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  1. Article ; Online: A meta-analysis of the incidence of infections following open tibia fractures and the microorganisms that cause them in high-, middle- and low-income countries.

    Chebli, Djenna / Dhaif, Fatema / Ridha, Ali / Schade, Alexander / Khatri, Chetan

    Tropical doctor

    2024  , Page(s) 494755241232171

    Abstract: Open tibia fractures are devastating, life changing injuries, with infection associated with substantial morbidity to the patient. Reducing infection is a research priority, but before interventional studies can be designed, the incidence of infection ... ...

    Abstract Open tibia fractures are devastating, life changing injuries, with infection associated with substantial morbidity to the patient. Reducing infection is a research priority, but before interventional studies can be designed, the incidence of infection following this injury needs to be better defined. Our aim was to estimate the global incidence of infection following an open tibia fracture. A systematic review was performed of MEDLINE, EMBASE, Central Register of Controlled Trials (CENTRAL), Web of Science and Global Index Medicus. We included randomised controlled trials with more than ten participants which reported infections after open diaphyseal or distal fractures (AO 42 or 43). Primary outcome was deep infection according to the Centres for Disease Control and Prevention criteria. Secondary outcome included causative micro-organisms. A meta-analysis using a random effects model to assess incidence and between-treatment effects was performed. Thirteen studies including 1463 adults from seven middle-income countries, seven high-income countries and one low-income country were included. The incidence of infection was 12.12 person-years (95% CI 7.95-18.47). A subgroup analysis compared external fixation and intramedullary nailing showed no difference between infection rates. There were limited data on organisms, but
    Language English
    Publishing date 2024-02-27
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 193169-6
    ISSN 1758-1133 ; 0049-4755
    ISSN (online) 1758-1133
    ISSN 0049-4755
    DOI 10.1177/00494755241232171
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  2. Article ; Online: Clinically Meaningful Achievement in Outcomes After Subacromial Balloon Spacer Implantation: Letter to the Editor.

    Khatri, Chetan / Ridha, Ali / Ahmed, Imran

    The American journal of sports medicine

    2023  Volume 51, Issue 12, Page(s) NP43–NP44

    MeSH term(s) Humans ; Rotator Cuff Injuries ; Arthroscopy
    Language English
    Publishing date 2023-09-30
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 197482-8
    ISSN 1552-3365 ; 0363-5465
    ISSN (online) 1552-3365
    ISSN 0363-5465
    DOI 10.1177/03635465231184386
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  3. Article ; Online: Robotic trials in arthroplasty surgery.

    Khatri, Chetan / Metcalfe, Andrew / Wall, Peter / Underwood, Martin / Haddad, Fares S / Davis, Edward T

    The bone & joint journal

    2024  Volume 106-B, Issue 2, Page(s) 114–120

    Abstract: Total hip and knee arthroplasty (THA, TKA) are largely successful procedures; however, both have variable outcomes, resulting in some patients being dissatisfied with the outcome. Surgeons are turning to technologies such as robotic-assisted surgery in ... ...

    Abstract Total hip and knee arthroplasty (THA, TKA) are largely successful procedures; however, both have variable outcomes, resulting in some patients being dissatisfied with the outcome. Surgeons are turning to technologies such as robotic-assisted surgery in an attempt to improve outcomes. Robust studies are needed to find out if these innovations are really benefitting patients. The Robotic Arthroplasty Clinical and Cost Effectiveness Randomised Controlled Trials (RACER) trials are multicentre, patient-blinded randomized controlled trials. The patients have primary osteoarthritis of the hip or knee. The operation is Mako-assisted THA or TKA and the control groups have operations using conventional instruments. The primary clinical outcome is the Forgotten Joint Score at 12 months, and there is a built-in analysis of cost-effectiveness. Secondary outcomes include early pain, the alignment of the components, and medium- to long-term outcomes. This annotation outlines the need to assess these technologies and discusses the design and challenges when conducting such trials, including surgical workflows, isolating the effect of the operation, blinding, and assessing the learning curve. Finally, the future of robotic surgery is discussed, including the need to contemporaneously introduce and evaluate such technologies.
    MeSH term(s) Humans ; Robotic Surgical Procedures/methods ; Arthroplasty, Replacement, Knee/methods ; Knee Joint/surgery ; Arthroplasty, Replacement, Hip ; Pain/etiology ; Osteoarthritis, Knee/surgery ; Osteoarthritis, Knee/etiology ; Treatment Outcome
    Language English
    Publishing date 2024-02-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 2697156-2
    ISSN 2049-4408 ; 2049-4394
    ISSN (online) 2049-4408
    ISSN 2049-4394
    DOI 10.1302/0301-620X.106B2.BJJ-2023-0711.R1
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  4. Article ; Online: Item Response Theory Validation of the Forgotten Joint Score for Persons Undergoing Total Knee Replacement.

