Imperial College London

Camilla Halewood

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Research Fellow
 
 
 
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Contact

 

+44 (0)20 7594 3600c.halewood Website

 
 
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Location

 

215Sir Michael Uren HubWhite City Campus

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Summary

 

Publications

Publication Type
Year
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34 results found

Karia M, Boughton O, Mohan S, Halewood C, Wozencroft R, Clarke S, Cobb Jet al., 2023, Enhancing acetabular reaming accuracy: optimal techniques and a novel reamer design, Journal of Orthopaedic Surgery and Research, Vol: 18, Pages: 1-7, ISSN: 1749-799X

IntroductionSuccessful press-fit implantation relies on an accurately reamed bone cavity. Inaccurate reaming can lead to a suboptimal press-fit risking fracture and cup deformation or excessive micromotion and loosening. Several factors may impact reaming accuracy including the reamer design, the surgeon’s technique and the bone quality. The aim of this study is to investigate the accuracy of reaming techniques and the accuracy of a novel reamer design.MethodsEighty composite bone models, half high-density and half low-density, were reamed with either a conventional or an additively-manufactured reamer with a novel design employing either a straight or ‘whirlwind’ reaming technique. Reamed cavities were scanned using a 3D laser scanner and the median difference between achieved and expected diameters compared. ResultsThe novel reamer design was more accurate than the unused conventional reamer, using both whirlwind (0.1mm (IQR 0-0.2) vs 0.3mm (IQR 0.3-0.4); p<0.001) and straight techniques (0.3mm (IQR 0.1-1.0) vs 1.2mm (IQR 1-1.6); p=0.001). Whirlwind reaming was more accurate than straight reaming using both conventional (0.3mm (IQR 0.3-0.4) vs 1.2mm (IQR 1-1.6); p<0.0001) and single use reamers (0.1mm (IQR 0-0.2) vs 0.3mm (IQR 0.1-1.0); p=0.007). Reaming errors were higher in low-density bone compared to high-density bone, for both reamer types and reaming techniques tested (0.6mm (IQR 0.3-1.5) vs 0.3mm (IQR 0.1-0.8); p=0.005). ConclusionWe present a novel reamer design that demonstrates superior accuracy to conventional reamers in achieving the desired reaming diameter. Improved reaming accuracy was also demonstrated using both devices and in both bone models, using a ‘whirlwind’ technique. We recommend the use of this novel reamer design employing a ‘whirlwind’ technique to optimise reaming accuracy. Particular attention should be paid towards patients with lower bone quality which may be more susceptible to highe

Journal article

Maslivec A, Halewood C, Clarke S, Cobb Jet al., 2023, Hip resurfacing arthroplasty in women: A novel ceramic device enables near normal gait function, Gait and Posture, Vol: 103, Pages: 166-171, ISSN: 0966-6362

BackgroundGait function improves after Total Hip Arthroplasty (THA) but is not restored to normal levels. Metal-on-metal Resurfacing Arthroplasty (MoM-HRA) is an alternative to THA and has shown to restore normal levels gait function and physical activity but has been restricted to men owing to problems of metal-ion release. Ceramic HRA (cHRA) removes the cobalt-chrome bearing surfaces, thereby eliminating these specific metal-ion concerns and aiming to be safe for females.Research questionIs there a difference in gait function of female cHRA patients compared to female THA using subjective and objective measures?MethodsFifteen unilateral cHRA and 15 unilateral THA, age and BMI matched, completed patient reported outcome measures (PROMs) (Oxford Hip Score, EQ5d and MET score) and underwent gait analysis using an instrumented treadmill pre- (2–10 weeks) and post-operatively (52–74 weeks). Maximum walking speed (MWS), Vertical GRF of the stance phase, GRF symmetry index (SI) and spatiotemporal gait measures were recorded. Patients were compared to age, gender and BMI healthy controls (CON).ResultsThere were no differences in PROMs or gait function between groups pre-operatively. Post- operatively, cHRA had a higher MET score (11.2 vs 7.1, p = 0.02) and a higher MWS (6.2 vs 6.8 km/hr, p = 0.003) compared to THA. cHRA had a similar GRF profile to CON, whereas THA had a reduced push-off force at 70–77 % of the stance phase compared to CON. At faster walking speeds of 6 km/hr walking speed, THA displayed an asymmetric GRF profile (SI<4.4 %) whereas the cHRA patients continued to display a symmetrical gait profile. cHRA was able to increase step length from pre-op levels (63 vs 66 cm, p = 0.02) and produced a larger step length compared to THA (73 vs 79 cm, p = 0.02).SignificanceFemale cHRA returned to levels of gait function and activity similar to healthy controls unlike female THA.

