A pervasive body sensor network for monitoring post-operative recovery

Over the past decade, miniaturisation and cost reduction brought about by the semiconductor industry has led to computers smaller in size than a pin head, powerful enough to carry out the processing required, and affordable enough to be disposable. Similar technological advances in wireless communication, sensor design, and energy storage have resulted in the development of wireless “Body Sensor Network (BSN) platforms comprising of tiny integrated micro sensors with onboard processing and wireless data transfer capability, offering the prospect of pervasive and continuous home health monitoring. In surgery, the reduced trauma of minimally invasive interventions combined with initiatives to reduce length of hospital stay and a socioeconomic drive to reduce hospitalisation costs, have all resulted in a trend towards earlier discharge from hospital. There is now a real need for objective, pervasive, and continuous post-operative home recovery monitoring systems. Surgical recovery is a multi-faceted and dynamic process involving biological, physiological, functional, and psychological components. Functional recovery (physical independence, activities of daily living, and mobility) is recognised as a good global indicator of a patient’s post-operative course, but has traditionally been difficult to objectively quantify. This thesis outlines the development of a pervasive wireless BSN system to objectively monitor the functional recovery of post-operative patients at home. Biomechanical markers were identified as surrogate measures for activities of daily living and mobility impairment, and an ear-worn activity recognition (e-AR) sensor containing a three-axis accelerometer and a pulse oximeter was used to collect this data. A simulated home environment was created to test a Bayesian classifier framework with multivariate Gaussians to model activity classes. A real-time activity index was used to provide information on the intensity of activity being performed. Mobility impairment was simulated with bracing systems and a multiresolution wavelet analysis and margin-based feature selection framework was used to detect impaired mobility. The e-AR sensor was tested in a home environment before its clinical use in monitoring post-operative home recovery of real patients who have undergone surgery. Such a system may eventually form part of an objective pervasive home recovery monitoring system tailored to the needs of today’s post-operative patient.Open acces

Biomedical Engineering

Biomedical engineering is currently relatively wide scientific area which has been constantly bringing innovations with an objective to support and improve all areas of medicine such as therapy, diagnostics and rehabilitation. It holds a strong position also in natural and biological sciences. In the terms of application, biomedical engineering is present at almost all technical universities where some of them are targeted for the research and development in this area. The presented book brings chosen outputs and results of research and development tasks, often supported by important world or European framework programs or grant agencies. The knowledge and findings from the area of biomaterials, bioelectronics, bioinformatics, biomedical devices and tools or computer support in the processes of diagnostics and therapy are defined in a way that they bring both basic information to a reader and also specific outputs with a possible further use in research and development

Assessment of Bore-Cone Taper Junctions in Explanted Modular Total Hip Replacements

For people with chronic hip pain due to arthritis or other conditions, a total hip replacement (THR) is a common procedure used to eliminate the pain. Due to the natural variation in patient anatomy, THR prostheses are becoming increasingly more modular to allow for a more customized initial replacement and for an easier revision if needed in the future. Currently, THR prostheses routinely have modular femoral heads to provide surgeons with intraoperative flexibility. This modularity allows the surgeons to maintain the proper leg length and restore hip biomechanics for the patient and insert the components more easily and precisely. Modular femoral heads attach to the neck cone on the femoral stem using a bore-cone taper junction. Different bore depths into the head alter the position of the head center relative to the end of the neck cone, effectively providing the surgeon a means of altering the head-neck length during surgery. This affects the moment arm at the bore-cone modular junction since the joint reaction force at the hip passes through the center of the femoral head. There are concerns that variations in this head-neck moment arm and other neck cone geometries can negatively impact the stability and surface of the modular bore-cone taper junction, leading to corrosion and other modes of surface damage. The broad objective of this thesis was to use explanted THR prostheses and basic mathematical modeling to understand how variations in component geometry, specifically the head-neck moment arm (HMA) and neck cone geometry, may impact bore-cone taper junctions. The objective was accomplished by 1) characterizing surface damage on modular bore-cone tapers of explanted THR prostheses; 2) correlating surface damage with stem design features and patient factors, and 3) characterizing the stress distribution in different neck designs with varying taper geometry. It was hypothesized that explanted THR prostheses would exhibit surface damage on the modular bore-cone tapers, that surface damage would vary with design type and taper geometry (specifically HMA and neck cone contact surface area), and that changing the taper geometry would affect the stress distribution in the neck. The results from this thesis establish that explanted THR prostheses exhibit surface damage on modular bore-cone tapers, and that the corrosion was significantly correlated with neck diameter, neck stiffness, and patient body weight. HMA and the overall neck cone contact surface area did not have a significant correlation with corrosion. Changing neck cone geometry and HMA did not change the stress distribution in the neck in the simple computational models, but these changes did impact the magnitude of the stresses in the neck. There is still more information to learn about damage mechanisms existing at bore-cone modular junctions, but this thesis confirmed that severe corrosion can occur in modular bore-cone tapers during in vivo function. There remains a need to find the optimal design parameters for HMA and taper geometry in order to maintain the clinical benefits of varied neck lengths but minimize the potential design failures

