John Dowell’s research while affiliated with Anglia Ruskin University and other places

A three-dimensional (3D) knee joint computational model was developed and validated to predict knee joint contact forces and pressures for different degrees of malalignment. A 3D computational knee model was created from high-resolution radiological images to emulate passive sagittal rotation (full-extension to 65°-flexion) and weight acceptance. A cadaveric knee mounted on a six-degree-of-freedom robot was subjected to matching boundary and loading conditions. A ligament-tuning process minimised kinematic differences between the robotically loaded cadaver specimen and the finite element (FE) model. The model was validated by measured intra-articular force and pressure measurements. Percent full scale error between FE-predicted and in vitro-measured values in the medial and lateral compartments were 6.67% and 5.94%, respectively, for normalised peak pressure values, and 7.56% and 4.48%, respectively, for normalised force values. The knee model can accurately predict normalised intra-articular pressure and forces for different loading conditions and could be further developed for subject-specific surgical planning.

In the world, approximately 800,000 total hip replacements are implanted, while, at least 50,000 hip replacements are performed in the United Kingdom each year. Orthopaedic surgeons have traditionally delayed joint replacement surgery in patients younger than 60 due to its limited survivorship time and biological effect inside the human body. The highest percentage (71%) hip joint failure was caused by aseptic loosening of the femoral and acetabular components and the war rate and debris are the accepted causes of that aseptic loosening. The wear particles, either ion or stable form, can react with proteins and change the pH value of albumin solutions inside the human body, causing damage to the DNA resulting in genotoxicity. There has been a great deal of research into the materials, dimension of the prosthesis, surface roughness, and lubrication effect by surface coating. But it is very rare to apply surface texture technique to a metallic prosthesis bearing surface although it has proven very successful in many engineering applications including automobile industry due to secondary lubrication effect and hydrodynamic effect. A TE 77 high frequency friction simulator has been used for the experiment where specimens were manufactured with 50 mm diameters and 50 μ m clearance. A dynamic loading was applied synchronized with Hip CD 98 while the temperature was controlled at 37 ° C . The output data including friction coefficient, friction force and contact pot were recorded in connected computer via COMPEND 2000 software. The surfaces were inspected after and before test under scanning electronic microscopy. The plateau honed surfaces were produced on the moving specimens with controlled load, speed and various grade of emery paper using a specially designed tool. The friction coefficient was recorded 0.035 for the honing surface which was made by 30 kg laod and 60 emery paper, 0.04 for the honing surface profile made by 30 kg load and 150 emery paper and 0.06 for plane surface after one million cycles. The rest of surfaces profiled surface were broken down before one million cycles. That made a conclusion that plateau honing surface made with 30 kg load and 60 emery paper was best surface texture profile ( 45 ° honed angle, 40 ± 10 μ m width and 35 ± 10 μ m depth honing) for the metal on metal hip prosthesis. The comparison experiment was continue for plane surface and plateau honing surface of 60 emery paper and 30 kg load up to one and half millions cycles. It was found that the friction coefficient (0.03) was further reduced 0.005 after one and half million cycles for plateau honing surface but it was increased nearly double (0.065) for plane surface. The static friction coefficient was also reduced 38% in case of that plateau honing surface. The contact pot profile which is an indicator of fluid film thickness was noticed higher in plateau honing surface. This was evidence that the lubrication distribution was better in plateau honed surface which should provide longer life of joint, reduce wear and improves acceptability of metal on metal hip joints.

The effects of femoral prosthetic heads of diameters 22 and 28 mm were investigated on the stability of reconstructed hemi-pelves with cement mantles of thicknesses 1-4 mm and different bone qualities. Materialise medical imaging package and I-Deas finite element (FE) software were used to create accurate geometry of a hemi-pelvis from CT-scan images. Our FE results show an increase in cement mantle stresses associated with the larger femoral head. When a 22 mm femoral head is used on acetabulae of diameters 56 mm and above, the probability of survivorship can be increased by creating a cement mantle of at least 1 mm thick. However, when a 28 mm femoral head is used, a cement mantle thickness of at least 4 mm is needed. Poor bone quality resulted in an average 45% increase in the tensile stresses of the cement mantles, indicating resulting poor survivorship rate.

