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Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_16 | Pages 68 - 68
1 Dec 2021
USING PRINCIPAL COMPONENT ANALYSIS TO IDENTIFY DIFFERENCES IN KNEE JOINT FUNCTION BETWEEN A NON-PATHOLOGICAL GROUP AND A PRE– HIGH TIBIAL OSTEOTOMY COHORT
Bowd J Williams D de Vecchis M Wilson C Elson D Whatling G Holt C
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Abstract

Objectives

Principal Component Analysis (PCA) is a useful method for analysing human motion data. The objective of this study was to use PCA to quantify the biggest variance in knee kinematics waveforms between a Non-Pathological (NP) group and individuals awaiting High Tibial Osteotomy (HTO) surgery.

Methods

Thirty knees (29 participants) who were scheduled for HTO surgery were included in this study. Twenty-eight NP volunteers were recruited into the study. Human motion analysis was performed during level gait using a modified Cleveland marker set. Subjects walked at their self-selected speed for a minimum of 6 successful trials. Knee kinematics were calculated within Visual3D (C-Motion). The first three Principal Components (PCs) of each input variable were selected. Single-component reconstruction was performed alongside representative extremes of each PC to aid interpretation of the biomechanical feature reconstructed by each component.

Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_2 | Pages 59 - 59
1 Mar 2021
PEAK KNEE CONTACT FORCES PRE- TO POST- HIGH TIBIAL OSTEOTOMY AND THE RELATIONSHIP TO PEAK EXTERNAL KNEE ADDUCTION MOMENTS
Bowd J van Rossom S Wilson C Elson D Jonkers I Whatling G Holt C
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Abstract

Objective

Explore whether high tibial osteotomy (HTO) changes knee contact forces and to explore the relationship between the external knee adduction moment (EKAM) pre and 12 months post HTO.

Methods

Three-dimensional gait analysis was performed on 17 patients pre and 12-months post HTO using a modified Cleveland marker-set. Tibiofemoral contact forces were calculated in SIMM. The scaled musculoskeletal model integrated an extended knee model allowing for 6 degrees of freedom in the tibiofemoral and patellofemoral joint. Joint angles were calculated using inverse kinematics then muscle and contact forces and secondary knee kinematics were estimated using the COMAC algorithm. Paired samples t-test were performed using SPSS version 25 (SPSS Inc., USA). Testing for normality was undertaken with Shapiro-Wilk. Pearson correlations established the relationships between EKAM1 to medial KCF1, and EKAM2 to medial KCF2, pre and post HTO.

Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_III | Pages 76 - 76
1 Feb 2012
THE CONJOINT JUNCTION OF THE TRICEPS SURAE: IMPLICATIONS FOR GASTROCNEMIUS TENDON LENGTHENING
Elson D Whiten S Robb J
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Introduction

The gastrocnemius tendon extends from the musculotendinous junction proximally to the conjoint junction with soleus distally. The morphology of the junction has not, to our knowledge, been described previously. Lengthening of the gastrocnemius tendon is a standard surgical procedure in surgery for cerebral palsy. The aims of the study were to describe the morphology of the conjoint junction and to identify the location of the gastrocnemius tendon relative to palpable bony landmarks to assist with incision planning.

Methods

Twenty-one embalmed adult cadaveric specimens were dissected to document the morphology of the conjoint junction. The location of the gastrocnemius tendon was measured relative to the distance between the palpable bony landmarks of the calcaneus and the head of the fibula.

Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 28 - 28
1 Mar 2006
PREDICTION OF POOR PAIN OUTCOMES IN TOTAL KNEE ARTHROPLASTY
Elson D Brenkel I
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Introduction: Pain is one of the most important outcome measures that contributes to patient dissatisfaction following total knee arthroplasty (TKA) and unexplained pain poses a difficult problem to manage. This paper focuses on a group of patients with unexplained knee pain post arthroplasty to identify any predictors of a poor pain outcome.

Methods: A prospective study of 622 primary TKAs performed on 512 patients using cemented press fit condylar prosthesis was the basis to examine a group of patients that reported moderate or severe pain at 5 years. Demographic and operative variables as well as American Knee Society Scores were collected prospectively. Data was available for 462 knees at 5 years. After exclusion of patients with mild pain, two groups were generated; 374 with no pain and 28 with moderate or severe unexplained pain. Univariate linear analysis was performed to identify possible predictors of poor outcome and this was further refined using multiple regression analysis to remove the effect of confounding factors.

Results: Comparison of the pain and no pain group found the following to be significant predictors of poor outcome: Staged approach to bilateral disease when compared to simultaneous bilateral surgery (13% vs 2%, P< 0.01), age below 60 (17% vs 7%, P< 0.01) and performing lateral release (13% vs 5%, P< 0.01). Other factors which had no predictive effect were gender, body mass index, operating surgeon, patella component, instability and range of motion.

Conclusions: Avoiding surgery in patients aged below 60 and performing simultaneous bilateral TKA instead of a staged approach to bilateral disease, should aid selection of patients for improved outcome in terms of pain. Good surgical technique to avoid lateral release is also recommended to improve outcome.