Objectives. The aim of this study was to systematically review the literature on measurement of muscle strength in patients with femoroacetabular impingement (FAI) and other pathologies and to suggest guidelines to standardise protocols for future research in the field. Methods. The Cochrane and PubMed libraries were searched for any publications using the terms ‘hip’, ‘muscle’, ‘strength’, and ‘measurement’ in the ‘Title, Abstract, Keywords’ field. A further search was performed using the terms ‘femoroacetabular’ or ‘impingement’. The search was limited to recent literature only. Results. A total of 29 articles were reviewed to obtain information on a number of variables. These comprised the type of device used for measurement, rater standardisation, the type of movements tested, body positioning and comparative studies of muscle strength in FAI versus normal controls. The studies found that hip muscle strength is lower in patients with FAI; this is also true for the asymptomatic hip in patients with FAI. Conclusions. Current literature on this subject is limited and examines multiple variables. Our recommendations for achieving reproducible results include stabilising the patient, measuring isometric movements and maximising standardisation by using a single tester and familiarising the participants with the protocol. Further work must be done to demonstrate the reliability of any new testing method. Cite this article: E. Mayne, A. Memarzadeh, P. Raut, A. Arora, V. Khanduja. Measuring hip muscle strength in patients with femoroacetabular impingement and other hip pathologies: A systematic review. Bone Joint Res 2017;6:66–72. DOI: 10.1302/2046-3758.61.BJR-2016-0081

Aims. Rotational acetabular osteotomy (RAO) is an effective joint-preserving surgical treatment for acetabular dysplasia. The purpose of this study was to investigate changes in muscle strength, gait speed, and clinical outcome in the operated hip after RAO over a one-year period using a standard protocol for rehabilitation. Patients and Methods. A total of 57 patients underwent RAO for acetabular dysplasia. Changes in muscle strength of the operated hip, 10 m gait speed, Japanese Orthopaedic Association (JOA) hip score, and factors correlated with hip muscle strength after RAO were retrospectively analyzed. Results. Three months postoperatively, the strength of the operated hip in flexion and abduction and gait speed had decreased from their preoperative levels. After six months, the strength of flexion and abduction had recovered to their preoperative level, as had gait speed. At one-year follow-up, significant improvements were seen in the strength of hip abduction and gait speed, but muscle strength in hip flexion remained at the preoperative level. The mean JOA score for hip function was 91.4 (51 to 100)) at one-year follow-up. Body mass index (BMI) showed a negative correlation with both strength of hip flexion (r = -0.4203) and abduction (r = -0.4589) one year after RAO. Although weak negative correlations were detected between strength of hip flexion one year after surgery and age (r = -0.2755) and centre-edge (CE) angle (r = -0.2989), no correlation was found between the strength of abduction and age and radiological evaluations of CE angle and acetabular roof obliquity (ARO). Conclusion. Hip muscle strength and gait speed had recovered to their preoperative levels six months after RAO. The clinical outcome at one year was excellent, although the strength of hip flexion did not improve to the same degree as that of hip abduction and gait speed. A higher BMI may result in poorer recovery of hip muscle strength after RAO. Radiologically, acetabular coverage did not affect the recovery of hip muscle strength at one year’s follow-up. A more intensive rehabilitation programme may improve this. Cite this article: Bone Joint J 2019;101-B:1459–1463

Introduction. There is a lack of evidence-based treatments for patients with chronic pain after total knee arthroplasty (TKA). It is well-established that knee extensor and flexor muscle strength are markedly impaired following TKA, but no studies have examined muscle strength and power in patients with chronic pain after TKA. Therefore, the aim was to investigate if neuromuscular exercises and pain neuroscience education (PNE) were superior to PNE alone for improvement of muscle strength and power in patients with chronic pain after TKA. Method. This report presents the exploratory analysis of a randomized controlled trial (NCT03886259). Participants with chronic moderate-to-severe average daily pain intensity and no signs of prosthesis failure at least one year after primary TKA were included. Participants were randomized to receive either supervised neuromuscular exercise and PNE or the same PNE sessions alone. The outcomes were changes from baseline to 12-months for peak leg extension power and maximum muscle strength, measured during maximal voluntary isometric contractions, for the knee extensors and flexors. Result. Sixty-nine participants (age 62.2±7.2, 40 females) were included. No between-group differences were observed for peak leg extension power (difference 13.6 Watts, 95% CI -22.2 to 49.3), maximum knee extensor muscle strength (difference -20.9 Newtons, 95% CI -65.8 to 24.0) or maximum knee flexor muscle strength (difference 8.6 Newtons, 95% CI -11.9 to 29.1). Peak leg extension power (26.3 Watts, 95% CI 4.3 to 48.3) and maximum knee flexor muscle strength (19.7 Newtons, 95% CI 7.6 to 31.9) improved significantly in the neuromuscular exercise and PNE group with no significant improvements observed in the PNE alone group. Conclusion. Neuromuscular exercise and PNE did not improve muscle strength and power compared to PNE alone in patients with chronic pain after TKA. Acknowledgements. This study was funded by the Danish Rheumatism Association, the Svend Andersen Foundation and Lions Club Denmark

