Dissertations / Theses on the topic 'Orthopaedic'
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Tarazi, Kamal. "Computer assisted orthopaedic surgery." Thesis, Imperial College London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.321608.
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Ashby, Elizabeth. "Morbidity following orthopaedic surgery." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10054431/.
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Morbidity following hip and knee arthroplasty has previously been poorly recorded. This is the first time the Post-Operative Morbidity Survey (POMS) has been used for this purpose. The POMS identifies clinically significant morbidity using indicators of organ system dysfunction rather than traditional diagnostic categories. The most common types of morbidity following hip and knee arthroplasty are infection and renal morbidity. Pulmonary, pain and gastro-intestinal morbidity are less common. Cardiovascular, wound, neurological and haematological morbidity are least common. Many arthroplasty patients remain in hospital without morbidity. The POMS identifies these patients and thus has potential as a prospective bed utilisation tool. To be used for this purpose, the POMS must identify all clinically significant morbidity. Mobility is an important factor for safe discharge of arthroplasty patients. Addition of a ‘mobility’ domain could improve the utility of POMS as a bed utilisation tool following orthopaedic surgery. This study showed no association between post-operative morbidity defined by the POMS and longer-term patient-reported outcome measures (PROMs). This study does not support the POMS as an early surrogate marker of long-term PROMs in orthopaedic patients. The wound domain of the POMS has a high specificity, reasonable sensitivity, high negative predictive value and low positive predictive value compared to the inpatient ASEPSIS (Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, inpatient Stay over 14 days) score. The wound domain of POMS could be replaced with a validated definition of wound infection such as ASEPSIS. On the same series of orthopaedic patients, surgical site infection (SSI) rate according to the Centres for Disease Control (CDC) definition was 15.45%, according to the Nosocomial Infection National Surveillance Scheme (NINSS) definition was 11.32% and according to the ASEPSIS definition was 8.79%. This highlights the need for a consistent definition of SSI.
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Widman, Jan. "Blood saving in orthopaedic surgery /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-220-5.
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Johansson, Åke. "Experimental implant-associated orthopaedic infections /." Stockholm, 1999. http://diss.kib.ki.se/1999/91-628-3562-9/.
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Di, Laura Anna. "Corrosion of metal orthopaedic implants." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10045267/.
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Tribocorrosion at the taper junctions of femoral components in total hip arthroplasty is a complex mechanism and a source of metal release in the body. Understanding the various modes and mechanisms of in-vivo corrosion and the pathogenesis of the body’s biological response that results in implant failure is of significant clinical importance. This thesis focused on the forensic analysis, using both metrology methods and synchrotron radiation, of a class of modular orthopaedic implants - dual-taper hip arthroplasty, retrieved from patients whose hip replacements were revised secondary to adverse reaction to metal debris (ARMD). Emphasis was placed on the forensic investigation of the neck/stem junction of contemporary designs and the recalled Rejuvenate modular femoral stem. All the retrieved implants in the CoCr/Ti combination group showed moderate to severe corrosive attack. The severity of taper degradation was found to increase with implant time in situ and to be associated with a greater Co to Cr ion ratio in the blood. Metal species identified in periprosthetic tissue from these corroded implants, were analysed for metal distribution and oxidation state by means of synchrotron radiation. For the first time, Ti was found in an amorphous dioxide form and Cr in Cr2O3. The metal species showed preferential affinity between each other and were often co-localized. This suggests that the complexity (in morphology and chemistry) of the debris may play an active role in eliciting a pathologic response in periprosthetic tissues. The findings from this body of research will inform future toxicological studies and may provide useful information helping to better design future pre-marketing tests of orthopaedic implants and more broadly the understanding of the metal/metal and metal/body interactions.
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Slocum, Alexander Henry Jr. "Rolling contact orthopaedic joint design." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/81736.
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Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2013.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references.
Arthroplasty, the practice of rebuilding diseased biological joints using engineering materials, is often used to treat severe arthritis of the knee and hip. Prosthetic joints have been created in a "biomimetic" manner to reconstruct the shape of the biological joint. We are at a disadvantage, however, in that metals and polymers used to replace bone and articular cartilage often wear out too soon, leading to significant morbidity. This thesis explores the use of kinetic-mimicry, instead of bio-mimicry, to design prosthetic rolling contact joints, including knee braces, limb prosthetics, and joint prostheses, with the intent of reducing morbidity and complications associated with joint/tissue failure. A deterministic approach to joint design is taken to elucidating six functional requirements for a prosthetic tibiofemoral joint based on anatomical observations of human knee kinetics and kinematics. Current prostheses have a high slide/roll ratio, resulting in unnecessary wear. A rolling contact joint, however, has a negligible slide/roll ratio; rolling contact prostheses would therefore be more efficient. A well-established four-bar linkage knee model, in a sagittal plane that encapsulates with the knee's flexion/extension degree of freedom, is used to link human anatomy to the shape of rolling cam surfaces. The first embodiment of the design is a flexure coupling-based joint for knee braces. Failure mode analysis, followed by cyclic failure testing, has shown that the prototype joint is extremely robust and withstood half a million cycles during the first round of tests. Lubrication in the joint is also considered: micro- and nano-textured porous coatings are investigated for their potential to support the formation of favorable lubrication regimes. Hydrodynamic lubrication is optimal, as two surfaces are separated by a fluid gap, thus mitigating wear. Preliminary results have shown that shear stress is reduced by more than 60% when a coating is combined with a shear thinning lubricant like synovial fluid. These coatings could be incorporated into existing joint prostheses to help mitigate wear in current technology. This thesis seeks to describe improvements to the design of prosthetic joints, both existing and future, with the intent of increasing the overall quality of care delivered to the patient.
by Alexander Henry Slocum, Jr.
Ph.D.
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Wilkinson, Andrew James. "Biomimetic topography in orthopaedic ceramic." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7791/.
