BACKGROUND:Anticoagulation with vitamin K antagonists such as warfarin has historically been used for the long term management of patients with thromboembolic disease. However, these agents have a slow onset of action which requires bridging therapy with heparin and its analogues, which are available only in parenteral route. To overcome these limitations, new oral anticoagulants such as factor Xa inhibitors and direct thrombin inhibitors have been developed. The aim of this article is to systematically review the phase 3 clinical trials of new oral anticoagulants in common medical conditions.METHODS:We searched PubMed (Medline) from January 2007 to February 2013 using "Oral anticoagulants", "New oral anticoagulants", "Randomized controlled trial", "Novel anticoagulants", "Apixaban", "Rivaroxaban", "Edoxaban", "Dabigatran etexilate", "Dabigatran" and a combination of the above terms. The available evidence from the phase 3 RCTs was summarized on the basis of individual drug and the medical conditions categorized into "atrial fibrillation", "acute coronary syndrome", "orthopedic surgery", "venous thromboembolism" and "medically ill patients".RESULTS:Apixaban, rivaroxaban and dabigatran have been found to be either non-inferior or superior to enoxaparin in prophylaxis of venous thromboembolism in knee and hip replacement with similar bleeding risk, superior to warfarin for stroke prevention in atrial fibrillation with significant reduction in the risk of major bleeding, non-inferior to aspirin for reducing cardiovascular death and stroke in acute coronary syndrome with significant increase in the risk of major bleed. Rivaroxaban and dabigatran are also superior to the conventional agents in the management of symptomatic venous thromboembolism. However, compared to enoxaparin, apixaban and rivaroxaban use lead to significantly increased bleeding risk in medically ill patients. Additional studies evaluating the specific reversal agents of these new drugs for the management of life-threatening bleeding or other adverse effects are necessary.CONCLUSION:Considering their pharmacological properties, their efficacy and bleeding complications, the new oral agents offer a net favourable clinical profile in orthopedic surgery, atrial fibrillation, acute coronary syndrome and increase the risk of bleeding in critically ill patients. Further studies are necessary to determine the long term safety and to identify the specific reversal agents of these new drugs.

