Introduction. Accurate assessment of alignment in pre-operative and post-operative knee radiographs is important for planning and evaluating knee replacement surgery. Existing methods predominantly rely on manual
Gait
Rotational laxity increases the risk of anterior cruciate ligament (ACL) injuries and residual rotational laxity can result in inferior surgical outcomes and risk of retears. The dynamic rotatory knee stability can be assessed through manual examination, but it is limited to the surgeon's experience and it provides inaccurate
Abstract. Objectives. Ultrasound speckle tracking is a safe and non-invasive diagnostic tool to measure soft tissue deformation and strain. In orthopaedics, it could have broad application to measure how injury or surgery affects muscle, tendon or ligament biomechanics. However, its application requires custom tuning of the speckle-tracking algorithm then validation against gold-standard reference data. Implementing an experiment to acquire these data takes months and is expensive, and therefore prohibits use for new applications. Here, we present an alternative optimisation approach that automatically finds suitable machine and algorithmic settings without requiring gold-standard reference data. Methods. The optimisation routine consisted of two steps. First, convergence of the displacement field was tested to exclude the settings that would not track the underlying tissue motion (e.g. frame rates that were too low). Second, repeatability was maximised through a surrogate optimisation scheme. All settings that could influence the strain calculation were included, ranging from acquisition settings to post-processing smoothing and filtering settings, totalling >1,000,000 combinations of settings. The optimisation criterion minimised the normalised standard deviation between strain maps of repeat measures. The optimisation approach was validated for the medial collateral ligament (MCL) with quasi-static testing on porcine joints (n=3), and dynamic testing on a cadaveric human knee (n=1, female, aged 49). Porcine joints were fully dissected except for the MCL and loaded in a material-testing machine (0 to 3% strain at 0.2 Hz), which was captured using both ultrasound (>14 repeats per specimen) and optical digital image correlation (DIC). For the human cadaveric knee (undissected), 3 repeat ultrasound acquisitions were taken at 18 different anterior/posterior positions over the MCL while the knee was extended/flexed between 0° and 90° in a knee extension rig. Simultaneous optical tracking recorded the position of the ultrasound transducer, knee kinematics and the MCL attachments (which were digitised under direct visualisation post testing). Half of the data collected was used for optimisation of the speckle tracking algorithms for the porcine and human MCLs separately, with the remaining unseen data used as a validation test set. Results. For the porcine MCLs, ultrasound strains closely matched DIC strains (R. 2. > 0.98, RMSE < 0.59%) (Figure 1A). For the human MCL (Figure 1B), ultrasound strains matched the strains estimated from the optically tracked displacements of the MCL attachments. Furthermore, strains developed during flexion were highly correlated with AP position (R = 0.94) with strains decreasing the further posterior the transducer was on the ligament. This is in line with previously reported length change values for the posterior, intermediate and anterior bundles of the MCL. Conclusions. Ultrasound speckle tracking algorithms can be adapted for new applications without ground-truth data by using an optimisation approach that verifies displacement field convergence then minimises variance between repeat
Foot pain and related problems are quite common in the community. It is reported that 24% of individuals older than 45 experienced foot pain. Also, it is stated that at least two thirds of individuals experiences moderate physical disability due to foot problems. In the absence of evaluation of risk factors such as limited ankle dorsiflexion in the early period of the diseases (Plantar fasciitis, Achilles Tendinopathy e.g.) and the lack of mobile systems with portable remote access, foot pain becomes refractory/chronic foot pain, secondary pathologies and ends with workload of 1., 2. and 3rd level healthcare services. In the literature, manuel and dijital methods have been used to analyze the ankle range of motion (ROM). These studies are generally based on placing protractors on the image and / or angle detection from inclination
Background. Biomechanical joint contact pressure distribution
Polymer foams have been used extensively in the testing and development of orthopaedic devices and for verification of computational models. Their use is often preferred over cadaver and animal models due to being relatively inexpensive and their consistent material properties. Successful validation of such models requires accurate material/mechanical data. The assumed range of compressive moduli, provided in the sawbones technical sheet, is 16 MPa to 1.15 GPa depending on the density of foam. In this investigation, we apply two non-contact
Range of Motion (ROM) assessments are routinely used during joint replacement to evaluate joint stability before, during and after surgery to ensure the effective restoration of patient biomechanics. This study aimed to quantify axial torque in the femur during ROM assessment in total hip arthroplasty to define performance criteria against which hip instruments can be verified. Longer term, this information may provide the ability to quantitatively assess joint stability, extending to quantitation of bone preparation and quality. Joint loads measured with strain-gaged instruments in five cadaveric femurs prepared using posterior approach were analysed. Variables such as surgeon-evaluator, trial offset and specimen leg and weight were used to define 13 individual setups and paired with surgeon appraisal of joint tension for each setup. Peak torque loads were then identified for specific motions within the ROM assessment. The largest torque measured in most setups was observed during maximum extension and external rotation of the joint, with a peak torque of 13Nm recorded in a specimen weighing 98kg. The largest torque range (19.4Nm) was also recorded in this specimen. Other motions within the trial reduction showed clear peaks in applied torque but with lower magnitude. Relationships between peak torque, torque range and specimen weight produced an R2 value greater than 0.65. The data indicated that key influencers of torsional loads during ROM were patient weight, joint tension and limb motion. This correlation with patient weight should be further investigated and highlights the need for population representation during cadaveric evaluation. Although this study considered a small sample size, consistent patterns were seen across several users and specimens. Follow-up studies should aim to increase the number of surgeon-evaluators and further vary specimen size and weight. Consideration should also be given to alternative surgical approaches such as the Direct Anterior Approach.