Background. Revision total knee arthroplasties (rTKA) are performed with increasing frequency due to the increasing numbers of primary arthroplasties, but very little is known regarding the influence of muscle strength impairments on functional limitations in this population. Objectives. The aim of this study was to assess relationship between muscle strength and functional level in patient with rTKA. Design and Methods. Twenty-three patients (8 males, 15 females) were included in the study with mean age 68.4±10 years. Patients performed 3 performance tests (50-Step Walking Test, 10 Meter Walk Test, 30-Second Chair-Stand Test), and one self-report test (HSS) were preferred to assess patients. The maximum isometric muscle strength of quadriceps femoris and hamstring muscles of all the patients was measured using Hand-Held Dynamometer (HHD). Results. While moderate-to-strong significant correlations was found between quadriceps femoris muscle strength and 30- Second Chair-Stand Test (r=0.390, p=0.049), 50-Step Walking Test (r=−0.530, p=0.005), 10 Meter Walk Test (r=−0.587, p=0.002), there were not significant correlation between HSS knee score and all performance-based tests (p>0.05). Also there were not significant correlation between hamstring muscle strength and all other measurement tests (p>0.05). Conclusion. The moderate-to-strong statistical significant correlation between quadriceps femoris muscle strength and functional performance tests suggests that improved postoperative quadriceps strengthening could be important to enhance the potential benefits of rTKA

Purpose. Investigating the effects of femoral stem length on hip and knee muscle strength. Methods. The study included 20 patients having undergone total knee prostheses (TKP) due to coxarthrosis and 10 healthy subjects. Of the 20 patients, 10 underwent conventional TKP and 10 had Thrust Plate Prothesis (TPP). For the assessment of the patients’ muscle strength of operated and non-operated hips (Gl. medius and Gl. Maximus) and knees (Quadriceps Femoris-QF), the Hand-Held Dynamometer (HHD) was used. Results. A significant difference was observed in the muscle strength of Gl. medius in TPP patients and of Gl. maksimus in conventional TKP patients (p <0.05). Compared to the healthy group, only hip muscle strength decreased in TPP patients, but both hip and knee muscle strengths decreased in conventional TKP patients (p <0.05). Conclusion. A decrease in hip and knee muscle strengths was determined in the TPP and conventional THA patients, compared to healthy subjects. Compared to the bone protective prosthetic systems (eg TPP), a significant difference is observed in the QF muscle strength in intramedullary prosthesis applications. This data may be used in planning the treatment of patients with hip arthroplasty

There are many previous reports dealing with the relationship between the abductor moment arm or femoral offset (FO), and other factors such as the abductor muscle strength after total hip arthroplasty (THA). Moreover, there have been no studies involving quantitative examination of the influence of posterolateral reconstruction on abductor muscle strength and FO. This study was to evaluate posterolateral reconstruction including posterior capsule, piriformis tendon and external rotators in THA and the relationship among the posterolateral reconstruction, abductor muscle strength, and FO. We arbitrarily selected 48 limbs of 24 patients who underwent unilateral THA using a posterolateral approach. In 16 patients (12 women and 4 men; mean age, 66.8 years; range 50 to 82 years), posterolateral reconstruction was not performed (non- reconstruction group). In eight patients (6 women and 2 men; mean age, 61.6 years; range 52 to 72 years), posterolateral reconstruction was performed (reconstruction group). None of the selected cases were revision cases, cases in which the patient showed marked acetabular dysplasia, or cases involving the osteotomy of the greater trochanter. We compared these two groups. FO was measured on standard antero-posterior hip radiographs. Isometric abductor muscle (N) was measured with hand-held dynamometer. Each muscle strength was converted into a ratio of force to body weight (N/kg), and this ratio was used for comparison. The reconstruction group showed higher value than the non-reconstruction group on the abductor muscle strength (p< 0.05). The correlation was recognised in the reconstruction group between abductor muscle strength and FO (p< 0.01 r=0.68). There have been no studies involving quantitative examination of the influence of posterolateral reconstruction on abductor muscle strength and FO. Our results suggested that posterolateral reconstruction and appropriate reconstruction of FO were important in order to obtain the improvement on the abductor muscle strength after THA

