Publications
284 results found
Aqil A, Wiik A, Zanotto M, et al., 2016, The Effect of Hip Arthroplasty on Osteoarthritic Gait: A Blinded, Prospective and Controlled Gait Study at Fast Walking Speeds, JOURNAL OF ARTHROPLASTY, Vol: 31, Pages: 2337-2341, ISSN: 0883-5403
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- Citations: 11
Aframian A, Smith TO, Tennent TD, et al., 2016, Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy., Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 25, Pages: 3755-3772, ISSN: 0942-2056
PURPOSE: The medial patellofemoral ligament (MPFL) is the major medial soft-tissue stabiliser of the patella, originating from the medial femoral condyle and inserting onto the medial patella. The exact position reported in the literature varies. Understanding the true anatomical origin and insertion of the MPFL is critical to successful reconstruction. The purpose of this systematic review was to determine these locations. METHODS: A systematic search of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed and Cochrane Library) and unpublished literature databases was conducted from their inception to the 3 February 2016. All papers investigating the anatomy of the MPFL were eligible. Methodological quality was assessed using a modified CASP tool. A narrative analysis approach was adopted to synthesise the findings. RESULTS: After screening and review of 2045 papers, a total of 67 studies investigating the relevant anatomy were included. From this, the origin appears to be from an area rather than (as previously reported) a single point on the medial femoral condyle. The weighted average length was 56 mm with an 'hourglass' shape, fanning out at both ligament ends. CONCLUSION: The MPFL is an hourglass-shaped structure running from a triangular space between the adductor tubercle, medial femoral epicondyle and gastrocnemius tubercle and inserts onto the superomedial aspect of the patella. Awareness of anatomy is critical for assessment, anatomical repair and successful surgical patellar stabilisation. LEVEL OF EVIDENCE: Systematic review of anatomical dissections and imaging studies, Level IV.
Ma 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: 1559-0119
Bone 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.
Auvinet E, Multon F, Manning V, et al., 2016, Validity and sensitivity of the longitudinal asymmetry index to detect gait asymmetry using Microsoft Kinect data, Gait & Posture, Vol: 51, Pages: 162-168, ISSN: 1879-2219
Gait asymmetry information is a key point in disease screening and follow-up. Constant Relative Phase (CRP) has been used to quantify within-stride asymmetry index, which requires noise-free and accurate motion capture, which is difficult to obtain in clinical settings. This study explores a new index, the Longitudinal Asymmetry Index (ILong) which is derived using data from a low-cost depth camera (Kinect). ILong is based on depth images averaged over several gait cycles, rather than derived joint positions or angles. This study aims to evaluate (1) the validity of CRP computed with Kinect, (2) the validity and sensitivity of ILong for measuring gait asymmetry based solely on data provided by a depth camera, (3) the clinical applicability of a posteriorly mounted camera system to avoid occlusion caused by the standard front-fitted treadmill consoles and (4) the number of strides needed to reliably calculate ILong. The gait of 15 subjects was recorded concurrently with a marker-based system (MBS) and Kinect, and asymmetry was artificially reproduced by introducing a 5 cm sole attached to one foot. CRP computed with Kinect was not reliable. ILong detected this disturbed gait reliably and could be computed from a posteriorly placed Kinect without loss of validity. A minimum of five strides was needed to achieve a correlation coefficient of 0.9 between standard MBS and low-cost depth camera based ILong. ILong provides a clinically pragmatic method for measuring gait asymmetry, with application for improved patient care through enhanced disease, screening, diagnosis and monitoring.
Jin 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
Davda K, Smyth N, Cobb JP, et al., 2016, 2D measurements of cup orientation are less reliable than 3D measurements, ACTA ORTHOPAEDICA, Vol: 87, Pages: 314-317, ISSN: 1745-3674
Cobb J, 2016, Accuracy, precision and knee replacement: a cautionary tale, TRENDS IN UROLOGY & MENS HEALTH, Vol: 7, Pages: 25-27, ISSN: 2044-3730
Masjedi M, Mandalia R, Aqil A, et 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
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- Citations: 2
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
Iranpour F, Aframian A, Cobb JP, 2016, The patellofemoral joint, Joint Preservation in the Adult Knee, Pages: 43-53, ISBN: 9783319418070
The patellofemoral joint has traditionally been poorly understood and interventions for patellofemoral joint problems have generally been less successful than those employed for the tibiofemoral joint. Pathologies affecting the patellofemoral joint in the adult can be largely divided into three groups: instability, osteochondral defects and osteoarthritis. These three conditions share a number of aetiological factors and all represent disorders of the normal mechanics of the patellofemoral articulation. As such, understanding the normal and abnormal anatomy and kinematics of the joint are vital to clinicians treating patellofemoral disorders. Treating the symptoms of these conditions without addressing the underlying disorder of kinematics will be likely to fail. In this chapter, the normal and abnormal anatomy and physiology of the joint are discussed as are the clinical features and treatments for the three commonly encountered pathologies of the patellofemoral joint.
