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KJ Pirate Activator 1.11 Crack [2022] Download For Windows & Office

KJ Pirate Activator 1.11 Crack [2022] Download For Windows & Office

at a photo of the commander in chief with his foot on his Oval Office desk. his goal is to “crack the pavement and make new grounds&mdash. d) Award the Crack Sealing Project to Denler, Inc. of Joliet, Christopher Elder appointed to a 3-year term through April 30, You can download the “KJ Starter” via the link provided below. The KJ starter is used to solve Windows and Office at no cost. KJ Windows.

KJ Pirate Activator 1.11 Crack [2022] Download For Windows & Office - idea

Windows 8 activator Crack is provided to you with which you can activate your Windows 8 easily no matter which edition you have. Windows 7 was a good one not a problematic one like Windows Vista which had some driver problems.  The new windows released by Microsoft for its users were Windows 8 which had all the errors solved in it. The newer OS which doesn’t have a storycall.us file in it and a split for the user interface was there in it. These are the amazing features of Windows 8 which were missing in Windows 7. But to use all these cool features, you will have to first activate your windows 8. That you can not do without having a proper license from Microsoft.

( &#;_&#;)o&#;*-KMSPico Activator Crack Download for All Windows & Office []

Don’t worry, that’s the reason we are sharing this Windows 8 Activator by KJ pirate here. So you do not have to struggle anywhere else to search it. Well, to be honest, they did not change everything in the new version.  In Windows 8 the trial period cannot extend as it used to extend in case of Windows 7. This is a new thing introduced in this release but no worries, as we have the Windows 8 permanent Activator for you which will help you to activate your Windows.

Kj Activator for Windows 8 Key Features

  • This activator is a small utility and takes very little time to download.
  • Easy to use and simple user interface.
  • Tested for viruses and malware by many users offline and online.
  • It has been working for thousands of people other than us.
  • Our team has first tested its functionality and features before posting here.
  • It does not require any internet connection for the activation procedure.
  • A user just has to run it and click on the activate button, KJ activator will do all the work.

windowsactivator-download

How to use it?

( &#;_&#;)o&#;*-Windows 10 Crack + Product Key Generator 32/64 Bit (% Working) Get Free Download

To successfully activate your windows 8 with the windows 8 activator by KJ, all you have to do is simply follow the step by step guide below.

  • Download the Activator file from here.
  • Extract the archive you have just downloaded from this page.
  • Double click on the KJ Activator file after you have extracted it.
  • Click on the Activate button.
  • Wait for the tool to do its work.
  • Restart your PC.
  • Enjoy

Please Note:

To make this process smoother, we recommend you to restart your PC immediately after activation. And you should never uninstall or delete “KMSpico” once you have activated your windows. If you do so, this will revert your activation and you will have to do all this again.

If you have windows 10, You can check out How to Activate Windows 10

Windows 8 Activation / Product Key:

( &#;_&#;)o&#;*-Removewat Crack + Windows Activator Free Download

Every genuine copy of Windows has its key in it. The user has to then use a Windows 8 Activation Key to activate it after installation. The key contains five groups, and it has five characters in each group. The key is unique for every copy of Windows. We can also say that the key is proof of the purchase of Windows. We can download the iso of Windows 8 free and install it as well but to activate it, we need to use the product key for a successful activation.

About Windows 8 Build

People often also search for Windows 8 build Product key. This is something you can find on every blog, but most of them are just spam and do not activate your Windows. Even if they activate your Windows, they do not unlock all the features of Windows 8. So here we are with a solution for you. You need to follow some necessary steps to install your Windows 8 correctly and then activate it through a product key. The consumer has to follow the commands and instructions strictly to activate windows and the same goes for you. If you are installing it by using a crack, then it is easy for you to install because cracks give you some unique features and activation tips as well. Now Windows 8 is at your desk that too on the help of product key we are providing to you.

The Windows 8 Build is a very advanced version and has some excellent features in it. The user interface is fantastic and meanwhile, its start menu is itself a very unusual feature. Windows 8 Build Product key is very exclusive for you to purchase, but now you can get it from here. Now you can download this Windows 8 and activate it using product key given here. It does not require any internet connection and one can do it offline as well.

We have collected some of the working windows 8 product keys used by many people for windows 8 activation. These keys are genuine and will activate your Windows. Just copy and paste a single key from the list below into the windows activation screen and click on Register. If it fails, move on to the next product key and use it. Do the same until one works for you.

windowspro-activatorfull-download

windowsactivation-key

Windows 8 Activation Keys ():

F8XCNV3F-RH7MY-C73YT-XP73H

XWCHQ-CDMYC-9WN2C-BWWTV-YY2KV

84NRV-6CJR6-DBDXH-FYTBF-4X49V

N4-R7KXM-CJKJB-BHGCW-CPKT7

HNRGD-JP8FC-6F6CY-2XHYY-RCWXV

ND8P2-BD2PB-DD8HMR-CRYQH

BDDNV-BQ27P-9P9JJ-BQJKTJXV

RRYGR-8JNBY-V2RJ9-TJP4PT7

84NRV-6CJR6-DBDXH-FYTBF-4X49V

KNTGM-BGJCJ-BPH3X-XX8V4-K4PKV

N4-R7KXM-CJKJB-BHGCW-CPKT7

BDDNV-BQ27P-9P9JJ-BQJKTJXV

Benefits of using a Product Key:

  • It can unbolt the start screen settings.
  • It allows you to unbolt account picture settings.
  • It can unbolt the personalization settings.
  • This can activate any edition or Bit 32 or 64 o Windows 8.
  • All the updates of Windows 8 are automatic.

Please Note:

We do not hold any responsibility for how you use these keys. They are just collected and submitted by online users just like you. They shared with us and we shared with you. We can not say if all or any of those keys work or not. Microsoft usually deactivates the keys and changes its rules for them. So we recommend you to use an alternate tool such as an activator or a loader for activation of windows 8. You can find both of them here on this same page.

Windows 8 KMS Activator

If you are searching online for a Windows 8 loader from the third party, then stop doing it because most of them are not working and are unable to activate your Windows. Some of those activators can even harm your computer. You must be frustrated after using so many options for activating Windows 8, but there is a bet that you will not be frustrated here. Because we have one of the best KMS Activator for Windows 8, which will activate your Windows 8 for a lifetime. This activator will never disappoint you.

The Windows 8 KMS Activator is so far the best activator in the field of activation because it can activate all the editions of OS. This activator can also activate the server versions of windows and Microsoft Office products as well. This activator is already in the market and with the new release of Windows 10, it’s even more efficient. Most of the bugs in it are fixed to make it one of the best in the world. The best thing about this tool is that it activates all the latest OS and Microsoft Office products with just a few clicks for you.

Maybe you are having some bad experience of downloading activators from other sites but the activator from this site will be entirely genuine and will activate your Windows for a lifetime. Uninstall the previous one and download the KMS activator from here.

Key features of KMS Activator for Windows 8:

  • It is capable of activating all these programs Windows Vista, 7, 8, , 10, Server , , R2 and Microsoft Office , , , (both bit & bit).
  • The activation is genuine and is for a lifetime. It will not show you any such message that the activation is not permanent.
  • After activating your Windows, this activator will do the auto-activation twice in a year.
  • No manual intervention required after activation.
  • One-click and it will do the rest itself.
  • It can activate both Windows and Office products at the same time which is a great thing.
  • It is entirely clean and contains no such file which will harm your system.
  • The activation is offline with no need for the internet.
  • It Supports bit & bit versions OS.
  • KMS Activator now supports multiple languages.

How to use it?

  • First of all, you will have to disable your antivirus protection.
  • Then download the activator setup from here.
  • Find the file you just downloaded from the folder you saved it to.
  • Extract the archive and search for the file named “KMSActivator”.
  • Double-click on it to run it via administrator.
  • Allow it to run if it asks for permission.
  • Click on the Activate button after seeing your windows version and build it from the menu.
  • Wait for the tool to complete its work.
  • Enjoy

Here on this page, We have shared some best multiple ways by which you can easily activate your windows 8 any build or version. If by any chance, no method works for you, please let us know. We will come up with some other ideas and tips on how you can do it. We appreciate your help to let us help you back. Cheers.

Why you are wasting the money to purchase the Windows 8 Crack. We are here for providing the solution in the form of cracking all the software. Therefore, we Windows 8 Crack make for you so that you never waste money to get this software. If you like this software, please share on your social profile for your friends and family.
Nothing is % , therefore, we can’t claim the working of Windows 8 Keygen. But, you can send us the detail instructions if you are not able to install this crack version. We are requested to follow the same instructions what we supplied in crack folder. Anyway thanks for visiting the AI Pro Crack (storycall.us). Please feel free to comments what you have any doubt regarding this software for crack and getting the keys. Once again, Thanks and enjoy the Cracking and Serial Keys.

Like this:

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Источник: [storycall.us]
Single Mb
Name : Windows 8 AIO Orion
Version : Orion  (x86/x64/April/)
Languange : English/French
Medicine : Include - Key
OS Support : Xp/Vista/7/8
Password : No
Type File : rar
Code File : a.i.o.0rion
Updated : April
Publisher :Kiran Maji
Size : Gb






Configuration Minimal :

Windows 8 32bits
1 gigahertz (GHZ)
1 gigabyte (GB) RAM
12 GB available hard disk space

Windows 8 64bits
1 gigahertz (GHZ)
2 gigabyte (GB) RAM
16 GB available hard disk space


Sytem : Windows 8 32bits 64bits
Langage : French
Editor : Team Orion
Files Type : .iso
Total Syze : Go
File Validation : MD5 SHA1

MD5: BA0BAAEB0DCC30BF

SHA 2DCCE1DF0EDCDF90FC

Screen Shots:




For Information go Here : storycall.us?topic=
How to Activation With All Key :
 1.) Run the command prompt as administrator (start menu, type cmd, right click, run as administrator)
    2.) Type:
    slmgr / upk
    slmgr / rearm
    3.) Restart
    4.) Reopen the command prompt in admin
    5.) Type:
    slmgr-skms
    slmgr-ipk "8 PRO FOR WINDOWS KEY IS-NG4HW VH26CKW-K6FJ8CK4 FOR NOW ISJNW 9KQP47T8-D8GGY-CWCK7" "FOR PRO MEDIA CENTER IS-C7MCR 3R9N7-KX8YH-2X4QC-DD GGKFW-OR-TBH8R H8R6B-NDTK2BRQ "(without the quotes)
    slmgr-ato


    For those who want to activate by phone life

    Windows 8 Pro:

    MAK Keys:

    storycall.us / ipk-7JVN8 WVRPVM-QM7P9-YDR92
    storycall.us / ipk 6TGNVPPXY-KMVD2-V8MQP
    storycall.us / ipk-NWJW3 GVYWR-P89R3-VH3VW-9TJX2
    storycall.us / ipk R8NYQXMTHJ-X8B7M-FF9VC

    Number to call on Skype: 01 88

    Look Fot All Key For APRIL :

    slmgr -ipk put-the-right-key
    slmgr -skms
    slmgr -ato

    run as admin

    Operating system edition         KMS Client Setup Key
    Windows 8 Professional
    NG4HW-VH26CKW-K6FJ8CK4
    Windows 8 Professional N
    XCVCF-2NXMPB-MHCBRYQQ
    Windows 8 Enterprise
    32JNW-9KQP47T8-D8GGY-CWCK7
    Windows 8 Enterprise N
    JMNMF-RHW7P-DMY6X-RF3DR-X2BQT
    Windows Server Core
    BN3D2-R7TKB-3YPBD-8DRPGG4
    Windows Server Core N
    8N2M2-HWPGY-7PGT9-HGDD8-GVGGY
    Windows Server Core Single Language
    2WN2H-YGCQR-KFX6K-CD6TFYXQ
    Windows Server Core Country Specific
    4K36P-JN4VD-GDC6V-KDTDYFKP
    Windows Server Server Standard
    XC9B7-NBPPJ2H-RHMBYBT4
    Windows Server Standard Core
    XC9B7-NBPPJ2H-RHMBYBT4
    Windows Server MultiPoint Standard
    HM7DN-YVMHJC3-XYTG7-CYQJJ
    Windows Server MultiPoint Premium
    XNH6W-2V9GX-RGJ4K-Y8X6F-QGJ2G
    Windows Server Datacenter
    48HP8-DN98B-MYWDG-T2DCC-8W83P
    Windows Server Datacenter Core
    48HP8-DN98B-MYWDG-T2DCC-8W83P

    MAK Keys:
    J87JG-PXNRBRP-DGJ9P-TMQHC
    7NKFGQDF-4PGMR-KP74B-VQR92
    CNVTB-YK4RV- M8CHM-R6V3P
    NGTBT-FWPVK-WDFP9-G3GV8-W4YQP

    ProWMC:
    C7MCR-3R9N7-KX8YH-2X4QC-DD
    GGKFW-TBH8R-H8R6B-NDTK2BRQ

    Pro Retail Keys:
    3NX4V-DMFVR-4PMKM3-QRPKV
    4HDN9-XTYYB6FV-MKVBMQH
    HB39N-V9K6F-PV-KWBTC-Q3R9V
    QGR4NPMD-KCRQBXT-YG
    XKY4K-2NRWR-8F6PRF-CRYQH

    Operating system edition         KMS Client Setup Key
    Windows 7 Professional
    FJ82H-XT6CR-J8D7P-XQJJ2-GPDD4
    Windows 7 Professional N
    MRPKT-YTGK7D7T-X2JMM-QY7MG
    Windows 7 Professional E
    W82YF-2Q76YHXB-FGJG9-GF7QX
    Windows 7 Enterprise
    33PXH-7Y6KF-2VJC9-XBBR8-HVTHH
    Windows 7 Enterprise N
    YDRBP-3D83W-TY26F-D46B2-XCKRJ
    Windows 7 Enterprise E
    C29WBCC8-VJGHFJW-H9DH4
    Windows Server R2 Web
    6TPJF-RBVHG-WBW2RQPH-6RTM4
    Windows Server R2 HPC edition
    TT8MH-CGD3D7QWQCTX
    Windows Server R2 Standard
    YC6KT-GKW9T-YTKYR-T4XR7VHC
    Windows Server R2 Enterprise
    J6-VHDMP-X63PK-3KCPX3Y
    Windows Server R2 Datacenter
    74YFP-3QFB3-KQT8W-PMXWJ-7M
    Windows Server R2 for Itanium-based Systems
    GT63C-RJFQGMB6-BRFB9-CB83V


NOTE:RAR and Archive Password is "kiranmaji"


Download Windows 8 AIO storycall.us here:
Download
Источник: [storycall.us]

Emerging Topics in Hardware Security

Mark Tehranipoor is currently the Intel Charles E. Young Preeminence Endowed Chair Professor in Cybersecurity at the Department of Electrical and Computer Engineering, the University of Florida. He has published over journal articles and refereed conference papers and has delivered more than invited talks and keynote addresses in international conferences, industry consortiums and government. In addition, he has 8 patents and has published 11 books and 25 book chapters. He is a recipient of 12 best paper awards and nominations, the NSF CAREER award, the MURI award on Nanoscale Security, the IEEE Computer Society (CS) Meritorious Service Award, the and IEEE CS Outstanding Contribution, the and IEEE TTTC/CS Most Successful Technical Event for co-founding and chairing HOST Symposium. He co-founded IEEE International Symposium on Hardware-Oriented Security and Trust (HOST) and served as HOST and HOST General Chair and continues to serve as Chair of the Steering Committee for HOST. He also co-founded IEEE Asian-HOST. Further, he co-founded Journal on Hardware and Systems Security (HaSS) and currently serving as EIC for HaSS. He is also a co-founder of Trust-Hub. He served as associate Editor-in-Chief (EIC) for IEEE Design and Test of Computers from He is currently serving as an Associate Editor for IEEE Design and Test of Computers, an Associate Editor for JETTA, an Associate Editor for Journal of Low Power Electronics (JOLPE), an Associate Editor for ACM Transactions for Design Automation of Electronic Systems (TODAES), and an Associate Editor for IEEE Transactions on VLSI (TVLSI). He has served as an IEEE Distinguished Speaker and an ACM Distinguished Speaker from Dr. Tehranipoor is a Fellow of the IEEE, Golden Core Member of IEEE Computer Society, and Member of ACM and ACM SIGDA. He is also a member of the Connecticut Academy of Science and Engineering (CASE).


Источник: [storycall.us]

Windows XP Nour Style Win 8 Black SP3

KJ Pirate Activator 1.11 Crack [2022] Download For Windows & Office - good

Windows 8 activator Crack is provided to you with which you can activate your Windows 8 easily no matter which edition you have. Windows 7 was a good one not a problematic one like Windows Vista which had some driver problems.  The new windows released by Microsoft for its users were Windows 8 which had all the errors solved in it. The newer OS which doesn’t have a storycall.us file in it and a split for the user interface was there in it. These are the amazing features of Windows 8 which were missing in Windows 7. But to use all these cool features, you will have to first activate your windows 8. That you can not do without having a proper license from Microsoft.

( &#;_&#;)o&#;*-KMSPico Activator Crack Download for All Windows & Office []

Don’t worry, that’s the reason we are sharing this Windows 8 Activator by KJ pirate here. So you do not have to struggle anywhere else to search it. Well, to be honest, they did not change everything in the new version.  In Windows 8 the trial period cannot extend as it used to extend in case of Windows 7. This is a new thing introduced in this release but no worries, as we have the Windows 8 permanent Activator for you which will help you to activate your Windows.

Kj Activator for Windows 8 Key Features

  • This activator is a small utility and takes very little time to download.
  • Easy to use and simple user interface.
  • Tested for viruses and malware by many users offline and online.
  • It has been working for thousands of people other than us.
  • Our team has first tested its functionality and features before posting here.
  • It does not require any internet connection for the activation procedure.
  • A user just has to run it and click on the activate button, KJ activator will do all the work.

windowsactivator-download

How to use it?

( &#;_&#;)o&#;*-Windows 10 Crack + Product Key Generator 32/64 Bit (% Working) Get Free Download

To successfully activate your windows 8 with the windows 8 activator by KJ, all you have to do is simply follow the step by step guide below.

  • Download the Activator file from here.
  • Extract the archive you have just downloaded from this page.
  • Double click on the KJ Activator file after you have extracted it.
  • Click on the Activate button.
  • Wait for the tool to do its work.
  • Restart your PC.
  • Enjoy

Please Note:

To make this process smoother, we recommend you to restart your PC immediately after activation. And you should never uninstall or delete “KMSpico” once you have activated your windows. If you do so, this will revert your activation and you will have to do all this again.

If you have windows 10, You can check out How to Activate Windows 10

Windows 8 Activation / Product Key:

( &#;_&#;)o&#;*-Removewat Crack + Windows Activator Free Download

Every genuine copy of Windows has its key in it. The user has to then use a Windows 8 Activation Key to activate it after installation. The key contains five groups, and it has five characters in each group. The key is unique for every copy of Windows. We can also say that the key is proof of the purchase of Windows. We can download the iso of Windows 8 free and install it as well but to activate it, we need to use the product key for a successful activation.

