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Journal articleJones GG, Campi S, von Knoch F, et al., 2025, , ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, Vol: 145, ISSN: 0936-8051
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Journal articleHall TAG, Jones GG, van Arkel RJ, 2024, , Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 32, Pages: 3133-3140, ISSN: 0942-2056
PurposeFemorotibial angle (FTA) is a convenient measure of coronal knee alignment that can be extracted from a short knee radiograph, avoiding the additional radiation exposure and specialist equipment required for full-leg radiographs. While intra- and inter-reader reproducibility from the same image has been reported, the full scan–rescan reproducibility across images, as calculated in this study, has not.MethodsIn this study, 4589 FTA measurement pairs from 2586 subjects acquired a year apart were used to estimate FTA scan–rescan reproducibility using data from the Osteoarthritis Initiative. Subjects with radiographic progression of osteoarthritis or other conditions that may cause a change in coronal knee alignment were excluded. Measurement pairs were analysed using paired-samples mathematical equation tests to detect differences and compared to symptomatic changes in Western Ontario and McMaster Universities Arthritis Index scores for joint pain, stiffness and physical function to detect correlations.ResultsThe 95% limit of agreement and the paired-samples correlation were calculated with high precision to be [−1.76°, +1.78°] and 0.938, considerably worse than the corresponding figures for intra- and inter-reader reproducibility, without relation to symptomatic or radiographic changes in knee condition. This error will weakly attenuate mathematical equation and mathematical equation values from their true values in correlative studies involving FTA. The realistic maximum value for mathematical equation is 87% and for Pearson's mathematical equation is 93%.ConclusionThe scan–rescan reproducibility in FTA is almost double the intra- and inter-reader reliability from a single scan. At almost ±2° accuracy, FTA is inappropriate for surgical use, but it is sufficiently reproducible to produce good correlations in studies predicting disease incidence and progression.Level of EvidenceLevel II, retrospective study.
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Journal articleMusbahi O, Nurek M, Pouris K, et al., 2024, , Knee, Vol: 51, Pages: 120-129, ISSN: 0968-0160
BACKGROUND: Unicompartmental knee replacements (UKRs) have become an increasingly attractive option for end-stage single-compartment knee osteoarthritis (OA). However, there remains controversy in patient selection. Natural language processing (NLP) is a form of artificial intelligence (AI). We aimed to determine whether general-purpose open-source natural language programs can make decisions regarding a patient's suitability for a total knee replacement (TKR) or a UKR and how confident AI NLP programs are in surgical decision making. METHODS: We conducted a case-based cohort study using data from a separate study, where participants (73 surgeons and AI NLP programs) were presented with 32 fictitious clinical case scenarios that simulated patients with predominantly medial knee OA who would require surgery. Using the overall UKR/TKR judgments of the 73 experienced knee surgeons as the gold standard reference, we calculated the sensitivity, specificity, and positive predictive value of AI NLP programs to identify whether a patient should undergo UKR. RESULTS: There was disagreement between the surgeons and ChatGPT in only five scenarios (15.6%). With the 73 surgeons' decision as the gold standard, the sensitivity of ChatGPT in determining whether a patient should undergo UKR was 0.91 (95% confidence interval (CI): 0.71 to 0.98). The positive predictive value for ChatGPT was 0.87 (95% CI: 0.72 to 0.94). ChatGPT was more confident in its UKR decision making (surgeon mean confidence = 1.7, ChatGPT mean confidence = 2.4). CONCLUSIONS: It has been demonstrated that ChatGPT can make surgical decisions, and exceeded the confidence of experienced knee surgeons with substantial inter-rater agreement when deciding whether a patient was most appropriate for a UKR.
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Journal articleBicer M, Phillips ATM, Melis A, et al., 2024, , Journal of Biomechanics, Vol: 177, ISSN: 0021-9290
Resource-intensive motion capture (mocap) systems challenge predictive deep learning applications, requiring large and diverse datasets. We tackled this by modifying generative adversarial networks (GANs) into conditional GANs (cGANs) that can generate diverse mocap data, including 15 marker trajectories, lower limb joint angles, and 3D ground reaction forces (GRFs), based on specified subject and gait characteristics. The cGAN comprised 1) an encoder compressing mocap data to a latent vector, 2) a decoder reconstructing the mocap data from the latent vector with specific conditions and 3) a discriminator distinguishing random vectors with conditions from encoded latent vectors with conditions. Single-conditional models were trained separately for age, sex, leg length, mass, and walking speed, while an additional model (Multi-cGAN) combined all conditions simultaneously to generate synthetic data. All models closely replicated the training dataset (<8.1 % of the gait cycle different between experimental and synthetic kinematics and GRFs), while a subset with narrow condition ranges was best replicated by the Multi-cGAN, producing similar kinematics (<1°) and GRFs (<0.02 body-weight) averaged by walking speeds. Multi-cGAN also generated synthetic datasets for three previous studies using reported mean and standard deviation of subject and gait characteristics. Additionally, unseen test data was best predicted by the walking speed-conditional, showcasing synthetic data diversity. The same model also matched the dynamical consistency of the experimental data (32 % average difference throughout the gait cycle), meaning that transforming the gait cycle data to the original time domain yielded accurate derivative calculations. Importantly, synthetic data poses no privacy concerns, potentially facilitating data sharing.
