Search results for: unilateral knee arthroplasty

Authors: Valentina Narvaez Gaitan, Paula K. Rodriguez Ramirez, Derian D. Espinosa

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Corrective orthosis has great importance in orthopedic treatments providing assistance in improving mobility and stability in order to improve the quality of life for a different patient. The corrective orthosis studied in this article can correct deformities, reduce pain, and improve the ability to perform daily activities. This work describes the design and evaluation of a corrective orthosis for knee hyperextension. This orthosis is capable of generating a progressive and variable alignment of the joint, limiting the range of motion according to medical criteria. The main objective was to design a corrective knee orthosis capable of correcting knee hyperextension progressively to return to its natural angle with greater economic affordability and adjustable size. The limiting mechanism is based on a goniometer to determine the desired angles. The orthosis was made of acrylic to reduce costs and maintenance; neoprene is also used to make comfortable contact; additionally, Velcro was used in order to adjust the orthosis for various sizes. Simulations of static and fatigue analysis of the mechanism were performed to verify its resistance and durability under normal conditions. A biomechanical gait study of gait was carried out on 10 healthy subjects without the orthosis and limiting their knee extension capacity in a normal gait cycle with the orthosis to observe the efficiency of the proposed system. In the results obtained, the knee angle curves show that the maximum extension angle was the established angle by the orthosis. Showing the efficiency of the proposed design for different leg sizes.

Keywords: biomechanical study, corrective orthosis, efficiency, goniometer, knee hyperextension.

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Authors: Mike T. Wei, Douglas N. Mintz, Lisa A. Mandl, Arielle W. Fein, Jayme C. Burket, Yuo-Yu Lee, Wei-Ti Huang, Vivian P. Bykerk, Mark P. Figgie, Edward F. Di Carlo, Bruce N. Cronstein, Susan M. Goodman

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Background/Purpose: Rheumatoid arthritis (RA) patients have excellent total hip arthroplasty (THA) survival, and methotrexate (MTX), an anti-inflammatory disease modifying drug which may affect bone reabsorption, may play a role. The purpose of this study is to determine the diagnosis leading to revision THA (rTHA) in RA patients and to assess the association of radiographic lucency with MTX use. Methods: All patients with validated diagnosis of RA in the institution’s THA registry undergoing rTHA from May 2007 - February 2011 were eligible. Diagnosis leading to rTHA and medication use was determined by chart review. Osteolysis was evaluated on available radiographs by measuring maximum lucency in each Gruen zone. Differences within RA patients with/without MTX in osteolysis, demographics, and medications were assessed with chi-squared, Fisher's exact tests or Mann-Whitney U tests as appropriate. The error rate for multiple comparisons of lucency in the different Gruen zones was corrected via false discovery rate methods. A secondary analysis was performed to determine differences in diagnoses leading to revision between RA and matched OA controls (2:1 match by sex age +/- 5 years). OA exclusion criteria included presence of rheumatic diseases, use of MTX, and lack of records. Results: 51 RA rTHA were identified and compared with 103 OA. Mean age for RA was 57.7 v 59.4 years for OA (p = 0.240). 82.4% RA were female v 83.5% OA (p = 0.859). RA had lower BMI than OA (25.5 v 28.2; p = 0.166). There was no difference in diagnosis leading to rTHA, including infection (RA 3.9 v OA 6.8%; p = 0.719) or dislocation (RA 23.5 v OA 23.3%; p = 0.975). There was no significant difference in the length of time the implant was in before revision: RA 11.0 v OA 8.8 years (p = 0.060). Among RA with/without MTX, there was no difference in use of biologics (30.0 v 43.3%, p = 0.283), steroids (47.6 v 50.0%, p = 0.867) or bisphosphonates (23.8 v 33.3%, p = 0.543). There was no difference in rTHA diagnosis with/without MTX, including loosening (52.4 v 56.7%, p = 0.762). There was no significant difference in lucencies with MTX use in any Gruen zone. Patients with MTX had femoral stem subsidence of 3.7mm v no subsidence without MTX (p = 0.006). Conclusion: There was no difference in the diagnosis leading to rTHR in RA and OA, although RA trended longer prior to rTHA. In this small retrospective study, there were no significant differences associated with MTX exposure or radiographic lucency among RA patients. The significance of subsidence is not clear. Further study of arthroplasty survival in RA patients is warranted.

Keywords: hip arthroplasty, methotrexate, revision arthroplasty, rheumatoid arthritis

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Authors: Mokhtar Arazpour

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Objectives: Recently a new kind of stance control knee joint has been developed called the 'sensor lock.' This study aimed to develop and evaluate 'sensor lock', which could potentially solve the problems of walking parameters and gait symmetry in subjects with quadriceps weakness. Methods: Nine subjects with quadriceps weakness were enrolled in this study. A custom-made knee ankle foot orthosis (KAFO) with the same set of components was constructed for each participant. Testing began after orthotic gait training was completed with each of the KAFOs and subjects demonstrated that they could safely walk with crutches. Subjects rested 30 minutes between each trial. The 10 meters walking test is used to assess walking speed in meters/second (m/s). The total time taken to ambulate 6 meters (m) is recorded to the nearest hundredth of a second. 6 m is then divided by the total time (in seconds) taken to ambulate and recorded in m/s. The 6 Minutes Walking Test was used to assess walking endurance in this study. Participants walked around the perimeter of a set circuit for a total of six minutes. To evaluate Physiological cost index (PCI), the subjects were asked to walk using each type of KAFOs along a pre-determined 40 m rectangular walkway at their comfortable self-selected speed. A stopwatch was used to calculate the speed of walking by measuring the time between starting and stopping time and the distance walked. Results: The use of a KAFO fitted with the “sensor lock” knee joint resulted in improvements to walking speed, distance walked and physiological cost index when compared with the knee joint in lock mode. Conclusions: This study demonstrated that the use of a KAFO with the “sensor lock” knee joint could provide significant benefits for subjects with a quadriceps weakness when compared to a KAFO with the knee joint in lock mode.

