Publications
77 results found
Kechagias S, Karunaseelan K, Oosterbeek R, et al., 2024, The coupled effect of aspect ratio and strut micro-deformation mode on the mechanical properties of lattice structures, Mechanics of Materials, Vol: 191, ISSN: 0167-6636
Lattice structures have been integrated into various industrial applications owing to their unique compressive properties. Mechanical characterisation is usually done by testing a small specimen which is assumed representative of the utilised lattice. A specimen's aspect ratio (height to diameter/width ratio) is known to affect compressive properties in various engineering materials, yet its influence in lattices has not been investigated thoroughly. In this study, titanium lattice specimens designed with different aspect ratios (ranging from 0.5 to 3.0) and four different topologies (displaying bend and stretch-dominated micro-deformation modes) were fabricated using powder bed fusion and tested in quasi-static compression. Their compressive properties and failure modes were evaluated using acquired stress-strain curves and digital image correlation (DIC) analysis. Reducing the aspect ratio in the bend-dominated lattices increased the measured stiffness of the specimens by up to 40%. Conversely, increasing the aspect ratio of the stretch dominated lattices increased the measured stiffness of the specimens by up to 30%. For both topology types, decreasing the aspect ratio increased the measured strength of the specimens, but the effect was less than that observed for stiffness. Different responses were attributed to gradient strain accumulation and different failure patterns (densification versus shear banding) that were observed depending on the combination of aspect ratio and topology. These findings are particularly important for better predicting the mechanical behaviour of lattice-based components that have aspect ratios outside the range of conventional test specimens.
Karunaseelan K, Nasser R, Cobb J, et al., 2024, Optimal hip capsular release for joint exposure in hip resurfacing via the direct anterior approach: a biomechanical study, The Bone & Joint Journal, Vol: 106, ISSN: 2049-4408
Aims:Surgical approaches that claim to be minimally invasive, such as the direct anterior approach (DAA), are reported to have a clinical advantage, but are technically challenging and may create more injury to the soft-tissues during joint exposure. Our aim was to quantify the effect of soft-tissue releases on the joint torque and femoral mobility during joint exposure for hip resurfacing performed via the DAA.Methods:Nine fresh-frozen hip joints from five pelvis to mid-tibia cadaveric specimens were approached using the DAA. A custom fixture consisting of a six-axis force/torque sensor and motion sensor was attached to tibial diaphysis to measure manually applied torques and joint angles by the surgeon. Following dislocation, the torques generated to visualize the acetabulum and proximal femur were assessed after sequential release of the joint capsule and short external rotators.Results:Following initial exposure, the ischiofemoral ligament (7 to 8 o’clock) was the largest restrictor of exposure of the acetabulum, contributing to a mean 25% of overall external rotational restraint. The ischiofemoral ligament (10 to 12 o’clock) was the largest restrictor of exposure of the proximal femur, contributing to 25% of overall extension restraint. Releasing the short external rotators had minimal contribution in torque generated during joint exposure (≤ 5%).Conclusion:Adequate exposure of both proximal femur and acetabulum may be achieved with minimal torque by performing a full proximal circumferential capsulotomy while preserving short external rotators. The joint torque generated and exposure achieved is dependent on patient factors; therefore, some cases may necessitate further releases.
