Results
- Showing results for:
- Reset all filters
Search results
-
Journal articleGrigoras M, Boughton O, Cleary M, et al., 2021, , SICOT-J, Vol: 7, ISSN: 2426-8887
- Cite
- Citations: 1
-
Journal articleBogomolova K, Sam AH, Misky AT, et al., 2021, , Anatomical Sciences Education, Vol: 14, Pages: 385-393, ISSN: 1935-9772
In anatomical education three-dimensional (3D) visualization technology allows for active and stereoscopic exploration of anatomy and can easily be adopted into medical curricula along with traditional 3D teaching methods. However, most often knowledge is still assessed with two-dimensional (2D) paper-and-pencil tests. To address the growing misalignment between learning and assessment, this viewpoint commentary highlights the development of a virtual 3D assessment scenario and perspectives from students and teachers on the use of this assessment tool: a 10-minute session of anatomical knowledge assessment with real-time interaction between assessor and examinee, both wearing a HoloLens and sharing the same stereoscopic 3D augmented reality model. Additionally, recommendations for future directions, including implementation, validation, logistic challenges, and cost-effectiveness, are provided. Continued collaboration between developers, researchers, teachers, and students is critical to advancing these processes.
-
Journal articleLex JR, Edwards TC, Packer TW, et al., 2021, , JOURNAL OF ARTHROPLASTY, Vol: 36, Pages: 1168-1186, ISSN: 0883-5403
- Cite
- Citations: 68
-
Journal articleMullington CJ, Shetty P, Dalton J, 2021, , ANAESTHESIA, Vol: 76, Pages: 3-4, ISSN: 0003-2409
- Cite
- Citations: 2
-
Journal articleFavier C, Finnegan M, Quest R, et al., 2021, , Computer Methods in Biomechanics and Biomedical Engineering, Vol: 24, Pages: 1310-1325, ISSN: 1025-5842
Musculoskeletal models of the lumbar spine have been developed with varying level of detail for a wide range of clinical applications. Providing consistency is ensured throughout the modelling approach, these models can be combined with other computational models and be used in predictive modelling studies to investigate bone health deterioration and the associated fracture risk. To provide precise physiological loading conditions for such predictive modelling studies, a new full-body musculoskeletal model including a detailed and consistent representation of the lower limbs and the lumbar spine was developed. The model was assessed against in-vivo measurements from the literature for a range of spine movements representative of daily living activities. Comparison between model estimations and electromyography recordings was also made for a range of lifting tasks. This new musculoskeletal model will provide a comprehensive physiological mechanical environment for future predictive finite element modelling studies on bone structural adaptation. It will be made freely available on https://simtk.org/projects/llsm/.
-
Journal articleLogishetty K, Edwards TC, Subbiah Ponniah H, et al., 2021, , Bone & Joint Open, Vol: 2, Pages: 134-140, ISSN: 2633-1462
AIMS: Restarting planned surgery during the COVID-19 pandemic is a clinical and societal priority, but it is unknown whether it can be done safely and include high-risk or complex cases. We developed a Surgical Prioritization and Allocation Guide (SPAG). Here, we validate its effectiveness and safety in COVID-free sites. METHODS: A multidisciplinary surgical prioritization committee developed the SPAG, incorporating procedural urgency, shared decision-making, patient safety, and biopsychosocial factors; and applied it to 1,142 adult patients awaiting orthopaedic surgery. Patients were stratified into four priority