Tato práce se zabývá pokročilou technologií výroby personalizovaných kloubních implantátů metodou EBM za použití titanové slitiny Ti6Al4V-ELI a navrhuje nový unikátní design kolenního implantátu společně s metodologií jeho inserce, přičemž tato řešení jsou součástí patentové přihlášky č. PV 2020-459. Toto neinvazivní řešení náhrady kolenního kloubu je šetrnější k pacientovi, maximálně chrání jeho zdravé tkáně a kosti, navíc se dá předpokládat vyšší životnost implantátu ve srovnání s tradičními dostupnými řešeními. Byla uskutečněna výroba vzorků z materiálu Ti6Al4V-ELI metodou EBM, proveden rozbor jejich materiálových, mechanických, technologických a únavových vlastností. Dále byly popsány pokročilé metody zobrazování, úpravy a tvorby kloubních ploch a použity k vyvinutí nového designu personalizovaného kloubního implantátu společně s inovační technologií jeho inserce a nástroji potřebnými k její úspěšné realizaci. Toto nové řešení bylo úspěšně ověřeno mnoha testy i výrobou Ti6Al4V-ELI a CoCrMo prototypů implantátů metodou EBM. Proveditelnost a použití v praxi bylo konzultováno a schváleno odborníky v této oblasti.

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Purpose Allergy against implant materials is discussed controversially and still not fully understood. Despite these controversies, a relevant number of patients receive hypoallergenic knee implants. The aim of this study was to compare a new coating system with the standard implant in total knee arthroplasty (TKA). Additionally, the influence of proinflammatory cytokines on patient-reported outcome measures (PROMs) was investigated. Methods 120 patients without known metal allergy and without previous metal implants were included. The patients were randomized to receive a coated or standard TKA of the same knee system. 105 patients completed the 5 year follow-up. Patient-reported outcome measures (PROMs) including knee function (Oxford Knee Score, OKS), quality of life (SF36) and UCLA activity scale were assessed. Additionally, several cytokines with a possible role in implant allergy were measured in patient`s serum (IL-1beta, IL-5, IL-6, IL-8, IL-10, IP-10, IFN γ, TNF α). Group comparison was performed using Mann–Whitney U test for continuous values and chi-square test for categorical values. Results There were no differences in PROMs between both groups at any follow-up. The majority of patients demonstrated no elevation of the measured blood cytokines. The blood cytokine pattern after 5 years demonstrated no differences between study groups. There was a significant association between elevated IL-8 values and worse results in the overall OKS (p = 0.041), the OKS function component (p = 0.004), the UCLA activity scale (p = 0.007) and the physical component of SF36 (p = 0.001). Conclusion There were no problems with the new coating during mid-term follow-up and no differences in PROMs between coated and standard TKA. Patients with an increased inflammatory response demonstrated worse functional results, regardless of the implant. Level of evidence I. Clinical trial registration The study protocol was registered in the US National Institutes of Health’s database (http:// www.clini caltr ials. gov) registry under NCT00862511.

No / We retrospectively reviewed the hospital records of 68 patients who had been referred with an injury to the posterolateral corner of the knee to a specialist knee surgeon between 2005 and 2009. These injuries were diagnosed based on a combination of clinical testing and imaging and arthroscopy when available. In all, 51 patients (75%) presented within 24 hours of their injury with a mean presentation at eight days (0 to 20) after the injury. A total of 63 patients (93%) had instability of the knee at presentation. There was a mean delay to the diagnosis of injury to the posterolateral corner of 30 months (0 to 420) from the time of injury. In all, the injuries in 49 patients (72%) were not identified at the time of the initial presentation, with the injury to the posterolateral corner only recognised in those patients who had severe multiple ligamentous injuries. The correct diagnosis, including injury to the posterolateral corner, had only been made in 34 patients (50%) at time of referral to a specialist knee clinic. MRI correctly identified 14 of 15 injuries when performed acutely (within 12 weeks of injury), but this was the case in only four of 15 patients in whom it was performed more than 12 weeks after the injury. Our study highlights a need for greater diligence in the examination and investigation of acute ligamentous injuries at the knee with symptoms of instability, in order to avoid failure to identify the true extent of the injury at the time when anatomical repair is most straightforward.

