Leg Length Research Articles

Clinical Efficacy of Modified Arthroscopic Revision Release of Gluteal Muscle Contracture With Residual Symptoms After Open Surgery

To investigate the clinical efficacy of modified arthroscopic revision release for patients who have gluteal muscle contracture and who have poor outcomes after traditional open surgery. The data of patients who underwent modified arthroscopic revision release for residual symptoms of gluteal muscle contracture after traditional open surgery were retrospectively collected and analyzed. All subjects underwent the procedure between December 2015 and December 2022. The surgical efficacy was assessed by evaluating improvements in specific symptoms, including bilateral lower extremity inequality, hip internal rotation and adduction mobility, squatting with both knees pressed together, and the ability to cross one's legs in supine position, as well as the preoperative and postoperative results for the gluteal muscle contracture functionality scale. Paired t-test was performed to examine whether the differences between preoperative and postoperative measurements were statistically significant. A total of 36 patients were followed up systematically, with the mean follow-up period being (22.4±4.9) months. All patients had significantly higher scores for assessment with the gluteal muscle contracture functionality scale at the last follow-up than their preoperative assessment results, showing an increase from the preoperative scores of 40.2±5.5 to 78.4±4.9 (P<0.05). At the follow-up, all patients showed improvement in hip adduction and internal rotation mobility compared with their preoperative status and all patients were able to squat with both knees pressed together. Moreover, only 1 patient still had difficulty in crossing his legs. A total of 27 cases (75%) had preoperative leg length inequality, all of which improved to varying degrees at follow-up. Among all the patients (72 hips/cases), 8 cases had subcutaneous hematomas and incisional ecchymosis, which were resolved after conservative treatments such as hot compresses. 3 cases showed decreased hip abductor strength, but the muscle strength gradually recovered after postoperative exercise and rehabilitation. There were no complications such as subcutaneous exudate, neurovascular injury, or surgical site infection. Modified arthroscopic revision release of gluteus muscle contracture is suitable for cases with poor outcomes after conventional open surgery.

The Sum of the Leg Length Discrepancy and the Difference in Global Femoral Offset Is Equal to That of the Contralateral Intact Side and Improves Postoperative Outcomes after Total Hip Arthroplasty: A Three-Dimensional Analysis.

Background/Objectives: Global femoral offset (GFO) and leg length discrepancy (LLD) affect outcomes after total hip arthroplasty (THA). Moreover, the sum of the difference in GFO between the THA and non-surgical sides and LLD (SGL) reportedly affects the outcomes in a two-dimensional evaluation. We examined the association of the GFO, LLD, and SGL with the Harris Hip Score (HHS) using a three-dimensional (3D) evaluation. Methods: We retrospectively surveyed 172 patients with hemilateral hip osteoarthritis who underwent THA. The GFO, LLD, and SGL were measured using the 3D pelvis and femur models; these models were adjusted for the pelvis and femur, and the coordinate systems were parallelized. Furthermore, their relationship with the modified HHS (mHHS) 1 year after THA was determined. Results: Significant correlations were found among mHHS, GFO, and SGL in the binomial group, whereas LLD was not significantly correlated. The optimal values of GFO and SGL were 1.01 mm and 0.18 mm/100 cm body height, respectively, which were considered optimal when the SGL values were approximately equal to those of the non-operative side. The optimal ranges for GFO and SGL were -1.65 to 3.67 mm and -4.78 to 5.14 mm/100 cm, respectively. Conclusions: Our findings were obtained after adjusting the pelvis and femur to a unified coordinate system. Therefore, the results of this study can be directly applied to 3D planning.

Importance of injury severity in the choice of treatment and its impact on prognosis in gunshot fractures.

The management of femur and tibia fractures resulting from gunshot injuries is a challenge for orthopedic surgeons. One-stage and two-stage treatments are applied according to the anatomical location and severity of the injury. In this study, the importance of injury severity and anatomical location was evaluated in the choice of treatment method and its impact on prognosis in cases of lower extremity gunshot fractures. A total of 124 patients who met the study criteria were evaluated. They were grouped separately according to the anatomical location of the injury (femur, n = 73; tibia, n = 51) and the surgical method (one-stage, n = 77; two-stage, n = 47). The demographic characteristics of the patients, fracture classification, presence of neurological or vascular damage at the time of diagnosis, anatomical location of the injury, surgical procedure, and follow-up time were recorded. The time of union and the presence of malunion were evaluated radiologically. Finally, patients were assessed clinically with the New Injury Severity Score (NISS) and leg length discrepancy (LLD) calculated through measurements made on lower extremity orthoroentgenograms. The rate of vascular injury and the number of Gustilo-Anderson type IIIB and IIIC cases were significantly higher in the two-stage treatment group (p = 0.001 and p = 0.000, respectively). The infection rate was also higher in the two-stage group; therefore, time to union was significantly longer (p = 0.004 and p = 0.05, respectively). LLD was higher among patients who received two-stage treatment (p = 0.015). According to the NISS scale used in clinical assessment, better scores were obtained for the one-stage group (p = 0.002). In comparisons made according to anatomical location, no significant difference was found between femur and tibia injuries. Regardless of anatomical location and treatment method, injuries of higher severity such as Gustilo-Anderson type IIIB and IIIC are correlated with higher rates of complications such as vascular injury, postoperative infection, delayed union, and LLD. Furthermore, in cases of severe injuries, a two-stage approach is commonly favored.

