Influence of shear-thinning blood rheology on the laminar-turbulent transition over a backward facing step

Cardiovascular diseases are the leading cause of death globally and there is an unmet need for effective, safer blood-contacting devices, including valves, stents and artificial hearts. In these, recirculation regions promote thrombosis, triggering mechanical failure, neurological dysfunction and infarctions. Transitional flow over a backward facing step is an idealised model of these flow conditions; the aim was to understand the impact of non-Newtonian blood rheology on modelling this flow. Flow simulations of shear-thinning and Newtonian fluids were compared for Reynolds numbers ( R e ) covering the comprehensive range of laminar, transitional and turbulent flow for the first time. Both unsteady Reynolds Averaged Navier–Stokes ( k − ω SST) and Smagorinsky Large Eddy Simulations (LES) were assessed; only LES correctly predicted trends in the recirculation zone length for all R e . Turbulent-transition was assessed by several criteria, revealing a complex picture. Instantaneous turbulent parameters, such as velocity, indicated delayed transition: R e = 1600 versus R e = 2000, for Newtonian and shear-thinning transitions, respectively. Conversely, when using a Re defined on spatially averaged viscosity, the shear-thinning model transitioned below the Newtonian. However, recirculation zone length, a mean flow parameter, did not indicate any difference in the transitional Re between the two. This work shows a shear-thinning rheology can explain the delayed transition for whole blood seen in published experimental data, but this delay is not the full story. The results show that, to accurately model transitional blood flow, and so enable the design of advanced cardiovascular devices, it is essential to incorporate the shear-thinning rheology, and to explicitly model the turbulent eddies

Electromyography-Assisted Neuromusculoskeletal Models Can Estimate Physiological Muscle Activations and Joint Moments Across the Neck Before Impacts

Knowledge of neck muscle activation strategies prior to sporting impacts is crucial for investigating mechanisms of severe spinal injuries. However, measurement of muscle activations during impacts is experimentally challenging and computational estimations are not often guided by experimental measurements. We investigated neck muscle activations prior to impacts with the use of electromyography (EMG)-assisted neuromusculoskeletal models. Kinematics and EMG recordings from four major neck muscles of a rugby player were experimentally measured during rugby activities. A subject-specific musculoskeletal model was created with muscle parameters informed from MRI measurements. The model was used in the Calibrated EMG-Informed Neuromusculoskeletal Modelling toolbox and three neural solutions were compared: i) static optimisation (SO), ii) EMG-assisted (EMGa) and iii) MRI-informed EMG-assisted (EMGaMRI). EMGaMRI and EMGa significantly (p¡0.01) outperformed SO when tracking cervical spine net joint moments from inverse dynamics in flexion/extension (RMSE = 0.95, 1.14 and 2.32 Nm) but not in lateral bending (RMSE = 1.07, 2.07 and 0.84 Nm). EMG-assisted solutions generated physiological muscle activation patterns and maintained experimental co-contractions significantly (p¡0.01) outperforming SO, which was characterised by saturation and non-physiological "on-off" patterns. This study showed for the first time that physiological neck muscle activations and cervical spine net joint moments can be estimated without assumed a priori objective criteria prior to impacts. Future studies could use this technique to provide detailed initial loading conditions for theoretical simulations of neck injury during impacts.</p

Asymmetrical hip loading correlates with metal ion levels in patients with metal-on-metal hip resurfacing during sit-to-stand

The occurrence of pseudotumours following metal-on-metal hip resurfacing arthroplasty (MoMHRA) has been associated with high serum metal ion levels and consequently higher than normal bearing wear. Measuring ground reaction force is a simple method of collecting information on joint loading during a sit-to-stand (STS). We investigated vertical ground reaction force (VGRF) asymmetry during sit-to-stand for 12 MoMHRA patients with known serum metal ion levels. Asymmetry was assessed using two methods: a ratio of VGRF for implanted/unimplanted side and an absolute symmetry index (ASI). It was found that subjects with high serum metal ion levels preferentially loaded their implanted sides. The difference between the two groups was most apparent during the first 22% of STS. VGRF ratio showed significant and strong correlation with serum metal ion levels (Spearman's rho = 0.8, p = 0.003). These results suggest that individual activity patterns play a role in the wear of MoMHRA and preferential loading of an implanted limb during the initiation of motion may increase the wear of metal-on-metal hip replacements. </jats:p

Integrating the Combined Sagittal Index Reduces the Risk of Dislocation Following Total Hip Replacement

