INTRODUCTION: Range of motion following TKA is a commonly assessed and important outcome parameter. The reported knee ROM is often measured using manual
Work in the clinical environment led to the identification of the need for an instrument that was capable of continuously monitoring lumbar spinal curves of patients with back pain in order to establish degree of compliance with therapist advice regarding posture and activity during their normal day. Additionally, work by others in the laboratory setting has started to reveal some differences in motion parameters between those with and without back pain. Although there are changes of, in particular, maximum angular velocity associated with pathology of the spine, these changes may be considered the effects of the pathology. By looking at motion parameters taken over longer periods of time, more subtle differences, hopefully more related to possible causes of back pain, may be eventually identified. Factors such as time spent at extremes of range of motion and degree of activity or inactivity may have as great an affect on the production of back pain as vibration and heavy physical load. Unfortunately, even those factors thought most likely to contribute to the onset of back pain have only ever been proven to explain a small percentage of cases. By logging lumbar spinal curves continuously over many hours, profiles of lumbar spinal usage can be calculated thus enabling study of the relationships between posture, activity and pain production. Conventional instrumentation can not be used in the users normal environment either because of bulk or interference from everyday appliances. A small optical fibre
We aim to explore the potential technologies for monitoring and assessment of patients undergoing arthroplasty by examining selected literature focusing on the technology currently available and reflecting on possible future development and application. The reviewed literature indicates a large variety of different hardware and software, widely available and used in a limited manner, to assess patients’ performance. There are extensive opportunities to enhance and integrate the systems which are already in existence to develop patient-specific pathways for rehabilitation. Cite this article:
Dynamic assessment of the wrist motion and the specific angles are difficult using the conventional methods. We wanted to adapt and assess the repeatability of the Fas-trak system for continuous monitoring of three dimensional (3 D) wrist movements. Twenty seven volunteers, aged 18 to 30 years were asked to perform predetermined tasks. The exclusion criteria were previous history of wrist trauma or joint disease. The transmitter was mounted on the dorsum of the forearm while the sensor was placed over the third metacarpal head. The protocol of three tasks was developed. Task 1 measured maximal flexion, extension, radial and ulnar deviation of the wrist. Task 2 involved picking up an object and moving it across a barrier. Task 3 involved the writing simulation. The comparison between the left and the right wrists indicated suitability of the system to be used on either of the limbs. Repeated measurements on the right wrist provided an assessment of repeatability of the Fastrak system. The Fastrak system was successful in acquiring data in 3 D. The transmitter and the sensor were easy to attach and were of no discomfort to the subjects. As expected the maximum movement was noted in the flexion-extension plane. The total arc of movement in the flexion-extension plane was 127.1 degrees and 69.7 degrees in the radio-ulnar plane. There was no statistically signifi-cant difference between the movements in the left and the right wrists, even when the effect of dominance was considered. The lift and move task showed that most subjects utilised three-fourths of the total possible radio-ulnar movement, but only one-thirds of the total flexion and extension. The writing simulation revealed a substantial variability between subjects. The Fastrak system revealed variation up to 3 degrees in the means of range of movements, while measuring wrist movements. The current study showed that the Fastrak system is a user-friendly and repeatable device, which could be used in everyday clinical use. It has the potential to be used for evaluation of the diseased wrist and the results of therapeutic interventions, operative or otherwise.
Distal radius fractures are common in South Africa. Accurate, decisive radiographic parameter interpretation is key in appropriate management. Digital radiographic facilities are rare in the public setting and
Recently, several smartphone applications (apps) have been developed and validated for ankle ROM measurement tools like the universal
Aims. The aim of this study was to assess and compare active rotation of the forearm in normal subjects after the application of a short-arm cast (SAC) in the semisupination position and a long-arm cast (LAC) in the neutral position. A clinical study was also conducted to compare the functional outcomes of using a SAC in the semisupination position with those of using a LAC in the neutral position in patients who underwent arthroscopic triangular fibrocartilage complex (TFCC) foveal repair. Methods. A total of 40 healthy right-handed volunteers were recruited. Active pronation and supination of the forearm were measured in each subject using a
Introduction. Intraoperative assessment of coronal alignment is important when performing corrective osteotomies around the knee and ankle, limb lengthening and trauma surgery. The Joint Angle Tool (JAT) provides surgeons with information about the anatomic and mechanical axes intraoperatively based on true anteroposterior radiographs. Aim: Presentation of the JAT, a low-cost
Abstract. Aim. This study aims to Inter and intra observer reliability compare, use of a standard
The aim is to investigate if there is a relation between patellar height and knee flexion angle. For this purpose we retrospectively evaluated the radiographs of 500 knees presented for a variety of reasons. We measure knee flexion angle using a computer-generated
Introduction: Cervical range of motion is affected by a wide variety of pathologies and is routinely measured in clinical assessment of the neck. It is therefore crucial to use a method that is both accurate and reliable but that is also non-invasive and inexpensive. This study assessed cervical range of motion using different methods of measurement, namely the universal
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 movement of a joint to track progress after surgery. This data can be used by physiotherapists to change patients’ exercise regimes with more objectively and help patients visualise the progress that they have made. In this study, we tested our program's reliability and validity to find a benchmark for future use on patients. We compared 150 shoulder joint angles, measured using a
Abstract. Introduction. This study compared biomechanical and functional parameters of a total knee arthroplasty (TKA) implant (Cemented Zimmer Hi-Flex) against healthy older adults to determine whether knee biomechanics was restored in this patient population. Methodology. Patients with a primary TKA and healthy adults >55 years old with no musculoskeletal deficits or arthritis participated. Bilateral knee range of motion (RoM) was assessed with a
Intraoperative range of motion (ROM) radiographs are routinely taken during scaphoidectomy and four corner fusion surgery (S4CF) at our institution. It is not known if intraoperative ROM predicts postoperative ROM. We hypothesize that patients with a greater intra-operativeROM would have an improved postoperative ROM at one year, but that this arc would be less than that achieved intra- operatively. We retrospectively reviewed 56 patients that had undergone S4CF at our institution in the past 10 years. Patients less than 18, those who underwent the procedure for reasons other than arthritis, those less than one year from surgery, and those that had since undergone wrist arthrodesis were excluded. Intraoperative ROM was measured from fluoroscopic images taken in flexion and extension at the time of surgery. Patients that met criteria were then invited to take part in a virtual assessment and their ROM was measured using a
Total knee arthroplasty (TKA) aims to alleviate pain and restore joint biomechanics to an equivalent degree to age-matched peers. Zimmer Biomet's Nexgen TKA was the most common implant in the UK between 2003 and 2016. This study compared the biomechanical outcomes of the Nexgen implant against a cohort of healthy older adults to determine whether knee biomechanics is restored post-TKA. Patients with a primary Nexgen TKA and healthy adults >55 years old with no musculoskeletal deficits or diagnosis of arthritis were recruited locally. Eligible participants attended one research appointment. Bilateral knee range of motion (RoM) was assessed with a
Plantar fasciitis (PF) is one of the widespread conditions causing hindfoot pain. The most common presenting symptoms are functional limitation and pain (first step and activity) on plantar surface of the foot. The non-operative treatments provide complete resolution of pain in 90% of patients, but functional limitation still remains as a risk factor for recurrency of PF. Although the number of non-operative treatment options showing efficacy on pain and functional limitation are excessive, the evidences are limited for functional limitation. Additionally, Mulligan mobilization with movement (MMWM) in Chronic Plantar Fasciitis has been poorly studied in the literature. According to these findings, the study was aimed to determine effectiveness of Mulligan mobilization with movement on Chronic Plantar Fasciitis. A total of 25 patients (40 feet) with chronic PF were included in the study. The patients were randomly divided into Mulligan concept rehabilitation group (PF-M, n=20 feet) and Home Rehabilitation group (PF-H, n=20 feet). (MMWM), Foot and ankle exercises program were applied to PF-M, twice a week totally 8 week (16 sessions) and foot- ankle exercises as a home program were given for PF-H, 8 weeks. The range of motion (ROM) for dorsiflexion and plantar flexion was measured by using a manual