Keywords: stance control knee joint, knee ankle foot orthosis, quadriceps weakness, walking, energy consumption

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Authors: Trupti Chavan, Ramachandra Guda, Kameshwar Rao

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The lack of data is a pain problem in medical image analysis using a convolutional neural network (CNN). This work uses various spatial transformation techniques to address the medical image augmentation issue for knee detection and localization using an enhanced single shot detector (SSD) network. The spatial transforms like a negative, histogram equalization, power law, sharpening, averaging, gaussian blurring, etc. help to generate more samples, serve as pre-processing methods, and highlight the features of interest. The experimentation is done on the OpenKnee dataset which is a collection of knee images from the openly available online sources. The CNN called enhanced single shot detector (SSD) is utilized for the detection and localization of the knee joint from a given X-ray image. It is an enhanced version of the famous SSD network and is modified in such a way that it will reduce the number of prediction boxes at the output side. It consists of a classification network (VGGNET) and an auxiliary detection network. The performance is measured in mean average precision (mAP), and 99.96% mAP is achieved using the proposed enhanced SSD with spatial transformations. It is also seen that the localization boundary is comparatively more refined and closer to the ground truth in spatial augmentation and gives better detection and localization of knee joints.

Keywords: data augmentation, enhanced SSD, knee detection and localization, medical image analysis, openKnee, Spatial transformations

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Authors: Peter Kutis, Vladimir Littva

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Nowadays, it is necessary to ensure that this reduction in costs is not at the expense of the quality of health care and future medical success. In general, physiotherapy for total hip joint arthroplasty is considered to be a routine matter that deals mainly with mobility training, increased muscular strength, and basic day-to-day activities such as bed-to-chair transition, standing, and walking. Within the KEGA project no. 003KU-4-2021, we decided to investigate preoperative physiotherapy care in Slovakia and Austria in total hip arthroplasty patients to shortened overall recovery. Research Sample and Methods: The sample comprised 498 respondents –patients who were indicated to total hip arthroplasty on the territory of Slovakia and Austria. There were 130 women in Slovakia and 135 women in Austria. The numbers of men were 120 in Slovakia and 113 men in Austria. The age of respondents was between 40 and 85 years of age. As a method of our research, we chose a non-standardized questionnaire, which consisted of three parts. The first part for the initial examination of the patient contained the identification of the patient according to the assigned number and subsequently 19 questions conditioned by the physical examination and evaluation of the patients. The second part of our questionnaire was completed after the patient's hospitalization and contained 10 questions that were conditioned by the patient's examination. The last third part for the overall assessment of the patient's state of health consisted of 12 questions conditioned by the patient's examination. This part was performed at the last meeting with the patient at the end of the treatment. All data were statistically processed by SPSS 25. Results: All data were evaluated at a significance level of p = 0.05. From the comparison of patients who underwent preoperative preparation, we can clearly state that the total duration of treatment is significantly shorter. A t-test of two mean values with uneven variance was used to verify the validity of the assumption. The total duration of treatment in patients with preoperative preparation was on average 92,635 days and without preoperative preparation was on average 135,884 days (t-Stat = 44,52784, t Critical one-tail = 1,648187415, t Critical two-tail = 1,965157). Conclusion: The results obtained during the research show the importance of adequate preoperative physiotherapeutic preparation of the patient. The results of total hip joint arthroplasty studies showed a significant reduction in a hospital stay as well as shortened total treatment time.

Keywords: THA, physiotherapy, recovery, preoperative physiotherapy care

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Authors: Jing Fang, Yao Cui, Mingming Wang, Shengli She, Jianping Yuan

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Wearable robotics is a potential solution in aiding gait rehabilitation of lower limbs dyskinesia patients, such as knee osteoarthritis or stroke afflicted patients. Many wearable robots have been developed in the form of rigid exoskeletons, but their bulk devices, high cost and control complexity hinder their popularity in the field of gait rehabilitation. Thus, the development of a portable, compliant and low-cost wearable robot for gait rehabilitation is necessary. Inspired by Chinese traditional folding fans and balloon inflators, the authors present an inflatable, foldable and variable stiffness knee exosuit (IFVSKE) in this paper. The pneumatic actuator of IFVSKE was fabricated in the shape of folding fans by using thermoplastic polyurethane (TPU) fabric materials. The geometric and mechanical properties of IFVSKE were characterized with experimental methods. To assist the knee joint smartly, an intelligent control profile for IFVSKE was proposed based on the concept of full-cycle energy management of the biomechanical energy during human movement. The biomechanical energy of knee joints in a walking gait cycle of patients could be collected and released to assist the joint motion just by adjusting the inner pressure of IFVSKE. Finally, a healthy subject was involved to walk with and without the IFVSKE to evaluate the assisting effects.

Keywords: biomechanical energy management, knee exosuit, gait rehabilitation, wearable robotics

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Authors: Nosratollah Hedayatpour, Hamid Reza Taheri, Mehrdad Fathi

