Theivendran, Kanthan

Theivendran, Kanthan

Biography

Kanthan qualified in medicine from Imperial College London in 2003 and obtained a BSc in Orthopaedic Science from University College London in 2001 whilst an undergraduate. He completed his Orthopaedic training in Birmingham and specialist fellowship training in shoulder and upper limb surgery in Derby & Wrightington. He is a Consultant Orthopaedic Surgeon at Sandwell & West Birmingham Hospitals NHS Trust since 2016 and is the Upper limb and Research lead within the department. He sits on the R&D committee for the trust. Mr Theivendran is an Honorary Professor at the School of Engineering and Applied Science, Biomedical Engineering Research Unit at Aston University and an Honorary Senior Lecturer in Orthopaedic Surgery at Aston Medical School. His interests include Clinical trials, Biomedical Engineering, Health Tech/Health IT and patient reported outcome measures (PROMs).

Publication Search Results

Now showing 1 - 10 of 17

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A new diagnostic technique to detect early migration of joint prostheses
(Institute of Electrical and Electronics Engineers, 2021-01) Khan, Muhammad MK.; Theivendran, Kanthan; Deshmukh, Subodh C.; Leslie, Laura J.; Junaid, Sarah; Aston University; Sandwell and West Birmingham NHS Trust; Royal Orthopaedic Hospital; Trauma and Orthopaedics; Medical and Dental; Theivendran, Kanthan; Deshmukh, Subodh C.
Migration of an implanted prosthesis due to aseptic loosening is difficult to detect without regular imaging. In this paper, a low-cost, non-radiographic, robust diagnostic technique is presented, which can detect the migration of the humeral component of an elbow prosthesis. The system consists of a single magnet single sensor configuration and migration data are based on the variation in the magnetic field. The magnetic sensor was enclosed in titanium alloy and a magnet was embedded at a reference point in the humeral bone enclosed in ultra-high molecular weight polyethylene (UHMWPE). A layer of bone cement was then placed between the enclosed magnet and sensor. An algorithm linked with a Savitzky- Golay (SG) filter was developed that could decouple, convert, and filter the magnetic field signal to provide both the linear and angular displacement. The system was also designed to eliminate the cross talk and non-linearity effect of the magnet. The highest resolution the sensor achieved was 0.3 mm with a detectable linear migration range of 0.3 mm to 4 mm in the x/y axis and between 8-20 mm in the z-axis (along the humeral canal). The detectable rotational range was 0.5 to 3.0 degrees in the x/y axis. The repeatability of the calibrated sensor was analysed and showed a standard deviation of 0.05 mm over 150 cycles. The resolution was dependent upon the operating conditions and sensor positioning. There was no interference from the titanium alloy, bone cement nor the UHMWPE. This sensor system offers an alternative non-radiographic option for measuring migration of implanted prostheses.
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Using three-dimensional rapid prototyping in the design and development of orthopaedic screws in standardised pull-out tests
(SAGE Publications, 2018-05-11) Leslie, Laura Jane; Connolly, Ashley; Swadener, John G; Junaid, Sarah; Theivendran, Kanthan; Deshmukh, Subodh C; Aston University; Sandwell and West Birmingham NHS Trust; Trauma and Orthopaedics; Medical and Dental; Theivendran, Kanthan; Deshmukh, Subodh C.
