Quantitative Computerized Assessment of the Degree of Acetabular Bone Deficiency: Total radial Acetabular Bone Loss (TrABL)

A novel quantitative, computerized, and, therefore, highly objective method is presented to assess the degree of total radical acetabular bone loss. The method, which is abbreviated to “TrABL”, makes use of advanced 3D CT-based image processing and effective 3D anatomical reconstruction methodology. The output data consist of a ratio and a graph, which can both be used for direct comparison between specimens. A first dataset of twelve highly deficient hemipelves, mainly Paprosky types IIIB, is used as illustration. Although generalization of the findings will require further investigation on a larger population, it can be assumed that the presented method has the potential to facilitate the preoperative use of existing classifications and related decision schemes for treatment selection in complex revision cases

Chloride-binding effect of blast furnace slag in cement pastes containing added chlorides

Corrosion of rebar in concrete is commonly associated with, and to a large degree influenced by, the free chloride concentration in the pore water. It is standard industry practice to add various mineral admixtures such as pulverised fuel ash (PFA), or fly ash, ground granulated blast furnace slag (GGBS) and silica fume (SF), to concrete mixtures to increase the corrosion resistance of the reinforcement in the matrix and its subsequent design life span. Various investigations have reported on the effect of mineral admixtures and additions on chloride binding in cementitious matrices, and the current study contributes further to knowledge in this field. Unlike previous investigations, this study attempted to make a clear distinction between the contributions of the two components in a blended cement consisting of ordinary Portland cement (OPC) and ground blast furnace slag (BFS). These contributions of each component have been quantified. Relationships between the total amount of chloride bound, the level of BFS additions, and the levels of initial chloride content present in the matrix were determined. It was found that the OPC/BFS blended cement with partial BFS replacements of up to 50%displayed a lower binding capacity than that of the OPC on its own. This observation was derived based on the assumption that theOPCand slag reactions were treated as competing and equivalent and did not take any potential time delays into account, nor the degree of cement hydration. The chloride-binding efficiency by the BFS is dependent on both the BFS partial replacement addition level as well as the initial amount of chloride present in the matrix. It is shown that both the OPC and BFS contribute to chloride binding in cement pastes, depending on the amount of BFS that replace the OPC component in the matrix.The authors express their gratitude to the NRF (National Research Foundation) for financial assistance.http://journals.sabinet.co.za/sajchem

Can standard implants reproduce the native kinematics of a TKA patient?

Total knee arthroplasty (TKA) is a reliable surgical procedure, yet up to a fifth of primary implant patients remains unsatisfied. Musculoskeletal modeling (MSM) has the potential to explore the relationship between implant alignment and functional outcome [3]. Consequently, implant alignment can be quantitatively optimized to restore the preTKA joint behavior and, therefore, achieve the most favorable functional outcome for the specific patient. For this reason, we developed a method to optimize the implant alignment, with the aim of restoring the native kinematics and ligament elongations of the patient before undergoing TKA. Subject-specific optimization towards ligament elongations demonstrated to accurately emulate the pre-TKA ligament behavior, in contrast to the mechanically aligned approach. However, the values of the optimized implant positions resulting from the pre-TKA kinematic optimization were extreme in some cases. The presented modelling approach is a promising starting point for allowing surgeons to evaluate the patient-specific implant alignment and restore the patientspecific biomechanics

Chronic defensiveness and neuroendocrine dysfunction reflect a novel cardiac troponin T cut point: The SABPA study.

Background: Sympatho-adrenal responses are activated as an innate defense coping (DefS) mechanism during emotional stress. Whether these sympatho-adrenal responses drive cardiac troponin T (cTnT) increases are unknown. Therefore, associations between cTnT and sympatho-adrenal responses were assessed. Methods: A prospective bi-ethnic cohort, excluding atrial fibrillation, myocardial infarction and stroke cases, was followed for 3 years (N=342; 45.6±9.0 years). We obtained serum high-sensitive cTnT and outcome measures [Coping-Strategy-Indicator, depression/Patient-Health-Questionnarie-9, 24h BP, 24h heart-rate-variability (HRV) and 24h urinary catecholamines]. Results: cTnT levels of the cohort remained similar over 3 years but recovery to cTnT-negative levels was higher in Blacks. Blacks showed moderate depression (45% vs. 16%) and 24h hypertension (67% vs. 42%) prevalence compared to Whites. A receiver-operating-characteristics cTnT cut-point 4.2 ng/L predicting hypertension in Blacks was used as binary exposure measure in relation to outcome measures [AUC 0.68 (95% CI 0.60-0.76); sensitivity/specificity 63/70%; P≤0.001]. In cross-sectional analyses, elevated cTnT was related to DefS [OR 1.08 (95% CI 0.99-1.16); P=0.06]; 24h BP [OR 1.03-1.04 (95% CI 1.01-1.08); P≤0.02] and depressed HRV [OR 2.19 (95% CI 1.09-4.41); P=0.03] in Blacks, but not in Whites. At 3 year follow-up, elevated cTnT was related to attenuated urine norepinephrine:creatinine ratio in Blacks [OR 1.46 (95% CI 1.01-2.10); P=0.04]. In Whites, a cut point of 5.6 ng/L cTnT predicting hypertension was not associated with outcome measures. Conclusion: Central neural control systems exemplified a brain-heart stress pathway. Desensitization of sympatho-adrenal responses occurred with initial neural- (HRV) followed by neuroendocrine dysfunction (norepinephrine:creatinine) in relation to elevated cTnT. Chronic defensiveness may thus drive the desensitization or physiological depression, reflecting ischemic heart disease risk at a 4.2 ng/L cTnT cut-point in Blacks

The Use of Patient-Specific Intra-Operative Guides for Total Knee Arthroplasty (TKA)

Purpose: We describe a new technique of total knee replacement using patient-specific guides. Postoperatively, extremity and component alignment were evaluated by full-length leg x-rays and CT scans. Material and methods: 5 patients who underwent Total Knee Replacement with this technique were included in the study. In every patient, a preoperative MRI was taken. This MRI scan leads to a patient-specific plan of implant size and positioning. The surgeon has the ability to alter the planning before the approval and manufacturing of guides (BIOMET, Vanguard Signature Personalised Arthritis Care). During the operation, the patient-specific guides find their unique position on the patient and #8217;s knee, providing exact pin placement for the distal resection guide, 4-in-1 cutting block and the proximal tibial cutting guide. The advantage of this method is providing each patient with a specific guide depending upon the proper anatomy. Intramedullary access for axis alignment is unnecessary. By providing specific guides for individual knees, each knee is dealt with differently, corresponding to its native anatomy. Perioperative time of surgery and postoperative implant position were evaluated by standing antero-posterior and lateral x-rays of the knee as well as a CT scan for rotational alignment of components. Results: The mean operative time is 65.6 minutes. The mean coronal femoral component angle is 89.2. The mean sagittal femoral component angle is 88.8. The mean coronal tibial component angle is 89.4. The mean femoral rotation angle is 0.6 degrees, and the mean tibial rotation angle is 1.2. Conclusions: We conclude that this novel technique hereby described has major benefits: less operative time and proper implant positioning, but more prospective studies are mandatory. [Arch Clin Exp Surg 2012; 1(4.000): 206-212