Associations between biological maturation, physical performance, postural control, and mathematical achievement in youth soccer players.

This investigation explored relationships between biological maturation, physical and academic performance in young male soccer players. Thirty-eight players (age: 9.79 ± 1.21 years; body mass index (BMI): 20.4 ± 2.39 kg/m2; body fat: 16.8 ± 2.21%) participated. Measures of anthropometry used for body mass, body fat percentage (%BF), and BMI as well. Postural control, 15 m sprint, squat jumps and counter-movement jumps (SJ, CMJ), and T-half test for change-of-direction (CoD) were parameters of physical performance. The grade point average (GPA) of mathematics determined academic attainment. Moore's equations were used to estimate their maturity status (PHV). Biological maturation was highly correlated with most (not 15 m sprint) physical and academic performance parameters, especially CMJ (r = -0.812) and mathematics (r = -0.781). Academic performance showed the largest relations to the jumping performance (CMJ: r = 0.771; SJ: r = 0.723). In contrast, anthropometric and fatness parameters were not relevantly (r ≥ 0.5) correlated with any other parameters. The largest correlations were calculated for sitting height vs. SJ (r = -0.408), sitting height vs. postural control (r = -0.355), leg length vs. postural control (r = -0.339). As a result, it is essential to take biological maturation inconsideration while assessing the physical and academic achievement of young soccer players. In consequence, soccer coaches and physical education (PE) teachers should be cognizant of the impact of biological maturity on physical and academic performance to assist fair and equal opportunities for achievement in young players.

Intramedullary nailing of femoral shaft fractures: an analysis of rotational malunions using 3D EOS.

Rotational malalignment and leg length discrepancy after intramedullary nailing of femoral shaft are frequent. This study has three objectives: evaluate the rate of femoral rotational malalignment and leg length discrepancy using EOS imaging after antegrade intramedullary nailing of femoral shaft fracture, find a relevant clinical examination to detect malrotation and identified risk factors. We performed a retrospective single-centre study between January 2014 and January 2022. Fifty-eight patients were clinically and radiographically assessed at a minimum of three months. The femoral rotation of the operated side was significantly greater by a mean of 15.4° in internal rotation compared to the healthy side. There was no statically significant difference for the femoral length (p = 0.08). When using EOS stereography following antegrade intramedullary nailing of post-traumatic diaphyseal femur fractures, a statistically significant difference of more than 15.4° in internal rotation was found for femoral rotation on the operated side compared to the healthy side.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [B. Poirot] Last name [Seynaeve]. Also, kindly confirm the details in the metadata are correct.The last name of the first author was corrected : Given name = B. and last name = Poirot Seynaeve The details in matadata are correct LEVEL OF EVIDENCE: III.

Parametric study and design optimization of a thermoelectric generator system for waste heat recovery

This article proposes a transient simulation based on Comsol software to investigate the behavior of a segmented thermoelectric device (S-TEG) exposed to a pulsed heat flux. It is found that thermoelectric generators (TEG) incorporating segmented materials have offered greater thermal and electrical performance. An increase in the electrical output power and efficiency of 60% and 40% were reached respectively. Furthermore, the effect of segmentation is most noticeable for short TE leg lengths and large cross-sectional areas. For the S-TEG with a leg length of 2 mm, there is a 104% increase in output power compared to the TEG with a leg length of 3 mm. The effect of asymmetric TE legs on the improvement of the performance of the segmented TEG was carried out. It was found that when a pulsed heat source is applied, the performance of S-TEGs are maximum when the N-leg area is lower than the P-leg area (AN/AP <1). Therefore, to attain the highest TEG performance, an asymmetric shape of AN < AP is required.

The Influence of Temporary Epiphysiodesis of the Proximal End of the Tibia on the Shape of the Knee Joint in Children Treated for Leg Length Discrepancy.