About Windows 8 Build

People often also search for Windows 8 build Product key. This is something you can find on every blog, but most of them are just spam and do not activate your Windows. Even if they activate your Windows, they do not unlock all the features of Windows 8. So here we are with a solution for you. You need to follow some necessary steps to install your Windows 8 correctly and then activate it through a product key. The consumer has to follow the commands and instructions strictly to activate windows and the same goes for you. If you are installing it by using a crack, then it is easy for you to install because cracks give you some unique features and activation tips as well. Now Windows 8 is at your desk that too on the help of product key we are providing to you.

The Windows 8 Build is a very advanced version and has some excellent features in it. The user interface is fantastic and meanwhile, its start menu is itself a very unusual feature. Windows 8 Build Product key is very exclusive for you to purchase, but now you can get it from here. Now you can download this Windows 8 and activate it using product key given here. It does not require any internet connection and one can do it offline as well.

We have collected some of the working windows 8 product keys used by many people for windows 8 activation. These keys are genuine and will activate your Windows. Just copy and paste a single key from the list below into the windows activation screen and click on Register. If it fails, move on to the next product key and use it. Do the same until one works for you.

windowspro-activatorfull-download

windowsactivation-key

Windows 8 Activation Keys ():

F8XCNV3F-RH7MY-C73YT-XP73H

XWCHQ-CDMYC-9WN2C-BWWTV-YY2KV

84NRV-6CJR6-DBDXH-FYTBF-4X49V

N4-R7KXM-CJKJB-BHGCW-CPKT7

HNRGD-JP8FC-6F6CY-2XHYY-RCWXV

ND8P2-BD2PB-DD8HMR-CRYQH

BDDNV-BQ27P-9P9JJ-BQJKTJXV

RRYGR-8JNBY-V2RJ9-TJP4PT7

84NRV-6CJR6-DBDXH-FYTBF-4X49V

KNTGM-BGJCJ-BPH3X-XX8V4-K4PKV

N4-R7KXM-CJKJB-BHGCW-CPKT7

BDDNV-BQ27P-9P9JJ-BQJKTJXV

Benefits of using a Product Key:

  • It can unbolt the start screen settings.
  • It allows you to unbolt account picture settings.
  • It can unbolt the personalization settings.
  • This can activate any edition or Bit 32 or 64 o Windows 8.
  • All the updates of Windows 8 are automatic.

Please Note:

We do not hold any responsibility for how you use these keys. They are just collected and submitted by online users just like you. They shared with us and we shared with you. We can not say if all or any of those keys work or not. Microsoft usually deactivates the keys and changes its rules for them. So we recommend you to use an alternate tool such as an activator or a loader for activation of windows 8. You can find both of them here on this same page.

Windows 8 KMS Activator

If you are searching online for a Windows 8 loader from the third party, then stop doing it because most of them are not working and are unable to activate your Windows. Some of those activators can even harm your computer. You must be frustrated after using so many options for activating Windows 8, but there is a bet that you will not be frustrated here. Because we have one of the best KMS Activator for Windows 8, which will activate your Windows 8 for a lifetime. This activator will never disappoint you.

The Windows 8 KMS Activator is so far the best activator in the field of activation because it can activate all the editions of OS. This activator can also activate the server versions of windows and Microsoft Office products as well. This activator is already in the market and with the new release of Windows 10, it’s even more efficient. Most of the bugs in it are fixed to make it one of the best in the world. The best thing about this tool is that it activates all the latest OS and Microsoft Office products with just a few clicks for you.

Maybe you are having some bad experience of downloading activators from other sites but the activator from this site will be entirely genuine and will activate your Windows for a lifetime. Uninstall the previous one and download the KMS activator from here.

Key features of KMS Activator for Windows 8:

  • It is capable of activating all these programs Windows Vista, 7, 8, , 10, Server , , R2 and Microsoft Office , , , (both bit & bit).
  • The activation is genuine and is for a lifetime. It will not show you any such message that the activation is not permanent.
  • After activating your Windows, this activator will do the auto-activation twice in a year.
  • No manual intervention required after activation.
  • One-click and it will do the rest itself.
  • It can activate both Windows and Office products at the same time which is a great thing.
  • It is entirely clean and contains no such file which will harm your system.
  • The activation is offline with no need for the internet.
  • It Supports bit & bit versions OS.
  • KMS Activator now supports multiple languages.

How to use it?

  • First of all, you will have to disable your antivirus protection.
  • Then download the activator setup from here.
  • Find the file you just downloaded from the folder you saved it to.
  • Extract the archive and search for the file named “KMSActivator”.
  • Double-click on it to run it via administrator.
  • Allow it to run if it asks for permission.
  • Click on the Activate button after seeing your windows version and build it from the menu.
  • Wait for the tool to complete its work.
  • Enjoy

Here on this page, We have shared some best multiple ways by which you can easily activate your windows 8 any build or version. If by any chance, no method works for you, please let us know. We will come up with some other ideas and tips on how you can do it. We appreciate your help to let us help you back. Cheers.

Why you are wasting the money to purchase the Windows 8 Crack. We are here for providing the solution in the form of cracking all the software. Therefore, we Windows 8 Crack make for you so that you never waste money to get this software. If you like this software, please share on your social profile for your friends and family.
Nothing is % , therefore, we can’t claim the working of Windows 8 Keygen. But, you can send us the detail instructions if you are not able to install this crack version. We are requested to follow the same instructions what we supplied in crack folder. Anyway thanks for visiting the AI Pro Crack (storycall.us). Please feel free to comments what you have any doubt regarding this software for crack and getting the keys. Once again, Thanks and enjoy the Cracking and Serial Keys.

Like this:

LikeLoading

Источник: [storycall.us]

International Society For Technology in Arthroplasty - Indicação de Artigos

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Original Title

International Society for Technology in Arthroplasty - Indicação de Artigos

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Original Title:

International Society for Technology in Arthroplasty - Indicação de Artigos

International Society for Technology in Arthroplasty


Big Island, Hawaii, USA : October
President: Richard Komistek, PhD
Correspondence should be addressed to Diane Przepiorski at ISTA, PO Box , Auburn, CA , USA.
Phone: +1 ; Fax: +1 ; E-mail: ista@storycall.us
A ADVANCED OSTEOARTHRITIC GAIT
KINEMATICS AND KINETICS
D.J. Jacofsky, J.D. McCamley, M. Bhowmik-
Stoker, M.C. Jacofsky, M.W. Shrader
The Core Institute, Sun City West, AZ, USA, Sun
Health Research Institute, Sun City, AZ, USA
Previous studies (Chen et al., ; Kaufmann et al.,
) have shown that persons with osteoarthritis (OA)
walk more slowly with lower cadence, have lower peak
ground reaction forces and load their injured limb at
a lower rate than healthy age matched subjects. How-
ever, another study (Mndermann et al., ) found
that patients with severe bilateral OA loaded their knee
joint at a higher rate. They also found these patients
had higher knee adduction moments and lower hip
adduction moments. It has been reported (McGibbon
and Krebs ) that when subjects with knee OA are
required to walk at the same speed as healthy subjects
they generate more power at the hip joint to help over-
come reduced knee power and aid in the advancement
of the leg prior to the swing phase of the gait cycle.
Myles et al. () reported that patients with knee
OA have reduced knee range of motion during walking.
This paper presents detailed kinematic and kinetic data
collected on a large group of patients with advanced
knee osteoarthritis to show the differences in the gait of
these patients just prior to surgery compared with age-
matched control group.
This study was approved by the Sun Health Institu-
tional Review Board. Subjects volunteered to partici-
pate in the study and signed informed consent prior to
testing. Subjects were excluded if the had signicant
diseases of the other joints of the lower extremity or a
diagnosed disorder with gait disturbance. Motion data
was captured using a ten-camera motion capture system
(Motion Analysis Corp., Santa Rosa, CA). Three-
dimensional force data was recorded using four oor
embedded force platforms (AMTI Inc., Watertown,
MA). Patients were asked to walk at a self selected speed
along a meter walkway. A minimum of ve good
foot strikes for each limb were recorded. Data were col-
lected using EVaRT 5 software (Motion Analysis Corp.,
Santa Rosa, CA) and analyzed using OrthoTrak
(Motion Analysis Corp., Santa Rosa, CA) and MatLab
software (The Mathworks Inc., Natick, MA). Statistical
analysis was performed using SPSS software (SPSS
Inc., Chicago, Il) ( = ).
Eighty-six patients (71 7 years) along with sixty-
four control subjects (65 10 years) volunteered to par-
ticipate in the study. All measured temporal and spatial
parameters showed signicant differences between the
OA patients and the control group. The OA patients
were found to walk at a signicantly lower velocity
(p<) and cadence (p<) using a wider step width
(p<) than the control subjects. Patients had their
injured knee signicantly more exed at foot strike
(p<) but exed the knee signicantly less during
swing (p<) when compared to the control group.
Patients had signicantly higher knee exion angles as
well as hip exion and abduction angles during stance.
Knee varus angles were signicantly higher for the OA
patients during stance (p<) but not during swing
when compared to the control group.
Signicant increases in pelvic tilt and pelvic obliquity
were measured during the stance phase. Hip abduction
angles during stance were signicantly lower for the
OA group. Patients generated signicantly lower verti-
cal ground reaction forces during stance (p<) while
sagittal plane kinetic analysis showed signicantly lower
external knee exion moments (p<) and knee power
generation (p<) during this phase of the gait cycle.
Analysis of frontal plane angles showed OA patients had
a signicantly higher maximum knee varus angle during
stance as well as generating a higher external knee varus
moment (p=) during this phase of the gait cycle.
Changes in gait measured in this study support and
enhance ndings from previous studies. OA patients
appeared to walk with a more crouched posture with
higher knee and hip exion angles through mid stance.
This along with lower velocity and cadence and a larger
step width would indicate a desire for more stability
while walking. Patients also exed their knees more at
foot strike in an attempt to absorb the forces generated
during weight acceptance. While knee exion angles
measured for the OA group were similar to the con-
trol subjects during the initial period of stance, the OA
patients did not extend their knees as much during mid
stance indicating a desire to reduce the angular rotation
of the knee while in single support. Changes measured
in frontal plane angles of the hip and pelvis may be an
attempt to compensate for the different angles gener-
ated by the knee during stance. The differences in hip
and knee angles measured during stance for patients
and controls allowed patients to have reduced peak
external knee exion moments during initial stance
but a higher knee exion moment at mid stance. The
reduction in knee angular change during stance and the
reduced cadence meant power absorption during early
and late stance and generation during mid stance was
much lower for the OA patients than the control group.
All the changes noted appear to be designed to limit the
movement of the knee joint while loaded and reduce the
peak loads in an effort to reduce pain at the affected
joint while at the same time increase stability during
gait. These data show the differences that exist between
the gait patterns of patients with advanced osteoarthri-
tis and healthy age-matched persons and highlight the
changes that are necessary following knee replacement
surgery and rehabilitation to return the gait of these
patients to normal.
References:
1. Chen, C.P.C., et al. Am J Phys Med Rehabil.
;82(4)
2. Kaufman, K.R., et al. J Biomech ;
3. McGibbon, C.A., & Krebs, D.E. J Rheumatol.
Nov;29(11)
4. Mndermann A., et al. Arthritis Rheum ;
52(9)
5. Myles, et al. Gait and Posture ;
A A MINIMUM 2 YEARS EXPERIENCE
WITH DELTA

AMC CERAMIC JOINTS


IN THA USING STANDARD AND SLEEVED
FEMORAL HEADS
JY Lazennec, A Ducat, H Sarialli, Y Catonne
Pitie Salpetriere Hospital,orthopaedic department
83 bd de lhopital Paris France
Introduction: Wear performances and fracture tough-
ness of the alumina-matrix composite (AMC) Biolox-
delta

are pointed out in the literature. Clinical and


radiological studies are needed to assess the potential
benets of AMC/AMC bearing surfaces. The aim of this
study is the prospective evaluation of complications and
risk factors in patients implanted with AMC liners and
32 mm AMC femoral heads.
Methods: consecutive patients were included pro-
spectively since
were implanted for primary surgery with 32 or
36 mm ball heads for a , 6 tapers.
In 80 cases, we used 32 and 36 mm Delta

sleeved
heads (M,L,XL) for the adaptation on , tapers
or , 6 tapers (acetabular revisions in absence of
stem exchange, or to increase the lenght of the femoral
neck and the offset) All the clinical and radiological les
were evaluated at a minimum 2 years follow-up with
a special attention for the fracture risk and squeaking.
Radiological data were analysed using Dicomesure


software.
Results: We did not face any signicant problem in
this series. No fracture occurred. No abnormal wear
or implants migration could be detected. We did not
observe squeaking phenomenons. 2 THP were revised
for septic complications ; the retrivials were analysed for
transformation studies(Xray diffraction method XRD).
The phase transformation tetragonal to monoclinic was
mild, in accordance with previous experimental data.
Conclusion: The limitation of this study is its short
follow-up; nevertheless the clinical results are in accor-
dance with the previously published experimental data.
A TOTAL HIP ARTHROPLASTY
FOLLOWING ACETABULAR FRACTURE
M.A. Swanson, C. Schwan, F. Gottschalk, R.
Bucholz, M.H. Huo
University of Texas Southwestern Medical Center
Inwood Rd, WAF Dallas, TX

