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Ravi K. Bashyal, M.D.

Ravi K. Bashyal, M.D.

Ravi K. Bashyal, M.D.

Minimally Invasive Custom Hip and Knee Replacement
  • Locations

    NorthShore Medical Group

    9650 Gross Point Rd.
    Suite 2900
    Skokie, IL 60076
    847.866.7846 224.251.2905 fax Get Directions This location is wheelchair accessible.

    NorthShore Medical Group

    2180 Pfingsten Rd.
    Suite 3100
    Glenview, IL 60026
    847.866.7846 866.954.5787 fax Get Directions This location is wheelchair accessible.
  • Publications
    • Robotic-Assisted Knee Arthroplasty (RAKA): The Technique, the Technology and the Transition.

      Indian journal of orthopaedics 2020 Nov

      Authors: Bagaria V, Sadigale OS, Pawar PP, Bashyal RK
      There has been an exponential increase in knee arthroplasty over the past 20 years. This has led to a quest for improvement in outcomes and patient satisfaction. While the last decade of last century proved to be the decade for Computer-Assisted Surgery (CAS) or Computer Navigation wherein the technology demonstrated a clear benefit in terms of improving mechanical axis alignment and component positioning, this decade is likely to belong to Robotics. Robotics adds an independent dimension to the benefits that CAS offers. The article deals with the generation of robots, technical steps in robotics, advantages and downsides of robotics and way forward in the field of knee arthroplasty.
      The review article was designed and edited by six different authors reviewing 32 relevant pubmed-based articles related to robotics in arthroplasty and orthopaedics. The concept, design and the definition of the intellectual content were based on the internationally published literature and insightful articles. The review is also based on the clinical experimental studies published in the literature.
      The robotic arm is actively involved with surgeon to achieve the precision and outcomes that the surgeon aims for. With the concept of haptic boundaries and augmented reality being incorporated in most systems, Robotic Assisted Arthroplasty (RAA) is likely to offer several advantages. The potential advantages of these systems may include accuracy in gap balancing, component positioning, minimal bone resection, reduced soft tissue handling and trauma, patient anatomy specific resection, and real time feedback. They, however, come with their own downsides in terms of capital cost, learning curve, time consumption and unclear advantages in term of long-term clinical outcomes.
      To conclude, this review article offers a balanced view on how the technology is impacting current arthroplasty practice and what can be expected in coming years. The commitment of almost all major implant manufacturers in investing in robotics likely means that the evolution of Robotic technology and this decade will be exciting with rapid strides revealing paradigm shift and evolution of technology with significant reductions of cost enabling it to be available universally. For technology to populate in operating room, I think it will be result of exposure of young surgeons to these computers and robotics, as they grow in with confidence with technology from residency days to offer better precision in future.
      PMID: 33133397 [PubMed - as supplied by publisher]
    • The impact of total joint arthroplasty on sexual function in young, active patients.

      The Journal of arthroplasty 2015 Feb

      Authors: Nunley RM, Nam D, Bashyal RK, Della Valle CJ, Hamilton WG, Berend ME, Parvizi J, Clohisy JC, Barrack RL
      There is limited information regarding sexual function following total hip (THA) and knee arthroplasty (TKA). A multicenter study of 806 THA, 542 TKA, and 181 control patients less than 60 years of age was conducted using an independent survey center to question subjects about their sexual function. Only 1.3% of THA and 1.6% of TKA patients stated they were not sexually active due to their operation. No significant differences were noted in sexual function based on the bearing surface, femoral head size, or use of surface replacement arthroplasty in the hip cohort. Multivariate analysis revealed no difference in the percentage of patients sexually active following a THA or TKA (OR 1.19, P=0.38). Most young active patients return to sexual activity after hip and knee arthroplasty.
      PMID: 25449592 [PubMed - as supplied by publisher]
    • Is administratively coded comorbidity and complication data in total joint arthroplasty valid?

