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Biomedical subjects

D S Barrett

Publications and source records attributed to D S Barrett.

At least 19 recordsLinked to original sources
PubMed2003

Explicit finite element simulation of eccentric loading in total knee replacement.

In vivo kinematic data indicate that unicondylar or edge loading occurs during normal activities in well-aligned and malpositioned knee replacements. Using a validated explicit finite element model of a knee replacement, the effects of eccentric loading of a total knee replacement are simulated. Only minor variations were observed in the kinematics with a medial offset of the vertical load of as much as 15 mm (representing a medial:lateral loading ratio of 86:14), although the polyethylene stresses did increase by approximately 3 MPa throughout the stance phase of gait. There was a significant change in the kinematics and stresses when unicondylar loading occurred (95:5 medial:lateral loading ratio). Even for the unicondylar load case, contact always was maintained within the lateral compartment. This raises the question whether lift-off often observed in fluoroscopy studies really occurs. The model predicted regions of plastic deformation that closely resemble those observed in retrieved specimens of catastrophic wear. The explicit finite element model offers considerable insight into the kinematics and stresses generated by total knee replacement during different and varied loading conditions that occur during normal usage.

Arthroplasty, Replacement, Knee↗
PubMed2000

The importance of tibial alignment: finite element analysis of tibial malalignment.

The influence of the tibial plateau orientation on cancellous bone stress was examined by finite element analysis for a cemented device. The objectives of the study were i) to examine the effect of the plateau-ankle angle on the cancellous bone stress, ii) to analyze the significance of the anteroposterior angles of the tibial component on these stresses, and iii) to compare the finite element predictions with clinical data. In general, positioning the tibial plateau in valgus resulted in lower cancellous bone stresses. These results support previous clinical studies, which suggest that overall alignment in valgus results in lower migration rates and lower incidence of loosening.

Biomechanical Phenomena↗
PubMed2000

Prevention of loosening in total hip replacements using guided bone regeneration.

The aim of this study was to prevent wear debris from reaching the interface of the acetabular cup and femoral component by using a partially occlusive expanded polytetrafluoroethylene membrane. This membrane initially acted as a physical seal, which became incorporated by bone and soft tissue, forming a secondary biologic seal, preventing loosening. An animal model was developed to test the hypothesis. The model replicated the mechanisms of loosening where the effects of wear debris were studied. Using femoral heads with the appropriate roughness, a goat model produced the radiologic and histologic presentation of loosening as observed in total hip replacements in humans. Loosening was assessed by measurement of the radiolucent lines, and was attributed to wear debris by histologic investigation. The expanded polytetrafluoroethylene membrane prevented acetabular implant loosening to a statistical significance of 0.02 in a blinded assessment when compared with the control groups. Loosening of the first 5 mm of the proximomedial aspect of the femur also was prevented. The authors of the current study prevented wear particle-induced osteolysis in the acetabular component by using an expanded polytetrafluoroethylene membrane to seal the bone-cement interface.

Animals↗
PubMed1998

Enhanced bone regeneration and formation around implants using guided bone regeneration.

This study investigated the use of a prototype expanded polytetrafluoroethylene membrane attached to bone with butyl-cyanoacrylate, in facilitating guided bone regeneration into bone defects and around titanium screws in rabbit femora. Two experimental models were used to assess bone growth. The first model investigated two unicortical defects in each femora. The second was bone growth in a 500-micron engineered space around one transcortical titanium screw. In the first model there was a significant increase in bone formation at 1 and 2 months in the membrane groups (p < 0.01) as compared to the controls. In the second model the percentage of bone in contact with the implant was significant at 1 and 2 months in the defects covered with membrane compared to the uncovered defects. The uncovered defects had fibrous tissue adherent to the implant continuous with the overlying soft tissue. Our study demonstrated three points: this membrane can be used to increase bone regeneration into defects, this technique allows bone to grow directly around an implant, and butyl-cyanoacrylate can be used in deep soft tissue and bone applications without any apparent deleterious effects.

Animals↗
PubMed1996

Preclinical toxicity evaluation of tepoxalin, a dual inhibitor of cyclooxygenase and 5-lipoxygenase, in Sprague-Dawley rats and beagle dogs.

