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Journal articleKotti M, Duffell LD, Faisal AA, et al., 2017,
Detecting knee osteoarthritis and its discriminating parameters using random forests
, Medical Engineering and Physics, Vol: 43, Pages: 19-29, ISSN: 1350-4533This papertackles the problem of automatic detection of knee osteoarthritis. A computer system is built that takes as input the body kinetics and produces as output not only an estimation of presence of the knee osteoarthritis,as previouslydone inthe literature, but alsothe most discriminating parameters along with a set of rules on how this decision was reached.This fills the gap of interpretability between the medical and the engineering approaches. We collected locomotion data from 47 subjects with knee osteoarthritis and 47 healthy subjects.Osteoarthritis subjects were recruited from hospital clinics and GP surgeries, and age and sex matched heathy subjects from the local community. Subjects walked on a walkway equippedwith two force plates with piezoelectric 3-component force sensors. Parameters of the vertical, anterior-posterior, and medio-lateral ground reaction forces, such asmean value, push-off time, and slope,were extracted. Then random forest regressors map thoseparameters via rule induction to the degree of knee osteoarthritis.To boost generalisation ability,a subject-independent protocol is employed.The 5-fold cross-validated accuracy is 72.61%±4.24%. We show that with 3 steps or lessa reliable clinical measure can be extractedin a rule-based approachwhen the dataset is analysed appropriately.
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Journal articleLogishetty K, 2017,
Adopting and sustaining a Virtual Fracture Clinic model in the District Hospital setting – a quality improvement approach
, BMJ Quality Improvement Reports, Vol: 6, ISSN: 2050-1315Virtual Fracture Clinics (VFCs) are an alternative to the conventional fracture clinics, to manage certain musculoskeletal injuries. This has recently been reported as a safe, cost-effective and efficient care model. As demonstrated at vanguard sites in the United Kingdom, VFCs can enhance patient care by standardising treatment and reducing outpatient appointments.This project demonstrates how a Quality Improvement approach was applied to introduce VFCs in the District General Hospital setting. We demonstrate how undertaking Process Mapping, Driver Diagrams, and Stakeholder Analysis can assist implementation. We discuss Whole Systems Measures applicable to VFCs, to consider how robust and specific data collection can progress this care model.Three Plan-Do-Study-Act cycles led to a change in practice over a 21-month period. Our target for uptake of new patients seen in VFCs within 6 months of starting was set at 50%. It increased from 0% to 56.1% soon after introduction, and plateaued at an average of 56.4% in the six-months before the end of the study period.Careful planning, frequent monitoring, and gathering feedback from a multidisciplinary team of varying seniority, were the important factors in transitioning to, and sustaining, a successful VFC model.
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Conference paperBoughton OR, Zhao S, Arnold M, et al., 2017,
Measuring bone stiffness using microindentation
, British Orthopaedic Research Society (BORS) 2016 Conference, Publisher: British Editorial Society of Bone and Joint Surgery, Pages: 31-31, ISSN: 2049-4416 -
Journal articleGreen A, Salman M, Yentis S, et al., 2017,
Ergonomics and posture of midwives, obstetricians and anaesthetists on labour ward
, Anaesthesia, Vol: 72, Pages: 82-82, ISSN: 0003-2409Awkward body postures and the progressive accumulation of muscle fatigue are known risk factors for the development of injury, with most work-related musculoskeletal disorders developing over time [1]. Work-related disorders can develop while carrying out normal physical work activities and are associated with fixed or constrained body positions and continual repetition of movements [1]. Heavy workloads on the maternity unit often require staff to perform physically demanding activities under pressure and adopt suboptimal postures. Simple ergonomic intervention such as providing suitable adjustable seating and the appropriate layout of equipment can reduce injuries, reduce sickness absence and improve productivity [2].
