Aims. The primary aim of the survey was to map the current provision of
Hip joint biomechanics can be altered by abnormal morphology of the acetabulum and/or femur. This may affect load distribution and contact stresses on the articular surfaces, hence, leading to damage and degradation of the tissue. Experimental hip joint simulators have been used to assess tribology of total hip replacements and recently methods further developed to assess the natural hip joint mechanics. The aim of this study was to evaluate articular surfaces of human cadaveric joints following prolonged experimental
The treatment of paediatric supracondylar humeral fractures is likely one of the first procedures involving X-ray guided wire insertion that trainee orthopaedic surgeons will encounter. Pinning is a skill that requires high levels of anatomical knowledge, spatial awareness, and hand-eye coordination. We developed a
Surgical trainees are finding it increasingly more challenging to meet operative requirements and coupled with the effects of COVID-19, we face a future of insufficiently trained surgeons. As a result, virtual reality (VR) simulator training has become more prevalent and whilst more readily accepted in certain arthroscopic fields, its use in hip arthroscopy (HA) remains novel. This project aimed to validate VR high-fidelity HA
Iliopsoas tendonitis occurs in up to 30% of patients after hip resurfacing arthroplasty (HRA) and is a common reason for revision. The primary purpose of this study was to validate our novel computational model for quantifying iliopsoas impingement in HRA patients using a case-controlled investigation. Secondary purpose was to compare these results with previously measured THA patients. We conducted a retrospective search in an experienced surgeon's database for HRA patients with iliopsoas tendonitis, confirmed via the active hip flexion test in supine, and control patients without iliopsoas tendonitis, resulting in two cohorts of 12 patients. The CT scans were segmented, landmarked, and used to simulate the iliopsoas impingement in supine and standing pelvic positions. Three discrete impingement values were output for each pelvic position, and the mean and maximum of these values were reported. Cup prominence was measured using a novel, nearest-neighbour algorithm. The mean cup prominence for the symptomatic cohort was 10.7mm and 5.1mm for the asymptomatic cohort (p << 0.01). The average standing mean impingement for the symptomatic cohort was 0.1mm and 0.0mm for the asymptomatic cohort (p << 0.01). The average standing maximum impingement for the symptomatic cohort was 0.2mm and 0.0mm for the asymptomatic cohort (p << 0.01). Impingement significantly predicted the probability of pain in logistic regression models and the
Abstract. Introduction. Knee arthroscopy can be used for ligamentous repair, reconstruction and to reduce burden of infection. Understanding and feeling confident with knee arthroscopy is therefore a highly important skillset for the orthopaedic surgeon. However, with limited training or experience, furthered by reduced practical education due to COVID-19, this skill can be under-developed amongst trainee surgeons. Methods. At a single institution, ten junior doctors (FY1 to CT2), were recruited as a part of a five, two-hour session, training programme utilising the Simbionix® ARTHRO Mentor knee arthroscopy simulator, supplemented alongside educational guidance with a consultant orthopaedic knee surgeon. All students had minimal to no levels of prior arthroscopic experience. Exercises completed included maintaining steadiness, image centering and orientation, probe triangulation, arthroscopic knee examination, removal of loose bodies, and meniscectomy. Pre and post-experience questionnaires and quantitative repeat analysis on
Introduction. Knee arthroscopy can be used for ligamentous repair, reconstruction and to reduce burden of infection. Understanding and feeling confident with knee arthroscopy is therefore a highly important skillset for the orthopaedic surgeon. However, with limited training or experience, furthered by reduced practical education due to COVID-19, this skill can be under-developed amongst trainee surgeons. Methods. At a single institution, ten junior doctors (FY1 to CT2), were recruited as a part of a five, two-hour session, training programme utilising the Simbionix® ARTHRO Mentor knee arthroscopy simulator, supplemented alongside educational guidance with a consultant orthopaedic knee surgeon. All students had minimal to no levels of prior arthroscopic experience. Exercises completed included maintaining steadiness, image centring and orientation, probe triangulation, arthroscopic knee examination, removal of loose bodies and meniscectomy. Pre and post experience questionnaires and quantitative repeat analysis on
Abstract. OBJECTIVES. Abnormal joint mechanics have been proposed as adversely affecting natural hip joint tribology, whereby increased stress on the articular cartilage from abnormal loading leads to joint degeneration. The aim of this project was to assess the damage caused by different loading conditions on the articular surfaces of the porcine hip joint in an experimental simulator. METHODS. Porcine hip joints were dissected and mounted in a single station hip simulator (SimSol, UK) and tested under loading scenarios (that corresponded to equivalent of different body mass index's’ (BMI) in humans), as follows:“Normal” (n=4), the loading cycle consisted of a simplified gait cycle based on a scaled version of a simplified twin-peak human gait cycle, the peak load was 900N (representative of a healthy BMI). Representative of an “Overweight” BMI (n=3), as the normal cycle with a peak load of 1,130N Representative of an “Obese” BMI (n=1), as the normal cycle with a peak load of 1,340N Tests were conducted at 1Hz for 14,400 cycles in Ringers solution; photogrammetry was used to characterise the appearance of the cartilage and labrum pre, during and post