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The primary objective of this research was to perform an in vitro assessment of the ability of microscale topography to alter cell behaviour, with specific regard to producing favourable topography in an orthopaedic ceramic material suitable for implantation in the treatment of arthritis. Topography at microscale and nanoscale alters the bioactivity of the material. This has been used in orthopaedics for some time as seen with optimal pore size in uncemented hip and knee implants. This level of topography involves scale in hundreds of micrometres and allows for the ingrowth of tissue. Topography at smaller scale is possible thanks to progressive miniaturisation of technology. A topographic feature was created in a readily available clinically licensed polymer, Polycaprolcatone (PCL). The effect of this topography was assessed in vitro. The same topography was transferred to the latest generation composite orthopaedic ceramic, zirconia toughened alumina (ZTA). The fidelity of reproduction of the topography was examined using scanning electron microscopy (SEM) and atomic force microscopy (AFM). These investigations showed more accurate reproduction of the topography in PCL than ZTA with some material artefacts in the ZTA. Cell culture in vitro was performed on the patterned substrates. The response of osteoprogenitor cells was assessed using immunohistochemistry, real-time polymerase chain reaction and alizarin staining. These results showed a small effect on cell behaviour. Finally metabolic comparison was made of the effects created by the two different materials and the topography in each. The results have shown a reproducible topography in orthopaedic ceramics. This topography has demonstrated a positive osteogenic effect in both polycaprolactone and zirconia toughened alumina across multiple assessment modalities.
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Millar, Lindsay Jane. "Visual feedback in orthopaedic rehabilitation." Thesis, University of Strathclyde, 2016. http://digitool.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=27634.
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Currently, functional outcome following total knee arthroplasty (TKA) surgery is often not restored, with the majority of TKA patients exhibiting lower functional outcome scores than healthy counterparts. There is some controversy regarding the nature of rehabilitation delivery following TKA surgery which could contribute to sub-optimal outcomes. Visual feedback has had a positive effect in other patient populations, such as stroke survivors, and therefore may also improve the efficacy of TKA rehabilitation. Currently, the most effective way to deliver visual feedback is with motion analysis technology. However, current protocols are not suitable for routine clinical use as they are time consuming and complex. Therefore, the aims of this study were to develop a motion analysis protocol tailored for routine clinical use, use the protocol to implement real-time visual feedback to TKA patients and test the effectiveness of the feedback on patients’ functional outcome. A cluster based protocol was developed (Strathclyde Cluster Model; SCM) and compared to the current clinical gold standard (Vicon Plug in Gait; PiG) in terms of kinematic output and inter/intra-assessor reliability. SCM was used to implement 3 visual feedback scenarios during TKA rehabilitation. To test the effectiveness of visual feedback, functional outcome was compared for a group of patients who received feedback and a group of controls. Further, the acceptability and reliability of SCM was tested with clinicians who had no prior experience in motion analysis. Results demonstrated that SCM was generally as reliable and accurate as PiG. Further, visual feedback does appear to have a positive effect on TKA patients and when tested with clinicians who were inexperienced in motion analysis, SCM was generally acceptable and reliable. In conclusion, SCM is an appropriate protocol for routine clinical use to deliver visual feedback during TKA rehabilitation and visual feedback has a positive effect on outcome for TKA patients.
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Hughes, Gareth Martin. "Surface analysis of orthopaedic implants." Thesis, University of Bristol, 2003. http://hdl.handle.net/1983/03628cc5-0770-4017-97c4-7753d184e308.
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Yang, Jun. "Immune response to orthopaedic biomaterials." Case Western Reserve University School of Graduate Studies / OhioLINK, 1995. http://rave.ohiolink.edu/etdc/view?acc_num=case1058195837.
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Okhiria, David. "Orthopaedic application of magnetic sensors." Thesis, Cardiff University, 2018. http://orca.cf.ac.uk/109877/.
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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.
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Sharifi, Husham. "Cost Effectiveness Analysis in Orthopaedic Surgery." Yale University, 2010. http://ymtdl.med.yale.edu/theses/available/etd-03302010-163307/.
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The purpose of this thesis was to explore the use of cost effectiveness for interventions in orthopaedics. This was done through three cost effectiveness articles that have been published by the author. In each of these articles, similar methodologies were used. Decision models were constructed for cost-effectiveness analyses of competing orthopaedic interventions. Outcome probabilities and effectiveness values were derived from the literature. Effectiveness was expressed in quality adjusted life years gained. Cost data were compiled and verified from either hospital cost data or from Medicare data. Costs and utilities were discounted in accord with the United States Panel on Cost Effectiveness in Health and Medicine. Principal outcome measures were average incremental costs, incremental effectiveness, incremental quality-adjusted life years, and, in the case of one article, net health benefits. In particular the articles compared the following: 1. Core decompression versus conservative management for osteonecrosis of the hip as a way to delay hip replacement; 2. Total knee arthroplasty versus unicompartmental knee arthroplasty; and 3. Periacetabular osteotomy versus total hip arthroplasty for a young adult with developmental dysplasia of the hip. The more cost effective intervention was identified in each case, along with implications of the results for clinical and operative decision-making. Cost effectiveness was found to be a useful tool in orthopaedic surgery under limited circumstances of either scarce data on new interventions or the need to use more resources to achieve greater effectiveness. It also can provide excellent insight into ways to direct future clinical research.
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Pitz, Mary Katlyn. "Compression-aided stability of orthopaedic devices." Thesis, Georgia Institute of Technology, 2011. http://hdl.handle.net/1853/39487.
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Repair and remodeling of bone during healing and fusion require a combination of bone resorption and formation to successfully restore the bone to its previous strength. The healing process is highly responsive to the mechanical conditions of the construct, where excessive loading can cause high strains that delay healing, but moderate loading can be beneficial. Maintaining compression at the site of fracture can benefit healing by maintaining bone congruency and increasing the stability of the bone-implant construct to prevent excessive shifting. For these reasons, compressive mechanisms are employed in many orthopaedic devices, including both intramedullary (IM) nails and external fixators for ankle arthrodesis applications. Tibiotalocalcaneal (TTC) arthrodesis is a salvage procedure that fuses both the ankle and the subtalar joints. It has become the standard of care in ankle degeneration, which can be brought on by posttraumatic arthritis, failed total ankle arthroplasty, or diabetic conditions such as Charcot arthropathy. While current devices are effective in many cases, TTC arthrodesis procedures still incur failure rates as high as 22%, where failure of the bones to successfully fuse can result in amputation. Because bone healing relies upon bone resorption, the initial compression applied to the implanted constructs can be quickly lost, which may sacrifice the stability of the structure and delay or inhibit further healing.
