Change in pattern of muscle activity following botulinum toxin injections for torticollis

Twenty patients with torticollis had electromyographic studies of their neck muscles performed before and after a series of local injections of botulinum toxin. The pattern of muscle activity changed after the injections, and this effect persisted even after head position had returned to baseline. Patients who did not experience any clinical benefit from the injections also demonstrated a change in the pattern of muscle activity. These results suggest that the underlying abnormality in torticollis usually involves a general motor program for head position, rather than the activity of individual neck muscles.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50342/1/410290407_ftp.pd

Articular contact in a three-dimensional model of the knee

This study is aimed at the analysis of articular contact in a three-dimensional mathematical model of the human knee-joint. In particular the effect of articular contact on the passive motion characteristics is assessed in relation to experimentally obtained joint kinematics. Two basically different mathematical contact descriptions were compared for this purpose. One description was for rigid contact and one for deformable contact. The description of deformable contact is based on a simplified theory for contact of a thin elastic layer on a rigid foundation. The articular cartilage was described either as a linear elastic material or as a non-linear elastic material. The contact descriptions were introduced in a mathematical model of the knee. The locations of the ligament insertions and the geometry of the articular surfaces were obtained from a joint specimen of which experimentally determined kinematic data were available, and were used as input for the model. The ligaments were described by non-linear elastic line elements. The mechanical properties of the ligaments and the articular cartilage were derived from literature data. Parametric model evaluations showed that, relative to rigid articular contact, the incorporation of deformable contact did not alter the motion characteristics in a qualitative sense, and that the quantitative changes were small. Variation of the elasticity of the elastic layer revealed that decreasing the surface stiffness caused the ligaments to relax and, as a consequence, increased the joint laxity, particularly for axial rotation. The difference between the linear and the non-linear deformable contact in the knee model was very small for moderate loading conditions. The motion characteristics simulated with the knee model compared very well with the experiments. It is concluded that for simulation of the passive motion characteristics of the knee, the simplified description for contact of a thin linear elastic layer on a rigid foundation is a valid approach when aiming at the study of the motion characteristics for moderate loading conditions. With deformable contact in the knee model, geometric conformity between the surfaces can be modelled as opposed to rigid contact which assumed only point contact

Simulation and design of an active orthosis for an incomplete spinal cord injured subject

The dynamic simulation of incomplete spinal cord injured individuals equipped with active orthoses is a challenging problem due to the redundancy of the simultaneous human-orthosis actuation. The objective of this work is two-fold. Firstly, a physiological static optimization approach to solve the muscle-orthosis actuation sharing problem is presented. For this purpose, a biomechanical model based on multibody dynamics techniques is used. The muscles are modeled as Hill-type actuators and the atrophy of denervated muscles is considered by adding stiff and dissipative elements. Secondly, the mechanical design of a new active stance-control knee-ankle-foot orthosis (A-SCKAFO) is addressed. The proposed device consists of a passive joint that constrains ankle plantar flexion, along with a powered knee unit that prevents flexion during stance and controls flexion-extension during swing. The knee actuation is selected based on the results obtained through the optimization approach.Peer ReviewedPostprint (published version

Non-Invasive Mouse Models of Post-Traumatic Osteoarthritis

SummaryAnimal models of osteoarthritis (OA) are essential tools for investigating the development of the disease on a more rapid timeline than human OA. Mice are particularly useful due to the plethora of genetically modified or inbred mouse strains available. The majority of available mouse models of OA use a joint injury or other acute insult to initiate joint degeneration, representing post-traumatic osteoarthritis (PTOA). However, no consensus exists on which injury methods are most translatable to human OA. Currently, surgical injury methods are most commonly used for studies of OA in mice; however, these methods may have confounding effects due to the surgical/invasive injury procedure itself, rather than the targeted joint injury. Non-invasive injury methods avoid this complication by mechanically inducing a joint injury externally, without breaking the skin or disrupting the joint. In this regard, non-invasive injury models may be crucial for investigating early adaptive processes initiated at the time of injury, and may be more representative of human OA in which injury is induced mechanically. A small number of non-invasive mouse models of PTOA have been described within the last few years, including intra-articular fracture of tibial subchondral bone, cyclic tibial compression loading of articular cartilage, and anterior cruciate ligament (ACL) rupture via tibial compression overload. This review describes the methods used to induce joint injury in each of these non-invasive models, and presents the findings of studies utilizing these models. Altogether, these non-invasive mouse models represent a unique and important spectrum of animal models for studying different aspects of PTOA

Does a micro-grooved trunnion stem surface finish improve fixation and reduce fretting wear at the taper junction of total hip replacements? A finite element evaluation.

