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  1. Article: The role of hydroxyapatite coating in joint replacement surgery - Key considerations.

    Botterill, Jonathan / Khatkar, Harman

    Journal of clinical orthopaedics and trauma

    2022  Volume 29, Page(s) 101874

    Abstract: The use of a porous hydroxyapatite (HA) coating has definitively increased the durability and biocompatibility of joint replacement prostheses (JRP) since its introduction. This article will contextualise the properties of porous HA and relate these ... ...

    Abstract The use of a porous hydroxyapatite (HA) coating has definitively increased the durability and biocompatibility of joint replacement prostheses (JRP) since its introduction. This article will contextualise the properties of porous HA and relate these characteristics to its clinical function. Novel strategies to encourage osseointegration will also be explored, alongside their clinical relevance. All major literature databases were scrutinised for literature relevant to the scope of our review. The role of Hydroxyapatite was evaluated, alongside further strategies to augment bone ingrowth. HA coatings remain the most optimal coating for widespread clinical use. Advantages are conferred due to the method of application, the tribology and the biocompatibility of the material. Further strategies are available to augment bone ingrowth, pertaining to biological modifications and implantation of external factors. An evaluation of the literature has described the relative long term performance of the HA coated JRPs both in isolation and when compared with cemented prosthesis. Metanalyses have shown HA coated JRPs to perform as well as cemented prosthesis in terms of survivability over both short and long term follow ups. Concerning strategies to augment osseointegration, consideration should be given to form and function of the coating surface, as this provides the basis for cell adherence, proliferation, and differentiation.
    Language English
    Publishing date 2022-04-22
    Publishing country India
    Document type Journal Article ; Review
    ZDB-ID 2596956-0
    ISSN 2213-3445 ; 0976-5662
    ISSN (online) 2213-3445
    ISSN 0976-5662
    DOI 10.1016/j.jcot.2022.101874
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Stem Cell Therapy in the Management of Fracture Non-Union - Evaluating Cellular Mechanisms and Clinical Progress.

    Khatkar, Harman / See, Abbas

    Cureus

    2021  Volume 13, Issue 3, Page(s) e13869

    Abstract: Bone, as a physiological and anatomical construct, displays remarkable intrinsic healing capacity. The overwhelming majority of fractures will heal satisfactorily, if aligned anatomically, compressed and immobilised appropriately. Of the 10% of fractures ...

    Abstract Bone, as a physiological and anatomical construct, displays remarkable intrinsic healing capacity. The overwhelming majority of fractures will heal satisfactorily, if aligned anatomically, compressed and immobilised appropriately. Of the 10% of fractures that do not heal, even under ideal mechanical and biological conditions, further consideration must be given to augment bone healing. Management strategies for non-union pose a significant clinical challenge to the practicing orthopaedic surgeon. Stem cell therapy is beginning to demonstrate significant potential for augmented bone repair in the context of non-union. This review attempts to contextualise the function of stem cells within this clinical setting, reviewing the relevant cellular mechanisms and clinical applications. From evaluating the literature base, there is a lack of high-quality evidence examining the role of mesenchymal stem cells (MSCs) within this research focus. Appropriately designed randomised controlled trials are required to evaluate this research area further, with a view to guiding future treatment options for the practicing orthopaedic surgeon.
    Language English
    Publishing date 2021-03-13
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.13869
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: The environmental impact of orthopaedic surgery: assessing strategies for change.

    Khatkar, Harman / Kyrdiakides, Jonathon / McNamara, John

    British journal of hospital medicine (London, England : 2005)

    2022  Volume 83, Issue 11, Page(s) 1–4

    Abstract: Climate change poses one of the most critical threats to humanity. Surgical care needs to be considered in relation to the impending climate emergency. Little thought appears to have been given to the role of operating departments as a high-yield target ... ...

