Current outcomes of triceps-sparing elbow arthroplasties: a systematic review

Background More knowledge about the impact of elbow arthroplasty is needed. Objectives To describe pain and function in patients with elbow arthroplasty and to explore frequently used clinical- and patient-assessed measures for elbow function. Methods Pain and function [grip strength, range of motion (ROM)] were explored in a cross-sectional study of patients with elbow arthroplasty 1 year to 5 years after surgery. The properties of three outcome measures were assessed: the Disabilities of Arm, Shoulder and Hand questionnaire (Quick-DASH); the American Shoulder and Elbow Surgeons Elbow assessment form; and the Mayo Elbow Performance Score. For comparison, scales were transformed to 0 to 100. Correlations between measures and factors explaining patient-reported function (Quick-DASH) were explored. Results The study included 32 patients with a mean age of 68 years (75% females). Patients reported moderate level of pain (mean ± SD = 77), low arm function (Quick-DASH mean ± SD = 47), low grip strength (compared to norms) and limited ROM (flexion/extension arc less than 100°). Significant correlations with Quick-DASH were found for all measures (p < 0.01), except for ROM (p = 0.35). Grip strength contributed significantly (p = 0.03) to the variation in Quick-DASH, whereas ROM did not (p = 0.81). Conclusion Patients with elbow arthroplasty had moderate pain, but limited grip strength and ROM, 1 year to 5 years after surgery.

Posttraumatic heterotopic ossification (HO) of the hip frequently follows acetabular fracture and hip surgery and can become symptomatic, with significant pain and limited range of motion (ROM). Definitive treatment may require surgical excision, which can result in serious complications if not planned and executed appropriately. Surgical excision of posttraumatic hip HO requires appropriate indications, preoperative planning, and intraoperative guidance using fluoroscopy to maximize excision of HO and minimize complications. This video presents a case of severe posttraumatic hip HO, indications and technique of surgical excision using fluoroscopic guidance, postoperative protocol, and the patient's clinical follow-up. Surgical excision along with appropriate postoperative HO prophylaxis and immediate mobilization resulted in significant improvement in hip ROM and return to activities of daily living without complications or recurrence. Intraoperative blood loss can be significant and should be appropriately planned for preoperatively. Posttraumatic hip HO can cause significantly limited hip ROM and pain with resulting disability. Surgical excision of posttraumatic hip HO in a preserved hip joint can be successful in restoring hip ROM and function. Appropriate postoperative HO prophylaxis can prevent recurrence.

BackgroundCervical disc arthroplasty (CDA) has been demonstrated, in clinical trials, as an effective and safe treatment for patients diagnosed with radiculopathy and/or myelopathy. However, the current CDA indication criteria, based on the preoperative segmental range of motion (ROM), comprises a wide range of variability. Although the arthroplasty level preserved ROM averages 7°-9° after CDA, there are no clear guidelines on preoperatively limited or excessive ROM at the index level, which could be considered as suitable for CDA.MethodsThis was a retrospective study of patients who underwent CDA between January 2008 and October 2018 using Prestige-LP discs in our hospital. They were divided into the small-ROM (≤5.5°) and the large-ROM (> 12.5°) groups according to preoperatively index-level ROM. Clinical outcomes, including the Japanese Orthopedics Association (JOA), Neck Disability Index (NDI), and Visual Analogue Scale (VAS) scores, were evaluated. Radiological parameters, including cervical lordosis, disc angle (DA), global and segmental ROM, disc height (DH), and complications were measured.ResultsOne hundred and twenty six patients, with a total of 132 arthroplasty segments were analyzed. There were 64 patients in the small-ROM and 62 in the large-ROM group. There were more patients diagnosed with cervical spondylosis in the small-ROM than in the large-ROM group (P = 0.046). Patients in both groups had significantly improved JOA, NDI, and VAS scores after surgery, but the intergroup difference was not significant. Patients in the small-ROM group had dramatic postoperative increase in cervical lordosis, global and segmental ROM (P < 0.001). However, there was a paradoxical postoperative decrease in global and segmental ROM in the large-ROM group postoperatively (P < 0.001). Patients in the small-ROM group had lower preoperative DH (P = 0.012), and a higher rate of postoperative heterotopic ossification (HO) (P = 0.037).ConclusionPatients with preoperatively limited segmental ROM had severe HO, and achieved similar postoperative clinical outcomes as patients with preoperatively excessive segmental ROM. Patients with preoperatively limited segmental ROM showed a postoperative increase in segmental mobility, which decreased in patients with preoperatively excessive segmental ROM.

