The orientation of the acetabular component is
influenced not only by the orientation at which the surgeon implants
the component, but also the orientation of the pelvis at the time
of implantation. Hence, the orientation of the pelvis at set-up
and its
Patients with osteoarthritis (OA) of the knee commonly alter their
Digital Ventilated Cages (DVC) offer an innovative technology to obtain accurate
Purpose: The deleterious effects of blocking
Purpose and Background. Work-related musculoskeletal disorders (WRMSD) can affect 56–80% of physiotherapists. Patient handling is reported as a significant risk factor for developing WRMSD with the back most frequently injured. Physiotherapists perform therapeutic handling to manually assist and facilitate patients’
Aims. Few reports compare the contribution of the talonavicular articulation
to overall range of
We have previously reported on the medium-term outcomes following a non-operative protocol of a short period of splinting followed by early
Technological advancements in orthopaedic surgery have mainly focused on increasing precision during the operation however, there have been few developments in post-operative physiotherapy. We have developed a computer vision program using machine learning that can virtually measure the range of
Objectives. The objective of this study was to quantify the relative
For clinical
Mechanical loading of joints with osteoarthritis (OA) results in pain-related functional impairment, altered joint mechanics and physiological nociceptor interactions leading to an experience of pain. However, the current tools to measure this are largely patient reported subjective impressions of a nociceptive impact. A direct measure of nociception may offer a more objective indicator. Specifically, movement-induced physiological responses to nociception may offer a useful way to monitor knee OA. In this study, we gathered preliminary data on healthy volunteers to analyse whether integrated biomechanical and physiological sensor datasets could display linked and quantifiable information to a nociceptive stimulus. Following ethical approval, 15 healthy volunteers completed 5
Non-operative management of displaced olecranon fractures in elderly low demand patients is reported to result in a satisfactory outcome despite routinely producing a nonunion. The aim of this study was to assess whether there is evidence of dynamic
INTRODUCTION. In living normal knee the lateral femoral condyle rolls posteriorly more than the medial side to the extent that in deep flexion the lateral femoral condyle sublux from the tibial surface (Nakagawa et al). The purpose of this presentation is to study the tibiofemoral
Construction of a functional skeleton is accomplished
through co-ordination of the developmental processes of chondrogenesis,
osteogenesis, and synovial joint formation. Infants whose
Aim. To quantify the micro-motion at the fracture gap in a tibial fracture model stabilised with an external fixator. Method. A surrogate model of a tibia and a cadaver leg were fractured and stabilised using a two-ring hexapod external fixator. They were tested initially under static loading and then subjected to vibration. Results. The overall stiffness of the cadaver leg was significantly higher than the surrogate model under static loading. This resulted in a significantly higher facture
Objectives. To elucidate the effects of age on the expression levels of the receptor activator of the nuclear factor-κB ligand (RANKL) and osteoclasts in the periodontal ligament during orthodontic mechanical loading and post-orthodontic retention. Materials and Methods. The study included 20 male Sprague-Dawley rats, ten in the young group (aged four to five weeks) and ten in the adult group (aged 18 to 20 weeks). In each rat, the upper-left first molar was subjected to a seven-day orthodontic force loading followed by a seven-day retention period. The upper-right first molar served as a control. The amount of orthodontic tooth
Cervical spinal arthrodesis is the standard of care for the treatment of spinal diseases induced neck pain. However, adjacent segment disease (ASD) is the primary postoperative complication, which draws great concerns. At present, controversy still exists for the etiology of ASD. Knowledge of cervical spinal loading pattern after cervical spinal arthrodesis is proposed to be the key to answer these questions. Musculoskeletal (MSK) multi-body dynamics (MBD) models have an opportunity to obtain spinal loading that is very difficult to directly measure in vivo. In present study, a previously validated cervical spine MSK MBD model was developed for simulating cervical spine after single-level anterior arthrodesis at C5-C6 disc level. In this cervical spine model, postoperative sagittal alignment and spine rhythms of each disc level, different from normal healthy subject, were both taken into account. Moreover, the biomechanical properties of facet joints of adjacent levels after anterior arthrodesis were modified according to the experimental results. Dynamic full range of motion (ROM) flexion/extension simulation was performed, where the motion data after arthrodesis was derived from published in-vivo kinematic observations. Meanwhile, the full ROM flexion/extension of normal subject was also simulated by the generic cervical spine model for comparative purpose. The intervertebral compressive and shear forces and loading-sharing distribution (the proportions of intervertebral compressive and shear force and facet joint force) at adjacent levels (C3-C4, C4-C5 and C6-C7 disc levels) were then predicted. By comparison, arthrodesis led to a significant increase of adjacent intervertebral compressive force during the head extension
