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Article: Day-case hip and knee arthroplasty: stages of care and the development of an institutional pathway.

Wignadasan, Warran / Haddad, Fares S

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

2023 Volume 84, Issue 12, Page(s) 1–11

Abstract: Day-case, or outpatient, arthroplasty is growing and has been adopted in healthcare systems because of its cost-effectiveness. A number of studies that reported on day-case total hip arthroplasty, total knee arthroplasty and unicompartmental knee ... ...

Abstract	Day-case, or outpatient, arthroplasty is growing and has been adopted in healthcare systems because of its cost-effectiveness. A number of studies that reported on day-case total hip arthroplasty, total knee arthroplasty and unicompartmental knee arthroplasty have shown that they can be performed successfully in a select group of patients. However, safety remains a concern, as a clear pathway, including discharge criteria, is not well described in the literature. This article outlines the stages of care involved in day-case hip and knee arthroplasty and gives insights from University College London Hospital's own evidence-based day-case arthroplasty pathway.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Knee ; Arthroplasty, Replacement, Hip ; Delivery of Health Care ; Patient Discharge ; London
Language	English
Publishing date	2023-12-27
Publishing country	England
Document type	Journal Article
ISSN	1750-8460
ISSN	1750-8460
DOI	10.12968/hmed.2023.0037
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Article ; Online: One- or two-stage reimplantation for infected total knee prosthesis?

Wignadasan, Warran / Ibrahim, Mazin / Haddad, Fares S

Orthopaedics & traumatology, surgery & research : OTSR

2022 Volume 109, Issue 1S, Page(s) 103453

Abstract: A prosthetic joint infection (PJI) is possibly the most significant potential complication of total knee arthroplasty (TKA) and is associated with substantial morbidity and socioeconomic burden. It is a devastating complication for both the patient and ... ...

Abstract	A prosthetic joint infection (PJI) is possibly the most significant potential complication of total knee arthroplasty (TKA) and is associated with substantial morbidity and socioeconomic burden. It is a devastating complication for both the patient and the surgeon alike. A two-stage revision approach for infected TKA has been the standard for surgical management; however, there is growing interest in single-stage revision surgery due to fewer procedures, reduced inpatient hospital stay and reduced costs to healthcare systems. A one-stage exchange is indicated when there is no sign of systemic sepsis and in cases where a microorganism has been isolated. It involves removal of the old prosthesis, debridement of all infected tissue, a copious washout and re-draping, and finally, re-implantation of a new prosthesis. The two-stage approach involves the use of an antibiotic spacer before the second stage is carried out. The length of time between the stages is discussed. Patients with a PJI should be managed by a multidisciplinary team. We recommend these patients are managed in specialist arthroplasty centres by high volume revision arthroplasty specialists.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Knee/adverse effects ; Knee Prosthesis/adverse effects ; Prosthesis-Related Infections/surgery ; Prosthesis-Related Infections/complications ; Anti-Bacterial Agents/therapeutic use ; Reoperation/adverse effects ; Replantation ; Arthritis, Infectious/surgery ; Retrospective Studies
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-10-24
Publishing country	France
Document type	Journal Article ; Review
ISSN	1877-0568
ISSN (online)	1877-0568
DOI	10.1016/j.otsr.2022.103453
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Article: Short term outcomes following robotic arm-assisted lateral unicompartmental knee arthroplasty.

Wignadasan, Warran / Chang, Justin / Fontalis, Andreas / Plastow, Ricci / Haddad, Fares S

Frontiers in surgery

2023 Volume 10, Page(s) 1215280

Abstract: Introduction: Robotic-arm assisted medial unicompartmental knee arthroplasty (RA-UKA) is associated with improved accuracy of implant positioning and excellent early functional outcomes. However, there is paucity of evidence regarding outcomes following ...

