

Manoj Ramachandran BSc(Hons) MBBS(Hons) MRCS(Eng) FRCS(Tr&Orth)
- Home
- About Me
- Achievements
- Where I Work
- Entrepreneurship
- Books
- Teaching & Speaking
- Collaborations
- Research
- Publications
- Charity Work
- Some Cool Projects
- Conditions & Feedback
- Media Appearances
- Trainee Area
- Contact Me
- Where Else
Welcome to my personal site!
Welcome to my personal website
MANOJ RAMACHANDRAN
Manoj Ramachandran
BSc(Hons) MBBS(Hons) MRCS(Eng) FRCS(Tr&Orth)
Co-founder, Halfloop and Viz.ai
Consultant Paediatric Orthopaedic & Trauma Surgeon/Professor
Royal London Hospital, Barts Health NHS Trust;
Queen Mary, University of London, England
Clinical
Paediatric and young adult orthopaedics and trauma;
Professor (Visiting)
Digital Health/Med Tech
Co-founder Halfloop and Viz.ai;
Founded/run/advised digital health and med tech companies;
ex-Director of Informatics, Surgery and Cancer;
ex-CCIO, Barts Health NHS Trust
Research
Honorary Reader, Queen Mary, University of London;
Director of Innovation for Orthopaedics at Barts Health
Education
Founded/run multiple education companies
Publications
18 published books;
>120 published peer-reviewed papers
ACHIEVEMENTS
In numbers
18
Books published
>120
Papers published in peer-reviewed journals
>£6 million
Research grant funding raised
>10
Start-ups/companies founded/advised/run/sold
WHERE I WORK
Building national and international clinical and research collaborations
Royal London Hospital,
Barts Health NHS Trust
London, England
Consultant Paediatric Orthopaedic and Trauma Surgeon
Treating children and young people with bone and joint disorders
Queen Mary University,
University of London
London, England
Honorary Reader and Director of Clinical Strategy, Institute of Bioengineering (IOB)
ENTREPRENEURSHIP
Some (ad)ventures
Orthopediatrics Inc
Advisory board member (current)
Orthopediatrics' focus is purely on advancing the field of paediatric orthopaedics through the innovative development of state-of-the-art technologies, commitment to quality products, and industry-leading support and clinical education.
EduSurg
Online medical education
EduSurg delivers high-end online education for surgical trainees. Our flagship website Pass The MRCS is aimed at the postgraduate membership surgical exam.
TEACHING & SPEAKING
Some of my educational, keynote, judging and chairing gigs
COLLABORATIONS
International groups I work with
Aarhus
Aarhus University Hospital
Children's hip arthroscopy
Chief collaborator: Bjarne Moller-Madsen
Singapore
National University Hospital
Postgraduate courses
Chief collaborator:
James Hui
Stanford
Stanford Business School
Med tech design and artificial intelligence.
Chief collaborator:
Chris Mansi
Sydney
Children's Hospital at Westmead
The paediatric hip and basic science.
Chief collaborator:
David Little
RESEARCH
Focus areas
My research interests are varied within orthopaedics and range from clinical studies to basic science/translational work. Innovation is at the core of my research interests and I'm always open to novel research ideas and collaborations.
Grants
Ramachandran (CI), Bates P, Millington S, Hilton C and Kassam J
Barts Orthopaedic Research and innovation Centre - Building Life Changing Research Foundations
Barts Charity (£2.9m); 2019-2023
Ramachandran M (CI), Parvez N and Parvez S
PRINT study -3D printed orthotics in children with cerebral palsy
Innovate UK (£1.4m); 2018-2019
Dell’Accio F, Eldridge SE, Bertrand J, Sherwood J, Ramachandran M (Co-I)
ECM-sequestered GCP2, an unexpected chondrogenic factor
Arthritis Research UK (£267K); 2015-2018
Jaremko J, Mansi C, Golan D and Ramachandran M (Co-I)
A novel deep learning artificial intelligence algorithm for ultrasound in DDH
Joule Canadian Medical Association (CMA) Grant ($25K)Ramachandran M (CI) and Coggings D
Children’s Orthopaedic Outreach Programme
Barts and The London Charity Grant (£433K) 2014-2016
Mata A and Ramachandran M (PI)
Novel periosteal graft for bone regeneration
QM Proof of Concept award (£50K); 2014-2016
Knight M, Beales P, Chaple P, Mitchison H and Ramachandran M (Co-I)
Osteoarthritis may be treated as an environmental ciliopathy
Medical Research Council grant (£425K) 2014-2016
Lee D, Caton P, Heywood H and Ramachandran M (Co-I)
Augmenting sirtuin activity to drive cartilage regeneration and treat osteoarthritis
Dunhill Medical Trust grant (£150K); 2014-2016
Chowdhury TT, Peake N, Stebbings R, Vessellier S and Ramachandran M (Co-I)
Beneficial effects of CNP and mechanical conditioning in osteoarthritis and FAI
National Institute of Biological Standards Control grant (£30K); 2013-2015
Chowdhury TT, Homandberg GA, Bader DL and Ramachandran M (Co-l)
Role of matrix fragments and mechanical signals in the development of osteoarthritis
Government of Malaysia programme grant PDRA/PhD (£1m); 2012-2015
Ramachandran M (CI), Gottliebsen M, Rahbek O and Moller-Madsen B
Clinical outcomes, scoring systems and porcine animal model for paediatric hip arthroscopy
Aarhus University, Denmark (£250K); 2012-2015
Chowdhury TT, Ramachandran M (Co-I) and Bader DL.
Influence of mechanical conditioning and CNP in osteoarthritis modulation
Arthritis Research UK (£156K); 2011-2013
Ramachandran M (CI), Gottliebsen M and Moller-Madsen B.
Pump priming grant for hip arthroscopy skeletally immature porcine model
Aarhus University, Denmark (£16K); 2011-2012
Chowdhury TT, Ramachandran M (Co-I) and Salter DM.
Beneficial effect of C-type natriuretic peptide and mechanical loading in human cartilage
AO Foundation, 75, 695 CHF (£50K); 2010-2012
Chowdhury TT, Ramachandran M (Co-I) and Bader DL.
Anti-inflammatory effect of CNP in human engineered cartilage
DBI (MRC and EPSRC), Pump Priming Award (£10K); 2009-2010
PUBLICATIONS
My peer-reviewed journal articles arranged by category
Cartilage biology
Peake NJ, Bader DL, Vessillier S, Ramachandran M, Salter DM, Hobbs AJ, Chowdhury TT (2015). C-type natriuretic peptide signalling drives homeostatic effects in human chondrocytes. Biochem Biophys Res Commun. 2015 Oct 2;465(4):784-9. doi: 10.1016/j.bbrc.2015.08.087. Epub 2015 Aug 22.
Eldridge S, Nalesso G, Ismail H, Vicente-Greco K, Kabouridis P, Ramachandran M, Niemeier A, Herz J, Pitzalis C, Perretti M, Dell'Accio F (2015). Agrin mediates chondrocyte homeostasis and requires both LRP4 and α-dystroglycan to enhance cartilage formation in vitro and in vivo. Ann Rheum Dis. 2015 Aug 19. pii: annrheumdis-2015-207316. doi: 10.1136/annrheumdis-2015-207316. [Epub ahead of print]
Peake N, Su N, Ramachandran M, Achan P, Salter DM, Bader DL, Moyes AJ, Hobbs AJ, Chowdhury TT (2013).
