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Journal articleKaria M, Ghaly Y, Al-Hadithy N, et al., 2019, , Eur J Orthop Surg Traumatol, Vol: 29, Pages: 509-520
Knee arthroscopy for meniscal tears is one of the most commonly performed orthopaedic procedures. In recent years, there has been an increasing incidence of meniscal repairs, as there are concerns that meniscectomy predisposes patients to early osteoarthritis. Indications for meniscal repair are increasing and can now be performed in older patients who are active, even if the tear is in the avascular zone. Options for meniscal tear management broadly fall into three categories: non-operative management, meniscal repair or meniscectomy. With limited evidence directly comparing each of these options optimal management strategies can be difficult. Decision making requires thorough assessment of patient factors (e.g. age and comorbidities) and tear characteristics (e.g. location and reducibility). The purpose of this paper is, therefore, to review the management options of meniscal tears and summarize the evidence for meniscal tear repair.
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Journal articleBoughton O, Uemura K, Tamura K, et al., 2019,
Gender and Disease Severity Determine Proximal Femoral Morphology in Developmental Dysplasia of the Hip
, Journal of Orthopaedic Research, ISSN: 0736-0266 -
Conference paperKaufmann J, Phillips A, McGregor A, 2019,
Investigating bone health in lower-limb amputees
, TGCS 2019 - 17th International Symposium on Computer Simulation in Biomechanics -
Conference paperFormstone L, Pucek M, Wilson S, et al., 2019,
Myographic Information Enables Hand Function Classification in Automated Fugl-Meyer Assessment
, 9th IEEE/EMBS International Conference on Neural Engineering (NER), Publisher: IEEE, Pages: 239-242, ISSN: 1948-3546 -
Journal articleRane L, Ding Z, McGregor AH, et al., 2019, , Annals of Biomedical Engineering, Vol: 47, Pages: 778-789, ISSN: 0090-6964
Musculoskeletal models permit the determination of internal forces acting during dynamic movement, which is clinically useful, but traditional methods may suffer from slowness and a need for extensive input data. Recently, there has been interest in the use of supervised learning to build approximate models for computationally demanding processes, with benefits in speed and flexibility. Here, we use a deep neural network to learn the mapping from movement space to muscle space. Trained on a set of kinematic, kinetic and electromyographic measurements from 156 subjects during gait, the network’s predictions of internal force magnitudes show good concordance with those derived by musculoskeletal modelling. In a separate set of experiments, training on data from the most widely known benchmarks of modelling performance, the international Grand Challenge competitions, generates predictions that better those of the winning submissions in four of the six competitions. Computational speedup facilitates incorporation into a lab-based system permitting real-time estimation of forces, and interrogation of the trained neural networks provides novel insights into population-level relationships between kinematic and kinetic factors.
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Journal articleStevenson H, Jaggard M, Akhbari P, et al., 2019, , Biotribology, Vol: 17, Pages: 49-63, ISSN: 2352-5738
CoCrMo ball-on-flat wear tests were carried out with 25 wt% bovine calf serum (25BCS) and human synovial fluid (HSF) to investigate artificial joint lubricating mechanisms. Post-test the wear scar on the disc was measured and surface deposits in and around the rubbed region were analysed by Micro InfraRed Reflection Absorption Spectroscopy (Micro-IRRAS). In most tests the HSF samples gave higher wear than the 25BCS solution; in some cases, up to 77%. After rinsing a similar pattern of surface deposits was observed in and around the wear scar for both the model and HSF. Micro-IRRAS showed the deposits were primarily denatured proteins with an increased β-sheet content. In some cases, trans-alkyl chain/carbonyl components were also present and these were assigned to lipids. Thioflavin T fluorescent imaging also indicated aggregated non-native β-sheet fibrils were present in the deposits and their presence was associated with lower wear. The formation of insoluble, denatured protein films is thought to be the primary lubrication mechanism contributing to surface protection during rubbing. From this and earlier work we suggest inlet shear induces denaturing of proteins resulting in the formation of non-native β-sheet aggregates. This material is entrained into the contact region where it forms the lubricating film. Patient synovial fluid chemistry appears to influence wear, at least in the bench test, and thus could contributes to increased risk of failure, or success, with metal-metal hips. Finally using 25BCS as a reference screening fluid gives an overly optimistic view of wear in these systems.
