Ziel der vorliegenden Arbeit war es, retrospektiv die Ergebnisse der bei medialer Schenkelhalsfraktur mittels 3-fach Verschraubung osteosynthetisch versorgten Patienten zu ermitteln und die Ergebnisse im aktuellen Kontext im Vergleich zu den Ergebnissen anderer Studien darzustellen. Aufgrund der zunehmenden sozioökonomischen Bedeutung der Therapie der medialen Schenkelhalsfraktur ist es im Prozess des Findens einer optimalen Versorgung der betroffenen Patienten erforderlich, die aktuell angewandten Therapieverfahren klinischen Studien zu unterziehen, um für künftige Patienten eine fundierte Entscheidung für das entsprechende Therapieverfahren treffen zu können. Die retrospektive Arbeit bezog sich auf 86 Patienten, welche auf Grund einer medialen Schenkelhalsfraktur durch 3-fach Verschraubung versorgt worden sind. Es wurden entscheidende präoperative Daten, wie der präoperative Zustand des Patienten, deren Alter, Geschlecht, Frakturklassifikation und die Zeit zwischen Aufnahme in der Unfallambulanz und Operation erfasst. Zusätzlich wurden postoperative Daten zu Komplikationen erhoben und Langzeitergebnisse im Rahmen einer klinischen Nachuntersuchung erfasst. Bei einem Frauenanteil von 63% hatte das Patientenkollektiv ein Durchschnittsalter von 73 Jahren. Zum Zeitpunkt der Nachuntersuchung waren 38,4% der Patienten verstorben. Insgesamt kam es bei 10,5% der Patienten zu einer Redislokation, wobei der Anteil der Redislokationen bei den Patienten mit einer dislozierten Fraktur 26% und bei den Patienten mit einer nicht dislozierten Fraktur 3,4% betrug. Im Patientenkollektiv entwickelten 4,7% der Patienten eine Pseudarthrose und bei 5,8% der Patienten konnte die Entstehung einer Hüftkopfnekrose beobachtet werden. Bei den 24 nachuntersuchten Patienten konnte ein durchschnittlicher Harris Hip Score von 89,5 Punkten ermittelt werden.

In the pool of women over the age of 50, the likeliness of an atypical fracture increase drastically, partly due to osteoporosis. With a pre-existing implant in the femur bone, inserted due to a prior atypical fracture, treating a later femoral neck fracture is complex and risky. Currently, a fractured femoral diaphysis is treated using an intermedullary nail which is fixed to the femur bone either through the femoral neck (Recon locking method)or through the lesser trochanter (Antegrade locking method). In a study conducted by Bögl et.al. JBJS102.17 (2020), pp. 1486-1494, it is found that the fixation of the intermedullary nail through the femoral neck reduces the risk of future femoral neck fractures. The study also states that more than 50% of the patients with atypical femoral fractures related to bisphosphonate treatment for osteoporosis (within the study sub population) were treated with the Antegrade locking implant. There does not exist much literature that reasons as to how one locking method is showing lesser risk of re-operation as compared to the other. The purpose of this study is to look into the effects these two implants have on the femur bone using the Finite Element Analysis (FEA). The study presented is aimed at comparing the results of the finite element analysis for the Recon implant model (Recon model) and Antegrade implant model (Antegrade model). The femur model without the implants (native bone model) is used to verify material behavior, while the other two are used for the comparison to study the stress-strain distribution, primarily in the neck region. This is a patient specific study, hence the femur bone model is generated using patient Computed Tomography (CT) scans. The bone model was assigned a heterogeneous isotropic material property derived from patient CT data. The finite element (FE) model of the bone was meshed using Hypermesh. The peak loading condition including the muscle forces were applied on the native bone model along with the Recon and the Antegrademodel. While the loading conditions during normal walking cycle were only applied to theRecon and the Antegrade model to compare the impacts of the two implant types. Both loading conditions were simulated by fixing the distal condyle region of the bone. The analysis results show that the Antegrade implant experiences much higher stresses and strains in the neck region as compared to Recon implant. Also, the presence of the intermedullary nail through the femur diaphysis helps to distribute the stresses and strains in the anterior distal diaphysis region of the bone. For the case of no implants, the model showed strains and stresses in the lateral distal region of femoral diaphysis.