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Introduction: Quadriceps femoris muscle is frequently involved in various movements e.g., jumping, landing) during sport and/or daily activities. During ballistic movement when individuals are faced with unexpected knee perturbation, fast twitch muscle fibers contribute to force production to stabilize knee joint. Fast twitch muscle fiber is more susceptible to fatigue and therefor may reduce the ability of the quadriceps muscle to stabilize knee joint during fast perturbation. Aim: The aim of this study was to investigate the effect of fatigue on postural response of the knee extensor muscles to fast and slow perturbations. Methods: Fatigue was induced to the quadriceps muscle using a KinCom Isokinetic Dynamometer (Chattanooga, TN). Bipolar surface electromyography (EMG) signals were simultaneously recorded from quadriceps components (vastus medialis, rectus femoris, and vastus lateralis) during pre- and post-fatigue postural perturbation performed at two different velocities of 120 ms and 250 mes. Results: One-way ANOVA showed that maximal voluntary knee extension force and time to task failure, and associated EMG activities were significantly reduced after fatiguing knee exercise (P< 0.05). Two-ways ANOVA also showed that ARV of EMG during backward direction was significantly larger than forward direction (P< 0.05), and during fast-perturbation it was significantly higher than slow-perturbation (P< 0.05). Moreover, ARV of EMG was significantly reduced during post fatigue perturbation, with the largest reduction identified for fast-perturbation compared with slow perturbation (P< 0.05). Conclusion: A larger reduction in muscle activity of the quadriceps muscle was observed during post fatigue fast-perturbation to stabilize knee joint, most likely due to preferential recruitment of fast twitch muscle fiber which are more susceptible to fatigue. This may partly explain that why knee injuries is common after fast ballistic movement.

Keywords: electromyography, fast-slow perturbations, fatigue, quadriceps femoris muscle

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Authors: G. Espriú-Pérez, F. A. Vargas-Oviedo, I. Zenteno-Aguirrezábal, M. D. Moya-Bencomo

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One of the injuries with a higher incidence among university-level athletes in the North of Mexico is presented in the knee. This injury generates absenteeism in training and competitions for at least 8 weeks. There is no active quantitative methodology, or protocol, that directly contributes to the clinical evaluation performed by the medical personnel at the prevalence of knee injuries. The main objective is to contribute with a quantitative tool that allows further development of preventive and corrective measures to these injuries. The study analyzed 55 athletes for 6 weeks, belonging to the disciplines of basketball, volleyball, soccer and swimming. Using a motion capture system (Nexus®, Vicon®), a three-dimensional analysis was developed that allows the measurement of the range of movement of the joint. To focus on the performance of the lower limb, eleven different movements were chosen from the Functional Performance Test, Functional Movement Screen, and the Cincinnati Jump Test. The research identifies the profile of the natural movement of a healthy knee, with the use of medical guidance, and its differences between each sport. The data recovered by the single-leg crossover hop managed to differentiate the type of knee movement among athletes. A maximum difference of 60° of offset was found in the adduction movement between male and female athletes of the same discipline. The research also seeks to serve as a guideline for the implementation of protocols that help identify the recovery level of such injuries.

Keywords: Cincinnati jump test, functional movement screen, functional performance test, knee, motion capture system

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Authors: M. Haruna, O. O. Onafowokan, G. Holt, K. Anderson, R. G. Middleton

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Background: Requirements for satisfactory outcomes following total hip arthroplasty (THA) include restoration of femoral offset, version, and leg length. Various techniques have been described for restoring these biomechanical parameters, with leg length restoration being the most predominantly described. We describe a “quartered head technique” (QHT) which uses a stepwise series of femoral head osteotomies to identify and preserve the centre of rotation of the femoral head during THA in order to ensure reconstruction of leg length, offset and stem version, such that hip biomechanics are restored as near to normal as possible. This study aims to identify whether using the QHT during hip arthroplasty effectively restores leg length and femoral offset to within acceptable parameters. Methods: A retrospective review of 206 hips was carried out, leaving 124 hips in the final analysis. Power analysis indicated a minimum of 37 patients required. All operations were performed using an anterolateral approach by a single surgeon. All femoral implants were cemented, collarless, polished double taper CPT® stems (Zimmer, Swindon, UK). Both cemented, and uncemented acetabular components were used (Zimmer, Swindon, UK). Leg length, version, and offset were assessed intra-operatively and reproduced using the QHT. Post-operative leg length and femoral offset were determined and compared with the contralateral native hip, and the difference was then calculated. For the determination of leg length discrepancy (LLD), we used the method described by Williamson & Reckling, which has been shown to be reproducible with a measurement error of ±1mm. As a reference, the inferior margin of the acetabular teardrop and the most prominent point of the lesser trochanter were used. A discrepancy of less than 6mm LLD was chosen as acceptable. All peri-operative radiographs were assessed by two independent observers. Results: The mean absolute post-operative difference in leg length from the contralateral leg was +3.58mm. 84% of patients (104/124) had LLD within ±6mm of the contralateral limb. The mean absolute post-operative difference in offset from contralateral leg was +3.88mm (range -15 to +9mm, median 3mm). 90% of patients (112/124) were within ±6mm offset of the contralateral limb. There was no statistical difference noted between observer measurements. Conclusion: The QHT provides a simple, inexpensive yet effective method of maintaining femoral leg length and offset during total hip arthroplasty. Combining this technique with pre-operative templating or other techniques described may enable surgeons to reduce even further the discrepancies between pre-operative state and post-operative outcome.

Keywords: leg length discrepancy, technical tip, total hip arthroplasty, operative technique

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Authors: Pedro Ferraz-Gameiro

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Introduction: The Pellegrini-Stieda lesion is the result of post-traumatic calcification and/or ossification on the medial collateral ligament (MCL) of the knee. When this calcification is accompanied by gonalgia and limitation of knee flexion, it is called Pellegrini-Stieda syndrome. The pathogenesis is probably the calcification of a post-traumatic hematoma at least three weeks after the initial trauma or secondary to repetitive microtrauma. On anteroposterior radiographs, a Pellegrini-Stieda lesion is a linear vertical ossification or calcification of the proximal portion of the MCL and usually near the medial femoral condyle. Patients with Pellegrini-Stieda syndrome present knee pain associated with loss of range of motion. The treatment is usually conservative with analgesic and anti-inflammatory drugs, either systemic or intra-articular. Physical medicine and rehabilitation techniques associated with shock wave therapy can be a way of reduction of pain/inflammation. Patients who maintain instability with significant limitation of knee mobility may require surgical excision. Methods: Research was done using PubMed central using the terms Pellegrini-Stieda syndrome. Discussion/conclusion: Medical treatment is the rule, with initial rest, anti-inflammatory, and physiotherapy. If left untreated, this ossification can potentially form a significant bone mass, which can compromise the range of motion of the knee. Physical medicine and rehabilitation techniques associated with shock wave therapy are a way of reduction of pain/inflammation.

