Nonmodular Components Research Articles

Development and evaluation of a modular smart garment framework

PurposeThis study aims to develop and evaluate a modular smart garment design framework that simplifies the technical content associated with smart garment design.Design/methodology/approachSmart garment design challenges were first identified through literature review and interviews. Then, a modular framework and toolkit was created to address these challenges. Finally, workshops were held to evaluate the modular toolkit.FindingsInterviews highlighted the need for easier attachment of hard devices to soft textile materials, simpler electrical connection creation and straightforward device selection. A modular framework was proposed and divided into four elements: (1) the Central Computation Module, (2) Peripheral Electrical Modules, (3) Securely Attaching Modules with Substrates and (4) Managing Intra-garment Connections. Workshops showed the modular framework had statistically significant improvements in function and certain ease ratings when compared to non-modular components.Originality/valueThis research identified specific technical challenges faced by smart garment designers and alleviated them through a modular smart garment framework that in workshops outperformed non-modular components in key function and ease ratings.

Total hip arthroplasty monobloc stem neck rupture in patient with massive heterotopic ossifications: a case report and literature review.

Fractures of the femoral stem neck are a rare complication in hip prosthetic surgery, especially in non-modular components. The authors report a case associated with massive heterotopic ossifications, with the purpose to analyze risk factors and specific characteristics. A case of femoral monobloc stem neck rupture is described. A non-systematic literature review regarding risk factors for femoral stem neck fracture was conducted in the PubMed database. We report the case of a 61-year-old male who underwent surgery to remove calcifications four years after THA. Four months later the patient reported acute pain in the left hip, arising after a combined movement of external rotation and axial load while standing on the left foot, in the absence of any prodromic symptom. On radiographs, a displaced fracture of the neck of the hip prosthesis was revealed, together with massive heterotopic ossifications. After THA revision the patient's symptoms were resolved. Prosthetic femoral neck fractures are a rare complication. We suggest that this case represents a unique type of fatigue rupture, where neck length and the presence of massive heterotopic calcifications contributed to flexion forces, resulting in failure in the midpoint of the neck.

Nonmodular Stems Are a Viable Alternative to Modular Stems in Revision Total Hip Arthroplasty

BackgroundNonmodular and modular femoral stems have been associated with complications after revision total hip arthroplasty (rTHA). As such, the ideal femoral component for rTHA remains undecided. This study aims to report outcomes of titanium, tapered-fluted, modular and nonmodular femoral components in rTHA. MethodsFrom January 1, 2013 to September 30, 2017, all rTHAs using modular or nonmodular femoral stems were identified. Demographic data including age, gender, and American Society of Anesthesiologists scores were collected. Surgical details including operative time and implant cost were also collected. Clinical outcomes including length of stay, dislocation, infection, fracture, reoperation, and re-revision were collected. Statistical analysis was performed using chi-square test and Student's t-test for all categorical and continuous variables, respectively. ResultsOne hundred forty-six rTHA cases (103 modular and 43 nonmodular) were identified with an average follow-up of 29 months (range 3-59 months). Nonmodular stems had a significantly lower cost when compared to modular implants (modular stems 120.8% higher cost; P < .001). The surgical time of nonmodular components was significantly greater (193 minutes vs 163 minutes; P = .029). There were no differences observed in any other surgical details or clinical outcomes assessed, including length of stay (P = .323), rate of re-revision of the femoral implant (P = .389), rate of re-operation (P = .383), and postop complications (P = .241), including infection (P = .095), dislocation (P = .778), and fracture (P = .959). ConclusionsNonmodular components provide encouraging clinical results with significantly lower costs compared to modular implants in rTHA. The use of titanium, tapered-fluted, nonmodular components may offer a more cost-effective approach to rTHA compared to their modular counterparts.

Contemporary failure aetiologies of the primary, posterior-stabilised total knee arthroplasty.

