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Book chapterRodríguez-Merchán EC, Liddle AD, 2019,
Patellofemoral Osteoarthritis: Partial Lateral Patellar Facetectomy
, Disorders of the Patellofemoral Joint Diagnosis and Management, Pages: 123-127Partial lateral facetectomy is a relatively easy and efficacious surgical treatment for middle-aged to elderly active patients with isolated lateral patellofemoral osteoarthritis (OA) who require pain relief and maintenance of level of activity but who wish to avoid arthroplasty. It can be performed arthroscopically or open. The indications are isolated patellofemoral OA in patients with an overhanging lateral facet of the patella with anterolateral knee pain and lack of response to conservative treatment. A satisfactory outcome after lateral patellar facetectomy for isolated patellofemoral OA can be foreseen in about half of the cases at 10 years follow-up; patellofemoral arthroplasty (PFA) or total knee arthroplasty (TKA) may be performed with no special considerations in patients who do not achieve adequate pain relief following partial lateral facetectomy.
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Journal articlePapi E, Bull A, McGregor A, 2019,
Spinal segments do not move together predictably during daily activities
, Gait and Posture, Vol: 67, Pages: 277-283, ISSN: 0966-6362Background: Considering the thoracic, lumbar spine or whole spine as rigid segments has been the norm until recent studies highlighted the importance of more detailed modelling. A better understanding of the requirement for spine multi-segmental analysis could guide planning of future studies and avoid missing clinically-relevant information.Research question: This study aims to assess the correlation between adjacent spine segments movement thereby evaluating segmental redundancy in both healthy and participants with low back pain (LBP).Methods: A 3D motion capture system tracked the movement of upper and lower thoracic and lumbar spine segments in twenty healthy and twenty participants with LBP. Tasks performed included walking, sit-to-stand and lifting, repeated 3 times. 3D angular kinematics were calculated for each spine segment. Segmental redundancy was evaluated through cross-correlation (Rxy) analysis of kinematics time series and correlation of range of motion (RROM) of adjacent spine segments.Results: The upper/lower lumbar pairing showed weak correlations in the LBP group for all tasks and anatomical planes (Rxyrange:0.02–0.36) but moderate and strong correlations during walking (Rxy _frontalplane:0.4) and lifting (Rxy _sagittalplane:0.64) in the healthy group. The lower thoracic/upper lumbar pairing had weak correlations for both groups during lifting and sit-to-stand in the frontal plane and for walking (Rxy:0.01) in the sagittal plane only. The upper/lower thoracic pairing had moderate correlations during sit-to-stand in sagittal and transverse plane in patients with LBP (Rxy _sagittalplane:0.41; Rxy _transverse plane:−0.42) but weak in healthy (Rxy _sagittalplane:0.23; Rxy _transverseplane:−0.34); the contrary was observed during lifting.The majority of RROM values (55/72) demonstrated weak correlations.Significance:The results suggest that multi-segmental analysis of the spine is necessary if spine movement characteristics are to be
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Journal articleMaillot C, Leong A, Harman C, et al., 2019,
Poor relationship between frontal tibiofemoral and trochlear anatomic parameters: Implications for designing a trochlea for kinematic alignment
, KNEE, Vol: 26, Pages: 106-114, ISSN: 0968-0160- Author Web Link
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- Citations: 7
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Journal articleBhattacharyya R, Davidson DJ, Sugand K, et al., 2018,
Knee Arthroscopy: A Simulation Demonstrating the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool.
