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  • Journal article
    Clark JN, Heyraud A, Tavana S, Al-Jabri T, Tallia F, Clark B, Blunn GW, Cobb JP, Hansen U, Jones JR, Jeffers JRTet al., 2020,

    Exploratory Full-Field Mechanical Analysis across the Osteochondral Tissue-Biomaterial Interface in an Ovine Model

    , MATERIALS, Vol: 13
  • Journal article
    Edwards TC, Logishetty K, Cobb JP, 2020,

    Letter to the Editor on "Patient-Reported Outcomes Following Total Hip Arthroplasty: A Multicenter Comparison Based on Surgical Approaches"

    , JOURNAL OF ARTHROPLASTY, Vol: 35, Pages: 2686-2687, ISSN: 0883-5403
  • Journal article
    Ma S, Goh EL, Tay T, Wiles C, Boughton O, Churchwell J, Wu Y, Karunaratne A, Bhattacharya R, Terrill N, Cobb J, Hansen U, Abel Ret al., 2020,

    Nanoscale mechanisms in age-related hip-fractures

    , Scientific Reports, Vol: 10, Pages: 1-14, ISSN: 2045-2322

    Nanoscale mineralized collagen fibrils may be important determinants of whole-bone mechanical properties and contribute to the risk of age-related fractures. In a cross-sectional study nano-and tissue-level mechanics were compared across trabecular sections from the proximal femora of three groups(n=10 each): ageing non-fractured donors (Controls);untreated fracture patients (Fx-Untreated); bisphosphonate-treated fracture patients (Fx-BisTreated).Collagen fibril, mineral and tissue mechanics were measured using synchrotron X-Ray diffraction,of bone sections under load. Mechanical data were compared across groups, and tissue-level data were regressed against nano. Compared to controls fracture patients exhibited significantly lower critical strain, max strain and normalized strength, with lower peak collagen and mineral strain. Bisphosphonate-treated exhibited the lowest properties. In all three groups, peak mineral strain coincided with maximum tissue strength (i.e. ultimate stress), whilst peak fibril strain occurred afterwards(i.e. higher strain). Tissue strain and strength were positively and strongly correlated with peak fibril and mineral strains. Age-related fractures were associated with lower peak fibril and mineral strain irrespective of treatment. Indicating earlier mineral disengagement and the subsequent onset of fibril sliding is one of the key mechanisms leading to fracture. Treatments for fragility should target collagen-mineral interactions to restore nano-scale strain to that of healthy bone.
  • Journal article
    Mullington CJ, Low DA, Strutton PH, Malhotra Set al., 2020,

    A mechanistic study of the tremor associated with epidural anaesthesia for intrapartum caesarean delivery

    , International Journal of Obstetric Anesthesia, Vol: 43, Pages: 56-64, ISSN: 0959-289X

    BackgroundIt is not known if the tremor associated with an epidural top-up dose for intrapartum caesarean delivery is thermoregulatory shivering. A tremor is only shivering if it has the same frequency profile as cold stress-induced shivering. Thermoregulatory shivering is a response to a reduction in actual body temperature, whereas non-thermoregulatory shivering may be triggered by a reduction in sensed body temperature. This mechanistic study aimed to compare: 1. the frequency profiles of epidural top-up tremor and cold stress-induced shivering; and 2. body temperature (actual and sensed) before epidural top-up and at the onset of tremor.MethodsTwenty obstetric patients received an epidural top-up for intrapartum caesarean delivery and 20 non-pregnant female volunteers underwent a cold stress. Tremor, surface electromyography, core temperature, skin temperature (seven sites) and temperature sensation votes (a bipolar visual analog score ranging from −50 to +50 mm) were recorded.ResultsThe mean (SD) primary oscillation (9.9 (1.9) Hz) frequency of epidural top-up tremor did not differ from that of cold stress-induced shivering (9.0 (1.6) Hz; P=0.194), but the mean (SD) burst frequency was slower (6.1 (1.2) × 10−2 Hz vs 6.9 (0.7) × 10−2 Hz, respectively; P=0.046). Before the epidural top-up dose, the mean (SD) core temperature was 37.6 (0.6) °C. Between the epidural top-up dose and the onset of tremor the mean (SD) core temperature did not change (–0.1 (0.1) °C; P=0.126), the mean (SD) skin temperature increased (+0.4 (0.4) °C; P=0.002) and the mean (SD) temperature sensation votes decreased (−12 (16) mm; P=0.012).ConclusionThese results suggest that epidural top-up tremor is a form of non-thermoregulatory shivering triggered by a reduction in sensed body temperature.
  • Journal article
    Mullington CJ, Kua J, Malhotra S, 2020,

