Introduction. The purpose of this study was to characterize the recovery of physical activity following knee arthroplasty by means of step counts and flight counts (flights of stairs) measured using a smartphone-based care platform. Methods. This is a secondary data analysis on the treatment cohort of a multicenter prospective trial evaluating the use of a smartphone-based care platform for primary total and unicondylar joint arthroplasty. Participants in the treatment arm that underwent primary total or unicondylar knee arthroplasty and had at least 3 months of follow-up were included (n=367). Participants were provided the app with an associated smart watch for measuring several different health measures including daily step and flight counts. These measures were monitored preoperatively, and the following postoperative intervals were selected for review: 2–4 days, 1 month, 1.5 month, 3 months and 6 months. The data are presented as mean, standard deviation, median, and interquartile range (IQR). Signed rank tests were used to assess the difference in average of daily step counts over time. As not all patients reported having multiple stairs at home, a separate analysis was also performed on average flights of stairs (n=214). A sub-study was performed to evaluate patients who returned to preoperative levels at 1.5 months (step count) and 3 months (flight count) using an independent samples T test or Fisher's Exact test was to compare demographics between patients that returned to preoperative levels and those that did not. Results. The mean age of the step count population was 63.1 ± 8.3 years and 64.31% were female, 35.69% were male. The mean body mass index was 31.1 ± 5.9 kg/m. 2. For those who reported multiple stairs at home, the mean age was 62.6 ± 8.3 years and 62.3% were female. The mean body mass index was 30.7 ± 5.4 kg/m. 2. . As expected, the immediate post-op (2–4 days) step count (median 1257.5 steps, IQR 523 – 2267) was significantly lower than preop (median 4160 steps, IQR 2669 – 6034, p < 0.001). Approximately 50% of patients returned to preoperative step counts by 1.5 months postoperatively with a median 4,504 steps (IQR, 2711, 6121, p=0.8230, Figure 1). Improvements in step count continued throughout the remainder of follow-up with the 6-month follow-up visit (median 5517 steps, IQR 3888 – 7279) showing the greatest magnitude (p<0.001). In patients who reported stairs in their homes, approximately 64% of subjects returned to pre-op flight counts by 3 months (p=0.085), followed similar trends with significant improvements at 6 months (p=0.003). Finally, there was no difference in age, sex, BMI, or operative knee between those that returned to mean preoperative step or flight counts by 1.5 months and 3 months, respectively. Discussion and Conclusion. These data demonstrated a recovery curve similar to previously reported curves for patient reported outcome measures in the arthroplasty arena. Patients and surgeons may use this information to help set goals for recovery following total and unicondylar knee arthroplasty using objective activity measures. For any figures or tables, please contact the authors directly

Obesity is associated with worse outcomes following total knee/hip arthroplasty (TKA/TKA). This study aimed to determine the feasibility of a dietitian-led low-inflammatory weight-loss program for people with obesity awaiting arthroplasty. Quasi-experimental pilot study enrolled people with obesity waitlisted for primary TKA/THA into ‘usual care’ (UC) or weight-loss (low-inflammatory diet) program (Diet). Recruitment occurred between July 2019 and February 2020 at Fairfield and Campbelltown Hospitals. Assessments at baseline, pre-surgery, time of surgery and 90-days following surgery included anthropometric measurements, patient-reported outcomes, serum biomarkers and 90-day postoperative complication rate. 97 people consented to the study (UC, n=47, mean age 67, BMI 37, TKA 79%; Diet, n=50, mean age 66, BMI 36, TKA 72%). Baseline characteristics indicated gross joint impairments and poor compliance with a low-inflammatory diet. Study feasibility criteria included recruitment rate (52%), proportion of diet patients that improved compliance to low-inflammatory diet by ≥10% (57%) and had ≥60% attendance of dietitian consultations (72%), proportion of patients who undertook serum biomarkers (55%). By presurgery assessments, the diet group had more patients who cancelled their surgery due to symptom improvement (4 vs 0), reduced waist-circumference measurements, increased compliance with the Low-Inflammatory diet and preservation of physical activity parameters. More usual care participants experienced at least one postoperative complication to 90-days (59% vs 47%) and were discharged to inpatient rehabilitation (21% vs 11%). There was no difference in weight change, physical function, and patient-reported outcome measures from pre-surgery to 90-days post-surgery, and length of hospital stay. Using pre-determined feasibility criteria, conducting a definitive trial is not feasible. However, intervention audit demonstrated high intervention fidelity. Pilot data suggest our program may promote weight loss but the clinical effects for most are modest. Further research utilising a stronger intervention may be required to assess the effectiveness of a pre-arthroplasty weight-loss intervention