To compare strength and recruitment of periarticular knee muscles in subjects with severe osteoarthritis (OA) one week before and one year after a total knee replacement (TKR). Twenty-eight subjects, mean age = 64.5 years, with severe knee OA performed maximum voluntary isometric contractions for six exercises designed to test knee flexor and extensor and plantarflexor muscle strength. Torque and surface electromyograms (EMG) from the lateral and medial gastrocnemius, lateral and medial hamstring, vastus lateralis and medialis and rectus femoris muscles were recorded. Exercises included knee extension and flexion at mid range (45°) and closed-pack (15°) positions and plantarflexion with knee extended. Subjects completed WOMAC questionnaires to assess function. Custom software written in Matlab version 7.0.4 was used to calculate muscle torque and process EMG data. Paired Student t-tests (alpha = 0.05) were used to detect significant differences between pre-test and post-test data. Statistical analyses were performed in Minitab. Post-TKR torque increases ranged from 1.6% to 19.7%, but only knee extension with the subject’s knee at 45° showed a statistically significant (p< 0.05) increase (74.3 ± 29.5 Nm to 86.1 ± 28.5 Nm). EMG amplitudes increased for the quadriceps and hamstring muscles (p< 0.05) post TKR, but the relative contributions of each muscle did not change, excepting rectus femoris. Within each exercise, some subjects increased their torque, but almost as many decreased their post-TKR torque. WOMAC scores for pain, stiffness, and function improved significantly (p< 0.05) by one year after TKR. TKR surgery is becoming more common as a treatment for OA, but few studies have examined muscle strength before and after, which impacts patient function and the lifespan of the implant. By one year post-TKR subjects reported significant decreases in pain and stiffness, and significant improvements in function. This is consistent with the literature. Half of the subjects decreased in muscle strength to levels lower than pre-surgery. The results provide evidence that post-TKR management must address muscular strength deficits in addition to subjective assessments of improved symptoms to measure success

Current modeling techniques have been used to model the Reverse Total Shoulder Arthroplasty (RTSA) to account for the geometric changes implemented after RTSA. Though these models have provided insight into the effects of geometric changes from RTSA these is still a limitation of understanding muscle function after RTSA on a patient-specific basis. The goal of this study sought to overcome this limitation by developing an approach to calibrate patient-specific muscle strength for an RTSA subject. The approach was performed for both isometric 0° abduction and dynamic abduction. A 12 degree of freedom (DOF) model developed in our previous work was used in conjunction with our clinical data to create a set of patient-specific data (3 dimensional kinematics, muscle activations, muscle moment arms, joint moments, muscle length, muscle velocity, tendon slack length, optimal fiber length, peak isometric force)) that was used in a novel optimization scheme to estimate muscle parameters that correspond to the patient's muscle strength[4]. The optimization varied to minimize the difference between measured(“in vivo”) and predicted joint moments and measured (“in vivo”) and predicted muscle activations. The predicted joint moments were constructed as a summation of muscle moments. The nested optimization was implemented within matlab (Mathworks). The optimization yields a set of muscle parameters that correspond to the subject's muscle strength. The abduction activity was optimized. The maximum activation for the muscles within the model ranged between .03–2.4 (Figure 1). The maximum joint moment produced was 11 newton-meters. The joint moments were reproduced to an value of 1. Muscle parameters were calculated for both isometric and dynamic abduction (Figure 2). The muscle parameters produced provided a feasible solution to reproduce the joint moments seen “in vivo” (Figure 3). Current modeling techniques of the upper extremity focus primarily on geometry. In efforts to create patient-specific models we have developed a framework to predict subject-specific strength characteristics. In order to fully understand muscle function we need muscle parameters that correspond to the subject's strength. This effort in conjunction with patient-specific models that incorporate the patient's joint configurations, kinematics and bone anatomy hopes to provide a framework to gain insight into muscle tensioning effects after RTSA. With this framework improvements can be made to the surgical implementation and design of RTSA to improve surgical outcomes