Natriuretic peptide receptors regulate cytoprotective effects in an ex vivo human 3D/bioreactor model. Arthritis Res Ther. Jul 24;15(4):R76.
Ramachandran M, Achan P, Salter DM, Bader DL and Chowdhury TT (2011). Biomechanical signals and the C-type natriuretic peptide counteract catabolic activities induced by IL-1β in chondrocyte/agarose constructs. Arthritis Res Ther 13:R145.
Nalesso G, Sherwood J, Bertrand J, Pap T, Ramachandran M, De Bari C, Pitzalis C and Dell'accio F (2011).
WNT-3A modulates articular chondrocyte phenotype by activating both canonical and noncanonical pathways. J Cell Biol 193(3):551-64.
F1000 score: must read. Commentary in Generating a Wnt switch: it's all about the right dosage. Kestler HA, Kühl M. J Cell Biol 2011 May 2;193(3):431-3.
Bone biology
Duckworth AD, McQueen MM, Tuck CE, Tobias JH, Wilkinson JM, Biant LC, Pulford EC, Aldridge S, Edwards C, Roberts CP, Ramachandran M, McAndrew AR, Cheng KCK, Johnston P, Shah NH, Mathew P, Harvie J, Hanusch BC, Harkess R, Rodriguez A, Murray GD, Ralston SH (2019). Effects of Alendronic Acid on Fracture Healing. J Bone Miner Res. 2019 Nov 6. doi: 10.1002/jbmr.3899. [Epub ahead of print]
Duckworth AD, McQueen MM, Tuck CE, Tobias JH, Wilkinson JM, Biant LC, Pulford EC, Aldridge S, Edwards C, Roberts CP, Ramachandran M, McAndrew AR, Cheng KC, Johnston P, Shah NH, Mathew P, Harvie J, Hanusch BC, Harkess R, Rodriguez A, Murray GD, Ralston SH (2019). Effect of Alendronic Acid on Fracture Healing: A Multicenter Randomized Placebo-Controlled Trial. J Bone Miner Res. 2019 Jun;34(6):1025-1032. doi: 10.1002/jbmr.3679. Epub 2019 Mar 7.
Briggs AD, Kuan V, Greiller CL, Maclaughlin BD, Ramachandran M, Harris T, Timms PM, Venton TR, Vieth R, Norman AW, Griffiths CJ, Martineau AR (2012). Longitudinal study of vitamin D metabolites following long bone fracture. J Bone Miner Res. Dec 21. doi: 10.1002/jbmr.1855. [Epub ahead of print]
Birke O, Schindeler A, Ramachandran M, Cowell C, Munns C, Bellemore M and Little DG (2010). Preliminary experience with the combined use of recombinant bone morphogenetic protein and bisphosphonates in the treatment of congenital pseudarthrosis of the tibia. Journal of Children’s Orthopaedics 4(6): 507-517.
Miles J, Ramachandran M and Marsh DR (2008). Bisphosphonates in osteoporosis. Geriatric Medicine ; 38:275-82.
Ramachandran M and Little DG (2008). Orthopedic surgical principles of fracture management. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism 7:225-227.
Schindeler A, Ramachandran M, Godfrey C, Morse A, McDonald M, Mikulec K and Little DG (2008). Modeling bone morphogenetic protein and bisphosphonate combination therapy in wild-type and Nf1 haploinsufficient mice. Journal of Orthopaedic Research 26(1):65-74.
Little DG, Ramachandran M and Schindeler A (2007). The anabolic and catabolic responses in bone repair. J Bone Joint Surg (Br) 89(4): 425-433.
Schindeler A, Ramachandran M and Little DG (2006). BMP-2 treatment produces an attenuated response in a mouse model of type 1 neurofibromatosis. Bone 38(3): 18.
Hip
Firth GB, Foster M, Pieterse C, Ramguthy Y, Izu A, Bacarese-Hamilton J, Ramachandran M (2019). Effect of seasonal variation on the peak presentation of slipped capital femoral epiphysis. A comparison of children in Johannesburg, South Africa and London, UK. J Pediatr Orthop B. 2019 Oct 29. doi: 10.1097/BPB.0000000000000689. [Epub ahead of print]
Hatzikotoulas K, Roposch A; DDH Case Control Consortium (including Ramachandran M), Shah KM, Clark MJ, Bratherton S, Limbani V, Steinberg J, Zengini E, Warsame K, Ratnayake M, Tselepi M, Schwartzentruber J, Loughlin J, Eastwood DM, Zeggini E, Wilkinson JM (2018). Genome-wide association study of developmental dysplasia of the hip identifies an association with GDF5. Commun Biol. 2018 May 31;1:56. doi: 10.1038/s42003-018-0052-4. eCollection 2018.
Wright J, Ramachandran M (2018). Slipped Capital Femoral Epiphysis: The European Perspective. J Pediatr Orthop. 2018 Jul;38 Suppl 1:S1-S4. doi: 10.1097/BPO.0000000000001161
Hanna SA, Sarraf KM, Ramachandran M, Achan P (2017). Systematic review of the outcome of total hip arthroplasty in patients with sequelae of Legg-Calvé-Perthes disease. Arch Orthop Trauma Surg. 2017 Aug;137(8):1149-1154.
Jamjoom BA, Butler D, Thomas S, Ramachandran M, Cooke S (2017). Opinion survey of members of British Society of Children's Orthopaedic Surgery related to specific case scenarios in slipped capital femoral epiphysis. J Pediatr Orthop B. 2017 Jul;26(4):340-343
Jamjoom BA, Butler D, Thomas S, Ramachandran M, Cooke S (2017). Opinion survey of members of British Society of Children's Orthopaedic Surgery related to specific case scenarios in slipped capital femoral epiphysis. J Pediatr Orthop B. 2017 Jan 10. doi: 10.1097/BPB.0000000000000421. [Epub ahead of print]
Firth GB, Robertson AJ, Ramguthy Y, Ramachandran M, Schepers A (2016). Prognostication in developmental dysplasia of the hip using the ossific nucleus center edge angle. J Pediatr Orthop. 2016 Sep 23. [Epub ahead of print]
Massa E, Silk Z, Heidari N, Ramachandran M (2014).Hardware complications related to the surgical fixation of slipped capital femoral epiphyses. J Long Term Eff Med Implants 24(2-3):163-71.
Tibrewal S, Gulati V, Ramachandran M (2013). The Pavlik method: a systematic review of current concepts. J Pediatr Orthop B. Aug 29.
Kosuge D, Yamada N, Azegami S, Achan P, Ramachandran M (2013). Management of developmental dysplasia of the hip in young adults: Current concepts. Bone Joint J. Jun;95-B(6):732-7.
Karlen JW, Skaggs DL, Ramachandran M and Kay RM (2009). The Dega osteotomy: a versatile osteotomy in the treatment of developmental and neuromuscular hip pathology. Journal of Pediatric Orthopaedics 29(7): 676-682.
Nelson D, Ward K, Zenios M, Ramachandran M and Little DG (2007). The deformity index as a predictor of final outcome of femoral head sphericity in Perthes’ disease. Journal of Bone and Joint Surgery (Br) 89(10):1369-74.
