Pre-operative pain pressure threshold association with patient satisfaction following Total Knee Arthroplasty.

Background: Total knee arthroplasty (TKA) is commonly performed for the treatment of knee osteoarthritis (KOA). Poor satisfaction continues to be seen after TKA. Whilst reasons for poor patient satisfaction are multifactorial, there is a strong correlation with persistent pain following TKA. Studies have shown an association between local and remote mechanical hypersensitivity, measured using pressure pain thresholds (PPTs), and severity of knee osteoarthritis and functional status. We aimed to determine if the pre-operative PPTs were associated with patient satisfaction following TKA. Methods: A prospective longitudinal study of 77 individuals was undertaken. Regression modelling assessed the relationship between Patient Satisfaction using the Knee Society Score (satisfaction subscale) following TKA for KOA, and PPTs recorded pre-operatively locally and remote to the affected knee, while accounting for potentially confounding patient demographic and psychosocial factors. Results: Lower PPTs (indicating increased mechanical hypersensitivity) locally and remote to the operative knee were modestly associated with lower patient satisfaction in the short-term (six weeks) following TKA (ß 0.25-0.28, adjR2 = 0.14-0.15), independent of demographic or psychosocial influences. However, this relationship progressively diminished in the intermediate and long-term post TKA. Conclusion: While pre-operative PPT measures may provide some foresight to patient satisfaction post TKA in the short term, these measures appear to provide little insight to patient satisfaction in the intermediate and longer term.

Novel multispectral imaging to predict disease progression in pediatric morphea.

BACKGROUND: Morphea, or localized scleroderma, is an inflammatory, fibrosing skin disorder that can be progressive and debilitating. Infrared thermography frequently has false positive results. The aim of this study was to assess the ability of multispectral imaging to predict disease progression in children with morphea. METHODS: Children with morphea were recruited between 2016 and 2022. Multispectral images of affected and matched contralateral unaffected sites were obtained using the Antera™ 3D camera. Clinical assessment was performed using the Localized Scleroderma Assessment Tool (LoSCAT). Children were followed up every 3 months for imaging and clinical review. The main outcome measurement was correlation of hemoglobin gradient between affected and matched contralateral unaffected tissue and progression. RESULTS: Of 17 children, the average age was 12 years (range 6-18 years); most were female (76.5%) and white (94.1%). Nearly two-thirds (64.7%) had linear morphea, 35.2% had plaque morphea; 58.8% had been treated with systemic agents. The average LoSCAT score was 20.6 (range 5-73). The average hemoglobin gradient between affected and matched contralateral unaffected skin was four times higher in those who had progression (average differential 0.3, range 0.1-0.4) compared to those who did not (average differential 0.08, range 0.02-0.15). Using a cut off of a 0.18 hemoglobin gradient between affected and unaffected skin, the sensitivity of multispectral imaging for detecting progression in pediatric morphea is 90% with specificity of 100%. CONCLUSIONS: Multispectral imaging is a novel assessment tool with promising accuracy in predicting progression as an adjunct to clinical assessment in pediatric morphea. Further research should examine its performance against thermography.

What Is the Correlation between Coronal Plane Alignment Measured on Pre- and Postoperative Weight-bearing Radiographs and Intraoperative Navigation When Stress Is Applied to the Knee?

This study examines the correlation between the weight-bearing (WB) long leg radiograph (LLR)-derived hip-knee-ankle angle (HKAA) and intraoperative supine computer-assisted surgery (CAS)-derived HKAA measurements at the beginning and end of total knee arthroplasty (TKA). The primary aim of the study was to determine if WB alignment could be mimicked or inferred based on intraoperative alignment findings. We conducted a prospective analysis from a cohort of 129 TKAs undergoing a CAS TKA at a single center by a single surgeon. The HKAA was recorded using the CAS navigation system immediately postregistration of navigation data and after implantation of the prosthesis. The intraoperative HKAA was recorded in both the supine "resting" position of the knee and also while the knee was manipulated in an effort to replicate the patient's WB alignment. These measurements were compared with the HKAA recorded on pre- and postoperative WB LLRs. There was a strong correlation between the preoperative WB LLR HKAA and the intraoperative preimplant CAS-derived stressed HKAA (R = 0.946). However, there was no correlation between the postoperative WB LLR HKAA and the postimplant insertion HKAA as measured intraoperatively via CAS for either a "resting" or "stressed" position of the operated knee (R = 0.165 and R = 0.041, respectively). Thus, the interpretation of intraoperative alignment data is potentially problematic. Despite technological advances in the development and utilization of computer navigation and robotics in arthroplasty to help obtain the optimal alignment, it would seem apparent from our study that this alignment does not correlate to upright stance postoperatively. Surgeons should apply caution to the strength of assumptions they place on intraoperative coronal plane alignment findings.