The purpose of this study was to review the clinical and
radiographic outcome in THRs done following acetabu-
lar fractures (fx). All patients undergoing conversion
THR after previous acetabular fx between and
at a single institution were identied.
Clinical evaluation was done using the Harris hip
scale. Radiographic evaluation was done using the
system proposed by the Hip society. THRs as part of
initial treatment for acute acetabular fx were excluded.
INTERNATIONAL SOCIETY FOR TECHNOLOGY IN ARTHROPLASTY
J BONE JOINT SURG [BR] ; B:SUPP IV
There were 90 THRs (90 patients) performed in
patients previously treated for an acetabular fracture. At
the time of their acetabular facture, 67 had been treated
with ORIF, 12 were treated with closed or limited open
reduction and percutaneous xation, and 11 were treated
without surgery. The mean age at injury was years,
(range, 14 ). 68 patients sustained their fx from a
high-energy mechanism (MVC, MPC, or MCC).
Three patterns accounted for 52% of the fx: trans-
verse posterior wall (20), both column (18), and T-
Type (9). Associated pelvic fractures were present in 14
patients. Associated ipsilateral proximal femur fractures
were present: femoral head (four), femoral neck (ve),
and femoral shaft (three). Among those treated with
ORIF, marginal impaction was noted in 31 and osteo-
chondral head damage in 32 hips.
The mean interval between injury and THR was
42 months (range, two months to 32 years). Cement-
less xation was used in 81 of the 90 cups. Similarly,
cementless stems were used in 80 stems. Bone graft was
necessary in 26 patients (17 autograft, nine allograft).
Two cases each required pelvic augments and reinforce-
ment cage, respectively.
Additional ndings at THR included: femoral head
erosion (53 hips), femoral head osteonecrosis (37 hips),
osteonecrosis of the acetabulum (22 hips), and fx non-
union (six hips). The average cup abduction angle was
(range, 28 to 60), the average cup height was 24
mm (range, 10 to 42), and the average medialization
distance was 23 mm (range, 5 to 48). The mean EBL
was ml and mean operative time was minutes.
The mean F/U was 36 months (range, 6 months to 17
years). The median Harris hip score was 89 at the most
recent F/U. Fifteen revisions (16%) have been done:
aseptic loosening (seven hips), recurrent dislocation (six
hips) and infection (two hips).
Five of the six revisions for recurrent dislocation were
performed in patients who had a posterior approach for
both their acetabular fracture treatment and their THR.
No revision was done in those who had been initially
with percutaneous xation. There was no infection in
those who had been initially with percutaneous xation
either from the fx treatment or the THR. In contrast, 14
ORIF patients were complicated by infection. One of
these developed infection following THR.
Our data support the clinical efcacy and mid-term
durability of THR in this patient group. Aseptic loosen-
ing and recurrent dislocation remain the primary rea-
sons for revision surgery.
A THE EFFECT OF MODERN TOTAL
KNEE ARTHROPLASTY ON MUSCLE
BALANCE AT THE KNEE
W. L. Buford, Jr., F. M. Ivey, D. M. Loveland, C.
W. Flowers
Department of Orthopaedic Surgery and
Rehabilitation, University of Texas Medical
Branch, Galveston TX
Past work in our laboratory identied the generalized effects
of TKA on muscle balance, showing a signicant change
in relative moment generating potential balance favoring
exion and external rotation relative to the normal (intact)
knee (for both PCL sparing and posterior stabilized TKA).
However, there are no reliable data descriptive of the effect
of any single prosthesis. This study hypothesized that using
a modern TKA (Smith Nephew Journey) and implantation
by a single surgeon in ve fresh cadaver specimens would
result in change in muscle balance similar to the earlier
results for posterior stabilized TKA.
Using the tendon excursion-angular motion method
(MA = dr/d, r is excursion, is joint angle in radians),
moment arms of all muscles at the knee were determined
for each of three conditions (intact, ACL-decient, and
prosthesis). The moment arms were then multiplied by
the known muscle tension fractions to generate each
muscles relative moment potential for each specimen
across the three conditions. The resultant summed total
moment potential was then examined for differences
in the exion-extension (FE) and internal-external (IE)
rotation components.
There was no signicant difference in either FE or
IE component for intact versus either the ACL decient
condition (FE, p=, IE, p=) or arthroplasty (FE,
p=, IE, p=). TKA agreed more closely with
the intact knee. Thus, we reject the hypothesis that a
modern TKA (Journey) performs as projected by past
generic results, and conclude that modern TKA effec-
tively reconstructs the balance of the intact knee.
This improves prospects for rehabilitation following
TKA.
A CLINICAL RESULTS OF THE HIP
RESURFACING ARTHROPLASTY FOR
OSTEONECROSIS OF THE FEMORAL
HEAD HEMI-RESURFACING VS TOTAL
RESURFACING
T. Kabata
1
, T. Maeda
1
, T. Murao
1
, K. Tanaka
1
, H.
Yoshida
1
, Y. Kajino
1
, T. Horii
2
, storycall.usita
3
, K.
Tomita
1
1. Department of Orthopaedic Surgery, Kanazawa
University School of Medicine, Kanazawa, Japan;
2. Department of Orthopaedic Surgery, Noto
General Hospital, Nanao, Japan; 3. Department
of Orthopaedic Surgery, Tsuruga Muncipal
Hospital, Tsuruga, Japan.
Objective: The treatment of osteonecrosis of the femoral
head (ONFH) in young active patients remains a challenge.
The purpose of this study was to determine and compare
the clinical and radiographic results of the two different
hip resurfacing systems, hemi-resurfacing and metal-on-
metal total-resurfacing, in patients with ONFH.
Materials and Methods: We retrospectively reviewed
20 patients with 30 hips with ONFH who underwent
hemi-resurfacing or total-resurfacing between Novem-
ber and February We mainly performed
hemi-resurfacing for early stage ONFH, and total-resur-
facing for advanced stage. Fifteen hips in 11 patients
had a hemi-resurfacing component (Conserve, Wright
Medical Co) with the mean age at operation of 50 years
and the average follow-up of years. Fifteen hips in
10 patients had a metal-on-metal total-resurfacing com-
ponent (Birmingham hip resurfacing, Smith & Nephew
Co.) with the mean age at operation of 40 years and the
average follow-up of 5 years. Clinical and radiographic
reviews were performed.
Results: The average postoperative JOA hip scores were
86 points in hemi-resurfacing, 96 points in total-resur-
facing. The difference of pain score was a main factor
to explain the difference of total JOA hip score in the
two groups. Both implants were radiographically stable,
but radiolucent lines around the metaphyseal stem were
more frequent in total-resurfacing. In hemi-resurfacing
patients, ten of 15 hips had groin pain or groin discom-
fort, three hips were revised to total hip arthroplasties
(THA) because of femoral neck fracture, acetabular pro-
trusio, and osteoarthritic change, respectively. On the
other hand, in total-resurfacing patients, there were no
revision and no groin pain.
Discussion: In the prosthetic treatment of young active
patients with ONFH, it is theoretically desirable to
choose an implant with conservative design in antici-
pation of the future revision surgery. Hemi-resurfacing
hip arthroplasty is the most conservative implant for the
treatment of ONFH. However, the results of hemi-resur-
facing in this study have been very disappointing due
to high revision rates and insufcient pain relief despite
of the good implant stability. On the other hand, the
pain relief and implant survivorship after total-resur-
facing were superior to the results of hemi-resurfacing,
although the usages of the total-resurfacing were for
more advanced cases. These results suggested that total-
resurfacing was a more valuable treatment option for
active patients with ONFH than hemi-resurfacing
ATHE INFLUENCE OF MEDIALISATION
AND LATERALISATION OF THE FEMORAL
HEAD ON THE FORCES ACTING ON THE
HIP AFTER TOTAL HIP REPLACEMENT
C. Manders, A.M. New and M. Taylor
Bioengineering Science Research Group,
University of Southampton, Southampton, UK
During hip replacement surgery the hip centre may
become offset from its natural position and it is impor-
tant to investigate the effect of this on the musculoskel-
etal system. Johnston et al [1] found that medialisation
of the hip centre reduced the hip joint moment, hip
contact and abductor force using a musculoskeletal
model with hip centre displacements in 10mm incre-
ments. More recently an in vivo study found that the
range of displacement of the hip centre of rotation was
from mm laterally to mm medially [2]. To inves-
tigate the hypothesis that medialisation of the hip centre
reduces the hip contact force, a musculoskeletal model
of a single gait cycle was analysed using three scenarios
with the hip in the neutral position and with it displaced
by 10mm medially and laterally.
The lower limb musculoskeletal model included
Hill type muscle units in each leg and uses a muscle
recruitment criterion based on minimising the squared
muscle activities, where the muscle activity is the muscle
force divided by the muscles maximum potential force.
The maximum potential force is affected by the length
of the muscle unit and the muscles tendons each are
calibrated to give the correct length in its neutral posi-
tion. The same gait analysis data from one normal walk-
ing cycle was applied to each modelled scenario and
the resultant hip joint moment, hip contact force and
muscle forces were calculated. The abductor muscles
forces were summed and the peak force at heel strike
reported. The peak resultant hip moments and the peak
hip contact forces at heel strike are also reported and
compared between the different scenarios. The scenar-
ios were each run twice, once with the muscle tendon
lengths calibrated for the hip in the altered position and
subsequently with the muscle tendon lengths maintained
from the neutral hip position.
For the medialising of the femoral head, the hip con-
tact force and the peak abductor force were reduced by
4% and 2% respectively compared the neutral position.
However if the tendon lengths of the muscles were main-
tained from the neutral position, the medial displacement
model had a 3% higher hip contact force and a 6% larger
abductor force than calculated for the neutral position.
Although the peak resultant hip joint moment increases
with a lateral displacement by 3%, the peak abductor
force and peak hip contact force have a reduced force of
3% compared to the neutral hip. Using the muscle tendon
lengths calibrated for the hip in the original position pro-
duces a 3% increase in the hip contact and abductor force
for the lateralised femoral head.
This study has shown that the hip contact force and
abductor force depend on the calibration of the muscles
tendon lengths. Using the model with muscles calibrated
for the altered hip centre produced the hypothesed
reduction in hip contact force. However, maintaining
the tendon lengths from the neutral position had a sig-
nicant effect the calculated forces. The hip contact and
abductor forces increased in the models with the origi-
nal tendon lengths and the effect was also found to be
greater when the hip was displaced medially.
References:
1. Johnston, et al, Reconstruction Of The Hip. A Math-
ematical Approach To Determine Optimum Relation-
ships. JBJS(Am.), 61(5): p
2. Wan, et al, The Inuence of Acetabular Compo-
nent Position on Wear in Total Hip Arthroplasty. J.
Arthrop, 23(1): p
INTERNATIONAL SOCIETY FOR TECHNOLOGY IN ARTHROPLASTY
J BONE JOINT SURG [BR] ; B:SUPP IV
A AUTOMATIC SEGMENTATION
OF OSTEOARTHRITIC KNEE JOINTS IN
CT VOLUMES USING STATISTICAL BONE
ATLASES
J. M. Johnson, M.R. Mahfouz
Center for Musculoskeletal Research,
University of Tennessee, Knoxville, TN, USA.
Correspondence: J. Michael Johnson Perkins
Hall University of Tennessee Knoxville, TN
Email: jjohn@storycall.us
Accurate segmentation of bone structures is an impor-
tant step in surgical planning. Patient specic 3D bone
models can be reconstructed using statistical atlases with
submillimeter accuracy. By iteratively projecting noisy
models onto the bone atlas, we can utilize the statisti-
cal variation present in the atlas to accurately segment
patient specic distal femur and proximal tibia models
from the CT data.
Our statistical atlas for the knee consists of male
distal femur models and 71 male proximal tibia models.
We performed an initial registration between the aver-
age model from the atlas and the volume space before
beginning the segmentation algorithm. Intensity proles
were linearly interpolated along the direction normal
to the surface of the current model. The proles were
then smoothed via a low-pass lter. A point-tonearest
peak gradient was calculated for each prole, and then
weighted by a Gaussian window centered about the origi-
nating vertex. The esh-to-bone edge locations are taken
as the maximum of the weighted gradient. The detected
locations were then projected onto the atlas using a subset
of the available principal components (PCs). The amount
of variation is increased by projecting the edge locations
onto a larger subset of PCs. The process is repeated until
% of the statistical variation is represented by the
PCs. Though our dataset is much larger, we initially per-
formed bone segmentation on 5 male knee joints. The
knee joint was considered to be the distal femur and
proximal tibia. We used manually segmented models to
determine ground truth. Initial results on the 5 knee joints
(distal femur and proximal tibia) had a mean RMS error
of mm, with a minimum of mm. Segmenta-
tion on the distal femur achieved a mean RMS error of
mm, and the results for the tibia had a mean RMS
error of mm.
Our results suggest that our atlas-based segmenta-
tion is capable of producing patient-specic 3D models
with high accuracy, though patient-specic degeneration
was often not well represented. To achieve more accu-
rate patient-specic models, we must incorporate local
deformations into the nal model.
A IN VIVO DETERMINATION OF THA
KINEMATICS FOR SUBJECTS HAVING TWO
DIFFERENT SURGICAL APPROACHES.
storycall.us, storycall.ust, storycall.us,
storycall.ust, storycall.usek, storycall.use,
storycall.usz.
Presenting author: Tennessee Orthopaedic Clinics,
Park West Blvd, Knoxville, TN
Previous uoroscopic analyses of Total Hip Arthroplasty
(THA) determined that the femoral head slides within the
acetabular cup, leading to separation of certain aspects of
the articular geometries. Although separation has been
well documented, it has not been correlated to clinical
complications or a more indepth understanding of the
cause and effect. Surgical technique is one of the important
clinical factors when considering THA procedures, and
it is hypothesized, that it could affect the magnitude and
occurrence of femoral head separation (sliding) in THAs.
Hence, the objective of this study was to determine and
compare in-vivo THA kinematics for subjects implanted
with a THA using two different surgical approaches.
Thirty seven subjects, each implanted with one of
two types of THA were analysed under in vivo, weight-
bearing conditions using video uoroscopy while
performing a sit-to-stand activity. Ten subjects were
implanted by Surgeon 1 using a long incision postero-
lateral approach (G1); while a further 10 subjects were
implanted by the same surgeon using a short incision
posterolateral approach (G2). The remaining 17 sub-
jects were implanted using the anterolateral approach;
10 by Surgeon 2 (G3) and seven by Surgeon 3 (G4).
All patients with excellent clinical results, without pain
or functional decits were invited to participate in the
study (HHS > 90). 3D kinematics of the hip joint was
determined, with the help of a previously published 2D-
to-3D registration technique. From a completely seated
position to the standing position, four frames of the
uoroscopy video were analysed.
Subjects in all groups experienced some degree of
femoral head separation at all increments of the sit-to-
stand activity that were analysed. The magnitude and
frequency of separation greater than mm varied
between each surgeon group, between incision types,
between incision lengths and between the two types of
THA that were analysed. The average maximum separa-
tion was , , and mm for G1, G2, G3 and
G4 respectively. Though there was no difference in the
average maximum separation values for the 4 groups,
the maimum separation varied signicantly. While the
maximum separation in G2 was mm, the maximum
separation in G4 was mm. G1 and G3 had maximum
separation values of mm and mm respectively.
This study suggests that there may be a correlation
between incision lengths and surgical approach with
femoral head separation in THAs. The maximum sep-
aration that was seen among all groups was a subject
with a traditional long incision, while the short incision
group had less incidence of separation. Results from this
study may give researchers and implant developers a
better understanding of kinematics around the hip joint
and how they vary with respect to different surgical
techniques. Further analysis is being conducted on the
subjects before denitive conclusions can be made.
AB HIP RESURFACING
ARTHROPLASTY: THE EFFECT OF
ANTERIOR AND POSTERIOR NOTCHING
ON FRACTURE RESISTANCE
GA Higgins, Z Morison, M Olsen, EH Schemitsch
St Michaels Hospital, 30 Bond St, Toronto,
Ontario, M5B 1W8 Canada
Surgeons performing hip resurfacing ante-vert and
translate the femoral component anterior to maximize
head/neck offset and educe impingement. The anterior
femoral neck is under tensile forces during gait similarly
to the superior neck [6]. This study was esigned to deter-
mine the risk of femoral neck fracture after anterior or
posterior notching of the femoral neck.
Method: Fortyseven 4th generation synthetic femora
were implanted with Birmingham Hip Resurfacing pros-
theses (Smith & Nephew Inc. emphis, USA). Implant
preparation was performed using imageless computer
navigation (VectorVision SR , BrainLAB, Grmany).
The virtual prosthesis was initially planned for neutral
version and translated anterior, or posterior, to create
the notch. The femora were xed in a single-leg stance
and tested with axial compression using a mechanical
testing machine. This method enabled comparison with
previously published data. The synthetic femora were
prepared in 8 experimental groups:2mm and 5mm ante-
rior notches, 2mm and 5mm posterior notches, neutral
alignment with no notching (control), 5mm superior
notch, 5mm anterior notch tested with the femur in 25
exion and 5mm posterior notch tested with the femur
in 25 extension We tested the femora exed at 25 ex-
ion to simul ate loading as seen during stair ascent. [3]
The posterior 5mm notched femoral necks were tested
in extension to simulate sporting activities like running.
The results were compared to the control group in neu-
tral alignment using a one-way ANOVA:
Results: Testing Group Mean load to failure Signicance
Neutral (Control) N Anterior 2mm
N p= Anterior 5mm
N p= Posterior 2mm N
p= Posterior 5mm N p= Supe-
rior 5mm N p= Anterior 5mm in
25 exion N p= Posterior 5mm
in 25 extension N p= Both the
anterior 5mm notch tested in single-leg stance and ante-
rior notch in exion displayed lower compressive loads to
failure (N and N). The mean load to fail-
ure value for the posterior 5mm notches in extension was
N compared to N for the control group.
Our data suggests that anterior and posterior 2mm notches
are not statistically signicantly weaker in axial compres-
sion. The anterior 5mm notches tend towards signicance
in axial compression (p=) and bordered signicance
in exion (p=). The 5mm posterior notches were not
signicantly weakened in axial compression (p=),
but tended towards signicance in extension (p=).
The 5mm superior notch group was signicantly weaker
with axial compression supporting previous data pub-
lished (p=). We are currently assessing offset and
other variables that may reduce data spread.
Conclusion: We conclude that anterior and posterior
2mm notching of the femoral neck has no clinical
implications, however 5mm anterior notches may lead
to fracture. The fracture is more likely to occur with
stair ascent rather than normal walking. Posterior 5mm
notches are not likely to fracture with normal gait, but
may fracture with higher impact activities that promote
weight bearing in extension. Hip resurfacing is com-
monly performed on active patients and ultimately 5mm
notching in the anterior or posterior cortices has clini-
cally important implications.
A AUTOMATIC THREE DIMENSIONAL
DISTAL RADIUS ANALYSIS USING
STATISTICAL ATLASES
E. E. Abdel Fatah, M. R. Mahfouz, L N. Bowers
Center of Musculoskeletal Research, University of
Tennessee, Knoxville, TN, USA
Fracture of the distal radius is one of the most common
wrist fractures that orthopedic surgeons face. Quite
often an injury is too severe to be repaired by support-
ive measures and pin or plate xation is the subsequent
alternative. In this study we present a novel method for
automated 3D analysis of distal radius utilizing statisti-
cal atlases, this method can be used to design pin or
plate xation device that accurately t the anatomy.
A set of bones (60 males and 60 females) were
scanned using high resolution CT. These CT scans were
then segmented and the surface models of the radius
were added to the statistical atlas. Global shape differ-
ences between males and females were then identied
using the statistical atlas. A set of landmarks were then
calculated including the tip of the lateral styloid process
and centroid of the distal plateau. These landmarks were
then used to calculate the width of the distal plateau, the
height of the distal plateau, overall radius length and
the curvature of the distal plateau. These measurements
were then compared for both males and females. Three
of the measurements came statistically signicant with
p< Curvature of the distal plateau wasnt found to
be signicant, with females having slightly higher radius
of curvature than males.
This automated 3D analysis overcomes the major
drawbacks of 2D x-ray measurements and manual
localization methods. Thus, this analysis quanties
more accurately the anatomical differences between
males and females. Statistically signicant anatomical
gender differences were found and quantied, which
can be used for the design of trauma prosthesis that can
t normal anatomy.
A HARD TO HARD BEARING:
ACTUALITY, PERSPECTIVES,
COMPLICATIONS
storycall.uso, G. Calafiore, M. Rossoni, R.
Simonetta
The return to the use of big diameter femoral heads is
now a well-established reality.
The certainty of a better result is not only for young
patients with an high functional demand, but also for
elderly people, who need a reduction of enticement time
and an increase of intrinsic Materials optimization and
hard to hard bearings allowed surgeons to reduce
the problem of volumetric wear and to guarantee some
undeniable advantages such as: -better articular stabil-
INTERNATIONAL SOCIETY FOR TECHNOLOGY IN ARTHROPLASTY
J BONE JOINT SURG [BR] ; B:SUPP IV
ity, thanks to the off-set restore -better range of motion
-reduction of dislocation risk Increasing the femoral
head diameter means increasing the off-set therefore the
lever arm of the gluteus medius which is a great articu-
lar stabilizer. With the old metal to polyethylene and
ceramic to polyethylene bearings, the bigger contact sur-
face between the head and the cotyle interior certainly
increased the volumetric wear in the past. The introduc-
tion of bearings at low friction coefcient ceramic-to-
ceramic and metal-to-metal solved this problem and the
undeniable improvement of the polyethylene prepara-
tion made this material to be considered safe even with
big diameter heads. All articular stability parameters, in
primis for the off-set, can be improved by the use of
those solutions which are all efcient and able to give
the surgeon the right mean to solve every single case.
The eventuality to break ceramic heads is reported in
literature and has fortunately reference to a low percent-
age, about % (Biolox 28 mm ceramic-ceramic THR:
% fractures 7 years f.u. Toni, storycall.usgs, NYC,
), but it maybe limits this kind of choice in cases
of hip dysplasia, in which a bigger acetabulum upright-
ness increases the percentage of mistake in placing the
cotyle. Nowadays, the diameter of the available heads is
progressively increasing with the cotyle diameter (32, 36),
so ceramic-ceramic is anyway an excellent solution for all
other fatigued coxofemural articulations, above all if they
are still eumorphic, and for female patients in which a
worst bone quality reduces the choice of metal-metal.
The metal-metal bearing nds instead a great indica-
tion in all patients, above all male patients with a good
bone quality with high functional demand. The only
reasons to go back preferring the metal-metal bearing
are the reduction of the average age of the prosthesized
patient and the increasing performance need. New tech-
niques of supercial nish of the chrome-cobalt allowed
surgeons to optimize the clearance, the self-smoothing
ability in case of streaks of third body.
Tests drawn in gate analysis demonstrated a reduced
detachment between the two prosthesis components
when the metal-metal operated patient makes the step,
not only in favour of the bearing, but also of the choice
of big diameters (Metal on metal and distraction: an in
vivo comparison. Komistec et al; JBJS; October ).
Moreover, other indications in literature show that there
is no direct correlation between the cancer development
and the metal-metal bearing prosthesis implant (Visuri,
COOR ) (The risk of cancer following total hip
or knee arthroplasty Tharani et al., JBJS May ),
and even that there were no cobalt toxic serum levels
able to justify cardio-pneumatie (Brodner, JBJS ).
Independently by the materials choice, the bearing with
big diameter heads undeniably reduces dislocation risk
and accelerates the post-operative recovery even in old
patients surgically treated for fracture.
The larger distance a big diameter head has to cover
in order to come out of the acetabular cavity (Jump dis-
tance) certainly reduces the number of dislocation cases.
(Large versus small femoral heads in metal on metal
total hip arthroplasty Cucler J.M. et al., JoA, Vol 19,
num 8, suppl. 3., ) (Effect of femoral head diam-
eter and operative approach on risk of dislocation after
primary total hip arthroplasty Berry DJ et al., JBJS
Am. Nov; 87(11)).
All those reasons pushed us to believe in hard to
hard bearings with big diameter, whose results could
not be more satisfying. Nevertheless, there are some
complications which can make us think, such as cases of
pseudocancer for metal-metal bearing and the squeak-
ing in the ceramic-ceramic bearing. The introduction
of last generation polyethylene could bring the golden
standard near the ceramicpolyethylene again.
A STATE OF ORTHOPAEDIC IMAGING
RELATIVE TO JOINT REPLACEMENT
Robert E. Booth, Jr.
3B Orthopaedics, Pennsylvania Hospital,
Spruce Street, Philadelphia, Pennsylvania
Orthographic radiography, a revelation at its inception,
has been the orthopaedic standard for a century. It has
facilitated osteology and empowered arthroplasty like
no other parallel technology. While many new imaging
modalities nuclear scans, computerized axial tomogra-
phy, magnetic resonance imaging, etc. have advanced
the art even further, plain XRays, quite frankly, remain
the standard for identifying patient pathology and
evaluating surgical intervention. The enlightened scru-
tiny of properly obtained and successfully reproduced
radiographic images still yields far more information in
the daily practice of orthopaedics than its more sophis-
ticated and expensive derivatives. A detailed review of
readily available diagnostic information is intended
to rejuvenate/resuscitate our most valuable ally in the
evolving struggle against arthritic disease.
A A PROSPECTIVE DUOCENTER STUDY
ON THE CLINICAL AND RADIOLOGICAL
OUTCOME OF THE MULTIGEN PLUS TOTAL
KNEE SYSTEM WITH A BIOLOX DELTA
CERAMIC FEMORAL COMPONENT
P. Bergschmidt, C. Lohmann, R. Bader, C. Lukas,
W. Ruether, W. Mittelmeier
Department of Orthopaedics, University Rostock,
Germany Department of Orthopaedics, University
Hamburg-Eppendorf, Germany
The objective of this prospective duo-center study was
to evaluate the clinical and radiological outcome of the
unconstrained Multigen Plus total knee system (Lima
Lto, San Daniele, Italy) with the new BIOLOX Delta
ceramic femoral component.
40 patients underwent cemented total knee arthro-
plasty in two university hospitals. Clinical evaluations
were undertaken preoperatively and at 3 as well as 12
months postoperatively using the HSS-Score, WOMAC-
Score and SFScore. The radiological investigations
included ant-post. radiographs (whole leg in two leg
stance and lateral view of the knee) and patella tangen-
tial radiographs (Merchant view).
During 12 months follow-up three patients under-
went revision surgery. One patient had to be revised
due to infection after postoperative opening of the knee
joint due to direct trauma. One patient sustained an
osteosynthetic procedure due to periprosthetic fracture
after trauma. In one patient a retropatellar replacement
was inserted one year postoperatively. Implant related
complications were not found. The mean preoperative
HSS-Score amounted to points. At 3 and 12
month follow-up the mean HSS-Score was
and points respectively.
Therefore HSS, as well as WOMAC and SF Score
improved signicantly from preoperativly to both post-
operative evaluations (Wilcoxon-Test p<). Radio-
lucent lines around the femoral ceramic component
were found in six cases.
However, subsequent long-term studies must be car-
ried out in order to prove the good early clinical results
and to clarify if progression of radiolucent lines may
inuence the clinical outcome of the presented newly
ceramic total knee system.
A A PERSONAL JOURNEY IN THE
DEVELOPMENT OF KNEE REPLACEMENT
FROM TO TODAY
C.S. Ranawat, M.D.
Ranawat Orthopaedic, Hospital for Special
Surgery, New York, NY, USA
The three distinct phases of design and development of
total knee replacement (TKR) were: (1) , (2)
and (3) to today and beyond.
Hinge designs and early condylar designs highlight
the rst major period of TKR development from
to These designs included but were not limited
to the Waldius, Shiers, and GUEPAR hinges, Gunstons
Polycentric Knee in , Freemans ICLH Knee in
, Coventrys Geomedic Knee in , St. Georges
Sled Prosthesis in , Marmors Modular Uni in
, Townleys Condylar Design in , Walker and
Ranawats Duocondylar in , Waughs UCI Knee
in , Eftekars Metal Backing in , Murray and
Shaws Metal Backed Variable Axis Knee in , Insall
and Bursteins IB-1 Knee in , the Kinematics in
, and nally Walker, Ranawat and Insalls Total
Condylar in
The Total Condylar Knee, developed by Walker,
Ranawat, and Insall between and , has been
the benchmark for all designs through the 20th century.
My personal experience of cemented TKR from
has shown a survivorship of 89% % at
years. Similar data has been presented in several 10+
year follow-up studies.
The next major phase of development gave birth to
semi-constrained TKR, cruciate saving and substituting
PS designs, improved instrumentation and improved
cemented xation. Other guiding principles involved
improving alignment, managing soft-tissue balance for
varus-valgus deformity, improving kinematics and pro-
ducing superior polyethylene for reduced wear and oxi-
dation. The advent of rotating platform mobile bearing
knees with multiple sizes marked the most recent major
advancement in TKR design.
With more total knee replacements being performed
on younger, more active patients, improved design,
better xation (non-cemented), and more durable artic-
ulation are needed. The new standard for ROM will be
degrees. Non-cemented xation, improved poly,
such as E-poly, and the rotating platform design will
play a major role in increasing the longevity of TKR to
over 25 years.
A THE LEGACY OF JOHN N. INSALL
G.R. Scuderi
The Insall Scott Kelly Institute for Orthopaedics
and Sports Medicine, New York, NY
John N. Insall accomplished unparalleled success as
an orthopedic surgeon, implant designer, and teacher.
Over a span of 4 decades he was a pioneer in the eld
of knee surgery and was instrumental in evolving total
knee arthroplasty to its current state of excellence. His
legacy in total knee implant design began with the Duo-
condylar and Duopatellar prosthesis; was revolutionary
with the implantation of the rst Total Condylar Pros-
thesis -the rst modern prosthesis; followed by posterior
cruciate ligament substitution with the Insall Burst-
ein Posterior Stabilized Prosthesis; and ultimately with
the Legacy Posterior Stabilized High Flexion Prosthesis
a xed and mobile bearing high performance implant.
Recognizing the importance of surgical technique with
any implant design, Insall simultaneously described the
surgical technique of ligament releases for restoring
axial alignment and balancing the exion and extension
gaps. Over time his innovations have been embraced by
the majority of surgeons and have become the founda-
tion of what we do today. During more than 40 years of
clinical practice, John N. Insall was an unselsh educa-
tor. He shared his clinical experiences with the medical
community by publishing, along with his students and
associates, an exhaustive array of articles and books on
various afictions of the knee. Recognized by his con-
temporaries as a leader in the eld of total knee arthro-
plasty, he was elected president of the Knee Society in
For the entire orthopedic community he contin-
ued to work laboriously, sharing his experiences with
his fellows and colleagues until his death in The
life of John N. Insall will be remembered in perpetuity
for his unparalleled inuence on knee surgery.
A TRIBUTE TO SIR JOHN CHARNLEY
D.J. Berry
Mayo Clinic Department of Orthopedic Surgery,
First Street SW, Rochester, MN
Sir John Charnley unquestionably was the pioneer of
modern joint arthroplasty. He was also an innovator in
many other areas of orthopedics, including fracture care
and arthrodesis, but this tribute will focus on his contri-
butions to arthroplasty.
Charnley pioneered the use of methyl methacrylate
cement and in so doing provided the rst reliable means
of xing implants to bone. For the rst time, this pro-
vided arthritis patients with reproducible long-term,
reliable pain relief from advanced joint arthritis. Charn-
INTERNATIONAL SOCIETY FOR TECHNOLOGY IN ARTHROPLASTY
J BONE JOINT SURG [BR] ; B:SUPP IV
ley also pioneered the use of a novel bearing surface,
high molecular weight polyethylene. In so doing, he pio-
neered resurfacing of both sides of a joint with a low-
friction, low-wear bearing. This provided the potential
for excellent pain relief and also durable function of a
hip arthroplasty.
Charnley understood the importance of reproducing
joint mechanics and kinematics, and the arthroplasties
he designed fully reproduced leg length and hip offset,
and therefore the mechanics of the hip.
Finally, Charnley understood that technology is only
a great value when it can be transferred effectively to
many surgeons around the world. He created a carefully
constructed educational structure to teaching the meth-
odology in a way that would allow surgeons to practice
this procedure successfully in other centers. Charnley
understood the importance of minimizing complications
for a procedure to be widely adopted and successful.
It is no exaggeration to state that Charnleys contri-
butions have helped tens of millions of patients world-
wide who otherwise would have been permanently
crippled by arthritis. Todays further advances in joint
arthroplasty are all dependent on the foundations of
joint arthroplasty pioneered by Sir John Charnley.
A TRIBUTE TO HAP PAUL
WL Bargar
Sutter Institute for Medical Research and UC
Davis School of Medicine, Sacramento, CA, USA
Hap Paul was a unique individual. It is appropriate that
this award should go a unique paper presented at this
years ISTA. The name Hap comes from his initials
Howard A. Paul. He was an outstanding veterinar-
ian, but he was also much more than that. He had an
insatiable curiosity combined with a quick mind and a
surgeons practicality. His rst love was research. After
graduating from high school in Connecticut, he went to
Notre Dame as a swimmer. He graduated with a degree
in Microbiology and a strong desire to cure cancer.
Acting on his dreams, as he always did, he decided to
go to Paris to work with one of the pioneers of Inter-
feron research. Never mind that he didnt have a job and
did not know a word of French. Of course he got the
job and learned French playing rugby (hence his awful
accent and colorful vocabulary). The funding ran out
for the Interferon research, but he somehow got a shot
at a spot in the veterinary school in Paris. He got mar-
ried and nished his veterinary training. The veterinary
thing worked out, but the marriage didnt. He returned
to the US after 9 years living in France, to attend the UC
Davis School of Veterinary Science as a surgical resident
in the small animal area. He met his wife, Dr. Wendy
Shelton there but that is another story.
I met Hap when I was a new attending orthopaedic
surgeon at UC Davis and looking to do some animal
modeling of hip replacement revision techniques. He
was an imposing gure: six feet four, big curly afro and
wire glasses. He dressed like a Frenchman, wore big
clogs and carried a purse. Needless to say I was intimi-
dated initially. But, he had great joi de vive and lived up
to his name he was almost always happy.
Hip replacement in dogs began in the s, but
was nearly abandoned by the early s because of
infections and luxations (dislocations). In order to
develop an animal model we had to develop instruments
and techniques that incorporated third generation
cementing techniques. This we did, but Hap took these
instruments and began using them clinically on working
dogs. He developed quite a reputation for resurrecting
hip replacements for dogs in the US and internationally.
Hap and I went on to develop dog models for CT-based
custom implants and later surgical robotics (eventually
leading to the development of Robodoc). Despite our
academic interests, both Hap and I went into private
practice in the mid s separately, of course (he
as a veterinary orthpaedic surgeon and I specialized in
hip and knee replacements for humans). Our research in
surgical robotics took off when we landed a huge grant
from IBM. But then the sky fell in when we learned that
Hap had developed lymphoma. After surgery, radiation
and chemotherapy, he was in remission, but temporarily
couldnt perform surgery due to a peripheral neuropa-
thy attributed to Vincristine. So Hap went to the lab
at UC Davis to work directly with the robotics team.
He was a slave driver but a pleasant one. Certainly
the basic research behind Robodoc could not have been
done without Hap getting lymphoma.
Over 5 years () we both had a ball working
with some of the best minds in robotics and imaging
research. We presented our research on CT-based cus-
toms and robotics at many international venues, and
Hap made many friends some are in the audience
today. He was one of the founders of this organization
(ISTA). Hap returned to veterinary practice when he
could nally work with his hands again but this was
not for long. Soon our research lead to the founding of
Integrated Surgical Services (ISS) in , the makers of
Robodoc. Hap agreed to leave his practice to lead the
company and I stayed in clinical practice to develop and
utilize the device on patients. In , we shocked the
world by being the rst to use an active robot in human
surgery. It looked like the dawning of a new age. (I still
believe it is, but it has been a very slow dawn).
For Hap, the joy was short-lived. He developed leu-
kemia as a complication of his prior chemotherapy. He
died while recovering from a bone marrow transplant
on Feb. 10, at the young age of During his
short life he contributed tremendously to the benet
of others by his research and development work. But
mostly he inspired others to excel in their endeavors. He
was a wonderful guy. And we are all pleased to honor
him with the presentation of the Hap Paul Award at
each years meeting of ISTA.
A IN VITRO IMAGING OF LIVING
CELLS WITH ULTRASOUND INTENSITY
MICROSCOPE
E. Chimoto
1
, Y. Hagiwara
1
, Y. Saijo
2
, A. Ando
1
,
H. Suda
1
, Y. Onoda
1
, E. Itoi
1
hagi@storycall.us
storycall.us
1. Department of Orthopaedic Surgery, Tohoku
University Graduate School of Medicine, Sendai,
Japan; 2. Graduate School of Biomedical
Engineering, Tohoku University.
Introduction: Acoustic microscopy for medicine and
biology has been developed for more than twenty years
at Tohoku University []. Application of acoustic
microscopy in medicine and biology has three major
features and objectives. First, it is useful for intra-opera-
tive pathological examination because staining is not
required. Second, it provides basic acoustic properties to
assess the origin of lower frequency ultrasonic images.
Third, it provides information on biomechanical proper-
ties at a microscopic level because ultrasound has close
correlation with mechanical properties of the tissues.
This paper describes the preliminary results obtained
using MHz ultrasound intensity microscopy for in
vitro characterization of rat synovial cell cultures. The
novelty of the approach lies in the fact that it allows
remote, non-contact and disturbance-free imaging of
cultured synovial cells and the changes in the cells prop-
erties due to external stimulants such as transforming
growth factor beta-1 (TGFbeta1).
Materials and Methods: Ultrasound intensity micro-
scope: An electric impulse was generated by a high speed
switching semiconductor. The electric pulse was input to
a transducer with sapphire rod as an acoustic lens and
with the central frequency of MHz. The reections
from the tissue was received by the transducer and were
introduced into a Windows-based PC (Pentium D,
GHz, 2GB RAM, GB HDD) via a digital oscilloscope
(Tektronix TDSB, Beaverton, USA). The frequency
range was 1GHz, and the sampling rate was 20 GS/s. Four
values of the time taken for a pulse response at the same
point were averaged in order to reduce random noise.
The transducer was mounted on an X-Y stage with a
microcomputer board that was driven by the PC through
RSC. The Both X-scan and Y-scan were driven by
linear servo motors. The ultrasound propagates through
the thin specimen such as cultured cells and reects at
the interface between the specimen and substrate. A
two-dimensional distribution of the ultrasound intensity,
which is closely related to the mechanical properties, was
visualized with by pixels.
Tissue preparation: The synovial membrane was
obtained from non-operated male rats weighing from
to g through medial para-patellar incision.
The tissue was diluted and loosened % DispaseII
(Boehringer, Mannheim) in DMEM for 2 hours at 37
C. Then centrifuged at g for 5 min and discard
the supernatant. The cells were plated in 75 mm2 dish
(Falcon) with Dulbeccos modied Eagles medium
(DMEM, GIBCO Laboratories) containing 10% fetal
bovine serum (SIGMA Chemical Co.) at 37 C in a
CO2 incubator. To determine changes of intensity, the
cells were treated with 1 ng/ml of human recombinant
TGF-1 (hTGF-1, R&D Systems, Inc.) for 1 and 3
days after reaching conuent. The non-treated cells was
harvested at 3 days after reaching conuent and dened
as control. Randomized four points at each dish were
measured and averaged data was dened as the repre-
sentative value of each dish. The cells used for experi-
ments were at the third passage.
Signal processing: The reection from the tissue area
contains two components. One is from the tissue surface
and another from the interface between the tissue and
the substrate (phosphate buffered saline). Frequency
domain analysis of the reection enables the separa-
tion of these two components and the calculation of the
tissue thickness and intensity by Fourier-transforming
the waveform [9].
Image analysis: Randomized point regions were deter-
mined using ultrasound intensity microscopic images.
This was done by employing commercially available
image analysis software (PhotoShop CS2, Adobe Sys-
tems Inc.). Ultrasound intensity microscopic images
with a gradation color scale were also produced for clear
visualization of the ultrasound intensity variations.
Statistics: Statistical analysis among groups was per-
formed using one factor analysis of variance. Data were
expressed as mean standard deviation. A value of P <
was accepted as statistically signicant.
Results: The ultrasound intensity microscope can clearly
visualize cells. The high intensity variations area of the
reected ultrasound energy at the central part of the cell
corresponded to the nucleus and the high intensity area
at the peripheral zone corresponded to the cytoskeleton
mainly consisting of actin laments. The intensity of the
reected ultrasound energy at the peripheral zone was
signicantly increased after stimulation with hTGF-b1.
References:
1. M. Tanaka, H. Okawai, N. Chubachi, J. Kushibiki, T.
Sannomiya, Propagation properties of ultrasound in
acoustic microscopy through a double-layered speci-
men consisting of thin biological tissue and its holder,
Japanese, Journal of Applied Physics 23 ()

