Biomedical subjects
Yaser M Behairy
Publications and source records attributed to Yaser M Behairy.
A survey of patients' attitude toward total knee replacement in a major center in the Kingdom of Saudi Arabia.
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Percutaneous versus open epiphysiodesis.
OBJECTIVE: Epiphysiodesis is used for the treatment of leg-length discrepancy in skeletally immature patients. Phemister described an open technique that requires surgical dissection with potential morbidity. Recently, minimally invasive approaches that utilize intraoperative fluoroscopy have been introduced. The aim of this study is to compare our experience using the open and the minimally invasive percutaneous techniques. METHODS: A prospective follow-up of 87 consecutive patients undergoing epiphysiodesis for correction of post traumatic leg-length discrepancy using either the open or the percutaneous technique at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between January 1993 and December 2000. RESULTS: Out of the 87 patients, 52 were carried out using the open technique and 35 were utilized by this percutaneous technique. There was no statistically significant difference between the 2 groups in terms of demographic date, operative time, perioperative complications or time required to achieve the growth arrest. However, there was a significant difference in the hospital stay and postoperative need for physiotherapy. The percutaneous group had a shorter hospitalization (average 2.5 days) compared to the open technique group (average 4 days). CONCLUSION: Our experience is similar to what is reported in the literature and confirms that the percutaneous technique has an advantage over the open technique with shorter hospitalization and less duration of physiotherapy.
Removal of internal fixation in pediatric patients.
OBJECTIVE: Internal fixation devices are commonly used in the surgical treatment of many orthopedic conditions. Their prolonged presence, however, has been associated with potential complications. Many surgeons advocate the routine removal of internal fixation in the pediatric age group. In this report we present our experience with removal of internal fixation in pediatric patients and evaluate the benefits and difficulties of doing so. METHODS: A retrospective analysis of 304 pediatric patients who underwent removal of internal fixation implants for various indications at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between January 1985 and December 1999, was carried out. RESULTS: A total of 176 males and 128 females were included. Their mean age at time of removal of internal fixation was 11 years (range 2-18). The fixation device was removed at an average of 16.3 months (range 10-40) after implantation. One hundred and twenty (39.5%) patients had the initial fixation for the treatment of fractures. For all 304 patients, late removal of the implant was found to be more difficult than early removal. Implants around the hip and pelvis were more difficult to remove than other locations. CONCLUSION: Our experience supports the indication for timely removal of internal fixation devices in the pediatric population. When carried out on a routine basis it can avoid the difficulties associated with the late removal of implants.
A survey of patients attitude toward low back surgery in a major center in Saudi Arabia.
OBJECTIVE: Similar to any other invasive procedure, low back surgery has potential complications. These potential complications lead many patients to refuse the surgery when it is indicated. The aim of this study was to evaluate patient's attitude toward low back surgery and identify factors that might influence their decision. METHODS: Seventy consecutive patients who attended the outpatient clinic of the King Fahad National Guard Hospital Riyadh, Kingdom of Saudi Arabia, between May 2002 and July 2002, due to chronic low back problems and who were surgical candidates were included in this study. The low back outcome score (LBOS) was used to assess these patients. The proposed surgical procedure was explained to each patient and the family and the potential complications were discussed. The patient's response to the proposed surgery was assessed. Mantel-Haeuszel Chi-square test was used for statistical analysis. RESULTS: A total of 70 patients were included in this study. Thirty-eight were females and 32 were males. The average duration of symptoms was 3.3 years (range 0.5-20). Of the whole group of 70 patients, 31 (44%) agreed to surgery. The remaining 39 (56%) refused surgery for various reasons. There was no statistically significant difference in the demographic data or the LBOS between the 2 groups. CONCLUSION: There is a relatively high refusal rate (56%) for low back surgery in the group studied. No specific influencing factor could be identified in this group. Pain and disability as measured by the LBOS does not seem to be a factor. Patient's education on the disease process and the contemplated surgery are crucial in helping them to make an informed and reasonable decision.