Nano-Hydroxyapatite/PLGA Mixed Scaffolds as a Tool for Drug Development and to Study Metastatic Prostate Cancer in the Bone.

(1) Background: Three-dimensional (3D) in vitro, biorelevant culture models that recapitulate cancer progression can help elucidate physio-pathological disease cues and enhance the screening of more effective therapies. Insufficient research has been conducted to generate in vitro 3D models to replicate the spread of prostate cancer to the bone, a key metastatic site of the disease, and to understand the interplay between the key cell players. In this study, we aim to investigate PLGA and nano-hydroxyapatite (nHA)/PLGA mixed scaffolds as a predictive preclinical tool to study metastatic prostate cancer (mPC) in the bone and reduce the gap that exists with traditional 2D cultures. (2) Methods: nHA/PLGA mixed scaffolds were produced by electrospraying, compacting, and foaming PLGA polymer microparticles, +/- nano-hydroxyapatite (nHA), and a salt porogen to produce 3D, porous scaffolds. Physicochemical scaffold characterisation together with an evaluation of osteoblastic (hFOB 1.19) and mPC (PC-3) cell behaviour (RT-qPCR, viability, and differentiation) in mono- and co-culture, was undertaken. (3) Results: The results show that the addition of nHA, particularly at the higher-level impacted scaffolds in terms of mechanical and degradation behaviour. The nHA 4 mg resulted in weaker scaffolds, but cell viability increased. Qualitatively, fluorescent imaging of cultures showed an increase in PC-3 cells compared to osteoblasts despite lower initial PC-3 seeding densities. Osteoblast monocultures, in general, caused an upregulation (or at least equivalent to controls) in gene production, which was highest in plain scaffolds and decreased with increases in nHA. Additionally, the genes were downregulated in PC3 and co-cultures. Further, drug toxicity tests demonstrated a significant effect in 2D and 3D co-cultures. (4) Conclusions: The results demonstrate that culture conditions and environment (2D versus 3D, monoculture versus co-culture) and scaffold composition all impact cell behaviour and model development.

In-Vial Detection of Protein Denaturation Using Intrinsic Fluorescence Anisotropy.

The conventional quality control techniques for identifying the denaturation of biopharmaceuticals includes sodium dodecyl sulfate-polyacrylamide gel electrophoresis for identifying fragmentation, ion exchange chromatography and isoelectric focusing for identifying deamidation, reverse-phase high-performance liquid chromatography (HPLC) for identifying oxidation, and size-exclusion HPLC for identifying aggregation. These stability assessments require essential processes that are destructive to the product tested. All these techniques are lab based and require sample removal from a sealed storage vial, which can breach the sterility. In this work, we investigate the heat- and surfactant-induced denaturation of an in-vial-stored model protein, bovine serum albumin (BSA), by analyzing its intrinsic fluorescence without removing the sample from the vial. A lab-based bespoke setup which can do the measurement in vial is used to demonstrate the change in fluorescence polarization of the protein to determine the denaturation level. The results obtained are compared to circular dichroism and size-exclusion HPLC measurements. The results prove that in-vial fluorescence measurements can be performed to monitor protein denaturation. A cost-effective portable solution to provide a top-level overview of biopharmaceutical product stability from manufacture to the point of patient administration can be further developed using the same technique.

Further exploring the relationship between pressure pain thresholds and function in knee osteoarthritis.

