Publications by authors named "Lalit Maini"

79 Publications

Spontaneous subcapital femoral neck fracture complicating osteonecrosis of femoral head.

Acta Orthop Belg 2021 Mar;87(1):25-34

Spontaneous subcapital fracture (SSF) of femoral neck in pre-existent osteonecrosis of femoral head (ONFH) is a rare presentation. Only a few cases have been reported so far and majority of them have been reported to have unilateral hip involvement. We retrospectively reviewed clinical-radiological data of 10 patients (12 hips) with SSF complicating ONFH. All of them underwent uncemented total hip arthroplasty. All the available publications in the English language based medical literature were critically reviewed and results were summarized. The median age of presentation was 32 years (range : 24 years to 61 years). They were followed up for a mean duration of 25 months (range : 12 months to 59 months). The most common risk factor was corticosteroid consumption (7 out of 10 patients). All except one (modified Ficat and Arlet stage II) belonged to advanced stage of ONFH {stage III 3 patients (3 hips), stage IV 6 patients (8 hips)}. The mean time lag of ONFH to presentation was 22.3 months (range : 5 months to 60 months), and SSF to presentation was 13.8 days (range : 1 day to 28 days). Mean pre- operative Harris Hip Score was 10.8 (range : 8 to 14), which improved to 93 (range : 91 to 96) after total hip arthroplasty when last followed up (p<0.05). Corticosteroids induced ONFH has a propensity to develop SSF. This entity should find a place in existing classification system.
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March 2021

Excision of Osteosarcoma of Patella without Extensor Mechanism Reconstruction: A Case Report.

J Orthop Case Rep 2020 May-Jun;10(3):67-70

Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.

Introduction: Osteogenic sarcoma of patella is extremely rare and only few cases have been reported in the literature so far. Limb salvage, particularly reconstructing extensors of the knee, is a matter of debate in available literature. Henceforth, we would like to present this uncommon case of patellar osteosarcoma in a young female managed by chemotherapy and wide excision without extensor mechanism reconstruction.

Case Report: A 25-year-old female had a history of painless swelling around the left knee for 6 months, which was progressively increasing in size. It was diagnosed as osteoblastic osteosarcoma patella radiologically, confirmed by open biopsy. The patient was managed by recommended protocol comprising neoadjuvant chemotherapy followed by tumor excision, thereafter chemotherapy in post-operative period. However, no reconstruction of the extensor mechanism was done. At 1-year follow-up, the patient was able to perform activities of daily living without any discomfort. She was able to ambulate unaided with no extensor lag.

Conclusion: For managing a case with osteosarcoma patella, chemotherapy along with optimal excision comprising total patellectomy without extensor mechanism reconstruction is a viable option.
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http://dx.doi.org/10.13107/jocr.2020.v10.i03.1754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051558PMC
May 2021

Status of Hip Arthroscopy in India: A Short Questionnaire Based Survey and Review of Literature.

Indian J Orthop 2021 Apr 19;55(2):325-332. Epub 2021 Jan 19.

Dr L H Hiranandani Hospital, Mumbai, India.

Background: Hip arthroscopy is a minimally invasive technology for diagnostic and therapeutic interventions in various hip disorders. Over the past decade or so, the technology and understanding related to this surgery have improved by leaps and bounds; however, in India the overall pace has been limited. The present review highlights the status of hip arthroscopy in the Indian context.

Methodology: A small survey with five questions related to practice of hip arthroscopy among Indian orthopaedic surgeons was conducted. Additionally a PubMed database search was conducted to recognise and assess studies pertaining to hip arthroscopy originating from India.

Results: Forty-two responses were received for the questionnaire, out of which 38 surgeons performed hip arthroscopy in their practice; the overall numbers were very low with only one respondent performing more than 50 surgeries in a year. For 84.2% of the respondents, the practice was limited to less than ten surgeries per year. 63.2% of the surgeons affirmed that there has been no change in their practice of hip arthroscopies over the past 5 years, signifying the slow growth and limited application of the technique. Only nine studies pertaining to the topic were available in the literature search, out of which five were case reports. The most common indication was removal of intraarticular foreign bodies, followed by joint debridement and lavage, synovial biopsies and femoroacetabular impingement (FAI). The outcomes in all the studies were satisfactory.