    The Timing of Labor Epidurals in COVID-19 Parturients: A Balance of Risk and Benefit

    , ANESTHESIA AND ANALGESIA, Vol: 131, Pages: E131-E132, ISSN: 0003-2999
  • Journal article
    Deane JA, Pavlova A, Lim A, Gregory J, Aspden R, McGregor Aet al., 2020,

    Is intrinsic lumbar spine shape associated with Lumbar Disc Degeneration? An exploratory study

    , BMC Musculoskeletal Disorders, Vol: 21, Pages: 1-10, ISSN: 1471-2474

    Background: Lumbar disc degeneration (LDD) is a condition associated with recurrentlow back pain (LBP). Knowledge regarding effective management is limited. As a steptowards the identification of risk, prognostic or potentially modifiable factors in LDDpatients, the aim of this study was to explore the hypothesis that intrinsic lumbar spineshape is associated with LDD and clinical outcomes in symptomatic adults. Methods: 3T MRI was used to acquire T2-weighted sagittal images (L1-S1) from 70healthy controls and LDD patients (mean age 49 years, SD 11, range 31-71years). Statistical Shape Modelling (SSM) was used to describe lumbar spine shape.SSM identified variations in lumbar shape as ‘modes’ of variation and quantifieddeviation from the mean. Intrinsic shape differences were determined between LDDgroups using analysis of variance with post-hoc comparisons. The relationshipbetween intrinsic shape and self-reported function, mental health and quality of lifewere also examined.Results: The first 7 modes of variation explained 91% of variance in lumbarshape. Higher LDD sum scores correlated with a larger lumbar lordosis (Mode 1 (55%variance), P=0.02), even lumbar curve distribution (Mode 2 (12% variance), P=0.05),larger anterior-posterior (A-P) vertebral diameter (Mode 3 (10% variance), P=0.007)and smaller L4-S1 disc spaces (Mode 7 (2% variance), P≤0.001). In the presence ofrecurrent LBP, LDD was associated with a larger A-P vertebral diameter (Mode 3) anda more even lumbar curvature with smaller L5/S1 disc spaces (Mode 4), which wassignificantly associated with patient quality of life (P=0.002-0.04, r p =0.43-0.61)).Conclusions: This exploratory study provides new evidence that intrinsic shapephenotypes are associated with LDD and quality of life in patients. Longitudinalstudies are required to establish the potential role of these risk or prognostic shapephenotypes.
  • Journal article
    Carlos Rodriguez-Merchan E, Liddle AD, 2020,

    Prevention of Periprosthetic Joint Infection in Total Knee Arthroplasty: Main Studies Reported Between November 2017 and January 2020

    , ARCHIVES OF BONE AND JOINT SURGERY-ABJS, Vol: 8, Pages: 465-469, ISSN: 2345-4644
  • Journal article
    Saracco A, Grassi A, Romagnoli M, Camarda L, Logishetty K, Zaffagnini S, Cobb Jet al., 2020,

    Reduced -dose computed tomography is the most accurate method to measure ceramic hip resurfacing cup version

    , EUROPEAN JOURNAL OF RADIOLOGY, Vol: 128, ISSN: 0720-048X
  • Conference paper
    Clunie G, Belsi A, Roe J, Alexander C, Sandhu G, McGregor Aet al., 2020,

    Not Just Dyspnoea – Swallowing as a Concern for Adults with Laryngotracheal Stenosis Who Undergo Reconstructive Surgery?

    , UK Swallowing Research Group 2020 Conference
  • Journal article
    Ajdari N, Tempelaere C, Masouleh MI, Abel R, Delfosse D, Emery R, Dini D, Hansen Uet al., 2020,

    Hemiarthroplasties: the choice of prosthetic material causes different levels of damage in the articular cartilage

    , Journal of Shoulder and Elbow Surgery, Vol: 29, Pages: 1019-1029, ISSN: 1058-2746

