Aims The aim of this study was to compare the clinical outcomes of robotic arm-assisted bi-unicom... more Aims The aim of this study was to compare the clinical outcomes of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) during the first six weeks and at one year postoperatively. Methods A per protocol analysis of 76 patients, 43 of whom underwent TKA and 34 of whom underwent bi-UKA, was performed from a prospective, single-centre, randomized controlled trial. Diaries kept by the patients recorded pain, function, and the use of analgesics daily throughout the first week and weekly between the second and sixth weeks. Patient-reported outcome measures (PROMs) were compared preoperatively, and at three months and one year postoperatively. Data were also compared longitudinally and a subgroup analysis was conducted, stratified by preoperative PROM status. Results Both operations were shown to offer comparable outcomes, with no significant differences between the groups across all timepoints and outcome ...
Aims Unicompartmental knee arthroplasty (UKA) is a bone-preserving treatment option for osteoarth... more Aims Unicompartmental knee arthroplasty (UKA) is a bone-preserving treatment option for osteoarthritis localized to a single compartment in the knee. The success of the procedure is sensitive to patient selection and alignment errors. Robotic arm-assisted UKA provides technological assistance to intraoperative bony resection accuracy, which is thought to improve ligament balancing. This paper presents the five-year outcomes of a comparison between manual and robotically assisted UKAs. Methods The trial design was a prospective, randomized, parallel, single-centre study comparing surgical alignment in patients undergoing UKA for the treatment of medial compartment osteoarthritis (ISRCTN77119437). Participants underwent surgery using either robotic arm-assisted surgery or conventional manual instrumentation. The primary outcome measure (surgical accuracy) has previously been reported, and, along with secondary outcomes, were collected at one-, two-, and five-year timepoints. Analysis ...
Validation testing is a necessary step for inertial measurement unit (IMU) motion analysis for re... more Validation testing is a necessary step for inertial measurement unit (IMU) motion analysis for research and clinical use. Optical tracking systems utilize marker models which must be precise in measurement and mitigate skin artifacts. Prosthesis wearers present challenges to optical tracking marker model choice. Seven participants were recruited and underwent simultaneous motion capture from two marker sets; Plug in Gait (PiG) and the Strathclyde Cluster Model (SCM). Variability of joint kinematics within and between subjects was evaluated. Variability was higher for PiG than SCM for all parameters. The within-subjects variability as reported by the average standard deviation (SD), was below 5.6° for all rotations of the hip on the prosthesis side for all participants for both methods, with an average of 2.1° for PiG and 2.5° for SCM. Statistically significant differences in joint parameters caused by a change in the protocol were evident in the sagittal plane (p < 0.05) on the a...
Jaswal and Akhtar identify the necessary social nature of the human mind, even in autism. We agre... more Jaswal and Akhtar identify the necessary social nature of the human mind, even in autism. We agree with the authors and present significant contributory origins of this autistic isolation in disruption of purposeful movement made social from infancy. Timing differences in expression can be misunderstood in embodied engagement, and social intention misread. Sensitive relations can repair this.
Robot-assisted unicompartmental knee surgery has been shown to improve the accuracy of implant al... more Robot-assisted unicompartmental knee surgery has been shown to improve the accuracy of implant alignment. However, little research has been conducted to ascertain if this results in a measureable improvement in knee function post operatively and a more normal gait. The kinematics of 70 OA knees were assessed using motion analysis in an RCT (31 receiving robotic-assisted surgery, and 39 receiving traditional manual surgery) and compared to healthy knees. Statistically significant kinematic differences were seen between the two surgical groups from foot-strike to mid-stance. The robotic-assisted group achieved a higher knee excursion (18.0°, SD 4.9°) compared to the manual group (15.7°, SD 4.1°). There were no significant difference between the healthy group and the robotic assisted group, however there was a significant difference between the healthy group and the manual group (p < 0.001). Hence robotically-assisted knee replacement with Mako Restoris Implants appears to lead not ...