Objectives. To date, no study has considered the impact of acromial morphology on shoulder range of
Introduction: The Lachman test for anterior cruciate ligament (ACL) deficiency, requires a subjective assessment of joint
Ankle sprains are very common, and usually tear or partly tear one or more of the ligaments on the outer side of the ankle. The ankle joint is only designed to move up and down, whereas there is another joint immediately below the ankle joint, called the subtalar joint, which is designed to do the tilting in and out
Objective: To evaluate the impact of soft tissue release on range of
Objective: To evaluate the impact of soft tissue release on range of
Aims. This study aimed to determine the minimal detectable change (MDC), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) under distribution- and anchor-based methods for the Mayo Elbow Performance Index (MEPI) and range of
Aims. This study aims to evaluate a new home medical stretching device called the Self Treatment Assisted Knee (STAK) tool to treat knee arthrofibrosis. Methods. 35 patients post-major knee surgery with arthrofibrosis and mean range of
The painful hip without obvious clinical or radiographic signs of complications is a well-known scenario for surgeons. The clinical tools we have access to currently lack a dynamic test for detecting early signs of motion between implant and bone. A new software, Sectra IMA, has a potential to facilitate diagnosis of early implant loosening by analysis of paired CT exams. In clinical practise the two scans are acquired by endpoint of a possible motion, “a provocation CT”, for example maximal external and internal rotation in a CT hip examination. 20 years of research by Olivecrona and Weidenhielm is the scientific background for the technique. Early results are presented by Sandberg et al 2022. To further validate and create clinical evidence more extensive clinical studies is needed. A proposal for a multicentric, global clinical study will be presented for further discussion. A new technique for diagnosis of acetabular cup loosening using computed tomography: preliminary experience in 10 patients. Henrik Olivecrona, Lotta Olivecrona, Lars Weidenhielm, Marilyn E Noz, Jocelyn Kardos, Gerald Q Maguire Jr, Michael P Zeleznik, Peter Aspelin. Acta Orthop. 2008 Jun;79(3):346-53. doi: 10.1080/17453670710015247. Inducible displacement CT increases the diagnostic accuracy of aseptic loosening in primary total hip arthroplasty. Sandberg O, Carlsson S, Harbom E, Cappelen V, Tholén S, Olivecrona H, Wretenberg P. Acta Orthop. 2022 Oct 31;93:831-836. doi: 10.2340/17453674.2022.5240.PMID: 36314542
Aim: The aim of this investigation was to determine how the rotational axis of the wrist moves as the hand goes from full ulna to full radial deviation. Materials &
Methods: Ulna to radial deviation was assessed in 30 normal wrists in 15 normal subjects aged 19 to 32.
We present the first study in vivo of meniscal
A method of assessing foot
Aim: The carpal bone arrangement can be described as a matrix of two rows and three columns. There a various theories as to how the bones within the matrix move during ulna to radial deviation. One theory suggests that there are two types of wrist
The most widely accepted method to measure kneekinematics is using external
Background. The clinical assessment of Chronic Low Back Pain (CLBP) is usually undertaken at a single time point at clinic rather than through continuous monitoring. To address this, a wearable prototype sensor to monitor motion of the lumbar spine and pelvis has been developed. Sensor Development, Testing and Results. The system devised was based on inertial sensor technology combined with wireless Body Sensor Network (BSN) platform. This was tested on 16 healthy volunteers for ten common movements (including sit to stand, lifting, walking, and stairs) with results validated by optical tracking. Preliminary findings suggest good agreement between the optical tracker and device with mean average orientation error (°) ranging from 0.1 ± 2.3 to 4.2 ± 2.6. The sensor repeatability errors range from 0 to 4° while subject
We used three-dimensional
When performing the Scandinavian Total Ankle Replacement (STAR), the positioning of the talar component and the selection of mobile-bearing thickness are critical. A biomechanical experiment was undertaken to establish the effects of these variables on the range of
The aim of this study was to investigate how the rotational axis of the wrist moves as the hand goes from full ulna to full radial deviation. Fifty normal wrists in 25 subjects were assessed with a Polhemus Fastrak (TM) magnetic tracking system. The subjects, aged 19 to 57, placed their palms on a flat wooded stool. Sensors were attached over their 3rd metcarpal and distal radius. The sensors then recorded