BACKGROUND: Studies in Knee Osteoarthritis (KOA) have shown lowered Pressure Pain Threshold (PPT) values compared to healthy controls potentially signifying mechanical hypersensitivity, although the relevance of these findings to knee function remains unclear. OBJECTIVE: This study further explores the relationship between PPT measures and knee function (self-reported, physical) in individuals undergoing total knee arthroplasty for advanced KOA. DESIGN: Cross-sectional observational study. METHODS: PPT's were recorded both local to the affected knee and at a remote site (deltoid) in 79 individuals with advanced KOA. Participants also completed self-report (Knee Society Score - functional sub-score) and physical (6-min walk test distance)) measures of knee function, as well as measures of pain-related psychological distress. Hierarchical linear regression models evaluated the relationship between the measures of function (self-report and physical measures modelled separately), PPT measures (local and remote), while accounting for demographic and psychological distress measures. RESULTS: Higher knee PPT scores were independently associated with higher self-reported knee function (ß 0.33, p < 0.02) and higher 6-min walk test distance (ß 0.41, p < 0.01), although pain self-efficacy (ß 0.33, p < 0.01) was also a significant variable in both models. Nearly identical findings were evident for PPT's measured at the deltoid. Overall PPT's could only explain a modest portion of variance (adjusted R2 = 0.15 to 0.17) in the functional measures. CONCLUSIONS: PPT measures may be limited in their capacity to distinguish the impact of peripheral and central pain mechanisms on knee function in individuals undergoing total knee arthroplasty for advanced KOA.

Fluorescence spectroscopy for the determination of reconstitution time of an in-vial lyophilised product.

Lyophilisation is a prominent technique used to create stabilised, dried forms of biopharmaceutical formulations. Reconstitution of lyophilised parenteral formulations is a key step prior to patient administration. The accurate determination of reconstitution time is a necessity to aid formulation development and support product quality control. Traditional methods for quantifying reconstitution time involve the visual identification of the endpoint, which has led to variable values reported across studies. In this work, the use of ultra-violet (UV) excited fluorescence spectroscopy as an alternative to the visual quantification of the reconstitution time was investigated. Spectrographic information was collected via a bespoke setup that allowed the measurement of the reconstitution time in a standard sealed lyophilisation vial. The spectra were analysed via principal component analysis (PCA) to obtain a time-based representation of the changes in a reconstituting formulation. The analysis was followed by the identification of an endpoint using three techniques ranging from fully automated to manual with regards to the required level of user input. At high protein concentration, the variability of the reconstitution time measurements was reduced from 80.4% relative standard deviation obtained via the traditional method to 8.2% for the instrumental method presented in.

Which Pre- and Postoperative Coronal Plane Laxity Parameters Influence Patient Satisfaction and Function after Primary Total Knee Arthroplasty?

Soft tissue balancing, while accepted as crucial to total knee arthroplasty (TKA) outcomes, is incompletely defined as the subject of broad recommendations. We analyzed 120 computer-assisted, posterior stabilized TKA undertaken for osteoarthritis. Coronal plane laxity was measured, in the 91 varus and 29 valgus knees, prior to any bone resection or soft tissue release, and again after implant insertion. Soft tissue laxity parameters were correlated to the American Knee Society Score (2011) at a minimum follow-up of 12 months with a focus on patient function and satisfaction. Thirteen specific laxity parameters showed a significant correlation to satisfaction, one parameter correlated to function, and another to both functional and satisfaction outcomes. Most correlations were weak, the strongest related to postoperative decreases in coronal plane laxity. Greater preoperative varus but not valgus deformity was associated with higher satisfaction scores. Additionally, 30 patients who reported 40 of 40 satisfaction and that their TKA knee felt normal at all times did not have soft tissue balancing parameters distinguishing them from other subjects. Patient satisfaction and function outcomes demonstrated limited correlation to coronal plane soft tissue parameters. It appears that optimizing TKA satisfaction and function is not as simple as producing a narrow range of coronal laxity parameters. The ongoing debate around optimal coronal plane alignment and its subsequent effect on coronal plane soft tissues may not be as independently important as currently argued. Soft tissue balance may need to be considered as a more complex global envelope.

IR Imaging of Solid Lubricant Coatings on Concealed/Disjointed Surfaces for Transparent Polymer Delivery Device Applications.