groups and underwent surgery at three COVID-free sites, including one with access to a high dependency unit (HDU) or intensive care unit (ICU) and specialist resources. Safety was assessed by the number of patients requiring inpatient postoperative HDU/ICU admission, contracting COVID-19 within 14 days postoperatively, and mortality within 30 days postoperatively. RESULTS: A total of 1,142 patients were included, 47 declined surgery, and 110 were deemed high-risk or requiring specialist resources. In the ten-week study period, 28 high-risk patients underwent surgery, during which 68% (13/19) of Priority 2 (P2, surgery within one month) patients underwent surgery, and 15% (3/20) of P3 (< three months) and 16% (11/71) of P4 (> three months) groups. Of the 1,032 low-risk patients, 322 patients underwent surgery. Overall, 21 P3 and P4 patients were expedited to 'Urgent' based on biopsychosocial factors identified by the SPAG. During the study period, 91% (19/21) of the Urgent group, 52% (49/95) of P2, 36% (70/196) of P3, and 26% (184/720) of P4 underwent surgery. No patients died or were admitted to HDU/ICU, or contracted COVID-19. CONCLUSION: Our widely generalizable model enabled the restart of planned surgery during the COVID-19 pandemic, without compromising patient safety or excluding high-risk or complex cases. Patients classified as Urgent or P2 w
-
Journal articleBoughton O, Cobb J, owyang D, et al., 2021,
Patient and Public Involvement Within Orthopaedic Research: A Systematic Review
, Journal of Bone and Joint Surgery: American Volume, ISSN: 0021-9355 -
Journal articleRaymond AC, Liddle AD, Alvand A, et al., 2021, , JOURNAL OF ARTHROPLASTY, Vol: 36, Pages: 664-669, ISSN: 0883-5403
- Cite
- Citations: 5
-
Journal articleMorton S, Kua J, Mullington CJ, 2021, , British Journal of Anaesthesia, Vol: 126, Pages: 500-515, ISSN: 0007-0912
BackgroundEpidural analgesia is associated with intrapartum hyperthermia, and chorioamnionitis is associated with neonatal brain injury. However, it is not known if epidural hyperthermia is associated with neonatal brain injury. This systematic review and meta-analysis investigated three questions: (1) does epidural analgesia cause intrapartum hyperthermia, (2) is intrapartum hyperthermia associated with neonatal brain injury, and (3) is epidural-induced hyperthermia associated with neonatal brain injury?MethodsPubMed, ISI Web of Knowledge, The Cochrane Library, and Embase were searched from inception to January 2020 using Medical Subject Headings (MeSH) terms relating to epidural analgesia, hyperthermia, labour, and neonatal brain injury. Studies were reviewed independently for inclusion and quality by two authors (Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach). Two meta-analyses were performed using the Mantel–Haenszel fixed effect method to generate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsForty-one studies were included for Question 1 (646 296 participants), 36 for Question 2 (11 866 021 participants), and two studies for Question 3 (297 113 participants). When the mode of analgesia was randomised, epidural analgesia was associated with intrapartum hyperthermia (OR: 4.21; 95% CI: 3.48–5.09). There was an association between intrapartum hyperthermia and neonatal brain injury (OR: 2.79; 95% CI: 2.54–2.3.06). It was not possible to quantify the association between epidural-induced hyperthermia and neonatal brain injury.ConclusionsEpidural analgesia is a cause of intrapartum hyperthermia, and intrapartum hyperthermia of any cause is associated with neonatal brain injury. Further work is required to establish if epidural-induced hyperthermia is a cause of neonatal brain injury.