BackgroundWe currently lack clear definitions for structural and symptomatic spinal osteoarthritis (OA). To define spinal OA and create diagnostic criteria for this condition, it is necessary to determine the relationship between clinical signs and symptoms of back pain and radiographic features of OA. Notably, recent studies suggest a defining sign of spinal OA could be a limited or painful spinal range of motion (ROM). Therefore, our objective was to assess the association between restricted or painful active spinal ROM, and multilevel structural features of lumbar disc degeneration (LDD) (i.e., disc space narrowing, osteophytes) on radiographs.MethodsWe used the baseline data from the’Back Complaints in Older Adults’ (BACE) study. The association between a limited or painful active spinal ROM, and multilevel disc space narrowing or osteophytes was assessed using multivariable logistic regression adjusted for age, mean pain intensity in the previous week, sex, BMI, and the Fear Avoidance Belief Questionnaire score. Primary analyses were performed on imputed datasets.ResultsWe included 675 patients with a mean age of 66.52 years (SD 7.69). Limited latero-flexion (fingertip that at best reached halfway up the upper leg) was associated with increased odds of having multilevel osteophytes (OR 1.85; 95% CI: 1.13 to 3.01). However, a limited or painful ROM in other directions (i.e., rotation, ante-flexion) was not associated with multilevel osteophytes, and a limited or painful active ROM in any direction was found to have no association with multilevel disc space narrowing.ConclusionsOur study indicates that a restricted ROM in latero-flexion could potentially be a defining sign in future definitions of symptomatic spinal OA. However, since our results partially differ from previous studies, further research is needed to explore the association between active ROM and LDD.

Estudos anteriores têm mostrado que o nível aeróbico e de força pré-treinamento influenciam os ganhos obtidos após um período de treino. Nenhum estudo investigou esta relação em um programa de flexibilidade. O objetivo deste estudo foi observar a influência da limitação da amplitude de movimento (ADM) sobre a melhora da ADM de rotação externa de ombro após um programa de alongamento de seis semanas. 30 voluntários, estudantes de fisioterapia, com limitação da ADM de rotação externa de ombro foram divididos de forma randomizadas em três grupos: grupo controle (GC), grupo experimental 1 (GE1), com maior limitação de ADM e grupo experimental 2 (GE2), com menor limitação de ADM. Os sujeitos do grupo experimental foram submetidos a um programa de seis semanas de alongamento ativo para melhora da ADM de rotação externa de ombro. Na análise dos resultados, o teste de ANOVA one-way mostrou uma diferença significativa entre a média do ganho de ADM de rotação externa de ombro entre os três grupos (p=0,001), sendo que o GE1 teve o maior ganho de ADM (30,1° ± 8,6°) seguido pelos grupos GE2 (15,2° ± 7,5°) e GC (1,1° ± 5,8°). O teste de correlação de Pearson mostrou uma correlação negativa significativa entre ADM prévia e ganho de ADM (r= -0,70, p=0,001). Os resultados deste estudo mostraram que a ADM prévia de rotação externa de ombro influencia o ganho de ADM deste movimento após um programa de alongamento de seis semanas em uma população jovem e saudável. Indivíduos com maior limitação de ADM respondem com um ganho de ADM mais pronunciado.

