Are there functional biomechanical differences in robotic arm-assisted bi-unicompartmental knee arthroplasty compared with conventional total knee arthroplasty? A prospective, randomized controlled trial.

Aims: The aim of this study was to compare any differences in the primary outcome (biphasic flexion knee moment during gait) of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) at one year post-surgery.

Methods: A total of 76 patients (34 bi-UKA and 42 TKA patients) were analyzed in a prospective, single-centre, randomized controlled trial. Flat ground shod gait analysis was performed preoperatively and one year postoperatively.

Early outcomes after robotic arm-assisted bi-unicompartmental knee arthroplasty compared with total knee arthroplasty: a prospective, randomized controlled trial.

Aims: The aim of this study was to compare the clinical outcomes of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) during the first six weeks and at one year postoperatively.

Methods: A per protocol analysis of 76 patients, 43 of whom underwent TKA and 34 of whom underwent bi-UKA, was performed from a prospective, single-centre, randomized controlled trial. Diaries kept by the patients recorded pain, function, and the use of analgesics daily throughout the first week and weekly between the second and sixth weeks.

Robotic arm-assisted bi-unicompartmental knee arthroplasty maintains natural knee joint anatomy compared with total knee arthroplasty: a prospective randomized controlled trial.

Aims: The aim of this study was to compare robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) in order to determine the changes in the anatomy of the knee and alignment of the lower limb following surgery.

Methods: An analysis of 38 patients who underwent TKA and 32 who underwent bi-UKA was performed as a secondary study from a prospective, single-centre, randomized controlled trial. CT imaging was used to measure coronal, sagittal, and axial alignment of the knee preoperatively and at three months postoperatively to determine changes in anatomy that had occurred as a result of the surgery.

Routine clinical motion analysis: comparison of a bespoke real-time protocol to current clinical methods.

Motion analysis (MA) hardware has recently become more accessible; however, protocols have not developed in conjunction. Routine clinical assessment mostly relies on unreliable observational methods. This study aimed to develop an MA protocol for routine clinical use and compare kinematics and reliability to the gold-standard.

A novel approach for intra-operative shape acquisition of the tibio-femoral joints using 3D laser scanning in computer assisted orthopaedic surgery.

Background: Image registration (IR) is an important process of developing a spatial relationship between pre-operative data and the physical patient in the operation theatre. Current IR techniques for Computer Assisted Orthopaedic Surgery (CAOS) are time consuming and costly. There is a need to automate and accelerate this process.

Thermal Damage Done to Bone by Burring and Sawing With and Without Irrigation in Knee Arthroplasty.

Background: Heat from bone resecting tools used in knee surgery can induce thermal osteonecrosis, potentially causing aseptic implant loosening. This study compared oscillating saws to burrs in terms of temperature generation and histologic damage. Use of irrigation to reduce bone temperature was also investigated.

Does stroke location predict walk speed response to gait rehabilitation?

Objectives: Recovery of independent ambulation after stroke is a major goal. However, which rehabilitation regimen best benefits each individual is unknown and decisions are currently made on a subjective basis. Predictors of response to specific therapies would guide the type of therapy most appropriate for each patient.

Tensile properties of the transverse carpal ligament and carpal tunnel complex.

Background: A new sophisticated method that uses video analysis techniques together with a Maillon Rapide Delta to determine the tensile properties of the transverse carpal ligament-carpal tunnel complex has been developed.

Methods: Six embalmed cadaveric specimens amputated at the mid-forearm and aged (mean (SD)): 82 (6.29) years were tested.

Analysis of gait within the uncontrolled manifold hypothesis: stabilisation of the centre of mass during gait.

This study investigated the feasibility of the uncontrolled manifold approach (UCM) to analyse gait data variability in relation to the control of the centre of mass (COM) in adults with and without neuropathology. The proposed method was applied to six able-bodied subjects to characterise mechanisms of normal postural control during stance phase. This approach was repeated on an early stroke patient, who attended the laboratory three times at three monthly intervals, to characterise the variability of COM movement during walking with and without an orthosis.

Electromagnetic navigation in total knee arthroplasty-a single center, randomized, single-blind study comparing the results with conventional techniques.

We report on the results of a randomized study (n=200) to compare total knee arthroplasty performed using conventional instrumentation or electromagnetic computer assisted surgical technique. 92% of navigated and 85% of conventional knees were implanted within ±3° from neutral mechanical alignment; there was no statistically significant difference between these proportions. There was also no difference in femoral or tibial rotation assessed by CT scan.

High degree of accuracy of a novel image-free handheld robot for unicondylar knee arthroplasty in a cadaveric study.

Background: Surgical robotics has been shown to improve the accuracy of bone preparation and soft tissue balance in unicondylar knee arthroplasty (UKA). However, although extensive data have emerged with regard to a CT scan-based haptically constrained robotic arm, little is known about the accuracy of a newer alternative, an imageless robotic system.

Questions/purposes: We assessed the accuracy of a novel imageless semiautonomous freehand robotic sculpting system in performing bone resection and preparation in UKA using cadaveric specimens.

Research synthesis of recommended acetabular cup orientations for total hip arthroplasty.

Total hip arthroplasty (THA) is regarded as one of the most successful surgical procedures of modern times yet continues to be associated with a small but significant complication rate. Many early failures may be associated with poor component positioning with, in particular, acetabular component orientation dependent on the subjective judgement of the surgeon. In this paper, we compare the manufacturers' instructions on acetabular cup orientation with the literature-based recommended safety zones and surgical technique, by transforming them onto a single, clinically-relevant framework in which the different reference systems, safety guidelines and current instrumentation surgical techniques can be evaluated.