The majority of orthopaedic screws are designed, tested and manufactured by existing orthopaedics companies and are predominantly developed with healthy bone in mind. The timescales and costs involved in the development of a new screw design, for example, for osteoporotic bone, are high. In this study, standard wood screws were used to analyse the concept of using three-dimensional printing, or rapid prototyping, as a viable stage of development in the design of a new bone screw. Six wood screws were reverse engineered and printed in polymeric material using stereolithography. Three of the designs were also printed in Ti6Al4V using direct metal laser sintering; however, these were not of sufficient quality to test further. Both the original metal screws (metal) and polymeric rapid prototyping screws were then tested using standard pull-out tests from low-density polyurethane blocks (Sawbones). Results showed the highest pull-out strengths for screws with the longest thread length and the smallest inner diameter. Of the six screw designs tested, five showed no more than a 17% variance between the metal and rapid prototyping results. A similar pattern of results was shown between the screw designs for both the metal and rapid prototyping screws in five of the six cases. While not producing fully comparable pull-out results to orthopaedic screws, the results from this study do provide evidence of the potential usefulness and cost-effectiveness of rapid prototyping in the early stages of design and testing of orthopaedic screws.
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Closed reduction techniques for acute anterior shoulder dislocation : a systematic review and meta-analysis
(Springer, 2020-06-30) Dong, Huan; Jenner, Edward; Theivendran, Kanthan; Sandwell and West Birmingham NHS Trust; Trauma and Orthopaedics; Medical and Dental; Theivendran, Kanthan; Dong, Huan; Jenner, Edward A.
Background: Anterior shoulder dislocations are the most common type of joint dislocation with the majority treated with closed reduction. Reduction methods can be grouped into their principle mode of action: traction-countertraction, leverage and scapular manipulation. The best method has yet to be identified and our aim was to find the most effective, safe and least painful method of closed reduction for acute anterior shoulder dislocations. Methods: A search of the online databases of CENTRAL, MEDLINE and Embase was performed to identify randomised control trials (RCTs) comparing closed reduction methods for anterior shoulder dislocations. A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Twelve eligible RCTs were included with a total of 1055 patients. Our meta-analysis showed traction-countertraction methods are marginally less painful than leverage methods by 0.86 points on the VAS scale but leverage methods are quicker by 20 s. Amongst traction-countertraction methods, the Spaso technique was the least painful and quickest, albeit with no difference in overall success rate. A meta-analysis was not possible for comparisons involving scapular manipulation due to the paucity of studies, but within two studies, scapular manipulation was significantly less painful than both leverage and traction-countertraction methods by 1.5 and 2.3 points (VAS), respectively. Conclusion: Traction-countertraction methods are less painful but slower than leverage methods with no difference in complication rates. However, there was no difference in overall reduction success rate between any of the groups.
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Assessment of urgent investigative images transfer effectiveness from trauma and orthopaedic to neurosurgery department : a quality improvement project
(BMJ Publishing Group, 2025-05-08) Khan, Marwa; Khaleeq, Tahir; Theivendran, Kanthan; Sandwell and West Birmingham NHS Trust; Trauma and Orthopaedics; Medical and Dental; Khan, Marwa; Khaleeq, Tahir; Theivendran, Kanthan
Background: Neurosurgical emergencies, including cauda equina syndrome, traumatic spinal cord injuries and traumatic brain injuries, require timely diagnosis and intervention to prevent severe morbidity and mortality. Delays in these cases often stem from inefficiencies in transferring investigational images from district hospitals to external neurosurgery units. Aims: This quality improvement project aimed to reduce image transfer time at Sandwell and West Birmingham Hospitals Trust (SWBH) to the Queen Elizabeth Hospital Birmingham neurosurgery unit. It sought to empower Trauma and Orthopaedics (T&O) doctors to independently transfer images using an image exchange portal (IEP) software, bypassing reliance on traditional picture archiving and communication teams. Methods: Over three Plan-Do-Study-Act cycles (February and September 2024), T&O registrars and junior doctors were trained to use the IEP. Additional instructional resources were provided following low compliance. Image transfer times and neurosurgical response times were compared preintervention and postintervention. Results: The intervention reduced the average time from referral to image transfer from 18 hours to 3.6 hours across the cycles. The proportion of images transferred within 1 hour increased from 36% to 59%, and 87% of images were reviewed by neurosurgery within 6 hours by the final cycle. Operational cost savings were achieved by reducing reliance on IT services, radiographers and length of stay. Conclusions: This project improved the timeliness of image transfer and neurosurgical care at SWBH. Although IEP software proved effective locally, its broader applicability across UK hospitals remains uncertain. The findings highlight the need for a national solution to streamline image transfers and further research to enhance technologies supporting rapid investigative imaging. Empowering front-line clinicians with appropriate tools provides a replicable model for addressing similar challenges in other institutions.
