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Conference paperKaufmann J, Phillips A, McGregor A, 2019,
Investigating bone health in lower-limb amputees
, TGCS 2019 - 17th International Symposium on Computer Simulation in Biomechanics -
Conference paperFormstone L, Pucek M, Wilson S, et al., 2019,
Myographic Information Enables Hand Function Classification in Automated Fugl-Meyer Assessment
, 9th IEEE/EMBS International Conference on Neural Engineering (NER), Publisher: IEEE, Pages: 239-242, ISSN: 1948-3546 -
Journal articleRane L, Ding Z, McGregor AH, et al., 2019,
Deep learning for musculoskeletal force prediction
, Annals of Biomedical Engineering, Vol: 47, Pages: 778-789, ISSN: 0090-6964Musculoskeletal models permit the determination of internal forces acting during dynamic movement, which is clinically useful, but traditional methods may suffer from slowness and a need for extensive input data. Recently, there has been interest in the use of supervised learning to build approximate models for computationally demanding processes, with benefits in speed and flexibility. Here, we use a deep neural network to learn the mapping from movement space to muscle space. Trained on a set of kinematic, kinetic and electromyographic measurements from 156 subjects during gait, the network’s predictions of internal force magnitudes show good concordance with those derived by musculoskeletal modelling. In a separate set of experiments, training on data from the most widely known benchmarks of modelling performance, the international Grand Challenge competitions, generates predictions that better those of the winning submissions in four of the six competitions. Computational speedup facilitates incorporation into a lab-based system permitting real-time estimation of forces, and interrogation of the trained neural networks provides novel insights into population-level relationships between kinematic and kinetic factors.
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Journal articleStevenson H, Jaggard M, Akhbari P, et al., 2019,
The role of denatured synovial fluid proteins in the lubrication of artificial joints
, Biotribology, Vol: 17, Pages: 49-63, ISSN: 2352-5738CoCrMo ball-on-flat wear tests were carried out with 25 wt% bovine calf serum (25BCS) and human synovial fluid (HSF) to investigate artificial joint lubricating mechanisms. Post-test the wear scar on the disc was measured and surface deposits in and around the rubbed region were analysed by Micro InfraRed Reflection Absorption Spectroscopy (Micro-IRRAS). In most tests the HSF samples gave higher wear than the 25BCS solution; in some cases, up to 77%. After rinsing a similar pattern of surface deposits was observed in and around the wear scar for both the model and HSF. Micro-IRRAS showed the deposits were primarily denatured proteins with an increased β-sheet content. In some cases, trans-alkyl chain/carbonyl components were also present and these were assigned to lipids. Thioflavin T fluorescent imaging also indicated aggregated non-native β-sheet fibrils were present in the deposits and their presence was associated with lower wear. The formation of insoluble, denatured protein films is thought to be the primary lubrication mechanism contributing to surface protection during rubbing. From this and earlier work we suggest inlet shear induces denaturing of proteins resulting in the formation of non-native β-sheet aggregates. This material is entrained into the contact region where it forms the lubricating film. Patient synovial fluid chemistry appears to influence wear, at least in the bench test, and thus could contributes to increased risk of failure, or success, with metal-metal hips. Finally using 25BCS as a reference screening fluid gives an overly optimistic view of wear in these systems.
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Journal articleCowell I, O'Sullivan P, O'Sullivan K, et al., 2019,
The Perspectives of physiotherapists on managing non-specific low back pain following a training programme in Cognitive Functional Therapy: a qualitative study
, Musculoskeletal Care, Vol: 17, Pages: 79-90, ISSN: 1478-2189Background: It has long been acknowledged that nonspecific chronic low back pain (NSCLBP) is associated with a complex combination of biopsychosocial (BPS) factors, and recent guidelines advocate that the management of back pain should reflect this multidimensional complexity. Cognitive functional therapy (CFT) is a behaviourally oriented intervention that targets patients' individual BPS profiles. Although the efficacy of CFT has been demonstrated in primary care, little evidence exists about the training requirements of this approach.Methods: Qualitative semistructured interviews were conducted with 10 physiotherapists working in primary care, who had undergone a formal training programme in CFT. A purposive sampling method was employed to seek the broadest perspectives. Thematic analysis was used to analyse the interview transcripts and capture the emergent themes.Results: Five main themes emerged: (i) the learning challenge; (ii) self‐reported changes in confidence; (iii) self‐reported changes in communication practice; (iv) self‐reported changes in attitudes and understanding; (v) the physiotherapists felt that CFT was more effective than their usual approach for NSCLBP but identified barriers to successful implementation, which included a lack of time and difficulties in engaging patients with strong biomedical beliefs.Conclusions: The study suggested that training in CFT has the capacity to produce self‐reported changes in physiotherapists' attitudes, confidence and practice. The provision of such training has implications in terms of time and costs; however, this this may be warranted, given the physiotherapists' strong allegiance to the approach compared with their usual practice.
