Dr Jarrad Stevens has been published in over twenty-five medical journals focussed on the areas of Orthopaedic Surgery, bone and joints, trauma, hip and knee joint replacement and soft tissue conditions.
The following publications provide insight to some of these areas of research.
“Research and publication is critical to my professional practice. This discovery and sharing of knowledge is not only a privilege, but also a responsibility.”
Dr. Jarrad Stevens
Research & Publications
Dr Stevens and Surgeons from the Avon Orthopaedic Centre in England researched the congruency of the articular surface contact area of the patellofemoral joint (PFJ) during both active and passive movement of the knee with the use of an MRI mapping technique in both the stable and unstable PFJ.
Dr Stevens and surgeons from the Royal Infirmary of Edinburgh researched revision knee replacement surgery. This is difficult surgery and can range from patella resurfacing or polyethylene exchange, to staged revision and revision to a more constrained implant. Subsequently, the ability to elicit outcomes becomes difficult to obtain and hence information on functional outcome and survivorship for all modes of failure with a single revision system is valuable.
Dr Stevens describes an extensile surgical approach to the distal femur, which incorporates the medial parapatellar arthrotomy. This extensile exposure serves as an anterior utility approach to the knee, allowing the surgeon access to all aspects of the anterior knee and near circumferential access to the distal femur.
Dr Stevens evaluated the mobility and excursion of the patella achieved by two different techniques for increasing exposure to the knee joint: the quadriceps snip and the extensile medial parapatellar approach. Both provide better exposure and have their own benefits which surgeons should consider when deciding how best to approach the knee.
Dr Stevens and colleagues report a diagnosis of exogenous steroid-induced hypoadrenalism in a person living with HIV caused by a drug–drug interaction (DDI) between intrabursal triamcinolone and the pharmacokinetic booster cobicistat.
Dr Stevens published an interesting case of delayed septic arthritis of the knee in a 12-year-old boy following a penetrating injury. This case highlighted the need for suspicion of retained penetrating foreign bodies, especially if they are not radio-opaque.
Together with Associate Professor Martin Richardson and colleagues, Dr Stevens published the technique for repairing shoulder tendons with sutures and anchors. This study also highlighted the high incidence of tears of the shoulder tendons in Australia.
Dr Stevens reports a rare case of desmoplastic fibroma (DF) of the midshaft femur presenting as a pathological fracture. A team of skilled surgeons in Edinburgh where able to successful remove the fractured lesion and save the leg.
Dr Stevens and Professor Peter Choong analysed 129 consecutive patients who underwent hip arthroplasty at St Vincent’s hospital in Melbourne, Australia between February and September 2011 with respect to the quality of the week one radiographs, placement of the prosthesis and the presence of a peri-prosthetic fracture or dislocation.
X-rays were helpful for surgeon feedback but did not change the management of patients following surgery.
Total hip replacement is a common and effective surgical intervention for patients with debilitating
joint pain but it does represent a significant surgical intervention. For such interventions, blood loss is a potential cause of morbidity and mortality. Optimisation of surgical interventions focuses on reducing such risks. Dr Stevens and colleagues researched whether the order of surgical steps, preparing the femur before or after the acetabulum, was associated with the amount of total blood loss in total hip replacement.
As most imaging is now digital, the aim of this study was to investigate the reliability of one method to measure acetabular component position using a basic diagnostic imaging software program that is readily available to orthopaedic surgeons.
Dr Stevens, Dr Lahey and Professor Richard de Steiger explored how reliable x-rays were in interpreting hip replacement position.
Lesions affecting the ventral surface of the scapula are rare but can be associated with significant mechanical symptoms, such a pseudo- winging or snapping scapula syndrome. Excision of osteochondromas arising from this region can be challenging due to the numerous muscle origins and attachments. Access to the bony surface of the scapula may be associated with extensive muscular detachment and soft tissue dissection. Dr Stevens describes a novel open trapezius-sparing approach to the ventral surface of the scapula as performed by leading orthopaedic surgeon – Mr Sam Patton.
Dr Stevens presents a simple technique to achieve a smooth rounded finish with the infix bar and external fixator pins.
Acetabular fractures are a rare injury, with a reported annual incidence of 3 patients per 100,000 per year. Open fractures of the acetabulum are extremely rare, with only explosive penetrating trauma (blast or gunshot injury) being previously reported. An open acetabular fracture as a result of blunt trauma is presented, in which the only indication was a wound in the buttock. Dr Stevens reports in the management of early definitive surgical treatment of the injury at Southmead Major Trauma Centre in England which provided a good clinical outcome.
