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Edwards TC, Coombs AW, Szyszka B, et al., 2021, Cognitive task analysis-based training in surgery: a meta-analysis, BJS OPEN, Vol: 5, ISSN: 2474-9842
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Garner A, Dandridge O, Amis A, et al., 2021, Partial and combined partial knee arthroplasty: greater anterior-posterior stability than posterior-cruciate retaining total knee arthroplasty, The Journal of Arthroplasty, Vol: 36, Pages: 3765-3772.e4, ISSN: 0883-5403
BackgroundLittle is known regarding anterior-posterior stability after anterior cruciate ligament–preserving partial (PKA) and combined partial knee arthroplasty (CPKA) compared to standard posterior cruciate–retaining total knee arthroplasty (TKA).MethodsThe anterior-posterior tibial translation of twenty-four cadaveric knees was measured, with optical tracking, while under 90N drawer with the knee flexed 0-90°. Knees were tested before and after PKA, CPKA (medial and lateral bicompartmental and bi-unicondylar), and then posterior cruciate–retaining TKA. The anterior-posterior tibial translations of the arthroplasty states, at each flexion angle, were compared to the native knee and each other with repeated measures analyses of variance and post-hoc t-tests.ResultsUnicompartmental and bicompartmental arthroplasty states had similar laxities to the native knee and to each other, with ≤1-mm differences throughout the flexion range (P ≥ .199). Bi-unicondylar arthroplasty resulted in 6- to 8-mm increase of anterior tibial translation at high flexion angles compared to the native knee (P ≤ .023 at 80-90°). Meanwhile, TKA exhibited increased laxity across all flexion angles, with increased anterior tibial translation of up to 18 ± 6 mm (P < .001) and increased posterior translation of up to 4 ± 2 mm (P < .001).ConclusionsIn a cadaveric study, anterior-posterior tibial translation did not differ from native laxity after PKA and CPKA. Posterior cruciate ligament–preserving TKA demonstrated increased laxity, particularly in anterior tibial translation.
Edwards TC, Patel A, Szyszka B, et al., 2021, The Impact of Using A Virtual Reality Surgical Curriculum to Train Scrub Practitioners in Complex Orthopaedic Surgery, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Garner AJ, Edwards TC, Liddle AD, et al., 2021, The revision partial knee classification system: understanding the causative pathology and magnitude of further surgery following partial knee arthroplasty., Bone & Joint Open, Vol: 2, Pages: 638-645, ISSN: 2633-1462
AIMS: Joint registries classify all further arthroplasty procedures to a knee with an existing partial arthroplasty as revision surgery, regardless of the actual procedure performed. Relatively minor procedures, including bearing exchanges, are classified in the same way as major operations requiring augments and stems. A new classification system is proposed to acknowledge and describe the detail of these procedures, which has implications for risk, recovery, and health economics. METHODS: Classification categories were proposed by a surgical consensus group, then ranked by patients, according to perceived invasiveness and implications for recovery. In round one, 26 revision cases were classified by the consensus group. Results were tested for inter-rater reliability. In round two, four additional cases were added for clarity. Round three repeated the survey one month later, subject to inter- and intrarater reliability testing. In round four, five additional expert partial knee arthroplasty surgeons were asked to classify the 30 cases according to the proposed revision partial knee classification (RPKC) system. RESULTS: Four classes were proposed: PR1, where no bone-implant interfaces are affected; PR2, where surgery does not include conversion to total knee arthroplasty, for example, a second partial arthroplasty to a native compartment; PR3, when a standard primary total knee prosthesis is used; and PR4 when revision components are necessary. Round one resulted in 92% inter-rater agreement (Kendall's W 0.97; p < 0.005), rising to 93% in round two (Kendall's W 0.98; p < 0.001). Round three demonstrated 97% agreement (Kendall's W 0.98; p < 0.001), with high intra-rater reliability (interclass correlation coefficient (ICC) 0.99; 95% confidence interval 0.98 to 0.99). Round four resulted in 80% agreement (Kendall's W 0.92; p < 0.001). CONCLUSION: The RPKC system accounts for all procedures which may be appropriate following partial knee arthroplasty. It h
Edwards TC, Patel A, Szyszka B, et al., 2021, Immersive virtual reality enables technical skill acquisition for scrub nurses in complex revision total knee arthroplasty., Archives of Orthopaedic and Trauma Surgery, Vol: 141, ISSN: 0344-8444