Background: Anterior cruciate ligament (ACL) injury and re-injury rates are high and continue to rise in adolescents. After surgical reconstruction, less than 50% of patients return to their pre-injury level of physical activity. Clearance for return-to-play and rehabilitation progression typically requires assessment of performance during functional tests. Pain may impact this performance. However, the patient's level of pain is often overlooked during these assessments. Purpose: To investigate the level of pain during functional tests in adolescents with ACL injury. Fifty-nine adolescents with ACL injury (ACLi; female n=43; 15 ± 1 yrs; 167.6 ± 8.4 cm; 67.8 ± 19.9 kg) and sixty-nine uninjured (CON; female n=38; 14 ± 2 yrs; 165.0 ± 10.8 cm; 54.2 ± 11.5 kg) performed a series of functional tests. These tests included: maximum voluntary isometric contraction (MVIC) and isokinetic knee flexion-extension strength tests, single-limb hop tests, double-limb squats, countermovement jumps (CMJ), lunges, drop-vertical jumps (DVJ), and side-cuts. Pain was reported on a 5-point Likert scale, with 1 indicating no pain and 5 indicating extreme pain for the injured limb of the ACLi group and non-dominant limb for the CON group, after completion of each test. Chi-Square test was used to compare groups for the level of pain in each test. Analysis of the level of pain within and between groups was performed using descriptive statistics. The distribution of the level of pain was different between groups for all functional tests (p≤0.008), except for ankle plantar flexion and hip abduction MVICs (Table 1). The percentage of participants reporting pain was higher in the ACLi group in all tests compared to the CON group (Figure 1). Participants most often reported pain during the strength tests involving the knee joint, followed by the hop tests and dynamic tasks, respectively. More specifically, the knee extension MVIC was the test most frequently reported as painful (70% of the ACLi group), followed by the isokinetic knee flexion-extension test, with 65% of ACLi group. In addition, among all hop tests, pain was most often reported during the timed 6m hop (53% of ACLi), and, among all dynamic tasks, during the side-cut (40% of ACLi) test (Figure 1). Furthermore, the tests that led to the higher levels of pain (severe or extreme) were the cross-hop (9.8% of ACLi), CMJ (7.1% of ACLi), and the isokinetic knee flexion-extension test (11.5% of ACLi) (Table 1). Adolescents with and without ACL injury reported different levels of pain for all functional tasks, except for ankle and hip MVICs. The isokinetic knee flexion-extension test resulted in greater rates of severe or extreme pain and was also the test most frequently reported as painful. Functional tests that frequently cause pain or severe level of pain (e.g., timed 6m and cross hops, side-cut, knee flexion/extension MVICs and isokinetic tests) might not be the first test choices to assess function in patients after ACL injury/reconstruction. Reported pain during functional tests should be considered by clinicians and rehabilitation team members when evaluating a patient's readiness to return-to-play. For any figures or tables, please contact the authors directly

