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Journal articlePapi E, Bull A, McGregor A, 2018,
Is there evidence to use kinematic/kinetic measures clinically in low back pain patients? A systematic review
, Clinical Biomechanics, Vol: 55, Pages: 53-64, ISSN: 0268-0033BackgroundCurrently, there is a widespread reliance on self-reported questionnaires to assess low back pain patients. However, it has been suggested that objective measures of low back pain patients' functional status should be used to aid clinical assessment. The aim of this study is to systematically review which kinematic /kinetic parameters have been used to assess low back pain patients against healthy controls and to propose clinical kinematic/kinetic measures.MethodsPubMed, Embase and Scopus databases were searched for relevant studies. Reference lists of selected studies and hand searches were performed. Studies had to compare people with and without non-specific low back pain while performing functional tasks and report body segment/joint kinematic and/or kinetic data. Two reviewers independently identified relevant papers.FindingsSixty-two studies were included. Common biases identified were lack of assessor blinding and sample size calculation, use of samples of convenience, and poor experimental protocol standardization. Studies had small sample sizes. Range of motion maneuvers were the main task performed (33/62). Kinematic/kinetic data of different individual or combination of body segments/joints were reported among the studies, commonest was to assess the hip joint and lumbar segment motion (13/62). Only one study described full body movement. The most commonly reported outcome was range of motion. Statistically significant differences between controls and low back pain groups were reported for different outcomes among the studies. Moreover, when the same outcome was reported disagreements were noted.InterpretationThe literature to date offers limited and inconsistent evidence of kinematic/kinetic measures in low back pain patients that could be used clinically.
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Journal articleJones GG, Jaere M, Clarke S, et al., 2018,
3D printing and high tibial osteotomy
, EFORT Open Reviews, Vol: 3, Pages: 254-259, ISSN: 2058-5241High tibial osteotomy (HTO) is a relatively conservative surgical option in the management of medial knee pain. Thus far, the outcomes have been variable, and apparently worse than the arthroplasty alternatives when judged using conventional metrics, owing in large part to uncer-tainty around the extent of the correction planned and achieved.This review paper introduces the concept of detailed 3D planning of the procedure, and describes the 3D printing technology that enables the plan to be performed.The different ways that the osteotomy can be undertaken, and the varying guide designs that enable accurate regis-tration are discussed and described. The system accuracy is reported.In keeping with other assistive technologies, 3D printing enables the surgeon to achieve a preoperative plan with a degree of accuracy that is not possible using conventional instruments. With the advent of low dose CT, it has been possible to confirm that the procedure has been under-taken accurately too.HTO is the ‘ultimate’ personal intervention: the amount of correction needed for optimal offloading is not yet com-pletely understood.For the athletic person with early medial joint line over-load who still runs and enjoys life, HTO using 3D printing is an attractive option. The clinical effectiveness remains unproven.
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Journal articleJones GG, Clarke S, Jaere M, et al., 2018,
3D printing and unicompartmental knee arthroplasty
, EFORT Open Reviews, Vol: 3, Pages: 248-253, ISSN: 2058-5241In suitable patients, unicompartmental knee arthroplasty (UKA) offers a number of advantages compared with total knee arthroplasty. However, the procedure is technically demanding, with a small tolerance for error. Assistive technology has the potential to improve the accuracy of implant positioning. This review paper describes the concept of detailed UKA planning in 3D, and the 3D printing technology that enables a plan to be delivered intraoperatively using patient-specific instrumentation (PSI). The varying guide designs that enable accurate registration are discussed and described. The system accuracy is reported. Future studies need to ascertain whether accuracy for low-volume surgeons can be delivered in the operating theatre using PSI, and reflected in improved patient reported outcome measures, and lower revision rates.