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Journal articleCowell I, O'Sullivan P, O'Sullivan K, et al., 2019, , Musculoskeletal Care, Vol: 17, Pages: 79-90, ISSN: 1478-2189
Background: It has long been acknowledged that nonspecific chronic low back pain (NSCLBP) is associated with a complex combination of biopsychosocial (BPS) factors, and recent guidelines advocate that the management of back pain should reflect this multidimensional complexity. Cognitive functional therapy (CFT) is a behaviourally oriented intervention that targets patients' individual BPS profiles. Although the efficacy of CFT has been demonstrated in primary care, little evidence exists about the training requirements of this approach.Methods: Qualitative semistructured interviews were conducted with 10 physiotherapists working in primary care, who had undergone a formal training programme in CFT. A purposive sampling method was employed to seek the broadest perspectives. Thematic analysis was used to analyse the interview transcripts and capture the emergent themes.Results: Five main themes emerged: (i) the learning challenge; (ii) selfreported changes in confidence; (iii) selfreported changes in communication practice; (iv) selfreported changes in attitudes and understanding; (v) the physiotherapists felt that CFT was more effective than their usual approach for NSCLBP but identified barriers to successful implementation, which included a lack of time and difficulties in engaging patients with strong biomedical beliefs.Conclusions: The study suggested that training in CFT has the capacity to produce selfreported changes in physiotherapists' attitudes, confidence and practice. The provision of such training has implications in terms of time and costs; however, this this may be warranted, given the physiotherapists' strong allegiance to the approach compared with their usual practice.
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Journal articleOosthuizen CR, Takahashi T, Rogan DM, et al., 2019, , The Journal of Arthroplasty, Vol: 34, Pages: 450-455, ISSN: 0883-5403
BackgroundThe aim of this study is to validate the Knee Osteoarthritis Grading system (KOGS) of progressive osteoarthritic (OA) degeneration for the Tri-compartmental knee. This system defines the site and severity of OA to determine a specific knee replacement.MethodsThe radiographic sequence for KOGS includes standing coronal (antero-posterior), lateral, 30° skyline patella, 15° and 45° Rosenberg and stress views in 20° of flexion.Cohen’s Kappa and related agreement statistical methods were used to assess the level of concordance of the seven evaluators between A and B cohorts for each evaluator and also against the actual arthroplasty used. Sensitivity and specificity was also assessed for the KOGS in identifying true partial knee replacements (PKR) and total knee replacements (TKR) as decided from the cohort A evaluations.ResultsFrom a cohort of 330 patients who were included in the study, 71 (22.5%) underwent a TKR procedure, 258 (78.2%) a PKR and 1 (0.3%) was neither a TKR nor PKR. KOGS was able to identify true PKRs (sensitivity) in the range of 92.2% to 98.5% across all the different evaluators. The KOGS method was able to identify a PKR or a TKR with an accuracy ranging from 92% to 98.8% across all different evaluators.The surgical results after 20 months are at least comparable with the expected average in the academic literature.ConclusionThe KOGS classification provides a reliable and accurate tool to assess suitability of an individual patient for undergoing partial or total knee replacement.
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BookSugand K, Berry M, Yusuf I, et al., 2019,
Oxford Handbook for Medical School
, Publisher: Oxford University Press, USA, ISBN: 9780199681907This handbook includes quick-access summaries covering the crucial information for your preclinical years and for each clinical specialty.
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Conference paperKaufmann J, Phillips A, McGregor A, 2019,
Investigating bone health in lower-limb amputees
, ISB/ASB 2019 -
Journal articleReznikov N, Boughton O, Ghouse S, et al., 2019, , Biomaterials, Vol: 194, Pages: 183-194, ISSN: 0142-9612
This study explored the regenerative osteogenic response in the distal femur of sheep using scaffolds having stiffness values within, and above and below, the range of trabecular bone apparent modulus. Scaffolds 3D-printed from stiff titanium and compliant polyamide were implanted into a cylindrical metaphyseal defect 15×15痂m. After six weeks, bone ingrowth varied between 7 and 21% of the scaffold pore volume and this was generally inversely proportional to scaffold stiffness. The individual reparative response considerably varied among the animals, which could be divided into weak and strong responders. Notably, bone regeneration specifically within the interior of the scaffold was inversely proportional to scaffold stiffness and was strain-driven in strongly-responding animals. Conversely, bone regeneration at the periphery of the defect was injury-driven and equal in all scaffolds and in all strongly- and weakly-responding animals. The observation of the strain-driven response in some, but not all, animals highlights that scaffold compliance is desirable for triggering host bone regeneration, but scaffold permanence is important for the load-bearing, structural role of the bone-replacing device. Indeed, scaffolds may benefit from being nonresorbable and mechanically reliable for those unforeseeable cases of weakly responding recipients.
