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Conference paperFavier C, McGregor A, Phillips A, 2019,
Subject specific multiscale modelling for the study of lumbar pathologies
, 17th International symposium on computer simulation in biomechanics, Publisher: International Society of Biomechanics -
Journal articleBabu S, Gupte C, Gajjar S, et al., 2019, , EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY, Vol: 29, Pages: 1115-1118, ISSN: 1633-8065
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- Citations: 5
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Journal articleSalman D, Farooqi M, McGregor A, et al., 2019, , British Journal of General Practice, Vol: 69, Pages: 278-279, ISSN: 0960-1643
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Journal articleLiddle AD, 2019, , Clinical Orthopaedics and Related Research, Vol: 477, Pages: 1447-1449, ISSN: 0009-921X
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Journal articleGhouse S, Reznikov N, Boughton O, et al., 2019, , Applied Materials Today, Vol: 15, Pages: 377-388, ISSN: 2352-9407
An increasing volume of work supports utilising the mechanobiology of bone for bone ingrowth into a porous scaffold. However, typically during in vivo testing of implants, the mechanical properties of the bone being replaced are not quantified. Consequently there remains inconsistencies in the literature regarding ‘optimum’ pore size and porosity for bone ingrowth. It is also difficult to compare ingrowth results between studies and to translate in vivo animal testing to human subjects without understanding the mechanical environment. This study presents a clinically applicable approach to determining local bone mechanical properties and design of a scaffold with similar properties. The performance of the scaffold was investigated in vivo in an ovine model.The density, modulus and strength of trabecular bone from the medial femoral condyle from ovine bones was characterised and power-law relationships were established. A porous titanium scaffold, intended to maintain bone mechanical homeostasis, was additively manufactured and implanted into the medial femoral condyle of 6 ewes. The stiffness of the scaffold varied throughout the heterogeneous structure and matched the stiffness variation of bone at the surgical site. Bone ingrowth into the scaffold was 10.73 ± 2.97% after 6 weeks. Fine woven bone, in the interior of the scaffold, and intense formations of more developed woven bone overlaid with lamellar bone at the implant periphery were observed. The workflow presented will allow future in vivo testing to test specific bone strains on bone ingrowth in response to a scaffold and allow for better translation from in vivo testing to commercial implants.
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Journal articleSivapuratharasu B, Bull AMJ, McGregor AH, 2019, , Archives of Rehabilitation Research and Clinical Translation, Vol: 1, ISSN: 2590-1095
Objective: This systematic review aims to evaluate current literature for the prevalence, causes and effect of low back pain (LBP) in traumatic lower limb amputees, specifically its association with the kinematics and kinetics of the lumbar spine and lower extremities. Data Sources: Databases (EMBASE, MEDLINE, Scopus, CINAHL, and PsycINFO) were searched systematically for eligible studies from inception to January 2018. Study Selection: The inclusion terms were synonyms of ‘low back pain’, ‘lower limb amputation’, and ‘trauma’, whilst studies involving non-traumatic amputee populations, single cases or reviews were excluded. 1822 studies were initially identified, of which 44 progressed to full-text reading, and 11 studies were included in the review.Data Extraction: Two independent reviewers reviewed the included studies, which were evaluated using a quality assessment tool and the GRADE system for risk of bias, prior to analysing results and conclusions. Data Synthesis: There was a LBP prevalence of 52–64% in traumatic amputees, compared to the 48–77% in the general amputee population (predominantly vascular, tumour and trauma), attributed to a mixture of biomechanical, psycho-social and personal factors. These factors determined the presence, frequency and severity of the pain in the amputees, significantly impacting on their quality of life. However, little evidence was available on causality. Conclusion: The high prevalence of LBP in traumatic amputees highlights the necessity to advance research into the underlying mechanics behind LBP, specifically the spinal kinematics and kinetics. This may facilitate improvements in rehabilitation, with the potential to improve quality of life in traumatic amputees.
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Journal articleBONE Collaborative, 2019, , Foot (Edinb), Vol: 39, Pages: 28-36
INTRODUCTION: The purpose of this national study was to audit the weight-bearing practice of orthopaedic services in the National Health Service (NHS) in the treatment of operatively and non-operatively treated ankle fractures. METHODS: A multicentre prospective two-week audit of all adult ankle fractures was conducted between July 3rd 2017 and July 17th 2017. Fractures were classified using the AO/OTA classification. Fractures fixed with syndesmosis screws or unstable fractures (>1 malleolus fractured or talar shift present) treated conservatively were excluded. No outcome data were collected. In line with NICE (The National Institute for Health and Care Excellence) criteria, "early" weight-bearing was defined as unrestricted weight-bearing on the affected leg within 3 weeks of injury or surgery and "delayed" weight-bearing as unrestricted weight-bearing permitted after 3 weeks. RESULTS: 251 collaborators from 81 NHS hospitals collected data: 531 patients were managed non-operatively and 276 operatively. The mean age was 52.6 years and 50.5 respectively. 81% of non-operatively managed patients were instructed for early weight-bearing as recommended by NICE. In contrast, only 21% of operatively managed patients were instructed for early weight-bearing. DISCUSSION: The majority of patients with uni-malleolar ankle fractures which are managed non-operatively are treated in accordance with NICE guidance. There is notable variability amongst and within NHS hospitals in the weight-bearing instructions given to patients with operatively managed ankle fractures. CONCLUSION: This study demonstrates community equipoise and suggests that the randomized study to determine the most effective strategy for postoperative weight-bearing in ankle fractures described in the NICE research recommendation is feasible.