Summary Statement. Bio-impedance analysis (BIA) provides a convenient method for the estimation of whole body and segmental measurement of skeletal muscle mass (SMM). BIA-measured SMM parameters may be effectively used for the normalisation of muscle strength and removing body-size dependence. Introduction. Despite an increasing interest in using bio-impedance analysis (BIA) for the estimation of segmental skeletal muscle mass (SMM); existing data is sparse. On the other hand, there is a need for better understanding of the influence of SMM on gender-related differences in muscle strength. Using BIA technique, this study aimed to measure the SMM, determine its correlation with muscle strength, and examine its relation with gender-related differences in muscle strength. Patients and Methods. Segmental and whole body SMM (3-segment electrode configuration) and maximum voluntary contraction in five distinct shoulder planes (forward flexion, abduction in scapular plane, abduction in coronal plane, and internal- and external rotation) were measured in 45 healthy participants (22 males, 23 females) with a mean age of 30.3 years. Independent t-tests and Pearson Correlation test were applied for comparative and correlational analysis, respectively. Results. All muscle-related parameters including muscle volume, SMM, and SMM index were significantly different between men and women. There was a significant gender-related difference in the absolute shoulder strength but not after normalisation to SMM. A strong correlation was found between strength and SMM and in-between strength measurements. Conclusion. BIA provided a convenient method for SMM estimation. SMM parameters may be effectively used for strength normalisation allowing comparisons of individuals with differing body masses. Strong correlations between SMM and muscle strength supported the use of BIA in assessing muscle size-strength relations and its applicability in muscle function assessments

Introduction. Intra-articular injury has been described as primary cause of pain in hip dysplasia. At this point it is unknown whether external muscle-tendon related pain coexists with intra-articular pathology. The primary aim was to identify muscle-tendon related pain in 100 dysplasia patients. The secondary aim was to test if muscle-tendon related pain is linearly associated to self-reported hip disability and muscle strength in patient with hip dysplasia. Materials and methods. One hundred patients (17 men) with a mean age of 29 years (SD 9) were included. Clinical entity approach was carried out to identify muscle-tendon related pain. Muscle strength was assessed with a handheld dynamometer and self-reported hip disability was recorded with the Copenhagen Hip and Groin Outcome Score (HAGOS). Results. Iliopsoas- and abductor-related pain were most prevalent with prevalences of 56% (CI 46; 66) and 42% (CI 32; 52), respectively. Adductor-, hamstrings- and rectus abdominis-related pain were less common. There was a significant inverse linear association between muscle-tendon related pain and self-reported hip disability ranging from −3.35 to −7.51 points in the adjusted analysis (p<0.05). Likewise an inverse linear association between muscle-tendon related pain and muscle strength was found ranging from −0.11 Nm/kg to −0.12 Nm/kg in the adjusted analysis (p<0.05). Conclusion. Muscle-tendon related pain seem to exist in about half of patients with hip dysplasia with a high prevalence of muscle-tendon related pain in the iliopsoas and the hip abductors and affects patients” self-reported hip disability and muscle strength negatively

Introduction. Current modeling techniques have been used to model the Reverse Total Shoulder Arthroplasty (RTSA) to account for the geometric changes implemented after RTSA [2,3]. Though these models have provided insight into the effects of geometric changes from RTSA these is still a limitation of understanding muscle function after RTSA on a patient-specific basis. The goal of this study sought to overcome this limitation by developing an approach to calibrate patient-specific muscle strength for an RTSA subject. Methods. The approach was performed for both isometric 0° abduction and dynamic abduction. A 12 degree of freedom (DOF) model developed in our previous work was used in conjunction with our clinical data to create a set of patient-specific data (3 dimensional kinematics, muscle activations (), muscle moment arms, joint moments, muscle length, muscle velocity, tendon slack length (), optimal fiber length, peak isometric force)) that was used in a novel optimization scheme to estimate muscle parameters that correspond to the patient's muscle strength[4]. The optimization varied to minimize the difference between measured (“in vivo”) and predicted joint moments and measured (“in vivo”) and predicted muscle activations (). The predicted joint moments were constructed as a summation of muscle moments. The nested optimization was implemented within matlab (Mathworks). The optimization yields a set of muscle parameters that correspond to the subject's muscle strength. The abduction activity was optimized [4,5]. To validate the model we predicted dynamic joint moment and activation for the abduction activity (Figure 1). Results. The muscle activation for the lateral deltoid had a normalized correlation of value of .91(Figure 1 left). The maximum joint moment produced was 18 newton-meters. The joint moments were reproduced to an value of 1 (Figure 1 Right). Muscle parameters were calculated for both isometric and dynamic abduction. The muscle parameters produced provided a feasible solution to reproduce the muscle activation and joint moments seen “in vivo” (Figure 1). Discussion. Current modeling techniques of the upper extremity focus primarily on geometric changes and their effects on shoulder muscle moment arms. In efforts to create patient-specific models we have developed a framework to predict subject-specific strength characteristics. In order to fully understand muscle function we need muscle parameters that correspond to the subject's strength. This effort in conjunction with patient-specific models that incorporate the patient's joint configurations, kinematics and bone anatomy provide a framework to gain insight into muscle tensioning effects after RTSA. This framework describes the relationship between muscle lengthening and muscle performance (recruitment and force generation). With this framework improvements can be made to the surgical implementation and design of RTSA to improve surgical outcomes. Significance. This abstract is the first of its kind to use patient-specific fluoroscopy kinematics, muscle activation and joint moments to create a framework to predict a patients muscle function (activation, force) for RTSA groups. This now allows us to understand how differences in implant design and surgical technique affect each muscle's ability to generate force and function. For any figures or tables, please contact authors directly (see Info & Metrics tab above).