Aframian A, Boughton OR, Auvinet E, et al., 2015, Patellofemoral pain is a symptom, not a diagnosis, British Medical Journal, Vol: 351, ISSN: 1468-5833
Aqil A, Wiik A, Clarke S, et al., 2015, Resurfacing head size and femoral fracture: Are registry conclusions on head size justified?, Eur J Orthop Surg Traumatol, Vol: 25, Pages: 1301-1305
BACKGROUND: Joint registries report that peri-prosthetic fractures are the most common reason for early revision of a hip resurfacing arthroplasty (HRA) and are twice as likely with small implant sizes. However, a national survey found peri-prosthetic fracture to be strongly associated with surgical accuracy. We therefore asked whether the force required to induce a peri-prosthetic fracture: (1) was significantly lower when using smaller implants and (2) correlated to the size of implant used, when surgery was performed accurately. METHODS: To ensure an adequate power, we calculated our sample size from pilot data. Forty-four femurs were tested in two experiments. The first experiment tested femurs with either a small (48 mm) or a large (54 mm) HRA implant. The second involved testing femurs with a range of implant sizes. A rapid prototyped femur-specific guide ensured accurate implantation. Specimens were then vertically loaded in a servo-hydraulic testing machine till fracture. Displacement (mm) and force (N) required for fracture were recorded. RESULTS: A median force of 1081 N was required to fracture specimens implanted with small 48-mm heads, while 1134 N was required when a 54-mm head was used (U = 77, z = -0.054, p = 0.957). Implant head size and force required to fracture were not related, r = 0.12, p = 0.63. CONCLUSIONS: The force required to induce a resurfacing peri-prosthetic fracture was not related to the size of the implant. The increased failure rate seen in all registries is unlikely to be directly the result of this single variable. Correctly performed resurfacing arthroplasty is highly resistant to fracture.
Manning V, Yiallourides C, Brevadt M, et al., 2015, Knee sounds may predict osteoarthritis severity, symptoms and function: pilot investigation toward a novel dynamic imaging system, Arthritis & Rheumatology, Vol: 67, ISSN: 2326-5191
Sugand K, Akhtar K, Khatri C, et 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.
Akhtar K, Sugand K, Wijendra A, et al., 2015, The Transferability of Generic Minimally Invasive Surgical Skills: Is There Crossover of Core Skills Between Laparoscopy and Arthroscopy?, JOURNAL OF SURGICAL EDUCATION, Vol: 73, Pages: 329-338, ISSN: 1931-7204
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- Citations: 9
Brevadt MJ, manning V, 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
Jones C, Aqil A, Clarke S, et al., 2015, Short uncemented stems allow greater femoral flexibility and may reduce peri-prosthetic fracture risk: a dry bone and cadaveric study, Journal of Orthopaedics and Traumatology, Vol: 16, Pages: 229-235, ISSN: 1590-9921
BackgroundShort femoral stems for uncemented total hip arthroplasty have been introduced as a safe alternative to traditional longer stem designs. However, there has been little biomechanical examination of the effects of stem length on complications of surgery. This study aims to examine the effect of femoral stem length on torsional resistance to peri-prosthetic fracture.Materials and methodsWe tested 16 synthetic and two paired cadaveric femora. Specimens were implanted and then rapidly rotated until fracture to simulate internal rotation on a planted foot, as might occur during stumbling. 3D planning software and custom-printed 3D cutting guides were used to enhance the accuracy and consistency of our stem insertion technique.ResultsSynthetic femora implanted with short stems fractured at a significantly higher torque (27.1 vs. 24.2 Nm, p = 0.03) and angle (30.3° vs. 22.3°, p = 0.002) than those implanted with long stems. Fracture patterns of the two groups were different, but showed remarkable consistency within each group. These characteristic fracture patterns were closely replicated in the pair of cadaveric femora.ConclusionsThis new short-stemmed press-fit femoral component allows more femoral flexibility and confers a higher resistance to peri-prosthetic fracture from torsional forces than long stems.
Akhtar 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: 1745-3674
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.
Aqil A, Sheikh HQ, Masjedi M, et 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.