    Abstract Climate change poses one of the most critical threats to humanity. Surgical care needs to be considered in relation to the impending climate emergency. Little thought appears to have been given to the role of operating departments as a high-yield target for environmental change. This article evaluates the environmental impact of orthopaedic surgery, focusing on anaesthesia, waste management and surgical hardware. Developing 'green' operating protocols should be the minimum expectation of orthopaedic departments. Just as the management of complex surgical pathology requires a multidisciplinary approach, mitigating the environmental impact of surgical endeavour requires collective action and buy-in.
    MeSH term(s) Humans ; Orthopedics ; Orthopedic Procedures ; Anesthesia ; Anesthesiology ; Environment
    Language English
    Publishing date 2022-11-15
    Publishing country England
    Document type Journal Article ; Review
    ISSN 1750-8460
    ISSN 1750-8460
    DOI 10.12968/hmed.2022.0388
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: A quality improvement project: Reducing the number of unnecessary plain abdominal radiographs performed in the emergency department of a London district general hospital.

    Kyriakides, Jonathon / Khamar, Rahul / Khani, Aria / Khatkar, Harman

    Journal of family medicine and primary care

    2022  Volume 11, Issue 1, Page(s) 190–193

    Abstract: Background: Inappropriate completion of abdominal radiographs results in unnecessary exposure to ionizing radiation. This quality improvement project aimed to reduce the number of inappropriate abdominal radiographs performed in the emergency department. ...

    Abstract Background: Inappropriate completion of abdominal radiographs results in unnecessary exposure to ionizing radiation. This quality improvement project aimed to reduce the number of inappropriate abdominal radiographs performed in the emergency department.
    Materials and methods: Abdominal radiograph request forms were analyzed with reference to the Royal College of Radiologists (RCR) iRefer guidance. A teaching session was then delivered to ED clinicians and posters were disseminated within the department. Post-intervention data collection followed.
    Results: Following the intervention, there was an increase in the proportion of abdominal radiographs meeting iRefer guidance, which was accompanied by an increased diagnostic yield of these investigations. There was a reduction in the number of requests post-intervention.
    Conclusions: Our interventions helped increase awareness of both the guidelines and radiation dose associated with each study. Routine education of the iRefer guidelines will help reduce inappropriate requests. This in turn will reduce unnecessary radiation exposure, whilst also reducing the financial burden.
    Language English
    Publishing date 2022-01-31
    Publishing country India
    Document type Journal Article
    ZDB-ID 2735275-4
    ISSN 2278-7135 ; 2249-4863
    ISSN (online) 2278-7135
    ISSN 2249-4863
    DOI 10.4103/jfmpc.jfmpc_1193_21
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  5. Article ; Online: A surgical trainee's perspective on: Training in polytrauma management in medical curricula: A scoping review.

    Khatkar, Harman / Prokopenko, Max

    Medical teacher

    2020  Volume 43, Issue 9, Page(s) 1097

    MeSH term(s) Curriculum ; Emergency Medicine/education ; Humans ; Multiple Trauma
    Language English
    Publishing date 2020-12-23
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 424426-6
    ISSN 1466-187X ; 0142-159X
    ISSN (online) 1466-187X
    ISSN 0142-159X
    DOI 10.1080/0142159X.2020.1863935
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    In stock of ZB MED Cologne/Königswinter

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  6. Article: A District General Hospital Trauma Service Response to COVID-19: Lessons Learnt.

    Prokopenko, Max / Khatkar, Harman

    Cureus

    2020  Volume 12, Issue 12, Page(s) e12087

    Abstract: Objective: This article seeks to evaluate and outline the changes made to the trauma and orthopaedic department in a district general hospital in the United Kingdom during the COVID-19 pandemic. We detail the approach in relation to surgical management, ...