    Khatri, Chetan / Harrison, Conrad J / Clement, Nick D / Scott, Chloe E H / MacDonald, Deborah / Metcalfe, Andrew J / Rodrigues, Jeremy N

    The Journal of bone and joint surgery. American volume

    2024  

    Abstract: Background: The Forgotten Joint Score (FJS), a commonly used patient-reported outcome measure, was developed without fully confirming assumptions such as unidimensionality (all items reflect 1 underlying factor), appropriate weighting of each item in ... ...

    Abstract Background: The Forgotten Joint Score (FJS), a commonly used patient-reported outcome measure, was developed without fully confirming assumptions such as unidimensionality (all items reflect 1 underlying factor), appropriate weighting of each item in scoring, absence of differential item functioning (in which different groups, e.g., men and women, respond differently), local dependence (pairs of items are measuring only 1 underlying factor), and monotonicity (persons with higher function have a higher score). We applied item response theory (IRT) to perform validation of the FJS according to contemporary standards, and thus support its ongoing use. We aimed to confirm that the FJS reflects a single latent trait. In addition, we aimed to determine whether an IRT model could be fitted to the FJS.
    Methods: Participants undergoing primary total knee replacement provided responses to the FJS items preoperatively and at 6 and 12 months postoperatively. An exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Mokken analysis were conducted. A graded response model (GRM) was fitted to the data.
    Results: A total of 1,774 patient responses were analyzed. EFA indicated a 1-factor model (all 12 items reflecting 1 underlying trait). CFA demonstrated an excellent model fit. Items did not have equal weighting. The FJS demonstrated good monotonicity and no differential item functioning by sex, age, or body mass index. GRM parameters are reported in this paper.
    Conclusions: The FJS meets key validity assumptions, supporting its use in clinical practice and research. The IRT-adapted FJS has potential advantages over the traditional FJS: it provides continuous measurements with finer granularity between health states, includes individual measurement error, and can compute scores despite more missing data (with only 1 response required to estimate a score). It can be applied retrospectively to existing data sets or used to deliver individualized computerized adaptive tests.
    Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
    Language English
    Publishing date 2024-03-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 220625-0
    ISSN 1535-1386 ; 0021-9355
    ISSN (online) 1535-1386
    ISSN 0021-9355
    DOI 10.2106/JBJS.23.00814
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    Zs.MO 464: Show issues

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  5. Article ; Online: Diagnostic impacts on management of soft tissue injuries associated with tibial plateau fractures: A narrative review.

    Stephens, Alastair / Searle, Henry / Carlos, William / Gomindes, Austin / Pilarski, Adam / Syed, Farhan / Smith, Nicholas / Khatri, Chetan

    Injury

    2024  Volume 55, Issue 6, Page(s) 111546

    Abstract: Introduction: Currently there is no consensus on the need for investigating knee ligamentous and meniscal injuries in a patient with a tibial plateau fracture. Consequently, many soft tissue injuries are likely undiagnosed and therefore untreated. The ... ...

