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  • Book chapter
    Rivière C, Harman C, Logishetty K, 2020,

    'À la carte’ joint replacement

    , Personalized Hip and Knee Joint Replacement, Pages: 343-350

    Hip and knee arthroplasties are life-changing procedures, reducing pain and restoring function after end-stage arthrosis. Almost 90% of patients who have undergone hip arthroplasty, and 82% after knee arthroplasty, report improvement in quality of life after surgery [1]; this leaves a significant number of dissatisfied patients. The modern surgeon can make decisions regarding surgical approach, implant design and component orientation. However, it is challenging to gain proficiency in a wide variety of surgical configurations. A smaller repertoire is technically and economically more feasible, and thus a one-size-fits-all approach is commonplace. Hip and knee arthroplasties are forgiving procedures, most frequently performed in older patients without high functional demands. The future arthroplasty surgeon is faced with new challenges-patients with higher demand, expectations and longer life expectancy, in addition to an increasing burden of revision surgery. Here, we discuss ‘a la carte’ joint replacement, which is both patient specific and bone/soft tissue conservative. It may improve overall satisfaction while conserving bone stock in the event of future revision surgery.
  • Journal article
    Akhbari P, Jaggard MK, Boulange CL, Vaghela U, Graca G, Bhattacharya R, Lindon JC, Williams HRT, Gupte CMet al., 2019,

    Differences in the composition of hip and knee synovial fluid in osteoarthritis: a nuclear magnetic resonance (NMR) spectroscopy study of metabolic profiles

    , OSTEOARTHRITIS AND CARTILAGE, Vol: 27, Pages: 1768-1777, ISSN: 1063-4584
  • Journal article
    Logishetty K, Rudran B, Cobb JP, 2019,

    Virtual reality training improves trainee performance in total hip arthroplasty: a randomized controlled trial

    , BONE & JOINT JOURNAL, Vol: 101B, Pages: 1585-1592, ISSN: 2049-4394
  • Journal article
    Jones G, Clarke S, Harris S, Jaere M, Thunayan A, de Klee P, Cobb Jet al., 2019,

    A novel patient-specific instrument design can deliver robotic level accuracy in unicompartmental knee arthroplasty

    , The Knee, Vol: 26, Pages: 1421-1428, ISSN: 0968-0160

    BackgroundA previous randomised controlled trial (RCT) by our group found that robotic assisted unicompartmental knee arthroplasty (UKA) surgery was significantly more accurate than conventional instrumentation. The aim of this study was to determine whether a low-cost novel PSI design could deliver the same level of accuracy as the robot in the same time efficient manner as conventional instruments.MethodsThirty patients undergoing medial UKA took part. Tibial component position was planned using a low dose CT-scan, and compared to a day 1 postoperative CT-scan to determine the difference between the planned and achieved positions. Operations were performed by one expert surgeon using PSI (Embody, London, UK).ResultsThe mean absolute difference between planned and achieved tibial implant positions using PSI was 2.0° (SD 1.0°) in the coronal plane, 1.8° (SD 1.5) in the sagittal plane, and 4.5° (SD 3.3) in the axial plane. These results were not significantly different to the 13 historical robotic cases (mean difference 0.5°, 0.5°, and 1.7°, p = 0.1907, 0.2867 and 0.1049 respectively). PSI mean operating time was on average 62 min shorter than the robotic group (p < 0.0001) and 40 min shorter than the conventional instrument group (p < 0.0001). No complications were reported.ConclusionsIn conclusion, this clinical trial demonstrates that for tibial component positioning in UKA, a novel design PSI guide in the hands of an expert surgeon, can safely deliver comparable accuracy to a robotic system, whilst being significantly faster than conventional instruments.NIHR Clinical Research Network Reference: 16100.
  • Journal article
    Wiik AV, Lambkin R, Cobb JP, 2019,

