Khaled M Sarraf

Imperial College Healthcare NHS Trust

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Co-Authors

Kapil Sugand

Imperial College Healthcare NHS Trust

Chang Park

Chelsea and Westminster Hospital NHS Foundation Trust

Catrin Morgan

Imperial College Healthcare NHS Trust

Mazyar Kanani

University College London

Arash Aframian

Imperial College Healthcare NHS Trust

Rajarshi Bhattacharya

Imperial College Healthcare NHS Trust

Akib Majed Khan

Imperial College Healthcare NHS Trust

Hani B. Abdul-Jabar

London North West Healthcare NHS Trust

Rory Cuthbert

Royal London Hospital

Sammy A. Hanna

Healthpoint

Cooperative Institutions

University of Birmingham

2,978

Institut de Virologie

2,076

NIHR Birmingham Biomedical Research Centre

1,902

Yorkshire Cancer Research

1,727

Urology Foundation

1,621

Association for Cancer Surgery

1,479

Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie

1,454

AstraZeneca (Brazil)

1,183

Stryker (United Kingdom)

1,034

Pfizer (United Kingdom)

833

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Fatigue fractures of total knee prostheses - a cause of knee pain.

PubMed (2014)

Khaled M Sarraf Rupert Wharton Hani B. Abdul-Jabar Guarangkumar Shah G.C. Singer

Femoral component fracture is a rarely reported complication in cemented total knee arthroplasty. We present a case of new- onset acute unresolving knee pain caused by fatigue fracture of the medial condyle of the femoral component 11 years after primary total knee replacement. This was identified and subsequently revised with a revision prosthesis. The patient had an uneventful recovery, and his symptoms resolved. Considering that the aging population and the rate of obesity are increasing and that there is an exponential increase in the number of joint arthroplasties; this case sheds light on a rare cause of acute non-traumatic knee pain following knee arthroplasty that could be present with or without evidence of osteolysis. We also review the literature of cases of fractured cemented and uncemented knee replacements and discuss the causes proposed.

Knee pain

Osteolysis

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Citations (10)

AN ANALYSIS OF FACTORS AFFECTING THE INCIDENCE OF DEEP VEIN THROMBOSIS IN KNEE REPLACEMENT IN 3449 CASES

Orthopaedic Proceedings (2012)

Khaled M Sarraf Charles A Willis-Owen Alice Martin David K. Martin

Deep vein thrombosis remains a significant and common complication following joint replacement and debate exists over which contributing factors are important. This study investigates the effect of a number of variables on the incidence of symptomatic deep vein thrombosis in knee arthroplasty surgery. Data was collected prospectively on 3449 knee replacements including procedure type, tourniquet time, surgeon, patient age, and gender. These variables were assessed by the use of generalised linear modelling against the presence or absence of symptomatic deep vein thrombosis demonstrated on duplex ultrasonography. The overall deep vein thrombosis rate was 1.6%. The only variable which had an association with confirmed symptomatic DVT was operation type with total knee replacements having a higher incidence than unicompartmental knee replacements (2.2% vs 0.3% p=0.0003). Tourniquet time did not exhibit a statistically significant effect (p=0.63) These data show that the DVT rate in unicompartmental knee replacement is statistically significantly lower than that of total knee replacement. They do not support the notion that increased tourniquet time is associated with an increased risk of DVT.

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Anatomic, diagnostic and management challenges in paediatric pelvic injuries: a review

Journal of Pediatric Orthopaedics B (2019)

Rupert Wharton Sam Trowbridge Ashley Simpson Khaled M Sarraf Yaser Jabbar

Pelvic injuries have an incidence of 1: 100 000 children per year in the UK, of which 10% are unstable. A literature review was conducted. Clinical examination alone in a stable patient precludes the need for imaging. Imaging options in the acute pelvic injury are critically reviewed. Where appropriate Judet views or limited exposure computed tomography scan remain of diagnostic benefit. Displacement greater than 1 cm should be reduced and held with an appropriate method. Closed reduction and external fixation for rotationally unstable fractures, and closed or open reduction with internal fixation of two columns should be considered for rotationally and vertically unstable fractures.

10.1097/bpb.0000000000000591

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Citations (9)

Osteochondritis dissecans

British Journal of Hospital Medicine (2023)

Sophia Hashim Catrin Morgan Khaled M Sarraf

Osteochondritis dissecans is a condition characterised by acquired pathological subchondral bone lesions and its incidence is unknown. It has a multifactorial aetiology, with a combination of genetic and acquired risk factors. It commonly presents in adolescents and young adults. Patients have variable presentations, including trauma, insidious onset and pain exacerbated by exercise. The joints primarily affected are the knee, ankle and elbow joint. Early identification is key to treatment and to prevent future osteoarthritis of the joint. This article gives an overview of the presentation, assessment and management of the juvenile form of osteochondritis dissecans.

Osteochondritis dissecans

Etiology

10.12968/hmed.2023.0044

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Citations (4)

OUTCOME OF SURGICAL DISLOCATION OF THE HIP IN PERTHES DISEASE

Orthopaedic Proceedings (2018)

Khaled M Sarraf Konstantinos Tsitskaris Tahir Khan Aresh Hashemi-Nejad

Purpose of the study is to investigate the outcome of the patients with Perthes disease who have had a surgical dislocation of their hip for the treatment of resultant symptoms from the disease pro...

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Appendix: Additional high-yield topics for the MRCS

M. K. Kanani Khaled M Sarraf

Further to the use of the chapters in this book as an aid for question-and-answer scenarios and practice with colleagues, here are a few more scenarios that may not be covered fully in independent chapters, which might be useful for consideration prior to the examination.