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Journal articleJones GG, Clarke S, Jaere M, et al., 2019, , Orthopaedics and Traumatology: Surgery and Research, Vol: 105, Pages: 85-88, ISSN: 1877-0568
High tibial osteotomy is an attractive treatment option for young active patients wishing to return to high-level activities. However, it is not considered a long-term solution, with 30% revised at ten years. Currently, the only revision option is a total knee arthroplasty, a procedure that might not deliver the functional level expected by these highly active patients. This paper describes a novel joint preserving approach to HTO revision, using assistive technology, in the form of 3D printed guides, to reverse the osteotomy and simultaneously perform a unicompartmental knee replacement. The indications and planning aims for this procedure are discussed, and the preliminary results in four patients presented.
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Journal articleJones GG, Clarke S, Jaere M, et al., 2019, , Revue de Chirurgie Orthopedique et Traumatologique, Vol: 105, Pages: 41-41, ISSN: 1877-0517
High tibial osteotomy is an attractive treatment option for young active patients wishing to return to high level activities. However, it is not considered a long-term solution, with 30% revised at ten years. Currently, the only revision option is a total knee arthroplasty, a procedure that might not deliver the functional level expected by these highly active patients. This paper describes a novel joint preserving approach to HTO revision, using assistive technology, in the form of 3D printed guides, to reverse the osteotomy and simultaneously perform a unicompartmental knee replacement. The indications and planning aims for this procedure are discussed, and the preliminary results in four patients presented. Level of evidence: IV.
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Journal articleRiyiere C, Harman C, Leong A, et al., 2019, , ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, Vol: 105, Pages: 63-70, ISSN: 1877-0568
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- Citations: 13
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Journal articleSperry MM, Phillips ATM, McGregor AH, 2019, , Journal of Back and Musculoskeletal Rehabilitation, Vol: 32, Pages: 27-35, ISSN: 1053-8127
BACKGROUND: It is hypothesized that inherent differences in movement strategies exist between control subjects and those with a history of lower back pain (LBP). Previous motion analysis studies focus primarily on tracking spinal movements, neglecting the connection between the lower limbs and spinal function. Lack of knowledge surrounding the functional implications of LBP may explain the diversity in success from general treatments currently offered to LBP patients. OBJECTIVE: This pilot study evaluated the response of healthy controls and individuals with a history of LBP (hLBP) to a postural disturbance. METHODS: Volunteers (n= 26) were asked to maintain standing balance in response to repeated balance disturbances delivered via a perturbation platform while both kinematic and electromyographic data were recorded from the trunk, pelvis, and lower limb. RESULTS: The healthy cohort utilized an upper body-focused strategy for balance control, with substantial activation of the external oblique muscles. The hLBP cohort implemented a lower limb-focused strategy, relying on activation of the semitendinosus and soleus muscles. No significant differences in joint range of motion were identified. CONCLUSIONS: These findings suggest that particular reactive movement patterns may indicate muscular deficits in subjects with hLBP. Identification of these deficits may aid in developing specific rehabilitation programs to prevent future LBP recurrence.
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Journal articleWang H, Sugand K, Newman S, et al., 2019, , PLoS ONE, Vol: 14, ISSN: 1932-6203
s Metrics Comments Media Coverage Abstract Introduction Materials and methods Results Discussion Conclusion Supporting information References Reader Comments (0) Media Coverage (0) FiguresAbstractPurposeSurgical education videos currently all use a single point of view (POV) with the trainee locked onto a fixed viewpoint, which may not deliver sufficient information for complex procedures. We developed a novel multiple POV video system and evaluated its training outcome compared with traditional single POV.MethodsWe filmed a hip resurfacing procedure performed by an expert attending using 8 cameras in theatre. 30 medical students were randomly and equally allocated to learn the procedure using the multiple POV (experiment group [EG]) versus single POV system (control group [CG]). Participants advanced a pin into the femoral head as demonstrated in the video. We measured the drilling trajectories and compared it with pre-operative plan to evaluate distance of the pin insertion and angular deviations. Two orthopedic attendings expertly evaluated the participants’ performance using a modified global rating scale (GRS). There was a pre-video knowledge test that was repeated post-simulation alongside a Likert-scale questionnaire.ResultsThe angular deviation of the pin in EG was significantly less by 29% compared to CG (p = 0.037), with no significant difference in the entry point’s distance between groups (p = 0.204). The GRS scores for EG were 3.5% higher than CG (p = 0.046). There was a 32% higher overall knowledge test score (p<0.001) and 21% improved Likert-scale questionnaire score (p = 0.002) after video-learning in EG than CG, albeit no significant difference in the knowledge test score before video-learning (p = 0.721).ConclusionThe novel multiple POV provided significant objective and subjective advantages over single POV for acquisition of technical skills in hip surgery.
