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Journal articleKanca Y, Milner P, Dini D, et al., 2018,
Tribological evaluation of biomedical polycarbonate urethanes against articular cartilage
, Journal of the Mechanical Behavior of Biomedical Materials, Vol: 82, Pages: 394-402, ISSN: 1751-6161This research investigated the in-vitro wear and friction performance of polycarbonate urethane (PCU) 80A as they interact with articular cartilage, using a customised multidirectional pin-on-plate tester. Condyles were articulated against PCU 80A discs (Bionate® I and Bionate® II) (configuration 1) and the results arising from these tests were compared to those recorded during the sliding of PCU pins against cartilage plates (configuration 2). Configuration 1 produced steadily increasing coefficient of friction (COF) (up to 0.64 ± 0.05) and had the same trend as the cartilage–on–stainless steel articulation (positive control). When synovial fluid rather than bovine calf serum was used as lubricant, average COF significantly decreased from 0.50 ± 0.02–0.38 ± 0.06 for condyle–on–Bionate® I (80AI) and from 0.41 ± 0.02–0.24 ± 0.04 for condyle–on–Bionate® II (80AII) test configurations (p < 0.05). After 15 h testing, the cartilage–on–cartilage articulation (negative control) tests showed no cartilage degeneration. However, different levels of cartilage volume loss were found on the condyles from the positive control (12.5 ± 4.2 mm3) and the PCUs (20.1 ± 3.6 mm3 for 80 AI and 19.0 ± 2.3 mm3 for 80AII) (p > 0.05). A good correlation (R2 =0.84) was found between the levels of average COF and the volume of cartilage lost during testing; increasing wear was found at higher levels of COF. Configuration 2 showed low and constant COF values (0.04 ± 0.01), which were closer to the negative control (0.03 ± 0.01) and significantly lower than configuration 1 (p < 0.05). The investigation showed that PCU is a good candidate for use in hemiarthroplasty components, where only one of the two articulating surfaces is replaced, as long as the synthetic material is implanted in a region where migrating cartilage contact is achieved. Bio
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Journal articleHalewood C, Athwal KK, Amis A, 2018,
Pre-clinical assessment of total knee replacement anterior-posterior constraint
, Journal of Biomechanics, Vol: 73, Pages: 153-160, ISSN: 0021-9290Pre-clinical, bench-top assessment of Total Knee Replacements (TKR) can provide information about the inherent constraint provided by a TKR, which does not depend on the condition of the patient undergoing the arthroplasty. However little guidance is given by the ASTM standard on test configurations such as medial-lateral (M:L) loading distribution, flexion angle or restriction of secondary motions. Using a purpose built rig for a materials testing machine, four TKRs currently in widespread clinical use, including medial-pivot and symmetrical condyle types, were tested for anterior-posterior translational constraint. Compressive joint loads from 710 to 2000 N, and a range of medial-lateral (M:L) load distributions, from 70:30% to 30:70% M:L, were applied at different flexion angles with secondary motions unconstrained. It was found that TKA constraint was significantly less at 60 and 90° flexion than at 0°, whilst increasing the compressive joint load increased the force required to translate the tibia to limits of AP constraint at all flexion angles tested. Additionally when M:L load distribution was shifted medially, a coupled internal rotation was observed with anterior translation and external rotation with posterior translation. This paper includes some recommendations for future development of pre-clinical testing methods.
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Journal articlevan Arkel R, Ghouse S, Milner P, et al., 2018,
Additive manufactured push-fit implant fixation with screw-strength pull out
, Journal of Orthopaedic Research, Vol: 36, Pages: 1508-1518, ISSN: 0736-0266Additive manufacturing offers exciting new possibilities for improving long-term metallic implant fixation in bone through enabling open porous structures for bony ingrowth. The aim of this research was to investigate how the technology could also improve initial fixation, a precursor to successful long-term fixation. A new barbed fixation mechanism, relying on flexible struts was proposed and manufactured as a push-fit peg. The technology was optimized using a synthetic bone model and compared with conventional press-fit peg controls tested over a range of interference fits. Optimum designs, achieving maximum pull-out force, were subsequently tested in a cadaveric femoral condyle model. The barbed fixation surface provided more than double the pull-out force for less than a third of the insertion force compared to the best performing conventional press-fit peg (p < 0.001). Indeed, it provided screw-strength pull out from a push-fit device (1,124 ± 146 N). This step change in implant fixation potential offers new capabilities for low profile, minimally invasive implant design, while providing new options to simplify surgery, allowing for one-piece push-fit components with high levels of initial stability.