2. Y. Saijo, M. Tanaka, H. Okawai, F. Dun, The ultra-
sonic properties of gastric cancer tissues obtained
with a scanning acoustic microscope system, Ultra-
sound in Medicine and Biology 17 ()
3. H. Sasaki, M. Tanaka, Y. Saijo, H. Okawai, Y. Tera-
sawa, S. Nitta, K. Suzuki, Ultrasonic tissue charac-
terization of renal cell carcinoma tissue, Nephron 74
()
4. Y. Saijo, H. Sasaki, M. Sato, S. Nitta, M. Tanaka,
Visualization of human umbilical vein endothelial
cells by acoustic microscopy, Ultrasonics 38 ()

5. Y. Hagiwara, Y. Saijo, E. Chimoto, H. Akita, Y.
Sasano, F. Matsumoto, S. Kokubun, Increased elas-
ticity of capsule after immobilization in a rat knee
experimental model assessed by scanning acoustic
microscopy, Upsala Journal of Medical Sciences
()
6. Y. Hagiwara, A. Ando, E. Chimoto, Y. Saijo, K.
Ohomori-Matsuda, E. Itoi, Changes of articular car-
tilage after immobilization in a rat knee contracture
model, Journal of Orthopaedic Research 27 ()

7. Y. Saijo, K. Kobayashi, N. Okada, N. Hozumi, Y.
Hagiwara, A. Tanaka, T. Iwamoto, Conf Proc IEEE
Eng Med Biol Soc 1 ()
8. Y. Hagiwara, Y. Saijo, A. Ando, E. Chimoto, H. Suda,
Y. Onoda, E. Itoi, Ultrasonic Intensity Microscopy
for Imaging of Living Cells, Ultrasonics 49 ()