Background. Calipered kinematically aligned (KA) total knee arthroplasty (TKA) restores the in vitro internal-external (I-E) rotation laxities at 0° and 90° of the native knee. Although increasing and decreasing the thickness of the insert in 1 mm increments loosens and tightens the flexion space, there are little data on how this might adversely affect the screw-home mechanism and I-E rotational laxity. The present study determined the differences in the I-E range of rotation and I-E positions at maximum extension and at 90° of flexion that result from the use of insert thicknesses that deviate ± 1mm in thickness from the implanted insert. Methods. 20 patients were treated with a calipered KA and a PCL retaining implant with a 1:1 medial ball-in-socket constraint and a non-constrained lateral flat articular insert surface. Verification checks, that are validated to restore native tibial compartment forces without release of healthy ligaments including the PCL, were used to select the optimal insert thickness. Trial inserts with thicknesses ranging from 10 to 13 mm were 3-D printed with medial goniometric markings that record rotation from 20° external to −20° internal with respect to a sagittal line laser marked on center of the medial condyle of the trial femoral component at maximum extension and 90° of flexion (Figure 1). Results. For all three inserts, the tibial component progressively internally rotated on the femoral component from maximum extension to maximum flexion. From maximum extension to 90° flexion the −21.7° range of internal rotation for the optimal insert thickness was greater than the −16° for the 1mm thinner insert (p < 0.000), and the −13.1° for the 1mm thicker insert (p < 0.000). At maximum extension, the mean insert position of 7° external for the optimal insert thickness was more external than the 4.5° for the 1mm thinner insert (p < 0.000), and the 3.5° for the 1mm thicker insert (p < 0.000) (Figure 2). At 90° the mean −14.7° internal insert position for the optimal insert thickness was more internal than the −11.5° for the 1mm thinner insert (p < 0.000), and the −9.5° for the 1mm thicker insert (p < 0.000) (Figure 3). Discussion and Conclusions. The insert
Introduction:. External rotation (ER) of the shoulder is a commonly used clinical measurement to assess the glenohumeral joint; however, the position in which these measurements are obtained varies between clinicians. The purpose of this study was to compare the following: ER in the upright & supine positions, motion capture & goniometric values of ER, active & passive ER, ER in the right & left shoulders, and ER in male & female subjects. Methods:. Eighteen subjects (mean age 25.4 yrs) with ‘normal’ shoulders (by screening questionnaire) were enrolled in the study and subject to triplicate measurements of active and passive ER of both shoulders with a
Gavril Ilizarov advocated a fine wire tension of between 900N and 1200N for circular frame construction. Wire tension can be achieved via a tensioning device or ‘Russian tensioning’ (a fixed wire lengthening around a bolt). There is limited information on the latter technique. This study explored the tensions achieved via Russian tensioning and reports the impact of a second wire on construct tension. A single 160mm stainless-steel ring was constructed, then 1.8mm stainless steel wires were secured using a Russian fixation bolt and Russian tensioned with a 2nd bolt. The angle subtended by tensioning using the 2nd bolt was measured using a
Aims. In the UK, fasciectomy for Dupuytren’s contracture is generally performed under general or regional anaesthetic, with an arm tourniquet and in a hospital setting. We have changed our practice to use local anaesthetic with adrenaline, no arm tourniquet, and perform the surgery in a community setting. We present the outcome of a consecutive series of 30 patients. Methods. Prospective data were collected for 30 patients undergoing open fasciectomy on 36 digits (six having two digits affected), over a one-year period and under the care of two surgeons. In total, 10 ml to 20 ml volume of 1% lidocaine with 1:100,000 adrenaline was used. A standard postoperative rehabilitation regime was used. Preoperative health scores,
Although the pre- or intraoperative flexion angle in TKA has been commonly considered as a predictor of the postoperative flexion angle, patients with well flexion intraoperatively cannot necessarily obtain deep flexion angle postoperatively. The reason why inconsistencies remains has been unsolved. The intraoperative compressive force between femoral and tibial components has the advantage of the sequential changes during knee motion. However, the relationship between the compressive force and the postoperative ROM has not yet been clarified. We aimed to evaluate the intraoperative femorotibial compressive force during passive knee motion, and determine the relationship between the compressive force and the postoperative flexion angle. A total of 11 knees in 10 patients who underwent primary cruciate-retaining (CR) TKA (The FINE Total Knee System; Teijin Nakashima Medical Co., Ltd., Okayama, Japan) for osteoarthritis were studied retrospectively, with a mean age of 76 years via a measured resection technique. We developed a customized measurement device mimicking the tibial component with this platform of six load sensors arranged in two rows (medial and lateral) by three tandem sets (anterior, center and posterior): anteromedial (AM), anterolateral (AL); centromedial (CM), centrolateral (CL); and posteromedial (PM), posterolateral compartment (PL) (Fig. 1). At the step of the implant trial, this device was placed on the tibia with compressive force recorded three times, while the knee was subsequently taken from 0° to full flexion manually in 15 seconds with the flexion angle of the knee recorded simultaneously by using an electric
Introduction. During its conception, Ilizarov advocated a fine wire tension of between 900N and 1200N for circular frame construction. Wire tension can be achieved via a tensioning device or ‘Russian tensioning’ (a fixed wire lengthening around a bolt). There is limited information on the latter technique. This study aimed to explore the tensions achieved via Russian tensioning and report the impact of a second wire on construct tension. Materials and Methods. A single 160mm stainless-steel ring was constructed, then 1.8mm stainless steel wires secured using a Russian fixation bolt and Russian tensioned with a 2nd bolt. The angle subtended by tensioning using the 2nd bolt was measured using a
Shoulder active range of flexion, abduction and external rotation was measured with three devices in 33 subjects using a blinded protocol. The aim was to compare the accuracy and interobserver reliability of the
We investigated the effect of neck dimension upon cervical range of movement. Data relating to 100 subjects healthy subjects aged between 20 and 40yrs was recorded with respect to age, gender and ranges of movement in three planes. Additionally two commonly used methods of measuring neck motion, chin-sternal distance and uniplanar
Background. Severe hallux rigidus can be treated with total or hemi arthroplasty to preserve motion in the 1st metatarsophalangeal joint (MTPJ). Decreased dorsiflexion impairs the rollover motion of the 1st MTPJ and recent studies of patients with 1st MTPJ osteoarthritis show increased plantar forces on the hallux. Objectives. Our aim was to examine the plantar force variables under the hallux and the 1st, 2nd, and 3rd – 5th distal metatarsal head (MH) on patients operated with a proximal hemiarthroplasty (HemiCap) in the 1st MTPJ and compare to a control group of healthy patients. Secondary aims: To examine correlations between the force and the 1st MTPJ range of motion (ROM) and pain. Study Design & Methods. Seventy patients operated with HemiCap were invited. 41 were included, (10 men, 31 women), median operation date 2011(range 2007–2014), age 63(47–78), 37 unilateral and 4 bilateral. Dorsal ROM of the 1st MTPJ was measured by
Foot pain and related problems are quite common in the community. It is reported that 24% of individuals older than 45 experienced foot pain. Also, it is stated that at least two thirds of individuals experiences moderate physical disability due to foot problems. In the absence of evaluation of risk factors such as limited ankle dorsiflexion in the early period of the diseases (Plantar fasciitis, Achilles Tendinopathy e.g.) and the lack of mobile systems with portable remote access, foot pain becomes refractory/chronic foot pain, secondary pathologies and ends with workload of 1., 2. and 3rd level healthcare services. In the literature, manuel and dijital methods have been used to analyze the ankle range of motion (ROM). These studies are generally based on placing protractors on the image and / or angle detection from inclination measurement by using the gyroscope sensor of the mobile device. Some of these applications are effective and they are designed to be suitable for measuring in a clinical setting by a physician or physiotherapist. To the best of our knowledge, there is no system developed to measure real-time ankle ROM remotely with collaboration of the patients. In this research, we proposed to develop an ankle ROM analyze system with smart phone application that can be used comfortably by subjects. We present a case of a 22-year-old male with a symptomatic pes planus. The mobile application, which was used for data collection, was designed and implemented for Android devices. Initially, before the mobile application home page is opened, a consent page was submitted to the acceptance of individual within the scope of Law (KVKK) data privacy. Then, the participant was asked to state his sociodemographic characteristics [age, gender, height, weight] and dominant side. No history of foot-ankle injury, trauma, and surgery was recorded. Activity pain of the foot was 6 according to visual anolog scale (VAS) in the mobile application. His ankle dorsiflexion was 15 ° by manuel
Background: The purpose of this study was to assess the anterior femoral cortical line (AFCL) as an additional anatomical landmark for determining intraoperative femoral component rotation in total knee arthroplasty. The AFCL was compared with the Epicondylar axis, the anteroposterior (AP) axis (Whiteside’s line), and the posterior condylar axis. Dry bone, cadaver, MRI and intra-operative measurements were compared. Methods: Fifty dry bone femora, and 16 wet cadaveric specimens were assessed to identify the AFCL and this was compared against the 3 reference axes discussed above. Photographs were taken of the specimens with K-wires/marker pins secured to the reference axes and then a digital on-screen
