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 goniometer. Besides, server was responsible for storing the collected data and ROM measurement. ROM was calculated by processing the foot video which was sent through the mobile application. During the processing phase, a segmentation model was used which was trained with image process and deep learning methods. With the developed system, we obtained the manual goniometric measurement result with 2 degrees deviation. As the application is calibrated, it is expected to approach the actual measurement of ROM. We can conclude that mobile app-goniometer result in dorsiflexion measurement is a novel promising evaluation method for ankle ROM. it will be easy and practical to detect and monitor risk factor of the diseases, decrease medical costs, provide health services in rural areas, and contribution to life quality and to reduce the workload on physicians and physiotherapist

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 goniometer. T-tests were used to measure differences between intraoperative and postoperative ROM, Pearson Correlation was used to measure associations, and linear regression was conducted to assess whether intraoperative ROM predicts postoperative ROM. Nineteen patients, two of whom had bilateral surgery, agreed to participate. Mean age was 54 and 14 were male and 5 were male. In the majority, surgical indication was scapholunate advanced collapse; however, two of the participants had scaphoid nonunion advanced collapse. No difference was observed between intraoperative and postoperative flexion. On average there was an increase of seven degrees of extension and 12° arc of motion postoperatively with p values reaching significance Correlation between intr-operative and postoperative ROM did not reach statistical significance for flexion, extension, or arc of motion. There were no statistically significant correlations between intraoperative and postoperative ROM. Intraoperative ROM radiographs are not useful at predicting postoperative ROM. Postoperative extension and arc of motion did increase from that measured intraoperatively

As the field of hip arthroscopy continues to develop, functional measures and testing become increasingly important in patient selection, managing patient expectations prior to surgery, and physical readiness for return to athletic participation. The Hip Sport Test (HST) was developed to assess strength, coordination, agility, and range of motion prior to and following hip arthroscopy as a functional assessment. However, the relationship between HST and hip strength, range of motion, and hip-specific patient reported outcome (PRO) measures have not been investigated. The purpose of this study was to evaluate the correlation between the HST scores and measurements of hip strength and range of motion prior to undergoing hip arthroscopy. Between September 2009 and January 2017, patients aged 18-40 who underwent primary hip arthroscopy for the treatment of femoroacetabular impingement with available pre-operative HST, dynamometry, range of motion, and functional scores (mHHS, WOMAC, HOS-SSS) were identified. Patients were excluded if they were 40 years old, had a Tegner activity score < 7, or did not have HST and dynamometry evaluations within one week of each other. Muscle strength scores were compared between affected and unaffected side to establish a percent difference with a positive score indicating a weaker affected limb and a negative score indicating a stronger affected limb. Correlations were made between HST and strength testing, range of motion, and PROs. A total of 350 patients met inclusion criteria. The average age was 26.9 ± 6.5 years, with 34% females and 36% professional athletes. Total and component HST scores were significantly associated with measure of strength most strongly for flexion (rs = −0.20, p < 0 .001), extension (rs = −0.24, p<.001) and external rotation (rs = −0.20, p < 0 .001). Lateral and diagonal agility, components of HST, were also significantly associated with muscle strength imbalances between internal rotation versus external rotation (rs = −0.18, p=0.01) and flexion versus extension (rs = 0.12, p=0.03). In terms of range of motion, a significant correlation was detected between HST and internal rotation (rs = −0.19, p < 0 .001). Both the total and component HST scores were positively correlated with pre-operative mHHS, WOMAC, and HOS-SSS (p<.001 for all rs). The Hip Sport Test correlates with strength, range of motion, and PROs in the preoperative setting of hip arthroscopy. This test alone and in combination with other diagnostic examinations can provide valuable information about initial hip function and patient prognosis

Aims. In computer simulations, the shape of the range of motion (ROM) of a stem with a cylindrical neck design will be a perfect cone. However, many modern stems have rectangular/oval-shaped necks. We hypothesized that the rectangular/oval stem neck will affect the shape of the ROM and the prosthetic impingement. Methods. Total hip arthroplasty (THA) motion while standing and sitting was simulated using a MATLAB model (one stem with a cylindrical neck and one stem with a rectangular neck). The primary predictor was the geometry of the neck (cylindrical vs rectangular) and the main outcome was the shape of ROM based on the prosthetic impingement between the neck and the liner. The secondary outcome was the difference in the ROM provided by each neck geometry and the effect of the pelvic tilt on this ROM. Multiple regression was used to analyze the data. Results. The stem with a rectangular neck has increased internal and external rotation with a quatrefoil cross-section compared to a cone in a cylindrical neck. Modification of the cup orientation and pelvic tilt affected the direction of projection of the cone or quatrefoil shape. The mean increase in internal rotation with a rectangular neck was 3.4° (0° to 7.9°; p < 0.001); for external rotation, it was 2.8° (0.5° to 7.8°; p < 0.001). Conclusion. Our study shows the importance of attention to femoral implant design for the assessment of prosthetic impingement. Any universal mathematical model or computer simulation that ignores each stem’s unique neck geometry will provide inaccurate predictions of prosthetic impingement. Cite this article: Bone Joint Res 2021;10(12):780–789

Aims. 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. Methods. 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. Results. OpenPose had excellent test-retest reliability (intraclass correlation coefficient (1,1) = 1.000). The R. 2. of all regression models indicated large correlations (0.747 to 0.927). In the flexion position, the intraclass correlation coefficients (2,1) of OpenPose indicated excellent agreement (0.953) with radiography. In the extension position, the intraclass correlation coefficients (2,1) indicated good agreement of OpenPose and radiography (0.815) and moderate agreement of goniometry with radiography (0.593). OpenPose had no systematic error in the flexion position, and a 2.3° fixed error in the extension position, compared to radiography. Conclusion. OpenPose is a reliable and valid tool for measuring flexion and extension positions after TKA. It has better accuracy than goniometry, especially in the extension position. Accurate measurement values can be obtained with low error, high reproducibility, and no contact, independent of the examiner’s skills. Cite this article: Bone Joint Res 2023;12(5):313–320

Abstract. Objectives. Impingement in total hip replacements (THRs), including bone-on-bone impingement, can lead to complications such as dislocation and loosening. The aim of this study was to investigate how the location of the anterior inferior iliac spine (AIIS) affected the range of motion before impingement. Methods. A cohort of 25 CT scans (50 hips) were assessed and nine hips were selected with a range of AIIS locations relative to the hip joint centre. The selected CT Scans were converted to solid models (ScanIP) and THR components (DePuy Synthes) were virtually implanted (Solidworks). Flexion angles of 100⁰, 110⁰, and 120⁰ were applied to the femur, each followed by internal rotation to the point of impingement. The lateral, superior and anterior extent of the AIIS from the Centre of Rotation (CoR) of the hip was measured and its effect on the range of motion was recorded. Results. There was found to be a significant (p<0.05) inverse relationship between the ROM of the THR and the lateral measure of the AIIS. Of the three measures, the lateral AIIS measure showed the strongest relationship with ROM to impingement (R=0.73) with the anterior and superior measures resulting in R values of 0.41 and 0.56 respectively. For every millimetre lateral the AIIS location, there was typically a loss of 1.2° of range of motion. With increasing lateralisation, the AIIS was positioned more directly over the femur, thereby reducing the ROM in the THR during high flexion positions. No soft tissue was included in the models which would have affected the ROM. Conclusions. The results from this study have shown that the lateral measure of the AIIS could be a predictor for bone-on-bone impingement. To build confidence, wider study of AIIS location variation is needed, as well as analysis under impingement prone activities of daily living. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

There are a variety of sizes currently available for reverse total shoulder arthroplasty (RTSA) implant systems. Common sizing options include a smaller 36 to 38 mm or a larger 40 to 42 mm glenosphere, and are typically selected based on surgeon preference or patient size. Previous studies have only evaluated the abduction and adduction range of motion within a single plane of elevation, providing a limited view of the joint's possible range of motion. The purpose of this study was to use computer modeling to evaluate the abduction and adduction range of motion across multiple planes of elevation for a range of glenosphere sizes. Computed tomography images of four cadaveric specimens (age: 54 ± 24 years) were used to obtain the osseous anatomy to be utilised in the model. Solid-body motion studies of the RTSA models were constructed with varying glenosphere diameters of 33, 36, 39, 42, and 45 mm in Solidworks (Dassault Systems, US). The implant components were scaled, while maintaining a consistent centre of rotation. Simulations encompassing the full range of abduction and adduction were conducted for the planes of elevation between −15˚ and 135˚ at 15˚ intervals, with the motion of the humerus being constrained in neutral internal-external rotation throughout all planes. Angles of elevation were obtained utilising the humeral long axis and the RTSA centre of rotation. Statistical analysis was performed using repeated measures ANOVA. Glenosphere diameter was found to significantly affect the adduction range of motion (p=0.043), in which the largest size provided approximately 17˚ more adduction range of motion than the smallest. However, abduction range of motion was not found to be significantly affected through the alteration of glenosphere size (p=0.449). The plane of elevation was not found to significantly affect abduction or abduction (p=0.585 & p=0.225, respectively). Increasing glenosphere diameter resulted in an increased adduction range of motion when averaged across the tested planes of elevation; however the observed influence on abduction was not significant. These are similar to the trends observed in the previous single plane of elevation studies. These findings illustrate the importance of implant sizing related to range of motion. Further studies are required to determine the influence of glenosphere size on internal and external range of motion