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Journal articleOosthuizen CR, Takahashi T, Rogan DM, et al., 2019,
The Knee Osteoarthritis Grading System (KOGS) for arthroplasty
, The Journal of Arthroplasty, Vol: 34, Pages: 450-455, ISSN: 0883-5403BackgroundThe aim of this study is to validate the Knee Osteoarthritis Grading system (KOGS) of progressive osteoarthritic (OA) degeneration for the Tri-compartmental knee. This system defines the site and severity of OA to determine a specific knee replacement.MethodsThe radiographic sequence for KOGS includes standing coronal (antero-posterior), lateral, 30° skyline patella, 15° and 45° Rosenberg and stress views in 20° of flexion.Cohen’s Kappa and related agreement statistical methods were used to assess the level of concordance of the seven evaluators between A and B cohorts for each evaluator and also against the actual arthroplasty used. Sensitivity and specificity was also assessed for the KOGS in identifying true partial knee replacements (PKR) and total knee replacements (TKR) as decided from the cohort A evaluations.ResultsFrom a cohort of 330 patients who were included in the study, 71 (22.5%) underwent a TKR procedure, 258 (78.2%) a PKR and 1 (0.3%) was neither a TKR nor PKR. KOGS was able to identify true PKRs (sensitivity) in the range of 92.2% to 98.5% across all the different evaluators. The KOGS method was able to identify a PKR or a TKR with an accuracy ranging from 92% to 98.8% across all different evaluators.The surgical results after 20 months are at least comparable with the expected average in the academic literature.ConclusionThe KOGS classification provides a reliable and accurate tool to assess suitability of an individual patient for undergoing partial or total knee replacement.
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BookSugand K, Berry M, Yusuf I, et al., 2019,
Oxford Handbook for Medical School
, Publisher: Oxford University Press, USA, ISBN: 9780199681907This handbook includes quick-access summaries covering the crucial information for your preclinical years and for each clinical specialty.
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Conference paperKaufmann J, Phillips A, McGregor A, 2019,
Investigating bone health in lower-limb amputees
, ISB/ASB 2019 -
Journal articleJones GG, Clarke S, Jaere M, et al., 2019,
Failed high tibial osteotomy: A joint preserving alternative to total knee arthroplasty
, Orthopaedics and Traumatology: Surgery and Research, Vol: 105, Pages: 85-88, ISSN: 1877-0568High tibial osteotomy is an attractive treatment option for young active patients wishing to return to high-level activities. However, it is not considered a long-term solution, with 30% revised at ten years. Currently, the only revision option is a total knee arthroplasty, a procedure that might not deliver the functional level expected by these highly active patients. This paper describes a novel joint preserving approach to HTO revision, using assistive technology, in the form of 3D printed guides, to reverse the osteotomy and simultaneously perform a unicompartmental knee replacement. The indications and planning aims for this procedure are discussed, and the preliminary results in four patients presented.
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Journal articleJones GG, Clarke S, Jaere M, et al., 2019,
Prothèse unicompartimentaire et désostéotomie pour échec d’ostéotomie tibiale : une alternative chirurgicale à l’arthroplastie totale de genouFailed high tibial osteotomy: A joint preserving alternative to total knee arthroplasty
, Revue de Chirurgie Orthopedique et Traumatologique, Vol: 105, Pages: 41-41, ISSN: 1877-0517High tibial osteotomy is an attractive treatment option for young active patients wishing to return to high level activities. However, it is not considered a long-term solution, with 30% revised at ten years. Currently, the only revision option is a total knee arthroplasty, a procedure that might not deliver the functional level expected by these highly active patients. This paper describes a novel joint preserving approach to HTO revision, using assistive technology, in the form of 3D printed guides, to reverse the osteotomy and simultaneously perform a unicompartmental knee replacement. The indications and planning aims for this procedure are discussed, and the preliminary results in four patients presented. Level of evidence: IV.