Conclusion: Hip arthroscopy is in its nascent stages in India and much is still needed to be done for better implementation of the technique on a wider scale. Adequate training and continued medical education programme, with exposure to the experts in the field, will go a long way in better utilisation of the surgery in India.
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http://dx.doi.org/10.1007/s43465-020-00346-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046872PMC
April 2021

Virtual planning on contralateral hemipelvis for posteriorly fixed acetabular fractures.

Eur J Trauma Emerg Surg 2021 Mar 8. Epub 2021 Mar 8.

Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.

Background: Open reduction and internal fixation is a standard treatment for displaced acetabular fractures using 3.5 mm reconstruction plates contoured intra-operatively. This process is difficult and time consuming hence resulting in increased surgical morbidity. Virtual surgical planning is now being commonly used worldwide to aid in management of such complex problems. Patient-specific reconstruction plate pre contoured using virtual surgical planning on contralateral intact hemipelvis will be helpful in achieving better surgical outcomes. Also, it has an added advantage of considerably reducing the time and effort spent in virtual pre-operative planning process.

Methodology: This study was performed in 30 patients with acetabulum fracture who were fixed posteriorly via Kocher-Langenbeck approach. Virtual planning was done on contralateral hemipelvis to prepare patient-specific pre-contoured plates and mirrored to the fractured side. The time required for virtual planning on fractured and normal side was recorded and compared. The efficiency of plates so prepared were accessed in terms of outcome variables like duration of surgery, blood loss, reduction obtained on X-ray as well as CT Scan.

Result: Time required for virtual planning was more on fractured side and lesser when it was done using normal hemipelvis with mean values of 81.83 (sd = 28.02) min and 15.67 (sd = 6.12) min, respectively. Values of blood loss, duration of surgery and reduction as accessed on X-ray and CT scan were comparable or even better than compared to other studies.

Conclusion: Contralateral normal pelvis can be used for virtual preoperative planning making the whole process easier and less time consuming.
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http://dx.doi.org/10.1007/s00068-021-01617-zDOI Listing
March 2021

Relationship of triceps aponeurosis with radial nerve in anterior compartment of the arm.

Surg Radiol Anat 2021 May 27;43(5):695-696. Epub 2021 Feb 27.

Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, 110002, India.

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http://dx.doi.org/10.1007/s00276-021-02722-9DOI Listing
May 2021

Unusual aetiology of foot pain in the elderly: A case report & review of literature.

J Clin Orthop Trauma 2020 Oct 29;11(Suppl 5):S899-S901. Epub 2020 Jul 29.

Orthopaedics, Maulana Azad Medical College, New Delhi, India.

The osteochondroma of metatarsal is a rare clinical entity. It generally occurs in the first or second decade of life. The osteochondroma should be investigated to rule out any malignant changes before embarking any surgical intervention. We report an osteochondroma of 5th metatarsal in a 65 years old female as an unusual aetiology of foot pain. We propose the scalloping effect of the osteochondroma on adjacent metatarsal as one of the mechanisms of causing pain in the foot. After ruling out the malignant transformation with the help of MRI, excision of the tumour was done with a curvilinear incision on the dorsum of the foot. There was no recurrence in 1 year follow up. This case report depicts the occurrence of osteochondroma in geriatric patient as an unusual cause of foot pain. The scalloping effect on the adjacent bone and tissues can be the aetiology of the pain.
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http://dx.doi.org/10.1016/j.jcot.2020.07.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503793PMC
October 2020

Out Patient Department practices in orthopaedics amidst COVID-19: The evolving model.

J Clin Orthop Trauma 2020 Jul-Aug;11(4):700-712. Epub 2020 May 18.

Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, 110002, India.