10.1017/cbo9781139149723.010

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Paediatric supracondylar humerus fractures

British Journal of Hospital Medicine (2019)

Anna Kropelnicki Adam M. Ali Ravi Popat Khaled M Sarraf

This article gives a practical guide to the management of supracondylar fractures of the humerus in paediatric patients, from initial presentation to definitive treatment. It reviews the optimal management of this common and serious injury based on current evidence including the British Orthopaedic Association Standards for Trauma (BOAST) 11 standard.

Presentation (obstetrics)

10.12968/hmed.2019.80.6.312

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Citations (22)

THE USE OF ROUTINE PREOPERATIVE BLOOD TESTS: AN OVERUSED REQUEST

Orthopaedic Proceedings (2012)

Philip Pastides Szymon Tokarczyk Laura Ismail Khaled M Sarraf David Ahearne

The main purpose of preoperative blood tests is to provide information to reduce the possible harm or increase the benefit to patients by altering their clinical management if necessary. This information may help clinicians assess the risk to the patient, predict postoperative complications and establish a baseline measurement for later reference. National Institute of Clinical Excellence (NICE) has issued guidelines around the need for pre-operative blood tests related to the age of the patient, comorbidities and the complexity of the procedure they will undergo. We decided to retrospectively review the pre-operative blood requests for patients under the age of 65 who were admitted at our institution over a 2 month period for open reduction and internal fixation of the ankle or tibial plateau and manipulation under anaesthesia of the lower limb. Patients were divided into 2 groups, under the age of 40 and between 40-65 years old. Patients under the age of 18 were excluded. These surgical procedures were classified as ‘intermediate complexity’. Admission clerkings of our 63 patient cohort were reviewed to ascertain if any patients had a significant co-morbidity or past medical history. The pre operative blood tests requested for each patient were audited against the NICE recommendations. None of the patients under the age of 40 had any significant comorbidites, whilst 8 patients above the age of 40 suffered with hypertension. 95% of patients had at least one blood test carried out. All patients over the age of 40 had at least one blood test. Tests requested included full blood count (91%), urea and electrolytes (91%), coagulation (66%), liver function tests (67%), group and save (69%), CRP (70%), ESR (2%), thyroid function tests (5%) and CK (2%). Only 5 patients (5%) followed the guidelines correctly. The clinical value of testing healthy individuals before an operation is debatable. The possible benefits of routine preoperative investigations include identification of unsuspected conditions that may require treatment before surgery or a change in surgical or anaesthetic management. The American Society of Anaesthesiologists has stated that ‘routine preoperative tests (i.e. tests intended to discover a disease or disorder in an asymptomatic patient) do not make an important contribution to the process of perioperative assessment and management of the patient by the anaesthesiologist.’ The overzealous requesting of preoperative blood tests also has a financial burden upon individual institutions. Our study also showed that some blood tests, such as inflammatory markers and thyroid function tests, were inappropriately requested. Adherence to the NICE guidelines would have resulted in a significant financial saving. This review has shown that adopting the NICE guidelines may result in a decrease in the amount of unnecessary blood tests patients undergo when they attend hospital for routine, minor or intermediate surgical procedures. If these guidelines were implemented for all surgical procedures, this would undoubtedly result in a significant financial saving for the institution and the NHS as a whole. At our institution we have implemented surgical and anaesthetic team awareness and education around these guidelines in a bid to reduce the use of unnecessary testing.

Nice

Blood test

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FATIGUE FRACTURE OF FEMORAL COMPONENT IN A TOTAL KNEE PROSTHESIS: A RARE CAUSE OF KNEE PAIN

Orthopaedic Proceedings (2012)

Khaled M Sarraf Hani B. Abdul-Jabar Rupert Wharton Guarangkumar Shah G.C. Singer

Femoral component fracture is a rarely reported but devastating complication of total knee arthroplasty. It has occurred most frequently with Whiteside Ortholoc II replacements uncemented knee replacements. Presentation may be with acute pain, progressive pain or returning deformity. It occurs more commonly in the medial condyle of the femoral component. It is rarely seen in cemented replacements. All currently available literature describing fractures of condylar replacements, both cemented and uncemented. Predisposing factors include varus deformity either pre or post operatively. The mechanism of failure is thought to be failure of the infiltration of bone into the replacement. This is often due to polyethylene wear or metallosis causing abnormal tissue reaction with or without osteolysis. We present the case of a fractured Press Fit Condylar (PFC) cemented implant (DePuy, Johnson&Johnson, Raynham, Massachusettes, USA) affecting the medial condyle. To our knowledge this is only the third reported case of fracture in a PFC implant, and the first in a cemented PFC implant. Our patient was a 64 year old male who presented with unresolving knee pain post total knee arthroplasty, caused by fatigue fracture of the medial condyle of the femoral component. This was identified as loosening on plain radiographs and replaced with a revision prosthesis with a good post operative result. Given our aging population and with the increase of joint arthroplasty, this case sheds light on a potentially under recognised and increasingly important cause of knee pain following arthroplasty.

Metallosis

Varus deformity

Osteolysis

Knee pain

Implant Failure

Femoral fracture

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Preface

Cambridge University Press eBooks (2012)

Mazyar Kanani Khaled M Sarraf

Vigilance is the only tool we have to manage the errors that lurk around each hospital corridor. It is hoped that this book will not only help prepare for the challenges of the new MRCS exam, but also help keep our clinical vigilance honed and ready for the supreme challenge – our sick patients.

Vigilance (psychology)

10.1017/cbo9781139149723.001

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