Wear of knee prostheses

This paper describes how three different unique design solutions for artificial knee joints each provide extremely low wear and the potential for a 50-year osteolysis-free lifetime in high-demand patients. Each of the three low-wearing prosthetic design solutions provides a different and distinctive functional solution for the patient and surgeon

PEEK and CFR-PEEK as alternative bearing materials to UHMWPE in a fixed bearing total knee replacement: An experimental wear study

New bearing materials for total joint replacement have been explored as the need to improve longevity and enhance performance is driven by the changing demands of the patient demographic. Carbon-reinforced PEEK has demonstrated good wear characteristics in experimental wear simulation in both simple geometry pin-on-plate studies and in total hip joint replacement. Carbon reinforced PEEK CFR-PEEK has the potential to reduce tibial insert thickness and preserve bone in the knee. This study investigated the wear performance of PEEK and CFR-PEEK in a low conformity total knee replacement configuration. Custom-made flat inserts were tested against cobalt-chromium femoral bearings in a knee wear simulation for a period of three million cycles. Wear was assessed gravimetrically at intervals throughout the study. The wear rates of both PEEK and CFR-PEEK were very high and almost two orders of magnitude higher than the wear rate of UHMWPE under comparable conditions. Evidence of mechanical failure of the materials, including surface cracking and delamination was observed in both materials. This study highlights that these materials may not be suitable alternatives for UHMWPE in low-conformity designs

Quantification of the effect of cross-shear and applied nominal contact pressure on the wear of moderately cross-linked polyethylene

Polyethylene wear is a great concern in total joint replacement. It is now considered a major limiting factor to the long life of such prostheses. Cross-linking has been introduced to reduce the wear of ultra-high-molecular-weight polyethylene (UHMWPE). Computational models have been used extensively for wear prediction and optimization of artificial knee designs. However, in order to be independent and have general applicability and predictability, computational wear models should be based on inputs from independent experimentally determined wear parameters (wear factors or wear coefficients). The objective of this study was to investigate moderately cross-linked UHMWPE, using a multidirectional pin-on-plate wear test machine, under a wide range of applied nominal contact pressure (from 1 to 11 MPa) and under five different kinematic inputs, varying from a purely linear track to a maximum rotation of ±55°. A computational model, based on a direct simulation of the multidirectional pin-on-plate wear tester, was developed to quantify the degree of cross-shear (CS) of the polyethylene pins articulating against the metallic plates. The moderately cross-linked UHMWPE showed wear factors less than half of that reported in the literature for the conventional UHMWPE, under the same loading and kinematic inputs. In addition, under high applied nominal contact stress, the moderately cross-linked UHMWPE wear showed lower dependence on the degree of CS compared to that under low applied nominal contact stress. The calculated wear coefficients were found to be independent of the applied nominal contact stress, in contrast to the wear factors that were shown to be highly pressure dependent. This study provided independent wear data for inputs into computational models for moderately cross-linked polyethylene and supported the application of wear coefficient–based computational wear models

2015 ACVIM Small Animal Consensus Statement on Seizure Management in Dogs

This report represents a scientific and working clinical consensus statement on seizure management in dogs based on current literature and clinical expertise. The goal was to establish guidelines for a predetermined, concise, and logical sequential approach to chronic seizure management starting with seizure identification and diagnosis (not included in this report), reviewing decision‐making, treatment strategies, focusing on issues related to chronic antiepileptic drug treatment response and monitoring, and guidelines to enhance patient response and quality of life. Ultimately, we hope to provide a foundation for ongoing and future clinical epilepsy research in veterinary medicine

Hamstring stretch reflex:could it be a reproducible objective measure of functional knee stability?"

