Nanoscale reinforced orthopaedic bone cement with graphene oxide - a possible solution to aseptic loosening of cemented hip implants? Preliminary results of an ongoing study

Hip replacement surgery is amongst the most common orthopaedic operations performed in the UK. Aseptic loosening is responsible for 40% of hip revision procedures. Aseptic loosening is a result of cement mantle fatigue. The aim of the current study is to analyse the effect of nanoscale Graphene Oxide (GO) on the mechanical properties of orthopaedic bone cement. Study Design A experimental thermal and mechanical analysis was conducted in a laboratory set up conforming to international standards for bone cement testing according to ISO 5583. Testing was performed on control cement samples of Colacryl bone cement, and additional samples reinforced with variable wt% of Graphene Oxide containing composites – 0.1%, 0.25%, 0.5% and 1.0% GO loading. Pilot Data Porosity demonstrated a linear relationship with increasing wt% loading compared to control (p<0.001). Thermal characterisation demonstrated maximal temperature during polymerization, and generated exotherm were inversely proportional to w%t loading (p<0.05) Fatigue strength performed on the control and 0.1 and 0.25%wt loadings of GO demonstrate increased average cycles to failure compared to control specimens. A right shift of the Weibull curve was demonstrated for both wt% available currently. Logistic regression analysis for failure demonstrated significant increases in number of cycles to failure for both specimens compared to a control (p<0.001). Forward Plan Early results convey positive benefits at low wt% loadings of GO containing bone cement. Study completion and further analysis is required in order to elude to the optimum w%t of GO which conveys the greatest mechanical advantage.

Trapezoid stress fracture in an international shot-putter: a case report.

Trapezoid fractures are relatively rare upper limb fractures. The case report of a trapezoid stress fracture in the dominant hand of a 22 year old international standard shot-putter is presented.

Microstructure and high cycle fatigue fracture surface of a Ti-5Al-5Mo-5V-1Cr-1Fe titanium alloy

Because of the requirements for the damage tolerance and fatigue life of commercial aircraft components, the high cycle fatigue (HCF) properties of Ti–5Al–5Mo–5V–1Cr–1Fe titanium alloy forgings are important. The effects of microstructure types of the α+β titanium alloy on fatigue properties need to be understood. In this paper, by analysing the fracture surfaces of the titanium alloy having four types of microstructure, the effects of microstructure are investigated. The differences of initiation areas and crack propagation among different microstructures were studied. It was found that the area of the initiation region decreases in the order of coarse basketweave, fine basketweave, Widmanstätten, and bimodal microstructure.

Investigation of chip formation and fracture toughness in orthogonal cutting of UD-CFRP

Features of chip formation can inform the mechanism of a machining process. In this paper, a series of orthogonal cutting experiments were carried out on unidirectional carbon fiber reinforced polymer (UD-CFRP) under cutting speed of 0.5 m/min. The specially designed orthogonal cutting tools and high-speed camera were used in this paper. Two main factors are found to influence the chip morphology, namely the depth of cut (DOC) and the fiber orientation (angle 휃), and the latter of which plays a more dominant role. Based on the investigation of chip formation, a new approach is proposed for predicting fracture toughness of the newly machined surface and the total energy consumption during CFRP orthogonal cutting is introduced as a function of the surface energy of machined surface, the energy consumed to overcome friction, and the energy for chip fracture. The results show that the proportion of energy spent on tool-chip friction is the greatest, and the proportions of energy spent on creating new surface decrease with the increasing of fiber angle.

Measurement of fibre fracture toughness using an alternative specimen geometry

This paper presents an experimental and numerical study focused on the tensile fibre fracture toughness characterisation of hybrid plain weave composite laminates using non-standardized Overheight Compact Tension (OCT) specimens. The position as well as the strain field ahead of the crack tip in the specimens was determined using a digital speckle photogrammetry system. The limitation on the applicability of standard data reduction schemes for the determination of the intralaminar fibre fracture toughness of composites is presented and discussed. A methodology based on the numerical evaluation of the strain energy release rate using the J-integral method is proposed to derive new geometric correction functions for the determination of stress intensity factor for alternative composite specimen geometries. A comparison between different methods currently available to compute the intralaminar fracture toughness in composites is also presented and discussed. Good agreement between numerical and experimental results using the proposed methodology was obtained.

Visual outcomes and astigmatism after sutureless, manual cataract extraction in rural China: study of cataract outcomes and up-take of services (SCOUTS) in the caring is hip project, report 1.