Transparent polymer delivery devices often contain a solid lubricant coating on a stronger bulk polymer. The distribution of lubricant coating must be monitored for device optimisation appraisals and to ensure consistency during mass production. However, coating evaluation is difficult to perform as surfaces are often concealed and/or disjointed. Dye stain analysis, which is destructive and time-consuming, is the current industry standard. We present a prototype IR transmission microscope to evaluate micron-level coating coverage of polyurethane and/or polyvinylpyrrolidone on a poly(propylene)-based delivery device. The device has a common industrial configuration, containing a duct and bevel. Inferred absorption of the coating was used to identify coating coverage and a multivariate analysis was used to remove the effects of absorption and scattering by the bulk. Coverage on concealed and disjointed surfaces was imaged and evaluated from a single camera viewpoint and ≈50 µm defects were detectable. The industrial applicability of the prototype was demonstrated using comparisons with dye stain analysis by estimating water dilution of coating and identifying artifacts in coating, which may indicate machine malfunction. The sensitivity and speed of the IR technique makes it a favourable alternative to the current industry standard.

Highly Satisfied Total Knee Arthroplasty Patients Display a Wide Range of Soft Tissue Balance.

Soft tissue balancing while crucial for a successful total knee arthroplasty (TKA) is incompletely defined and the subject of broad recommendations. We analyzed 69 unilateral computer-assisted surgery posterior stabilized (PS) TKA subjects who postoperatively scored ≥36 out of a possible 40 points on the satisfaction section of the American Knee Society score (2011). We examined a range of postoperative coronal plane laxity parameters and the correlation between preoperative and postoperative laxity. Total postoperative coronal laxity arcs at maximum extension and 20 degrees of flexion varied between 2 and 12 and 3 and 13 degrees, respectively. Depending on the position of measurement, medial laxity was between 0.5 and 9.5 degrees and lateral laxity between 1 and 12 degrees. The change in laxity between maximum extension and 90 degrees of flexion demonstrated a range of 7 degrees medially and 12 degrees laterally. The total coronal arc of movement did not affect functional outcomes. A moderate correlation of 0.452 and 0.424 was seen between initial and postoperative total coronal laxity arcs in maximum extension and 20 degrees of flexion, respectively. The individual variability for each measured parameter within our cohort demonstrates TKA satisfaction is not as simple as producing a narrow range of coronal laxity parameters and that as with many body systems considerable variation is still consistent with excellent function. Our findings help to define acceptable balance parameters for PS TKA. It does not appear necessary to closely match postoperative laxity to that present preoperatively.

Deep UV Laser-Induced Fluorescence for Pharmaceutical Cleaning Validation.

Cleaning verification and validation is a requirement in the pharmaceutical industry. Due to the limited number of mobile devices that do effective and accurate onsite cleaning verification, it is mostly done via lab-based quality control techniques. These techniques, such as high-performance liquid chromatography (HPLC) or total organic carbon, often lead to extending the validation of cleaning by days. The void of more sensitive, accurate, and portable instruments to verify cleaning onsite has to be filled. The article discusses the use of deep ultra violet (DUV) laser-induced fluorescence for detecting carryover of active pharmaceutical ingredients (APIs) and detergents onsite. A modified spectrometer was used as an offsite bench type prototype for analyzing trace samples of API and cleaning detergents with various substrates. Even if the API to be detected has a low fluorescence efficiency, the specificity of the technique allows API traces having concentrations as low as ≈0.20 µg/cm2 to be identified. The work also shows the possibility of using a probe for validating cleaning of hard to reach areas using DUV laser-induced fluorescence. DUV laser-induced fluorescence of trace API over any polymer/glass substrate has better signal to background ratio (SBR) compared to FTIR absorption techniques. Processing times of DUV laser-induced fluorescence trace detection are shown to be much less than swab based methods.

The Goldilocks Zone of Perceptual Learning.

BACKGROUND/AIMS: Lexically guided perceptual learning in speech is the updating of linguistic categories based on novel input disambiguated by the structure provided in a recognized lexical item. We test the range of variation that allows for perceptual learning by presenting listeners with items that vary from subtle within-category variation to fully remapped cross-category variation. METHODS: Experiment 1 uses a lexically guided perceptual learning paradigm with words containing noncanonical /s/ realizations from s/ʃ continua that correspond to "typical," "ambiguous," "atypical," and "remapped" steps. Perceptual learning is tested in an s/ʃ categorization task. Experiment 2 addresses listener sensitivity to variation in the exposure items using AX discrimination tasks. RESULTS: Listeners in experiment 1 showed perceptual learning with the maximally ambiguous tokens. Performance of listeners in experiment 2 suggests that tokens which showed the most perceptual learning were not perceptually salient on their own. CONCLUSION: These results demonstrate that perceptual learning is enhanced with maximally ambiguous stimuli. Excessively atypical pronunciations show attenuated perceptual learning, while typical pronunciations show no evidence for perceptual learning. AX discrimination illustrates that the maximally ambiguous stimuli are not perceptually unique. Together, these results suggest that perceptual learning relies on an interplay between confidence in phonetic and lexical predictions and category typicality.