Range of motion (ROM) is a well recognised outcome measure following TKA and combines both knee flexion and extension. In contrast to achieved flexion, fewer studies have recognised the importance of fixed flexion deformity (FFD). A post-operative FFD can adversely affect pain and functional knee scores and so its detection is important. The aim of this study was to investigate the accuracy of standard clinical ROM
Background. Radiological and clinical results of total shoulder arthroplasty are dependent upon ability to accurately measure and correct glenoid version. There are a variety of imaging modalities and computer-assisted reconstruction programmes that are employed with varying degrees of success. We have compared three freely available modalities: unformatted 2D CT; formatted 2D CT; and 3D CT reconstructions. Methods. A retrospective analysis of 20 shoulder CT scans was performed. Glenoid version was measured at the estimated mid-point of the glenoid from unformatted 2D CT scans (Scapula body method) and again following formatting of 2D CT scans in the plane of the scapula (Friedman method). 3D scapula reconstructions were also performed by downloading CT DICOM images to OSIRIX 6 and plotting ROI points on Friedman's axis to most accurately define glenoid version. Both
Objectives. Lengthening osteotomies of the calcaneus in children are in general
grafted with bone from the iliac crest. Artificial bone grafts have
been introduced, however, their structural and clinical durability
has not been documented. Radiostereometric analysis (RSA) is a very
accurate and precise method for
An unresolved challenge in osteoarthritis research is characterising the localised intra-tissue mechanical response of articular cartilage. The aim of this study was to explore whether laboratory micro-computed tomography (micro-CT) and digital volume correlation (DVC) permit non-destructive visualisation of three-dimensional (3D) strain fields in human articular cartilage. Human articular cartilage specimens were harvested from the knee (n=4 specimens from 2 doners), mounted into a loading device and imaged in the loaded and unloaded state using a micro-CT scanner. Strain was calculated throughout the volume of the cartilage using the CT image data.Abstract
OBJECTIVES
METHODS
Our aim was to determine whether tantalum markers improved the accuracy and/or precision of methods for the
Introduction. Subtle variations in hip morphology associate with risk of hip osteoarthritis (OA). However, validated accurate methods to quantitate hip morphology using plain radiography are lacking. We have developed a Matlab-based software-tool (SHIPs) that measures 19 OA-associated morphological-parameters of the hip using a PACS pelvic radiograph. In this study we evaluated the accuracy and repeatability of the method. Methods. Software accuracy was assessed by firstly measuring the linear ratio of 2 fixed distances and several angles against a gold-standard test radiograph, and secondly by repeated
Current methods of
Background & Objectives. Sensory and motor manifestations in carpal tunnel syndrome (CTS) are well documented, whereas the associated autonomic dysfunction is often overlooked. The aim of this study is to demonstrate that autonomic dysfunction of the CTS hands can be quantified by measuring skin capacitance. Methods. Patients with clinical and electrophysiological signs of idiopathic carpal tunnel syndrome meeting the inclusion criteria were recruited. The patients were also scored based on the Brigham carpal tunnel severity score. Skin capacitance was measured using Corneometer CM825 (C&K Electronic, GmbH). The
Hip dislocations remain one of the most common complications of total-hip-arthroplasty (Zahar et al.,2013). There is contradicting evidence whether the surgical approach affects dislocation rates (Sheth et al., 2015; Maratt, 2018). The aim of this study was to develop instrumentation to measure hip forces during simulated range-of-motion tests where the hip was forced to dislocate in cadaveric specimen. A total-hip-replacement was completed on both hips of a single cadaveric specimen by a trained orthopaedic surgeon during a lab initiated by DePuy. A direct-anterior surgical approach was performed on the right leg and a posterior approach was performed on the left. Before final implantation of the femoral component, a trial reduction with a femoral neck trial was performed. The neck trial was modified with strain gauges placed around the shaft which were designed to measure resultant hip forces throughout the range-of-motion assessment. A force-calibration was performed using a calibration-block to convert strain to force values.Abstract
OBJECTIVES
METHODS
Non-invasive, in vivo
Our aim was to determine the precision of the
We obtained simultaneous