INTRODUÇÃO: Tem-se afirmado que a via de acesso minimamente invasiva na artroplastia total de joelho (ATJ) por não agredir o músculo quadríceps femoral permite reabilitação mais precoce. A fim de verificar a influência da preservação do aparelho extensor no ato cirúrgico, avaliou-se a força da musculatura extensora e flexora do joelho em pacientes submetidos à ATJ por duas vias de acesso diferentes. MÉTODOS: Este estudo comparou, no período de janeiro de 2005 a julho de 2006, os valores de torque máximo e de trabalho total obtidos por dinamometria isocinética aos seis meses de pós-operatório. Foram avaliados 12 indivíduos submetidos à ATJ por via de acesso minimamente invasiva e 8 indivíduos submetidos à ATJ por via de acesso transquadricipital. RESULTADOS: A análise estatística dos valores de torque máximo e de trabalho total absolutos e corrigidos pelo peso corporal não demonstrou diferença entre os dois grupos. CONCLUSÃO: Não há diferença de força da musculatura extensora e flexora do joelho aos seis meses de cirurgia. / INTRODUCTION: It has been stated that for total knee arthroplasty (TKA), the minimally invasive approach permits earlier rehabilitation because it is not prejudicial for the femoral quadriceps muscle. To verify the influence of preserving the extensor apparatus during surgery, strength of the knee extension and flexion muscles was evaluated in patients submitted to TKA with different approaches. METHODS: The values of maximum torque and total work obtained by isokinetic dynamometry six months after surgery were compared for the MIS group of 12 individuals submitted to TKA by the minimally invasive surgical approach and the Control group of eight others submitted to TKA by the transquadricipital approach, between January 2005 and July 2006. RESULTS: Statistical analysis of the absolute values of maximum torque and total work corrected by body weights did not show a difference between the two groups. CONCLUSION: There was no difference in the extension and flexion strength of the knee muscles six months after surgery.

Thesis (MScEng)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Osteoarthritis (OA), also known as degenerative joint disease is a progressive disorder of the joints caused by gradual loss of cartilage and resulting in the development of bony spurs and cysts at the margins of the joints. The degradation of the musculoskeletal system, which is mainly caused by joint injury, obesity (leading to musculoskeletal fatigue) and aging can also lead to osteoarthritis. The hands, feet, spine, and large weight-bearing joints, such as the hips and knees are commonly affected. The only medical solution to severe cases of osteoarthritis is the surgical reconstruction or replacement of a malformed or degenerated joint, better known as arthroplasty. Arthroplasty makes use of biomedical implants and replacements to restore functionality of the joints. Biomedical engineering in arthroplasty is an ever increasing field of interest as a result of its innovative improvements to surgical quality. Certain cases of partial osteoarthritis require less surgical action. Partial knee replacement surgery, also known as unicondylar (or unicompartmental) knee arthroplasty involves a covering which is placed over the affected area to resurface the affected bone and protect the patient from further degeneration. Advantages of partial replacement include faster recovery time and less post-operative pain. The biomedical implants used for these operations consist of a standardized implant that is fit onto the bone by modifying (cutting away) the outer structure of the bone. The result is known to cause post-operative discomfort among some patients. The problem with these standard designs includes the requirement of the removal of unaffected (healthy) bone matter, leading to induced trauma and pain for patients during the recovery phase of the operations. A preferred alternative to the standard design would be to create a custom implant for every patient, reducing the need to remove parts of unaffected bone matter. The implementation of this proposed method tends toward Minimally Invasive Surgery (MIS). MIS is normally preferred as it reduces the risk of various negative consequences of normal arthroplasty such