INTRODUCTION: Immersive Virtual Reality (iVR) is a novel technology which can enhance surgical training in a virtual environment without supervision. However, it is untested for the training to select, assemble and deliver instrumentation in orthopaedic surgery-typically performed by scrub nurses. This study investigates the impact of an iVR curriculum on this facet of the technically demanding revision total knee arthroplasty. MATERIALS AND METHODS: Ten scrub nurses completed training in four iVR sessions over a 4-week period. Initially, nurses completed a baseline real-world assessment, performing their role with real equipment in a simulated operation assessment. Each subsequent iVR session involved a guided mode, where the software taught participants the procedural choreography and assembly of instrumentation in a simulated operating room. In the latter three sessions, nurses also undertook an assessment in iVR. Outcome measures were related to procedural sequence, duration of surgery and efficiency of movement. Transfer of skills from iVR to the real world was assessed in a post-training simulated operation assessment. A pre- and post-training questionnaire assessed the participants knowledge, confidence and anxiety. RESULTS: Operative time reduced by an average of 47% across the 3 unguided sessions (mean 55.5 ± 17.6 min to 29.3 ± 12.1 min, p > 0.001). Assistive prompts reduced by 75% (34.1 ± 16.8 to 8.6 ± 8.8, p < 0.001), dominant hand motion by 28% (881.3 ± 178.5 m to 643.3 ± 119.8 m, p < 0.001) and head motion by 36% (459.9 ± 99.7 m to 292.6 ± 85.3 m, p < 0.001). Real-world skill improved from 11% prior to iVR training to 84% correct post-training. Participants reported increased confidence and r
Subbiah Ponniah H, Ahmed M, Edwards T, et al., 2021, 905 How to prioritise patients and safely resume elective surgery during the Covid-19 pandemic, ASiT/MedAll Virtual Surgical Summit, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Abel R, Behforootan S, Boughton O, et al., 2021, Ultrasound and Bone Disease: A Systematic Review, World Journal of Surgery and Surgical Research
Stoddart J, Dandridge O, Garner A, et al., 2021, The compartmental distribution of knee osteoarthritis – a systematic review and meta-analysis, Osteoarthritis and Cartilage, Vol: 29, Pages: 445-455, ISSN: 1063-4584
ObjectivesFor a population with knee osteoarthritis (OA), determine: 1) the prevalence of single compartmental, bicompartmental and tricompartmental OA, 2) the prevalence of isolated medial tibiofemoral, lateral tibiofemoral, or patellofemoral OA, and combinations thereof.MethodsPubMed and Web of Science databases, and reference lists of identified studies, were searched to find studies which reported on the compartmental distribution and prevalence of knee OA. Two independent reviewers assessed studies against pre-defined inclusion criteria and prevalence data were extracted along with subject characteristics. The methodological quality of each included study was assessed. A random-effects model meta-analysis was performed for each OA category to estimate the relative prevalence of OA in the knee compartments amongst people with knee OA.Results16 studies (3,786 knees) met the inclusion criteria. High heterogeneity was measured. Normalised for knees with OA, estimated prevalence rates (95% CI) were: single compartmental 50% (31.5–58.3%), bicompartmental 33% (23.1–37.2%) and tricompartmental only 17% (8.8–24.8%). Isolated medial tibiofemoral OA, isolated patellofemoral OA, and combined medial tibiofemoral and patellofemoral OA were more common than tricompartmental disease, occurring in 27% (15.2–31.1%), 18% (9.9–22.7%) and 23% (14.1–27.3%) of people respectively. Single/bicompartmental patterns of disease involving the lateral tibiofemoral compartment were less common, summing to 15% (8.5–18.7%).ConclusionThree-quarters of people with knee OA do not have tricompartmental disease. This is not reflected in the frequency with which partial and combined partial knee arthroplasties are currently used.Trial registration numberPROSPERO systematic review protocol (CRD42019140345).KeywordsGonarthrosisUnicompartmentalBicompartmentalPrevalenceEpidemiology
Wiik AV, Aqil A, Al-Obaidi B, et al., 2021, The impact of reducing the femoral stem length in total hip arthroplasty during gait, Archives of Orthopaedic and Trauma Surgery, Vol: 141, Pages: 1993-2000, ISSN: 0344-8444