Medial osteoarthritis (OA) and lateral OA have distinct characteristic cartilage lesion locations and knee flexion angles associated with lesion development. These types of OA are suggested to be caused by loading when the knee is in extension and mid-range flexion, respectively. This project used subject-specific finite element (FE) models to investigate contact conditions within the extended and flexed knee. A method of creating subject-specific FE models by combining geometry (derived from magnetic resonance imaging scans) and load cases (calculated from motion analysis data) collected from the same subject was developed. This model creation method was validated by comparing experimentally-measured pressure data to contact data calculated by FE models. Models of normal knees in three subjects were created first. Models with larger subject-specific loads had larger displacements and higher stresses and contact pressures. Contact occurred over most of the articulating cartilage surfaces, both in areas of typical cartilage lesions and outside areas of typical cartilage lesions. Parameters in the normal models were then altered to reflect three mechanical changes hypothesized to lead to OA: increased loading, globally decreased cartilage stiffness, and locally decreased cartilage stiffness. Increased loading led to increased displacements, stresses, and contact pressures. Contact shifted anteriorly in the extended knee models to locations of typical medial OA cartilage lesions; contact remained stationary with elevated stress magnitudes in the flexed knee models. Globally decreasing cartilage stiffness had limited effects on contact results. Locally decreased cartilage stiffness led to locally increased displacement and strain and locally decreased stress and contact pressure. Contact again shifted anteriorly in the extended knee models. Potential mechanisms of OA initiation were then proposed. Increased weight or locally decreased cartilage stiffness increased strains within the cartilage. High strains can damage the cartilage matrix fibres, further decreasing cartilage stiffness and eventually leading to cartilage lesions and OA.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2009. / The ability to walk has been rated by stroke patients as one of the most important goals of their rehabilitation. Knee control is a key element in normal gait. Currently, treatment options aimed at improving poor knee control in stroke patients are often costly, need specialised equipment and have poor patient compliance. The purpose of the current study was to assess whether medial patellar taping could improve knee control in stroke patients. Gait speed, dynamic standing balance, knee alignment and whether the subjects experienced any subjective stabilising effect on the knee after taping were tested. Twenty subjects diagnosed with hemiplegia after a stroke served as their own controls in a repeated measures experimental study. Results indicated that dynamic standing balance as tested by the Step Test (p=0.063) and the Timed-up-and-go test (p=0.099) (Wilcoxon test) showed marginal improvement after taping. This improvement in dynamic standing balance may indicate that neuro-motor control and/or eccentric knee control had improved. There was no change in walking speed and knee alignment as tested by change in the Q-angle (Wilcoxon test). However, a decrease in the Q-angle correlated with an improvement in dynamic standing balance as tested by the Step Test (p=0.029) (Spearman‟s test). Participants with decreased Q-angles after taping possibly had better knee alignment and were more willing to accept weight on their affected leg indicating a change in quadriceps activation. No change in walking speed (p=0.351) (Wilcoxon test) before and after taping may indicate that there was no change in the magnitude of contraction and/or concentric activity in the quadriceps muscle. Thirty percent of the participants reported a subjective change in knee stability after taping. Subjective change did not, however, significantly correlate with either of the balance tests, walking speed or Q-angle measurements. The possibility that medial patellar taping may be useful in treating poor knee control in stroke patients during dynamic balance activities should be investigated further.

Thesis (MScPhysio)--Stellenbosch University, 2012. / Background: Evidence for the effectiveness of physiotherapeutic interventions in the management of knee osteoarthritis (OA) is synthesised in the current clinical guidelines (CGs), providing clinicians with readily accessible and interpretable practice guidelines. However, CGs are often not specific to the local context of the target users, therefore hindering successful implementation of evidence into clinical practice. Formulating succinct and composite recommendations by synthesising the current CGs reporting on the evidence-based (EB) management of knee OA may assure contextual relevance and facilitate implementation of evidence into clinical practice. In addition, multifaceted interventions, such as evidence-based practice (EBP) workshops, are also postulated to promote the implementation of guideline recommendations, thereby enhancing clinical outcomes. Objectives: The primary objectives of this study were to: 1) describe the range of EB physiotherapeutic interventions in the management of knee OA as documented in the current CGs; and 2) develop composite clinical recommendations for a specific group of users working in Jerusalem. A secondary study objective was to ascertain the effect of translating the knowledge through a specifically-designed EBP workshop on the uptake of