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Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_12 | Pages 1 - 1
1 Jun 2017
Smeatham A Powell R Moore S Chauhan R Wilson M
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Research into the treatment of Femoro-Acetabular Impingement (FAI) has focussed on surgical correction of structural abnormalities and tended to overlook the dynamic process of impingement. The role of Physiotherapy in addressing abnormal hip movement and any resulting effect on the symptoms of FAI remains untested. A pilot study was therefore instigated to evaluate the effect of physiotherapy on pain and function in patients with FAI.

30 adults aged between 18 and 50 years with a diagnosis of symptomatic FAI were recruited. 23 (77%) completed the study.

Intervention was 3 months of specialist physiotherapy focused on improving pelvic and proximal femoral control. The control group received routine care.

All functional outcomes improved in the Physiotherapy group and this included improvement beyond minimal clinically important difference and measurement error on the Hip Outcome Score.

There was marginal improvement in pain in both groups

Results suggest that physiotherapy treatment can improve function in adults with symptomatic FAI. Larger studies are needed to evaluate the role of conservative management in FAI.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 187 - 187
1 Jul 2014
Moore S Saidel G Tate MK
Full Access

Summary Statement

A coupled finite element - analytical model is presented to predict and to elucidate a clinical healing scenario where bone regenerates in a critical-sized femoral defect, bounded by periosteum or a periosteum substitute implant and stabilised via an intramedullary nail.

Introduction

Bone regeneration and maintenance processes are intrinsically linked to mechanical environment. However, the cellular and subcellular mechanisms of mechanically-modulated bone (re-) generation are not fully understood. Recent studies with periosteum osteoprogenitor cells exhibit their mechanosensitivity in vitro and in situ. In addtion, while a variety of growth factors are implicated in bone healing processes, bone morphogenetic protein-2 (BMP-2) is recognised to be involved in all stages of bone regeneration. Furthermore, periosteal injuries heal predominantly via endochondral ossification mechanisms. With this background in mind, the current study aims to understand the role of mechanical environment on BMP-2 production and periosteally-mediated bone regeneration. The one-stage bone transport model [1] provides a clinically relevant experimental platform on which to model the mechanobiological process of periosteum-mediated bone regeneration in a critical-sized defect. Here we develop a model framework to study the cellular-, extracellular- and mechanically-modulated process of defect infilling, governed by the mechanically-modulated production of BMP-2 by osteoprogenitor cells located in the periosteum.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 189 - 189
1 Jul 2014
Moore S Milz S Tate MK
Full Access

Summary Statement

Thickness and cellularity of human periosteum are important parameters both for engineering replacement tissue as well as for surgeons looking to minimise tissue damage while harvesting the most viable periosteum possible for autologous regenerative therapies. This study provides a new foundation for understanding the basic structural features of middiaphyseal periosteum from femora and tibiae of aged donors.

Introduction

A number of recent studies describe mechanical, permeability and regenerative properties of periosteal tissue and periosteum derived cells in a variety of animal models [1,2]. However, due to lack of access in healthy patients, the structural properties underlying human periosteum's inherent regenerative power and advanced material properties are not well understood. Periosteum comprises a cellular cambium layer directly apposing the outer surface of bone and an outer fibrous layer encompassed by the surrounding soft tissues. As a first step to elucidate periosteum's structural and cellular characteristics in human bone, the current study aims to measure cambium and fibrous layer thickness as well as cambium cellularity in human femora and tibiae of aged donors.