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Journal articleGeorgiakakis ECT, Khan AM, Logishetty K, et al., 2024, , SICOT-J, Vol: 10, ISSN: 2426-8887
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Conference paperDhaliwal J, Harris S, Logishetty K, et al., 2024, , The European Orthopaedic Research Society (EORS) 32nd Annual Meeting
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Conference paperThakur A, Harris S, Brkljac M, et al., 2024, , The European Orthopaedic Research Society (EORS) 32nd Annual Meeting
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Journal articleChang R, Campbell A, Kent P, et al., 2024, , JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, Vol: 54, Pages: 721-731, ISSN: 0190-6011
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Journal articleBehan F, Bull A, Beck B, et al., 2024, , British Journal of Sports Medicine, Vol: 58, ISSN: 0306-3674
Objective To elicit expert opinion and gain consensus on specific exercise intervention parameters to minimise hip bone mineral density (BMD) loss following traumatic lower limb amputation.Methods In three Delphi rounds, statements were presented to a panel of 13 experts from six countries. Experts were identified through publications or clinical expertise. Round 1 involved participants rating their agreement with 22 exercise prescription statements regarding BMD loss post amputation using a 5-point Likert scale. Agreement was deemed as 3–4 on the scale (agree/strongly agree). Statements of <50% agreement were excluded. Round 2 repeated remaining statements alongside round 1 feedback. Round 3 allowed reflection on round 2 responses considering group findings and the chance to change or maintain the resp onse. Round 3 statements reaching ≥70% agreement were defined as consensus.Results All 13 experts completed rounds 1, 2 and 3 (100% completion). Round 1 excluded 12 statements and added 1 statement (11 statements for rounds 2–3). Round 3 reached consensus on nine statements to guide future exercise interventions. Experts agreed that exercise interventions should be performed at least 2 days per week for a minimum of 6 months, including at least three different resistance exercises at an intensity of 8–12 repetitions. Interventions should include weight-bearing and multiplanar exercises, involve high-impact activities and be supervised initially.Conclusion This expert Delphi process achieved consensus on nine items related to exercise prescription to minimise hip BMD loss following traumatic lower limb amputation. These recommendations should be tested in future interventional trials.
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Journal articleCampi S, Jones G, von Knoch F, et al., 2024, , ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, Vol: 144, Pages: 4685-4696, ISSN: 0936-8051
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Journal articleDavies AR, Sabharwal S, Liddle AD, et al., 2024, , JOURNAL OF SHOULDER AND ELBOW SURGERY, Vol: 33, Pages: 2411-2420, ISSN: 1058-2746
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Journal articleYork TJ, Szyszka B, Brivio A, et al., 2024, , Archives of Orthopaedic and Trauma Surgery, Vol: 144, Pages: 4963-4968, ISSN: 0936-8051
Introduction: Knee osteoarthritis is a prevalent condition frequently necessitating knee replacement surgery, with demand projected to rise substantially. Partial knee arthroplasty (PKA) offers advantages over total knee arthroplasty (TKA), yet its utilisation remains low despite guidance recommending consideration alongside TKA in shared decision making. Radiographic decision aids exist but are underutilised due to clinician time constraints.Materials and Methods: This research develops a novel radiographic artificial intelligence (AI) tool using a dataset of knee radiographs and a panel of expert orthopaedic surgeons' assessments. Six AI models were trained to identify PKA candidacy. Results: 4,967 labelled four-view radiograph series were included. Models achieved statistically significant accuracies above random assignment, with EfficientNet-ES demonstrating the highest performance (AUC 95%, F1 score 83% and accuracy 80%). Conclusions: The AI decision tool shows promise in identifying PKA candidates, potentially addressing underutilisation of this procedure. Its integration into clinical practice could enhance shared decision making and improve patient outcomes. Further validation and implementation studies are warranted to assess real-world utility and impact.