Abstract	Introduction: Robotic-arm assisted medial unicompartmental knee arthroplasty (RA-UKA) is associated with improved accuracy of implant positioning and excellent early functional outcomes. However, there is paucity of evidence regarding outcomes following RA-UKA for isolated lateral compartment osteoarthritis. The purpose of this study was to assess the short-term clinical and patient reported outcomes of lateral compartment UKA, utilising robotic-arm assistance. Methods: This was a retrospective study of prospectively collected data of 21 consecutive patients who underwent lateral RA-UKA. The study included 9 (42.9%) males and 12 (57.1%) females with a mean age of 63.4 ± 9.2 years. The Oxford Knee Score (OKS) was measured pre-operatively and at 1-year post-operatively, while range of motion (ROM) and complications were also recorded. Results: There was significant improvement of OKS at 1 year's follow up compared with the baseline score (21.8 ± 5.6 vs. 45.2 ± 2.8 respectively; Conclusion: In our study, lateral RA-UKA resulted in significant improvements in clinical and patient reported outcomes with low complications rates. Further long-term comparative studies are needed to assess the utility of lateral RA-UKA vs. conventional UKA.
Language	English
Publishing date	2023-12-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2023.1215280
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Article ; Online: Factors associated with decreased length of stay following robotic arm-assisted and conventional total hip arthroplasty.

Fontalis, Andreas / Wignadasan, Warran / Mancino, Fabio / The, Crystallynn S / Magan, Ahmed / Plastow, Ricci / Haddad, Fares S

The bone & joint journal

2024 Volume 106-B, Issue 3 Supple A, Page(s) 24–30

Abstract: Aims: Postoperative length of stay (LOS) and discharge dispositions following arthroplasty can be used as surrogate measurements for improvements in patients' pathways and costs. With the increasing use of robotic technology in arthroplasty, it is ... ...

Abstract	Aims: Postoperative length of stay (LOS) and discharge dispositions following arthroplasty can be used as surrogate measurements for improvements in patients' pathways and costs. With the increasing use of robotic technology in arthroplasty, it is important to assess its impact on LOS. The aim of this study was to identify factors associated with decreased LOS following robotic arm-assisted total hip arthroplasty (RO THA) compared with the conventional technique (CO THA). Methods: This large-scale, single-institution study included 1,607 patients of any age who underwent 1,732 primary THAs for any indication between May 2019 and January 2023. The data which were collected included the demographics of the patients, LOS, type of anaesthetic, the need for treatment in a post-anaesthesia care unit (PACU), readmission within 30 days, and discharge disposition. Univariate and multivariate logistic regression models were used to identify factors and the characteristics of patients which were associated with delayed discharge. Results: The multivariate model identified that age, female sex, admission into a PACU, American Society of Anesthesiologists grade > II, and CO THA were associated with a significantly higher risk of a LOS of > two days. The median LOS was 54 hours (interquartile range (IQR) 34 to 78) in the RO THA group compared with 60 hours (IQR 51 to 100) in the CO THA group (p < 0.001). The discharge dispositions were comparable between the two groups. A higher proportion of patients undergoing CO THA required PACU admission postoperatively, although without reaching statistical significance (7.2% vs 5.2%, p = 0.238). Conclusion: We found that among other baseline characteristics and comorbidities, RO THA was associated with a significantly shorter LOS, with no difference in discharge destination. With the increasing demand for THA, these findings suggest that robotic assistance in THA could reduce costs. However, randomized controlled trials are required to investigate the cost-effectiveness of this technology.
MeSH term(s)	Humans ; Female ; Infant, Newborn ; Arthroplasty, Replacement, Hip/methods ; Length of Stay ; Robotic Surgical Procedures ; Costs and Cost Analysis ; Comorbidity
Language	English
Publishing date	2024-03-01
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.106B3.BJJ-2023-0569.R2
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Article ; Online: Concomitant coracoid base fracture and acromioclavicular joint disruption: A series of patients treated with a clavicle hook plate and review of the literature.