Range of Motion (ROM) assessments are routinely used during joint replacement to evaluate joint stability before, during and after surgery to ensure the effective restoration of patient biomechanics. This study aimed to quantify axial torque in the femur during ROM assessment in total hip arthroplasty to define performance criteria against which hip instruments can be verified. Longer term, this information may provide the ability to quantitatively assess joint stability, extending to quantitation of bone preparation and quality. Joint loads measured with strain-gaged instruments in five cadaveric femurs prepared using posterior approach were analysed. Variables such as surgeon-evaluator, trial offset and specimen leg and weight were used to define 13 individual setups and paired with surgeon appraisal of joint tension for each setup. Peak torque loads were then identified for specific motions within the ROM assessment. The largest torque measured in most setups was observed during maximum extension and external rotation of the joint, with a peak torque of 13Nm recorded in a specimen weighing 98kg. The largest torque range (19.4Nm) was also recorded in this specimen. Other motions within the trial reduction showed clear peaks in applied torque but with lower magnitude. Relationships between peak torque, torque range and specimen weight produced an R2 value greater than 0.65. The data indicated that key influencers of torsional loads during ROM were patient weight, joint tension and limb motion. This correlation with patient weight should be further investigated and highlights the need for population representation during cadaveric evaluation. Although this study considered a small sample size, consistent patterns were seen across several users and specimens. Follow-up studies should aim to increase the number of surgeon-evaluators and further vary specimen size and weight. Consideration should also be given to alternative surgical approaches such as the Direct Anterior Approach

Nearly one quarter of ankle fractures have a recognized syndesmosis injury. An intact syndesmosis ligament complex stabilizes the distal tibio-fibular joint while allowing small, physiologic amounts of relative motion. When injured, malreduction of the syndesmosis has been found to be the most important independent factor that contributes to inferior functional outcomes. Despite this, significant variability in surgical treatment remains. This may be due to a poor understanding of normal dynamic syndesmosis motion and the resultant impact of static and dynamic fixation on post-injury syndesmosis kinematics. As the syndesmosis is a dynamic structure, conventional CT static images do not provide a complete picture of syndesmosis position, giving potentially misleading results. Dynamic CT technology has the ability to image joints in real time, as they are moved through a range-of-motion (ROM). The aim of this study was to determine if syndesmosis position changes significantly throughout ankle range of motion, thus warranting further investigation with dynamic CT. This is an a priori planned subgroup analysis of a larger multicentre randomized clinical trial, in which patients with AO-OTA 44-C injuries were randomized to either Tightrope or screw fixation. Bilateral ankle CT scans were performed at 1 year post-injury, while patients moved from maximal dorsiflexion (DF) to maximal plantar flexion (PF). In the uninjured ankles, three measurements were taken at one cm proximal to the ankle joint line in maximal DF and maximal PF: Anterior (ASD), middle (MSD), and posterior (PSD) syndesmosis distance, in order to determine normal syndesmosis position. Paired samples t-tests compared measurements taken at maximal DF and maximal PF. Twelve patients (eight male, six female) were included, with a mean age of 44 years (±13years). The mean maximal DF achieved was 1-degree (± 7-degrees), whereas the mean maximal PF was 47-degrees (± 8-degrees). The ASD in DF was 3.0mm (± 1.1mm) versus 1.9mm (± 0.8mm) in PF (p<0.01). The MSD in DF was 3.3mm (±1.1mm) versus 2.3mm (±0.9mm) in PF (p<0.01). The PSD in DF was 5.3mm (±1.5mm) versus 4.6mm (±1.9mm) in PF (p<0.01). These values are consistent with the range of normal parameters previously reported in the literature, however this is the first study to report the ankle position at which these measurements are acquired and that there is a significant change in syndesmosis measurements based on ankle position. Normal syndesmosis position changes in uninjured ankles significantly throughout range of motion. This motion may contribute to the variation in normal anatomy previously reported and controversies surrounding quantifying anatomic reduction after injury, as the ankle position is not routinely standardized, but rather static measurements are taken at patient-selected ankle positions. Dynamic CT is a promising modality to quantify normal ankle kinematics, in order to better understand normal syndesmosis motion. This information will help optimize assessment of reduction methods and potentially improve patient outcomes. Future directions include side-to-side comparison using dynamic CT analysis in healthy volunteers

Introduction. The reliability of currently available proximal humeral fracture classi?cation systems has been shown to be poor, giving rise to the question whether a more objective measure entails improved predictability of surgical outcome. This study aims to apply a novel software system to predict the functional range of motion of the glenohumeral joint after proximal humeral fracture. Method. Using a validated system that simulates bone-determined range of motion of spheroidal joints such as the shoulder joint, we categorically analysed a consecutive series of 79 proximal humeral fractures. Morphological properties of the proximal humerus fractures were related to simulated bone-determined range of motion. Results. The interobserver variability of range of motion assessment using our system showed excellent agreement (0.798). Maximal glenohumeral abduction and forward ?exion of intra-articular fractures were 34.3±6.6 SE and 60.7±12.4 SE degrees. For fractures with a displaced greater tuberosity abduction was 75.0±5.9 SE and forward flexion was 118.2±4.9 SE degrees, whilst for fractures where both tuberosities had been displaced they were 60.0±10.9 SE and 69.6±13.4 SE degrees respectively. For non-intra articular fractures without displaced tuberosities movements were 89.3±3.3 SE and 122.6±3.4 SE degrees respectively. The head inclination angle was positively correlated with maximum abduction (0.362, p = 0.014). Offset was negatively correlated with maximum abduction, but not statistically signi?cant (0.834, p = 0.087). Conclusion. This study has demonstrated a novel and effective tool allowing the prediction of functional motion after proximal humeral fracture based on bone anatomy. The study demonstrates that intra-articular fractures generally have the worst prognosis with regards to bone-determined ROM. Fractures with displaced tuberosities show more motion limitations for abduction than for forward ?exion. A reduced head inclination angle is a strong predictor of limited bone-determined range of motion for all types of proximal humerus fractures

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 goniometer and the cervical range of motion (CROM) goniometer. These methods were then compared with each other. In addition, we were interested in determining whether a single component of neck movement is representative of total cervical range of motion. Methods: 50 healthy subjects between the ages of 18–87 with no shoulder or spine pathology were asked to perform six active neck movements, flexion, extension, lateral flexion and axial rotation while the movements were measured first using the universal goniometer and then with the CROM goniometer. The CROM goniometer has been shown previously to have excellent validity and reliability. The researchers were trained to use the measuring techniques prior to data collection. All measurements were performed by the same researcher for each subject and the two researchers alternated between subjects. Results: Comparison between the universal goniometer and the CROM goniometer was performed using Bland and Altman plots. This revealed that 60.6% of universal goniometer readings were within ±5° of the CROM reading; however 31.6% of readings differed by > ±5° and 7.8% differed by > ±10°. The interobserver variance was calculated and there was excellent agreement between the two researchers for both the universal goniometer and CROM goniometer, with an intraclass correlation coefficient of ≥0.80 for every movement. Extension was the most predictive of total neck movement (Pearson coefficient 0.643, p < 0.001). This continues to be the case even when the negative effect of age on range of motion is taken into account. Discussion: The finding that extension was the most representative neck movement has implications for the assessment of cervical motion. Accordingly, if a single neck movement is measured to represent total range of motion, extension should be used. The comparison between the CROM and universal goniometer demonstrated that the majority of goniometer readings were within 5° of the CROM result; however, this was not consistently the case. Given that the CROM is a valid and reliable method of measuring neck movement, the inconsistency between the goniometer and CROM can be taken as inaccuracy on the part of the universal goniometer. As the interobserver variance is excellent one can assume that these results are reproducible and that the errors observed are a true reflection of the limitations of the device

Introduction: Subject to recent literature citing a reduction in ankle range of motion predisposing to ankle fractures in children, we decided prospectively to analyse the passive range of motion in children presenting to our fracture clinic with simple distal radial metaphyseal fractures treated conservatively in cast. The range of motion was assessed by two observers, and measured using a goniometer in 80 patients. (42 radial fractures and 38 controls) The controls were recruited from children presenting with lower limb injuries and with no prior history of an upper limb injury or neuromuscular condition. The fractures were as a result of simple falls onto the outstretched hand with definite radiological and clinical findings. The range of motion in the contralateral limb was assessed. Both groups showed an equal distribution of dominant and non-dominant limbs. Results: Both groups were well matched with an average age of 10 and 10.3 years fracture group and control group respectively, and gender 55% male fracture group and 52.5% control group. The m injured group showed a passive range of motion of 1680, whereas the control group showed a higher range of motion of 1820, a difference of 140 (p< . 005 student t-test). A third blinded independent observer of 20 children assessed Intra and interobserver error, and no observer was noted to have higher or lower readings. Conclusion: Children with radial fractures have a lower passive range of motion of their wrists than Controls. This may contribute to the aetiology of wrist fractures in a paediatric population. An possible explanation may be as cited in original work that children who sustain fractures have less mobility around their joints due to reduced elasticity in their musculoskeletal framework. Simple passive stretching of fracture prone joints should therefore be advised

Introduction. Sheffield Children's Hospital specialises in limb lengthening for children. Soft tissue contracture and loss of range of motion at the knee and ankle are common complications. This review aims to look at therapeutic techniques used by the therapy team to manage these issues. Materials & Methods. A retrospective case review of therapy notes was performed of femoral and tibial lengthening's over the last 3 years. Included were children having long bone lengthening with an iIntramedullary nail, circular frame or mono-lateral rail. Patients excluded were any external fixators crossing the knee/ankle joints. Results. 20 tibial and 25 femoral lengthening's met the inclusion criteria. Pathologies included, complex fractures, limb deficiency, post septic necrosis and other congenital conditions leading to growth disturbance. All patients had issues with loss of motion at some point during the lengthening process. The knee and foot/ankle were equally affected. Numerous risk factors were identified across the cohort. Treatment provided included splinting, serial casting, bolt on shoes, exercise therapy, electrical muscle stimulation and passive stretching. Conclusions. Loss of motion in lower limb joints was common. Patients at higher risk were those with abnormal anatomy, larger target lengthening's, poor compliance or lack of access to local services. Therapy played a significant role in managing joint motion during treatment. However, limitations were noted. No one treatment option gave preferential outcomes, selection of treatment needed to be patient specific. Future research should look at guidelines to aid timely input and avoid secondary complications

