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

Introduction. As the aging society progresses rapidly, the number of patients underwent total knee arthroplasty (TKA) is increasing especially for the elderly population. In Japan, the average age for TKA is around 75 years old. Japanese Orthopaedic Association indicated a new clinical entity of musculoskeletal ambulation disability symptom complex (MADS) to define the higher risk of fall and ambulatory disability in the elderly population in 2006. The diagnosing criteria for MADS consists of 2 simple performance tests. 3m timed up and go test (TUG) evaluates ambulatory function, and one leg standing time (ST) assesses balancing ability. Objective. In this study, we analyzed the effect of TKA on the ambulatory function by quantitative measurement using 2 simple performances test: TUG and ST. Materials & Methods. Forty four patients (6 males and 38 females) with varus type osteoarthritic knees underwent TKA were involved. The mean age of surgery was 72.7 years old. TUG and ST were performed at 4 time periods; pre-operatively, 2 weeks after surgery, at hospital discharge (average 24.1 days) and 1year after surgery. Ambulatory disability (MADS) was diagnosed if TUG was not less than 11 seconds and/or ST was less than 15 seconds. 36 patients (82%) were diagnosed to MADS preoperatively. We divided these 36 patients into two groups depending on the performance tests one year after TKA. 24 patients (67%) still suffered from MADS (Group1), and remaining 12 patients (33%) recovered from MADS (Group2). We compared preoperative factors (age, femoro-tibial angle, ROM, etc.) and the results of ST and TUG between Group 1 and Group 2 using the Mann-Whitney test (p<0.05). Results. The complication rates of MADS in all 44 patients were 82.0, 88.9, 83.3, and 55.6% at 4 time periods respectively. Significant functional recoveries were observed with decrease of TUG and increase of ST at 1 year after surgery (Fig. 1). Average age at surgery was significantly higher in Group 1 (74.7yo) comparing to Group 2 (69.3yo). The sequential change of mean TUG and ST at 4 time periods were shown for each group in Fig. 2 and Fig. 3. We found no significant difference in TUG but significant difference in ST between two groups. Patient in Group 2 could stand on one leg longer than Group 1 preoperatively even with no significant difference in TUG. Discussions. We evaluated the ambulatory function using 2 simple performance tests, and found significant improvements in both balancing ability (ST) and ambulatory function (TUG) one year after TKA. However, more than 50% of our patient population still suffered from ambulatory disability (MADS) at 1 year after surgery. As much as 70% of preoperatively MADS complicated patients were found to meet MADS criteria even one year after TKA. Only 30% of preoperatively MADS complicated patient could recover from MADS. This group was relatively younger and showed better balancing ability preoperatively. Our results suggested that standing time measurement would be simple and useful predictor for the functional recovery after TKA

Background. Kinesiophobia is simply defined as a fear of movement and physical activity. It can be seen in patients as a result of any injury, which results in pain or a fear of injury recurrence. It leads to decreased motion and disuse that may result in a chronic pain syndrome and decreased physical function. High levels of fear-avoidance have been found in subjects with total knee arthroplasty (TKA) and knee injuries, which predisposes them to the development of chronic pain conditions and seriously affect functional outcomes and their return to previous activity levels. However, the relationship between pain, kinesiophobia and performance-based outcomes in assessment of patients with TKA is unclear. Purpose. The aim of our study was to investigate relationship between pain, kinesiophobia and performance-based tests in assessment of patients with TKA. Methods. Twenty-eight patients (10 males, 18 females) were included in the study with mean age 63.6±9.8 years. Patients performed 2 performance tests (Timed “Up & Go” Test (TUG), 10 Meter Walk Test (10-MWT)) and one self-report measurement (TAMPA Scale) which measure the kinesiophobia were preferred to assess patients. Also the activity pain level was evaluated by The Numeric Pain Rating Scale (NPRS). Patients were evaluated preoperatively and at discharge. Results. While there was a moderate significant correlation in preoperatively between activity NPRS and 10-MWT score (r=0.432, p=0.022), there was no correlation between activity NPRS and TUG (p>0.05). Also there were no correlations between TAMPA scale and 2 performance-based tests in preoperatively (p>0.05). There were high significant correlations between TAMPA scale and 2 performance-based tests (TUG, 10-MWT) in the evaluation of patients with TKA (respectively; r=0.899, p<0.001; r=0.608, p=0.001). However, there were no correlations between activity NPRS and 2 performance-based tests in postoperatively in patients with TKA. Conclusion. While there were high significant correlations between TAMPA scale and 2 performance-based tests, there were no correlations between activity NPRS and 2 performance-based tests in postoperatively in patients with TKA. The functional level at early stage after TKA may be more related with the kinesiophobia level than the activity pain level. Given these results suggest that the rehabilitation after TKA focused on reducing kinesiophobia level could be important to enhance the potential benefits of the patients' functional outcomes at early stage after TKA