Impact of Image-Derived Instrumentation on Total Knee Arthroplasty Revision Rates: An Analysis of 83,823 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.

BACKGROUND: Computer navigation and image-derived instrumentation (IDI) are technology-based methods developed to improve outcomes and potentially reduce revision total knee arthroplasty (TKA). IDI refers to the use of manufactured, patient-specific surgical jigs. Conflicting reports exist on IDI-associated improvements in outcomes. The primary aim of the current study was to compare the rates of revision among TKA cases in which components were initially implanted with use of IDI, computer navigation, or neither of these methods ("other" TKA). The secondary aim was to determine whether the outcomes of IDI differed for specific subgroups. METHODS: Data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) for the 3 TKA groups: IDI, computer-navigated, and other TKA. The study period was from the first IDI procedure recorded by the AOANJRR (April 2010) to December 31, 2016. The analysis was restricted to primary TKA cases undertaken for osteoarthritis and involving patellar resurfacing and the use of a cross-linked polyethylene insert. Subanalyses were performed to evaluate the effects of age, sex, implantation method, IDI manufacturer, prosthetic design, and prosthesis type on the rates of revision. Kaplan-Meier estimates of survivorship described the time to first revision. Hazard ratios (HRs, Cox proportional hazards models) with adjustment for age and sex were used to compare revision rates. RESULTS: IDI was used in 5,486 primary TKA procedures. There was no significant difference among the groups in the cumulative percent revision (CPR) at 5 years: 3.3% (95% confidence interval [CI], 2.4% to 4.6%) for IDI, 2.4% (95% CI, 2.2% to 2.7%) for the computer-navigated group, and 2.5% (95% CI, 2.3% to 2.7%) for other TKA. Posterior-stabilized TKA with use of the IDI method had a significantly higher rate of revision at >3 months (HR, 1.45 [95% CI, 1.02 to 2.04]; p = 0.036), as did IDI TKA in the ≤65-year-old patient cohort (HR, 1.52 [95% CI, 1.10 to 2.09]; p = 0.010), compared with computer-navigated TKA. Patellar revision was significantly more likely in the IDI group. CONCLUSIONS: IDI TKA demonstrated no overall difference in early to mid-term revision rates compared with standard implantation methods. However, elevated rates of revision were seen with posterior-stabilized TKA, in patients ≤65 years of age, and for patellar revision, meaning that this method should be used with some caution and requires further study. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Coronal plane laxity of valgus osteoarthritic knee.

INTRODUCTION: Balanced soft tissues are important to total knee arthroplasty (TKA) outcomes. Surgical algorithms for balancing are potentially varied in varus and valgus osteoarthritic (OA) knees. While coronal plane varus knee laxity has been documented, no study has objectively defined the medial and lateral laxity of the valgus OA knee. The lower limb was manipulated at the time of TKA using computer navigation, prior to surgical releases, to allow the limb weight-bearing axis to pass through the knee center in maximum extension, 20° and 90° of flexion. The hip-knee-ankle-angle was documented at this position. Coronal plane laxity was then measured in 30 valgus (7.9 ± 4.0°) knees as medial and lateral displacement from this point and compared to published values for healthy subjects. In maximum knee extension, lateral contracture was present in 26.6% (8/30) of subjects, and abnormally lax medial tissue was present in 46.6% (14/30). Six patterns of medial versus lateral laxity were documented in maximum extension. In maximum knee extension, mean medial laxity was 7.1° (±3.8°) compared to 2.7° (±2.7°) laterally. In 20° of knee flexion, mean medial laxity was 8.5° (±3.5°) compared to 3.0° (±2.6°) laterally. In 90° of knee flexion, mean medial laxity was 3.7° (±1.3°) and 7.5° (±3.0°) laterally. A highly significant difference ( p < 0.0001) in mean laxity was demonstrated when comparing medial versus lateral values at each measurement angle and for medial versus medial and lateral versus lateral values for maximum extension and 90° of flexion. The valgus knee at the time of TKA demonstrates significant preoperative mediolateral and flexion-extension imbalance. In maximum extension, medial tissue is significantly laxer whereas in flexion this reverses and the lateral tissue is significantly laxer. We documented more patterns of medial and lateral laxity in maximum extension than advocated in prior subjective grading systems. These findings demonstrate the challenges of valgus OA knee balancing during TKA but provide, for the first time, objective measures for the starting point of this process.