, JBJS Essent Surg Tech, Vol: 8, Pages: e32-e32, ISSN: 2160-2204Background: Virtual reality and cadaveric simulations are expensive and not readily accessible1. Innovative and accessible training adjuncts are required to help meet training needs. Cognitive task analysis (CTA) has been used extensively to train pilots and surgeons in other surgical specialties2-6. However, the use of CTA tools within orthopaedics is in its infancy. Arthroscopic procedures are minimally invasive and require a different skill set compared with open surgery. Residents often feel poorly prepared to perform this in the operating room because of the steep learning curve associated with acquiring basic arthroscopic skills. We designed the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) tool, which is, to our knowledge, the first CTA tool described in the orthopaedic literature, demonstrating significant objective benefits in training novices to perform diagnostic knee arthroscopy. Description: The IKACTA tool, which is the combination of the written description of the phases below and the videos (with superimposed audio recordings) of each phase, utilizes simultaneous written and audiovisual modalities to teach diagnostic knee arthroscopy. The procedure was divided into 7 phases: (1) operating room and patient setup, (2) preparation and draping, (3) anterolateral portal placement, (4) examination of the patellofemoral joint and the lateral gutter, (5) examination of the medial compartment and anteromedial portal placement, (6) examination of the intercondylar notch and the lateral compartment, and (7) postoperative care and rehabilitation.For each phase, there are sections on the technical steps, cognitive decision-making behind each technical step, and potential errors and solutions. Video clips recorded by an expert surgeon in the operating room specific to each phase and audio voice recordings explaining each phase superimposed on the video clips were combined with the written information to design the IKACTA tool. Alternatives: Not applic
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Journal articleMullington CJ, Low DA, Strutton PH, et al., 2018,
Body temperature, cutaneous heat loss and skin blood flow during epidural anaesthesia for emergency caesarean section
, Anaesthesia, Vol: 73, Pages: 1500-1506, ISSN: 0003-2409It is not clear how converting epidural analgesia for labour to epidural anaesthesia for emergency caesarean section affects either cutaneous vasomotor tone or mean body temperature. We hypothesised that topping up a labour epidural blocks active cutaneous vasodilation (cutaneous heat loss and skin blood flow decrease), and that as a result mean body temperature increases. Twenty women in established labour had body temperature, cutaneous heat loss and skin blood flow recorded before and after epidural top‐up for emergency caesarean section. Changes over time were analysed with repeated measures ANOVA. Mean (SD) mean body temperature was 36.8 (0.5)°C at epidural top‐up and 36.9 (0.6)°C at delivery. Between epidural top‐up and delivery, the mean (SD) rate of increase in mean body temperature was 0.5 (0.5) °C.h−1. Following epidural top‐up, chest (p < 0.001) and forearm (p = 0.004) heat loss decreased, but head (p = 0.05), thigh (p = 0.79) and calf (p = 1.00) heat loss did not change. The mean (SD) decrease in heat loss was 15 (19) % (p < 0.001). Neither arm (p = 0.06) nor thigh (p = 0.10) skin blood flow changed following epidural top‐up. Despite the lack of change in skin blood flow, the most plausible explanation for the reduction in heat loss and the increase in mean body temperature is blockade of active cutaneous vasodilation. It is possible that a similar mechanism is responsible for the hyperthermia associated with labour epidural analgesia.
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Journal articleCowell I, O'Sullivan P, O'Sullivan K, et al., 2018,
Perceptions of physiotherapists towards the management of non-specific chronic low back pain from a biopsychosocial perspective: a qualitative study
, Musculoskeletal Science and Practice, Vol: 38, Pages: 113-119, ISSN: 2468-8630BackgroundPhysiotherapists have been urged to embrace a patient-oriented biopsychosocial (BPS) framework for the management of non-specific chronic low back pain (NSCLBP). However, recent evidence suggests that providing broader BPS interventions demonstrates small differences in pain or disability compared to usual care. Little is known about how to integrate a BPS model into physiotherapy practice and the challenges it presents.ObjectiveTo explore the perceptions of physiotherapists' in primary care in England adopting a BPS approach to managing NSCLBP patients.MethodQualitative semi-structured interviews were conducted with ten physiotherapists working in primary care. 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.ResultsThree main themes emerged: (1) physiotherapists recognised the multi-dimensional nature of NSCLBP and the need to manage the condition from a BPS perspective, (2) addressing psychological factors was viewed as challenging due to a lack of training and guidance, (3) engaging patients to self-manage their NSCLBP was seen as a key objective.ConclusionAlthough employing a BPS approach is recognised by physiotherapists in the management of NSCLBP, this study highlights the problems of implementing evidence based guidelines recommending that psychological factors be addressed but providing limited support for this. It also supports the need to allocate more time to explore these domains in distressed individuals. Engaging patients to self-manage was seen as a key objective, which was not a straightforward process, requiring careful negotiation.