Introduction. It is essential to investigate the tribological maturation of tissue-engineered cartilage that is to be used in medical applications. The frictional performances of tissue engineered cartilage have been measured using flat counter surfaces such as stainless steel, glass or ceramics. However, the measured friction performances were significantly inferior to those of natural cartilage, likely because of cartilage adhesion to the counter surface. Tamura et al. reported that a poly (2- methacryloyloxyethyl phosphoryl-choline (MPC)) grafted surface shows low friction coefficient against cartilage without the adhesion to be equivalent to those for natural cartilage-on-cartilage friction. [1]. On the other hand, Yamamoto et al. reported that applying a relative sliding
After a unicompartmental Oxford knee replacement, a clear lateral radiographic view of the components may be obtained without the shadow of prosthetic components in the other compartment. Radiographs of 20 knees were studied; with the patient supine and the muscles relaxed, views with the knee at full extension and 90 degrees of flexion were obtained and the
Introduction: Activities that require extreme hip
In living normal knee the lateral femoral condyle rolls posteriorly more than the medial side to the extent that in deep flexion the lateral femoral condyle sublux from the tibial surface (Nakagawa et al). The purpose of this presentation is to study the tibiofemoral
Introduction: In living normal knee the lateral femoral condyle rolls posteriorly more than the medial side to the extent that in deep flexion the lateral femoral condyle sublux from the tibial surface(Nakagawa et al). The purpose of this presentation is to study the tibiofemoral
Modular knee bearings typically consist of a femoral component, a tibial base-plate and a polyethylene insert, which is located in the tibial base-plate using some sort of locking mechanism. Although modular knee bearings offer many advantages there is the potential for micro-motion between the tibial insert and the base-plate. Tests were performed on six large Kinemax Plus knee bearings (snap-fit design) to evaluate the amount of
Background: The determinants of range of
The pathogenesis of aseptic loosening of total joint prostheses is not clearly understood. Two features are associated with loosened prostheses, namely, particulate debris and
I have tried to stimulate interest in
Introduction. Hip-Spine syndrome has various clinical aspects. For example, schoolchild with severe congenital dislocation of the hip have unfavorable standing posture and disadvantageous motions in ADL. Hip-Spine syndrome is closely related closely as the adjacent lumbar vertebrae and the hip joint. Furthermore, not only the pelvis and the lumbar spine, but also the neck position might influence on the maximum hip flexion angle. In this study, we examined the maximum hip flexion angle and pelvic
The aim of this study was to define objectively gait function in children with treated congenital talipes equinovarus (CTEV) and a good clinical result. The study also attempted an analysis of
1. The range of variation in the movements at the metatarso-phalangeal and interphalangeal joints of the big toe in fifty males has been investigated by means of lateral radiographs. 2. In the "neutral" position the proximal phalanx is dorsiflexed on the metatarsal and the distal phalanx dorsiflexed on the proximal. Sometimes the distal phalanx is plantar flexed on the proximal but this is not associated with any obvious abnormality of function. 3. There is a wide variation between individuals in the amount of
Introduction: Total lumbar disc replacement (TLDR) is a motion-preserving alternative to lumbar spinal fusion for degenerative disc disease. Although in vitro cadaveric studies have provided invaluable information in preserving motion and possibly prevent abnormal loading at the adjacent level for TLDR, there is still lack evidence of in vivo consequences for sagittal balance and
Current tools to measure pain are broadly subjective impressions of the impact of the nociceptive impulse felt by the patient. A direct measure of nociception may offer a more objective indicator. Specifically, movement-induced physiological responses to nociception may offer a useful way to monitor knee OA. In this proof-of-concept study, we evaluated whether integrated biomechanical and physiological sensor datasets could display linked and quantifiable information to a nociceptive stimulus. Following ethical approval, we applied a quantified thermal pain stimulus to a volunteer during stationary standing in a gait lab setting. An inertial measurement unit (IMU) and an electromyography (EMG) lower body marker set were tested and integrated with ground reaction force (GRF) data collection. Galvanic skin response electrodes and skin thermal sensors were manually timestamp linked to the integrated system.Abstract
Objectives
Method
We investigated the effect of neck dimension upon cervical range of
Cervical orthoses are currently used in the pre-hospital stabilization of trauma patients and also as part of the definitive non-operative treatment of injuries of the cervical spine. The construct stability of orthoses is compromised by virtue of the fact that the cervical spine exhibits the greatest range of
Aim: One of the issues of metatarsophalangeal joint (MTPJ) replacements is that they do not restore full range of
Treatment by continuous passive
Introduction: Hip replacement patients are prone to dislocations during extreme hip