Journal article

Clarke SG, Logishetty K, Halewood C, Cobb JPet al., 2023, Low dose CT-based spatial analysis (CTSA) to measure implant migration after ceramic hip resurfacing arthroplasty (HRA): a phantom study, Proceedings of the Institution of Mechanical Engineers Part H: Journal of Engineering in Medicine, Vol: 237, Pages: 359-367, ISSN: 0954-4119

Implant migration is a predictor of arthroplasty survivorship. It is crucial to monitor the migration of novel hip prostheses within premarket clinical investigations. RSA is the gold standard method, but requires calibrated radiographs using specialised equipment. A commercial computed tomography micromotion analysis solution is a promising alternative but is not yet available for use with monobloc ceramic implants. This study aimed to develop and validate a CT-based spatial analysis (CTSA) method for use with ceramic implants. A phantom study was undertaken to assess accuracy and precision. A ceramic hip resurfacing arthroplasty (HRA) and 20 tantalum beads were implanted into a synthetic hip model and mounted onto a 6-degree of freedom motion stage. The hip was repeatedly scanned with a low dose CT protocol, with imposed micromovements. Data were interrogated using a semiautomated technique. The effective radiation dose for each scan was estimated to be 0.25 mSv. For the head implant, precision ranged between 0.11 and 0.28 mm for translations and 0.34°-0.42° for rotations. For the cup implant, precision ranged between 0.08 and 0.11 mm and 0.19° and 0.42°. For the head, accuracy ranged between 0.04 and 0.18 mm for translations and 0.28°-0.46° for rotations. For the cup, accuracy ranged between 0.04 and 0.08 mm and 0.17° and 0.43°. This in vitro study demonstrates that low dose CTSA of a ceramic HRA is similar in accuracy to RSA. CT is ubiquitous, and this method may be an alternative to RSA to measure prosthesis migration.

Journal article

Uemura K, Boughton O, Logishetty K, Halewood C, Clarke S, Harris S, Sugano N, Cobb Jet al., 2019, A single-use, size-specific, nylon arthroplasty guide: a preliminary study, Hip International, ISSN: 1120-7000

Journal article

Willmott H, Al-Wattar Z, Halewood C, Dunning M, Amis Aet al., 2018, Evaluation of different shape-memory staple configurations against crossed screws for first metatarsophalangeal joint arthrodesis: A biomechanical study, Foot and Ankle Surgery, Vol: 24, Pages: 259-263, ISSN: 1268-7731

BACKGROUND: The first metatarsophalangeal joint may be fused in order to treat arthritis or instability. The use of shape-memory staples for fixation is well recognised, but little work has been done into the optimal configuration of staples. METHODS: The structural behaviour of first metatarsophalangeal joint (MTPJ) arthrodeses using shape-memory staples or crossed screws was studied using cadaveric porcine joints. Five fixation configurations were tested: single vertical or horizontal staple, paired staples in dorsal-medial configuration (0-90° to the sagittal plane), paired staples in oblique orthogonal configuration (45-135°); or two crossed screws. Specimens were loaded in cyclical dorsiflexion for 1000 cycles. Plantar gapping and shearing were measured. Specimens were then loaded to failure. RESULTS: Cyclic testing caused more shear in the 45-135° staples than the crossed screws (1.0mm±0.5mm compared to 0.14mm±0.4mm, p<0.01). No significant difference was found in plantar gap formation. Single vertical and horizontal single staples failed at 15N and 19. CONCLUSIONS: N, respectively. Paired 0-90° staples failed at 43N±9N, significantly lower than the 45-135° staples (141N±25N; p<0.001) and crossed screws (180N±67N; p<0.001). There was no significant difference between the 45-135° staples and crossed screws. Screws failed by sudden cortical fracture; staples displayed gradual pull-out and shearing. First MTPJ arthrodeses fixed with single staples are not recommended. Arthrodeses fixed with staples at 0-90° to the sagittal plane were significantly less strong than two crossed screws. However, positioning oblique staples at 45-135° significantly improved stability, creating a construct as strong as, crossed screws. None of the constructs was strong enough for immediate weight bearing.

