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  • Conference paper
    Geraldes D, Hansen U, Jeffers J, Amis Aet 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
  • Journal article
    Masjedi M, Mandalia R, Aqil A, Cobb Jet al., 2016,

    Validation of the 'FeMorph' software in planning cam osteochondroplasty by incorporating labral morphology

    , COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING, Vol: 19, Pages: 67-73, ISSN: 1025-5842
  • Journal article
    Greenwood J, McGregor A, Jones F, Mullane J, Hurley Met al., 2016,

    Rehabilitation Following Lumbar Fusion Surgery: A Systematic Review and Meta-Analysis.

    , Spine, Vol: 41, Pages: E28-E36, ISSN: 0362-2436

    STUDY DESIGN: A systematic review with meta-analysis. OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis of current evidence evaluating the effectiveness of rehabilitation following lumbar fusion surgery (LFS). SUMMARY OF BACKGROUND DATA: LFS for the management of lower back pain, with(out) neurogenic leg pain, is increasing as the population ages. Clinical outcomes commonly lag behind surgical outcomes and 40% of patients experience significant back-related disability 12 months after LFS. Identifying rehabilitation strategies to improve function and quality of life following LFS is important. METHODS: A systematic review of databases were searched, including MEDLINE, CINAHL, and grey literature. Studies identified were screened for inclusion by title and abstract. Full text of eligible/potentially eligible studies was evaluated against predetermined eligibility criteria. Included studies were subjected to critical appraisal and risk of bias evaluation. The GRADE approach to quality of evidence was utilized. A meta-analysis comparing usual care with "complex rehabilitation," comprising exercise and cognitive behavioral therapy, for outcomes relating to pain, disability, fear of movement, and mental health was conducted at short and longer term (<3 and >12 months postsurgery) time points. RESULTS: Three studies were identified for the systematic review and 2 included in the meta-analysis (n = 237, female = 62%, mean age = 55). Low-quality evidence suggests that "complex rehabilitation" provides short-term improvement in disability [effect size, -0.85, 95% confidence interval (95% CI), -1.41 to -0.29] and fear avoidance behavior (-1.07, 95% CI -1.33, -0.80), compared with usual care. Low-quality evidence exists favoring "complex rehabilitation" over usual care for longer term disability (-0.84, 95% CI -1.11 to -0.58) and fear avoidance behavior (-1.40, 95% CI -1.69 to -1.12). CONCLUSIONS: A small n

  • Journal article
    Logishetty K, Jones GG, Cobb JP, 2016,

    Letter to the Editor: The John Insall Award: no functional benefit after unicompartmental knee arthroplasty performed with patient-specific instrumentation: a randomized trial

    , Clinical Orthopaedics and Related Research, Vol: 474, Pages: 272-273, ISSN: 1528-1132
  • Journal article
    Aframian A, Boughton OR, Auvinet E, Iranpour Boroujeni F, Harris S, Hing CB, Cobb JPet al., 2015,

    Patellofemoral pain is a symptom, not a diagnosis

    , British Medical Journal, Vol: 351, ISSN: 1468-5833
  • Journal article
    Sugand K, Akhtar K, Khatri C, Cobb J, Gupte Cet al., 2015,

    Training effect of a virtual reality haptics-enabled dynamic hip screw simulator.

    , Acta Orthopaedica, Vol: 86, Pages: 695-701, ISSN: 1745-3682

    Background and purpose - Virtual reality (VR) simulation offers a safe, controlled, and effective environment to complement training but requires extensive validation before it can be implemented within the curriculum. The main objective was to assess whether VR dynamic hip screw (DHS) simulation has a training effect to improve objective performance metrics. Patients and methods - 52 surgical trainees who were naïve to DHS procedures were randomized to 2 groups: the training group, which had 5 attempts, and the control group, which had only one attempt. After 1 week, both cohorts repeated the same number of attempts. Objective performance metrics included total procedural time (sec), fluoroscopy time (sec), number of radiographs (n), tip-apex distance (TAD; mm), attempts at guide-wire insertion (n), and probability of cut-out (%). Mean scores (with SD) and learning curves were calculated. Significance was set as p < 0.05. Results - The training group was 68% quicker than the control group, used 75% less fluoroscopy, took 66% fewer radiographs, had 82% less retries at guide-wire insertion, achieved a reduced TAD (by 41%), had lower probability of cut-out (by 85%), and obtained an increased global score (by 63%). All these results were statistically significant (p < 0.001). The participants agreed that the simulator provided a realistic learning environment, they stated that they had enjoyed using the simulator, and they recognized the need for the simulator in formal training. Interpretation - We found a significant training effect on the VR DHS simulator in improving objective performance metrics of naïve surgical trainees. Patient safety, an important priority, was not compromised.

  • Journal article
    Athwal KK, Daou HE, Kittl C, Davies AJ, Deehan DJ, Amis AAet al., 2015,

    The superficial medial collateral ligament is the primary medial restraint to knee laxity after cruciate-retaining or posterior-stabilised total knee arthroplasty: effects of implant type and partial release.

    , Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 24, Pages: 2646-2655, ISSN: 0942-2056

    PURPOSE: The aim of this study was to quantify the contributions of medial soft tissues to stability following cruciate-retaining (CR) or posterior-stabilised (PS) total knee arthroplasty (TKA). METHODS: Using a robotic system, eight cadaveric knees were subjected to ±90-N anterior-posterior force, ±5-Nm internal-external and ±8-Nm varus-valgus torques at various flexion angles. The knees were tested intact and then with CR and PS implants, and successive cuts of the deep and superficial medial collateral ligaments (dMCL, sMCL) and posteromedial capsule (PMC) quantified the percentage contributions of each structure to restraining the applied loads. RESULTS: In implanted knees, the sMCL restrained valgus rotation (62 % across flexion angles), anterior-posterior drawer (24 and 10 %, respectively) and internal-external rotation (22 and 37 %). Changing from CR TKA to PS TKA increased the load on the sMCL when resisting valgus loads. The dMCL restrained 11 % of external and 13 % of valgus rotations, and the PMC was significant at low flexion angles. CONCLUSIONS: This work has shown that medial release in the varus knee should be minimised, as it may inadvertently result in a combined laxity pattern. There is increasing interest in preserving constitutional varus in TKA, and this work argues for preservation of the sMCL to afford the surgeon consistent restraint and maintain a balanced knee for the patient.

  • Journal article
    Bergmann JHM, Goodier H, Spulber I, Anastasova S, Georgiou P, McGregor AHet al., 2015,

    The "Wear and Measure" Approach: Linking Joint Stability Measurements from a Smart Clothing System to Optical Tracking

    , Journal of Sensors, Vol: 2015, ISSN: 1687-7268

    Joint stability is essential for maintaining normal everyday function. However, assessment of stability often still relies on subjective or obtrusive methods. An unobtrusive approach would be to have our clothes assess our joint stability. Methods. A new application consisting of an attachable clothing sensing system (ACSS), constructed from a flexible carbon black and polyurethane composite film, was tested against an optical tracking system to assess if the ACSS placed across the knee could provide stability results that correlate with the optical tracking outcomes. Stability was challenged by reducing the base of support and by removing vision generating different experimental conditions. Results. Bland and Altman plots indicated a general proportional error between the measurement systems within each stability condition. However, across all conditions a Spearman correlation coefficient of 0.81 () was found between the displacement values and ACSS, showing a good association between stability measurements. Electromyography (EMG) also indicated that joint stability was challenged between the different conditions. The ACSS was experienced by users as comfortable and hardly noticeable. Conclusions. This study indicates that smart clothing can measure important physiological parameters in an unobtrusive manner. This “wear and measure” approach might change how we gather relevant clinical data in the future.

  • Book chapter
    Masouros S, Halewood C, Bull A, Amis Aet al., 2015,

    Biomechanics

    , Expertise orthopadie und unfallchirurgie: Knie, Editors: Kohn, ISBN: 978-3-1317500-1-3
  • Conference paper
    Geraldes D, Hansen U, Amis A, 2015,

    An automated framework for parametric analysis glenoid implant design

    , Bath Biomechanics Symposium 2015
  • Conference paper
    Geraldes D, Hansen U, Amis A, 2015,

    Parametric analysis of glenoid implant design

    , International Society of Biomechanics 2015
  • Journal article
    Papi E, Belsi A, McGregor AH, 2015,

    A knee monitoring device and the preferences of patients living with osteoarthritis: A qualitative study

    , BMJ Open, Vol: 5, ISSN: 2044-6055
  • Journal article
    Akhtar K, Sugand K, Sperrin M, Cobb J, Standfield N, Gupte Cet 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: 1745-3674

    Background 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.

  • Journal article
    Chen A, Patel NK, Khan Y, Cobb JP, Gupte CMet 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
  • Journal article
    Aqil A, Sheikh HQ, Masjedi M, Jeffers J, Cobb Jet al., 2015,

    Birmingham Mid-Head Resection Periprosthetic Fracture.

    , CiOS Clinics in Orthopedic Surgery, Vol: 7, Pages: 402-405, ISSN: 2005-4408

    Total 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.

  • Journal article
    Buckeridge EM, Bull AMJ, McGregor AH, 2015,

    Incremental training intensities increases loads on the lower back of elite female rowers

    , Journal of Sports Sciences, ISSN: 0264-0414

    Lumbar-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.

  • Journal article
    Halewood C, Traynor A, Bellemans J, Victor J, Amis AAet 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: 1532-8406

    The 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.

  • Journal article
    Papi E, Spulber I, Kotti M, Georgiou P, McGregor Aet 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 article
    Greenwood J, McGregor A, Jones F, Hurley Met al., 2015,

    Evaluating rehabilitation following lumbar fusion surgery (REFS): study protocol for a randomised controlled trial

    , Trials, Vol: 16, ISSN: 1745-6215
  • Journal article
    Berwin JT, Burton TMW, Taylor J, McGregor AH, Roche Aet 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: 1944-7876

    Background: 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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