Purpose:. The reverse total shoulder arthroplasty (RTSA) was approved for use by the United States FDA in 2004. Since its introduction, its popularity for treating a number of shoulder conditions has grown considerably. However, many patients inquire about the potential to return to playing recreational golf, and at present there are no published data about how the RTSA prosthesis affects the golf swing. The purpose of this study is to evaluate the biomechanics of the golf swing in patients with RTSA, as well as the postoperative changes in handicap, driving distance, and holes played/week. Methods:. A review of patient records for those that had an RTSA placed between June 2004 and December 2008 was performed. These patients were sent a questionnaire inquiring about details of golfing before and after RTSA. Patients who were still golfing after implantation of the RTSA prosthesis were selected for six-camera motion analysis testing of their golf swing. Computer analysis program was used to calculate parameters to biomechanically describe the golf swing. Results:. Of the 97 patients that had an RTSA placed during the specified time period, 23 patients responded to the questionnaire and only 3 patients had ever and were still playing golf. A mean increase of 2.3 points in the handicap as well as a 33.3 yard decrease in driving distance was observed. The number of holes played per week decreased by 12 postoperatively. Motion analysis of the golf swings in patients with an RTSA showed decreased motion compared to high handicap golfers at the peak of the backswing at every shoulder parameter measured (forward flexion, horizontal adduction, external rotation); however, these differences were not statistically significant. The mean postoperative external rotation in our patients was 26.2°. Discussion:. Though patients can return to golf after RTSA, self-reported trends towards worse handicaps, decreased driving distances, as well as decreased number of holes played/week were found. Furthermore, the RTSA prosthesis changes the biomechanics of the shoulder, resulting in alterations in ROM, specifically external rotation. Patients with the prosthesis in the leading and trailing shoulders compensate by increasing rotation through their torso during follow-through or increasing abduction during the backswing, respectively. Slower swing speeds during backswing and downswing were also observed. Conclusion:. Patients can continue to play golf after RTSA; however, they may observe slower swing speeds, increases in their preoperative handicaps, as well as decreased driving distances. Possible changes in their swing may also occur that will require compensatory mechanisms to complete a full swing

INTRODUCTION. Golf is considered low-impact sport, but concerns exist about whether golf swing can be performed in safe manner after THA. The purpose of this study was to clarify dynamic hip kinematics during golf swing after THA using image-matching techniques. METHODS. This study group consisted of eight right-handed recreational golfers with 10 primary THAs. Each operation was performed using a posterolateral approach with combined anteversion technique. Nine of ten polyethylene liners used had elevated portion of 15°. Continuous radiographic images of five trail and five lead hips during golf swing were recorded using a flat panel X-ray detector (Fig. 1) and analyzed using image-matching techniques (Fig. 2). The relative distance between the center of cup and femoral head and the minimum liner-to-stem distance were measured using a CAD software program. The cup inclination, cup anteversion, and stem anteversion were measured in postoperative CT data. Hip kinematics, orientation of components, and cup-head distance were compared between patients with and without liner-to-stem contact by Mann-Whitney U test. RESULTS. At the top of backswing, lead hips showed 26 ± 11° ER, and trail hips showed 24 ± 19° IR. At the end of follow-through, lead hips showed 24 ± 19° IR, and trail hips showed 24 ± 12° ER. The mean cup inclination and anteversion, stem anteversion, and combined anteversion were 40 ± 5°, 18 ± 11°, 33 ± 14°, and 50 ± 8°, respectively. The minimum liner-to-stem distance showed the smallest value of 3 ± 4 mm at the maximum ER. Bone-to-bone and bone-to-implant impingements were not observed in all hips at all phases. The liner-to-stem contact was observed in four hips with elevated liners (two trail and two lead hips; Fig 3). Patients with elevated liner-to-stem contact demonstrated significantly (p < .05) larger maximum ER and larger cup anteversion than patients without contact. The mean cup-head distance was 0.9 ± 0.5 mm of translation. No significant difference was found in the flexion/extension and adduction/abduction at the maximum ER, cup inclination, combined anteversion, and cup-head distance between patients with and without contact. DISCUSSION. Golf swing produced approximately 50° of axial rotations in both lead and trail hips after THA. The mean cup-head distances showed less than 1.0 mm, and there was no significant difference between patients with and without neck-liner contact. Therefore, we consider that dynamic stability without excessive hip rotations or subluxation was demonstrated during golf swing. Despite no evidence of component malpositioning, elevated liner-to-stem contact was observed in 40% of hips with significantly larger ER and cup anteversion. Because the liner-to-stem contact may be a concern with regard to the long-term prognosis following THA, further attention must be given to the anteversion of the components and the use of elevated liner at the time of surgery. To view tables/figures, please contact authors directly