knowledge and implementation of EBP into clinical practice by physiotherapists working in Jerusalem. The EBP workshop was aimed at educating physiotherapists about the EB physiotherapeutic techniques for knee OA management. Study design: Two studies were conducted. A systematic review (SR) into EB clinical guidelines was conducted to describe and synthesise the available evidence and formulate composite recommendations for knee OA. The results of the SR were used to design an EBP workshop aimed at educating physiotherapists about EB physiotherapeutic techniques for treating knee OA patients. A pre-post quasi-experimental design was then conducted to assess the effect of this EBP workshop on the uptake and implementation of EBP into clinical practice amongst public sector physiotherapists working in Jerusalem. Methodology for quasi experimental study: Physiotherapists who regularly treat knee OA patients were recruited from a list of members registered with the Palestinian Physiotherapy Association Jerusalem. A three-month retrospective audit (initial audit) of knee OA patients’ physiotherapy records kept by the participating physiotherapists was conducted to establish current management patterns. EB strategies for knee OA was presented to the participating physiotherapists during a one-day workshop. A second audit of physiotherapy records was conducted three months after the EBP workshop to establish changes in the selection of physiotherapeutic management techniques for knee OA. Results: The initial audit revealed that the participating physiotherapists utilized one high EB modality namely, exercises, as a core management strategy in knee OA, but did not frequently implement other high EB modalities such as self-management and weight-loss programs. Following the EBP workshop, a statistically significant increase (p=0.008) in the implementation of weight-loss and self-management strategies in the management of knee OA was noted. Conversely, a statistically significant decrease was noticed in using patellar taping (low EB modality) in the management of knee OA (p=0.04). No significant changes were noticed in the utilization of other physiotherapy modalities supported by weak or modest EB recommendations. Conclusion: The study concluded that physiotherapists inherently prescribed exercise as a core management strategy for knee OA. Modalities supported by modest levels of evidence were used as adjunct treatments. The EBP workshop facilitated the increased application of high EB modalities such as weight-loss and self-management programs. The results of this study illustrate that an EBP workshop may be effective in promoting the implementation of EB physiotherapeutic modalities in the management of knee OA. However, larger studies with longer follow-up periods are required. / No Afrikaans abstract available

Thesis (MScPhysio)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction: Groin injuries are among the top six injuries in contact sports and may lead to career ending chronic pain. Research on the role of knee kinematics in developing chronic groin pain in sport is scarce. Objective: The purpose of this study was to determine if there are differences in knee kinematics during a single-leg drop-landing in sports participants with chronic groin pain compared to asymptomatic controls. Methodology: A descriptive study was conducted. Twenty active sports’ participants were recruited from soccer and rugby clubs situated around the Cape Peninsula area, Western Cape, South Africa. The three-dimensional (3D) knee kinematics of ten cases with chronic groin pain and ten asymptomatic controls was analysed. Knee kinematics was analysed in the FNB-3D Vicon Laboratory at Stellenbosch University, using an eight camera Vicon system. A positive adductor squeeze test was used as a diagnostic test to include cases with chronic groin pain. Each participant performed six single-leg drop landings. The main outcome measure was 3D knee kinematics at initial foot contact and at the lowest vertical position of the drop landing. The following sub-groups were analysed: seven unilateral groin pain cases compared to their seven matched controls; three bilateral groin pain cases where their most painful leg and least painful leg were compared to their matched controls, respectively. Descriptive statistical techniques were used for all outcome measures; means and standard deviations (SD) were calculated, followed by a Student’s t-test to determine significant differences between the cases and controls. For all outcomes with p-values equal to or below 0.05, the effect size was calculated using the Cohen’s D. Results: The findings of this study indicated a significant difference (p=0.0001) between cases with unilateral groin pain having less knee internal rotation compared to the controls at the lowest vertical position of the drop landing in the transverse plane. Significantly less internal rotation (p<0.0001), was also noted in the cases with bilateral groin pain (in the most painful leg and the less painful leg), although this was noted at foot contact. Cases with bilateral groin pain also had significantly (p<0.001) more knee varus (adduction) during the landing phase. Conclusion: Differences in knee kinematics between sports participants with chronic groin pain and asymptomatic controls were found. These findings imply that the knee joint should be included during assessment and rehabilitation of individuals suffering with chronic groin pain. Due to the cross-sectional study design of the current study, it cannot be stated for certain whether the knee kinematics noted in the groin pain group are causative or as