Recommendations for resuming elective hip and knee arthroplasty in the setting of the SARS‑CoV‑2 pandemic: the European Hip Society and European Knee Associates Survey of Members

The COVID-19 pandemic has disrupted the health care system around the entire globe. A consensus is needed about resuming total hip and knee procedures. The European Hip Society (EHS) and the European Knee Association (EKA) formed a panel of experts that have produced a consensus statement on how the safe re-introduction of elective hip and knee arthroplasty should be undertaken. Methods A prospective online survey was done among members of EHS and EKA. The survey consisted of 27 questions. It includes basic information on demographics and details the participant’s agreement with each recommendation. The participant could choose among three options (agree, disagree, abstain). Recommendations focussed on pre-operative, perioperative, and post-operative handling of patients and precautions. Results A total of 681 arthroplasty surgeons participated in the survey, with 479 fully completing the survey. The participants were from 44 countries and 6 continents. Apart from adhering to National and Local Guidelines, the recommendations concerned how to make elective arthroplasty safe for patients and staf. Conclusion The survey has shown good-to-excellent agreement of the participants with regards to the statements made in the recommendations for the safe return to elective arthroplasty following the frst wave of the COVID-19 pandemi

Resuming elective hip and knee arthroplasty after the first phase of the SARS-CoV-2 pandemic: the European Hip Society and European Knee Associates recommendations

The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. Methods A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. Results The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. Conclusion Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe retur

Applications of data science in offshore geotechnical engineering : state of practice and future perspectives

Data-driven predictive models are becoming ubiquitous in society with a wide range of applications, including engineering design. For offshore geotechnical engineering, semi-empirical models make up most of the predictive models to date. These models implicitly include knowledge on soil mechanics and foundation behaviour gathered from laboratory testing, scale model testing and field observations. Modern data science techniques enable researchers and practising engineers to leverage state-of-the-art artificial intelligence tools to re-evaluate the creation of these predictive models. This keynote explores basic and advanced applications of artificial intelligence in offshore geotechnical engineering and aims to offer a perspective on the future use of these techniques in solving complex geotechnical problems

Trochleoplasty in dysplastic knee trochlea

In patients complaining of recurrent patellar dislocations or persistent retropatellar pain due to a dysplastic femoral trochlea, we perform a Henri Dejour trochleoplasty. In this technique the femoral trochlea is deepened by removing the subchondral trochlear bone followed by incision, impaction and fixation of the cartilage flange along the trochlear groove. Between 1996 and 1999, 13 procedures were performed in 12 patients. Strictly lateral X-rays showed dysplasia of the trochlea, as defined by the "crossing sign", whether or not in combination with patella alta. Patients were assessed using the Larsen-Lauridsen score considering pain, stiffness, osteopatellar crepitus, flexion and loss of function. Although the majority of patients scored fair and poor on an objective scoring system, we achieved 77% good to very good subjective results. Although the result was not perfect, the patients were satisfied with the procedure. This technique might be a valuable alternative in cases of frank trochlear dysplasia associated with persistent retropatellar pain or recurrent patellar dislocations

Practical approach for data-efficient metamodeling and real-time modeling of monopiles using physics-informed multifidelity data fusion

This paper proposes a practical approach for data-efficient metamodeling and real-time modeling of laterally loaded monopiles using physics-informed multifidelity data fusion. The proposed approach fuses information from one-dimensional (1D) beam-column model analysis, three-dimensional (3D) finite element analysis, and field measurements (in order of increasing fidelity) for enhanced accuracy. It uses an interpretable scale factor–based data fusion architecture within a deep learning framework and incorporates physics-based constraints for robust predictions with limited data. The proposed approach is demonstrated for modeling monopile lateral load–displacement behavior using data from a real-world case study. Results show that the approach provides significantly more accurate predictions compared to a single-fidelity metamodel and a widely used multifidelity data fusion model. The model’s interpretability and data efficiency make it suitable for practical applications

Missed diagnosis of false aneurysm of the superficial femoral artery after closed complex fracture of the distal femur

AbstractThis case report presents a 38-year-old male patient who developed a false aneurysm of the superficial femoral artery after minimally invasive plate internal fixation of a comminuted articular distal femoral fracture sustained in a motor vehicle accident. Two days after surgery, the patient developed pain, non-pulsatile swelling on the medial side of the knee and anemia. After about six weeks, diagnosis of false aneurysm of the superficial femoral artery was confirmed by duplex ultrasound and computed tomographic angiography. A percutaneous endovascular procedure was performed to treat the false aneurysm without evacuating the blood collection

Multifidelity data fusion for the estimation of static stiffness of suction caisson foundations in layered soil

The static stiffness of suction caisson foundations is an important engineering factor for offshore wind foundation design. However, existing simplified design models are mainly developed for nonlayered soil conditions, and their accuracy for layered soil conditions is uncertain. This creates a challenge for designing these foundations in offshore wind farm sites, where layered soil conditions are commonplace. To address this, this paper proposes a multifidelity data fusion approach that combines information from different physics-based models of varying accuracy, data sparsity, and computational costs in order to improve the accuracy of stiffness estimations for layered soil conditions. The results indicate that the proposed approach is more accurate than both the simplified design model and a single-fidelity machine learning model, even with limited training data. The proposed method offers a promising data-efficient solution for fast and robust stiffness estimations, which could lead to more cost-effective offshore foundation designs

Anatomic single-bundle ACL surgery: consequences of tibial tunnel diameter and drill-guide angle on tibial footprint coverage

To investigate the consequences of differences in drill-guide angle and tibial tunnel diameter on the amount of tibial anatomical anterior cruciate ligament (ACL) footprint coverage and the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint. Twenty fresh-frozen adult human knee specimens with a median age of 46 years were used for this study. Digital templates mimicking the ellipsoid aperture of tibial tunnels with a different drill-guide angle and a different diameter were designed. The centres of these templates were positioned over the geometric centre of the tibial ACL footprint. The amount of tibial ACL footprint coverage and overhang was calculated. Risk factors for overhang were determined. Footprint coverage and the risk of overhang were also compared between a lateral tibial tunnel and a classic antero-medial tibial tunnel. A larger tibial tunnel diameter and a smaller drill-guide angle both will create significant more footprint coverage and overhang. In 45 % of the knees, an overhang was created with a 10-mm diameter tibial tunnel with drill-guide angle 45A degrees. Furthermore, a lateral tibial tunnel was found not to be at increased risk of overhang. A larger tibial tunnel diameter and a smaller drill-guide angle both will increase the amount of footprint coverage. Inversely, larger tibial tunnel diameters and smaller drill-guide angles will increase the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint. A lateral tibial tunnel does not increase the risk of overhang