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Journal articleZhao Y, Coppola A, Karamchandani U, et al., 2025, , EUROPEAN RADIOLOGY, ISSN: 0938-7994
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Journal articleRiley N, Kasza I, Hermsmeyer IDK, et al., 2024, , Res Sq
Skin has been shown to be a regulatory hub for energy expenditure and metabolism: mutations of skin lipid metabolism enzymes can change the rate of thermogenesis and susceptibility to diet-induced obesity. However, little is known about the physiological basis for this function. Here we show that the thermal properties of skin are highly reactive to diet: within three days, a high fat diet reduces heat transfer through skin. In contrast, a dietary manipulation that prevents obesity accelerates energy loss through skins. We found that skin was the largest target in a mouse body for dietary fat delivery, and that dietary triglyceride was assimilated both by epidermis and by dermal white adipose tissue. Skin from mice calorie-restricted for 3 weeks did not take up circulating lipids and showed a highly depleted stratum corneum. Dietary triglyceride acyl groups persist in skin for weeks after feeding. Using multi-modal lipid profiling, we have implicated both keratinocytes and sebocytes in the altered lipids which correlate with thermal function. In response to high fat feeding, wax diesters and ceramides accumulate, and triglycerides become more saturated. In contrast, in response to the dramatic loss of adipose tissue that accompanies restriction of the branched chain amino acid isoleucine, skin becomes more heat-permeable, resisting changes induced by Western diet feeding, with a signature of depleted signaling lipids. We propose that skin should be routinely included in physiological studies of lipid metabolism, given the size of the skin lipid reservoir and its adaptable functionality.
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Journal articleHadjipanayi C, Yin M, Bannon A, et al., 2024, , IEEE Transactions on Biomedical Engineering, Vol: 71, Pages: 2854-2865, ISSN: 0018-9294
Objective: In recent years, radar technology has been extensively utilized in contactless human behavior monitoring systems. The unique capabilities of ultra-wideband (UWB) radars compared to conventional radar technologies, due to time-of-flight measurements, present new untapped opportunities for in-depth monitoring of human movement during overground locomotion. This study aims to investigate the deployability of UWB radars in accurately capturing the gait patterns of healthy individuals with no known walking impairments.Methods: A novel algorithm was developed that can extract ten clinical spatiotemporal gait features using the Doppler information captured from three monostatic UWB radar sensors during a 6-meter walking task. Key gait events are detected from lower-extremity movements based on the joint range-Doppler-time representation of recorded radar data. The estimated gait parameters were validated against a gold-standard optical motion tracking system using 12 healthy volunteers.Results: On average, nine gait parameters can be consistently estimated with 90-98% accuracy, while capturing 94.5% of participants' gait variability and 90.8% of inter-limb symmetry. Correlation and Bland-Altman analysis revealed a strong correlation between radar-based parameters and the ground-truth values, with average discrepancies consistently close to 0.Conclusion: Results prove that radar sensing can provide accurate biomarkers to supplement clinical human gait assessment, with quality similar to gold standard assessment.Significance: Radars can potentially allow a transition from expensive and cumbersome lab-based gait analysis tools toward a completely unobtrusive and affordable solution for in-home deployment, enabling continuous long-term monitoring of individuals for research and healthcare applications.
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Journal articleSugand K, Park C, Aframian A, et al., 2024, , Frontiers in Pediatrics, Vol: 12, ISSN: 2296-2360
Introduction: The COVID-19 pandemic has been recognized as an unprecedented global health crisis. Over 7 million mortalities have been documented with many paediatric fatalities. Trauma and orthopaedic care, much like other specialities, were marginalized due to resource allocation during the pandemic which affected paediatric care. This is the first systematic review to centralise and compile the recommended published guidelines from professional bodies in principally English speaking countries on managing paediatric trauma and orthopaedic care. These guidelines will be required to be implemented sooner and more effectively in case of future pandemics with similar impact.Methods: A search was conducted on PubMed/MedLine, Cochrane Library and Embase using terms including p(a)ediatric or child* and/or COVID* or coronavirus or SARS-CoV-2 and/or trauma and/or orthop(a)edic* with a simplified MeSH heading [mh] in order to make the search as comprehensive as possible. General terminology was utilized to make the search as exhaustive as possible for this systematic review. Another search was conducted on resources available in the public domain from professional bodies publishing on consensus statements and clinical practice guidelines in countries where English is the principal language managing pediatric trauma and orthopedics. The review adhered to PRISMA guidance.Results: The search revealed a total of 62 results from both databases and professional bodies. Duplicates were removed. This was then reviewed to identify a total of 21 results which fit the inclusion criteria and included within the main analysis. The guidelines from professional bodies were outlined and categorized into aspects of clinical care.Discussion: The impact of COVID-19 pandemic has compelled for changes in clinical practice and pediatric management. The systematic review highlights the relevant guidelines on service provision for pediatric patients including indications for urgent referrals, surg