      Clinical orthopaedics and related research 2013 Jan

      Authors: Bozic KJ, Bashyal RK, Anthony SG, Chiu V, Shulman B, Rubash HE
      Administrative claims data are increasingly being used in public reporting of provider performance and health services research. However, the concordance between administrative claims data and the clinical record in lower extremity total joint arthroplasty (TJA) is unknown.
      We evaluated the concordance between administrative claims and the clinical record for 13 commonly reported comorbidities and complications in patients undergoing TJA.
      We compared 13 administratively coded comorbidities and complications derived from hospital billing records with clinical documentation from a consecutive series of 1350 primary and revision TJAs performed at three high-volume institutions during 2009.
      Concordance between administrative claims and the clinical record varied across comorbidities and complications. Concordance between diabetes and postoperative myocardial infarction was reflected by a kappa value > 0.80; chronic lung disease, coronary artery disease, and postoperative venous thromboembolic events by kappa values between 0.60 and 0.79; and for congestive heart failure, obesity, prior myocardial infarction, peripheral arterial disease, bleeding complications, history of venous thromboembolism, prosthetic-related complications, and postoperative renal failure by kappa values between 0.40 and 0.59. All comorbidities and complications had a high degree of specificity (> 92%) but lower sensitivity (29%-100%).
      The data suggest administratively coded comorbidities and complications correlate reasonably well with the clinical record. However, the specificity of administrative claims is much higher than the sensitivity, indicating that comorbidities and complications coded in the administrative record were accurate but often incomplete.
      PMID: 22528384 [PubMed - as supplied by publisher]
    • Immobilization after pinning of supracondylar distal humerus fractures in children: use of the A-frame cast.

      Journal of pediatric orthopedics

      Authors: McKeon KE, O'Donnell JC, Bashyal R, Hou CC, Luhmann SJ, Dobbs MB, Gordon JE
      Circumferential casts can contribute to elevated compartment pressures in the setting of acute swelling. We have developed a novel casting method (A-frame cast) that allows cast placement while leaving the antecubital fossa free of casting material. The purpose of this study was to evaluate the safety, efficacy, and complications associated with acute placement of this definitive cast after closed reduction percutaneous pinning (CRPP) of acute supracondylar distal humerus fractures.
      A retrospective medical record reviewed 436 patients treated with CRPP of supracondylar fractures by 3 surgeons who routinely used an A-frame cast over a 12-year period. All complications or the need for cast modification were noted. Patients with open reduction, ipsilateral fractures, or patients lost to follow-up were excluded.
      There were 387 patients who met inclusion criteria, including 204 type 2 fractures and 183 type 3 fractures. Forty-three patients had preoperative nerve palsy and 1 had preoperative vascular injury. Of these 387 patients, 369 (95.3%) had an uneventful postoperative course. Nineteen patients (4.9%) required either cast splitting (15) or strict elevation (4) secondary to pain and swelling. Seven of these 19 patients had preoperative nerve palsy and 1 had preoperative vascular injury. The average time from procedure to cast splitting was 17.6 hours. No patients lost their reduction or required a second surgical procedure related to a complication from casting.
      An "A-frame" cast provides sturdy immobilization without increased risk of compartment syndrome after CRPP of supracondylar fractures in the pediatric population. Consideration should be given to splitting the cast prophylactically in patients with preoperative neurological or vascular deficits.
      IV-Case Series.
      PMID: 22173398 [PubMed - as supplied by publisher]
    • Acute traumatic compartment syndrome of the leg in children: diagnosis and outcome.