Thesis (PhD)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: The knee is the largest, most complicated and incongruent joint in the human body. It sustains very high forces and is susceptible to injury and disease. Osteoarthritis is a common disease prevalent among the elderly and causes softening or degradation of the cartilage and subcondral bone in the joint, which leads to a loss of function and pain. This problem can be alleviated through a surgical intervention commonly termed a “knee replacement”. The aim of a knee replacement procedure is to relieve pain and restore normal function. Ideally, the knee replacement prosthesis should have an articulating geometry similar to that of the patient’s healthy knee, and must allow for normal motion. Unfortunately, this is often problematic since knee prostheses are supplied in standard sizes from a variety of manufacturers and each one has a slightly different design. Furthermore, commercial prostheses are not always able to restore the complex geometry of an individual patient’s original articulating surfaces. This dissertation shows that there is a significant variation between knee geometries, regardless of gender and race. This research aims to resolve the problem in two parts: Firstly by presenting a method for preoperatively selecting the optimal knee prosthesis type and size for a specific patient, and secondly by presenting a design procedure for designing and manufacturing patient-specific unicompartmental knee replacements. The design procedure uses mathematical modelling and an artificial neural network to estimate the original and healthy articulating surfaces of a patient’s knee. The models are combined with medical images from the patient to create a knee prosthesis that is patient-specific. These patient-specific implants are then compared to conventional implants with respect to contact stresses and kinematics. The dissertation concludes that patient-specific implants can have characteristics that are comparable to or better than conventional prostheses. The unique design methodology presented in this dissertation introduces a significant advancement in knee replacement technology, with the potential to dramatically improve clinical outcomes of knee replacement surgery. / AFRIKAANSE OPSOMMING: Die knie is die grootste, mees komplekse en mees ongelyksoortige gewrig in die liggaam. Osteoarthritis is ’n siekte wat algemeen by bejaardes voorkom en die versagting of agteruitgang van die kraakbeen en subchondrale bene in die gewrig tot gevolg het, wat tot ’n verlies van funksionering en pyn lei. Hierdie probleem kan verlig word deur ’n chirurgiese ingryping wat algemeen as ’n “knievervanging” bekend staan. Die doel van ’n knievervangingsprosedure is om pyn te verlig en normale funksionering te herstel. Ideaal gesproke behoort die knievervangingsprostese ’n gewrigsgeometrie te hê wat soortgelyk aan die pasiënt se gesonde knie is, en normale beweging moontlik maak. Ongelukkig is dit dikwels problematies aangesien knieprosteses in standaardgroottes en deur ’n verskeidenheid vervaardigers verskaf word, wat elkeen se ontwerp effens anders maak. Verder kan kommersiële prosteses nie altyd die komplekse geometrie van ’n individuele pasiënt se oorspronklike gewrigsoppervlakke vervang nie. Hierdie proefskrif wys dat daar ’n betekenisvolle variasie tussen knieafmetings is, afgesien van geslag en ras. Hierdie navorsing is daarop gemik om die problem op tweërlei wyse te benader: Eerstens deur ’n metode aan te bied om die optimal knieprostesetipe en -grootte vir ’n spesifieke pasiënt voor die operasie uit te soek, en tweedens om ’n ontwerpprosedure aan te bied vir die ontwerp en vervaardiging van pasiëntspesifieke unikompartementele knievervangings. Die ontwerpprosedure gebruik wiskundige modellering en ’n kunsmatige neurale netwerk om die oorspronklike en gesonde gewrigsoppervlakke van ’n pasiënt se knie te bepaal. Die modelle word met mediese beelde van die pasiënt gekombineer om ’n knieprostese te skep wat pasiëntspesifiek is. Hierdie pasiëntspesifieke inplantings word dan met konvensionele inplantings vergelyk wat kontakstres en kinematika betref. Daar word tot die slotsom gekom dat die pasiëntspesifieke inplantings oor eienskappe kan beskik wat vergelykbaar is met of selfs beter is as dié van konvensionele prosteses. Die unieke ontwerpmetodologie wat in hierdie proefskrif aangebied word, stel beduidende vordering in knievervangingstegnologie bekend, met die potensiaal om die kliniese uitkomste van knievervangingsoperasies dramaties te verbeter.

Adverse effects of cyclooxygenase (COX) inhibitors on bone healing have previously been demonstrated in diaphyseal fracture models in animals. In spite of that, they are widely used as postoperative analgesics in orthopaedic surgery. After joint replacement, a bone repair process starts at the interface between bone and cement. If this process is disturbed, the prosthesis may never become rigidly fixed to the bone, leading to migration and with time loosening. This thesis investigates the effects of a selective COX-2 inhibitor (parecoxib or celecoxib) on bone healing in metaphyseal bone in a rat model and on knee prosthesis migration after total knee replacement, as measured with radiostereometric analysis. Blood loss, postoperative recovery, and the 2-year subjective outcome, were also measured. In addition, a hemoglobin dilution method for blood loss estimation, used in this thesis, was evaluated. In the first study, pull-out force of a screw inserted in metaphyseal bone of the tibia in rats was only marginally decreased by parecoxib after 7 days but not after 14 days. In the second and third study, celecoxib treatment resulted in less pain postoperatively in conjunction with total knee replacement (TKR), but no effects were seen on blood loss, range of motion, subjective outcome, or prosthesis migration after 2 years. Comparing the true blood loss of blood donors with the blood loss estimated by the hemoglobin dilution method, this method was found to underestimate the true blood loss. It is therefore not suitable for calculation of the absolute blood loss volume, but may be used for a rough estimate. In summary, celecoxib and presumably other cyclooxygenase inhibitors seems not likely to increase the risk of prosthesis loosening.

Thesis (Ph. D.)--University of Missouri--Columbia, 2003. / Typescript. Vita. Includes bibliographical references (leaves 162-175). Also available on the Internet.

