. CONCLUSIONS Airflow significantly increased articular cartilage dehydration and chondrocyte death compared to static air. As laminar airflow is routinely utilised in operating theatres, it is essential that articular cartilage is kept wet via irrigation or by covering with saline-saturated gauze to prevent chondrocyte death.
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Affiliation(s)
- S I Paterson
- Centre for Integrative Physiology, School of Biomedical Sciences, University of Edinburgh, Edinburgh, UK
| | - A K Amin
- Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A C Hall
- Centre for Integrative Physiology, School of Biomedical Sciences, University of Edinburgh, Edinburgh, UK.
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Houston DA, Amin AK, White TO, Smith IDM, Hall AC. Chondrocyte death after drilling and articular screw insertion in a bovine model. Osteoarthritis Cartilage 2013; 21:721-9. [PMID: 23428599 DOI: 10.1016/j.joca.2013.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 01/30/2013] [Accepted: 02/07/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Intra-articular screws are used for internal fixation of osteochondral fragments after fracture or osteochondritis dissecans. This causes cartilage injury potentially leading to chondrocyte death. We have visualised/quantified the hole and zone of cell death (ZCD) in cartilage after drilling/insertion of various articular screws. METHOD Using an ex vivo bovine model with transmitted light and confocal laser scanning microscopy (CLSM), the holes and ZCD following drilling/insertion of articular screws (cortical screw, headless variable pitch metallic screw, headless variable pitch bioabsorbable screw) were evaluated. In situ chondrocyte death was determined by live/dead cell viability assay. An imaging/quantification protocol was developed to compare hole diameter and ZCD from drilling/insertion of screws into cartilage. The effect of saline irrigation during drilling on the ZCD was also quantified. RESULTS Screw insertion created holes in cartilage that were significantly (P ≤ 0.001) less than the diameters of the equipment used. With a 1.5 mm drill, a ZCD of 580.2 ± 124 μm was produced which increased to 637.0 ± 44 μm following insertion of a 2 mm cortical screw although this was not significant (P > 0.05). The ZCD from insertion of the variable pitch headless screws (diam. 3.5 mm) was lower for the metallic compared to the bioabsorbable design (800.9 ± 159 vs 1,236.4 ± 212 μm, respectively; P < 0.01). The ZCD from drilling was reduced ∼50% (P < 0.001) by saline irrigation. CONCLUSIONS Cartilage injury during intra-articular screw fixation caused a ZCD around the hole irrespective of screw design. Saline irrigation significantly reduced the ZCD from drilling into cartilage.
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Affiliation(s)
- D A Houston
- Centre for Integrative Physiology, School of Biomedical Sciences, Hugh Robson Building, George Square, Edinburgh EH8 9XD, Scotland, UK
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Collins RA, Walmsley PJ, Amin AK, Brenkel IJ, Clayton RAE. Does obesity influence clinical outcome at nine years following total knee replacement? ACTA ACUST UNITED AC 2012; 94:1351-5. [PMID: 23015559 DOI: 10.1302/0301-620x.94b10.28894] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A total of 445 consecutive primary total knee replacements (TKRs) were followed up prospectively at six and 18 months and three, six and nine years. Patients were divided into two groups: non-obese (body mass index (BMI) < 30 kg/m(2)) and obese (BMI ≥ 30 kg/m(2)). The obese group was subdivided into mildly obese (BMI 30 to 35 kg/m(2)) and highly obese (BMI ≥ 35 kg/m(2)) in order to determine the effects of increasing obesity on outcome. The clinical data analysed included the Knee Society score, peri-operative complications and implant survival. There was no difference in the overall complication rates or implant survival between the two groups. Obesity appears to have a small but significant adverse effect on clinical outcome, with highly obese patients showing lower function scores than non-obese patients. However, significant improvements in outcome are sustained in all groups nine years after TKR. Given the substantial, sustainable relief of symptoms after TKR and the low peri-operative complication and revision rates in these two groups, we have found no reason to limit access to TKR in obese patients.