We report a prospective study, using multivariate analysis, of the factors which influence the range of
Objective. To compare the effectiveness of the Aspen, Aspen Vista, Philadelphia, Miami-J and Miami-J Advanced collars at restricting cervical spine
We used electrogoniometers to measure the range of
We have attempted to quantify the influence of clinical, radiological and prosthetic design factors upon flexion following knee replacement. Our study examined the outcome following 101 knee replacements performed in two prospective randomized trials using similar cruciate retaining implants. Multivariate analyses, after adjusting for age, sex, diagnosis and the type of prosthesis revealed that the only significant correlates for range of
We performed a randomised, prospective study of 80 mobile-bearing total knee arthroplasties (80 knees) in order to measure the effects of varus-valgus laxity and balance on the range of
The purpose of this study was to establish if the Bateman prosthesis functions as a bipolar device moving primarily at the inner metal-on-polyethylene bearing as originally proposed, or as a unipolar hemiarthroplasty moving at the outer metal-on-cartilage surface as has recently been suggested. One hundred hips were examined at one year follow-up; 78 were examined again at two to four years. The replacement was performed for arthritis in 76 hips and for femoral neck fracture in 24.
INTRODUCTION: The techniques to stabilize the patella can be divided into two groups: the first group seeks to change the direction of the extensor mechanism in order to medialize the extending force vector of the quadriceps muscle, e.g. by a distal medialization of the tibial tuberosity or a proximal realignment; the second seeks to reconstruct the medial patellofemoral ligament (MPFL). The goal of this study was therefore to measure changes in patellofemoral kinematics in the intact, MPFL deficient knee, after medial transfer of the tibial tuberosity, after proximal realignment as well as after reconstruction of the MPFL. METHODS: Eight fresh frozen right knee specimens were mounted in a knee simulator in which isokinetic flexion-extension motions were simulated. Extension cycles were simulated from 120° flexion to full knee extension with an extension moment of 31 Nm.
The amount of anteroposterior laxity required for a good range of
To confirm whether developmental dysplasia of
the hip has a risk of hip impingement, we analysed maximum ranges
of
We have previously shown that joint distraction and
Introduction: The aim of this study was to compare hip
We studied active flexion from 90° to 133° and passive flexion to 162° using MRI in 20 unloaded knees in Japanese subjects. Flexion over this arc is accompanied by backward
Purpose: Femoral roll causes the sagittal plane axis of the knee to move posteriorly and anteriorly with flexion and extension. The aim of this study was to measure this
We have investigated those factors which influence the range of
Introduction: Sock application is a daily task that can pose a dislocation risk to implanted hips. The aim of this study was to measure hip flexion and rotation using three seated techniques of sock application. Namely:- 1. The leg crossed in a “figure of four” technique, 2. The lean forward technique, and 3. using a specialised sock applicator (Foxy Sock Aid). Methods: The
The benefit of mobile-bearing mechanism in total knee arthroplasty (TKA) has been controversial. The aim of this paper is to analyse the rotation of polyethylene (PE) and its effect on the range of motion (ROM) in mobile-bearing, posterior stabilised TKA (LPS-Flex™, Zimmer Co. Ltd.). Thirty-four consecutive PS-Flex™ TKAs (28 patients) were analysed. Three tantalum markers were inserted in the PE and the tibia (one for medial side and two for lateral side; total six markers). The rotation of the PE and the tibia was analysed in fluoroscopically-controlled radiograph taken at one years in full extension, 90 degrees flexion and passive maximum flexion. The markers in the tibia were identifiable in 19 knees and the analysis was based on these knees. The tibia rotated internally relative to the femur by 7.1± 5.2 degrees (mean ± SD, range −1 to 20 degrees). The amount of tibial rotation has no correlation to ROM. The rotation of the PE relative to the femur was unpredictable showing three knees with external rotation and four knees without rotation (Average; 4.0 ± 4.5 degrees internal rotation). The rotation of the PE on the tibia was 4.2± 5.2 degrees and seven knees (37 %) showed no rotation and 12 knees (63 %) showed less than 5 degrees rotation. There was a positive correlation between the amount of PE rotation on the tibia and ROM, which approached to statistical significance (p = 0.0684). This study has demonstrated that the rotation of the PE on the tibial tray is generally small (<
5 degrees). Because not tibial internal rotation but PE
To determine whether resection of osteophyte at TKR improves
Temporary immobilisation of joints can lead to permanent ankylosis or fusion. The aim of this study is to demonstrate that treatment of vertebral fractures by single level fusion and 2 level fixation preserves