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Journal articleGreen A, Salman M, Yentis S, et al., 2017,
Musculoskeletal aches and pains reported by labour ward staff
, Anaesthesia, Vol: 72, Pages: 82-82, ISSN: 0003-2409Awkward body postures and the progressive accumulation of muscle fatigue are known risk factors for the development of injury, with most work-related musculoskeletal disorders developing over time [1]. Work-related disorders can develop while carrying out normal physical work activities and are associated with fixed or constrained body positions and continual repetition of movements [1]. Heavy workloads on the maternity unit often require staff to perform physically demanding activities under pressure and adopt suboptimal postures. Simple ergonomic intervention such as providing suitable adjustable seating and the appropriate layout of equipment can reduce injuries, reduce sickness absence and improve productivity [2].
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Journal articleNazruzov T, Van Der Straeten C, Iranpour Boroujeni F, et al.,
REGISTRATION OF PRE- AND POST-OPERATIVE CT DATA USING ICP FOR PATIENTS UNDERGOING TOTAL KNEE ARTHROPLASTY (TKA)
, Bone & Joint Journal, ISSN: 2049-4394 -
Conference paperMa S, Goh EL, Patel B, et al., 2016,
Are the cracks starting to appear in bisphosphonate therapy?
, British Orthopaedic Research Society (BORS) 2016 Conference, Publisher: British Editorial Society of Bone and Joint Surgery, Pages: 53-53, ISSN: 2049-4416 -
Journal articleLord BR, El-Daou H, Sabnis BM, et al., 2016,
Erratum to: Biomechanical comparison of graft structures in anterior cruciate ligament reconstruction (vol 25, pg 559, 2017)
, Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 25, Pages: 988-988, ISSN: 0942-2056Purpose: Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction may offer kinematic restoration superior to anatomic single bundle (SB), but it remains technically challenging. The femoral attachment site has the most effect on ACL graft isometry, so a simplified three-socket (3S) construct which still uses two sockets to cover the femoral ACL attachment is attractive. It was hypothesised that ACL reconstruction using three- and four-socket techniques would more closely restore native knee kinematics compared to anatomic two-socket (SB) surgery.Methods: Nine cadaveric knees were used to evaluate the kinematics of ACL-intact, ACL-deficient, anatomic SB, three-socket, and DB arthroscopic ACL reconstructions. Suspensory fixation was used, and grafts were tensioned to match the anterior draw of the intact knee at 20°. A six-degree-of-freedom robotic system measured knee laxity under 90 N anterior tibial force and rotational laxity under 5 N-m torque. Combined moments were applied to simulate the pivot-shift subluxation: 4 N-m internal rotation and 8 N-m valgus.Results: Significant differences between reconstructions were not found during anterior tibial loading, apart from SB being more lax than DB at 60° flexion. All reconstructions produced comparable laxity to the intact state, apart from SB at 60°. Significant differences between reconstructions were not found at any flexion angle during tibial internal/external applied torques. Under combined loading, DB produced significantly less laxity than SB constructs apart from anterior tibial translation at 0° and internal rotation at 45°. 3S and DB were comparable to the native knee throughout.Conclusion: Although 3S restored laxities to a similar extent to DB, significant superiority over SB surgery was not observed. Although statistically significant differences were found between SB and DB surgery during anterior tibial and simulated pivot-shift loading, both remained similar to the nativ
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Journal articleSabharwal S, Patel NK, Griffiths D, et al., 2016,
Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus
, Bone & Joint Research, Vol: 5, Pages: 470-480, ISSN: 2046-3758Objectives The objective of this study was to perform a meta-analysis of all randomised controlled trials (RCTs) comparing surgical and non-surgical management of fractures of the proximal humerus, and to determine whether further analyses based on complexity of fracture, or the type of surgical intervention, produced disparate findings on patient outcomes.Methods A systematic review of the literature was performed identifying all RCTs that compared surgical and non-surgical management of fractures of the proximal humerus. Meta-analysis of clinical outcomes was performed where possible. Subgroup analysis based on the type of fracture, and a sensitivity analysis based on the type of surgical intervention, were also performed.Results Seven studies including 528 patients were included. The overall meta-analysis found that there was no difference in clinical outcomes. However, subgroup and sensitivity analyses found improved patient outcomes for more complex fractures managed surgically. Four-part fractures that underwent surgery had improved long-term health utility scores (mean difference, MD 95% CI 0.04 to 0.28; p = 0.007). They were also less likely to result in osteoarthritis, osteonecrosis and non/malunion (OR 7.38, 95% CI 1.97 to 27.60; p = 0.003). Another significant subgroup finding was that secondary surgery was more common for patients that underwent internal fixation compared with conservative management within the studies with predominantly three-part fractures (OR 0.15, 95% CI 0.04 to 0.63; p = 0.009).Conclusion This meta-analysis has demonstrated that differences in the type of fracture and surgical treatment result in outcomes that are distinct from those generated from analysis of all types of fracture and surgical treatments grouped together. This has important implications for clinical decision making and should highlight the need for future trials to adopt more specific inclusion criteria.