Tepoxalin [5- (4-chlorophenyl)-N-hydroxy-1-(4-methoxyphenyl)-N-methyl-1H-pyrazole -3-propanamide] is an orally active anti-inflammatory agent, which inhibits both cyclooxygenase and 5-lipoxygenase activities. The oral toxicity of tepoxalin was evaluated in 1- and 6-month rat (up to 50 mg/kg/day) and dog (up to 150 mg/kg bid) studies. In rats, increased liver weight, centrilobular hypertrophy, and hepatic necrosis were observed at dosages >/=20 mg/kg/day. Renal changes indicative of analgesic nephropathy syndrome (i.e., papillary edema or necrosis, cortical tubular dilatation) were seen at >/=15 mg/kg. In rats treated for 1 month, these hepatic and renal effects were largely reversible after a 1-month recovery period. Gastrointestinal erosions and ulcers were seen in female rats given 40 mg/kg/day for 6 months. Changes in clinical pathology parameters included decreases in red blood cell count, hemoglobin, and hematocrit mean values; elevation in platelet counts; and an increase in prothrombin and activated partial thromboplastin times. Mild increases in alanine aminotransferase, aspartate aminotransferase, and cholesterol were also noted in rats. Decreased erythrocyte parameters, increased leukocyte counts, and decreased total protein, albumin, and/or calcium were noted in some dogs in the 300 mg/kg/day group following 6 months of dosing. Small pyloric ulcerations were seen at 100 and 300 mg/kg/day dosages for up to 6 months. In both rats and dogs, no accumulation of tepoxalin or its carboxylic acid metabolite was detected in plasma following multiple dosing over a range of 5 to 50 mg/kg/day for rats and 20 to 300 mg/kg/day for dogs. Plasma concentrations of the carboxylic acid metabolite were severalfold higher than those of the parent compound. The no-effect dosages in rats (5 mg/kg/day) and dogs (20 mg/kg/day) were approximately one and six times the ED50 (3.5 mg/kg), respectively, for inhibition of inflammatory effects in the adjuvant arthritic rat without gastric mucosal damage. In terms of severity, the relative lack of gastrointestinal side effects, within the estimated therapeutic dose range, distinguishes tepoxalin from most marketed anti-inflammatory drugs.

Absorption↗
PubMed1994

The effect of a single oral dose of tri-o-cresyl phosphate on neurotoxic esterase and acetylcholinesterase activities in the central nervous system, erythrocytes and plasma.

This study reports the activity of neurotoxic esterase (NTE) and acetylcholinesterase (AChE) in the blood and central nervous system (CNS) of swine 6, 12, 24 and 48 h after a single oral dose of 800 mg tri-o-cresyl phosphate (TOCP)/kg. At all evaluated intervals, inhibition of NTE activity in leukocytes and the CNS was 88% or higher, with only slight differences in NTE inhibition apparent among the various tissues examined. This extreme inhibition of NTE activity precluded correlation between inhibition of NTE in peripheral leukocytes and the CNS. However, the similarity in NTE response in leukocytes and the CNS following TOCP administration indicates the potential for leukocyte NTE as a biochemical marker for organophosphorus ester-induced delayed neurotoxicity (OPIDN) development. As the distribution pattern of NTE in the CNS of swine closely parallels that of man, these results further suggest that swine may prove a useful animal model for the study of OPIDN. The activity of AChE was highly variable based on time of assay and tissue examined. In general, plasma AChE activity was more severely depressed in all animals and responded more rapidly to TOCP administration. However, erythrocyte AChE more accurately reflected the enzyme's activity in the CNS and the clinical response to TOCP. Based on the data provided by this study, a threshold inhibition of erythrocyte AChE between 59 and 74% is required for production of acute cholinergic signs.

Acetylcholinesterase↗
PubMed1994

Clinical manifestations and leukocyte neurotoxic esterase and red blood cell and plasma acetylcholinesterase activities in swine following a single oral dose of tri-o-cresyl phosphate.

We report the clinical signs and the effects on leukocyte neurotoxic esterase and red blood cell and plasma acetylcholinesterase (AChE) activities in swine orally administered a single dose of tri-o-cresyl phosphate (TOCP) at 400, 800 or 1000 mg/kg. Swine in all dosage groups exhibited signs consistent with inhibition of nervous tissue cholinesterase 3-48 h after TOCP administration. Onset was dose-related, and 2/3 1000 mg/kg dosed swine died 3 or 35 h postdosing. In surviving swine, significant depressions in plasma AChE activity were apparent at 6 h postdosing, ranging from 16-23% of predosing levels. Similar depressions of red blood cell AChE were not observed until 24 h postdosing. Plasma AChE activities appeared to more accurately reflect the development of acute cholinergic signs observed in the 1000 mg/kg dosed swine at 3 h postdosing while red blood cell AChE activities were more consistent with the delayed cholinergic signs exhibited by the 400 and 800 mg/kg dosed swine at 24 h postdosing. All survivors developed signs of delayed neurotoxicity 10-12 d after TOCP administration, and 70% or greater inhibition of neurotoxic esterase activity in leukocytes was apparent during the first 48 h postdosing.

Acetylcholinesterase↗
PubMed1993

Costoplasty in adolescent idiopathic scoliosis. Objective results in 55 patients.

