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Journal articleAkhtar K, Sugand K, Sperrin M, et al., 2015,
Training safer orthopedic surgeons Construct validation of a virtual-reality simulator for hip fracture surgery
, ACTA ORTHOPAEDICA, Vol: 86, Pages: 616-621, ISSN: 1745-3674Background and purpose — Virtual-reality (VR) simulation inorthopedic training is still in its infancy, and much of the work hasbeen focused on arthroscopy. We evaluated the construct validityof a new VR trauma simulator for performing dynamic hip screw(DHS) fixation of a trochanteric femoral fracture.Patients and methods — 30 volunteers were divided into 3groups according to the number of postgraduate (PG) years andthe amount of clinical experience: novice (1–4 PG years; less than10 DHS procedures); intermediate (5–12 PG years; 10–100 procedures);expert (> 12 PG years; > 100 procedures). Each participantperformed a DHS procedure and objective performancemetrics were recorded. These data were analyzed with each performancemetric taken as the dependent variable in 3 regressionmodels.Results — There were statistically significant differences inperformance between groups for (1) number of attempts at guidewireinsertion, (2) total fluoroscopy time, (3) tip-apex distance,(4) probability of screw cutout, and (5) overall simulator score.The intermediate group performed the procedure most quickly,with the lowest fluoroscopy time, the lowest tip-apex distance,the lowest probability of cutout, and the highest simulator score,which correlated with their frequency of exposure to running thetrauma lists for hip fracture surgery.Interpretation — This study demonstrates the construct validityof a haptic VR trauma simulator with surgeons undertakingthe procedure most frequently performing best on the simulator.VR simulation may be a means of addressing restrictionson working hours and allows trainees to practice technical taskswithout putting patients at risk. The VR DHS simulator evaluatedin this study may provide valid assessment of technical skill.
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Journal articleAqil A, Sheikh HQ, Masjedi M, et al., 2015,
Birmingham Mid-Head Resection Periprosthetic Fracture.
, Clin Orthop Surg, Vol: 7, Pages: 402-405Total hip arthroplasty in the young leads to difficult choices in implant selection. Until recently bone conserving options were not available for younger patients with deficient femoral head bone stock. The novel Birmingham Mid-Head Resection (BMHR) device offers the option of bone conserving arthroplasty in spite of deficient femoral head bone stock. Femoral neck fracture is a known complication of standard resurfacing arthroplasty and is the most common reason for revision. It is unknown whether this remains to be the case for the BMHR neck preserving implants. We report a case of a 57-year-old male, who sustained a periprosthetic fracture following surgery with a BMHR arthroplasty. This paper illustrates the first reported case of a BMHR periprosthetic fracture. The fracture pattern is spiral in nature and reaches to the subtrochanteric area. This fracture pattern is different from published cadaveric studies, and clinicians using this implant should be aware of this as revision is likely to require a distally fitting, rather than a metaphyseal fitting stem. We have illustrated the surgical technique to manage this rare complication.
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Journal articleChen A, Patel NK, Khan Y, et al., 2015,
The cost of adverse events from knee surgery in the United Kingdom: An in-depth review of the National Health Service Litigation Authority database
, KNEE, Vol: 22, Pages: 286-291, ISSN: 0968-0160- Author Web Link
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- Citations: 13
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Journal articleCole JM, Wood J, Lopes NC, et al., 2015,
Laser-wakefield accelerators as hard x-ray sources for 3D medical imaging of human bone
, Scientific Reports, Vol: 5, ISSN: 2045-2322A bright μm-sized source of hard synchrotron x-rays (critical energy Ecrit > 30 keV) based on the betatron oscillations of laser wakefield accelerated electrons has been developed. The potential of this source for medical imaging was demonstrated by performing micro-computed tomography of a human femoral trabecular bone sample, allowing full 3D reconstruction to a resolution below 50 μm. The use of a 1 cm long wakefield accelerator means that the length of the beamline (excluding the laser) is dominated by the x-ray imaging distances rather than the electron acceleration distances. The source possesses high peak brightness, which allows each image to be recorded with a single exposure and reduces the time required for a full tomographic scan. These properties make this an interesting laboratory source for many tomographic imaging applications.