Purpose. Stress fractures (SFs) are highly prevalent in female athletes, especially runners (1337%), and result in pain and lost training time. There are numerous risk factors for SFs in athletes; however, the role of bone quality in the etiology of SFs is currently unknown. Therefore, our primary objective was to examine whether there are characteristic differences in bone quality and bone strength in female athletes with lower limb SFs using high-resolution peripheral quantitative computed tomography (HR-pQCT). A secondary objective was to compare muscle strength between SF subjects and controls. Method. Female athletes with (n=19) and without (n=19) lower limb SFs were recruited from the local community. All SFs were medically confirmed by a physician and subjects were assessed within 1–47 weeks (12.7 13.7) of diagnosis. Controls were age-, training volume- and sport-matched to SF athletes. Bone density and microarchitectural bone parameters such as cortical thickness and porosity, as well as trabecular thickness, separation and number of all subjects were assessed using HR-pQCT at two distal tibia scanning sites (distal, ultra-distal). Finite element (FE) analysis was employed to estimate bone strength and load sharing of cortical and trabecular bone from the HR-pQCT scans. Regional analysis was applied to the HR-pQCT scans to investigate site-specific bone differences between groups. Muscle torque was measured by a Biodex dynamometer as a surrogate of muscle strength. Independent sample t-tests and Mann-Whitney U-tests were used for statistical analyses (p < 0.05). Results. Significant differences and trends indicated compromised trabecular bone and slightly thicker cortices with fewer pores in SF subjects compared with controls. This was most pronounced in the posterior region of the distal tibia, which is the site of highest tensile stresses during running and a common SF site. FE analysis indicated significantly higher cortical loads (median 4.2% higher; p=0.03) in the distal tibia site (but not ultra-distal site) of SF subjects compared to controls. The SF group exhibited significantly reduced knee extension strength (median 18.3% lower; p=0.03) and a trend towards reduced plantarflexion (median 17.3% lower; p=0.24) and eversion strength (median 9.6% lower; p=0.49) compared to controls. Conclusion. This is the first study to compare bone microarchitectural quality and lower-limb muscle strength between female athletes with SFs and health controls. A reduced trabecular bone quality in SF subjects may result in an insufficient ability to absorb and distribute tibial loads. This, in turn, may lead to higher stresses in the cortex and a higher risk for SFs. Low muscle strength may increase SF risk by providing insufficient muscular support to counteract shear stresses associated with reaction forces during running. Further study is needed to determine whether a resistance-training program can improve bone quality and in turn, reduce SF risk

Introduction: The purpose of this study was to quantify changes in lower limb muscle strength in children with spastic diplegic cerebral palsy 6 months after multi-level orthopaedic surgery. Method: A consecutive sample of 20 children ( 10 girls and 10 boys, mean age 10.6) with spastic diplegia was studied prospectively. All participants had soft-tissue and bony surgical procedures performed as part of their clinical management. Physiotherapy treatment commenced following surgery. Lower limb muscle strength, pre and 6 months post-surgery, was measured, in addition to routine gait and function assessment. Maximum voluntary isometric strength of 5 muscle groups was measured bilaterally using a digital dynamometer. Paired-samples t-tests were performed. Results: There was a marked deterioration of muscle strength (p < 0.05) in all muscle groups. Medial hamstrings and hip flexors showed the greatest decline with an average decrease of 54% and 41% respectively. Analysis of gait parameters showed a significant improvement in kinematics (p< 0.05) but a decrease in walking velocity and cadence. Motor function decreased significantly (p< 0.05). There was reduced motor power in 18 of the 20 at 6 months. Discussion: Our results quantified objectively the magnitude of strength changes after multi-level surgery and show that weakness may be greater and persist longer than expected. This information will be useful for planning treatment after multi-level surgery and is part of a randomised trial investigating strength training. In general there is a decrease in power but an improvement in gait