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Journal articleRudran B, Logishetty K, 2018,
Virtual reality simulation: a paradigm shift for therapy and medical education
, BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 79, Pages: 666-667, ISSN: 1750-8460- Author Web Link
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- Citations: 10
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Conference paperCourtney A, Harvey R, Abel R, et al., 2018,
CHANGES IN BONE TURNOVER MARKERS IN ADVANCED PROSTATE CANCER PATIENTS TREATED WITH LHRH AGONISTS AND TRANSDERMAL OESTRADIOL PATCHES
, Osteoporosis Conference, Publisher: SPRINGER LONDON LTD, Pages: 617-617, ISSN: 0937-941X -
Journal articleLogishetty K, Western L, Morgan R, et al., 2018,
Can an Augmented Reality Headset Improve Accuracy of Acetabular Cup Orientation in Simulated THA? A Randomized Trial.
, Clin Orthop Relat ResBACKGROUND: Accurate implant orientation reduces wear and increases stability in arthroplasty but is a technically demanding skill. Augmented reality (AR) headsets overlay digital information on top of the real world. We have developed an enhanced AR headset capable of tracking bony anatomy in relation to an implant, but it has not yet been assessed for its suitability as a training tool for implant orientation. QUESTIONS/PURPOSES: (1) In the setting of simulated THA performed by novices, does an AR headset improve the accuracy of acetabular component positioning compared with hands-on training by an expert surgeon? (2) What are trainees' perceptions of the AR headset in terms of realism of the task, acceptability of the technology, and its potential role for surgical training? METHODS: Twenty-four study participants (medical students in their final year of school, who were applying to surgery residency programs, and who had no prior arthroplasty experience) participated in a randomized simulation trial using an AR headset and a simulated THA. Participants were randomized to two groups completing four once-weekly sessions of baseline assessment, training, and reassessment. One group trained using AR (with live holographic orientation feedback) and the other received one-on-one training from a hip arthroplasty surgeon. Demographics and baseline performance in orienting an acetabular implant to six patient-specific values on the phantom pelvis were collected before training and were comparable. The orientation error in degrees between the planned and achieved orientations was measured and was not different between groups with the numbers available (surgeon group mean error ± SD 16° ± 7° versus AR 14° ± 7°; p = 0.22). Participants trained by AR also completed a validated posttraining questionnaire evaluating their experiences. RESULTS: During the four training sessions, participants using AR-guidance had smaller mean (± SD) e
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Journal articleJones GG, Logishetty K, Clarke S, et al., 2018,
Do patient-specific instruments (PSI) for UKA allow non-expert surgeons to achieve the same saw cut accuracy as expert surgeons?
, Archives of Orthopaedic and Trauma Surgery, Vol: 138, Pages: 1601-1608, ISSN: 0936-8051INTRODUCTION: High-volume unicompartmental knee arthroplasty (UKA) surgeons have lower revision rates, in part due to improved intra-operative component alignment. This study set out to determine whether PSI might allow non-expert surgeons to achieve the same level of accuracy as expert surgeons. MATERIALS AND METHODS: Thirty-four surgical trainees with no prior experience of UKA, and four high-volume UKA surgeons were asked to perform the tibial saw cuts for a medial UKA in a sawbone model using both conventional and patient-specific instrumentation (PSI) with the aim of achieving a specified pre-operative plan. Half the participants in each group started with conventional instrumentation, and half with PSI. CT scans of the 76 cut sawbones were then segmented and reliably orientated in space, before saw cut position in the sagittal, coronal and axial planes was measured, and compared to the pre-operative plan. RESULTS: The compound error (absolute error in the coronal, sagittal and axial planes combined) for experts using conventional instruments was significantly less than that of the trainees (11.6°±4.0° v 7.7° ±2.3º, p = 0.029). PSI improved trainee accuracy to the same level as experts using conventional instruments (compound error 5.5° ±3.4º v 7.7° ±2.3º, p = 0.396) and patient-specific instruments (compound error 5.5° ±3.4º v 7.3° ±4.1º, p = 0.3). PSI did not improve the accuracy of high-volume surgeons (p = 0.3). CONCLUSIONS: In a sawbone model, PSI allowed inexperienced surgeons to achieve more accurate saw cuts, equivalent to expert surgeons, and thus has the potential to reduce revision rates. The next test will be to determine whether these results can be replicated in a clinical trial.