Reynolds A, Boughton O, Doyle R, et al., 2024, Dynamics of manual impaction instruments during THA, Bone & Joint Research, ISSN: 2046-3758
Kechagias S, Theodoridis K, Broomfield J, et al., 2023, The effect of nodal connectivity and strut density within stochastic titanium scaffolds on osteogenesis, Frontiers in Bioengineering and Biotechnology, Vol: 11, ISSN: 2296-4185
Modern orthopaedic implants use lattice structures that act as 3D scaffolds to enhance bone growth into and around implants. Stochastic scaffolds are of particular interest as they mimic the architecture of trabecular bone and can combine isotropic properties and adjustable structure. The existing research mainly concentrates on controlling the mechanical and biological performance of periodic lattices by adjusting pore size and shape. Still, less is known on how we can control the performance of stochastic lattices through their design parameters: nodal connectivity, strut density and strut thickness. To elucidate this, four lattice structures were evaluated with varied strut densities and connectivity, hence different local geometry and mechanical properties: low apparent modulus, high apparent modulus, and two with near-identical modulus. Pre-osteoblast murine cells were seeded on scaffolds and cultured in vitro for 28 days. Cell adhesion, proliferation and differentiation were evaluated. Additionally, the expression levels of key osteogenic biomarkers were used to assess the effect of each design parameter on the quality of newly formed tissue. The main finding was that increasing connectivity increased the rate of osteoblast maturation, tissue formation and mineralisation. In detail, doubling the connectivity, over fixed strut density, increased collagen type-I by 140%, increased osteopontin by 130% and osteocalcin by 110%. This was attributed to the increased number of acute angles formed by the numerous connected struts, which facilitated the organization of cells and accelerated the cell cycle. Overall, increasing connectivity and adjusting strut density is a novel technique to design stochastic structures which combine a broad range of biomimetic properties and rapid ossification.
Jones A, Jeffers J, Oosterbeek R, 2023, Frequency dependent fatigue behaviour of additively manufactured titanium lattices, Engineering Failure Analysis, Vol: 152, Pages: 1-7, ISSN: 1350-6307
Additively manufactured (AM) porous titanium lattices, with their ability to match the mechanical properties of bone and avoid stress shielding, are a popular candidate material for orthopaedic implants. Such implants are now emerging as treatments for conditions like osteoarthritis and fixation of bone fractures. Fatigue tests are critical due to the cyclic loading environment and must be carried out at an accelerated loading rate to simulate many years of use. Tests are typically performed with servohydraulic instruments, which limits the cyclic compression to relatively low frequencies (15 Hz). Fatigue testing at a higher frequency would accelerate research, however, may introduce phenomena such as heat accumulation and strain rate effects. In this study the fatigue behaviour of a pure titanium stochastic lattice was determined at two test frequencies, 15 Hz and 110 Hz. Testing was conducted using an electromechanical dynamic system. The fatigue strengths at 106 cycles were 5.607±0.106 MPa and 5.764±0.214 MPa at 15 Hz and 110 Hz respectively. A hypothesis t-test at a 95% confidence level stated that there was significant evidence that the population means were not the same, demonstrating evidence of a difference in fatigue strength with testing frequency. However, we can conclude that the 2.8% increase in fatigue strength due to test frequency effects is inconsequential relative to the time saved (16 hours per test) and typical batch-to-batch variability in fatigue strength of approximately 12%. The results of this study should help accelerate research into the fatigue properties of AM porous lattices.
Oosterbeek RN, Sirbu G, Hansal S, et al., 2023, Effect of chemical–electrochemical surface treatment on the roughness and fatigue performance of porous titanium lattice structures, Additive Manufacturing, Vol: 78, ISSN: 2214-7810
Additive manufacturing (AM) has enabled the fabrication of extremely complex components such as porousmetallic lattices, which have applications in aerospace, automotive, and in particular biomedical devices.The fatigue resistance of these materials is currently an important limitation however, due to manufacturingdefects such as semi-fused particles and weld lines. In this work a chemical–electrochemical surface treatment(Hirtisation®) is used for post-processing of Ti-6Al-4V lattices, reducing the strut surface roughness (Sa) from12 to 6 μm, removing all visible semi-fused particles. The evenness of this treatment in lattices with relativedensity up to 18.3% and treatment depth of 6.5 mm was assessed, finding no evidence of reduced effectivenesson internal surfaces. After normalising to quasi-static mechanical properties to account for material lossesduring hirtisation (34%–37% reduction in strut diameter), the fatigue properties show a marked improvementdue to the reduction in surface roughness. Normalised high cycle fatigue strength increased from around 0.1 to0.16-0.21 after hirtisation, an average increase of 80%. For orthopaedic implant devices where matching thestiffness of surrounding bone is crucial, the fatigue strength to modulus ratio is a key metric. After hirtisationthe fatigue strength to modulus ratio increased by 90%, enabling design of stiffness matched implant materialswith greater fatigue strength. This work demonstrates that hirtisation is an effective method for improving thesurface roughness of porous lattice materials, thereby enhancing their fatigue performance.