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Affiliation(s)
- R A Collins
- University of Edinburgh College of Medicine & Veterinary Medicine, Chancellor's Building, Little France, Edinburgh, EH14 6SA, UK.
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Seoudi N, Mitchell SL, Brown TJ, Dashti F, Amin AK, Drobniewski FA. Rapid molecular detection of tuberculosis and rifampicin drug resistance: retrospective analysis of a national UK molecular service over the last decade. Thorax 2012; 67:361-7. [DOI: 10.1136/thoraxjnl-2011-200610] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Most proximal humeral fractures are stable injuries of the ageing population, and can be successfully treated non-operatively. The management of the smaller number of more complex displaced fractures is more controversial and new fixation techniques have greatly increased the range of fractures that may benefit from surgery. This article explores current concepts in the classification and clinical aspects of these injuries, reviewing the indications, innovations and outcomes for the most common methods of treatment.
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Affiliation(s)
- I R Murray
- Edinburgh Shoulder Clinic, New Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Amin AK, Huntley JS, Bush PG, Simpson AHRW, Hall AC. Chondrocyte death in mechanically injured articular cartilage--the influence of extracellular calcium. J Orthop Res 2009; 27:778-84. [PMID: 19030171 DOI: 10.1002/jor.20809] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Calcium is thought to be an important regulator of chondrocyte death associated with articular cartilage injury. Our objective was to determine the influence of extracellular calcium on chondrocyte death following mechanical injury. Using a surgically relevant model of sharp mechanical injury (with a scalpel) and confocal laser scanning microscopy (CLSM), in situ chondrocyte death was quantified within the full thickness of articular cartilage as a function of medium calcium concentration and time (2.5 h and 7 days). Exposure of articular cartilage to calcium-free media (approximately 0 mM) significantly reduced superficial zone chondrocyte death after mechanical injury compared with exposure to calcium-rich media (2-20 mM, ANOVA at 2.5 h, p = 0.002). In calcium-rich media, although the extent of chondrocyte death increased with increasing medium calcium concentration, cell death remained localized to the superficial zone of articular cartilage over 7 days (ANOVA, p < 0.05). However, in calcium-free media, there was an increase in chondrocyte death within deeper zones of articular cartilage over 7 days. The early (within hours) chondroprotective effect in calcium-free media suggests that the use of joint irrigation solutions without added calcium may decrease chondrocyte death from mechanical injury during articular surgery. The delayed (within days) increase in chondrocyte death in calcium-free media supports the use of calcium supplementation in media used during cartilage culture for tissue engineering or transplantation.
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Affiliation(s)
- Anish K Amin
- Department of Orthopaedic and Trauma Surgery, University of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, Scotland, United Kingdom.
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Ng CY, Amin AK, Narborough S, McMullan L, Cook R, Brenkel IJ. Manipulation Under Anaesthesia and Early Physiotherapy Facilitate Recovery of Patients with Frozen Shoulder Syndrome. Scott Med J 2009; 54:29-31. [DOI: 10.1258/rsmsmj.54.1.29] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aim The aim of this study was to examine the efficacy of manipulation under anaesthesia (MUA) followed by early physiotherapy in treating frozen shoulder syndrome. Methods In a prospective trial conducted between 26th August 2002 and 25th June 2004 in 86 patients with frozen shoulder syndrome, MUA was performed as a day procedure. Main outcomes were Disabilities of the Arm, Shoulder and Hand (DASH) score, a visual analogue score (VAS) for pain and range of movement, which were measured preoperatively and at six weeks postprocedure. Results Fifty (58.1%) patients had complete data. The average age was 54.5 years. The mean duration of symptoms until MUA was 13 months. The mean DASH score decreased from 48.07 to 15.84 (p<0.0005). The mean VAS reduced from 6.07 to 1.88 (p<0.0005). Flexion improved from 104.18 to 157.56 (p<0.0005); abduction from 70.48 to 150.00 (p<0.0005); and external rotation from 13.88 to 45.62 (p<0.0005). Conclusion MUA combined with early physiotherapy alleviates pain and facilitates recovery of function in patients with frozen shoulder syndrome.