    Abstract Introduction: Currently there is no consensus on the need for investigating knee ligamentous and meniscal injuries in a patient with a tibial plateau fracture. Consequently, many soft tissue injuries are likely undiagnosed and therefore untreated. The impact this has on long term knee outcomes is not well defined. We aimed to identify the impacts of various diagnostic methods on the management of meniscal injuries associated with tibial plateau fractures and evaluate the clinical outcomes.
    Materials and methods: We performed a systematic review using Pubmed, Medline, Embase, CINAHL and Cochrane following Cochrane guidelines. We included studies that operatively managed tibial plateau fractures and soft tissue injuries, which were diagnosed with either preoperative MRI, intra-operative arthroscopy or arthrotomy.
    Results: 18 articles with 884 people, with a mean age of 46.4 years were included. Soft tissue injuries were detected on MRI (32-73%) and arthroscopy (12-70%), of which the most common were lateral meniscal injuries (7-64% of tibial plateau fractures). When identified by arthroscopy and arthrotomy, these injuries were almost always treated, either by repair or debridement. The clinical outcomes of these patients were poorly reported, with a heterogenous use of patient reported outcome measures, and follow up time points. There were no randomised trials or control groups for comparative analysis, however operative treatment yielded good to excellent outcomes.
    Conclusion: There is a high incidence of concomitant soft tissue injuries with tibial plateau fractures, particularly lateral meniscal injuries. There are 2 main approaches to meniscal injuries: surgeons who don't investigate, don't treat, whilst surgeons who do investigate often do surgically treat. Although studies that treated these injuries achieved good to excellent results, the currently available evidence doesn't confirm treatment superiority. As there is plausibility for better outcomes, randomised studies are needed to further investigate this clinical question.
    Language English
    Publishing date 2024-04-03
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 218778-4
    ISSN 1879-0267 ; 0020-1383
    ISSN (online) 1879-0267
    ISSN 0020-1383
    DOI 10.1016/j.injury.2024.111546
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  6. Article ; Online: What's important for recovery after a total knee replacement? A systematic review of mixed methods studies.

    Khatri, Chetan / Ahmed, Imran / Dhaif, Fatema / Rodrigues, Jeremy / Underwood, Martin / Davis, Edward T / Mitchell, Paul / Metcalfe, Andrew

    Archives of orthopaedic and trauma surgery

    2023  

    Abstract: Background: Understanding how patients perceive and prioritise various aspects of recovery following total knee replacement, including pain, function and return to activity, will help clinicians in pre-operative consultations by ensuring they ... ...

    Abstract Background: Understanding how patients perceive and prioritise various aspects of recovery following total knee replacement, including pain, function and return to activity, will help clinicians in pre-operative consultations by ensuring they effectively address patient concerns and managing their expectations.
    Aims: The aim of this study is to identify aspects of recovery that are important to people after a total knee replacement.
    Methods: Studies were identified from Medline, Embase, PsycInfo, Cochrane Library and Web of Science. This mixed methods review included all original study types (quantitative, qualitative, discrete choice experiments and mixed methods design). Reviews and non-peer-reviewed publications were excluded. Studies with participants (age ≥ 18 years) who had a primary TKR for osteoarthritis were included. Studies of people with unicompartmental knee, patella-femoral or revision knee replacement were excluded. Recovery attributes were extracted from individual papers and grouped into recovery themes.
    Results: A total of 23 studies with 8404 participants and 18 recovery themes were developed. The most frequently identified overarching theme was pain, followed by activities of daily living, mobility (walking), recreational activities, specific functional movements of the knee, use of walking aids, sexual activity and range of motion of the knee. Medical complications were an infrequently reported theme, however, was deemed to be high importance.
    Conclusions: Reducing pain, returning of activities and daily living and mobility are the three most frequently reported recovery domains for people after TKR. Clinicians should be aware of recovery themes, to ensure they are explored sufficiently when consenting for a TKR. Future research should aim to determine the relative importance of these attributes compared to each other. Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021253699.
    Language English
    Publishing date 2023-12-09
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 80407-1
    ISSN 1434-3916 ; 0003-9330 ; 0344-8444
    ISSN (online) 1434-3916
    ISSN 0003-9330 ; 0344-8444
    DOI 10.1007/s00402-023-05136-x
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  7. Article ; Online: The economic burden of open tibia fractures: A systematic review.