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Journal articleHancock M, Smith A, O'Sullivan P, et al., 2024, , Journal of Physiotherapy, Vol: 70, Pages: 294-301, ISSN: 1836-9553
QuestionDo five baseline moderators identify patients with chronic low back pain who respond best to cognitive functional therapy (CFT) when compared with usual care?DesignSecondary analysis of the RESTORE randomised controlled trial.ParticipantsA total of 492 adults with low back pain for > 3 months with at least moderate pain-related activity limitation.InterventionParticipants were allocated to CFT alone or CFT plus biofeedback; these two groups were combined for this secondary analysis. The control group was usual care.Outcome measuresThe outcome was activity limitation measured using the Roland Morris Disability Questionnaire (RMDQ) at 3, 6, 13, 26, 40 and 52 weeks. Investigated effect modifiers were baseline measures of activity limitation, cognitive flexibility, pain intensity, self-efficacy and catastrophising.ResultsBaseline levels of activity limitation and, potentially, cognitive flexibility were associated with different effects of CFT treatment, while pain intensity, self-efficacy and catastrophising were not. Patients who had higher baseline activity limitation had greater treatment effects at 13 and 52 weeks. A person with a baseline RMDQ score of 18 (90th percentile) would on average be 6.1 (95% CI 4.8 to 7.4) points better at 13 weeks if they received CFT compared with usual care. However, a person with a baseline score of 7 (10th percentile) would on average be 3.6 (95% CI 2.6 to 4.6) points better at 13 weeks.ConclusionThe finding that CFT is most effective among patients who are most disabled and incur the greatest burden strongly suggests that CFT should be considered as a treatment for this group of patients.RegistrationACTRN12618001396213.
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Journal articleJohnson M-C, McGregor AH, A'Hern R, et al., 2024, , European Journal of Surgical Oncology, Vol: 50, ISSN: 0748-7983
PURPOSE: Sixty percent of breast cancer patients develop persistent upper limb pain and dysfunction, but only limited knowledge exists about how these symptoms relate to rehabilitation access. METHODS: A postal survey was sent to patients treated at a London University Teaching Hospital (2018-2020). Data were collected on pain (Pain Detect), shoulder function (Disability of Shoulder Arm and Hand (DASH)), quality-of-life (QoL) (EQ-5D-5L), and clinical characteristics, including treatment and access to rehabilitation. The free-text section invited patients' comments on upper limb symptoms and management strategies, which were analysed thematically. Quantitative data were analysed descriptively, and the medians were examined with Mann-Whitley U-Tests or Kruskal-Wallis Test. RESULTS: Of 511 patients surveyed, 162 (32 %) questionnaires were returned and analysed. Respondents' mean age was 62 years (SD 11.3). The majority had Sentinel Node Biopsy 71 % (116/162) and mastectomy 61 % (99/162). 73 % (119/162) reported pain. Mean (SD) Pain Detect and DASH Score were respectively 11.07 (7) and 21.7 (21.5), with 51 % recording significant shoulder dysfunction, and only 28 % reporting access to rehabilitation. Individuals with neuropathic pain had significantly higher median (range) DASH score 60.8 (35.8, 75.0) p = 0.000. Median DASH score for sedentary individuals was significantly higher 22.9 (7.9, 31.8) p = 0.0009. Free-text analysis revealed persistent, progressive symptoms, mixed attitudes towards exercise and variations in access to rehabilitation and support. CONCLUSION: Two years following surgery many patients reported significant upper limb symptoms which adversely impact on QoL. However, approximately two thirds did not access potentially beneficial rehabilitation treatments. There is a need to improve pathways of care.
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Journal articleKhan AM, Gupte CM, 2024, , BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 85, ISSN: 1750-8460
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Conference paperSgambato BG, Hakami H, Yang X, et al., 2024, , 2024 IEEE Ultrasonics, Ferroelectrics, and Frequency Control Joint Symposium (UFFC-JS), Publisher: IEEE, Pages: 1-6
Powered hand prostheses are essential to support limb-difference users living independently. However, prosthesis abandonment rates are high due to a mismatch between the user’s needs and the performance of current surface electromyography-powered prostheses. Ultrasound has been proposed as an alternative modality of interfacing, but current work has mainly investigated offline scenarios or virtual benchtop validations. To advance in this area, we designed a custom socket and prosthesis solution with 32 distributed single-element transducers to record line-scanning ultrasound across the stump of one participant. A machine learning model was trained, allowing the participant to voluntarily control simultaneous wrist rotation and hand aperture. Offline cross-validation showed a high performance with an r-square of 0.69 ± 0.26. An Online experiment demonstrated that the participant was able to complete the virtual target achievement control task, the box and blocks test, and the clothespin relocation test in an accurate way. This marks the first functional demonstration of A-mode ultrasound-based simultaneous and proportional control, demonstrating its potential for natural and flexible control of prosthetic hands.
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