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Affiliation(s)
- CY Ng
- Specialist Registrar in Orthopaedics, Department of Orthopaedics, Queen Margaret Hospital, Dunfermline KY12 0SU
| | - AK Amin
- Specialist Registrar in Orthopaedics, Department of Orthopaedics, Queen Margaret Hospital, Dunfermline KY12 0SU
| | - S Narborough
- Senior Physiotherapist, Department of Orthopaedics, Queen Margaret Hospital, Dunfermline KY12 0SU
| | - L McMullan
- Senior Physiotherapist, Department of Orthopaedics, Queen Margaret Hospital, Dunfermline KY12 0SU
| | - R Cook
- Consultant Orthopaedic Surgeon, Department of Orthopaedics, Queen Margaret Hospital, Dunfermline KY12 0SU
| | - IJ Brenkel
- Consultant Orthopaedic Surgeon, Department of Orthopaedics, Queen Margaret Hospital, Dunfermline KY12 0SU
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Amin AK, Manuel RJ, Ison CA, Woodham R, Shemko M, Maguire H, Giraudon I, Forde J, Gillespie SH. Audit of laboratory diagnostic methods for syphilis in England and Wales. Sex Transm Infect 2008; 85:88-91. [DOI: 10.1136/sti.2008.033159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abstract
BACKGROUND Mechanical injury results in chondrocyte death in articular cartilage. The purpose of the present study was to determine whether medium osmolarity affects chondrocyte death in injured articular cartilage. METHODS Osteochondral explants (n = 48) that had been harvested from the metacarpophalangeal joints of three-year-old cows were exposed to media with varying osmolarity (0 to 480 mOsm) for ninety seconds to allow in situ chondrocytes to respond to the altered osmotic environment. Explants were then wounded with a scalpel through the full thickness of articular cartilage, incubated in the same media for 2.5 hours, and transferred to 340-mOsm Dulbecco's Modified Eagle Medium (control medium) with further incubation for seven days. The spatial distribution of in situ chondrocyte death, percentage cell death, and marginal cell death at the wounded cartilage edge were compared as a function of osmolarity and time (2.5 hours compared with seven days) with use of confocal laser scanning microscopy. RESULTS In situ chondrocyte death was mainly localized to the superficial tangential zone of injured articular cartilage for the range of medium osmolarities (0 to 480 mOsm) at 2.5 hours and seven days. Therefore, a sample of articular cartilage from the superficial region (which included the scalpel-wounded cartilage edge) was studied with use of confocal laser scanning microscopy to compare the effects of osmolarity on percentage and marginal cell death in the superficial tangential zone. Compared with the control explants exposed to 340-mOsm Dulbecco's Modified Eagle Medium, percentage cell death in the superficial tangential zone was greatest for explants exposed to 0-mOsm (distilled water) and least for explants exposed to 480-mOsm Dulbecco's Modified Eagle Medium at 2.5 hours (13.0% at 340 mOsm [control], 35.5% at 0 mOsm, and 4.3% at 480 mOsm; p <or= 0.02 for paired comparisons) and seven days (9.9% at 340 mOsm [control], 37.7% at 0 mOsm, and 3.5% at 480 mOsm; p <or= 0.01 for paired comparisons). Marginal cell death in the superficial tangential zone decreased with increasing medium osmolarity at 2.5 hours (p = 0.001) and seven days (p = 0.002). There was no significant change in percentage cell death from 2.5 hours to seven days for explants initially exposed to any of the medium osmolarities. CONCLUSIONS Medium osmolarity significantly affects chondrocyte death in wounded articular cartilage. The greatest chondrocyte death occurs at 0 mOsm. Conversely, increased medium osmolarity (480 mOsm) is chondroprotective. The majority of cell death occurs within 2.5 hours, with no significant increase over seven days.
