Introduction and Objective. Kinesiophobia, the fear of physical movement and activity related to injury vulnerability, has been linked to sub-optimal outcomes following total knee replacement (TKR). This systematic review has two aims: to define the relationship between kinesiophobia and functional outcomes, pain and range of motion following TKR, and to evaluate published treatments for kinesiophobia following TKR. Materials and Methods. A primary search was performed in March 2020. English-language studies recruiting adult primary TKR patients, using the Tampa Scale of Kinesiophobia (TSK) were included. Study quality was assessed using the Newcastle Ottawa Scale for cohort or case control studies, and the Cochrane Collaboration Risk of Bias tool for randomised controlled trials. Results. All thirteen included papers (82 identified) showed adequately low risk of methodological bias. TSK1 (activity avoidance) correlated with WOMAC functional score at 12 months in three studies (r=0.20 p<0.05, R=0.317 p=0.001, and correlation coefficient 0.197 p=0.005). TSK score significantly correlated with mean active range of motion (ROM) at six months (105.33 (SD=12.34) vs 85.53 (SD=14.77) p=0.000) post-operation. Three post-operative interventions improved TSK score vs control following TKR: a home-based functional exercise programme (TSK −14.30 (SD=0.80) vs −2.10 (SD=0.80) p<0.001)), an outpatient CBT programme (TSK 27.76 (SD=4.56) vs 36.54 (SD=3.58), and video-based psychological treatment (TSK 24 (SD=5) vs 29 (SD=5) p<0.01). Conclusions. Kinesiophobia negatively affects functional outcomes up until one year post-operatively, while active ROM is reduced up to six months post procedure. Post-operative functional and psychological interventions can improve kinesiophobia following TKR

Osteoarthritis is one of the major causes of immobility. Most commonly, osteoarthritis manifests at the knee joint. Prevalence of knee osteoarthritis (KNOA) increases with age. Another important risk factor for KNOA is obesity. Research has shown that obese subjects have almost four times the risk of developing KNOA, which may be explained by both an increased knee loading. In medial compartment KNOA, the knee adduction moment (KAM) during gait is considered a marker for disease severity. KAM is dependent of the magnitude of the ground reaction force and its moment arm relative to the knee joint centre. In addition, obesity has been reported to augment KAM during gait. However, after removal of the direct contributions of body weight, KAM parameters may be different due to obesity-related gait adaptations to limit knee loading. While KAM has been thoroughly investigated during gait, little is known about KAM during stair negotiation, during which knee loads are higher compared to gait. The aim of the current study is therefore to compare normalized KAM during the stance phase of stair negotiation between lean KNOA patients, obese KNOA patients, and healthy controls. This case control study included 20 lean controls, 14 lean KNOA patients, and 16 obese KNOA patients. All subjects ascended and descended a two-step staircase at a self-selected, comfortable speed. Radiographic imaging and MRI were used to evaluate knee cartilage and KNOA status. Motion analysis was performed with a three-dimensional motion capture system. Kinetic data were obtained by one force platform. The parameters of study included: stance phase duration, toe-out angle, KAM peaks and KAM impulse. During stair ascent obese KNOA patients showed a longer stance phase than healthy controls (P 0.050). Despite high between-subject variability, KAM impulse was found 45% higher in the obese KNOA group during stair descent, when compared to healthy controls (P =0.012). The absence of a significant effect of groups on the normalized KAM during stair negotiation may be explained by a lower ambulatory speed in the obese KNOA group, that effectively lowers GRFz. Decreasing ambulatory speed may be an effective strategy to lower KAM during stair negotiation