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Journal articleHan S, Alexander JW, Thomas VS, et al., 2018,
Does Capsular Laxity Lead to Microinstability of the Native Hip?
, AMERICAN JOURNAL OF SPORTS MEDICINE, Vol: 46, Pages: 1315-1323, ISSN: 0363-5465 -
Journal articleNg KCG, Lamontagne M, Jeffers JRT, et al., 2018,
Anatomic Predictors of Sagittal Hip and Pelvic Motions in Patients With a Cam Deformity
, AMERICAN JOURNAL OF SPORTS MEDICINE, Vol: 46, Pages: 1331-1342, ISSN: 0363-5465- Cite
- Citations: 30
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Journal articleMusahl V, Getgood A, Neyret P, et al., 2018,
Contributions of the anterolateral complex and the anterolateral ligament to rotatory knee stability in the setting of ACL Injury: a roundtable discussion
, Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 25, Pages: 997-1008, ISSN: 0942-2056Persistent rotatory knee laxity is increasingly recognized as a common finding after anterior cruciate ligament (ACL) reconstruction. While the reasons behind rotator knee laxity are multifactorial, the impact of the anterolateral knee structures is significant. As such, substantial focus has been directed toward better understanding these structures, including their anatomy, biomechanics, in vivo function, injury patterns, and the ideal procedures with which to address any rotatory knee laxity that results from damage to these structures. However, the complexity of lateral knee anatomy, varying dissection techniques, differing specimen preparation methods, inconsistent sectioning techniques in biomechanical studies, and confusing terminology have led to discrepancies in published studies on the topic. Furthermore, anatomical and functional descriptions have varied widely. As such, we have assembled a panel of expert surgeons and scientists to discuss the roles of the anterolateral structures in rotatory knee laxity, the healing potential of these structures, the most appropriate procedures to address rotatory knee laxity, and the indications for these procedures. In this round table discussion, KSSTA Editor-in-Chief Professor Jón Karlsson poses a variety of relevant and timely questions, and experts from around the world provide answers based on their personal experiences, scientific study, and interpretations of the literature. Level of evidence V.
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Journal articleMilner P, Parkes M, Puetzer J, et al., 2018,
A low friction, biphasic and boundary lubricating hydrogel for cartilage replacement
, Acta Biomaterialia, Vol: 65, Pages: 102-111, ISSN: 1742-7061Partial joint repair is a surgical procedure where an artificial material is used to replace localised chondral damage. These artificial bearing surfaces must articulate against cartilage, but current materials do not replicate both the biphasic and boundary lubrication mechanisms of cartilage. A research challenge therefore exists to provide a material that mimics both boundary and biphasic lubrication mechanisms of cartilage.In this work a polymeric network of a biomimetic boundary lubricant, poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC), was incorporated into an ultra-tough double network (DN) biphasic (water phase + polymer phase) gel, to form a PMPC triple network (PMPC TN) hydrogel with boundary and biphasic lubrication capability. The presence of this third network of MPC was confirmed using ATR-FTIR. The PMPC TN hydrogel had a yield stress of 26 MPa, which is an order of magnitude higher than the peak stresses found in the native human knee. A preliminary pin on plate tribology study was performed where both the DN and PMPC TN hydrogels experienced a reduction in friction with increasing sliding speed which is consistent with biphasic lubrication. In the physiological sliding speed range, the PMPC TN hydrogel halved the friction compared to the DN hydrogel indicating the boundary lubricating PMPC network was working.A biocompatible, tough, strong and chondral lubrication imitating PMPC TN hydrogel was synthesised in this work. By complementing the biphasic and boundary lubrication mechanisms of cartilage, PMPC TN hydrogel could reduce the reported incidence of chondral damage opposite partial joint repair implants, and therefore increase the clinical efficacy of partial joint repair.Statement of SignificanceThis paper presents the synthesis, characterisation and preliminary tribological testing of a new biomaterial that aims to recreate the primary chondral lubrication mechanisms: boundary and biphasic lubrication. This work has demonstrated that the
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Book chapterInderhaug E, Amis AA, 2018,
Femoral Tunnel Placement to Restore Normal Knee Laxity after Anterior Cruciate Ligament Reconstruction
, Anterior Cruciate Ligament Reconstruction and Basic Science Second Edition, Pages: 188-193.e1 -
Journal articleWilliams A, Amis A, Zaffagnini S, et al., 2018,
Erratum to: Contributions of the anterolateral complex and the anterolateral ligament to rotatory knee stability in the setting of ACL Injury: a roundtable discussion (Knee Surgery, Sports Traumatology, Arthroscopy, (2017), 25, 4, (997-1008), 10.1007/s00167-017-4436-7)
, Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 26, Pages: 353-353, ISSN: 0942-2056© 2016, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA). In the original article, one of the co-authors’ name has been published incorrectly. The correct name should be Jeremy M. Burnham. The original article has been updated accordingly.