Zenios M, Ramachandran M, Axt M, Gibbons PJ, Peat J and Little DG (2007). Posterior sloping angle of the capital femoral physis: interobserver and intraobserver reliability testing and predictor of bilaterality. Journal of Pediatric Orthopaedics 27(7):801-4.
Ramachandran M, Ward K, Brown RR , Munns C, Cowell CT, and Little DG (2007). Intravenous bisphosphonate therapy for traumatic osteonecrosis of the femoral head in adolescents. Journal of Bone and Joint Surgery (Am) 89(8):1727-34.
Ramachandran M, Kay RM and Skaggs DL (2007). Treatment of hip dislocation in Kabuki syndrome: a report of three hips in two patients. J Pediatr Orthop 27(1): 37-40.
Utukuri MM, Ramachandran M and Monsell F (2005). Successful excision of neurogenic heterotopic ossification around the hip in cerebral palsy. Hip International 15: 123-127.
Tai CC, Ridgeway S, Ramachandran M, Ng VA, Devic N and Singh D (2008). Patient expectations for hallux valgus surgery. Journal of Orthopaedic Surgery (Hong Kong) 16(1):91-5.
Foot
Malagelada F, Mayet S, Firth G, Ramachandran M (2016). The impact of the Ponseti treatment method on parents and caregivers of children with clubfoot: a comparison of two urban populations in Europe and Africa. J Child Orthop. Apr;10(2):101-7. doi: 10.1007/s11832-016-0719-7.
Wright J, Coggings D, Maizen C, Ramachandran M (2014). Reverse Ponseti-type treatment for children with congenital vertical talus: Comparison between idiopathic and teratological patients. Bone Joint J. Feb;96-B(2):274-8.
Chou DTs, Ramachandran M (2013). Prevalence of developmental dysplasia of the hip in children with clubfoot. J Child Orthop. Oct;7(4):263-7.
Jowett CR, Morcuende JA and Ramachandran M. Management of congenital talipes equinovarus using the Ponseti method: a systematic review (2011). J Bone Joint Surg (Br) 93(9):1160-4.
Utukuri MM, Ramachandran M, Hartley J and Hill RA (2006). Patient-based outcomes after Ilizarov surgery in resistant clubfeet. J Pediatr Orthop B 15(4):278-84.
General
Two-year clinical results of a novel load redistribution device for the treatment of medial knee OA.
Haverkamp D, van der Vis HM, Lee J, Achan P, Sierevelt IN, Ramachandran M.Arch Orthop Trauma Surg. 2020 Dec;140(12):1873-1881. doi: 10.1007/s00402-020-03390-x. Epub 2020 Mar 4.
Hemiepiphysiodesis: when should it be considered a day-case procedure?
Barrett MC, Manoukian D, Tzatzairis T, Segaren N, Firth GB, Ramachandran M.J Pediatr Orthop B. 2021 Jan;30(1):48-51. doi: 10.1097/BPB.0000000000000779.
Prasad A, Donovan R, Ramachandran M, Dawson-Bowling S, Millington S, Bhumbra R, Achan P, Hanna SA (2018). Outcome of total knee arthroplasty in patients with poliomyelitis: A systematic review. EFORT Open Rev. 2018 Jun 6;3(6):358-362. doi: 10.1302/2058-5241.3.170028. eCollection 2018 Jun.
Jones LD, Golan D, Hanna SA, Ramachandran M (2018). Artificial intelligence, machine learning and the evolution of healthcare: A bright future or cause for concern? Bone Joint Res. 2018 May 5;7(3):223-225. doi: 10.1302/2046-3758.73.BJR-2017-0147.R1. eCollection 2018 Mar.
Malagelada F, Rahbek O, Sahirad C, Ramachandran M (2017). Results of operative 4-in-1 patella realignment in children with recurrent patella instability. J Orthop. 2017 Nov 11;15(1):13-17. doi: 10.1016/j.jor.2017.11.002. eCollection 2018 Mar.
Yeo A, James K, Ramachandran M (2015). Normal lower limb variants in children. BMJ. 2015 Jul 7;350:h3394. doi:10.1136/bmj.h3394.
Kosuge DD, Pugh H, Ramachandran M, Barry M and Timms A (2011). Marginal excision and Ilizarov hemicallotasis for osteofibrous dysplasia of the tibia: a case report. J Pediatr Orthop B 20(2):89-93.
Zenios M, Ramachandran M and Bellemore MC (2007). Unilateral limb deformity due to fibrous tethers: A report of three cases. J Pediatr Orthop 27(4):398-401.
Lau K, Utukuri MM, Ramachandran M and Jones DHA (2007). Iron supplementation for post-operative anaemia following major paediatric orthopaedic surgery. Ann R Coll Surg Engl 89: 44-46.
Ramachandran M and Eastwood DM (2006). Botulinum toxin and its orthopaedic applications. J Bone Joint Surg (Br) 88(8): 981-7.
Ramachandran M, Lau K and Jones DHA (2005). Rotational osteotomies for congenital radioulnar synostosis. J Bone Joint Surg (Br) 87(10): 1406-10.
Ramachandran M, Tsirikos AI, Lee J and Saifuddin A (2004). Whole spine magnetic resonance imaging in patients with neurofibromatosis type-1 and spinal deformity. J Spinal Disord Tech 17(6): 483-491.
Tsirikos AI, Ramachandran M, Lee J and Saifuddin A (2004). Assessment of vertebral scalloping in NF-1 with plain radiography and MRI. Clin Radiol 59(11): 1009-1117.
Ramachandran M, Utukuri MM and Hill RA (2003). Spot the diagnosis. Recurrent Blount’s disease. J Postgrad Med 49(4): 324, 327.
Layton M, Ramachandran M, O' Shaughnessy D and Luzzatto L (1995). Glucose-6-phosphate dehydrogenase deficiency. Curr Paediatr 5: 190-194.
Ramachandran M and Benjamin IS (1997). Metastasectomy: Aspects relating to the liver. Cancer Topics 10(8): 1-4.
Femoroacetabular impingement and hip arthroscopy
Griffin DR, Dickenson EJ, Wall PDH, Achana F, Donovan JL, Griffin J, Hobson R, Hutchinson CE, Jepson M, Parsons NR, Petrou S, Realpe A, Smith J, Foster NE; FASHIoN Study Group (including Ramachandran M) (2018). Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet. 2018 Jun 2;391(10136):2225-2235. doi: 10.1016/S0140-6736(18)31202-9. Epub 2018 Jun 1.
Griffin DR, Dickenson EJ, Wall PD, Donovan JL, Foster NE, Hutchinson CE, Parsons N, Petrou S, Realpe A, Achten J, Achana F, Adams A, Costa ML, Griffin J, Hobson R2, Smith J; FASHIoN Study Group.
Collaborators (33): Bache E, Bankes M, Bartlett G, Board T, Cronin M, Dandacholi W, Eastaugh-Waring S, Fehily M, Fern E, Field R, George M, Hashimi-Nejad A, Kavathapu V, Khan T, Kiely N, Latimer P, Madan S, Malviya A, Mcbryde C, Mohammed A, Norton M, Patil S, Politis A, Rajpura A, Ramachandran M, Stafford G, Sturridge S, Thomas P, White C, Wilson M, Whitaker J, Williams M, Witt J.
BMJ Open. 2016 Aug 31;6(8):e012453. doi: 10.1136/bmjopen-2016-012453.
