Quadriceps femoris muscle weakness has long been associated with disuse atrophy in symptomatic knee osteoarthritis but more recently implicated in the aetiology of this condition. The purpose of this study was to assess the benefits of two interventions aimed at increasing quadriceps strength in subjects with moderate to severe knee osteoarthritis.

Twenty-eight patients, aged fifty-five to seventy-five, were recruited and randomised to either a six-week home resistance-training exercise program or a six-week neuromuscular electrical stimulation (NMES) program. Eleven patients matched for age, gender and osteoarthritis severity formed a control group, receiving standard care. The resistance-training group performed six exercises three times per week, while the NMES group used the garment stimulator for twenty minutes five times per week Outcome measures included isometric and isokinetic quadriceps strength, functional capacity, quadriceps cross-sectional area, and validated health survey scores. These measures were assessed at baseline, post-intervention and at 6-weeks post-intervention.

Both intervention groups showed significant improvements in all functional tests, in the global health survey, and in quadriceps cross-sectional area immediately post-intervention. An increase in isokinetic strength was seen in the exercise group only. With the exception of isokinetic strength, all benefits were maintained six weeks post-intervention.

Both a six-week home resistance-training program and a six-week NMES program produce significant improvements in functional performance as well as physical and mental health for patients with moderate to severe knee osteoarthritis. Home-based NMES is an acceptable alternative to physical therapy, and is especially appropriate for patients who have difficulty complying with an exercise program.

Introduction. A 6cm femoral gain requires 5-Y during normal growth, but only 6–8-W surgically (x30–40 faster). In lengthening surgery, losses of muscle force (MF) and circumferences (MC) are major. Recovery is long, preventing sports till bone fusion. Can we maintain MC and strength throughout the entire lengthening and how?. We monitored for over 30 years patients for muscle force (isokinetic), circumferences, activities (including sports) and food intake, and acted on the 5 principles of the Osteostasis. Materials & Methods. Over 750 femoral lengthening with Full WB Nails (FWBN) got Isokinetic testing (≧1991), circumferences measurements (≧2012; 20-15-10-5-0cm above patella, max-calf, mini/max-ankle), food intake (≧2012), using MyFitnessPal App (≧2016), gradually enforced. Preoperative training along with a daily post-operative training are supervised by our trainers. Recommendations for food intake and activities were provided. Patients noted on a specific App all parameters. Compliance was noted. Results. Instead of a traditional 7–9cm circumference loss for 8–10cm gains using Ex-fix or nails, with FWBN and our protocols, no MC loss could be noted in compliant pre-trained patients, intensive early post-op resistance training, high calory intake (M:>4200, F:>3000; 20–25% Proteins) and supplements (no fat pad increase). Bone fusion could be obtained at the end of lengthening or within short weeks (Healing Index down to 8D/cm). Non-compliant patients (or using morphine), lost weight and MC. Conclusions. Increasing by 8–10cm muscle length, even bilaterally, and maintaining MC during lengthening, is possible, with very fast bone fusion. It requires building up several hundred of grams of muscles. The ‘building up equation’ associating resistance bike from the early post-operative phase with sports, strong food intake with increased protein intake, and added supplements with no morphine medication, proved to boost circumferences and bone fusion. It induced fast recovery, walking and sports capacities

Introduction. Humans Functions (locomotion, protection of organs, reproduction) require a strong support system (bones). The ‘Osteostasis’ is the ability of maintaining the bone structure, its mechanical characteristics and function. Five principles are required for an efficient bone system:. Basic Requirements:. 1) Stability and 2) Function. Repair System (like house building in desert or sea):. 3) Roads (vessels), 4) Materials (calories, proteins), 5) Workers (bone cells). Analysis of bone problems through these principles bring to optimised treatments. Materials & Methods. Measurements (>700 lengthening, 32-year follow-up, Full WB Albizzia/G-Nails FWBAG): Bone-DEXA, WB conditions, muscle, fat, etc. Principle-1. Solid bone replacement with a 100% biocompatible and reliable FWBAG with sports (POD0). Principle-2. Bone, Muscle & neural integrity for function Principle-3. Vascular flow lesions induce non-healing (arteriography). Muscle activity accounts for 90% of bone blood flow, ×10 by sports. Required: Checks (arteriography) and treatments (training). Principle-4. Food (NRV Kcal × 2–3, 20–25% proteins). Principle-5. Maintain bone cells and increase them. Suppress ‘opening’, ‘venting’, ‘drainages’. Results. Principle1. Nail fracture (1.2%), nail dysfunction (0%) with FWBAG. Principle2. Intensive sports preop and from POD0 - Principle3. Increased preop vascular supply & muscle force, postop resistance sports fasten recovery. Wheel-chair or low activity decreases healing. Principle4. 6–9 cm circumference loss (non WB-nails or no proper training); 0 cm circumference loss (gain <10 cm) with intense resistance training + high calory intake. - Principle5. Bone cells preservation (no opening, IM saw, increasing bone cells) allow Healing Index down to 8D/cm. Conclusions. The ‘5P’ allow reaching treatment targets by optimisation of problem solving, maintaining Osteostasis. What would I like or tolerate for me? How can I reach it? Full WB and sports from POD0 was a target 38 years-ago, still not enforced by most of us. Resistance sports, high-calory intake suppress muscle loss and fasten healing, thanks to muscle blood flow and the ‘5P’

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