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Journal articleParkes M, Sayer K, Goldhofer M, et al., 2017,
Zirconia phase transformation in retrieved, wear simulated, and artificially aged ceramic femoral heads
, JOURNAL OF ORTHOPAEDIC RESEARCH, Vol: 35, Pages: 2781-2789, ISSN: 0736-0266- Cite
- Citations: 8
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Journal articleGeraldes DM, Hansen U, Jeffers J, et al., 2017,
Stability of small pegs for cementless implant fixation
, JOURNAL OF ORTHOPAEDIC RESEARCH, Vol: 35, Pages: 2765-2772, ISSN: 0736-0266- Author Web Link
- Cite
- Citations: 8
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Journal articleInderhaug E, Stephen JM, Williams A, et al., 2017,
Anterolateral Tenodesis or Anterolateral Ligament Complex Reconstruction Effect of Flexion Angle at Graft Fixation When Combined With ACL Reconstruction
, American Journal of Sports Medicine, Vol: 45, Pages: 3089-3097, ISSN: 0363-5465Background:Despite numerous technical descriptions of anterolateral procedures, knowledge is limited regarding the effect of knee flexion angle during graft fixation.Purpose:To determine the effect of knee flexion angle during graft fixation on tibiofemoral joint kinematics for a modified Lemaire tenodesis or an anterolateral ligament (ALL) complex reconstruction combined with anterior cruciate ligament (ACL) reconstruction.Study Design:Controlled laboratory study.Methods:Twelve cadaveric knees were mounted in a test rig with kinematics recorded from 0° to 90° flexion. Loads applied to the tibia were 90-N anterior translation, 5-N·m internal tibial rotation, and combined 90-N anterior force and 5-N·m internal rotation. Intact, ACL-deficient, and combined ACL plus anterolateral-deficient states were tested, and then ACL reconstruction was performed and testing was repeated. Thereafter, modified Lemaire tenodeses and ALL procedures with graft fixation at 0°, 30°, and 60° of knee flexion and 20-N graft tension were performed combined with the ACL reconstruction, and repeat testing was performed throughout. Repeated-measures analysis of variance and Bonferroni-adjusted t tests were used for statistical analysis.Results:In combined ACL and anterolateral deficiency, isolated ACL reconstruction left residual laxity for both anterior translation and internal rotation. Anterior translation was restored for all combinations of ACL and anterolateral procedures. The combined ACL reconstruction and ALL procedure restored intact knee kinematics when the graft was fixed in full extension, but when the graft was fixed in 30° and 60°, the combined procedure left residual laxity in internal rotation (P = .043). The combined ACL reconstruction and modified Lemaire procedure restored internal rotation regardless of knee flexion angle at graft fixation. When the combined ACL reconstruction and lateral procedure states were compared with the ACL-
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Journal articleKanca Y, Milner P, Dini D, et al., 2017,
Tribological properties of PVA/PVP blend hydrogels against articular cartilage.
, Journal of the Mechanical Behavior of Biomedical Materials, Vol: 78, Pages: 36-45, ISSN: 1751-6161This research investigated in-vitro tribological performance of the articulation of cartilage-on- polyvinyl alcohol (PVA) and polyvinyl pyrrolidone (PVP) blend hydrogels using a custom-designed multi-directional wear rig. The hydrogels were prepared by repeated freezing-thawing cycles at different concentrations and PVA to PVP fractions at a given concentration. PVA/PVP blend hydrogels showed low coefficient of friction (COF) values (between 0.12 ± 0.01 and 0.14 ± 0.02) which were closer to the cartilage-on-cartilage articulation (0.03 ± 0.01) compared to the cartilage-on-stainless steel articulation (0.46 ± 0.06). The COF increased with increasing hydrogel concentration (p = 0.03) and decreasing PVP content at a given concentration (p < 0.05). The cartilage-on-hydrogel tests showed only the surface layers of the cartilage being removed (average volume loss of the condyles was 12.5 ± 4.2mm3). However, the hydrogels were found to be worn/deformed. The hydrogels prepared at a higher concentration showed lower apparent volume loss. A strong correlation (R2 = 0.94) was found between the COF and compressive moduli of the hydrogel groups, resulting from decreasing contact congruency. It was concluded that the hydrogels were promising as hemiarthroplasty materials, but that improved mechanical behaviour was required for clinical use.