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Experimental testing of fracture fixation plates: A review.
(SAGE Publications, 2022-08-03) Zhang, Shiling; Patel, Dharmesh; Brady, Mark; Gambill, Sherri; Theivendran, Kanthan; Deshmukh, Subodh; Swadener, John; Junaid, Sarah; Leslie, Laura Jane; Aston University; Invibio Biomaterial Solutions Limited; Sandwell and West Birmingham NHS Trust; Trauma and Orthopedic Surgery Department; Medical and Dental; Theivendran, Kanthan; Deshmukh, Subodh
Metal and its alloys have been predominantly used in fracture fixation for centuries, but new materials such as composites and polymers have begun to see clinical use for fracture fixation during the past couple of decades. Along with the emerging of new materials, tribological issues, especially debris, have become a growing concern for fracture fixation plates. This article for the first time systematically reviews the most recent biomechanical research, with a focus on experimental testing, of those plates within ScienceDirect and PubMed databases. Based on the search criteria, a total of 5449 papers were retrieved, which were then further filtered to exclude nonrelevant, duplicate or non-accessible full article papers. In the end, a total of 83 papers were reviewed. In experimental testing plates, screws and simulated bones or cadaver bones are employed to build a fixation construct in order to test the strength and stability of different plate and screw configurations. The test set-up conditions and conclusions are well documented and summarised here, including fracture gap size, types of bones deployed, as well as the applied load, test speed and test ending criteria. However, research on long term plate usage was very limited. It is also discovered that there is very limited experimental research around the tribological behaviour particularly on the debris' generation, collection and characterisation. In addition, there is no identified standard studying debris of fracture fixation plate. Therefore, the authors suggested the generation of a suite of tribological testing standards on fracture fixation plate and screws in the aim to answer key questions around the debris from fracture fixation plate of new materials or new design and ultimately to provide an insight on how to reduce the risks of debris-related osteolysis, inflammation and aseptic loosening.
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Assessment of lower limb rotational profile and its correlation with the tibial tuberosity-trochlea groove distance : a radiological study
(SAGE Publications, 2019-09) Thakrar, Raj R; Al-Obaedi, Ossama; Theivendran, Kanthan; Snow, Martin; Lister Hospital; The Royal London Hospital; Sandwell and West Birmingham NHS Trust; The Royal Orthopaedic Hospital; Trauma and Orthopaedics; Medical and Dental; Theivendran, Kanthan
Objective: The purpose of our study was to determine whether there is a correlation between the lower limb rotational profile and tibial tuberosity-trochlea groove (TT-TG) distance. Design and patients: The computed tomography cross-sectional imaging on 50 patients' lower limbs (100 limbs) was investigated at our institution. The TT-TG distance was measured along with rotational measurements including femoral version (FV), tibial torsion and knee joint rotation angle (KJRA). Patients were divided into two groups. Group 1 had a TT-TG ≥ 20 mm which was considered pathological and group 2 with a non-pathological TT-TG (≤19 mm). Rotational angles were compared between groups. Statistical analysis was performed using the t-test and Mann-Whitney U analysis. Results and conclusions: Our results demonstrated a statistically significant difference in the mean KJRA (p = 0.026) between the pathological (mean = 10.6, standard deviation (SD) = 7.79°) and the non-pathological TT-TG groups (mean = 6.99, SD = 5.06°). A higher mean value for FV and tibial torsion was also demonstrated in patients with a pathological TT-TG (18.2 vs. 13.7, 32.8 vs. 30.9, p > 0.05, respectively). In conclusion, there was a statistically significant higher mean value for the KJRA in patients with a pathological TT-TG. Hence, a lateralized tibial tubercle as demonstrated by an increase in the TT-TG distance may be associated with a coexisting lower limb rotational malalignment.