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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 articleLogishetty K, Western L, Morgan R, et al.,
Augmented reality for arthroplasty training - a randomised controlled trial of simulator-based training for acetabular cup orientation skills
, Clinical Orthopaedics and Related Research, ISSN: 0009-921XBackground:Accurate implant orientation reduces wear and increases stability in arthroplasty. This is a technically demanding skill. Augmented Reality headsets overlay digital information over the real world. We have developed an enhanced AR headset capable of tracking bony anatomy in relation to an implant. Questions/Purposes:The purpose of this study was to validate this enhanced AR headset in the training simulator setting as determined by (1) quantitative assessments accurately orientating an acetabular component, and (2) a questionnaire regarding the realism of the task, acceptability ofthe technology, and its potential role for surgical training. Methods:Twenty-four novice surgeons voluntarily participated in a simulation trial. Demographics and baseline performance in orientating an acetabular implant to six patient-specific values on the phantom pelvis, were collected prior to training. All participants received standardised educational lectures based around four clinical vignettes on hip surgery to normalise their knowledge. Participants were randomised to two groups, completing four, once-weekly sessions of baseline assessment, training, and re-assessment. One group trained using AR (with live holographic feedback of orientation), and the other received one-on-one tuition from an expert surgeon (ES). The solid-angle error in degrees between the planned and achieved orientations was measured. Participants completed baseline assessments, then training, and then assessment in this fashion after each weekly session, and a validated post-training questionnaire evaluating their experiences. Results:Novice surgeons of similar experience in both groups performed with a similar error prior to training (Baseline ES mean error 16° ± SD 7° compared to AR 14±7°, p>0.05). During training, participants achieved average errors in orientations of 1±1° using AR, and 6±4° when guided by the ES (p<0.001). At fin
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Journal articlePapi E, Bo YN, McGregor A, 2018,
A flexible wearable sensor for knee flexion assessment during gait
, Gait and Posture, Vol: 62, Pages: 480-483, ISSN: 0966-6362Background:Gait analysis plays an important role in the diagnosis and management of patients with movement disorders but it is usually performed within a laboratory. Recently interest has shifted towards the possibility of conducting gait assessments in everyday environments thus facilitating long-term monitoring. This is possible by using wearable technologies rather than laboratory based equipment.Research questionThis study aims to validate a novel wearable sensor system’s ability to measure peak knee sagittal angles during gait.Methods:The proposed system comprises a flexible conductive polymer unit interfaced with a wireless acquisition node attached over the knee on a pair of leggings. Sixteen healthy volunteers participated to two gait assessments on separate occasions. Data was simultaneously collected from the novel sensor and a gold standard 10 camera motion capture system. The relationship between sensor signal and reference knee flexion angles was defined for each subject to allow the transformation of sensor voltage outputs to angular measures (degrees). The knee peak flexion angle from the sensor and reference system were compared by means of root mean square error (RMSE), absolute error, Bland-Altman plots and intra-class correlation coefficients (ICCs) to assess test-retest reliability.Results:Comparisons of knee peak flexion angles calculated from the sensor and gold standard yielded an absolute error of 0.35(±2.9°) and RMSE of 1.2(±0.4)°. Good agreement was found between the two systems with the majority of data lying within the limits of agreement. The sensor demonstrated high test-retest reliability (ICCs>0.8).Significance:These results show the ability of the sensor to monitor knee peak sagittal angles with small margins of error and in agreement with the gold standard system. The sensor has potential to be used in clinical settings as a discreet, unobtrusive wearable device allowing for long-term gait analysis.
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Journal articleRiviere C, Iranpoura F, Harris S, et al., 2018,
Differences in trochlear parameters between native and prosthetic kinematically or mechanically aligned knees
, Revue de Chirurgie Orthopedique et Traumatologique, Vol: 104, Pages: 124-130, ISSN: 1877-0517 -
Journal articleRiviere C, Iranpour F, Harris S, et al., 2018,
Differences in trochlear parameters between native and prosthetic kinematically or mechanically aligned knees
, ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, Vol: 104, Pages: 165-170, ISSN: 1877-0568- Author Web Link
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- Citations: 65
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Journal articleKaria M, Masjedi M, Duffell L, et al., 2018,
Comparison of gait biomechanics in patients with and without knee osteoarthritis during different phases of gait
, Journal of Orthopaedics, Trauma and Rehabilitation, Vol: 25, Pages: 11-15, ISSN: 2210-4917Background: This study aimed to characterise knee adduction angles (KAA) and knee adduction moments (KAM) and compare this with foot centre of pressure (COP) in volunteers with and without knee osteoarthritis (OA). Methods: A total of 108 participants were recruited; 84 had no known pathology, 18 had medial knee OA, and six had lateral knee OA. Linear regression was used to determine correlations between the normalised COP, KAM, and KAA during each phase of gait for all participants. Results: The first phase of gait demonstrated significant differences between groups for all measures: KAA in all phases, COP in phases one and two, and KAM in phase one only. Conclusion: The largest mechanical changes are seen in the first phase of gait in osteoarthritic patients. Although COP is an easy to measure tool, it is not as sensitive as KAA and did not demonstrate a significant difference between healthy and medial OA patients.
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Journal articleRiviere C, Lazic S, Boughton OR, et al., 2018,
Current concepts for aligning knee implants: patient-specific or systematic?