    Abstract Objective: This article seeks to evaluate and outline the changes made to the trauma and orthopaedic department in a district general hospital in the United Kingdom during the COVID-19 pandemic. We detail the approach in relation to surgical management, workforce optimisation and our general reflections as a department.
    Methods: We interviewed, collated and have subsequently described the adaptations implemented by our department. We have collected their shared strategy and reflections on how the COVID-19 pandemic affected our department.
    Results: Alterations were implemented to mitigate the effects of the COVID-19 pandemic. A strategy focused on ensuring the workforce remained healthy, and patient care pathways were altered as minimally as possible.
    Conclusions:  As a unit, a sense of heightened vigilance needs to remain for the foreseeable future. Decisive action by departmental leadership, alongside a cohesive and open, has allowed for our trauma service to continue largely unchanged. This analysis serves as an important aide-memoire for future periods of extreme uncertainty.
    Language English
    Publishing date 2020-12-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.12087
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  7. Article ; Online: A commentary on "The WHO safer surgery checklist time out procedure revisited: Strategies to optimise compliance and safety" [International Journal of Surgery 69 (2019) 19-22].

    Khatkar, Harman / Prokopenko, Max

    International journal of surgery (London, England)

    2019  Volume 72, Page(s) 135–136

    MeSH term(s) Checklist ; Humans ; Medical Errors ; Patient Safety
    Language English
    Publishing date 2019-11-09
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 2212038-5
    ISSN 1743-9159 ; 1743-9191
    ISSN (online) 1743-9159
    ISSN 1743-9191
    DOI 10.1016/j.ijsu.2019.10.051
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  8. Article: The role of specialist nurses in delivering effective care in a tertiary sarcoma referral service.

    Rajasekaran, Raja Bhaskara / Khatkar, Harman / Kotecha, Sanjeev

    Journal of clinical orthopaedics and trauma

    2021  Volume 20, Page(s) 101501

    Abstract: Musculoskeletal sarcomas are rare cancers with an incidence of less than 1% of all cancers. Management of these tumors requires multidisciplinary care comprising of numerous specialists. Critical decisions following collaborative discussion among ... ...

    Abstract Musculoskeletal sarcomas are rare cancers with an incidence of less than 1% of all cancers. Management of these tumors requires multidisciplinary care comprising of numerous specialists. Critical decisions following collaborative discussion among treating specialists followed by timely communication and starting prompt treatment are vital in delivering care in such rare sarcomas. While musculoskeletal surgeons, radiologists, and clinical oncologists are well known, the role of specialist nurses has been less described. They form a vital pillar in any tertiary sarcoma service by assisting in collaborative care, having consultations in nurse-led clinics, offering psychological support, imparting details of treatment to patient and helping in palliative care. This narrative review focuses on the role of trained specialist nurses in a tertiary sarcoma service and gives insight into their vital role in delivering timely, coordinated, effective care.
    Language English
    Publishing date 2021-07-09
    Publishing country India
    Document type Journal Article
    ZDB-ID 2596956-0
    ISSN 2213-3445 ; 0976-5662
    ISSN (online) 2213-3445
    ISSN 0976-5662
    DOI 10.1016/j.jcot.2021.101501
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  9. Article: Preventing Venous Thromboembolism after elective total hip arthroplasty surgery - are the current guidelines appropriate? Venous thromboembolism prophylaxis in elective total hip arthroplasty surgery.

    Khatkar, Harman / Elahi, Zain / See, Abbas / McDonald, Stephen / Neal-Smith, Greg

    Journal of clinical orthopaedics and trauma

    2022  Volume 26, Page(s) 101782

    Abstract: Introduction: Venous Thromboembolism after elective Total Hip Arthroplasty surgery is a well-recognised complication, resulting in fatal pulmonary embolism, post thrombotic syndrome and recurrent thrombotic episodes. Guidelines developed by clinical ... ...