The generation of particulate debris at the taper junction of total hip replacements (THRs), can cause failure of the artificial hip. The taper surfaces of femoral heads and trunnions of femoral stems are generally machined to a certain roughness to enhance fixation. However, the effect of the surface roughness of these surfaces on the fixation, wear and consequently clinical outcomes of the design is largely unknown. In this study, we asked whether a micro-grooved trunnion surface finish (1) improves the fixation and (2) reduces the wear rate at the taper junction of THRs. We used 3D finite element (FE) models of THRs to, firstly, investigate the effect of initial fixation of a Cobalt-Chromium femoral head with a smooth taper surface mated with a Titanium (1) micro-grooved and (2) smooth, trunnion surface finishes. Secondly, we used a computational FE wear model to compare the wear evolution between the models, which was then validated against wear measurements of the taper surface of explanted femoral heads. The fixation at the taper junction was found to be better for the smooth couplings. Over a 7 million load cycle analysis in-silico, the linear wear depth and the total material loss was around 3.2 and 1.4 times higher for the femoral heads mated with micro-grooved trunnions. It was therefore concluded that smooth taper and trunnion surfaces will provide better fixation at the taper junction and reduce the volumetric wear rates

Large head metal-on-metal cementless total hip arthroplasty versus 28mm metal-on-polyethylene cementless total hip arthroplasty: design of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Osteoarthritis of the hip is successfully treated by total hip arthroplasty with metal-on-polyethylene articulation. Polyethylene wear debris can however lead to osteolysis, aseptic loosening and failure of the implant. Large head metal-on-metal total hip arthroplasty may overcome polyethylene wear induced prosthetic failure, but can increase systemic cobalt and chromium ion concentrations. The objective of this study is to compare two cementless total hip arthroplasties: a conventional 28 mm metal-on-polyethylene articulation and a large head metal-on-metal articulation. We hypothesize that the latter arthroplasties show less bone density loss and higher serum metal ion concentrations. We expect equal functional scores, greater range of motion, fewer dislocations, fewer periprosthetic radiolucencies and increased prosthetic survival with the metal-on-metal articulation.</p> <p>Methods</p> <p>A randomized controlled trial will be conducted. Patients to be included suffer from non-inflammatory degenerative joint disease of the hip, are aged between 18 and 80 and are admitted for primary cementless unilateral total hip arthroplasty. Patients in the metal-on-metal group will receive a cementless titanium alloy acetabular component with a cobalt-chromium liner and a cobalt-chromium femoral head varying from 38 to 60 mm. Patients in the metal-on-polyethylene group will receive a cementless titanium alloy acetabular component with a polyethylene liner and a 28 mm cobalt-chromium femoral head. We will assess acetabular bone mineral density by dual energy x-ray absorptiometry (DEXA), serum ion concentrations of cobalt, chromium and titanium, self reported functional status (Oxford hip score), physician reported functional status and range of motion (Harris hip score), number of dislocations and prosthetic survival. Measurements will take place preoperatively, perioperatively, and postoperatively (6 weeks, 1 year, 5 years and 10 years).</p> <p>Discussion</p> <p>Superior results of large head metal-on-metal total hip arthroplasty over conventional hip arthroplasty have been put forward by experts, case series and the industry, but to our knowledge there is no randomized controlled evidence.</p> <p>Conclusion</p> <p>This randomized controlled study has been designed to test whether large head metal-on-metal cementless total hip arthroplasty leads to less periprosthetic bone density loss and higher serum metal ion concentrations compared to 28 mm metal-on-polyethylene cementless total hip arthroplasty.</p> <p>Trial registration</p> <p>Netherlands Trial Registry NTR1399</p