    Schade, Alexander T / Khatri, Chetan / Nwankwo, Henry / Carlos, William / Harrison, William J / Metcalfe, Andrew J

    Injury

    2021  Volume 52, Issue 6, Page(s) 1251–1259

    Abstract: Background: Open tibia fractures are a common injury following road traffic collisions and place a large economic burden on patients and healthcare systems. Summarising their economic burden is key to inform policy and help prioritise treatment.: ... ...

    Abstract Background: Open tibia fractures are a common injury following road traffic collisions and place a large economic burden on patients and healthcare systems. Summarising their economic burden is key to inform policy and help prioritise treatment.
    Methods: All studies were identified from a systematic search of Medline, Embase and the Cochrane Central Register of Controlled Trials. We included any human with a diagnosed open tibia fracture, following any intervention. The primary outcome was any costs reported or patient return to work status. Secondary outcomes included average length of stay, wage loss, absenteeism and complications such as infection, amputation and nonunion. Data was extracted and we performed a descriptive narrative summary.
    Results: We reviewed 1,204 studies from our searches. A total of 34 studies were included from 14 different countries. The average age was 37.7 years old and 76% of the patients were male. 6.5% were Gustilo I, 12% Gustilo II and 82% Gustilo III. Initial direct hospitalisation costs were reported to be between £356 to £126,479 with an average length of stay of 56 days (3.1-244). 89% of participants were working pre-injury, 60% fully returned to work, 17% returned to work part time or changed profession and 22% did not return to work at one-year. The most common complications reported were 22% infection, 11% nonunion and 16% amputation. Mean follow-up duration for the studies was 25 months.
    Conclusion: The economic burden of open tibia fractures varies greatly, but it is costly for both hospitals and patients. The current evidence is predominantly from high-income countries (HICs), especially the USA. Further research is required to investigate the costs of open tibia fractures using validated costing tools, especially in low-income countries (LICs), to help inform and direct policy.
    MeSH term(s) Accidents, Traffic ; Adult ; Amputation ; Cost of Illness ; Female ; Fractures, Open/surgery ; Humans ; Male ; Tibia ; Tibial Fractures/surgery
    Language English
    Publishing date 2021-02-14
    Publishing country Netherlands
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 218778-4
    ISSN 1879-0267 ; 0020-1383
    ISSN (online) 1879-0267
    ISSN 0020-1383
    DOI 10.1016/j.injury.2021.02.022
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  8. Article ; Online: Pressure of academic publishing for medical students: a student's perspective.

    Mahalingam, Jeevahan / Khatri, Chetan / Fitzgerald, J Edward

    Postgraduate medical journal

    2018  Volume 94, Issue 1112, Page(s) 367–368

    MeSH term(s) Biomedical Research/education ; Education, Medical, Undergraduate ; Humans ; Manuscripts as Topic ; Motivation ; Periodicals as Topic ; Publishing ; Research Personnel/education ; Students, Medical/psychology
    Language English
    Publishing date 2018-05-19
    Publishing country England
    Document type Letter
    ZDB-ID 80325-x
    ISSN 1469-0756 ; 0032-5473
    ISSN (online) 1469-0756
    ISSN 0032-5473
    DOI 10.1136/postgradmedj-2017-135440
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  9. Article ; Online: The meniscal tear outcome (METRO) review: A systematic review summarising the clinical course and outcomes of patients with a meniscal tear.

    Ahmed, Imran / Dhaif, Fatema / Khatri, Chetan / Parsons, Nicholas / Hutchinson, Charles / Staniszewska, Sophie / Price, Andrew / Metcalfe, Andrew

    The Knee

    2022  Volume 38, Page(s) 117–131

    Abstract: Background: Meniscal tears affect 222 per 100,000 of the population and can be managed non-operatively or operatively with an arthroscopic partial meniscectomy (APM), meniscal repair or meniscal transplantation. The purpose of this review is to ... ...