By employing a mechanism that can sustain compression during the bone healing process, it was possible to increase the stability of the construct even during bone resorption, minimizing the failures that still occur. The focus of this study was to determine the effects of compression on the mechanical stability of the implant-bone construct found in TTC arthrodesis. A comparison was made between the torsional stability of two currently marketed intramedullary devices, as well as a prototype IM device comprised of a nickel titanium core, designed to hold constant compression for up to 9mm of resorption. Additionally, the stability of each construct over time was evaluated by correlating bone resorption to a loss in compressive force.
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Lilley, Kevin James. "Novel cement formulations for orthopaedic applications." Thesis, University of Birmingham, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442648.
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Evans, S. E. K. "Applied photogrammetry in orthopaedic implant manufacture." Thesis, University of Liverpool, 2018. http://livrepository.liverpool.ac.uk/3020338/.
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Song, Xiaodong. "Titanium vaulted structures for orthopaedic applications." Thesis, University of Liverpool, 2013. http://livrepository.liverpool.ac.uk/13335/.
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Medical devices are used to recreate damaged or diseased joints and also to restore pain reduced mobility to patients. Devices such as hip and knee implants are fixed to the host bone by use of acrylic bone cement or by a press-fit interference technique. The surface of the press fit implants may be roughened, but non-porous, which allows new bone to form on the surface, or they may be porous to encourage bone growth into the structure. Traditionally implants are produced by machining, casting or forging, before applying any coatings that are required. More recently Additive Manufacturing (AM) techniques such as Electron Beam Manufacturing (EBM) and Selective Laser Melting (SLM) have attracted interest as they may be able to create the whole device in one operation. This thesis describes the research carried out to produce “Vaulted Structure (VS)” as a method for creating specific porosity with increased strength in porous medical devices. Unit cell structures (Wire frames) are inherently weak because of the struts. It was proposed that VSs, constructed of platelets, would have a higher specific strength and therefore extend the range of available properties while still maintaining a structure that resembles cancellous bone, a structure preferred by surgeons. The creation of a VS begins with a computer model of the object to be created. This is then surrounded by an axis aligned bounding box, a box that has edges parallel to the x, y and z directions and just encloses the object. The bounding box is then voxelised, so it consists of many smaller cubic boxes, these boxes being the size of the required structure. The VS is then constructed by creating holed platelets on some of the surfaces of the smaller boxes, with these platelets being randomly deformed if required. The structure within the bounding box is then trimmed to the boundary of the required structure, this being accomplished using a rapid technique developed during this project. To allow manufacture of the components, the structure is sliced to create a suitable format for the SLM. By using SLM in combination with these new novel structures, a wide range of possible properties and morphologies can be generated, these being controlled by the cell size, hole size, thickness of the platelet and the level of randomisation. ii A range of structures with different morphologies were produced and mechanically tested in compression. It was found that a percentage randomisation of more than 60% and a cell aspect ratio of 1:1:2, produced isotropic mechanical behaviour, while other structures produced very different behaviour. It was also observed that the failure mode in compression could be controlled by the degree of randomisation and this is discussed in the thesis. A property that is important in the medical device industry is the look of the component as this affects up take by surgeons. The preferred structures are ones that look like cancellous bone and the new structures created here match both the look and mechanical properties of this material, but with the added advantage that it is possible, by modifying the control variables, to match the structure to cancellous bone from different aged patients. The research presented in this thesis considers the inter-relationship between the process parameters, architecture, properties of the structures and why these inter relationships occur. The research presented here extends knowledge of how to create these novel material/structure combinations, how to tailor them to a given purpose and by predicting behaviour in software produce the most suitable properties for a given medical device without extensive testing.
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Bick, Simon Millard. "Occipito-cervical fusion." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10142.
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The aim of this study is to review the different surgical indications, techniques and outcomes of occipito-cervical fusion, including C2 fixation methods, the influence on clinical outcome, patient scoring systems and complications.
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Blanquer, Jerez Andreu. "Biocompatibility of new biomaterials for orthopaedic applications." Doctoral thesis, Universitat Autònoma de Barcelona, 2016. http://hdl.handle.net/10803/386500.
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L’ús de materials biocompatibles ha assolit una importància creixent en aplicacions ortopèdiques i quirúrgiques, degut a l’envelliment de la població. Els aliatges metàl·lics que s’empren actualment en medicina presenten propietats físiques i mecàniques diferents a les de l’os humà, incrementant la probabilitat de pèrdua de l’implant. Per aquesta raó, s’estan desenvolupant nous aliatges metàl·lics amb millors propietats. En aquest sentit, la present tesi té com objectiu l’anàlisi de la biocompatibilitat de nous aliatges pel seu ús en implants ortopèdics. En primer lloc, s’ha demostrat la biocompatibilitat del vidre metàl·lic massís TiZrCuPd en termes de citotoxicitat, i d’adhesió i de diferenciació d’osteoblasts. En segon lloc, s’ha avaluat l’efecte de dues modificacions de superfície, anodització electroquímica i modificació física, dels aliatges TiZrCuPd i Ti-6Al-4V sobre el comportament dels osteoblasts. En aquest cas, no hem observat cap efecte de la topografia en la proliferació, l’adhesió i la diferenciació. En tercer lloc, hem demostrat que els aliatges TiZrPdSi i TiZrPdSiNb són biocompatibles i afavoreixen l’adhesió, la proliferació i la diferenciació d’osteoblasts. Finalment, hem avaluat l’efecte electroestimulador de dos nous nanogeneradors piezoelèctrics, basats en ZnO, emprant dues línies cel·lulars implicades en la regeneració òssia (osteoblasts i macròfags). Els resultats observats indiquen que els nanogeneradors són biocompatibles i que la seva interacció amb les cèl·lules produeix un camp elèctric local que estimula la motilitat dels macròfags i l’augment de la concentració intracel·lular de Ca2+ en osteoblasts. Aquests nous materials intel·ligents presenten propietats força interessants pel seu ús en aplicacions biomèdiques. En conjunt, els resultats obtinguts en els nostres estudis contribueixen en el desenvolupament de materials per millorar la reparació i la regeneració òssia.The use of biocompatible materials has attained an increasing importance for medical surgery and orthopaedics due to population aging. Metallic alloys currently used in bone implants have physical and mechanical properties different from those of the bone, which increases the probability of implant loosening. For this reason, new metallic alloys with better properties are being developed. In this regard, the present thesis aims to analyse the biocompatibility of new biomaterials for orthopaedic applications. First, we demonstrated the biocompatibility of TiZrCuPd bulk metallic glass in terms of cytotoxicity, and osteoblast adhesion and differentiation. Second, we assessed the effect of surface modification of TiZrCuPd and Ti-6Al-4V alloys by electrochemical anodization and physical modification on osteoblast behaviour. Differences in topography did not cause changes on osteoblasts adhesion, proliferation and differentiation. Third, we demonstrated that TiZrPdSi and TiZrPdSiNb alloys are also biocompatible and enhance osteoblasts adhesion, spreading, proliferation and differentiation. Fourth, we evaluated the electrostimulation effect of two new ZnO piezoelectric nanogenerators using two cell lines involved in bone regeneration (osteoblasts and macrophages). We observed that both nanogenerators are biocompatible and that their interaction with cells produces a local electric field that stimulate macrophages motility and the increase in intracellular Ca2+ concentration in osteoblasts. Thus, these new smart materials have interesting properties for their use in biomedical devices. Collectively, the results obtained in our studies contribute to the progress in the development of better materials for bone repair and regeneration.