We sought to validate a method of measuring the range of motion of knees on radiographs as part of a new system of “Virtual Knee Clinics”. The range of motion of 52 knees in 45 patients were first obtained clinically with
Objectives. The development of tibiofemoral angle in children has shown ethnic
variations. However this data is unavailable for our population. Methods. We measured the tibiofemoral angle (TFA) and intercondylar and
intermalleolar distances in 360 children aged between two and 18
years, dividing them into six interrupted age group intervals: two
to three years; five to six years; eight to nine years; 11 to 12
years; 14 to 15Â years; and 17 to 18 years. Each age group comprised
30 boys and 30 girls. Other variables recorded included standing
height, sitting height, weight, thigh length, leg length and length
of the lower limb. Results. Children aged two to three years had a valgus angulation with
a mean TFA of 1.8° (. sd. 0.65) in boys and 2.45° (. sd. 0.87)
in girls. Peak valgus was seen in the five- to six-year age group,
with mean TFAs of 6.7° (. sd. 1.3) and 7.25° (. sd. 0.64)
for boys and girls, respectively. From this age the values gradually
declined to a mean of 3.18° (. sd. 1.74) and 4.43° (. sd. 0.68)
for boys and girls, respectively, at 17 to 18 years. Girls showed
a higher valgus angulation than boys at all age groups. Conclusion. This study defines the normal range of the TFA in south Indian
boys and girls using an easy and reliable technique of measurement
with a standardised custom-made
Aims. Accurate knowledge of the normal shoulder range of movement (ROM) is imperative for evaluating pathology and clinical success. However, in orthopaedic texts, the quoted normal shoulder ROM has significant variation. Furthermore we suspect there is a high incidence of intra and inter observer error during shoulder ROM examination. The aims of our study were thus:. To perform a literature review and record the published values for normal shoulder ROM. Subsequently, to calculate the average of these published values. To perform visual and
BACKGROUND. Telerehabilitation has been shown to both promote effective recovery after shoulder arthroplasty and may improve adherence to treatment. Such systems require demonstration of feasibility, ease of use, efficacy, patient and clinician satisfaction, and overall cost of care, and much of this data has yet to be provided. Few augmented reality rehabilitation approaches have been developed to date. Evidence suggests augmented reality rehabilitation may be equivalent to conventional methods for adherence, improvement of function, and relief of pain seen in these musculoskeletal conditions. We proposed that the development of an augmented reality rehabilitation platform during the pre and postoperative period (including post-shoulder arthroplasty) could be used to track patient activity and range of motion as well as promote recovery. METHODS. A prototype augmented reality platform equipped with a motion sensor system optimised for the upper arm was developed to be used to validate 4 arcs of shoulder motion and complete directed upper arm exercises designed for post-shoulder arthroplasty rehabilitation was built and tested. This system combined augmented reality instructions and motion tracking to follow patients over the course of their therapy, along with a telehealth patient-clinician interface. FINDINGS. The augmented reality platform was tested to validate shoulder range of motion examination similar to that of standard
Varus malalignment after total knee replacement is associated with a poor outcome. Our aim was to determine whether the same was true for medial unicompartmental knee replacement (UKR). The anatomical leg alignment was measured prospectively using a long-arm
Management of a knee with valgus deformities has always been considered a major challenge. Total knee arthroplasty requires not only correction of this deformity but also meticulous soft tissue balancing and achievement of a balanced rectangular gap. Bony deformities such as hypoplastic lateral condyle, tibial bone loss, and malaligned/malpositioned patella also need to be addressed. In addition, external rotation of the tibia and adaptive metaphyseal remodeling offers a challenge in obtaining the correct rotational alignment of the components. Various techniques for soft tissue balancing have been described in the literature and use of different implant options reported. These options include use of cruciate retaining, sacrificing, substituting and constrained implants. Purpose. This presentation describes options to correct a severe valgus deformity (severe being defined as a femorotibial angle of greater than 15 degrees) and their long term results. Methods. 34 women (50 knees) and 19 men (28 knees) aged 39 to 84 (mean 74) years with severe valgus knees underwent primary TKA by a senior surgeon. A valgus knee was defined as one having a preoperative valgus alignment greater than 15 degrees on a standing anteroposterior radiograph. The authors recommend a medial approach to correct the deformity, a minimal medial release and a distal femoral valgus resection of angle of 3 degrees. We recommend a sequential release of the lateral structures starting anteriorly from the attachment of ITB to the Gerdy's tubercle and going all the way back to the posterolaetral corner and capsule. Correctability of the deformity is checked sequentially after each release. After adequate posterolateral release, if the tibial tubercle could be rotated past the mid-coronal plate medially in both flexion and extension, it indicated appropriate soft tissue release and balance. Fine tuning in terms of final piecrusting of the ITB and or popliteus was carried out after using the trial components. Valgus secondary to an extra-articular deformity was treated using the criteria of Wen et al. In our study the majority of severe valgus knees (86%) could be treated by using unconstrained (CR, PS) knee options reserving the constrained knee / rotating hinge options only in cases of posterolateral instability secondary to an inadequate large release or in situations with very lax or incompetent MCL. Results. The average follow up was 10 years (range 8 to 14 years). The average HSS knee scores improved from 48 points preoperatively (range 32 to 68 points) to 91 points (range 78 to 95 points) postoperatively. The average postoperative range of motion measured with a
To examine the long-term outcome of arthrodesis of the hip undertaken in a paediatric population in treating painful arthritis of the hip. In our patient population, most of whom live rurally in hilly terrain and have limited healthcare access and resources, hip arthrodesis has been an important surgical option for the monoarticular painful hip in a child. A follow-up investigation was undertaken on a cohort of 28 children previously reported at a mean of 4.8 years. The present study looked at 26 patients who had an arthrodesis of the hip as a child at a mean follow-up of 20 years (15 to 29).Aims
Methods
Tibial rotation and translation provide important stability parameters after ACL reconstruction. An accurate tool for a combined pre- intra- and postoperative stability measurement is not in clinical use so far. Navigation of the drill canals for the ACL placement and evaluation of possible impingement problems has been introduced for some years already, while measurement of the tibial translation and rotation is only available for a short time and only available for a few navigation modules. Navigation provides an accuracy of 1mm/1°, therefore navigated measurement of tibial rotation and translation were evaluated in this study with a new developed mechanical device and directly compared to conventional measurement techniques. Accuracy of navigation was compared with the KT1000 for the anterior-posterior (AP) translation and to a new developed
This study compared patient-reported outcomes of three total knee arthroplasty (TKA) designs from one manufacturer: one cruciate-retaining (CR) design, and two cruciate-sacrificing designs, anterior-stabilized (AS) and posterior-stabilized (PS). Patients scheduled for primary TKA were included in a single-centre, prospective, three-armed, blinded randomized trial (n = 216; 72 per group). After intraoperative confirmation of posterior cruciate ligament (PCL) integrity, patients were randomly allocated to receive a CR, AS, or PS design from the same TKA system. Insertion of an AS or PS design required PCL resection. The primary outcome was the mean score of all five subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS) at two-year follow-up. Secondary outcomes included all KOOS subscales, Oxford Knee Score, EuroQol five-dimension health questionnaire, EuroQol visual analogue scale, range of motion (ROM), and willingness to undergo the operation again. Patient satisfaction was also assessed.Aims
Methods
Background. Previous in vivo fluoroscopic studies have documented that subjects having a PS TKA experience a more posterior condylar contact position at full extension, a high incidence of reverse axial rotation and mid flexion instability. More recently, a PS TKA was designed with a Gradually Reducing Radius (Gradius) curved condylar geometry to offer patients greater mid flexion stability while reducing the incidence of reverse axial rotation and maintaining posterior condylar rollback. Therefore, the objective of this study was to assess the in vivo kinematics for subjects implanted with a Gradius curved condylar geometry to determine if these subjects experience an advantage over previously designed TKA. Methods. In vivo kinematics for 30 clinically successful patients all having a Gradius designed PS fixed bearing TKA with a symmetric tibia were assessed using mobile fluoroscopy. All of the subjects were scored to be clinically successful. In vivo kinematics were determined using a 3D-2D registration during three weight-bearing activities: deep-knee-bend (DKB), gait, and ramp down (RD). Flexion measurements were recorded using a digital