Burge T, Jeffers J, Myant C, 2023, A computational design of experiments based method for evaluation of off-the-shelf total knee replacement implants, Computer Methods in Biomechanics and Biomedical Engineering, Vol: 26, Pages: 629-638, ISSN: 1025-5842
A methodology to explore the design space of off-the-shelf total knee replacement implant designs is outlined. Generic femur component and tibia plate designs were scaled to thousands of sizes and virtually fitted to 244 test subjects. Various implant designs and sizing requirements between genders and ethnicities were evaluated. 5 sizes optimised via the methodology produced a good global fit for most subjects. However, clinically significant over/underhang was present in 19% of subjects for tibia plates and 25% for femur components, reducing to 11/20% with 8 sizes. The analysis highlighted subtly better fit performance was obtained using sizes with unequal spacing.
Burge TA, Munford MJ, Kechagias S, et al., 2023, Automating the customization of stiffness-matched knee implants using machine learning techniques, The International Journal of Advanced Manufacturing Technology, ISSN: 0268-3768
In knee arthroplasty, implants are used to replace the articulating surfaces of the tibia and femur bones, with most constituting of solid metallic components. Consequentially, biomechanical stresses and strains are no longer adequately distributed at the joint post-surgery, preventing beneficial bone remodeling. To mitigate this studies have explored additively manufacturing implants with porous lattice structures to match the mechanical properties of bone. Authors have also outlined how such structures can be designed using computed tomography data to simulate the stiffness of individuals’ bones. Such methods however currently require substantial manual work by trained professionals to process the image files, extract the density information, and design lattice structures. This study proposes what is believed to be the first fully automatic pipeline capable of producing tibial trays with compliant structures customized specifically for individuals’ bones, achieved using machine learning methods. The novel process, combining classification, object detection, and segmentation machine learning models, used to facilitate the automated workflow, is outlined. The efficaciousness of the pipeline is then demonstrated by testing it using clinical computed tomography data and comparing the results with those obtained manually. As a proof of concept, prototype designs generated by the pipeline with differing degrees of complexity, up to and including mapping stiffness variation in 3D through the shaft of the tibia, were also fabricated.
Young G, Tallia F, Clark J, et al., 2023, Hybrid materials with continuous mechanical property gradients that can be 3D printed, Materials Today Advances, Vol: 17, Pages: 1-9, ISSN: 2590-0498
Here, we show tough materials with continuous composition and stiffness gradients, without interfaces between regions, using inorganic/organic hybrid materials that can also be 3Dprinted. Sol-gel hybrid materials have interacting and interpenetrating organic and inorganic co-networks and can deliver a synergy of the properties of those constituents. Their mechanical behaviour can be tuned through inorganic/organic content and cross-linkingdensity. We describe hybrids of covalently linked silica-poly(tetrahydrofuran) (SiO 2 /PTHF) that show an unprecedented range of mechanical properties. SiO2 /PTHF hybrids were formed with different silica contents, producing materials ranging from elastomeric to glassy, with a compressive stiffness at 10% strain of between 2 and 200 MPa: at an SiO 2 content of 9 wt.%, hybrids show a failure stress in compression of 8 MPa, at 70% strain, and in tension of 2 MPa at 80% strain. Gradual sol-gel gelation was employed to generate monoliths with composition and stiffness gradients without visible joins or points of weakness, and for the development of ‘inks’ for additive manufacturing of 3D structures through direct ink writing. Monoliths with gradients were at least as strong, in tension and compression, as those made by casting a single sol. Cytocompatible materials with seamless stiffness gradients will have many applications: one is biomimicry of natural cartilaginous structures of the body, such as the intervertebral disc, which has a natural radial stiffness gradient.