A Salter innominate osteotomy is used to treat acetabular dysplasia, but reports of its effects on the position of the femoral head are few and conflicting. Lateral shift would increase the resultant forces acting on the joint and be detrimental. We studied 15 Salter innominate osteotomies and demonstrated that a correctly performed osteotomy does not significantly alter the distance from the centre of the femoral head to the midline of the body. Stereophotogrammetry was used in three patients to delineate the axis of rotation of the distal acetabular fragment and determine the locus of
Introduction and Objective: Although the causation and progression of adolescent idiopathic scoliosis (AIS) remains unclear, a recent review has highlighted a series of possible aetiological factors. Additionally, research investigations have indicated that the kinematic differences in various body segments may be a major contributing factor. The value of gait analysis systems employed to measure dynamic back movements in furthering understanding of spinal deformity has also been demonstrated by various studies. Research employing gait measurements have indicated asymmetries in the ground reaction forces and have suggested relationship between these asymmetries, neurological dysfunction and spinal deformity. This investigation, which formed part of a wider comprehensive study, was aimed at identifying asymmetries in lower limb kinematics and pelvic and back movements during level walking in scoliotic subjects that could be related to the spinal deformity. Design and Methodology: The research employed a
The presented study investigated the difference of positioning sense of the shoulder before and after surgery (capsular shift or Arthroscopic Bankart repair) for shoulder instability. For this purpose a sample of patients with recurrent dislocations of the shoulder that underwent surgery and patients with instability before surgery volunteered to participate in a set of experiments. Their results were compared to the results obtained from a matching sample of healthy subjects. All subjects completed all
Dislocation is the most frequent serious complication following total hip replacement for subcapital femoral fracture. We report a prospective study, using matched groups, which compared the range of hip
Purpose and Background. This pilot study aimed to determine the accuracy of lumbar spine combined
At present, wear investigations of total hip replacement (THR) are performed in accordance with the ISO standard 14242, which is based on empirically determined relative motion data and exclusively describes the gait cycle. However, besides continuous walking, a number of additional activities characterize the
We performed CT myelography in 38 patients with cervical myelopathy before and after laminoplasty to enlarge the canal. The sagittal and transverse diameters, the cross-sectional area, and the central point of the spinal cord were measured. After cervical laminoplasty, the mean sagittal diameter of the spinal cord at C5 increased by 0.8 mm, but the mean transverse diameter decreased by 0.9 mm. The mean cross-sectional area of the cord increased by 7.4% and that of the dural sac and its contents by 33.8% at C5. The centre of the spinal cord moved a mean 2.8 mm posteriorly at this level. Enlargement of the spinal canal is sufficient to decompress the spinal cord, but posterior
Background. Shoulder pain limits range of motion (ROM) and reduces performing activities of daily living (ADL). Objective assessment of shoulder function could be of interest for diagnosing shoulder pathology or functional assessment of the shoulder after therapy. The feasibility of 2 wearable inertial sensors for functional assessment to differentiate between healthy subjects and patients with unilateral shoulder pathology is investigated using parameters as asymmetry. Methods. 75 subjects were recruited into this study and were measured for at least 8 h a day with the human activity monitor (HAM) sensor. In addition, patients completed the Disability of the Arm, Should and Hand (DASH) score and the Simple Shoulder Test (SST) score. From 39 patients with a variety of shoulder pathologies 24 (Age: 53.3 ± 10.5;% male: 62.5%) complete datasets were successfully collected. From the 36 age-matched healthy controls 28 (Age: 54.9 ± 5.8;% male = 57.1%) full datasets could be retrieved. Activity parameters were obtained using a self-developed algorithm (Matlab). Outcome parameters were gyroscope and accelerometry-based relative and absolute asymmetry scores (affected/unaffected; dominant/non-dominant) of
This study looks at the dynamic tendon-to-bone contact properties of rotator cuff (RC) repairs—comparing single row repairs (SRR) with double row transosseous- equivalent (TOE) repairs. It was postulated that relaxation during, and
There is limited information about the extent to which the association between pre-operative and chronic post-operative pain is mediated via pain-on-movement or pain-at-rest. We explored these associations in patients undergoing total hip (THR) and total knee (TKR) replacement. 322 and 316 patients receiving THR and TKR respectively were recruited into in a single centre UK cohort (APEX) study. Pre-operative, acute post-operative and 12-month pain severity was measured using self-reported pain instruments. The association between pre-operative / acute pain and chronic post-operative pain was investigated using structural equation modelling (SEM).Objective
Methods
Summary.