Background: The anterior cruciate ligament (ACL) plays an important role in anterior knee stability by preventing anterior translation of the tibia on the femur. Rapid translation of the tibia with respect to the femur produces an ACL-hamstring stretch reflex which may provide an object measure of neuromuscular function following ACL injury or reconstruction. The aim of this study was to determine if the ACL-hamstring stretch reflex could be reliably and consistently obtained using the KT-2000 arthrometer.  Methods: A KT-2000 arthrometer was used to translate the tibia on the femur while recording the electromyography over the biceps femoris muscle in 20 participants, all with intact ACLs. In addition, a sub-group comprising 4 patients undergoing a knee arthroscopy for meniscal pathology, were tested before and after anaesthetic and with direct traction on the ACL during arthroscopy. The remaining 16 participants underwent testing to elicit the reflex using the KT-2000 only.  Results: A total number of 182 trials were performed from which 70 trials elicited stretch reflex (38.5 %). The mean onset latency of the hamstring stretch reflexes was 58.9 ± 17.9 ms. The average pull force was 195 ± 47 N, stretch velocity 48 ± 35 mm/s and rate of force 19.7 ± 6.4 N/s. Conclusions Based on these results, we concluded that the response rate of the anterior cruciate ligament-hamstring reflex is too low for it to be reliably used in a clinical setting, and thus would have limited value in assessing the return of neuromuscular function following ACL injuries

Does offering an incentive payment improve recruitment to clinical trials and increase the proportion of socially deprived and elderly participants?

BACKGROUND: Patient recruitment into clinical trials is a major challenge, and the elderly, socially deprived and those with multiple comorbidities are often underrepresented. The idea of paying patients an incentive to participate in research is controversial, and evidence is needed to evaluate this as a recruitment strategy. METHOD: In this study, we sought to assess the impact on clinical trial recruitment of a £100 incentive payment and whether the offer of this payment attracted more elderly and socially deprived patients. A total of 1,015 potential patients for five clinical trials (SCOT, FAST and PATHWAY 1, 2 and 3) were randomised to receive either a standard trial invitation letter or a trial invitation letter containing an incentive offer of £100. To receive payment, patients had to attend a screening visit and consent to be screened (that is, sign a consent form). To maintain equality, eventually all patients who signed a consent form were paid £100. RESULTS: The £100 incentive offer increased positive response to the first invitation letter from 24.7% to 31.6%, an increase of 6.9% (P < 0.05). The incentive offer increased the number of patients signing a consent form by 5.1% (P < 0.05). The mean age of patients who responded positively to the invitation letter was 66.5 ± 8.7 years, whereas those who responded negatively were significantly older, with a mean age of 68.9 ± 9.0 years. The incentive offer did not influence the age of patients responding. The incentive offer did not improve response in the most socially deprived areas, and the response from patients in these areas was significantly lower overall. CONCLUSION: A £100 incentive payment offer led to small but significant improvements in both patient response to a clinical trial invitation letter and in the number of patients who consented to be screened. The incentive payment did not attract elderly or more socially deprived patients. TRIAL REGISTRATIONS: Standard care versus Celecoxib Outcome Trial (SCOT) (ClinicalTrials.gov identifier: NCT00447759). Febuxostat versus Allopurinol Streamlined Trial (FAST) (EudraCT number: 2011-001883-23). Prevention and Treatment of Hypertension with Algorithm Guided Therapy (British Heart Foundation funded trials) (PATHWAY) 1: Monotherapy versus dual therapy for initiating treatment (EudraCT number: 2008-007749-29). PATHWAY 2: Optimal treatment of drug-resistant hypertension (EudraCT number: 2008-007149-30). PATHWAY 3: Comparison of single and combination diuretics in low-renin hypertension (EudraCT number: 2009-010068-41). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-015-0582-8) contains supplementary material, which is available to authorized users

Wear of moderately cross-linked polyethylene in fixed-bearing total knee replacements

Cross-linked polyethylene has been introduced into total joint replacement to improve wear resistance. Although the performance of highly cross-linked polyethylene is well documented clinically and experimentally for total hip replacements, the reduction in mechanical properties with increasing irradiation is of concern for application to total knee replacement. The aim of this study was to investigate the wear performance of a moderately cross-linked polyethylene material in a fixed-bearing total knee replacement. The study was conducted using two femoral geometries, a conventional cruciate-retaining femoral and a high-flexion femoral geometry. The femoral geometry appeared to have no effect on the wear of the knee replacement under standard gait conditions. A significant reduction in wear volume was measured with the moderately cross-linked polyethylene compared with the conventional polyethylene over a six-million-cycle wear study. This study indicates the use of a moderately cross-linked polyethylene in a fixed-bearing total knee replacement may provide a low wearing option for total knee replacement