OBJECTIVE: To study the visual acuity and astigmatism of persons undergoing cataract extraction by local surgeons in rural China. METHODS: Visual acuity, keratometry, and refraction were measured 10 to 14 months postoperatively for all cataract cases during 4 months in Sanrao, China. RESULTS: Among 313 eligible subjects, 242 (77%) could be contacted, of whom 176 (73%) were examined. Of those who were examined, mean +/- SD age was 69.3 +/- 10.5 years, 66.5% were female, 35 had been operated on bilaterally at Sanrao, and 85.2% had a preoperative presenting visual acuity of 6/60 or worse. Presenting and best-corrected postoperative acuity in the eye that was operated on were 6/18 or better in 83.4% and 95.7%, respectively. Among 27 fellow eyes operated on elsewhere, 40.7% had a presenting acuity of 6/18 or better and 40.7% were blind (P < .001). Mean +/- SD postoperative astigmatism did not differ between 211 eyes that were operated on (-1.13 +/- 0.84 diopters) and 109 eyes that were not (-1.13 +/- 1.17 diopters; P = .27). Presence of operative complications (8.5%) and older age were associated with worse vision; bilateral surgery was associated with better vision. CONCLUSIONS: These results confirm the effectiveness of skill transfer in this setting, with superior outcomes to most studies in rural Asia and to eyes in this cohort operated on at other facilities.

Visual function and postoperative care after cataract surgery in rural China: study of cataract outcomes and up-take of services (SCOUTS) in the caring is hip project, report 2.

OBJECTIVE:

To study the postoperative visual function and uptake of refraction and second-eye surgery among persons undergoing cataract surgery in rural China.

METHODS:

Self-reported visual function was measured 10 to 14 months after surgery. Subjects with improvement of 2 or more lines with refraction were offered glasses, and those with significant cataract were offered second-eye surgery.

RESULTS:

Among 313 eligible subjects, 242 (77%) could be contacted; 176 (73%) of those contacted were examined. Interviewed subjects had a mean +/- SD age of 69.9 +/- 10.2 years, and 63.6% were female. The mean +/- SD visual function score was 88.4 +/- 12.3, higher than previously reported for cataract programs in rural China and significantly (P = .03) correlated with presenting vision. Forty-two percent of subjects had spectacles, more than half being reading glasses. Though 87% of subjects' vision improved with refraction, only 35% accepted prescriptions, the most common reason for refusal being lack of perceived need. Second-eye surgery was accepted by a total of 48% (85 of 176) of patients, cost being the biggest reason for refusal.

CONCLUSIONS:

Visual function was high in this cohort. Potential benefit of refraction and second-eye surgery was substantial, but uptake of services was modest. Programs to improve service uptake should focus on reading glasses and cost-reduction strategies such as tiered pricing.

Ocular comorbidities among cataract-operated patients in rural China: the caring is hip Study of Cataract Outcomes and Uptake of Services (SCOUTS), report No. 3.

PURPOSE: To determine the prevalence and impact on vision and visual function of ocular comorbidities in a rural Chinese cataract surgical program, and to devise strategies to reduce their associated burden. DESIGN: Cross-sectional cohort study. PARTICIPANTS: Persons undergoing cataract surgery by one of two recently trained local surgeons at a government-run village-level hospital in rural Guangdong between August 8 and December 31, 2005. INTERVENTIONS: Eligible subjects were invited to return for a comprehensive ocular examination and visual function interview 10 to 14 months after surgery. Prevalent ocular comorbid conditions were identified. MAIN OUTCOME MEASURES: Presenting and best-corrected vision, visual function, and treatability of the comorbidity. RESULTS: Of 313 persons operated within the study window, 242 (77%) could be contacted by telephone; study examinations and interviews were performed on 176 (74%). Examined subjects had a mean age of 69.4+/-10.5 years, 116 (66%) were female, and 149 (85%) had been blind (presenting vision < or = 6/60) in the operative eye before surgery. Among unoperated eyes, 89 of 109 (81.7%) had > or =1 ocular comorbidities, whereas for operated eyes the corresponding proportion was 72 of 211 (34.1%). The leading comorbidity among operated eyes was refractive error (43/72 [59.7%]), followed by glaucoma/glaucoma suspect (14/72 [19.4%]), whereas for unoperated eyes, it was cataract (80/92 [87.0%]), followed by refractive error (12/92 [13.0%]). Among operated eyes with comorbidities, 90.3% (65/72) had > or =1 comorbidities that were treatable. In separate models adjusting for age and gender, persons with > or =1 comorbidities in the operated eye had significantly worse presenting vision (P<0.001) than those without such findings, but visual function (P = 0.197) and satisfaction with surgery (P = 0.796) were unassociated with comorbidities. CONCLUSIONS: Ocular comorbidities are highly prevalent among persons undergoing cataract surgery in this rural Asian setting, and their presence is significantly associated with poorer visual outcomes. The fact that the great majority of comorbidities encountered in this program are treatable suggests that strategies to reduce their impact can be successful.