Introduction. Rapid increase of aged population has been one of major issue affecting national health care plan in Japan. In 2006, Japanese Orthopaedic Association proposed the clinical entity of musculoskeletal ambulation disorder symptom complex (MADS) to define the elderly population with high risk of fall and ambulatory disability caused by musculoskeletal disorders. Osteoarthritis of the knee is one of major cause of MADS. The number of patients with MADS underwent total knee arthroplasty (TKA) had been increased in Japan, and also expected to increase worldwide in the near future. The effectiveness of TKA for the patient with MADS has not been well evaluated. In the present study, we analyzed the early post-operative functional recovery after TKA using 2 simple performance tests to diagnose MADS. Material & Method. Fifty patients with varus type osteoarthritic knees implanted with posterior-stabilized (PS) TKAs were subjected to this study. There were 44 female and 6 male patients. The mean age of the patients was 71.6 years (range, 59 to 84 years). Patients were subjected to 2 functional performance tests which were essential tests for MADS diagnosis. Firstly, 3 meter timed up and go test (TUG) was used to evaluate ambulation. Secondary one leg standing time with open eyes was measured to assess balancing ability. 2 tests were performed pre-operatively, 2 weeks after surgery and at discharge (23.8 days po). MADS was defined to be diagnosed if TUG and one leg standing time was not less than 11 seconds and/or less than 15 seconds respectively. Each parameter was compared among at above mentioned three time points -using a repeated measured analysis of variance (p<0.05). Results. The number of the patients with MADS were 37, 44 and 38 in 50 patient pre-operatively, 2 weeks after surgery and at hospital discharge respectively. Mean TUG was 12.9, 16.9 and 14.0 sec. respectively [fig 1]. TUG significantly increased during 2 weeks after TKA, followed by significant decrease at discharge. There were no significant improvements in ambulation during hospital stay. Mean one leg standing time with operated and non-operated side leg at three time points were 11.0, 12.4, 17.9 sec, and 18.4, 17.9, 24.2 sec. each respectively [fig 2]. There were no significant improvements during initial 2 weeks after surgery. Significant increase of one leg standing time was found after 2 weeks, and balancing ability was found to be improved during hospital stay. Discussion & Conclusion. Although both parameters assessing ambulatory and balancing function were found to be improved post-operative 2 weeks, still as much as 76% of patients were suffered from MADS at hospital discharge in our patient population. These results indicate that the patient after TKA has still exposed to high risk of fall and ambulatory dysfunction at discharge. We should reconsider the appropriate rehabilitation protocol especially for the elderly patient with MADS to meet with patient expectation and enhance early post-operative care

Aims

The evidence base within trauma and orthopaedics has traditionally favoured quantitative research methodologies. Qualitative research can provide unique insights which illuminate patient experiences and perceptions of care. Qualitative methods reveal the subjective narratives of patients that are not captured by quantitative data, providing a more comprehensive understanding of patient-centred care. The aim of this study is to quantify the level of qualitative research within the orthopaedic literature.

