Aerosol morphology and particle size distribution in orthopaedic bone machining: a laboratory worst-case contamination simulation. Is high-speed bone machining potentially harmful by pollution and quality schemes and what measures could be taken for prevention?

AIM OF THE STUDY: High-speed bone machining devices with irrigation fluid were used in surgery to spread aerosols and toss tissue particles of varying morphology into the operating room. Based on measurements taken on a phantom object, the shape, size, and spatial contamination distribution of such particles were assessed. METHOD: Cadaveric femoral heads were continuously machined with a spherical bur, manually held at a fixed attack angle. The irrigation fluid used during bone machining was enriched with bacteria to act as a tracer to quantify the spatial contamination. A vertical board equipped with snippets served as a phantom object to assess contamination load and morphology of airborne particles. RESULTS: Eight-nine percent of the particles had a non-circular cross section. The detected particle size ranged across six orders of magnitude, from 0.006 to 4 mm2 with a median particle size of 0.125 mm2. The CFU counts observed after the standard machining time ranged from 7 to 240, with a median of 2 CFUs. The highest median contamination was seen at the upper right corner of the phantom. DISCUSSION: The experiments show that contaminating particles of a wide variety of shapes and sizes are part of the aerosol created by high-speed burring. While protection of personnel and equipment is always important, surgical helmets should be worn, especially at contamination hotspots, and gloves should be replaced at the end of machining. Sensitive instruments and measuring devices-such as optical sensors-should also be protected effectively, as the optical measurement may be obstructed by aerosol particles.

Validation of a Finite Element Simulation for Predicting Individual Knee Joint Kinematics.

Goal: We introduce an in-vivo validated finite element (FE) simulation approach for predicting individual knee joint kinematics. Our vision is to improve clinicians' understanding of the complex individual anatomy and potential pathologies to improve treatment and restore physiological joint kinematics. Methods: Our 3D FE modeling approach for individual human knee joints is based on segmentation of anatomical structures extracted from routine static magnetic resonance (MR) images. We validate the predictive abilities of our model using static MR images of the knees of eleven healthy volunteers in dedicated knee poses, which are achieved using a customized MR-compatible pneumatic loading device. Results: Our FE simulations reach an average translational accuracy of 2 mm and an average angular accuracy of 1[Formula: see text] compared to the reference knee pose. Conclusions: Reaching high accuracy, our individual FE model can be used in the decision-making process to restore knee joint stability and functionality after various knee injuries.

The spatial distribution of aerosols in high-speed bone burring with external irrigation.

It is well-known that the use of high-speed burring devices with irrigation used in bone surgery produces aerosols, and can toss tissue particles into space. The aim of this study was to assess the spatial vertical contamination in the sterile operation field while using a high-speed cutting device at various locations. A fresh porcine knee was resected for 10 min with a high-speed burring device. To determine the spatial contamination distribution bacteria were used as a tracer. In this novel method for detecting environmental contamination droplets of the contaminated irrigation solution were collected on vertically mounted Petri dishes and the number of colony-forming units was counted. Contamination of varying intensity was observed throughout the room. The highest contamination was found perpendicular to the bur rotation axis in a distance 0.5 m from the bur, at a height of 1.4 m. Around this spot, colony-forming units count isotropically drops to less than 100 CFUs at an area of 0.5 m in diameter. The contamination decreases with increasing distance to the bur head and a main direction of contamination was identified. Placing critical sterile objects in the highly contaminated space during and after bone resection procedures should be avoided whenever possible.

The effect of sprint and endurance training on electromyogram signal analysis by wavelets.

The purpose of this study was to relate the spectral changes of surface electromyograms (EMGs) to training regimes. The EMGs of M. vastus medialis and M. vastus lateralis of 8 female sprint-trained and 7 female endurance-trained athletes (ST and ET athletes) were examined while performing isokinetic knee extension on a dynamometer under 4 different loading conditions (angular velocity and load). The EMG signals were wavelet transformed, and the corresponding spectra were classified using a spherical classification, support vector machines (SVMs) and mean frequencies (MFs). Consistent differences in the EMG spectra between the 2 groups were expected because of the difference in the muscle features resulting from the various training regimes. On average, the ST athletes showed a downshift in the EMG spectra compared with the ET athletes. The spectra of the ST and ET athletes were classifiable by spherical classification and SVM but not by the MF. Thus, the different shapes of the EMG spectra contained the information for the classification. The hypothesis that specific muscle differences caused by various training regimes are consistent and lead to systematic changes in surface EMG spectra was confirmed. With the availability of new apparels, ones with integrated EMG electrodes, a measurement of the EMG will be available to coaches more frequently in the near future. The classification of wavelet transformed EMGs will allow monitoring training-related spectral changes.