Mid-infrared optical sensing using sub-wavelength gratings.

Optical sensing has shown great potential for both quantitative and qualitative analysis of compounds. In particular sensors which are capable of detecting changes in refractive index at a surface as well as in bulk material have received much attention. Much of the recent research has focused on developing technologies that enable such sensors to be deployed in an integrated photonic device. In this work we demonstrate experimentally, using a sub-wavelength grating the detection of ethanol in aqueous solution by interrogating its large absorption band at 9.54 µm. Theoretical investigation of the operating principle of our grating sensor shows that in general, as the total field interacting with the analyte is increased, the corresponding absorption is also increased. We also theoretically demonstrate how sub-wavelength gratings can detect changes in the real part of the refractive index, similar to conventional refractive index (RI) sensors.

Major Aseptic Revision Following Total Knee Replacement: A Study of 478,081 Total Knee Replacements from the Australian Orthopaedic Association National Joint Replacement Registry.

BACKGROUND: Major revision is associated with less satisfactory outcomes, substantial complications, and added cost. Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were analyzed to identify factors associated with major aseptic revision (MAR) of primary total knee replacement (TKR). METHODS: The cumulative percent major aseptic revision rate following all primary TKRs performed in Australia from September 1, 1999, to December 31, 2015, was assessed. Kaplan-Meier estimates of survivorship were utilized to describe the time to first revision. Hazard ratios (HRs) from Cox proportional hazard models, adjusted for age and sex, were utilized to compare revision rates. RESULTS: There were 5,973 MARs recorded from the total cohort of 478,081 primary TKRs. The cumulative percent MAR at 15 years was 3.0% (95% confidence interval [CI], 2.8% to 3.2%). Fixed bearings had a significantly lower rate of MAR at 15 years: 2.7% (95% CI, 2.4% to 2.9%) compared with 4.1% (95% CI, 3.8% to 4.5%) for mobile bearings (HR, 1.77 [95% CI, 1.68 to 1.86]; p < 0.001). Age had a significant effect on MAR rates, with a cumulative percent revision at 15 years for patients <55 years old of 7.8% (95% CI, 6.5% to 9.2%) compared with 1.0% for those ≥75 years old (95% CI, 0.8% to 1.1%; p < 0.001). Minimally stabilized TKR had a lower rate of MAR compared with posterior-stabilized TKR after 2 years (HR, 0.83 [95% CI, 0.77 to 0.90]; p < 0.001). Cementless fixation had a higher rate of revision than cemented or hybrid fixation. There was a higher rate of MAR with non-navigated compared with computer navigated TKR (HR, 1.32 [95% CI, 1.21 to 1.44], p < 0.001). The tibial component was revised more commonly than the femoral component. CONCLUSIONS: Younger age, posterior stabilization, cementless fixation, a mobile bearing, and non-navigation were risk factors for higher rates of MAR following TKR. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Evidence of generalised mechanical hyperalgesia in patients with advanced knee osteoarthritis undergoing total knee arthroplasty.

BACKGROUND AND OBJECTIVE: Persistent pain is reported in up to 34% of patients following total knee arthroplasty (TKA) for management of knee osteoarthritis (KOA). Persistent pain in this group is thought to be at least partly reflective of pain sensory hypersensitivity. The objective of this study was to evaluate sensory hypersensitivity, using mechanical and thermal quantitative sensory testing, in patients about to undergo TKA. DESIGN AND METHODS: Pressure pain thresholds (PPT) and cold pain thresholds (CPT) were recorded from 30 participants prior to their TKA, and compared with recordings taken from 30 healthy control participants of similar age and gender. Thresholds were recorded locally and remotely (other knee, deltoid) to the operative knee. Group comparisons (KOA, control, groups) were made using a general linear mixed models approach with age, gender, and body mass index (BMI) included as covariates. Pairwise comparisons were conducted with Bonferonni correction for multiple comparisons. RESULTS: Significantly lower PPTs were at all measured sites in the KOA group compared to the control group (P<0.001 at all sites, except the deltoid P=0.004). Males demonstrated higher pain threshold compared to females, averaged over all sites, P=0.02. There were no observed between-group differences in CPT (P=0.122). CONCLUSIONS: This study suggested that some individuals about to undergo TKA for their advanced KOA demonstrated widespread mechanical sensory hypersensitivity. These findings have potentially important clinical implications regarding perioperative and longer-term pain management in these patients.