Dr Stevens describes a simple technique for positioning the image intensifier (II) during shoulder procedures that can both reduce II positioning time and decrease the risk of inadvertent desterilization of the equipment. For the shoulder surgeon who uses II while operating in the lateral position, this technical pearl is worth considering.
In this study, Dr Stevens and his research team investigated how the patella interacts with the knee after surgery to stabilise it. The team found that the knee cap had better coverage on the knee joint after surgery.
Teamwork is the cornerstone of patient safety with effective communication essential in producing fewer complications during a patient’s stay. The Royal College of England published “The High Performing Surgical Team” which outlined the components of a high-functioning team broken down into 7 attributes; individual, team, trust, conflict resolution, commitment to task, accountability, and results. Dr Stevens and Dr Louis Sisk researched and evaluated teamwork amongst surgical specialties at St Vincent’s Hospital in Melbourne.
Together with Surgeons from the Alfred Hospital in Melbourne, Dr Stevens researched the application of an external fixator for unstable pelvic fractures. This is an important component of many resuscitation protocols. Moreover, certain pelvic fractures may be treated with an external fixator without requiring further internal fixation. We reported on our initial clinical results with an alternate pelvic external fixator site, the lateral posterior external fixator (LPEF), and described the surgical technique.
Dr Stevens and a team of researchers from England and Scotland are the first surgeons to report on the outcomes of bilateral distal femoral endoprosthesis for acute trauma of native knees. To add to the complexity, this case was managed at two different tertiary institutions, ultimately resulting in a very good outcome. We concur with the small volume of already published results indicating that distal femoral replacement is a viable option for complex distal femoral fractures and it may yield good short-term results.
Dr Stevens and the pelvic reconstruction team at Southmead major trauma centre, England, reported on bilateral pelvic acetabular fractures. Acetabular fractures are uncommon and their management is often reserved for specialist pelvic and acetabular surgeons. Bilateral acetabular fractures are a particularly rare subgroup. We reported the incidence, fracture pattern, mechanism of injury and outcome of patients presenting to a tertiary trauma centre with traumatic bilateral acetabular fractures.
Together with Melbourne Hip and Knee Surgeon – Mr Matthew Alexander, Dr Stevens describes a fixation technique for tibial tuberosity osteotomies (TTO) utilising a plate and screw construct which adheres to established principles of bone healing. We record and discuss the complication profile and benefits of this technique.
Placing distal locking screws into an intramedullary nail (IMN) can be a difficult step for the young surgeon to master. Crucial preparation for successful placement often includes the use of the image intensifier and the gaining of “perfect circles.”
Dr Stevens and his trauma surgeon colleagues describe a step-by-step approach to drilling the distal locking screw holes.
Paget’s sarcomatous transformation is a rare and potentially fatal complication of Paget’s disease. Histologically, it is typically described as a high-grade and extremely aggressive malignancy. Dr Stevens presents an unusual radiographic series from a patient diagnosed with a low-grade Paget’s osteosarcoma, a very rare and poorly described variant of the disease.
Removal of a well-fixed, cemented acetabular component at the time of revision hip surgery can be complex. It is essential to remove the implant and cement mantle in a timely fashion while preserving bone stock and osseous integrity. The biomechanical properties of polymethylmethacrylate cement and polyethylene can be utilised to aid with the removal of well cemented implants which are often harder than the surrounding bone. While removal of loose components may be relatively straightforward, the challenge for the revision arthroplasty surgeon often involves the removal of well-fixed implants. Dr Stevens and Professor Howie present three established techniques for the removal of a well-fixed cemented acetabular component and one new technique.
Dr Stevens and Dr Sam Patton present a summary of treatment and evaluation for Gorham-Stout disease. This is a very rare condition which causes bones to disappear. A series of x-rays show how the humerus bone of a lady in Scotland slowly disappeared over a number of years. It may be the best example of how this condition can be seen on x-rays.
Dr Stevens has an interest in managing fractures around joint replacements.
Periprosthetic fractures of the proximal femur place a significant burden on the patients who endure them, as well as the medical health system that supports them. The purpose of this study by Dr Stevens was to determine whether femoral cortical thickness, as an absolute measurement, is a predictor of periprosthetic fracture pattern.