The major objective of this thesis was to investigate how the use of a recently developed microprocessor-controlled limb system altered the negative mechanical work done by the intact and prosthetic limb when trans-femoral amputees terminated gait. Participants terminated gait on a level surface from their self-selected walking speed and on declined surface from slow and customary speeds, using limb system prosthesis with microprocessor active or inactive. Limb negative work, determined as the integral of the negative mechanical (external) limb power during the braking phase, was compared across surface, speed and microprocessor conditions. Halting gait was achieved predominantly from negative work done by the trailing/intact. Trailing versus leading limb mechanical work imbalance was similar to how able body individuals halted gait. Importantly, the negative limb work performed on the prosthetic side when terminating gait on declined surface was increased when the microprocessor was active for both slow and customary speeds (no difference on level surface) but no change on intact limb. This indicates the limb system’s ‘ramp-descent mode’ effectively/dynamically altered the hydraulic resistances at the respective joints with evidence indicating changes at the ankle were the key factor for increasing the prosthetic limb negative work contribution. Findings suggest that trans-femoral amputees became more assured using their prosthetic limb to arrest body centre of mass velocity when the limb system’s microprocessor was active. More generally findings suggest, trans-femoral amputees should obtain clinically significant biomechanical benefits from using a limb system prosthesis for locomotion involving adapting to their everyday walking where adaptations to an endlessly changing environment are required. / Higher Committee of Education Development in IRAQ (HCED)

No description available.

<p><h1>ABSTRACT</h1> <h1>Individuals with spinal cord injuries (SCI) are prone to significant alterations in vascular structure and function. This study was designed to examine the effects of osteopathic treatment on mean leg (MLBF) blood flow and skin temperature in the lower extremities of individuals with chronic SCI compared to able-bodied (AB) individuals. Methods: Nine individuals (age 44 ± 17.5 years) with a chronic SCI (C6-T12; AIS A-B; 3.7 ± 4.6 years post-injury) and six AB individuals (38.3 ± 9.7 years) participated. The protocol consisted of 1 interview session and 3 osteopathic treatment sessions. Doppler ultrasound measured the diameter and mean blood velocity in the CFA before (Pre) and after (Post) each session. Skin temperatures were measured using skin thermistors at three different sites on the left leg. Change scores were calculated and measured as post-treatment minus pre-treatment. Results: A two-way ANOVA revealed an increase in flow of 16±2 ml/min within the SCI group and a decrease in flow of 25±2 ml/min in the AB group (p = 0.04). There was also a smaller reduction in skin temperature in individuals within the SCI versus AB (left thigh: SCI, -0.5±0.2° C; AB, -1.2±0.2°C, p(left foot: SCI, -0.1±0.4°C; AB, -1.8±0.4°C, pAll treatments resulted in small increases in MLBF in the SCI group versus small decreases in the able-bodied group and smaller skin temperature decreases in the SCI versus the decreases in the AB group, potentially indicating reduced skin temperature reactivity. These findings emphasize the potential for different physiological responses to interventions in individuals with SCI compared to AB individuals.</h1></p> / Master of Science in Kinesiology

Peripheral artery disease (PAD) affects more than 200 million people worldwide. PAD refers to illness due to a reduction or complete occlusion of blood flow in the artery, especially to the extremities in disease conditions, such as atherosclerosis or diabetes. Critical limb ischemia (CLI) is a severe form of PAD associated with high morbidity and mortality. Currently, no effective and permanent treatments are available for this disease. The current endovascular medications (e.g., angioplasty or stents) only relieve the clinical symptoms while the surgical therapies (e.g., bypass or endarterectomy) require grafting vessels from a healthy organ to the diseased