Introduction. Knee osteoarthritis (OA) is a major contributor to disability in seniors and affecting millions of people around the world. Its main problem and the biggest factor in the disability of patients is pain. Pain renders patient inactive and develops lower extremity muscle wasting and worsens patient status adversely. However no radical solution existed until now. Recently I discovered a very valid manipulative technique (Squeeze-hold) for OA knee. This study presents the one-year follow-up data (three cases) by this treatment. Methods. Subjects. The subjects were three severe knee OA patients who had their data collected for 12 months after having a treatment. Treatment (squeeze-hold): The lower limb muscles (all muscles attached to the knee joint) were squeezed and held by hand. Each squeeze was performed in linear sequence all the way through the lower limbs. The squeezes were held for 20 seconds. This treatment was performed on a weekly basis. Evaluation: The conditions of the OA were evaluated using a Kellgren-Lawrence Grading Scale. Visual analogue scale as indicator of pain and Japanese Knee Osteoarthritis Measure as indicator of the activity restriction were recorded every month for a year. Results. In all three cases, OA knee pain and ADL were gradually improved by sustained once-a-week treatment. The daily activities were gradually increased. After a year, the pain passed approximately away. In case 1 and 2, a limitation in ROM did not show a marked improvement and joint contracture remained. Discussion. Squeeze-hold therapy that is approach to lower-limb muscles relieved OA knee pain. It is suggested by the fact that lower-limb muscles is responsible for the pain. And the physical activity of knee OA patient increases with decreasing pain effected by Squeeze-hold therapy. This increase in physical activity provides increase in joint movement and it lead to improve articular metabolism. Cyclical loading increases chondrocyte activity. Additionally, It inhibits the release of matrix metalloproteinase, pro-inflammatory mediators and shear stress-induced nitric oxide that induces chondrocyte apoptosis. And further, this increased physical activity improves muscle-strengthening of the lower extremity. It is plausible that these effects may continuously lead to decreased pain and improved ADL. A primary pain in knee OA can be attributed to inflammation of knee joint capsule or within knee joint capsule. And the pain leads to muscular hypertonicity thereby a bigger secondary pain develops in the muscles. Decreased physical activity due to the pain worsens pathological condition to induce greater pain. By this means, there might be formed pain-deterioration chain. Squeeze-hold therapy reduces the myogenic pain and cut the pain-deterioration chain. However, ROM could not improve though the pain and ADL activity imploved. This treatment ought to be performed before the formation of articular contracture. The results indicate Squeeze-hold treatment for lower-limb muscles might improves OA knee pain and limited ADL. However, this study had only three cases. Further research efforts are needed to identify the adaptation to diverse clinical symptoms knee OA

Introduction. Patients who undergo hip resurfacing, total hip arthroplasty (THA), and total knee arthroplasty (TKA) are frequently assessed post-operatively using objective scoring indices. A small yet significant percentage of these patients report pain and discomfort related to specific physical activities following surgery. The purpose of this study was to examine the types of activities which prove difficult for patients for each class of surgery, how important these activities are to the individual patients, and the demographic of patients who experience/report these limitations. Methods. Four groups of subjects were enrolled in this study: (i) 111 hip resurfacing patients at an average of 14 months after resurfacing, (ii) 170 patients at an average of 16 months post-primary THA, (iii) 61 patients at an average of 12 months post-primary TKA, and (iv) 64 control subjects with no history of hip or knee surgery or pathology. Each participant completed a self-administered Hip Function Questionnaire, Knee Function Questionnaire, or Hip Resurfacing Questionnaire which assessed each subject's overall satisfaction and expectations following surgery. The questionnaires included a section with 58 physical activities and asked the patients to rate the activities based on frequency of participation, importance of the activity, and how much their knee or hip bothered them when performing the activity. Results. The activities were scored for difficulty/bother on a scale of 1–5 with 5 being the most difficult, and scores of 4 or 5 were classified as “very difficult.” A population of patients rated activities as very difficult after surgery, including 33 (29.7%) resurfacing, 17 (10.0%) THA, and 32 (50.8%) TKA. The difficult activities varied based on the procedure, with many resurfacing patients reporting trouble with kneeling, squatting, and running; THA patients reporting trouble with squatting, sexual activity, and stretching; and TKA patients reporting trouble with gardening, kneeling, and squatting. The importance of the activities were also scored on a 1–5 scale with 5 being very important to the patient. The average importance scores for the difficult activities were 3.88 for resurfacing patients, 3.35 for THA patients, and 3.58 for THA patients. The demographic of patients who reported activities as difficult varied based on the type of surgery. After hip resurfacing 19.0% (4/21) of female patients reported activities as being difficult compared to 34.5% (29/84) of male patients; 13.6% (11/81) of female THA patients reported compared to 6.0% (5/84) of males, and 48.6% (18/37) of female TKA patients reported compared to 54.2% (13/24) of males. Conclusions. A significant portion of patients experience great difficulty with certain physical activities following hip resurfacing, TKA, and THA procedures. The frequency and types of difficult activities reported vary based on the surgery, with TKA patients reporting with the highest frequency and THA patients reporting with the lowest frequency. The gender of the patient appears to play a role in whether certain activities are difficult or not, with female patients more likely to report after THA and TKA, and male patients more likely to report after hip resurfacing