Journal article

Halewood C, Athwal KK, Amis A, 2018, Pre-clinical assessment of total knee replacement anterior-posterior constraint, Journal of Biomechanics, Vol: 73, Pages: 153-160, ISSN: 0021-9290

Pre-clinical, bench-top assessment of Total Knee Replacements (TKR) can provide information about the inherent constraint provided by a TKR, which does not depend on the condition of the patient undergoing the arthroplasty. However little guidance is given by the ASTM standard on test configurations such as medial-lateral (M:L) loading distribution, flexion angle or restriction of secondary motions. Using a purpose built rig for a materials testing machine, four TKRs currently in widespread clinical use, including medial-pivot and symmetrical condyle types, were tested for anterior-posterior translational constraint. Compressive joint loads from 710 to 2000 N, and a range of medial-lateral (M:L) load distributions, from 70:30% to 30:70% M:L, were applied at different flexion angles with secondary motions unconstrained. It was found that TKA constraint was significantly less at 60 and 90° flexion than at 0°, whilst increasing the compressive joint load increased the force required to translate the tibia to limits of AP constraint at all flexion angles tested. Additionally when M:L load distribution was shifted medially, a coupled internal rotation was observed with anterior translation and external rotation with posterior translation. This paper includes some recommendations for future development of pre-clinical testing methods.

Journal article

Williams A, Stephen J, Kittl C, Inderhaug E, El-Daou H, Dodds A, Halewood C, Amis Aet al., 2017, The Role of the Lateral Soft Tissues in Controlling Anterior Translation And Internal Rotation of the Tibia, and An Investigation of Lateral Reconstructions Accompanying ACL Reconstruction, Orthopaedic journal of sports medicine, Vol: 5, ISSN: 2325-9671

<h4>Introduction:</h4> There is considerable current interest in the role of the lateral soft tissue structures in the context of ACL deficiency (ACLD). Of course the topic is not new but a re-visitation, although with improved experimental techniques available. It was clear that there was a rush to create surgical techniques based on the ‘Anterolateral Ligament’ (ALL) but without investigative ‘due-diligence’ and without consideration that other structures may be important, or more important. <h4>Objectives:</h4> To study the anatomy and biomechanics of the lateral soft tissues relevant to the ACL and ACL reconstruction techniques investigating isometricity, structures’ contributions to resistance of anterior tibial translation (ATT), internal rotation (IR), and pivot shift (PS). Also we studied the impact of various reconstructions on restoration of kinematics and potential over-constraint and effects on articular surface compression load. <h4>Methods:</h4> Several studies were undertaken. In all healthy fresh-frozen cadaveric specimens were used. Descriptive anatomy was described. Length changes of suture fixed at structure and reconstruction attachment points on the tibia and femur were measured with linear variable displacement transducers (LVDTs). To investigate structures’ contribution to resist translation and torque a 6-degrees of freedom robot with a universal force-moment sensor was used in a classic ‘cutting study’. The robot replayed the same movement with sequential sectioning of structures recording the decrease in force / torque needed to reach the same movement limit. In this way the structure’s resistance to motion as a percentage of the total could be calculated. In other studies knees were mounted in a test rig where knee kinematics were recorded from 0° to 100° of flexion by use of an optical tracking system. Joint surface compression was measured w