, EFORT Open Reviews, Vol: 3, Pages: 1-6, ISSN: 2058-5241 -
Book chapterClarke S, Cobb J, Jaere M, et al., 2018,
Osteotomies: Advanced and complex techniques
, Esska Instructional Course Lecture Book Glasgow 2018, Pages: 129-151We started performing precise surgery based upon CT plans in the last century - the first embodiment of this approach was a robotic assistant built for total knee replacement, the “Acrobot” [1]. Abundant evidence now exists to confirm that assistive technologies enable surgeons to achieve their preoperative goals [2]. The concept of planned surgery is therefore not novel. Patient-matched instruments share several key elements with the robotic platform, and these formed the basis of this current project. The essential elements include image segmentation, planning, and registration. We applied the know-how of these dimensions to design and build patient-matched guides for a range of tasks using biocompatible polymer 3D printers. Having established a workflow for arthroplasty, the adaptation of the same principles to osteotomy was a short step, requiring software to be developed to deliver semiautomated useful information regarding limb segment alignment and the shapes of bones.
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Conference paperGreen A, Salman M, Yentis S, et al., 2018,
Staff perceptions of activity on labour ward
, Winter Scientific Meeting (WSM) of the Association-of-Anaesthetists-of-Great-Britain-and-Ireland (AAGBI), Publisher: WILEY, Pages: 73-73, ISSN: 0003-2409 -
Conference paperMa S, Hansen U, Cobb J, et al., 2017,
Long-term effects of bisphosphonate therapy: perforations, microcracks and mechanical properties.
, Annual Meeting of the American-Society-for-Bone-and-Mineral-Research (ASBMR), Publisher: WILEY, Pages: S106-S107, ISSN: 0884-0431 -
Journal articleRivière C, Iranpour F, Auvinet E, et al., 2017,
Mechanical alignment technique for TKA: Are there intrinsic technical limitations?
, Revue de Chirurgie Orthopedique et Traumatologique, Vol: 103, Pages: 762-772, ISSN: 1877-0517 -
Journal articleRivière C, Iranpour F, Harris S, et al., 2017,
The kinematic alignment technique for TKA reliably aligns the femoral component with the cylindrical axis
, Revue de Chirurgie Orthopedique et Traumatologique, Vol: 103, Pages: 773-777, ISSN: 1877-0517 -
Journal articleRiviere C, Iranpour F, Harris S, et al., 2017,
The kinematic alignment technique for TKA reliably aligns the femoral component with the cylindrical axis
, ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, Vol: 103, Pages: 1069-1073, ISSN: 1877-0568- Author Web Link
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- Citations: 38
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Journal articleRiviere C, Iranpour F, Auvinet E, et al., 2017,
Alignment options for total knee arthroplasty: A systematic review
, ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, Vol: 103, Pages: 1047-1056, ISSN: 1877-0568- Author Web Link
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- Citations: 293
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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 articleGupte CM, 2017,
Knee Arthroscopy SimulationA Randomized Controlled Trial Evaluating the Effectiveness of the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool
, Journal of Bone and Joint Surgery, American Volume, ISSN: 0021-9355 -
Journal articlePapi E, Koh WS, McGregor AH, 2017,
Wearable technology for spine movement assessment: A systematic review
, Journal of Biomechanics, Vol: 64, Pages: 186-197, ISSN: 0021-9290Continuous monitoring of spine movement function could enhance our understanding of low back pain development. Wearable technologies have gained popularity as promising alternative to laboratory systems in allowing ambulatory movement analysis. This paper aims to review the state of art of current use of wearable technology to assess spine kinematics and kinetics.Four electronic databases and reference lists of relevant articles were searched to find studies employing wearable technologies to assess the spine in adults performing dynamic movements. Two reviewers independently identified relevant papers. Customised data extraction and quality appraisal form were developed to extrapolate key details and identify risk of biases of each study. Twenty-two articles were retrieved that met the inclusion criteria: 12 were deemed of medium quality (score 33.4-66.7%), and 10 of high quality (score> 66.8%). The majority of articles (19/22) reported validation type studies. Only 6 reported data collection in real-life environments. Multiple sensors type were used: electrogoniometers (3/22), strain gauges based sensors (3/22), textile piezoresistive sensor (1/22) and accelerometers often used with gyroscopes and magnetometers (15/22). Two sensors units were mainly used and placing was commonly reported on the spine lumbar and sacral regions. The sensors were often wired to data transmitter/logger resulting in cumbersome systems. Outcomes were mostly reported relative to the lumbar segment and in the sagittal plane, including angles, range of motion, angular velocity, joint moments and forces.This review demonstrates the applicability of wearable technology to assess the spine, although this technique is still at an early stage of development.
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