Modern musculoskeletal modeling techniques have been used to simulate shoulders with reverse total shoulder arthroplasty and study how geometric changes resulting from implant placement affect shoulder muscle moment arms. These studies do not, however, take into account how changes in muscle length will affect the force generating capacity of muscles in their post-operative state. The goal of this study was to develop and calibrate a patient-specific shoulder model for subjects with RTSA in order to predict muscle activation during dynamic activities. Patient-specific muscle parameters were estimated using a nested optimization scheme calibrating the model to isometric arm abduction data at 0°, 45° and 90°. The model was validated by comparing predicted muscle activation for dynamic abduction to experimental electromyography recordings. A twelve-degree of freedom model was used with experimental measurements to create a set of patient-specific data (three-dimensional kinematics, muscle activations, muscle moment arms, joint moments, muscle lengths, muscle velocities, tendon slack lengths, optimal fiber lengths and peak isometric forces) estimating muscle parameters corresponding to each patient's measured strength. The optimization varied muscle parameters to minimize the difference between measured and estimated joint moments and muscle activations for isometric abduction trials. This optimization yields a set of patient-specific muscle parameters corresponding to the subject's own muscle strength that can be used to predict muscle activation and muscle lengths for a range of dynamic activities. The model calibration/optimization procedure was performed on arm abduction data for a subject with reverse total shoulder arthroplasty. Muscle activation predicted by the model ranged between 3% and 90% of maximum. The maximum joint moment produced was 20 Nm. The model replicated measured joint moments accurately (R2 > 0.99). The optimized muscle parameter set produced feasible muscle moments and muscle activations for dynamic arm abduction, when calibrated using data from isometric force trials. Current modeling techniques for the upper extremity focus primarily on geometric changes and their effects on shoulder muscle moment arms. In an effort to create patient-specific models, we have developed a framework to predict subject-specific muscle parameters. These estimated muscle parameters, in combination with patient-specific models that incorporate the patient's joint configurations, kinematics and bone anatomy, provide a framework to predict dynamic muscle activation in novel tasks and, for example, predict how joint center changes with reverse total shoulder arthroplasty may affect muscle function

Introduction. Although Total elbow arthroplasty (TEA) generally provides favorable clinical outcomes, its complications have been reported with high rate compared with other joints. Previously, we used the Bryan & Morrey approach in TEA, which included separating the triceps muscle subperiosteally from the olecranon; however, since 2008, in order to prevent skin trouble and deficiency of the triceps, we performed TEA by MISTEA method, which required no removal of the subcutaneous tissue in the region of the olecranon and no release or stripping of the triceps tendon. Objectives. The purpose of this study was to examine the utility of the MISTEA method by evaluating and comparing muscle strength and complications by using both the Bryan & Morrey approach and MISTEA method. Materials and Methods. The study was conducted on 23 elbows, on which elbow muscle strength could be measured postoperatively at more than 6 months after TEA. Thirteen elbows were operated on the Bryan & Morrey approach (BM group; mean age, 62.3 years; mean follow-up period, 27 months), and 10 elbows on the MISTEA method (MIS group; mean age, 67.6 years; mean follow-up period, 19.1 months). To determine the elbow extensor and flexor strengths, measurements were conducted on the affected side for the BM group, and on both the affected and healthy sides for the MIS group. Further, the “extension/flexion ratio” as well as the “affected/healthy side ratio” and complications were assessed. Results. Excluding the elbow extensor strength of 3 elbows in the BM group, which could not be measured too week. The extension/flexion ratio was as follows: in the BM group, 0.61 and in the MIS group, 0.93 on the affected side and 0.81 on the healthy side. For the MIS group, in which measurements could be performed on both the sides, the “affected/healthy side ratio” was 0.72 in flexion and 0.91 in extension. In terms of complications, skin trouble was found on 2 elbows in the BM group and on 1 elbow in the MIS group; further, rupture of the triceps tendon was suspected in 3 elbows in the BM group but was not found in the MIS group. Discussion. In our study, deficiency in triceps muscle was found in 3 of 13 elbows with the Bryan & Morrey approach. MISTEA method may be the reason for prevention of deficiency or rupture of the triceps tendon. The MIS group had higher extension/flexion ratio in the affected side, suggesting the possibility that either the extensor strength had increased or the flexor strength had weakened. Further, in the MIS group, the extension showed an “affected/healthy side” ratio, which means that an extensor strength almost equivalent to that of the healthy side was maintained, whereas the flexor strength was 72% of that on the healthy side, suggesting that the flexor strength may have decreased. Loss of the flexor strength may be because the MISTEA method involves partial release of the brachialis muscle and the joint's center of rotation to move slightly towards the proximal side