limb of the patient. However, even with these therapeutic techniques, 30% of patients still undergo limb amputation within a year. Thus, understanding of disease mechanism and development of new therapeutic approaches are in urgent needs. Meis1 (myeloid ecotropic viral integration site 1) gene belongs to the three-amino-acid loop extension subclass of homeobox gene families, and it is a highly conserved transcription factor in all eukaryotes. Up to date, little is known about the role of Meis1 in regulating vascular remodeling under ischemic condition. In this study, we aim to investigate the role and underlying mechanism of Meis1 in the regulation of arteriogenesis and angiogenesis using hindlimb ischemia model of transgenic neonatal mice. The long-term goal is to develop a new treatment for patients with PAD. Three separate but related studies were planned to complete the proposed research aims. To better understand the role of Meis1, we reviewed, in the first chapter, all literature relevant to the recent advances of the Meis1 in normal hematopoiesis, vasculogenesis, and heart developments, which were mostly studied in zebrafish and mouse. Briefly, Meis1 is found to be highly expressed in the brain and retina in zebrafish and additional in the heart, nose, and limb in mouse during the very early developmental stage, and remains at a low level quickly after birth. Meis1 is necessary for both primitive and definitive hematopoiesis and required for posterior erythroid differentiation. The absence of Meis1 results in a severe reduction of the number of mature erythrocytes and weakens the heart beats in zebrafish. Meis1 deficiency mouse is dead as early as E11.5 due to the severe internal hemorrhage. In addition, Meis1 is essential in heart development. Knock-down of Meis1 can promote angiotensin II-induced cardiomyocytes (CMs) hypertrophy or CMs proliferation, which can be repressed by a transcription factor Tbx20. Meis1 appears to play a complicated role in the blood vessels. Although the major blood vessels are still normal when global deletion of Meis1, the intersegmental vessel cannot be formed in Meis1 morphants in the zebrafish, and the small vessels are either too narrow or form larger sinuses in Meis1 deficient mouse. The effects of Meis1 on the vascular network under normal and disease (ischemia) condition remain largely unknown, and the existing data in this field is limited. In the second chapter, we developed a method protocol to identify mice of all ages, especially neonates that we faced methodological difficulties to easily and permanently label prior to our major experiments. In this study, single- or 2-color tattooing (ear, tail, or toe or combinations) was performed to identify a defined or unlimited number of mice, respectively. Tail tattooing using both green and red pastes was suitable for identifying white-haired neonatal mice as early as postnatal day (PND) 1, whereas toe tattooing with green paste was an effective alternative approach for labeling black-haired mouse pups. In comparison, single-color (green) or 2-color (green and red) ear tattooing identified both white and black adult mice older than three weeks. Ear tattooing can be adapted to labeling an unlimited number of adult mice by adding the cage number. Thus, tattooing various combinations of the ears, tail, and toes provides an easy and permanent approach for identifying mice of all ages with minimal disturbance to the animals, which shows a new approach than any existing method to identify mouse at all ages, especially the neonatal pups used in the present study (Chapter 4). Various formation of hindlimb ischemia with ligations of femoral artery or vein or both have been reported in the literature. The ischemic severity varies dependent on mouse strains and ligation methods. Due to the tiny body size of our experimental neonatal mice (PND2), it is technically challenging to separate the femoral artery from femoral vein without potential bleeding. In the third chapter, we aimed to explore a suitable surgical approach that can apply to neonatal mice. To this end, we compared the effects of femoral artery/vein (FAV) excision vs. femoral artery (FA) excision on hindlimb model using adult CD-1 mice. We showed during the 4-week period of blood