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Journal articleReznikov N, Boughton OR, Ghouse S, et al., 2019,
Individual response variations in scaffold-guided bone regeneration are determined by independent strain- and injury-induced mechanisms
, BIOMATERIALS, Vol: 194, Pages: 183-194, ISSN: 0142-9612- Cite
- Citations: 49
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Journal articleRiyiere C, Harman C, Leong A, et al., 2019,
Kinematic alignment technique for medial OXFORD UKA: An in-silico study
, ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, Vol: 105, Pages: 63-70, ISSN: 1877-0568- Author Web Link
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- Citations: 13
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Journal articleSperry MM, Phillips ATM, McGregor AH, 2019,
Lower back pain and healthy subjects exhibit distinct lower limb perturbation response strategies: a preliminary study
, Journal of Back and Musculoskeletal Rehabilitation, Vol: 32, Pages: 27-35, ISSN: 1053-8127BACKGROUND: It is hypothesized that inherent differences in movement strategies exist between control subjects and those with a history of lower back pain (LBP). Previous motion analysis studies focus primarily on tracking spinal movements, neglecting the connection between the lower limbs and spinal function. Lack of knowledge surrounding the functional implications of LBP may explain the diversity in success from general treatments currently offered to LBP patients. OBJECTIVE: This pilot study evaluated the response of healthy controls and individuals with a history of LBP (hLBP) to a postural disturbance. METHODS: Volunteers (n= 26) were asked to maintain standing balance in response to repeated balance disturbances delivered via a perturbation platform while both kinematic and electromyographic data were recorded from the trunk, pelvis, and lower limb. RESULTS: The healthy cohort utilized an upper body-focused strategy for balance control, with substantial activation of the external oblique muscles. The hLBP cohort implemented a lower limb-focused strategy, relying on activation of the semitendinosus and soleus muscles. No significant differences in joint range of motion were identified. CONCLUSIONS: These findings suggest that particular reactive movement patterns may indicate muscular deficits in subjects with hLBP. Identification of these deficits may aid in developing specific rehabilitation programs to prevent future LBP recurrence.
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Journal articleWang H, Sugand K, Newman S, et al., 2019,
Are multiple views superior to a single view when teaching hip surgery? A single-blinded randomized controlled trial of technical skill acquisition
, PLoS ONE, Vol: 14, ISSN: 1932-6203s Metrics Comments Media Coverage Abstract Introduction Materials and methods Results Discussion Conclusion Supporting information References Reader Comments (0) Media Coverage (0) FiguresAbstractPurposeSurgical education videos currently all use a single point of view (POV) with the trainee locked onto a fixed viewpoint, which may not deliver sufficient information for complex procedures. We developed a novel multiple POV video system and evaluated its training outcome compared with traditional single POV.MethodsWe filmed a hip resurfacing procedure performed by an expert attending using 8 cameras in theatre. 30 medical students were randomly and equally allocated to learn the procedure using the multiple POV (experiment group [EG]) versus single POV system (control group [CG]). Participants advanced a pin into the femoral head as demonstrated in the video. We measured the drilling trajectories and compared it with pre-operative plan to evaluate distance of the pin insertion and angular deviations. Two orthopedic attendings expertly evaluated the participants’ performance using a modified global rating scale (GRS). There was a pre-video knowledge test that was repeated post-simulation alongside a Likert-scale questionnaire.ResultsThe angular deviation of the pin in EG was significantly less by 29% compared to CG (p = 0.037), with no significant difference in the entry point’s distance between groups (p = 0.204). The GRS scores for EG were 3.5% higher than CG (p = 0.046). There was a 32% higher overall knowledge test score (p<0.001) and 21% improved Likert-scale questionnaire score (p = 0.002) after video-learning in EG than CG, albeit no significant difference in the knowledge test score before video-learning (p = 0.721).ConclusionThe novel multiple POV provided significant objective and subjective advantages over single POV for acquisition of technical skills in hip surgery.