Unicompartmental knee arthroplasty (UKA) for treatment of medial compartment osteoarthritis has p... more Unicompartmental knee arthroplasty (UKA) for treatment of medial compartment osteoarthritis has potential benefits over total knee arthroplasty but UKA has a higher revision rate. Robotic-assisted UKA is increasingly common and offers more accurate implant positioning and limb alignment, lower early postoperative pain but evidence of functional outcome is lacking. The aim was to assess the clinical outcomes of a single-centre, prospective, randomised controlled trial, comparing robotic-arm-assisted UKA with conventional surgery. A total of 139 participants were recruited and underwent robotic-arm-assisted (fixed bearing) or conventional (mobile bearing) UKA. Fifty-eight patients in the robotic-arm-assisted group and 54 in the manual group at 2 years. The main outcome measures were the Oxford Knee Score, American Knee Society Score and revision rate. At 2 years, there were no significant differences for any of the outcome measures. Sub-group analysis (n = 35) of participants with a p...
Recently, systems have been developed to improve alignment of unicompartmental knee arthroplasty ... more Recently, systems have been developed to improve alignment of unicompartmental knee arthroplasty (UKA) implants, although improvement in function has been difficult to document. The MAKO RIO robotic surgery system has previously shown improvements in in knee flexion during weight acceptance (WA) in comparison to conventional methods at a one year follow up. This study aimed to determine if these improvements remained at five years follow up. Twenty five MAKO and 21 conventional knees were tested using three dimensional gait analysis to measure knee kinematics. Results demonstrated that the MAKO group achieved significantly greater knee flexion in WA than the conventional group which was consistent with results are one year. This could be due to the improved accuracy of prosthesis implantation offered by the MAKO system.
Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine, 2018
This article presents the construction of a flexible drill which is designed to cut a curved cana... more This article presents the construction of a flexible drill which is designed to cut a curved canal in the bone or remove bone materials, to improve the outcome of orthopedic surgery and to facilitate minimally invasive. This article reports the design of the flexible drill and uses it in an experimental rig to evaluate the drilling force generated when cutting bovine bone. The experiments facilitate the measurement of action forces between the mill bits when moving the tip toward or across a bone sample in various configurations caused by bending the flexible drill sheath to enable cutting of a curved path of variable radius in the bone. The reaction force represents the force trying to deflect the mill bit tip away from the bone sample surface and must be resisted in order to continue cutting without deflection or buckling of the tip during the drilling of curved pathways. The experiment shows the flexible drill can cut bones in both configurations and experienced a maximal force o...
The Journal of bone and joint surgery. American volume, Jan 20, 2016
Higher revision rates have been reported in patients who have undergone unicompartmental knee art... more Higher revision rates have been reported in patients who have undergone unicompartmental knee arthroplasty compared with patients who have undergone total knee arthroplasty, with poor component positioning identified as a factor in implant failure. A robotic-assisted surgical procedure has been proposed as a method of improving the accuracy of component implantation in arthroplasty. The aim of this prospective, randomized, single-blinded, controlled trial was to evaluate the accuracy of component positioning in unicompartmental knee arthroplasty comparing robotic-assisted and conventional implantation techniques. One hundred and thirty-nine patients were randomly assigned to treatment with either a robotic-assisted surgical procedure using the MAKO Robotic Interactive Orthopaedic Arm (RIO) system or a conventional surgical procedure using the Oxford Phase-3 unicompartmental knee replacement with traditional instrumentation. A postoperative computed tomographic scan was performed at ...
Over the last decade Computer Assisted Orthopaedic Surgery (CAOS) has emerged particularly in the... more Over the last decade Computer Assisted Orthopaedic Surgery (CAOS) has emerged particularly in the area of minimally invasive Uni-compartmental Knee Replacement (UKR) surgery. Image registration is an important aspect in all computer assisted surgery including Neurosurgery, Cranio-maxillofacial surgery and Orthopaedics. It is possible for example to visualise the patient's medial or lateral condyle on the tibia in the pre-operated CT scan as well as to locate the same points on the actual patient during surgery using intra-operative sensors or probes. However their spatial correspondence remains unknown until image registration is achieved. Image registration process generates this relationship and allows the surgeon to visualise the 3D pre-operative scan data in-relation to the patient's anatomy in the operating theatre.