Severe Acute Respiratory Syndrome COVID-19 was declared as a pandemic on 11 March 2020 by the World Health Organization and consequent lockdown imposed in several areas resulted in a marked reduction in orthopaedic practices. Although some guidelines for patient care in orthopaedic practice have been published, overall, publications focusing exclusively on guidelines on starting orthopaedic outpatient departments (OPD) after the COVID-19 lockdown amidst the on-going pandemic are lacking. We hereby propose the evolving knowledge in changes in OPD management practices for orthopaedic surgeons in the COVID- 19 era. The emphasis on online registration (e-registration) should be given impetus and become the new norm supplemented by telephonic and spot registration for the uneducated patients. The review highlights the safety of patient and orthopaedic surgeons in OPD by screening and maintaining hygiene at various levels. The article also mentions the duties of the help desk, OPD hall supervisor and the new norms of air conditioning, ventilation, safe use of elevators, sanitization of OPD premises and biomedical waste disposal. The optimum and safe utilization of human & material resources, DO's and DON'Ts for patients & health staff have also been proposed. The reorganization of plaster room, the precaution during plastering, fracture clinic, dressing and injection room services are discussed as per evolving guidelines. This article will also give deep insight into the OPD plan & telemedicine graphically. The authors suggest updating and downward permeation of existing e-infrastructure of government health services that is up-gradation of existing tertiary level online registration services, a paperless model of OPD consultation & dispensation. The future updating of Aarogya Setu App (https://mygov.in/aarogya-setu-app/) for convenient online OPD registration and dispensation has been discussed and proposed. This review will help in containing the spread of COVID 19 and build upon the health gains achieved after lockdown. The easy concept of CCCATTT has been introduced, and the OPD Plan has also been suggested. We have endeavoured to holistically detail an orthopaedic OPD setup and its upkeep in COVID-19 pandemic, but since the knowledge of COVID 19 is ever-evolving it needs replenishment by regular education for health staff.
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http://dx.doi.org/10.1016/j.jcot.2020.05.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233223PMC
May 2020

Fast and economic cardboard cutout use to increase compliance of face mask wear during COVID-19 pandemic.

J Clin Orthop Trauma 2020 May 13;11(Suppl 3):S298-S300. Epub 2020 May 13.

Department of Orthopaedics, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India.

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http://dx.doi.org/10.1016/j.jcot.2020.04.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219360PMC
May 2020

Post COVID-19: Planning strategies to resume orthopaedic surgery -challenges and considerations.

J Clin Orthop Trauma 2020 May 4;11(Suppl 3):S291-S295. Epub 2020 May 4.

Department of Orthopaedics, Sports Injury Centre, Safdarjung Hospital, New Delhi, India.

The Coronavirus SARS-CoV-2 (COVID-19) pandemic has had a substantial effect on the health care systems around the world. As the disease has spread, many developed and developing countries have been stretched on their resources such as personnel as well as adequate equipment. As a result of resource disparity, in a populous country like India, the elective orthopaedic surgeries stand cancelled whilst trauma and emergency services have been reorganised following Indian Orthopaedic Association and recent urgent British Orthopaedic association guidelines. Though these guidelines provide strategies to deal with trauma and orthopaedic surgery management in the present scenario, once the COVID-19 pandemic stabilizes, restarting elective orthopaedic surgery and managing delayed trauma conditions in evolving health care systems is going to be a profound task. We look at the future challenges and considerations of re-establishing trauma and orthopaedic flow during the post-COVID-19 phase and suggest an algorithm to follow (Fig. 1).
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http://dx.doi.org/10.1016/j.jcot.2020.04.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196552PMC
May 2020

3D Printed Patient-Specific Acetabular Jig for Cup Placement in Total Hip Arthroplasty.

Indian J Orthop 2020 Apr 17;54(2):174-180. Epub 2020 Mar 17.

1Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.

Introduction: Acetabular cup placement is an important modifiable factor determining complication rates like aseptic loosening and hip dislocation related to faulty cup placement, which by standard method is largely dependent upon eyeballing and surgeon's judgment. We evaluated a self-designed, low-cost, patient-specific acetabular jig to guide cup placement in total hip arthroplasty in comparison to conventional technique.

Methods: It was a prospective randomized control study. Thirty-six patients were categorized into group-A & group-B. In group-A, virtually designed acetabular jig was 3 Dimensional (3D) printed and used intra-operatively to guide cup placement. In group-B, the standard method of cup placement was used. Acetabular cup placement was evaluated on post-operative x-rays and compared between two groups.

Results: In group-A, angle of anteversion were significantly in centre of range of safe zone as compared to group B in which hip is maximally stable with more precision in creating hip centre as compared to group-B without any significant( = 0.325) increase in surgical time or blood loss.