AimThe length of the femoral stem in total hip arthroplasty (THA) is a practical consideration to prevent gait impairment. The aim of this study was to determine if reducing the femoral stem length in THA would lead to impaired gait biomechanics.MethodsPatients uniformly with the same brand implant of differing lengths (100 mm vs 140–166 mm) were taken retrospectively from a prospective trial introducing a new short stem. Twelve patients without any other disorder to alter gait besides contralateral differing length stem THA were tested at differing gradients and speed on a validated instrumented treadmill measuring ground reaction forces. An anthropometrically similar group of healthy controls were analysed to compare.ResultsWith the same posterior surgical approach, the offset and length of both hips were reconstructed within 5 mm of each other with an identical mean head size of 36 mm. The short stem was the last procedure for all the hips with gait analysis occurring at a mean of 31 and 79 months postoperatively for the short and long stem THA, respectively. Gait analysis between limbs of both stem lengths demonstrated no statistical difference during any walking condition. In the 90 gait assessments with three loading variables, the short stem was the favoured side 51% of the time compared 49% for the long stem.ConclusionBy testing a range of practical walking activities, no lower limb loading differences can be observed by reducing the femoral stem length. A shorter stem demonstrates equivalence in preference during gait when compared to a reputable conventional stem in total hip arthroplasty.
Logishetty K, Edwards TC, Subbiah Ponniah H, et al., 2021, How to prioritize patients and redesign care to safely resume planned surgery during the COVID-19 pandemic., Bone & Joint Open, Vol: 2, Pages: 134-140, ISSN: 2633-1462
AIMS: Restarting planned surgery during the COVID-19 pandemic is a clinical and societal priority, but it is unknown whether it can be done safely and include high-risk or complex cases. We developed a Surgical Prioritization and Allocation Guide (SPAG). Here, we validate its effectiveness and safety in COVID-free sites. METHODS: A multidisciplinary surgical prioritization committee developed the SPAG, incorporating procedural urgency, shared decision-making, patient safety, and biopsychosocial factors; and applied it to 1,142 adult patients awaiting orthopaedic surgery. Patients were stratified into four priority groups and underwent surgery at three COVID-free sites, including one with access to a high dependency unit (HDU) or intensive care unit (ICU) and specialist resources. Safety was assessed by the number of patients requiring inpatient postoperative HDU/ICU admission, contracting COVID-19 within 14 days postoperatively, and mortality within 30 days postoperatively. RESULTS: A total of 1,142 patients were included, 47 declined surgery, and 110 were deemed high-risk or requiring specialist resources. In the ten-week study period, 28 high-risk patients underwent surgery, during which 68% (13/19) of Priority 2 (P2, surgery within one month) patients underwent surgery, and 15% (3/20) of P3 (< three months) and 16% (11/71) of P4 (> three months) groups. Of the 1,032 low-risk patients, 322 patients underwent surgery. Overall, 21 P3 and P4 patients were expedited to 'Urgent' based on biopsychosocial factors identified by the SPAG. During the study period, 91% (19/21) of the Urgent group, 52% (49/95) of P2, 36% (70/196) of P3, and 26% (184/720) of P4 underwent surgery. No patients died or were admitted to HDU/ICU, or contracted COVID-19. CONCLUSION: Our widely generalizable model enabled the restart of planned surgery during the COVID-19 pandemic, without compromising patient safety or excluding high-risk or complex cases. Patients classified as Urgent or P2 w
Boughton O, Cobb J, owyang D, et al., 2021, Patient and Public Involvement Within Orthopaedic Research: A Systematic Review, Journal of Bone and Joint Surgery: American Volume, ISSN: 0021-9355
Musbahi O, Logishetty K, Cobb JP, 2021, Hip Resurfacing Arthroplasty or Total Hip Arthroplasty?, Controversies in Orthopaedic Surgery of the Lower Limb, Pages: 15-22, ISBN: 9783030806941
Hip resurfacing arthroplasty (HRA) is an alternative to total hip arthroplasty (THA) in younger patients with good bone quality who wish to return to high levels of activity. Usage of HRA has declined due to implant-specific complications—metal debris and periarticular soft tissue damage, implant loosening, and femoral neck fracture. These were most common with implants which have now been withdrawn, but fears remain. HRA is more technically challenging than THA, but revision rates for patients operated at specialist centres are equivalent. Gait and biomechanical studies suggest that HRA better restores normal function compared to THA, and registry-based studies suggest a lower mortality. However, randomised clinical trials have not shown superiority using conventional patient-reported outcome measures. As the clinical indications are dependent on patient demands, and more active patients are more likely to wear out artificial joints, it is difficult to robustly compare HRA and THA. Today, safe HRA implants inserted by experienced surgeons in active, male patients seem to deliver the most predictable outcomes, high performance and longevity.