    Gait after Birmingham Hip Resurfacing

    , The Bone & Joint Journal, Vol: 101-B, Pages: 1423-1430, ISSN: 2049-4394

    The aim of this study was to assess the functional gain achieved following hip resurfacing arthroplasty (HRA).Patients and MethodsA total of 28 patients (23 male, five female; mean age, 56 years (25 to 73)) awaiting Birmingham HRA volunteered for this prospective gait study, with an age-matched control group of 26 healthy adults (16 male, ten female; mean age, 56 years (33 to 84)). The Oxford Hip Score (OHS) and gait analysis using an instrumented treadmill were used preoperatively and more than two years postoperatively to measure the functional change attributable to the intervention.ResultsThe mean OHS improved significantly from 27 to 46 points (p < 0.001) at a mean of 29 months (12 to 60) after HRA. The mean metal ion levels at a mean 32 months (13 to 60) postoperatively were 1.71 (0.77 to 4.83) µg/l (ppb) and 1.77 (0.68 to 4.16) µg/l (ppb) for cobalt and chromium, respectively. When compared with healthy controls, preoperative patients overloaded the contralateral good hip, limping significantly. After HRA, patients walked at high speeds, with symmetrical gait, statistically indistinguishable from healthy controls over almost all characteristics. The control group could only be distinguished by an increased push-off force at higher speeds, which may reflect the operative approach.ConclusionPatients undergoing HRA improved their preoperative gait pattern of a significant limp to a symmetrical gait at high speeds and on inclines, almost indistinguishable from normal controls. HRA with an approved device offers substantial functional gains, almost indistinguishable from healthy controls.
  • Journal article
    Davidson DJ, Spratt D, Liddle AD, 2019,

    Implant materials and prosthetic joint infection: the battle with the biofilm

    , EFORT Open Reviews, Vol: 4, ISSN: 2058-5241

    • Prosthetic joint infection (PJI) is associated with poor clinical outcomes and is expensive to treat.• Although uncommon overall (affecting between 0.5% and 2.2% of cases), PJI is one of the most commonly encountered complications of joint replacement and its incidence is increasing, putting a significant burden on healthcare systems.• Once established, PJI is extremely difficult to eradicate as bacteria exist in biofilms which protect them from antibiotics and the host immune response.• Improved understanding of the microbial pathology in PJI has generated potential new treatment strategies for prevention and eradication of biofilm associated infection including modification of implant surfaces to prevent adhesion of bacteria.• Much research is currently ongoing looking at different implant surface coatings and modifications, and although most of this work has not translated into clinical medicine there has been some early clinical success.
  • Journal article
    Wiik A, Lambkin R, Cobb JP, 2019,

    Gait after Birmingham hip resurfacing an age-matched controlled prospective study

    , Bone and Joint Journal, Vol: 101B, Pages: 1423-1430, ISSN: 2049-4394

    AimsThe aim of this study was to assess the functional gain achieved following hip resurfacing arthroplasty (HRA).Patients and MethodsA total of 28 patients (23 male, five female; mean age, 56 years (25 to 73)) awaiting Birmingham HRA volunteered for this prospective gait study, with an age-matched control group of 26 healthy adults (16 male, ten female; mean age, 56 years (33 to 84)). The Oxford Hip Score (OHS) and gait analysis using an instrumented treadmill were used preoperatively and more than two years postoperatively to measure the functional change attributable to the intervention.ResultsThe mean OHS improved significantly from 27 to 46 points (p < 0.001) at a mean of 29 months (12 to 60) after HRA. The mean metal ion levels at a mean 32 months (13 to 60) postoperatively were 1.71 (0.77 to 4.83) µg/l (ppb) and 1.77 (0.68 to 4.16) µg/l (ppb) for cobalt and chromium, respectively. When compared with healthy controls, preoperative patients overloaded the contralateral good hip, limping significantly. After HRA, patients walked at high speeds, with symmetrical gait, statistically indistinguishable from healthy controls over almost all characteristics. The control group could only be distinguished by an increased push-off force at higher speeds, which may reflect the operative approach.ConclusionPatients undergoing HRA improved their preoperative gait pattern of a significant limp to a symmetrical gait at high speeds and on inclines, almost indistinguishable from normal controls. HRA with an approved device offers substantial functional gains, almost indistinguishable from healthy controls.
  • Journal article
    Favier C, Deane J, McGregor A, Phillips Aet al., 2019,

    Design and preliminary testing of a low-cost balance perturbation system for the evaluation of real life postural adjustment on public transport

    , Journal of Medical Engineering and Technology, Vol: 43, Pages: 356-362, ISSN: 0309-1902

    Balance recovery mechanisms are of paramount importance in situations like public transport where sudden loss of equilibrium can occur. These mechanisms can be altered by aging or pathological disorders. However it is almost impossible to investigate these phenomena in real-life conditions, and the safe environment of a laboratory is needed. This paper investigates how jerk perturbations in the transverse plane similar to those experienced on public transport can be simulated in a controlled manner. A platform capable of producing horizontal perturbations with a person standing on it was developed. Accuracy, repeatability, and load sensitivity of the system were assessed with repeated trials in all four directions of movement. Comparison between the destabilising effect experienced on public transport and the postural response to perturbations from the platform was also made by tracking acceleration of the centre of mass of four subjects in these two situations. Results show that balance perturbations representative of real-life situations, such as standing on public transport, can accurately and repeatedly be produced in a safe and controlled environment with a low-cost and low-maintenance system. Coupled to motion capture technology, the system can be used for pathology assessment and rehabilitation treatments.
  • Journal article
    To M, Strutton P, Alexander C, 2019,