-
Journal articleBates A, McGregor A, Alexander C, 2021, , BMC Musculoskeletal Disorders, Vol: 22, ISSN: 1471-2474
BackgroundJoint Hypermobility Syndrome (JHS) is a Heritable Disorder of Connective tissue characterised by joint laxity and chronic widespread arthralgia. People with JHS exhibit a range of other symptoms including balance problems. To explore balance further, the objective of this study is to compare responses to forward perturbations between three groups; people who are hypermobile with (JHS) and without symptoms and people with normal flexibility.MethodsTwenty-one participants with JHS, 23 participants with Generalised Joint Hypermobility (GJH) and 22 participants who have normal flexibility (NF) stood on a platform that performed 6 sequential, sudden forward perturbations (the platform moved to the anterior to the participant). Electromyographic outcomes (EMG) and kinematics for the lower limbs were recorded using a Vicon motion capture system. Within and between group comparisons were made using Kruskal Wallis tests.ResultsThere were no significant differences between groups in muscle onset latency. At the 1st perturbation the group with JHS had significantly longer time-to-peak amplitude than the NF group in tibialis anterior, vastus medialis, rectus femoris, vastus lateralis, and than the GJH group in the gluteus medius. The JHS group showed significantly higher cumulative joint angle (CA) than the NF group in the hip and knee at the 1st and 2nd and 6th perturbation, and in the ankle at the 2nd perturbation. Participants with JHS had significantly higher CA than the GJH group at the in the hip and knee in the 1st and 2nd perturbation. There were no significant differences in TTR.ConclusionsThe JHS group were able to normalise the timing of their muscular response in relation to control groups. They were less able to normalise joint CA, which may be indicative of impaired balance control and strength, resulting in reduced stability.
-
Journal articleAkhbari P, Jaggard MK, Boulange CL, et al., 2021, , Bone & Joint Research, Vol: 10, Pages: 85-95, ISSN: 2046-3758
AimsThe diagnosis of joint infections is an inexact science using combinations of blood inflammatory markers and microscopy, culture, and sensitivity of synovial fluid (SF). There is potential for small molecule metabolites in infected SF to act as infection markers that could improve accuracy and speed of detection. The objective of this study was to use nuclear magnetic resonance (NMR) spectroscopy to identify small molecule differences between infected and noninfected human SF.MethodsIn all, 16 SF samples (eight infected native and prosthetic joints plus eight noninfected joints requiring arthroplasty for end-stage osteoarthritis) were collected from patients. NMR spectroscopy was used to analyze the metabolites present in each sample. Principal component analysis and univariate statistical analysis were undertaken to investigate metabolic differences between the two groups.ResultsA total of 16 metabolites were found in significantly different concentrations between the groups. Three were in higher relative concentrations (lipids, cholesterol, and N-acetylated molecules) and 13 in lower relative concentrations in the infected group (citrate, glycine, glycosaminoglycans, creatinine, histidine, lysine, formate, glucose, proline, valine, dimethylsulfone, mannose, and glutamine).ConclusionMetabolites found in significantly greater concentrations in the infected cohort are markers of inflammation and infection. They play a role in lipid metabolism and the inflammatory response. Those found in significantly reduced concentrations were involved in carbohydrate metabolism, nucleoside metabolism, the glutamate metabolic pathway, increased oxidative stress in the diseased state, and reduced articular cartilage breakdown. This is the first study to demonstrate differences in the metabolic profile of infected and noninfected human SF, using a noninfected matched cohort, and may represent putative biomarkers that form the basis of new diagnostic tests for infected SF.
-
Journal articleSalman D, Vishnubala D, Le Feuvre P, et al., 2021, , BMJ: British Medical Journal, Vol: 372, Pages: 372-m4721, ISSN: 0959-535X
-
Journal articleNugent FJ, Vinther A, McGregor A, et al., 2021, , British Journal of Sports Medicine, Vol: 55, Pages: 616-630, ISSN: 0306-3674
BACKGROUND: Low back pain (LBP) is common in rowers. Understanding rowing biomechanics may help facilitate prevention and improve rehabilitation. OBJECTIVES: To define the kinematics and muscle activity of rowers and to compare with rowers with current or LBP history. DESIGN: Systematic review. DATA SOURCES: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Scopus from inception to December 2019. Grey literature was searched. STUDY ELIGIBILITY CRITERIA: Experimental and non-experimental designs. METHODS: Primary outcomes were kinematics and muscle activity. Modified Quality Index (QI) checklist was used. RESULTS: 22 studies were included (429 participants). Modified QI score had a mean of 16.7/28 points (range: 15-21). Thirteen studies investigated kinematics and nine investigated muscle activity. Rowers without LBP ('healthy') have distinct kinematics (neutral or anterior pelvic rotation at the catch, greater hip range of motion, flatter low back spinal position at the finish) and muscle activity (trunk extensor dominant with less flexor activity). Rowers with LBP had relatively greater posterior pelvic rotation at the catch, greater hip extension at the finish and less efficient trunk muscle activity. In both groups fatigue results in increased lumbar spine flexion at the catch, which is greater on the ergometer. There is insufficient evidence to recommend one ergometer type (fixed vs dynamic) over the other to avoid LBP. Trunk asymmetries are not associated with LBP in rowers. CONCLUSION: Improving clinicians' and coaches' understanding of safe and effective rowing biomechanics, particularly of the spine, pelvis and hips may be an important strategy in reducing incidence and burden of LBP.