Mid- to Long-term Clinical Outcome and Gait Biomechanics After Realignment Surgery in Asymmetric Ankle Osteoarthritis.

BACKGROUND: Joint-preserving, realignment surgical procedures have gained increasing popularity as treatment of asymmetric early- and mid-stage ankle osteoarthritis. The aim of the present study was to quantify bilateral gait biomechanics in patients who underwent ankle realignment surgery by supramalleolar osteotomies. METHODS: Eight patients, a minimum of 7 years after realignment surgery, and 8 healthy controls were included in this study. Three-dimensional instrumented gait analysis was used to assess spatiotemporal parameters, bilateral joint angles, and moments. Furthermore, a clinical evaluation on pain, ankle function, and quality of life was performed. RESULTS: Compared with the healthy controls, the patients walked more slowly, had a smaller sagittal hindfoot range of motion on their affected leg, and had a lower peak ankle dorsiflexion moment (P < .05). There were no significant differences compared with controls for the ranges of motion in the foot segments of the nonaffected foot and for the knee and hip joint ranges of motion and peak moments of both legs. Additionally, patients and controls did not differ in the quality of life score. However, in the pain subscore, the patients reported significantly more pain than the healthy persons. CONCLUSION: Despite different gait biomechanics of the affected foot after ankle realignment surgery, the quality of life for patients was comparable to that of healthy controls. Therefore, supramalleolar osteotomies should be considered as a promising treatment option in patients with asymmetric non-end-stage ankle osteoarthritis. LEVEL OF EVIDENCE: Level III, comparative study.

Effects of supramalleolar osteotomies for ankle osteoarthritis on foot kinematics and lower leg muscle activation during walking.

BACKGROUND: Early stages of asymmetric ankle osteoarthritis can be treated by joint preserving supramalleolar osteotomies that surgically realign the ankle and unload degenerated cartilage. While studies have already shown pain relief and functional improvements, the effects on gait biomechanics are largely unknown. This study investigated patients' gait pattern after supramalleolar osteotomies by focusing on foot kinematics and lower leg muscle activation. METHODS: An instrumented three-dimensional gait analysis with simultaneous electromyography of gastrocnemius medialis and lateralis, soleus, peroneus longus, and tibialis anterior muscles was performed on 12 patients with ankle osteoarthritis, seven of which were followed up 12-18months postoperatively. Additionally, seven different long-term follow-up patients (8-9years postoperatively) and 15 healthy control subjects were measured. The waveforms of the foot kinematics and muscle activation were analyzed using principal component analysis. FINDINGS: Compared to healthy controls, principal component scores that affected the sagittal range of motion of the hindfoot and hallux were lower in all patient groups, while scores that affected the timing of the peaks in the sagittal forefoot motion were mainly altered in short-term follow-up patients. Lower principal component scores in patients with ankle osteoarthritis and short-term follow-up patients resulted in a less pronounced peak activation of gastrocnemius medialis and soleus. INTERPRETATION: Both postoperative patient groups showed similar adaptations in their gait pattern as those observed in patients with ankle osteoarthritis. These changes are probably related to the lower ankle mobility. However, the reduced mobility seems to affect the patients' well-being less than a painful joint.

Heel-strike in walking: assessment of potential sources of intra- and inter-subject variability in the activation patterns of muscles stabilizing the knee joint.

The electromyographic (EMG) signal is known to show large intra-subject and inter-subject variability. Adaptation to, and preparation for, the heel-strike event have been hypothesized to be major sources of EMG variability in walking. The aim of this study was to assess these hypotheses using a principal component analysis (PCA). Two waveform shapes with distinct characteristic features were proposed based on conceptual considerations of how the neuro-muscular system might prepare for, or adapt to, the heel-strike event. PCA waveforms obtained from knee muscle EMG signals were then compared with the predicted characteristic features of the two proposed waveforms. Surface EMG signals were recorded for ten healthy adult female subjects during level walking at a self-selected speed, for the following muscles; rectus femoris, vastus medialis, vastus lateralis, semitendinosus, and biceps femoris. For a period of 200 ms before and after heel-strike, EMG power was extracted using a wavelet transformation (19-395 Hz). The resultant EMG waveforms (18 per subject) were submitted to intra-subject and inter-subject PCA. In all analyzed muscles, the shapes of the first and second principal component (PC-) vectors agreed well with the predicted waveforms. These two PC-vectors accounted for 50-60% of the overall variability, in both inter-subject and intra-subject analyses. It was also found that the shape of the first PC-vector was consistent between subjects, while higher-order PC-vectors differed between subjects. These results support the hypothesis that adaptation to, and preparation for, a variable heel-strike event are both major sources of EMG variability in walking.

Gait patterns of asymmetric ankle osteoarthritis patients.