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Mucinous adenocarcinoma of the lung presenting as pathological humeral fracture : a case report and novel surgical treatment
(BMJ Publishing Group, 2021-08-06) Prakash, Rohan; Gella, Sreenadh; Theivendran, Kanthan; Sandwell and West Birmingham NHS Trust; Trauma and Orthopaedics; Medical and Dental; Theivendran, Kanthan; Prakash, Rohan; Gella, Sreenadh
We present a 73-year-old woman who presented with a pathological fracture of her right humerus. Further imaging and biopsy indicated a mucinous adenocarcinoma of the lung as the primary neoplasm. This represents the first published case of a mucinous adenocarcinoma of the lung presenting as a metastatic lesion of the humerus. Operative management of pathological fractures of the humerus has typically included either intramedullary nailing or the use of single-plating or double-plating techniques. The authors describe a novel technique using both intramedullary fixation augmented with a locking plate, steel cables and bone cement, with good outcome.
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Radiological outcomes following surgical fixation with wires versus moulded cast for patients with a dorsally displaced fracture of the distal radius : a radiographic analysis from the DRAFFT2 trial
(British Editorial Society of Bone and Joint Surgery, 2024-02-13) Plant, Caroline E; Ooms, Alexander; Cook, Jonathan A; Costa, Matthew L; Dritsaki, Melina; Dakin, Helen; Jones, Jonathan; Mckee, Andrew; Smith, Kevin; Hamadto, Mohamed; Gwilym, Steve; Chesser, Tim; Candal-Couto, Jaime; Hing, Caroline; Giddin, David; Johnston, Phil; Ullah, Aamer; Williams, John; Eardley, Will; Srinivasan, Makaram; Sampalli, Sridharrao; Farrar, Mark; Roberts, Chris; Mohanty, Khitish; MacLeod, Iain; Sarda, Praveen; Elseehy, Amr; Rossiter, Nigel; Warwick, David; Peach, Chris; MacKay, David; Benson, Richard; Watts, Adam; Young, Jonathan; Shah, Feisal; Lipscombe, Stephen; Ng, Aaron; Charalambous, Charalambos P.; Sheriden, Barnaby; Theivendran, Kanthan; Sanjay, Pulimamidi; Nanda, Rajesh; Bateman, Antony; Butler, Michael; Keast-Butler, Oliver; McAndrew, Andrew; Chevannes, Wystan; Kankanalu, Pradeep; Wijendra, Asanka; Fontalis, Andreas; Afifi, Hytham; Killen, Marie-Clare; Higgin, Ryan; Wignadasan, Warran; Wong, Ken; Gibson, Catherine; Beale, Harry; Jennings, Bob; Kennedy, James; Williamson, Mark; Rasidovic, Damir; Jenner, Lydia; Tadros, John B; Milner, Steve; Duncan, James; Kerr, Sally; Nordin, Louise; Weston, Matt; Payton, Olivia; Oni, Tofi; Zhao, Craig; Gill, Sukhdeep; Iqbal, Mohammad; Killen, Marie-Clare; Aneiba, Khaled; Wignadasan, Warran; Pillai, Dilip; Hughes, Luke; Crosby, Jonathan; Whitehouse, Mike; Corbett, Thomas; Iqbal, Arshad; Buchan, Steph; Beddard, Laura; Vardhan, Venkat; Beamish, Becky; Jones, Matt; Holley, Jonathan; Morrell, Rebecca; Lerner, Robin; Draper, Kylea; University of Oxford; University Hospitals Coventry and Warwickshire NHS Trust; Sandwell and West Birmingham NHS Trust; Trauma and Orthopaedics; Theivendran, Kanthan; Medical and Dental; Theivendran, Kanthan
Aims: The primary aim of this study was to report the radiological outcomes of patients with a dorsally displaced distal radius fracture who were randomized to a moulded cast or surgical fixation with wires following manipulation and closed reduction of their fracture. The secondary aim was to correlate radiological outcomes with patient-reported outcome measures (PROMs) in the year following injury. Methods: Participants were recruited as part of DRAFFT2, a UK multicentre clinical trial. Participants were aged 16 years or over with a dorsally displaced distal radius fracture, and were eligible for the trial if they needed a manipulation of their fracture, as recommended by their treating surgeon. Participants were randomly allocated