Introduction. Regular, repeated stretching increases joint range of
We studied 27 patients with low back pain and unilateral L5 or S1 spinal nerve root pain. Significant radiological changes were restricted to the symptomatic root level, when compared with controls. Low back and leg pain were graded on a visual analogue scale. Dermatomal quantitative sensory tests revealed significant elevations of warm, cool and touch perception thresholds in the affected dermatome, compared with controls. These elevations correlated with root pain (warm v L5 root pain; r = 0.88, p <
0.0001), but not with back pain. Low back pain correlated with restriction of anteroposterior spinal flexion (p = 0.02), but not with leg pain. A subset of 16 patients underwent decompressive surgery with improvement of pain scores, sensory thresholds and spinal mobility. A further 14 patients with back pain, multilevel nerve root symptoms and radiological changes were also studied. The only correlation found was of low back pain with spinal
Purpose of the study: The objective was to analyse shoulder motion, particularly abduction and anterior elevation, in patients with an reversed prosthesis. A radiocinematographic study enable an analysis of the movements of the prosthesis it self and movements due to scapulothoracic participation. Material and methods: This study was based on the analysis of 33 patients with an reversed shoulder prosthesis. A videoscopic recording (25 images per second) of anterior elevation from a workstation used for abduction arteriography was used. The Constant score was noted and a standard x-ray work-up (four views) was obtained for all patients. Results: The cohort was a homogeneous continuous series of 21 women and 12 men, mean age 72.5 years (range 39–84). Two modes of motion were observed. The first (group 12, n=17 shoulders) was «monoarticular»: shoulder motion was almost exclusively related to
In six unloaded cadaver knees we used MRI to determine the shapes of the articular surfaces and their relative movements. These were confirmed by dissection. Medially, the femoral condyle in sagittal section is composed of the arcs of two circles and that of the tibia of two angled flats. The anterior facets articulate in extension. At about 20° the femur ‘rocks’ to articulate through the posterior facets. The medial femoral condyle does not move anteroposteriorly with flexion to 110°. Laterally, the femoral condyle is composed entirely, or almost entirely, of a single circular facet similar in radius and arc to the posterior medial facet. The tibia is roughly flat. The femur tends to roll backwards with flexion. The combination during flexion of no antero-posterior
Purpose. To describe the frequency of different patterns of pain response and their association with outcomes (prognosis) and MRI findings in patients experiencing sciatica. Methods. 176 consecutive consenting patients with radicular pain underwent an MRI and a clinical assessment at baseline using a standardized procedure of repeated lumbar movements and positioning guided. Based on their pain response, patients were divided into five groups: abolition centralization, reduction centralization, unstable centralization, peripheralization, and no effect on pain. Results. Overall, 84.8 % of patients reported experiencing one of the three forms of centralization, 7.3 % reported peripheralization and 7.9 % reported “No effect”. The median reduction in RMQ scores across all three centralization groups was 9.5 points at 3-months and 12.0 points at 12-months. The peripheralization group improved by a similar amount (7.0 and 14.0 respectively). In contrast, the ‘no effect’ group improved by 3.0 at both time points and this was significantly different (p<0.001) from the other groups. These results were mimicked in relation to leg pain. In addition, there was no association between the reported pain responses (centralization, peripheralization or no effect) and the type of disc lesion observed on MRI. Conclusion. In patients with sciatica, centralization was common. Centralization and peripheralization at baseline were equally associated with improvement in activity limitation and leg pain over time. As there was no association between MRI findings and the pain response to
Background: The main aim of this study is to compare the difference between early mobilisation versus non weight bearing in patients post ankle fracture fixation in terms of pain and functional outcome. Methods: We recruited 60 patients and were divide into two equal groups. Patients in Group A were treated with a below knee cast post ankle fracture fixation and remained non weight bearing for six weeks while groub B were patients that were treated with a backslab for two weeks post fixation. The backslab was removed and once their radiographs were deemed satisfactory, They were referred to the physiotherapy service in our unit for range of motion exercises while still remaining non-weight bearing. All patients were allowed to weight bear at six weeks time post fixation. The inclusion criteria included patients within the age of 18 to 40 years of age and all the fractures are classified using the Weber classification. Patients that were excluded from theses studies are those with unstable fractures and have high co-morbid conditions. All these patients were followed up at 2 weeks, 6 weeks, 3 months and 9 months post ankle fracture fixation. Pain and functional outcome were scored using the AOFAS scoring system. Results: We found that patients in both these groups scored almost equally during the 2 week follow up but at 6 week, group B showed much better range of