    Abstract Background: Meniscal tears affect 222 per 100,000 of the population and can be managed non-operatively or operatively with an arthroscopic partial meniscectomy (APM), meniscal repair or meniscal transplantation. The purpose of this review is to summarise the outcomes following treatment with a meniscal tear and explore correlations between outcomes.
    Method: A systematic review was performed of MEDLINE, EMBASE, AMED and the Cochrane Central Register of Controlled Trials to identify prospective studies describing the outcomes of patients with a meniscal tear. Comparisons were made of outcomes between APM and non-operative groups. Outcomes were graphically presented over time for all treatment interventions. Pearson's correlations were calculated between outcome timepoints.
    Results: 35 studies were included, 28 reported outcomes following APM; four following meniscal repair and three following meniscal transplant. Graphical plots demonstrated a sustained improvement for all treatment interventions. A moderate to very strong correlation was reported between baseline and three-month outcomes. In the medium term, there was small significant difference in outcome between APM and non-operative measures (SMD 0.17; 95 % CI 0.04, 0.29), however, this was not clinically significant.
    Conclusions: Patients with a meniscal tear demonstrated a sustained initial improvement in function scores, which was true of all treatments examined. APM may have little benefit in older people, however, previous trials did not include patients who meet the current indications for surgery as a result the findings should not be generalised to all patients with a meniscal tear. Further trials are required in patients who meet current operative indications.
    MeSH term(s) Aged ; Arthroscopy/adverse effects ; Humans ; Knee Injuries/etiology ; Knee Injuries/surgery ; Meniscectomy/adverse effects ; Menisci, Tibial/surgery ; Prospective Studies ; Tibial Meniscus Injuries/etiology ; Tibial Meniscus Injuries/surgery
    Language English
    Publishing date 2022-08-27
    Publishing country Netherlands
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 1200476-5
    ISSN 1873-5800 ; 0968-0160
    ISSN (online) 1873-5800
    ISSN 0968-0160
    DOI 10.1016/j.knee.2022.07.002
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  10. Article: Use of three-dimensional printing in preoperative planning in orthopaedic trauma surgery: A systematic review and meta-analysis.

    Morgan, Catrin / Khatri, Chetan / Hanna, Sammy A / Ashrafian, Hutan / Sarraf, Khaled M

    World journal of orthopedics

    2020  Volume 11, Issue 1, Page(s) 57–67

    Abstract: Background: With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in three-dimensional (3D) printing, there has been an increased interest in the concept. It has been shown ... ...

    Abstract Background: With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in three-dimensional (3D) printing, there has been an increased interest in the concept. It has been shown that 3D models allow surgeons to better visualise anatomy, aid in planning and performing complex surgery. It is however not clear how best to utilise the technique and whether this results in better outcomes.
    Aim: To evaluate the effect of 3D printing used in pre-operative planning in orthopaedic trauma surgery on clinical outcomes.
    Methods: We performed a comprehensive systematic review of the literature and a meta-analysis. Medline, Ovid and Embase were searched from inception to February 8, 2018. Randomised controlled trials, case-control studies, cohort studies and case series of five patients or more were included across any area of orthopaedic trauma. The primary outcomes were operation time, intra-operative blood loss and fluoroscopy used.
    Results: Seventeen studies (922 patients) met our inclusion criteria and were reviewed. The use of 3D printing across all specialties in orthopaedic trauma surgery demonstrated an overall reduction in operation time of 19.85% [95% confidence intervals (CI): (-22.99, -16.71)], intra-operative blood loss of 25.73% [95%CI: (-31.07, -20.40)], and number of times fluoroscopy was used by 23.80% [95%CI: (-38.49, -9.10)].
    Conclusion: Our results suggest that the use of 3D printing in pre-operative planning in orthopaedic trauma reduces operative time, intraoperative blood loss and the number of times fluoroscopy is used.
    Language English
    Publishing date 2020-01-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2649712-8
    ISSN 2218-5836
    ISSN 2218-5836
    DOI 10.5312/wjo.v11.i1.57
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