Wignadasan, Warran / Al-Obaedi, Ossama / Chambers, Alastair / Lee, Marcus / Rajesparan, Kannan / Rashid, Abbas

Journal of orthopaedic surgery (Hong Kong)

2022 Volume 30, Issue 3, Page(s) 10225536221139888

Abstract: Introduction: Concomitant acromioclavicular joint (ACJ) disruptions with coracoid base fractures are rare high energy injuries. The management of these injuries can be challenging. The aim of this study is to assess the functional and radiographic ... ...

Abstract	Introduction: Concomitant acromioclavicular joint (ACJ) disruptions with coracoid base fractures are rare high energy injuries. The management of these injuries can be challenging. The aim of this study is to assess the functional and radiographic outcomes of a retrospective case series of patients presenting with concomitant ACJ and coracoid base injuries managed with a clavicle hook plate with subsequent hardware removal at a later stage. Methods: Six patients were identified for inclusion in the study. Radiographic and clinical data were available which allowed for collection of demographic information as well as classification of the fractures. Telephone consultation with patients allowed for collection of functional scores which included the Oxford shoulder score (OSS), QuickDASH (Q-DASH), Euroqol-5 Dimension (EQ-5D) and the SF-12 score. Results: All patients were male with a mean age of 39.8 years and a median follow-up period of 34 months. All patients underwent a successful operative procedure with a median time to union of 3.75 months. Good functional outcomes were reported by all patients: mean OSS 45.0, mean Q-DASH 4.8, mean EQ-VAS 82.8 and encouraging SF-12 scores (mean PCS 56.0, mean MCS 56.4). Conclusion: The use of a lateral clavicle hook plate can achieve good healing and functional outcomes when managing patients with acromioclavicular joint disruptions associated with a coracoid base fracture.
MeSH term(s)	Humans ; Male ; Adult ; Female ; Acromioclavicular Joint/diagnostic imaging ; Acromioclavicular Joint/surgery ; Acromioclavicular Joint/injuries ; Clavicle/surgery ; Clavicle/injuries ; Retrospective Studies ; Referral and Consultation ; Telephone ; Bone Plates ; Fractures, Bone/diagnostic imaging ; Fractures, Bone/surgery ; Bone Diseases/etiology ; Treatment Outcome ; Joint Dislocations/surgery ; Fracture Fixation, Internal/methods
Language	English
Publishing date	2022-11-14
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	1493368-8
ISSN	2309-4990 ; 1022-5536
ISSN (online)	2309-4990
ISSN	1022-5536
DOI	10.1177/10225536221139888
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Article ; Online: Restarting elective orthopaedic surgery as COVID-19 lockdown restrictions are reduced : have patient perceptions towards surgery changed?

Wignadasan, Warran / Mohamed, Abdulrahman / Kayani, Babar / Magan, Ahmed / Plastow, Ricci / Haddad, Fares S

Bone & joint open

2021 Volume 2, Issue 10, Page(s) 865–870

Abstract: Aims: The COVID-19 pandemic drastically affected elective orthopaedic services globally as routine orthopaedic activity was largely halted to combat this global threat. Our institution (University College London Hospital, UK) previously showed that ... ...