Femoroacetabular impingement (FAI) deformities are a potential precursor to hip osteoarthritis and an important contributor to non-arthritic hip pain. Some hips with FAI deformities develop symptoms of pain in the hip and groin that are primarily position related. The reason for pain generation in these hips is unclear. Understanding potential impingement mechanisms in FAI hips will help us understand pain generation. Impingement between the femoral head-neck contour and acetabular rim has been proposed as a pathomechanism in FAI hips. This proposed pathomechanism has not been quantified with direct measurements in physiological postures. Research question: Is femoroacetabular clearance different in symptomatic FAI hips compared to asymptomatic FAI and control hips in sitting flexion, adduction, and internal rotation (FADIR) and squatting postures?. We recruited 33 participants: 9 with symptomatic FAI, 13 with asymptomatic FAI, and 11 controls from the Investigation of Mobility, Physical Activity, and Knowledge Translation in Hip Pain (IMAKT-HIP) cohort. We scanned each participant's study hip in sitting FADIR and squatting postures using an upright open MRI scanner (MROpen, Paramed, Genoa, Italy). We quantified femoroacetabular clearance in sitting FADIR and squatting using beta angle measurements which have been shown to be a reliable surrogate for acetabular rim pressures. We chose sitting FADIR and squatting because they represent, respectively, passive and active maneuvers that involve high flexion combined with internal/external rotation and adduction/abduction, which are thought to provoke impingement. In the squatting posture, the symptomatic FAI group had a significantly smaller minimum beta angle (−4.6º±15.2º) than the asymptomatic FAI (12.5º ±13.2º) (P= 0.018) and control groups (19.8º ±8.6º) (P=0.001). In the sitting FADIR posture, both symptomatic and asymptomatic FAI groups had significantly smaller beta angles (−9.3º ±14º [P=0.010] and −3.9º ±9.7º [P=0.028], respectively) than the control group (5.7º ±5.7º). Our results show loss of clearance between the femoral head-neck contour and acetabular rim (negative beta angle) occurred in symptomatic FAI hips in sitting FADIR and squatting. We did not observe loss of clearance in the asymptomatic FAI group for squatting, while we did observe loss of clearance for this group in sitting FADIR. These differences may be due to accommodation mechanisms in the active, squatting posture that are not present in the passive, sitting FADIR posture. Our results support the hypothesis that impingement between the femoral head-neck contour and acetabular rim is a pathomechanism in FAI hips leading to pain generation

Introduction. There is a growing recognition that evaluation should use patient-reported outcome tools and assessments of satisfaction in procedures like total knee replacement. These ensure that the patient's perception of outcome is included in the evaluation. Considering the increasing demands on physical function from the aging population, it is important to evaluate demanding physical activities for the population with end stage arthritis assigned for TKR. Objectives. The aims of this prospective study were. To describe the outcome (from the patient's perspective) one year after TKR. To evaluate the patient satisfaction in terms of post op pain and functional outcome. To identify preoperative characteristics predicting the postoperative outcome. Material and methods. A retrospective as well as prospective study was done to analyse the satisfaction level, physical activity and quality of life after Total Knee Arthroplasty using a cemented modular posteriorly stabilized prosthesis one year after surgery using Knee injury and Osteoarthritis Outcome score (KOOS) and DMC & H General Patient Questionnaire. Clinical data was recorded and a proforma was filled of 104 patients operated from June 2010 till December 2012 of who consented and underwent Total Knee Arthroplasty at Dayanand Medical College and Hospital, Ludhiana. Results. There was significant improvement in all KOOS subscale scores but post op sports/rec scores remained at the lowest level in the Likert scale. There was no significant effect of age, sex, duration of symptoms, number of co-morbidities and BMI on post op KOOS outcome scores and patient satisfaction. There was no significant difference in post op. mean pain and function scores in patients with higher and lower ranges of pre op scores, though patients with higher pre op scores had slightly higher post op scores. Mean postoperative Koos scores had trend of higher scores in RA patients as compared to OA patients. However there was no statistical significant difference in koos outcome scores between these two groups. Post op KOOS pain and ADL scores were comparable to patient satisfaction level. Conclusion. Total knee replacement significantly improves patient's pain, symptoms, function and activities of daily living and knee related quality of life as more than 80% patients showed excellent satisfaction one year after surgery. Sports and recreational activities are not improved to the same extent as these activities were not applicable to more than 30 % of the patients. Patient satisfaction and fulfillment of expectations are comparable to KOOS sub scale scores. However, patient specific characters like age, sex, duration of symptoms, number of co-morbidities and BMI do not have significant effect on outcome measures