Accuracy of a freehand sculpting tool for unicondylar knee replacement.

Background: Unicondylar knee replacement is technically challenging and malalignment of the implant components is one of the factors that results in high failure rates. Surgical robotics with navigation is emerging as a potential solution to improve the accuracy of implant placement.

Methods: The accuracy of performing unicondylar knee replacement using a freehand sculpting, semi-active robotic tool was investigated using 20 synthetic femurs and tibia.

The evaluation of an inexpensive, 2D, video based gait assessment system for clinical use.

The purpose of this study was to investigate the clinical potential of an augmented-video-based-portable-system (AVPS). The AVPS included a walkway grid mat made of vinyl flooring, flat paper bull's eye markers, four photoswitches mounted on tripods, a light-indicator, a video camera, and a computer with ProTrainer System software. The AVPS output was compared to a "gold standard" 3D Vicon Motion Analysis System both statically and dynamically over a fixed range (-90° to +90°) using a two-segment-goniometric-rig marked with both bull's eye and retroreflective markers.

The effect of electromagnetic navigation in total knee arthroplasty on knee kinematics during functional activities using flexible electrogoniometry.

Background: Navigated total knee arthroplasty has been shown to increase accuracy in post operative implant alignment. By contrast navigated total knee arthroplasty has not shown significant functional improvements to date, when compared with conventional surgery using subjective clinical questionnaire scores. The aim of this study was to compare the knee joint kinematics measured during functional activities using electrogoniometry 12 months after total knee arthroplasty in randomised navigated and conventional total knee arthroplasty groups.

Developing visualisation software for rehabilitation: investigating the requirements of patients, therapists and the rehabilitation process.

This article describes the ongoing process of engaging with users in the development and evaluation of prototype visualisation software, which aims to assist in the understanding and improvement of appropriate movements during rehabilitation. The value of the process is illustrated in the article with a discussion of the key findings of pre-pilot focus groups with stroke survivors and therapists. The article describes how the design of the visualisation software is being adapted to meet the emerging understanding of the needs of patients and professionals, and of the rehabilitation process.

Visualisation to enhance biomechanical tuning of ankle-foot orthoses (AFOs) in stroke: study protocol for a randomised controlled trial.

Background: There are a number of gaps in the evidence base for the use of ankle-foot orthoses for stroke patients. Three dimensional motion analysis offers an ideal method for objectively obtaining biomechanical gait data from stroke patients, however there are a number of major barriers to its use in routine clinical practice. One significant problem is the way in which the biomechanical data generated by these systems is presented.

Gait kinematics and passive knee joint range of motion in children with hypermobility syndrome.

Hypermobility syndrome (HMS) is characterised by generalised joint laxity and musculoskeletal complaints. Gait abnormalities have been reported in children with HMS but have not been empirically investigated. The extent of passive knee joint range of motion (ROM) has also not been well reported in children with HMS.

Development and validation of a user-friendly data logger (SUDALS) for use with flexible electrogoniometers to measure joint movement in clinical trials.

Objective: Our aim was to develop and validate a user-friendly data logger system (SUDALS) for use with flexible electrogoniometry.

Methods: Data pertaining to flexion/extension of the knee from 10 normal subjects were collected during a range of activities of daily living (ADL) such as walking, ascending and descending stairs, getting in and out of a chair and deep squatting. The accuracy, reliability and reproducibility of the data from SUDALS were verified by comparing against the data simultaneously collected from the Vicon system.

Effect of ageing on isometric strength through joint range at knee and hip joints in three age groups of older adults.

Background: Strength of lower extremity muscles is an important determinant of mobility-based functional activities. Loss of strength with age produces functional limitation in activities of daily living such as rising from a chair or stair negotiation. However, there is limited information on the effect of age-related changes on the torque-producing ability of muscles through their ranges of joint motion.

Physical activity and quality of life: A study of a lower-limb amputee population.

This cross-sectional descriptive study was initiated to investigate the relationship between physical activity and perceived quality of life in a lower-limb amputee population. The objective was to show which aspects of physical activity were most strongly linked to quality-of-life factors in this special patient group. The outcome measurements were two questionnaires: a section of the Trinity Amputation and Prosthetic Experience Scales (TAPES) and the World Health Organization Quality-of-Life Scale (WHOQOL-Bref).

Repeatability of joint proprioception and muscle torque assessment in healthy children and in children diagnosed with hypermobility syndrome.

Background: Impairment of joint proprioception in patients with hypermobility syndrome (HMS) has been well documented. Both joint proprioception and muscle torque are commonly assessed in patients with musculoskeletal complaints. It is unknown, however, if these measures change significantly on repeated application in healthy children and in children with HMS.

Knee kinematics in functional activities seven years after total knee arthroplasty.

Background: Detailed knowledge of knee kinematics during functional activities is lacking in current studies on the long-term outcome of total knee replacement surgery. The aim of this study was to assess functional knee kinematics using flexible electrogoniometry in patients seven years after unilateral primary total knee arthroplasty for osteoarthritis.

Methods: The knee joint functional movement of a cohort of patients (n=19) with knee osteoarthritis was assessed using electrogoniometry before surgery and 18-24 months and seven years after total knee surgery.

The effect of patella resurfacing in total knee arthroplasty on functional range of movement measured by flexible electrogoniometry.

Background: The need for patella resurfacing remains an area of considerable controversy in total knee replacement surgery. There would appear to be no reported evidence on the effect of patella resurfacing on knee function, as measured by functional range of movement used in a series of tasks, in patients undergoing knee replacement. The object of this study was to measure knee joint motion during functional activities both prior to and following total knee replacement in a randomised group of patients with and without patella resurfacing and to compare these patient groups with a group of normal age-matched subjects.