Garner A, Dandridge O, Amis A, et al., 2021, The extensor efficiency of unicompartmental, bicompartmental and total knee arthroplasty, Bone and Joint Research, Vol: 10, Pages: 1-9, ISSN: 2046-3758
Aims: Unicompartmental (UKA) and bicompartmental (BCA) knee arthroplasty have been associated with improved functional outcomes compared to Total Knee Arthroplasty (TKA) in suitable patients, although the reason is poorly understood. The aim of this study was to measure how the different arthroplasties affect knee extensor function. Methods: Extensor function was measured for sixteen cadaveric knees and then re-tested following the different arthroplasties. Eight knees underwent medial UKA then BCA, then posterior-cruciate retaining TKA, and eight underwent the lateral equivalents then TKA. Extensorefficiency was calculated for ranges of knee flexion associated with common 46activities of daily living. Data were analyzed with repeated measures analysis of variance (=0.05). Results: Compared to native, there were no reductions in either extension moment or efficiency following UKA. Conversion to BCA resulted in a small decrease in extension moment between 70-90° flexion(p<0.05), but when examined in the context of daily activity ranges of flexion, extensor efficiency was largely unaffected. Following TKA, large decreases in extension moment were measured at low knee flexion angles(p<0.05), resulting in 12-43% reductions in extensor efficiency for the daily activity ranges. Conclusion: This cadaveric study found that TKA resulted in inferior extensor function compared to UKA and BCA. This may, in part, help explain the reported differences in 58function and satisfaction differences between partial and total knee arthroplasty.
Ng KCG, Bankes M, El Daou H, et al., 2021, Cam osteochondroplasty for femoroacetabular impingement increases microinstability in deep flexion: A cadaveric study, Arthroscopy: The Journal of Arthroscopy and Related Surgery, Vol: 37, Pages: 159-170, ISSN: 0749-8063
Purpose: The purpose of this in vitro cadaveric study was to examine the contributions of each surgical stage during cam femoroacetabular impingement (FAI) surgery (i.e., intact cam hip, T8 capsulotomy, cam resection, capsular repair) towards hip range of motion, translations, and microinstability.Methods: Twelve cadaveric cam hips were denuded to the capsule and mounted onto a robotic tester. Hips were positioned in several flexion positions: Full Extension, Neutral 0°, Flexion 30°, and Flexion 90°; and performed internal-external rotations to 5-Nm torque in each position. Hips underwent a series of surgical stages (T-capsulotomy, cam resection, capsular repair) and was retested after each stage. Changes in range of motion, translation, and microinstability (overall translation normalized by femoral head radius) were measured after each stage.Results: For range of motion, cam resection increased internal rotation at Flexion 90° (ΔIR = +6°, P = .001), but did not affect external rotation. Capsular repairs restrained external rotations compared to the cam resection stage (ΔER = –4 to –8°, P ≤ .04). For translations, the hip translated after cam resection at Flexion 90° in the medial-lateral plane (ΔT = +1.9 mm, P = .04), relative to the intact and capsulotomy stages. For microinstability, capsulotomy increased microinstability in Flexion 30° (ΔM = +0.05; P = .003), but did not further increase after cam resection. At Flexion 90°, microinstability did not increase after capsulotomy (ΔM = +0.03; P = .2, d = .24), but substantially increased after cam resection (ΔM = +0.08; P = .03), accounting for a 31% change with respect to the intact stage.Conclusions: Cam resection increased microinstability by 31% during deep hip flexion relative to the intact hip. This suggests that iatrogenic microinstability may be due to separation of the labral seal and resected contour of the femoral head.