Orthopaedic application of magnetic sensors

The purpose of this thesis is to propose a novel application of amorphous magnetic ribbons for use as knee force measurement sensors, without the need for secondary windings. This thesis demonstrates that the magnetic properties of amorphous ribbons are retained when embedded in Ultra-high molecular weight polyethylene (UHMWPE) tibial inserts, and these properties can be interrogated non-invasively. This is of importance, as it offers a viable solution for instrumented prosthesis which can be used for in-vivo monitoring. The research conducted also demonstrates that the tibiofemoral contact force on the instrumented tibial insert can be measured by observing the impedance changes in adjacent coils. Other conventional methods, though effective, require additional circuitry for non-invasive retrieval of measured data. The work contained herein eliminates this need, thereby reducing the structural modification of the implant required to accommodate the additional components. This research also shows that the variation in the coil impedance can be related to the permeability changes in the amorphous ribbons, and these can be quantified by tracking the resonant frequency of the coils. Amorphous ribbons have not been used in monitoring orthopaedic prosthesis before, and this work shows how the simplified measurement system can offer an alternative technique to knee implant monitoring

Firmware design of a portable medical device to measure the quadriceps muscle group after a total knee arthroplasty by EMG, LBIA and clinical score methods

El objetivo de este proyecto es el diseño del firmware de un dispositivo médico portátil para mediciones de EMG y LBIA, que se utilizará para la evaluación de pacientes de artroplastia total de rodilla, para estudiar la progresión de diferentes prótesis de rodilla (Medial-Pivot y Ultra-Congruente). En la tesis, se expone el conocimiento actual de los estudios y aplicaciones de EMG y LBIA, junto con los dispositivos comerciales utilizados actualmente. Además, se han estudiado e implementado las diferentes técnicas de filtrado y procesamiento digital para señales de EMG y LBIAs. Adicionalmente, se ha realizado un estudio estadístico preliminar con datos LBIA de 12 pacientes de artroplastia total de rodilla. El diseño del firmware de esta tesis incluye: los procesos de adquisición de datos con el uso de diferentes ADCs (Conversor Analógico a Digital) (de la propia placa y externos, utilizando la interfaz SPI) y un DAC (Conversor Digital a Analógico), el correspondiente procesamiento de la señal y la extracción de sus características, la comunicación con un dispositivo externo utilizando un módulo BLE externo con interfaz UART, el proceso de encriptación de los datos médicos, la funcionalidad de manejo de errores y la aproximación del nivel de batería. En esta tesis, todos los flujos de trabajo de los procesos se exponen y explican mediante diagramas de flujo, mientras que se justifica cada cálculo y configuración. Además, todo el código correspondiente se ha programado en lenguaje C y se expone en los anexos. También se ha revisado la normativa aplicable y se ha analizado tanto el impacto ambiental como el coste económico del producto. Por último, se proponen mejoras para futuros trabajos.The aim of this project is the firmware design for a portable medical device for EMG and LBIA measurements which will be used for the assessment of total knee arthroplasty patients to study the progression of different knee prostheses (Medial-Pivot and Ultra-Congruent). For its realization, the state of the art of the EMG and LBIA studies and applications are exposed, along with the currently used medical devices. In addition, the different digital filtering and processing techniques for these studies have been studied and implemented. Furthermore, a preliminary statistical study has been performed with LBIA data from 12 patients with total knee arthroplasty. The firmware design of this thesis includes: the acquiring data processes with the use of different ADCs (from the actual board and external, using the SPI interface) and a DAC, the corresponding signal processing and feature abstraction, the communication with an external device using an external BLE module with UART interface, the medical data encrypting process, the error handling functionality, and the battery level approximation. In this work, all the process workflows are exposed and explained using flowcharts, while every calculation and configuration is justified. In addition, all the corresponding code has been programmed using C language and exposed in the Annexes. Moreover, the applicable regulation has been reviewed, and both the environmental impact and economic cost of the product have been analyzed. Finally, improvements are proposed for future work.L'objectiu d'aquest projecte és el disseny del microprogramari d'un dispositiu mèdic portàtil per a mesures d'EMG i LBIA. L’aparell mèdic s'utilitzarà per a l'avaluació de pacients d'artroplàstia total de genoll per estudiar la progressió de dues pròtesis de genoll (Medial-Pivot i Ultra- Congruent). En el treball, s'exposa el coneixement actual dels estudis i aplicacions d'EMG i LBIA, juntament amb els dispositius comercials utilitzats actualment. A més, s'han estudiat i implementat les diferents tècniques de filtrat i processament digital dels senyals de EMG i LBIA. Addicionalment, s'ha fet un estudi estadístic preliminar amb dades de LBIA de 12 pacients amb artroplàstia total de genoll. El disseny del microprogramari d'aquesta tesi inclou: els processos d'adquisició de dades fent ús de diferents ADCs (de la pròpia placa i externs, utilitzant la interfície SPI) i un DAC, el processament dels senyals i l'abstracció de les seves característiques, la comunicació amb un dispositiu extern utilitzant un mòdul BLE extern amb interfície UART, el procés d'encriptació de les dades mèdiques, la funcionalitat de l’avaluació d'errors i l'aproximació del nivell de bateria. En aquest treball, totes les funcionalitats del dispositiu s'exposen i s'expliquen mitjançant diagrames de flux i es justifiquen els càlculs i configuracions corresponents. Tot el codi desenvolupat s'ha programat en llenguatge C i s'exposa als annexos. A més, s'ha revisat la normativa aplicable i s'ha analitzat tant l'impacte ambiental com el cost econòmic de l’aparell. Finalment, es proposen millores per a futurs desenvolupaments