reperfusion, no statistically significant differences were found between FAV and FA excision-induced ischemia regarding the reduction of limb blood flow, paw size, number of necrotic toes, or skeletal muscle cell size. We conclude that FAV and FA excision in CD-1 mice generate a comparable severity of hindlimb ischemia. In other words, FAV ligation is no more severe than FA ligation. These findings provide valuable information for researchers when selecting ligation methods for their neonate hindlimb models. Based on these findings, we selected FAV ligation of hindlimb ischemia approach to study the function of Meis1 in vascular remodeling of neonatal mice. In the fourth chapter (the main part of my dissertation), we investigated the roles of Meis1 in regulating arteriogenesis and angiogenesis of neonatal mouse under the ischemic condition. To this end, endothelial cell-specific deletion of Meis1 was generated by cross-breeding Meis1flox/flox mice with Tie2-Cre mice. Wild-type (WT, Meis1f/f) and endothelial cell-specific knock-out (KO, Meis1ec-/-Tie2-Cre+) C57BL/6 mice at the age of PND2 were used. Under the anesthesia, the pups were subject to hindlimb ischemia by excising FAV. Laser Doppler Imager was used to measure the blood flow pre- and post-surgery up to 28 days. Toe necrosis, skeletal regeneration, and vascular distributions were examined at the end of experiments (PND28 post-ischemia). Surprisingly, during 4-week periods after ischemia, the blood flow ratios (ischemic vs. control limb) in KO mice significantly increased compared to WT on PND14 and PND28, suggesting the inhibitory effects of Meis1 on blood flow recovery under ischemic condition. Meanwhile, WT mice showed more severe necrotic limb (lower ratio of limb length and area, and higher necrotic scores at PND7) than those in the KO mice. Furthermore, significant increases in diameters of Dil-stained arterioles of the skin vessel and the vessels on the ligation site were observed in KO mice, indicating the enhanced arteriogenesis in KO mice. To investigate the underlying mechanism, RNA from the ischemia and control limb was extracted and q-PCR was used to study the potential genes involved in the mechanism. Casp3 and Casp8 were found downregulated showing less apoptosis in the KO mice. On the other hand, endothelial cells (ECs) were isolated from the lungs of 3-5 WT and KO neonates using CD31 Microbeads. CD31+ cells were plated and treated with 0, 0.5, and 1μM doxorubicin for 24 hours and analyzed with various assays. Meis1-KO ECs demonstrated higher cell viability and formed a higher number of vascular tubes than those in WT ECs following 0.5μM Dox treatment, presenting the potential ability of angiogenesis in KO-ECs. Furthermore, the increased viability in KO ECs may be due to the decreased expression or activities of Casp8 and Casp3. In conclusion, my present studies have developed a new methodology to easily and permanently identify all mice at any ages. The insignificant differences between FAV and FA ligations suggest that a relative-easy surgical approach could be used to generate hindlimb ischemic model, which potentially reduces the cost, decreases the surgical time and prevents damage of femoral nerve from surgical tools. More importantly, by using transgenic mice, we found that Meis1-KO dramatically increased blood flow and protected the ischemic hindlimb through vascular remodeling. Obviously, the molecular and cellular mechanisms underlying the above beneficial effects appear complicated and likely to involve multiple cellular remodeling processes and molecular signaling pathways to enhance arteriogenesis and angiogenesis and/or reduce cellular apoptosis through Meis1-mediated pathways. Our study demonstrated that under ischemic condition, knockout of Meis1 increases expression of Hif1a, which then activates Agt or VEGF, thus enhances arteriogenesis or angiogenesis; In addition, knockout of Meis1 activates Ccnd1, which subsequently promotes regeneration of skeletal muscle, and reduces expression of Casp8 and Casp3, thus preventing limb tissue from ischemia-induced apoptosis. Our innovative findings offer great potential to ultimately lead to new drug discovery or therapeutic approaches for prevention or treatment of PAD. / PHD

No description available.