Keywords: knee, Pellegrini-Stieda syndrome, rehabilitation, shock waves therapy

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Authors: Arash Sharafat Vaziri, Leila Aghaghazvini, Soodeh Jahangiri, Mohammad Tahami, Roham Borazjani, Mohammad Naghi Tahmasebi, Hamid Rabie, Hesan Jelodari Mamaghani, Fardis Vosoughi, Maryam Salimi

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Aims: It is essential to know the normal extrusion measures in order to detect pathological ones. In this study, we aimed to define some normal reference values for meniscal extrusion in the normal knees during different ranges of motion. Methods: The amount of anterior and posterior portion of meniscal extrusion among twenty-one asymptomatic volunteers (42 knees) were tracked at 0, 45, and 90 degrees of knee flexion using an ultrasound machine. The repeated measures analysis of variance (ANOVA) was used to show the interaction between the amounts of meniscal extrusion and the different degrees of knee flexion. Result: The anterior portion of the lateral menisci at full knee extension (0.59±1.40) and the posterior portion of the medial menisci during 90° flexion (3.06±2.36) showed the smallest and the highest mean amount of extrusion, respectively. The normal average amounts of anterior extrusion were 1.12± 1.17 mm and 0.99± 1.34 mm for medial and lateral menisci, respectively. The posterior meniscal normal extrusions were significantly increasing in both medial and lateral menisci during the survey (F= 20.250 and 11.298; both P-values< 0.001) as they were measured at 2.37± 2.16 mm and 1.53± 2.18 mm in order. Conclusion: The medial meniscus can extrude 1.74± 1.84 mm normally, while this amount was 1.26± 1.82 mm for the lateral meniscus. These measures commonly increased with the rising of knee flexion motion. Likewise, the posterior portion showed more extrusion than the anterior portion on both sides. These measures commonly increased with higher knee flexion.

Keywords: meniscal extrusion, ultrasonography, knee

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Authors: S. Alireza Mirghasemi, Javad Parvizi, Narges R. Gabaran, Shervin Rashidinia, Mahdi M. Bijanabadi, Dariush G. Savadkoohi

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Background: The anterior cruciate ligament is one of the most frequent ligament to be disrupted. Surgical reconstruction of the anterior cruciate ligament is a common practice to treat the disability or chronic instability of the knee. Several factors associated with success or failure of the ACL reconstruction including preoperative laxity of the knee, selection of the graft material, surgical technique, graft tension, and postoperative rehabilitation. We aimed to examine the biomechanical properties of any graft type and initial graft tensioning during ACL reconstruction using 3-dimensional computational finite element simulation. Methods: In this paper, 3-dimensional model of the knee was constructed to investigate the effect of graft tensioning on the knee joint biomechanics. Four different grafts were compared: 1) Bone-patellar tendon-bone graft (BPTB) 2) Hamstring tendon 3) BPTB and a band of gracilis4) Hamstring and a band of gracilis. The initial graft tension was set as “0, 20, 40, or 60N”. The anterior loading was set to 134 N. Findings: The resulting stress pattern and deflection in any of these models were compared to that of the intact knee. The obtained results showed that the combination of a band of gracilis with the former graft (BPTB or Hamstring) increases the structural stiffness of the knee. Conclusion: Required pretension during surgery decreases significantly by adding a band of gracilis to the proper graft.

Keywords: ACL reconstruction, deflection, finite element simulation, stress pattern

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Authors: Anuj Pathare, Aleksandra Birn-Jeffery

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Background: The Anterior Cruciate Ligament(ACL) helps stabilize the knee joint minimizing tibial anterior translation. Anterior Cruciate Ligament (ACL) injury is common in racquet sports and often occurs due to sudden acceleration, deceleration or changes of direction. This mechanism in badminton most commonly occurs during landing after an overhead stroke. Knee biomechanics during dynamic movements such as walking, running and stair negotiation, do not return to normal for more than a year after an ACL reconstruction. This change in the biomechanics may lead to re-injury whilst performing non-steady movements during sports, where these injuries are most prevalent. Aims: To compare if the knee kinetics and kinematics in ACL injury recovered athletes return to the same level as those from an uninjured cohort during standard movements used for clinical assessment and badminton shots. Objectives: The objectives of the study were to determine: Knee valgus during the single leg squat, vertical drop jump, net shot and drop shot; Degree of internal or external rotation during the single leg squat, vertical drop jump, net shot and drop shot; Maximum knee flexion during the single leg squat, vertical drop jump and net shot. Methods: This case-control study included 14 participants with three ACL injury recovered athletes and 11 uninjured participants. The participants performed various functional tasks including vertical drop jump, single leg squat; the forehand net shot and the forehand drop shot. The data was analysed using the two-way ANOVA test, and the reliability of the data was evaluated using the Intra Class Coefficient. Results: The data showed a significant decrease in the range of knee rotation in ACL injured participants as compared to the uninjured cohort (F₇,₅₅₆=2.37; p=0.021). There was also a decrease in the maximum knee flexion angles and an increase in knee valgus angles in ACL injured participants although they were not statistically significant. Conclusion: There was a significant decrease in the knee rotation angles in the ACL injured participants which could be a potential cause for re-injury in these athletes in the future. Although the results for decrease in maximum knee flexion angles and increase in knee valgus angles were not significant, this may be due to a limited sample of ACL injured participants; there is potential for it to be identified as a variable of interest in the rehabilitation of ACL injuries. These changes in the knee biomechanics could be vital in the rehabilitation of ACL injured athletes in the future, and an inclusion of sports based tasks, e.g., Net shot along with standard protocol movements for ACL assessment would provide a better measure of the rehabilitation of the athlete.