Kinematics of the knee change during the full range of flexion [1]. The lateral femoral condyle (LFC) rolls back progressively through the entire range of flexion. The medial femoral condyle (MFC) does not move back during the first 110 degrees, but from 110 to 160 degrees it moves back by 10mm. This dual arc makes anatomical knee design a challenging task. In medial rotation, during flexion, the MFC stays in place, but the LFC moves forward in extension and backward in flexion. In lateral rotation the LFC stays still while the MFC moves back and forward in flexion and extension. During central rotation both condyles move reciprocally. However the knee is stable against an anteriorly or posteriorly directed force. It is important that all these degrees of freedom and stability are reproduced in total knee replacement (TKR) design. Furthermore, the two femoral condyles together form a spiral. Like the threads of a screw in a nut they allow medio-lateral translation of the femur [2] in the tibial reference frame. During flexion the knee centre moves laterally nearly 20% of the width of the tibial plateau and in extension the femur translates medially. This medio-lateral translation occurs in the natural normal knee joint. This has special significance in knee design because the natural femur (along with the trochlea) moves laterally in flexion, allowing the patella to be sited laterally, while most regular TKRs drive the patella medially. In order to test this anomaly we studied patellar maltracking in vivo and in cadavers.
This has application to total knee replacement design. Unless the spiral design is incorporated in the condyles, patellar maltracking is inevitable and is likely to cause lateral knee pain and stiffness post-operatively.
We used roentgen stereophotogrammetric analysis to follow 33 C-stem femoral components for two years after primary total hip arthroplasty. All components migrated distally and posteriorly within the cement mantle. The mean distal migration was 1.35 mm (
Introduction: The Oxford unicompartmental knee replacement (UKR) use in the lateral compartment has been associated with a reduced flexion range and increased medial compartment pain than seen with its medial counterpart due to, in part, the inadequacy of a flat tibial tray replacing the domed anatomy of the lateral tibia. A new design incorporating a domed tibial component and a biconcave meniscal bearing has been developed to overcome these problems. This study reports a clinical comparison of new and old establishing whether this modified implant has maintained the established normal kinematic profile of the Oxford UKR. Method: Patients undergoing lateral UKR for OA were recruited for the study. Fifty one patients who underwent UKR with the domed design were compared to 60 patients who had lateral UKR with a flat inferior bearing surface. Kinematic evaluation was performed on 3 equal subgroups (n = 20); Group 1-Normal volunteer knees, Group 2-Flat Oxford Lateral UKR’s and Group 3-Domed Oxford Lateral UKR’s. The sagittal plane kinematics of each knee was assessed using videofluoroscopic analysis whilst performing a step up and deep knee bend activity. The fluoroscopic images were recorded digitally, corrected for distortion using a global correction method and analysed using specially developed software to identify the anatomical landmarks needed to determine the Patella Tendon Angle (PTA) (the angle the patella tendon and the tibial axis). Knee kinematics were assessed by analysing the
A new generation of knee prostheses has been introduced with the intention of improving post-operative knee flexion. In order to evaluate whether this goal has been achieved we performed a systematic review and meta-analysis. Systematic literature searches were conducted on MEDLINE and EMBASE from their inception to December 2007, and proceedings of scientific meetings were also searched. Only randomised, clinical trials were included in the meta-analysis. The mean difference in the maximum post-operative flexion between the ‘high-flex’ and conventional types of prosthesis was defined as the primary outcome measure. A total of five relevant articles was identified. Analysis of these trials suggested that no clinically relevant or statistically significant improvement was obtained in flexion with the ‘high-flex’ prostheses. The weighted mean difference was 2.1° (95% confidence interval −0.2 to +4.3; p = 0.07).