Wiik AV, Nathwani D, Akhtar A, et al., 2020, The unicompartmental knee is the preferred side in individuals with both a unicompartmental and total knee arthroplasty, Knee Surgery Sports Traumatology Arthroscopy, Vol: 28, Pages: 3193-3199, ISSN: 0942-2056
PurposeTo determine the preferred knee in patients with both one total and one unicompartmental knee arthroplasty.MethodPatients simply with a unicompartmental (UKA) and total knee arthroplasty (TKA) on contralateral sides were retrospectively screened from three senior knee surgeon’s logs over a 15 year period. Patients safe and free from other diseases to affect gait were approached. A total of 16 patients (mean age 70 ± 8) agreed to ground reaction force testing on an instrumented treadmill at a fair pace and incline. A gender-ratio identical group of 16 healthy control subjects (mean age 67 ± 10) and 16 patients with ipsilateral medial knee OA (mean age 66 ± 7) were analysed to compare.ResultsRadiographically the mode preoperative Kellgren–Lawrence knee grade for each side was 3. Postoperatively, the TKA side had a mean coronal femoral component alignment of 7° and a mean tibial coronal alignment of 89° with a mean posterior slope of 5° in the sagittal plane. The UKA side had a mean coronal femoral component alignment of 7° and a mean tibial coronal alignment of 86° with a mean posterior slope of 4° in the sagittal plane. In 7 patients, the TKA was the first procedure, while 6 for the UKA and 3 done simultaneously. Gait analysis demonstrated in both walking conditions the UKA limb was the preferred side through all phases of loading (p < 0.05) and nearer to normal than the TKA limb when compared to healthy controls and patients with knee OA. The greatest difference was observed between the transition of weight acceptance and midstance (p = 0.008), when 22% more load was taken by the UKA side.ConclusionBy using a dynamic metric of an everyday activity, a distinct gait difference between differing arthroplasty types were established. A more natural loading pattern can be achieved with unicompartmentals as compared to total knees.Level o
Clark J, Heyraud A, Tavana S, et al., 2020, Exploratory full-field mechanical analysis across the osteochondral tissue– biomaterial interface in an ovine model, Materials, Vol: 13, ISSN: 1996-1944
Osteochondral injuries are increasingly prevalent, yet success in articular cartilage regeneration remains elusive, necessitating the development of new surgical interventions and novel medical devices. As part of device development, animal models are an important milestone in illustrating functionality of novel implants. Inspection of the tissue-biomaterial system is vital to understand and predict load-sharing capacity, fixation mechanics and micromotion, none of which are directly captured by traditional post-mortem techniques. This study aims to characterize the localised mechanics of an ex vivo ovine osteochondral tissue–biomaterial system extracted following six weeks in vivo testing, utilising laboratory micro-computed tomography, in situ loading and digital volume correlation. Herein, the full-field displacement and strain distributions were visualised across the interface of the system components, including newly formed tissue. The results from this exploratory study suggest that implant micromotion in respect to the surrounding tissue could be visualised in 3D across multiple loading steps. The methodology provides a non-destructive means to assess device performance holistically, informing device design to improve osteochondral regeneration strategies.
Babu S, Singh P, Wiik A, et al., 2020, A comparison of patient-reported outcome measures (PROMs) between short and conventional stem hip replacements: a systematic review and meta-analysis, HIP INTERNATIONAL, Vol: 30, Pages: 513-522, ISSN: 1120-7000
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Edwards TC, Logishetty K, Cobb JP, 2020, Letter to the Editor on "Patient-Reported Outcomes Following Total Hip Arthroplasty: A Multicenter Comparison Based on Surgical Approaches", JOURNAL OF ARTHROPLASTY, Vol: 35, Pages: 2686-2687, ISSN: 0883-5403
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Ma S, Goh EL, Tay T, et al., 2020, Nanoscale mechanisms in age-related hip-fractures, Scientific Reports, Vol: 10, Pages: 1-14, ISSN: 2045-2322
Nanoscale mineralized collagen fibrils may be important determinants of whole-bone mechanical properties and contribute to the risk of age-related fractures. In a cross-sectional study nano-and tissue-level mechanics were compared across trabecular sections from the proximal femora of three groups(n=10 each): ageing non-fractured donors (Controls);untreated fracture patients (Fx-Untreated); bisphosphonate-treated fracture patients (Fx-BisTreated).Collagen fibril, mineral and tissue mechanics were measured using synchrotron X-Ray diffraction,of bone sections under load. Mechanical data were compared across groups, and tissue-level data were regressed against nano. Compared to controls fracture patients exhibited significantly lower critical strain, max strain and normalized strength, with lower peak collagen and mineral strain. Bisphosphonate-treated exhibited the lowest properties. In all three groups, peak mineral strain coincided with maximum tissue strength (i.e. ultimate stress), whilst peak fibril strain occurred afterwards(i.e. higher strain). Tissue strain and strength were positively and strongly correlated with peak fibril and mineral strains. Age-related fractures were associated with lower peak fibril and mineral strain irrespective of treatment. Indicating earlier mineral disengagement and the subsequent onset of fibril sliding is one of the key mechanisms leading to fracture. Treatments for fragility should target collagen-mineral interactions to restore nano-scale strain to that of healthy bone.