Ponseti method has become the most common and validated initial non-operative and/or minimally invasive treatment modality of idiopathic clubfoot regardless of the severity of the deformity worldwide. Despite hundreds of publications in the literature favoring Ponseti method, the data about secondary procedures performed in the follow-up period of clubfoot and their incidence remains sparse and given as small details in the articles. The objective of this study was to analyse our incidence of secondary procedures performed in the midterm followup period of idiopathic clubfoot patients treated with Ponseti method and review of the relevant literature. For this purpose 86 feet of 60 patients with idiopathic clubfoot who were treated with original Ponseti method were enrolled in this retrospective case control study. Unilateral ankle foot orthosis (AFO) was used rather than standart bar-connected foot abduction orthosis varying from 12 months to 25 months in the follow-up period and 74 of 86 (86%) feet required percutaneous achilles tenotomy. The average age of initial cast treatment was 12.64 days (range 1 to 102 days). The mean follow-up time was 71 months (range 19 to 153 months). Thirty seven feet of 24 patients recieved secondary procedures (43%) consisting of; supramalleolary derotational osteotomy (SMDO) (1 patient/2 feet), complete subtalar release (3 patients/5 feet), medial opening lateral closing osteotomy (double osteotomy) (2 patients/3 feet), double osteotomy with transfer of tibialis anterior tendon (TTAT) (2 patients/3 feet), partial subtalar release (PSTR) (3 patients/5 feet), PSTR with SDO (1 patient/1 foot), posterior release (PR) with repeated achillotomy (1 patient/2 feet), TTAT (6 patients/10 feet), TTAT with PR (2 patients/2 feet), TTAT with Vulpius procedure (1 patient/1 foot) and TTAT with SMDO (2 patients/3 feet) respectively. The amount of percutaneous achilles tenotomy (86%) in our study correlated with the literature which ranged from 80 to 90 %. The transfer of tibialis anterior tendon continued to be the most performed secondary procedure both in our study (51%) and in the literature, but the amount of total secondary procedures in our study (43%) was determined to be higher than the literature data varying from 7 to 27 percent which may be due to unilateral AFO application after Ponseti method for idiopathic clubfoot deformity in our study

Systemic concentrations of metal ions (cobalt and chromium) are persistently elevated in patients with metal-on-metal hip resurfacing (MOMHR) compared to conventional total hip arthroplasty (THA). Several studies by us and others have described the detrimental effects of metal exposure on survival and function of various cell types in-vitro, but the mechanisms for these effects remain unclear. Epigenetic modifications following chronic metal exposure is a possible mechanism that could mediate these effects. Here we test the methylation status in genomic DNA from MOMHR (“cases”) and THA (“controls”) patient-groups, and its correlation with circulating metal levels. The cohort consisted of 34 patients with a well-functioning MOMHR at a median follow-up of 9.75 years. These were individually matched for gender, age and time-since-surgery to a non-exposure group consisting of patients with THA. Genomic DNA was isolated from blood samples and cell composition estimated using the ‘estimateCellCounts’ function in ‘minfi R-package’. Methylation was assessed using the Illumina 450k BeadChip array analysing 426,225 probes. Logit model was fitted at each probe with case/control status as independent variable and covariates of gender, age, time-since-surgery, smoking, non-arthroplasty metal exposure, and cell composition. DNA methylation age was assessed using an online calculator (. https://dnamage.genetics.ucla.edu/. ) and comparisons made between cases and controls, and correlated with circulating metal levels. Cell distributions did not differ between the cases and controls (Wilcoxon test p<0.17) with no probe having an association at 5% FDR. Circulating metal levels and LVEDD also had no association with any probe at 5% FDR. There was no preferential age acceleration between cases and controls (Wilcox p<0.7), and it had no correlation with plasma-chromium or blood-cobalt levels (p<0.9). In summary, large methylation changes following MOMHR seem to be absent, compared to THA. Future research with larger samples will be needed to clarify the presence and extent of small methylation changes