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White, Courtney Ellen. "Characteristics of bisphosphonate elution from orthopaedic implants." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=99121.
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Bisphosphonates, drugs typically used to prevent bone loss for patients with osteoporosis, could also be used to enhance bone growth into porous implants. Since systemic administration of bisphosphonates is not appropriate for all patients, there is a need to develop a localized drug delivery system and characterize the drug release. The chemical affinity of bisphosphonates for hydroxyapatite was used to temporarily bind them to hydroxyapatite coatings on porous implants. Implants were immersed in aqueous solution and the drug elution was measured using UV spectrophotometry. With hydroxyapatite coating there was an initial burst of elution followed by more gradual drug release over several weeks. Without hydroxyapatite coating, all of the drug eluted in a maximum of three hours. This study served to demonstrate the feasibility of binding bisphosphonate compounds to hydroxyapatite coatings and characterized the elution characteristics as a function of time.
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Bainbridge, John Anthony. "The macrophage response to orthopaedic wear debris." Thesis, Queen Mary, University of London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.395027.
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Rodriguez, y. Baena Ferdinando Maria. "Improving accuracy in robotic assisted orthopaedic surgery." Thesis, Imperial College London, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.407196.
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Ozanian, Takouhi Ovaness. "Image analysis for computer-assisted orthopaedic surgery." Thesis, University of Hull, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310255.
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McNamee, David Anthony. "An evaluation of ropivacaine in orthopaedic anaesthesia." Thesis, Queen's University Belfast, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343102.
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Roether, Judith Anna. "Bioactive acrylic bone cements for orthopaedic applications." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.429217.
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Evans, Samuel Evans. "Adhesively bonded hydroxyapatite coatings for orthopaedic implants." Thesis, University of Southampton, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.241146.
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Hurst, Simon. "Electronic patient centred outcomes in orthopaedic surgery." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/57103.
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This thesis primarily reports on the national pilot of an electronic patient reported outcomes (ePRO) system for orthopaedic patients. Also reported on within the pilot is a new electronic patient centred outcome measure (ePCO) with focus on activity participation, and aspiration. At the time of publishing the pilot remains the largest of its kind within the speciality, and the first of its kind with respect to ePCOs. A background with historical perspective is provided for the use of outcomes in orthopaedic surgery, including a discussion surrounding current practices, and controversies. The engineering principles behind the construction of an ePCO/PCO system are also explained, along with the current regulatory guidelines governing them in Europe and the United States. The development and piloting of three individual software platforms are explained, evaluated, and discussed. This includes in the appendix a discussion on their wider context within industry, and within an increasingly technological able society. The final platform (Software C) is piloted in a large cohort both nationally, and internationally. Results from the pilot are presented and discussed in terms of the software usability, the ability for PROs to be successfully digitalised to ePROs within the software, and patient’s opinion of the technology. Objective outcome data obtained from a instrumented treadmill is used as an adjunct to the analysis of the impact of ePROs collected during the pilot, and also helping to address the validation parameters for the ePCO. Finally, the PCO is reported on. This includes the principles providing its conception, and foundation. It is tested using parameters for outcome score validation in both an initial paper-based pilot study, and in a national pilot using a modified digitalised format of the PCO.
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Clasper, Jonathan C. "Mortality and orthopaedic injury following military trauma." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8964/.
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This thesis details my contribution to the literature on military surgery, based on both front-line surgical experiences as well as research carried out on causes of death and disability, particularly in relation to limb injuries, the most common site of wounding in conflict. Injury analysis (6 papers). Injury prevention/mitigation (5 papers). Management (8 papers). Outcome (13 papers). Education (9 papers).
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Hedjazi, Ghazal. "Assessment of processing techniques for Orthopaedic Composites." Thesis, Högskolan i Borås, Institutionen Ingenjörshögskolan, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-19578.
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Metallic implants have been used widely in a lot of orthopaedic applications. Titanium, Ceramics,medical grade titanium and other metal alloys are inserted in large bones designed as artificialjoints. Plates and bars are also attached to bones in order to facilitate healing of fracturedbones. The disadvantages of metal implants however are corrosion and the release of ions, sothere is need for finding new orthopaedic materials like composites, which have a closer densityto the natural bone too.This project is part of European project NEWBONE and it is based on the manufacturing andprocessing of glass fiber reinforced composite and the assessment of its properties.The goal of the project is to manufacture composite parts in the lab in different designs and dimensionswhich are suitable for mechanical and chemical tests.The theoretical work deals with the processing methods and the medical composites, medical devices,plastics, reinforcement of medical composites, PEEK and carbon fibers and other materials.The glass fibers are impregnated with dental curing resin. The residual void content, glass fibercontent and chemical and mechanical properties are estimated by ASTM standard methods.Results are resented according to evaluation of composite performance mechanically and chemicallyand show the best choice of composite parts in order to improve future use of orthopaedicapplications.
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Guo, Weimin M. Eng Massachusetts Institute of Technology. "Orthopaedic applications of ferromagnetic shape memory alloys." Thesis, Massachusetts Institute of Technology, 2008. http://hdl.handle.net/1721.1/45957.
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Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Materials Science and Engineering, 2008.Includes bibliographical references (leaves 36-40).