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Journal articleHolme TJ, Henckel J, Hartshorn K, et al., 2015,
Computed tomography scanogram compared to long leg radiograph for determining axial knee alignment
, ACTA ORTHOPAEDICA, Vol: 86, Pages: 440-443, ISSN: 1745-3674- Author Web Link
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- Citations: 44
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Journal articleDavda K, Smyth N, Cobb JP, et al., 2015,
2D measurements of cup orientation are less reliable than 3D measurements A retrospective study of 87 metal-on-metal hips
, ACTA ORTHOPAEDICA, Vol: 86, Pages: 485-490, ISSN: 1745-3674- Author Web Link
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- Citations: 10
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Journal articleTuncer M, Patel R, Cobb JP, et al., 2015,
Variable bone mineral density reductions post-unicompartmental knee arthroplasty
, KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol: 23, Pages: 2230-2236, ISSN: 0942-2056- Author Web Link
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- Citations: 8
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Conference paperBrevadt MJ, manning VL, wiik A, et al., 2015,
THE IMPACT OF STEM LENGTH ON FUNCTION FOLLOWING HIP ARTHROPLASTY: ARE LONG STEMS STILL REQUIRED?
, International Society for Technology in Arthroplasty -
Journal articleBabu S, Al-Obaidi B, Abdul-Jabar HB, et al., 2015,
CASE REVIEW Knee injury in a 12 year old girl
, BMJ-BRITISH MEDICAL JOURNAL, Vol: 351, ISSN: 0959-535X- Author Web Link
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- Citations: 1
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Journal articleBuckeridge EM, Bull AMJ, McGregor AH, 2015,
Incremental training intensities increases loads on the lower back of elite female rowers
, Journal of Sports Sciences, ISSN: 0264-0414Lumbar-pelvic kinematics change in response to increasing rowing stroke rates, but little is known about the effect of incremental stroke rates on changes in joint kinetics and their implications for injury. The purpose of this study was to quantify the effects of incremental rowing intensities on lower limb and lumbar-pelvic kinetics. Twelve female rowers performed an incremental test on a rowing ergometer. Kinematic data of rowers’ ankle, knee, hip and lumbar-pelvic joints, as well as external forces at the handle, seat and foot-stretchers of the rowing machine were recorded. Inter-segmental moments and forces were calculated using inverse dynamics and were compared across stroke rates using repeated measures ANOVA. Rowers exhibited increases in peak ankle and L5/S1 extensor moments, reductions in peak knee moments and no change in peak hip moments, with respect to stroke rate. Large shear and compressive forces were seen at L5/S1 and increased with stroke rate (P < 0.05). This coincided with increased levels of lumbar-pelvic flexion. High levels of lumbar-pelvic loading at higher stroke rates have implications with respect to injury and indicated that technique was declining, leading to increased lumbar-pelvic flexion. Such changes are not advantageous to performance and can potentially increase the risk of developing injuries.
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Journal articlePincus T, Anwar S, McCracken LM, et al., 2015,
Delivering an Optimised Behavioural Intervention (OBI) to people with low back pain with high psychological risk; results and lessons learnt from a feasibility randomised controlled trial of Contextual Cognitive Behavioural Therapy (CCBT) vs. Physiotherapy
, BMC Musculoskeletal Disorders, Vol: 16, ISSN: 1471-2474BackgroundLow Back Pain (LBP) remains a common and costly problem. Psychological obstacles to recovery have been identified, but psychological and behavioural interventions have produced only moderate improvements. Reviews of trials have suggested that the interventions lack clear theoretical basis, are often compromised by low dose, lack of fidelity, and delivery by non-experts. In addition, interventions do not directly target known risk mechanisms. We identified a theory driven intervention (Contexual Cognitive Behavioural Therapy, CCBT) that directly targets an evidence-based risk mechanism (avoidance and ensured dose and delivery were optimised. This feasibility study was designed to test the credibility and acceptability of optimised CCBT against physiotherapy for avoidant LBP patients, and to test recruitment, delivery of the intervention and response rates prior to moving to a full definitive trial.MethodsA randomised controlled feasibility trial with patients randomised to receive CCBT or physiotherapy. CCBT was delivered by trained supervised psychologists on a one to one basis and comprised up to 8 one-hour sessions. Physiotherapy comprised back to fitness group exercises with at least 60 % of content exercise-based. Patients were eligible to take part if they had back pain for more than 3 months, and scored above a threshold indicating fear avoidance, catastrophic beliefs and distress.Results89 patients were recruited. Uptake rates were above those predicted. Scores for credibility and acceptability of the interventions met the set criteria. Response rates at three and six months fell short of the 75 % target. Problems associated with poor response rates were identified and successfully resolved, rates increased to 77 % at 3 months, and 68 % at 6 months. Independent ratings of treatment sessions indicated that CCBT was delivered to fidelity. Numbers were too small for formal analysis. Although average scores for acceptance were higher in the CCBT group t
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Journal articleHalewood C, Traynor A, Bellemans J, et al., 2015,
Anteroposterior Laxity After Bicruciate-Retaining Total Knee Arthroplasty Is Closer to the Native Knee Than ACL-Resecting TKA: A Biomechanical Cadaver Study.