Current image registration for most CAOS applications is achieved through probing along the articulating surface of the femur and tibial plateau and using these digitised points to form a rigid body which is then fitted to the pre-operative scan data using a best fit type minimisation. However, the probe approach is time consuming which often takes 10–15 minutes to complete and therefore costly. Thus the rationale for this study was to develop a new, cost effective, contactless, automated registration method which would entail much lesser time to produce the rigid body model in theatre from the ends of the exposed bones. This can be achieved by taking 3D scans intra-operatively using a Laser Displacement Sensor.
A number of techniques using hand held and automated 3D Laser scanners for acquiring geometry of non-reflective objects have been developed and used to scan the surface geometry of a porcine femur with four holes drilled in it. The distances between the holes and the geometry of the bone were measured using digital vernier callipers as well as measurements acquired from the 3D scans. These distances were measured in an open source package MESHLAB version 1.3.2 used for the interpretation, post-processing and analysis of the 3D meshes. Absolute errors ranging from of 0.1 mm to 0.4 mm and the absolute percentage errors ranging from 0.48% to 0.75% were found. Additionally, a pre-calibrated dental model was scanned using a 650 nm FARO™ Laser arm using the global surface registration approach in Geomagic Qualify package and our 3D Laser scanner. Results indicate an average measurement error of 0.16 mm, with deviations ranging from 0.12mm to −0.13 mm and a standard deviation of 0.2 mm. We demonstrated that by acquiring multiple scans of the targets, complete 3D models along with their surface texture can be developed. The overall scanning process, including time required for the post-processing of the data requires less than 20 minutes and is a cost-efficient approach. Moreover, the majority of that time was used in post processing the acquired data which could be potentially reduced through the use of bespoke application software. This project has provided proof of concept for a new automated, non-invasive and cost efficient registration technique with the potential of providing a quantitative assessment of the articular cartilage integrity during lower limb arthroplasty.
Aims The aim of this study was to compare the clinical outcomes of robotic arm-assisted bi-unicom... more Aims The aim of this study was to compare the clinical outcomes of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) during the first six weeks and at one year postoperatively. Methods A per protocol analysis of 76 patients, 43 of whom underwent TKA and 34 of whom underwent bi-UKA, was performed from a prospective, single-centre, randomized controlled trial. Diaries kept by the patients recorded pain, function, and the use of analgesics daily throughout the first week and weekly between the second and sixth weeks. Patient-reported outcome measures (PROMs) were compared preoperatively, and at three months and one year postoperatively. Data were also compared longitudinally and a subgroup analysis was conducted, stratified by preoperative PROM status. Results Both operations were shown to offer comparable outcomes, with no significant differences between the groups across all timepoints and outcome ...
Aims Unicompartmental knee arthroplasty (UKA) is a bone-preserving treatment option for osteoarth... more Aims Unicompartmental knee arthroplasty (UKA) is a bone-preserving treatment option for osteoarthritis localized to a single compartment in the knee. The success of the procedure is sensitive to patient selection and alignment errors. Robotic arm-assisted UKA provides technological assistance to intraoperative bony resection accuracy, which is thought to improve ligament balancing. This paper presents the five-year outcomes of a comparison between manual and robotically assisted UKAs. Methods The trial design was a prospective, randomized, parallel, single-centre study comparing surgical alignment in patients undergoing UKA for the treatment of medial compartment osteoarthritis (ISRCTN77119437). Participants underwent surgery using either robotic arm-assisted surgery or conventional manual instrumentation. The primary outcome measure (surgical accuracy) has previously been reported, and, along with secondary outcomes, were collected at one-, two-, and five-year timepoints. Analysis ...