Ferromagnetic shape memory alloys (FSMAs) are a new class of magnetic field-actuated active materials with no current commercial applications. By applying a magnetic field of around 0.4 T, they can exert a stress of approximately 1.5 MPa, exhibiting a strain of up to 6%. This thesis evaluates their technical and commercial feasibility in orthopaedic applications. Remote actuation is a key advantage FSMAs have over current implant materials. Also, the human body temperature is constant, providing a stable environment for FSMAs to operate. A number of potential orthopaedic applications are proposed and evaluated. Out of these, the most prominent application is the spinal traction device. It is a temporary implantable device, intended to perform internal spinal traction. A design has been proposed, with suggestions of suitable materials for its various components and appropriate device dimensions. Preliminary market and cost analyses have been conducted. This orthopaedic technology is currently in its infant stage. To commercialize this device, more trials are needed.
by Weimin Guo.
M.Eng.
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Marti, Patrick. "Zinc-containing hydroxyapatite coatings for orthopaedic applications." Thesis, University of Cambridge, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.611527.
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Pendegrass, Catherine Jane. "Soft tissue attachment to orthopaedic implant materials." Thesis, University College London (University of London), 2005. http://discovery.ucl.ac.uk/1445781/.
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Most orthopaedic endoprostheses are used to replace damaged joint surfaces and rely little on soft tissue attachment for their function. Massive bone tumour implants and solutions to attach external implants to the skeleton for amputees rely on soft tissue attachment for successful function. Massive implants require a tendon-metal attachment to preserve joint movement. Implants for amputees where the skeletally anchored implant penetrates the skin, require soft tissue attachment to produce an effective microbial seal which prevents infection. My thesis aims to investigate the concept that biomimetic soft tissue-implant interfaces can be engineered using surface texturing, coatings and biological augmentation, to enhance the attachment and function of the soft tissues between: 1) Metallic implants and tendons, used for proximal tibial replacement 2) The epithelial and sub-epithelial soft tissues to transcutaneous implants used for amputation prostheses I have shown that soft tissue derived cells' proliferative capacity, morphology and attachment are significantly affected by biomaterials and surface topography of the substrate used to support their growth, whilst biological substrate coatings can be used to optimise these functions to suit the requirements of an implant. My findings have demonstrated that a functionally and morphologically successful tendon soft tissue - implant interface can be engineered using autologous cancellous bone and marrow graft combined with hydroxyapatite coatings in a clamp device, resulting in an interface that has significantly more bone attachment associated with fibrocartilage compared with hydroxyapatite alone. My thesis demonstrates that the soft tissue - implant interface around intraosseous transcutaneous amputation prostheses can be optimised based on natural analogues. Deer antlers produce a microbial seal by engineering a region of thick dermal collagen fibres attached to the bone surface which supports the epithelium. Increasing the surface porosity and area of transcutaneous implants in the dermis results in significantly less epithelial down growth and significantly greater attachment of the epithelial and dermal tissue layers respectively.
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Bernhoff, Karin. "Orthopaedic Patients with Lower Limb Vascular Injuries." Doctoral thesis, Uppsala universitet, Ortopedi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-296141.
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Vascular injuries in lower limbs are rare but serious events. If not detected and managed correctly and timely they can lead to permanent functional impairment and even limb loss. The increasing number of orthopaedic interventions, worldwide, makes awareness of this problem among orthopaedic surgeons important. The overall aim of this thesis was to describe lower limb orthopaedic injuries with associated concomitant arterial injuries, especially to the popliteal artery. Epidemiology, mechanisms of injury, management, outcomes and the patient perspective were all addressed. The research questions were generated from clinical praxis. Vascular injuries are rare events, but by using as the National Patient (NPR) and National Vascular registries (Swedvasc) a relatively speaking large cohort was studied. Deep interviews with qualitative study method were used to investigate the patients’ perspective. In papers I and II iatrogenic popliteal artery injuries (PAI) in knee-replacements, and in non-knee-replacements, were investigated. The number of knee arthroplasties in Sweden increased 1987-2008, but not the frequency of iatrogenic PAI. The most common mechanism of injury was sharp, directly to the artery. One third of the injuries resulted in pseudo-aneurysms. This was an unexpected and important finding, since these patients were often diagnosed late, resulting in poor outcome. Paper III. The interviewed patients narrated substantial functional, cosmetic and psychological impairments,4-17 years after their accidents, yet they described their lives as “normal”. Patients with saved limbs reported a need for better interpersonal support in their rehabilitation and adaptation back to “normal” life. Paper IV. Popliteal artery injury is feared in knee dislocations and fractures. The proportion incidence of vascular injury was previously reported to be 2-60%. In this large population-based study, the incidence proportion in knee dislocations was 3.4-8.2%, depending on the definition of dislocation/ligamentous injury. In knee fractures the incidence proportion was lower, only 0.2%. The dominating cause of arterial injury in knee dislocations was fall, in knee fractures it was motor vehicle accidents. Amputation- free survival after arterial injury was inferior in knee fractures compared with knee dislocations. In conclusion, PAI is a serious injury but on sequences can be limited by awareness and timely action.
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Li, Qingde. "Registration techniques for computer assisted orthopaedic surgery." Thesis, University of Hull, 2002. http://hydra.hull.ac.uk/resources/hull:13615.
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The registration of 3D preoperative medical data to patients is a key task in developing computer assisted surgery systems. In computer assisted surgery, the patient in the operation theatre must be aligned with the coordinate system in which the preoperative data has been acquired, so that the planned surgery based on the preoperative data can be carried out under the guidance of the computer assisted surgery system. The aim of this research is to investigate registration algorithms for developing computer assisted bone surgery systems. We start with reference mark registration. New interpretations are given to the development of well knowm algorithms based on singular value decomposition, polar decomposition techniques and the unit quaternion representation of the rotation matrix. In addition, a new algorithm is developed based on the estimate of the rotation axis. For non-land mark registration, we first develop iterative closest line segment and iterative closest triangle patch registrations, similar to the well known iterative closest point registration, when the preoperative data are dense enough. We then move to the situation where the preoperative data are not dense enough. Implicit fitting is considered to interpolate the gaps between the data . A new ellipsoid fitting algorithm and a new constructive implicit fitting strategy are developed. Finally, a region to region matching procedure is proposed based on our novel constructive implicit fitting technique. Experiments demonstrate that the new algorithm is very stable and very efficient.
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Beidelschies, Michelle. "Orthopaedic Wear Particle-Induced Activation of Macrophages." Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1228363163.