    Background Hemiarthroplasty has clear advantages over alternative procedures and is used in 20% of all shoulder joint replacements. Because of cartilage wear, the clinical outcome of hemiarthroplasty is unreliable and controversial. This paper suggests that the optimal choice of prosthetic material may reduce cartilage degeneration and improve the reliability of the procedure. The specific objectives were to assess 3 materials and assess how the severity of arthritis might affect the choice of prosthetic material. Methods A CoCr alloy, an AL2O3 ceramic, and a polycarbonate urethane polymer (PCU) were mechanically tested against 5 levels of human osteoarthritic cartilage (from intact to severely arthritic, n = 45). A high friction coefficient, a decrease in Young's modulus, an increase in permeability, a decrease in relaxation time, an increase in surface roughness, and a disrupted appearance of the cartilage after testing were used as measures of cartilage damage. The biomaterial that caused minimal cartilage damage was defined as superior. Results The CoCr caused the most damage. This was followed by the AL2O3 ceramic, whereas the PCU caused the least amount of damage. Although the degree of arthritis had an effect on the results, it did not change the trend that CoCr performed worst and PCU the best. Discussion and Conclusion This study indicates that ceramic implants may be a better choice than metals, and the articulating surface should be as smooth as possible. Although our results indicate that the degree of arthritis should not affect the choice of prosthetic material, this suggestion needs to be further investigated.
  • Journal article
    Maillot C, Auvinet E, Harman C, Cobb J, Riviere Cet al., 2020,

    Hip resurfacing generates a more physiological gait than total hip replacement: A case-control study

    , ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, Vol: 106, Pages: 527-534, ISSN: 1877-0568
  • Journal article
    Logishetty K, Gofton WT, Rudran B, Beaule PE, Cobb JPet al., 2020,

    Fully Immersive Virtual Reality for Total Hip Arthroplasty: Objective Measurement of Skills and Transfer of Visuospatial Performance After a Competency-Based Simulation Curriculum

    , JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, Vol: 102, ISSN: 0021-9355
  • Journal article
    Hopkins M, Vaidyanathan R, McGregor AH, 2020,

    Examination of the performance characteristics of velostat as an in-socket pressure sensor

    , IEEE Sensors Journal, Vol: 20, Pages: 6992-7000, ISSN: 1530-437X

    Velostat is a low-cost, low-profile electrical bagging material with piezoresistive properties, making it an attractive option for in-socket pressure sensing. The focus of this research was to explore the suitability of a Velostat-based system for providing real-time socket pressure profiles. The prototype system performance was explored through a series of bench tests to determine properties including accuracy, repeatability and hysteresis responses, and through participant testing with a single subject. The fabricated sensors demonstrated mean accuracy errors of 110 kPa and significant cyclical and thermal drift effects of up to 0.00715 V/cycle and leading to up to a 67% difference in voltage range respectively. Despite these errors the system was able to capture data within a prosthetic socket, aligning to expected contact and loading patterns for the socket and amputation type. Distinct pressure maps were obtained for standing and walking tasks displaying loading patterns indicative of posture and gait phase. The system demonstrated utility for assessing contact and movement patterns within a prosthetic socket, potentially useful for improvement of socket fit, in a low cost, low profile and adaptable format. However, Velostat requires significant improvement in its electrical properties before proving suitable for accurate pressure measurement tools in lower limb prosthetics.
  • Journal article
    Tukanova K, Papi E, Jamel S, Hanna GB, McGregor AH, Markar SRet al., 2020,

    Assessment of chest wall movement following thoracotomy: a systematic review

    , JOURNAL OF THORACIC DISEASE, Vol: 12, Pages: 1031-+, ISSN: 2072-1439
  • Journal article
    Akhbari P, Karamchandani U, Jaggard MKJ, Graca G, Bhattacharya R, Lindon JC, Williams HRT, Gupte CMet al., 2020,

    Can joint fluid metabolic profiling (or "metabonomics") reveal biomarkers for osteoarthritis and inflammatory joint disease? A SYSTEMATIC REVIEW

    , BONE & JOINT RESEARCH, Vol: 9, Pages: 108-119, ISSN: 2046-3758
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    • Citations: 24
  • Book chapter
    Ng KCG, Bankes MJK, Cobb J, Jeffers Jet al., 2020,

    Biomechanics of the Native Hip from Normal to Instability

    , Hip Dysplasia Understanding and Treating Instability of the Native Hip, Editors: Beaulé, Publisher: Springer, Pages: 55-70, ISBN: 9783030333577