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Journal articleRivière C, Dhaif F, Shah H, et al., 2018,
Kinematic alignment of current TKA implants does not restore the native trochlear anatomy
, Revue de Chirurgie Orthopedique et Traumatologique, Vol: 104, Pages: 673-685, ISSN: 1877-0517 -
Journal articleRivière C, Dhaif F, Shah H, et al., 2018,
Kinematic alignment of current TKA implants does not restore the native trochlear anatomy
, Orthopaedics and Traumatology: Surgery and Research, Vol: 104, Pages: 983-995, ISSN: 1877-0568INTRODUCTION: Preserving constitutional patellofemoral anatomy, and thus producing physiological patellofemoral kinematics, could prevent patellofemoral complications and improve clinical outcomes after kinematically aligned TKA (KA TKA). Our study aims 1) to compare the native and prosthetic trochleae (planned or implanted), and 2) to estimate the safety of implanting a larger Persona® femoral component size matching the proximal lateral trochlea facet height (flange area) in order to reduce the native articular surfaces understuffing generated by the prosthetic KA trochlea. METHODS: Persona® femoral component 3D model was virtually kinematically aligned on 3D bone-cartilage models of healthy knees by using a conventional KA technique (group 1, 36 models, planned KA TKA) or an alternative KA technique (AT KA TKA) aiming to match the proximal (flange area) lateral facet height (10 models, planned AT KA TKA). Also, 13 postoperative bone-implant (KA Persona®) models were co-registered to the same coordinate geometry as their preoperative bone-cartilage models (group 2 - implanted KA TKA). In-house analysis software was used to compare native and prosthetic trochlea articular surfaces and medio-lateral implant overhangs for every group. RESULTS: The planned and performed prosthetic trochleae were similar and valgus oriented (6.1° and 8.5°, respectively), substantially proximally understuffed compared to the native trochlea. The AT KA TKAs shows a high rate of native trochlea surface overstuffing (70%, 90%, and 100% for lateral facet, groove, medial facet) and mediolateral implant overhang (60%). There was no overstuffing with conventional KA TKAs having their anterior femoral cut flush. CONCLUSION: We found that with both the planned and implanted femoral components, the KA Persona® trochlea was more valgus oriented and understuffed compared to the native trochlear anatomy. In addition, restoring the lateral trochlea facet height by increasing t
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Conference paperMa S, Goh EL, Karunaratne A, et al., 2018,
The Effects of Bisphosphonate at the Nanoscale: Effects on Bone Collagen, Mineral Strain and Collagen-Mineral Interaction
, Annual Meeting of the American-Society-for-Bone-and-Mineral-Research, Publisher: WILEY, Pages: 410-411, ISSN: 0884-0431 -
Journal articleAqil A, Patel S, Wiik A, et al., 2018,
Patient-specific guides improve hip arthroplasty surgical accuracy
, COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING, Vol: 21, Pages: 579-584, ISSN: 1025-5842 -
Journal articleWong JKL, McGregor AH, 2018,
Spatiotemporal gait changes in healthy pregnant women and women with pelvic girdle pain: a systematic review
, Journal of Back and Musculoskeletal Rehabilitation, Vol: 31, Pages: 821-838, ISSN: 1053-8127INTRODUCTION: Gait is affected in women with pelvic girdle pain (PGP), a musculoskeletal condition affecting 20% of pregnant women. Whilst there is evidence of spatiotemporal changes in gait during healthy pregnancy, less is known in relation to women with PGP. Appreciating gait characteristics during healthy pregnancy could inform our understanding of the role of gait in PGP. PURPOSE: The purpose of this review was to systematically analyse differences in the spatiotemporal parameters of gait in healthy pregnant women and those with PGP, and to make recommendations to improve research methods in investigating gait in PGP women. METHODS: The review was undertaken following the PRISMA guidelines. Three