Design and Development Towards a Novel Prosthesis for Total Shoulder Arthroplasty to Reduce Aseptic Glenoid Loosening

Total shoulder arthroplasty (TSA) is the most common surgical solution, that helps in restoring the structural and functional integrity of a diseased glenohumeral (GH) joint with intact rotator-cuff. A 300% increase in the usage of TSA has been observed since 2007, along with 2.5% increase in revision rate. Aseptic glenoid loosening accounts for 37% of postsurgical failures in TSA. Eccentric loading of the prosthetic glenoid cup, leading to the “rocking horse” effect, is one of the prevalent causes of aseptic glenoid loosening. Current anatomical total shoulder prosthesis (ATSP) geometry does not consider all the GH morphometric features, for example the elliptical shape of the humeral head. Moreover, the morphometric studies leading to the initial ATSP design did not consider the GH morphology of any sub-Saharan population. Hence, there exists a gap in understanding of the implications of certain morphometric features on the functionality of a post-TSA GH joint. This thesis had two primary aims to address this gap in knowledge. Firstly, to study the GH morphometric variations between cohorts representing native European (Swiss) and native sub-Saharan (South African) populations. Secondly, to develop anatomically inspired ATSP design concepts and test them using biomechanical and finite element (FE) models, insilico, under standardised testing protocols. The morphometric analysis suggested that an average Swiss humeral head radius of curvature was larger (P28mm or <19mm. Considering both the populations, the inherent shape of an average humeral head was found to be elliptical. The thickest region of the head was found to lie in the posterior region and not at the geometric center. Hertzian contact theory was applied to calculate the GH stresses produced by symmetric and asymmetric elliptical heads. Higher concentric stresses (P<0.001), within the acceptable limit for polyethylene, were observed to be imparted by the asymmetric heads. Population-specific musculoskeletal models were developed to study the post-TSA kinematic variation. When an identical range of motion (RoM) was performed by these models, population-specific variation in muscle moment arms was observed. The novel glenoid designs were not found to alter the post-surgical kinematics. FE models of the biradial, compartmental and pear-shaped glenoid implant designs were subjected to compressive and shear loading according to the American Society for Testing and Materials (ASTM). Using the bi-radial the glenoid cup, with thickened posterior-superior surface, anatomically relevant force distribution patterns could be replicated. Compartmentalising the glenoid prosthesis into concentric and eccentric regions with the gaps, proved to be highly beneficial. When compared to a commercially available glenoid prosthesis, the compartmental prosthesis was able to contain the GH forces to the concentric region for longer, delaying the eccentric loading and therefore potentially reducing the “rocking horse” effect. In the light of the above observations, two conclusions can be drawn from this thesis. Firstly, it would be beneficial if population-specific ATSP were made available for natives of certain geographic locations. Secondly, glenoid prosthesis designs could be compartmentalised to contain the GH joint forces within the concentric regions of the cup which might aid in the reduction of post-TSA complications

The safety and efficacy of mesenchymal stem cells for prevention or regeneration of intervertebral disc degeneration: a systematic review

General Posters: abstract no. GP86INTRODUCTION: Mesenchymal stem cells (MSCs) have been used to halt the progression or regenerate the disc with hopes to prevent or treat discogenic back pain. However, the safety and efficacy of the use of MSCs for such treatment in animal and human models at short and long term assessment (i.e. greater than 48 weeks) have not been systematically addressed. This study addressed a systematic review of comparative controlled studies addressing the use of MSCs to that of no treatment/saline for the treatment of disc degeneration. METHODS: Online databases were extensively searched. Controlled trials in animal models and humans were eligible for inclusion. Trial design, MSC characteristics, injection method, disc assessment, outcome intervals, and complication events were assessed. Validity of each study was assessed addressing trial design. Two individuals independently addressed the aforementioned. RESULTS: Twenty-two animal studies were included. No human comparative controlled trials were reported. All three types of MSCs (i.e. derived from bone marrow, synovial and adipose tissue) showed successful inhibition of disc degeneration progression. From three included studies, bone marrow derived MSC showed superior quality of disc repair when compared to other treatments, including TGF-β1, NP bilaminar co-culture and axial distraction regimen. However, osteophyte development was reported in two studies as potential complication of MSC transplantation. CONCLUSIONS: Based on animal models, the current evidence suggests that in the short-term MSC transplantation is safe and effective in halting disc degeneration; however, additional and larger studies are needed to assess the long-term regenerative effects and potential complications. Inconsistency in methodological design and outcome parameters prevent any robust conclusions. In addition, randomized controlled trials in humans are needed to assess the safety and efficacy of such therapy.published_or_final_versio