    Abstract Introduction: Venous Thromboembolism after elective Total Hip Arthroplasty surgery is a well-recognised complication, resulting in fatal pulmonary embolism, post thrombotic syndrome and recurrent thrombotic episodes. Guidelines developed by clinical organisations attempt to provide evidence-based recommendations to clinicians.
    Methods: This narrative review evaluated the current available literature in relation to the available guidelines, to evaluate whether the current major guidelines reflect the evidence base. All major clinical guidelines were collated through database searching, alongside the relevant clinical studies.
    Principal findings: The promotion of a multi-modal approach, combining mechanical and chemical prophylaxis, does appear to be well validated, with mechanical prophylaxis offering positive clinical effects with little negative clinical consequence. Within the current guidelines surrounding VTE prevention in the elective-THA patient, there does appear to be a lack of prescription in relation to risk stratification and adopting personalised approaches for specific patient subsets.
    Conclusion: We suggest moving away from protocolisation of VTE prevention, given the evidence base is not fully developed to allow a 'one-size-fits-all' approach.
    Language English
    Publishing date 2022-01-25
    Publishing country India
    Document type Journal Article ; Review
    ZDB-ID 2596956-0
    ISSN 2213-3445 ; 0976-5662
    ISSN (online) 2213-3445
    ISSN 0976-5662
    DOI 10.1016/j.jcot.2022.101782
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  10. Article ; Online: The outcomes of total hip replacement in osteonecrosis versus osteoarthritis: a systematic review and meta-analysis.

    Salman, Loay A / Hantouly, Ashraf T / Khatkar, Harman / Al-Ani, Abdallah / Abudalou, Abedallah / Al-Juboori, Mohammed / Ahmed, Ghalib

    International orthopaedics

    2023  Volume 47, Issue 12, Page(s) 3043–3052

    Abstract: Purpose: This systematic review and meta-analysis aimed to compare the outcomes of THA in patients with osteonecrosis (ON) and those with osteoarthritis (OA).: Methods: Four databases were searched from inception till December 2022 for original ... ...

    Abstract Purpose: This systematic review and meta-analysis aimed to compare the outcomes of THA in patients with osteonecrosis (ON) and those with osteoarthritis (OA).
    Methods: Four databases were searched from inception till December 2022 for original studies that compared the outcomes of THA in ON and OA. The primary outcome was the revision rate; the secondary outcomes were dislocation and Harris hip score. This review was conducted in line with PRISMA guidelines, and the risk of bias was assessed using the Newcastle-Ottawa scale.
    Results: A total of 14 observational studies with 2,111,102 hips were included, with a mean age of 50.83 ± 9.32 and 55.51 ± 8.95 for ON and OA groups, respectively. The average follow-up was 7.25 ± 4.6 years. There was a statistically significant difference in revision rate between ON and OA patients in favour of OA (OR: 1.576; 95%CI: 1.24-2.00; p-value: 0.0015). However, dislocation rate (OR: 1.5004; 95%CI: 0.92-2.43; p-value: 0.0916) and Haris hip score (HHS) (SMD: - 0.0486; 95%CI: - 0.35-0.25; p-value: 0.6987) were comparable across both groups. Further sub-analysis adjusting for registry data also showed similar results between both groups.
    Conclusion: A higher revision rate, periprosthetic fracture and periprosthetic joint infection following total hip arthroplasty were associated with osteonecrosis of the femoral head compared with osteoarthritis. However, both groups had similar dislocation rates and functional outcome measures. This finding should be applied in context due to potential confounding factors, including patient's age and activity level.
    MeSH term(s) Humans ; Adult ; Middle Aged ; Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Hip/methods ; Osteonecrosis/surgery ; Osteonecrosis/etiology ; Osteoarthritis/surgery ; Osteoarthritis/etiology ; Joint Dislocations/surgery ; Periprosthetic Fractures/surgery ; Reoperation ; Hip Prosthesis/adverse effects ; Treatment Outcome ; Retrospective Studies ; Osteoarthritis, Hip/surgery ; Osteoarthritis, Hip/etiology
    Language English
    Publishing date 2023-03-11
    Publishing country Germany
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review
    ZDB-ID 80384-4
    ISSN 1432-5195 ; 0341-2695
    ISSN (online) 1432-5195
    ISSN 0341-2695
    DOI 10.1007/s00264-023-05761-6
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