High quality health services are often difficult to access in rural and remote areas of Australia. This is due to a shortage of health care professionals and specialists, inadequate and poorly distributed resources, and the tyranny of distance. The result is a reduced level of health and a higher mortality rate than seen in urban communities. Telemedicine, which is the use of various technologies to deliver a range of health care services over a distance, has the potential to increase equity and access to health care in rural and remote areas. To date there has been a poor uptake of telemedicine technology within the profession of physiotherapy. This undoubtedly stems from the perceived, and indeed, real difficulty of performing what is traditionally ‘hands on’ therapy, via an electronic medium. Added to this is a paucity of rigorous clinical outcome studies to demonstrate the efficacy of performing successful treatment via this delivery method. The aim of this thesis was to establish the efficacy of telemedicine as a clinical tool for physiotherapists. To achieve this, the first major undertaking was the development of a telemedicine system to meet the unique needs of clinical physiotherapists and their patients. A series of studies was then performed to calibrate the system and establish its validity and reliability as a clinical assessment tool. Finally, a randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The telemedicine system was constructed using a human systems development approach, with close consultation with senior clinical physiotherapists and potential users of the system. The personal computer-based system was designed to connect patients in their home with physiotherapists in the hospital, via low-speed and low-cost communications. The system incorporated real-time videoconferencing and physical measurement tools to enable the remote assessment of patients. The validity and reliability of the telemedicine physical measurement tools were established through a series of five studies. The results demonstrated these measurements to be accurate and reliable, under various measurement conditions, when compared to reference instruments. A prospective randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The research model chosen for this study was the rehabilitation of subjects who had undergone total knee replacement surgery. Block randomisation was used to assign 65 participants to either a traditional face-to-face therapy group or a telemedicine rehabilitation group. Participants in both groups received treatment over a six week period. Data analysis focussed on comparing physical and functional rehabilitation outcomes achieved in each treatment group. The results of this study demonstrated that the rehabilitation outcomes produced via the telemedicine system were similar to those achieved in the traditional manner. Additionally, the telemedicine therapy was found to produce greater improvements in a number of functional outcome measurements. A high level of satisfaction was expressed by participants who received treatment via the telemedicine method. This thesis provides evidence of the efficacy of telemedicine as a clinical tool for physiotherapists. Furthermore, the work detailed in this thesis represents one of the first randomised control trials in telerehabilitation and makes a significant contribution towards the knowledge of low-bandwidth telemedicine in general. This thesis provides a framework upon which further research and telemedicine applications may be developed, with the ultimate goal of improving equity and access to high quality health services in rural and remote areas.

High quality health services are often difficult to access in rural and remote areas of Australia. This is due to a shortage of health care professionals and specialists, inadequate and poorly distributed resources, and the tyranny of distance. The result is a reduced level of health and a higher mortality rate than seen in urban communities. Telemedicine, which is the use of various technologies to deliver a range of health care services over a distance, has the potential to increase equity and access to health care in rural and remote areas. To date there has been a poor uptake of telemedicine technology within the profession of physiotherapy. This undoubtedly stems from the perceived, and indeed, real difficulty of performing what is traditionally ‘hands on’ therapy, via an electronic medium. Added to this is a paucity of rigorous clinical outcome studies to demonstrate the efficacy of performing successful treatment via this delivery method. The aim of this thesis was to establish the efficacy of telemedicine as a clinical tool for physiotherapists. To achieve this, the first major undertaking was the development of a telemedicine system to meet the unique needs of clinical physiotherapists and their patients. A series of studies was then performed to calibrate the system and establish its validity and reliability as a clinical assessment tool. Finally, a randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The telemedicine system was constructed using a human systems development approach, with close consultation with senior clinical physiotherapists and potential users of the system. The personal computer-based system was designed to connect patients in their home with physiotherapists in the hospital, via low-speed and low-cost communications. The system incorporated real-time videoconferencing and physical measurement tools to enable the remote assessment of patients. The validity and reliability of the telemedicine physical measurement tools were established through a series of five studies. The results demonstrated these measurements to be accurate and reliable, under various measurement conditions, when compared to reference instruments. A prospective randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The research model chosen for this study was the rehabilitation of subjects who had undergone total knee replacement surgery. Block randomisation was used to assign 65 participants to either a traditional face-to-face therapy group or a telemedicine rehabilitation group. Participants in both groups received treatment over a six week period. Data analysis focussed on comparing physical and functional rehabilitation outcomes achieved in each treatment group. The results of this study demonstrated that the rehabilitation outcomes produced via the telemedicine system were similar to those achieved in the traditional manner. Additionally, the telemedicine therapy was found to produce greater improvements in a number of functional outcome measurements. A high level of satisfaction was expressed by participants who received treatment via the telemedicine method. This thesis provides evidence of the efficacy of telemedicine as a clinical tool for physiotherapists. Furthermore, the work detailed in this thesis represents one of the first randomised control trials in telerehabilitation and makes a significant contribution towards the knowledge of low-bandwidth telemedicine in general. This thesis provides a framework upon which further research and telemedicine applications may be developed, with the ultimate goal of improving equity and access to high quality health services in rural and remote areas.