Journal article

Grice JE, Willmott H, Halewood C, MBiomedE M, Dunning M, Amis Aet al., 2016, A Biomechanical Comparison of First Metatarsophalangeal Arthrodesis Using Crossed Screws and Shape-Memory Staples in Various Configurations, Foot &amp; Ankle Orthopaedics, Vol: 1, Pages: 2473011416S0005-2473011416S0005, ISSN: 2473-0114

<jats:sec><jats:title>Category:</jats:title><jats:p> Midfoot/Forefoot </jats:p></jats:sec><jats:sec><jats:title>Introduction/Purpose:</jats:title><jats:p> Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a commonly performed procedure for the treatment of hallux rigidus. A range of fixation methods have been used. Most recently, the shape-memory staple has been described. Made from an equiatomic alloy, the staple changes its shape when heated to body temperature so as to provide compression across the arthrodesis. We aimed to determine load to failure, cyclic loading and failure characteristics of different staple configurations compared to crossed screws. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A cadaveric porcine model was used to simulate first MTPJ arthrodesis. Five forms of fixation were tested: single vertical staple; single horizontal staple; paired staples in orthogonal superior-inferior and medial-lateral configuration (0-90° to sagittal plane); paired staples in an oblique orthogonal configuration (45-135° to sagittal plane); two crossed screws. Using a materials-testing machine, specimens were loaded in dorsiflexion to simulate weight bearing. Cyclical loading was performed from 5-40N at a rate of 0.5 Hz for 1000 cycles. Plantar gapping, shear and creep were measured. Specimens were then loaded to failure in order to generate a load-displacement curve. The mechanism of failure was noted for each group. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Single staple configurations failed at very low loads. Single vertical staples failed at a mean load 15N±5N and single horizontal staples at 19N±3N. Mean failure load for paired 0-90° staples was 43N±9N which was significantly lower than the paired 45-135° staples which failed

Journal article

Halewood C, Amis AA, 2016, Physiology: Biomechanics, Surgery of the Meniscus, Pages: 35-45, ISBN: 9783662491867

Book chapter

Stephen JM, Halewood C, Kittl C, Bollen SR, Williams A, Amis AAet al., 2016, Posteromedial Meniscocapsular Lesions Increase Tibiofemoral Joint Laxity With Anterior Cruciate Ligament Deficiency, and Their Repair Reduces Laxity, American Journal of Sports Medicine, Vol: 44, Pages: 400-408, ISSN: 0363-5465

Background:Injury to the posteromedial meniscocapsular junction has been identified after anterior cruciate ligament (ACL) rupture; however, there is a lack of objective evidence investigating how this affects knee kinematics or whether increased laxity can be restored by repair. Such injury is often overlooked at surgery, with possible compromise to results.Hypotheses:(1) Sectioning the posteromedial meniscocapsular junction in an ACL-deficient knee will result in increased anterior tibial translation and rotation. (2) Isolated ACL reconstruction in the presence of a posteromedial meniscocapsular junction lesion will not restore intact knee laxity. (3) Repair of the posteromedial capsule at the time of ACL reconstruction will reduce tibial translation and rotation to normal. (4) These changes will be clinically detectable.Study Design:Controlled laboratory study.Methods:Nine cadaveric knees were mounted in a test rig where knee kinematics were recorded from 0° to 100° of flexion by use of an optical tracking system. Measurements were recorded with the following loads: 90-N anterior-posterior tibial forces, 5-N·m internal-external tibial rotation torques, and combined 90-N anterior force and 5-N·m external rotation torque. Manual Rolimeter readings of anterior translation were taken at 30° and 90°. The knees were tested in the following conditions: intact, ACL deficient, ACL deficient and posteromedial meniscocapsular junction sectioned, ACL deficient and posteromedial meniscocapsular junction repaired, ACL patellar tendon reconstruction with posteromedial meniscocapsular junction repair, and ACL reconstructed and capsular lesion re-created. Statistical analysis used repeated-measures analysis of variance and post hoc paired t tests with Bonferroni correction.Results:Tibial anterior translation and external rotation were both significantly increased compared with the ACL-deficient knee after posterior meniscocapsular sectioning (P <