We aimed to assess the reliability and validity of OpenPose, a posture estimation algorithm, for measurement of knee range of motion after total knee arthroplasty (TKA), in comparison to radiography and goniometry. In this prospective observational study, we analyzed 35 primary TKAs (24 patients) for knee osteoarthritis. We measured the knee angles in flexion and extension using OpenPose, radiography, and goniometry. We assessed the test-retest reliability of each method using intraclass correlation coefficient (1,1). We evaluated the ability to estimate other measurement values from the OpenPose value using linear regression analysis. We used intraclass correlation coefficients (2,1) and Bland–Altman analyses to evaluate the agreement and error between radiography and the other measurements.Aims
Methods
Background. Non-contact anterior cruciate ligament (ACL) injuries occurs with a higher incidence in female athletes compared with males after the onset of puberty. One anatomical factor with clinically observable differences between males and females is lower extremity alignment. The knee joint valgus in the coronal plane, which is associated with ACL injury risk, is composed of rotation of the tibia around the stationary femur and hip rotation combined with knee flexion. The purpose of this study was to prove the difference of hip rotation between female and male handball players with or without history of ACL injury. Methods. Elite collegiate athletes on the varsity handball team (17 females and 24 males) were recruited. Whereas 8 females and 1 male had a history of ACL injury, there were 9 females and 23 males with no history of ACL injury. The 6 measures of hip joint motion [flexion, extension, abduction, adduction, external rotation (ER), and internal rotation (IR)] and the 2 measures of knee joint motion (flexion and extension) were measured with the standard procedure using a
Both anatomical and reverse total shoulder arthroplasty (aTSA and rTSA) provide functional improvements. A reported benefit of aTSA is better range of motion (ROM). However, it is not clear which procedure provides better outcomes in patients with limited foward elevation (FE). The aim of this study was to compare the outcome of aTSA and rTSA in patients with glenohumeral osteoarthritis (OA), an intact rotator cuff, and limited FE. This was a retrospective review of a single institution’s prospectively collected shoulder arthroplasty database for TSAs undertaken between 2007 and 2020. A total of 344 aTSAs and 163 rTSAs, which were performed in patients with OA and an intact rotator cuff with a minimum follow-up of two years, were included. Using the definition of preoperative stiffness as passive FE ≤ 105°, three cohorts were matched 1:1 by age, sex, and follow-up: stiff aTSAs (85) to non-stiff aTSAs (85); stiff rTSAs (74) to non-stiff rTSAs (74); and stiff rTSAs (64) to stiff aTSAs (64). We the compared ROMs, outcome scores, and complication and revision rates.Aims
Methods
Range of motion (ROM) is a well recognised outcome measure following total knee arthroplasty (TKA). Reduced knee flexion can lead to poor outcome after TKA and therefore identification at an early stage is important as it may provide a window for intervention with targeted physiotherapy, closer follow-up and in resistant cases possible manipulation or arthrolysis. ROM combines both flexion and extension and in contrast to flexion, fewer studies have recognised the importance of a lack of full extension or fixed flexion deformity (FFD) following TKA. A residual FFD can increase energy cost, decrease velocity during ambulation and result in pain with knee scores more likely to be diminished than if knee extension was normal. Recognition and early detection of FFD is therefore important. Methods of assessment include by visual estimation or goniometric measurement of knee flexion angle. While
Treatment of Weber B ankle fractures that are stable on weightbearing radiographs but unstable on concomitant stress tests (classified SER4a) is controversial. Recent studies indicate that these fractures should be treated nonoperatively, but no studies have compared alternative nonoperative options. This study aims to evaluate patient-reported outcomes and the safety of fracture treatment using functional orthosis versus cast immobilization. A total of 110 patients with Weber B/SER4a ankle fractures will be randomized (1:1 ratio) to receive six weeks of functional orthosis treatment or cast immobilization with a two-year follow-up. The primary outcome is patient-reported ankle function and symptoms measured by the Manchester-Oxford Foot and Ankle Questionnaire (MOxFQ); secondary outcomes include Olerud-Molander Ankle Score, radiological evaluation of ankle congruence in weightbearing and gravity stress tests, and rates of treatment-related adverse events. The Regional Committee for Medical and Health Research (approval number 277693) has granted ethical approval, and the study is funded by South-Eastern Norway Regional Health Authority (grant number 2023014).Aims
Methods
There is no level I evidence dealing with the optimal period of immobilization for patients with a displaced distal radial fracture following closed reduction. A shorter period might lead to a better functional outcome due to less stiffness and pain. The aim of this study was to investigate whether this period could be safely reduced from six to four weeks. This multicentre randomized controlled trial (RCT) included adult patients with a displaced distal radial fracture, who were randomized to be treated with immobilization in a cast for four or six weeks following closed reduction. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE) score after follow-up at one year. Secondary outcomes were the abbreviated version of the Disability of Arm, Shoulder and Hand (QuickDASH) score after one year, the functional outcome at six weeks, 12 weeks, and six months, range of motion (ROM), the level of pain after removal of the cast, and complications.Aims
Methods
Acute and chronic injuries of the interosseus membrane can result in longitudinal instability of the forearm. Reconstruction of the central band of the interosseus membrane can help to restore biomechanical stability. Different methods have been used to reconstruct the central band, including tendon grafts, bone-ligament-bone grafts, and synthetic grafts. This Idea, Development, Exploration, Assessment, and Long-term (IDEAL) phase 1 study aims to review the clinical results of reconstruction using a synthetic braided cross-linked graft secured at either end with an Endobutton to restore the force balance between the bones of the forearm. An independent retrospective review was conducted of a consecutive series of 21 patients with longitudinal instability injuries treated with anatomical central band reconstruction between February 2011 and July 2019. Patients with less than 12 months’ follow-up or who were treated acutely were excluded, leaving 18 patients in total. Preoperative clinical and radiological assessments were compared with prospectively gathered data using range of motion and the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) functional outcome score.Aims
Methods
The tibial component of total knee arthroplasty can either be an all-polyethylene (AP) implant or a metal-backed (MB) implant. This study aims to compare the five-year functional outcomes of AP tibial components to MB components in patients aged over 70 years. Secondary aims are to compare quality of life, implant survivorship, and cost-effectiveness. A group of 130 patients who had received an AP tibial component were matched for demographic factors of age, BMI, American Society of Anesthesiologists (ASA) grade, sex, and preoperative Knee Society Score (KSS) to create a comparison group of 130 patients who received a MB tibial component. Functional outcome was assessed prospectively by KSS, quality of life by 12-Item Short-Form Health Survey questionnaire (SF-12), and range of motion (ROM), and implant survivorships were compared. The SF six-dimension (6D) was used to calculate the incremental cost effectiveness ratio (ICER) for AP compared to MB tibial components using quality-adjusted life year methodology.Aims
Methods
The epiphyseal approach to a chondroblastoma of the intercondylar notch of a child’s distal femur does not provide adequate exposure, thereby necessitating the removal of a substantial amount of unaffected bone to expose the lesion. In this study, we compared the functional outcomes, local recurrence, and surgical complications of treating a chondroblastoma of the distal femoral epiphysis by either an intercondylar or an epiphyseal approach. A total of 30 children with a chondroblastoma of the distal femur who had been treated by intraregional curettage and bone grafting were retrospectively reviewed. An intercondylar approach was used in 16 patients (group A) and an epiphyseal approach in 14 (group B). Limb function was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system and Sailhan’s functional criteria.Aims
Methods
Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but the feasibility and early outcomes when using this technology for revision surgery remain unknown. The objective of this study was to compare the outcomes of robotic arm-assisted revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) versus primary robotic arm-assisted TKA at short-term follow-up. This prospective study included 16 patients undergoing robotic arm-assisted revision of UKA to TKA versus 35 matched patients receiving robotic arm-assisted primary TKA. In all study patients, the following data were recorded: operating time, polyethylene liner size, change in haemoglobin concentration (g/dl), length of inpatient stay, postoperative complications, and hip-knee-ankle (HKA) alignment. All procedures were performed using the principles of functional alignment. At most recent follow-up, range of motion (ROM), Forgotten Joint Score (FJS), and Oxford Knee Score (OKS) were collected. Mean follow-up time was 21 months (6 to 36).Aims
Methods