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Vassiliou, Katelia. "Tribological studies of modern orthopaedic biomaterial combinations." Thesis, Durham University, 2005. http://etheses.dur.ac.uk/2773/.
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Debris created during the wear of prosthetic joints is known to have an effect on the success of the implant. As such the factors affecting wear and lubrication need to be understood in order to reduce wear as much as possible in vivo. In this thesis a number of orthopaedic biomaterials were tested in vitro, and various factors affecting their tribology were investigated. Load was found to affect wear for stainless steel on UHMWPE contacts, but not the wear factor which has a load term incorporated into it. Increasing nominal contact stress, however, was found to cause a decrease in wear factor particularly at low values of contact stress. The wear factor was less affected at higher values of contact stress. Clearance and roughness were both seen to affect the lubrication mode under which ceramic-on-ceramic joints operated, as noted by extensive friction testing. Lower clearances and lower roughnesses respectively promoted fluid film lubrication. The wear remained very low in both cases and was undetectable gravimetrically. However, changes in the surface morphology throughout testing supported the fact that some wear did occur, but that this was so small as to be beyond the detection limits of the experiment. This is encouraging for the longevity of these joints in vivo. The "running-in" phenomenon seen in metal-on-metal combinations was investigated using large diameter metal-on-metal resurfacing prostheses. During the course of wear testing the initially higher wear rate dropped to a much lower steady state wear. Friction testing indicated that the joints were operating closer to fluid film lubrication and the topography of the joint surfaces became more negatively skewed as the test progressed.
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Fang, Liming. "Processing of HA/UHMWPE for orthopaedic applications /." View abstract or full-text, 2003. http://library.ust.hk/cgi/db/thesis.pl?MECH%202003%20FANG.
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Thesis (M.Phil.)--Hong Kong University of Science and Technology, 2003.Includes bibliographical references (leaves 128-138). Also available in electronic version. Access restricted to campus users.
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Roberts, Jacintha. "Studies on bisphosphonate elution from orthopaedic implants." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=112582.
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In a 6-week rat model it was demonstrated that a small dose of peri-implant zoledronic acid (ZA) increased local bone formation 3-fold compared with controls. Ancillary in vitro studies using 14C-labeled ZA implant doses demonstrated biphasic elution profiles for implants coated with hydroxyapatite; complete ZA release occurred within one to three weeks in serum compared with only 60% ZA release after 12 weeks in water. Implants without hydroxyapatite coating showed more burst-type release profiles and full ZA elution within 24 hours of hydration in serum or water. Canine studies at 6 weeks using implants with 14C-labeled ZA showed that the compound remained localized, with the greatest ZA concentration immediately adjacent to the implant. Although there was evidence of skeletal ZA distribution via diffusion into the circulation, the levels were two orders of magnitude less than at the implant site.
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Moonda, Zaheer. "Does the Intra-operatively measured Leg Length Correction compare to the Post-operative radiograph in Total Hip Replacement surgery?" Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33852.
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Aims This study aims to compare the leg length correction (LLC) measured intra-operatively using the Vertical Measurement SystemTM (VMS) in total hip arthroplasty (THA), with the LLC measured on a 6-week post-operative Xray. We also wanted to quantify any residual leg length discrepancy (LLD) using this method. Patients and Methods A prospective cohort study was conducted, in which patients undergoing primary THA were enrolled at two centres in Cape Town, over a period of 19 weeks. THA's were performed by four surgeons. Pre-operative leg length discrepancy measurements were obtained in 92 patients. The VMS was used to predict intra-operative leg length correction (LLC), and this measurement was compared to the post-operative leg length correction measured on the 6-week follow-up X-ray. These measurements were statistically compared using Mann-Whitney U Test. Results The difference between the intra-operative VMS calculation and the 6-week radiological measurement was not significant (p>0.05), with the difference in their mean values being 0.07 ± 3.26mm. In the cohort, 81.52% of the patients (n=75) were within 5mm of the target LLC, and 95.65% of patients (n=88) were within 10mm of the target LLC. The mean absolute residual LLD at 6 weeks was 3.22 ± 3.13mm. Conclusion The intra operative LLC measurement obtained using the VMS accurately predicts the 6-week post op radiographic LLC measurement.
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Laubscher, Maritz. "Subtotal capsulectomy for idiopathic chondrolysis of the hip : a clinical, radiological and histological study." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13251.
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Includes bibliographical references.The purpose of this study will be to review the outcome of a subtotal capsulectomy of the hip for idiopathic chondrolysis. Idiopathic chondrolysis of the hip is a very rare condition. It is characterized by cartilage necrosis of the hip joint not associated with trauma, SUFE, infections or other demonstrable causes. It was first described in 1971 by Jones from the Princess Alice Orthopaedic Hospital in Cape Town. It occurs mainly in adolescent girls. The outcome in South Africa has been reported as a progressive downhill course resulting in a painful, stiff hip. The aetiology of the disease remains unknown. Theories suggested are mechanical (decreased movement with loss of synovial nutrition; increased joint pressure) and an auto-immune response in genetically predisposed individuals. The differential diagnosis includes atrophic-type tuberculosis of the hip. Suggested treatment ranges from NSAIDs and range of motion exercises alone to early aggressive surgical treatment. Our experience with continuous passive motion (CPM) and NSAID treatment have been disappointing.
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Wever, Stefan. "The Management of acute lateral ankle sprains: A survey of South African Surgeons and best evidence available." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33083.
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Introduction: Ankle sprains remain the single most frequent injury in modern sports with increasing evidence that it is not as innocuous as previously thought. Conservative treatment options include various forms of immobilization such as casts, moonboots and stirrup braces, followed by a rehabilitation period involving different modalities. Despite clinical evidence there seems to be a divergence between research and practice with an increase in acute surgical repair especially with regards to professional athletes. Design: Descriptive cross-sectional survey analysis Aim of the study: To assess the approach on management of acute ankle sprains by orthopaedic surgeons in South Africa. Methods: A two part study. Firstly, a questionnaire was emailed to participating orthopaedic surgeons, consisting of eight treatment options for a grade 3 lateral ankle sprain in a non-professional athlete. Secondly, a literature review to establish the current best practice concerning ankle sprain management. Results: The total number of respones where 129 out of 719 that were sent out. Surgical repair was offered in 24 (19%). Conservative treatment including either cast or moonboot for a period of 6 weeks was chosen by 49 (38%) and 2 to 4 weeks by 55 (43%) as their preferred treatment. Only 39 (30%) of responding SAOA members chose a short period of immobilization followed by functional rehabilitation in accordance with the current best evidence available, based on the literature review done. Conclusion: Despite good clinical evidence there seem to be a lack of consensus in the management of grade 3 lateral ankle sprains.