The number of revision total knee arthroplasties (TKA) that are performed is expected to increase. However, previous reports of the causes of failure after TKA are limited in that they report the causes at specific institutions, which are often dependent on referral patterns. Our aim was to report the most common indications for re-operations and revisions in a large series of posterior-stabilised TKAs undertaken at a single institution, excluding referrals from elsewhere, which may bias the causes of failure. A total of 5098 TKAs which were undertaken between 2000 and 2012 were included in the study. Re-operations, revisions with modular component exchange, and revisions with non-modular component replacement or removal were identified from the medical records. The mean follow-up was five years (two to 12). The Kaplan-Meier ten-year survival without a re-operation, modular component revision and non-modular component revision was 95.7%, 99.3% and 95.3%, respectively. The most common indications for a re-operation were: post-operative stiffness (58%), delayed wound healing (21%), and patellar clunk (11%). The indications for isolated modular component revision were acute periprosthetic joint infection (PJI) (64%) and instability (36%). The most common indications for non-modular component revision were chronic PJI (52%), aseptic loosening (17%), periprosthetic fracture (10%), and instability (10%). Post-operative stiffness remains the most common indication for re-operation after TKA. Infection is the most common indication for modular and non-modular component revision. Aseptic loosening was not an uncommon cause of failure, however, it was much less common than in national registry and non-registry data. Focusing on posterior-stabilised TKAs initially performed at our institution allowed for an accurate assessment of the causes of failure in a contemporary specialty practice. Cite this article: Bone Joint J 2017;99-B:647-52.

Structural and Functional Organizing Principles of Language: Evolving Theories

The overall goal of this paper is to evaluate theories that attempt to address the organizing principles of language and review the development of these theories toward the integration of language within an interactive network of higher-level cognitive functions. Commencing with an overview of traditional concepts of language as modular, distinct, and innate, we focus firstly on areas that highlight the foundation of modularity theory including various module definitions and criteria, and applications of modularity in information processing and biological systems. We also discuss challenges to the overall applicability of a modular system and limitations of modular models in dealing with adaptation, novelty, innate versus learned, domain-general and domain-specific features, and developmental and age-related changes of cognitive organization. Prompted by the rapidly increasing amount of empirical data on the functional elements of the human brain, we then evaluate several major theories of cognition, including views that oppose modular organization and those that integrate modular and semi-modular views with topological modularity in simpler, and dynamic integration in higher-level cognitive functions.Within this framework, modular and non-modular components of linguistic knowledge, organizing principles of language viewed either as specific or derived from other systems, and concepts of language as one of the cognitive functions or the outcome of unique interactions among cognitive components are discussed. Emerging theories that integrate interactive network models support a cognitive architecture as a mosaic of domain-specific and domain-general processes involving both functional segregation and integration within a global neuronal workspace. Within this anatomically distributed workspace, the language function represents unique interactions among cognitive components consistent with an organization that is task-dependent with a continuum between degrees of modular and shared processing. As a higher-level, learning-based, and effortful cognitive process language transiently enlists a less modular organization for an efficient network configuration in interaction with several cognitive systems and the domain-general cognitive control/multiple-demand network.

Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty Conversion: Assuring a Primary Outcome

Converting unicompartmental knee arthroplasty (UKA) to total knee arthroplasty can be difficult, and specialized techniques are needed. Issues include bone loss, joint-line, sizing, and rotation. Determining the complexity of conversion preoperatively helps predict the need for augmentation, grafting, stems, or constraint. We examined insert thickness, augmentation, stem use, and effect of failure mode on complexity of UKA conversion. Fifty cases (1997-2007) were reviewed: 9 implants (18%) were modular fixed-bearing, 4 (8%) were metal-backed nonmodular fixed-bearing, 8 (16%) were resurfacing onlay, 10 (20%) were all-polyethylene step-cut, and 19 (38%) were mobile bearing designs; 5 knees (10%) failed due to infection, 5 (10%) due to wear and/or instability, 10 (20%) for pain or progression of arthritis, 8 (16%) for tibial fracture or severe subsidence, and 22 (44%) due to loosening of either one or both components. Complexity was evaluated using analysis of variance and chi-squared 2-by-k test (80% power; 95% confidence interval). Insert thickness was no different between implants (P=.23) or failure modes (P=.27). Stemmed component use was most frequent with nonmodular components (50%), all-polyethylene step-cut implants (44%), and modular fixed-bearing implants (33%; P=.40). Stem use was highest in tibial fracture (86%; P=.002). Augment use was highest among all-polyethylene step-cut implants (all-polyethylene, 56%; metal-backed, 50%; modular fixed-bearing, 33%; P=.01). Augmentation use was highest in fracture (86%) and infection (67%), with a significant difference noted between failure modes (P=.003). Failure of nonmodular all-polyethylene step-cut devices was more complex than resurfacing or mobile bearing. Failure mode was predictive of complexity. Reestablishing the joint-line, ligamentous balance, and durable fixation are critical to assuring a primary outcome.