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Journal articleDoyle R, Boughton O, Plant D, et al., 2019, , Journal of Biomechanics, Vol: 82, Pages: 220-227, ISSN: 0021-9290
Impaction is required to properly seat press-fit implants and ensure initial implant stability and long term bone ingrowth, however excessive impaction or press-fit presents a high fracture risk in the acetabulum and femur. Current in-vitro impaction testing methods do not replicate the compliance of the soft tissues surrounding the hip, a factor that may be important in fracture and force prediction. This study presents the measurement of compliance of the soft tissues supporting the hip during impaction in operative conditions, and replicates these in vitro. Hip replacements were carried out on 4 full body cadavers while impact force traces and acetabular/femoral displacement were measured. Compliance was then simulated computationally using a Voigt model. These data were subsequently used to inform the design of a representative in-vitro drop rig. Effective masses of 19.7疼g and 12.7疼g, spring stiffnesses of 8.0疼N/m and 4.1疼N/m and dashpot coefficients of 595烤盎/m and 322烤盎/m were calculated for the acetabular and femoral soft tissues respectively. A good agreement between cadaveric and in-vitro peak displacement and rise time during impact is found. Such an in-vitro setup is of use during laboratory testing, simulation or even surgical training.
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Book chapterRodríguez-Merchán EC, Liddle AD, 2019, , Disorders of the Patellofemoral Joint Diagnosis and Management, Pages: 123-127
Partial lateral facetectomy is a relatively easy and efficacious surgical treatment for middle-aged to elderly active patients with isolated lateral patellofemoral osteoarthritis (OA) who require pain relief and maintenance of level of activity but who wish to avoid arthroplasty. It can be performed arthroscopically or open. The indications are isolated patellofemoral OA in patients with an overhanging lateral facet of the patella with anterolateral knee pain and lack of response to conservative treatment. A satisfactory outcome after lateral patellar facetectomy for isolated patellofemoral OA can be foreseen in about half of the cases at 10 years follow-up; patellofemoral arthroplasty (PFA) or total knee arthroplasty (TKA) may be performed with no special considerations in patients who do not achieve adequate pain relief following partial lateral facetectomy.
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Book chapterLiddle AD, Rodríguez-Merchán EC, 2019, , Disorders of the Patellofemoral Joint Diagnosis and Management, Pages: 89-94
Lateral retinacular release has historically been a popular procedure for the treatment of recurrent patellar instability in adolescents and adults. However, as our understanding of the anatomy, physiology and pathology of patellar instability has increased, it has fallen out of favour. Current management of patellar instability has focused on treating the pathoanatomy involved, in an approach individualized to the patient. Currently, lateral release is used as an adjunct to other surgical procedures for instability, with other indications including isolated retinacular pain or symptomatic bipartite patella. In this chapter, the techniques, indications, results and complications of lateral release are discussed.
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Book chapterIranpour F, Aframian A, Cobb JP, 2019, , Disorders of the Patellofemoral Joint Diagnosis and Management, Pages: 129-134
Patellofemoral osteoarthritis is common in older people and those with risk factors including trochlear dysplasia and patellofemoral instability. Patellofemoral arthroplasty (PFA) is indicated in such patients and has the advantage of leaving the remaining structures of the knee intact, including the native tibiofemoral joint surfaces and cruciate ligaments. The design of PFA has evolved from inlay designs to onlay designs which are either symmetrical or asymmetrical, to match the native trochlea. Long-term survival of currently used implants is suboptimal, with the largest series of the most commonly used implant reporting a 10-year survival of 77.3% at 10 years, with most patients being revised for progression of disease. Improvements in our understanding of the indications for PFA together with improvements in the design of instruments and instrumentation have the potential to improve the survival of PFA in the future, allowing more people to benefit from the advantages it confers over total knee arthroplasty (TKA).
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