Introduction

Tennis and Golfers elbows (TE, GE) are difficult conditions to treat. Ultrasound guided steroid injection (UGSI) is one of the treatment modalities in treating refractory TE and GE. We present our clinical experience and short to mid-term results of patients with TE and GE treated with UGSI.

1. Introduction. Such a Total Knee Arthroplasty (TKA) that is capable of making high knee flexion has been long awaited for the Asian and Muslim people. Our research group has developed the TKA possible to attain complete deep knee flexion such as seiza sitting. Yet as seiza is peculiar to the Japanese, other strategies will be necessary for our TKA to be on the overseas market. Still it is impractical to prepare many kinds of modifications of our TKA to meet various demands from every country/region. To this end, we contrived a way to modularize the post-cum alignment of our TKA in order to facilitate the following three activities containing high knee flexion: praying for the Muslim, gardening or golfing for the Westerner, sedentary siting on a floor for the Asian. We performed simulation and experiment, such as a mathematical model analysis, FEM analysis and a cadaveric study, thereby determining the optimal combination of moduli for the above activities respectively. 2. Methods. We modularized the post-cum alignment by three parameters in three levels respectively (Fig.1). The shape of the post's sagittal section and the total shape of cum were unchanged. The three parameters for modularization were the post location which was shifted anterior and posterior by 5 mm from the neutral position, the post inclination which was inclined forward and backward by 5° from the vertical, and the radius of curvature of the post's horizontal section which was increased and decreased by 2 mm from the original value. It is crucial to decrease contact stress between the post and cum during praying for the Muslim and during gardening or golfing for the Westerner, which would be realized by choosing the optimal location and inclination of post when kneeling for the Muslim and when squatting for the Westerner respectively (Fig.2). As for the Asian, it is desirable for them to perform various kinds of sedentary sittings on a floor without difficulties, which would be facilitated by choosing the optimal radius of curvature value to increase range of rotation when the knee is in high-flexion (Fig.2). First we performed a mathematical model analysis to introduce the kinetic data during sit-to-stand activities. Then by using the above kinetic data we performed the FEM analysis to determine the contact stress between the post and cum during praying, gardening or golfing. Finally we carried out the cadaveric study to determine the range of rotation at high flexion of the knee. 3. Results and Discussion. The results of FEM analysis demonstrated that the best modular set for the activities for Muslim and Westerners were so that the post location should be shifted by 5 mm and the post inclination should not be applied (Fig.3). The results of cadaveric study demonstrated that the radius of horizontal curvature should be increased by 2mm so as to increase the range of rotation especially when the knee is in high flexion. The subjects for our future study are to verify the validities of the above results through our simulator tests