Burge T, Jeffers J, Myant C, 2023, Applying machine learning methods to enable automatic customisation of knee replacement implants from CT data, Scientific Reports, Vol: 13, Pages: 1-9, ISSN: 2045-2322
The aim of this study was to develop an automated pipeline capable of designing custom total knee replacement implants from CT scans. The developed pipeline firstly utilised a series of machine learning methods including classification, object detection, and image segmentation models, to extract geometrical information from inputted DICOM files. Statistical shape models then used the information to create femur and tibia 3D surface model predictions which were ultimately used by computer aided design scripts to generate customised implant designs. The developed pipeline was trained and tested using CT scan images, along with segmented 3D models, obtained for 98 Korean Asian subjects. The performance of the pipeline was tested computationally by virtually fitting outputted implant designs with ‘ground truth’ 3D models for each test subject’s bones. This demonstrated the pipeline was capable of repeatably producing highly accurate designs, and its performance was not impacted by subject sex, height, age, or knee side. In conclusion, a robust, accurate and automatic, CT-based total knee replacement customisation pipeline was shown to be feasible and could afford significant time and cost advantages over conventional methods. The pipeline framework could also be adapted to enable customisation of other medical implants.
Burge TA, Jeffers JRT, Myant CW, 2022, Performance and Sensitivity Analysis of an Automated X-Ray Based Total Knee Replacement Mass-Customization Pipeline, JOURNAL OF MEDICAL DEVICES-TRANSACTIONS OF THE ASME, Vol: 16, ISSN: 1932-6181
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Saeidi M, Barnes S, Berthaume M, et al., 2022, Low-cost locally manufacturable unilateral imperial external fixator for low- and middle-income countries, Frontiers in Medical Technology, Vol: 4, Pages: 1-8, ISSN: 2673-3129
Treating open fractures in long bones can be challenging and if not performed properly can lead to poor outcomes such as mal/non-union, deformity, and amputation. One of the most common methods of treating these fracture types is temporary external fixation followed by definitive fixation. The shortage of high-quality affordable external fixators is a long-recognised need, particularly in Low- and Middle-Income Countries (LMICs). This research aimed to develop a low-cost device that can be manufactured locally to international standards. This can provide surge capacity for conflict zones or in response to unpredictable incidents and situations. The fixator presented here and developed by us, the Imperial external fixator, was tested on femur and tibia specimens under 100 cycles of 100 N compression-tension and the results were compared with those of the Stryker Hoffmann 3 frame. The Imperial device was stiffer than the Stryker Hoffmann 3 with a lower median interfragmentary motion (of 0.94 vs. 1.48 mm). The low-cost, easy to use, relatively lightweight, and easy to manufacture (since minimum skillset and basic workshop equipment and materials are needed) device can address a critical shortage and need in LMICs particularly in conflict-affected regions with unpredictable demand and supply. The device is currently being piloted in three countries for road traffic accidents, gunshot wounds and other conflict trauma—including blast cohorts.
Burge T, Jones G, Jordan C, et al., 2022, A computational tool for automatic selection of total knee replacementimplant size using x-ray images, Frontiers in Bioengineering and Biotechnology, Vol: 10, Pages: 1-11, ISSN: 2296-4185
Purpose: The aim of this study was to outline a fully automatic tool capable of reliably predicting the most suitable total kneereplacement implant sizes for patients, using bi-planar X-ray images. By eliminating the need for manual templating or guidingsoftware tools via the adoption of convolutional neural networks, time and resource requirements for pre-operative assessmentand surgery could be reduced, the risk of human error minimized, and patients could see improved outcomes.Methods: The tool utilizes a machine learning-based 2D – 3D pipeline to generate accurate predictions of subjects’ distal femur andproximal tibia bones from X-ray images. It then virtually fits different implant models and sizes to the 3D predictions, calculatesthe implant to bone root-mean-squared error and maximum over/under hang for each, and advises the best option for thepatient. The tool was tested on 78, predominantly White subjects (45 female/33 male), using generic femur component and tibiaplate designs scaled to sizes obtained for five commercially available products. The predictions were then compared to the groundtruth best options, determined using subjects’ MRI data.Results: The tool achieved average femur component size prediction accuracies across the five implant models of 77.95% in termsof global fit (root-mean-squared error), and 71.79% for minimizing over/underhang. These increased to 99.74% and 99.49% with ±1size permitted. For tibia plates, the average prediction accuracies were 80.51% and 72.82% respectively. These increased to99.74% and 98.98% for ±1 size. Better prediction accuracies were obtained for implant models with fewer size options, howeversuch models more frequently resulted in a poor fit.Conclusion: A fully automatic tool was developed and found to enable higher prediction accuracies than generally reported formanual templating techniques, as well as similar computational methods.