Impact of posterior subcapsular opacification on vision and visual function among subjects undergoing cataract surgery in rural China: Study of Cataract Outcomes and Up-Take of Services (SCOUTS) in the Caring is Hip Project, report 5.

AIM: To study the effect of posterior capsular opacification (PCO) on vision and visual function in patients undergoing cataract surgery in rural China, and to compare this with the effect of refractive error. METHODS: Patients undergoing cataract surgery in at least one eye by local surgeons in a rural setting between 8 August and 31 December 2005 were examined with slit lamp grading of PCO 10-14 months after surgery. Subjects with any PCO associated with best-corrected visual acuity of 6/7.5 or worse, or with grade 2+ or worse PCO without visual decrement, were offered YAG laser capsulotomy. Vision and self-reported visual function were assessed, and various demographic and clinical factors potentially associated with PCO were recorded. RESULTS: Of 313 patients operated on within the study window, 239 (76%) could be contacted by telephone; study examinations were performed on 176 (74%). Examined subjects had a mean (SD) age of 69.4 (10.5) years, 116 (67%) were female, and 149 (86%) had been blind (presenting visual acuity < or = 6/60) in the operated eye before surgery. PCO of grade 1 or above was present in 34 of 204 operated eyes (16.7%). Those with PCO had significantly worse presenting vision (p = 0.007) but not visual function (p>0.3) than those without PCO. Women had a significantly higher prevalence of PCO (20.9%) than did men (8.6%, p<0.05). Of 19 eyes undergoing capsulotomy with best-corrected visual acuity measured the next day, 13 (68%) improved by one or more lines, and seven (37%) improved by two or more lines. Despite a higher uptake of capsulotomy (95%) as opposed to refraction (35%) in this cohort, the yield in terms of eyes with poor presenting visual acuity (< 6/18) that could be improved was higher for refraction (26% = 9/35) than for capsulotomy (9% = 3/35). CONCLUSION: The prevalence of PCO and impact on vision and visual function in this cohort was modest 1 year after surgery. However, PCO prevalence increases with time. Follow-up of this cohort is underway to determine the effectiveness of this early intervention in identifying and treating subjects who will eventually experience clinically significant PCO.

Modelling the nonlinear behaviour and fracture process of AS4/PEKK thermoplastic composite under shear loading

The accurate determination of non-linear shear behaviour and fracture toughness of continuous carbon-fibre/polymer composites remains a considerable challenge. These measurements are often necessary to generate material parameters for advanced computational damage models. In particular, there is a dearth of detailed shear fracture toughness characterisation for thermoplastic composites which are increasingly generating renewed interest within the aerospace and automotive sectors. In this work, carbon fibre (AS4)/ thermoplastic Polyetherketoneketone (PEKK) composite V-notched cross-ply specimens were manufactured to investigate their non-linear response under pure shear loading. Both monotonic and cyclic loading were applied to study the shear modulus degradation and progressive failure. For the first time in the reported literature, we use the essential work of fracture approach to measure the shear fracture toughness of continuous fibre reinforced composite laminates. Excellent geometric similarity in the load-displacement curves was observed for ligament-scaled specimens. The laminate fracture toughness was determined by linear regression, of the specific work of fracture values, to zero ligament thickness, and verified with computational models. The matrix intralaminar fracture toughness (ply level fracture toughness), associated with shear loading was determined by the area method. This paper also details the numerical implementation of a new three-dimensional phenomenological model for carbon fibre thermoplastic composites using the measured values, which is able to accurately represent the full non-linear mechanical response and fracture process. The constitutive model includes a new non-linear shear profile, shear modulus degradation and load reversal. It is combined with a smeared crack model for representing ply-level damage initiation and propagation. The model is shown to accurately predict the constitutive response in terms of permanent plastic strain, degraded modulus as well as load reversal. Predictions are also shown to compare favourably with the evolution of damage leading to final fracture.