Protocol for a multicentre, parallel-arm, 12-month, randomised, controlled trial of arthroscopic surgery versus conservative care for femoroacetabular impingement syndrome (FASHIoN).
Azegami S, Kosuge D, Ramachandran M (2013). Surgical treatment of femoroacetabular impingement in patients with slipped capital femoral epiphysis: A review of current surgical techniques. Bone Joint J.;95-B(4):445-51.
Ramachandran M, Azegami S and Hosalkar H (2013). Current concepts in the treatment of adolescent femoroacetabular impingement. Journal of Children's Orthopaedics March 2013, 7(2):79-90.
Jayakumar P, Ramachandran M, Youm T, Achan P (2012). Arthroscopy of the hip for paediatric and adolescent disorders: Current concepts. J Bone Joint Surg (Br) 94(3):290-6
Orthopaedic infection
Iliadis AD, Ramachandran M (2017). Paediatric bone and joint infection. EFORT Open Rev. 2017 Mar 13;2(1):7-12.
Yeo A, Ramachandran M (2014). Acute haematogenous osteomyelitis in children. BMJ. Jan 20;348:g66. doi: 10.1136/bmj.g66.
Dartnell J, Ramachandran M and Katchburian M (2012). Haematogenous acute and subacute paediatric osteomyelitis: a systematic review of the literature. J Bone Joint Surg (Br) 94(5):584-95.
Chou DTS, Achan P and Ramachandran M (2012). The World Health Organisation ‘5-moments of Hand Hygiene’: The Scientific Foundation. J Bone Joint Surg (Br) 94(4):441-445.
Pabla R, Tibrewal S, Ramachandran M and Barry M (2011). Primary subacute osteomyelitis of the talus in children: case series and review. Acta Orthop Belg 77(3):294-8.
Kumar J, Ramachandran M, Little D and Zenios M (2010). Pelvic osteomyelitis in children. Journal of Pediatric Orthopaedics B 19(1):38-41.
Kang S-N, Sanghera T, Mangwani J, Paterson JMH and Ramachandran M (2009). The management of paediatric septic arthritis: systematic review of the English language literature. Journal of Bone and Joint Surgery (Br) 91(9):1127-33.
Orthopaedic trauma
Tzatzairis T, Firth G, Loke WJ, Serlis A, Ramachandran M.J Pediatr Orthop B. 2021 Mar 1;30(2):154-160. doi: 10.1097/BPB.0000000000000770.
Coyle C, Jagernauth S, Ramachandran M (2014). Tibial eminence fractures in the paediatric population: a systematic review. J Child Orthop. Mar 2. [Epub ahead of print].
Kang SN, Mangwani J, Ramachandran M, Paterson JM and Barry M (2011). Elastic intramedullary nailing of paediatric fractures of the forearm: a decade of experience in a teaching hospital in the United Kingdom. J Bone Joint Surg (Br) 93(2):262-5.
Jayakumar P, Barry M and Ramachandran M (2010). Orthopaedic aspects of paediatric non-accidental injury. Journal of Bone and Joint Surg (Br) 92(2):189-95.
Ramachandran M, Skaggs DL, Crawford HA, Eastwood DM, Lalonde FD, Vitale MG, Do TT and Kay RM (2008).
Delaying treatment of supracondylar fractures in children: has the pendulum swung too far? Journal of Bone and Joint Surgery (Br) 90(9):1228-33.
Zenios M, Ramachandran M, Milne B, Smith N and Little DG (2007). Intraoperative stability testing of lateral-entry pin fixation of pediatric supracondylar humeral fractures. Journal of Pediatric Orthopaedics 27(6):695-702.
Weiss J and Ramachandran M. Hip and pelvic injuries in the young athlete (2007). Op Tech Sports Med 14(3): 212-217.
Ramachandran M, Birch R and Eastwood DM (2006). Clinical outcome of nerve injuries associated with supracondylar fractures of the humerus in children: the experience of a specialist referral centre. J Bone Joint Surg (Br) 88(1): 90-94.
Tai CC, Ramachandran M, McDermott ID, Ridgeway S and Mirza Z (2005). Management of suspected scaphoid fractures in accident and emergency departments - time for new guidelines. Ann R Coll Surg Engl 87(5): 353-7.
Tai CC, Ramachandran M, Young SW and Nathan SS (2004). Unusual cause of deep vein thrombosis following dynamic hip screw fixation Hip International 14: 262–264.
Training and education
Heaton SR, Little Z, Akhtar K, Ramachandran M, Lee J (2016). Using simulation to train orthopaedic trainees in non-technical skills: a pilot study. World J Orthop. 2016 Aug 18;7(8):475-80. doi: 10.5312/wjo.v7.i8.475.
Al-Nammari SS, Pengas I, Asopa V, Jawad A, Rafferty M, Ramachandran M (2015). The Inadequacy of Musculoskeletal Knowledge in Graduating Medical Students in the United Kingdom. J Bone Joint Surg Am. 2015 Apr 1;97(7):e36.
Aresti N, Ramachandran M (2014). Developing an electronic teaching and training portfolio. Curr Rev Musculoskelet Med. Feb 6. [Epub ahead of print].
Farooq S, Kang SN, Ramachandran M (2009). Sex, power and orthopaedics. Journal of the Royal Society of Medicine 102(4):124-5.
Al-Nammari SS, James BK and Ramachandran M (2009). The inadequacy of musculoskeletal knowledge after foundation training in the United Kingdom. Journal of Bone and Joint Surgery (Br) 91(11):1413-8.
Ramachandran M (2002). Becoming a preregistration house officer. BMJ 325: S33-34.
Connor A, Poole A and Ramachandran M (2002). House officers need formal career development. BMJ 324: S71.
Ramachandran M (2000). The teaching of trauma and orthopaedic surgery to the undergraduate in the United Kingdom. J Bone Joint Surg (Br) 82(8): 1206.
Medical history
Huntley C, Hodder A, Ramachandran M (2015). Clinical and historical aspects of the Elephant Man: exploring the facts and the myths. Gene Jan 15;555(1):63-5. doi: 10.1016/j.gene.2014.09.056. Epub 2014 Sep 30.
Aresti N, Ramachandran M (2012). Nonoriginal Malappropriate Eponymous Nomenclature: examples relevant to paediatric orthopaedics (2012). J Pediatr Orthop B. 21(6):606-10.Ramachandran M and Aronson JK (2011). John Marshall's first description of surgical electrocautery. J R Soc Med;104(9):355-60.
Ramachandran M and Aronson JK (2011). John and James Parkinson's first description of acute appendicitis and its associated complications of perforation and death. J R Soc Med;104(7):283-5.
Ramachandran M and Aronson JK (2011). John Bostock’s first description of hayfever. J R Soc Med;104(6):237-40.
Ramachandran M and Aronson JK (2011). Frederick Treve's first surgical operation for appendicitis. J R Soc Med;104(5):191-7.
Ramachandran M and Aronson JK (2011). Benjamin Brodie's infamous case of Isambard Kingdom Brunel and an inhaled gold coin. J R Soc Med; 104(4):149-54.
Medical art
Hodder A, Huntley C, Aronson JK, Ramachandran M (2015). Pycnodysostosis and the making of an artist. Gene Jan 15;555(1):59-62. doi: 10.1016/j.gene.2014.09.055. Epub 2014 Sep 30.