as nerve or tendon damage during surgery. It could be argued that the proposed method may cause less damage to the fragile tendon, bloodflow, and nerve networks of the knee. Increasing material costs of metal products introduce great interest in more cost efficient forming processes to reduce the loss of redundant blank material. Incremental Sheet Forming (ISF), a relatively new class of forming process, has the potential to meet the need for this more efficient forming process. The ISF process is highly flexible, can be developed in normal milling machines, and can reduce production cost by up to 90% in comparison to processes such as stamping. The ISF process is a non-patented process, as the existing patents are referred to the designed machines and not the process. The availability of the ISF process contributes greatly to its attractiveness. ISF can be implemented in any facility that has access to a three- or more-axis CNC machine. The advantage of ISF implemented in CNC machines is that CNC technology has already reached a mature stage in development, contributing to the accuracy and methodology (such as feed rate or angular velocity of the tool) of the ISF process. The forming of valuable lightweight materials is well covered by ISF processes. A variety of studies contribute to research on the forming of titanium and titanium based alloys as part of ISF of lightweight materials. The ISF process utilizes the functionality of commercial CNC machines, improving the process availability of many manufacturing companies. The ISF process offers fast setup times and flexibility of the forming process. The purpose of this project is to define a process chain for creating a customized biomedical implant as well as determining the validity of the process chain by applying each step. The design and development procedure of a titanium based biomedical arthroplasty implant using innovative Incremental Sheet Forming (ISF) techniques will be documented, as well as an investigation of the financial cost and potential gain that this implant can offer. / AFRIKAANSE OPSOMMING: Osteoartritis is 'n gewrig siekte wat degeneratiewe newe-effekte behels in die gewrigte. Hierdie siekte lei to die geleidelike verlies van kraakbeen en lei tot die onreelmatige ontwikkeling van abnormale beengroei. Osteoartritis kan ook deur beserings in die gewrig veroorsaak word. Die hande, voete, ruggraat, en enige groter gewigdraende gewrigte, soos die heupe en knieë kan geaffekteer word. Die enigste mediese oplossing tot ernstige gevalle van die siekte is chirurgiese rekonstruksie of vervanging van die gewrig, meer bekend as artroplastie. Artroplastie maak gebruik van biomediese implantate om funksionaliteit van die gewrig te herstel. Biomediese ingenieurswese in artroplastie is 'n toenemende navorsingsveld as gevolg van die innoverende aspekte om chirurgiese kwaliteit te verhoog. Sekere gevalle van gedeeltelike osteoartritis vereis veel minder chirurgiese behandeling. Gedeeltelike knie vervanging chirurgie, meer bekend as unikompartementele knie artroplastie, behels 'n bedekking wat slegs die geaffekteerde been bedek, om die pasiënt van verdere degenerasie te beskerm. Voordele van gedeeltelike vervanging sluit vinniger herstel tyd en minder pyn in. Die biomediese implantate wat gebruik word vir hieride operasies bestaan uit standaard ontwerpe wat aan die been gepas word deur die wysiging (of wegsny) van die buitenste beenstruktuur. Die nagevolg van hierdie chirurgie is lang herstel periodes en kan ongemaklikheid in die knie veroorsaak. Die probleem met die bogenoemde standaard is dat die prosedure die verweidering van selfs ongeaffekteerde (of gesonde) been in sluit, wat lei tot verdere kniepyn en ongemak vir pasiënte lei tydens die herstelperiode. 