Conclusion: Computed tomography (CT) scan based virtual pre-operative templating and cup placement guided by virtually designed, patient-specific acetabular jig is a low-cost tool with a short learning curve which can be designed and made available easily. It is a useful tool in decreasing chances of malpositioning of cup and recreates hip centre close to anatomical one especially in cases where anatomy has been distorted such as bony ankylosis and developmental dysplasia of hip.
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http://dx.doi.org/10.1007/s43465-020-00061-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096340PMC
April 2020

Arthroscopy and COVID-19: Impact of the pandemic on our surgical practices.

J Arthrosc Jt Surg 2020 Apr-Jun;7(2):47-53. Epub 2020 Jun 23.

Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India.

The aim of this article is to study systematically current evidence on status of arthroscopic surgeries during the COVID-19 pandemic. We aim to study (1) changes in global arthroscopic practices, (2) recommendations on reducing risk to patients and health care workers (HCW), (3) changes in follow-up protocols of these patients. Systematic search was carried out by two different reviewers using three different online databases for all studies published in the English language before April 2020. The total number of abstracts screened initially was 314. After screening of these abstracts, a total of 13 studies were included for the systematic review. Numbers of orthopaedic injuries have seen a sharp fall during this time. Most elective surgical facilities were also closed at this time. Most studies have recommended telemedicine as an essential medium of providing continued care to patients during COVID-19. Studies have recommended that a conservative approach should be preferred for most patients with ligament injuries, and alternative procedures that have less requirement for an operating room should be explored. Common recommendation in all studies is that procedures of more elective nature should be postponed to a safer time frame when the transmission of COVID-19 virus in the population has declined. When surgeries are resumed, there is a need for triage of arthroscopy procedures from more important or urgent to less important ones. Elective surgical procedures should preferably be started with patients with no co-morbidities and lesser risk of peri-operative complications. All patients undergoing surgery and health care personnels should have some screening for disease. Attempts should be made to have shortest hospital stay. Choice of anaesthetic procedure should emphasize on minimal aerosolization of the virus. Regional anaesthesia is the preferred choice as far as possible. Most guidelines have recommended that patient follow up should be made telephonically or on video-conferencing.
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http://dx.doi.org/10.1016/j.jajs.2020.06.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308741PMC
June 2020

Heralding Change: The Evolution of the IJO in 2019.

Indian J Orthop 2019 Nov-Dec;53(6):679-681

Department of Orthopedics, Maulana Azad Medical College, New Delhi, India.

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http://dx.doi.org/10.4103/ortho.IJOrtho_555_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6804393PMC
November 2019

Virtual preoperative planning and 3D printing are valuable for the management of complex orthopaedic trauma.

Chin J Traumatol 2019 Dec 7;22(6):350-355. Epub 2019 Sep 7.

Department of Orthopaedics and Joint Replacement Surgery, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi 110001, India.

Purpose: The technology of 3D printing (3DP) exists for quite some time, but it is still not utilized to its full potential in the field of orthopaedics and traumatology, such as underestimating its worth in virtual preoperative planning (VPP) and designing various models, templates, and jigs. It can be a significant tool in the reduction of surgical morbidity and better surgical outcome avoiding various associated complications.

Methods: An observational study was done including 91 cases of complex trauma presented in our institution requiring operative fixation. Virtual preoperative planning and 3DP were used in the management of these fractures. Surgeons managing these cases were given a set of questionnaire and responses were recorded and assessed as a quantitative data.

Results: In all the 91 cases, where VPP and 3DP were used, the surgeons were satisfied with the outcome which they got intraoperatively and postoperatively. Surgical time was reduced, with a better outcome. Three dimensional models of complex fracture were helpful in understanding the anatomy and sketching out the plans for optimum reduction and fixation. The average score of the questionnaire was 4.5, out of a maximum of 6, suggesting a positive role of 3DP in orthopaedics.

Conclusion: 3DP is useful in complex trauma management by accurate reduction and placement of implants, reduction of surgical time and with a better outcome. Although there is an initial learning curve to understand and execute the VPP and 3DP, these become easier with practice and experience.
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http://dx.doi.org/10.1016/j.cjtee.2019.07.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6921216PMC
December 2019

Formatting References for Scientific Manuscripts.

Indian J Orthop 2019 May-Jun;53(3):381-383

Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India.

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http://dx.doi.org/10.4103/ortho.IJOrtho_197_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501625PMC
May 2019

Spontaneous regression of giant cell tumor of the wrist: Myth or fact? A case report.

Indian J Pathol Microbiol 2019 Apr-Jun;62(2):346-348

Department of Orthopedics, Maulana Azad Medical College, New Delhi, India.