Ng KCG, Bankes MJK, El Daou H, et al., 2022, Capsular Mechanics After Periacetabular Osteotomy for Hip Dysplasia., J Bone Joint Surg Am, Vol: 104, Pages: 1015-1023
BACKGROUND: Hip dysplasia is characterized by insufficient acetabular coverage around the femoral head, which leads to instability, pain, and injury. Periacetabular osteotomy (PAO) aims to restore acetabular coverage and function, but its effects on capsular mechanics and joint stability are still unclear. The purpose of this study was to examine the effects of PAO on capsular mechanics and joint range of motion in dysplastic hips. METHODS: Twelve cadaveric dysplastic hips (denuded to bone and capsule) were mounted onto a robotic tester and tested in multiple positions: (1) full extension, (2) neutral 0°, (3) flexion of 30°, (4) flexion of 60°, and (5) flexion of 90°. In each position, the hips underwent internal and external rotation, abduction, and adduction using 5 Nm of torque. Each hip then underwent PAO to reorient the acetabular fragment, preserving the capsular ligaments, and was retested. RESULTS: The PAO reduced internal rotation in flexion of 90° (∆IR = -5°; p = 0.003), and increased external rotation in flexion of 60° (∆ER = +7°; p = 0.001) and flexion of 90° (∆ER = +11°; p = 0.001). The PAO also reduced abduction in extension (∆ABD = -10°; p = 0.002), neutral 0° (∆ABD = -7°; p = 0.001), and flexion of 30° (∆ABD = -8°; p = 0.001), but increased adduction in neutral 0° (∆ADD = +9°; p = 0.001), flexion of 30° (∆ADD = +11°; p = 0.002), and flexion of 60° (∆ADD = +11°; p = 0.003). CONCLUSIONS: PAO caused reductions in hip abduction and internal rotation but greater increases in hip adduction and external rotation. The osseous acetabular structure and capsule both play a role in the balance between joint mobility and stability after PAO.
Oosterbeek R, Jeffers J, 2022, StrutSurf: A tool for analysis of strut morphology and surface roughness in additively manufactured lattices, SoftwareX, Vol: 18, ISSN: 2352-7110
Additively manufactured lattice materials are of great interest in manyapplications, however the surface defects generated during manufacturingcan prove a significant barrier. The small feature size and intricate geometrymakes characterisation of lattice struts difficult, so we present StrutSurf asa new tool for analysis of lattice struts. Using micro-CT data, StrutSurfallows random sampling of struts within a lattice, and automates analysis toprovide detailed morphological information such as strut diameter, ellipticity,orientation, and surface roughness. StrutSurf will enable a range of newresearch questions to be investigated such as the effects of surface treatmentsand other manufacturing methods on strut morphology and roughness.
Kechagias S, Oosterbeek R, Munford M, et al., 2022, Controlling the mechanical behaviour of stochastic lattice structures: the key role of nodal connectivity, Additive Manufacturing, Vol: 54, ISSN: 2214-8604
Additive manufacturing has enabled the fabrication of lattice structures with controlled micro-architectures and mechanical properties. These structures are particularly attractive in the orthopaedic industry where their osseointegration capability and bone-matching mechanical properties are ideally suited for use in implants and bone scaffolds. The broad range of mechanical properties required for this application is a challenge – it typically requires a range of periodic lattice structures, each of which require separate characterisation. An alternative approach is to use a stochastic lattice structure, where a single relationship between the lattice design parameters (connectivity, strut density and strut thickness) and resulting mechanical properties should be possible. To investigate this, we manufactured stochastic lattices in pure Titanium with connectivity from 4 to 14, strut density from 3 to 7 [struts/mm3] and strut thickness of 230 and 300 µm. Specimens were compression tested in quasi-static and fatigue loading. In static loading, the low connectivity structures displayed bend-dominated deformation while the high connectivity structures displayed stretch-dominated deformation. The structures had a stiffness ranging from 0.1 to 8 GPa and different Gibson-Ashby stiffness/relative density relationships