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Intensity-Modulated Radiation Therapy and Inverse Planning
Published in W. P. M. Mayles, A. E. Nahum, J.-C. Rosenwald, Handbook of Radiotherapy Physics, 2021
Helen Mayles, John Fenwick, Steve Webb
Patients with hip replacements merit a class solution of their own. IMRT field directions should be chosen to avoid fields entering through the hip prosthesis. Plans for a single hip prosthesis should be as good as the ones without. Those with double prostheses will inevitably result in higher doses to the rectum and bladder.
The Cutting Edge
Published in Evelyn Brister, Robert Frodeman, A Guide to Field Philosophy, 2020
We were also interested in the ethical issues raised by surgical innovation. In work leading up to this project we identified four types of ethical concern (Johnson et al. 2010). The first involved the possible harms to patients that may occur with surgery that is not well established in the profession (such as when there is a new hip prosthesis), or with surgeons new to a procedure and still scaling the learning curve. Second was the question of informed consent. Patient consent to surgery could be compromised as they may be inadequately informed about various elements of the procedure they are to undergo. For instance, patients may be unaware of the innovative nature of their operation and of the risks associated with new procedures. There could also be poor safety and efficacy data to inform their decision, and patients may not be cognizant of where their surgeon sits on the learning curve.
Musculoskeletal trauma
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
The head of the femur may dislocate from the acetabulum in high-energy injuries, although significantly less energy is required to dislocate a hip prosthesis. This usually occurs as a result of transmitted force along a flexed leg. In the most common type of dislocation (posterior dislocation) the patient presents with the leg in flexion at the knee, the hip internally rotated and the leg abducted. In all cases the neurovascular status should be assessed, including in the case of clinically posterior dislocations the function of the sciatic nerve. The powerful upper leg muscles work against spontaneous reduction and a general anaesthetic is usually required for relocation. Attempts at re-location in the pre-hospital phase are not generally practical or appropriate.
Decomposition of micromotion at the head-neck interface in total hip arthroplasty during walking
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Guoxian Zhang, Shu Yang, Wen Cui, Zhi Huang, Xiaogang Zhang, Yali Zhang, Junyan Li, Zhongmin Jin
There are some limitations in the study. First, the models were not directly compared with the experiments, due to the difficulty of in vivo measurement of micromotion. Furthermore, in comparison with literatures, the differences in the loading conditions and implant geometry between the models used in different studies should be noted. Second, taper surfaces were assumed to be smooth in the models and the machining marks and roughness during manufacturing that might lead to plastic deformation and trunnion damage (Stockhausen et al. 2021) were not considered. However, the CoF between the contact surfaces measured in experiments was accounted for to simulate the impact of surface roughness. Third, a constant CoF was assumed in our model, but the CoF would vary according to the contact geometry, normal pressure and lubricant, which might have an influence on fretting behavior at the head-neck interface. However, these assumptions do not affect the qualitative predictions of this study. In addition, the effect of soft tissues around the hip prosthesis, including the muscles (Li 2021) and ligaments (van Arkel et al. 2018) and the dissection of bones, on the results were not considered. However, the contribution of these tissues to the joint loads had already been accounted for in the boundary conditions used in this study. These aspects will be implemented in our future studies to enable more realistic modelling.
Computational prediction of the long-term behavior of the femoral density after THR using the Silent Hip stem
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Zainab Al-Hajaj, Pouria Tavakkoli Avval, Habiba Bougherara
The conventional cementless hip prosthesis has a serious issue of stress shielding of the proximal femur, periprosthetic fractures, thigh pain and removal during revision (Kumar 2012; Kim et al. 2016). In an effort to overcome the limitations of the traditional prostheses, Silent Hip prosthesis was introduced. The present study revealed significant results in demonstrating less bone resorption using Silent Hip prosthesis compared to the conventional hip stem design. The sophisticated design of the Silent short stem allows to preserve more bone stock and soft tissue, during the prosthesis inserting procedure (i.e. incision) and following the THR, than of the traditional design (Kumar 2012). Waller and McTighe (2013) confirmed that the Silent Hip transfers the load to the femur bone, throughout the neck to the femoral shaft in movement a more physiological fashion than other conventional stems. Silent Hip provides stability and does not show continuing patterns movement over time (Waller and McTighe 2013). Studies (Chen et al. 2009; Dabirrahmani et al. 2010) confirmed that the short stem shows less stress shielding with no cortical hypertrophy compared to the traditional long stem implant, as it acts as a shorter cantilever.
Comparison of surgical gloves: perforation, satisfaction and manual dexterity
Published in International Journal of Occupational Safety and Ergonomics, 2022
Tulay Basak, Gul Sahin, Ayla Demirtas
An observational, prospective study was performed during April–May 2018. Scrub nurses used specified gloves during nine selected surgeries: (a) total hip prosthesis or total knee prosthesis; (b) lumbar laminectomy; (c) vitrectomy; (d) transurethral resection of the prostate or ureterorenoscopy; (e) ileus surgery; (f) caesarean section; (g) graft-flap surgeries; (h) video-assisted thoracoscopic surgery (VATS); (i) appendectomy surgery. We determined the cases by taking the frequencies of procedures into consideration in our hospital. A homogeneous number for the surgeries is aimed at mostly operative clinics in our hospital. scrub nurses wore antiallergenic surgical (powder and latex free). Also use powder and latex free gloves during three operations, double latex and powdered gloves during three operations and single latex and powdered gloves during three operations. Within the scope of the study, each type of glove was used in each of nine operations. All gloves were worn 105 times by 35 nurses. Thus, the effectiveness of all types of gloves was examined 315 times in total (Figure 1). If the gloves were visibly perforated during surgery, they were immediately replaced with new gloves of the same type and size. The number of punctured gloves was recorded. Among the scrub nurses, 60% were women and 40% were men.