ORCID Profile
0000-0001-6637-3801
Current Organisation
The Hashemite University Faculty of Medicine
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Publisher: SAGE Publications
Date: 05-2017
Abstract: Present scientific literature supports patellar resurfacing with regards to reduced re-operation risk and improved long term patient satisfaction in total knee arthroplasty (Schindler 2012). Two basic techniques are present for resurfacing the patella (Lachiewicz 2003) onlay and round inset (IN). Onlay designs are either symmetrical (round) (OR) or oval shaped with an asymmetric ridge (OO). When using a round patellar implant, a lateral facetectomy is often performed to avoid lateral compression syndrome and enhance patellar tracking (Zhang, Zhang et al. 2012). However, none of these implants have been found to be superior to the other. This study will compare three different types of patellar implant designs commonly used for resurfacing in TKA and report on intra-operative outcomes. We hypothesise that OO design offers improved bone coverage with less need to perform facetectomy when compared to round designs. A prospective, randomised trial was performed on patients undergoing unilateral TKA by 2 surgeons. Patients who agreed to participate were allocated to one of the three patellar design groups (IN, OR, OO). Patients were blinded to the implant assigned to them. The prostheses were implanted with the aim to restore pre-resection thickness, uniform facet thickness, with maximal bone coverage and medialisation of the median ridge to enhance tracking. Groups were compared in terms of implant size, percentage bone coverage, lateral facet underhang and requirement for facetectomy. Paired t-tests and ANOVA were used to compare continuous outcome measures with chi-squared test for categorical variables. 86 patients were initially assessed for inclusion. Eight patients refused to participate and a further 18 did not meet the study inclusion criteria. A total of 60 patients were included in the final analysis. There were no differences between the 3 groups with regards to mean age, sex, pre-resection patellar thickness, patellar dimensions or pre-operative Kujala score. The asymmetrical onlay design resulted in a statistically significant larger button size (mean size 25.3 mm IN, 32.7 mm OR, 34.6 mm OO p .001), reduced lateral underhang (mean 11.1mmm IN, 7.7 mm OR, 1.2 mm OO p .001), and reduced need for facetectomy (85% IN, 85% OR, 0% OO). Percentage of surface bone coverage was 49%, 63.8%, 89.6% for IN, OR, OO implants respectively (p 0.001). Oval onlay design demonstrates better surface bone coverage than round onlay or inlay implants. There were no cases in the oval group that required lateral facetectomy. Future analysis of this study group will aim to determine whether radiographic, patellar vascular and functional outcomes vary amongst the designs.
Publisher: SAGE Publications
Date: 20-04-2017
Abstract: Bipolar radiofrequency (bRF) ablation is gaining popularity as a treatment modality for unstable knee chondral lesions of the knee. Limited reports of osteonecrosis and chondrolysis have been published however, there is little data examining the safety of this treatment in larger series. This study aims to evaluate the safety and efficacy of bRF in the treatment of chondral lesions encountered during knee arthroscopy. A retrospective evaluation of adverse outcomes in patients that underwent treatment of chondral lesions using bRF was undertaken. Secondary outcome measures included change in patient reported outcome scores and its correlation to patient demographics and quality of chondral and meniscal lesions using Chondropenia Severity Score. Only 2.2% and 2.7% of the patients had a postoperative complication or required a reoperation, respectively. None of the complications were directly related to the use of bRF. A statistically significant difference was observed when comparing pre- and postoperative scores in all normalized categories ( P 0.0001). No statistically significant correlation was found between change in self-reported scores and Chondropenia Severity Score. Bipolar radiofrequency ablation is a safe modality in treatment of chondral lesions.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.ARTH.2018.10.003
Abstract: Soft tissue balance is believed to be a major determinant of improved outcomes in total knee arthroplasty (TKA). We conducted this study to assess the accuracy of surgeon-defined assessment (SDA) of knee balance compared to pressure sensor data. We also assessed for any association between experience (learning curve) and accuracy of SDA. A total of 308 patients undergoing 322 mechanically aligned TKA were prospectively analyzed. Femoral and tibial trial implants were inserted before performing knee balancing. We compared the surgeon determination on knee balance at 10°, 45°, and 90° of flexion to sensor data at the same flexion angles. Accuracy of SDA was 63%, 57.5%, and 63.8% at 10°, 45°, and 90°, respectively, when compared to sensor data. SDA had an overall sensitivity of 81% and specificity of 37.7%. Capacity to determine an unbalanced knee worsened at higher knee flexion angles with SDA test specificity of 53.5%, 34.8%, and 24.8% at 10°, 45°, and 90°, respectively (P = .0004 at 10° vs 45°, P < .0001 at 10° vs 90°). Cohen's kappa coefficient was 0.29 at 10° indicating fair agreement, and 0.14 and 0.12 at 45° and 90°, respectively, indicating poor agreement. The use of sensor had no time-based learning effect on capacity to determine knee balance. SDA is a poor predictor of the true soft tissue balance when compared to sensor data, particularly in assessing whether a knee is unbalanced. In addition, increased use of sensors did not improve surgeon capacity to determine knee balance.