databases and pre-existing literature were electronically and manually searched. Study selection and data extraction were conducted by two reviewers. Quality assessment was performed using the NHLBI tool for Observational Cohort and Cross-sectional Studies. RESULTS: The search returned 2925 results. Fourteen studies were selected for data extraction. Twelve studies investigated gait in healthy pregnant women and two in PGP women. Studies employed either a cohort or cross-sectional design and used various methods to assess gait. Three, nine and two studies were high, medium and low in quality, respectively. Direct comparisons between studies were impeded due to incomparable gestational time-points investigated, in addition to variations in gait parameters and definitions used. CONCLUSION: Evidence from studies on healthy pregnant women could inform future research on PGP women, for which current evidence is scarce. We recommend the standardisation of critical factors to allow inter-study comparisons for a meta-analysis.
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Journal articleBhattacharyya R, Sugand K, Al-Obaidi B, et al., 2018,
Trauma simulation training: a randomized controlled trial -evaluating the effectiveness of the Imperial Femoral Intramedullary Nailing Cognitive Task Analysis (IFINCTA) tool
, Acta Orthopaedica, Vol: 89, Pages: 689-695, ISSN: 1745-3674Background and purpose - Cognitive task analysis (CTA) has been used extensively to train pilots and in other surgical specialties. However, the use of CTA within orthopedics is in its infancy. We evaluated the effectiveness of a novel CTA tool to improve understanding of the procedural steps in antegrade femoral intramedullary nailing. Material and methods - Design: A modified Delphi technique was used to generate a CTA from 3 expert orthopedic trauma surgeons for antegrade femoral intramedullary nailing. The written and audiovisual information was combined to describe the technical steps, decision points, and errors for each phase of this procedure Validation: A randomized double-blind controlled trial was undertaken with 22 medical students (novices) randomized into 2 equal groups. The intervention group were given the CTA tool and the control group were given a standard operative technique manual. They were assessed using the validated "Touch Surgery™" application assessment tool on femoral intramedullary nailing. Results - The pre-test scores between the two groups were similar. However, the post-test scores were statistically significantly better in the intervention group compared with the control group. The improvement (post-test median scores) in the intervention group compared with the control group was 20% for patient positioning and preparation, 21% for femoral preparation, 10% for proximal locking, and 19% for distal locking respectively (p < 0.001 for all comparisons). Interpretation - This is the first multimedia CTA tool in femoral intramedullary nailing that is easily accessible, user-friendly, and has demonstrated significant benefits in training novices over the traditional use of operative technique manuals.
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Conference paperFavier C, McGregor A, Phillips A, 2018,
Subject specific multiscale modelling of the lumbar spine
, 14th Annual Bath Biomechanics Symposium -
Journal articleJones G, Jaere M, Clarke S, et al., 2018,
A Clinical Trial Examining the Accuracy of High Tibial Osteotomy When Performed by Experts Using a Novel Patient Specific Instrument (PSI)
, SSRN -
Journal articleChoudhury A, Lambkin R, Auvinet E, et al., 2018,
P 004 - Patellofemoral arthroplasty improves gait in isolated patellofemoral arthritis, a prospective cohort gait analysis study.
, Gait Posture, Vol: 65 Suppl 1, Pages: 241-242 -
Journal articleZhao S, Arnold M, Ma S, et al., 2018,
Standardizing compression testing for measuring the stiffness of human bone
, BONE & JOINT RESEARCH, Vol: 7, Pages: 524-538, ISSN: 2046-3758
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