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Journal articleJin A, Cobb JP, Hansen U, et al., 2017,
The effect of long term bisphosphonate therapy on trabecular bone strength and microcrack density
, Bone & Joint Research, Vol: 6, Pages: 602-609, ISSN: 2046-3758ObjectivesBisphosphonates (BP) are the first-line treatment for preventing fragility fractures. However, concern regarding the efficacy is growing because bisphosphonate is associated with over-suppression of remodelling and accumulation of microcracks. While DEXA scanning may show a gain in bone density the impact of this class of drug on mechanical properties remains unclear. We therefore sought to quantify the mechanical strength of bone treated with BP (oral alendronate for this study), and correlate this with the microarchitecture and density of microcracks in comparison with untreated controls. MethodsTrabecular bone from hip-fracture patients treated with BP (n=10) was compared to naïve fractured (n=14) and non-fractured controls (n=6). Trabecular cores were synchrotron and micro-CT scanned for microstructural analysis including quantification of bone volume fraction, micro-architecture and microcracks, then mechanically tested in compression. ResultsBP bone was 28% lower in strength than untreated hip-fracture bone and 48% lower in strength than and non-fracture control bone (4.6 vs 6.4 vs 8.9 MPa). BP treated bone had 24% more microcracks than naïve fractured bone and 51% more than non-fractured control (8.12 vs 6.55 vs 5.25 /cm2). BP and naïve fracture bone exhibited similar trabecular microarchitecture, with significantly lower bone volume fraction and connectivity than non-fractured controls. ConclusionsBP therapy had no detectable mechanical benefit. Instead its use was associated with substantially reduced bone strength. This low strength was probably due to the greater accumulation of microcracks and a lack of any discernible improvement in bone volume or microarchitecture. This preliminary study suggests that the clinical impact of BP induced microcrack accumulation may be substantial and long term.
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Journal articleGhouse S, Babu S, van Arkel R, et al., 2017,
The influence of laser parameters and scanning strategies on the mechanical properties of a stochastic porous material
, Materials & Design, Vol: 131, Pages: 498-508, ISSN: 0261-3069Additive manufacturing enables architectured porous material design, but 3D-CAD modelling of these materials is prohibitively computationally expensive. This bottleneck can be removed using a line-based representation of porous materials instead, with strut thickness controlled by the supplied laser energy.This study investigated how laser energy and scan strategy affects strut thickness and mechanical strength of porous materials. Specimens were manufactured using varying laser parameters, 3 scan strategies (Contour, Points, Pulsing), 2 porous architectures and 2 materials (Titanium, Stainless Steel), with strut thickness, density, modulus, mechanical strength and build time measured.Struts could be built successfully as low as 15° with a minimum diameter of 0.13 mm. Strut thickness was linearly related to the specific enthalpy delivered by the laser to the melt-pool. For a given stiffness, Titanium specimens built at low power/slow speed had a 10% higher strength than those built at high power/fast speed. The opposite was found in Stainless Steel. As specimen stiffness increased, the Contour Strategy produced samples with the highest strength:stiffness and strength:weight ratio. The Points strategy offered the fastest build time, 20% and 100% faster than the Contour and Pulsing strategies, respectively. This work highlights the importance of optimising build parameters to maximize mechanical performance.