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Affiliation(s)
- Anish K Amin
- Department of Orthopaedic and Trauma Surgery, University of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, Scotland, UK.
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Abstract
The DePuy Sigma total knee arthroplasty (TKA) was introduced in 1997 as a modification of the Press Fit Condylar Knee (PFC) TKA and has been used extensively in the United Kingdom and worldwide. It is the most commonly used TKA in England and Wales, where it accounts for 36% of all primary TKA. The PFC was well established, with reported 10-year survival rates of 93-97%, but this study reports the first 5-year clinical and radiographic follow-up data for the Sigma TKA. Over a 10-month period, 212 Sigma TKAs were performed in 180 patients. Patients were seen at a specialist nurse-led clinic 7 to 10 days before admission and at 6 months, 18 months, 3 years and 5 years after surgery. Data were recorded prospectively at each visit. Radiographs were obtained at the 5-year follow-up appointment. Of 212 knees, 178 (151 patients) were alive at 5 years. Three were lost to follow up. Six knees (3.0%) were revised, five for infection and one underwent change of polyethylene insert at 4.9 years. Five-year survival with an endpoint of revision for any reason was 97.0%; with an endpoint of revision for aseptic failure it was 99.5%. The median American Knee Society knee rating score was 93 out of 100 at 5 years compared with 25 out of 100 at admission. Of 147 radiographs, none showed radiographic loosening of either component. Seventeen (11.6%) showed radiolucent lines. Twenty-eight (19.0%) had alignment outside the range of 7+/-3 degrees valgus. These results suggest that the Sigma TKA gives acceptable clinical results after 5 years. Further follow-up studies are required to see if this performance is maintained in the long term.
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Affiliation(s)
- Robert A E Clayton
- Department of Orthopaedic Surgery, Queen Margaret's Hospital, Whitefield Road, Dunfermline KY12 0SU, UK.
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Abstract
The results of 41 consecutive total knee replacements performed on morbidly obese patients with a body mass index > 40 kg/m2, were compared with a matched group of 41 similar procedures carried out in non-obese patients (body mass index < 30 kg/m2). The groups were matched for age, gender, diagnosis, type of prosthesis, laterality and pre-operative Knee Society Score. We prospectively followed up the patients for a mean of 38.5 months (6 to 66). No patients were lost to follow-up. At less than four years after operation, the results were worse in the morbidly obese group compared with the non-obese, as demonstrated by inferior Knee Society Scores (mean knee score 85.7 and 90.5 respectively, p = 0.08; mean function score 75.6 and 83.4, p = 0.01), a higher incidence of radiolucent lines on post-operative radiographs (29% and 7%, respectively, p = 0.02), a higher rate of complications (32% and 0%, respectively, p = 0.001) and inferior survivorship using revision and pain as end-points (72.3% and 97.6%, respectively, p = 0.02). Patients with a body mass index > 40 kg/m2 should be advised to lose weight prior to total knee replacement and to maintain weight reduction. They should also be counselled regarding the inferior results which may occur if they do not lose weight before surgery.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/physiopathology
- Arthritis, Rheumatoid/surgery
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Body Mass Index
- Case-Control Studies
- Female
- Follow-Up Studies
- Humans
- Knee Joint/physiopathology
- Knee Joint/surgery
- Male
- Middle Aged
- Obesity, Morbid/complications
- Osteoarthritis, Hip/complications
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/surgery
- Pain Measurement/methods
- Prospective Studies
- Reoperation
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- A K Amin
- Department of Orthopaedics, Queen Margaret Hospital, Whitefield Road, Dunfermline KY12 0SU, UK.