Keywords: ACL, biomechanics, knee injury, racquet sport

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Authors: Alò Roberta, Bottiglione Francesco, Mantriota Giacomo

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The efficiency of the actuation system of lower limb exoskeletons and of active orthoses is a significant aspect of the design of such devices because it affects their efficacy. F-IVT is an innovative actuation system to power artificial knee joint with energy recovery capabilities. Its key and non-conventional elements are a flywheel, that acts as a mechanical energy storage system, and an Infinitely Variable Transmission (IVT). The design of the F-IVT can be optimized for a certain walking condition, resulting in a heavy reduction of both the electric energy consumption and of the electric peak power. In this work, by means of simulations of level ground walking at different speeds, it is demonstrated how F-IVT is still an advantageous actuator, even when it does not work in nominal conditions.

Keywords: active orthoses, actuators, lower extremity exoskeletons, knee joint

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Authors: Muskaan Sethi, Arnab Banerjee, Bappaditya Manna

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The present paper aims to investigate a suitable contact between a wheel rolling over a flexible beam. A Linear Complementary (LCP) based approach has been adopted to simulate the contact dynamics for a rigid wheel traversing over a flexible Euler Bernoulli simply supported beam. The adopted methodology is suitable to incorporate the effect of frictional force acting at the wheel-beam interface. Moreover, the possibility of the generation of a gap between the two bodies has also been considered. The present method is based on a unilateral contact assumption which assumes that no penetration would occur when the two bodies come in contact. This assumption helps to predict the contact between wheels and beams in a more practical sense. The proposed methodology is validated with the previously published results and is found to be in good agreement. Further, this method is applied to simulate the contact between wheels and beams for various railway configurations. Moreover, different parametric studies are conducted to study the contact dynamics between the wheel and beam more thoroughly.

Keywords: contact dynamics, linear complementary problem, railway dynamics, unilateral contact

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Authors: Masoumeh Shojaei, Natalie Gedayloo, Amir Sarshin

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The purpose of the present study was to investigate the effect of Isokinetic fatigue of muscles around the ankle, knee, and hip on the indicators of dynamic postural stability. Therefore, 15 female university students (age 19.7± 0.6 years old, weight 54.6± 9.4 kg, and height 163.9± 5.6 cm) participated in within-subjects design for 5 different days. In the first session, the postural stability indices (time to stabilization after jump-landing) without fatigue were assessed by force plate and in each next sessions, one of muscle groups of the lower limb including the muscles around ankles, knees, and hip was randomly exhausted by Biodex Isokinetic dynamometer and the indices were assessed immediately after the fatigue of each muscle group. The method involved landing on a force plate from a dynamic state, and transitioning balance into a static state. Results of ANOVA with repeated measures indicated that there was no significant difference between the time to stabilization (TTS) before and after Isokinetic fatigue of the muscles around the ankle, knee and hip in medial – lateral direction (p > 0.05), but in the anterior – posterior (AP) direction, the difference was statistically significant (p < 0.05). Least Significant Difference (LSD) post hoc test results also showed that there was significant difference between TTS in knee and hip muscles before and after isokinetic fatigue in AP direction. In the other hand knee and hip muscles group were affected by isokinetic fatigue only in AP surface (p < 0.05).

Keywords: dynamic balance, fatigue, lower limb muscles, postural control

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Authors: Shaival Dalal, Nilesh Shah, Dinshaw Pardiwala, David Rajan, Satyen Sanghavi, Charul Bhanji

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Autologous Chondrocyte Implantation (ACI) is used worldwide since 1998 to treat cartilage defect. GEL based ACI is a new tissue-engineering technique to treat full thickness cartilage defect with fibrin and thrombin as scaffold for chondrocytes. Purpose of this study is to see safety and efficacy of gel based ACI for knee cartilage defect in multiple centres with different surgeons. Gel-based Autologous Chondrocyte Implantation (GACI) has shown effectiveness in treating isolated cartilage defect of knee joint. Long term results are still needed to be studied. This study was followed-up up to two years and showed benefit to patients. All enrolled patients with a mean age of 28.5 years had an average defect size of3 square centimeters, and were grade IV as per ICRS grading. All patients were followed up several times and at several intervals at 6th week, 8th week, 11th week, 17th week, 29th week, 57th week after surgery. The outcomes were measured based on the IKDC (subjective and objective) and MOCART scores.

Keywords: knee, chondrocyte, autologous chondrocyte implantation, fibrin gel based

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Authors: Diaa Othman, Muhammad Adil Khan, Muhammad Riaz

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Without an early intervention to correct the unilateral complete cleft lip and palate deformity, nasal architecture can progress to an exaggerated cleft nose deformity. We present the results of a modified unilateral cleft rhinoplasty procedure ‘the Gujrat technique’ to correct this deformity. Ninety pediatric and adult patients with non-syndromic unilateral cleft lip underwent primary and secondary composite cleft rhinoplasty using the Gujrat technique as a single stage operation over a 10-year period. The technique involved an open rhinoplasty with Tennison lip repair, and employed a combination of three autologous cartilage grafts, seven cartilage-molding sutures and a prolene mesh graft for alar base support. Post-operative evaluation of nasal symmetry was undertaken using the validated computer program ‘SymNose’. Functional outcome and patient satisfaction were assessed using the NOSE scale and ROE (rhinoplasty outcome evaluation) questionnaires. The single group study design used the non-parametric matching pairs Wilcoxon Sign test (p < 0.001), and showed overall good to excellent functional and aesthetic outcomes, including nasal projection and tip definition, and higher scores of the digital SymNose grading system. Objective assessment of the Gujrat cleft rhinoplasty technique demonstrates its aesthetic appeal and functional versatility. Overall it is a simple and reproducible technique, with no significant complications.