Unconventional alternative for hook plate fixation of the cervicothoracic junction.
The most common cause for instability at the cervicothoracic junction (C7-T1) is traumatic fracture-dislocation. Surgical treatment of these unstable injuries has gained wide acceptance as the treatment of choice. The hook plate is the device of choice for achieving dorsal fusion of these injuries. It guarantees independent stability that is sufficient even in cases without anterior stabilization. Because of the high cost of commercially available hook plate systems, we resorted to the use of modified semi-tubular plates for posterior fixation of the cervicothoracic junction. Semi-tubular plates are widely available, cost effective, and can be easily modified to function as a hook plate.
Mode of loosening of matt-finished femoral stems in primary total hip replacement.
OBJECTIVE: Major advances have occurred in total hip replacement (THR) surgery aiming at minimizing or delaying loosening of the components. Currently, substantial controversy exists regarding the possible role of the surface finish of cemented femoral stems in the loosening process. Several authors have recently suggested that a roughened surface finish of the femoral component in cemented THR can predispose the implant to early loosening and subsequently severe osteolysis. The aim of this study was to evaluate both the incidence of, and the mode of loosening of the cemented femoral components in a large series of primary THR with matt-finished surface followed over a span of 2 decades. The aim was to assess the behavior of bead-blasted chrome-cobalt cemented femoral stems of the computer assisted design (CAD) and Harris Design-2 (HD-2). METHODS: From a prospective study of 161 consecutive hips in 140 patients who underwent primary THR using HD-2 or CAD cemented femoral components performed by a single surgeon between 1976 and 1979, all hips were evaluated with special emphasis on the 73 patients (84 hips) who were followed for an average of 18 years. Among the 161 hips, all femoral stems that became loose were studied in detail. The cement technique used in all cases was the so-called 2nd generation cementing technique. No patient was lost to follow-up. We now report on the subset of 10 hips (6%) (9 patients) among the entire 161 hips that had an aseptic failure of fixation of their femoral components. RESULTS: Ten of 117 CAD stems (8.5%) and none of 44 HD-2 stems became loose. Five percent (8 of 161) of those (all CAD) were revised due to aseptic loosening. Two of those revisions for aseptic femoral loosening were carried out during the first decade (1.2%). One of these 2 loose stems was converted into a resection arthroplasty at another hospital despite not being loose radiographically and having no osteolysis. The other loose stem was removed at 9 years and 10 months for a fracture secondary to lysis below the tip of the stem. The remaining 8 loose stems were not diagnosed as loose until the 2nd decade following the operation. Six of those 8 stems were revised and 2 have not been revised. The average duration until these 6 were revised was 18 years after the operation (range 14-19). The remaining 2 unrevised stems are debonded (<1mm) but functioning well. No stem showed the early type of rapid lysis reported for the Iowa design. There was no consistent relationship between the development of loosening and osteolysis in the 10 hips that became loose. Among the 5 hips that debonded, the debonding was initially noted at an average of 13 years (range 4-21) but in this group, osteolysis was present in 3 hips and was first noticed at an average of 9 years (range 5-12) after the operation. Of those that developed both osteolysis and radiographic evidence of loosening, the lysis preceded the debonding in 2 of the 3 cases. CONCLUSION: There is no evidence in this series of 161 hips that a matt surface finish was associated with either the premature loosening or the marked progressive osteolysis pattern of the type that has been described with the Iowa stem. The evidence in our report does not support the hypothesis that a bead-blasted surface finish in the 2 designs studied here (CAD and HD-2) lead to a high incidence of early loosening and marked progressive lysis. In general, these stems have functioned well in the long term, both clinically and radiologically. This data raises the question that other factors, such as the design, the offset, the high placement of the medial curvature of the stem, and the large body weight in the patients in the Iowa series may have contributed to the early failure of fixation of those hips in that series in conjunction with, or independent of the surface finish of that design of stem.