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http://dx.doi.org/10.4103/IJPM.IJPM_251_18DOI Listing
August 2019

Letters about Published Papers.

J Orthop Surg (Hong Kong) 2019 Jan-Apr;27(1):2309499019825504

2 Lok Nayak Hospital, New Delhi, India.

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http://dx.doi.org/10.1177/2309499019825504DOI Listing
December 2019

Fibrodysplasia ossificans progressiva - can we diagnose it right at the outset?

Turk J Pediatr 2019 ;61(6):958-962

Department of Orthopaedics, Maulana Azad Medical College, Delhi.

Sharma A, Maini D, Agarwal G, Sharma P, Maini L. Fibrodysplasia ossificans progressiva - can we diagnose it right at the outset? Turk J Pediatr 2019; 61: 958-962. Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disorder with no definitive treatment options available yet, except for physiotherapy and bisphosphonates. Due to its initial presentation with multiple lumps in the body, it is often misdiagnosed as a benign tumour most commonly being an osteochondroma or Olliers syndrome. Delay in diagnosis not only delays the management but can also expose the patient to unnecessary interventions. Moreover, earlier diagnosis can also make the patient aware of the precautions to be taken. So our remark is `can we diagnose this disease right at the outset`? We present a case of a 10 year old boy, who had all the classical features of FOP yet was misdiagnosed. Therefore, classical hallmark features of this disease are highlighted in this case report which can be picked up easily by any clinician to reach to a definitive diagnosis as early as possible avoiding unnecessary iatrogenic insult.
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http://dx.doi.org/10.24953/turkjped.2019.06.021DOI Listing
August 2020

Radiological evaluation of pelvic inlet and outlet radiographic view in Indian population.

J Clin Orthop Trauma 2018 Oct-Dec;9(4):334-337. Epub 2018 Jun 20.

Max Smart Superspeciality Hospital, New Delhi, India.

Background: Pelvic fractures represent one of the most challenging clinical problems in which an urgent multidisciplinary approach is required. The early management in a suspected pelvic fracture starts with the good radiological evaluation. The standard radiographic view includes the anteroposterior, inlet and outlet views. The inlet and outlet views are taken with 45° tilt from anteroposterior plane. However, recent studies have shown that there is significant individual variation within the population and these values should be redefined.

Material And Methods: This is a retrospective study carried out in a tertiary care teaching institute. Total 110 patients (including 42 female and 68 male patients) of age older than 18 years, who had a routine pelvic Computed Tomography (CT) scan performed for any indications unrelated to pelvic pathologies were included.

Statistical Analysis: Mean and standard deviation were calculated. For each angle measured, the effect of age was determined and a comparison was made between male and female patients, p value <0.05 is considered significant.

Results: The mean angle of caudal tilt for the ideal screening inlet view was 33° +/-8 (16.3-31.3) and the mean angle of cephalic tilt for the ideal screening outlet view was 56° +/-9 (51.6-81.8).

Conclusion: This study re-evaluated the optimal inlet and outlet angles in Indians and demonstrated that the mean angles needed to create an ideal pelvic inlet and outlet views are 33° and 56° respectively.
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http://dx.doi.org/10.1016/j.jcot.2018.05.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224698PMC
June 2018

A journey of the Journal of Clinical Orthopaedics and Trauma.

J Clin Orthop Trauma 2018 Oct-Dec;9(4):277-280. Epub 2018 Sep 21.

Sports Injury Centre, Safdarjung Hospital, New Delhi, India.

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http://dx.doi.org/10.1016/j.jcot.2018.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224646PMC
September 2018

Three dimensional surgical planning for mosaicplasty in chondroblastoma of femoral head with articular disruption.

J Orthop Sci 2021 Jul 1;26(4):719-724. Epub 2018 Nov 1.

Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. Electronic address:

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http://dx.doi.org/10.1016/j.jos.2018.09.022DOI Listing
July 2021

Application of three dimensional printing in surgery for cam type of femoro-acetabular impingement.

J Clin Orthop Trauma 2018 Jul-Sep;9(3):241-246. Epub 2018 Jul 23.

Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.