Journal article

Masouros S, Halewood C, Bull A, Amis Aet al., 2015, Biomechanics, Expertise orthopadie und unfallchirurgie: Knie, Editors: Kohn, ISBN: 978-3-1317500-1-3

Book chapter

Halewood C, Traynor A, Bellemans J, Victor J, Amis AAet al., 2015, Anteroposterior Laxity After Bicruciate-Retaining Total Knee Arthroplasty Is Closer to the Native Knee Than ACL-Resecting TKA: A Biomechanical Cadaver Study., Journal of Arthroplasty, ISSN: 1532-8406

The purpose of this study was to examine whether a bicruciate retaining (BCR) TKA would yield anteroposterior (AP) laxity closer to the native knee than a posterior cruciate ligament retaining (CR) TKA. A BCR TKA was designed and compared to CR TKA and the native knee using cadaver specimens. AP laxity with the CR TKA was greater than the native knee (P=0.006) and BCR TKA (P=0.039), but no difference was found between the BCR TKA and the native knee. No significant differences were found in rotations between the prostheses and the native knee. BCR TKA was shown to be surgically feasible, reduced AP laxity versus CR TKA, and may improve knee stability without using conforming geometry in the implant design.

Journal article

Halewood C, Masouros S, Amis AA, 2015, Structure and function of the menisci, Meniscal Allograft Transplantation. A comprehensive review., Editors: Getgood, Spalding, Cole, Gersoff, Verdonk, ISBN: 978-0-9558873-5-2

Book chapter

Halewood C, Lumpaopong P, Stephen JM, Amis AAet al., 2015, Functional Biomechanics with Cadaver Specimens, Experimental Research Methods in Orthopedics and Trauma, Editors: Simpson, Augat, Publisher: Thieme Medical Publishers, ISBN: 9783131731111

This book provides a comprehensive summary of all current research methodologies for translational and pre-clinical studies in biomechanics and orthopedic trauma surgery.

Book chapter

Halewood C, Amis AA, 2015, Clinically relevant biomechanics of the knee capsule and ligaments, Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 23, Pages: 2789-2796, ISSN: 0942-2056

The paper describes the concepts of primary and secondary restraints to knee joint stability and explains systematically how the tibia is stabilised against translational forces and rotational torques in different directions and axes, and how those vary across the arc of flexion–extension. It also shows how the menisci act to stabilise the knee, in addition to load carrying across the joint. It compares the properties of the natural stabilising structures with the strength and stiffness of autogenous tissue grafts and relates those strengths to the strength of graft fixation devices. A good understanding of the biomechanical behaviour of these various structures in the knee will help the surgeon in the assessment and treatment of single and multi-ligament injuries.

Journal article

Halewood C, 2015, Anteroposterior laxity after bicruciate-retaining total knee replacement is closer to the intact knee than conventional ACL-resecting TKR: a biomechanical cadaver study, BASK

Conference paper

Stephen JM, Halewood C, Kittl C, Bollen S, Williams A, Amis AAet al., 2015, The influence of posterior medial meniscocapsular lesions on tibiofemoral joint laxity in ACL deficient and reconstructed knees, British Association of Surgery of the Knee

Conference paper

Kittl C, Halewood C, Stephen JM, Gupte CM, Weiler A, Williams A, Amis AAet al., 2015, Length change patterns in the lateral extra-articular structures of the knee and related reconstructions, American Journal of Sports Medicine, Vol: 43, Pages: 354-362, ISSN: 0363-5465