on a 1:1 ratio to moulded cast or Kirschner wires after manipulation of the fracture in the operating theatre. Standard posteroanterior and lateral radiographs were performed in the radiology department of participating centres at the time of the patient's initial assessment in the emergency department and six weeks postoperatively. Intraoperative fluoroscopic images taken at the time of fracture reduction were also assessed. Results: Patients treated with surgical fixation with wires had less dorsal angulation of the radius versus those treated in a moulded cast at six weeks after manipulation of the fracture; the mean difference of -4.13° was statistically significant (95% confidence interval 5.82 to -2.45). There was no evidence of a difference in radial shortening. However, there was no correlation between these radiological measurements and PROMs at any timepoint in the 12 months post-injury. Conclusion: For patients with a dorsally displaced distal radius fracture treated with a closed manipulation, surgical fixation with wires leads to less dorsal angulation on radiographs at six weeks compared with patients treated in a moulded plaster cast alone. However, the difference in dorsal angulation was small and did not correlate with patient-reported pain and function.
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Carbon fibre reinforced PEEK versus traditional metallic implants for orthopaedic trauma surgery : a systematic review
(Elsevier, 2021-10-28) Theivendran, Kanthan; Arshad, Faizan; Hanif, Umar-Khetaab; Reito, Aleksi; Griffin, Xavier; Foote, Clary J; Sandwell and West Birmingham NHS Trust; Aston University; Tampere University Hospital; Queen Mary University of London; et al.; Trauma and Orthopaedics; Medical and Dental; Theivendran, Kanthan; Arshad, Faizan; Hanif, Umar-Khetaab
Introduction: There is no literature review comparing outcomes of fixation using carbon-fibre-reinforced polyetheretherketone (CFR PEEK) compared to metal implants used in orthopaedic extremity trauma surgery. A systematic review was performed to compare CFR PEEK to metal implants for clinically-important fracture outcomes. Methods: A search of the online databases of PubMed/Medline, EMBASE and Cochrane Database was conducted. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analyses was performed for functional outcomes in proximal humerus fractures converting the score differences to standard mean difference units. GRADE approach was used to determine the level of certainty of the estimates. Results: Two prospective randomised controlled trials and seven comparative observational studies with a total of 431 patients were included. Of the nine studies included, four compared the use of CFR PEEK against metal plates in proximal humerus fractures. Aggregated functional scores across the proximal humerus studies, there was a small signal of better improvement with CFR PEEK (SMD 0.22, 95% CI -0.03 to 0.47, p = 0.08, low certainty). Greater odds of adverse events occurred in the metal group (OR 2.34, 95% CI 0.73 to 7.55, p = 0.15, low certainty). Conclusions: Low to very low certainty evidence suggests a small improvement in functional recovery with CFR PEEK in proximal humerus fractures. This may be mediated through a small reduction in major adverse events related to fracture healing and stability. There is currently insufficient evidence to support the widespread use of CFR PEEK implants in fracture fixation.
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A technique to stabilise the Herbert-Huene jig during scaphoid fracture fixation
(Royal College of Surgeons of England, 2009-10) Theivendran, Kanthan; Deshmukh, Subodh C; Sandwell and West Birmingham NHS Trust; Trauma and Orthopaedics; Medical and Dental; Theivendran, Kanthan; Deshmukh, Subodh C.
No abstract available.