Power production in the terminal stance phase is essential for propelling the body forward during walking and is generated primarily by ankle plantarflexion. Osteoarthritis (OA) of the ankle restricts joint range of motion and is expected to reduce power production at that ankle. This loss of power may be compensated for by unaffected joints on both the ipsilateral and contralateral limbs resulting in overloading of the asymptomatic joints. Total ankle arthroplasty (TAA) has been shown to reduce pain and has the potential to restore range of motion and therefore increase ankle joint power, which could reduce overloading of the unaffected joints and increase walking speed. The purpose of this study was to test the hypothesis that ankle OA causes a loss of power in the affected ankle, compensatory power changes in unaffected lower limb joints, and that TAA will increase ankle power in the repaired ankle and reduce compensatory changes in other joints. One hundred and eighty-three patients (86 men, 97 women with average ages 64.1 and 62.4 years respectively) requiring surgical intervention for ankle OA were prospectively enrolled. Implant selection of either a fixed (INBONE or Salto Talaris) or mobile (STAR) bearing implant was based on surgeon preference. Three-dimensional kinematics and kinetics were collected prior to surgery and one year post-operatively during self-selected speed level walking using an eight-camera motion capture system and a series of force platforms. Subject walking speed and lower extremity joint power during the last third of stance at the ankle, knee, and hip were calculated bilaterally and compared before and after surgical intervention across the entire group and by implant type (fixed vs. mobile), and gender using a series of ANOVAs (JMP SAS, Cary, NC), with statistical significance defined as p < 0 .05. There were no gender differences in age, walking speed, or joint power. All patients increased walking as a result of surgery (0.87 m/s±0.26 prior to surgery and 1.13 m/s±0.24 after surgery, p < 0 .001) and increased total limb power. Normalized to total power (which accounts for changes in speed and distribution of power production across joints), prior to surgery the affected ankle contributed 19%±10% of total power while the unaffected ankle contributed 42%±12% (P < 0 .001). After surgery, the affected ankle increased to 25%±9% of total power and the unaffected ankle decreased to 38%±9% of total (P < 0.001). Other joints showed no significant power changes following surgery. Fixed bearing implants provide greater surgical ankle power improvement (61% versus 29% increase, p < 0 .002). Much of that change was due to the fact that those that received fixed-bearing implants had significantly lower walking speed and power before surgery. Ankle OA reduced ankle power production, which was partially compensated for by the unaffected ankle. TAA increases walking speed and power at the affected ankle while lowering power production on the unaffected side. The modifications in power production could lead to increased physical activity and reduced overloading of asymptomatic joints

Introduction. Unicompartmental knee arthroplasty is in particular promoted for knee OA patients with high demands on function and activity. This study used wearable inertial sensors to objectively assess function during specific motion tasks and to monitor activities of daily living to verify if UKA permits better function or more activity in particular with demanding tasks. Methods. In this retrospective, cross-sectional study, UKA patients (Oxford, n=26, 13m/13f, age at FU: 66.5 ±7.6yrs) were compared to TKA patients (Vanguard, n=26, 13m/13f, age: 66.0 ±6.9yrs) matched for gender, age and BMI (29.5 ±4.6) at 5 years follow-up. Subjective evaluation of pain, function, physical activity and awareness of the joint arthroplasty was performed by means of four PROMs: VAS pain, KOOS-PS, SQUASH (activity) and Forgotten Joint Score (FJS),. Objective measurement of function was performed using a 3D inertia sensor attached to the sacrum while performing gait test, sit-stand and block-step tests. To derive functional parameters such as walking cadence or sway during transfers or step-up previously validated algorithms were used (Bolink et al., 2012). Daily physical activity was objectively monitored with a 3D accelerometer attached to the lateral side of the unaffected upper leg during four consecutive days. Activity parameters (counts and times of postures, steps, stairs, transfers, etc.) were also derived using validated algorithms. Data was analysed using independent T-test, Mann-Whitney U test and Pearson's correlation. Results. PROM's did not show any significant difference between UKA and TKA especially for the routinely used VAS-Pain and KOOS-PS (p>0.57) while higher (better) mean scores were recorded for UKA using more specialist measures such as self-reported activity (SQUASH; UKA vs TKA: 5659 ±3753 vs 4245 ±2489, p=0.12) and joint awareness (FJS; UKA vs TKA: 50.7 ±24.3 vs 41.4 ±29.2, p=0.08). Sensor based measures of function showed significantly higher walking cadence for UKA (107.9 ±10.5 steps/min) than TKA (102.2 ±10.9 steps/min, p=0.049). Other functional parameters also indicated better UKA function, e.g. forward sway during sit-stand (UKA vs TKA: 38.0 ±13.2 deg vs 43.2 ±10.7 deg, p=0.06). The wearable activity monitors showed that UKA patients perform significantly more steps downwards on stairs or slopes (89.0 ±77.4) than TKA patients (46.9 ±51.3, p=0.03). Other, less demanding activity counts such as daily steps (6522 vs 6343, p=0.85) or sit-stand transfers (39.4 vs 42.3, p=0.37) were not different. Discussion and Conclusion. PROM's could not differentiate UKA from TKA although more specialist or demanding scores such SQUASH (activity) or FJS (joint awareness) seem to have more power. Objective assessment could show for UKA faster cadence and more steps down on stairs and slopes, indicating that UKA benefits functional quality and enables demanding activities. Objective measures of function and activity may be required in routine clinical follow-up to provide evidence and wearable sensors may facilitate this

