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Journal articleSabharwal S, Archer S, Cadoux-Hudson D, et al., 2019,
Exploring elderly patients' experiences of recovery following complex proximal humerus fracture: A qualitative study.
, J Health Psychol, Pages: 1359105319850883-1359105319850883This 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,
Computed tomography porosity and spherical indentation for determining cortical bone millimetre-scale mechanical properties
, Scientific Reports, Vol: 9, ISSN: 2045-2322The 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,
Magnetic resonance imaging appearances of the capsulo-osseous layer of the iliotibial band and femoral attachments of the iliotibial band in the normal and pivot-shift ACL injured knee
, SKELETAL RADIOLOGY, Vol: 48, Pages: 729-740, ISSN: 0364-2348- Author Web Link
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- Citations: 21
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Journal articleLin D, Papi E, McGregor A, 2019,
Exploring the clinical context of adopting an instrumented insole: a qualitative study of clinicians’ preferences in England
, BMJ Open, Vol: 9, Pages: 1-8, ISSN: 2044-6055Objectives: 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,
Diagnostic Accuracy of Serum, Synovial, and Tissue Testing for Chronic Periprosthetic Joint Infection After Hip and Knee Replacements A Systematic Review
, JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, Vol: 101, Pages: 635-649, ISSN: 0021-9355- Author Web Link
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- Citations: 71
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Journal articleAdesida Y, Papi E, McGregor A, 2019,
Exploring the role of wearable technology in sport kinematics and kinetics: a systematic review
, Sensors, Vol: 19, ISSN: 1424-2818The 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,
The posterolateral corner of the knee
, Orthopaedics and Trauma, Vol: 33, Pages: 100-108, ISSN: 1877-1327The 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 articleLogishetty K, van Arkel RJ, Ng KCG, et al., 2019,
Hip capsule biomechanics after arthroplasty THE EFFECT OF IMPLANT, APPROACH, AND SURGICAL REPAIR
, BONE & JOINT JOURNAL, Vol: 101B, Pages: 426-434, ISSN: 2049-4394- Author Web Link
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- Citations: 19
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Journal articleGreenwood J, McGregor A, Jones F, et al., 2019,
Rehabilitation following lumbar fusion surgery (REFS) a randomised controlled feasibility study
, European Spine Journal, Vol: 28, Pages: 735-744, ISSN: 0940-6719PURPOSE: 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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Journal articleKaria M, Ghaly Y, Al-Hadithy N, et al., 2019,
Current concepts in the techniques, indications and outcomes of meniscal repairs.
, Eur J Orthop Surg Traumatol, Vol: 29, Pages: 509-520Knee 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 articleJaggard MKJ, Boulange CL, Akhbari P, et al., 2019,
A systematic review of the small molecule studies of osteoarthritis using nuclear magnetic resonance and mass spectroscopy
, OSTEOARTHRITIS AND CARTILAGE, Vol: 27, Pages: 560-570, ISSN: 1063-4584- Author Web Link
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- Citations: 14
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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,
Deep learning for musculoskeletal force prediction
, Annals of Biomedical Engineering, Vol: 47, Pages: 778-789, ISSN: 0090-6964Musculoskeletal 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,
The role of denatured synovial fluid proteins in the lubrication of artificial joints
, Biotribology, Vol: 17, Pages: 49-63, ISSN: 2352-5738CoCrMo 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,
The Perspectives of physiotherapists on managing non-specific low back pain following a training programme in Cognitive Functional Therapy: a qualitative study
, Musculoskeletal Care, Vol: 17, Pages: 79-90, ISSN: 1478-2189Background: 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) self‐reported changes in confidence; (iii) self‐reported changes in communication practice; (iv) self‐reported 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 self‐reported 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 Knee Osteoarthritis Grading System (KOGS) for arthroplasty
, The Journal of Arthroplasty, Vol: 34, Pages: 450-455, ISSN: 0883-5403BackgroundThe 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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