, Journal of Arthroplasty, ISSN: 1532-8406The purpose of this study was to examine whether a bicruciate retaining (BCR) TKA would yield anteroposterior (AP) laxity closer to the native knee than a posterior cruciate ligament retaining (CR) TKA. A BCR TKA was designed and compared to CR TKA and the native knee using cadaver specimens. AP laxity with the CR TKA was greater than the native knee (P=0.006) and BCR TKA (P=0.039), but no difference was found between the BCR TKA and the native knee. No significant differences were found in rotations between the prostheses and the native knee. BCR TKA was shown to be surgically feasible, reduced AP laxity versus CR TKA, and may improve knee stability without using conforming geometry in the implant design.
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Journal articlePapi E, Spulber I, Kotti M, et al., 2015,
Smart sensing system for combined activity classification and estimation of knee range of motion
, IEEE Sensors Journal, Vol: 15, Pages: 5535-5544, ISSN: 1558-1748 -
Journal articleBerwin JT, Burton TMW, Taylor J, et al., 2015,
Plantar Loading Forces While Walking in a Below-Knee Cast With an Attached Loadbearing Frame
, Foot & Ankle International, Vol: 36, Pages: 722-729, ISSN: 1944-7876Background: We measured loading forces across different points of the plantar foot surface to examine how different types of casts affect load distribution through the foot and ankle. The patella tendon-bearing (PTB) or Sarmiento cast is the current “gold-standard” casting method for offloading force through the foot and ankle. We aimed to determine if a rocker bottom frame attached to a below-knee cast (Beagle Böhler Walker) would be as effective or better at reducing load distribution during full weightbearing.Method: We applied TekScan FlexiForce A201 force sensors to the first and fifth metatarsal heads and the plantar surface of the calcaneus of 14 healthy volunteers. All volunteers had force measurements taken without a cast applied and then with a traditional Sarmiento cast, a standard below-knee cast, and a below-knee cast with the Böhler Walker frame fitted.Results: Compared with a standard below-knee cast, the Böhler Walker frame reduced the mean peak force through the head of the first metatarsal by 58.9% (P < .0001), 73.1% through the head of the fifth metatarsal (P < .0001), and 32.2% (P < .0001) through the calcaneus. The Sarmiento cast demonstrated a mean percentage reduction in peak force of 8.6% (P = .39) and 4.4% (P = .87) through the first and fifth metatarsal heads, respectively, but increased the mean peak force by 5.9% (P = .54) through the calcaneus.Conclusion: Using a Böhler Walker frame applied to a below-knee cast significantly reduced weight transfer through the foot compared with a Sarmiento cast or standard below-knee cast.Clinical Relevance: This reduction in force through the foot could mean early weightbearing would be safer in patients with a wide variety of foot and ankle pathologies such as ankle fractures or operative fixations. This may reduce the incidence of immobility-dependent morbidity.