Abstract	Aims: The COVID-19 pandemic drastically affected elective orthopaedic services globally as routine orthopaedic activity was largely halted to combat this global threat. Our institution (University College London Hospital, UK) previously showed that during the first peak, a large proportion of patients were hesitant to be listed for their elective lower limb procedure. The aim of this study is to assess if there is a patient perception change towards having elective surgery now that we have passed the peak of the second wave of the pandemic. Methods: This is a prospective study of 100 patients who were on the waiting list of a single surgeon for an elective hip or knee procedure. Baseline characteristics including age, American Society of Anesthesiologists (ASA) grade, COVID-19 risk, procedure type, and admission type were recorded. The primary outcome was patient consent to continue with their scheduled surgical procedure. Subgroup analysis was also conducted to define if any specific patient factors influenced decision to continue with surgery. Results: Overall, 88 patients (88%) were happy to continue with their scheduled procedure at the earliest opportunity. Patients with an ASA grade I were most likely to agree to surgery, followed by patients with ASA grades II, then those with grade III (93.3%, 88.7%, and 78.6% willingness, respectively). Patients waitlisted for an injection were least likely to consent to surgery, with just 73.7% agreeing. In all, there was a large increase in the proportion of patient willingness to continue with surgery compared to our initial study during the first wave of the pandemic. Conclusion: As COVID-19 lockdown restrictions are lifted after the second peak of the pandemic, we are seeing greater willingness to continue with scheduled orthopaedic surgery, reinforcing a change in patient perception towards having elective surgery. However, we must continue with strict COVID-19 precautions in order to minimize viral transmission as we increase our elective orthopaedic services going forward. Cite this article:
Language	English
Publishing date	2021-10-20
Publishing country	England
Document type	Journal Article
ISSN	2633-1462
ISSN (online)	2633-1462
DOI	10.1302/2633-1462.210.BJO-2021-0076.R1
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Article: The introduction of day-case total knee arthroplasty in a national healthcare system: A review of the literature and development of a hospital pathway.

Thompson, Joshua W / Wignadasan, Warran / Ibrahim, Mazin / Plastow, Ricci / Beasley, Lucy / Haddad, Fares S

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2021 Volume 20, Issue 2, Page(s) 103–114

Abstract: Introduction: As we now drive to reinitiate our full capacity elective services in an attempt to tackle an ever-growing demand for lower limb arthroplasty, this pandemic has presented rare opportunities to revise and re-engage elective arthroplasty ... ...

Abstract	Introduction: As we now drive to reinitiate our full capacity elective services in an attempt to tackle an ever-growing demand for lower limb arthroplasty, this pandemic has presented rare opportunities to revise and re-engage elective arthroplasty pathways aimed at improving patient care and healthcare efficiency. Aims: We present the development of an evidence-based multidisciplinary perioperative care pathway for day-case total knee arthroplasty (TKA) in a United Kingdom National Health Service (NHS) institution, in conjunction with a review of the literature upon which the protocol is founded. Methodology: We performed a review of the literature reporting complication or readmission rates at ≥30 day postoperative following day-case TKA. Electronic searches were performed using four databases from the date of inception to November 2020. Relevant studies were identified, data extracted, and qualitative synthesis performed. Results: 13 manuscripts with a total of 3370 day-case TKAs, defined as discharged on the same-calendar-day of surgery, were included in analysis. Mean 90-day complication rates (8.31% [range, 0-16.3%] vs 9.49% [range, 0-13.1%], respectively) and readmission rates (2.71% [range, 0-10.0%] vs 3.41% [range, 0-9.9%], respectively) were equivocal between day-case and inpatient TKA. The overall rate of successful same-calendar-day discharge was 95.8%. Our evaluation and critique of the evidence-based literature identifies day-case TKA to be safe, effective and economical, benefitting both patients and healthcare systems alike. Conclusion: We further validate the introduction of our institutional Elective Day Surgery Arthroplasty Pathway (EDSAP) based on the evidence presented. Careful patient selection paralleled with well-defined care pathways are essential for successful introduction of day-case TKA into the NHS.
MeSH term(s)	Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Knee/adverse effects ; Delivery of Health Care ; Hospitals ; Humans ; Length of Stay ; Patient Readmission ; Postoperative Complications/etiology ; State Medicine
Language	English
Publishing date	2021-03-23
Publishing country	Scotland
Document type	Journal Article ; Review
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2021.01.017
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Article ; Online: Implant Malalignment may be a Risk Factor for Poor Patient-Reported Outcomes Measures (PROMs) Following Total Knee Arthroplasty (TKA).