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 goniometer under the general anesthesia at the time of operation in increments of 1°. Preoperative flexion angle was measured by passively flexing the patient's hip 90 degrees and allowing the weight of the leg to flex the knee joint (Lee et al 1998). Extension angle was measured by holding the heel and raising the leg by another examiner. During TKA, flexion and extension angle was measured in a similar manner when each insert trial (8, 10, 12, and 15mm) was inserted. After the wound closure and removing the draping, ROM was measured again. Statistical analysis of range of motion was performed using a paired t-test to determine significance. Results. Preoperative extension angle was-11.8±7.5°and flexion angle was 125.4±14.9 °. postoperative extension angle after removing drapes was −5.0±3.4°and flexion angle was126.4±8.8°. Although extension angle was improved statistically (p<0.001), flexion angle was not improved. Intraoperative extension and flexion angle that were measured with the same thick insert trial as the polyethylene insert finally selected was −3.7±3.0°and 120.8±9.8°respectively. The thickness of polyethylene insert finally set was 8mm (28knees), 10mm (58knee), 12mm (24 knee), and 15mm (5knee). The amount of deficit in extension ROM by changing the trial inserts those were measured intraoperatively were 2.5±2.2° (n=112, 8 to 10mm, p<0.01), 3.2±2.8° (n=80, 10 to 12mm, p< 0.01), and 4.7±2.5° (n=15, 12 to 15mm, p<0.01). Flexion angle was 0.6±4.3° (8 to 10mm, n.s), 1.5±4.0° (10 to 12mm, p=0.002), 2.6±4.0° (12 to 15mm, p=0.025). Discussion. Although it is important to select a sufficient thick polyethylene insert to prevent postoperative instability, excessive thick polyethylene can decrease ROM especially extension. In many type of prosthesis, thickness of polyethylene insert differs every 2 mm is prepared. In the current study, if the thickness of polyethylene is increased 2mm (8 to10mm and 10 to 12mm) or 3mm (12 to15mm), extension and flexion angle was decreased 2.5–4.7°and 0.6–2.6°respectively

Aims. Pelvic tilt (PT) can significantly change the functional orientation of the acetabular component and may differ markedly between patients undergoing total hip arthroplasty (THA). Patients with stiff spines who have little change in PT are considered at high risk for instability following THA. Femoral component position also contributes to the limits of impingement-free range of motion (ROM), but has been less studied. Little is known about the impact of combined anteversion on risk of impingement with changing pelvic position. Methods. We used a virtual hip ROM (vROM) tool to investigate whether there is an ideal functional combined anteversion for reduced risk of hip impingement. We collected PT information from functional lateral radiographs (standing and sitting) and a supine CT scan, which was then input into the vROM tool. We developed a novel vROM scoring system, considering both seated flexion and standing extension manoeuvres, to quantify whether hips had limited ROM and then correlated the vROM score to component position. Results. The vast majority of THA planned with standing combined anteversion between 30° to 50° and sitting combined anteversion between 45° to 65° had a vROM score > 99%, while the majority of vROM scores less than 99% were outside of this zone. The range of PT in supine, standing, and sitting positions varied widely between patients. Patients who had little change in PT from standing to sitting positions had decreased hip vROM. Conclusion. It has been shown previously that an individual’s unique spinopelvic alignment influences functional cup anteversion. But functional combined anteversion, which also considers stem position, should be used to identify an ideal THA position for impingement-free ROM. We found a functional combined anteversion zone for THA that may be used moving forward to place total hip components. Cite this article: Bone Jt Open 2021;2(10):834–841

Purpose. This study was to investigate the effect of posterior tibial slope (PTS) on the kinematics in the cruciate-retaining total knee arthroplasty (CR-TKA) using 2- to 3- dimensional registration technique. Material & Methods. A total of 75 knees in 58 patients were recruited and categorized into the following two groups according to PTS. Group A was categorized PTS under 7degrees (n = 33) and group B was categorized PTS over 7 degrees (n = 42). The average age of group A and group B at the time of fluoroscopic surveillance date was 73.5 ± 7.4 years and 74.3 ± 4.5 years, respectively and the average follow-up period from operation date to fluoroscopic surveillance date was 13.8 ± 9.3 months and 16.7 ± 8.6 months, respectively. In vivo kinematics during sequential deep knee bending under weight-bearing condition were evaluated using fluoroscopic image analysis and 2- to 3- dimensional registration technique. Range of motion (ROM), axial rotation, anteroposterior (AP) translations of medial and lateral nearest points of the femoral component relative to the tibial component were measured and compared between the two groups. The nearest points were determined by calculating the closest distance between the surfaces of femoral component model and the axial plane of coordinate system of the tibial component. We defined external rotation and anterior translation as positive. P values under 0.05 was defined as statistically significant. Results. The mean PTS in group A and B were 5.5 ± 1.4°and 9.9 ± 1.9°, respectively. There was no statistically significant difference in the degrees of axial rotation from 0° to 110° of flexion between the two groups (4.9 ± 4.2° vs 5.2 ± 4.2°, p > 0.05), respectively. The hyperextension of group B were significantly larger than group A (−2.3 ± 6.6°vs −9.8 ± 8.7°, p <0.05). The ROM of group B were significantly larger than group A (118.7 ± 10.8°vs 128.7 ± 17.7°, p <0.05). However, there was no significant difference in the maximum flexion between the two groups (116.4 ±10.8°vs 118.9±14.5°, p >0.05), respectively. In terms of AP translation, medial nearest points were located significantly more posterior at 0°, 10°, 30°, 40° of flexion in group B compared to group A. There was no significant difference in the location of lateral nearest points between the two groups during all knee range of motion. Discussion/Conclusion. The results shown in this study demonstrated that the PTS influenced the kinematics and ROM under weight-bearing condition in CR-TKA. The large PTS induced great posterior displacement of medial nearest points during early flexion phase and increased hyperextension between the femoral and tibial components

The incidence of first metatarsophalangeal joint (MTPJ) stiffness following bunion surgery varies in the literature from 2% to 60%. The causes include pre-existing degenerative joint disease, infection, chronic regional pain syndrome (Type 1), joint incongruence and avascular necrosis. The aim of this study was to establish whether closure of the capsule influences the range of motion in the first MTPJ. We performed a cadaveric study using a ‘Y’ shaped medial capsulotomy as our model. A mid-medial approach was performed on ten cadaveric feet, exposing the medial capsule of the 1st MTPJ. The range of motion of the 1st MTPJ was recorded, and a ‘Y’ shaped capsulotomy performed. The capsule was then closed in neutral, full plantar flexion, and full dorsi flexion and the range of motion recorded. When the capsule was closed with the first MTPJ at the limit of plantar flexion there was a mean loss of 13.7° of dorsi-flexion (range 12°–15°, p< 0.01) compared with the pre-capsulotomy range of motion. When the capsule was closed in dorsi-flexion there was a mean loss of 9.3° of plantar flexion (range 0°–20°, p< 0.05). There was no change in range of motion when the capsule was closed in neutral. Capsular closure can influence first MPTJ motion. Care should therefore be taken during capsular repair. Closure in extremes of extension or flexion, as advocated in some techniques such as the Mitchell osteotomy, should be avoided

Purpose: The purpose of this historical prospective study was to compare the pre and post-operative range of motion (ROM) and quality of life outcomes 6 months post-operatively in patients with partial and full-thickness tears of the rotator cuff. Methods: Data of 90 consecutive patients diagnosed with partial thickness tear (PTT) who had undergone decompression and or acromiploasty were compared with 90 patients (age and gender-matched) who had undergone repair of a full-thickness tear (FTT). The outcomes were objective pre and post-operative range of motion (ROM) in 5 directions and three patient-derived outcome measures; one disease-specific, the Western Ontario Rotator Cuff Index, and two shoulder specific measures: the American Shoulder & Elbow Surgeons standardized shoulder assessment form and, the Constant-Murley. A statistical paired t-test analysis was conducted between change (pre vs. 6 months) in ROM and QOL scores to examine the impact of severity on improvement between the 2 groups. Results: Forty-three females and 47 males in each group (180 subjects in total) were included in the analysis. The mean age was 54.8 and 54.9 for the PTT and FTT groups respectively. The PTT group was significantly stiffer in pre-operative passive flexion (p=0.010), abduction (p=0.022) and active external rotation at 0 degree of abduction (p=0.040). The 6-month WORC, ASES, and relative Constant all showed significant improvement in quality of life in both groups (p< 0.0001). There was a statistically significant difference in passive external rotation at 0 degrees of abduction between groups with FTT group being stiffer than the PTT group (p=0.019) post-operatively. Change in ROM was not significantly different in all other directions. Conclusions: The intent of this study was to compare the pre-operative and rate of improvement in two groups of patients suffering from different severity of pathology. The results indicate that quality of life improves significantly regardless of the extent of tear (partial thickness vs. full thickness). Patients with FTT may require a longer time to improve their range of motion in external rotation

Purpose. The remplissage procedure may be performed as an adjunct to Bankart repair to address an engaging Hill-Sachs defect. Clinically, it has been reported that the remplissage procedure improves joint stability but that it may also restrict shoulder range of motion. The purpose of this biomechanical study was to examine the effects of the remplissage procedure on shoulder motion and stability. We hypothesized that the remplissage procedure would improve stability and prevent engagement but may have a deleterious effect on motion. Method. Eight cadaveric forequarters were mounted on a custom biomechanical testing apparatus which applied simulated loads independently to the rotator cuff muscles and to the anterior, middle and posterior deltoid. The testing conditions included: intact shoulder, Bankart defect, Bankart repair, 2 Hill-Sachs defects (15%, 30%) with and without remplissage. Joint range of motion and translation were recorded with an optical tracking system. Outcomes measured were internal-external rotation range of motion in adduction and 90 combined abduction, extension range of motion and stability, quantified in terms of joint stiffness and engagement, in abduction. Results. With a 15% Hill-Sachs defect, the remplissage significantly reduced internal-external rotation in adduction (15.111.1, p=0.039), but not in abduction (7.79.0, p=0.380). In a 30% Hill-Sachs defect, the remplissage procedure significantly reduced internal-external rotation in adduction (19.57.8, p=0.001), and in abduction (12.28.6, p=0.03). The remplissage procedure significantly enhanced stability in the 15% Hill-Sachs defect (4.74.0 N/mm, p=0.038), and in the 30% defect (3.93.2 N/mm, P=0.030) compared to the unrepaired defect. All of the unrepaired 30% defects engaged and the remplissage procedure successfully eliminated engagement in each case. However, impingement of the repair on the posterior glenoid with paradoxical posterior pivoting of the humeral head was observed in 50% of the specimens. Conclusion. The remplissage procedure significantly augmented a Bankart repair in 15% and 30% Hill-Sachs defects and, in 30% Hill-Sachs defects, the remplissage successfully prevented engagement of the defect. The remplissage procedure, however, did significantly reduced shoulder internal-external rotation range of motion as reported clinically, and was also found to reduce extension in the two defect groups. During extension the intra-articular soft tissue bumper created by the remplissage procedure was found to impinge on the posterior glenoid rim and cause pivoting, which produced non-physiologic glenohumeral joint distraction. Therefore, the remplissage procedure stabilized the joint to a significantly greater degree than did a Bankart repair alone; however, it also significantly reduced shoulder range of motion