Salter V and Ramachandran M (2008). Medical conditions in works of art. British Journal of Hospital Medicine ; 69: 91-4.
The Diagnosis of Art series with JK Aronson in the Journal of the Royal Society of Medicine:
WH Auden’s face. J R Soc Med 2011 104:38-40.
Ernst Ludwig Kirchner's 'nervous breakdown'. J R Soc Med 2010 103:112-3.
Scleroderma in Paul Klee – and Rembrandt's scholar? J R Soc Med 2010 103: 70 - 71.
Durer's squint – and Shakespeare's? J R Soc Med 2009 102: 391-3.
Van Gogh and male pattern baldness. J R Soc Med 2009; 102: 32-33.
Sir George Savile, 8th Baronet – the ears have it? J R Soc Med 2008; 101: 605-606.
Millais' Blind Girl. J R Soc Med 2008; 101: 564 - 565.
Dr Péan's operation. J R Soc Med 2008; 101: 423 - 424.
Albrecht Dürer and the Christ Child's drooped shoulder. J R Soc Med 2008; 101: 87 - 88.
Alice, the Duchess, Sir John Tenniel, foxgloves and roses. J R Soc Med 2007; 100: 576-8.
Caravaggio's jaundiced Bacchus. J R Soc Med 2007; 100: 429-430.
Achilles Emperaire and spondyloepiphyseal dysplasia congenita. J R Soc Med 2007; 100: 384-385.
Valentin le desossé and Ehlers-Danlos syndrome. J R Soc Med 2007; 100: 193-194.
Lowry’s cripples. J R Soc Med 2007; 100: 153-154.
Diastrophic dysplasia and Hephaistos. J R Soc Med 2006; 99: 584-5.
Rachmaninoff’s hand span. J R Soc Med 2006; 99: 529-30.
Exophthalmos and Gustave Doré’s ogre. J R Soc Med 2006; 99: 421.
Melancholy and the Portrait of Doctor Gachet. J R Soc Med 2006; 99: 373-4.
Arthrogryposis and Ribera’s The Clubfoot. J R Soc Med 2006; 99: 327-8
CHARITY WORK
Projects I have founded or been involved in
Mark Paterson Trust, Ghana (2018-present)
Co-founder of the Mark Paterson Trust (in association with MOTEC Life), in honour of my ex-colleague at the Royal London Hospital Mark, providing bi-annual trips of treatment and training to Ghana, where we see and treat complex children's bone and joint disorders in underserved populations
F.R.O.D.O. (Foundation for Relief of Disabled Orphans), Albania
(2009-2012)Assessing and treating children and young adults with bone and joint disorders with my colleague Mark Paterson (5 trips in total)
SOME COOL PROJECTS
A selection from the past
PRINT study
Innovate UK-funded project for 3D printed orthotics
Chief Investigator (2018-2019)
This is the UK's first major study investigating the use of 3D printed orthotics in children with cerebral palsy compared to standard orthotics.
Bespoke study on urban cycling injuries
Chief investigator (2015-2017)
The Bespoke project is a collaboration between the research teams of the Orthopaedic and Emergency Departments of Barts Health NHS Trust with Barts Charity to explore bicycle related injuries in London to record the wheres, whys and hows of cycling-related injuries in London.
Children's Orthopaedic Outreach Program (COOP)
Bring children's bone and joint care closer to home
Chief investigator (2015-2017)
I set up a novel multidisciplinary ‘Children’s Orthopaedic Outreach Programme - COOP’ to assess and treat children in North East London with initiation of treatment at Barts and The London Children’s Hospital in the paediatric orthopaedic service and subsequent virtual follow-up at home via telephone and/or video.
Hip Tracker
Digital perioperative symptom tracking in hip surgery
Chief investigator (2013)
I worked with an innovative software company, umotif, to test a new smartphone app (HipTracker) for patients following hip surgery to self-track their symptoms, complete standard surveys and receive condition-specific content to help recovery. HipTracker won second place in the Vodafone Foundation Mobile for Good Europe Awards in 2013 and helped umotif win the Cisco BIG (British Innovation Gateway) Award in 2013.
Walk This Way
Charity-funded project for Ponseti treatment of clubfoot
Organiser (2009)
With funding from Barts and The London Charity, my team and I were able to travel to Iowa to learn from Dr Ponseti first hand in 2009. Sadly, Dr Ponseti died just weeks after the visit. The Barts and The London Children's Hospital paediatric foot clinic is now the UK’s largest centre, with satellite clinics established in other hospitals in East London, Essex and beyond.
CONDITIONS & FEEDBACK
FAQs on common bone and joint conditions for patients and parents/carers and some feedback
Developmental Dysplasia of the Hip (DDH)
Q: What is DDH?
A: In DDH, the ball and socket of the hip joint do not fit snugly together, making the joint less stable and the ball may slide in and out of the socket. This is called a subluxatable hip if the ball can pop back in. If the ball loses contact with the socket and stays outside the joint, it is called a dislocated hip.
Q: How common is hip dysplasia?
A: DDH requiring treatment affects 1-3 babies per 1000 births. That's up to a 1 in 30 chance of your child having this condition.
Q: What are the risk factors?
A: The most common risk factors are:
- breech position (at any time during pregnancy or at birth) and
- family history of DDH or hip problems in early life.
Other risk factors include:
- multiple pregnancy (twins, triplets or more)
- oligohydramnios (low levels of amniotic fluid during pregnancy)
- torticollis (baby born with a crooked or wry neck) and
- foot abnormalities (including positional talipes, where the foot is turned down and in but is flexible, metatarsus adductus, where the front of the foot is hooked or turned in, and calcaneovalgus, where the foot is turned upwards and outwards)
Q: When should I suspect it?
A: In addition to the above risk factors, you should suspect it clinically if:
- When changing a nappy, one leg/thigh does not seem to move outwards or open as fully as the other or both legs seem restricted
- Deep unequal creases may be present in the buttocks or thighs
- One leg appears shorter than the other (bend both knees up and compare their heights - one will be lying lower than the other)
- When moving one or both hip joints e.g. when changing nappies, you may feel a click and/or a clunk
- There are additional clinical tests such as Ortolani's and Barlow's - these tests are best performed by an experienced paediatric orthopaedic surgeon
- In older children, one leg may be shorter than the other and your child walks with a limp, tiptoes on the shorter leg or bends the knee on the longer leg. If both hips are dislocated, your child may walk with a waddling limp.
Q: How is it diagnosed?
A: If any of the above applies to your child, then this may well have been picked up at the newborn and 6-8 week baby check. If not, then go and see your GP who will refer on for an ultrasound scan of the hip (if less than 4 months of age) or an X-ray (if more than 4 months of age). At the Royal London Hospital, we run a one-stop baby hip clinic every Wednesday afternoon where clinical assessment, imaging and treatment all happen at the same time.
Q: How is it treated?
A: When picked up at less than 4 months of age on an ultrasound scan, treatment is with a special soft hip harness (Pavlik harness) that holds the hip joint in the correct position for 4-6 weeks. Tis has a success rate of more than 90%. If picked up later or if the harness treatment fails, the hip joint has to be relocated gently (closed reduction) under general anaesthesia and held in position for 3 months in a special plaster cast called a hip spica (including a change of spica cast at 6 weeks under anaesthetic). My preference is not to have a bar between the legs in the spica cast. Occasionally, tight tendons in the groin may have to be released to maintain a hip joint relocation (tenotomies).