High quality health services are often difficult to access in rural and remote areas of Australia. This is due to a shortage of health care professionals and specialists, inadequate and poorly distributed resources, and the tyranny of distance. The result is a reduced level of health and a higher mortality rate than seen in urban communities. Telemedicine, which is the use of various technologies to deliver a range of health care services over a distance, has the potential to increase equity and access to health care in rural and remote areas. To date there has been a poor uptake of telemedicine technology within the profession of physiotherapy. This undoubtedly stems from the perceived, and indeed, real difficulty of performing what is traditionally ‘hands on’ therapy, via an electronic medium. Added to this is a paucity of rigorous clinical outcome studies to demonstrate the efficacy of performing successful treatment via this delivery method. The aim of this thesis was to establish the efficacy of telemedicine as a clinical tool for physiotherapists. To achieve this, the first major undertaking was the development of a telemedicine system to meet the unique needs of clinical physiotherapists and their patients. A series of studies was then performed to calibrate the system and establish its validity and reliability as a clinical assessment tool. Finally, a randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The telemedicine system was constructed using a human systems development approach, with close consultation with senior clinical physiotherapists and potential users of the system. The personal computer-based system was designed to connect patients in their home with physiotherapists in the hospital, via low-speed and low-cost communications. The system incorporated real-time videoconferencing and physical measurement tools to enable the remote assessment of patients. The validity and reliability of the telemedicine physical measurement tools were established through a series of five studies. The results demonstrated these measurements to be accurate and reliable, under various measurement conditions, when compared to reference instruments. A prospective randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The research model chosen for this study was the rehabilitation of subjects who had undergone total knee replacement surgery. Block randomisation was used to assign 65 participants to either a traditional face-to-face therapy group or a telemedicine rehabilitation group. Participants in both groups received treatment over a six week period. Data analysis focussed on comparing physical and functional rehabilitation outcomes achieved in each treatment group. The results of this study demonstrated that the rehabilitation outcomes produced via the telemedicine system were similar to those achieved in the traditional manner. Additionally, the telemedicine therapy was found to produce greater improvements in a number of functional outcome measurements. A high level of satisfaction was expressed by participants who received treatment via the telemedicine method. This thesis provides evidence of the efficacy of telemedicine as a clinical tool for physiotherapists. Furthermore, the work detailed in this thesis represents one of the first randomised control trials in telerehabilitation and makes a significant contribution towards the knowledge of low-bandwidth telemedicine in general. This thesis provides a framework upon which further research and telemedicine applications may be developed, with the ultimate goal of improving equity and access to high quality health services in rural and remote areas.