-
Journal articleGarner A, Dandridge O, Amis A, et al., 2021, , Bone and Joint Research, Vol: 10, Pages: 1-9, ISSN: 2046-3758
Aims: Unicompartmental (UKA) and bicompartmental (BCA) knee arthroplasty have been associated with improved functional outcomes compared to Total Knee Arthroplasty (TKA) in suitable patients, although the reason is poorly understood. The aim of this study was to measure how the different arthroplasties affect knee extensor function. Methods: Extensor function was measured for sixteen cadaveric knees and then re-tested following the different arthroplasties. Eight knees underwent medial UKA then BCA, then posterior-cruciate retaining TKA, and eight underwent the lateral equivalents then TKA. Extensorefficiency was calculated for ranges of knee flexion associated with common 46activities of daily living. Data were analyzed with repeated measures analysis of variance (=0.05). Results: Compared to native, there were no reductions in either extension moment or efficiency following UKA. Conversion to BCA resulted in a small decrease in extension moment between 70-90° flexion(p<0.05), but when examined in the context of daily activity ranges of flexion, extensor efficiency was largely unaffected. Following TKA, large decreases in extension moment were measured at low knee flexion angles(p<0.05), resulting in 12-43% reductions in extensor efficiency for the daily activity ranges. Conclusion: This cadaveric study found that TKA resulted in inferior extensor function compared to UKA and BCA. This may, in part, help explain the reported differences in 58function and satisfaction differences between partial and total knee arthroplasty.
-
Book chapterMusbahi O, Logishetty K, Cobb JP, 2021, , Controversies in Orthopaedic Surgery of the Lower Limb, Pages: 15-22
Hip resurfacing arthroplasty (HRA) is an alternative to total hip arthroplasty (THA) in younger patients with good bone quality who wish to return to high levels of activity. Usage of HRA has declined due to implant-specific complications—metal debris and periarticular soft tissue damage, implant loosening, and femoral neck fracture. These were most common with implants which have now been withdrawn, but fears remain. HRA is more technically challenging than THA, but revision rates for patients operated at specialist centres are equivalent. Gait and biomechanical studies suggest that HRA better restores normal function compared to THA, and registry-based studies suggest a lower mortality. However, randomised clinical trials have not shown superiority using conventional patient-reported outcome measures. As the clinical indications are dependent on patient demands, and more active patients are more likely to wear out artificial joints, it is difficult to robustly compare HRA and THA. Today, safe HRA implants inserted by experienced surgeons in active, male patients seem to deliver the most predictable outcomes, high performance and longevity.
-
Book chapterMatthews E, Sinha I, Liddle AD, 2021, , Controversies in Orthopaedic Surgery of the Lower Limb, Pages: 143-150
Whilst fractures around a knee replacement are uncommon, their incidence can be expected to increase in line with the increase in primary knee arthroplasty procedures being performed. These patients are often elderly and these injuries represent fragility fractures. The challenges of treating this patient and injury are significant. There is no consensus on which modality of treatment is best for treating the periprosthetic distal femoral fracture. Most fractures present with displacement but without loosening or compromise of the implant, these are amenable to fixation. Modalities of fixation have improved with an increase in understanding of fracture biology and improvements in technology, and locking plates, intramedullary nails, and combinations of both are being used. Fractures with poor or inadequate bone stock or a loose prosthesis may necessitate treatment with an endoprosthetic replacement.