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Journal articleFanous R, Sabharwal S, Altaie A, et al., 2016,
Hip fracture litigation: A 10-year review of NHS Litigation Authority data and the effect of national guidelines.
, Annals of the Royal College of Surgeons of England, ISSN: 1478-7083We present a review evaluating all litigation claims relating to hip fractures made in a 10-year period between 2005 and 2015. Data was obtained from the NHS Litigation Authority through a freedom of information request. All claims relating to hip fractures were reviewed. During the period analysed, 216 claims were made, of which 148 were successful (69%). The total cost of settling these claims was in excess of £5 million. The introduction of a best-practice tariff by the Department of Health in 2010 was designed to improve the quality of care for hip fracture patients. This was followed by guidance from the National Institute for Health and Clinical Excellence in 2011 and the British Orthopaedic Association in 2012. We analysed claims submitted before and after these guidelines were introduced and no significant difference in the number of claims was noted. The most common cause for litigation was a delay in diagnosis, which accounted for 86 claims in total (40%). Despite the presence of these guidelines and targets, there has not been a significant reduction in the number of claims or an improvement in diagnostic accuracy. This may be due to an increasing level of litigation in the UK but we must also question whether we are indeed providing best-practice care to our hip fracture patients and whether these guidelines need further review.
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Journal articleLord BR, El-Daou H, Sabnis BM, et al., 2016,
Biomechanical comparison of graft structures in anterior cruciate ligament reconstruction
, Knee Surgery Sports Traumatology Arthroscopy, Vol: 25, Pages: 559-568, ISSN: 1433-7347PURPOSE: Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction may offer kinematic restoration superior to anatomic single bundle (SB), but it remains technically challenging. The femoral attachment site has the most effect on ACL graft isometry, so a simplified three-socket (3S) construct which still uses two sockets to cover the femoral ACL attachment is attractive. It was hypothesised that ACL reconstruction using three- and four-socket techniques would more closely restore native knee kinematics compared to anatomic two-socket (SB) surgery. METHODS: Nine cadaveric knees were used to evaluate the kinematics of ACL-intact, ACL-deficient, anatomic SB, three-socket, and DB arthroscopic ACL reconstructions. Suspensory fixation was used, and grafts were tensioned to match the anterior draw of the intact knee at 20°. A six-degree-of-freedom robotic system measured knee laxity under 90 N anterior tibial force and rotational laxity under 5 N-m torque. Combined moments were applied to simulate the pivot-shift subluxation: 4 N-m internal rotation and 8 N-m valgus. RESULTS: Significant differences between reconstructions were not found during anterior tibial loading, apart from SB being more lax than DB at 60° flexion. All reconstructions produced comparable laxity to the intact state, apart from SB at 60°. Significant differences between reconstructions were not found at any flexion angle during tibial internal/external applied torques. Under combined loading, DB produced significantly less laxity than SB constructs apart from anterior tibial translation at 0° and internal rotation at 45°. 3S and DB were comparable to the native knee throughout. CONCLUSION: Although 3S restored laxities to a similar extent to DB, significant superiority over SB surgery was not observed. Although statistically significant differences were found between SB and DB surgery during anterior tibial and simulated pivot-shift loading, both remain
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Journal articleDeane JA, Mcgregor A, 2016,
Current and Future Perspectives on Lumbar Degenerative Disc Disease: a UK survey exploring specialist multidisciplinary clinical opinion.