Surgical treatment of femoroacetabular impingement (FAI) focuses on improving the clearance for hip motion and alleviation of femoral abutment against the acetabular rim. Cam type of impingement is managed by performing an osteochondroplasty to remove the excess impinging bone from the head neck junction, thus improving the head neck offset. This procedure can be done by safe surgical dislocation, arthroscopy assisted mini-open method or all arthroscopy technique. Whatever be the approach, adequate excision of the Cam deformity is necessary to avoid suboptimal results. Under-excision leads to persistent symptoms and progression of disease, while over-excision can lead to weak bone vulnerable to fracture or disturb the labral seal. Various techniques utilized for intra-operative evaluation of amount of excision required described in literature are fluoroscopy, spherometer gauges, intra-operative Computed Tomography (CT) scan, navigation etc. Rapid prototyping, also called as three dimensional (3D) printing, is a technology to create dimensionally accurate model from a computer-assisted design. Accurate physical models can be designed from the medical imaging data like CT scans and 3D printed to aid in various medical applications. Its application in orthopaedic field is on a rise, recently. However, there is no report on utilization of this technique in surgeries for FAI. We have reported a case of Cam type FAI in an eighteen year old boy, which we treated surgically by performing osteochondroplasty using safe surgical dislocation. We did CT based virtual surgical planning to design femoral head and neck jigs, which were 3D printed and used intra-operatively to guide for adequate and optimum excision of bone at head neck junction. We found these customized jigs accurate and useful for the surgery. However, a comparison study with various other techniques is warranted for a detailed research on its usefulness and challenges. The main purpose of this article is to elaborate on the technical steps for designing of jigs for 3D printing to guide in osteochondroplasty surgery for FAI.
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http://dx.doi.org/10.1016/j.jcot.2018.07.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128803PMC
July 2018

3D printing in designing of anatomical posterior column plate.

J Clin Orthop Trauma 2018 Jul-Sep;9(3):236-240. Epub 2018 Jul 30.

Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.

Background: Acetabulum has a complex anatomy due to which anatomical acetabular plates are still under developmental phase. Although intra-operative contouring of reconstruction plate is done as a standard practice, it is associated with increased operative time and morbidity of patient. We have designed an acetabular plate for posterior fixation from experience of previous studies performed in our institute on acetabular fracture fixation which should be appropriate for most of the patient of Indian origin. Apart from avoiding intra-operative contouring of acetabular plates it also helps in preventing intra articular screw penetration.

Methods: We selected five consecutive patients with acetabular fracture needed to be operated from posterior approach and designed patient specific plate template from virtual surgical planning and 3D printing. These plate templates were then matched with our acetabular plate design and were used intra-operatively. Many parameters were assessed to evaluate accuracy of our plate design in those five patients.

Result: All the plate templates appear to match our designed plate and no intra-operative contouring was required with our plate design.

Conclusion: This was a pilot study and we need a large sample size to study accuracy of our acetabular plate design which might avoid intra-operative contouring, decreasing morbidity of patient and prevent wastage of resources in pre-operative planning and computer designing.
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http://dx.doi.org/10.1016/j.jcot.2018.07.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128798PMC
July 2018

Cervical pedicle screw guiding jig, an innovative solution.

J Clin Orthop Trauma 2018 Jul-Sep;9(3):226-229. Epub 2018 Jul 17.

Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.

Pedicle screws are one the commonest used modality in spinal instrumentation. However, the method of pedicle screw fixation in cervical spine as compared to thoracic and lumbar spine is still technically demanding because it carries the risk of catastrophic damage to the surrounding neurovascular structures We have utilized virtual planning and 3D (3-dimension) printing to develop a patient specific jig to guide the accurate placement of pedicle screws. A patient with bifacetal dislocation C7 over D1 classified as flexion-distraction injury type 3 who was planned for decompression and fusion by posterior instrumentation at C6, C7, D1 and D2 was selected. A CT scan with 1 mm cuts was used to produce DICOM images of the same. Using these DICOM images virtual planning was done on MIMICS and 3 MATICS software to create patient specific jigs. These jigs were then 3D printed using a 3D printer and used for accurate placement of pedicle screws intra-operatively after adequate sterilization. Our procedure is low cost but high technology based. It is simple, accurate, and very cost effective. The technology transfer is very easy and can be adopted easily.
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http://dx.doi.org/10.1016/j.jcot.2018.07.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128793PMC
July 2018

Will 3D printing take away surgical planning from doctors?