Zielstellung: Die Ruptur des vorderen Kreuzbandes (VkB) ist die häufigste Ursache einer Lahmheit beim Hund. Im Gegensatz zu der Humanmedizin, wo die anatomische intraartikuläre Rekonstruktion des vorderen Kreuzbandes als Therapie der Wahl gilt, wird die intraartikuläre Rekonstruktion beim Hund nur selten durchgeführt und hat bis jetzt nicht dauerhaften Erfolg. Die anatomische Platzierung der Bohrkanäle ist bei Menschen für den Erfolg der Operation bei Menschen entscheidend. Erstes Ziel der Studie war die Bestimmung der radiologischen Lage des Zentrums des femoralen vorderen Kreuzbandursprungs beim Hund. Zweites Ziel war die Entwicklung und Erprobung eines Zielgerätes für die arthroskopisch-assistierte, anatomische vordere Kreuzbandrekonstruktion beim Hund. Material und Methode: A. Radiologische Studie: Die kraniale Begrenzung des femoralen Ursprungs des vorderen Kreuzbandes (VK) wurde mit einem röntgendichten Draht bei 49 Femora orthopädisch gesunder Hunde (KM > 20 kg) markiert. Anschließend wurde eine Computertomographie und 3D- Rekonstruktion jedes Femurs angerfertigt, anhand derer der Ursprung manuell segmentiert und das Zentrum berechnet wurde. Schließlich wurden, basierend auf den 3D-Modellen, virtuelle Röntgenbilder in zwei Ebenen berechnet. An diesen wurde die Position des berechneten Zentrums mit drei unterschiedlichen Methoden bestimmt (4x4-Gitterbox-Methode und prozentuale Position für die medio-laterale Projektion; Ziffernblattmethode für die disto-proximale Projektion). B. Zielgerät: Hintergliedmaßen (n = 12) von 6 Hundekadavern (KM ≥20 kg) wurden verwendet. Eine Gliedmaße jedes Kadavers wurde zufällig ausgewählt und die kaudo-kraniale Lage des Zentrums des vorderen Kreuzbandansatzes (vKBA) in medio-lateralen Röntgenbildern berechnet und anschließend auf ein justierbares Zielgerät übertragen. Unter arthroskopischer Kontrolle wurde das Zielgerät hinter der lateralen Kondyle eingehakt und ein Steinmann Pin von extra nach intraartikulär platziert. Die Position der resultierenden Bohrkanäle wurde sowohl röntgenologisch bestimmt als auch dreidimensional mit dem anatomischen Zentrum des vKBA der kontralateralen Hintergliedmaßen verglichen. Ergebnisse: A. Radiologische Studie: In der medio-lateralen Projektion befand sich das Zentrum des femoralen Kreuzbandursprungs im zweiten Rechteck von proximal in der kaudalen Spalte. Die mittlere prozentuale kaudo-kraniale und proximo-distale Position war 20,2 % (± 2,2), beziehungsweise 33,8% (± 3,7). Im disto-proximalen Röntgenbild lag in 97,6 % der Femora das Zentrum des femoralen Kreuzbandursprungs zwischen 14:00 und 15:00 Uhr. B. Zielgerät: In allen postoperativen Röntgenaufnahmen lagen die sechs Bohrkanäle im bzw. nahe dem Zentrum des vKBA. Die 3D- Messungen ergaben eine mediane Abweichung der Bohrkanalposition im Vergleich zum anatomischen Zentrum der kontralateralen Seite von 0,6 mm (Bereich:0,2– 0,9 mm). Schlussfolgerung: Die erarbeiteten Referenzwerte können für die Planung sowie die intra- und postoperative Kontrolle der femoralen Bohrung verwendet werden. Die Verwendung eines justierbaren Zielgerätes ermöglicht die präzise anatomische Platzierung des femoralen Bohrkanals für die intraartikuläre Rekonstruktion des vorderen Kreuzbandes. Die beschriebene Methode wird helfen, eine Fehlplatzierung des femoralen Bohrkanals im Zuge der intraartikulären vorderen Kreuzbandplastik zu reduzieren. In Kombination mit dem bereits beschriebenen tibialen Zielgerät sind nun die technischen Voraussetzungen für die arthroskopisch-assistierte anatomische vordere Kreuzbandplastik in der Tiermedizin gegeben. / Objective: Cranial cruciate ligament (CrCL) pathology is the most frequent cause of lameness in dogs. In contrast to human medicine, where anatomic reconstruction of the ACL is considered the treatment of choice, intra-articular repair in dogs is not commonly performed and until now has not met with enduring success. Accurate tunnel placement has been shown to be crucial in obtaining a successful outcome after anterior cruciate ligament reconstruction in humans. The first aim of our study was to define the radiographic location of the center of the femoral attachment of the CrCL in dogs, for the pre- operative planning as well as post-operative control of anatomical placement of the femoral tunnel. Second aim of the study was to develop and validate an aiming device for arthroscopic femoral tunnel placement. Materials and Methods: A. Radiographic study: Using femora from 49 adult, orthopedically