To assess the incidence of radiological lateral osteoarthritis (OA) at 15 years after medial unicompartmental knee arthroplasty (UKA) and assess the relationship of lateral OA with symptoms and patient characteristics. Cemented Phase 3 medial Oxford UKA implanted by two surgeons since 1998 for the recommended indications were prospectively followed. A 15-year cumulative revision rate for lateral OA of 5% for this series was previously reported. A total of 163 unrevised knees with 15-year (SD 1) anterior-posterior knee radiographs were studied. Lateral joint space width (JSWL) was measured and severity of lateral OA was classified as: nil/mild, moderate, and severe. Preoperative and 15-year Oxford Knee Scores (OKS) and American Knee Society Scores were determined. The effect of age, sex, BMI, and intraoperative findings was analyzed. Statistical analysis included one-way analysis of variance and Kruskal-Wallis H test, with significance set at 5%.Aims
Methods
The gold standard for percutaneous Achilles tendon tenotomy during the Ponseti treatment for idiopathic clubfoot is a tenotomy with a No. 15 blade. This trial aims to establish the technique where the tenotomy is performed with a large-bore needle as noninferior to the gold standard. We randomized feet from children aged below 36 months with idiopathic clubfoot on a 1:1 basis in either the blade or needle group. Follow-up was conducted at three weeks and three months postoperatively, where dorsiflexion range, Pirani scores, and complications were recorded. The noninferiority margin was set at 4° difference in dorsiflexion range at three months postoperatively.Aims
Methods
There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA). We retrospectively reviewed the records of 26 elbows of 21 patients with RA who were aged less than 50 years who underwent primary TEA with an unlinked elbow prosthesis. The mean patient age was 46 years (35 to 49), and the mean follow-up period was 13.6 years (6 to 27). Outcome measures included pain, range of motion, Mayo Elbow Performance Score (MEPS), radiological evaluation for radiolucent line and loosening, complications, and revision surgery with or without implant removal.Aims
Methods
The use of high tibial osteotomy (HTO) to delay total knee arthroplasty (TKA) in young patients with osteoarthritis (OA) and constitutional deformity remains debated. The aim of this study was to compare the long-term outcomes of TKA after HTO compared to TKA without HTO, using the time from the index OA surgery as reference (HTO for the study group, TKA for the control group). This was a case-control study of consecutive patients receiving a posterior-stabilized TKA for OA between 1996 and 2010 with previous HTO. A total of 73 TKAs after HTO with minimum ten years’ follow-up were included. Cases were matched with a TKA without previous HTO for age at the time of the HTO. All revisions were recorded. Kaplan-Meier survivorship analysis was performed using revision of metal component as the endpoint. The Knee Society Score, range of motion, and patient satisfaction were assessed.Aims
Methods
The aim of this study was to capture 12-month outcomes from a representative multicentre cohort of patients undergoing total ankle arthroplasty (TAA), describe the pattern of patient-reported outcome measures (PROMs) at 12 months, and identify predictors of these outcome measures. Patients listed for a primary TAA at 19 NHS hospitals between February 2016 and October 2017 were eligible. PROMs data were collected preoperatively and at six and 12 months including: Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ (foot and ankle)) and the EuroQol five-dimension five-level questionnaire (EQ-5D-5L). Radiological pre- and postoperative data included Kellgren-Lawrence score and implant position measurement. This was supplemented by data from the National Joint Registry through record linkage to determine: American Society of Anesthesiologists (ASA) grade at index procedure; indication for surgery, index ankle previous fracture; tibial hind foot alignment; additional surgery at the time of TAA; and implant type. Multivariate regression models assessed outcomes, and the relationship between MOXFQ and EQ-5D-5L outcomes, with patient characteristics.Aims
Methods
Total knee arthroplasty (TKA) may provoke ankle symptoms. The aim of this study was to validate the impact of the preoperative mechanical tibiofemoral angle (mTFA), the talar tilt (TT) on ankle symptoms after TKA, and assess changes in the range of motion (ROM) of the subtalar joint, foot posture, and ankle laxity. Patients who underwent TKA from September 2020 to September 2021 were prospectively included. Inclusion criteria were primary end-stage osteoarthritis (Kellgren-Lawrence stage IV) of the knee. Exclusion criteria were missed follow-up visit, post-traumatic pathologies of the foot, and neurological disorders. Radiological angles measured included the mTFA, hindfoot alignment view angle, and TT. The Foot Function Index (FFI) score was assessed. Gait analyses were conducted to measure mediolateral changes of the gait line and ankle laxity was tested using an ankle arthrometer. All parameters were acquired one week pre- and three months postoperatively.Aims
Methods
Olecranon fractures are usually caused by falling directly on to the olecranon or following a fall on to an outstretched arm. Displaced fractures of the olecranon with a stable ulnohumeral joint are commonly managed by open reduction and internal fixation. The current predominant method of management of simple displaced fractures with ulnohumeral stability (Mayo grade IIA) in the UK and internationally is a low-cost technique using tension band wiring. Suture or suture anchor techniques have been described with the aim of reducing the hardware related complications and reoperation. An all-suture technique has been developed to fix the fracture using strong synthetic sutures alone. The aim of this trial is to investigate the clinical and cost-effectiveness of tension suture repair versus traditional tension band wiring for the surgical fixation of Mayo grade IIA fractures of the olecranon. SOFFT is a multicentre, pragmatic, two-arm parallel-group, non-inferiority, randomized controlled trial. Participants will be assigned 1:1 to receive either tension suture fixation or tension band wiring. 280 adult participants will be recruited. The primary outcome will be the Disabilities of the Arm, Shoulder and Hand (DASH) score at four months post-randomization. Secondary outcome measures include DASH (at 12, 18, and 24 months), pain, Net Promotor Score (patient satisfaction), EuroQol five-dimension five-level score (EQ-5D-5L), radiological union, complications, elbow range of motion, and re-operations related to the injury or to remove metalwork. An economic evaluation will assess the cost-effectiveness of treatments.Aims
Methods
To analyze the short-term outcome of two types of total wrist arthroplasty (TWA) in terms of wrist function, migration, and periprosthetic bone behaviour. A total of 40 patients suffering from non-rheumatoid wrist arthritis were enrolled in a randomized controlled trial comparing the ReMotion and Motec TWAs. Patient-rated and functional outcomes, radiological changes, blood metal ion levels, migration measured by model-based radiostereometric analysis (RSA), bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA), complications, loosening, and revision rates at two years were compared.Aims
Methods
The management of displaced forearm diaphyseal fractures in adults is predominantly operative. Anatomical reduction is necessary to infer optimal motion and strength. The authors have observed an intraoperative technique where passive pronosupination is examined to assess quality of reduction as a surrogate marker for active movement. We aimed to assess the value of this technique, but intentionally malreducing a simulated diaphyseal fracture of a radius in a cadaveric model, and measuring the effect on pronosupination. A single cadaveric arm was prepared and pronation/supination was examined according to American Academy of Orthopaedic Surgeons guidance. A Henry approach was then performed and a transverse osteotomy achieved in the radial diaphysis. A volar locking plate was used to hold the radius in progressive amounts of translation and rotation, with pronosupaintion measured with a
Sagittal stability of the knee is believed to be of significant importance following total knee arthroplasty. We examine four different knee designs at a minimum of twenty-four months postoperatively. Sagittal stability was measured at four degrees of flexion: 0°; 30°; 60°; and 90°, to examine the effect of design on mid-flexion stability. The knee designs included were: the rotating platform LCS design (DePuy); the cruciate sparing Triathlon system (Stryker); SAIPH system (Matortho, UK); and the medial rotating knee design, MRK (Matortho, UK). Following ethical approval, 64 cases were enrolled into the study, 22 male and 42 female. Inclusion criteria included: a minimum of 18 months from surgery; ability to flex beyond 90 degrees; and have no postoperative complications. 18 LCS, 18 MRK, 14 SAIPH and 14 Triathlon knee designs were analysed. Sagittal stability was measured using the KT1000 device. Active range of movement was measured using a hand held
The aim was to assess the long-term impact of humeral and forearm rodding on functional ability, grip strength, joint range of motion and angular deformity in children with osteogenesis imperfecta. A retrospective chart review was conducted on 57 children with osteogenesis imperfecta who underwent humeral rodding or forearm rodding at our institution between 1996 and 2013. Functional ability was assessed using the self-care and mobility domains of the Pediatric Evaluation and Disability Inventory (PEDI). Grip strength was measured using a dynamometer and joint range of motion with a
Postoperative functional outcomes and patients’ satisfaction after total knee arthroplasty are associated with postoperative range of motion. Severe deformities require surgical correction such as soft tissue release and appropriate bone resection. The goal of surgery is to correct the contracture and bring the knee to good range of motion. Using gap-balancing technique is one of the major techniques to obtain good range of motion. Although the gaps are well balanced, the thickness of tibial insert would affect the range of motion. In this study, we analyzed the difference between intraoperative extension joint gap and the thickness of implanted insert (DJI). The objective of this study was to investigate whether DJI affected the postoperative extension of the knee. A total of 155 knees were analyzed retrospectively. Subject included 27 males and 128 females with an average of 72.7 ± 7.0 years. The mean preoperative knee flexion angle was 136.1 ± 20.0°and the mean preoperative knee extension deficit was 4.0 ± 6.1°. All the patients had a diagnosis of varus-type osteoarthritis, identical prostheses (Stryker NRG posterior-stabilized type) implanted with a modified gap-balancing technique and no postoperative complications which may have affected the range of motion. Range of motion was measured using a