9. N. Hozumi, R. Yamashita, C.K. Lee, M. Nagao,
K. Kobayashi, Y. Saijo, M. Tanaka, N. Tanaka, S.
INTERNATIONAL SOCIETY FOR TECHNOLOGY IN ARTHROPLASTY
J BONE JOINT SURG [BR] ; B:SUPP IV
Ohtsuki, Time-frequency analysis driven ultrasonic
microscopy for biological tissue characterization,
Ultrasonics 42 ()
A CLINICAL RESULTS OF CERAMIC/
CERAMIC IN THR
W.N. Capello
Clinical Dr. Ste. , Indianapolis, IN
At ten years, alumina ceramic bearings are functioning
well with low complication rates and a fewer number of
revisions than the control cohort.
Alumina ceramic bearings have proven superior wear
resistance, lubrication, and scratch resistance, without
carrying the risk of metal ion release. In a U.S. IDE
clinical trial was initiated utilizing newly improved alu-
mina ceramic materials and implant design. The purpose
of this multi-center, prospective, randomized study is to
prove comparable safety and efcacy of alumina-alumina
ceramic to a control cobalt chrome-polyethylene bearing.
Four hundred fty two patients ( hips) are fol-
lowed in this study. Subjects include ceramic on ceramic,
with either porous coated cup or arc deposited cup, or
control group with metal on polyethylene with porous
coated cup. Average age of subject at time of surgery
was 53 years with 82% diagnosis of OA. The average
Harris Hip Score was 96 and 94% of hips had little to
no pain. Kaplan-Maier survivorship at 10 years, com-
ponent revision for any reason, was % for ceramic
bearings compared to % for metal on polyethylene
control. There have been nine hips requiring revision of
one or both components for any reason.
Data was recently collected on the subjects that par-
ticipated in either the IDE or Continued Access arms of
the ABC

and Trident

study. Data collection included


revisions, complications, and noise. Out of hips
( patients) there were nine incidences of squeaking
noise reported, no wear/osteolysis issues, and only two
insert fractures (%).
At ten years ceramic bearings show no wear, incon-
sequential lysis, minimal breakage, and occasion noise.
Clinically, alumina ceramic bearings perform as well as
the metal-on-polyethylene, with fewer revisions and less
osteolysis, suggesting that they are a safe, viable option
for younger, more active patients.
A TWO DIFFERENTS APPROACHES IN
THR: A GAIT ANALYSIS STUDY
A. Speranza, E. Monaco E, M. Vetrano, C.
DArrigo, A. Ferretti
Sapienza Univeristy of Rome, Department
of Orthopedic and Traumatology,
SantAndrea Hospital, Rome, Italy. Address
for correspondence: Attilio Speranza, via
Luigi Mancinelli Rome, Italy, e-mail:
storycall.usza75@storycall.us, tel/fax:
The choice of surgical technique for total hip arthro-
plasty (THA) can affect time and postoperative rehabili-
tation procedures. The aim of this prospective blinded
cohort study is to determine signicant differences in
gait parameters in the short term between those patients
who have experienced THA using a limited incision
anterolateral intermuscular (MIS) approach compared
with those who have experienced traditional lateral
transmuscular (LTM) approach.
Thirty patients were enrolled in this study, 15 of who
received the MIS technique and 15 the LTM approach.
A single surgeon performed all the operations using
short hip stem implants with 36mm femoral head size
and all patients received a standard postoperative reha-
bilitation protocol. Patients, physiotherapists, and asses-
sors were blinded to the incision used. Gait analysis was
performed 30 day after surgery, when patients were able
to ambulate without crutches.
Minimal differences in temporostatial parameters
were shown between the MIS and LTM groups, whereas
signicant differences (p<) in kinematics (hip range
of motion in sagittal, frontal and transverse planes),
kinetics (hip exion/extension and abduction/adduc-
tion moments) and electromiography parameters (glu-
teus medius activation pattern and degree of activity)
between two groups.
This study demonstrates functional benets of the
minimally invasive incision over the standard lateral
transmuscular approach in terms of walking ability 30
days postoperatively.
A CORRELATING RETRIEVAL STUDIES
OF BIOLOX-DELTA ( YEARS) AND
BIOLOX-FORTE (YRS) WITH HIP
SIMULATOR WEAR STUDIES
I. C. Clarke, K. Kubo, A. Lombardi, E.
McPherson, A. Turnbull, A. Gustafson and D.
Donaldson
Peterson Research Center, Loma Linda University,
Loma Linda Drive, Loma Linda, CA, USA
Ceramic-on-ceramic alumina bearings (ALX) have
demonstrated low wear with minimal biological conse-
quences for almost four decades. An alumina-zirconia
composite (BIOLOX-DELTATM) was introduced in
as an alternative ceramic. This contains well-dis-
tributed zirconia grains that can undergo some surface
phase transformations from tetragonal to monoclinic.
We analyzed 5 cases revised at years to compare to
our simulator wear studies. For the retrieved DELTA
bearings, two important questions were (a) how much
tetragonal to monoclinic transformation was there in the
zirconia phase and (b) how much did the articular sur-
faces roughen, either as a result of this transformation or
from formation of stripe wear zones? The retrieval cases
were photographed and logged with respect to clini-
cal and revision details. The DELTA balls varied from
22mm to 36mm diameters. These had been mated with
liner inserts varying by UHMWPE, BIOLOX-FORTE
and BIOLOX-DELTA materials. Bearing features were
analyzed for roughness by white-light interferometry, for
wear by SEM, for dimensions by CMM and for trans-
fer layers by EDS technique. Surface transformations
on DELTA retrievals were mapped by XRD. The four
combinations of 36mm diameter BIOLOX-FORTE and
BIOLOX-DELTA were studied in a hip simulator, which
was run in severe micro-separation test mode to 5 mil-
lion cycles. Wear rates, wear stripes, bearing roughness
and wear debris were compared to the retrieval data.
In two DELTA ball cases, there were conspicuous
impingement signs, stripe wear and black metallic
smears. It is to be noted that the metal transfer sites
(EDS) appeared to be from the revision procedures. The
retrieved balls run with alumina liners showed mono-
clinic phase peaking at 32% on the particular surface
and internal bore. On the fracture surface of case 1, the
monoclinic content had increased to 40%. Various sur-
face roughness indices were assessed on the bearings.
The polished articular surfaces averaged roughness (Sa)
of the order 3 nm, representing extremely smooth sur-
faces. The main wear zone was only marginally rougher
(5 nm). In contrast the stripe wear zones had roughness
of the order nm.
In the laboratory, the DELTA bearings provided a
fold wear reduction compared to FORTE controls.
Roughness of stripes increased to maximum nm on
controls. Roughness of wear stripes showed FORTE
with the highest and DELTA with the lowest values.
DELTA bearings also revealed much milder wear by
SEM imaging. Phase transformations showed peaks at <
30% for both main wear zone and stripe wear sites. It is
hypothesized that the concentration of monoclinic phase
reached a certain level due to compression contraint
imposed by the alumina matrix. With implant wear,
additional tetragonal grains of zirconia are exposed and
these will also transform to tetragonal. This consistency
between laboratory and retrieval studies conrmed the
stable nature of the bearings. The BIOLOX-DELTA
combination provides optimal potential for a clinically
relevant reduction in stripe wear.
A PERFORMANCE OF THE RESURFACED
HIP: THE INFLUENCE OF PROSTHESIS SIZE
AND POSITIONING ON REMODELLING AND
FRACTURE OF THE FEMORAL NECK
A.S. Dickinson, M. Browne, A.C. Taylor
7/ Bioengineering Research Group, School of
Engineering Sciences University of Southampton,
Southampton, SO17 1BJ, United Kingdom
Although resurfacing hip replacement (RHR) is asso-
ciated with a more demanding patient cohort, it has
achieved survivorship approaching that of total hip
replacement. Occasional failures from femoral neck
fracture, or migration and loosening of the femoral
head prosthesis have been observed, the causes of which
are multifactorial, but predominately biomechanical in
nature. Current surgical technique recommends valgus
implant orientation and reduction of the femoral offset,
reducing joint contact force and the femoral neck frac-
ture risk. Radiographic changes including femoral neck
narrowing and pedestal lines around the implant stem
are present in well performing hips, but more common
in failing joints indicating that loosening may involve
remodelling. The importance of prosthesis positioning
on the biomechanics of the resurfaced joint was investi-
gated using nite element analysis (FEA).
Seven FE models were generated from a CT scan
of a male patient: the femur in its intact state, and the
resurfaced femur with either a 50mm or 52mm pros-
thesis head in (i) neutral orientation, (ii) 10 of relative
varus or (iii) 10 of relative valgus tilt. The fracture risk
during trauma was investigated for stumbling and a
sideways fall onto the greater trochanter, by calculating
the volume of yielding bone. Remodelling was quanti-
ed for normal gait, as the percentage volume of head
and neck bone with over 75% post-operative change in
strain energy density for an older patient, and 50% for
a younger patient.
Resurfacing with the smaller, 50mm prosthesis
reduced the femoral offset by mm, mm and
mm in varus, neutral and valgus orientations. When
the 52mm head was used, the natural joint centre could
be recreated rrespective of orientation, without notching
the femoral neck. The 50mm head reduced the volume
of yielding femoral neck bone relative to the intact
femur in a linear correlation with femoral offset. When
the natural femoral offset was recreated with the 52mm
prosthesis, the predicted neck fracture load in stumbling
was decreased by 9% and 20% in neutral and varus
orientations, but remained in line with the intact bone
when implanted with valgus orientation. This agrees
with clinical experience and justies currently recom-
mended techniques. In oblique falling, the neck fracture
load was again improved slightly when the femoral
offset was reduced, and never fell below 97% of the
natural case for the larger implant in all orientations.
Predicted patterns of remodelling stimulus were con-
sistent with radiographic clinical evidence. Stress shield-
ing increased slightly from varus to valgus orientation,
but was restricted to the superior femoral head in the
older patient. Bone densication around the stem was
predicted, indicating load transfer. Stress shielding only
extended into the femoral neck in the young patient and
where the femoral offset was reduced with the 50mm
prosthesis. The increase in remodelling correlated with
valgus orientation, or reduced femoral offset. The trend
would become more marked if this were to reduce the
joint contact force, but there was no such correlation for
the 52mm prosthesis, when the natural femoral offset
was recreated. Only in extreme cases would remodelling
alone be sufcient to cause visible femoral neck narrow-
ing, i.e. patients with a high metabolism and consider-
ably reduced femoral offset, implying that other factors
including damage from surgery or impingement, inam-
matory response or retinacular blood supply interrup-
tion may also be involved in femoral neck adaptation.
The results of this FEA biomechanical study justify
current surgical techniques, indicating improved femoral
neck fracture strength in stumbling with valgus position.
Fracture risk under oblique falling was less sensitive to
resurfacing. Furthermore, the results imply that reduced
femoral offset could be linked to narrowing of the
femoral neck; however the effects of positioning alone
on bone remodelling may be insufcient to account for
this. The study suggests that surgical technique should
INTERNATIONAL SOCIETY FOR TECHNOLOGY IN ARTHROPLASTY
J BONE JOINT SURG [BR] ; B:SUPP IV
attempt to recreate the natural head centre, but still aim
primarily for valgus positioning of the prosthesis, to
reduce the femoral neck fracture risk.
A THE QUEAKING HIP: AN UPDATE
Jonathan Garnio
Squeaking has become a more common problem fol-
lowing hard on hard bearings in total hip replacements.
Although most squeaking is occasional and not concern-
ing to either patient or health care practitioner, some
reports of squeaking indicate high percentages (7% or
higher) that can be constant and quite concerning. Much
work has been done in this area, and although the exact
mechanism is not yet understood, most of the data sug-
gests a particular hip replacement system (metal alloy,
taper design, cup design) signicantly elevates to quan-
tity and quality of the squeaking problem to concerning
levels. Those specic details are described in depth along
with future studies to improve our understanding in the
nature of this acoustical phenomenon.
A KNEE FORCES DURING
DOWNHILL SKIING AFTER TOTAL KNEE
ARTHROPLASTY
C. Colwell Jr, N. Steklov, S. Patil, D. DLima
Shiley Center for Orthopaedic Research and
Education at Scripps Clinic, La Jolla, CA USA
Total knee arthroplasty (TKA) provides relatively
pain-free function for patients with end-stage arthritis.
However, return to recreational and athletic activities
is often restricted based on the potential for long-term
wear and damage to the prosthetic components. Advice
regarding safe and unsafe activities is typically based on
the individual surgeons subjective bias. We measured
knee forces in vivo during downhill skiing to develop a
more scientic rationale for advice on post-TKA activi-
ties A TKA patient with the tibial tray instrumented to
measure tibial forces was studied at two years postop-
eratively. Tibial forces were measured for the various
phases of downhill skiing on slopes ranging in difculty
from green to black.
Walking on skis to get to the ski lift generated peak
forces of xBW (times body weight), cruis-
ing on gentle slopes xBW, skating on a at
slope xBW, snowplowing xBW,
and coming to a stop 3 xBW. Carving on steeper
slopes generated substantially higher forces: blue slopes
(range 6 to10), xBW; black slopes (range
15 to 20), xBW. These forces were com-
pared to peak forces generated by the same patient
during level walking: xBW, stationary biking
xBW, stair climbing xBW, and jog-
ging xBW.
The forces generated on the knee during recreational
skiing vary with activity and level of difculty. Snow-
plowing and cruising on gentle slopes generated lower
forces than level walking (comparable to stationary
biking). Stopping and skating generated forces com-
parable to stair climbing. Carving on steeper slopes
(blues and blacks) generated forces as high as those seen
during jogging. This study provides quantitative results
to assist the surgeon in advising the patient regarding
postoperative exercise.
A
DOES IMPLANT DESIGN AFFECT KNEE
FLEXION? A SIMULTANEOUS BILATERAL
TKA RANDOMIZED CONTROLLED TRIAL
D.A. DENNIS, D.R. HEEKIN, J. MURPHY
COLORADO JOINT REPLACEMENT,
DENVER, CO
INTRODUCTION: Many orthopaedic device compa-
nies now offer a high exion (HF) choice within their
knee Arthroplasty portfolios. Early published results
are mixed between standard (STD) and HF knee devices
despite claims of increased exion with the HF offer-
ings. The purpose of this randomized, controlled, simul-
taneous, bilateral study was to compare two coronally
conforming rotating platform devices to determine if
exion differences were attributed to implant design.
METHODS: Ninety-three subjects underwent simul-
taneous bilateral TKA across 8 centers. The HF device
was randomly assigned to one side and the contralateral
leg received the STD device. Average age was 61 years,
99% were diagnosed with osteoarthritis, 66% were
females, average BMI was 32 and range of motion was
measured by subjective expectations versus satisfaction.
RESULTS: The HF design had statistically better single
leg active exion (SLAF) 12 months after surgery com-
pared to the STD. Consistent with Gupta storycall.us, in a sub-
group with pre-op exion < degrees in both knees,
the HF device was statistically superior in passive ex-
ion, ROM, and SLAF by between and degrees at
6 months, 12 months, and longitudinally over all post-
operative intervals using raw degrees, improvement
from pre-op, and adjusting for potentially confounding
variables. 57% of subjects preferred their HF knee 6
months postoperatively, although there was no differ-
ence in preference at 12 months.
DISCUSSION: The simultaneous bilateral design of this
study necessitates that subjects act as their own control
eliminating most confounding variables. Gains in post-
operative exion, although small, were superior in the
HF TKA group and were greater in those subjects with
less than degrees of preoperative exion, suggest-
ing the ideal candidate for a HF TKA is one with lesser
preoperative exion.
A IN VIVO ASSESSMENT OF HIP
KINEMATICS DURING FOUR ACTIVITIES
Blumenfeld TJ
a
, Glaser DA
b
, Bargar WL
a
,
Komistek RD
b
, Langston GD
b
, Mahfouz MR
b

a Sutter General Hospital, Sacramento, CA, USA
b University of Tennessee, Knoxville, TN, USA
Previous in vivo studies pertaining to THA performance
have focused on the analysis of gait. Unfortunately,
higher demand activities have not yet been analyzed.
Therefore, the objective of the present study was to
determine the in vivo kinematics for THA patients,
using uoroscopy, while they performed four higher
demand activities.
The 3D in vivo kinematics of 10 THA patients were
analyzed during the following activities: pivoting (PI),
tying a shoe (SHOE), sitting down (SDOWN) and
standing up (SUP) with and without the aid of hand-
rails. Patients were matched for age, height, weight,
body mass index, diagnosis and femoral head diameter
to control for confounding variables possibly having
inuence on the hip performance and kinematics of the
various activities.
The largest amount, incidence and variation of sepa-
ration (femoral head sliding in the acetabular cup) were
achieved during the PI with mm (SD ) and 9 of 10
(90%) subjects experiencing separation. For the SHOE,
SDOWN and SUP activities the average separation
values were , and mm, respectively. Femoral
head separation was observed in 8 of 10 subjects (80%)
during SHOE, in 9 (90%) during SDOWN, and in only
one of 6 (60%) during SUP.
In this present study, subjects demonstrated hip sepa-
ration during the high demand subjects, which could be
a concern because these same activities are subjected to
higher bearing surface forces. Also, the presence of hip
separation leads to reduced contact area between the
femoral head and the acetabular cup, possibly leading to
higher contact stresses.
A LONG TERM DURABILITY IN DEEP
FLEXION KNEE WITH BI-SURFACE KNEE
ARTHROPLASTY
S. Nakamura
1
, M. Kobayashi
1
, H. Ito
1
, H.
Yoshitomi
1
, R. Arai
1
, K. Nakamura
2
, T. Ueo
2
, T.
Nakamura
1