Keywords: cleft lip and palate, congenital rhinoplasty, nasal deformity, secondary rhinoplasty

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Authors: Gabriel Sitler, Yousef Sardahi, Asad Salem

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This paper presents an optimal and robust sliding mode controller (SMC) to regulate the position of the knee joint angle for patients suffering from knee injuries. The controller imitates the role of active orthoses that produce the joint torques required to overcome gravity and loading forces and regain natural human movements. To this end, a mathematical model of the shank, the lower part of the leg, is derived first and then used for the control system design and computer simulations. The design of the controller is carried out in optimal and multi-objective settings. Four objectives are considered: minimization of the control effort and tracking error; and maximization of the control signal smoothness and closed-loop system’s speed of response. Optimal solutions in terms of the Pareto set and its image, the Pareto front, are obtained. The results show that there are trade-offs among the design objectives and many optimal solutions from which the decision-maker can choose to implement. Also, computer simulations conducted at different points from the Pareto set and assuming knee squat movement demonstrate competing relationships among the design goals. In addition, the proposed control algorithm shows robustness in tracking a standard gait signal when accounting for uncertainty in the shank’s parameters.

Keywords: optimal control, multi-objective optimization, sliding mode control, wearable knee exoskeletons

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Authors: Taraneh Ashrafi Motlagh, Abdolrasoul Daneshjoo

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Background and Aim: Increased fatigue causes injuries; the purpose of this article was to investigate the angular displacement of the hip and knee joints in girls with patellofemoral syndrome. Materials and Methods: Thirty girls with an average age (age 28.73±1.83, height 168.49±5.59, weight 63.73±12.73) participated in this study in two groups of 15, experimental and control. The jet evaluation test was taken from the subjects' knee and thigh angle, and then these tests were repeated with the application of different inclines of the treadmill; the tests were examined in a neutral position and in a positive and negative slope of 5 degrees. The mean and standard deviation were used to describe the data, and the Shapirovik test was used for the normalization of the data to compare and examine the variables in the two research groups using an independent t-test and repeated analysis of variance at a significance level of 0.05. Conclusion: In general, according to the current studies of people with patellofemoral syndrome, running on steep inclines, as well as running on a treadmill and making the incline angle of the treadmill within the limit of minus 5% to plus 5%, does not affect the improvement of this condition, and it is not recommended. And according to the research, girls with patellofemoral syndrome should be placed on the treadmill at an inclined angle to run.

Keywords: patellofemoral syndrome, angular displacement of the knee, angular displacement of the thigh

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Authors: Soo Min Kim, Soo-Won Chae, Soung-Yon Kim, Haea Lee, Ju Yong Kang, Juneyong Lee, Seung-Ho Han

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Reverse total shoulder arthroplasty (RTSA) has become an effective treatment option for cuff tear arthropathy and massive, irreparable rotator cuff tears and indications for its use are expanding. Numerous methods for optimal fixation of the glenoid component have been suggested, such as inferior overhang, inferior tilt, to maximize initial fixation and prevent glenoid component loosening. The inferior tilt fixation of a glenoid component has been suggested, which is expected to decrease scapular notching and to improve the stability of a glenoid component fixation in reverse total shoulder arthroplasty. Inferior tilt fixation of the glenoid component has been suggested, which can improve stability and, because it provides the most uniform compressive forces and imparts the least amount of tensile forces and micromotion, reduce the likelihood of mechanical failure. Another study reported that glenoid component inferior tilt improved impingement-free range of motion as well as minimized the scapular notching. Several authors have shown that inferior tilt of a glenoid component reduces scapular notching. However, controversy still exists regarding its importance in the literature. In this study the influence of inferior tilt fixation on the primary stability of a glenoid component has been investigated. Finite element models were constructed from cadaveric scapulae and glenoid components were implanted with neutral and 10° inferior tilts. Most previous biomechanical studies regarding the effect of glenoid component inferior tilt used a solid rigid polyurethane foam or sawbones block, not cadaveric scapulae, to evaluate the stability of the RTSA. Relative micromotions at the bone-glenoid component interface, and the distribution of bone stresses under the glenoid component and around the screws were analyzed and compared between neutral and 10° inferior tilt groups. Contact area between bone and screws and cut surface area of the cancellous bone exposed after reaming of the glenoid have also been investigated because of the fact that cancellous and cortical bone thickness vary depending on the resection level of the inferior glenoid bone. The greater relative micromotion of the bone-glenoid component interface occurred in the 10° inferior tilt group than in the neutral tilt group, especially at the inferior area of the bone-glenoid component interface. Bone stresses under the glenoid component and around the screws were also higher in the 10° inferior tilt group than in the neutral tilt group, especially at the inferior third of the glenoid bone surface under the glenoid component and inferior scapula. Thus inferior tilt fixation of the glenoid component may adversely affect the primary stability and longevity of the reverse total shoulder arthroplasty.

Keywords: finite element analysis, glenoid component, inferior tilt, reverse total shoulder arthroplasty

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Authors: Pooja Balasubramanian, Ghida Karbala

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Unfair treatment at the workplace encourages workers to adjust their behavior in order to restore fairness and align monetary returns to costs. This adjustment of behavior, however, may differ depending on the reference group considered to evaluate equity. In this aspect two main questions are to be considered: How do workers respond to unfair treatment at the workplace? And how does this response change depending on the identity of the reference group? To answer the above research questions, this paper utilizes data from a randomized field experiment conducted in Kolkata, India where student assistants were hired to help in a data entry task. Recruited workers were working in a team of two and were offered a fixed wage per hour. Workers were randomly assigned to one of the following treatment groups: A control group not subjected (1) to wage cuts (2) A general wage cut (3) A unilateral wage cut in reference to colleagues with similar social identity (4) A unilateral wage cut in reference to colleagues with a different social identity, where social identity is defined in terms of gender. Results show a significant decrease in the quantity and quality of work following a general wage cut. A more severe drop in productivity was presented by men in the case of unilateral wage cut, while women experiencing unilateral wage cuts didn’t exhibit a similar behavior regardless of the gender of the team member. To the contrary, women matched with a male colleague and experiencing unilateral wage cut show a slight increase in productivity, a result that contributes to the discussion regarding the paradox of the 'content female worker'. These findings highlight the necessity of a better understanding of the social comparison processes prevailing at the workplace, given the major role they play in determining the level of productivity supplied.