In older children, further treatments may need to be added at the time of surgery, such as opening the hip joint to relocate the ball accurately into the socket (open reduction), cutting the pelvic bone in order to restore the socket shape (pelvic osteotomy) and/or cutting and reshaping the femur bone to repoint the ball in the right direction (femoral osteotomy). My preference is to avoid leaving any metalwork behind is possible in order to prevent the need for further surgery for metalwork removal. My preferred pelvic osteotomy is the Dega which can be done without fixation with pins or wires. The success rates are very high and I have published on the technique and results previously here.
Q: If it needs an operation, what happens before, during and after?
A: Most children do not need any special preparation for surgery. Anaesthetic assessment is performed on the day of admission (including weight and general health check). If any blood tests are needed, then they are performed when your child goes to sleep in order to reduce distress. For closed reductions, your child is admitted as a day case and can go home the same day once you are comfortable looking after her in her new cast and she has recovered fully from the anaesthetic. For open reductions +/- osteotomies, she will spend 1-2 nights in the hospital but one of you can stay with her in the hospital.
Pain is well controlled by the anaesthetist who will give an injection into your child's back (spinal) to make the hip joint area numb. In addition, the lack of hip joint movement in the spica cast minimises the level of pain.
Q: What complications should I be most concerned about?
A: The three most common complications are:
- redislocation (where the ball pops out of the socket - this most commonly happens within the first 10 days, is diagnosed on X-ray and is treated by removing the spica cast and waiting till your child is older to attempt a further relocation)
- avascular necrosis (this is loss of the blood supply to the hip joint and is rare - if mild to moderate, it often improves spontaneously - if severe, which is very rare, your child may need further surgery)
- need for further surgery (this may either be needed because of loss of position and/or failure to achieve a full relocation at the initial operation, or because the hip joint fails to develop fully, necessitating further surgery when your child is older)
Q: What will the hip spica plaster cast be like?
A: Most commonly, your child will be in a spica similar to the one in the image above (but most likely white in colour!). The legs will usually be bent at the knee in what is known as the 'frog' position. I rarely use a bar between the legs. There is excellent information on spica casts on the STEPS Charity website but we will provide you with all the information you need, most commonly via our Specialist Physiotherapists and Occupational Therapists.
A small selection of patient/parent/carer feedback I have received over the years
Robert (and Holly) Walsh 21/09/2018
Mr Manoj Ramachandran, Thank you and thank you again.
These 2 words have been uttered so many countless times that they have lost any true emphasis of gratitude and cant at all come close to my thanks for you, your amazing team and all in the NHS. Today we had a check up scan for our daughter Holly Walsh. I’m very sorry but the name of the doctor we spoke with has completely escaped my memory, we were so anxious that I only took in Holly’s prognosis which we were told that her procedures and surgery worked very well. This is all thanks to you and your team. We do understand that over the next few years Holly will be checked and could potentially show up any other issues but we are optimistic it will all be fine. I do understand that Holly is now part of a growing number of children who are born with hip problems/issues that vary in severity along with their corrective procedures and outcome.
I also know this was something that was missed for so long and went undiagnosed. This is no longer the case because of people like you. Your constant research, development and better diagnosis along with the non stop learning of how to fix these issues and mostly with non invasive procedures means this will no longer be some dormant problem that can cause major problems latter in life but is now something that can be dealt with at an early age. I know and understand that because of the volume of children and parents/guardians you see is extremely large and I don’t at all expect you to remember my daughter Holly, my wife Liz or myself and I don’t expect for you to reply to my mail as I am sure you’re extremely busy. This is just my very small way of letting you know just how much everything you have done for Holly means so much to us and I really hope that you are told this by everyone of your patients and their families.
My wife and I since day one of meeting you have both always agreed that as amazing and talented as every nurse, doctor, surgeon or consultant in the NHS is, they could learn so much more from a person like you Mr Ramachandran. I have said to anyone I have spoken to about Holly’s procedures that how you explained and reassured us of Holly’s problems made everything so much more positive and always filled us with such optimism. I truly believe that you could give somebody such awful news that they had 2 weeks to live and that person would leave your office removed of any fear or negativity and this is really something that can’t be studied in medical schools. For first time parents of a child we wanted for so long, as common as this problem is, for us it was our beautiful little girl who needed help and we couldn’t have been more lucky to have had you to help her. You have no idea how much you have done for us and we will be forever grateful to you. Thank you so much and please thank all of your team for us.
Kindest regards
Robert Walsh
Sean Drewery (Lewis) 04/02/2016
Thank you for your time and ongoing support with our son and can only express how happy we are with the treatment you have provided to date.
Many thanksColin Blakemore 19/12/2013
Hello Dr Ramachandran
Just a quick email to say that Sam Blakemore is healing very well indeed after his recent op. We can't even find a scar!
A big thanks to you and your team and we'll see you in January for his follow up.Colette and Torquil (and Luke!) 29/06/2012
Hi Manoj
I hope you and your family are well? I just wanted to say a big thank you again for what you have done for Luke!
I just came across this old mail where we had posed many worries about his knee surgery and you replied and completely gave us confidence! Sorry we were such a pain but it is always hard when a surgery is coming up for your child and you start to question whether you're doing the right thing. Thanks you so much for your kindness and patience. You'll be pleased to hear that Luke is walking completely unaided now,hasn't used the walker for a couple of months. He is dancing, spinning around, bending his knees and trying to run, bless him. He still falls a bit but is generally really steady and growing more confident every day. It's so amazing to see him wandering about on his own, it freaked us out at first but he's all over the place now and very happy with his new-found freedom. He's started at school nursery too and is settled and supported. I feel that we have all come through the hardest part, the first 2 years were really stressful and we are very thankful to you and Di for always giving us reassurance and confidence that you knew what was best for Luke, I know we have been very fortunate in our experience compared to what others have been through.
Hope you have a lovely weekend and thanks again from all of us for everything you've done.
Best wishesRichard Alleyne 22/05/2012
Hello Manoj
It's Richard Alleyne....
Sorry for not contacting you before things have been a bit crazy since I returned to athletics!
Things are going really well at the moment, I am currently ranked 4th in the country and not far from qualifying for the Olympic Games.
My hip is perfect, I'm not having any issues with it all, my rehab was good and I am hurdleing without discomfort, you really have helped me with my dreams and for that I am truly grateful.
The film is due for release in some cinemas around London on the 25th of May. When I get the list I will forward it to you.
Best wishesLinda Lawrance C.A 25/01/2011
Hi Dr Ramachandran,
I hope you remember my husband Jason & I. You both treated our son Jack Lawrance just after he was born in June 2007.
Jack is now 3 ½ and he has a little sister Grace who is 10 months old. Grace was not born with Talipes or any other foot problems, and we are also expecting our third child but have yet to have our 20w scan to determine if there is anything out of the ordinary.
Over the last month or two, Jack has been featured in a Magazine article and has appeared on 2 current affairs TV shows here in Australia. The article is attached if you’d like to read it (sorry it’s upside down), but only the most recent TV show is available to view online at this link…
http://video.au.msn.com/watch/video/child-smile/xanz92t?fg=AU_ninemsn_kerrianne
I hope you are able to view it and see how far Jack has come over the last 3 years. He truly is a remarkable little boy and nothing is holding him back, all thanks to the fantastic treatment he received from you both in London.