    Central fatigue is greater than peripheral fatigue in people with Joint Hypermobility Syndrome

    , Journal of Electromyography and Kinesiology, Vol: 48, Pages: 197-204, ISSN: 1050-6411

    Purpose: People with Joint Hypermobility Syndrome (JHS) suffer with fatigue. The purpose of this project was to investigate the contribution of central and peripheral fatigue.Methods: Electrical stimulation of the musculocutaneous nerve to biceps brachii, and transcranial magnetic stimulation over the motor cortex supplying biceps brachii were used. Peripheral and central fatigue were assessed during a control, fatiguing and recovery phase protocol. Results: JHS participants perceived greater fatigue during the protocol compared to a control group and did not recover. Central and peripheral fatigue did not occur in the control group. However, the JHS group showed central fatigue. MEP amplitude increased in the JHS group during the fatiguing protocol (p<0.01) before recovering. Superimposed twitch amplitude increased in the JHS group during the fatiguing protocol and stayed elevated during the recovery phase (p<0.04). Time to peak (TTP) amplitude of the torque generated by the TMS was longer in the JHS group (p<0.05). RMS during MVCs decreased during the fatiguing protocol reaching significance during the recovery phase (p<0.01).Conclusion: JHS participants suffered central but not peripheral fatigue. A modified strength programme to target this is discussed.
  • Journal article
    Al-Ani A, Bence M, Liddle AD, Ferris Bet al., 2019,

    Admission and treatment at a weekend is not associated with worse outcomes for patients admitted with fractured neck of femur

    , Trauma, Pages: 146040861878592-146040861878592, ISSN: 1460-4086
  • Journal article
    Logishetty K, Gofton WT, Rudran B, Beaulé PE, Gupte CM, Cobb JPet al., 2019,

    A Multicenter Randomized Controlled Trial Evaluating the Effectiveness of Cognitive Training for Anterior Approach Total Hip Arthroplasty.

    , J Bone Joint Surg Am

    BACKGROUND: For total hip arthroplasty (THA), cognitive training prior to performing real surgery may be an effective adjunct alongside simulation to shorten the learning curve. This study sought to create a cognitive training tool (CTT) to perform anterior approach (AA)-THA, which was validated by expert surgeons, and test its use as a training tool compared with conventional material. METHODS: We employed a modified Delphi method with 4 expert surgeons from 3 international centers of excellence. Surgeons were independently observed performing THA before undergoing semistructured cognitive task analysis (CTA) and before completing successive rounds of surveys until a consensus was reached. Thirty-six surgical residents (postgraduate year [PGY]-1 through PGY-4) were randomized to cognitive training or training with a standard operation manual with surgical videos before performing a simulated AA-THA. RESULTS: The consensus CTA defined THA in 11 phases, in which were embedded 46 basic steps, 36 decision points, and 42 critical errors and linked strategies. This CTA was mapped onto an open-access web-based CTT. Surgeons who prepared with the CTT performed a simulated THA 35% more quickly (time, mean 28 versus 38 minutes) with 69% fewer errors in instrument selection (mean 29 versus 49 instances), and required 92% fewer prompts (mean 13 versus 25 instances). They were more accurate in acetabular cup orientation (inclination error, mean 8° versus 10°; anteversion error, mean 14° versus 22°). CONCLUSIONS: This validated CTT for arthroplasty provides structure for competency-based learning. It is more effective at preparing orthopaedic trainees for a complex procedure than conventional materials, as well as for learning sequence, instrumentation utilization, and motor skills. CLINICAL RELEVANCE: Cognitive training combines education on decision-making, knowledge, and technical skill. It is an inexpensive technique to teach surgeons to perform hip arthropla
  • Journal article
    Wilson S, Eberle H, Hayashi Y, Madgwick SOH, McGregor A, Jing X, Vaidyanathan Ret al., 2019,

    Formulation of a new gradient descent MARG orientation algorithm: case study on robot teleoperation

    , Mechanical Systems and Signal Processing, Vol: 130, Pages: 183-200, ISSN: 0888-3270