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Held, Michael. "Evaluation of diagnostic advances in musculoskeletal tuberculosis; the automated xpert MTB/RIF assay." Doctoral thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20495.
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The aim of this thesis was to investigate the diagnostic accuracy of Xpert for musculoskeletal TB and for rifampicin resistance against a gold standard of culture or histology. Site of disease, HIV status, and age of patients, and accuracy in spinal compared to extraspinal TB were investigated as secondary objectives. The overarching hypothesis was that Xpert is more accurate and would provide results faster than the gold standard for musculoskeletal TB, and that it would have a higher yield in HIV infected patients, adult patients, and patients with spinal disease.
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Kauta, Ntambue. "The management of fragility fractures of the hip: a quality assessment project." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25067.
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Introduction: Fragility fractures of the hip (FFH) constitute the most serious complication of osteoporosis carrying a mortality rate of up to 20 – 30% in the first year after injury and are associated with post injury decay in patient's level of activity in more than 50% of the cases. It is also a predictor of future osteoporosis related fractures. Surgical fixation of the hip fracture within 48 of admission, multimodal pain management, deep vein thrombo-prophylaxis, early physical therapy, appropriate assessment and management of osteoporosis and frailty in a multidisciplinary approach are the standard of care for FFH to keep the mortality and morbidity rate as low as possible and prevent future fragility fractures. Aim: To assess the standard of care of FFH at our institution and determine areas of care which need more attention and improvement. Methods: Retrospective review of clinical and radiographic records of all patients admitted at our level 1 trauma unit for fragility fracture of the hip from 1st January 2014 to 31st December 2014. The waiting time from admission to surgical fixation of the hip fracture, pain control and thrombo-prophylaxis strategies, the rate of geriatric referrals and the extent of osteoporosis management were assessed. Results: We admitted 113 fragility fractures of the hip from 1st January to 31st December 2014. Ninety- eight clinical records and 98 pelvis radiographs were included in the study. The other 15 clinical records were incomplete and were therefore excluded. The average waiting time from admission to surgery was 49 hours (range 9 -120). Low dose morphine, paracetamol and tramadol were the only perioperative pain control medication used for all patients. All patients had low molecular weight heparin and compression stockings prescribed for thrombo-prophylaxis. Only 2 (2, 04%) of patients had some osteoporosis investigations ordered. There were no geriatric referrals made and no formal osteoporosis management in all reviewed records. Conclusion: While the waiting time from admission to surgery was largely within the recommended time frame, there were no signs of a multidisciplinary approach to the management of fragility fractures of the hip at our institution leaving osteoporosis and frailty largely untreated.
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Roussot, Mark. "Amputation rate following tibia fractures with associated popliteal artery injuries." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25507.
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Objectives: 1. Determine the amputation rate; and 2. identify risk factors in patients with tibia fractures and associated popliteal artery injuries. Intervention: Amputation or limb salvage. Design: Retrospective case-control study. Setting: Level 1 trauma center. Patients: Thirty popliteal artery injuries with ipsilateral tibial fractures. Outcome measures: Primary and delayed amputation rates were determined. Risk factors tested for significance (Fischer's Exact) included: mechanism of injury, signs of threatened viability, compartment syndrome, fracture pattern, surgical sequence, and time delay from injury or presentation to revascularization. Results: The study group consisted of 22 males and 8 females, with a mean age of 31 years. Motor vehicle accidents and gunshot wounds constituted the mechanism in 17 and 11 patients respectively. Twenty-one were polytrauma victims. Intra/extra16 articular metaphyseal fractures (OTA 41 A-C) were recorded in 19 and diaphyseal (OTA 42 A-C) in 7 patients. Primary amputation was performed in 7 and delayed in 10 patients (overall rate 57%). No individual risk factors were predictive of amputation; however, the "miserable triad" of a proximal tibia fracture (OTA 41) with signs of threatened viability, and delay to revascularization ≥ 6 hours from injury or ≥ 2 hours from presentation was predictive of amputation (p = 0,036 and p = 0,018 respectively). Conclusions: We should aim to intervene within 6 hours following injury or 2 hours following presentation to reduce the risk of amputation. This provides a target for trauma teams even with uncertain time of injury. Level of Evidence: III.
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HIlton, Thomas. "Clinical outcomes following reduction and pinning of lesser arc injuries without repair of the scapholunate interosseous ligament." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20373.
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Study Rationale: Purely ligamentous lesser arc, Mayfield grade 3 and 4, perilunate dislocations (PLD's) are uncommon. Current recommendations are for open reduction and repair of the interosseous ligaments to prevent the development of scapholunate dissociation and degeneration to a scapholunate advance collapse (SLAC) wrist. This study proposes a less invasive treatment method which includes closed reduction and pinning alone without repair of the scapholunate interosseous ligament. We propose that the majority of patients will obtain good function and pain scores and the few that develop instability may still have a reconstruction performed through a naïve surgical field. Methods: Dislocations were reduced anatomically and held with buried k-wires which were removed at 6 weeks with no specific rehabilitation protocol observed. Subjective assessment included MAYO wrist scoring system, wrist range of movement, instability and grip strength testing. Radiological measurements included scapholunate distance, scapholunate angle, radiolunate angle and osteoarthritis. Results: 10 male patients, median age of 35, were followed-up for a median of 22 months. 7 patients underwent a closed reduction and anatomical pinning while 3 underwent open reduction due to unachievable reduction by closed means. All of these patients presented at a median of 14 days after the injury occurred. None of the patients had their scapholunate ligaments repaired or reconstructed. MAYO scores included, 3 excellent scores, 2 good scores and 5 fair scores. Instability was found clinically in 1 asymptomatic patient who had a positive Watson shift test. Radiological scores include a median scapholunate distance of 2mm, a scapholunate angle of 70° and a radiolunate angle of 15°. Osteoarthritis was found in 2 patients, all of whom were asymptomatic. Discussion: Current recommendations in the literature are that PLD's should be reduced via an open surgical technique with repair of the SLIL and percutaneous pinning. However the results of this treatment strategy are not optimal and do not confer uniformly good results. We propose a closed anatomical reduction and percutaneous pinning of the PLD. Our study shows that the majority of patients will demonstrate good function and pain scores when managed this way. A smaller number of these injured wrists will go on to develop instability. However the advantage of our method over the current recommendations is that when this happens the reconstruction of the SLIL will be made easier through a naïve surgical field. Conclusion: We recommend the closed reduction and anatomical pinning of a purely ligamentous lesser arc injury. This treatment strategy yields good results at medium term follow-up and preserves the option for the reconstruction of the scapholunate interosseous ligament should instability develop.