'n Verkiesde alternatief tot die standaard ontwerpe is om 'n persoonlikke implantaat vir elke pasiënt te skep, en so kan die behoefte om dele van ongeaffekteerde been te behou moontlik wees. Die toepassing van die voorgestelde metode neig na Minimale Skade Chirurgie (MSC). MSC word gewoonlik verkies om die risiko van verskeie negatiewe nagevolge te verminder, en skade aan die tendon, bloed- en senunetwerke van die knie te beperk. Die toenemende materiaalkoste vand metal produkte lei tot 'n groot belangstelling in meer koste besparing vormings prosesse, om sodoende die verlies van oortollige materiaalverlies te verminder. Inkrementele Plaat Vervorming (IPV), 'n relatiewe nuwe klas van vervorming, is 'n waardige kanidaat om hierdie doel te bereik. Die IPV proses is baie toepaslik, en kan deur die gebruik van Rekenaar Numeriese Kontrole (RNK) masjienerie toegepas word. Verder sal dit vervaardigingskoste kan verlaag met soveel as 90% in vergelyking met ander prosese soos die stempel metode. Die beskikbaarheid van die IPV proses dra grootliks by tot die proses se aantreklikheid in die industrie. IPV kan geimplementeer word in enige fasiliteit wat toegang tot 'n drie-as RNK masjien het. Die voordeel van dit is die feit dat RNK masjienerie klaar ontwikkel en volwasse is, wat kan bydra tot goeie akkuraatheid in die vormingsproses. Die vervaardiging van laegewig materiale soos titaan of aluminium is gedokumenteer. 'n Verskeidenheid van studies dra waarde tot navorsing van die vormingsproses van titaan as deel hiervan. Die IPV proses bied vinnige opstel tye en goeie buigsaamheid met die vormingsproses, veral met behulp van 'n vyf-as masjien. Die doel van hierdie projek is om 'n proses ketting te ontwerp. Die proses ketting, wat uit vele stappe bestaan, sal die ontwerp en vervaardigingsproses van 'n persoonlike biomediese knie implantaat bevestig deur middel van die IPV vormings tegniek. Validasie van die proses ketting sal dus plaasvind deur die stappe van die voorgestelde proses ketting uit te voer. 'n Finale ondersoek sal die finansiele en regalutoriese aspekte van die projek aanspreek.

The Crioulo horse industry has increased exponentially in the last few years, this scenario, leads horse breeders to neglect individual aspects of the horse s development, interfering, mostly, in the nutritional management, as younger animals are participating in halter shows. These changes in horse management without considering individual aspects of growth, feeding and exercise level predispose these animals to the complex of diseases known as developmental orthopedic diseases. Radiographs were taken of both tarsi of 77 (31 fillies and 46 colts), of nine up to 26 months old Crioulo horses, competing or not in halter events. These young horses were divided in groups by age, with one including nine to 18 months old foals (G1) (34/77) and the other 19 to 26 months old ones (G2) (43/77). According to preparation or not for halter competition, horses were divided into GI (48/77) (average preparation time 4.55 months) and GC (control group, 29/77), respectively. Data were collected on 24 breeding farms or training centers, to determine the prevalence of osteoarticular changes. The results showed that 77.22% (61/77) presented some degree of radiographically visible lesions. The prevalence of lesions in males was 80.44%, 77.42% in females; 77.31% in the GC; 79.17% in the GI; 86.67% in G1 and 76.75% in G2. The mean body weight of the 10 to 12 month old yearlings (G1) was 293.25kg, representing 71.28% of the mature weight and that of the 19 to 26 month old ones (G2) was 360.5kg (87.71% of mature weight), the mean body weight of GC was 288.9kg (70.22% of the mature weight), and that of GI was 341.9kg (83.11% of the mature weight), even with the mean age of both groups being 16.79 and 18.98 months, respectively. A significant relationship was found between the animal s weight gain (p= 0.02; r= 0.26), body condition score (p= 0.03; r= 0.23), neck crest score (p= 0.018; r= 0.27) and wither s height (p= 0.01; r= 0.28) and the degree of the radiographic lesions found in the tarsi. Several factors can be involved in distal tarsal juvenile osteoarthritis; however the most important factor present in Crioulo breeding farms was the horse s overweight. / O comércio do cavalo Crioulo tem crescido de forma exponencial nos últimos anos, este cenário de valorização dos animais desta raça induz os proprietários e criadores a interferirem profundamente no manejo, principalmente nutricional, destes animais, decorrente da participação de potros e animais adultos em exposições e competições morfológicas. A interferência no manejo dos animais não levando em conta os aspectos individuais do desenvolvimento, sem controle exato da alimentação fornecida e do nível de