Patient perceptions regarding the functional outcomes and return to sports after shoulder replacement are often pessimistic, with many patients presenting for shoulder replacement surgery after months or years of avoiding the procedure so they could continue to live the current life they have, despite the increasing pain and dysfunction. Less common, but becoming more frequent, patients present with expectations that they will be able to return to all activities including heavy resistance training, cross-fit, rock climbing, and other strenuous overhead sports. In the past, little information has been available regarding the activities of shoulder arthroplasty patients after surgery. Typically, the boundaries have been set by the surgeon, with many patients cautioned or even prohibited from overhead sports, weight training, or heavy work responsibilities. A typical set of guidelines may include no repetitive overhead sports, except for recreational swimming, and no lifting over 20 pounds. Golf, jogging, hiking and other activities are allowed. The origin of these restricted guidelines and expectations is unknown, but many believe that since the results of shoulder replacements are less favorable in younger patients, it may be due to the overuse or abuse of the shoulder joint that is more typical at a younger age. Others have suggested that common sense prevails and that an artificial joint made of metal and plastic has a finite number of total movements and tolerance to resistance activities, and therefore keeping these activities at a minimum would extend the longevity of the artificial joint. None of these concepts are backed up by evidence-based literature, essentially reflecting the personal bias of the surgeons who care for patients with these problems. Despite all of the sophisticated research, scoring scales, outcome measures, and value-based metrics, the only outcome that really matters is whether the patient can return back to their normal way of life, at home, at work, during sport, or any activity that is important to them. Recent studies of patients who have had joint replacement surgery have revealed that our patients who participated in sports and work activities before surgery have a strong predilection to returning to those activities after successful shoulder replacement. The most common sports that shoulder arthroplasty patients enjoy including golf, swimming, tennis, but may also include many other choices including fitness activities, rowing, skiing, basketball, and softball. As expected, the return to these sports is less for reverse shoulder arthroplasty patients vs. anatomic shoulder arthroplasty patients. In a systematic review, more than 90% of anatomic shoulder replacement patients returned to sport, while 75% of reverse shoulder arthroplasty patients returned to some sporting activity. This may reflect the constraints of the reverse prosthesis, or, quite possibly reflect the typically older age and more sedentary lifestyle of patients who are indicated for reverse shoulder arthroplasty. In addition, if the patient had a preoperative expectation of return to recreational and sports activities as part of their normal way of life, their final results demonstrated better overall outcomes. Shoulder arthroplasty surgeons should be concerned about the outcomes desired by our patients, and the results that provide true value to their lives. We are now more aware of the activities that they are going to return to, whether we recommend restrictions or not

Introduction: Although volumetric wear reduction has been demonstrated in knee simulator studies, there is no long-term in-vivo evidence supporting wear reduction and durability with uni-directional rotating platform PS design. This design was introduced to reduced spin-out and provide greater range of motion. This is the first long-term report of this implant, a prospective study investigating clinical and radiographic survivorship with 10 years follow-up. Material and Methods: Between January 2000 to March 2001, 118 consecutive patients (141 knees) received cemented RP TKRs. All patients were followed prospectively using clinical and radiographic criteria as defined by the Knee Society. At minimum nine years follow-up 20 patients were deceased, 11 were lost to follow-up and two refused to participate in the study, leaving 85 patients (100 knees) for final analysis. Results: Good to excellent results were achieved in 95% of patients. There were no cases of malalignment, spinout, aseptic loosening or osteolysis. The mean ROM improved from 111.2 ± 15.2 degrees to 119 ± 3.8 degrees. The mean WOMAC score was 30 ± 14, KSS scores improved from an average of 48 to 96. Sporting activities such as golf, tennis and walking was 29%, 12% and 32%, respectively. Anterior knee pain was present in 15% of cases. The incidence of asymptomatic crepitation and painful crepitation requiring scar excision was 10% and 4% respectively. During this period we had one case of infection and one revision for fracture. Kaplan-Meier survivorship at 10 years for mechanical failure and failure for all failures was 100% and 95.7%, respectively. Discussion and Conclusion: Ten-year follow-up of RP-PS design demonstrates excellent clinical and radiographic results with no failures for mechanical reasons. There were no spin-out and average ROM was 119 ± 3.8 degrees

Following the recognition of platelet rich plasma (PRP) as an interventional procedure by NICE, patients who had failed standard conservative treatment for chronic elbow tendinitis and referred for surgery were recruited prospectively into a PRP injection study. 52 patients at Torbay Hospital, Devon, UK received PRP injections in 18 months and 37 had a minimum of 6 months follow up. The outcomes in these patients are summarised. There were 16 males and 21 females. 30 had tennis elbow and 7 had golfers elbow. All patients had their symptoms for a minimum of 6 months and had failed to improve with standard conservative treatment. 2 had a failed outcome from previous tennis elbow release surgery. The PRP injections were carried out under ultrasound guidance after correlating the tender spot with neovascularisation on flow Doppler. 31 patients had a single injection; the other 21 patients had 2 injections. Quick DASH score and patients own self-satisfaction was used to measure outcome. 18 patients (48%) were discharged by 6 months. DASH score worsened in 7 patients (19%) and 2 of these patients opted to have surgery, which had no benefit either. No complications were observed with the use of PRP. Overall, by using PRP injections, surgery was avoided in 35 patients (95%) at 18 months and nearly half of the patients were discharged from follow up by 6 months