Hydration of dicalcium silicate and diffusion through neo-formed calcium-silicate-hydrates at weathered surfaces control the long-term leaching behaviour of basic oxygen furnace (BOF) steelmaking slag

Alkalinity generation and toxic trace metal (such as vanadium) leaching from basic oxygen furnace (BOF) steel slag particles must be properly understood and managed by pre-conditioning if beneficial reuse of slag is to be maximised. Water leaching under aerated conditions was investigated using fresh BOF slag at three different particle sizes (0.5–1.0, 2–5 and 10 × 10 × 20 mm blocks) and a 6-month pre-weathered block. There were several distinct leaching stages observed over time associated with different phases controlling the solution chemistry: (1) free-lime (CaO) dissolution (days 0–2); (2) dicalcium silicate (Ca₂SiO₄) dissolution (days 2–14) and (3) Ca–Si–H and CaCO₃ formation and subsequent dissolution (days 14–73). Experiments with the smallest size fraction resulted in the highest Ca, Si and V concentrations, highlighting the role of surface area in controlling initial leaching. After ~2 weeks, the solution Ca/Si ratio (0.7–0.9) evolved to equal those found within a Ca–Si–H phase that replaced dicalcium silicate and free-lime phases in a 30- to 150-μm altered surface region. V release was a two-stage process; initially, V was released by dicalcium silicate dissolution, but V also isomorphically substituted for Si into the neo-formed Ca–Si–H in the alteration zone. Therefore, on longer timescales, the release of V to solution was primarily controlled by considerably slower Ca–Si–H dissolution rates, which decreased the rate of V release by an order of magnitude. Overall, the results indicate that the BOF slag leaching mechanism evolves from a situation initially dominated by rapid hydration and dissolution of primary dicalcium silicate/free-lime phases, to a slow diffusion limited process controlled by the solubility of secondary Ca–Si–H and CaCO₃ phases that replace and cover more reactive primary slag phases at particle surfaces

Corrosion of the International Simple Glass under acidic to hyperalkaline conditions

Assessment of glass dissolution kinetics, under disposal relevant temperature and pH environments, is required to credibly estimate radionuclide release rates from vitrified radioactive waste. Leaching of the International Simple Glass (ISG) under acidic to hyperalkaline conditions was examined. Forward rate measurements have been obtained using the dynamic leaching SPFT protocol and rate parameters for B, Na and Si in the basic regime; errors in rates predicted using these parameters at high pH and temperature are significant because the fitting uses logarithmic data. Longer term behaviour under hyperalkaline conditions, representative of some disposal environments, was investigated using the PCT and MCC-1 static leaching protocols with Ca(OH)2 solutions for up to 120 days (PCT) and 720 days (MCC-1). In hyperalkaline conditions dissolution was incongruent for all elements and the presence of alternating zirconia-rich and zirconia-poor alteration layers was observed on all leached monoliths, indicating the occurrence of a self-organisation phenomenon during leaching

Historicising Material Agency: from Relations to Relational Constellations

Relational approaches have gradually been changing the face of archaeology over the last decade: analytically, through formal network analysis; and interpretively, with various frameworks of human-thing relations. Their popularity has been such, however, that it threatens to undermine their relevance. If everyone agrees that we should understand past worlds by tracing relations, then ‘finding relations’ in the past becomes a self-fulfilling prophecy. Focusing primarily on the interpretive approaches of material culture studies, this article proposes to counter the threat of irrelevance by not just tracing human-thing relations, but characterising how sets of relations were ordered. Such ordered sets are termed ‘relational constellations’. The article describes three relational constellations and their consequences based on practices of fine ware production in the Western Roman provinces (first century BC – third century AD): the fluid, the categorical, and the rooted constellation. Specifying relational constellations allows reconnecting material culture to specific historical trajectories, and offers scope for meaningful cross-cultural comparisons. As such a small theoretical addition based on the existing toolbox of practice-based approaches and relational thought can impact on historical narratives, and can save relational frameworks from the danger of triviality.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s10816-015-9244-