exercício exigido predispõem os animais ao complexo de doenças conhecido como doenças ortopédicas do desenvolvimento. Foram examinados radiograficamente os tarsos de 77 animais (31 fêmeas e 46 machos), com nove até 26 meses de idade, participantes ou não de exposições ou competições morfológicas. Os animais foram divididos em grupos por idade, um incluindo potros de nove a 18 meses (G1) (34/77) e outro com animais de 19 a 26 meses (G2) (43/77), e pelo tempo de preparo para exposição morfológica em grupo controle (GC) (29/77) (sem preparo para exposição) e grupo incentivo (GI) (48/77), com preparo médio de 4,55 meses. Os dados foram coletados em 24 propriedades de criação ou centros de treinamento/preparo, para determinar a prevalência de alterações osteoarticulares. Observou-se que 77,22% (61/77) apresentaram alguma lesão radiograficamente visível. A prevalência de lesões articulares foi de 80,44% nos machos, 77,42% nas fêmeas, 77,31% nos animais do GC, 79,17% dos animais do GI, 86,67% nos animais do G1 e 76,75% nos animais do G2. O peso médio aos 10 a 12 meses de idade foi de 293,25kg, representando 71,28% do peso adulto e dos animais com idade de 19 a 26 meses o peso médio foi de 360,5kg (87,62% do peso adulto), nos animais do GC o peso médio foi de 288,9kg (70,22% do peso adulto) e os animais do GI apresentaram peso médio de 341,9kg (83,11% do peso adulto), mesmo a idade média dos dois últimos grupos tendo sido de 16,79 meses e 18,98 meses respectivamente. Foi constatada relação entre o aumento do peso dos animais (p= 0,02; r= 0,26), do escore corporal (p= 0,03; r= 0,23), do escore de deposição de gordura na crista do pescoço (p= 0,018; r= 0,27) e da altura (p= 0,01; r= 0,28) com as lesões radiográficas no tarso dos potros. Vários fatores podem estar envolvidos na osteoartrite társica distal, entretanto, o fator mais importante presente nas criações de cavalos Crioulos, é o sobrepeso.

This diploma thesis had two primary objectives. The first one was to examine if the incidence and development of primary degenerative joint disease (DJD) of the joints of the vertebral column and the limbs in an early medieval population from a cemetery by the sixth church in Mikulčice were affected mainly by the skeletal age of the deceased, or if other factor of physical loads was more significant. A set of 83 skeletal remains was evaluated primarily by Waldron's method (2009), but methods by Stloukal and Vyhnánek (1976); Buikstra and Ubelaker (1994); and Sager (1969) were also used. Schmorl nodes and eburnation were tracked too. Evaluated were vertebral joint (both intervertebral and apophyseal), jaw and limb joints. The results indicate that the incidence of degenerative joint disease in intervertebral joints, temporomandibular joint and appendicular joints is significantly affected by age, with the onset of degeneration being after the 40th year of skeletal age. No correlation of incidence of Schmorl nodes with age was present, and only a few cases of eburnace were noted. The relationship between the presence of DJD and the sex of the skeletons was not approved. I have compared these results with those from similar studies. I have deemed the primary evaluation by Waldron's method to be good...

Bei den langjährigen Ausgrabungen im Ringwall von Starigard/Oldenburg, der Hauptburg des westslawischen Stammes der Wagrier, wurde auch ein Gräberfeld freigelegt. Es datiert in das 10. Jh. und ist aufgrund der ausgesprochen reichen Beigaben als „fürstlicher“ Bestattungsplatz anzusprechen. Die Langknochen und Wirbel der 34 Erwachsenen des Fürstengräberfeldes von Starigard/Oldenburg wurden auf das Vorhandensein degenerativer Gelenkveränderungen nach den Vorschlägen von Schultz (1988) untersucht. Ausgewertet wurden die erhobenen Daten nach Kreutz (u.a. 1995). Die Auswertung der Arthrosebelastung der Toten aus dem sog. slawischen Fürstengräberfeld Starigard/ Oldenburg (10. Jh.) ergab, dass Männer und Frauen unterschiedlich starke Veränderungen im Bereich der Handgelenke aufwiesen. Dies lässt sich vermutlich mit verschiedenen Aufgabenbereichen beider Geschlechter in Verbindung bringen. Die stärkeren Veränderungen im Handgelenk könnten auf eine Tätigkeit der Frauen im Textilhandwerk deuten, eine Aufgabe, die v.a. sozial hochstehenden Frauen