Muhammad Adeel Akhtar

NHS Fife · Department of Orthopaedic Surgery

Background Femoral stem fracture following total hip arthroplasty (THA) is an infrequent but nevertheless devastating complication, with an increasing worldwide prevalence as demand for primary THA continues to increase. The aim of this study was to perform a systematic review and meta-analysis of risk factors for femoral stem fracture to help iden...

Introduction Increasing interest in the use of anatomical stems has developed as the prevalence of periprosthetic fractures (PPFs) continues to increase. The primary aim of this study was to determine the long-term survivorship and PPF rate of an anatomical femoral stem in a single UK centre. Patients and methods Between 2000 and 2002, 94 consecut...

Aims: Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality. Methods: Using a multicentre study design, independent of registry data, we included adult patient...

Although osseointegration has proven successful at improving the physical deficits that traditional prostheses leave unfulfilled, future innovation should be systematically guided rather than randomly explored. Therefore, this article attempts to summarise, in a systematic manner, the challenges and prospects of osseointegration limb reconstruction...

Aims: Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade. Methods: Using a multicentre collaborative study design, independent of registry data, we identified adults from 29 cen...

Aim Digital health technologies provide high-reach, low cost, readily accessible and scalable interventions for large patient populations that address time and resource constraints. Weight loss may reduce the risk of symptomatic lower limb osteoarthritis and may lead to the resolution of symptoms. Musculoskeletal-focused digital apps are increasing...

Aim The field of osseointegration has existed for almost 30 years and now appears to be on the verge of greater acceptance and widespread implementation. We reviewed the current challenges and future prospects of osseointegration limb reconstruction. Method A scoping review of the literature was conducted by researchers with an interest in Osseoin...

Aim Obesity increases the risk of postoperative complications following Total Knee Replacement (TKR). The Covid-19 pandemic has increased waiting times for TKR in the United Kingdom. It is therefore important to understand whether these prolonged waiting times are impacting patient Body Mass Index (BMI) at the time of surgery. The aim of our study...

Aim Obesity is associated with increased risk of postoperative complications such as wound infection and venous thromboembolism. The aim of our study was to assess changes in the epidemiology of severe obesity (WHO classification, BMI ≥ 40) in NHS Fife, Scotland, from 2001-2021 in patients undergoing Total Knee Replacement (TKR). Method A retrospe...

Introduction: As the clinical burden of peri-prosthetic fractures (PPFs) continues to increase, it has been suggested that the use of anatomical femoral stems may help reduce PPF risk. The primary aim of this study was to determine the survivorship and PPF rate of an anatomical femoral stem in a single center at minimum 10-year follow-up. Patient...

Osteoarthritis (OA) of the hip is the most common indication for total hip replacement (THR). Obesity is a risk factor for the development of OA and has recently resulted in patients requiring THRs at much younger ages to relieve pain at the joint capsule and restore mobility. However, the impact of obesity on THR mortality is not well understood....

The Lubinus SP II is an anatomical femoral stem with high survivorship levels notably described in the Swedish Arthroplasty Register. As the clinical and economic burden of revision total hip arthroplasty (THA) and periprosthetic fracture (PPF) continues to increase, it has been suggested that use of anatomical stems may facilitate more uniform cem...

Purpose of Review To introduce and review the field of transcutaneous osseointegration for amputees (TOFA). TOFA surgically inserts a permanent metal prosthetic attachment anchor directly into an amputee’s residual limb, which connects to standard external prosthetic through a transcutaneous stoma. This confers a replacement limb while eliminating...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Importance: Transcutaneous osseointegration post amputation (TOPA) creates a direct linkage between residual bone and an external prosthetic limb, providing superior mobility and quality of life compared with a socket prosthesis. The causes and potential risks of mortality after TOPA have not been investigated. Objective: To investigate the asso...

Aim: In some amputees they are unable to adequately ambulate using conventional socket prosthetics, osseointegrated prosthetics have been described as an alternative strategy in this patient group. This paper aims to assess the effect of osseointegrated prosthetics, commonly simply referred to as osseointegration, in transfemoral amputees on health...

Background Management of total knee replacement (TKR) infection may sometimes prompt knee fusion (KF) or transfemoral amputation (TFA), both associated with low mobility and quality of life (QOL). Transcutaneous osseointegration for amputees provides superior mobility and QOL vs traditional socket prostheses but has not been studied for patients wi...