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Journal articleSugand K, Malik HH, Newman S, et al., 2019, , SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, Vol: 17, Pages: 146-155, ISSN: 1479-666X
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- Citations: 5
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Journal articleSabharwal S, Archer S, Cadoux-Hudson D, et al., 2019, , J Health Psychol, Pages: 1359105319850883-1359105319850883
This study explores the experiences and perceptions of recovery in elderly patients who had sustained a proximal humerus fracture. In-depth semi-structured interviews were conducted with 15 patients over the age of 65. Thematic analysis identified aspects of care that impacted upon patient experience and quality of life. Seven main patient-reported themes were identified, including pain, sleep, shoulder function, emotional state, social support, relationship with their professional and experience of healthcare institution. These themes offer insight into the experiences of adults receiving care for proximal humerus fracture and highlight that existing quantitative measures of quality of life do not measure domains that are important to patients.
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Journal articleBoughton O, Ma S, Cai X, et al., 2019, , Scientific Reports, Vol: 9, ISSN: 2045-2322
The cortex of the femoral neck is a key structural element of the human body, yet there is not a reliable metric for predicting the mechanical properties of the bone in this critical region. This study explored the use of a range of non-destructive metrics to measure femoral neck cortical bone stiffness at the millimetre length scale. A range of testing methods and imaging techniques were assessed for their ability to measure or predict the mechanical properties of cortical bone samples obtained from the femoral neck of hip replacement patients. Techniques that can potentially be applied in vivo to measure bone stiffness, including computed tomography (CT), bulk wave ultrasound (BWUS) and indentation, were compared against in vitro techniques, including compression testing, density measurements and resonant ultrasound spectroscopy. Porosity, as measured by micro-CT, correlated with femoral neck cortical bone’s elastic modulus and ultimate compressive strength at the millimetre length scale. Large-tip spherical indentation also correlated with bone mechanical properties at this length scale but to a lesser extent. As the elastic mechanical properties of cortical bone correlated with porosity, we would recommend further development of technologies that can safely measure cortical porosity in vivo.Introduction
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Journal articleKhanna M, Gupte C, Dodds A, et al., 2019, , SKELETAL RADIOLOGY, Vol: 48, Pages: 729-740, ISSN: 0364-2348
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- Citations: 21
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Journal articleLin D, Papi E, McGregor A, 2019, , BMJ Open, Vol: 9, Pages: 1-8, ISSN: 2044-6055
Objectives: This study explores clinicians’ views of the clinical uptake of a smart pressure-sensing insole, named Flexifoot, to enhance the care and management of patients with osteoarthritis (OA). Clinicians are key users of wearable technologies, and can provide appropriate feedback for a specific device for successful clinical implementation.Design: Qualitative study with in-depth, semi-structured interviews, analysed using inductive analysis to generate key themes.Setting: Conducted in a University setting.Participants: 30 clinicians were interviewed (11 physiotherapists, 11 orthopaedic surgeons, 5 general practitioners, 3 podiatrists).Results: All clinicians regarded Flexifoot to be useful for the care and management of patients in adjunction to current methods. Responses revealed four main themes: use, data presentation, barriers to use, and future development. Flexifoot data was recognised as capable of enhancing information exchange between clinicians and patients, and also between clinicians themselves. Participants supported the use of feedback for rehabilitation, screening and evaluation of treatment progress/success purposes. Flexifoot use by patients was encouraged as a self-management tool that may motivate them by setting attainment goals. The data interface should be secure, concise and visually appealing. The measured parameters of Flexifoot, its duration of wear and frequency of data output would all depend on the rationale for its use. The clinicians and patients must collaborate to optimise the use of Flexifoot for long-term monitoring of disease for patient care in clinical practice. Many identified potential other uses for Flexifoot.Conclusions: Clinicians thought that Flexifoot may complement and improve current methods of long-term patient management for OA or other conditions in clinical settings. Flexifoot was recognised to be useful for objective measures and should be tailored carefully for each person and condition to maximise com
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Conference paperFavier C, McGregor A, Phillips A, 2019,
Full body subject specific musculoskeletal model for complex spine movements
, XXVII Congress of the International Society of Biomechanics -
Journal articleUemura K, Boughton O, Logishetty K, et al., 2020,
A single-use, size-specific, nylon arthroplasty guide: a preliminary study
, Hip International, ISSN: 1120-7000 -
Journal articleCarli A, Abdelbary H, Ahmadzai N, et al., 2019, , JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, Vol: 101, Pages: 635-649, ISSN: 0021-9355
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- Citations: 71
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Journal articleAdesida Y, Papi E, McGregor A, 2019, , Sensors, Vol: 19, ISSN: 1424-2818
The aim of this review was to understand the use of wearable technology in sport in order to enhance performance and prevent injury. Understanding sports biomechanics is important for injury prevention and performance enhancement and is traditionally assessed using optical motion capture. However, such approaches are limited by capture volume restricting assessment to a laboratory environment, a factor that can be overcome by wearable technology. A systematic search was carried out across seven databases where wearable technology was employed to assess kinetic and kinematic variables in sport. Articles were excluded if they focused on sensor design and did not measure kinetic or kinematic variables or apply the technology on targeted participants. A total of 33 articles were included for full-text analysis where participants took part in a sport and performed dynamic movements relating to performance monitored by wearable technologies. Inertial measurement units, flex sensors and magnetic field and angular rate sensors were among the devices used in over 15 sports to quantify motion. Wearable technology usage is still in an exploratory phase, but there is potential for this technology to positively influence coaching practice and athletes’ technique.
