New functional and biomechanical assessments for the improvement of the surgical navigation systems for joint replacement in the human lower limb

In case of severe osteoarthritis at the knee causing pain, deformity, and loss of stability and mobility, the clinicians consider that the substitution of these surfaces by means of joint prostheses. The objectives to be pursued by this surgery are: complete pain elimination, restoration of the normal physiological mobility and joint stability, correction of all deformities and, thus, of limping. The knee surgical navigation systems have bee developed in computer-aided surgery in order to improve the surgical final outcome in total knee arthroplasty. These systems provide the surgeon with quantitative and real-time information about each surgical action, like bone cut executions and prosthesis component alignment, by mean of tracking tools rigidly fixed onto the femur and the tibia. Nevertheless, there is still a margin of error due to the incorrect surgical procedures and to the still limited number of kinematic information provided by the current systems. Particularly, patello-femoral joint kinematics is not considered in knee surgical navigation. It is also unclear and, thus, a source of misunderstanding, what the most appropriate methodology is to study the patellar motion. In addition, also the knee ligamentous apparatus is superficially considered in navigated total knee arthroplasty, without taking into account how their physiological behavior is altered by this surgery. The aim of the present research work was to provide new functional and biomechanical assessments for the improvement of the surgical navigation systems for joint replacement in the human lower limb. This was mainly realized by means of the identification and development of new techniques that allow a thorough comprehension of the functioning of the knee joint, with particular attention to the patello-femoral joint and to the main knee soft tissues. A knee surgical navigation system with active markers was used in all research activities presented in this research work. Particularly, preliminary test were performed in order to assess the system accuracy and the robustness of a number of navigation procedures. Four studies were performed in-vivo on patients requiring total knee arthroplasty and randomly implanted by means of traditional and navigated procedures in order to check for the real efficacy of the latter with respect to the former. In order to cope with assessment of patello-femoral joint kinematics in the intact and replaced knees, twenty in-vitro tests were performed by using a prototypal tracking tool also for the patella. In addition to standard anatomical and articular recommendations, original proposals for defining the patellar anatomical-based reference frame and for studying the patello-femoral joint kinematics were reported and used in these tests. These definitions were applied to two further in-vitro tests in which, for the first time, also the implant of patellar component insert was fully navigated. In addition, an original technique to analyze the main knee soft tissues by means of anatomical-based fiber mappings was also reported and used in the same tests. The preliminary instrumental tests revealed a system accuracy within the millimeter and a good inter- and intra-observer repeatability in defining all anatomical reference frames. In in-vivo studies, the general alignments of femoral and tibial prosthesis components and of the lower limb mechanical axis, as measured on radiographs, was more satisfactory, i.e. within ±3°, in those patient in which total knee arthroplasty was performed by navigated procedures. As for in-vitro tests, consistent patello-femoral joint kinematic patterns were observed over specimens throughout the knee flexion arc. Generally, the physiological intact knee patellar motion was not restored after the implant. This restoration was successfully achieved in the two further tests where all component implants, included the patellar insert, were fully navigated, i.e. by means of intra-operative assessment of also patellar component positioning and general tibio-femoral and patello-femoral joint assessment. The tests for assessing the behavior of the main knee ligaments revealed the complexity of the latter and the different functional roles played by the several sub-bundles compounding each ligament. Also in this case, total knee arthroplasty altered the physiological behavior of these knee soft tissues. These results reveal in-vitro the relevance and the feasibility of the applications of new techniques for accurate knee soft tissues monitoring, patellar tracking assessment and navigated patellar resurfacing intra-operatively in the contest of the most modern operative techniques. This present research work gives a contribution to the much controversial knowledge on the normal and replaced of knee kinematics by testing the reported new methodologies. The consistence of these results provides fundamental information for the comprehension and improvements of knee orthopedic treatments. In the future, the reported new techniques can be safely applied in-vivo and also adopted in other joint replacements.

Fellow travelers: an ethnographic study of the dynamics of inter-organizational collaboration

The research is a 13-months ethnographic field work on the early operations of a Multi-party alliance active in the global field of indoor positioning. The study aims to understand and investigate empirically the challenges that at the individual and group level influence the organizing principle guiding the alliance operations and evolution. Its contribution rests on the dynamics affecting ecosystems of innovation and collaborative spaces of value co-creation in inter-organizational projects.

Essays on Innovative Activity and the Protection of Innovations

This dissertation looks at three widely accepted assumptions about how the patent system works: patent documents disclose inventions; this disclosure happens quickly, and patent owners are able to enforce patents. The first chapter estimates the effect of stronger trade secret protection on the number of patented innovations. When firms find it easier to protect business information, there is less need for patent protection, and accordingly less need for the disclosure of technical information that is required by patent law. The novel finding is that when it is easier to keep innovations, there is not only a reduction in the number of patents but also a sizeable reduction in disclosed knowledge per patent. The chapter then shows how this endogeneity of the amount of knowledge per patent can affect the measurement of innovation using patent data. The second chapter develops a game-theoretic model to study how the introduction of fee-shifting in US patent litigation would influence firms’ patenting propensities. When the defeated party to a lawsuit has to bear not only their own cost but also the legal expenditure of the winning party, manufacturing firms in the model unambiguously reduce patenting, with small firms affected the most. For fee-shifting to have the same effect as in Europe, the US legal system would require shifting of a much smaller share of fees. Lessons from European patent litigation may, therefore, have only limited applicability in the US case. The third chapter contains a theoretical analysis of the influence of delayed disclosure of patent applications by the patent office. Such a delay is a feature of most patent systems around the world but has so far not attracted analytical scrutiny. This delay may give firms various kinds of strategic (non-)disclosure incentives when they are competing for more than a single innovation.