High quality health services are often difficult to access in rural and remote areas of Australia. This is due to a shortage of health care professionals and specialists, inadequate and poorly distributed resources, and the tyranny of distance. The result is a reduced level of health and a higher mortality rate than seen in urban communities. Telemedicine, which is the use of various technologies to deliver a range of health care services over a distance, has the potential to increase equity and access to health care in rural and remote areas. To date there has been a poor uptake of telemedicine technology within the profession of physiotherapy. This undoubtedly stems from the perceived, and indeed, real difficulty of performing what is traditionally ‘hands on’ therapy, via an electronic medium. Added to this is a paucity of rigorous clinical outcome studies to demonstrate the efficacy of performing successful treatment via this delivery method. The aim of this thesis was to establish the efficacy of telemedicine as a clinical tool for physiotherapists. To achieve this, the first major undertaking was the development of a telemedicine system to meet the unique needs of clinical physiotherapists and their patients. A series of studies was then performed to calibrate the system and establish its validity and reliability as a clinical assessment tool. Finally, a randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The telemedicine system was constructed using a human systems development approach, with close consultation with senior clinical physiotherapists and potential users of the system. The personal computer-based system was designed to connect patients in their home with physiotherapists in the hospital, via low-speed and low-cost communications. The system incorporated real-time videoconferencing and physical measurement tools to enable the remote assessment of patients. The validity and reliability of the telemedicine physical measurement tools were established through a series of five studies. The results demonstrated these measurements to be accurate and reliable, under various measurement conditions, when compared to reference instruments. A prospective randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The research model chosen for this study was the rehabilitation of subjects who had undergone total knee replacement surgery. Block randomisation was used to assign 65 participants to either a traditional face-to-face therapy group or a telemedicine rehabilitation group. Participants in both groups received treatment over a six week period. Data analysis focussed on comparing physical and functional rehabilitation outcomes achieved in each treatment group. The results of this study demonstrated that the rehabilitation outcomes produced via the telemedicine system were similar to those achieved in the traditional manner. Additionally, the telemedicine therapy was found to produce greater improvements in a number of functional outcome measurements. A high level of satisfaction was expressed by participants who received treatment via the telemedicine method. This thesis provides evidence of the efficacy of telemedicine as a clinical tool for physiotherapists. Furthermore, the work detailed in this thesis represents one of the first randomised control trials in telerehabilitation and makes a significant contribution towards the knowledge of low-bandwidth telemedicine in general. This thesis provides a framework upon which further research and telemedicine applications may be developed, with the ultimate goal of improving equity and access to high quality health services in rural and remote areas.

High quality health services are often difficult to access in rural and remote areas of Australia. This is due to a shortage of health care professionals and specialists, inadequate and poorly distributed resources, and the tyranny of distance. The result is a reduced level of health and a higher mortality rate than seen in urban communities. Telemedicine, which is the use of various technologies to deliver a range of health care services over a distance, has the potential to increase equity and access to health care in rural and remote areas. To date there has been a poor uptake of telemedicine technology within the profession of physiotherapy. This undoubtedly stems from the perceived, and indeed, real difficulty of performing what is traditionally ‘hands on’ therapy, via an electronic medium. Added to this is a paucity of rigorous clinical outcome studies to demonstrate the efficacy of performing successful treatment via this delivery method. The aim of this thesis was to establish the efficacy of telemedicine as a clinical tool for physiotherapists. To achieve this, the first major undertaking was the development of a telemedicine system to meet the unique needs of clinical physiotherapists and their patients. A series of studies was then performed to calibrate the system and establish its validity and reliability as a clinical assessment tool. Finally, a randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The telemedicine system was constructed using a human systems development approach, with close consultation with senior clinical physiotherapists and potential users of the system. The personal computer-based system was designed to connect patients in their home with physiotherapists in the hospital, via low-speed and low-cost communications. The system incorporated real-time videoconferencing and physical measurement tools to enable the remote assessment of patients. The validity and reliability of the telemedicine physical measurement tools were established through a series of five studies. The results demonstrated these measurements to be accurate and reliable, under various measurement conditions, when compared to reference instruments. A prospective randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The research model chosen for this study was the rehabilitation of subjects who had undergone total knee replacement surgery. Block randomisation was used to assign 65 participants to either a traditional face-to-face therapy group or a telemedicine rehabilitation group. Participants in both groups received treatment over a six week period. Data analysis focussed on comparing physical and functional rehabilitation outcomes achieved in each treatment group. The results of this study demonstrated that the rehabilitation outcomes produced via the telemedicine system were similar to those achieved in the traditional manner. Additionally, the telemedicine therapy was found to produce greater improvements in a number of functional outcome measurements. A high level of satisfaction was expressed by participants who received treatment via the telemedicine method. This thesis provides evidence of the efficacy of telemedicine as a clinical tool for physiotherapists. Furthermore, the work detailed in this thesis represents one of the first randomised control trials in telerehabilitation and makes a significant contribution towards the knowledge of low-bandwidth telemedicine in general. This thesis provides a framework upon which further research and telemedicine applications may be developed, with the ultimate goal of improving equity and access to high quality health services in rural and remote areas.

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.