-
Book chapterPopat R, Liddle AD, 2021, , Controversies in Orthopaedic Surgery of the Lower Limb, Pages: 121-126
Unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) are established treatment options for end-stage osteoarthritis of the knee. A vast amount of evidence is available on the relative risks and benefits of UKA and TKA. Proponents of TKA argue that the revision rate of UKA is much higher than that of TKA. Supporters of UKA point to data suggesting that the threshold for revision of a UKA is lower than that applied to TKA, potentially because revising a UKA is an easier operation. Additionally, UKA is associated with numerous other benefits over TKA, including better functional outcomes, shorter hospital stays and lower morbidity/mortality. In this chapter, a clear summary of the relevant evidence regarding UKA and TKA is presented to enable informed decision-making.
-
Journal articleRodr穩guez-Merch獺n EC, Liddle AD, 2021,
Preface
, Controversies in Orthopaedic Surgery of the Lower Limb -
Book chapterConnon F, Logishetty K, 2021, , Controversies in Orthopaedic Surgery of the Lower Limb, Pages: 41-52
Total hip arthroplasty, via any surgical approach, can offer reliable, substantial, and clinically relevant improvements in patient pain, mobility, and quality of life that makes it one of the most effective and reliable operations in modern medicine. The debate as to which surgical approach to utilise to perform total hip arthroplasty is as old as arthroplasty itself. At the time of writing, there is an increasing rate of utilisation of the Anterior Approach (AA), but the Posterior Approach (PA) is still the most employed worldwide, followed by the Lateral Approach (LA). The purported benefits and risks of the AA relative to the PA and LA are discussed here in greater detail, focusing on functional recovery, pain, implant longevity, infection, nerve palsy, and the learning curve. Training surgeons would be well advised to consider achieving proficiency in both the AA and PA. Surgeons already well-trained in any of the approaches described for this reliable procedure should consider the complications entailed with altering techniques as there is an associated learning curve, and should organise appropriate training if wishing to employ a different method.
-
Journal articleClunie G, Roe J, Alexander C, et al., 2021, , The Laryngoscope, Vol: 131, Pages: 146-157, ISSN: 0023-852X
Objectives: Laryngotracheal stenosis is a rare condition characterized by upper airway narrowing. Reconstructive surgical treatment aims to manage the area of stenosis to improve dyspnea and can impact on voice and swallowing function. This article critically evaluates the literature about voice and swallowing outcomes in adults with laryngotracheal stenosis who undergo reconstructive surgery.Study Design: Systematic review.Methods: Six databases were searched for articles referring to voice and swallowing outcome measures following reconstruction procedures in adults with laryngotracheal stenosis. Screening was completed using predefined inclusion/exclusion criteria. Results: A total of 143 abstracts were reviewed, with 67 articles selected for full text review. 20 studies met the inclusion criteria. Data extraction was completed with The Strengthening Reporting of Observational Studies in Epidemiology checklist with Oxford Centre for Evidence-Based Medicine Level of Evidence used to indicate quality. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-Randomized Studies. All studies scored a high risk of bias in at least one of the domains. Selection and timing of outcome measures was heterogenous and there was limited information provided about rationale or reliability.Conclusion: The literature acknowledges the importance of voice and swallowing outcomes following airway reconstruction. Studies show correlation between reconstructive surgery and deterioration in vocal function; there is no consistent data about swallowing outcomes. The lack of a core outcome measures set for adults with laryngotracheal stenosis limits the findings of this review. Further research is needed to establish clear criteria for robust and clinically relevant outcome measurement.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.