    This book represents the most advanced understanding of diagnosis and management of hip dysplasia in the young adult, written by the world’s leading experts and covering advanced imaging and biomechanical studies as well as latest ...
  • Journal article
    Papi E, Bull AMJ, McGregor AH, 2020,

    Alteration of movement patterns in low back pain assessed by Statistical Parametric Mapping

    , Journal of Biomechanics, Vol: 100, Pages: 109597-109597, ISSN: 0021-9290

    Changes in movement pattern in low back pain (LBP) groups have been analysed by reporting predefined discrete variables. However, this approach does not consider the full kinematic data waveform and its dynamic information, potentially exposing the analysis to bias. Statistical Parametric Mapping (SPM) has been introduced and applied to 1 dimensional (D) kinematic variables allowing the assessment of data over time. The aims of this study were to assess differences in 3D kinematics patterns in people with and without LBP during functional tasks by using SPM and to investigate if SPM analysis was consistent with standard 3D range of motion (RoM) assessments. 3D joints kinematics of the spine and lower limbs were compared between 20 healthy controls and 20 participants with non-specific LBP during walking, sit-to-stand and lifting. SPM analysis showed significant differences in the 3Dkinematics of the lower thoracic segment, upper and lower lumbar segment and knee joint during walking and lifting mostly observed at the beginning and/or towards the end of the tasks. ROMs differed between groups in the lower thoracic segment (walking/sit-to-stand), upper and lower lumbar segments (walking/sit-to-stand/lifting), hip and knee (sit-to-stand/lifting). Based on these results, the two approaches can yield different data interpretations. SPM analysis allows the identification of differences in movement that occur over time. This adds value to LBP movement analysis as it allows an understanding of the LBP strategies adopted during motion that may not be conveyed by simple discrete parameters such as ROMs.
  • Journal article
    Rowland S, Fitzgerald JE, Holme T, Powell J, McGregor Aet al., 2020,

    What is the clinical value of mHealth for patients?

    , npj Digital Medicine, Vol: 3, Pages: 1-6, ISSN: 2398-6352

    Despite growing interest from both patients and healthcare providers there is little clinical guidance on how mobile apps should be utilised to add value to patient care. We categorize apps according to their functionality (e.g. preventative behavior change, digital self-management of a specific condition, diagnostic) and discuss evidence for effectiveness from published systematic reviews and meta-analyses and the relevance to patient care. We discuss the limitations of the current literature describing clinical outcomes from mHealth apps, what FDA clearance means now (510(k) / de novo FDA clearance) and in the future. We discuss data security and privacy as a major concern for patients when using mHealth apps. Patients are often not involved in the development of mobile health guidelines, and professionals’ views regarding high quality health apps may not reflect patients’ views. We discuss efforts to develop guidelines for the development of safe and effective mHealth apps in the US and elsewhere and the role of independent app reviews sites in identifying mHealth apps for patient care. There are only a small number of clinical scenarios where published evidence suggests that mHealth apps may improve patient outcomes.
  • Book chapter
    Rivière C, Harman C, Logishetty K, Van Der Straeten Cet al., 2020,

    Hip replacement: Its development and future

    , Personalized Hip and Knee Joint Replacement, Pages: 23-32

    There have been significant developments since the first attempts to treat degenerated hips with tissue interpositional arthroplasty (with materials such as fascia lata and pig’s bladder) or hemi-resurfacing using glass molds by Smith-Peterson in 1937 [1]. While the first total hip replacement has been attributed to Wiles in 1938, it was considered a failure-its success and widespread adoption only occurred in the 1960s when Sir John Charnley introduced “low-friction arthroplasty” using acrylic cement for fixation. This early age of hip arthroplasty has been followed by decades of incremental development directed at reducing failure (including that related to loosening, instability, implant wear, and osteolysis) while accommodating the high-activity profile and increased longevity of the modern patient [1].
  • Book chapter
    Aframian A, Iranpour F, Cobb J, 2020,

    Medical devices and artificial intelligence

    , Artificial Intelligence in Healthcare, Pages: 163-177

    There is near infinite potential for artificial intelligence (AI) in medical devices, with almost all current technologies having the potential for improvement using AI. We discuss here some examples of how it is already being used and we have divided these into physical hardware devices and software or virtual devices, in part because they are different and also because the regulatory requirements vary for different medical devices. These devices have in turn been divided into community and specialist center (such as hospital) uses to provide context. The increasing use of medical devices has led to the need for new regulations in both Europe and worldwide and these too are discussed.

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