Aims. 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. Methods. 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. Results. A total of 69 patients (varus n = 45; valgus n = 24) underwent TKA and completed the postoperative follow-up visit. Of these, 16 patients (23.2%) reported the onset or progression of ankle symptoms. Varus patients with increased ankle symptoms after TKA had a significantly higher pre- and postoperative TT. Valgus patients with ankle symptoms after TKA showed a pathologically lateralized gait line which could not be corrected through TKA. Patients who reported increased ankle pain neither had a decreased ROM of the subtalar joint nor increased ankle laxity following TKA. The preoperative mTFA did not correlate with the postoperative FFI (r = 0.037; p = 0.759). Conclusion. Approximately one-quarter of the patients developed ankle pain after TKA. If patients complain about ankle symptoms after TKA, standing radiographs of the ankle and a gait analysis could help in detecting a malaligned TT or a pathological gait. Cite this article: Bone Joint J 2023;105-B(11):1159–1167

Introduction: Range of motion (ROM) is an important measure of the success of knee Arthroplasty. The extent to which pain relief contributes to improvements in knee ROM in total knee Arthroplasty (TKA) patients is unknown. This prospective study assessed the separate effects of pain abolition and surgery on ROM in a group of 141-osteoathritic patient’s undergoing TKA. Pain had a significant inhibitory effect on knee ROM. Improvements in ROM following TKA may be primarily due to pain relief. Methods: 141 randomly selected patients underwent LCS total knee arthroplasty (De Puy). A single surgeon performed all operations, using an identical surgical technique. Passive flexion and extension were measured when awake, under anaesthesia, and post-operatively under anaesthesia. Paired t-tests were used to test for significant differences between the measurements. Independent samples t-tests were used to test for significant differences between the changes in flexion, extension and ROM between the time points tested. Results:. When awake the mean flexion was 116.8°, extension 3.8°, and ROM 113.0°. When anaesthetised pre-op, the flexion was 130.2°, extension 0.8°, and ROM 129.4°. When anaesthetised post-op the flexion was 133.8°, extension 0.2°, and the ROM 133.5°. Knee flexion (p < 0.0001) and range of motion (p < 0.0001) were significantly greater and knee extension (p < 0.0001) was significantly reduced following anaesthesia only. A further significant increase in knee flexion (p < 0.0001) and range of motion (p = 0.00014) was observed post –operatively under anaesthetic. However knee extension did not significantly increase further (p = 0.29). The average improvement in range of motion once anaesthetised was 16.4° (SD = 13.1°) with the majority of this improvement due to an increase of flexion (average increase of 13.4° (SD = 11.9°) rather than an increase in extension (average increase of 3.0° (SD = 4.2°). The combined effect of surgery and anaesthetic was 20.5° (SD = 12.3°), with the majority of this improvement due to an increase of flexion (average increase of 17° (SD = 8.5°) rather than an increase in extension (average increase of 3.6° (SD = 6.0°). Discussion: Pain abolition resulted in a mean increase of 16.4° in the range of motion, and both TKA combined with pain abolition further increased significantly the range of motion to a mean of 20.5°. This study suggests that improvements in ROM following total knee arthroplasty are primarily due to reduction in the symptoms of pain and that other factors such as surgical technique and prosthesis design can further increase ROM. Future studies should record the measurements of passive flexion, extension and range of motion in the anaesthetised patient, as this will allow objective assessment of changes in range of movement

The influence of amount of tibial posterior slope changes on joint gap and postoperative range of motion was investigated in 35 patients undergoing unicompartmental knee arthroplasty (UKA). Component gap between the medial tibial osteotomy surface and the femoral trial prosthesis was measured throughout the range of motion using a tensor. The mean tibial posterior slope decreased from 10.2 to 7.3 degrees. Increased tibial slope change was positively correlated with component gap differences of 90° −10°, 120° −10°, and 135° −10° and negatively correlated with postoperative extension angle. Increasing tibial slope should be avoided to achieve full extension angle after UKA

Aim. To compare radiological and clinical outcomes between triceps-detaching and triceps-sparing approaches in total elbow arthroplasty, with specific focus on cementing technique and post-operative range of motion. Methods. A retrospective review was completed of medical records and radiographs of 56 consecutively managed patients who underwent a primary total elbow arthroplasty between 2000 and 2012 at a tertiary hospital. Rheumatoid Arthritis was the predominant pathology (47/56). Data analysed included patient demographics, range of motion pre-operatively and at various stages post-operatively, approach utilized, operative time and complications. Cementing technique was graded as adequate, marginal or inadequate according to Morrey's criteria. Results. 12 patients were lost to follow-up or had incomplete records, leaving 44 patients for analysis. 15 patients had a triceps-sparing approach, and 29 had a variation of a triceps-detaching approach. Average follow-up was 56.1 months. Flexion range of motion in the triceps-sparing group improved from 25°–122° (±19.6°) pre-op to 10°–140° (±22.5°) at final follow-up, and in the triceps-detaching group from 41°–104° (± 22.2°) pre-op to 27°–129° (±35.0°) at final follow-up. Tourniquet time averaged 85.4 (±17.0) minutes for the triceps-sparing group and 96.1 (±22.6) minutes for the triceps-detaching group. The complication rate in the triceps-sparing group was 13.3%, and included one olecranon fracture and one case of superficial wound sepsis. The complication rate for the triceps-detaching group was 24.1%, and included one patient with persistent ulnar nerve symptoms requiring transposition, one medial condyle fracture and five triceps ruptures. Three patients who had attempted repairs of the rupture developed deep infections requiring multiple further surgeries. Cementing technique was adequate in 91.7% in the triceps-sparing group and in 70.6% in the triceps-detaching group and marginal in the remainder of the cohort. Conclusion. A triceps-sparing approach results in a predictable improvement in range of motion with no compromise of the cement mantle. NO DISCLOSURES

Introduction/Aim. Mid-flexion instability is a well-documented, but often poorly understood cause of failure of TKA. NAVIO robotic-assisted TKA (RA-TKA) offers a novel, integrative approach as a planning, execution as well as an evaluation tool in TKA surgery. RA-TKA provides a hybrid planning technique of measured resection and gap balancing- generating a predictive soft-tissue balance model, prior to making cuts. Concurrently, the system uses a semi-active robot to facilitate both the execution and verification of the plan, as it pertains to both the static and dynamic anatomy. The goal of this study was to assess the ability of the NAVIO RA-TKA to plan, execute and deliver an individualized approach to the soft-tissue balance of the knee, specifically in the “mid-flexion” arc of motion. Materials and Methods. Between May and September 2018, 50 patients underwent NAVIO RA-TKA. Baseline demographics were collected, including age, gender, BMI, and range of motion. The NAVIO imageless technique was used to plan the procedure, including: surface-mapping of the static anatomy; objective assessment of the dynamic, soft-tissue anatomy; and then application of a hybrid of measured-resection and gap-balancing technique. Medial and lateral gaps as predicted by the software were recorded throughout the entire arc of motion at 15° increments. After executing the plan and placing the components, actual medial and lateral gaps were recorded throughout the arc of motion. Results. In the assessment of coronal-plane balance, the average deviation from the predicted plan between 0–90° was 0.9mm in both the medial and lateral compartments (range 0.5–1.2mm). In the mid-flexion arc (15–75°), final soft-tissue stability was within 1.0mm of the predictive plan (range 0.9–1.2mm). Discussion/Conclusions. In this study, NAVIO RA-TKA demonstrated a highly accurate and reproducible surgical technique to plan, execute and verify a balanced a soft-tissue envelope in TKA. Objective soft-tissue balancing of the TKA can now be performed, including the mid-flexion arc of motion. Further analysis can determine if these objective measurements will translate into improved patient-reported outcome scores

Introduction Range of motion (ROM) is an important measure of outcome. A better understanding of the factors influencing ROM is important when counselling patients undergoing TKA. Aim The aim of the study was to prospectively evaluate the influence of a number of selected variables on knee flexion at one year using the same prosthesis in a single surgeon series. Patients and Methods 170 patients (57 males; 113 females) undergoing TKA were prospectively evaluated. The following data was recorded for each patient: age, gender, primary diagnosis, direction and magnitude of the preoperative axial deformity, BMI, cement use, preoperative and one year Oxford Knee Scores (OKS), the active and passive range of motion (ROM) preoperatively, at the end of surgery and at three month and one year review. Results Average flexion values at each stage were as follows: preoperative (1110), end of surgery (1200), three months (1030) and one year (1070). There was a significant loss of flexion following TKA. The improvement between three months and one year however proved significant. Multiple regression analysis revealed that preoperative flexion was the strongest predictor of one-year flexion. Increasing age was also found to have a significant influence on final flexion. Gender, BMI, pre-operative OKS and cement use had no significant influence on final flexion. Patients tend to migrate towards a middle range of flexion i.e. those with poor flexion gain movement whilst those with good flexion tend to lose motion. Conclusions Preoperative flexion is the strongest predictor of final flexion following TKA