Validation testing is a necessary step for inertial measurement unit (IMU) motion analysis for re... more Validation testing is a necessary step for inertial measurement unit (IMU) motion analysis for research and clinical use. Optical tracking systems utilize marker models which must be precise in measurement and mitigate skin artifacts. Prosthesis wearers present challenges to optical tracking marker model choice. Seven participants were recruited and underwent simultaneous motion capture from two marker sets; Plug in Gait (PiG) and the Strathclyde Cluster Model (SCM). Variability of joint kinematics within and between subjects was evaluated. Variability was higher for PiG than SCM for all parameters. The within-subjects variability as reported by the average standard deviation (SD), was below 5.6° for all rotations of the hip on the prosthesis side for all participants for both methods, with an average of 2.1° for PiG and 2.5° for SCM. Statistically significant differences in joint parameters caused by a change in the protocol were evident in the sagittal plane (p < 0.05) on the a...
Jaswal and Akhtar identify the necessary social nature of the human mind, even in autism. We agre... more Jaswal and Akhtar identify the necessary social nature of the human mind, even in autism. We agree with the authors and present significant contributory origins of this autistic isolation in disruption of purposeful movement made social from infancy. Timing differences in expression can be misunderstood in embodied engagement, and social intention misread. Sensitive relations can repair this.
Robot-assisted unicompartmental knee surgery has been shown to improve the accuracy of implant al... more Robot-assisted unicompartmental knee surgery has been shown to improve the accuracy of implant alignment. However, little research has been conducted to ascertain if this results in a measureable improvement in knee function post operatively and a more normal gait. The kinematics of 70 OA knees were assessed using motion analysis in an RCT (31 receiving robotic-assisted surgery, and 39 receiving traditional manual surgery) and compared to healthy knees. Statistically significant kinematic differences were seen between the two surgical groups from foot-strike to mid-stance. The robotic-assisted group achieved a higher knee excursion (18.0°, SD 4.9°) compared to the manual group (15.7°, SD 4.1°). There were no significant difference between the healthy group and the robotic assisted group, however there was a significant difference between the healthy group and the manual group (p < 0.001). Hence robotically-assisted knee replacement with Mako Restoris Implants appears to lead not ...
Unicompartmental knee arthroplasty (UKA) for treatment of medial compartment osteoarthritis has p... more Unicompartmental knee arthroplasty (UKA) for treatment of medial compartment osteoarthritis has potential benefits over total knee arthroplasty but UKA has a higher revision rate. Robotic-assisted UKA is increasingly common and offers more accurate implant positioning and limb alignment, lower early postoperative pain but evidence of functional outcome is lacking. The aim was to assess the clinical outcomes of a single-centre, prospective, randomised controlled trial, comparing robotic-arm-assisted UKA with conventional surgery. A total of 139 participants were recruited and underwent robotic-arm-assisted (fixed bearing) or conventional (mobile bearing) UKA. Fifty-eight patients in the robotic-arm-assisted group and 54 in the manual group at 2 years. The main outcome measures were the Oxford Knee Score, American Knee Society Score and revision rate. At 2 years, there were no significant differences for any of the outcome measures. Sub-group analysis (n = 35) of participants with a p...
Recently, systems have been developed to improve alignment of unicompartmental knee arthroplasty ... more Recently, systems have been developed to improve alignment of unicompartmental knee arthroplasty (UKA) implants, although improvement in function has been difficult to document. The MAKO RIO robotic surgery system has previously shown improvements in in knee flexion during weight acceptance (WA) in comparison to conventional methods at a one year follow up. This study aimed to determine if these improvements remained at five years follow up. Twenty five MAKO and 21 conventional knees were tested using three dimensional gait analysis to measure knee kinematics. Results demonstrated that the MAKO group achieved significantly greater knee flexion in WA than the conventional group which was consistent with results are one year. This could be due to the improved accuracy of prosthesis implantation offered by the MAKO system.
Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine, 2018
This article presents the construction of a flexible drill which is designed to cut a curved cana... more This article presents the construction of a flexible drill which is designed to cut a curved canal in the bone or remove bone materials, to improve the outcome of orthopedic surgery and to facilitate minimally invasive. This article reports the design of the flexible drill and uses it in an experimental rig to evaluate the drilling force generated when cutting bovine bone. The experiments facilitate the measurement of action forces between the mill bits when moving the tip toward or across a bone sample in various configurations caused by bending the flexible drill sheath to enable cutting of a curved path of variable radius in the bone. The reaction force represents the force trying to deflect the mill bit tip away from the bone sample surface and must be resisted in order to continue cutting without deflection or buckling of the tip during the drilling of curved pathways. The experiment shows the flexible drill can cut bones in both configurations and experienced a maximal force o...
The Journal of bone and joint surgery. American volume, Jan 20, 2016
Higher revision rates have been reported in patients who have undergone unicompartmental knee art... more Higher revision rates have been reported in patients who have undergone unicompartmental knee arthroplasty compared with patients who have undergone total knee arthroplasty, with poor component positioning identified as a factor in implant failure. A robotic-assisted surgical procedure has been proposed as a method of improving the accuracy of component implantation in arthroplasty. The aim of this prospective, randomized, single-blinded, controlled trial was to evaluate the accuracy of component positioning in unicompartmental knee arthroplasty comparing robotic-assisted and conventional implantation techniques. One hundred and thirty-nine patients were randomly assigned to treatment with either a robotic-assisted surgical procedure using the MAKO Robotic Interactive Orthopaedic Arm (RIO) system or a conventional surgical procedure using the Oxford Phase-3 unicompartmental knee replacement with traditional instrumentation. A postoperative computed tomographic scan was performed at ...
Over the last decade Computer Assisted Orthopaedic Surgery (CAOS) has emerged particularly in the... more Over the last decade Computer Assisted Orthopaedic Surgery (CAOS) has emerged particularly in the area of minimally invasive Uni-compartmental Knee Replacement (UKR) surgery. Image registration is an important aspect in all computer assisted surgery including Neurosurgery, Cranio-maxillofacial surgery and Orthopaedics. It is possible for example to visualise the patient's medial or lateral condyle on the tibia in the pre-operated CT scan as well as to locate the same points on the actual patient during surgery using intra-operative sensors or probes. However their spatial correspondence remains unknown until image registration is achieved. Image registration process generates this relationship and allows the surgeon to visualise the 3D pre-operative scan data in-relation to the patient's anatomy in the operating theatre.
Current image registration for most CAOS applications is achieved through probing along the articulating surface of the femur and tibial plateau and using these digitised points to form a rigid body which is then fitted to the pre-operative scan data using a best fit type minimisation. However, the probe approach is time consuming which often takes 10–15 minutes to complete and therefore costly. Thus the rationale for this study was to develop a new, cost effective, contactless, automated registration method which would entail much lesser time to produce the rigid body model in theatre from the ends of the exposed bones. This can be achieved by taking 3D scans intra-operatively using a Laser Displacement Sensor.
A number of techniques using hand held and automated 3D Laser scanners for acquiring geometry of non-reflective objects have been developed and used to scan the surface geometry of a porcine femur with four holes drilled in it. The distances between the holes and the geometry of the bone were measured using digital vernier callipers as well as measurements acquired from the 3D scans. These distances were measured in an open source package MESHLAB version 1.3.2 used for the interpretation, post-processing and analysis of the 3D meshes. Absolute errors ranging from of 0.1 mm to 0.4 mm and the absolute percentage errors ranging from 0.48% to 0.75% were found. Additionally, a pre-calibrated dental model was scanned using a 650 nm FARO™ Laser arm using the global surface registration approach in Geomagic Qualify package and our 3D Laser scanner. Results indicate an average measurement error of 0.16 mm, with deviations ranging from 0.12mm to −0.13 mm and a standard deviation of 0.2 mm. We demonstrated that by acquiring multiple scans of the targets, complete 3D models along with their surface texture can be developed. The overall scanning process, including time required for the post-processing of the data requires less than 20 minutes and is a cost-efficient approach. Moreover, the majority of that time was used in post processing the acquired data which could be potentially reduced through the use of bespoke application software. This project has provided proof of concept for a new automated, non-invasive and cost efficient registration technique with the potential of providing a quantitative assessment of the articular cartilage integrity during lower limb arthroplasty.