Costoplasty can reduce the important cosmetic deformity of rib prominence in scoliosis but there are few objective reports of correction. We recorded the results of three objective methods of assessing back shape before and after short-segment costoplasty in 55 patients. We showed that significant improvement was maintained over a two-year follow-up period. Primary costoplasty at the time of scoliosis surgery (n = 35) achieved greater proportional correction than secondary costoplasty performed after fusion of the spine (n = 20). The rib segments removed at primary surgery provided enough bone for the autogenous graft; harvesting from the pelvis was unnecessary. We report a new classification of rib morphology which helps in planning the site and extent of costoplasty, and in predicting the possible correction.

Adolescent↗
PubMed1991

MacIntosh-Jones reconstruction for the unstable knee.

A group of 45 patients who underwent replacement of a ruptured anterior cruciate ligament with a free graft of one-third of the patellar tendon combined with a lateral extra-articular tenodesis have been reviewed. The average age of the patients was 26.4 years and the mean follow-up period 3.2 years. Stability was achieved in 42 patients (93 per cent), judged on clinical criteria. Overall patient satisfaction was high at 73 per cent and 38 patients (84 per cent) maintained their sporting activity at a social or competitive level. Those who had unsatisfactory results had undergone significant delay before anterior cruciate ligament reconstruction.

Adolescent↗
PubMed1991

Joint proprioception in normal, osteoarthritic and replaced knees.

We measured joint position sense in the knee by a new method which tests the proprioceptive contribution of the joint capsule and ligaments. The leg was supported on a splint, and held in several positions of flexion. The subjects' perception of the position was recorded on a visual analogue model and compared with the actual angle of flexion. Eighty-one normal and 45 osteoarthritic knees were examined, as were 10 knees with semi-constrained and 11 with hinged joint replacements. All were assessed with and without an elastic bandage around the knee. There was a steady decline in joint position sense with age in subjects with normal knees. Those with osteoarthritic knees had impaired joint position sense at all ages (p less than 0.001). Knee replacement improved the joint position sense slightly (p less than 0.02); semi-constrained replacement had a greater effect than hinged replacement. The effect of an elastic bandage in subjects with poor position sense was dramatic, improving accuracy by 40% (p less than 0.001). It is proposed that reduced proprioception in elderly and osteoarthritic subjects may be responsible for initiation or advancement of degeneration of the knee.

Adolescent↗
PubMed1991

Proprioception and function after anterior cruciate reconstruction.

We have assessed 45 patients who had undergone anterior cruciate reconstruction by a modified MacIntosh-Jones method. The results, using standard knee scores and clinical ligament testing, correlated poorly with the patient's own opinion and with the functional result. However, measurement of proprioception in the knee correlated well with both function (r = 0.84) and with patient satisfaction (r = 0.9). This study indicates that proprioception, rather than the clinical excellence of the repair, is a major factor in the outcome of anterior cruciate ligament reconstruction.

Adolescent↗
PubMed1991

Entrapment neuropathies: 1. Upper limb.

Accurate diagnosis of nerve entrapment requires a sound knowledge of anatomy and careful examination of the patient. Diagnosis is aided by specific clinical tests and neurophysiological investigation. This article reviews clinical presentation, relevant anatomical detail and appropriate investigations in the management of entrapment neuropathies of the upper limb.

Arm↗
PubMed1991

Entrapment neuropathies: 2. Lower limb.

Entrapment neuropathy is a form of compression neuropathy (see previous article). It is rare in the lower limb. Fibular tunnel syndrome, meralgia paraesthetica and tarsal tunnel syndrome are reviewed here.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1991

Arthroscopic and endoscopic skills: a method of assessment.

An aptitude test has been designed to assess the psychomotor ability of surgeons under the special conditions and difficulties of endoscopic surgery. Results show increased errors and inferior tracking skill when images are rotated or reflected under test conditions simulating endoscopy. This indicates that more than simple hand-eye co-ordination is required to perform good endoscopic surgery. Interestingly, a proportion of trainee surgeons found adaptation to these altered conditions difficult to master. This aptitude test might usefully identify junior surgeons who would benefit from extra tuition at instructional endoscopic courses. The implications for the selection and training of surgeons are discussed.

Aptitude Tests↗
PubMed1990

The Oxford knee replacement. A review from an independent centre.

We present a study of 67 Oxford bicompartmental total knee replacements performed at a district general hospital. In this general orthopaedic unit, 57 of the knees (85%) had significant relief of pain with a mean flexion range of 95 degrees and a mean flexion deformity of only 9 degrees. There was a noticeable difference between osteoarthritic and rheumatoid knees. Poor results could be directly related to an avoidable postoperative complication. The results of this independent assessment may be compared favourably with the previously published series from the specialist centre at which the prosthesis was designed.

Arthritis, Rheumatoid↗