We recommended an early discharge if rheumatoid patients who had undergone arthroplasty could easily walk around a flat barrier-free corridor as we had a financial motive to increase the circulation rate of patients. Unfortunately, after this discharge, two of our patients fell down in their home, one breaking her leg. So we began to ask our patients to use medical pole walking, which they learned during rehabilitation, after being discharged. There were two male and six female rheumatoid arthritis patients, with an average of 64. We required them to train in medical pole walking five times a week, 20 minutes a day for about 4–6 weeks until they were discharged. We checked for mobility, physical strength and flexibility. After one year of medical pole walking, two patients can play golf and one patient can visit many famous places in Japan with her sister without the assistance of a cane. At the point of 1 year after arthroplasty their time of with medical pole walking and T cane walking or free walking was improved about 5 seconds compared to the point 4 weeks after surgery. Chair stand test after 1 year medical pole walking exercise was much improved than after 4 weeks after arthroplasty

Aims

The purpose of this survey study was to examine the demographic and lifestyle factors of women currently in orthopaedic surgery.

Total knee arthroplasty has been shown to provide relief of pain and improved function; however studies have shown that younger active patients still note limitations in performing higher level activities such as dancing, golfing, skiing and gardening. Journey II BCS is designed to have physiological matching which more accurately reproduces the normal knee anatomy and kinematics. By providing more anatomic restoration of the articular geometry and substituting for both cruciate ligaments, Physiological Matching TKA has been shown, with in-vivo kinematic studies, to better reproduce the normal bending, rollback and rotational motions of knees. Patient matched instruments are patient specific custom designed cutting blocks. These instruments utilise pre-operative MRI and full leg x-rays to design guides that will position the knee in the desired mechanical alignment. The purpose of these instruments is to increase efficiency and accuracy, and possibly reduce cost. Efficiency occurs through the elimination of multiple steps compared to the standard operative technique. A single patient matched femoral guide is easily placed and can align the valgus angle with the mechanical axis, and determine the level of resection, rotation, size, and AP position of the implant. A single tibial instrument can determine tibial alignment, depth of resection, slope and rotation. Efficiency also results by eliminating the need for many standard instruments and trays. Implant size is determination pre-operatively so fewer implant trials are necessary. In summary, this Physiological Matching TKA surgery combines Journey II BCS with patient specific instruments to optimise kinematics, fit and efficiency in order to improve outcomes and patient satisfaction

Purpose of study:. A retrospective clinical and telephonic survey of AMIS patients. Minimally Invasive Anterior Hip Replacements have been performed according to the AMIS technique in two centres in South Africa on a regular basis since 2 February 2007. We report on the first 335 cases that were done from February 2007 till October 2009 in these two centers, by two surgeons. Description of methods:. The data reported from these patients was collected from clinical notes, hospital records and telephonic questionnaires. Of the 335 cases that were performed data could be collected from 283 patients. Patients lost to follow up were 16 deceased, 24 could not be reached and 12 others had co-morbidities like Alzheimers, Total deafness and CVA. Summary of results:. The data collected includes: Patient demographics, diagnosis, co-morbidities. We also collected data of the surgical procedures including the duration of the procedure, prosthesis used, and hospital stay. We also collected data of the functional activities and time duration to achieving this. These activities include driving a car, shopping, domestic work, gardening and sport like hiking and golf. Complications reported include superficial wound infection 4, deep infections 1, dislocation 6, hematoma 8, impingement 1 and fractures 4. Total rate of revision was 2.47 %. Analysis of the causes of revision were; subsidence and dislocation 3, anterior acetabular impingement 1, proximal femoral loosening and persistent thigh pain 1, fractured ceramic liner 1, displaced acetabular component 1. Discussion:. The anterior approach for total hip replacement is a new method that preserves all the musculature around the hip joint with resultant benefits. This is a demanding technique that is reflected in the results. 80 % of the revisions were encountered in the first 50 cases