Publisher: Wiley
Date: 21-06-2021
DOI: 10.1111/ANS.17017
Abstract: Portable accelerometer‐based navigation devices (PAD) in total knee arthroplasty (TKA) have been proposed to combine the alignment precision of computer navigation with the efficiency of conventional instrumentation (CON). The aim of this study was to determine if PAD was more effective than CON in TKA in improving clinical outcomes at medium term follow‐up. Participants undergoing primary TKA were randomly assigned to either PAD or CON. The primary outcome was the mean between‐group difference in the four subscales of the Knee injury and Osteoarthritis Outcome Score (∆KOOS 4 ) between preoperative status and latest follow‐up. Secondary outcomes included analysis of between‐group differences in all KOOS subscales, Western Ontario and McMaster Universities Osteoarthritis Index (∆WOMAC) scores, complications and reoperation rates. Of the 178 participants allocated to a treatment arm, 159 (89.3%) completed follow‐up at a mean of 4.3 years (range 3.2–5.8 years). There was no statistically significant or clinically meaningful difference in ∆KOOS 4 between preoperative status and latest follow‐up (PAD = 41, CON = 43 p = 0.5). There was no difference in mean ∆WOMAC scores (PAD = 39, CON = 41 p = 0.9) or ∆KOOS subscales between groups. In addition, there were no differences in complications or reoperations between groups. PAD was not superior to CON in improving patient‐reported outcomes or reducing complications and reoperation rates at medium term follow‐up. The use of PAD in TKA to improve clinical outcomes alone cannot be justified based on the results of this study.
Publisher: American Roentgen Ray Society
Date: 07-2012
DOI: 10.2214/AJR.11.6497
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.KNEE.2018.08.009
Abstract: Standard radiographic views for patellofemoral joint assessment do not reflect loading at which TKA patients may describe post-operative anterior symptoms. A novel weight bearing (WB) Merchant view has been described and demonstrated a number of tracking changes that correlated with clinical outcomes. In this study, we aim to validate the WB Merchant view and assess relationships with patient outcome scores. Patients were randomly allocated to receive one of the three commonly used patellar implants with a single TKA prosthesis. Patients were evaluated at six months post-operatively using both NWB and WB Merchant views. Indicators of patellar tracking were correlated with improvement in KOOS, WOMAC and Kujala scores. For reliability assessment, radiographs were assessed twice by two readers. The WB Merchant view showed a reduction in the percentage of outliers of tracking indices in comparison to the NWB view (Congruence angle: NWB = 37%, WB = 24% Displacement: NWB = 2%, WB = 0% Tilt angle: NWB = 60%, WB = 56%). There was an increase in the lateral contact state with the WB Merchant view (Type I: NWB = 19%, WB = 28% Type II: NWB = 3%, WB = 4%). The state of lateral contact had a consistent and statistically significant correlation with the improvement in KOOS, WOMAC and Kujala scores (p value = 0.01, 0.01 and 0.03, respectively). All radiographic indices had good reliability with accepted variability. The WB Merchant radiograph is an easy to perform and reliable view for the evaluation of patellar tracking and may provide additional information to the routinely used NWB view.
