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IntroductionTibial component design and positioning contribute more to patient satisfaction than previously realized. A surgeon needs to decide on the size and rotation, bearing in mind that coverage should be as high as possible, whilst malrotation and overhang should be avoided. No study investigates the impact of each of these components on clinical outcomes in a single cohort.Materials and methodsThis is a retrospective analysis of 1-year postoperative outcomes measured with the Knee Injury and Osteoarthritis Outcome (KOOS) Score, as well as a previously validated rotational CT protocol. Coverage, rotation from Insall’s axis, and overhang of an asymmetric tibial baseplate were measured, and positive and negative correlations to clinical outcomes were calculated.ResultsA total of 499 knees were analyzed. Patient average age was 68.4 years. Rotation within 7° internal and 5° external from Insall’s axis was a “safe zone”. Mean coverage was 76%. A total of 429 knees (94%) had a coverage of at least 70% and 102 knees (22%) greater than 80%. Overhang was detected in 23% of the cohort. Increased coverage was correlated to increased KOOS score and overhang correlated with a decreased KOOS score (p = 0.008).ConclusionsThis study demonstrates the individual role of three aspects of tibial component implantation properties in postoperative pain and short-term functional outcomes. Upsizing to the point of overhang with rotational tolerance of 7° internal and 3° external to Insall’s axis demonstrates best patient reported outcomes. Overhang decreases the clinical outcome by the same margin as loss of 16% of coverage.

Background Successful component alignment is a major metric of success in total knee arthroplasty. Component translational placement, however, is less well reported despite being shown to affect patient outcomes. CT scans and planar X-rays are routinely used to report alignment but do not report measurements as precisely or accurately as modern navigation systems can deliver, or with reference to the pre-operative anatomy. Methods A method is presented here that utilises a CT scan obtained for pre-operative planning and a post-operative CT scan for analysis to recreate a computation model of the knee with patient-specific axes. This model is then used to determine the post-operative component position in 3D space. Results Two subjects were investigated for reproducibility producing 12 sets of results. The maximum error using this technique was 0.9° ± 0.6° in rotation and 0.5 mm ± 0.3 mm in translation. Eleven subjects were investigated for reliability producing 22 sets of results. The intra-class correlation coefficient for each of the three axes of rotation and three primary resection planes was > 0.93 indicating excellent reliability. Conclusions Routine use of this analysis will allow surgeons and engineers to better understand the effect of component alignment as well as the placement on outcome.

Introduction Total Knee Arthroplasty (TKA) for both patients and the surgical team is a journey spanning many months, rather than purely a hospital episode of care. To improve patient outcomes and reduce costs in TKA, greater emphasis should be placed on the pre- and postoperative periods as, historically, innovation has focused on the intraoperative execution of the surgery. The purpose of this study was to determine if a pre- and postoperative physiotherapy program delivered via a digital application could reduce hospital length of stay (LOS) without compromising patient outcomes. Methods A retrospective series of 294 patients who underwent TKA from a single-surgeon in a single-centre was examined. This included 232 patients who underwent a pre- and postoperative physiotherapist-led program delivered via a digital application and 62 patients who underwent a conventional pre- and postoperative protocol. 2:1 nearest neighbour propensity score matching was performed to establish covariate balance between the cohorts. Data collected included pre- and postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS for Joint Replacement (KOOS, JR), and acute, rehabilitation, and total LOS. Results No significant difference in KOOS or KOOS, JR scores was observed at 12-month follow-up. A significantly reduced rehabilitation ( P = 0.014) and total LOS ( P = 0.015) was observed in the patients who received the digital physiotherapy program. Conclusions There may be significant economic benefits to a pre- and postoperative physiotherapy program delivered via a digital application. Our results suggest that a digital physiotherapist-led patient program may reduce the need for inpatient rehabilitation services without compromising patient outcomes.