Summary. A retrospective study on 98 patients shows that FE-based bone strength from CT data (using validated FE models) is a suitable candidate to discriminate fractured versus controls within a clinical cohort. Introduction. Subject-specific Finite element models (FEM) from CT data are a promising tool to non-invasively assess the bone strength and the risk of fracture of bones in vivo in individual patients. The current clinical indicators, based on the epidemiological models like the FRAX tool, give limitation estimation of the risk of femoral neck fracture and they do not account for the mechanical determinants of the fracture. Aim of the present study is to prove the better predictive accuracy of individualised computer models based a CT-FEM protocol, with the accuracy of a widely used standard of care, the FRAX risk indicator. Patients and Methods. This retrospective cohort is individually-matched case control study composed by 98 Caucasian women who were at least 5 years post menopause. The case group consisted of 49 patients who had sustained a hip fracture (36 intra-capsular and 13 extra-capsular fractures) within the previous 90 days due to low-energy trauma. The CT datasets were segmented (using the ITK-Snap software) in order to extract the periosteal bone surface. Unstructured meshes (10-node tetrahedral elements) were generated using ANSYS mesh morphing software. Each CT dataset was calibrated using the European Spine Phantom. The inhomogeneous material properties were mapped from CT datasets into the FEM with the BoneMat_V3 software. Bone strength was evaluated in quasi-axial loading conditions, for a set of 12 different configurations sampling the cone of recorded in vivo hip joint reactions, and was defined as the minimum load inducing on the femoral neck surface an elastic principal strain value greater than a limit value. Results. There were no statistically significant difference between the fracture and the control groups for age, height and weight (p<0.05). All indices of areal bone mineral density (aBMD) and the volumetric mineral density (vBMD) between fractured and controls showed on average a lower value for fractured respect of the controls, with similar mean difference (14% for aBMD and 13% for the vBMD). FEM-predicted strength differed between fractured and non-fractured on average for 20%. To evaluate its ability to identify patients at risk of hip fracture, FEM-based strength was compared to the FRAX predictor by computing for each predictor the Receiver Operating Characteristic (ROC) curve, and the Area Under the Curve (AUC). The individualised risk predictor based on FEM bone strength was found to perform significantly better (AUC=0.76) than FRAX (AUC=0.66). When the FEM-based strength indicator was combined with available clinical information in a logistic regression, the resulting predictor achieved in this retrospective study an excellent accuracy (AUC=0.82). Discussion. This study confirms that individualised, CT- FEM, when generated using to the state-of-the-art protocols, can provide a predictor of the risk of hip fracture more accurate than those based on clinical data alone. In the integrated workflow developed in the VPHOP Project (FP7-ICT-223865) CT-based risk prediction is requested only for those patients for whom the clinical decision is uncertain

Objective. To determine the use of oral anti-inflammatory drugs use in the year before and the two years after primary total hip (THR) or knee (TKR) replacement, and to assess whether this varied according to the Body mass Index (BMI). Design. Population based retrospective case control study. Setting. 433 General Practitioner practices contributing to the General Practitioner Research Database. Participants. 28,068 patients who had undergone a THR and 24,364 patients who had undergone a TKR between 1991-2006. 5 controls per case were matched for age, sex and GP practice. Main Outcome measures. Two categories of oral anti-inflammatory usage: (1)”zero coverage” – patients who were not prescribed any anti-inflammatory medication; (2)”greater than 80% coverage” – patients who were prescribed anti-inflammatory medication for greater than 80% of the days in the year. Secondary subset analysis according to BMI. Results. At 1 year post surgery the proportion of cases on >80% coverage reduced from 21% (95%CI: 20% to 22%) to 8% (95%CI: 7% to 10%) for THR and 21% (95%CI: 20% to 22%) to 13% (95%CI: 11% to 14%) for TKR, with no ongoing reduction at 2 years. The proportion of THR/TKR cases on zero coverage increased at both 1 and 2 years post op (THR: Pre op 39%, 95%CI: 38% to 40%); 1 year post op 52% (95%CI: 51% to 53%); 2 year post op 66% (95%CI: 65% to 67%) and TKR: Pre op 39% (95%CI: 38% to 40%); 1 year post op 46% (95%CI: 45% to 47%); 2 year post op 58% (95%CI: 57% to 59%). BMI analysis. >80% coverage increased with BMI in the control groups. The proportion of THR cases on >80% coverage increased with BMI pre op. The magnitude in reduction of >80% coverage post op was similar across all BMI groups. The proportion of TKR cases on >80% coverage pre op was greatest in the extreme BMI categories. Again the magnitude in reduction of >80% coverage post op was similar across all BMI groups. Conclusion. THR/TKR's reduce the patients' need for anti-inflammatory medication, with implications regarding the side effects of their long-term use. The majority of the benefit from reduction in anti-inflammatory use is observed by 1 year post operatively. Increasing BMI affects anti-inflammatory use in both the general population as well as those undergoing THR/TKR surgery but without strong evidence of a detrimental effect on the benefits of pain relief