Publisher: SPIE-Intl Soc Optical Eng
Date: 11-11-2022
Publisher: Wiley
Date: 26-05-2020
DOI: 10.1111/ANS.15988
Publisher: The University of Jordan
Date: 30-08-2023
Abstract: Objectives: Closed reduction (CR) is a well-established method for treating developmental dysplasia of the hip (DDH). Traditionally, the child is placed in a spica cast after DDH CR for three to four months and it is common practice to change the spica under general anesthesia after 6–8 weeks. To our knowledge, no previous studies have shown that changing the spica is necessary. We hypothesize that there is no need to change the spica and that it can be safely retained for three months without any significant complications. Methods: We used our department database to find all children who had DDH CR and a spica cast for a minimum of 90 days over a one-year period (March 2018 to March 2019) and who had at least a one year follow up after removal of the cast. We retrospectively reviewed the medical notes and radiographs, looking at complications that may be attributed to prolonged use of spica. Results: Thirty-nine patients (48 hips) met our criteria. None of the patients developed any cast-related complications during or after removal of the spica cast. No abdominal, joint or skin complications were reported throughout treatment. At one year follow up, there were no complications that could be attributed to using the spica for three months. Conclusion: Changing the spica every 6–8 weeks after DDH CR is of no benefit and exposes the infant to an unnecessary general anesthesia, with the risk of losing the hip reduction. We conclude that it is very safe to keep the spica cast on for three months without changing after DDH CR. We recommend changing practice to reflect our findings.
Publisher: Open Medical Publishing
Date: 28-01-2020
DOI: 10.4081/OR.2020.8833
Abstract: Amid the current pandemic of coronavirus disease 2019 (COVID-19), orthopaedic surgery was one of the fewer specialties that remained active managing emergent and urgent orthopaedic and trauma cases. On the other hand, with the continued spread of this pandemic and its associated socioeconomic confinement and unpredictability of the pandemic curve many health care facilities were forced into halting all elective and non-urgent activities including orthopaedic specialties. This in part was to help in reallocation of required resources and focusing on the proper management of COVID-19 patients, and to prevent the transmission of infection among health care workers and patients. In this article we analyzed developments and recommendations of international reports about the current outbreak and its impact on the practice of orthopaedic surgery. Our aim was to provide comprehensive and easy guidelines for the management of urgent and emergent cases in hot zones and for the process of returning to usual orthopaedic work flow in a balanced strategy to assure safe practice and providing quality care without the risk of exhausting institutional resources or the risk of COVID- 19 transmission among health care workers or patients
Publisher: sPage.direcT
Date: 12-11-2020
DOI: 10.36959/453/548
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-12-2022
Abstract: There is currently a lack of evidence to identify the optimal patellar implant design in total knee arthroplasty (TKA). The aim of this study was to assess clinical, intraoperative, radiographic, and scintigraphic differences between inlay (IN), onlay round (OR), and onlay oval (OO) patellar implants. A parallel-group, double-blinded, randomized trial compared IN, OR, and OO patellar implants using the same posterior-stabilized TKA prosthesis for each. Patient outcomes were prospectively followed for a minimum of 2 years, with survivorship outcomes followed for a mean of 5 years. The primary outcome was the between-group differences in the mean Kujala score change from preoperatively to 2 years postoperatively. The secondary outcomes included differences in other knee-specific and general health outcomes, intraoperative characteristics, radiographic parameters, patellar vascularity, and implant survivorship. A total of 121 participants (40 in the IN group, 41 in OR group, 40 in the OO group) were allocated to 1 of 3 implant designs. At 2 years postoperatively, there were no significant differences in Kujala score changes between groups (p = 0.7 Kruskal-Wallis test). Compared with the IN group, the OR group showed greater improvements in Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living and in KOOS Quality of Life compared with the OO group. However, the OO design exhibited better bone coverage and lower lateral facetectomy rates compared with the IN and OR designs. The IN group had more lateral contact compared with the OO group (p = 0.02 Fisher exact test), but the overall value for lateral contact was not significant (p = 0.09 chi-square test). There were no differences in postoperative scintigraphic vascularity (p = 0.8 chi-square test). There was 1 revision for infection at 3 years postoperatively in the OO group, and no revision in the other groups. Patellar design did not influence patellofemoral outcomes or survivorship. However, OR implants showed improvements in some secondary patient-reported outcome measures, and OO implants exhibited superior bone coverage and improvements in several intraoperative, radiographic, and scintigraphic outcomes. These findings, combined with superior long-term implant survivorship from previous studies, add support for the use of onlay designs in TKA. Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