J Clin Orthop Trauma 2018 Jul-Sep;9(3):193. Epub 2018 Sep 6.

Indraprastha Apollo Hospitals, New Delhi 94, Sukhdev Vihar Delhi, New Delhi, 110025, India.

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http://dx.doi.org/10.1016/j.jcot.2018.06.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128806PMC
September 2018

Total hip replacement in tuberculosis of hip: A systematic review.

J Clin Orthop Trauma 2018 Jan-Mar;9(1):54-57. Epub 2017 Sep 23.

Department of Orthopaedics, Maulana Azad Medical College, New Delhi 110002, India.

Total hip replacement (THR) in patients with tuberculous arthritis of the hip is controversial. The timing of surgery, type of prosthesis, reactivation of the disease, high complication rates and the long-term survival of the reconstruction are the major conc erns. There is little information regarding this concern in the literature. We conducted a systematic review of published studies on Total Hip Replacement in patients with Tuberculosis of the hip. A search of Pubmed and Google Scholar database articles published between January 2000 and July 2017 was performed. Thirteen articles were identified, comprising 226 patients. The mean follow-up was 5.48 years. Antituberculosis treatment was given for atleast 2 weeks pre-operatively and continued post-operatively for between six and 18 months after THR. Three patients had reactivation of infection. At the final follow-up, the mean Harris hip score was 89.98. Total Hip Replacement in tuberculosis of hip is safe and efficient way to save the joint function. The most important factors to achieve success include the accurate diagnosis, efficient pre- and postoperative anti-tuberculosis therapy, thorough debridement, two stage procedure for patients with sinus(es).
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http://dx.doi.org/10.1016/j.jcot.2017.09.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5884057PMC
September 2017

Making the Surgeons Safe in India.

Indian J Orthop 2018 Mar-Apr;52(2):212-213

Central Institute of Orthopaedics, Safdarjung Hospital, New Delhi, India.

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http://dx.doi.org/10.4103/ortho.IJOrtho_457_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858219PMC
March 2018

Evaluation of accuracy of virtual surgical planning for patient-specific pre-contoured plate in acetabular fracture fixation.

Arch Orthop Trauma Surg 2018 Apr 24;138(4):495-504. Epub 2018 Jan 24.

Department of Mechanical Engineering, Indian Institute of Technology, New Delhi, India.

Background: Acetabular fractures are amongst the most challenging fractures to treat because of complex anatomy. Open reduction and internal fixation remains the standard treatment for displaced acetabular fractures to achieve anatomical reduction as in any other intra-articular fracture. Patient-specific pre-contoured reconstruction plate template made by a pre-operative virtual surgical planning can be useful to respect patient's morphology, reduce surgical invasiveness and simplify the surgical procedure. Proper evaluation and surgical planning is necessary to achieve these goals. The goal of this study was to evaluate the outcomes of using virtual surgical planning and virtually pre-contoured plate template in comparison with the conventional method of intra-operative contouring of reconstruction plate for acetabular fracture fixation.

Methods: Twenty-five patients were categorized into group A and B by computerized randomization. In group A (12 patients), CT-based virtual surgical planning was done using Mimics and 3-Matic software to form virtually pre-contoured plates, which were 3D printed to act as templates over which 3.5 mm reconstruction plates were manually contoured pre-operatively and used for fixation. In group B (13 patient), conventional method of intra-operative contouring to adapt the plate to the fracture region was followed. Blood loss, surgical time, reduction on X-rays and post-operative computed tomography were compared between two groups.

Results: Duration of surgery and total blood loss were found to be less while reduction was found to satisfactory/anatomical in higher percentage of Group A than Group B patients.

Conclusions: Virtual surgical planning, patient-specific virtually pre-contoured plate template and 3D printing technology improve the outcomes of acetabular fracture surgery by reducing duration and invasiveness of surgery and improving the quality of reduction. However, studies with larger sample size are required to further validate it.
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http://dx.doi.org/10.1007/s00402-018-2868-2DOI Listing
April 2018

Ewings sarcoma of ilium: Resection and reconstruction with femoral head allograft.

J Clin Orthop Trauma 2017 Aug 11;8(Suppl 1):S53-S57. Epub 2017 Jul 11.

Lok Nayak Hospital, Room No. 72, PG Mens' Hostel, MAMC Campus, New Delhi-110002, India.