    We introduce a novel magnetic angular rate gravity (MARG) sensor fusion algorithm for inertial measurement. The new algorithm improves the popular gradient descent (ʻMadgwick’) algorithm increasing accuracy and robustness while preserving computational efficiency. Analytic and experimental results demonstrate faster convergence for multiple variations of the algorithm through changing magnetic inclination. Furthermore, decoupling of magnetic field variance from roll and pitch estimation is proven for enhanced robustness. The algorithm is validated in a human-machine interface (HMI) case study. The case study involves hardware implementation for wearable robot teleoperation in both Virtual Reality (VR) and in real-time on a 14 degree-of-freedom (DoF) humanoid robot. The experiment fuses inertial (movement) and mechanomyography (MMG) muscle sensing to control robot arm movement and grasp simultaneously, demonstrating algorithm efficacy and capacity to interface with other physiological sensors. To our knowledge, this is the first such formulation and the first fusion of inertial measurement and MMG in HMI. We believe the new algorithm holds the potential to impact a very wide range of inertial measurement applications where full orientation necessary. Physiological sensor synthesis and hardware interface further provides a foundation for robotic teleoperation systems with necessary robustness for use in the field.
  • Journal article
    Riviere C, Harman C, Parsons T, Villet L, Cobb J, Maillot Cet al., 2019,

    Kinematic alignment versus conventional techniques for total hip arthroplasty: A retrospective case control study

    , ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, Vol: 105, Pages: 895-905, ISSN: 1877-0568
  • Journal article
    Maillot C, Harman C, Villet L, Cobb J, Riviere Cet al., 2019,

    Modern cup alignment techniques in total hip arthroplasty: A systematic review

    , ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, Vol: 105, Pages: 907-913, ISSN: 1877-0568
  • Journal article
    Kent P, O'Sullivan P, Smith A, Haines T, Campbell A, McGregor AH, Hartvigsen J, O'Sullivan K, Vickery A, Caneiro JP, Schütze R, Laird RA, Attwell S, Hancock Met al., 2019,

    RESTORE-Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain: study protocol for a randomised controlled trial.

    , BMJ Open, Vol: 9, Pages: 1-11, ISSN: 2044-6055

    INTRODUCTION: Low back pain (LBP) is the leading cause of disability globally and its costs exceed those of cancer and diabetes combined. Recent evidence suggests that individualised cognitive and movement rehabilitation combined with lifestyle advice (cognitive functional therapy (CFT)) may produce larger and more sustained effects than traditional approaches, and movement sensor biofeedback may enhance outcomes. Therefore, this three-arm randomised controlled trial (RCT) aims to compare the clinical effectiveness and economic efficiency of individualised CFT delivered with or without movement sensor biofeedback, with usual care for patients with chronic, disabling LBP. METHODS AND ANALYSIS: Pragmatic, three-arm, randomised, parallel group, superiority RCT comparing usual care (n=164) with CFT (n=164) and CFT-plus-movement-sensor-biofeedback (n=164). Inclusion criteria include: adults with a current episode of LBP >3 months; sought primary care ≥6 weeks ago for this episode of LBP; average LBP intensity of ≥4 (0-10 scale); at least moderate pain-related interference with work or daily activities. The CFT-only and CFT-plus-movement-sensor-biofeedback participants will receive seven treatment sessions over 12 weeks plus a 'booster' session at 26 weeks. All participants will be assessed at baseline, 3, 6, 13, 26, 40 and 52 weeks. The primary outcome is pain-related physical activity limitation (Roland Morris Disability Questionnaire). Linear mixed models will be used to assess the effect of treatment on physical activity limitation across all time points, with the primary comparison being a formal test of adjusted mean differences between groups at 13 weeks. For the economic (cost-utility) analysis, the primary outcome of clinical effect will be quality-adjusted life years measured across the 12-month follow-up using the EuroQol EQ-5D-5L . ETHICS AND DISSEMINATION: Approved by Curtin University Human Research Ethics Committee (HRE2018-0062, 6 Feb 2018). Study
  • Journal article
    Cowell I, McGregor A, O'Sullivan P, O'Sullivan K, Poyton R, Murtagh GMet al., 2019,

    How do physiotherapists solicit and explore patients' concerns in back pain consultations: a conversation analytic approach

    , Physiotherapy Theory and Practice, Vol: 37, Pages: 693-709, ISSN: 1532-5040

    Background: Guidelines advocate that non-specific chronic low back pain (NSCLBP) be considered within a multi-dimensional bio-psychosocial (BPS) framework. This BPS approach advocates incorporating the patient’s perspective as part of the treatment process. ‘Agenda setting’ has been introduced as the key to understanding patients’ concerns in medical encounters; however, this has received little attention in physiotherapy. This study explored how physiotherapists solicit and respond to the agenda of concerns that patients’ with NSCLBP bring to initial encounters. Method: The research setting was primary care. Twenty initial physiotherapy consultations were video-recorded, transcribed and analysed using conversation analysis, a qualitative observational method. Both verbal and non-verbal features of the interaction were considered. Results: This data highlights a spectrum of communication styles ranging from more physiotherapist-focused, where the physiotherapists did not attend to patients’ concerns, to a more patient-focused style, which provided greater opportunities for patients to voice their concerns. On occasions patients were willing to pursue their own agenda when their concern was initially overlooked. Conclusion: This study provides empirical evidence on communication patterns in physiotherapy practice. A more collaborative style of communication with a shared conversational agenda provided patients with the conversational space to describe their concerns more fully.
  • Journal article
    Garner A, van Arkel RJ, Cobb J, 2019,