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Journal articleKittl C, Inderhaug E, Williams A, et al., 2017,
Biomechanics of the Anterolateral Structures of the Knee
, Clinics in Sports Medicine, Vol: 37, Pages: 21-31, ISSN: 0278-5919 -
Journal articleArnold M, Zhao S, Ma S, et al., 2017,
Microindentation: a tool for measuring cortical bone stiffness? A systematic review
, Bone & Joint Research, Vol: 6, Pages: 542-549, ISSN: 2046-3758Objectives: Microindentation hasthe potential to measuretheelasticity(stiffness)of individualpatients’bone. Bone elasticity plays a crucial role in the press-fit stability of orthopaedic implants.Arming surgeons with accuratebone elasticityinformation may reduce surgical complicationsincluding peri-prosthetic fractures. The question we address with this systematicreview is whether microindentation can accurately measure cortical bone stiffness.Methods: A systematic review of all English language articles using a keyword search was undertaken in Medline, Embase, PubMed, Scopus and Cochrane databases. Studies thatonly used nanoindentation, cancellous boneoranimal tissue were excluded.Results: 1094abstracts were retrieved and 32papers were included in the analysis, 20 of which used reference point indentation and 12of which used traditional depth sensing indentation.There are a number of factors thatmust be taken into account when using microindentation such as tip size, depth and method of analysis.Only two studies validated microindentation againsttraditional mechanical testing techniques. Bothstudies used reference point indentation(RPI) with one showing that RPI parameters correlate well with mechanical testing, butanother suggestedthatthey do not. Conclusion: Microindentation has been used in various studies to assess bone elasticity but only two studies with conflicting results compared microindentation to traditional mechanical testing techniques. Further research,includingmore studies comparingmicroindentationto other mechanical testing methodsare needed,before microindentation can be reliably used to calculate cortical bone stiffness.
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Journal articleEl Daou H, Lord B, Amis A, et al., 2017,
Assessment of pose repeatability and specimen repositioning of a robotic joint testing platform
, MEDICAL ENGINEERING & PHYSICS, Vol: 47, Pages: 210-213, ISSN: 1350-4533This paper describes the quantitative assessment of a robotic testing platform, consisting of an industrial robot and a universal force-moment sensor, via the design of fixtures used to hold the tibia and femur of cadaveric knees. This platform was used to study the contributions of different soft tissues and the ability of implants and reconstruction surgeries to restore normal joint functions, in previously published literature.To compare different conditions of human joints, it is essential to reposition specimens with high precision after they have been removed for a surgical procedure. Methods and experiments carried out to determine the pose repeatability and measure errors in repositioning specimens are presented. This was achieved using an optical tracking system (fusion Track 500, Atracsys Switzerland) to measure the position and orientation of bespoke rigid body markers attached to the tibial and femoral pots after removing and reinstalling them inside the rigs. The pose repeatability was then evaluated by controlling the robotic platform to move a knee joint repeatedly to/from a given pose while tracking the position and orientation of a rigid body marker attached to the tibial fixture.The results showed that the proposed design ensured a high repeatability in repositioning the pots with standard deviations for the computed distance and angle between the pots at both ends of the joint equal to 0.1 mm, 0.01 mm, 0.13° and 0.03° for the tibial and femoral fixtures respectively. Therefore, it is possible to remove and re-setup a joint with high precision. The results also showed that the errors in repositioning the robotic platform (that is: specimen path repeatability) were 0.11 mm and 0.12°, respectively.
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Journal articleAlidousti H, Giles JW, Emery RJH, et al., 2017,
Spatial mapping of humeral head bone density
, JOURNAL OF SHOULDER AND ELBOW SURGERY, Vol: 26, Pages: 1653-1661, ISSN: 1058-2746- Cite
- Citations: 25
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Journal articleLi J, Clarke S, Cobb JP, et al., 2017,
Novel curved surface preparation technique for knee resurfacing
, Medical Engineering and Physics, Vol: 49, Pages: 89-93, ISSN: 1350-4533Conventional tools are incapable of preparing the curved articular surface geometry required during cartilage repair procedures. A novel curved surface preparation technique was proposed and tested to provide an accurate low-cost solution. Three shapes of samples, with flat, 30 mm radius and 60 mm radius surfaces, were manufactured from foam bone substitute for testing. Registering guides and cutting guides were designed and 3-D printed to fit onto the foam samples. A rotational cutting tool with an adapter was used to prepare the surfaces following the guidance slots in the cutting guides. The accuracies of the positions and shapes of the prepared cavities were measured using a digital calliper, and the surface depth accuracy was measured using a 3-D scanner. The mean shape and position errors were both approximately ± 0.5 mm and the mean surface depth error ranged from 0 to 0.3 mm, range − 0.3 to + 0.45 mm 95% CI. This study showed that the technique was able to prepare a curved surface accurately; with some modification it can be used to prepare the knee surface for cartilage repair.
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