Saracco A, Grassi A, Romagnoli M, et al., 2020, Reduced -dose computed tomography is the most accurate method to measure ceramic hip resurfacing cup version, EUROPEAN JOURNAL OF RADIOLOGY, Vol: 128, ISSN: 0720-048X
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Maillot C, Auvinet E, Harman C, et al., 2020, Hip resurfacing generates a more physiological gait than total hip replacement: A case-control study, ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, Vol: 106, Pages: 527-534, ISSN: 1877-0568
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- Citations: 4
Logishetty K, Gofton WT, Rudran B, et al., 2020, Fully Immersive Virtual Reality for Total Hip Arthroplasty: Objective Measurement of Skills and Transfer of Visuospatial Performance After a Competency-Based Simulation Curriculum, JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, Vol: 102, ISSN: 0021-9355
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- Citations: 26
Ng KCG, Bankes MJK, Cobb J, et al., 2020, Biomechanics of the Native Hip from Normal to Instability, Hip Dysplasia Understanding and Treating Instability of the Native Hip, Editors: Beaulé, Publisher: Springer, Pages: 55-70, ISBN: 9783030333577
This book represents the most advanced understanding of diagnosis and management of hip dysplasia in the young adult, written by the world’s leading experts and covering advanced imaging and biomechanical studies as well as latest ...
Aframian A, Iranpour F, Cobb J, 2020, Medical devices and artificial intelligence, Artificial Intelligence in Healthcare, Pages: 163-177, ISBN: 9780128184387
There is near infinite potential for artificial intelligence (AI) in medical devices, with almost all current technologies having the potential for improvement using AI. We discuss here some examples of how it is already being used and we have divided these into physical hardware devices and software or virtual devices, in part because they are different and also because the regulatory requirements vary for different medical devices. These devices have in turn been divided into community and specialist center (such as hospital) uses to provide context. The increasing use of medical devices has led to the need for new regulations in both Europe and worldwide and these too are discussed.
Garner A, Cobb J, 2020, Combined partial knee arthroplasty, Personalized Hip and Knee Joint Replacement, Pages: 243-254, ISBN: 9783030242428
Arthrosis commonly affects a single compartment of the knee, but may present with two or even three compartments affected. Wear to the medial tibiofemoral compartment is ten times more common than that in the lateral tibiofemoral compartment; primary patellofemoral joint (PFJ) arthrosis is least common [1, 2]. Bicompartmental disease is present in 59% of those with gonarthrosis [3]. In one study, 40% of patients over 50 years old with knee pain had radiographic evidence of combined medial compartment and PFJ wear, 24% had isolated PFJ arthrosis, whilst only 4% had isolated tibiofemoral arthrosis [4]. Degeneration of all three compartments simultaneously is rare [2]. Consequently, removal of healthy tissue in total knee arthroplasty (TKA) is common. The anterior cruciate ligament (ACL) is present in 78% of cases of patients undergoing primary knee replacement [5]. The fundamental role of the ACL in knee stability and functional gait is well described [6]; however, regardless of its functional integrity, it is resected in almost all TKAs.
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
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- Citations: 54
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.
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.
Riviere C, Harman C, Parsons T, et 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
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Maillot C, Harman C, Villet L, et 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
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- Citations: 22
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