Transcutaneous osseointegration for amputees (TOFA) refers to an intramedullary metal endoprosthesis which passes transcutaneously to connect with a limb exoprosthesis. The first recognizably modern experiments and attempts occurred in the 1940s. Multiple researchers using a plethora of materials and techniques over the following 50 years identifie...

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients.Since surgical patients are already at higher risk of venous thromboembolism than general populations, thisstudy aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk ofvenous thromboembolism. We...

Transcutaneous limb osseointegration improves pain, mobility, and quality of life for patients struggling with a traditional socket prosthesis (TSP) by eliminating the socket and anchoring the prosthetic limb to the skeleton. This represents the greatest paradigm shift in amputee rehabilitation since Ambroise Paré’s prosthetic designs in the 1500s....

The management of peripheral vascular disease (PVD) can require amputation. Osseointegration surgery is an emerging rehabilitation strategy for amputees. In this study, we report on 6 patients who had PVD requiring transtibial amputation (PVD-TTA) and either simultaneous or subsequent osseointegration (PVD-TTOI). Methods: Six patients (aged 36 to...

Central acetabular defects are rare, and have been described using various terminologies (notches, fossae, pits). They are generally regarded as normal variants and often overlooked. This case series reviews five cases (age range 9-14 years) where presentation included hip pain and no alternative pathology was found. The defects tend to be bilatera...

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Su...

Introduction Lower extremity amputation uniformly impairs a person’s vocational, social and recreational capacity. Rehabilitation in traditional socket prostheses (TSP) is associated with a spectrum of complications involving the socket-residuum interface which lead to reduced prosthetic use and quality of life. Osseointegration has recently emerge...

Subspine impingement is an extra-articular form of impingement around the hip joint. The word ‘impinge’ is a verb defined in Cambridge Dictionary as ‘to have an effect on something, often causing problems by limiting it in some way’. Femoroacetabular impingement (FAI) as a cause of hip pain was brought to academic attention by Ganz et al. [1]. Trad...

Joint movements are essential for the function of human body during the activities of daily living and sports. The movement of human joints varies from normal to those which have an increased range of joint movement (gymnasts) to those with extreme disabling laxity in patients with a connective tissue disorder (Ehlers Danlos Syndrome). "Hypermobili...

Distal biceps femoris tendon is an unusual site of calcific tendinitis and a rare cause of knee pain. We present a case of 72-year-old lady who presented with a six-month history of pain over the lateral aspect of knee. Subsequent imaging demonstrated calcific deposits within the biceps femoris tendon substance. She was then successfully treated wi...

There are concerns regarding early years' training for junior doctors in Trauma & Orthopaedic Surgery (T&O) in the United Kingdom. Our primary objective was to audit the clinical activities undertaken by junior doctors working in Trauma & Orthopaedic (T&O) surgery in the National Health Service (NHS) in a typical workweek. A secondary objective was...

This study aims to determine the epidemiology of shoulder dislocations in Teeside area to help organise upper limb service provision. A and E records were searched within two large university hospitals covering Teeside population to identify all presentations coded as shoulder dislocation between October 2005 and March 2015. Radiological imaging fo...

Our aim was to study the functional and radiological outcomes following MPFL reconstruction. 108 patients undergoing MPFL reconstruction between January 2009 and July 2014 were identified. Demographic details, functional outcomes and complications were studied. A random cohort of 21 knees was selected to study pre-operative radiological findings wi...

Ankle sprain is a common sports injury, which settles with rest, analgesia and physiotherapy. A small number of patients present late with persistent unexplained ankle pain. Magnetic resonance imaging (MRI) and ankle arthroscopy is used for diagnostics and therapeutic purposes. Our aim was to study the operative findings, outcomes and MRI findings...

A 52-year-old man sustained a sternal fracture after a blunt traumatic chest injury. He was in severe pain in the intensive care unit, which resulted in difficulty breathing and increased analgesic requirement, and a decision was made to stabilize his manubrial fracture. Orthopaedic and thoracic surgeons jointly performed open reduction and interna...

Background: The aim of the present study was to investigate the relationship between generalised ligamentous laxity (GLL) and requirement for revision anterior cruciate ligament (ACL) reconstruction. Methods: The study cohort consisted of 139 patients undergoing primary ACL reconstruction, 44 patients undergoing revision ACL surgery and a contro...

Objectives: A variety of operative techniques have been described as under the term 'Bristow-Latarjet' procedure. This review aims to define the original procedure, and compare the variation in techniques described in the literature, assessing any effect on clinical outcomes. Materials and methods: A systematic review of 24 studies was performed...