were required for high and low connectivity structures. A unified multivariable linear regression model was found to predict relative density from the connectivity, strut density and strut thickness of the structure. In fatigue loading, increasing the connectivity from 4 to 14 increased the fatigue strength by 60% for a fixed relative density. These findings provide important design information when creating structures using stochastic lattices to maximise strength for a desired relative density or stiffness. The single integrated model presented in this study can define a structure to achieve a broad range of design requirements, even as gradient
Ovrebo O, Perale G, Wojciechowski J, et al., 2022, Design and clinical application of injectable hydrogels for musculoskeletal therapy, Bioengineering and Translational Medicine, Vol: 7, Pages: 1-21, ISSN: 2380-6761
Musculoskeletal defects are an enormous healthcare burden and source of pain and disability for individuals. With an ageing population, the proportion living with these medical indications will increase. Simultaneously, there is pressure on healthcare providers to source efficient solutions, which are cheaper and less invasive than conventional technology. This has led to an increased research focus on hydrogels as highly biocompatible biomaterials that can be delivered through minimally invasive procedures. This review will discuss how hydrogels can be designed for clinical translation, particularly in the context of the new European Medical Device Regulation (MDR). We will then do a deep dive into the clinically used hydrogel solutions that have been commercially approved or have undergone clinical trials in Europe or the US. We will discuss the therapeutic mechanism and limitations of these products. Due to the vast application areas of hydrogels, this work focuses only on treatments of cartilage, bone, and the nucleus pulposus. Lastly, the main steps towards clinical translation of hydrogels as medical devices are outlined. We suggest a framework for how academics can assist small and medium MedTech enterprises conducting the initial clinical investigation and Post-Market Clinical Follow-up (PMCF) required in the MDR. It is evident that the successful translation of hydrogels is governed by acquiring high-quality pre-clinical and clinical data confirming the device mechanism of action and safety.
Munford MJ, Xiao D, Jeffers JRT, 2022, Lattice implants that generate homeostatic and remodeling strains in bone, JOURNAL OF ORTHOPAEDIC RESEARCH, Vol: 40, Pages: 871-877, ISSN: 0736-0266
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- Citations: 4
Munford M, Liddle A, Stoddart J, et al., 2022, Total and partial knee replacement implants that maintain native load transfer in the Tibia, Bone and Joint Research, Vol: 11, Pages: 1-3, ISSN: 2046-3758
Aims:Unicompartmental and total knee arthroplasty (UKA and TKA) are successful treatments for osteoarthritis, but the solid metal implants disrupt the natural distribution of stress and strain which can lead to bone loss over time. This generates problems if the implant needs to be revised. This study investigates whether titanium lattice UKA and TKA implants can maintain natural load transfer in the proximal tibia. Methods:In a cadaveric model, UKA and TKA procedures were performed on 8 fresh-frozen knee specimens, using conventional (solid) and titanium lattice tibial implants. Stress at the bone-implant interfaces were measured and compared to the native knee.Results:Titanium lattice implants were able to restore the mechanical environment of the native tibia for both UKA and TKA designs. Maximum stress at the bone-implant interface ranged from 1.2-3.3 MPa compared to 1.3-2.7 MPa for the native tibia. The conventional solid UKA and TKA implants reduced the maximum stress in the bone by a factor of 10 and caused >70% of bone surface area to be underloaded compared to the native tibia. Conclusions:Titanium lattice implants maintained the natural mechanical loading in the proximal tibia after UKA and TKA, but conventional solid implants did not. This is an exciting first step towards implants that maintain bone health, but such implants also have to meet fatigue and micromotion criteria to be clinically viable.