Even though he has Moebius Syndrome and has trouble saying some words, he is a non-stop chatterbox and loves being outside running, kicking the ball, playing on his bike, swimming, and watching Jason play baseball. He is being cared for very well by various specialists here in Australia, but we will never forget everything you did for us and correcting Jacks feet so he can walk and run so well.
Thank you.Colette and Torquil Allen (and Luke, of course!) 29/11/2010
Hi Manoj
Hope you are well?
We just wanted to take this opportunity to say thank you so much for all your amazing input with Luke. We feel very fortunate to have been under the care of you and your team.
The difference in Luke in the past two years has been completely transforming and we are very grateful for all your knowledge, wisdom and encouragement. I know he still has a long way to go but we are very hopeful about his future, he is so bright, determined and happy that we know he’ll go far in life.
His knee looks great, it’s so good to finally see it bending in the right direction and the scar is so small, we are amazed and very thankful.
Please send our thanks and best wishes to Di and the team – we’ll see you next year.
Have a lovely Christmas.MEDIA APPEARANCES
Some micro-moments...
Disney's Save Our Squad 2022
David Beckham's Disney+ Reality TV show
Treating surgeon during Save Our Squad's season during which David Beckham mentored a London-based youth football team through their season.
Clubfoot
Mark visits the club foot clinic at The Royal London Hospital, which sent a team, led by consultant paediatric orthopaedic surgeon, Manoj Ramachandran to study with Dr Ponseti at his Iowan clinic. Mark meets Hannah, whose 8 week old baby, Penelope, is just beginning treatment and hears from Claire, whose son, Lucas, now four years old, has, post-treatment, two perfect feet.
Bandy legs and knock knees
Babies, toddlers and pre-school children often seem to have bow legs and knock-knees and parents frequently turn up at their doctor's surgery asking for reassurance about the way their children walk. Manoj Ramachandran, consultant children's orthopaedic and trauma surgeon based at The Royal London and Bart's Hospital tells Mark that up to a quarter of the children referred to his clinics have normal, developmental lower limb variants.
Normal lower limb variants in children
Clinical examination video recorded by the BMJ to accompany a review article on examining normal variants of the lower limb in children.
ITV News interview Bespoke project October 2014
Watch here
A new crowdsourced app will log cycle accidents, injuries and near misses in the capital
The Bespoke project collaborators have developed a crowd sourcing app that will log cycle accidents, injuries and near misses in the hope of mapping cycling blackspots. The app was suggested after Orthopaedic and Emergency Departments of Barts Health saw an increase in the number of cyclists brought into A and E departments after cycling on London's road.
TRAINEE AREA
For trainees in orthopaedics - common questions you need to know the answers to!
The answers are mostly in my books (what a plug!). Also tune into orthofastfacts, a free educational podcast.
Statistics (Basic Orthopaedic Sciences)
1. What are the different levels of evidence? What is the difference between a cohort and a case-control study? What is the difference between a systematic review and a meta-analysis? What are the features of a randomised controlled trial (use an example to describe the features)? Within RCTs, what are biases and confounding factors, and how can you randomise and mask/blind?
2. What is a Gaussian distribution? What is standard deviation (SD) as opposed to standard error of the mean (SEM)? What are the different types of errors? What is power analysis?
3. Tell me about correlation and regression.
4. What is the difference between incidence and prevalence?
5. Do you know of any screening programs in orthopaedics? Do they fit the criteria for screening?
6. Draw me a contingency table? Now explain sensitivity, specificity, positive and negative predictive value and accuracy?
7. How do you measure reliability in a study?
8. Tell me about survival analysis.
9. What do orthopaedic surgeons use funnel plots for? What are their features?
Genetics (Basic Orthopaedic Sciences)
1. What are chromosomes composed of? What is the basic structure of DNA?
2. What major chromosomal abnormalities relevant to orthopaedics are you aware of?
3. Draw an inheritance table for an autosomal dominant (or autosomal recessive or X-linked dominant or X-linked recessive) condition of your choice. Why is this condition of importance to orthopaedic surgeons?
4. Do you know of any X-linked dominant conditions? What is the risk of future offspring developing the condition?
5. Osteogenesis imperfecta (OI) is an example of single-gene inheritance. What are the different types of OI? What are the clinical manifestations?
Skeletal embryology (Basic Orthopaedic Sciences)
1. When does the limb bud of the embryo first appear?
2. What is a secondary ossification centre?
3. Draw a sketch of a physis. Describe the function of each of the layers.
4. Through which layer of the physis do fractures occur? Why?
5. How is the physis affected by rickets? What are the clinical manifestations of rickets?
Orthopaedic pharmacology (Basic Orthopaedic Sciences)
1. What are the different methods of achieving pain relief after joint arthroplasty? Tell me how the different classes of drugs work? What are their side effects?
2. What thromboprophylaxis regimen would you use for total hip arthroplasty? Why?
3. What are the indications for the use of bisphosphonates in orthopaedics? How do they work?
4. What classes of drug can be used to treat osteoporosis?
5. Have you ever performed a haematoma block? How do local anaesthetics work?
Inflammation and infection (Basic Orthopaedic Sciences)
1. Classify bacteria. Give some examples of Gram-positive bacteria.
2. How do penicillins act? What are the different classes of penicillins? What are their side effects?
3. How do bacteria develop resistance?
4. Describe the pathogenesis of septic arthritis.
5. What is MRSA, and how is it acquired?
6. How is musculoskeletal TB diagnosed and treated?
7. Why are prosthetic infections difficult to diagnose and treat? What methods are available for diagnosis in such cases?
Imaging techniques (Basic Orthopaedic Sciences)
1. What is the difference between how X-rays work in plain radiography versus fluoroscopy?
2. What are the advantages of digital radiography compared to conventional radiography?
3. What do you understand by the term ‘scatter’? Name some of the ways in which you can reduce radiation exposure from scatter during fluoroscopy.
4. Here is a DEXA scan report. Talk me through it.
5. How does ultrasound work? Talk me through the principles behind Doppler scanning.
Orthopaedic oncology (Basic Orthopaedic Sciences)
1. Describe this tumour. [Prop-based question using plain radiographs or other imaging modalities.]
2. How would you investigate a patient who presents with a possible malignant bone tumour?
3. How are bone tumours staged?
4. What are the principles of treatment of bone tumours?
5. What surgical options are available in the treatment of bone tumours?
Ligament and tendon (Basic Orthopaedic Sciences)
1. What is the structure of collagen?
2. Describe the blood supply of tendons and ligaments.
3. How do tendons and ligaments heal after injury?
4. Draw the stress–strain curve of a ligament/tendon and explain its various parts.
5. Discuss injuries to tendons and mechanisms of fatigue failure.
Meniscus (Basic Orthopaedic Sciences)
1. Can you describe the anatomy of a meniscus?
2. What are the three vascular zones of the meniscus?
3. What are the functions of the meniscus?
4. Is vertically or horizontally oriented suture more biomechanically advantageous? Why?
5. What is the usual mechanism of injury for a meniscal tear?
6. What are the indications for surgical repair of a meniscal tear?
Cartilage (Basic Orthopaedic Sciences)
1. What is the composition of articular cartilage?
2. Draw the structure of articular cartilage.
3. What are the functions of articular cartilage? How is structure related to function?
4. What pathological processes are involved when cartilage is injured??
5. What are the different options available for treating cartilage defects?
Nerve (Basic Orthopaedic Sciences)
1. Draw a cross-section of a nerve. Describe its structure and how this may vary along its course.
2. Classify nerve injuries. What does ‘axonotmesis’ mean? What is the mode of degeneration? What affects speed of recovery? What is the value of the Tinel sign?