Purpose Joint dynamics following Total Knee Arthroplasty (TKA) may influence patient-reported outcome. Simulations allow many knee alignment approaches to a single patient to be considered prior to surgery. The simulated kinematics can be matched to patient-reported outcome to predict kinematic patterns most likely to give the best outcome. This study aims to validate one such previously developed algorithm based on a simulated deep knee bend (the Dynamic Knee Score, DKS). Methods 1074 TKA patients with pre- and post-operative Computerised Tomography (CT) scans and 12-month post-operative Knee Injury and Osteoarthritis Outcomes (KOOS) Scores were identified from the 360 Med Care Joint Registry. Landmarking and registration of implant position was performed on all CT scans, and each of the achieved TKAs was computationally simulated and received a predictive outcome score from the DKS. In addition, a set of potential alternative surgical plans which might have been followed were simulated. Comparison of patient-reported issues and DKS score was evaluated in a counter-factual study design. Results Patient-reported impairment with the knee catching and squatting was shown to be 30% lower ( p  = 0.005) and 22% lower ( p  = 0.026) in patients where the best possible DKS result was the one surgically achieved. Similar findings were found relating attainment of the best tibial slope and posterior femoral resection DKS plans to patient-reported difficulty straightening the knee (40% less likely, p  < 0.001) and descending stairs (35% less likely, p  = 0.006). Conclusion The DKS has been shown to correlate with presence of patient-reported impairments post-TKA and the resultant algorithm can be applied in a pre-operative planning setting. Outcome optimization in the future may come from patient-specific selection of an alignment strategy and simulations may be a technological enabler of this trend. Level of evidence. III (Retrospective Cohort Study).

Identifying key physiological factors is essential in cycling; however, the unique nature of BMX decreases the validity and transferability of research findings from other cycling disciplines. Therefore, this study highlighted the physical and physiological characteristics of BMX riders that could influence track performance. Fifteen sub-elite BMX riders (male n = 12; age 18.3 ± 3.3 and female n = 3; 17.7 ± 5.7 years) undertook a battery of laboratory tests on three different occasions, including body composition, upper and lower body strength, flexibility, sprint and aerobic capacity measures. On a separate day, participants completed three full lap sprints on an outdoor BMX track. Correlation and multiple linear regression analyses were performed to develop predictive models of performance across the laboratory tests and race time. The final model indicated power to weight ratio, relative back-leg-chest strength and arm span explained ~87% of the variability in finish time (adjusted R2 = 0.87, p < .01). These findings highlighted the importance of a multidimensional approach for developing BMX race performance. Coaches should prioritise these variables in their training programs and selection of future talents. However, further physiological and biomechanical investigation is needed to validate current findings, particularly among elite riders.

Knee meniscal injuries account for the greatest number of surgical procedures performed by orthopaedic surgeons worldwide. Each year in excess of 400,000 operations are performed in Europe and over one million in the United States and yet no suitable replacement for the meniscus is available. Fibrocartilage tissue engineering holds great potential in the regeneration of meniscal tissue however current developments have been limited. Difficulties in imitating the anisotropic nature of the meniscus, patient specific geometry, attaining sterility assurance requirements remain as developmental challenges for meniscal scaffold devices. A novel approach was developed to rapidly form terminally sterilized pre-packaged scaffold templates into anatomically matched regenerative meniscal implants. Formed meniscal implants exhibited the structural and functional architecture of the native meniscus. Meniscal implants fabricated using this method displayed mechanical properties approaching to that of the native meniscus and imparted rotational stability. Fixation techniques influenced the biomechanical response of implants and 45S5 bioactive glass modification was found to enhance radio-opacity of the scaffold. Biocompatibility of the implant was confirmed using a fibroblast cell culture model.

When it comes to analyzing the value of a pharma company, the pipeline is often overlooked. This is a major issue for the pharmaceutical industry, but companies have not moved the needle much over the years. Keeping pipeline programs quiet is not only hurting the way analysts value traditional pharma companies, it is hurting the entire industry's reputation. Almost two decades of pushing R&D news has resulted in a potent branding of biotechs as innovators focused on exciting new science and on patients with rare and hard-to-treat diseases. Pharma companies can learn form biotechs by developing a communications strategy for each Phase II and Phase III product.

The FDA-approved drugs represent a company's prospects today. Drugs in the pipeline embody the company's future. But when it comes to analyzing the value of pharma company, the pipeline is often overlooked. Miles stresses that the industry can help its bad rep by communicating the promise of its pipeline--and the value of its companies.