Kazarian, Gregory S / Haddad, Fares S / Donaldson, Matthew J / Wignadasan, Warran / Nunley, Ryan M / Barrack, Robert L

The Journal of arthroplasty

2022 Volume 37, Issue 6S, Page(s) S129–S133

Abstract: Background: Implant malalignment may be a risk factor for poor patient-reported outcomes measures (PROMs) following total knee arthroplasty (TKA).: Methods: Postoperative surveys were administered to assess PROMs regarding satisfaction, pain, and ... ...

Abstract	Background: Implant malalignment may be a risk factor for poor patient-reported outcomes measures (PROMs) following total knee arthroplasty (TKA). Methods: Postoperative surveys were administered to assess PROMs regarding satisfaction, pain, and function in 262 patients who underwent surgery at 4 centers in the U.S. and U.K (average age, 67.2) at a mean 5.5 years after primary TKA. Postoperative distal femoral angle (DFA), proximal tibial angle (PTA), and posterior tibial slope angle (PSA) were radiographically measured, and outliers were recorded. PROMs were compared between patients with aligned versus malaligned knees using univariate analysis. Results: Patients with DFA, PTA, and PSA outliers were more likely to experience similar or decreased activity levels postoperatively than patients with no alignment outliers, as were patients with 1 or 2 outliers of any kind (P < .05). Patients with DFA, PTA, and PSA outliers were significantly more likely to be dissatisfied with their ability to perform activities of daily living (ADLs), as were patients with 1 or 2 outliers of any kind (P < .05). Patients with DFA and PSA outliers were more likely to be dissatisfied with their degree of pain relief, as were patients with 2 outliers of any kind (P < .05). Finally, patients with DFA and PSA outliers, as well as those with 1 outlier of any kind, were more likely to be dissatisfied with their overall knee function (P < .05). Conclusion: DFA, PTA, and PSA outliers represent a significant risk factor for decreased satisfaction with activities of daily living(ADLs), pain relief, and knee function, as well as decreased activity levels. Level of evidence: Level III.
MeSH term(s)	Activities of Daily Living ; Aged ; Arthroplasty, Replacement, Knee/adverse effects ; Humans ; Knee Joint/surgery ; Knee Prosthesis/adverse effects ; Male ; Osteoarthritis, Knee/surgery ; Pain/surgery ; Patient Reported Outcome Measures ; Prostate-Specific Antigen ; Risk Factors
Chemical Substances	Prostate-Specific Antigen (EC 3.4.21.77)
Language	English
Publishing date	2022-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2022.02.087
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Article ; Online: Elective orthopaedic surgery with a designated COVID-19-free pathway results in low perioperative viral transmission rates.

Chang, Justin S / Wignadasan, Warran / Pradhan, Raj / Kontoghiorghe, Christina / Kayani, Babar / Haddad, Fares S

Bone & joint open

2020 Volume 1, Issue 9, Page(s) 562–567

Abstract: Aims: The safe resumption of elective orthopaedic surgery following the peak of the COVID-19 pandemic remains a significant challenge. A number of institutions have developed a COVID-free pathway for elective surgery patients in order to minimize the ... ...