seit der Eisenzeit vorbehalten war. Die großen Körpergelenke waren recht ähnlich belastet, wobei Hüft- und Schultergelenke den größten Arthrosegrad aufwiesen. Dies entspricht den Verhältnissen, die - nach der Literatur - auf anderen slawischen Gräberfeldern herrschten. Die hohe degenerative Belastung von Hüft- und Schultergelenk ist typisch für präindustrielle, landwirtschaftlich orientierte Populationen. Die Bestattungen aus dem sog. Fürstengräberfeld von Starigard/ Oldenburg belegen, dass auch sozial hoch stehende Menschen starkem physischen Stress ausgesetzt waren. Aus archäologischer Sicht lassen sich bei ihnen die degenerativen Veränderungen eher mit Reiten und Fahren in Verbindung bringen. / Materials: From 1972 to 1986 the early medieval ringwall of Starigard/Oldenburg, main fortress of the western Slavic tribe wagrii was excavated. A cemetery of the 10th century AD belonging to the chiefs/kings of the wagrii was discoverd. The 34 adult skeletons were examined by macroscopic, radiological and scanning-electron microscopic techniques. The skeletons were well preserved. The degenerative joint diseases (DJD) and other pathological alterations were scored according to Schultz 1988, data analysis was carried out according to Kreutz (et al. 1995). Generally, a high degree of DJD was observed. Nearly all adult skeletons showed traces of DJD. The severity is clearly age dependent. Hip and shoulder joint were most affected. The other joints of the lower extremities were generally more affected than those of the upper extremity. 9 out of 34 adults (26.5%) showed also osteochondrosis dissecans on different joints. Inflammatory changes were rare: Prevalent chronic polyarthritis was recorded in one female skeleton (50+ years). Conclusions: The skeletons of the population of high social status showed clear evidence for heavy physical stress similar to patterns shown by agriculturalists. High rates of DJD in the lower extremities can further be interpreted as the result of riding and driving, both archaeologically documented by grave goods on the site. The results of this investigation was compared with other Slavic populations.

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The skeletal material used in this thesis consists of 258 individuals, whereas 179 individuals had the requirements entailed for an analysis of health and lifestyles. In other words, their sex and age had been osteologically determined. In addition, they are either young adults, adults, or seniors, as infants and subadults usually die before skeletal changes. Males represent 63 percent (n=112) and females 37 percent (n=67) of the material. The material is collected from a Stone Age dwelling site in Ajvide, Gotland, and six Medieval churches in Visby, Gotland: St Hans, St Per, St Clemens, Ryska Kyrkan, St Gertrud and St Mikael. One of the most noticeable traits caused by a change in subsistence strategies is an increase in enamel hypoplasia, cribra orbitalia, degenerative joint diseases, and activity-related pathologies, as well as a decrease in oral health. Therefore, the population of Medieval Visby was exposed to more stressors in the shape of infections and malnutrition. Furthermore, the high amount of degenerative joint diseases also indicates a more physically strenuous life. / Skelettmaterialet som använts i denna uppsats består av 258 individer, varav 179 individer uppfyllde de krav som krävdes för en lyckad analys. Individerna måste alltså ha en känd ålder och kön, dessutom exkluderades spädbarn och juvenila, då de oftast avled innan skeletala förändringar. I materialet representerade männen 63 procent (n=112) och kvinnorna 37 procent (n=67) av den totala mängden skelett. Materialet hade blivit insamlad från stenåldersboplatsen Ajvide på Gotland samt sex medeltida kyrkor från Visby, Gotland: St Hans, St Per, St Clemens, Ryska Kyrkan, St Gertrud och St Mikael. Noterbara förändringar är en ökning i emaljhypoplasi, cribra orbitalia, degenerativa ledsjukdomar, aktivitet-relaterade patologier samt försämrad oral hälsa. Detta tyder på att den medeltida befolkningen utsattes för mer stress i form av infektioner och undernäring. Mängden degenerativa ledsjukdomar indikerar dessutom på ett mer fysiskt ansträngande liv.

No description available.