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Naude, Petrus Hendrik. "Prospective study to compare the difference in cerebral perfusion in patients undergoing shoulder surgery with the standard beach chair position compared to 30˚ inclination." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20785.
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There have been devastating reports of patients suffering permanent neurological damage following surgery in the beach chair position. Recent literature have shown that placing a patient under general anaesthesia in the beach chair position may place patients at risk of complications. There is no set angle of inclination used by all orthopaedic surgeons. Previous research have used angles of 70˚-90˚. At these angles patients suffered a significant number of cerebral desaturation events that may lead to ischaemic neurological events. This angle is far more upright than what is used in our practice. We postulated that decreasing the angle of inclination may be protective of cerebral perfusion. We performed a prospective randomised single blind study. 45 consecutive patients presenting for shoulder surgery were randomised to 2 groups. The control group patients were placed in the normal position used by the surgeon for the procedure and this angle was measured. The patients in the trial group were all placed at 30˚. Patients with known cerebrovascular disease, younger than 18 years, ASA grade 4 and 5, allergy to local anaesthetic, pre-existing coagulopathies or a failed interscalene block were excluded. Cerebral oxygenation were measured with the INVOS system along with the other standard observations in theatre. The 2 most important parameters measured were mean arterial pressure and cerebral oxygenation levels.
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Dunn, Robert. "Posterior segmental spinal fixation in Scoliosis surgery." Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/2839.
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Includes bibliographical references.Spinal deformity was recognised in the ancient works for philosophy, religion, myths, and fairy tales dating back as far as 3500BC[1,6]. Scoliosis was first described in the 5th century BC by Hippocrates. He recommended treatment with axial distraction on an extension apparatus (figure 1).
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Marais, Christoff de Villiers. "Functional outcomes and patient satisfaction after fasciotomy performed for chronic exertional compartment syndrome." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25068.
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Study Rationale: Chronic exertional compartment syndrome often forces patients to change their sporting activities or reduce their level of participation. Many undergo surgery with the aim to return to their activities symptom free. The aim of the study was to determine if fasciotomies for chronic exertional compartment syndrome are a reliable treatment option with a predictable outcome to allow patients to return to the same level of activities. Objective: The evaluation of the functional outcomes and patient satisfaction in an active population who had surgery, namely fasciotomies, for chronic exertional compartment syndrome (CECS) of the lower leg. Design: A retrospective descriptive cohort study with a telephonic follow-up interview. Patients: A consecutive series of 41 patients that were surgically treated for CECS by a single orthopaedic surgeon from July 2005 to October 2013. Main Outcome Measures: Patient records were reviewed to determine their presenting symptoms, diagnostic investigations and surgical procedures performed. A questionnaire was completed by each participant to assess pain and level of activity before and after surgery, level of improvement after surgery and patient satisfaction with surgical outcomes. Results: Twenty-one of the 41 patients that were included in the study were categorized as active sportsmen, participating at a competitive or a non-competitive level. The remaining 20 were experiencing symptoms during leisure activities. The majority of all the patients (63%) had to stop their activity due to their symptoms. After surgery 95% were able to return to participate in the same level of activities as before surgery. Ninety percent of the active sportsmen were able to return to participation at a competitive or non-competitive level, with 45% reporting an increase in the level of intensity that they could maintain. Overall satisfaction was reported by 80% of participants although only 46% were completely pain free. Conclusions: Fasciotomies are a viable surgical treatment option for chronic exertional compartment syndrome in active patients, including athletes. There is an 87% return rate to previous activities within 6 months and an 80% satisfaction rate reported by patients post-surgery. We do acknowledge that some of the data collected regarding symptomology is subject to recall bias due to the interval between surgery and completion of the questionnaire.
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Dachs, Robert. "An assessment of undergraduate musculoskeletal training at Medical Schools in South Africa." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/2837.
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Kruger, Neil. "The Oxford Shoulder Score: Cross-cultural adaption and translation validation into Afrikaans." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29797.
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Purpose: The Oxford Shoulder Score (OSS) is a robust and universally utilised shoulder score that has been translated for use in Western and Asian countries. This study aimed to translate, cross-culturally adapt and psychometrically validate the Afrikaans version of the OSS for use in Africa. Methods: Translation and cross-cultural adaptation was performed in accordance with guidelines in the literature. 108 consecutive patients with either degenerative or inflammatory pain of the shoulder were prospectively enrolled. Patients were evaluated by completing the Afrikaans OSS, Constant-Murley, quickDASH, and the Subjective Shoulder Value (SSV) scores. Comprehensibility and acceptance, as well as any floor or ceiling effects, were calculated. Reliability was assessed through reproducibility. Internal consistency was assessed using Cronbach’s alpha. Validity was determined using a Pearson Correlation Co-efficient between the Afrikaans OSS and the other validated shoulder scores. Results: Comprehensibility and acceptance were excellent, and no floor or ceiling effects were observed. Reproducibility (r = 0.99) and internal consistency (Cronbach’s alpha = 0.93) were both excellent. Correlation of the Afrikaans OSS with the Constant-Murley and quickDASH was excellent (r = 0.84; r = 0.81 respectively), and very good with the SSV and VAS pain score (r = 0.73; r = 0.66). Conclusion: The Afrikaans OSS proved understandable, acceptable, reliable and valid. It is an appropriate instrument for use in Afrikaans speaking patients with shoulder pain from degenerative or inflammatory origin.
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Louw, Frederik Marthinus. "Neurovascular complications in displaced extension-type supracondylar fractures in children : outcome of conservative management." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/12517.
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Includes bibliographical referencesThe aim of our study was to review our conservative management of neurovascular complications in displaced extension-type supracond ylar fractures of the humerus in children. We critically analysed the outcomes. Our results shall aim to clarify the management of this contentious issue.