The Achilles tendon is the most commonly ruptured tendon in the body and yet its management remains controversial due to potential surgical complications. We believe that primary repair using LARS ligament augmentation, combined with early mobilisation will significantly reduce all these potential problems and lead to improved functional outcomes. Nine patients with acute Achilles tendon ruptures underwent primary repair using augmentation with a Ligament Augmentation and Reconstruction System (LARS) ligament. Day one postoperatively each patient was started on active range of motion exercises. Clinical parameters, isokinetic strength and outcome measurements (The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and Lower Extremity Functional Scale (LEFS) was utilised to assess pain and function, Tegner score to evaluate activity) were evaluated at an average follow-up of 17 months. Complications, if any, were also recorded. There were no re-ruptures and all patients returned to normal work (average time 9.2 weeks) and all but one returned to their previous level of recreational sporting activity (average time 20.8 weeks). The postoperative performance testing showed positive results with the mean decrease in calf circumference of affected leg was 1.0 cm (range, −0.5 to 2.0), and every patient was able to perform at least one heel-raise with the mean heel raise difference being −3.8 repetitions (range, −1 to −10 reps) when compared to the other leg. In terms of functional outcomes, all patients reported very good results. The mean AOFAS score postoperatively was 83.4% (range, 74% to 100%) and the mean LEFS score was 82.5% (range, 45 to 100%). The mean preoperative Tegner score was 4.75 (range, 2 to 8) and the postoperative score was 3.75 (range, 2 to 7). The results of our preliminary clinical series indicate that LARS ligament repair of acute Achilles tendon ruptures provides a reliable and effective technique for repair. It eliminates the need for graft harvesting, it decreases postoperative complications, but most importantly, patients have improved functional outcomes

[Introduction]. Rapid increase of aged population has been one of major issue affecting national health care plan in Japan. In 2006, Japanese Orthopaedic Association indicated a new clinical entity of musculoskeletal ambulation disorder symptom complex (MADS) to define the higher risk of fall and ambulatory disability in the elderly population caused by musculoskeletal disorders. Osteoarthritis of the knee is one of major cause of MADS. The number of patients with MADS underwent total knee arthroplasty (TKA) had been increased in Japan, and also expected to increase worldwide in the near future. The effectiveness of TKA for the patient with MADS would be a key issue for the patient satisfaction in TKA. In the present study, we analyzed the influence of pre-operative factors on the ambulatory functions in the patients of primary TKA. [Material & Method]. 132 patients with osteoarthritic knees implanted with posterior-stabilized (PS) TKAs were subjected to this study. There were 113 female and 19 male patients. The mean age of the patients was 73.6 years (range, 59 to 87 years). Patients were pre-operatively subjected to 2 functional performance tests which were essential tests for MADS diagnosis. Firstly, 3 meter timed up and go test (TUG) was used to evaluate ambulation ability. Secondary one leg standing time (ST) with open eyes was measured with both operated and non-operated leg to assess balancing ability. MADS was diagnosed if TUG and ST were not less than 11 seconds and/or less than 15 seconds respectively. The influence of each pre-operative factor was evaluated simple linear regression analysis (p < 0.05). Pre-operative factors consisted of age, sex, weight, height, BMI, standing femoro-tibial angle (FTA) and active knee range of motion. [Results]. Pre-operatively, 74% of the patients was diagnosed as MADS, with the results of 64, 74 and 64% of the patient matched to the MADS criteria with the evaluation of TUG and ST with operated and non-operated leg respectively (Fig 1). Firstly, pre-operative TUG was found to be negatively correlated to the weight (R = −0.25), ST with non-operated leg (R = −0.24) and active knee flexion angle (R = −0.28, Fig 2). Secondary, ST with operated leg was significantly affected by age (R = −0.32), standing FTA (R = −0.38) and ST with non-operated leg (R = 0.66, Fig 3). [Discussion & Conclusion]. As much as 74% of our patients was suffered from MADS before primary TKA. Majority of patient had both ambulatory and balancing disability with higher risk of fall and ambulatory dysfunction. We found ST with non-operated leg significantly affected both TUG representing ambulatory function and ST representing balancing function. This means the contra-lateral lower extremity function would play an important role on the pre-operative functional ability in the patient of TKA. Furthermore, we found pre-operatively that active knee flexion influenced ambulatory function, and coronal knee deformity deteriorated balancing ability. Then we should evaluate these pre-operative factors in analyzing the effectiveness of TKA on the functional recovery in the elderly patient underwent primary TKA