Aim: This study aims to establish whether or not mobile bearing TKR delivers the often stated benefits improved function and range of motion when compared to its fixed bearing equivalent. Methods and Results: A total of 357 patients undergoing TKR were randomly allocated to receive either a Mobile Bearing (181 knees) or a Fixed Bearing (176 knees) PSTKR. Further subrandomisation into patella resurfacing or retention was performed for both designs. All knees were scored using standard tools (Oxford, AKSS and SF12) preoperatively and at intervals postoperatively by independent observers. The range of motion increased from an average of 96 deg. (pre-op) to an average of 109 deg. at 1 year post-op for both the fixed and mobile bearing design. The management of the patella had no effect in either group. The knee society and knee function scores increased equally for both the fixed bearing and mobile bearing knees with no differences noted. Conclusion: There were no measurable differences in range of motion and clinical outcome scores at 1 year post-op for a mobile bearing design over its fixed bearing equivalent. It is likely that any potential advantages of a mobile bearing design will manifest in longevity rather than function

Introduction. There is uncertainty about the relationship between improvement in range of motion (ROM) and functional outcome or patient satisfaction after total hip arthroplasty (THA). Using data from a prospective multi-centre study we investigated this relationship. Methods. We recorded the Oxford Hip Score (OHS), Merle d'Aubigne and Postel score (MDA) and range of motion (ROM) preoperatively and at one and five years and a patient satisfaction questionnaire at five years. Complete 5 year data were available for 342 patients. Results. Improvement in ROM between one and five years was significant but minimal (p=0.005, year 1: mean 191(0–280), year 5: mean 191(70–300). Both absolute ROM (year 1, r=0.27; year 5, r=0.40) and ROM gain (r=0.45, 0.59) had a significant linear correlation (p=0.000). ROM improvement and MDA gain at five years had the best association and predicted 34% of the variability of the model. Absolute and ROM gain both had a linear correlation with OHS gain (p=0.001), but their predictive value was poor. ROM gain predicted OHS gain better than absolute ROM (year 1, r= 0.22 vs 0.10; year 5, r= 0.23 vs 0.09). The strongest association was between ROM gain and OHS gain at 5 years that explained 5% of the variability. There was no difference in absolute or ROM gain between those who were satisfied and not with surgery. Conclusion. There was minimal improvement in ROM after first year. ROM predicted surgeon reported assessment but not patient reported outcome. Relative gain predicted OHS improvement better than absolute ROM but did not affect patient satisfaction. It may be unnecessary to review patients in person to assess ROM after THA

Introduction: Gait analysis studies of patients following ankle arthrodesis have demonstrated a functional gait, largely due to tarsal hypermobility compensating for lost tibio-talar motion. We present a prospective radiographic study comparing the pre and post-operative range of motion of the foot following ankle arthrodesis. In this study, we introduce a radiographic technique using reliable anatomic landmarks to measure sagittal range of motion of the foot after ankle arthrodesis. Materials and Methods: Between 2002 and 2007, we performed 154 arthrodesis procedures of the ankle. Patients were suitable for inclusion in this study if an isolated arthrodesis of the ankle was performed for post traumatic arthritis with a minimum of 1 year follow-up without any additional hindfoot operations. Preoperative and post-operative passive plantar flexion and dorsiflexion radiographs were obtained in a standardized fashion. Anatomic landmarks were then used to measure and compare tibio-talar, mid-tarsal, and subtalar movement. Results: There were 48 patients who met the inclusion criteria for this study. Preoperatively, the mean measured motion was as follows: total sagittal motion 35o, tibio-talar motion18o, mid-tarsal (transverse tarsal + naviculo cuneiform + tarsometatarsal joints) motion 12o (34% of pre-op sagittal arc), subtalar motion 5.5o (15% of pre-op sagittal arc), and mid-tarsal + subtalar motion 17.5o (49% of pre-operative sagittal motion). These changed post operatively to a mean motion as follows: total sagittal motion 18.5o, (52% of preoperative sagittal motion), mid-tarsal motion 10o (28% of pre-op sagittal arc), subtalar motion 10.5o (27% of pre-op sagittal arc), and mid-tarsal + subtalar motion 20.5o (54% of pre-operative sagittal motion). Discussion: This study presents an accurate and reproducible means of measuring the sagittal plane range of motion of the hindfoot and ankle, and documents the presence of increased motion in the subtalar and talonavicular joints after ankle arthrodesis

The 3D interplay between femoral component placement on contact stresses and range of motion of hip resurfacing was investigated with a hip model. Pre- and post-operative contours of the bone geometry and the gluteus medius were obtained from grey-value CT-segmentations. The joint contact forces and stresses were simulated for variations in component placement during a normal gait. The effect of component placement on range of motion was determined with a collision model. The contact forces were not increased with optimal component placement due to the compensatory effect of the medialisation of the center of rotation. However, the total range of motion decreased by 33%. Accumulative displacements of the femoral and acetabular center of rotation could increase the contact stresses between 5–24%. Inclining and anteverting the socket further increased the contact stresses between 6–11%. Increased socket inclination and anteversion in combination with shortening of the neck were associated with extremely high contact stresses. The effect of femoral offset restoration on range of motion was significantly higher than the effect of socket positioning. In conclusion, displacement of the femoral center of rotation in the lateral direction is at least as important for failure of hip resurfacings as socket malpositioning

We hypothesize that tethering adhesions of the quadriceps muscle are the major pathological structures responsible for a limited range of motion in the stiff arthritic knee. Forty-two modified quadriceps muscle releases were performed on 24 patients with advanced osteoarthritis scheduled for total knee arthroplasty. The ranges of motion were documented intraoperatively both before and immediately after the release. Passive flexion improved significantly in all patients (mean, 32.4 degrees of improvement, P < .001) following a modified quadriceps release, despite any presence of osteophytes or severe deformities. These results strongly implicate adhesions of the quadriceps muscle to the underlying femur, which prevent the distal excursion of the quadriceps tendon, as the restrictive pathology preventing deep flexion in patients with osteoarthritis

The human hip capsule is a heterogeneous structure contributing greatly to the stability of this joint. A posterior approach to the hip necessarily sacrifices the ischio-femoral ligament but the decision to release the ilio-femoral and pubo-femoral ligaments remains at the discretion of the surgeon. This mechanical study aims to demonstrate that these anterior capsular structures, when left intact, may limit the external rotational range of motion when the variables of femoral offset, leg length and neck version are adjusted at the time of surgery. A dry bone pelvis-femur model was prepared and registered with the Stryker iNstride Hip Navigation software. A cemented 28 HDPE contemporary cup was inserted at 45° inclination with 20° of anteversion and a revision modular stem implanted in the femoral medullary canal. Artificial ilio-femoral and pubo-femoral ligaments were then prepared from plastinated rubber fabric and mounted in their anatomical positions. Using this model, a range of restoration body sizes was sequentially introduced to vary the offset. The rotational range of motion was then assessed. Repeat measurements were made using + 10mm length bodies across the same offset range. Finally, assessments of rotational range of motion were made using the 19mm body alone while varying neck lengths and degrees of version were trialled. All measurements of external rotation were taken in a position of 0° hip flexion and 0° abduction, as determined using the Stryker iNstride Hip Navigation System. As femoral offset was increased using our model, there was a progressive loss of external rotation. This consistent restriction of external rotation was further accentuated when +10mm length bodies were trialled across the same range of offsets. When a standard 19mm restoration body was placed and a range of heads trialled, it was again found that increasing neck length consistently correlated with a reduction in external rotation. Varying the restoration neck version with a standard head, it was found that increasing retroversion correlated with an increase in the external rotational range of motion. The findings of this mechanical study suggest a progressive limitation of hip external rotation with increasing femoral offset and leg length when the anterior capsular structures are intact. Such findings are of importance in pre-operative planning as they suggest that increases in these variables may significantly limit a patient’s range of external rotation unless the anterior hip capsule is released. Such considerations must of course be balanced against the potential to destabilise the hip if too extensive a soft tissue release is performed. The artificial model used in this study is intended to approximate the human hip and its ligaments. The absolute values for rotational range of motion measured using the Stryker hip navigation system are less significant than the overall trend which they suggest. A patient-based study is now planned to further test these findings

Introduction: Experimental studies in anatomic full size hip models indicate that larger femoral heads offer potential in providing greater hip range of motion and joint stability. We studied the effects of increasing head diameter from 28mm to 36 mm in total hip replacement (THR) on the range of flexion and abduction. Methods: 243 patients who underwent primary total hip replacement with S ROM prosthesis between July 1996 and June 2004 were studied. 151 patients (77 male and 74 female) underwent THR with 28 mm head and 92 patients (38 male and 54 female) underwent THR with 36 mm head. The range of flexion and abduction were studied and statistical analysis was performed using the Student t-test. We monitored the dislocation rate in both groups. Results: The mean flexion is 87.0 for the 28 mm group and 89.6 for the 36 mm group. The mean abduction is 27.77 and 27.98 for 28mm and 36mm groups respectively. Even though there is a slight increase in the mean flexion and abduction from the 28mm to 36mm group, this increase in not found to be statistically significant. For flexion (2.6 (−0.85 to 3.2); p=0.377), and for abduction (0.02 (−2.37 to 1.94); p=0.847). Three hips dislocated in the 28mm group (2%) but none of the hips in 36mm group has dislocated. Discussion: Even though experimental studies indicate improvement in range of motion with increasing head diameter in THR, this effect is not reflected in our clinical study. But there is improvement in the joint stability by using a prosthesis with larger head diameter as evidenced by a reduction in the dislocation rate

Abstract. Introduction. Persistent medial laxity increases the risk of failure for ACL reconstruction. To address this, multiple reconstruction techniques have been created. To date, no single strand reconstruction constructs have been able to restore both valgus and rotational stability. In response to this, a novel single strand Short Isometric Construct (SIC) MCL reconstruction was developed. Methods. Eight fresh-frozen cadaveric specimens were tested in three states: 1) intact 2) after sMCL and dMCL transection, and 3) after SIC MCL reconstruction. In each state, four loading conditions were applied at varying flexion angles: 90N anterior drawer, 5Nm tibial external rotation torque, 8Nm valgus torque, and combined 90N anterior drawer plus 5Nm tibial external rotation torque. Results. Transection of the sMCL and dMCL resulted in increased laxity with external rotation torque, valgus torque, and combined anterior drawer plus external rotation. SIC MCL reconstruction restored external rotation and valgus stability to intact levels throughout all degrees of flexion. In the combined test SIC MCL reconstruction also restored stability to intact levels for both anterior distraction and external rotation throughout the range of motion. No significant differences were noted between intact and SIC reconstruction. Conclusion. The single-limb short isometric construct (SIC) MCL reconstruction restored native valgus and rotatory stability to a sMCL- and dMCL-deficient knee in biomechanical testing