, BMJ Open, Vol: 6, ISSN: 2044-6055Objectives: Despite lumbar degenerative disc disease (LDDD) being significantly associatedwith non-specific low back pain and effective treatment remaining elusive, specialistmultidisciplinary clinical stakeholder opinion remains unexplored. The present studyexamines the views of such experts.Design: A reliable and valid electronic survey was designed to establish trends usingtheoretical constructs relating to current assessment and management practices. Cliniciansfrom the Society of Back Pain Research (SBPR) U.K. were invited to take part. Quantitativedata was collated and coded using Bristol On-line Surveys (BOS) software, and contentanalysis used to systematically code and categorise qualitative data.Setting: Specialist multidisciplinary spinal interest group in the U.K.Participants: 38/141 clinically active, multidisciplinary SBPR members with specialistspinal interest participated. 84% had greater than 9 years postgraduate clinical experience.Interventions: NoneOutcome Measures: Frequency distributions were used to establish general trends inquantitative data. Qualitative responses were coded and categorised in relation to each themeand percentage responses calculated.Results: LDDD symptom recurrence, in the absence of psychosocial influence, wasassociated with physical signs of joint stiffness (26%), weakness (17%), joint hypermobility(6%), while physical factors (21%) and the ability to adapt (11%) were postulated as reasonswhy some experience pain and others do not. No one management strategy was supportedexclusively or with consensus. Regarding effective modalities, there was no significantdifference between AHP and Medic responses (p= 0.1-0.9). The future of LDDD care wasexpressed in terms of improvements in patient communication (35%), patient education(38%) and treatment stratification (24%).
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Journal articleMa S, Boughton O, Karunaratne A, et al., 2016,
Synchrotron imaging assessment of bone quality
, Clinical Reviews in Bone and Mineral Metabolism, Vol: 14, Pages: 150-160, ISSN: 1559-0119Bone is a complex hierarchical structure and its principal function is to resist mechanical forces and fracture. Bone strength depends not only on the quantity of bone tissue but also on the shape and hierarchical structure. The hierarchical levels are interrelated, especially the micro-architecture, collagen and mineral components; hence analysis of their speciļ¬c roles in bone strength and stiffness is difficult. Synchrotron imaging technologies including micro-CT and small/wide angle X-Ray scattering/diffraction are becoming increasingly popular for studying bone because the images can resolve deformations in the micro-architecture and collagen-mineral matrix under in situ mechanical loading. Synchrotron cannot be directly applied in-vivo due to the high radiation dose but will allow researchers to carry out systematic multifaceted studies of bone ex-vivo. Identifying characteristics of aging and disease will underpin future efforts to generate novel devices and interventional therapies for assessing and promoting healthy aging. With our own research work as examples, this paper introduces how synchrotron imaging technology can be used with in-situ testing in bone research.