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. 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

Introduction & Aims. Patient recovery after total knee arthroplasty remains highly variable. Despite the growing interest in and implementation of patient reported outcome measures (e.g. Knee Society Score, Oxford Knee Score), the recovery process of the individual patient is poorly monitored. Unfortunately, patient reported outcomes represent a complex interaction of multiple physiological and psychological aspects, they are also limited by the discrete time intervals at which they are administered. The use of wearable sensors presents a potential alternative by continuously monitoring a patient's physical activity. These sensors however present their own challenges. This paper deals with the interpretation of the high frequency time signals acquired when using accelerometer-based wearable sensors. Method. During a preliminary validation, five healthy subjects were equipped with two wireless inertial measurement units (IMUs). Using adhesive tape, these IMU sensors were attached to the thigh and shank respectively. All subjects performed a series of supervised activities of daily living (ADL) in their everyday environment (1: walking, 2: stair ascent, 3: stair descent, 4: sitting, 5: laying, 6: standing). The supervisor timestamped the performed activities, such that the raw IMU signals could be uniquely linked to the performed activities. Subsequently, the acquired signals were reduced in Python. Each five second time window was characterized by the minimum, maximum and mean acceleration per sensor node. In addition, the frequency response was analyzed per sensor node as well as the correlation between both sensor nodes. Various machine learning approaches were subsequently implemented to predict the performed activities. Thereby, 60% of the acquired signals were used to train the mathematical models. These models were than used to predict the activity associated with the remaining 40% of the experimentally obtained data. Results. An overview of the obtained prediction accuracy per model stratified by ADL is provided in Table 1. The Nearest Neighbor and Random Forest algorithms performed worse compared to the Support Vector Machine and Decision Tree approaches. Even for the latter, differentiating between walking and stair ascent/descent remains challenging as well as differentiating between sitting, standing and laying. The prediction accuracies are however exceeding 90% for all activities when using the Support Vector Machine approach. This is further illustrated in Figure 1, indicating the actual versus predicted activity for the validation set. Conclusions. In conclusion, this paper presents an evaluation of different machine learning algorithms for the classification of activities of daily living from accelerometer-based wearable sensors. This facilitates evaluating a patient's ability to walk, climb or descend stairs, stand, lay or sit on a daily basis, understanding how active the patient is overall and which activities are routinely performed following arthroplasty surgery. Currently, effort is undertaken to understand how participation in these activities progresses with recovery following total knee arthroplasty

Both the patient and the surgeon want hip and knee arthroplasties to last a lifetime. As a result, many patients have been told to defer arthroplasty as long as possible. After arthroplasty, many patients have been advised to limit physical activity. Such management strategies prioritise longevity but compromise lifestyle. Given that the technical aspects of the arthroplasty are satisfactory, modern total hip and knee prostheses have demonstrated remarkable durability. Quantitative studies of patient activity have measured up to 48 million cycles in-vivo, with impact, without evidence of loosening, osteolysis, or other impending failure. These data suggest that with current technology, an active lifestyle is compatible with implant longevity