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Papers by Philip Rowe
Current image registration for most CAOS applications is achieved through probing along the articulating surface of the femur and tibial plateau and using these digitised points to form a rigid body which is then fitted to the pre-operative scan data using a best fit type minimisation. However, the probe approach is time consuming which often takes 10–15 minutes to complete and therefore costly. Thus the rationale for this study was to develop a new, cost effective, contactless, automated registration method which would entail much lesser time to produce the rigid body model in theatre from the ends of the exposed bones. This can be achieved by taking 3D scans intra-operatively using a Laser Displacement Sensor.
A number of techniques using hand held and automated 3D Laser scanners for acquiring geometry of non-reflective objects have been developed and used to scan the surface geometry of a porcine femur with four holes drilled in it. The distances between the holes and the geometry of the bone were measured using digital vernier callipers as well as measurements acquired from the 3D scans. These distances were measured in an open source package MESHLAB version 1.3.2 used for the interpretation, post-processing and analysis of the 3D meshes. Absolute errors ranging from of 0.1 mm to 0.4 mm and the absolute percentage errors ranging from 0.48% to 0.75% were found. Additionally, a pre-calibrated dental model was scanned using a 650 nm FARO™ Laser arm using the global surface registration approach in Geomagic Qualify package and our 3D Laser scanner. Results indicate an average measurement error of 0.16 mm, with deviations ranging from 0.12mm to −0.13 mm and a standard deviation of 0.2 mm. We demonstrated that by acquiring multiple scans of the targets, complete 3D models along with their surface texture can be developed. The overall scanning process, including time required for the post-processing of the data requires less than 20 minutes and is a cost-efficient approach. Moreover, the majority of that time was used in post processing the acquired data which could be potentially reduced through the use of bespoke application software. This project has provided proof of concept for a new automated, non-invasive and cost efficient registration technique with the potential of providing a quantitative assessment of the articular cartilage integrity during lower limb arthroplasty.
Current image registration for most CAOS applications is achieved through probing along the articulating surface of the femur and tibial plateau and using these digitised points to form a rigid body which is then fitted to the pre-operative scan data using a best fit type minimisation. However, the probe approach is time consuming which often takes 10–15 minutes to complete and therefore costly. Thus the rationale for this study was to develop a new, cost effective, contactless, automated registration method which would entail much lesser time to produce the rigid body model in theatre from the ends of the exposed bones. This can be achieved by taking 3D scans intra-operatively using a Laser Displacement Sensor.
A number of techniques using hand held and automated 3D Laser scanners for acquiring geometry of non-reflective objects have been developed and used to scan the surface geometry of a porcine femur with four holes drilled in it. The distances between the holes and the geometry of the bone were measured using digital vernier callipers as well as measurements acquired from the 3D scans. These distances were measured in an open source package MESHLAB version 1.3.2 used for the interpretation, post-processing and analysis of the 3D meshes. Absolute errors ranging from of 0.1 mm to 0.4 mm and the absolute percentage errors ranging from 0.48% to 0.75% were found. Additionally, a pre-calibrated dental model was scanned using a 650 nm FARO™ Laser arm using the global surface registration approach in Geomagic Qualify package and our 3D Laser scanner. Results indicate an average measurement error of 0.16 mm, with deviations ranging from 0.12mm to −0.13 mm and a standard deviation of 0.2 mm. We demonstrated that by acquiring multiple scans of the targets, complete 3D models along with their surface texture can be developed. The overall scanning process, including time required for the post-processing of the data requires less than 20 minutes and is a cost-efficient approach. Moreover, the majority of that time was used in post processing the acquired data which could be potentially reduced through the use of bespoke application software. This project has provided proof of concept for a new automated, non-invasive and cost efficient registration technique with the potential of providing a quantitative assessment of the articular cartilage integrity during lower limb arthroplasty.