      The Journal of bone and joint surgery. American volume 2011 May 18

      Authors: Flynn JM, Bashyal RK, Yeger-McKeever M, Garner MR, Launay F, Sponseller PD
      Currently, the most common clinical scenario for compartment syndrome in children is acute traumatic compartment syndrome of the leg. We studied the cause, diagnosis, treatment, and outcome of acute traumatic compartment syndrome of the leg in children.
      Forty-three cases of acute traumatic compartment syndrome of the leg in forty-two skeletally immature patients were collected from two large pediatric trauma centers over a seventeen-year period. All children with acute traumatic compartment syndrome underwent fasciotomy. The mechanism of injury, date and time of injury, time to diagnosis, compartment pressures, time to fasciotomy, and outcome at the time of the latest follow-up were recorded.
      Thirty-five (83%) of the forty-two patients were injured in a motor-vehicle accident and sustained tibial and fibular fractures. The average time from injury to fasciotomy was 20.5 hours (range, 3.9 to 118 hours). In general, the functional outcome was excellent at the time of the latest follow-up. No cases of infection were noted when fasciotomy was performed long after the injury. At the time of the latest follow-up, forty-one (95%) of forty-three cases were associated with no sequelae (such as pain, loss of function, or decreased sensation). The two patients who lost function had fasciotomy 82.5 and eighty-six hours after the injury.
      Despite a long period from injury to fasciotomy, most children who are managed for acute traumatic compartment syndrome of the leg have an excellent outcome. This delay may occur because acute traumatic compartment syndrome manifests itself more slowly in children or because the diagnosis is harder to establish in this age group. The results of the present study should raise awareness of late presentation and the importance of vigilance for developing compartment syndrome in the early days after injury. Fasciotomy during the acute swelling phase, even long after injury, produced excellent results with no cases of infection.
      PMID: 21593369 [PubMed - as supplied by publisher]
    • Complications after pinning of supracondylar distal humerus fractures.

      Journal of pediatric orthopedics

      Authors: Bashyal RK, Chu JY, Schoenecker PL, Dobbs MB, Luhmann SJ, Gordon JE
      Supracondylar distal humerus fractures are one of the most common skeletal injuries in children. The current treatment of choice in North America is closed reduction and percutaneous pin fixation. Often surgeons leave the pins exposed beneath a cast but outside the skin. Great variation exists with respect to preoperative skin preparation, and perioperative antibiotic administration. Few data exist regarding the rate of infection and other complications. The purpose of this study is to review a large series of children to evaluate the rate of infection and other complications.
      A retrospective review was carried out of all patients treated at our institution over an 11-year period. A total of 622 patients were identified that were followed for a minimum of 2 weeks after pin removal. Seventeen patients had flexion-type fractures, 294 had type II fractures, and 311 had type III fractures. Seventy-four fractures (11.9%) had preoperative nerve deficits with anterior interosseous palsies being the most common (33 fractures, 5.3%). Preoperative antibiotics were given to 163 patients (26.2%). Spray and towel draping were used in 362 patients, paint and towel draping were used in 65 patients, alcohol paint and towel draping were used in 146 patients, and a full preparation and draping were used in 13 patients. The pins were left exposed under the cast in 591 fractures (95%), and buried beneath the skin in 31 fractures (5.0%). A medial pin was placed in 311 fractures with a small incision made to aid placement in 18 of these cases.
      The most common complication was pin migration necessitating unexpected return to the operating room for pin removal in 11 patients (1.8%). One patient developed a deep infection with septic arthritis and osteomyelitis (0.2%). Five additional patients had superficial skin infections and were treated with oral antibiotics for a total infection rate of 6 of 622 patients (1.0%). One patient ultimately had a malunion and 4 others returned to the operating room for repeat reduction and pinning. Three patients developed compartment syndromes. Ulnar nerve injury was rare with only 1 postoperative ulnar nerve injury occurring in 311 patients treated with a medial pin (0.3%).
      Closed reduction with percutaneous pinning is effective and has a low complication rate with a very low rate of infection even when simple betadine preparation and towel draping are used. Preoperative antibiotics seem to have little effect on infection rate.
      Level III retrospective comparative study.
      PMID: 20104149 [PubMed - as supplied by publisher]
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