Both the patient and the surgeon want hip and knee arthroplasties to last a lifetime. As a result, many patients have been told to defer arthroplasty as long as possible. After arthroplasty, many patients have been advised to limit physical activity. Such management strategies prioritise longevity but compromise lifestyle. Given that the technical aspects of the arthroplasty are satisfactory, modern total hip and knee prostheses have demonstrated remarkable durability. Quantitative studies of patient activity have measured up to 48 million cycles in vivo, with impact, without evidence of loosening, osteolysis, or other impending failure. These data suggest that with current technology, an active lifestyle is compatible with implant longevity

Aims

Deprivation underpins many societal and health inequalities. COVID-19 has exacerbated these disparities, with access to planned care falling greatest in the most deprived areas of the UK during 2020. This study aimed to identify the impact of deprivation on patients on growing waiting lists for planned care.

Introduction & aims. Total knee Arthroplasty has revolutionized the lifestyle of patients with end stage knee arthritis. This study was conducted to describe the outcome from patient's perspective one year after TKR and patient satisfaction in terms of post operative pain and functional outcome Also, to identify preoperative characteristics predicting post operative outcome. Method. A prospective study was conducted at our institution (Dayanand Medical College and Hospital, Ludhiana) from 2010 to 2012. The study included 104 patients (74 females and 30 males) with 152 cemented TKR surgeries. The average age of the patients was 61.39 years. Out of 104 patients, 48 had bilateral TKR, 31 had left TKR and 25 had right TKR surgery. Knee injury and osteoarthritis outcome score (KOOS) and DMCH General Patient Questionnaire was used to analyse the satisfaction level, physical activity and quality of life one year after the TKR surgery. Results. There was significant improvement in all KOOS subscale scores but post operative sports and recreational scores remained at lowest level in the Likert scale. There was no significant effect of age, sex, duration of symptoms, co morbidities and BMI on post operative KOOS scores and patient satisfaction. There was no significant difference in post operative mean pain and functional scores in patients with higher and lower ranges of pre operative scores, though patients with higher pre operative scores had slightly higher post operative scores. The mean post operative KOOS scores had trend of higher scores in RA patients as compared to OA patients. However, there was no statiscally significant difference between these two groups. Post operative KOOS pain and activity daily living (ADL) scores were comparable to patient's satisfaction levels. Conclusions. TKR significantly improves patient's pain symptoms, function and activities of daily living and knee related quality of life as more than 80% patients showed excellent satisfaction one year after the surgery. Sports and recreational activities did not improve to the same extent as these activities were not applicable to more than 30% of the patients. For any figures or tables, please contact authors directly (see Info & Metrics tab above).

Aims

Chronic osteomyelitis (COM) of the lower limb in adults can be surgically managed by either limb reconstruction or amputation. This scoping review aims to map the outcomes used in studies surgically managing COM in order to aid future development of a core outcome set.

Hip fractures are estimated to cost the NHS over £2 billion per year and, with an ageing society, this is likely to increase. Rehabilitation and discharge planning in this population can be met with significant delays and prolonged hospital stay leading to bed shortages for acute and elective admissions. Planning care for these patients relies on a multidisciplinary approach with allied healthcare providers. The number of hip fracture patients in our hospital averages between 450–500/annum, the second largest number in the North West. The current average length of stay for the hip fracture patients is 22.9 days. We evaluated the impact and performance of a pilot early supported discharge service (ESD) for patients admitted with a hip fracture. The pilot period commenced 22 September 2014 for 3 months and included an initial phase to set up the service and supporting processes, followed by the recruitment of 20 patients during the pilot period. The length of stay and post-discharge care was reviewed. The journey of 20 patients was evaluated. The length of stay was dramatically reduced from an average of 22.9 days to 8.8 days in patients on the ESD pathway. Family feedback showed excellent results with communication regarding the ESD pathway and relatives felt the ESD helped patients return home (100% positive feedback). Prolonged recumbency adversely affects the long-term health of these patients leading to significant morbidity such as pressure sores, respiratory tract infections and loss of muscle mass leading to weakness. Mortality is also a significant risk for these patients. Longer hospital stays lead to disorientation, institutionalisation and loss of motivation. Enhancing self-efficacy has been shown to improve balance, confidence, independence and physical activity. This pilot has proven that the Fracture Neck of Femur ESD service can significantly reduce the length of hospital stay and also deliver excellent patient and family feedback. The benefits of patients with a lower length of stay, with effective rehabilitation in hospital and within the home, will provide significant benefits to the Wirral healthcare economy