Introduction. Derotation osteotomies are commonly performed in paediatric orthopaedic and limb reconstruction practice. The purpose of this study was to determine whether the use of a digital inclinometer significantly improves the accuracy in attaining the desired correction. Materials & Methods. We designed an electronic survey regarding derotation femoral osteotomy (DFO) including methods of intra-operative angular correction assessment and acceptable margins of error for correction. This was distributed to 28 paediatric orthopaedic surgeons in our region. A DFO model was created, using an anatomic sawbone with foam covering. 8 orthopaedic surgeons each performed two 30-degree DFOs, one using K-wires and visual estimation (VE), and the other using a Digital Inclinometer (DI). Two radiologists reported pre and post procedure rotational profile CT scans to assess the achieved rotational correction. Results. There was a 68% response rate to the survey. The most popular methods of estimating intra-operative correction were reported to be K-wires and rotation marks on bone. The majority of respondents reported that a 6–10 degree margin of error was acceptable for a 30-degree derotation. This was therefore set as the upper limit for acceptable error margin in the
We share our experiences in designing a complete simulator prototype and provide the technological basis to determine whether an immersive medical training environment for vertebroplasty is successful. In our study, the following key research contributions were realised: (1) the effective combination of a virtual reality surgical simulator and a computerised mannequin in designing a novel training setup for medical education, and (2) based on a user-study, the quantitative evaluation through surgical workflow and crisis
Paediatric musculoskeletal (MSK) disorders often produce severe limb deformities, that may require surgical correction. This may be challenging, especially in case of multiplanar, multifocal and/or multilevel deformities. The increasing implementation of novel technologies, such as virtual surgical planning (VSP), computer aided surgical
Introduction. Geometric variations of the hip joint can give rise to abnormal joint loading causing increased stress on the articular cartilage, which may ultimately lead to degenerative joint disease. In-vitro
Introduction. Loads acting on the knee are tied to the long term performance of implants, and are directly related to ligament function [1]. Previous work has used computational models coupled with optimization to estimate ligament properties based on experimental joint kinematics [2]. Our group recently utilized a similar optimization scheme that estimated ligament slack lengths based on experimental implant contact metrics [3]. A comparison with surgically relevant loading conditions that were excluded from the optimization would help establish the utility of the
Introduction. Total knee arthroplasty (TKA) prostheses are semi-constrained artificial joints. A well-functioning TKA prosthesis should be designed with a good balance between stability and mobility, meaning the femorotibial constraint of the artificial joint should be appropriate for the device's function. To assess the constraint behavior of a TKA prosthesis, physical testing is typically required, and an industrial testing standard has been developed for this purpose [1]. Computer
Summary Statement. The constraint behavior of total knee arthroplasty (TKA) prosthesis usually has to be physically tested. This study presents a computer
Introduction. Experimental wear
“Simulation”, “deliberate practice”, “rehearsal” have been used to describe safe acquisition and practice of skills before patient contact.
INTRODUCTION. While computational models have been used for many years to contribute to pre-clinical, design phase iterations of total knee replacement implants, the analysis time required has limited the real-time use as required for other applications, such as in patient-specific surgical alignment in the operating room. In this environment, the impact of variation in ligament balance and implant alignment on estimated joint mechanics must be available instantaneously. As neural networks (NN) have shown the ability to appropriately represent dynamic systems, the objective of this preliminary study was to evaluate deep learning to represent the joint level kinetic and kinematic results from a validated finite element lower limb model with varied surgical alignment. METHODS. External hip and ankle boundary conditions were created for a previously-developed finite element lower limb model [1] for step down (SD), deep knee bend (DKB) and gait to best reproduce in-vivo loading conditions as measured on patients with the Innex knee (. orthoload.com. ) (Figure1). These boundary conditions were subsequently used as inputs for the model with a current fixed-bearing total knee replacement to estimate implant-specific kinetics and kinematics during activities of daily living. Implant alignments were varied, including variation of the hip-knee-ankle angle-±3°, the frontal plane joint line −7° to +5°, internal-external femoral rotation ±3°, and the tibial posterior slope 5° and 0°. Through varying these parameters a total of 2464
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