Biomechanists have been trying to obtain integrated and accurate human motion data. However, it is not so easy, because some have limitation of accuracy, some have limitation of the observation area, and some are expensive. For example, motion capturing can obtain whole body motion data, but needs space, is expensive, but only surface motion could be obtained. So is not so sensitive for the bone rotation. Sensors of pressure, acceleration, and so forth are less expensive and less hard to use, but the data are limited. 2D–3D shape matching such as Jointtrack can describe bone motion including rotation, but the detectable area is limited by the size of flat panel fluoroscopy. In this study, we have combined multiple joint motion analysis by Jointtrack and reconstructed full lower extremities' motion. Pelvis, bilateral femurs, and bilateral tibiae geometries were obtained from CAT scan using Mimics®. Gait motion fluoroscopy was done on a treadmill around hip joints and knee joints (Fig.1). On each heal thin film switch was attached and connected to electrically driven metal flag which can be recorded in fluoroscopic images on heal strikes. Images of five gait cycles were taken with 15Hz and every image was sorted by the percentage of gait cycle, and then processed by Jointtrack. Centre of femoral head of observing side was defined as our origin. Using treadmill, the walking direction could be uniquely defined. From the femoral 3D displacement and rotation, knee position can be calculated. The same procedures were done for the knee assessment, mutual coordinate of hip centre from the knee can be calculated. All of them are sorted by the percentage of the gait cycle too. Combining data from hip and knee, complete lower extremities' motion could be described. Regression analyses of x, y, z coordinates of femurs from hip and from knee were done to evaluate the accuracy. Motion capture of floor gait and treadmill gait were done to evaluate the difference. (Fig.2)Introduction
Method
The concept that fluid percolating through bone matrix is the basis for mechanotransduction of stress stimuli to modeling and remodeling has proved challenging In order to make this explanation more intuitive we have developed a metaphorical rendering of the model. The rendering adds an extension to include our current model for the effects of skeletal muscle contraction on the basic multicellular unit (BMU). In the metaphor, cortical bone is the continent nation HaroldFrostland. Its cities are fed by waterways which serve as metaphors for each of the fluid transporting pathways from arteries to inter-collagen spaces of bone matrix. Bounding the continent are oceans wherein underwater earthquakes—metaphors for skeletal muscle contractions—generate solitary pressure waves (tsunamis) and a ripple effect in continental waterways. Critical for penetration by and effectiveness of such solutions is that flow resistance in the waterways must allow pressure buildup. Locks/valves serve to provide this resistance. When pressure is sufficient filtration at transfer points—metaphors for where nutrient exchange occurs--is enhanced. By this means, muscle contraction enhances delivery of fluid not only to bone cells; but around them as well, stimulating mechanotransduction.
Patients were clinically assessed for 2 years using the Knee Society Score (KSS). At final follow-up patients were assessed once using two accelerometer based motion tests (Dynaport Knee Test and Minimod Gait Test; McRoberts, Netherlands). The knee score is composed of four sub scores (Locomotion, Rise &
Descend, Transfers, Lift &
Move). The gait test records walking parameters such as step frequency, length and speed plus various parameters of step asymmetry, irregularity and efficiency. Statistical analysis was performed using the van Elteren’s test (KSS data) and a stratified regression analysis (Dynaport and Minimod data)
The Dynaport knee test showed a significant functional advantage for patella resurfacing (RS=44.1+/−12.1, NR=39.7+/−19.2, p=0.04). The sub score Rise &
Descend showed the largest advantage for patella resurfacing (RS=44.7, NR=39.7, p=0.04). The other sub scores also favored resurfacing but were not significant. The Minimod Gait test favoured RS in most parameters but at non-significant levels.
The advantage of patella resurfacing may be less due to pain relief but due to a functional benefit during demanding motion tasks for which standard clinical scores and low demanding tests do not account for sufficiently and objectively enough. We recommend complementing the classic evaluation tools with demanding functional tests.
All stems migrated distally and most of them also migrated medially or laterally and posteriorly. Migration was still observed in one third of stems between 1.5 and 2-year follow-ups. At 2 years stem subsidence averaged 2.5 mm, medial or lateral migration averaged 1.2 mm and posterior migration averaged 2.9 mm. No correlation to the preoperative bone stock deficiency was observed. Between 2 and 5 years only marginal migration occurred in 11 of the 15 stems followed for 5 years. No differences in the migration pattern were detected when free weight bearing was allowed immediately after revision in hips without intraoperative skeletal complications as compared to when restricted weight bearing was practiced. No rerevision was performed.