Aim: Patients treated with one-stage combined operations after walking age for developmental dysplasia of the hip (DDH), and whose follow-up revealed both clinical and radiological complete healing underwent flexor and extensor isokinetic muscle strength (IMS) measurements of the hip and results were evaluated in comparison with the contralateral hips. Methods: A total of 22 patients with unilateral DDH and treated with one-stage combined operations after walking age were included in the study. All patients were operated by the same surgeon. In their last follow-up visit, all patients were functionally excellent in accordance with the Barrett’s Modified McKay Criteria and according to the Severin’s Classification for radiological grading of the hip all cases were type I. IMS of hip flexors and extensors were tested by Biodex 3 Pro isokinetic test device at 120º/sc and 240º/sc. In all patients, peak torque (PT), peak torque angle (PTA), total work (TW), and average power (AP) values of operated and non-operated hips were measured at both angular velocities and recorded separately for flexors and extensors. For comparative evaluation, values of the operated and non-operated hips were used for determining the differences in IMS (DIMS), total work (DTW), and average power (DAP). In statistical assessment; Student’s t test, paired t test, and Spearman’s Rank correlation analysis were used. Results: The mean age of patients were 12,8±2,9 (9–18) years old. At the last control visit, the mean value of follow-up periods were 112,6±32,0 (68–159) months. Parameters like age, age at the time of operation, and the length of postoperative follow-up period showed no statistical relation with IMS measurements (p> 0,05). For flexors, TW was lower at the operated hip when compared with the non-operated hip at 120º/sc and 240º/sc (p=0,001 and p=0,002, respectively). AP was lower at the operated hip at 120º/sc and 240º/sc (p=0,011 and p=0,003, respectively). PT was lower at the operated hip (22,5±11,3) when compared with the non-operated hip (27,1±12,1) only at 120º/sc (p=0,001). For extensor muscles, PT, TW, AP, and PTA showed no statistically significant difference (p> 0,05). For flexors, the DIMS between operated and non-operated hips at 120º/sc and 240º/sc were measured as −15,3±22,2% (median;-14,4) and −8,0±21,4% (median;−2,5), respectively. Conclusions: In operated DDH patients with a mean follow-up period of around 10 years, IMS measurements revealed that the flexor muscle strength of the operated hip was still weaker than the non-operated hip. At 120º/sc, which represented evaluation against higher resistance, DIMS, DWF, and DAP were higher when compared with 240º/sc. This finding shows that hip flexors of these patients may remain weak in activities like sports, which require more resistance

Total joint replacement (TJR) is by far the most effective therapy for end-stage OA patients. Most of patients achieve joint pain reduction and function improvement following to TJR, however up to 22% of them either do not improve or deteriorate after surgery. The aim of this study was to identify genetic variants to be associated with poor outcome of TJR in primary OA patients by a genome-wide association approach (GWAS). Study participants were primary OA patients from the Newfoundland Osteoarthritis Study (NFOAS) that comprised total knee or hip replacement and recruited before 2016 in St. John's, NL. DNA samples were extracted from patients' blood. Study participants completed their pre-operation and 3.99±1.38 years post-surgery outcome assessment using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). DNA samples were genotyped using the genome-wide Illumina HumanOmni2.58 genotyping microarray containing 2.4 million SNPs. Pre-association quality control filtering was conducted for the raw genotyping data using PLINK 1.7 program, and genotype imputation was performed using the IMPUTE2 algorithm with multiple population reference data from 1000 Genome Project. The imputed data with ∼3.1 million variants was used to test the association with non-responders to TJR using the additive genetic model. Eighty three primary OA patients (44 responders and 39 non-responders) were included in the analysis. Association analysis detected three chromosomal regions on chr5, 7, and 8 to be significantly associated with non-responding to pain. The top SNPs at these loci are intergenic variants that include SNP (rs17118094, p=4.4×10-5) on chr5. This SNP is adjacent to SGCD gene that plays an important role in muscular strength and maintenance. Another associated SNP (rs71572810, p=4.7×10-5) is nearby IMMP2L gene on chr7. This gene is reported to be associated with behavioral abnormalities. Finally, SNP (rs6992938, p=5.8×10-5) on chr8 is located downstream of TRPA1 gene that is known to have a central role in the pain response to endogenous inflammatory mediators. Three loci were also found to be significantly associated with non-responding to function. The lead variant in the locus on chr1 is an intergenic SNP (rs9729377, p=1.7×10-5) falling between CTBS and MCOLN2 genes. CTBS gene is associated with TNF-α, a cytokine that stimulate the inflammation acute phase reaction, and MCOLN2 gene plays a role in the chemokine secretion and macrophage migration in the innate immune response. Other top SNPs in loci on chr2 and 10 harbor CCDC93, INSIG2, and KLF6 genes that are associated with heel bone mineral density, hypercholesterolemia, obesity and BMI. To our knowledge, this project is the first study that investigated the association between genetic factors and TJR non-responders. Our results demonstrated that genes related to muscle strength, behavioral trait, pain response, and inflammation play a significant role in poor outcome of TJR, warranting further investigation