Ewing's sarcoma is a common malignant bone tumor seen in 5-15 years age group. It often arises from diaphysis of long bones. Ewing's sarcoma arising from the ilium is very rare, and it has an unfavourable prognosis. We present a rare case report of Ewings sarcoma of ilium with no metastasis in a two and a half year old boy, who was treated with neoadjuvant chemotherapy followed by surgical excision of the tumor and reconstruction using allograft from the femoral head fixed with multiple k-wires and screw. The patient is disease free at one year follow up and the allograft has taken the shape of growing ilium and excellent functionality and gait with minimal limp. Through this report, we emphasize on the occurrence of Ewings sarcoma in unusual site and resection and reconstruction of the tumor utilizing the allograft.
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http://dx.doi.org/10.1016/j.jcot.2017.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574857PMC
August 2017

Customized iliac prosthesis for reconstruction in giant cell tumour: A unique treatment approach.

J Clin Orthop Trauma 2016 Oct-Dec;7(Suppl 1):35-40. Epub 2016 Oct 21.

Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.

Giant cell tumour (GCT) of flat bones of pelvis is extremely rare. GCT of the ilium and ischium represent less than 0.05% of all GCT. Iliac bone GCT has been treated traditionally by intra-lesion curettage with bone grafting, wide resection with or without reconstruction and hemi-pelvectomy in very aggressive tumours. None of the above treatments were without morbidities. Reconstruction using bone grafts and bone cement has also been inadequate. In GCT, where life expectancy is not decreased significantly, surgical treatment should be aimed at giving optimum functional outcome. We are reporting here a rare case of giant cell tumour of ilium bone in a 25-year-old female and its unique treatment approach. We designed a computed tomography (CT) based customized iliac prosthesis using Materialise Mimics and 3-Matic software. 3D model of pelvis was generated from the CT. After deciding the extent of resection on affected side, we virtually mirrored an identical portion of opposite ilium to the affected side. Connecting plates were made over the mirrored part and merged with it. Multiple relevant holes were made to attach various muscles to the prosthesis. Prosthesis was made in medical grade titanium by using Computerized Numerical Control (CNC) machine. The method is called as computer based subtractive manufacturing. Wide resection was done and the prosthesis was placed using multiple 3.5 millimetres screws through the connecting plates. Muscles were stitched to relevant holes using ethibond suture. Post-operative course was unremarkable. Patient was made to walk with full weight bearing after 5 weeks. Powers of abductors at 6 months is 4/5 and patient walks normally without a limp.
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http://dx.doi.org/10.1016/j.jcot.2016.10.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5167515PMC
October 2016

Non-union fracture neck femur in a toddler: Reconstructed by valgus osteotomy - A minimally invasive approach.

J Clin Orthop Trauma 2016 Oct-Dec;7(Suppl 1):8-11. Epub 2016 Nov 11.

Maulana Azad Medical College, Delhi, India.

Background: Non-union is one of the devastating complications of fracture neck of femur. Though a very rarely encountered entity in a toddler (1-3 years paediatric age group), non-united femoral neck fractures are reported in developing countries because of mismanagement by quacks and delay in referrals. For operative treatment, many different procedures have been described, including close/open reduction and internal fixation using K-wires, cannulated screws, fibula or nails. There is no evidence in the literature that one or other implant influences the rate of postoperative complications, such as avascular femoral head necrosis or coxa vara. But, still the choice of fixation implant is debatable.

Case Report: We present a case of 3-year-old child of non-union femoral neck fracture treated with valgus osteotomy. Choice of implant was kept to bare minimum to reduce the cost of implant and magnitude of surgery, which made the surgery minimally invasive, which is not the case in other studies. Two solid cancellous screws and a Kirschner wire (K-wire) were used to acheive fixation. Implant was removed after one year. The patient was followed up for 2 years and was found to be asymptomatic clinically with restoration of neck shaft angle and no signs of AVN.

Conclusion: Our method of intertrochanteric valgus osteotomy and internal fixation stabilized using K-wire and screws is a technically simple yet effective method of treating difficult fracture neck femur. Although a larger series and multicentric trails are needed, yet we would safely recommend extension of this technique to unstable fractures, to minimize the incidence of complications, cost and magnitude of surgery.
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http://dx.doi.org/10.1016/j.jcot.2016.10.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5167510PMC
November 2016
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