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In this study, a method was developed for distinguishing insertion and driving performance between different self-tapping bone screw designs. To measure screw starting load, torque and displacements, a test apparatus was developed utilizing a modified drill press with the capability to measure in-line torque, axial compression load, and axial displacement. Specimens were inserted into cadaver bone to measure a baseline response and a bone analog was developed to mimic the bicortical application of screws in the cadaver model. Recorded data could be used to measure a distinguishable screw starting load and the torque for the insertion of bone screws. The results were similar between the cadaver bone and the bone analog. The average insertion load ranged from 5.4 to 64.5 N in cadaver tests and 9.0-41.0 N in the construct tests. Average first cortex insertion torques ranged from 0.53 to 0.66 N-m in the cadaver tests and 0.29-0.32 N-m in the construct test. Average second cortex insertion torques ranged from 0.70 to 1.03 N-m in the cadaver tests and 0.60-0.63 N-m in the construct tests. This method successfully illuminated differences between several different selftapping screw designs and was also successfully employed to determine the impact of design and manufacturing methods on screw performance. An interesting finding in this study is that axial starting load is very sensitive to screw tip design whereas insertion torque is not.

To treat patients with tricompartimental knee osteoarthritis (OA), a customized cruciate-retaining total knee arthroplasty (CCR-TKA) system can be used, including both individualized instrumentation and implants. The objective of this monocentric cohort study was to analyze patient-reported and functional outcomes in a series of patients implanted with the second generation of this customized implant. Methods: At our arthroplasty center, we prospectively recruited a cohort of patients with tricompartmental gonarthrosis to be treated with total knee replacement (TKA) using a customized cruciate-retaining (CCR) implant design. Inclusion criteria for patients comprised the presence of intact posterior cruciate and collateral ligaments and a knee deformity that was restricted to <15° varus, valgus, or flexion contracture. Patients were assessed for their range of motion (ROM), Knee Society Score (KSS), Western Ontario and McMaster University osteoarthritis index (WOMAC), and short form (SF)-12 physical and mental scores, preoperatively, at 3 and 6 months, as well as at 1, 2, 3, and 5 years of follow-up (FU) postoperatively. Results: The average age of the patient population was 64 years (range: 40–81), the average BMI was 31 (range: 23–42), and in total, 28 female and 45 male patients were included. Implant survivorship was 97.5% (one septic loosening) at an average follow-up of 2.5 years. The KSS knee and function scores improved significantly (p < 0.001) from, respectively, 41 and 53 at the pre-operative visit, to 92 and 86, respectively, at the 5-year post-operative time point. The SF-12 Physical and Mental scores significantly (p < 0.001) improved from the pre-operative values of 28 and 50, to 50 and 53 at the 5-year FU, respectively. Patients experienced significant improvements in their overall knee range of motion, from 106° at the preoperative visit to 122°, on average, 5 years postoperatively. The total WOMAC score significantly (p < 0.001) improved from 49.1 preoperatively to 11.4 postoperatively at 5-year FU. Conclusion: Although there was no comparison to other implants within this study, patients reported high overall satisfaction and improvement in functional outcomes within the first year from surgery, which continued over the following years. These mid-term results are excellent compared with those reported in the current literature. Comparative long-term studies with this device are needed. Level of evidence 3b (individual case–control study).

Decarbonization of sugar factories for minimising the CO2-footprint has become a focus for sugar factories to survive in the contemporary world. Heat pumps can be a piece of the puzzle for meeting the challenge of elaborating the path to a green future. This paper explains the technological principles and shows some exemplary scenarios for integrating heat pumps into beet sugar factories. The scenarios demonstrate reductions between 2% and 30% of the total factory’s CO2-emissions. The potentials are limited by the local electricity-gas-price-relationship, which defines a lower limit in regards to operating costs equality.