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.

Studio e sviluppo di sistemi RFID in banda UHF

The recent widespread diffusion of radio-frequency identification (RFID) applications operating in the UHF band has been supported by both the request for greater interrogation ranges and greater and faster data exchange. UHF-RFID systems, exploiting a physical interaction based on Electromagnetic propagation, introduce many problems that have not been fully explored for the previous generations of RFID systems (e.g. HF). Therefore, the availability of reliable tools for modeling and evaluating the radio-communication between Reader and Tag within an RFID radio-link are needed. The first part of the thesis discuss the impact of real environment on system performance. In particular an analytical closed form formulation for the back-scattered field from the Tag antenna and the formulation for the lower bound of the BER achievable at the Reader side will be presented, considering different possible electromagnetic impairments. By means of the previous formulations, of the analysis of the RFID link operating in near filed conditions and of some electromagnetic/system-level co-simulations, an in-depth study of the dimensioning parameters and the actual performance of the systems will be discussed and analyzed, showing some relevant properties and trade-offs in transponder and reader design. Moreover a new low cost approach to extend the read range of the RFID UHF passive systems will be discussed. Within the scope to check the reliability of the analysis approaches and of innovative proposals, some reference transponder antennas have been designed and extensive measurement campaign has been carried out with satisfactory results. Finally, some commercial ad-hoc transponder for industrial application have been designed within the cooperation with Datalogic s.p.a., some guidelines and results will be briefly presented.

Progettazione e analisi di soluzioni per la QOS e il controllo di flusso in Networks-on-chip

Nel documento vengono principalmente trattati i principali meccanismi per il controllo di flusso per le NoC. Vengono trattati vari schemi di switching, gli stessi schemi associati all'introduzione dei Virtual Channel, alcuni low-level flow control, e due soluzioni per gli end-to-end flow control: Credit Based e CTC (STMicroelectronics). Nel corso della trattazione vengono presentate alcune possibili modifiche a CTC per incrementarne le prestazioni mantenendo la scalabilità che lo contraddistingue: queste sono le "back-to-back request" e "multiple incoming connections". Infine vengono introdotti alcune soluzioni per l'implementazione della qualità di servizio per le reti su chip. Proprio per il supporto al QoS viene introdotto CTTC: una versione di CTC con il supporto alla Time Division Multiplexing su rete Spidergon.