sound dogs (BW ≥ 20 kg), a radiopaque marker was placed on the cranial border of the femoral footprint of the CrCL. Computed tomography and 3D reconstruction of each femur was performed subsequently, followed by manual segmentation of the footprint on the 3D models and calculation of its center. Finally, virtual digital radiographs in two planes were produced and the location of the calculated center of the CrCL was expressed using three different methods (4x4 box grid method and percentage position for the medio-lateral projection; o’clock position for the disto-proximal projection). B. Aiming device: Hindlimbs (n=12) of 6 cadaveric dogs weighing ≥20 kg were used. One hindlimb from each cadaver was randomly chosen and the caudo- cranial position of the CrCL center was calculated, on standard medio-lateral stifle radiographs, and transferred onto to an adjustable aiming device. During stifle arthroscopy the aiming device was inserted and guide pin placed from extra-to-intra-articular. The position of the resulting bone tunnel was evaluated on stifle radiographs and also compared with the anatomic center of each contralateral hindlimb, in the three dimensional (3D) space. Results: A. Radiographic study: In the medio-lateral radiographs the center of the femoral footprint was consistently located in the second rectangle from the top of the most caudal column of the 4x4 grid. The mean percentage caudo- cranial and proximo-distal location was 20.2% (± 2.2) and 33.8% (± 3.7), respectively. In the disto-proximal radiograph, the o’clock position of the CrCL center was between 2 and 3 o’clock in 97.6% of the femora. B. Aiming device: According to the postoperative radiographs, the location of all 6 intra-articular tunnel openings was consistent with the results of the radiographic study. In 3D space, arthroscopic femoral drilling resulted in a median deviation of the drill tunnels of 0.6 mm around the CrCL center. All tunnel openings were located within the CrCL insertion. Conclusions: The reported data can be used to plan and verify the placement of the femoral tunnel opening during intra-articular anatomic CrCL repair. The use of the aiming device suggests that arthroscopic femoral tunnel placement can be achieved with high precision. The measurement for the device can be derived from a standard medio-lateral radiograph of the stifle, which is part of the diagnostic work up of every dog with lameness localized in the stifle. The proposed technique may reduce femoral tunnel misplacement when performing intra-articular CrCL repair in dogs. In combination with the described technique for arthroscopic tibial tunnel drilling, arthroscopic assisted anatomic reconstruction of the CrCL in dogs can be achieved.

Background: To ensure adequate function after orthopedic tumor reconstruction, it is important to reattach the remaining soft tissue to the implant. This study aimed at obtaining mechanical properties of textile muscle-implant and muscle-bone connections in a preliminary test. Methods: Two groups of soft-tissue attachment were mechanically tested and compared: Native bone-muscle samples obtained from human femora and muscles attached to a prosthetic implant by means of Trevira® attachment tubes. Additionally, muscle samples were tested with muscle fibers aligned parallel and perpendicular to the tension load. A uniaxial load was exerted upon all samples. Results: Failure loads of 26.7 ± 8.8 N were observed for the native bone-muscle group and of 18.1 ± 9.9 N for the Trevira® group. Elongations of 94.8 ± 36.2 % were observed for the native bone-muscle group and 79.3 ± 51.8 % for the Trevira® group. The location of failure was mainly observed in the central area of the muscle fibers. Muscle fibers with parallel fiber orientation (47.6 ± 11.5 N) yielded higher tensile strength than those with perpendicular fiber orientation (14.8 ± 4.1 N). Conclusions: Our experiments showed that higher forces were transmitted in the origin and insertion areas than in areas of flat soft tissue reconstruction using attachment tubes. The data indicate that the tested material allows reattaching muscles, but without reinforcing the insertion site. Therefore, attachment tubes with region-dependent and potentially anisotropic material behavior might be advantageous to optimize muscle-bone load transmission after surgery, which may allow lower complication rates and shorter physical recovery.

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.