13 patients (11 male and 2 females) were studied to assess the relationship between surgical scars following open shoulder stabilisation or primary ACL reconstruction and the expression of collagen V, decorin and Biglycan in skin. The grading of stain on immunohistochemistry was done on a 0–4 scale. Surgical scar was scored on 1–3 scale by 2 observ...

Biological ACL graft failure is a complex pathological entity. This results in an atonic, disorganised and non-viable graft. Our aim was to study biological failure in patients undergoing revision ACL reconstruction. We studied 72 patients undergoing revision ACL reconstruction between 1996 and 2010. These patients were divided into redundant ACL (...

ACL injury can affect activities of daily living and participation in sports. ACL rehabilitation can improve patient’s symptoms. Our aim was to study the epidemiology of ACL injuries and functional outcomes following rehabilitation. Patients undergoing ACL rehabilitation between 2009 and 2014 were identified from a prospective physiotherapy databas...

ACL rupture is a common sports injury. ACL deficiency affect activities of daily living and participation in sports. Surgical treatment is indicated following the failure of the non-operative management. Our aim was to study the functional outcomes following ACL reconstruction. Patients undergoing ACL reconstruction between January 2009 and July 20...

Hip arthroscopy has evolved over the last decade. There had been an increase in the demand for hip arthroscopies from patients and their general practitioners due to available information and better diagnostic modalities like Magnetic resonance Arthrography. The senior author has performed 132 hip arthroscopies since 2010. This study was performed...

This study was performed to assess the incidence of generalized ligament laxity (GLL) in patients undergoing hip arthroscopy for intraarticular hip pathology diagnosed by clinical examination and confirmed with magnetic resonance arthrography. Prospective data were collected for 27 patients between Feb and May 2013 under the care of a specialist hi...

Hypermobility is associated with increased risk of sporting injuries. This study was performed to assess the risk of failure following primary ACL reconstruction in patients with hypermobility. Prospective data were collected for 28 patients undergoing primary ACL reconstruction between October 2008 and July 2009 including demographic details, spor...

There is a growing trend to treat displaced midshaft clavicular fractures with primary open reduction and plate fixation; whether such treatment results in improved patient outcomes is debatable. The aim of this multicenter, single-blinded, randomized controlled trial was to compare union rates, functional outcomes, and economic costs for displaced...

BACKGROUND: There is a growing trend to treat displaced midshaft clavicular fractures with primary open reduction and plate fixation; whether such treatment results in improved patient outcomes is debatable. The aim of this multicenter, single-blinded, randomized controlled trial was to compare union rates, functional outcomes, and economic costs f...

Hypermobility is associated with increased risk of sporting injuries. This study was performed to assess the risk of recurrent shoulder dislocations in patients with hypermobility. Prospective data was collected for 38 patients with primary shoulder dislocations between October 2008 and July 2009 including demographic details, contact sport played,...

Tibial shaft fracture is a common sports injury in young athletic population. Open fractures can result in significant morbidity. Our aim was to study the epidemiology, severity and soft tissue coverage of sports related open tibial shaft fractures in the southeast of Scotland over the last 22 years. We identified 502 patients from our prospective...

Background Shoulder dislocation is a common sporting injury. Glenoid deficiency is thought to be a risk factor for recurrent shoulder dislocations. This study was performed to assess the role of CT scan in predicting recurrence following primary traumatic anterior shoulder dislocation. Methods Prospective data was collected for 39 patients followin...

Anterior cruciate ligament (ACL) rupture is a common sporting injury. Reconstruction of the ruptured ACL is accepted as standard treatment for athletes as it allows them to resume sporting activities. Revision reconstruction of the ACL is becoming a common operation following the failure of primary graft. This study looked at the aetiology of prima...

Back pain is a common problem in all age groups. Different risk factors have been identified including high BMI, Smoking, alcohol, and psychological history. The aim of our study was to identify if there was a difference in the incidence of these risk factors in different age groups. We collected data prospectively for 26 consecutive patients admit...

Anterior cruciate ligament (ACL) injuries are common in athletic population. Hyperlaxity is thought to be a risk factor for ACL injuries and results in stretched scar following surgery. The aim of our study was to investigate the relationship between the strength of the knee skin and hyperlaxity assessed by the Beighton score. Prospective data was...

Back pain is common in athletes and different risk factors are known to aggravate it. This study was performed to assess the incidence of generalised ligament laxity in patients admitted with severe back pain. Prospective data was collected for patients admitted with severe back pain between Jan 2011 and March 2011 including demographic details, MR...

