Summary Statment

The dual-mobility cup seems to bring more stability without changing the gait pattern.

INTRODUCTION

Mobile-bearing knee prostheses have been designed in order to provide less constrained knee kinematics compared to fixed-bearing prosthesis. Currently, there is no evidence to confirm the superiority of either of the two implants with regard to walking performances. It has been shown that subjective outcome scores correlate poorly with real walking performance and it has been recommended to obtain an additional assessment of walking ability with objective gait analysis.

Aim

Debate remains over the optimal treatment for severe unstable SCFE. AVN is the principle problem; current thinking suggests this can be minimized by emergent reduction and fixation within 24 hours. If emergent treatment is not possible, open osteotomy with a variable delay of 10–21 days has been advocated. We present our experience of delayed intracapsular cuneiform osteotomy (ICO)

Introduction: Coordination is a strategy chosen by the central nervous system to control the movements and maintain stability during gait. Coordinated multi-joint movements require a complex interaction between nervous outputs, biomechanical constraints, and pro-prioception. Quantitatively understanding and modeling gait coordination still remain a challenge. Surgeons lack a way to model and appreciate the coordination of patients before and after surgery of the lower limbs. Patients alter their gait patterns and their kinematic synergies when they walk faster or slower than normal speed to maintain their stability and minimize the energy cost of locomotion. The goal of this study was to provide a dynamical system approach to quantitatively describe human gait coordination and apply it to patients before and after total knee arthroplasty.

Methods: A new method of quantitative analysis of interjoint coordination during gait was designed, providing a general model to capture the whole dynamics and showing the kinematic synergies at various walking speeds. The proposed model imposed a relationship among lower limb joint angles (hips and knees) to parameterize the dynamics of locomotion of each individual. An integration of different analysis tools such as Harmonic analysis, Principal Component Analysis, and Artificial Neural Network helped overcome high-dimensionality, temporal dependence, and non-linear relationships of the gait patterns.

Ten patients were studied using an ambulatory gait device (Physilog®). Each participant was asked to perform two walking trials of 30m long at 3 different speeds and to complete an EQ-5D questionnaire, a WOMAC and Knee Society Score. Lower limbs rotations were measured by four miniature angular rate sensors mounted respectively, on each shank and thigh. The outcomes of the eight patients undergoing total knee arthroplasty, recorded pre-operatively and post-operatively at 6 weeks, 3 months, 6 months and 1 year were compared to 2 age-matched healthy subjects.

Results: The new method provided coordination scores at various walking speeds, ranged between 0 and 10. It determined the overall coordination of the lower limbs as well as the contribution of each joint to the total coordination. The difference between the pre-operative and post-operative coordination values were correlated with the improvements of the subjective outcome scores. Although the study group was small, the results showed a new way to objectively quantify gait coordination of patients undergoing total knee arthroplasty, using only portable body-fixed sensors.

Conclusion: A new method for objective gait coordination analysis has been developed with very encouraging results regarding the objective outcome of lower limb surgery.

Aims: Advance the understanding of the management of rheumatic conditions by capturing information on management of OA and primary care physicians’ (GPs) perceptions of the risks and benefits of different interventions in Germany, Spain and the UK. Methods: Telephone survey of 600 randomly selected GPs (200 per country) using a structured questionnaire. Results: Management of OA across all countries does not necessarily conform to EULAR guidelines. There are variations in physical therapies used and in firstline pharmacological management: in the UK, mainly analgesics (61%) with some NSAIDs (35%); in Spain, a combination of analgesics (76%) and NSAIDs (91%); and Germany, predominantly NSAIDs (94%) with almost no analgesia (8%). Cox II-specific inhibitors are rarely used as first-line treatment and only used in significant amounts in Germany (by 32% of GPs) when first-line NSAIDs had failed due to side-effects. GPs are concerned about NSAIDrelated GI toxicity, perceiving > 50% of their patients to be at moderate/high risk of serious GI side-effects, but there is a lack of awareness of some of the established risk factors. Conclusions: Variations in GP management of OA exist, related to use of physical therapies and first-line pharmacological management. Although there is universal concern about NSAID toxicity, there is a lack of awareness amongst GPs of some established risk factors or how side effects may present. Disclosure: This work was supported by an educational grant from Pharmacia/Pfizer