3. What is the pathology of carpal tunnel syndrome?
4. Interpret a nerve conduction study.
5. What are the F wave and the H reflex? What is their clinical significance?
Skeletal muscle (Basic Orthopaedic Sciences)
1. Describe the basic structure of skeletal muscle.
2. What is the mechanism of contraction of skeletal muscle?
3. What are the events that occur at the neuromuscular junction?
4. What different types of skeletal muscle fibre do you know of?
5. How does injured muscle heal?
Basics of bone (Basic Orthopaedic Sciences)
1. What is the structure of bone?
2. What cells are found in bone? What are their functions?
3. What does the matrix of bone contain?
5. How is calcium regulated in the body? What is the contribution of bone?
Bone injury (Basic Orthopaedic Sciences)
1. How do fractures heal?
2. What factors affect fracture healing?
3. What are the indications for the use of bone allografts? Are there any precautions to consider?
4. What types of bone graft do you know of? What are their pros and cons?
5. How are allografts processed?
Intervertebral disc (Basic Orthopaedic Sciences)
1. What type of joint is present between two vertebrae?
2. What is the function of an intervertebral disc?
3. How does the microscopic anatomy of the disc relate to its function?
4. What is an annular tear, and how does it differ from herniation?
5. Disc degeneration inevitably occurs with age. What changes occur during this process?
Basic concepts in biomechanics (Basic Orthopaedic Sciences)
1. What are the three Newton’s physical laws relevant to orthopaedics?
2. What is a force?
3. What is a moment?
4. Draw a free-body diagram of the x joint (where x can be any large joint in the human body).
5. What are the assumptions made when performing free-body analysis?
Biomaterial behaviour (Basic Orthopaedic Sciences)
1. Draw a stress\thin;strain curve and describe how to calculate the Young’s modulus.
2. What do you understand by the term ‘fatigue failure’? Draw an S-n curve.
3. Explain how increasing the thickness of metal plates affects their rigidity.
4. Explain how your choice of solid or slotted nails affects the rigidity of the construct.
5. How does the phenomenon of creep govern your surgical technique of implanting uncemented femoral prostheses?
Biomaterials (Basic Orthopaedic Sciences)
1. Discuss the advantages and disadvantages of bone cement in hip arthroplasty.
2. Explain what forging is and how the material properties are affected.
3. Discuss the available femoral stem materials and the relevance of surface coating to implant fixation.
4. Describe the processing of highly-crosslinked UHMWPE and its advantages and disadvantages.
5. Explain the testing and approval process prior to implant marketing.
6. Explain your choice of material for an intramedullary device.
Biomechanics of the hip (Basic Orthopaedic Sciences)
1. Which total hip prosthesis would you use, and what is the evidence to support this choice?
2. Describe the modes of failure of different types of total hip replacement (THR).
3. When planning a THR, which are the important factors to consider?
4. When reviewing a THR in a follow-up clinic, what clinical symptoms and radiological signs are of particular concern?
5. Which approach do you prefer for THR, and what are its relative merits and weaknesses?
Biomechanics of the knee (Basic Orthopaedic Sciences)
1. Which total knee replacement (TKR) would you use, and what is the evidence to support this choice?
2. When planning a TKR, which are the important factors to consider?
3. When reviewing a TKR in a follow-up clinic, what clinical symptoms and radiological signs are of particular concern?
4. How would you correct a varus/valgus/fixed-flexion knee deformity during TKR?
5. What factors contribute to failure of TKRs?
Biomechanics of the spine (Basic Orthopaedic Sciences)
1. What is spinal stability?
2. What unique features of the spine contribute to stability?
3. What do you know about the subsystems of the spine?
4. What is a functional spinal unit?
5. How does vertebral anatomy change as one proceeds caudally in the spine?
Biomechanics of the shoulder and elbow (Basic Orthopaedic Sciences)
1. What anatomical factors are involved in maintaining shoulder stability?
2. How do the muscles of the shoulder girdle control arm elevation and abduction?
3. Discuss the principles in the design of a total shoulder arthroplasty in the cuff-deficient shoulder.
4. Discuss the management of a comminuted fracture of the radial head with respect to maintaining elbow stability.
5. Draw a free-body diagram of an arm held in 90 degrees of elbow flexion and carrying a mass in the hand. Resolve the forces through the elbow and calculate the joint reaction force.
Biomechanics of the hand and wrist (Basic Orthopaedic Sciences)
1. What is an intrinsic plus/intrinsic minus/lumbrical plus hand?
2. What is Froment’s test? What is its anatomical basis?
3. What is carpal instability? What are the common types seen clinically?
4. What are the principles of tendon transfer?
5. What tendon transfers are suitable for a median/ulnar/radial nerve palsy?
Biomechanics of the foot and ankle (Basic Orthopaedic Sciences)
1. What is the ideal position in which to fuse an ankle joint?
2. What is the mechanism by which eccentric contraction of muscle is achieved?
3. Describe the windlass mechanism and its role in gait.
4. Describe changes in the gait cycle with:
(a) gastrosoleus weakness;
(b) tibialis anterior weakness.
5. What do you know about ankle joint replacements?
Gait (Basic Orthopaedic Sciences)
1. What are the pre-requisites of normal gait?
2. During gait, how may a person compensate for a leg length discrepancy?
3. Give examples of eccentric and concentric activity of the gastrocnemius muscle during the gait cycle.
4. What are the three rockers of gait?
5. What are the causes of a positive Trendelenburg gait?
Prosthetics (Basic Orthopaedic Sciences)
1. What is a prosthesis?
2. What are the indications for fitting a prosthesis?
3. Tell me about this prosthesis [prop-based question].
4. As a surgeon, what do you have to consider when fitting a prosthesis?
5. What are the complications of prosthetic use?
Orthotics (Basic Orthopaedic Sciences)
1. What is an orthosis?
2. How do orthoses work?
3. Describe this orthosis to me [prop-based question]. How does it work?
4. From what materials are orthoses manufactured?
5. Explain how a GRAFO works.
Inside the operating theatre (Basic Orthopaedic Sciences)
1. What is the layout of an operating theatre department?
2. What are the main sources of infection in an operating theatre environment?
3. What different types of ventilatory system are used in theatres?
4. What factors can be altered in operating theatres in order to help reduce the incidence of deep joint sepsis following joint arthroplasty?
5. What is moist bacterial strike-through? How can it be prevented?
Basic science of osteoarthritis (Basic Orthopaedic Sciences)
1. Define osteoarthritis? What is the fundamental principle in its pathogenesis?
2. Describe the biochemical changes seen in the extracellular matrix of osteoarthritic cartilage?
3. Describe and explain the biomechanical changes in osteoarthritic cartilage.
4. What is an osteophyte? Explain how they form?
5. Outline some of the biological mechanisms involved in the development of osteoarthritis.
CONTACT ME!
Don't be afraid to send me a message
Copyright 2016 Manoj Ramachandran