Chen 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
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- Citations: 11
Tuncer 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
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- Citations: 6
Holme 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
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- Citations: 33
Davda 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
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- Citations: 5
Brevadt 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
Wiik AV, Aqil A, Tankard S, et al., 2015, Downhill walking gait pattern discriminates between types of knee arthroplasty: improved physiological knee functionality in UKA versus TKA, KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol: 23, Pages: 1748-1755, ISSN: 0942-2056
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- Citations: 36
Kwasnicki RM, Ali R, Jordan SJ, et al., 2015, A wearable mobility assessment device for total knee replacement: A longitudinal feasibility study, International Journal of Surgery, Vol: 18, Pages: 14-20, ISSN: 1743-9191
BackgroundTotal knee replacement currently lacks robust indications and objective follow-up metrics. Patients and healthcare staff are under-equipped to optimise outcomes. This study aims to investigate the feasibility of using an ear-worn motion sensor (e-AR, Imperial College London) to conduct objective, home-based mobility assessments in the peri-operative setting.MethodsFourteen patients on the waiting list for knee replacement, and 15 healthy subjects, were recruited. Pre-operatively, and at 1, 3, 6, 12 and 24 weeks post-operatively, patients underwent functional mobility testing (Timed Up and Go), knee examination (including range of motion), and an activity protocol whilst wearing the e-AR sensor. Features extracted from sensor motion data were used to assess patient performance and predict patients' recovery phase.ResultsSensor-derived peri-operative mobility trends correlated with clinical measures in several activities, allowing functional recovery of individual subjects to be profiled and compared, including the detection of a complication. Sensor data features enabled classification of subjects into normal, pre-operative and 24-week post-operative groups with 89% (median) accuracy. Classification accuracy was reduced to 69% when including all time intervals.DiscussionThis study demonstrates a novel, objective method of assessing peri-operative mobility, which could be used to supplement surgical decision-making and facilitate community-based follow-up.
van Arkel RJ, Amis AA, Cobb JP, et al., 2015, The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres, Bone & Joint Journal, Vol: 97B, Pages: 484-491, ISSN: 2049-4394
In this in vitro study of the hip joint we examined which soft tissues act as primary and secondary passive rotational restraints when the hip joint is functionally loaded. A total of nine cadaveric left hips were mounted in a testing rig that allowed the application of forces, torques and rotations in all six degrees of freedom. The hip was rotated throughout a complete range of movement (ROM) and the contributions of the iliofemoral (medial and lateral arms), pubofemoral and ischiofemoral ligaments and the ligamentum teres to rotational restraint was determined by resecting a ligament and measuring the reduced torque required to achieve the same angular position as before resection. The contribution from the acetabular labrum was also measured. Each of the capsular ligaments acted as the primary hip rotation restraint somewhere within the complete ROM, and the ligamentum teres acted as a secondary restraint in high flexion, adduction and external rotation. The iliofemoral lateral arm and the ischiofemoral ligaments were primary restraints in two-thirds of the positions tested. Appreciation of the importance of these structures in preventing excessive hip rotation and subsequent impingement/instability may be relevant for surgeons undertaking both hip joint preserving surgery and hip arthroplasty.
Akhtar K, Sugand K, Wijendra A, et al., 2015, Training safer surgeons: How do patients view the role of simulation in orthopaedic training?, Patient Safety in Surgery, Vol: 9, ISSN: 1754-9493
BACKGROUND: Simulation allows training without posing risk to patient safety. It has developed in response to the demand for patient safety and the reduced training times for surgeons. Whilst there is an increasing role of simulation in orthopaedic training, the perception of patients and the general public of this novel method is yet unknown. Patients and the public were given the opportunity to perform a diagnostic knee arthroscopy on a virtual reality ARTHRO Mentor simulator. After their practice session, participants answered a validated questionnaire based on a 5-point Likert Scale assessing their opinions on arthroscopic simulation. Primary objective was observing perception of patients on orthopaedic virtual reality simulation. FINDINGS: There were a total of 159 respondents, of which 86% were of the opinion that simulators are widely used in surgical training and 94% felt that they should be compulsory. 91% would feel safer having an operation by a surgeon trained on simulators, 87% desired their surgeon to be trained on simulators and 72% believed that additional simulator training resulted in better surgeons. Moreover, none of the respondents would want their operation to be performed by a surgeon who had not trained on a simulator. Cronbach's alpha was 0.969. CONCLUSIONS: There is also a clear public consensus for this method of training to be more widely utilised and it would enhance public perception of safer training of orthopaedic surgeons. This study of public perception provides a mandate to increase investment and infrastructure in orthopaedic simulation as part of promoting clinical governance.
Yu AW, Duncan JM, Daurka JS, et al., 2015, A Feasibility Study into the Use of Three-Dimensional Printer Modelling in Acetabular Fracture Surgery, ADVANCES IN ORTHOPEDICS, Vol: 2015, ISSN: 2090-3464
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- Citations: 27
Duffell LD, Mushtaq J, Masjedi M, et al., 2014, The knee adduction angle of the osteo-arthritic knee: A comparison of 3D supine, static and dynamic alignment, KNEE, Vol: 21, Pages: 1096-1100, ISSN: 0968-0160
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- Citations: 7
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