    Classification of combined partial knee arthroplasty

    , Bone and Joint Journal, Vol: 101B, Pages: 922-928, ISSN: 2049-4394

    AimsThere has been a recent resurgence in interest in combined partial knee arthroplasty (PKA) as an alternative to total knee arthroplasty (TKA). The varied terminology used to describe these procedures leads to confusion and ambiguity in communication between surgeons, allied health professionals, and patients. A standardized classification system is required for patient safety, accurate clinical record-keeping, clear communication, correct coding for appropriate remuneration, and joint registry data collection.Materials and MethodsAn advanced PubMed search was conducted, using medical subject headings (MeSH) to identify terms and abbreviations used to describe knee arthroplasty procedures. The search related to TKA, unicompartmental (UKA), patellofemoral (PFA), and combined PKA procedures. Surveys were conducted of orthopaedic surgeons, trainees, and biomechanical engineers, who were asked which of the descriptive terms and abbreviations identified from the literature search they found most intuitive and appropriate to describe each procedure. The results were used to determine a popular consensus.ResultsSurvey participants preferred “bi-unicondylar arthroplasty” (Bi-UKA) to describe ipsilateral medial and lateral unicompartmental arthroplasty; “medial bi-compartmental arthroplasty” (BCA-M) to describe ipsilateral medial unicompartmental arthroplasty with patellofemoral arthroplasty; “lateral bi-compartmental arthroplasty” (BCA-L) to describe ipsilateral lateral unicompartmental arthroplasty with patellofemoral arthroplasty; and tri-compartmental arthroplasty (TCA) to describe ipsilateral patellofemoral and medial and lateral unicompartmental arthroplasties. “Combined partial knee arthroplasty” (CPKA) was the favoured umbrella term.ConclusionWe recommend bi-unicondylar arthroplasty (Bi-UKA), medial bicompartmental arthroplasty (BCA-M), lateral bicompartmental arthroplasty (BCA-L), and tricompartmental arthroplasty (
  • Journal article
    Koo K, Liddle AD, Pastides PS, Rosenfeld PFet al., 2019,

    The Salto total ankle arthroplasty - clinical and radiological outcomes at five years

    , Foot and Ankle Surgery, Vol: 25, Pages: 523-528, ISSN: 1268-7731

    BACKGROUND: Modern designs of total ankle arthroplasty (TAA) have the potential to treat symptomatic ankle OA without adversely affecting ankle biomechanics. We present the mid-term results of a modern, mobile-bearing TAA design. METHODS: TAA was performed in 50 consecutive patients (55 ankles) in an independent, prospective, single-centre series. Implant survival, patient-reported outcome measures (PROMs) and radiographic outcomes are presented at a mean of five years (range 2-10.5years). RESULTS: A total of three patients (four ankles) died and two (two ankles) were lost to follow-up. Three TAAs were revised for aseptic loosening (in two cases) or infection. Two further patients underwent reoperations, one for arthroscopic debridement of anterolateral synovitis and one for grafting of an asymptomatic tibial cyst. With all-cause revision as an endpoint, implant survival was 93.3% at five to ten years (95% CI 80.5%-97.8%). If reoperations are included this falls to 90.2% (95% CI 75.6%-96.3%) at five years. No other patient demonstrated radiographic evidence of loosening or subsidence. PROMs and satisfaction were excellent at latest follow-up. CONCLUSION: At five years, the outcomes for this design of TAA in this series were excellent, and were similar to those of previously published series from the designer centre.
  • Conference paper
    Favier C, McGregor A, Phillips A, 2019,

    Subject specific multiscale modelling for the study of lumbar pathologies

    , 17th International symposium on computer simulation in biomechanics, Publisher: International Society of Biomechanics
  • Journal article
    Babu S, Gupte C, Gajjar S, Morris Het al., 2019,

    The 'sentinel' vessel: an anatomical landmark to identify the pes anserinus during hamstrings harvest for ACL reconstruction

    , EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY, Vol: 29, Pages: 1115-1118, ISSN: 1633-8065

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