Abstract	Aims: The safe resumption of elective orthopaedic surgery following the peak of the COVID-19 pandemic remains a significant challenge. A number of institutions have developed a COVID-free pathway for elective surgery patients in order to minimize the risk of viral transmission. The aim of this study is to identify the perioperative viral transmission rate in elective orthopaedic patients following the restart of elective surgery. Methods: This is a prospective study of 121 patients who underwent elective orthopaedic procedures through a COVID-free pathway. All patients underwent a 14-day period of self-isolation, had a negative COVID-19 test within 72 hours of surgery, and underwent surgery at a COVID-free site. Baseline patient characteristics were recorded including age, American Society of Anaesthesiologists (ASA) grade, body mass index (BMI), procedure, and admission type. Patients were contacted 14 days following discharge to determine if they had had a positive COVID-19 test (COVID-confirmed) or developed symptoms consistent with COVID-19 (COVID-19-presumed). Results: The study included 74 females (61.2%) and 47 males (38.8%) with a mean age of 52.3 years ± 17.6 years (18 to 83 years). The ASA grade was grade I in 26 patients (21.5%), grade II in 70 patients (57.9%), grade III in 24 patients (19.8%), and grade IV in one patient (0.8%). A total of 18 patients (14.9%) had underlying cardiovascular disease, 17 (14.0%) had pulmonary disease, and eight (6.6%) had diabetes mellitus. No patients (0%) had a positive COVID-19 test in the postoperative period. One patient (0.8%) developed anosmia postoperatively without respiratory symptoms or a fever. The patient did not undergo a COVID-19 test and self-isolated for seven days. Her symptoms resolved within a few days. Conclusion: The development of a COVID-free pathway for elective orthopaedic patients results in very low viral transmission rates. While both surgeons and patients should remain vigilant, elective surgery can be safely restarted using dedicated pathways and procedures.Cite this article:
Keywords	covid19
Language	English
Publishing date	2020-09-14
Publishing country	England
Document type	Journal Article
ISSN	2633-1462
ISSN (online)	2633-1462
DOI	10.1302/2633-1462.19.BJO-2020-0110.R1
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Article ; Online: Long-term results of revision total knee arthroplasty using a rotating hinge implant.

Wignadasan, Warran / Chang, Justin S / Kayani, Babar / Kontoghiorghe, Christina / Haddad, Fares S

The Knee

2020 Volume 28, Page(s) 72–80

Abstract: Background: Rotating hinge implants are commonly used in revision total knee arthroplasty (TKA) in the setting of significant ligamentous instability or bone deficiency. These highly constrained implants have been associated with variable clinical ... ...

Abstract	Background: Rotating hinge implants are commonly used in revision total knee arthroplasty (TKA) in the setting of significant ligamentous instability or bone deficiency. These highly constrained implants have been associated with variable clinical outcomes and uncertain long-term survivorship. The aim of this study is to establish long-term functional outcomes, radiographic results, and survivorship after revision TKA with a rotating hinge implant. Method: This is a retrospective study of prospectively collected data of 41 consecutive patients undergoing revision TKA with rotating hinge components and minimum 10-years follow-up. The study included 22 females (53.7%) and 19 males (46.3%) with a mean age of 66.6 ± 8.5 years. Clinical outcomes recorded included the Oxford Knee Score (OKS) preoperatively and at latest follow-up. Range of motion, implant survivorship, and complications were also recorded. Predefined radiological outcomes were obtained using plain radiographs. Results: There was a significant improvement in OKS after revision TKA with a rotating hinge implant compared to preoperative scores (40.7 ± 4.2 vs. 21.4 ± 4.9 respectively, p < 0.001). At latest follow-up, mean range of motion was 111.5° ± 9.3° and mean overall limb alignment was 0.2° ± 2.0° varus. Implant survivorship at minimum 10-year follow-up was 90.2%. Radiographic lucent lines were observed in 14 patients (34.1%). Conclusion: Revision TKA with a rotating hinge implant leads to satisfactory clinical outcomes and very good implant survivorship at long-term follow-up. Surgeons should have a low threshold to use these versatile implants in complex revision knee arthroplasty.
MeSH term(s)	Aged ; Arthroplasty, Replacement, Knee/adverse effects ; Arthroplasty, Replacement, Knee/methods ; Female ; Follow-Up Studies ; Humans ; Joint Diseases/diagnostic imaging ; Joint Diseases/surgery ; Knee Joint/diagnostic imaging ; Knee Joint/surgery ; Knee Prosthesis ; Male ; Middle Aged ; Prosthesis Design ; Prosthesis Failure ; Range of Motion, Articular ; Recovery of Function ; Reoperation ; Retrospective Studies ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2020-12-10
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1200476-5
ISSN	1873-5800 ; 0968-0160
ISSN (online)	1873-5800
ISSN	0968-0160
DOI	10.1016/j.knee.2020.11.009
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