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Journal articleDoyle R, Boughton O, Plant D, et al., 2019,
An in vitro model of impaction during hip arthroplasty
, JOURNAL OF BIOMECHANICS, Vol: 82, Pages: 220-227, ISSN: 0021-9290- Cite
- Citations: 8
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Book chapterLiddle AD, Rodríguez-Merchán EC, 2019,
Patellofemoral Instability: Lateral Release
, Disorders of the Patellofemoral Joint Diagnosis and Management, Pages: 89-94Lateral retinacular release has historically been a popular procedure for the treatment of recurrent patellar instability in adolescents and adults. However, as our understanding of the anatomy, physiology and pathology of patellar instability has increased, it has fallen out of favour. Current management of patellar instability has focused on treating the pathoanatomy involved, in an approach individualized to the patient. Currently, lateral release is used as an adjunct to other surgical procedures for instability, with other indications including isolated retinacular pain or symptomatic bipartite patella. In this chapter, the techniques, indications, results and complications of lateral release are discussed.
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Book chapterRodríguez-Merchán EC, Encinas-Ullán CA, Liddle AD, 2019,
Risk Factors and Demographics for Recurrent Lateral Dislocation of the Patella in Adults
, Disorders of the Patellofemoral Joint Diagnosis and Management, Pages: 59-65The management of acute dislocation of the patella is focused on the avoidance of long term instability. In the absence of surgery, around one third of the up to 77 traumatic knee dislocations which occur per 100, 000 persons per year go on to chronic instability. Predictors include demographic factors (most importantly, the youth of the patient) and morphological factors. Those who go on to chronic instability generally have at least two morphological risk factors; the most important of these are trochlear dysplasia, patella alta, increased tibial tubercle-trochlear groove distance and generalised malalignment or malrotation of the lower limb.
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BookRodríguez-Merchán EC, Liddle AD, 2019,
Disorders of the Patellofemoral Joint: Diagnosis and Management
This state-of-the-art book provides a comprehensive overview of the most common patellofemoral joint problems. Utilizing the latest evidence, it guides readers through prevention, diagnosis and treatment for both adult and paediatric patients. After discussing clinical examination and diagnosis, it explores topics such as acute and recurrent dislocation of the patella, cartilage defects of the joint, patellofemoral instability and patellofemoral osteoarthritis. The book also features a chapter on conservative strategies, including physical medicine and rehabilitation. Research is moving quickly in this field, and as such there is a growing need for consensus documents: written by leading experts, this comprehensive book is a valuable resource for orthopaedic surgeons, knee specialists and sports medicine ones, and is also of great interest to physiatrists, physical therapists and all healthcare workers involved in the care of these patients.
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Journal articleRodríguez-Merchán EC, Liddle AD, 2019,
Preface
, Disorders of the Patellofemoral Joint Diagnosis and Management, Pages: v-vi- Cite
- Citations: 1
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Book chapterIranpour F, Aframian A, Cobb JP, 2019,
Patellofemoral Osteoarthritis: Patellofemoral Arthroplasty
, Disorders of the Patellofemoral Joint Diagnosis and Management, Pages: 129-134Patellofemoral osteoarthritis is common in older people and those with risk factors including trochlear dysplasia and patellofemoral instability. Patellofemoral arthroplasty (PFA) is indicated in such patients and has the advantage of leaving the remaining structures of the knee intact, including the native tibiofemoral joint surfaces and cruciate ligaments. The design of PFA has evolved from inlay designs to onlay designs which are either symmetrical or asymmetrical, to match the native trochlea. Long-term survival of currently used implants is suboptimal, with the largest series of the most commonly used implant reporting a 10-year survival of 77.3% at 10 years, with most patients being revised for progression of disease. Improvements in our understanding of the indications for PFA together with improvements in the design of instruments and instrumentation have the potential to improve the survival of PFA in the future, allowing more people to benefit from the advantages it confers over total knee arthroplasty (TKA).
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