Burge TA, Jeffers JRT, Myant CW, 2022, Development of an Automated Mass-Customization Pipeline for Knee Replacement Surgery Using Biplanar X-Rays, JOURNAL OF MECHANICAL DESIGN, Vol: 144, ISSN: 1050-0472
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Dandridge O, Garner A, Jeffers JRT, et al., 2021, Validity of repeated-measures analyses of in vitro arthroplasty kinematics and kinetics, JOURNAL OF BIOMECHANICS, Vol: 129, ISSN: 0021-9290
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Arnold M, Zhao S, Doyle R, et al., 2021, Power tool use in orthopaedic surgery: iatrogenic injury, its detection and technological advances, JBJS Open Access, Vol: 6, Pages: 1-16, ISSN: 2472-7245
Background: Power tools are an integral part to orthopaedic surgery but have the capacity to cause iatrogenic injury. This systematic review aimed to investigate the prevalence of iatrogenic injury due to power tools in orthopaedic surgery and discuss the current methods 9that can be used to reduce this. Methods: A systematic review of all English language articles using a keyword search was undertaken in Medline, Embase, PubMed and Scopus databases. Exclusion criteria included injuries related to cast saw, temperature induced damage and complications not clearly related to power tool use. Results: 3694 abstracts were retrieved, and 88studies were included in the final analysis. Only a few studies and individual case reports directly looked at prevalence of injury due to power tools. This included 2 studies looking at frequency of vascular injury during femoral fracture fixation (0.49% and 0.2%),2 studies investigating frequency of vertebral artery injury during spinal surgery (0.5% and 0.08%)and 3 studies investigating vascular injury during total joint arthroplasty (124 vascular injuries involving 138 blood vessels,0.13% and 0.1% incidence)in addition to 1 questionnaire sent electronically to surgeons. There are multiple methods to prevent damage during the use of power tools. These include robotics, Revised Manuscript (Maximum 3000 Words)simulation, specific drill settings and real-time feedback techniques such as spectroscopy and electromyography. Conclusion: Power tools have the potential to cause iatrogenic injury to surrounding structures during orthopaedic surgery. Fortunately, the published literature suggests the frequency of iatrogenic injury using orthopaedic power tools is low. There are multiple technologies available to reduce damage using power tools. In high-risk operations the use of advanced technologies to reduce the chance of iatrogenic injury should be considered. Clinical Relevance: Power tools used during orthopaedic surgery have the potentia
Clark JN, Tavana S, Clark B, et al., 2021, High resolution three-dimensional strain measurements in human articular cartilage, JOURNAL OF THE MECHANICAL BEHAVIOR OF BIOMEDICAL MATERIALS, Vol: 124, ISSN: 1751-6161
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- Citations: 6
Ruiz de Galarreta S, Doyle RJ, Jeffers J, et al., 2021, Laser powder bed fusion of porous graded structures: A comparison between computational and experimental analysis, JOURNAL OF THE MECHANICAL BEHAVIOR OF BIOMEDICAL MATERIALS, Vol: 123, ISSN: 1751-6161
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Ghouse S, Oosterbeek RN, Mehmood AT, et al., 2021, Vacuum heat treatments of titanium porous structures, ADDITIVE MANUFACTURING, Vol: 47, ISSN: 2214-8604
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Hossain U, Ghouse S, Nai K, et al., 2021, Mechanical and morphological properties of additively manufactured SS316L and Ti6Al4V micro-struts as a function of build angle, ADDITIVE MANUFACTURING, Vol: 46, ISSN: 2214-8604
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- Citations: 14
Karunaseelan KJ, Dandridge O, Muirhead-Allwood SK, et al., 2021, Capsular ligaments provide a passive stabilizing force to protect the hip against edge loading, BONE & JOINT RESEARCH, Vol: 10, Pages: 594-601, ISSN: 2046-3758
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Hossain U, Ghouse S, Nai K, et al., 2021, Controlling and testing anisotropy in additively manufactured stochastic structures, ADDITIVE MANUFACTURING, Vol: 39, ISSN: 2214-8604
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- Citations: 16
Parkes M, Tallia F, Young GR, et al., 2021, Tribological evaluation of a novel hybrid for repair of articular cartilage defects, MATERIALS SCIENCE & ENGINEERING C-MATERIALS FOR BIOLOGICAL APPLICATIONS, Vol: 119, ISSN: 0928-4931
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Ng KCG, El Daou H, Bankes MJK, et al., 2021, Cam Osteochondroplasty for Femoroacetabular Impingement Increases Microinstability in Deep Flexion: A Cadaveric Study, ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, Vol: 37, Pages: 159-170, ISSN: 0749-8063
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- Citations: 11
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