Keywords: effort supply, fairness, reference groups, social comparison

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Authors: Ananya Ananya, Karthik Rao

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Accurate segmentation of knee cartilage in 3-D magnetic resonance (MR) images for quantitative assessment of volume is crucial for studying and diagnosing osteoarthritis (OA) of the knee, one of the major causes of disability in elderly people. Radiologists generally perform this task in slice-by-slice manner taking 15-20 minutes per 3D image, and lead to high inter and intra observer variability. Hence automatic methods for knee cartilage segmentation are desirable and are an active field of research. This paper presents design and experimental evaluation of 2D convolutional neural networks based fully automated methods for knee cartilage segmentation in 3D MRI. The architectures are validated based on 40 test images and 60 training images from SKI10 dataset. The proposed methods segment 2D slices one by one, which are then combined to give segmentation for whole 3D images. Proposed methods are modified versions of U-net and dilated convolutions, consisting of a single step that segments the given image to 5 labels: background, femoral cartilage, tibia cartilage, femoral bone and tibia bone; cartilages being the primary components of interest. U-net consists of a contracting path and an expanding path, to capture context and localization respectively. Dilated convolutions lead to an exponential expansion of receptive field with only a linear increase in a number of parameters. A combination of modified U-net and dilated convolutions has also been explored. These architectures segment one 3D image in 8 – 10 seconds giving average volumetric Dice Score Coefficients (DSC) of 0.950 - 0.962 for femoral cartilage and 0.951 - 0.966 for tibia cartilage, reference being the manual segmentation.

Keywords: convolutional neural networks, dilated convolutions, 3 dimensional, fully automated, knee cartilage, MRI, segmentation, U-net

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Authors: Abdulkader Helwan

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Rheumatoid joint inflammation is characterized as a perpetual incendiary issue which influences the joints by hurting body tissues Therefore, there is an urgent need for an effective intelligent identification system of knee Rheumatoid arthritis especially in its early stages. This paper is to develop a new intelligent system for the identification of Rheumatoid arthritis of the knee utilizing image processing techniques and neural classifier. The system involves two principle stages. The first one is the image processing stage in which the images are processed using some techniques such as RGB to gryascale conversion, rescaling, median filtering, background extracting, images subtracting, segmentation using canny edge detection, and features extraction using pattern averaging. The extracted features are used then as inputs for the neural network which classifies the X-ray knee images as normal or abnormal (arthritic) based on a backpropagation learning algorithm which involves training of the network on 400 X-ray normal and abnormal knee images. The system was tested on 400 x-ray images and the network shows good performance during that phase, resulting in a good identification rate 97%.

Keywords: rheumatoid arthritis, intelligent identification, neural classifier, segmentation, backpropoagation

Procedia PDF Downloads 517

Authors: Renate Krassnig, Gloria M. Hohenberger, Uldis Berzins, Stefen Fischerauer

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Background: Only a few reports discuss the effectiveness of intraoperative radiographs for placing femoral components. Therefore there is no international standard in using intraoperative imaging in the proceeding of total hip replacement. Method: Case report; an 84-year-old female patient underwent changing the components of the Total hip arthroplasty (THA) because of aseptic loosening. Due to circumstances, the surgeon decided to implant a cemented femoral component. The procedure was without any significant abnormalities. The first postoperative radiograph was planned after recovery – as usual. The x-ray imaging showed a misplaced femoral component. Therefore a CT-scan was performed additionally and the malposition of the cemented femoral component was confirmed. The patient had to undergo another surgery – removing of the cemented femoral component and implantation of a new well placed one. Conclusion: Intraoperative imaging of the femoral component is not a common standard but this case shows that intraoperative imaging is a useful method for detecting errors and gives the surgeon the opportunity to correct errors intraoperatively.

Keywords: femoral component, intraoperative imaging, malplacement, revison

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Authors: Andrea Trimarchi

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This paper is designed to provide a comprehensive overview on the EU Regulation No. 868/2004 concerning protection against subsidisation and unfair pricing practices regarding non-EU carriers and causing injury to Community air carriers. The analysis will focus, at first, on the exegetical scrutiny of the legal categories encompassed by the Regulation. In addition to that, while considering the peculiarities of such legal instrument, the attention will be addressed on the assessment on its effectiveness. The Regulation, indeed, having received lots of criticism, is in need of a profound revision. In this context, the present work will try to take into account the policy alternatives. In light of the failure of Regulation 868, which is to be seen as the expression of a unilateral and regional approach, there would seem to be the necessity for the aviation sector to reconsider the topic of subsidisation and unfair pricing practices in a more international oriented manner.

Keywords: non-EU airlines, aviation, subisidisation, unfair

Procedia PDF Downloads 321

Authors: Rohith J. K., Amir Nazemi, Abbas S. Milani

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In Paralympic sports, athletes often depend on some form of equipment to enable competitive sporting, where most of this equipment would only allow passive physiological supports and discrete physiological measurements. Active feedback physiological support and continuous detection of performance indicators, without time or space constraints, would be beneficial in more effective training and performance measures of Paralympic athletes. Moreover, occasionally the athletes suffer from fatigue and muscular stains due to improper monitoring systems. The latter challenges can be overcome by using Smart Composites technology when manufacturing, e.g., knee brace and other sports wearables utilities, where the sensors can be fused together into the fabric and an assisted system actively support the athlete. This paper shows how different sensing functionality may be created by intrinsic and extrinsic modifications onto different types of composite fabrics, depending on the level of integration and the employed functional elements. Results demonstrate that fabric sensors can be well-tailored to measure muscular strain and be used in the fabrication of a smart knee brace as a sample potential application. Materials, connectors, fabric circuits, interconnects, encapsulation and fabrication methods associated with such smart fabric technologies prove to be customizable and versatile.