Improved understanding of the biomechanics and biology of rotator cuff tendons (RCT) may help reduce high re-rupture rates following repairs, particularly amongst larger tears. This study aims to use novel methods for quantitatively determining differences in the mechanical and thermal properties of intact healthy RCTs compared to torn ‘diseased’ tendons. A common problem in the mechanical testing of small tendon samples is that stress risers at the clamp-tendon interface can obscure measurements. As the shoulder is subject to shear, tension and compression, we developed a novel solution using Dynamic Shear Analysis (DSA), a form of rheology which studies material deformation. As collagen is the main component of RCT, the structure and mechanical properties may be affected by collagen conformational changes. Both dermis and rat tail tendon with increased collagen cross-linking exhibit stronger mechanical properties. Thermal changes detected by differential scanning calorimetry (DSC) can help to quantify collagen structural differences in torn RCT, and has been previously used to study muscle, cartilage and vertebral discs. There were 79 tears (mean age 65.2 years), which were classified according to the size of the tear as small, medium, large and massive. Two separate 3mm-sized biopsy samples were taken and subjected to DSA using oscillatory deformation under compression. The storage modulus (G') was calculated and used as an indicator of mechanical integrity. 18 control tendon specimens were obtained from patients aged between 22-89 years (mean age 58.8 years) during shoulder hemiarthroplasties and stabilisations. Additionally 7 normal, 7 small and 7 massive frozen specimens were thermally characterized. 3 samples per patient were heated between 20-80oC in hermetically sealed vessels. Useful thermal parameters were measured such as the melting temperature (TM) which apparently represents breaking of the amide-amide bonds and protein chains mobility, the denaturation temperature (TD) which supposedly corresponds to proteins falling out of solution and the denaturation enthalpy (ΔH) which reflects the relative amount of triple helical structure. Healthy tendons had a significantly higher modulus than torn tendons, indicating that torn tendons are mechanically weaker than normal tendons (p = 0.032). Normal tendons had significantly higher mean shear modulus than tendons with small and massive tears (p<0.01). Overall there was a negative correlation between moduli and severity of tendon tear (r = −0.698, p=0.189). The moduli did not significantly correlate with age, sex, hand dominance, or length of preservation in formalin. Massive RCT tears had significantly higher TM and TD when compared to normal RCT (p < 0.05), unlike small RCT tears. No significant difference was detected between the denaturation enthalpy of the different RCT groups. This case control study has demonstrated that normal RCTs have a significantly higher modulus than torn tendons, indicating that torn tendons have less mechanical integrity. Our study further demonstrated a trend between increasing tear size and decreasing mechanical integrity. This study has also demonstrated differences in some of the thermal properties of normal and torn RCTs. These are likely due to collagen structural changes. A decrease in the denaturation temperature of torn tendons, suggests that the material is intrinsically less stable. Torn tendons with reduced storage modulus and collagen integrity may be less able to withstand mechanical loads following repair. This pilot study provides some preliminary insight into the mechanisms that may contribute to, or represent adaptations to high rates of failure of RCT repairs

Objectives

Given the function of adiponectin (ADIPOQ) on the inflammatory condition of obesity and osteoarthritis (OA), we hypothesized that the ADIPOQ gene might be a candidate gene for a marker of susceptibility to OA.