Background:Lateral extra-articular soft tissue reconstructions in the knee may be used as a combined procedure in revision anterior cruciate ligament surgery as well as in primary treatment for patients who demonstrate excessive anterolateral rotatory instability. Only a few studies examining length change patterns and isometry in lateral extra-articular reconstructions have been published.Purpose:To determine a recommended femoral insertion area and graft path for lateral extra-articular reconstructions by measuring length change patterns through a range of knee flexion angles of several combinations of tibial and femoral insertion points on the lateral side of the knee.Study Design:Controlled laboratory study.Methods:Eight fresh-frozen cadaveric knees were freed of skin and subcutaneous fat. The knee was then mounted in a kinematics rig that loaded the quadriceps muscles and simulated open-chain knee flexion. The length changes of several combinations of tibiofemoral points were measured at knee flexion angles between 0° and 90° by use of linear variable displacement transducers. The changes in length relative to the 0° measurement were recorded.Results:The anterior fiber region of the iliotibial tract displayed a significantly different (P < .001) length change pattern compared with the posterior fiber region. The reconstructions that had a femoral insertion site located proximal to the lateral epicondyle and with the grafts passed deep to the lateral collateral ligament displayed similar length change patterns to each other, with small length increases during knee extension. These reconstructions also showed a significantly lower total strain range compared with the reconstruction located anterior to the epicondyle (P < .001).Conclusion:These findings show that the selection of graft attachment points and graft course affects length change pattern during knee flexion. A graft attached proximal to the lateral femoral epicondyle and running deep

Journal article

Halewood C, Risebury M, Thomas NP, Amis AAet al., 2014, Kinematic behaviour and soft tissue management in guided motion total knee replacement, KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol: 22, Pages: 3074-3082, ISSN: 0942-2056

Journal article

Halewood C, 2014, How to do a Proper Biomechanical Study, 2014 ESSKA Congress, Amsterdam

Conference paper

Halewood C, 2014, Pre-clinical stability assessment methods for total knee replacements, 2014 ESSKA Congress, Amsterdam

Conference paper

Halewood C, Samuelsson K, Kopf S, Alentorn-Geli E, Musahl Vet al., 2014, How to do proper research, ESSKA Instructional Course Lecture Book Amsterdam 2014, Publisher: Springer, ISBN: 9783642539824

This book provides an update on a wide variety of hot topics in the field of knee surgery, sports trauma and arthroscopy, covering the latest developments in basic science and clinical and surgical methods.

Book chapter

Dodds AL, Halewood C, Gupte CM, Williams A, Amis AAet al., 2014, The anterolateral ligament ANATOMY, LENGTH CHANGES AND ASSOCIATION WITH THE SEGOND FRACTURE, BONE & JOINT JOURNAL, Vol: 96B, Pages: 325-331, ISSN: 2049-4394

Journal article

Halewood C, Luyckx T, Claes S, Lowry C, Simpson D, Collins S, Amis Aet al., 2013, ACL Retaining Total Knee Arthroplasty can Improve Knee Stability, ESB 2013

Conference paper

Halewood C, Nawabi DH, Amis AA, 2012, Development of a novel test method for intra-articular fatigue and wear testing of meniscal reconstructions, 15th ESSKA Congress, Publisher: Springer, Pages: S237-S238, ISSN: 0942-2056

Conference paper

Miyatake S, Kondo E, Tsai T-Y, Hirschmann M, Halewood C, Jakobsen BW, Yasuda K, Amis AAet al., 2011, Biomechanical Comparisons Between 4-Strand and Modified Larson 2-Strand Procedures for Reconstruction of the Posterolateral Corner of the Knee, AMERICAN JOURNAL OF SPORTS MEDICINE, Vol: 39, Pages: 1462-1469, ISSN: 0363-5465

Journal article

Halewood C, Hirschmann MT, Newman S, Hleihil J, Chaimski G, Amis AAet al., 2011, The fixation strength of a novel ACL soft-tissue graft fixation device compared with conventional interference screws: a biomechanical study in vitro, KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol: 19, Pages: 559-567, ISSN: 0942-2056

Journal article

Castoldi F, Bonasia DE, Blonna D, Rossi R, Dettoni F, Assom M, Sankey A, Halewood C, Amis AAet al., 2010, The stability of percutaneous fixation of proximal humeral fractures., Journal of Bone and Joint Surgery-American Volume, Vol: 92, Pages: 90-97

Journal article

Miyatake S, Kondo E, Tsai T, Hirschmann M, Halewood C, Jakobsen B, Yasuda K, Amis Aet al., 2010, Biomechanical comparisons between 4-strand anatomic and modified Larson’s procedures for posterolateral corner reconstruction, 14th ESSKA Conference

Conference paper

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