Although surgical fixation techniques are major contributing factors to the survivorship of total hip replacements, they vary considerably among orthopaedic surgeons. We investigated the effect of the following configuration of anchorage holes on the stability of acetabular component fixation: 3 x 12 mm, 3 x 6 mm, 6 x 6 mm, and 12 x 6 mm. The reconstructed acetabulae were tested to torque failure, whilst being subjected to a compressive load of 2.1 KN. Higher torque to failure values were obtained for specimens with three 12 mm anchorage holes, compared with six or more 6 mm anchorage holes and were in line with our computer simulation results. We propose that the longevity of cemented total hip replacements could be improved by drilling a few large anchorage holes.

Our survey of current practice among UK orthopaedic surgeons shows wide variations in fixation techniques. The aim of this study, is to investigate the effect of drilling different configurations of anchorage holes in the acetabulum on implant stability. To avoid variables that could incur during in vitro testing, we used commercially available COSMOS finite element analysis package to investigate the stress distributions, deformations, and strains on the cement mantle when drilling three large anchorage holes and six smaller ones, with straight and rounded cement pegs. The results, which are in line with our in vitro studies on simulated reconstructed acetabulae, indicate better stability of the acetabular component when three larger holes than six smaller holes are drilled and when the necks of the anchorage holes are rounded. The longevity of total hip replacements could be improved by drilling three large anchorage holes, rather than many smaller ones, as initially proposed by Charnley.

Previous finite element studies and laboratory investigations on reconstructed acetabulum joints show that long-term fixation of the acetabular cup in total hip replacements (THRs) is influenced by surgical fixation techniques. The aim of this study is to determine and understand the reasons of current practice in the cement fixation of the acetabular cup in THRs in the UK. Following a pilot study, a postal survey was carried out among 1350 orthopaedic consultants. Response rate was 40% and data obtained from the returned questionnaires provided information about the current practice of 431 consultants with an average of 16.5 years of experience and who perform an average of 55 cemented THR operations annually. The survey showed wide variations in the fixation methods of the acetabular component. 95% of the respondents use cement to fix the acetabular cup, 46% maintain the subchondral bone and 63% use a flanged acetabular cup. The numbers of anchorage holes drilled vary from zero to thirty-six and drill diameters vary from 2 to 15 mm. Anchorage hole depths vary from 3 to 20 mm. Given the variability of surgical fixation methods, further studies need to be carried out to determine how fixation techniques could be improved to increase the longevity of the acetabular component in THRs. Further investigations could lead to a better understanding of the factors that contribute to the stability of THRs.

Previous finite element studies and laboratory investigations on reconstructed acetabulum joints show that long-term fixation of the acetabular cup in total hip replacements (THRs) is influenced by surgical fixation techniques. The aim of this study is to determine and understand the reasons of current practice in the cement fixation of the acetabular cup in THRs in the UK. Following a pilot study, a postal survey was carried out among 1350 orthopaedic consultants. Response rate was 40% and data obtained from the returned questionnaires provided information about the current practice of 431 consultants with an average of 16.5 years of experience and who perform an average of 55 cemented THR operations annually. The survey showed wide variations in the fixation methods of the acetabular component. 95% of the respondents use cement to fix the acetabular cup, 46% maintain the subchondral bone and 63% use a flanged acetabular cup. The numbers of anchorage holes drilled vary from zero to thirty-six and drill diameters vary from 2 to 15 mm. Anchorage hole depths vary from 3 to 20 mm. Given the variability of surgical fixation methods, further studies need to be carried out to determine how fixation techniques could be improved to increase the longevity of the acetabular component in THRs. Further investigations could lead to a better understanding of the factors that contribute to the stability of THRs.