Background: The aims of this matched cohort study were to (1) assess differences in spinopelvic characteristics between patients who sustained a dislocation after total hip arthroplasty (THA) and a control group without a dislocation, (2) identify spinopelvic characteristics associated with the risk of dislocation, and (3) propose an algorithm including individual spinopelvic characteristics to define an optimized cup orientation target to minimize dislocation risk.Methods: Fifty patients with a history of THA dislocation (29 posterior and 21 anterior dislocations) were matched for age, sex, body mass index (BMI), index diagnosis, surgical approach, and femoral head size with 200 controls. All patients underwent detailed quasi-static radiographic evaluations of the coronal (offset, center of rotation, and cup inclination/anteversion) and sagittal (pelvic tilt [PT], sacral slope [SS], pelvic incidence [PI], lumbar lordosis [LL], pelvic-femoral angle [PFA], and cup anteinclination [AI]) reconstructions. The spinopelvic balance (PI - LL), combined sagittal index (CSI = PFA + cup AI), and Hip-User Index were determined. Parameters were compared between the control and dislocation groups (2-group analysis) and between the controls and 2 dislocation groups identified according to the direction of the dislocation (3-group analysis). Important thresholds were determined from receiver operating characteristic (ROC) curve analyses and the mean values of the control group; thresholds were expanded incrementally in conjunction with running-hypothesis tests.Results: There were no coronal differences, other than cup anteversion, between groups. However, most sagittal parameters (LL, PT, CSI, PI - LL, and Hip-User Index) differed significantly. The 3 strongest predictors of instability were PI - LL &gt; 10° (sensitivity of 70% and specificity of 65% for instability regardless of direction), CSI standingof &lt; 216° (posterior instability), and CSI standingof &gt; 244° (anterior instability). A CSI that was not between 205° and 245° on the standing radiograph (CSI standing) was associated with a significantly increased dislocation risk (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 2.2 to 8.2; p &lt; 0.001). In patients with an unbalanced and/or rigid lumbar spine, a CSI standingthat was not 215° to 235° was associated with a significantly increased dislocation risk (OR: 5.1; 95% CI: 1.8 to 14.9; p = 0.001).Conclusions: Spinopelvic imbalance (PI - LL &gt; 10° ) determined from a preoperative standing lateral spinopelvic radiograph can be a useful screening tool, alerting surgeons that a patient is at increased dislocation risk. Measurement of the PFA preoperatively provides valuable information to determine the optimum cup orientation to aim for a CSI standingof 205° to 245° , which is associated with a reduced dislocation risk. For patients at increased dislocation risk due to spinopelvic imbalance (PI - LL &gt; 10° ), the range for the optimum CSI is narrower.Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p

Operative and Radiographic Acetabular Component Orientation in Total Hip Replacement: Influence of Pelvic Orientation and Surgical Positioning Technique

Orthopaedic surgeons often experience a mismatch between perceived intra-operative and radiographic acetabular cup orientation. This research aimed to assess the impact of pelvic orientation and surgical positioning technique on operative and radiographic cup orientation. Radiographic orientations for two surgical approaches were computationally simulated: a mechanical alignment guide and a transverse acetabular ligament approach, both in combination with different pelvic orientations. Positional errors were defined as the difference between the target radiographic orientation and that achieved. The transverse acetabular ligament method demonstrated smaller positional errors for radiographic version; 4.0° ± 2.9° as compared to 9.4° ± 7.3° for the mechanical alignment guide method. However, both methods resulted in similar errors in radiographic inclination. Multiple regression analysis showed that intraoperative pelvic rotation about the anterior-posterior axis was a strong predictor for these errors (B TAL = −0.893, B MAG = −0.951, p &lt; 0.01). Application of the transverse acetabular ligament method can reduce errors in radiographic version. However, if the orthopaedic surgeon is referencing off the theatre floor to control inclination when operating in lateral decubitus, this is only reliable if the pelvic sagittal plane is horizontal. There is currently no readily available method for ensuring that this is the case during total hip replacement surgery. </p

What is the early/mid-term survivorship and functional outcome after Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

BACKGROUND: The Bernese periacetabular osteotomy (PAO) is a recognized joint-preserving procedure. Achieving joint stability without creating impingement is important, but the orientation target that best balances these sometimes competing goals has not yet been clearly defined. Moreover, the learning curve of this challenging procedure has not been described. QUESTIONS/PURPOSES: The purposes of this study were (1) to determine the 10-year survivorship and functional outcome after Bernese PAO in a single-surgeon series; (2) to review which patient, surgical, and radiographic factors might predict outcome after the procedure; and (3) to define the learning curve for target acetabular correction. METHODS: The first 68 PAOs performed for symptomatic hip dysplasia were retrospectively evaluated. None have been lost to followup with followup less than 2 years. Endpoints for the lost to followup (n = 2) are at the time of when last seen. During the study period, the same surgeon performed 562 pelvic osteotomies (including Salter, Pemberton, Dega and Chiari) and 64 shelf acetabuloplasties. Bernese PAO was used only for symptomatic dysplasia (center-edge angle < 25° and nonhorizontal acetabular roof) in developmentally mature hips without evidence of major joint incongruence or subluxation. Most patients were female (n = 49 [60 hips, 88%]); mean age at operation was 25 years (SD 7). Sixteen hips had previous hip procedures. The study’s mean followup was 8 years (range, 2–18 years). Patient-reported functional outcome was obtained using the WOMAC score (best-worst: 0–96). Radiographic parameters of dysplasia (acetabular index [AI], center-edge angle [CEA], congruency, Tönnis grade, and joint space) were evaluated from preoperative and postoperative radiographs using computer software. RESULTS: The 10-year survival rate was 93% (95% confidence interval [CI], 82%–100%); four patients underwent further surgery to the hip in the study period. The mean WOMAC was 12 (range, 0–54). Factors that influenced survival included joint congruency (100% versus 78%; 95% CI, 61%–96%; p = 0.03) and acetabular orientation correction achieved (AI(postoperative) < 15° [100% versus 65%; 95% CI, 43–88; p < 0.001] and CEA(postoperative) 20° to 40° [100% versus 71.9%; 52.8–100; p < 0.001]). Better WOMAC scores were seen if postoperative AI < 15° (7 versus 25, p = 0.005) and CEA between 20° and 40° (7 versus 23, p = 0.005) were achieved. The chances of obtaining acetabular correction within this range improved after the 20(th) procedure (30% versus 70%, p = 0.008). CONCLUSIONS: This study reports excellent results after Bernese PAO in the hands of an experienced pediatric hip surgeon. We advocate cautious correction of the acetabular fragment. Future studies should concentrate on how to determine what the optimal target is and how to achieve it intraoperatively, minimizing the learning curve associated with it. LEVEL OF EVIDENCE: Level III, therapeutic study

In vitro comparison of the effects of rough and polished stem surface finish on pressure generation in cemented hip arthroplasty

Background and purpose High pressures around implants can cause bone lysis and loosening. We investigated how pressures are generated around cemented femoral stems