Range of motion (ROM) restriction influences quipazine-induced stepping behavior in postnatal day one and day ten rats

Functional outcomes may vary over time after patellar tendon and knee intra-articular heterotopic ossification excision: A case report.

Most longitudinal breast cancer studies have found that treatment-related sequelae such as arm morbidity [lymphedema, pain, and range of motion (ROM) restrictions] can have a significant impact on quality of life. In a previous study, we found that at 6-12 months after breast cancer surgery, 49% of participants had difficulties engaging in recreational activities and that arm morbidity significantly predicted difficulties with participation in recreation. A longitudinal national study employing clinical assessments and survey methods followed 178 women over 43 months (3.6 years) to assess issues related to arm morbidity post-breast cancer surgery. Hierarchical multiple regression analyses were conducted to identify which variables were predictive of recreational difficulties experienced by women 8 and 43 months post-surgery. Between 8 months (T1) and 43 months (T2) post-breast cancer surgery, women demonstrated slight increases in lymphedema. Conversely, a significant decrease was observed in the number of ROM restrictions and pain when using the arm. Despite the overall improvements in arm morbidity, some women continued to report moderate pain and ROM restrictions. The two arm morbidity factors were found to be statistically significant (p < 0.001) predictors of recreational difficulties at both 8 and 43 months post-surgery, with pain accounting for the greatest proportion of variance. Pain and ROM restrictions were the only significant predictors of recreational difficulties during the first 3.6 years after breast cancer surgery. Specifically, women who still experience pain years after breast cancer surgery report difficulties in their recreational pursuits. Pain and ROM restrictions may prohibit participation in recreational activity and targeted intervention should be sought.

Heterotopic ossification after total knee arthroplasty

Heterotopic ossification (HO) following primary total knee arthroplasty is a rare complication and may be symptomatic if massive enough. Especially the range of motion (ROM) is essential for the function and durability of the implant. The aim of the study was to evaluate the influence of HO on ROM using clinical and radiological parameters. We reviewed 191 primary total knee arthroplasties according to the clinical preoperative and postoperative parameters of the Knee Society Score with special interest paid to the ROM. Standardized radiographs were taken at three levels and the implant position compared. The patients were divided into group 1 (with HO) and group 2 (without HO). The clinical and radiological parameters were compared. We found an incidence of HO in 14.1% (n = 27). Group 1 showed a decreased ROM postoperatively (p = 0.003) and worse flexion contracture (p = 0.04) compared with group 2. The evaluated radiological parameters showed no significant difference between the two groups. We found a significant limitation of ROM because of HO in our study. We found no correlation between HO and component alignment or component position. Local irritation has to be considered the main reason for limited ROM.

Poster 13: Early surgery for heterotopic ossification in traumatic brain injury with 10-year follow-up: a report of 2 cases

Heterotopic ossification (HO) is defined as formation of bone in abnormal locations. HO has been extensively reported in the orthopaedic literature, particularly following total hip arthroplasty, the operative treatment of acetabular fractures, and after spinal cord, traumatic brain, and burn injuries1-24. The hip is the most common site of HO. While many patients with HO are asymptomatic, more severe cases can result in pain and substantial limitations in joint range of motion. The Brooker classification, which is based on the appearance of HO on a single anteroposterior radiograph, remains the most commonly used classification system for HO, although other modified rating systems have been suggested3,7,25. In patients who undergo procedures that result in substantial risk of HO, prophylaxis can be considered; numerous studies have reported successful prophylaxis against HO formation in patients following total hip arthroplasty and open reduction and internal fixation for acetabular fractures2,9,15,16,20,21,24,26-30. The key to preventing HO is early prophylaxis in the inflammatory stage. In patients with symptomatic HO, surgical excision may be considered. Previous studies report improved range of motion following HO excision31-35. Because the incidence of HO recurrence after surgical excision is extremely high, postoperative prophylaxis with radiation or anti-inflammatory medications is recommended. To the best of our knowledge, this is the first case report of HO excision with documentation of both static and dynamic changes of hip range of motion with use of preoperative and postoperative three-dimensional (3D) computerized motion analysis. The patient and her parents were informed that data concerning the case would be submitted for publication, and they provided consent. An eight-year-old girl with duodenal atresia had developed duodenal perforation …

Preoperative Hip Flexion and Extension Range of Motion and Global Sagittal Alignment Affect Sagittal Spino-Pelvic Alignment in Patients Undergoing Total Hip Arthroplasty.

