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Masters Degrees (Orthopaedics)

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    Arthroscopic arthrolysis after total knee arthroplasty.
    (2020) Desai, Yussuf Mohammed.; Ryan, Paul Vincent.
    Arthrofibrosis is an uncommon reason for poor outcomes after Total Knee Arthroplasty (TKA). There is paucity of evidence for the management of this complication. The aim of this study was to assess the longitudinal changes in the range of motion pre- and post-TKA, pre- and post-arthroscopy and at final follow up in patients who had arthroscopic arthrolysis for arthrofibrosis after TKA. Patients were identified from a prospectively collected database who had an arthroscopic arthrolysis for decreased range of movement following TKA which was not present immediately post-TKA and not attributable to any other cause. Patients underwent a systematic arthrolysis, manipulation under anaesthesia (MUA) and intensive physical therapy thereafter. The main outcome measures were range of motion (ROM) recorded at different intervals and overall patient satisfaction. A total of 16 patients were included for analysis. Patients were followed-up for a mean of 20 months (range 1 - 48 months) after the arthroscopic arthrolysis and MUA. The median prearthroscopic ROM was 28° (IQR 18°- 40°) and following arthroscopy was found to be 90° (IQR 88°- 100°). These gains however decreased with time to a median of 65° (IQR 38°- 88°) at final follow up. The mean improvement in the range of motion from the pre-arthroscopy value to that v found at final follow-up was 32 (95% CI = 19.0 - 45.3, p < 0.001). Three quarters of patients were satisfied with the outcome of the procedure. One patient developed a complication in the form of an iatrogenic patella fracture. Where other causes for knee loss of movement and pain have been ruled out, and arthrofibrosis is likely to be the sole cause of knee stiffness, arthroscopic debridement may be of benefit to improve ROM even if performed more than one year after the arthroplasty.
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    Preoperative factors associated with extended postoperative length of stay in patients undergoing primary hip arthroplasty.
    (2017) Dlamini, Nkanyiso Freedom.; Ryan, Paul Vincent.; Moodley, Yoshan.
    Orthopaedic disorders of the hip are becoming more common in many countries around the world, including South Africa. Conservative medical treatment of severe hip disorders might sometimes be ineffective in reducing pain or restoring hip function in some patients. In these patients, surgical intervention, through primary hip arthroplasty, remains the only viable option for reducing pain and restoring hip function. The increasing demand for primary hip arthroplasty in South Africa poses a problem for many resource-limited orthopaedic units in the country. It is possible that many of these orthopaedic units will be forced to consider fast-track surgery and recovery protocols to cope with the increased demand for primary hip arthroplasty. These protocols aim to shorten postoperative LoS, reduce complications, and allow for more efficient financial expenditure and resource allocation per patient. An understanding of which characteristics are associated with extended postoperative length of stay (EPLoS) in primary hip arthroplasty patients would have important implications for fast-track postoperative protocols being implemented in South African settings. This was the impetus for the current study. This study was a retrospective chart review involving 185 South African primary hip arthroplasty patients. Univariate and multivariate data analysis were performed to identify crude and independent associations between various characteristics and EPLoS. There were three preoperative risk factors (gender, fixed flexion deformity, patient’s maximum walking distance) and one intraoperative risk factor (extended duration of surgery) which were independently associated with EPLoS following primary hip arthroplasty in South African patients.
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    The orthopaedic manifestations of osteogenesis imperfecta : a collective review.
    (2016) Bhatta, Aabash Dev.; Rasool, Mahomed Noor.
    Osteogenesis imperfecta (OI), or brittle bone disease, is a debilitating genetic disorder of connective tissue which is characterized by reduced skeletal mass and bone fragility. OI results from mutations in genes encoding for type I collagen. Since collagen is the major structural protein in bone, ligaments, tendons, skin, sclera and dentin, clinical manifestations of OI include fragile bones with skeletal deformity, blue sclerae, hearing loss, and opalescent teeth. The orthopedic manifestations of OI are diverse. Most OI patients present with long bone fractures, joint contractures, foot deformities and bowing of long bones. Successful treatment of this condition is potentially challenging and requires a multidisciplinary approach. Surgical intervention is cumbersome because of growing bone, poor bone quality and soft tissue contractures. Advances in the medical management of OI have shown promising increases in bone mineral density and decreases in fracture incidence.