storycall.usment of Orthopaedic Surgery,
Faculty of Medicine, Kyoto University, Kyoto,
Japan; storycall.usment of Orthopaedic Surgery,
Tamatsukuri Koseinenkin Hospital, Matsue, Japan
In Far East, including Japan and the Middle East, daily
activities are frequently carried out on the oor. Deep
exion of the knee joint is therefore very important in
these societies. Some patients who underwent total knee
arthroplasty (TKA) in these countries often perform
deep exion activity, such as squatting, cross-leg sitting
and kneeling. However it is still unknown that deep
exion activity affects long term durability after TKA.
The purpose of this study was to examine the correla-
tion between deep exion and long term durability.
Between December and May , total
knee arthroplasties were carried out in patients
using the Bi-Surface Knee System (Japan Medical Mate-
rial, Osaka, Japan) at two institutions and routine reha-
bilitation program continued for one to two months
after TKA. One patient who underwent simultaneous
bilateral TKA was excluded because of pulmonary
embolism within one month. The other knees (
patients) were divided into two groups according to the
range of exion after our routine rehabilitation program;
one group (Group A: knees) consisted of more than
degrees exion knees and the other group (Group
B: knees) consists of less than degrees exion
knees. Patients whose follow-up period was less than 10
years were excluded from this clinical evaluation. Range
of exion was measured preoperatively, at the time after
routine rehabilitation program, and at the latest follow-
up. Knee function was evaluated on the basis of Knee
Society knee score and functional score preoperatively
and at the latest follow-up. Kaplan-Meier survivorship
analysis was performed with revision for any operation
as the end point.
In Group A, the mean preoperative range of exion
was degrees, and at the time after routine
rehabilitation program, this improved to
degrees. This angle maintained to at the
latest follow-up. In Group B, the mean preoperative
range of exion was degrees, and at the
time after routine rehabilitation program, this improved
to degrees. This angle maintained to
at the latest follow-up. The Knee Society
knee score and functional score was improved from
points and points preoperatively
to points and points at the latest
follow-up, respectively in Group A. The Knee Society
knee score and functional score was improved from
points and points preoperatively
to points and points at the latest
follow-up, respectively in Group B. Kaplan-Meier survi-
vorship at year was % in Group A and %
in Group B with any operation as the end point. The
survivorship between Group A and Group B was not
statistically signicant.
Good range of exion was maintained and Knee soci-
ety score was excellent after a long time follow-up for
the patients who achieved deep exion after TKA. Deep
exion was proved not to affect long term durability in
this Bi-Surface Knee System.
A FEMORAL COMPONENT
K. Kindsfater, D.A. Dennis, J. Politi
Colorado Joint Replacement, Denver, CO
Introduction: Although use of modular femoral com-
ponents in revision hip arthroplasty is widely accepted,
many still question the need for modular versatility in
primary THA. The purpose of our study was to examine
in a large cohort the percentage of hips in which femoral
component version was changed to optimize stability or
avoid prosthetic impingement of the THA construct. We
hypothesized that the percentage of hips needing version
change in routine primary THA would be low.
INTERNATIONAL SOCIETY FOR TECHNOLOGY IN ARTHROPLASTY
J BONE JOINT SURG [BR] ; B:SUPP IV
Methods: This prospective study analyzed consec-
utive primary THAs using a modular S-ROM (DePuy)
stem performed by 3 surgeons at 3 institutions all via
a posterior approach. Mean patient age at surgery was
years; % were male. The difference in version
between the femoral sleeve placed anatomically and the
femoral stem was recorded intra-operatively.
Results: Femoral component version was changed in
% of hips. Logistic regression analysis showed no
correlation between the likelihood of changing stem
version and patient age (p=), gender (p=), diag-
nosis (p=), or surgeon (p=). 10 hips (1%) expe-
rienced early dislocation (within 3 months post-op).
With the numbers available, there was a slight trend of
lower dislocation rate in hips where stem version was
changed (%) versus those in which it was not (%,
p=, chi squared).
Conclusion: The incidence of femoral version change in
routine primary THA was much higher than expected.
It was difcult to predict the need to alter version based
on clinical variables including diagnosis. Thus, we con-
clude it may be advantageous to routinely use a stem
that allows variable version as it is not possible to pre-
operatively determine when changing version will be
required. In addition, we surmise our low dislocation
rate compared to historical controls of THA performed
using a posterior approach was aided by the ability to
adjust version in almost half of our patients.
A A NOVEL COMPUTATIONAL
TOOL FOR THE ANALYSIS OF IMPLANT
POSITIONING EFFECTS IN CEMENTLESS
TOTAL HIP REPLACEMENTS
M.T. Bah, P.B. Nair and M. Browne
5/ Bioengineering Research Group, School of
Engineering Sciences University of Southampton,
Southampton SO17 1BJ, United Kingdom
Implant positioning is a critical factor in assuring the
primary stability of cementless Total Hip Replacements
(THRs). Although it is under the direct control of sur-
geons, nding the optimal implant position and achiev-
ing a perfect t remain a challenge even with the advent
of computer navigation. Placement of the femoral stem
in an excessive ante/retroversion or varus/valgus orienta-
tion can be detrimental to the performance of THR. To
determine the effect of such malalignment, nite element
(FE) computer modelling is often used. However, this can
be time consuming since FE meshes must be repeatedly
generated and solved each time for a range of dened
implant positions. In the present study, a mesh morphing
technique is developed for the automatic generation of FE
models of the implanted femur; in this way, many implant
orientations can be investigated in a single analysis.
An average femur geometry generated from a CT
scan population of 13 male and 8 female patients aged
between 43 and 84 years was considered. The femur
was virtually implanted with the Furlong HAC tita-
nium alloy stem (JRI Ltd, Shefeld, UK) and placed in
the medullary canal in a baseline neutral nominal posi-
tion. The head of the femur was then removed and both
femur and implant volumes were joined together to form
a single piece that was exported into ANSYS11 ICEM
CFD (ANSYS Inc., ) for meshing. To adequately
replicate implant ante/retroversion, varus/valgus or
anterior/posterior orientations, the rigid body displace-
ment of the implant was controlled by three rotations
with respect to a local coordinate system. One hundred
different implant positions were analysed and the qual-
ity of the morphed meshes analysed for consistency.
To check the morphed meshes, corresponding
models were generated individually by re-positioning
the implant in the femur. Selected models were solved
to predict the strain distribution in the bone and the
boneimplant relative micromovements under joint and
muscle loading. A good agreement was found for bone
strains and implant micromotions between the morphed
models and their individually run counterparts. In the
postprocessing stage further metrics were analysed to
corroborate the ndings of the morphed and individu-
ally run models. These included: average and maximum
strains in bone interface area and its entire volume, per-
centage of bone interface area and its volume strained
up to and beyond %; implant average and maximum
micromotions and nally percentages of implant area
undergoing reported critical micromotions of 50 m,
m and m for bone ingrowth. Excellent cor-
relation was observed in all cases.
In conclusion, the proposed technique allowed an
automatic generation of FE meshes of the implanted
femur as the implant position varies; the required com-
putational resources were considerably reduced and
the biomechanical response was evaluated. This model
forms a good basis for the development of a tool for
multiple statistical analyses of the effects of implant ori-
entation in pre-clinical studies.
A IN-VITRO AND IN-VIVO
INVESTIGATIONS OF THE IMPACTION AND
PULL-OUT BEHAVIOR OF METAL-BACKED
ACETABULAR CUPS
A. Fritsche, C. Zietz, S. Teufel, W. Kolp, I. Tokar,
C. Mauch, W. Mittelmeier, R. Bader
Department of Orthopedics, University of
Rostock, Rostock, Germany
Sufcient primary stability of the acetabular cup is
essential for stable osseous integration of the implant
after total hip arthroplasty. By means of under-reaming
the cavities press-t cups gain their primary stability in
the acetabular bone stock. These metal-backed cups are
inserted intra-operatively using an impact hammer.
The aim of this experimental study was to obtain the
forces exerted by the hammer both in-vivo and in-vitro
as well as to determine the resulting primary stability of
the cups in-vitro.
Two different articial bone models were applied
to simulate osteoporotic and sclerotic bone. Polymeth-
acrylamid (PMI, ROHACELL IG, Gaugler & Lutz,
Germany) was used as an osteoporotic bone substitute,
whereas a composite model made of a PMI-Block and
a 4 mm thick (cortical) Polyvinyl chloride (PVC) layer
(AIREX C, Gaugler & Lutz, Germany) was
deployed to simulate sclerotic bone. In all articial bone
blocks cavities were reamed for a press-t cup (Trident
PSL, Size 56mm, Stryker, USA) using the original surgi-
cal instrument. The impactor of the cup was equipped
with a piezoelectric ring sensor (PCB Piezotronics, Ger-
many). Using the standard surgical hammer (kg) the
acetabular cups were implanted into the bone substitute
material by a male (95kg) and a female (75kg) surgeon.
Subsequently, primary stability of the implant (n=5) was
determined in a pull-out test setup using a universal test-
ing machine (Z, Ziwck/Roell, Germany).
For validation the impaction forces were recorded
intra-operatively using the identical press-t cup design.
An average impaction force of kN and
kN using the PMI and the composite bone
models respectively were achieved by the female sur-
geon invitro.
kN and kN respectively were obtained
by the male surgeon who reached an average in-vivo
impaction force of kN.
Using the PMI-model a pull-out force of N
and N were determined for the female and
male surgeons respectively. However, using the com-
posite bone model approximately half the pull-out force
was measured for the female surgeon (N) com-
pared to the male surgeon (N).
Our results show that impact forces measured in-
vitro correspond to the data recorded in-vivo. Using the
osteoporotic bone model the pull-out test revealed that
too high impaction forces affect the pull-out force nega-
tively and hence the primary implant stability is reduced,
whereas higher impact forces improve primary stability
considerably in the sclerotic bone model. In conclusion,
the amount of impaction force contributes to the qual-
ity of the obtained primary cup stability substantially
and should be adjusted intra-operatively according to
the bone quality of each individual patient.
A THE INFLUENCE OF MUSCLE LOAD
ON TIBIOFEMORAL KNEE KINEMATICS
J. Victor, L. Labey, P. Wong, J. Bellemans
Belgium
A comparative kinematic study was carried out on six
cadaver limbs, comparing tibiofemoral kinematics in ve
different conditions: unloaded, under a constant N
ankle load with a variable quadriceps load, with and
without a constant 50 N medial and lateral hamstrings
load. Kinematics were described as translation of the pro-
jected centers of the medial (MFT) and lateral femoral
condyles (LFT) in the horizontal plane of the tibia, and
tibial axial rotation (TR) as a function of exion angle.
In passive conditions, the tibia rotated internally with
increasing exion, to an average of (range /,
SD ). Between 0 40 exion, the medial condyle
translated forwards 4 mm (range / mm, SD
mm), followed by a gradual posterior translation, total-
ing -9 mm (range / mm, SD mm) between
40 exion. The lateral femoral condyle translated
posteriorly with increasing exion completing mm
(range mm, SD mm). Dynamic, loaded
measurements were carried out in a knee rig. Under a
xed ankle load of N and variable quadriceps load-
ing, tibial rotation was inverted, mean TR (range -
/ SD ), MFT mm (range = / mm,
SD = mm), LFT mm (range = / mm, SD =
mm). As compared to the passive condition, all these
excursions were signicantly different: p=, p=,
and p= for TR, MFT and LFT respectively. Adding
medial and lateral hamstrings force of 50N each, reduced
TR, MFT and LFT signicantly as compared to the pas-
sive condition. In general, loading the knee with ham-
strings and quadriceps reduces rotation and translation
as compared to the passive condition. Lateral hamstring
action is more inuential on knee kinematics than medial
hamstrings action.
A THE ANATOMIC RATIONALE FOR
GUIDED MOTION TOTAL KNEES PETER
S. Walker, Gokce Yildirim, Sally Arno
Yonah Heller Laboratory for Minimally-
Invasive Surgery, Dept. of Orthopaedic Surgery,
NYUHospital for Joint Diseases, New York, NY
The treatment of osteoarthritis using articial knee joints
is expected to expand further over the next decade.
Increasingly, patients expect quicker rehabilitation,
improved performance, and high durability. However,
economic limitations require a reduced cost for each pro-
cedure, as well as early intervention and even preventa-
tive measures. The major goal of implant design needs to
be a restoration of normal knee mechanics, whether by
maximum preservation of tissues, or by guiding surfaces
which replicate their function. In this paper it is proposed
that total knees should exhibit anatomic knee mechanics,
namely medial stability lateral mobility.
Many studies in the past have shown that the neutral
path of motion of the anatomic knee, is that the medial
side remains relatively immobile in the AP direction,
which will impart a feeling of stability, while the lateral
side shows posterior femoral displacement with exion,
to obtain a high range of exion. There is considerable
rotational laxity about this neutral path to accommodate
a range of positions and activities. Recent studies carried
out in our laboratory using an up-and-down crouching
machine, and other test machines, have conformed this
mechanical behaviour. To further elaborate, we tested
eight young male subjects in a 7T MRI machine, where
compressive and shear loads were applied. AP displace-
ments occurred laterally but not medially. We attributed
this behaviour to the medial meniscus and the tibial
bearing geometry under weight-bearing conditions.
On the basis of these various studies, we developed a
method for the design of Guided Motion knees, which
would be implanted without the cruciates, and which
would restore anatomic knee mechanics. The method
started with the femoral component, where the medial
side had features to provide a continuous radius anteri-
orly, and distally to 75 degrees exion when a post-cam
would contact. This feature would prevent paradoxical
anterior femoral sliding in early exion. Multiple femo-
INTERNATIONAL SOCIETY FOR TECHNOLOGY IN ARTHROPLASTY
J BONE JOINT SURG [BR] ; B:SUPP IV
ral positions were then dened for accommodating ana-
tomic motion, in particular limited AP motion on the
medial side, but posterior displacement laterally. Tibial
bearing surfaces were generated accordingly.
Tests were carried out on the crouching machine and
on a Desktop TKR Test machine to compare the TKR
motion with anatomic. Although not accurate in all
respects, the Guided Motion designs were closer than
models of standard TKRs today. Such Guided Motion
designs hold the promise for restoring anatomic knee
mechanics and a normal feeling knee.
A ASYMMETRIC BONY GEOMETRY
AT THE ANTERO-LATERAL AND POSTRO-
LATERAL FEMORAL HEAD-NECK
JUNCTIONS
Y. Song, N. J Giori, H. Ito, M. R. Safran
Bone and Joint Center, VA Palo Alto Health Care
System, Palo Alto, CA, USA, Stanford University,
Stanford, CA, USA
Cam type femoro-acetabular impingement is dened
by a reduced femoral head-neck offset and by excessive
bone at antero-lateral femoral head-neck junction.
Reconstruction of the femoral head-neck offset by
removing the femoral bony prominence is a common
treatment for cam type impingement. In many cases, the
goal of this treatment is to make the antero-lateral head-
neck offset symmetrical to the postero-lateral offset.
However, guidelines for bony removal are not well
established. The objective of this study is to examine if
the antero-lateral and postero-lateral femoral offsets are
symmetrical in normal healthy hips.
CT analyses of the anatomic geometry of the femo-
ral head and neck were performed. Hip joints with
any evidence of cartilage defects and impingement
were storycall.us cadaveric hips (3 right and 5 left
hips) were examined. The average age of the cadavers
was years. A peripheral QCT scanner was
used which provided x x 2 mm resolution. To
improve the resolution of the nal result, each hip joint
was scanned in three different scanning directions (sag-
ittal, coronal, and axial scanning planes). A custom
imaging xture was built to position a joint sample in
three different scanning planes and a custom irrigation
system supplied saline to protect the sample from dehy-
dration. A custom segmentation program was devel-
oped to delineate the bony contours of the femoral head
and neck in a fully automated manner. The segmenta-
tion data from the three differenent imaging planes
were merged and a 3D solid model of each hip joint
was created. The prominence of the femoral head was
determined by the distance of the 3D head from an ideal
sphere tted into the 3D model.
All the femoral heads were found to be asymmetric.
Prominence of posteromedial femoral head averaged
mm more than the antero-medial femoral head.
The antero-lateral head-neck junction was also found
to be more prominent than the postero-lateral head-
neck junction by an average of mm. Asymmetry in
the femoral head and femoral head-neck junction was a
general nding in normal hip joints. The conventional
approach of symmetric reconstruction of femoral head-
neck junction may result in unnecessary removal of bone
at the antero-lateral head-neck junction and potentially
increase the risk of femoral neck fracture.
A THE USE OF EXTENDED EXTENSOR
MECHANISM ALLOGRAFT IN REVISION
TKA WITH SIGNIFICANT TIBIAL BONE LOSS
J.C. Finch, L.G. Morawa, R. Ramakrishnan
In patients with signicant bone loss and a nonfunc-
tioning extensor mechanism, the approach to revision
is complicated. We describe a unique approach to solve
this complex problem to help restore clinically satisfac-
tory results. Our technique involves the use of a donor
allograft that consists of proximal tibia along with the
attached extensor mechanism (patellar tendon-patella-
quadriceps tendon).
Five reconstructions utilizing bone allografts and
extensor mechanisms were performed by two surgeons.
Each has extensive surgical history on the affected knee
and presented with gross instability, considerable bone
loss, and signicant extensor lag or total loss of exten-
sion. The implants used were press-t stems with the
tibial baseplate cemented into the allograft prior to
implantation. In this series, either hinged or total stabi-
lized prostheses were used.
The follow up ranged from 1 to 5 years. The only
complication to date was reported in one patient who
required irrigation and debridement with surgical
wound closure after partial dehiscence. However the
patency of the allograft was not disrupted.
All prostheses have been noted to be stable with no
signs of loosening.
This procedure presented should be considered a
salvage procedure for bone stock and extensor mecha-
nism deciency in revision total knee arthroplasty. The
advantage to our allograft is the inherent stability of
the proximal tibia with the tibial tubercle and associ-
ated extensor mechanism. For patients with this com-
plex deciency, there has been no effective method of
treatment and we advocate the use of this procedure to
restore function and relieve pain to an otherwise grossly
unstable and functionally limited joint.
A KNEE DESIGN AND SURGICAL
TECHNIQUE SIGNIFICANTLY REDUCE
LATERAL RETINACULAR RELEASE RATES IN
PRIMARY TOTAL KNEE ARTHROPLASTY
A.V. Lombardi Jr., K.R. Berend, J.B. Adams
Joint Implant Surgeons, Inc., New Albany,
Ohio USA; The Ohio State University,
Columbus, Ohio USA; Mount Carmel
Health System, New Albany, Ohio USA
Lateral retinacular release (LRR) may be necessary to
balance the patellofemoral articulation in primary total
knee arthroplasty (TKA). However, lateral retinacular
release may be associated with an increased risk of patel-
lar necrosis, loosening, perioperative bleeding, and pain.
Additionally, the need for lateral retinacular release
may herald a more signicant problem with implant
positioning, rotation, and balance. The purpose of this
study is to report the lateral retinacular release rate with
a patella friendly femoral TKA design, and to identify
if a less invasive approach is associated with reduced
need for lateral retinacular release.
A retrospective review of our database identied
primary TKA performed by two surgeons between Octo-
ber and January Beginning in , a less
invasive approach has been used in over 95% of primary
TKA. Also beginning in , the authors began using a
new TKA design with a more swept back patellofemoral
articulation (Vanguard Complete Knee System; Biomet).
During the rst two years of the study, the authors also
used the Maxim Complete Knee System (Biomet). We
previously reported a lateral retinacular release rate asso-
ciated with the Maxim of 22%. There were Maxim
and Vanguard TKA performed. Lateral retinacu-
lar release with Maxim TKA was % (71/), sig-
nicantly less than that previously reported for the same
implant design using a standard approach. Lateral reti-
nacular release for Vanguard TKA was % (72/),
signicantly less than that with the Maxim TKA using
either a standard or less invasive approach (p<).
Implant design, surgical technique, and a less invasive
exposure combine to signicantly reduce the need for
lateral retinacular release in primary TKA.
A LARGE FEMORAL HEADS IN PRIMARY
TOTAL HIP ARTHROPLASTY REDUCE
DISLOCATION
A.V. Lombardi Jr., M.D. Skeels, K.R. Berend, J.B.
Adams
Joint Implant Surgeons, Inc., New Albany,
Ohio USA; The Ohio State University,
Columbus, Ohio USA; Mount Carmel
Health System, New Albany, Ohio USA
With increased use of alternative bearings, surgeons
have moved from utilization of 22, 26, 28 and 32mm
heads to larger head diameters in total hip arthroplasty
(THA). Reported benets of large heads are enhanced
stability secondary to the increased range of motion
prior to impingement and the increased jump distance
required for subluxation from the acetabulum.
This study evaluates the use of large diameter heads
in primary THA comparing the rate of dislocation to a
published study from our practice as a historic control.
Between October of and October ,
THA with large heads were performed in patients.
Femoral head sizes ranged from 36 to 60mm, with artic-
ulations consisting of metal-on-poly, ceramic-on-poly,
and metal-on-metal. Operative approach was 63% less
invasive direct lateral, 10% anterior supine intermuscu-
lar, and 27% standard direct lateral. In (Mallory
et al., Clin Orthop Relat Res) we reported a low inci-
dence of 12 dislocations (%) in primary THA
done with smaller femoral heads via a standard direct
lateral approach. In the current series with large heads,
follow-up averaged 22 months. There has been one dis-
location requiring revision (%), representing a sig-
nicant reduction from our earlier report (p=).
Forty additional acetabular components have been
revised (%), with eight related to sepsis (%), 23
aseptic loosening (%), six metal sensitivity (%),
one pseudotumor (%), one failure of ingrowth
(%), and one acute early migration (%).
The use of larger diameter heads has signicantly
lowered our dislocation rate in primary THA with only
one occurrence observed in cases, for a rate of
% at two years average follow-up.
A METAL-ON-METAL HIP RESURFACING
IN YOUNG PATIENTS: THE ROLE OF
FEMOROACETABULAR IMPINEGMENT
C. M. Maguire, T. M. Seyler, R. H. Jinnah
Department of Orthopaedic Surgery, Wake Forest
University School of Medicine, Winston-Salem,
North Carolina
Femoroacetabular impingement (FAI) has been identied
as the cause of idiopathic osteoarthritis in young patients.
FAI is the result of decreased femoral head/neck offset
ratio due to bony deformities and causes hip pain and
labral tears. Because the unique design and bone preserv-
ing nature of metal-onmetal hip resurfacing implants, it is
extremely difcult to correct extensive bony deformities
associated with FAI. Poor patient selection and lack of
orrection/undercorrection of the underlying FAI defor-
mity may lead to prosthetic impingement, extensive wear
and metal ion release, component loosening, and subse-
quent implant failure. Hence, it is critical to dene the
patient population undergoing hip resurfacing. Because
metal-on-metal hip resurfacing is performed more fre-
quently in a younger population, we hypothesize that
this patient population will have a larger proportion of
femoroacetabular impingement than the general popula-
tion and identication of this patient population is critical
to the longevity of the implant.
A retrospective review of hips undergoing metal-
on-metal hip resurfacing was performed. 52 hips were
excluded based on the exclusion criteria of inadequate
preoperative lms (6 subjects), existing hardware/history
of trauma (11 subjects), or if the resurfacing was per-
formed due to avascular necrosis secondary to trauma,
steroids, etc (35 subjects). The remaining hips (76
male, 25 female) had an average age of years.
Preoperative x-rays were utilized to assess impinge-
ment according to previously published methods. An
acetabular index (AI) of x 0, center edge angle (CE
angle) of x > 39, a Sharp angle of x < 33, and a pres-
INTERNATIONAL SOCIETY FOR TECHNOLOGY IN ARTHROPLASTY
J BONE JOINT SURG [BR] ; B:SUPP IV
ent cross-over sign were considered pathologic ndings
for pincer impingement. Pathologic ndings for cam
impingement included the triangular index (TI; patho-
logic with R=r+2mm) and an angle greater than 83
in men or 57 in women. Subjects were categorized as
having impingement if they had one or more pathologic
nding for either cam or pincer impingement and as
having mixed impingement if they had one pathologic
nding for both cam and pincer measurements. Prev-
alence rates were compared to published data for the
general population.
Fifty-ve subjects had at least one pathologic nding for
cam impingement (18, 7, and 30 subjects had pathologic
measurements for angle, TI, and both measurements,
respectively); 24 subjects had at least one pathologic
pincer measurement (4, 6, 14, and 4 pathologic measure-
ments for AI, CE angle, cross-over sign, and Sharp angle,
respectively; 3 subjects had multiple pincer ndings) 13
subjects were classied as having mixed impingement
(with angle and cross-over sign as the most prevalent
cam and pincer measurements). When compared to
published data for the general population (M: 17%, F:
4%), we found a signicantly larger proportion of cam
impingement in both males (%) and females (36%)
in patients undergoing resurfacing at our institution
(p<). There was also a signicantly larger propor-
tion of pincer impingement in our population (%)
than in the general population (%) (p=). There
was no signicant difference between our proportion of
patients with mixed impingement (%) and the gen-
eral population (%) (p=).
The patient population for metal-on-metal hip resur-
facing shows a greater prevalance of FAI than the general
population. Because the femoral head/neck junction is
preserved with hip resurfacing, patients undergoing this
type of procedure might be at increased risk of impinge-
ment. Hence, it is important to assess the degree of FAI
preoperatively. This will allow proper patient selection
and careful planning of surgical correction of the under-
lying FAI deformity to increase implant longevity.
A APPROPRIATE ENTRY POINT OF
INTRAMEDULLARY GUIDES FOR FEMUR
IN TOTAL KNEE ARTHROPLASTY:
USING THREE-DIMENSIONAL DIGIAL
TEMPLATING SOFTWARE ATHENA
Takashi Itokawa
1
, Makoto Kondo
1
, Kazuhide
Tomari
2
, Miyuki Sato
3
, Masashi Hirakawa
3
,
Katsutoshi Hara
3
, Nobuhiro Kaku
3
, Y. Higuma
2
,
T. Noguchi
2
, H. Tsumura
1,3
1. Department of Endoprosthetic Surgery,
Oita University, Oita, Japan; 2. Department of
Orthopedic Surgery, Shinbeppu Hospital, Oita,
Japan; 3. Department of Orthopedic Surgery, Oita
University, Oita, Japan
Introduction: Appropriate femoral component align-
ment is important for long-term survival of total knee
arthroplasty (TKA). Valgus angle of femoral component
is recommended as the angle between mechanical axis
and anatomical axis of the femur. Intramedullary guide
system is widely used for determining the valgus posi-
tioning of femoral component. Entry point of intramed-
ullary guide is one of the key factors for determining
valgus angle of femoral component. Some investigators
have shown appropriate entry points of intramedullary
guide, however, it is still unclear. In this study, appro-
priate entry point of intramedullary guide system was
calculated using three-dimensional digital templating
software Athena (Soft Cube, Osaka, Japan).
Method: Forty-one knees in 34 osteoarthritis patients
except valgus deformity (30 females and 4 males, mean
age years) received TKA and were simulated using
Athena from January to March All cases
were grade III or IV in Kellgren-Lawrence index. Radio-
graph and CT scan image were used for determination
of appropriate entry point of femur using Athena. The
anatomical axis of femur was dened as a line connect-
ing the midpoints of femoral AP and lateral diameter, at
60 mm and mm proximal to the center of intercon-
dylar notch. Two coordinate systems were congured
as representation of entry points. One was at the center
of intercondylar notch dened as the point of origin in
axial view of CT image and the line parallel to the clini-
cal epicondylar axis (cTEA) dened as X-axis. Another
coordinate system was the same point of origin but par-
allel to the line between trochlear groove and the center
of intercondylar notch (AP line) dened as Y-axis.
Result: In the coordinate system that dened the cTEA
as the X-axis, the average of entry point was
mm medial (range, ~ mm) and mm
anterior (range, ~ mm) to the center of inte-
condylar notch. In the other coordinate system that
dened AP line as the Y-axis, the average of entry point
was mm medial (range, ~ mm) and
mm anterior (range, ~ mm) to the
center of intercondylar notch.
Discussion: In this study, the appropriate entry point
of intramdullary guide was slightly medial and about
11mm anterior to the center of intercondylar notch
on average. However, individual entry point varied
considerably in distance. These data indicates that it
is important to simulate the appropriate entry point of
intramedullary guide in preoperative planning.
A THE INFLUENCE OF COMPONENT
SIZE ON THE OUTCOME OF HIP
RESURFACING
WL Walter, A. Shimmin.
Reasons for failure of hip resurfacing arthroplasty
include femoral neck fracture, loosening, femoral head
osteonecrosis, metal sensitivity or toxicity and compo-
nent malpositioning.
Patient factors that inuence the outcome include
prior surgery, body mass index, age and gender, with
female patients having two and a half times greater risk
of revision by 5 years than males In , the Aus-
tralian National Joint Replacement Registry (ANJRR)
reported poorer results with small sizes, whereby com-
ponent sizes 44mm or less have a ve times greater risk
of revision than those 55mm or greater 1. This nding is
true for both males and females and after accounting for
femoral head size, the effect of gender is eliminated.
We explore the relationship between component size
and the factors that may inuence the survivorship of
this procedure, resulting in higher revision rates with
smaller components.
These include femoral neck loading, edge loading,
wear debris production and the effects of metal ions,
cement penetration, component orientation, and femo-
ral head vascularity. In particular the way the compo-
nents are scaled from the large sizes down to the smaller
sizes results in some marked changes in interactions
between the implant and the patient.
Wall thickness of the acetabular and femoral com-
ponent does not change between the large and small
sizes in most devices. This results in a relative exces-
sively thick component in the small sizes. This may
cause more acetabular and femoral bone loss, increased
risk of femoral neck notching and relative undersizing
of the component where acetabular bone is a limiting
factor. Stem thickness does not change throughout the
size range in many of the devices leading to relatively
more femoral bone loss and a greater stiffness mismatch
between the femoral stem and the bone. Relatively stiff-
ness between the femoral stem and the bone is up to six
times greater in the small size compared to the large size
in some designs.
The angle subtended by the articular surface (the
articular arc) ranges from down to as low as
in the small sizes of some devices. A smaller articular arc
increases the risk of edge loading, especially if there is
any acetabular component malpositioning. Acetabular
inclination has been related to metal ion levels5 and to
the early development of pseudotumour6.
An acetabular component with a radiographic incli-
nation of 45 will have an effective inclination anywhere
from 50 to 64 depending on the type and size of the
component. This corresponds to a centre-edge angle
from 40 down to The effective anteversion is simi-
larly inuenced by design.
The result of a smaller articular arc is to reduce the
size of the safe window which is the target for ortho-
paedic surgeons.
1. Australian Orthopaedic Association National Joint
Replacement Registry. Annual Report. Adelaide:
AOA; ,
2. Duijsens AW, Keizer S, Vliet-Vlieland T, Nelissen RG.
Resurfacing hip prostheses revisited: failure analysis
during a year follow-up. Int Orthop ;