Distal radius fractures (DRF) are the most common fracture type in all age groups combined. Unstable DRF may be surgically managed with volar or dorsal plate fixation. Dorsal plating has traditionally been associated with decreased range of motion (ROM). However, this assumption has not been recently assessed to determine whether functional ROM is achievable (approximately 54o of flexion and 60o of extension) with recent advances in lower profile dorsal plate design. The aim of this study was therefore to compare ROM and patient reported outcome measures between volar and dorsal plating methods for DRF. A meta-analysis was performed to directly compare ROM and DASH scores between dorsal and volar plate fixation for DRF. Separate literature searches for each plating method were performed using MedLine and EMBase on January 28, 2018. Exclusion criteria consisted of non-English articles, basic science articles, animal/cadaver studies, case studies/series, combined operative approaches, papers published more than 20 years ago and paediatric studies. Only articles with at least one year patient follow-up and a) ROM and AO distal radius fracture classification, or b) DASH scores were included. Raw data was extracted from all articles that met inclusion criteria to compile a comprehensive dataset for analysis. Descriptive statistics with z-score comparison for AO classification or a two-tailed independent samples t-test for ROM and DASH scores for dorsal versus volar plating were performed. Significance was defined as p < 0 .05. After rigorous screening, 6 dorsal plating and 43 volar plating articles met inclusion criteria for ROM/AO classification versus 6 dorsal plating and 44 volar plating articles for DASH scores. The weighted means of flexion (dorsal 54.9o, SD 9.3, n=257, volar 61.3o, SD 11.5, n=1906) and extension (dorsal 60.0o, SD 12, n=257, volar 62.8o, SD 11.4, n=1906) were statistically significantly different (both p < 0 .001) between the two plating methods. The volar plating group had a significantly higher proportion of AO type C fractures (dorsal 0.5, n =169, volar 0.6, n=1246, p < 0 .001). The weighted means of reported DASH scores were not significantly different between dorsal (14.01, SD 14.8) versus volar (13.6, SD 12.8) plating (p=0.54). Though mean wrist flexion and extension were statistically different between the dorsal versus volar plating methods, the difference between group means was less than 5o, which is unlikely to be clinically significant. Additionally, we did not find a significant difference in DASH scores between the two plating methods. Taken together, these findings imply that the statistical difference in ROM outcomes are likely not clinically significant and should therefore not dictate choice of plating method for fixation of DRF

Introduction: Experimental studies in anatomic full size hip models indicate that larger femoral heads offer potential in providing greater hip range of motion and joint stability. We studied the effects of increasing head diameter from 28mm to 36 mm in total hip replacement (THR) on the range of flexion and abduction. Methods: 243 patients who underwent primary total hip replacement with S ROM prosthesis between July 1996 and June 2004 were studied. 151 patients (77 male and 74 female) underwent THR with 28 mm head and 92 patients (38 male and 54 female) underwent THR with 36 mm head. The range of flexion and abduction were studied and statistical analysis was performed using the Student t-test. We monitored the dislocation rate in both groups. Results: The mean flexion is 87.0 for the 28 mm group and 89.6 for the 36 mm group. The mean abduction is 27.77 and 27.98 for 28mm and 36mm groups respectively. Even though there is a slight increase in the mean flexion and abduction from the 28mm to 36mm group, this increase in not found to be statistically significant. For flexion (2.6 (−0.85 to 3.2); p=0.377), and for abduction (0.02 (−2.37 to 1.94); p=0.847). Three hips dislocated in the 28mm group (2%) but none of the hips in 36mm group has dislocated. Discussion: Even though experimental studies indicate improvement in range of motion with increasing head diameter in THR, this effect is not reflected in our clinical study. But there is improvement in the joint stability by using a prosthesis with larger head diameter as evidenced by a reduction in the dislocation rate

Aim: To study the outcome of the total excision of the clavicle focusing on the mobility of the upper limb. Material and Method: We performed total claviculectomy in five patients with a neoplasm of the clavicle. This operation is requiring because there is a high risk of severe neurovascular damage due to the close vicinity of major neural and vascular elements. The growth was always excised en block with the clavicle to avoid local recurrence. Specimens were sent for histology, microbiology and genetic studies. Results: Our patients had no complications so they could start rehabilitation soon. An abnormal scapular rhythm was noticed during shoulder abduction but normal motion was restored with exercises. The patients restored normal shoulder range of motion, they had no pain and there was no cosmetic problem. All patients were found and examined after 38±24 months. They maintained the excellent initial result and all they had returned to their former jobs and activities. Discussion and Conclusions: Surgery for primary tumors of bone aims on the patient’s survival and on the sparing of a functioning limb. Any skepticism about total cla-viculectomy is not justified as this procedure, often followed by adjuvant treatments, gives the patient a chance to save his life while exercise helps restoring the normal mobility and function of the upper limb. The clavicle provides the insertion fields for several muscles, suspends and supports the arm. Our cases show that this bone is an accessory to the skeleton and its absence does not cause any functional problems

Background. Patient satisfaction after total knee arthroplasty (TKA) has been lower than after a similar procedure, total hip arthroplasty. Poor subjective outcomes after TKA may be partially explained by abnormal kinematics patterns after TKA. The purpose of this study was to analyse rotational kinematics patterns in knees that had undergone posterior stabilized (PS)-TKA, and to clarify the relationships between rotational kinematics patterns and patient satisfaction, as well as between rotational kinematics patterns and knee function. Materials & Methods. A total of 49 osteoarthritis knees after primary PS-TKA (NexGen LPS-Flex fixed bearing knee system) were included in this study; deformed valgus, severe flexion contractures, and highly unstable knees were excluded. We used a computer navigation system and measured knee kinematics after each surgery was completed. A single investigator gently applied a manual range of motion from full extension to flexion. The angle of the internal rotation of the tibia was measured automatically at 0º, 30º, 45º, 60º, and 90º, along with maximum extension and flexion. We categorized the post-operative rotational kinematics patterns for individual cases, focusing on the initial knee flexion from 0–30º. Type A corresponded to an increased internal rotation angle of the tibia during the initial knee flexion (screw home-like movement). Type B corresponded to an increased external or an unchanged rotation angle of the tibia. We examined the range of motion (ROM) at 6 months after surgery and assessed the 2011 Knee Society Score (2011 KSS) at ≥1 year following surgery. Statistical analysis. The difference between the two groups was compared using a Wilcoxon rank sum test. Analyses were performed with JMP statistical software v8.0 (SAS Institute). A p-value of <0.05 was regarded as significant. Results. The tibia exhibited an average of 5º of internal rotation at initial knee flexion. The type A kinematics pattern achieved a better ROM and functional activity score (2011 KSS) than the type B kinematics pattern. Discussion. Modern TKA implants have been designed to reproduce normal knee kinematics to achieve better patient satisfaction and knee function. However, few reports have described the relationship between the rotational kinematics patterns at initial knee flexion and patient satisfaction. In our study, the type A postoperative rotational kinematics pattern (screw home-like movement) had better ROM and functional activity score than the type B kinematics pattern. The movement toward the internal rotation of the tibia during initial knee flexion might be important in achieving better clinical results after PS-TKA

Introduction:. Implant dislocations are often caused by implant or bone impingement, and less impingement is critical to prevent dislocations. Several reports demonstrated that greater femoral offset delayed bony impingement and led to an improved range of motion (ROM) after THA. Therefore, an increase in the femoral offset may improve ROM and decrease implant dislocation. The aim of this study was to clarify the effect of the femoral offset in avoiding component or bony impingement after total hip arthroplasty (THA). Methods:. Seventy-eight patients underwent THA with a Pinnacle cup and Summit stem (DePuy). Intraoperative kinematic analysis was performed with a navigation system, which was used to obtain intraoperative range of motion (ROM) measurements during trial insertion of stems of 2 different offset lengths with the same head size. Further, ROM was also measured after actual component insertion. Results:. Maximal ROM was independent of the femoral offset of the stem in each patient (Figure 1). Further, we measured the intraoperative maximal ROM corresponding to high offset stems of 2 different lengths (stem sizes 1–3; + 6 mm, stem sizes 4–9; +8 mm), and compared the maximal ROMs between the standard- and high-offset stems. There were no statistically significant differences (Figure 2). These results indicate that an excessive offset length of the stem may not affect ROM. We also analyzed the correlation between femoral offset length and ROM, and found that the range of external rotation was significantly greater in patients with greater femoral offset (RR = 0.36, P = 0.02) (Figure 3). However, we could not show any correlation for the ROM values in the other planes of motion. Discussions:. Summit stem is available in 9 different sizes with standard offset lengths ranging from 36.0 mm to 44.0 mm. The average offset of Summit stem was larger than other stems. These differences in offset length could be the reason why the high offset stem did not change maximal ROM in our study. Further, the summit stem employs 2 different types of high offset lengths (+6 mm and +8 mm). We did not find any difference in maximal ROM even after using the +8 mm high offset stem. Our results indicated that even the Summit standard offset stem might have enough femoral offset to avoid implant/bone impingement. However, several reports showed that increasing stem offset increased the bending moment on the prosthesis and increased the strain in the medial cortex, and may lead to early failure of the femoral component. Nevertheless, selection of the offset stem should be performed carefully to prevent offset complications