Publisher: Wiley
Date: 18-02-2018
DOI: 10.1111/ANS.14437
Abstract: Sensor-guided assessment for soft tissue balance in total knee arthroplasty (TKA) has been reported to improve patient satisfaction and self-reported outcome scores. As more surgeons adopt this technology in TKA, we performed this study to identify if there is a learning curve with its use. Analysis of a total of 90 consecutive cases was performed in this study. Initial and final intercompartmental pressure differences were recorded before and after knee ligament balancing. The first 45 patients (group 1) were compared to the last 45 patients (group 2) in terms of operative time and the final state of knee balance. A balanced knee was defined as pressure difference between medial and lateral compartments of ≤15 pounds. Group 1 had 10 unbalanced knees in the final pressure difference assessment, while all cases in group 2 were balanced (P < 0.001). There was no statistically significant difference in mean operative time between the two groups. A scatter plot of intercompartmental pressure difference identified that after 30 cases, the capacity to achieve knee ligament balance improved. This study suggests that there is a learning curve with the use of sensor-guided assessment in TKA in achieving knee balance however, the differences noted between initial and final groups were small and may not be of clinical significance.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-12-2022
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.ARTH.2016.08.025
Abstract: Accelerometer-based, portable navigation devices have been introduced as a less invasive and simpler technique to perform navigated surgical implantation of knee prostheses. They have been postulated to have better accuracy than conventional instruments in restoration of alignment in total knee arthroplasty. A total of 190 patients were enrolled in this prospective, randomized controlled trial and underwent total knee arthroplasty using either the KneeAlign or conventional guides. Multiplanar alignment was evaluated with a CT imaging protocol. A total of 86.5% of portable navigation device and 82.2% of conventional group had a postoperative hip-knee angle within 3° of neutral alignment (P = .54). There was no significant difference between the 2 groups for component coronal and sagittal plane alignment. Portable navigation device did not significantly increase the time to perform the surgery. Portable navigation device demonstrates accurate restoration of alignment however, there was no statistically significant difference when compared with conventional guides.
Publisher: SAGE Publications
Date: 05-2017
Abstract: Present literature supports the importance of final alignment and soft tissue balance in total knee arthroplasty (TKA) on implant survivorship and clinical outcomes. Current soft tissue balance techniques mostly depend on subjective static measures that don’t allow for quantitative determination of ligament tension. Sensor guided technique (Verasense, Orthosensor) allows demonstration of the magnitude and location of load in a dynamic way providing quantitative data about knee balance. The aim of this study is to test the accuracy of the surgeon’s manual assessment in judging knee balance in comparison to Verasense. We also aimed to determine whether Verasense can assist in achieving soft tissue balance from the unbalanced state. 58 patients were enrolled in this prospective cohort study. The level of agreement between SDA and Verasense at 10, 45, 90 degrees was recorded. Initial trial pressures and final pressures after release or re-cut were recorded and compared. Final pressure measurements were then documented to assess whether appropriate knee balance (differential compartmental pressure of 15 lb/inch on 2 or more angular positions) had been achieved. The mean age of the cohort was 67.5 years with deformities ranging from -16 degrees of varus to +20 degrees of valgus (mean -1.26 degrees varus). The capacity for the surgeon to manually identify an unbalanced knee was low with a test sensitivity of 33.3%. Manual test specificity to define a balanced knee was better with a specificity of 77.3%. The manual test had a positive predicitive value of 59.2% and a negative predictive value of 54%. There were 46.5% (27 of 58) of cases where the Verasense lead to a different surgical plan to that initially determined by the manual assessment. In 23 cases, either ligament release or tibial bone recut was performed. In the remaining 4 cases, the Verasense prevented a ligament release being performed. 95% of cases achieved a balanced state within 15lb/inch of pressure between compartments, with 100% balanced within 25 lb/inch. Manual surgeon assessment of soft tissue balance is a poor predictor of unbalanced knees. Verasense has the capacity to subsequently balance the knee within an acceptable pressure range as defined by prior studies. Further analysis to determine the impact on patient outcomes and implant survivorship is warranted.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 30-12-2022
No related grants have been discovered for Monther Gharaibeh.