Backside Wear Is Low in Retrieved Modern, Modular, and Nonmodular Acetabular Liners

Modern modular components with maximized conformity between liner and shell, improved locking mechanisms, and smooth inner surfaces should have less backside wear than first-generation modular designs. Also, nonmodular components should show no backside wear in vivo. We compared the backside wear of retrieved liners from nonmodular and modular components from first-generation and second-generation designs. We matched for time in situ, patient age and weight for nine retrieved Harris-Galante Type 1 liners, nine Harris-Galante Type 2 liners, nine Trilogy liners, and nine Implex nonmodular liners. The backside of the liners was divided in quadrants, examined under a x10 binocular loupe, and rated by a score of 0 (absence of wear) to 3 (severe backside wear) for a total ranging from 0 to 12. The average total backside wear score was 8.4 for the Harris-Galante Type 1 liner, 7.3 for the Harris-Galante Type 2 liner, 3.7 for the Trilogy liner, and 2.3 for the Implex liner. We observed a significant reduction in the backside wear of modern modular and nonmodular acetabular components (Trilogy(R) and Implex) when compared with first-generation modular designs (Harris-Galante Types 1 and 2). Nonmodular acetabular cups had a low backside wear in vivo. Therapeutic study, Level III (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

The Three-Dimensional Geometry of the Proximal Humerus: Implications for Surgical Technique and Prosthetic Design

We have studied the three-dimensional geometry of the proximal humerus on human cadaver specimens using a digitised measuring device linked to a computer. Our findings demonstrated the variable shape of the proximal humerus as well as its variable dimensions. The articular surface, which is part of a sphere varies individually in its orientation as regards inclination and retroversion, and it has variable medial and posterior offsets. These variations cannot be accommodated by the designs of most contemporary humeral components. Although good clinical results can be achieved with current modular and non-modular components their relatively fixed geometry prevents truly anatomical restoration in many cases. To try to restore the original three-dimensional geometry of the proximal humerus, we have developed a new type of humeral component which is modular and adaptable to the individual anatomy. Such adaptability allows correct positioning of the prosthetic head in relation to an individual anatomical neck, after removal of the marginal osteophytes. The design of this third-generation prosthesis respects the four geometrical variations which have been demonstrated in the present study. These are inclination, retroversion, medial offset and posterior offset.

THE THREE-DIMENSIONAL GEOMETRY OF THE PROXIMAL HUMERUS

We have studied the three-dimensional geometry of the proximal humerus on human cadaver specimens using a digitised measuring device linked to a computer. Our findings demonstrated the variable shape of the proximal humerus as well as its variable dimensions. The articular surface, which is part of a sphere varies individually in its orientation as regards inclination and retroversion, and it has variable medial and posterior offsets. These variations cannot be accommodated by the designs of most contemporary humeral components. Although good clinical results can be achieved with current modular and non-modular components their relatively fixed geometry prevents truly anatomical restoration in many cases. To try to restore the original three-dimensional geometry of the proximal humerus, we have developed a new type of humeral component which is modular and adaptable to the individual anatomy. Such adaptability allows correct positioning of the prosthetic head in relation to an individual anatomical neck, after removal of the marginal osteophytes. The design of this third-generation prosthesis respects the four geometrical variations which have been demonstrated in the present study. These are inclination, retroversion, medial offset and posterior offset.