3. Morlock MM, Bishop N, Ruther W, Delling G, Hahn
M. Biomechanical, morphological, and histological
analysis of early failures in hip resurfacing arthro-
plasty. Proc Inst Mech Eng [H] ;
4. Siebel T, Maubach S, Morlock MM. Lessons learned
from early clinical experience and results of ASR
hip resurfacing implantations. Proc Inst Mech Eng
[H] ;
5. De Haan R, Pattyn C, Gill HS, Murray DW, Camp-
bell PA, De Smet K. Correlation between inclination
of the acetabular component and metal ion levels in
metal-on-metal hip resurfacing replacement. J Bone
Joint Surg Br ;
6. Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R,
Whitwell D, Gibbons CL, Ostlere S, Athanasou N,
Gill HS, Murray DW. Pseudotumours associated with
metal-on-metal hip resurfacings. J Bone Joint Surg Br
;
A HIP GEOMETRY AND MODULAR
NECKS IN TOTAL HIP ARTHROPLASTY
Jean-Noel A. Argenson, MD Sebastien Parratte,
MD, Jean-Manuel Aubaniac, MD
Aix-Marseille University, Center for Arthritis
Surgery, Hopital Sainte-Marguerite, Marseille,
France.
Improving the adaptation between the implant and the
patient bone during total hip arthroplasty (THA) may
improve the survival of the implant. This requires a per-
fect understanding of the tridimensional characteristics
of the patient hip. The perfect evaluation of the tridi-
mensional anatomy of the patient hip can be done pre-
operatively using CT-scan and in case of important hip
deformation, a custom implant can be used. When this
solution is not available, modular necks may be a reli-
able alternative using standard x-rays and intraopera-
tive adaptation. We aimed to evaluate: 1) The usefulness
of modular neck to restore the anatomy of the hip and
2) the short-term clinical and radiological results of a
consecutive series of THA using modular neck.
We prospectively included hips treated in our
institution with a modular neck total hip arthroplasty
between January and December All patients
underwent a standard xrays evaluation in the same center
according to the same protocol. Pre-operatively, the fron-
tal analysis of the hip geometry was performed and the
optimal center of rotation, CCD angle, neck length and
lever arm was analyzed to choose the optimal modular
neck shape among 9 available shape. These 9 frontal
shapes are available in standard, anteverted or retro-
verted shapes, leading to 27 potential neck combinations.
The mean patient age was 68 years and the mean BMI 26
Kg/m All the procedures were performed supine using
a Watson-Jones approach and the same anatomic stem.
Intra-operatively the sagittal anatomy of the hip was ana-
lyzed and a standard, ante or retro modular necks were
tested for the frontal shape dened pre-operatively.
According to the pre-operative frontal planning, non-
standard necks were required in 24 % of the cases to
restore the anatomy of the hip. Intra-operatively, a sagit-
tal correction using anteverted neck was required in 5%
of the cases and retroverted necks in 18% of the cases.
Harris hip score improved from 56 to 95 points at
last follow-up. No leg length discrepancy greater than
1 cm was observed. Restoration of the lever arm (mean
mm, range 30 to 49 mm) and of the neck length
(, range 43 to 68 mm) was adapted for 95% com-
pared to the non operate opposite side. No loosening
was observed.
According to our results modular neck combined are
useful and reliable to restore optimal hip geometry and
in this series 25% of the patient would have had imper-
fect extra-medullary hip geometry with a standard pros-
thesis. The good clinical and radiological short-term
results should be conrmed at longer follow-up.
INTERNATIONAL SOCIETY FOR TECHNOLOGY IN ARTHROPLASTY
J BONE JOINT SURG [BR] ; B:SUPP IV
A TOTAL HIP REPLACEMENT: EFFECTS
OF BODY MASS INDEX, ACETABULAR
MORPHOLOGY, AND BONE QUALITY
ON STRESSES DEVELOPED IN CEMENT
MANTLES
storycall.usee
1
, storycall.usah
1
, P. Ingle
1
,
storycall.us
2
, K. Cheah
3

1. Anglia Ruskin University, Medical Engineering
Research Group, Essex, UK; 2. Mid-Essex
Hospitals Trust, Essex, UK; 3. Springfield Ramsay
Hospital, Essex, UK.
Cemented total hip replacements (THR) are widely used
and are still recognized as the gold standard by which
all other methods of hip replacements are compared. [1].
Long-term results of cemented total hip replacements
show that the revision rate due to aseptic loosening
could be as high as % [2]. Moreover, high stresses
developed in the cement mantle of reconstructed hips can
lead to premature failure of the constructs [3]. Surgical
xation techniques vary considerably [4]. The aim of this
study was to investigate the performances of different
surgical xation techniques of hip implants for patients
with different body mass indices, bone morphology and
bone quality, using nite element (FE) methods.
Anatomically correct reconstructed hemi-pelves were
created, using CT-Scan data of the Visible Human Data
set, downloaded to Mimics V software, where poly-
lines of cancellous and cortical bones were created, and
exported to I-Deas FE package, where the econ-
structed hemi-pelvis was simulated. Accurate 3D model
of the hemi-pelvis was scaled up and down to create
hemi-pelves of acetabular sizes of the following diam-
eters: 46 mm, 52 mm, and 58 mm. Following sensitivity
analyses, element sizes ranging from mm were used.
Material properties of the bones, implants and cement
were taken from literature []. Bones of poor quality
were simulated by a reduction in the elastic modulii of
the cortical bone by 50%, the cancellous bone by 10 %
and the subchondral bone by 50% [5]. The nodes at the
sacro-iliac joint areas and the pubic support areas were
xed. A compressive force of 3 times body weight was
simulated at the hip joint. The nodes between the can-
cellous and subchondral bones were merged. Contact
elements were used at the subchondral bone and cement
mantle interface and between the femoral head implant
and acetabular component. Dynamic in vitro tests, sim-
ulating forces acting on a hip joint during a gait cycle,
were carried out on reconstructed synthetic bones, posi-
tioned on an Instron hydraulic machine, to verify
the FE models.
The volume of cement stressed at different levels in
groups of MPa, MPa and up to 11 and above
MPa were calculated. Results of FE analyses showed that
(1) an increase in the body mass index from 20 to 30 gen-
erated an increase in the tensile stress level in the cement
mantle; (2) lower tensile and shear stresses developed in
thicker cement mantles. For a 46mm acetabular size, peak
tensile stresses decreased from MPa to MPa and
peak shear stresses decreased from MPa to MPa
when cement mantle thickness increased from 1mm to
4mm. (3) A reduction in the bone quality would result in
an increase of approximately 45% in the cement mantle
stresses. Results of in-vitro tests show that an increase in
the cement mantle thickness improved xation, corrobo-
rating with the FE results.
Performances of xation techniques depend on the
patients bone mass index, bone quality, bone mor-
phology.
References:
1. Goodman, S., The Orthopedics clinics of
North America 36(1),
2. Malchau, H. et al. J Bone Joint storycall.us(2)
20,
3. Kuehn, K. D. et al. storycall.us Am.
(): vi.
4. Mootanah, R., et al., Hip International 14(3),

5. Dalstra, M. et al. Proc. of the 10th European Society
of Biomechanics, ,
6. Phillips, A.T.M., et al. Proc. Inst. Mech. Eng, Part
H, J. of Engineering in Medicine, , (4),