INTRODUCTION. The extension and flexion gaps are affected by different factors in total knee arthroplasty (TKA). Flexion but not extension gap measurements are influenced by posterior cruciate ligament (PCL) preservation or resection and patella reduction or eversion and thigh weight. If the flexion gap is measured with the thigh placed on the tibia, the measurement results must include the thigh weight; nevertheless, there is no detailed report regarding the thigh weight influence on the flexion gap. In this study, we investigated how thigh weight affected flexion gap measurement. METHODS. Four knees of whole-body fresh-frozen cadavers (Mongolian race) were investigated. The femur and tibia were dissected with a standard measured resection technique. After the femoral component was set, the flexion gap was measured with a knee balancer. The distraction force of 20, 30, and 40 pounds were loaded at the joint level. For each measurement, the influences of the patella reduced or everted (PR or PE) and the PCL preserved or resected (CR or PS) were estimated. The flexion gap was measured five times in four different categories (CR/PR, CR/PE, PS/PR, PS/PE) and the thigh weight was reduced by weights (0, 0.5, 1.0, 2.0, 3.0 kg) using a string and pulley system. During measurement, the femur was just placed on the tibia, and the knee flexion angle was maintained at 90 degrees with a
To investigate the effectiveness of avulsion fracture of tibial insertion of posterior cruciate ligament using the safe postero-medial approach through analyzing the clinical and radiographic outcomes. We treated 14 cases of acute PCL tibial avulsion fracture with “safe postero-medial approach”. The PCL and avulsion bony fragment was fixed with 1 cannuated screw and washer. The patients were assessed clinically and radiographically at 3 months, 6 months, and 12 months. Clinical examination for each visit included assessment of the knee range of motion, using
INTRODUCTION. Wettability of bearing couples has always been related to the tribological performance of implants, and it is understood to affect lubrication of surfaces. So far researchers fail to understand the real mechanisms governing the lubrication process of prostheses. Different models attempt to explain the phenomena, but more research is needed. To add more difficulties, some classical measuring techniques have provided inaccurate values of surface properties. For instance, wettability may seem a priori a simple technique capable of providing easy-to-read cost-effective information. However, ignoring surface preparation may lead to wrong values of wettability and mis-understanding of the results. OBJECTIVES. The dependence of wettability of commercial bearing materials used in arthroplasty has been studied as a function of the cleaning procedure, showing the variability of the results, and providing a series of guidelines to understand and perform wettability measurements. EXPERIMENTAL METHODS. Three different materials were tested: BIOLOX®forte and BIOLOX®delta (CeramTec GmbH, Plochingen), and Cobalt Chrome Molybdenum alloy (CoCrMo; ISO 5832-12). All samples were polished to comparable mirror finish. For wettability assessment, water sessile drop contact angle tests both in static and dynamic mode in a
Introduction. A total knee replacement is a proven cost-effective treatment for end-stage osteoarthritis, with a positive effect on pain and function. However, only 80% of the patients are satisfied after surgery. It is known that high preoperative expectations and residual postoperative pain are important determinants of satisfaction, but also malalignment, poor function and disturbed kinematics can be a cause. The purpose of this study was to investigate the correlation between the preoperative function and the postoperative patient reported outcomes PROMs) as well as the influence of the postoperative functional rehabilitation on the PROMs. Methods. 57 patients (mean 62,9j ± 10,6j), who suffer from knee osteoarthritis and who were scheduled for a total knee replacement at our centre, participated in this study. The range of motion of the knee, the muscle strength of the M. Quadriceps and the M. Hamstrings and the functional parameters (‘stair climbing test’ (SCT), ‘Sit to stand’ (STS) and ‘6 minutes walking test’ (6MWT)) were measured the night before surgery, ±6 months and ±1 year after surgery. This happened respectively with the use of a
Introduction. Selection of an optimum thickness of polyethylene insert in total knee arthroplasty (TKA) is important for the good stability and range of motion (ROM). The purpose of this study is to investigate the amount of change of ROM as the thickness of trial insert increase. Material and Method. The study included 86 patients with 115 knees undergoing TKA from October 2012 to February 2014. There were 17 men and 69 women with an average age of 75±8 (58–92) years. The implants posterior stabilized knee (Scorpio NRG, Stryker) was used and all prostheses were fixed with cement. The ROM was measured by the
Introduction / Purpose. Many factors can influence postoperative knee flexion angle after total knee arthroplasty (TKA), and range of flexion is one of the most important clinical outcomes. Although many studies have reported that postoperative knee flexion is influenced by preoperative clinical conditions, the factors which affect postoperative knee flexion angle have not been fully elucidated. As appropriate soft-tissue balancing as well as accurate bony cuts and implantation has traditionally been the focus of TKA success, in this study, we tried to investigate the influence of intraoperative soft-tissue balance on postoperative knee flexion angle after cruciate-retaining (CR) TKA using a navigation system and offset-type tensor. Methods. We retrospectively analyzed 55 patients (43 women, 12 men) with osteoarthritis who underwent TKA using the same mobile-bearing CR-type implant (e.motion; B. Braun Aesculap, Germany). The mean age at the time of surgery was 74.2 (SD 7.3) years. The exclusion criteria for this study included valgus deformity, severe bony defect requiring bone graft or augmentation, revision TKA, active knee joint infection, and bilateral TKA. Intraoperative soft-tissue balance parameters such as varus ligament balance and joint component gap were measured in the navigation system (Orthopilot 4.2; B. Braun Aesculap) while applying 40-lb joint distraction force at 0°, 10°, 30°, 60°, 90°, and 120° of knee flexion using an offset-type tensor with the patella reduced. Varus ligament balance was defined as the angle (degree, positive value in varus imbalance) between the seesaw and platform plates of the tensor that was obtained from the values displayed by the navigation system. To determine clinical outcome, we measured knee flexion angle using a
This study reports updates the previously published two-year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow-up extended to a minimum of five years. We prospectively evaluated 89 patients who underwent transfibular TAA for end-stage osteoarthritis. Patients’ clinical and radiological examinations were collected pre- and postoperatively at six months and then annually for up to five years of follow-up. Three patients were lost at the final follow-up with a total of 86 patients at the final follow-up.Aims
Methods
The aim of this study was to develop and internally validate a prognostic nomogram to predict the probability of gaining a functional range of motion (ROM ≥ 120°) after open arthrolysis of the elbow in patients with post-traumatic stiffness of the elbow. We developed the Shanghai Prediction Model for Elbow Stiffness Surgical Outcome (SPESSO) based on a dataset of 551 patients who underwent open arthrolysis of the elbow in four institutions. Demographic and clinical characteristics were collected from medical records. The least absolute shrinkage and selection operator regression model was used to optimize the selection of relevant features. Multivariable logistic regression analysis was used to build the SPESSO. Its prediction performance was evaluated using the concordance index (C-index) and a calibration graph. Internal validation was conducted using bootstrapping validation.Aims
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Purpose of study. To study the effect of different shoes and orthotics have on patellar tendon tensile forces. Patellar tendinopathy is an overuse injury that affects tennis players and in high impact sports like basketball, volleyball and running has an incidence of 20%. The tensile forces in the patellar tendon can be reliably measured with an intratendinously placed fibre optic tube and wireless transmission device allows for dynamic testing. The biggest strain differentials have been confirmed in jumps from 30cm height. Tennis is played on 3 major different court surfaces and there is a variety of commercially designed tennis shoes on the market. Materials and methods. 6 male tennis players, ages 18–49 were enrolled for this study. A fibre optic cannula was placed in the middle of the proximal pole of patella tendon from lateral to medial direction in the dominant knee. The patellar tendon tensile forces deform the fibre optic cannula in turn modulating the light signal passing through the optic cannula. The drag in the fibre optic sensor signal was used to measure the tensile forces in the patellar tendon. MLTS 700