Knee mechanics - Knee forces during ADL and sports activities in TKA patients. Background. Tibiofemoral forces are important in the design and clinical outcomes of TKA. Knee forces and kinematics have been estimated using computer models or traditionally have been measured under laboratory conditions. Although this approach is useful for quantitative measurements and experimental studies, the extrapolation of results to clinical conditions may not always be valid. We therefore developed a tibial tray combining force transducers and a telemetry system to directly measure tibiofemoral compressive forces in vivo. Methods. Tibial forces were measured for activities of daily living, athletic and recreational activities, and with orthotics and braces, for 4 years postoperatively. Additional measurements included video motion analysis, EMG, fluoroscopic kinematic analysis, and ground reaction force measurement. A third-generation system was developed for continuous monitoring of knee forces and kinematics and for classifying and identifying unsupervised activities outside the laboratory using a wearable data acquisition hardware. Results. Peak forces measured for the following activities were: walking (2.6±0.2xBW); jogging (4.2±0.2)xBW; stationary bicycling (1.3±0.15)xBW; golfing (4.4±0.1)xBW; tennis (4.3±0.4)xBW; skiing (4.3±0.1)xBW; hiking(3.2±0.3)xBW; StairMaster exercise (3.3±0.3)xBW; Elliptical machine exercise (2.3±0.2)xBW; leg press machine (2.8±0.1)xBW; knee extension machine (1.5±0.03)xBW, rowing machine (0.9±0.1)xBW. Conclusions. In vivo measured knee forces can be used to enhance existing in vitro models and wear simulators and to improve prosthetic designs and biomaterials as well as guide physicians in their recommendations to patients of “safe” activities following TKA

Introduction. The new Knee Society Score has been developed and validated, in part, to characterize better the expectations, components of satisfaction, and the physical activities of the younger, more diverse modern population of TKA patients. This study aims to reveal patients' activity levels' post-TKA and to determine how it contributes to their subjective evaluation of the surgery. Methods. As part of a multi-centered and regionally diverse study sponsored by the Knee Society, the new Knee Society Score (KSS) was administered 243 patients (44% male; avg 66.4years; 56% female, avg 67.7years) following primary TKA (follow up > 1year, avg. 25mos). The new, validated KSS questionnaire consists of a traditional objective component, as well as subjective components inquiring into patient symptoms, satisfaction, expectations and activity levels as well as a survey of three physical activities that are viewed as important to the patients. Responses were analyzed as a whole group and as subgroups of male and female and as younger (<65) and older (>65). Results. Post-TKA, knee function met or exceeded 84% of patients' expectations, with 49% of patients reporting that their knee always feels normal. While performing standard activities (eg turning, climbing stairs), the majority of patients (78%) experienced few symptoms referable to the knee. Fewer (47%) report that they remain asymptomatic while performing more demanding (‘advanced’) activities (eg squatting, running). Distance walking (52%), swimming (28%) and stationary biking (25%) were among activities that were most commonly selected as personally important. Activities such as golf (Male 39%; Female 6%; p<0.001) and road cycling (Male 19%; Female 4%; p<0.001) were important to more men than women, whereas for gardening (Female 44%; Male 32%; p=0.001) and stretching (Female 44%; Male 16%; p<0.001) the gender preference was reversed. Overall, 24% of patients experienced severe symptoms when performing at least one of their most important activities. Older patients experienced symptoms more than younger patients (26% vs 21%; p<0.01). As a whole, 93% of patients reported that they were satisfied with their knee post-operatively. However, satisfaction with TKA decreased significantly among patients who experienced severe or debilitating symptoms during of their most important activities, (at least one activity: 78% satisfied; p<0.001; during all 3 activities: 50%; p<0.001). Discussion. The New Knee Society Scoring System provides sufficient flexibility and scope to capture the diverse lifestyles and activities of contemporary TKR patients. Data collected by this assessment tool allow surgeons and affiliated personnel to appreciate differences in the priorities of individual patients and the interplay between function, expectation, symptoms, and satisfaction after TKR. A resounding conclusion of this new multi-dimensional analysis is that a critical factor in many patients' assessment of the value of this procedure is their restored ability to perform activities that they personally consider important

Drug therapy forms an integral part of the management of many orthopaedic conditions. However, many medicines can produce serious adverse reactions if prescribed inappropriately, either alone or in combination with other drugs. Often these hazards are not appreciated. In response to this, the European Union recently issued legislation regarding safety measures which member states must adopt to minimise the risk of errors of medication.

In March 2014 the Medicines and Healthcare products Regulatory Agency and NHS England released a Patient Safety Alert initiative focussed on errors of medication. There have been similar initiatives in the United States under the auspices of The National Coordinating Council for Medication Error and The Joint Commission on the Accreditation of Healthcare Organizations. These initiatives have highlighted the importance of informing and educating clinicians.

Here, we discuss common drug interactions and contra-indications in orthopaedic practice. This is germane to safe and effective clinical care.

Cite this article: Bone Joint J 2015;97-B:434–41.