Anterior cruciate ligament reconstruction has become a standard procedure with a documented good and excellent outcome of 70–90%. It has been demonstrated by previous research that all patients following surgery demonstrate a strength deficit of almost 20%. However it is not known whether these strength deficits have an influence on postoperative functionality. 52 consecutive patients (38 males and 14 females) were selected (mean age 27.9 years). All subjects were tested prior and 12 month following anterior cruciate ligament reconstruction. Muscle strength was assessed using a Biodex dynamometer. Isometric strength was examined at 30 and 60 degrees of flexion. Isokinetic testing was performed at 180 degrees/sec and peak torque and symmetry indices were analysed. No correlations were found between the Cinncinnati Score and isokinetic peak torque for extension. A moderate significant (p=0.001–0.007) correlation (r=0.200.45) was found for peak flexion torque in ACL reconstructed patients. In ACL deficient patients symmetry indices (r=0.36–0.43, p=0.001–0.004) were moderately related to functionality for both flexion and extension. Quadriceps muscle strength does not seem to be an important predictor of knee function after ACL reconstruction. Flexors seem to be important to protect the graft from overload. In ACLD knees functionality is related to high symmetry indices suggesting similar strength is necessary to perceive knee function as near normal. This is possibly a normal neuromuscular adaptation caused by contralateral quadriceps avoidance

Sarcopenia is an age-related geriatric syndrome which is associated with subsequent disability and morbidity. Currently there is no promising therapy approved for the treatment of sarcopenia. The receptor activator of nuclear factor NF-κB ligand (RANKL) and its receptor (RANK) are expressed in bone and skeletal muscle. Activation of the NF-κB pathway mainly inhibits myogenic differentiation, which leads to skeletal muscle dysfunction and loss. LYVE1 and CD206 positive macrophage has been reported to be associated with progressive impairment of skeletal muscle function with aging. The study aims to investigate the effects of an anti-RANKL treatment on sarcopenic skeletal muscle and explore the related mechanisms on muscle inflammation and the polarization status of macrophages.

Sarcopenic senescence-accelerated mouse P8 (SAMP8) mice at month 8 were treated intraperitoneally with 5mg/kg anti-RANKL (IK22/5) or isotype control (2A3; Bio X Cell) antibody every 4 weeks and harvested at month 10. Senescence accelerated mouse resistant-1 (SAMR1) were collected at month 10 as the age-matched non-sarcopenic group. Ex-vivo functional assessment, grip strength and immunostaining of C/EBPa, CD206, F4/80, LYVE1 and PAX7 were performed. Data analysis was done with one-way ANOVA, and the significant level was set at p≤0.05.

At month 10, tetanic force/specific tetanic force, twitch force/specific twitch force in anti-RANKL group were significantly higher than control group (all p<0.01). The mice in the anti-RANKL treatment group also showed significantly higher grip strength than Con group (p<0.001). The SAMP8 mice at month 10 expressed significantly more C/EBPa, CD206 and LYVE1 positive area than in SAMR1, while anti-RANKL treatment significantly decreased C/EBPa, CD206 and LYVE1 positive area.

The anti-RANKL treatment protected against skeletal muscle dysfunctions through suppressing muscle inflammation and modulating M2 macrophages, which may represent a novel therapeutic approach for sarcopenia.

Acknowledgment: Collaborative Research Fund (CRF, Ref: C4032-21GF)