a result of groin pain. Future prospective studies are thus recommended; these studies should focus on the effect of contralateral knee kinematics on the hip adductors and may include exploration of the muscular components during a single-leg drop landing. / AFRIKAANSE OPSOMMING: Inleiding: Lies beserings is een van die top ses beserings in kontak sport en kan lei tot chroniese lies pyn en selfs die be-eindigging van ‘n sportloopbaan. Navorsing oor die rol van knie kinematika in die ontwikkeling van chroniese liesbeserings in sport is skaars. Doelwit: Die doel van hierdie studie was om te bepaal of daar verskille in die knie kinematika is tydens 'n enkel been val landing in sport deelnemers met chroniese lies pyn in vergelyking met gesonde kontroles. Metode: 'n Beskrywende studie was uitgevoer. Twintig aktiewe sport deelnemers is gewerf van rugby en sokker sportklubs geleë rondom die Kaapse Skiereiland, Wes-Kaap, Suid-Afrika. Die 3D knie kinematika van tien gevalle met chroniese lies pyn en tien asimptomatiese bypassende kontroles is ontleed. Knie kinematika was ontleed in die FNB-3D Vicon Laboratorium by die Universiteit van Stellenbosch, met behulp van 'n agt-kamera Vicon stelsel. 'n Positiewe Adduktor druk toets was gebruik as 'n diagnostiese toets om gevalle met chroniese lies pyn in te sluit. Om die knie kinematika te analiseer, het elke deelnemer ses enkel been val landings uitgevoer . Die belangrikste uitkomsmeting was 3D knie kinematika by die aanvanklike voet kontak en by die laagste vertikale posisie van die enkel-been val landing. Die volgende sub-groepe was ontleed: sewe unilaterale lies pyn gevalle in vergelyking met hul sewe bypassende kontroles; drie bilaterale lies pyn gevalle waar hul mees pynlike been, sowel as minder pynlike been onderskeidelik vergelyk was met hul bypassende kontroles. Beskrywende statistiese tegnieke was gebruik vir alle uitkoms maatreëls; gemiddeldes en standaardafwykings (SA) was bereken, gevolg deur 'n Studente’s t-toets om beduidende verskille tussen die gevalle en kontroles te bepaal. Vir al die uitkomste met p-waardes gelyk of onder 0.05, is die effekgrootte bereken deur die Cohen’s D. Resultate: Die bevindings van hierdie studie dui op 'n beduidende verskil (p=0,0001) tussen gevalle met unilaterale lies pyn met minder interne knie rotasie in vergelyking met die kontroles by die laagste vertikale posisie van die val landing in die dwars vlak. Aansienlik minder interne rotasie (p<0,0001), is ook opgemerk in gevalle met bilaterale lies pyn (in die mees pynlike been en die minder pynlik been), alhoewel tydens voet kontak. Gevalle met bilaterale lies pyn het ook betekenisvol (p <0.001) meer knie varus (adduksie) tydens die landingsfase gehad. Gevolgtrekking: Verskille bestaan in die knie kinematika tussen sport deelnemers met chroniese liesbesering pyn en gesonde kontroles. Hierdie bevindinge impliseer dat die knie behoort ingesluit te word tydens die assessering en rehabilitasie van individue met chroniese lies pyn. As gevolg van die deursnee-studie ontwerp van hierdie studie, kan dit nie bevestig word of die knie kinematika die oorsaak van die chroniese pyn is nie. Toekomstige voornemende studies word dus aanbeveel, hierdie studies moet fokus op die effek van die kinematika van die kontralaterale knie op die heup adduktore en kan moontlik die ondersoek van die spier kinetika tydens hierdie aktiwiteit insluit.

Low trauma hip fractures, due to bone fragility, are a major healthcare burden with serious consequences for individuals in terms of long-term morbidity and mortality; and also for society due to the high medical and care costs associated with these injuries. Because of the association with low bone mass, these fractures are particularly prevalent in elderly populations and are likely to become more common as longevity increases globally. Avoidance of these fractures is therefore an extremely important goal. Low bone mass, manifested in the conditions of osteopenia and osteoporosis, is the primary cause of bone fragility, and reductions in bone mass are the inevitable corollary of aging and menopause. Bone loss may be exacerbated by immobilisation and reduced weight-bearing activity, giving rise to the condition of disuse osteopenia. Immobilisation may itself be the result of low trauma leg fragility fractures that potentially causes further bone density loss. If this loss occurs at the hip, there is an increased risk for hip fracture as a sequela to the original injury. Osteoarthritis is also a condition strongly associated with aging that may necessitate knee arthroplasty as a last stage treatment, potentially causing a period of reduced mobility and weight-bearing activity following surgery. Leg fracture and knee replacement both present additional risk factors for hip fracture due to changes in muscle mass, gait and postural stability that may increase the risk of falls. This study aims primarily to investigate the effects of immobilisation on leg fracture and knee replacement patients, immediately following injury or surgery, in order to quantify bone and muscle loss and to monitor recovery over a one year period. A postmenopausal population were studied as they are already losing bone density systemically and may be at greater risk of further bone loss following immobilisation. Factors of activity, function, weight-bearing, pain, treatments, therapies, health perceptions and mental wellbeing, that potentially contribute to bone loss and recovery, were also investigated. Results from the study may provide information relating to increased future hip fracture risk and lead to treatment options to alleviate bone loss in these groups.