Four-Corner Fusions (4CF) and Proximal Row Carpectomies (PRC) are common procedures utilized to treat carpal pathologies and radial sided wrist pain. Usually, the range of motion (ROM) and grip strength (GS) is affected by such conditions. Literature quotes significant reduction in ROM (50–60%) and grip strength (GS) (80% of normal) with PRC and 4CF. This study aims to determine the correlation between pre-operative ROM and GS and post-operative ROM and GS for patients with wrist pain undergoing PRC or 4CF. We hypothesize that ROM between pre-operative and post-operative patients does not change, but GS improves. Data from a prospective database of patients with wrist pain was searched to identify patients who have undergone PRC or 4CF with one year follow-up completed in the past two years. 17 such participants were identified. The diagnosis, pre-operative ROM in flexion, extension, radial deviation, ulnar deviation, pronation and supination, as well as GS at time of surgery and at six months and one year follow up were identified and assessed. The data was analysed to determine correlation between pre-and postoperative ROM and GS. The analysis was subdivided to compare patients treated with PRC versus patients with 4CF. No significant difference between pre- and post-operative ROM was detected, except in flexion at 6 months post-operatively. The average flexion was significantly lower at 6 months (p=0.0251) compared to pre-operative levels. Average flexion pre-operatively and at 6 and 12 months was found to be 46.6 (SD=15), 34.3 (SD=13.3), 51.2 (SD=21.5) respectively. Extension was at 41.4 (SD=15.3) pre-operatively and at 33.4 (SD=12.8) and 42.1 (SD=15.5) at 6 and 12 months post-operatively. Similarly, radial and ulnar deviation averages pre-operatively and at 6 and 12 months post-operatively were found to be 11.33 (SD=5.9), 11.9 (SD=4.5), 16 (SD=8.2) [radial deviation] and 24.1 (SD=8.3), 21.4 (SD=7.3), 26 (SD=12.8) [ulnar deviation]. No significant difference was found in GS at 6 months post-operative. However, significant difference at 12 months post-operatively was observed with an average GS of 28.4 kg (SD=12.8) [p=0.0385]. Average GS pre-operatively and at 6 months was 15.8 kg (SD=9.7) and 17.3 kg (SD=8.9) respectively. This study provides an insight on ROM and GS after PRC and 4CF. It shows that patients do not gain or lose ROM after surgery. As expected, GS improves with treatment as the pain diminishes. It is interesting to note that flexion gets worse at 6 months post-operatively before it bounces back to pre-operative levels

In this prospectively randomized study, we compared the changes in the range of motion (ROM) in posterior cruciate ligament-retaining (PCLR) (n=50) and -sacrificing (PCLS) (n=50) total knee arthroplasties during the perioperative period. The median ROM in PCLR prostheses was 122.5° preoperatively, 120.0° intraoperatively, and 100.0° at discharge, and 115.0°, 120.0°, and 95.0°, respectively, in PCLS. The designs did not differ statistically in each period (p> 0.05). Both designs showed significant correlations between the preoperative and intraoperative ROM, and between the preoperative and discharge ROM. Only the PCLS showed a significant correlation between the intraoperative and discharge ROM. Since the PCL tenses with flexion, the degree of preoperative degeneration, intraoperative recession, and postoperative tension of the PCL may have played a major role in the results. The PCLS design has an advantage in rehabilitation planning because of the predictable changes in the ROM during the perioperative period, although the acquired average ROM at discharge did not differ statistically

Introduction: ROM after TKA can be influenced by multi-factors such as preoperative range of motion, body habitus, implant design, intraoperative surgical technique, and postoperative rehabilitation. Recently many implant manufacturers have made modifications to traditional total knee designs to improved maximal knee flexion and range of motion. Some posterior cruciate ligament (PCL) stabilized total knee prostheses that incorporate design features intended to improve knee kinematics in high flexion were introduced and the use of these prostheses has attracted attention. Recently in the cruciate retaining (CR) prosthesis, high-flexion knee (CR-Flex) and gender-specified prosthesis were designed to allow a greater and safer flexion after TKA. The aim of this study was to evaluate the effect of cruciate retaining typed different femoral component design on knee range of motion using a computerized navigation system. Materials & method: 30 patients who underwent primary TKA because of primary osteoarthritis were included. EM navigation system was used in all cases. After tibia and femoral cutting using standard CR cutting block, standard fixed bearing CR knee (NexGen CR, Zimmer, Warsaw, IN) trial was inserted. If surgeon is satisfactory with alignment, stability and ligament balancing, the maximal knee extension and flexion was recorded using gravity by navigation system. Then, high-flexion fixed bearing CR knees(NexGen CR-Flex and Gender solution NexGen CR-Flex knee, Zimmer, Warsaw, IN) trial was inserted after additional posterior cutting. The maximal knee extension and flexion was evaluated exactly same way. Results: Preoperative mean varus deformity was 10.52°. The mean flexion contracture was 7.52±6.81° and further flexion 129.9±7.94°. The average intraoperative maximal flexion of NexGen CR was 133.5±5.35° (125–146°) and that of hyper-flexion design were 135.5±5.77°(125–147°) in Nexgen CR-Flex and 136.1±5.76°(126–146°) in Gender knee. All knees showed greater than 125° of flexion regardless of the implant design. All knees can achieve physiologic leg alignment and nearly full extension of the knee after operation. Conclusion: Hyper flexion designs showed subtle increase in mean maximal flexion and overall range of motion of the knee compared with the standard design, when it measured using navigation system intraoperatively. But clinically, it is not certain that these differences can lead to significant improvement of range of motion

Introduction: A femoral stem with a modular neck can optimize the range of motion (ROM). The hip’s maximal rotational ranges were evaluated with three different modular neck versions. Methods: This study included 52 primary implantations of a short cementless anatomical modular stem using navigation control. ROM was measured using the sagittal femoral and the anterior pelvic plane as references. Once the cup and stem were implanted, three different neck versions (retroverted: −7°, neutral: 0, and anteverted: +7°) were used. A dynamic test measured the maximal ROM for each patient and neck version. Simultaneously, the surgeon evaluated the stability and the absence of posterior impingement. Results: The average rotational range in extension was 72° for a retroverted neck, 71° for a neutral neck and 76° for an anteverted neck. This difference was not clinically significant. The equilibrium of the rotational ranges appeared better with a retroverted neck (average center: −6°) than with a neutral neck (average center: −8°) or an anteverted neck (average center: −13°) (p< 0,001). The equilibrium of the rotational range correlated with the femoral stem anteversion (r=−0.70, p< 0.001) and with the combined anteversion (r=−0.74, p< 0.001). Finally, an anteverted neck was used in 3 cases, a neutral neck in 25 cases and a retroverted neck in 24 cases. The surgeon’s final neck version choice obtained the best equilibrium in 60% of cases. Discussion/Conclusion: The study showed that balancing the hip rotational ranges may be a helpful operative test when choosing a modular neck without a navigation system

The aim of this study was to investigate the pre-operative factors predicting the knee range of motion during stair ascending and descending a year after total knee arthroplasty. The pre-operative and one year post-operative results of fifty six patients with osteoarthritis were analysed. Range of knee motion during stair ascent and descent was recorded using electrogoniometry. Pre-operative measures were grouped in three different domains; the Demographic Domain with age and Body Mass Index (BMI), the Body Function Domain with knee range of motion in long sitting (ROMsit), Knee extensor moment, Pain on a Visual Analogue Scale and the stiffness component of the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and thirdly the Psychosocial Domain with the Tampa scale for ‘fear of movement’ (TSK) and the sense of helplessness due to pain. Hierarchical Multiple Regression was used to analyse the relative importance of measures grouped into the three domain blocks on range of motion of the operated knee during stair ascent and descent. Model 1 contained domain block 1, model 2 included domain blocks 1 and 2 and model 3 included domain blocks 1,2 and 3. Learned helplessness was a significant predicting factor for stair descent (beta; −0.538, p=0.025) while for stair ascent, age (beta 0.375, p=0.005) and ROMsit (beta 0.365, p=0.021) were significant predicting variables. These results show that postoperative stair ascent and descent are predicted by different pre-operative factors. For stair ascent the demographic factors age and function factor ROM are important, while for stair descent, only the addition of the psychosocial factors in model 3 resulted in a significant change. These results indicate that treatment of patients with end-stage osteoarthritis should not only be aimed at improving range of motion of the knee but should also take into account psychosocial variables such as a sense of helplessness due to pain

Distal radius fractures (DRF) are the most common fracture type in all age groups combined. Unstable DRF may be surgically managed with volar or dorsal plate fixation. Dorsal plating has traditionally been associated with decreased range of motion (ROM). However, this assumption has not been recently assessed to determine whether functional ROM is achievable (approximately 54 degrees of flexion and 60 degrees of extension) with recent advances in lower profile dorsal plate design. The aim of this study was therefore to compare ROM and patient reported outcome measures between volar and dorsal plating methods for DRF. A meta-analysis was performed to directly compare ROM and Disabilities of Arm, Shoulder and Hand (DASH) scores between dorsal and volar plate fixation for DRF. Separate literature searches for each plating method were performed using MedLine and EMBase on January 28, 2018. Exclusion criteria consisted of non-English articles, basic science articles, animal/cadaver studies, case studies/series, combined operative approaches, papers published more than 20 years ago and paediatric studies. Only articles with at least one year patient follow-up and a) ROM and AO-OTA distal radius fracture classification, or b) DASH scores were included. Raw data was extracted from all articles that met inclusion criteria to compile a comprehensive dataset for analysis. Descriptive statistics with z-score comparison for AO-OTA classification or a two-tailed independent samples t-tests for ROM and DASH scores for dorsal versus volar plating were performed. Significance was defined as p < 0 .05. After rigorous screening, six dorsal plating and 43 volar plating articles met inclusion criteria for ROM/AO-OTA classification versus six dorsal plating and 44 volar plating articles for DASH scores. The weighted means of flexion (dorsal 54.9 degrees, SD 9.3, n=257, volar 61.3 degrees, SD 11.5, n=1906) and extension (dorsal 60 degrees, SD 12, n=257, volar 62.8 degrees, SD 11.4, n=1906) were significantly different (both p < 0 .001) between the two plating methods. The volar plating group had a significantly higher proportion of type C fractures (dorsal 0.5, n =169, volar 0.6, n=1246, p < 0 .001). The weighted means of reported DASH scores were not significantly different between dorsal (14, SD 14.8) versus volar (13.6, SD 12.8) plating (p=0.54). Though mean wrist flexion and extension were statistically different between the dorsal versus volar plating methods, the difference between group means was less than 5-degrees, which is unlikely to be clinically significant. Additionally, there was no significant difference in DASH scores between the two plating methods. Taken together, these findings imply that the statistical difference in ROM outcomes are likely not clinically significant and should therefore not dictate choice of plating method for fixation of DRF