The calcar femorale or ‘true neck’ of the femur has a role in transmitting load from the cantilevered neck to the femoral shaft (Zhang 2009). It can appear as a distinct condensation in clinical CT images because its structure is very similar to compact bone (Aspden 1998). Harty (1957) proposed that the calcar acts as a ‘spike’ in certain fall situations, contributing to splitting of the trochanter. We hypothesised that among elderly fallers, the size of the calcar would influence whether fractures occurred in the trochanteric (TR) or femoral neck (FN) site. We also asked whether patients who sustained a fracture had more or less calcar bone than frailty-matched controls that fell but didn't fracture. The FEMCO study is designed to investigate male (M) and female (F) patients with acute hip fracture with multi-detector CT, before they undergo surgery. It includes an age, sex and frailty-matched control group (who have sustained at least one injurious fall without hip fracture). The fractured hip is reconstructed in 3D for classification of fracture type (FN or TR). For the present pilot study, there were 14 cases (5TR, 9FN mean 80+/−8.5yrs. 7M, 7F) and 11 controls (83+/−7.0yrs. 3M, 8F). Axial CT slices where a calcar was visible were opened in Stradwin 4.1 software (Treece 2011). The calcar femorale was semi-automatically selected with the flood fill tool. Each axial image that contained a visible calcar was included in the analysis, so that for each femur a single calcar volume was generated. Results were examined using ANOVA. Combining male and female results, there was a non-significant trend towards a higher calcar volume in patients sustaining trochanteric rather than femoral neck fractures (0.73cm3 +/− 0.26 vs 0.61cm3 +/−0.14, p=0.27) but no difference between cases and controls. Males had a significantly higher calcar volume than females (mean 0.82cm3 +/− 0.24 vs 0.59cm3 +/− 0.13, p=0.005). Further studies are now planned in larger samples of each sex, to examine the role of the calcar in fracture mechanics. Three-dimensional visualisations provide a novel insight into the damage patterns and resultant fragment locations

Objectives

Degenerative disc disease (DDD) and osteoarthritis (OA) are relatively frequent causes of disability amongst the elderly; they constitute serious socioeconomic costs and significantly impair quality of life. Previous studies to date have found that aggrecan variable number of tandem repeats (VNTR) contributes both to DDD and OA. However, current data are not consistent across studies. The purpose of this study was to evaluate systematically the relationship between aggrecan VNTR, and DDD and/or OA.

Objectives

The molecular mechanism of rheumatoid arthritis (RA) remains elusive. We conducted a protein-protein interaction network-based integrative analysis of genome-wide association studies (GWAS) and gene expression profiles of RA.

Objectives

We have observed clinical cases where bone is formed in the overlaying muscle covering surgically created bone defects treated with a hydroxyapatite/calcium sulphate biomaterial. Our objective was to investigate the osteoinductive potential of the biomaterial and to determine if growth factors secreted from local bone cells induce osteoblastic differentiation of muscle cells.

Objectives

Excessive acetabular coverage is the most common cause of pincer-type femoroacetabular impingement. To date, an association between acetabular over-coverage and genetic variations has not been studied. In this study we investigated the association between single nucleotide polymorphisms (SNPs) of paralogous Homeobox (HOX)9 genes and acetabular coverage in Japanese individuals to identify a possible genetic variation associated with acetabular over-coverage.

A cadaver study using six pairs of lower limbs was conducted to investigate the accuracy of computer navigation and standard instrumentation for the placement of the Birmingham Hip Resurfacing femoral component. The aim was to place all the femoral components with a stem-shaft angle of 135°.

The mean stem-shaft angle obtained in the standard instrumentation group was 127.7° (120° to 132°), compared with 133.3° (131° to 139°) in the computer navigation group (p = 0.03). The scatter obtained with computer-assisted navigation was approximately half that found using the conventional jig.

Computer navigation was more accurate and more consistent in its placement of the femoral component than standard instrumentation. We suggest that image-free computer-assisted navigation may have an application in aligning the femoral component during hip resurfacing.