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Journal articleNahas S, Patel A, Hodgson H, et al., 2019, , Orthopaedics and Trauma, Vol: 33, Pages: 100-108, ISSN: 1877-1327
The posterolateral corner (PLC) of the knee refers to a complex of structures that play a key role in knee stability. The main three structures in the PLC of the knee are the lateral collateral ligament, the popliteus and the popliteofibular ligament. These are primarily restraints to varus and external rotation forces. As such, mechanisms of injury include varus and hyperextension, and are typically high energy. These injuries are rarely isolated and are commonly associated with other injuries such as cruciate ligament injury or tibiofemoral knee dislocation. If undetected or untreated, PLC injuries can cause severe long-term disability due to instability and cartilage degeneration. Failure to recognize these injuries can also jeopardize the results of concomitant anterior or posterior cruciate ligament reconstruction. Immediate management in acute injuries involves assessment and treatment of any associated neurovascular injury, especially to the popliteal artery or peroneal nerve, and reduction of knee dislocation. Acute repairs of the damaged structures can be undertaken, but ligament reconstruction is often required, using either autograft or allograft. Graft reconstruction procedures can be fibula-based or anatomic, each having their own merits. The timing of surgery can be acute, chronic or staged, depending on the exact nature of the injury and on timing.
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Journal articleJaggard MKJ, Boulange CL, Akhbari P, et al., 2019, , OSTEOARTHRITIS AND CARTILAGE, Vol: 27, Pages: 560-570, ISSN: 1063-4584
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- Citations: 14
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Journal articleLogishetty K, van Arkel RJ, Ng KCG, et al., 2019, , BONE & JOINT JOURNAL, Vol: 101B, Pages: 426-434, ISSN: 2049-4394
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- Citations: 19
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Journal articleGreenwood J, McGregor A, Jones F, et al., 2019, , European Spine Journal, Vol: 28, Pages: 735-744, ISSN: 0940-6719
PURPOSE: Following lumbar fusion surgery (LFS), 40% of patients are unsure/dissatisfied with their outcome. A prospective, single-centre, randomised, controlled trial was conducted to evaluate the feasibility (including clinical and economic impact) of a theoretically informed rehabilitation programme following LFS (REFS). METHODS: REFS was informed by an explicit theoretical framework and consisted of 10 consecutive weekly group rehabilitation sessions (education, low-tech cardiovascular, limb and spine strengthening exercises, and peer support). Participants were randomised to REFS or 'usual care.' Primary feasibility outcomes included recruitment and engagement. Secondary outcomes, collected preoperatively and 3, 6, and 12 months postoperatively, comprised the Oswestry disability index, European Quality of Life 5 dimensions score, pain self-efficacy questionnaire, hospital anxiety and depression scale and the aggregated functional performance time. Economic impact was evaluated with the Client Services Receipt Inventory. RESULTS: Fifty-two of 58 eligible participants were recruited, and engagement with REFS was > 95%. REFS participants achieved a clinically meaningful reduction in unadjusted mean short-term disability (- 13.27 ± 13.46), which was not observed in the 'usual care' group (- 2.42 ± 12.33). This was maintained in the longer term (- 14.72% ± 13.34 vs - 7.57 ± 13.91). Multilevel regression analyses, adjusted for body mass index, baseline depression, and smoking status reported a statistically significant short-term improvement in disability (p = 0.014) and pain self-efficacy (p = 0.007). REFS costs £275 per participant. CONCLUSIONS: Results suggest that REFS is feasible and potentially affordable for delivery in the National Health Service. It is associated with a clinically meaningful i
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