BACKGROUND: In early stages, ankle osteoarthritis is often asymmetric with only partially degenerated joint surfaces. There is only limited knowledge on the effect of asymmetric ankle osteoarthritis on the patients' gait patterns. Therefore, the aim of this study was to characterize kinematic and kinetic changes compared to healthy adults. METHODS: Instrumented gait analysis was performed in eight asymmetric ankle osteoarthritis patients and 15 healthy controls. Beside conventional gait analysis methods, principal component analysis was used to analyze temporal progression of the most important variables: hindfoot dorsiflexion angle and vertical ground reaction force. FINDINGS: Asymmetric ankle osteoarthritis patients had a lower hindfoot dorsiflexion and rotation range of motion as well as reduced peak ground reaction forces and peak kinetic values. Principal component analysis revealed that for both the hindfoot dorsiflexion angle and the vertical ground reaction force those principal component vectors affecting the amplitudes had significantly lower principal component scores in patients than in controls. The use of the principal component scores for classification with a linear support vector machine resulted in a high recognition rate of 97.8% for the discrimination between the affected leg and the healthy controls. INTERPRETATION: Patients with asymmetric ankle osteoarthritis suffer from substantial pathological kinematic and kinetic gait changes. Principal component analysis combined with a linear support vector machine could successfully be used to temporally quantify and classify asymmetric ankle osteoarthritis gait patterns. This study therefore helps to understand the pathomechanism of early stage ankle osteoarthritis from a biomechanical view.

Muscle activation of patients suffering from asymmetric ankle osteoarthritis during isometric contractions and level walking - a time-frequency analysis.

Asymmetric osteoarthritis (OA) is a common type of OA in the ankle joint. OA also influences the muscles surrounding a joint, however, little is known about the muscle activation in asymmetric ankle OA. Therefore, the aim of this study was to characterize the patients' muscle activation during isometric ankle torque measurements and level walking. Surface electromyography (EMG) was measured of gastrocnemius medialis (GM) and lateralis (GL), soleus (SO), tibialis anterior (TA), and peroneus longus (PL) in 12 healthy subjects and 12 ankle OA patients. To obtain time and frequency components of the EMG power a wavelet transformation was performed. Furthermore, entropy was introduced to characterize the homogeneity of the wavelet patterns. Patients produced lower plantar- and dorsiflexion torques and their TA wavelet spectrum was shifted towards lower frequencies. While walking, the patients' muscles were active with a lower intensity and over a broader time-frequency region. In contrast to controls and varus OA patients, maximal GM activity of valgus OA patients lagged behind the activity of GL and SO. In both tasks, PL of the valgus patients contained more low frequency power. The results of this study will help to assess whether surgical interventions of ankle OA can reestablish the muscle activation patterns.

Automatic selection of a representative trial from multiple measurements using Principle Component Analysis.

Experimental data in human movement science commonly consist of repeated measurements under comparable conditions. One can face the question how to identify a single trial, a set of trials, or erroneous trials from the entire data set. This study presents and evaluates a Selection Method for a Representative Trial (SMaRT) based on the Principal Component Analysis. SMaRT was tested on 1841 data sets containing 11 joint angle curves of gait analysis. The automatically detected characteristic trials were compared with the choice of three independent experts. SMaRT required 1.4s to analyse 100 data sets consisting of 8±3 trials each. The robustness against outliers reached 98.8% (standard visual control). We conclude that SMaRT is a powerful tool to determine a representative, uncontaminated trial in movement analysis data sets with multiple parameters.

Muscular timing and inter-muscular coordination in healthy females while walking.

The dynamic interplay between muscles surrounding the knee joint, the central nervous system and external factors require a control strategy to generate and stabilise the preferred gait pattern. The electromyographic (EMG) signal is a common measure reflecting the neuromuscular control strategies during dynamic tasks. Neuromuscular control mechanisms, found in processed EMG signals, showed a precise pacing with a pacing rhythm and a tight control of muscle activity in running and maximally contracted muscles. The purpose of this study was to provide an insight how muscles get activated during walking. The EMG power, extracted by the wavelet transform (92-395Hz), over a time period encompassing 250ms before and 250ms after heel strike was analysed. The study showed that the wavelet-based analysis of EMG signals was sufficiently sensitive to detect a synchronisation of the activation of thigh muscles while walking. The results within each single subject and within the group consisting of 10 healthy females showed that, although there was a lot of jitter in the locations of the intensity peaks, the muscle activation is controlled, on average, by a neuromuscular activity paced at about 40ms, however with variable amplitudes. Albeit the jitter of the signal, the results resolved the temporal dependency of intensity peaks within muscles surrounding the knee and provided an insight into neural control of locomotion. The methodology to assess the stabilising muscle activation pattern may provide a way to discriminate subjects with normal gait pattern form those with a deteriorated neuromuscular control strategy.