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Book chapterMcGregor AH, 2016,
Sports innovation in the journey towards rowing gold: Enhancement of performance and well being
, Sports Innovation Technology and Research, Pages: 31-38 -
Journal articleNahas S, Ieong E, Logishetty K, et al., 2016,
The Use of Personalized Video Training for Orthopaedic Surgeons
, MUSCULOSKELETAL CARE, Vol: 14, Pages: 180-184, ISSN: 1478-2189- Author Web Link
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Journal articleGrice JE, Willmott H, Halewood C, et al., 2016,
A Biomechanical Comparison of First Metatarsophalangeal Arthrodesis Using Crossed Screws and Shape-Memory Staples in Various Configurations
, Foot & Ankle Orthopaedics, Vol: 1, ISSN: 2473-0114<jats:sec><jats:title>Category:</jats:title><jats:p> Midfoot/Forefoot </jats:p></jats:sec><jats:sec><jats:title>Introduction/Purpose:</jats:title><jats:p> Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a commonly performed procedure for the treatment of hallux rigidus. A range of fixation methods have been used. Most recently, the shape-memory staple has been described. Made from an equiatomic alloy, the staple changes its shape when heated to body temperature so as to provide compression across the arthrodesis. We aimed to determine load to failure, cyclic loading and failure characteristics of different staple configurations compared to crossed screws. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A cadaveric porcine model was used to simulate first MTPJ arthrodesis. Five forms of fixation were tested: single vertical staple; single horizontal staple; paired staples in orthogonal superior-inferior and medial-lateral configuration (0-90° to sagittal plane); paired staples in an oblique orthogonal configuration (45-135° to sagittal plane); two crossed screws. Using a materials-testing machine, specimens were loaded in dorsiflexion to simulate weight bearing. Cyclical loading was performed from 5-40N at a rate of 0.5 Hz for 1000 cycles. Plantar gapping, shear and creep were measured. Specimens were then loaded to failure in order to generate a load-displacement curve. The mechanism of failure was noted for each group. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Single staple configurations failed at very low loads. Single vertical staples failed at a mean load 15N±5N and single horizontal staples at 19N±3N. Mean failure load for paired 0-90° staples was 43N±9N which was significantly lower than the paired 45-135° staples which failed
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Conference paperBates AV, Mcgregor AH, Alexander C, 2016,
Comparison of prolonged unconstrained standing behaviour in people with Joint Hypermobility Syndrome and people who have normal flexibility
, ESMAC, Publisher: Elsevier, ISSN: 1879-2219 -
Journal articleBuckeridge EM, Weinert-Aplin RA, Bull AM, et al., 2016,
Influence of foot-stretcher height on rowing technique and performance
, Sports Biomechanics, Vol: 15, ISSN: 1752-6116Strength, technique, and coordination are crucial to rowing performance, but external interventions such as foot-stretcher set-up can fine-tune technique and optimise power output. For the same resultant force, raising the height of foot-stretchers on a rowing ergometer theoretically alters the orientation of the resultant force vector in favour of the horizontal component. This study modified foot-stretcher heights and examined their instantaneous effect on foot forces and rowing technique. Ten male participants rowed at four foot-stretcher heights on an ergometer that measured handle force, stroke length, and vertical and horizontal foot forces. Rowers were instrumented with motion sensors to measure ankle, knee, hip, and lumbar–pelvic kinematics. Key resultant effects of increased foot-stretcher heights included progressive reductions in horizontal foot force, stroke length, and pelvis range of motion. Raising foot-stretcher height did not increase the horizontal component of foot force as previously speculated. The reduced ability to anteriorly rotate the pelvis at the front of the stroke may be a key obstacle in gaining benefits from raised foot-stretcher heights. This study shows that small changes in athlete set-up can influence ergometer rowing technique, and rowers must individually fine-tune their foot-stretcher height to optimise power transfer through the rowing stroke on an ergometer.
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Conference paperJin A, Cobb JP, Hansen U, et al., 2016,
ARE THE CRACKS STARTING TO APPEAR IN BISPHOSPHONATE TREATMENT FOR OSTEOPOROSIS?
, WCO-IOF-ESCEO World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, Publisher: Springer Verlag (Germany), Pages: S490-S490, ISSN: 1433-2965 -
Conference paperGeraldes D, Hansen U, Jeffers J, et al., 2016,
Interference fit optimisation for small press-fitted pegs
, International Society for Technology in Arthroplasty 2015, Publisher: BRITISH EDITORIAL SOCIETY OF BONE & JOINT SURGERY, Pages: 150-150, ISSN: 2049-4416
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