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46
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Abstract
There are few direct comparative studies evaluating results after unicompartmental knee arthroplasty and total knee arthroplasty. We determined the active range of motion, Knee Society score, and 5-year survivorship rate after 54 consecutive unilateral unicompartmental knee arthroplasties compared with a matched group of 54 unilateral total knee arthroplasties. The two groups of patients were matched for age, gender, body mass index, preoperative active range of movement, and preoperative Knee Society scores. All patients had osteoarthritis of the knee. Patients were assessed prospectively at 6, 18, 36, and 60 months postoperatively, and the mean followup was 59 months in both groups. The mean postoperative active range of motion was greater after unicompartmental knee arthroplasty, but there were no differences in the overall Knee Society knee and function scores. The 5-year survivorship rate based on revision for any reason was 88% for unicompartmental knee arthroplasty and 100% for total knee arthroplasty. The worst case 5-year survivorship rate, assuming all patients lost to followup had revision surgery, was 85% for unicompartmental knee arthroplasty and 98% for total knee arthroplasty. Total knee arthroplasty was a more reliable procedure. Midterm clinical outcomes were similar for both procedures, but the complication rate may be greater for unicompartmental knee arthroplasty.
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Affiliation(s)
- Anish K Amin
- From the Department of Orthopaedics, Queen Margaret Hospital, Dunferm-line, Fife, UK
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48
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Amin AK, Patton JT, Cook RE, Brenkel IJ. Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis? ACTA ACUST UNITED AC 2006; 88:335-40. [PMID: 16498007 DOI: 10.1302/0301-620x.88b3.16488] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A total of 370 consecutive primary total knee replacements performed for osteoarthritis were followed up prospectively at 6, 18, 36 and 60 months. The Knee Society score and complications (perioperative mortality, superficial and deep wound infection, deep-vein thrombosis and revision rate) were recorded. By dividing the study sample into subgroups based on the body mass index overall, the body mass index in female patients and the absolute body-weight. The outcome in obese and non-obese patients was compared. A repeated measures analysis of variance showed no difference in the Knee Society score between the subgroups. There was no statistically-significant difference in the complication rates for the subgroups studied. Obesity did not influence the clinical outcome five years after total knee replacement.
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Affiliation(s)
- A K Amin
- Department of Orthopaedics, Fife Acute Hospitals NHS Trust, Queen Margaret Hospital, Whitefield Road, Dunfermline KY12 0SU, UK
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49
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Abstract
Fibromuscular dysplasia is an uncommon angiopathy that is principally observed in the renal and carotid arteries. Digital ischemia resulting from fibromuscular dysplasia of the forearm arteries is a rare occurrence. This article describes a case of distal radial and ulnar artery fibromuscular dysplasia presenting as paresthesia, claudication, and finger ulceration. Angiography was diagnostic in visualizing the characteristic "string of beads" appearance. In addition to the typical histological findings, we also observed a previously undescribed pathological finding. Surgical management involved resection of the diseased segment and primary anastomosis.
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Affiliation(s)
- V P Khatri
- Department of Surgery, Easton Hospital, PA 18042
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50
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Abstract
PURPOSE Several methods of managing the sacrococcygeal pilonidal sinus have been described, and fervent arguments for each form of therapy can be found in the literature. Recurrence unfortunately plagues all forms of therapy, though it is evident that the lowest rates have been reported for procedures involving local flap reconstruction. We conducted this case review to evaluate the validity of a simple reconstructive procedure for recurrent pilonidal disease. METHODS We describe the application of the V-Y fasciocutaneous advancement flap to reconstruct the defect following radical excision of recurrent pilonidal sinus in five consecutive patients. RESULTS Tension-free closure offers the benefits of a reduction in postoperative pain, less restriction in activity, and a shorter hospital stay. CONCLUSIONS Preliminary results offer evidence of the efficacy of the simple reconstructive procedure in the management of difficult cases.
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Affiliation(s)
- V P Khatri
- Department of General Surgery, Easton Hospital, Pennsylvania 18042
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