7. Choi, K., et. al. J Biomech., , 23(11),
Mech Eng [H]. ;(2)
A PROXIMAL FEMUR MORPHOLOGY AS
A BASIS FOR HIP STEM DESIGN: AGE AND
GENDER RELATED EFFECTS
B. Grimm, T. Boymans, I.C. Heyligers
AHORSE Foundation, Atrium Medical Center
Parkstad, Dept Orthopaedic Surgery, CX
Heerlen, the Netherlands.
Introduction: In total hip arthroplasty (THA) an opti-
mal t and ll of the stem is essential for stable xation.
Thus femur morphology must be studied during pre-op
planning (implant choice, sizing, positioning) or when a
new stem is to be designed. Using plain AP x-ray analy-
sis and the denition of a simple two-level parameter
(canal are index, CFI), Noble et al. identied an age
related transition of the endosteal canal in AP view from
a champagne ute to a stove pipe. This reference data
is 2D only, limited to the endosteal geometry and the
elderly age range was dened as yrs so that the
number of octogenerians >80yrs was too low to analyze
morphological features of this rapidly growing and criti-
cal THA patient population.
In this study the endosteal and periosteal femur
morphology of subjects >80yrs was studied using 3D
CT analysis. It was the goal to a) describe age related
changes of the femur morphology in 3D, b) to study the
inuence of gender c) to investigate if the results may
affect t & ll of current stem designs.
Methods: High-resolution CT-scans (slice thickness
1mm) were made of consenting volunteers (m/
f=/69). The old group consisted of subjects
80yrs (m/f=65/54, mean age: yrs []) and
the young group of 51 subjects <80yrs (m/f=36/15,
mean age yrs []). After thresholding the bone
boundaries in Mimics V12 (Materialise, B), the endos-
teal and periosteal coordinates were analyzed for width,
wall thickness, surface areas and various CFIs relat-
ing dimensions at 20mm above LT and at a distal level
(e.g. 60mm below LT, isthmus): Surface CFI (3D-CFI),
frontal and lateral CFI based on the AP and ML projec-
tions (2D-CFI) and aring in each of the four directions
(1DCFI).
Results: The surface CFI was sign. lower in subjects
80yrs ( ) than in subjects <80yrs ( ,
p<). This difference was sign. larger in females
than in males (% vs. %), an observation valid
with reference to any distal level. Equivalent age differ-
ences were found in both the frontal and lateral 2D-CFI
as well as the medial, lateral and anterior 1D-CFI with
changes in the anterior direction (%) being most
dominant. In addition wall thickness was sign. reduced
in the very elderly. E.g. at 20mm above LT, the medial
wall measured mm at <80yrs and at 80yrs,
a reduction of % (p<). In females (%) this
difference was sign. larger (males: %, p<) even
when corrected for height.
Discussion: The age driven transition of proximal femur
morphology continues in the octogenarian population.
This transition is not limited to two discrete levels in
the AP plane as previously reported but it is a continu-
ous 3D phenomenon with high directional asymmetry.
In addition, this transition also affects the wall thick-
ness and the periosteal shape. Furthermore a strong
gender effect was identied with aging females showing
increasingly and asymmetrically less aring and thin-
ner walls. An age and gender specic THA stem design
seems necessary to t the morphed femur. The asym-
metric transition prohibits the effective use of current
implant systems with proportionally scaled dimensions
but favors a matrix sizing scheme with frontal and lat-
eral dimensions changing independently.
A ASSOCIATION BETWEEN SQUEAKING
AND IMPLANT DESIGN AND MATERIALS
IN CERAMIC-CERAMIC TOTAL HIP
ARTHROPLASTY
T.M. Ecker, C. Robbins, G. van Flandern, D.
Patch, S.D. Steppacher, W. Kurtz, storycall.usum,
S.B. Murphy
New England Baptist Hospital, Parker Hill
Avenue, Boston, USA
While alumina ceramic-ceramic THA has been per-
formed in the US for more than 12 years, the phenom-
enon of frequent, clinically reproducible squeaking is
relatively new. The current study investigates the inu-
ence of implant design on the incidence of squeaking.
We reviewed implant information on consecu-
tive revision THAs performed from 10/ through
10/ to identify any patients who had complained
of squeaking or grinding. We also identied, con-
secutive primary ceramicceramic THA. Of these, we
reviewed the clinical records of 1, patients (37%)
to date. Any patient complaint of squeaking or grind-
ing at the time of an ofce visit or by phone interview
was recorded. Hips were divided into group 1: ush
mounted ceramic liner; group 2a: recessed ceramic liner
mated with a stem made of TiAlV and using a 12/14
neck taper; and group 2b: recessed ceramic liner mated
with a stem made of a beta titanium alloy comprised of
12% molybdenum, 6% Zirconium, and 2% Iron and
using a neck taper smaller than a 12/14 taper.
Of the revision THAs, 5 hips (%) were in patients
who had complained of squeaking or grinding. All 5 hips
had a recessed, metal-backed ceramic liner and evidence
of metallosis. In primary THAs, Group 2b had statisti-
cally signicantly (p=) more squeaking (%) than
group 2a (%) which had statistically signicantly
(p=) more squeaking than group 1 (%).
Squeaking following ceramic-ceramic THA is associ-
ated with use of a recessed metal-backed ceramic liner
in combination with a femoral component made of a
betatitanium alloy and using a relatively small head-
neck taper. Since all revised hips in our study had metal-
losis, it is possible that metal debris is adversely affecting
the bearing and that the elevated metal rim combined
with a small head neck taper and the beta-titanium alloy
contribute to this problem. Use of bearings with a ush-
mounted ceramic liner mated with femoral components
made of TiAlV and using a 12/14 taper appears to be
prudent.
A COMPUTED TOMOGRAPHIC
EVALUATION OF A MONOBLOCK POROUS
TANTALUM ACETABULAR CUP AT AN
AVERAGE 10 YEAR FOLLOW-UP
S.D. Stulberg, T.C. Moen, R. Ghate, and N. Salaz
Northwestern Orthopaedic Institute. N. Lake
Shore Drive, Suite Chicago, IL
Originally introduced in , porous tantalum is an
attractive alternative metal for orthopaedic implants
because of its unique mechanical properties. Porous tan-
talum has been used in numerous types of orthopaedic
implants, including acetabular cups in total hip arthro-
plasty. The early clinical results from porous tantalum
acetabular cups have been promising. The purpose of this
study was to evaluate the presence of bone ingrowth and
the incidence of osteolytic lesions in the acetabular cup -at
10 year follow up in patients who had a total hip arthro-
plasty with a monoblock porous tantalum acetabular cup.
50 consecutive patients underwent a total hip arthro-
plasty with a monoblock porous tantalum acetabular
component. All patients had computed tomography
at an average of 10 years of follow-up. The computed
tomography scan used a standard, validated protocol to
evaluate bony ingrowth in the cup and for the presence
of osteolysis.
The computed tomographic scans showed evidence of
extensive bony ingrowth, and no evidence of osteolysis.
This study reports the year results of a monoblock
porous tantalum acetabular cup. This is the rst study
to evaluate a porous tantalum acetabular cup with the
use of computed tomography. These results show that
a porous tantalum monoblock cup has excellent bony
INTERNATIONAL SOCIETY FOR TECHNOLOGY IN ARTHROPLASTY
J BONE JOINT SURG [BR] ; B:SUPP IV
ingrowth and no evidence osteolysis at 10 year follow-up.
These results suggest that porous tantalum is an attractive
material for implantation in young, active patients.
A CHAIN ENTANGLEMENTS AND
UHMWPE WEAR PERFORMANCE
J.J. Wu, Q.Q. Wang, I. Khan
School of Engineering, Durham University,
Durham, DH1 3LE, UK Correspondence E-mail:
storycall.us@storycall.us
Orthopaedic grade ultra-high molecular weight poly-
ethylene (UHMWPE) remains the preferred material
Источник: [storycall.us]

Kj Pirate Activator Crack For Windows 10 Free Download

KJ Pirate Activator Crack

KJ Pirate Activator Crack: and all its contents have been tested for viruses and malware, Trojans, and any other third-party applications, and they have been found to be % clean and safe. Some antivirus programs will receive alerts about activation applications, even though they are safe, because of the way they are written. It is recommended to make the necessary exceptions when this occurs to enable the application to function. You can activate your copy of Windows using this application. After you open the program as administrator and click Activate, it will activate automatically in two minutes.

KJ Activator for Windows 7 performs a virus scan and finds that all of its code is safe. The code is written completely in C and C++, so it can run on any hardware. There are no restrictions on which edition of Windows and Office can be activated with KJ Pirate Activator. KJ Loader is well organized by design. The memory is small and very few CPU cycles are used. It can easily be moved from one computer to another. There is no need to connect to the internet during activation.

KJ Pirate Activator Crack:  provides a variety of options. You can download &#;KJ Starter&#; by clicking on the link below. It is a free tool for cracking Windows and Office. KJ Windows Activator offers many options. The mode of KJ Starter is as follows:

  • Mode Windows 8 + Server
  • The Beginner&#;s mode.
  • Using the advanced mode.

Third world countries like India cannot afford Windows and Office products because the prices are too high. Many people in third world countries use cracking tools such as KJ Activator for Windows, KMSauto, KMSpico, Microsoft toolkit, and others. You will find links to some of the best tools here.

Windows 8 + Server (KJ Pirate Activator Mode)

KJ Starter&#;s very first mode is &#;Windows 8 + Server &#; Through this Mode, you can activate your Windows Activation. When you click on this mode, you will see the following options.

Pirate Activator

Individuals can use Pirate Activators for various purposes. It is possible to use Pirate Activator by one user at a time. Here are the options available for Pirate Activators.

Install Pirate Activation

You can activate any Windows Activation version with this option. Do not click anywhere else during the installation process. You computer will automatically restart once the process has been completed.

Remove Pirate Activation

You can cancel the activation by clicking this option if you are activating your Windows through KJ Starter.

Media Center Key

It is a video player that can be activated with the Media Center Key.

Media Center Activator

The Media Center Activator is also used to activate Media Center, which probably comes with Windows 7 and Windows

Install Windows 8 Privacy Patch

It is possible to activate Windows 8 with the blink of an eye using this option.

Remove Windows 8 Privacy Patch

It is possible to cancel the activation of Windows 8 via this option.

You may also download:Windows 7 All in One ISO

KJ Pirate Activator Crack

KJ Pirate Activator and the detail of the Modes are as under:

KJ Pirate Activator Beginner Mode:

You will see the following options in beginner mode;

  • You can use Windows XP, Windows Vista, Windows 7, Windows 8, Windows Server , or Windows Server
  • You can activate all Windows versions through Beginner Mode.

KJ Pirate Activator Advanced Mode:

Following are the options available in advance mode:

  • Microsoft OEM Activator, Windows KMS Activator, Windows 8 Activator, Windows XP Activator, and Office Activator.
  • Originally manufactured by: OEM
  • Key Management Server: KMS.

System Tweaks running on the Operating System:

  • Auto tuning has ever been so easy.
  • Hibernate mode is activated.
  • Removes prefetch parameters.
  • Automate the login process.
  • There are 7 DWM Aero Glass windows.
  • It is a means of preventing data from being executed.
  • You can delete the update error log.

Token manager programs list:

  • Backup manager that automatically backs up files.
  • Tokens can be manually restored.
  • Backup office codes automatically.
  • Restore Office files manually.
  • Install the Windows product key.
  • The Office Exchange product key is required.

KJ Pirate Admin Control Panel Programs List All windows:

  • Notepad is recommended.
  • Drop-off notepad included.
  • Click on the CMD icon.
  • Use the CMD dip to open.
  • Hide hidden files.
  • Undo, show hidden files.
  • How to take control of any security file.
  • How to take ownership of any security file for undoing

Download KJ Pirate Activator Crack:

You can download KJ Pirate Activator by following the steps below.

  • Click on the &#;KJ Activator&#; download button below.
  • There will be a dialogue box that will ask you where you want to save KJ Starter.
  • Click the &#;Download KJ Button.&#;
  • The zip file will start downloading within seconds.
  • You&#;ll enjoy it!

Installation Process:

The first thing you need to do is make sure Windows is activated. Activating Windows is as simple as:

  • Click the icon for my computer.
  • Select properties.
  • The Windows Activation Section will open in a new window.
  • You need to activate your Windows if the product ID is &#;Not Available&#; or &#;Windows is not activated.&#;.

During in installation you have to care about some things:

You must first disable your firewall and anti-virus software. (Because KJ Pirate Activator attempts to modify registry files, and operating systems do not allow modification of registry files.)

  • Install the KJ Windows 7 Activator.
  • Click on KJ_EXE.
  • The computer will ask you &#;Do u want to allow it&#; and click &#;Yes&#;.
  • You will be presented with the KJ Office Activator interface when the installation is complete.
  • Change the language given at the top. Korean -> English.
  • It is now time to activate your KJ Starter.
  • Click on nothing during Windows activation.
Источник: [storycall.us]
Mb

Name : Windows 8 AIO Orion
Version : Orion  (x86/x64/April/)
Languange : English/French
Medicine : Include - Key
OS Support : Xp/Vista/7/8
Password : No
Type File : rar
Code File : a.i.o.0rion
Updated : April
Publisher :Kiran Maji
Size : Gb






Configuration Minimal :

Windows 8 32bits
1 gigahertz (GHZ)
1 gigabyte (GB) RAM
12 GB available hard disk space

Windows 8 64bits
1 gigahertz (GHZ)
2 gigabyte (GB) RAM
16 GB available hard disk space


Sytem : Windows 8 32bits 64bits
Langage : French
Editor : Team Orion
Files Type : .iso
Total Syze : Go
File Validation : MD5 SHA1

MD5: BA0BAAEB0DCC30BF

SHA 2DCCE1DF0EDCDF90FC

Screen Shots:




For Information go Here : storycall.us?topic=
How to Activation With All Key :
 1.) Run the command prompt as administrator (start menu, type cmd, right click, run as administrator)
    2.) Type:
    slmgr / upk
    slmgr / rearm
    3.) Restart
    4.) Reopen the command prompt in admin
    5.) Type:
    slmgr-skms
    slmgr-ipk "8 PRO FOR WINDOWS KEY IS-NG4HW VH26CKW-K6FJ8CK4 FOR NOW ISJNW 9KQP47T8-D8GGY-CWCK7" "FOR PRO MEDIA CENTER IS-C7MCR 3R9N7-KX8YH-2X4QC-DD GGKFW-OR-TBH8R H8R6B-NDTK2BRQ "(without the quotes)
    slmgr-ato


    For those who want to activate by phone life

    Windows 8 Pro:

    MAK Keys:

    storycall.us / ipk-7JVN8 WVRPVM-QM7P9-YDR92
    storycall.us / ipk 6TGNVPPXY-KMVD2-V8MQP
    storycall.us / ipk-NWJW3 GVYWR-P89R3-VH3VW-9TJX2
    storycall.us / ipk R8NYQXMTHJ-X8B7M-FF9VC

    Number to call on Skype: 01 88

    Look Fot All Key For APRIL :

    slmgr -ipk put-the-right-key
    slmgr -skms
    slmgr -ato

    run as admin

    Operating system edition         KMS Client Setup Key
    Windows 8 Professional
    NG4HW-VH26CKW-K6FJ8CK4
    Windows 8 Professional N
    XCVCF-2NXMPB-MHCBRYQQ
    Windows 8 Enterprise
    32JNW-9KQP47T8-D8GGY-CWCK7
    Windows 8 Enterprise N
    JMNMF-RHW7P-DMY6X-RF3DR-X2BQT
    Windows Server Core
    BN3D2-R7TKB-3YPBD-8DRPGG4
    Windows Server Core N
    8N2M2-HWPGY-7PGT9-HGDD8-GVGGY
    Windows Server Core Single Language
    2WN2H-YGCQR-KFX6K-CD6TFYXQ
    Windows Server Core Country Specific
    4K36P-JN4VD-GDC6V-KDTDYFKP
    Windows Server Server Standard
    XC9B7-NBPPJ2H-RHMBYBT4
    Windows Server Standard Core
    XC9B7-NBPPJ2H-RHMBYBT4
    Windows Server MultiPoint Standard
    HM7DN-YVMHJC3-XYTG7-CYQJJ
    Windows Server MultiPoint Premium
    XNH6W-2V9GX-RGJ4K-Y8X6F-QGJ2G
    Windows Server Datacenter
    48HP8-DN98B-MYWDG-T2DCC-8W83P
    Windows Server Datacenter Core
    48HP8-DN98B-MYWDG-T2DCC-8W83P

    MAK Keys:
    J87JG-PXNRBRP-DGJ9P-TMQHC
    7NKFGQDF-4PGMR-KP74B-VQR92
    CNVTB-YK4RV- M8CHM-R6V3P
    NGTBT-FWPVK-WDFP9-G3GV8-W4YQP

    ProWMC:
    C7MCR-3R9N7-KX8YH-2X4QC-DD
    GGKFW-TBH8R-H8R6B-NDTK2BRQ

    Pro Retail Keys:
    3NX4V-DMFVR-4PMKM3-QRPKV
    4HDN9-XTYYB6FV-MKVBMQH
    HB39N-V9K6F-PV-KWBTC-Q3R9V
    QGR4NPMD-KCRQBXT-YG
    XKY4K-2NRWR-8F6PRF-CRYQH

    Operating system edition         KMS Client Setup Key
    Windows 7 Professional
    FJ82H-XT6CR-J8D7P-XQJJ2-GPDD4
    Windows 7 Professional N
    MRPKT-YTGK7D7T-X2JMM-QY7MG
    Windows 7 Professional E
    W82YF-2Q76YHXB-FGJG9-GF7QX
    Windows 7 Enterprise
    33PXH-7Y6KF-2VJC9-XBBR8-HVTHH
    Windows 7 Enterprise N
    YDRBP-3D83W-TY26F-D46B2-XCKRJ
    Windows 7 Enterprise E
    C29WBCC8-VJGHFJW-H9DH4
    Windows Server R2 Web
    6TPJF-RBVHG-WBW2RQPH-6RTM4
    Windows Server R2 HPC edition
    TT8MH-CGD3D7QWQCTX
    Windows Server R2 Standard
    YC6KT-GKW9T-YTKYR-T4XR7VHC
    Windows Server R2 Enterprise
    J6-VHDMP-X63PK-3KCPX3Y
    Windows Server R2 Datacenter
    74YFP-3QFB3-KQT8W-PMXWJ-7M
    Windows Server R2 for Itanium-based Systems
    GT63C-RJFQGMB6-BRFB9-CB83V


NOTE:RAR and Archive Password is "kiranmaji"


Download Windows 8 AIO storycall.us here:
Download
Источник: [storycall.us]

Emerging Topics in Hardware Security

Mark Tehranipoor is currently the Intel Charles E. Young Preeminence Endowed Chair Professor in Cybersecurity at the Department of Electrical and Computer Engineering, the University of Florida. He has published over journal articles and refereed conference papers and has delivered more than invited talks and keynote addresses in international conferences, industry consortiums and government. In addition, he has 8 patents and has published 11 books and 25 book chapters. He is a recipient of 12 best paper awards and nominations, the NSF CAREER award, the MURI award on Nanoscale Security, the IEEE Computer Society (CS) Meritorious Service Award, the and IEEE CS Outstanding Contribution, the and IEEE TTTC/CS Most Successful Technical Event for co-founding and chairing HOST Symposium. He co-founded IEEE International Symposium on Hardware-Oriented Security and Trust (HOST) and served as HOST and HOST General Chair and continues to serve as Chair of the Steering Committee for HOST. He also co-founded IEEE Asian-HOST. Further, he co-founded Journal on Hardware and Systems Security (HaSS) and currently serving as EIC for HaSS. He is also a co-founder of Trust-Hub. He served as associate Editor-in-Chief (EIC) for IEEE Design and Test of Computers from He is currently serving as an Associate Editor for IEEE Design and Test of Computers, an Associate Editor for JETTA, an Associate Editor for Journal of Low Power Electronics (JOLPE), an Associate Editor for ACM Transactions for Design Automation of Electronic Systems (TODAES), and an Associate Editor for IEEE Transactions on VLSI (TVLSI). He has served as an IEEE Distinguished Speaker and an ACM Distinguished Speaker from Dr. Tehranipoor is a Fellow of the IEEE, Golden Core Member of IEEE Computer Society, and Member of ACM and ACM SIGDA. He is also a member of the Connecticut Academy of Science and Engineering (CASE).


Источник: [storycall.us]
Single KJ Pirate Activator 1.11 Crack [2022] Download For Windows & Office

Thematic video

KMS VL ALL AIO 42.0 Full (2021) - How to Install and Activate [Working Method 100%]

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