Background and aim. Total hip replacement (THR) in young patients has been associated to higher revision rates than in older population. Different conditions may lead to end-stage arthritis of the hip in these patients. We compared the clinical and radiological outcome of two different groups of young and very young patients who underwent a ceramic-on-ceramic THR. Patients and Methods. 120 hips were prospectively followed for a mean of 10.4 years (range, 5 to 17). 38 patients (46 hips) were less than 30 years old (group 1), and, 68 (74 hips) were between 31 and 40 years old (group 2). Weight (p<0.001) and physical activity level were greater in group 2 (p<0.001). Preoperative function (p=0.03) and range of mobility (p=0.03) were worse in group 1. Primary osteoarthritis was not found in any case. Rheumatoid juvenile arthritis was the most frequent diagnosis in group 1 and avascular necrosis of the femoral head in group 2. A femoral funnel-shaped type 1 according to Dorr was more frequent in group 2 (p=0.04). The same ceramic-on-ceramic uncemented THR was used in all cases. Screws for cup fixation were only used when strictly needed. We analysed the clinical results according to the Merle-D´Aubignè and Postel scale, the postoperative radiological reconstruction of the hip and the radiological appearance of cup loosening. Kaplan-Meier survivorship analysis was used to estimate the cumulative probability of not having a revision surgery. Results. Screw use required to obtain a secured interference fit of the acetabular component was found more frequently in group 1 (p=0.01). Postoperative pain (p=0.002) and function (p=0.002) were better in group 1. Mean acetabular abduction angle of the cup was greater in group 1 (p=0.03) and reconstruction to the hip rotation center according to Ranawat (p=0.01) was better in group 2. Placement of the acetabular component inside the Lewinnek´s zone and stem position were similar in both groups. No hips were revised due to complications related to ceramic or to stem loosening. Three cups were revised for aseptic loosening in group 1 and four in group 2. The survival rate for cup aseptic loosening at 15 years was 92.3% (95% CI: 83.7 to 100) for group 1 and 93.1% (95% CI: 85.3 to 99.9) for group 2 (Log rank, p=0.88). Conclusion. Ceramic-on-ceramic uncemented THR is an excellent option for young and very young patients. Despite worse preoperative conditions in patients under the age of 30 years, a similar clinical outcome was found in this series

The Birmingham hip resurfacing (Smith & Nephew, Tennessee) (BHR) has been used in younger more active patients. Aim. We report on our experience of 206 BHR procedures in patients aged 50 years or less with a minimum ten year follow-up. Clinical outcome scores, body mass index (BMI), gender and age were analysed to investigate resurfacing outcomes. Methods. 200 patients (158 males and 42 females) with an average operation age of 43.33 years (SD ±5.66) were investigated. There were 6 bilateral procedures The mean follow-up period was 12.44 years (SD ±1.71). The arthroplasties were completed between April 1999 and December 2002 by one surgeon. Data and outcome measurements were collected prospectively and analysed retrospectively. We evaluated Harris Hip Scores, Short Form-36 (SF-36v2) Scores, Tegner Activity Score Scores and McMaster Universities Osteoarthritis Index Scores (WOMAC) comparatively at preoperative, six month and yearly intervals. Results. In 1 patient the implant was in situ at the time of death. Revision was carried out in 5 hips (2.4%) at a mean time period of 3.2 years (0–8) post-operatively. Failure was due to femoral neck fracture, acetabular loosening and avascular necrosis of the femoral head, leading to loosening. Kaplan-Meier analysis showed survivorship of 97.6%. The mean Harris Hip scores (paired t-test, p<0.05) improved significantly from 55.58 preoperatively to 91.33 at 15 years. The mean SF-36v2 physical scores (paired t-test, p<0.05) improved significantly from 32.70 preoperatively to 43.75 at 15 years. WOMAC total scores (paired t-test, p<0.05) improved significantly from 44.37 preoperatively to 14.67 at 15 years. Conclusion. In this demanding group of patients, without any restrictions to physical activity, the results of this procedure at 10 years are most encouraging. However, concerns remain in relation to the effect of elevated metal ions, tissue sensitivities, and anatomical variations, such as hip dysplasia, which may impact on function and success