Summary Statement. The circle theorem is a simple and effective measurement tool for estimating acetabular version after total hip arthroplasty. Introduction. Position of the acetabular cup is a major factor in the range of motion and risk of dislocation after total hip arthroplasty. However, there is no well established technique for accurately and easily estimating acetabular cup version intraoperatively or postoperatively. The objective of this study was to evaluate a recently proposed method for measuring acetabular cup version on a single plain radiograph of the hip, which is based on one of the circle theorems in basic geometry. Patients & Methods. Radiographic version is defined as the angle between the cup face plane and a plane perpendicular to the body coronal plane. Using this definition, a metal hemispheric cup was placed in a pelvic sawbone model at a series of known angles of radiographic version (based on direct
Introduction. One of the important criteria of the success of TKR is achievement of the Flexion ROM. Various factors responsible to achieve flexion are technique, Implant and patient related. Creation of the Posterior condylar offset is one such important factor to achieve satisfactory flexion. Aim. To correlate post op femoral condylar offset to final flexion ROM at 1 yr. post op. Methods. This is a clinico-radiological study of the cases done prospectively between September 2011 and August 2012. Inclusion criteria:. All patients undergoing Bilateral TKRs and have agreed for the follow up at 1 yr. Exclusion criteria:. Patients who had previous bony surgery on lower end femur. Patients with previous fracture of lower end femur. All the patients had PS PFC Sigma (De Puy, Warsaw) components cemented. ROMs were measured at 6 weeks, 3 months, & 1 year post op. The last reading was taken as final flexion ROM as measured by a Physiotherapist with the help of a
Introduction. Postoperative knee flexion is an important indicator of success in total knee arthroplasty (TKA). Factors influencing the postoperative range of motion (ROM) were reported to be preoperative ROM, primary indication, height of postoperative joint line, patellar thickness, postoperative pain and rehabilitation. In this study, we aimed to identify the relationship between preoperative hip ROMs and postoperative knee flexion through reviewing the TKA results in Japanese patients. Patients & Methods. We retrospectively reviewed primary TKAs 55 knees in 55 patients (33 left and 22 right) between April 2012 and March 2013 inclusive. The patients were 11 men and 44 women, with a mean age of 76.7 years. Preoperative hip ROMs and perioperative knee flexion were measured by using
Sagittal stability of the knee is believed to be of significant importance following a total knee arthroplasty. We examine three different knee designs at a minimum of twenty-four months postoperatively. Sagittal stability was measured at four degrees of flexion; 0°, 30°, 60° and 90° to examine the effect of design on mid-flexion stability. The knee designs included the rotating platform LCS design, the cruciate sparing Triathlon system and the medial rotating knee design, MRK. Following ethical approval 50 cases were enrolled into the study, 15 male and 35 female. Eighteen LCS, 18 MRK and 14 Triathlon knee designs were analysed. Sagittal stability was measured using the KT1000 device. Active range of movement was measured using a hand held
Introduction. This study investigates the effect of Rivaroxaban (Bayer HealthCare) on early post-operative stiffness in primary total knee replacement. Methods. The anticoagulant of choice for total knee arthroplasty in our Department was changed from Enoxaparin to Rivaroxaban in September 2009. We reviewed a consecutive, multi-surgeon, multi-implant series of primary total knee replacements for a 6 month period prior to (group A) and after (group B) the treatment change. All patients were reviewed by an independent Clinical Specialist Physiotherapist at 6 weeks post-surgery, where the range of movement was recorded prospectively using a
The aim of this study was to compare the characteristics and outcomes of L-shaped and reverse L-shaped rotator cuff tears. A total of 82 shoulders (81 patients) after arthroscopic rotator cuff repair were retrospectively enrolled. The mean age of the patients was 62 years (SD 6), 33 shoulders (40.2%) were in male patients, and 57 shoulders (69.5%) were the right shoulder. Of these, 36 shoulders had an L-shaped tear (group L) and 46 had a reverse L-shaped tear (group RL). Both groups were compared regarding characteristics, pre- and postoperative pain, and functional outcomes. Muscle status was assessed by preoperative MRI, and re-tear rates by postoperative ultrasonography or MRI.Aims
Methods
Outcomes of current operative treatments for arthrofibrosis after total knee arthroplasty (TKA) are not consistently positive or predictable. Pharmacological in vivo studies have focused mostly on prevention of arthrofibrosis. This study used a rabbit model to evaluate intra-articular (IA) effects of celecoxib in treating contracted knees alone, or in combination with capsular release. A total of 24 rabbits underwent contracture-forming surgery with knee immobilization followed by remobilization surgery at eight weeks. At remobilization, one cohort underwent capsular release (n = 12), while the other cohort did not (n = 12). Both groups were divided into two subcohorts (n = 6 each) – one receiving IA injections of celecoxib, and the other receiving injections of vehicle solution (injections every day for two weeks after remobilization). Passive extension angle (PEA) was assessed in live rabbits at 10, 16, and 24 weeks, and disarticulated limbs were analyzed for capsular stiffness at 24 weeks.Aims
Methods
The aim of this prospective study was to assess the long-term clinical, radiological, functional, and quality of life (QoL)-related outcome of patients treated with the synthetic Ligament Advanced Reinforcement System (LARS) device for anterior cruciate ligament (ACL) rupture. A total of 41 patients who underwent ACL reconstruction with the LARS device (mean age 39.8 years (SD 12.1 ); 32% females (n = 13)) were prospectively included between August 2001 and March 2005. MRI scans and radiographs were performed at a median follow-up of 2.0 years (interquartile range (IQR) 1.3 to 3.0; n = 40) and 12.8 years (IQR 12.1 to 13.8; n = 22). Functional and QoL-related outcome was assessed in 29 patients at a median follow-up of 12.8 years (IQR 12.0 to 14.0) and clinically reconfirmed at latest median follow-up of 16.5 years (IQR 15.5 to 17.9). International Knee Documentation Committee (IKDC) and Tegner scores were obtained pre- and postoperatively, and Lysholm score postoperatively only. At latest follow-up, range of motion, knee stability tests, 36-Item Short Form Health Survey (SF-36), and IKDC scores were ascertained. Complications and reoperations during follow-up were documented.Aims
Methods
Degenerative changes of the knee often cause loss of extension. This may affect aspects of posture such as lumbar lordosis. A total of 366 patients underwent radiological examination of the lumbar spine in a standing position. The knee and body angles were measured by physical examination using a
Intro: Total knee replacement (TKR) manufacturers offer the option of high flexion tibial tray inserts. The polyethylene is narrower posteriorly than the standard insert and comes with the theoretical risk of reduced longevity due to thinner implant. This trial studied both the intra-operative and post-operative difference in knee flexion. Method: 100 consecutive patients undergoing posterior stabilized Genesis II TKR with Brainlab navigation were studied. The flexion of each knee was assessed per-operatively using the Brainlab navigation system for both the high flex and standard tibial insert trials. Patients were then randomized to receive either a high flex or standard definitive implant and the knee flexion measured clinically with a
High flexion designs are intended to provide a greater range of knee flexion and possibly improve flexion in stiff knees. This study assessed the effects of two implant designs. A posterior stabilised high flexion mobile bearing (MB) design vs a cruciate retaining standard fixed bearing (FB) design. The aim of this study was to assess whether implant design has an effect on the functional outcome one year after total knee arthroplasty (TKA). Methods. Ninety patients with knee osteoarthritis on the waiting list for unilateral TKA were recruited and randomly allocated to either the MB or FB group. Patients were assessed between one and four weeks before, and one year after TKA. Primary outcome was knee flexion during high flexion activities of daily living such as stair ascending and descending and squatting as measured using gait analysis. Knee flexion in long sitting using a manual
A key determinant of long-term implant survival following primary TKA is post- operative alignment of the limb and components. The aim of this study was to compare the accuracy of the Vector-Vision CT-free navigation system versus conventional hand-guided TKA by comparing post-operative alignment. In a retrospective study 51 sets of post-operative radiographs were analysed, 33 computer-guided and 18 hand-guided. A specific protocol for the measurement of post-operative TKA radiographs was outlined and a novel Trigonometric Method (TM) of angle measurement was compared with the traditional
Background:. The safety implications of achieving high flexion after TKA and the use of high flexion prostheses remain issues of concern. It is possible that different designs have different clinical and radiological results and complications, such as, early aseptic loosening. However, little information is available on the clinical results of TKAs performed using single-radius, high-flex posterior stabilized design. Accordingly, this study was undertaken to document results of single-radius, high-flex posterior stabilized TKAs with minimum 7-year follow-up. Methods:. From April 2003 to February 2006, 308 patients (455 knees) underwent TKA using single-radius, high-flex posterior stabilized design and among those patients, 251 patients (388 knees) included in this study who were able to be followed up for a minimum 7 year. Clinical results were evaluated using Knee Society Knee scores (KSKS) and Knee Society Function scores (KSFS) at last follow-up. The passive knee flexion was measured using a
Tibiofemoral alignment has a direct correlation with the survival of total knee arthroplasty. Traditionally, it has been measured using a