Introduction. Our primary hypothesis was simple: does gait on a downhill gradient distinguish between types of knee arthroplasty? Our secondary hypotheses were these: are stride length and other kinematic variables affected by cruciate ligament integrity following knee arthroplasty?. Participants. Ethical approval was sought and gained prior to commencement of the study. 52 subjects were tested on the instrumented treadmill, 3 groups (UKA, TKA, and young healthy control) of 19, 14, and 19 respectively. The two high performing arthroplasty groups were recruited from a database of patient related outcome measures (PROMs) and were chosen based on high Oxford knee scores (OKS) with a minimum 12 months post hip arthroplasty. Gait Analysis. Gait performance was tested on a validated instrumented treadmill (Kistler Gaitway®, Kistler Instrument Corporation, Amherst NY)[22, 23]. The rear of the treadmill was ramped with 30 cm axle stands in order to create a 7 degree decline for downhill walking (figure 1). The speed was increased incrementally. Hof scaling and body weight normalising was also applied to the outputted mechanical data to correct for leg length and mass differences, respectively. Results. Patient Related Outcome Measures. Both arthroplasty groups outcome scores were substantially better than the average reported by national joint registries. Treadmill Gait Analysis. When walking fast downhill, UKA patients walked 15% faster than the TKA patients (1.75 vs 1.52 m/sec p=0.000) despite having the same cadence (134 vs 135step/min) (figures 2,3,4). The 15% difference in speed was largely due to the reduced mean step (p=0.001) and stride lengths (p=0.000) seen in the TKA patients. These finding persisted after Hof scaling, which normalised speed for leg length (p=0.000). The values are indicated as means ± standard deviation; †significant difference between implant versus control (p <0.05); ‡significant difference between implant groups (p<0.05);H=normalized to leg length; BW=normalized to body weight. Discussion. The UKA group walked 15% faster than the TKA, with stride length almost matching the normal controls. The presence of intact cruciate ligaments allow a normal and co-ordinated swing phase, enabling the more normal stride, while the absence of the anterior cruciate ligament contributes to the reduction of knee flexion in swing phase, and thus the shorter stride length

Aim

The coronavirus disease 2019 (COVID-19) pandemic presents significant challenges to healthcare systems globally. Orthopaedic surgeons are at risk of contracting COVID-19 due to their close contact with patients in both outpatient and theatre environments. The aim of this review was to perform a literature review, including articles of other coronaviruses, to formulate guidelines for orthopaedic healthcare staff.

Demand for TKR surgery is rising, including a more diverse patient demographic with increasing expectations [1]. Therefore, greater efforts are being devoted to laboratory testing. As a result, laboratory testing may set a clinical performance presumption for surgeons and patients. For example, oxidized ZrNB (Oxinium) femoral components have been projected to show 85% less wear than CoCr femoral components in bench-top testing [2]. However, recent clinical data show no difference in outcomes between Oxinium® and CoCr for the same design [3]. While it does not show lagging peformance for the Oxinium components, it does call into question the predictive ability of simulation. To better understand the performance of these two materials, a non standardized simulator evaluation was conducted. One commercially available design (Legion PS) was evaluated with two variations of femoral component material (n = 3/material) Oxinium® and Cobalt Chromium. All testing was conducted using a 7.5 kGy moderately crosslinked UHMWPE (XLPE). A 6-station knee simulator was utilized to simulate stair-climbing kinematics. The lubricant used was Alpha Calf Fraction serum which was replaced every 0.5 million cycles for a total of 5 million cycles. Soak controls were used to correct for fluid absorption and statistical analysis was performed using the Student's t-test. Total wear rate results for the tibial inserts are shown in Figure 1. There was no statistical difference in volume loss (p = 0.8) or wear rate (p = 0.9) for the Oxinium® system when compared to the CoCrsystem under stair-climbing kinematics. Visual examination revealed typical wear scars and features on the condylar surfaces, including burnishing. These results corroborate the recent clinical data showing no difference between Oxinium® components and their CoCr analogs [3]. The kinematics used here are not a combination of normal level walking with stair-climbing conditions as was published originally for the Oxinium® material [2], but stair-climbing kinematics only. Even though the stair-climbing profile utilized here does not represent standardized kinematics, it provided results that are in line with clinical observations for these femoral materials. Logic suggests that a combined duty cycle is more representative of patient behavior so there must be additional test factors contributing to the prediction previously reported. The goal of bench top testing is to simulate actual clinical performance so test models must be validated as clinicaly relevant in order to be predictive. Furthermore, the results of this test indicate that the different femoral materials evaluated in this study do not alter the wear characteristics of this TKR. This is further supported by a similar previous study showing the relative contribution of design versus materials in terms of wear behavior [4]. The main determination comes from clinical evidence, and as it has been demonstrated by Kim, et al [3], there is no significant difference in the clinical results of the two TKR devices analyzed