Are varus knees contracted? Reconciling the literature.

PURPOSE: There is direct literature conflict regarding coronal plane contracture or laxity in the end-stage varus osteoarthritic knee. Understanding the preoperative soft tissue status is important for optimizing the soft tissue envelope during total knee arthroplasty (TKA). METHODS: The lower limb was manipulated using computer navigation, prior to surgical releases, to allow the limb weight-bearing axis to pass through the knee centre in maximum extension and 20° of flexion. Coronal plane laxity was measured in 78 varus (-7.7° ± 2.8°) knees as medial and lateral displacement from this point and compared to published values for healthy subjects. RESULTS: Medial contracture was present in 12.8% (10/78) of the knees. Of these 10 knees, 5 displayed abnormal lateral laxity. Knees with a contracture in maximum extension also displayed a significant decrease ( p < 0.0001) in medial laxity at 20° of flexion compared to non-contracted knees. In maximum extension, 19.2% (15/78) of knees had abnormally increased lateral laxity, 10 did not have a medial contracture. The remaining five knees with increased lateral laxity or 6.4% (5/78) of the total cohort also displayed a medial contracture. Lateral laxity increased significantly with increasing varus deformity. Medial laxity did not significantly decrease when comparing varus deformity of 5-10° versus >10°. CONCLUSION: The majority of varus knees with deformity of up to 15° have neither a medial contracture nor abnormal lateral laxity when referenced to the individualized neutral axis of the knee. Surgical releases during TKA should be uncommon. Medial contracture when present is influenced by both posterior and medial structures. Lateral laxity is a more consistent feature of the varus knee. The patterns of contracture and laxity are variable with limited correlation to deformity.

Near-infrared monitoring of roller compacted ribbon density: Investigating sources of variation contributing to noisy spectral data.

The aim of this study was to highlight how variability in roller compacted ribbon quality can impact on NIR spectral measurement and to propose a simple method of data selection to remove erroneous spectra. The use of NIR spectroscopy for monitoring ribbon envelope density has been previously demonstrated, however to date there has been limited discussion as to how spectral data sets can contain erroneous outliers due to poor sample presentation to the NIR probes. In this study compacted ribbon of variable quality was produced from three separate blends of microcrystalline cellulose (MCC)/lactose/magnesium stearate at 8 Roll Force settings (2-16kN/cm). The three blends differed only in the storage conditions of MCC prior to blending and compaction. MCC sublots were stored at ambient (41% RH/20°C), low humidity (11% RH/20°C) and high humidity (75% RH/40°C) conditions prior to blending. Ribbon envelope density was measured and ribbon NIR spectral data was acquired at line using a multi-probe spectrometer (MultiEye™ NIR). Initial inspection of the at-line NIR spectral data set showed a large degree of variability which indicated that some form of data cleaning was required. The source of variability in spectral measurements was investigated by subjective visual examination and by statistical analysis. Spectral variability was noted due to the storage conditions of MCC prior to compaction, Roll Force settings and between individual ribbon samples sampled at a set Roll Force/Blend combination. Variability was also caused by ribbon presentation to probes, such as differences in the presentation of broken, curved and flat intact ribbons. Based on the subjective visual examination of data, a Visual Discard method was applied and was found to be particularly successful for blends containing MCC stored at ambient and low humidity. However the Visual Discard method of spectra cleaning is subjective and therefore a non-subjective method capable of screening for erroneous probe readings was developed. For this data set a Trimmed Mean method was applied to set a limit on how data is cleaned from the data set allowing for the removal of a faulty probe reading (25% of data) or a poor sample (33% of data). The 33% Trimmed Mean reduced the impact of spectral variation or misreads between samples or probes and was found to be as successful as the Visual Discard method at cleaning the data set prior to development of the calibration equation.