Keywords: smart composites, sensors, smart fabrics, knee brace

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Authors: Chirawat Wattanapanich, Hong Wei

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This study presents new gait representations for improving gait recognition accuracy on cross gait appearances, such as normal walking, wearing a coat and carrying a bag. Based on the Gait Energy Image (GEI), two ideas are implemented to generate new gait representations. One is to append lower knee regions to the original GEI, and the other is to apply convolutional operations to the GEI and its variants. A set of new gait representations are created and used for training multi-class Support Vector Machines (SVMs). Tests are conducted on the CASIA dataset B. Various combinations of the gait representations with different convolutional kernel size and different numbers of kernels used in the convolutional processes are examined. Both the entire images as features and reduced dimensional features by Principal Component Analysis (PCA) are tested in gait recognition. Interestingly, both new techniques, appending the lower knee regions to the original GEI and convolutional GEI, can significantly contribute to the performance improvement in the gait recognition. The experimental results have shown that the average recognition rate can be improved from 75.65% to 87.50%.

Keywords: convolutional image, lower knee, gait

Procedia PDF Downloads 186

Authors: Lewis J. Woollin, Robert I. Davidson, Paul Watson, Philip J. Hyde

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Introduction: In-vitro testing of arthroplasty materials is of paramount importance when ensuring that they can withstand the performance requirements encountered in-vivo. One common machine used for in-vitro testing is a pin-on-plate tribometer, an early stage screening device that generates data on the wear characteristics of arthroplasty bearing materials. These devices test vertically loaded rotating cylindrical pins acting against reciprocating plates, representing the bearing surfaces. In this study, a pin-on-plate machine has been developed that provides several improvements over current technology, thereby progressing arthroplasty bearing research. Historically, pin-on-plate tribometers have been used to investigate the performance of arthroplasty bearing materials under conditions commonly encountered during a standard gait cycle; nominal operating pressures of 2-6 MPa and an operating frequency of 1 Hz are typical. There has been increased interest in using pin-on-plate machines to test more representative in-vivo conditions, due to the drive to test 'beyond compliance', as well as their testing speed and economic advantages over hip simulators. Current pin-on-plate machines do not accommodate the increased performance requirements associated with more extreme kinematic conditions, therefore a next-generation pin-on-plate tribometer has been developed to bridge the gap between current technology and future research requirements. Methodology: The design was driven by several physiologically relevant requirements. Firstly, an increased loading capacity was essential to replicate the peak pressures that occur in the natural hip joint during running and chair-rising, as well as increasing the understanding of wear rates in obese patients. Secondly, the introduction of mid-cycle load variation was of paramount importance, as this allows for an approximation of the loads present in a gait cycle to be applied and to test the fatigue properties of materials. Finally, the rig must be validated against previous-generation pin-on-plate and arthroplasty wear data. Results: The resulting machine is a twelve station device that is split into three sets of four stations, providing an increased testing capacity compared to most current pin-on-plate tribometers. The loading of the pins is generated using a pneumatic system, which can produce contact pressures of up to 201 MPa on a 3.2 mm² round pin face. This greatly exceeds currently achievable contact pressures in literature and opens new research avenues such as testing rim wear of mal-positioned hip implants. Additionally, the contact pressure of each set can be changed independently of the others, allowing multiple loading conditions to be tested simultaneously. Using pneumatics also allows the applied pressure to be switched ON/OFF mid-cycle, another feature not currently reported elsewhere, which allows for investigation into intermittent loading and material fatigue. The device is currently undergoing a series of validation tests using Ultra-High-Molecular-Weight-Polyethylene pins and 316L Stainless Steel Plates (polished to a Ra < 0.05 µm). The operating pressures will be between 2-6 MPa, operating at 1 Hz, allowing for validation of the machine against results reported previously in the literature. The successful production of this next-generation pin-on-plate tribometer will, following its validation, unlock multiple previously unavailable research avenues.

Keywords: arthroplasty, mechanical design, pin-on-plate, total joint replacement, wear testing

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Authors: Mohamadreza Hatefi, Malihe Hadadnezhad

Abstract:

It is well established that jump-landing-related biomechanical deficiencies, such as dynamic knee valgus (DKV), can be improved by using various forms of feedback; However, the effectiveness of these interventions synchronously on athletes' jumping performance remains unknown. Twenty-one recreational athletes with DKV performed countermovement jump (CMJ) and drop vertical jump (DVJ) tasks before and after feedback intervention while the kinematic, force plate and electromyography data of the lower extremity were synchronously captured. The athletes’ jumping performance was calculated by using the reactive strength index-modified (RSIₘₒ𝒹). The athletes at the post-intervention exhibited significantly less hip adduction and more tibial internal rotation during both CMJ and DVJ tasks and maximum knee flexion just during DVJ task. Moreover, athletes exhibited increased time to take-off and consequently decreased RSIₘₒ𝒹 during DVJ task, but no difference was observed in CMJ task. Feedback immediately improved DKV without disturbing the athletes’ jumping height during both tasks, But athletes exhibited increased time to take-off and consequently decreased RSIₘₒ𝒹 only during DVJ task, which suggests that the results may differ according to the nature of jumping task. Nevertheless, the effectiveness of landing-related biomechanical deficiencies improvement on athletes' jumping performance must be investigated in the long-term as a new movement pattern.

Keywords: reactive strength index, feedback, biomechanics, dynamic knee valgus

Procedia PDF Downloads 86