Posterior glenohumeral dislocation is less common than anterior dislocation, and less is known about its epidemiology, functional outcome, and complications. The purposes of this study were to determine the epidemiology and demographics of posterior dislocations and to assess the risk of recurrence and the functional outcome after treatment. We per...

Introduction Cruciate ligament ruptures and shoulder dislocations are often caused by trauma, but predisposing intrinsic factors might also influence the risk. Decorin and biglycan are members of the small leucine rich proteoglycans (SLRP's) family which are important constituents of interstitial extracellular matrices (ECM) and play important role...

Introduction Cruciate ligament ruptures and shoulder dislocations are often caused by trauma, but predisposing intrinsic factors might also influence the risk. Collagen type V is widely distributed in tissues and helps regulate the diameters of fibrils of the abundant collagen type I. Mutations in its genes have been identified which can result in...

Background:{BR}Intra-articular steroid injection with local anaesthetic is commonly used as a diagnostic tool to differentiate between hip and spine pathology. The aim of our study was to identify the risk of avascular necrosis (AVN) after intra-articular steroid injection of the hip.{BR}Methods: {BR}We conducted a retrospective review of 103 patie...

This study assessed the incidence of generalised ligament laxity in patients presented with meniscal injuries. Prospective data were collected for 33 patients undergoing meniscal surgery, and a control group of 43 patients with clavicle fractures between June 2008 and July 2009, including demographic details, mechanism of injury and hyperlaxity. Cl...

Shoulder dislocation is a common sporting injury. Recent studies suggest a higher rate of recurrence in the presence of glenoid rim fracture (bony Bankart lesion). The authors looked at the incidence of glenoid rim fracture, glenoid flattening and Hill-Sachs defect after recurrent shoulder dislocations. A prospective study was conducted in the Trau...

This study was performed to assess the incidence of generalised ligament laxity in patients presented with shoulder dislocations. Prospective data were collected for patients presented with shoulder dislocations between August 2008 and August 2009 under the care of a specialist shoulder surgeon including demographic details, types of dislocation, m...

Displaced fractures of the lateral end of the clavicle in young patients have a high incidence of nonunion and a poor functional outcome after conservative management. Operative treatment is therefore usually recommended. However, current techniques may be associated with complications which require removal of the fixation device. We have evaluated...

We treated 47 patients with a mean age of 57 years (22 to 88) who had a proximal humeral fracture in which there was a severe varus deformity, using a standard operative protocol of anatomical reduction, fixation with a locking plate and supplementation by structural allografts in unstable fractures. The functional and radiological outcomes were re...

Radiofrequency microdebridement for Achilles tendinosis is a relatively new technique. We report a case of Achilles tendon rupture in a patient eight weeks after coblation for his right insertional Achilles tendinosis. We believe that this is the first reported case of Achilles tendon rupture following this new treatment of radiofrequency microdebr...

J.Orthopaedics 2008;5(3)e11

AbstractBackground: Edinburgh Orthopaedic Trauma Unit is a tertiary referral centre for south-east of Scotland. An Audit to determine the current practice of this busy fracture clinic was performed. Patients and Methods: A Prospective study of three consecutive fracture clinics under the care of a single consultant Trauma and Orthopaedic surgeon wa...

The recent technological developments in implant design and the wider availability of bone graft substitutes have stimulated a renaissance in the operative treatment of complex proximal humeral fractures. However, one of the remaining problems of the operative treatment of these injuries has been the limited surgical access to the posterior aspect...

Complex posterior fracture-dislocations of the shoulder are rare and often associated with poor long-term function regardless of the choice of treatment. The purposes of this study were to evaluate the epidemiology and pathological anatomy of posterior fracture-dislocations of the shoulder and to assess the clinical and radiographic outcomes of a s...

Spontaneous biloma is an uncommon entity. We report a case of subcapsular biloma in an elderly patient with a nonobstructed biliary channel, without prior history of surgery, instrumentation, or trauma. Computed tomography (CT) and magnetic resonance imaging are described. We believe that this is the first reported case of spontaneous subcapsular b...

Over a seven-year period we treated a consecutive series of 58 patients, 20 men and 38 women with a mean age of 66 years (21 to 87) who had an acute complex anterior fracture-dislocation of the proximal humerus. Two patterns of injury are proposed for study based upon a prospective assessment of the pattern of soft-tissue and bony injury and the de...