Knees with a limited range of motion caused by intraarticular scars benefit from arthroscopic arthrolysis. Usually these scars result from previous surgery, severe trauma with damage of intraarticular structures. Less frequent the reason is primary arthrofibrosis. Improvement of range of motion is achieved by arthroscopic release of scar tissue and removal of the fibrotic Hoffa fat pad. To improve the patients' range of motion which is necessary for activities of daily living and labour is the aim of this surgery. Scar tissue is debrided and resected arthroscopically with a radiofrequency device, a shaver or a punch. Flexion deficit of maximum 40°, extension deficit to a maximum 20°, reduced mobility of patella, intraarticular reason for limited range of motion, cyclops after anterior cruciate liagment reconstruction, fibrotic Hoffa fat pad. Origin of limited range of motion is extraarticular (e.g. fibrotic quadriceps muscle), local and general infection, major osteoarthritis, noncompliance, complex regional pain syndrome typeI. After creating an anterolateral and anteromedial standard portal, scar tissue is resected from the superior recess. Medial and lateral adhesions are detached. After removal of the fibrotic Hoffa fat pad, the notch is released while cruciate ligaments are preserved. After visualization of the posterior recessus, a posteromedial portal is placed. By releasing the posterior capsule, extension is improved. The range of motion is checked regularly during surgery. When mobility is restored and all attendant pathologies have been treated, the surgery is finished. Continuous physical therapy to maintain range of motion. If necessary, continuous passive motion is implemented. Pain adapted weight-bearing. A sufficient oral and (when indicated) regional pain management is important to guarantee the benefit of the surgery. Patients with a lack of mobility of the knee gain considerably range of motion by arthroscopic procedures. Because of the minimal invasiveness, trauma of surgery and risk of infection are reduced. Between 2010 and 2014, 16patients were treated by arthroscopic arthrolysis. Extension deficit decreased more than 10° from 13.6° to 3°, while flexion increased over 26° from 91.6° to 117.8°.

Background Cervicogenic headache (CGH) is a prevalent musculoskeletal disorder characterized by headache originating from cervical structures, often associated with restricted neck range of motion (ROM), pain, and functional impairment. Bankers are particularly vulnerable due to prolonged static postures and suboptimal workstation ergonomics, yet the relationship between desktop use duration, neck posture, and CGH remains underexplored in this population. Objective: To determine the impact of prolonged desktop computer usage on neck posture, ROM, and cervicogenic headache among bankers. Methods: A cross-sectional observational study was conducted involving 329 bankers from multiple branches in Lahore, recruited through non-probability convenience sampling. Neck posture and cervical ROM were clinically assessed, while CGH was evaluated using the Neck Disability Index (NDI) and pain intensity via the Visual Analogue Scale (VAS). Data were analysed using descriptive statistics and chi-square tests, with p &lt; 0.05 indicating significance. Results: Restricted cervical flexion (51.98%), extension (52.58%), lateral flexion (45.59%), and rotation (50.46%) were prevalent. Moderate-to-severe pain affected 65.9% of participants. Significant associations were found between longer desktop usage and restricted ROM (p = 0.045) and increased headache prevalence (OR = 1.64, 95% CI: 1.01–2.67). Conclusion: Prolonged desktop use is associated with impaired neck posture, reduced ROM, and increased CGH prevalence in bankers, underscoring the need for ergonomic interventions and preventive strategies.