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 goniometers and compared to radiographs of these patients' knees in full active flexion and extension. Four methods of plotting the range of motion on the radiographs were compared. The intra-class correlation coefficient (ICC) for inter-rater reliability using the goniometer was very high; ICC=0.90 in extension and 0.85 in flexion. The best ICC for radiographic measurement in extension was 0.86 indicating substantial agreement and best ICC in flexion was 0.95 (method 4). ICC for intra-rater reliability was 0.98 for extension and 0.99 for flexion on radiographic measurements. Measuring range of motion of the knee has never previously been validated in the literature. This study has allowed us to set up a “Virtual Knee Clinic,” combining postal questionnaires and radiographic measurements as a surrogate for knee function. We aim to maintain high quality patient surveillance following knee arthroplasty, reduce our new to follow-up ratios in line with Department of Health guidelines and improve patient satisfaction through reduced travel to hospital outpatients

Purpose of the study: The theoretical advantage of a disc prosthesis compared with fusion is to preserve spinal mobility. The purpose of our study was to determine the relationship, at nine years follow-up, between range of motion and clinical outcome after lumbar disc replacement. Material and methods: This retrospective analysis concerned the clinical and radiographic outcome observed in 38 patients who had undergone one- or two-stage disc replacement surgery (51 implanted prostheses). Mean follow-up was 8.6 years (range 6.9–10.7). Clinical outcome was assessed with the Stauffer-Coventry modified score (SCM), the Oswestry score (ODQ) and a visual analog scale (VAS) for lumbar and radicular pain. Flexion-extension range of motion (ROM) was measured on the upright films (Cobb method) at last follow-up. Each clinical element was compared with the ROM (Spearman coefficient of correlation). Two groups of patients were distinguished: high (> 5°) and low ≤ 5°) ROM for comparison with the Mann-Whitney test. Results: The Spearman coefficient of correlation disclosed a weak to moderate but statistically significant association between ROM, lumbar VAS (r=−0.35, p=0.034), ODQ (r=−0.33, p=0.046), SCM (r=0.42, p=0.0095); but no significant correlation between ROM and radicular VAS (r=−0.12,p=0.48). Patients with greater ROM had better clinical results and ODQ (mean difference 6.3 points, p=0.031) and SCM (mean difference 2.2 points, p=0.017); but no significant difference between the preoperative characteristics in each group (age, sex, weight, surgical history, lumbar and radicular pain, ODQ and SCM). Discussion: There are no data in the literature comparing range of motion and clinical outcome after lumbar disc replacement. The present study demonstrated a weak to moderate but statistically significant relationship (r=0.35) between range of flexion-extension motion and clinical outcome at nine years. In addition, patients with lesser ROM (< 5°) have slightly less favorable results compared with those with greater ROM (> 5°). This study suggests the preservation of motion has a positive effect on mid-term clinical outcome. Conclusion: These results need to be confirmed with long-term prospective data comparing discal prosthesis with fusion and non-surgical treatment in order to demonstrate the usefulness of preserving motion on the quality of the clinical outcome

Background Context: Total disc replacement (TDR) gained enormous popularity as a treatment option for symptomatic degenerative disc disease in the last few years. But the impact of the prosthesis design on the segmental biomechanics in most instances still remains unclear. As TDR results in a distraction of the capsuloligamentous structures, the disc height seems to be of crucial importance for the further biomechanical function of the operated level. Yet the biomechanical role of disc height after TDR still remains unclear. Purpose: The purpose of study was to evaluate the influence of prosthesis height after total disc replacement on: 1) the sagittal balance and 2) the range of motion. Study design: A radiological and an in-vitro biomechanical study. Method: 6 human, lumbar spines L4–L5 were tested in vitro.The segmental lordosis of the specimen were measured on plain radiographs and the range of motion was measured for all six degrees of freedom with a previously described spine tester. The segmental lordosis and the range of motion at level L4–L5 was evaluated for following settings: 1) intact state 2) after implantation of a prosthesis with 5mm endplate 3) after implantation of a prosthesis with 7mm endplate. The prosthesis used was a prototyp and had a constrained design with a ball and socket principle. Results: Even the implantation of the lowest possible prosthesis height (5mm endplate) resulted in an increase of segmental lordosis (intact: 6.9; 5mm endplate: 8.8; p=0,027). Using a higher prosthesis (7mm endplate) further increased the segmental lordosis (10.5, p=0.041). The implantation of the lowest prosthesis resulted in significant increase of movement capability compared to the intact status for flexion-extension (8.6 vs 11.4; p=0.046) and axial rotation (2.9 vs 5.1; p=0.028). Lateral bending did not changed significantly (9.4 vs 8.6; p=0.345). The implantation of the higher prosthesis (7mm endplate) resulted in similar movement capability compared to intact status for flexion-extension (8.4 vs 8.6; p=0.116) and axial rotation (3.3 vs 2.9; p=0.600). Lateral bending decreased significantly compared to the intact status (5.1 vs 8.6; p=0.028). Conclusion: Total disc replacement with the lowest prosthesis height inherently increases segmental lordosis. Further increase of disc height results in a significant enhancement of segmental lordosis by decreasing the range of motion for all three degrees of freedom. Yet, methods for scheduling the ideal disc height preoperatively, to provide a physiological lordosis thereby maintaining physiological range of motion postoperatively, seems not to be established already

Background. With the projected 673% increase in total knee arthroplasties (TKA) through the year 2030 in the United States alone, arthrofibrosis will become one of the more commonly encountered challenges in orthopaedic surgery. Methods. After obtaining Institutional Review Board approval we retrospectively reviewed the results of 19 patients with a mean age at the time of surgery of 55.4 years (41–83) who underwent arthroscopic lysis of adhesions (ALOA) for arthrofibrosis at a minimum of 3 months after primary total knee arthroplasty by a single surgeon (SJC) at a single institution. All patients underwent a standardized adhesiolysis in the operating room. All patients had a minimum of 6 months follow up. All patients underwent arthroscopic lysis of adhersions for restricted range of motion (ROM) after failing aggressive physical therapy. We defined restriction in ROM as any extension lag >5°, and flexion ≤90°. Eight patients underwent manipulation under anesthesia for ROM less than 90° after ALOA. Results. Preoperative ROM was compared to ROM measured at most recent follow up. The mean knee arc of motion improved by 17° (p=0.0402), the mean flexion arc improved from 17° (p=0.0263) and the number of patients with flexion less than or equal to 90° decreased from 13 patients to 6 patients (p=0.0049). There were no patients that required polyethylene exchange, no periprosthetic joint infections or intraoperative fractures and no patients who suffered deep vein thrombosis as a result of the procedure. Conclusion. We conclude that arthroscopic lysis of adhesions for treatment of arthrofibrosis after total knee arthroplasty is a safe and effective way to improve post-operative range of motion

Reverse total shoulder replacement is a viable surgical option for Cuff Tear Arthropathy. Short term results have been promising. Longer term follow-up has demonstrated a high rate of scapular notching. This is attributed to mechanical impingement between the humeral cup and scapular neck when the arm is fully adducted. The long term sequelae of scapular notching are unclear but there is concern that it may compromise fixation of the glenoid component and affect functional outcomes. Design modifications to address this problem include the newly available eccentric glenospheres and larger diameter glenospheres. These glenospheres are designed to offer greater ranges of motion and theoretically may reduce the risk of impingement and notching. The purpose of this biomechanical study is to demonstrate the difference in range of motions with each design of glenosphere. To our knowledge there is no published literature evaluating this design differences. The SMR (Lima Orthotec) reverse total shoulder prothesis was implanted into a synthetic bone model (Sawbones, Pacific Laboratories, Vashon, Washington). Four different types of glenospheres (Standard 36 mm, Eccentric 36 mm, Standard 44 mm, Eccentric 44 mm) were then implanted into the same model which was fixed on a measurement table. The precision coordinate measurement device (FARO-Arm, SO6/Rev22, FARO Technologies Inc., Lake Mary, Florida) was used to establish the centres of rotation and ranges of motion. To date, the collection of data has just been completed, but the data are yet to be analysed. In conclusion, this is a biomechanical study evaluating the ranges of motion and risk of notching, comparing different designs of glenospheres in Reverse Total Shoulder Joint Replacement

Abstract. Introduction. Historic MCL reconstruction techniques focused on the superficial MCL to restore valgus stability while overlooking tibial external rotation and the deep MCL. This study assessed the ability of a contemporary medial collateral ligament (MCL) reconstruction and a deep MCL (dMCL) reconstruction to restore rotational and valgus knee stability. Methods. Six pairs fresh-frozen cadaveric knee specimens with intact soft tissue were tested in four states: 1) intact 2) after sMCL and dMCL sectioning, 3) contemporary MCL reconstruction (LaPrade et al), and 4) dMCL reconstruction. In each state, four loading conditions were applied at varying flexion angles: 8Nm valgus torque, 5Nm tibial external rotation torque, 90N anterior drawer, and combined 90N anterior drawer plus 5Nm tibial external rotation torque. Results. Transection of the sMCL and dMCL resulted in increased laxity with valgus torque, external rotation torque, and combined anterior drawer plus external rotation. dMCL reconstruction restored external rotation stability to intact levels throughout all degrees of flexion but did not restore valgus stability at any flexion angle. Contemporary MCL reconstruction restored valgus and external rotation stability at 0° and 20° and valgus stability at 40°. In the combined anterior drawer plus tibial external rotation trial, the dMCL restored stability at 20° and improved stability between 40° and 90° flexion. Conversely, the contemporary MCL reconstruction did not restore stability at any degree of flexion. Conclusion. Deep MCL reconstruction restored rotational stability to the knee throughout range of motion but not valgus stability. The contemporary MCL reconstruction restored stability only near full extension