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Journal articleGreenwood J, McGregor A, Jones F, et al., 2015,
Evaluating rehabilitation following lumbar fusion surgery (REFS): study protocol for a randomised controlled trial
, Trials, Vol: 16, ISSN: 1745-6215 -
Journal articleWeinert-Aplin RA, Bull AMJ, McGregor AH, 2015,
Investigating the Effects of Knee Flexion during the Eccentric Heel-Drop Exercise
, Journal of Sports Science and Medicine, Vol: 14, Pages: 459-465, ISSN: 1303-2968This study aimed to characterise the biomechanics of the widelypracticed eccentric heel-drop exercises used in the managementof Achilles tendinosis. Specifically, the aim was to quantifychanges in lower limb kinematics, muscle lengths and Achillestendon force, when performing the exercise with a flexed kneeinstead of an extended knee. A musculoskeletal modelling approachwas used to quantify any differences between theseversions of the eccentric heel drop exercises used to treat Achillestendinosis. 19 healthy volunteers provided a group fromwhich optical motion, forceplate and plantar pressure data wererecorded while performing both the extended and flexed kneeeccentric heel-drop exercises over a wooden step when barefootor wearing running shoes. This data was used as inputs into ascaled musculoskeletal model of the lower limb. Range of anklemotion was unaffected by knee flexion. However, knee flexionwas found to significantly affect lower limb kinematics, intersegmentalloads and triceps muscle lengths. Peak Achilles loadwas not influenced despite significantly reduced peak ankleplantarflexion moments (p < 0.001). The combination of reducedtriceps lengths and greater ankle dorsiflexion, coupledwith reduced ankle plantarflexion moments were used to providea basis for previously unexplained observations regardingthe effect of knee flexion on the relative loading of the tricepsmuscles during the eccentric heel drop exercises. This findingquestions the role of the flexed knee heel drop exercise whenspecifically treating Achilles tendinosis
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Journal articleSabharwal S, Carter A, Darzi LA, et al., 2015,
The methodological quality of health economic evaluations for the management of hip fractures: A systematic review of the literature
, SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, Vol: 13, Pages: 170-176, ISSN: 1479-666XBackground and objectivesApproximately 76,000 people a year sustain a hip fracture in the UK and the estimated cost to the NHS is £1.4 billion a year. Health economic evaluations (HEEs) are one of the methods employed by decision makers to deliver healthcare policy supported by clinical and economic evidence. The objective of this study was to (1) identify and characterize HEEs for the management of patients with hip fractures, and (2) examine their methodological quality.MethodsA literature search was performed in MEDLINE, EMBASE and the NHS Economic Evaluation Database. Studies that met the specified definition for a HEE and evaluated hip fracture management were included. Methodological quality was assessed using the Consensus on Health Economic Criteria (CHEC).ResultsTwenty-seven publications met the inclusion criteria of this study and were included in our descriptive and methodological analysis. Domains of methodology that performed poorly included use of an appropriate time horizon (66.7% of studies), incremental analysis of costs and outcomes (63%), future discounting (44.4%), sensitivity analysis (40.7%), declaration of conflicts of interest (37%) and discussion of ethical considerations (29.6%).ConclusionsHEEs for patients with hip fractures are increasing in publication in recent years. Most of these studies fail to adopt a societal perspective and key aspects of their methodology are poor. The development of future HEEs in this field must adhere to established principles of methodology, so that better quality research can be used to inform health policy on the management of patients with a hip fracture.
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Journal articleGhosh KM, Hunt N, Blain A, et al., 2015,
Isolated popliteus tendon injury does not lead to abnormal laxity in posterior-stabilised total knee arthroplasty
, KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol: 23, Pages: 1763-1769, ISSN: 0942-2056- Author Web Link
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- Citations: 15
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Journal articleGulati V, Jaggard M, Al-Nammari SS, et al., 2015,
Management of achilles tendon injury: A current concepts systematic review.
, World J Orthop, Vol: 6, Pages: 380-386, ISSN: 2218-5836Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmBase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined.
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Journal articleAcquaah F, Robson Brown KA, Ahmed F, et al., 2015,
Early trabecular development in human vertebrae: overproduction, constructive regression, and refinement
, Frontiers in Endocrinology, Vol: 6, ISSN: 1664-2392Early bone development may have a significant impact upon bone health in adulthood. Bone mineral density (BMD) and bone mass are important determinants of adult bone strength. However, several studies have shown that BMD and bone mass decrease after birth. If early development is important for strength, why does this reduction occur? To investigate this, more data characterizing gestational, infant, and childhood bone development are needed in order to compare with adults. The aim of this study is to document early vertebral trabecular bone development, a key fragility fracture site, and infer whether this period is important for adult bone mass and structure. A series of 120 vertebrae aged between 6 months gestation and 2.5 years were visualized using microcomputed tomography. Spherical volumes of interest were defined, thresholded, and measured using 3D bone analysis software (BoneJ, Quant3D). The findings showed that gestation was characterized by increasing bone volume fraction whilst infancy was defined by significant bone loss (≈2/3rds) and the appearance of a highly anisotropic trabecular structure with a predominantly inferior–superior direction. Childhood development progressed via selective thickening of some trabeculae and the loss of others; maintaining bone volume whilst creating a more anisotropic structure. Overall, the pattern of vertebral development is one of gestational overproduction followed by infant “sculpting” of bone tissue during the first year of life (perhaps in order to regulate mineral homeostasis or to adapt to loading environment) and then subsequent refinement during early childhood. Comparison of early bone developmental data in this study with adult bone volume values taken from the literature shows that the loss in bone mass that occurs during the first year of life is never fully recovered. Early development could therefore be important for developing bone strength, but through structural changes in trabec
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