INTRODUCTION. The magnitude of knee flexion angle is a relevant information during clinical examination of the knee, and this item is a significant part of every knee scoring system. It is generally performed by visual analysis or with manual
The ideal management of acute syndesmotic injuries in elite athletes is controversial. Among several treatment methods used to stabilize the syndesmosis and facilitate healing of the ligaments, the use of suture tape (InternalBrace) has previously been described. The purpose of this study was to analyze the functional outcome, including American Orthopaedic Foot & Ankle Society (AOFAS) scores, knee-to-wall measurements, and the time to return to play in days, of unstable syndesmotic injuries treated with the use of the InternalBrace in elite athletes. Data on a consecutive group of elite athletes who underwent isolated reconstruction of the anterior inferior tibiofibular ligament using the InternalBrace were collected prospectively. Our patient group consisted of 19 elite male athletes with a mean age of 24.5 years (17 to 52). Isolated injuries were seen in 12 patients while associated injuries were found in seven patients (fibular fracture, medial malleolus fracture, anterior talofibular ligament rupture, and posterior malleolus fracture). All patients had a minimum follow-up period of 17 months (mean 27 months (17 to 35)).Aims
Methods
This study aimed to investigate the relationship between changes in patellar height and clinical outcomes at a mean follow-up of 7.7 years (5 to 10) after fixed-bearing posterior-stabilized total knee arthroplasty (PS-TKA). We retrospectively evaluated knee radiographs of 165 knees, which underwent fixed-bearing PS-TKA with patella resurfacing. The incidence of patella baja and changes in patellar height over a minimum of five years of follow-up were determined using Insall-Salvati ratio (ISR) measurement. We examined whether patella baja (ISR < 0.8) at final follow-up affected clinical outcomes, knee joint range of motion (ROM), and Knee Society Score (KSS). We also assessed inter- and intrarater reliability of ISR measurements and focused on the relationship between patellar height reduction beyond measurement error and clinical outcomes.Aims
Methods
The variability in measurement of angles in congenital scoliosis is not known, but it is postulated that it is larger than that in adolescent idiopathic scoliosis due to skeletal immaturity, incomplete ossification, and anomalous development of the end-vertebrae. To determine this variability, we selected 54 radiographs of adequate quality showing 67 scoliotic curves from children with congenital scoliosis. The end-vertebrae were preselected. Each curve was measured by the Cobb method on two separate occasions by six different observers, using the same
The objective of this study is to determine if surgical lengthening of the hamstrings and gastrocnemius/Achilles complex, affect muscle tone in patients with cerebral palsy. The question is if the dynamic component of muscle length changes after orthopedic surgery. A retrospective study was performed on ambulatory children with cerebral palsy who underwent either hamstring lengthening or gastrocnemius/Achilles tendon lengthening. A total of 135 consecutive patients with an average age of 13 years were included in the study. A single random side was selected for children with bilateral surgery and the affected limp was analyzed for those undergoing unilateral surgery. The popliteal angle was performed with a quick and slow stretch, as well as, the ankle dorsiflexion, and measured with a
Objective: To determine if a standard course of outpatient physiotherapy improves the range of knee motion following primary total knee arthroplasty. Design: One hundred and fifty patients undergoing primary total knee arthroplasty were recruited and randomly assigned into two groups. Group 1 received a course of physiotherapy with a standard protocol over a six week period within 4 weeks of hospital discharge. Group 2 received no outpatient physiotherapy. All patients received inpatient physiotherapy for the length of their hospital stay. Range of knee motion was measured using a
Shoulder movements from neutral into flexion, extension, abduction, adduction and external rotation are easily measured with a
To study the effect of ligament injuries and surgical repair we investigated the three-dimensional kinematics of the ankle joint complex and the talocrural and the subtalar joints in seven fresh-frozen lower legs before and after sectioning and reconstruction of the ligaments. A foot movement simulator produced controlled torque in one plane of movement while allowing unconstrained movement in the remainder. After testing the intact joint the measurements were repeated after simulation of ligament injuries by cutting the anterior talofibular and calcaneofibular ligaments. The tests were repeated after the Evans, Watson-Jones and Chrisman-Snook tenodeses. The range of movement (ROM) was measured using two
Purpose of study: The majority of children with cerebral palsy suffer from fixed flexion contractures of their knees. Procedures commonly used to correct these deformities include hamstring releases, anterior femoral hemi-epiphyseodesis and femoral extension osteotomies. The latter procedure can cause neurovascular complications. Femoral stapling procedures are unpopular because of the risk of permanent physeal closure. Soft tissue procedures are usually only partially effective, with a high recurrence rate. We present our initial experience of correcting of knee flexion deformities using the 8-plate technique which uses guided growth in the distal femoral physis to achieve gradual correction of the knee flexion deformity. Method: The case notes of patients who underwent an anterior distal femoral hemi-epiphyseodesis using the 8-plate technique between April 2005 and August 2006 were analysed. A total of 18 limbs in 12 patients underwent this procedure. The pre- and post-operative flexion deformity was measured with a
Single-shot adductor canal block (ACB) after total knee arthroplasty (TKA) for postoperative analgesia is a common modality. Patients can experience breakthrough pain when the effect of ACB wears off. Local anaesthetic infusion through an intra-articular catheter (IAC) can help manage breakthrough pain after TKA. We hypothesized that combined ACB with ropivacaine infusion through IAC is associated with better pain relief compared to ACB used alone. This study was a prospective double-blinded placebo-controlled randomized controlled trial to compare the efficacy of combined ACB+ IAC-ropivacaine infusion (study group, n = 68) versus single-shot ACB+ intra-articular normal saline placebo (control group, n = 66) after primary TKA. The primary outcome was assessment of pain, using the visual analogue scale (VAS) recorded at 6, 12, 24, and 48 hours after surgery. Secondary outcomes included active knee ROM 48 hours after surgery and additional requirement of analgesia for breakthrough pain.Aims
Methods
Aim of this study was to compare the postoperative range of motion of three types of total knee replacements. They were 72 posterior cruciate ligament retaining knee prostheses (group I), 61 postero-stabilized (group II), 52 ultracongruent plates (group III). Inclusion criteria were primary arthritis with varus deformity inferior to 15 degrees (°), no previous surgery on the knee, body mass index inferior to 35, preoperative flexion superior to 110°. All prostheses were performed with the same ancillary with one unique surgeon (DH). Recovery and analgesia protocols were similar in the three groups. Mobility was measured using a
Purpose: While several studies have reported improved pain control with use of femoral nerve blocks (FNB) following ACL reconstruction, there are few studies that have evaluated the effect of continuous perineural infusion on quadriceps activation and recovery of range of motion after ACL reconstruction. The purpose of this prospective randomized placebo-controlled clinical trial was to determine if the use of continuous infusion of levobupivacaine for pain control following ACL reconstruction had an adverse effect on postoperative quadriceps activation and recovery of ROM. Method: Two-hundred-seventy patients underwent ACL reconstruction and were randomly assigned to one of three FNB groups (placebo bolus and infusion, active bolus with placebo infusion, or active bolus and continuous infusion). The patients’ ability to perform a SLR was assessed daily for the first four post-operative days. Range of motion of the knee was measured with a
Introduction: Majority of children with cerebral palsy patients suffer from fixed flexion contractures of their knees. Procedures commonly used to correct knee flexion deformities include hamstring release, anterior femoral hemiepiphyseodesis and femoral extension osteotomies. The latter procedure can cause neurovascular complications. Femoral stapling procedures are not very popular because of a theoretical risk of permanent physeal closure. We present our initial experience in correction of knee flexion deformity by using the 8-plate technique. This uses guided growth in the distal femoral physis to achieve gradual correction of the knee flexion deformity. Materials and Methods: We analysed the case notes of patients who underwent an anterior distal femoral hemi-epiphyseodesis using the 8-plate techinique between April of 2005 and August 2006. A total of 18 limbs in 12 patients underwent this procedure. Preoperative and post operative flexion deformity was measured using a
Background: Researchers have measured exposure to sitting using self-reported questionnaires and observational analysis. Such methods are not a reliable measure of daily exposure or sensitive enough to take into account lumbar posture when seated. Recent innovations have produced a fibre-optic
Aims: We present a prospective study, with three-year follow-up, of the role and outcome of fasciectomy plus surgical release of structures of the PIP joint in Dupuy-tren’s contracture of the fifth ray. Methods: All patients presenting for surgery with primary Dupuytren’s contracture of the fifth ray over a six-month period were included in the study. All underwent fasciectomy followed sequentially by release of the abductor band, accessory collateral and checkrein ligaments as necessary. Deformity and range of motion in the PIPJ were measured by