Background: Leg length discrepancy (LLD) is a common problem in the daily clinical practice of pediatric orthopedists. Surgical treatment using LLD temporary epiphysiodesis with eight-plate implants is a minimally invasive, safe, and well-tolerated procedure that provides good treatment effects with a relatively low percentage of complications. The main aim of this retrospective study was to determine the effect of epiphysiodesis on the shape of the proximal tibia. Methods: The retrospective study was based on medical records from 2010 to 2019. Radiographs taken before the epiphysiodesis and at 6-month intervals until the end of the treatment were investigated. A total of 60 patients treated for LLD were included in the study (24 girls, 36 boys). They were divided into three groups depending on the duration of the LLD treatment: group I (18 months), group II (30 months), and group III (42 months of treatment). Radiological parameters were assessed, including the roof angle (D), the slope angles (α and β), and the specific parameters of the tibial epiphysis, namely LTH (lateral tubercle height), MTH (medial tubercle height), and TW (tibial width). Results: The roof angle decreased in all the groups, which was accompanied by an increase in the β or α angle. LTH, MTH and TW also increased, and the differences before and after the treatment for the treated legs were statistically significant in all the studied groups. The greatest change in the shape of the articular surface of the proximal tibia occurred after 42 months of treatment. Conclusions: The study showed that epiphysiodesis affects the proximal tibial articular surface over prolonged treatment. Thus, there is a need for future long-term follow-up studies to elucidate the potential effects of LLD egalization.

Faktor Fleksibilitas, Panjang Tungkai, dan Kekuatan: Bagaimana Korelasinya dengan Performa Gyaku Tsuki?

This study aimed to investigate the relationship between leg length, waist flexibility, and arm muscle strength and Gyaku Tsuki's punch speed in karate martial arts. A total of 30 karateka (age = 16.4 ± SD = 0.626) participated in the study. Leg length was measured using anthropometric methods, waist flexibility was measured by sit and reach tests, arm muscle strength was measured by push-up tests, and Gyaku Tsuki's punch speed was measured using Kinovea software. The results showed that leg length, waist flexibility, and arm muscle strength had a significant positive relationship with Gyaku Tsuki's punch speed (p = 0.000 0.005). This research can be the basis for further research in the field of kinematics and movement kinetics in the context of martial arts.

Techniques and Technologies for the Intraoperative Assessment of Component Positioning, Leg Lengths, and Offset in Total Hip Arthroplasty: A Systematic Review

BackgroundMany techniques and technologies exist for the intraoperative assessment of component positioning, leg lengths, and offset in total hip arthroplasty, but with limited comparative data. We conducted a systematic review of the available literature to evaluate the range of techniques and technologies for the intraoperative assessment of component position as well as leg lengths and offset in terms of accuracy, precision, surgical time, cost, and relationship to clinical outcomes. MethodsA comprehensive search of the Embase and Medline databases from 1974 to 2023 was performed. We included controlled or comparative prospective clinical studies. Cochrane’s risk-of-bias tool for randomized trials and Risk of Bias in Non-Randomized Studies – of Interventions tools were used by 2 independent reviewers to evaluate each study for risk of bias. We conducted both qualitative and quantitative analyses of the studies included. However, a meta-analysis was deemed not to be feasible due to heterogeneity. ResultsOur review included 25 studies with 52 intraoperative techniques and technologies. Mechanical guides and computerized navigation were most frequently evaluated in the included studies. Computerized navigation systems consistently showed the greatest accuracy and precision across all measures, at the cost of longer mean operative time. In contrast, freehand techniques demonstrated the poorest accuracy and precision. Insufficient data were found to reach any meaningful conclusions in terms of differences in overall surgical cost or clinical outcomes. ConclusionsEvidence shows that computerized navigation systems are most accurate and precise in positioning components during total hip arthroplasty. Further research is needed to determine their health and economic impact and whether the accuracy and precision of navigated techniques are justified in terms of clinical outcomes.

IMU-Based Approach to Detect Spastic Cerebral Palsy in Infants at Early Stages

INTRODUCTION: Cerebral Palsy (CP) is a non-progressive neurological disorder affecting muscle control in early childhood, leading to permanent alterations in body posture and movement. Early identification is crucial for accurate diagnosis and therapy-based interventions. In recent years, an automated monitoring system has been developed to facilitate the health assessment of infants, enabling early recognition of neurological dysfunctions in high-risk infants. However, the interpretation of these assessments lacks standardization and is subject to examiner bias.&#x0D; OBJECTIVES: Many infants with CP exhibit increased tonic stretch reflexes due to Upper Motor Neuron Syndrome (UMNS), resulting from motor neuron damage that disrupts muscle signalling.&#x0D; METHOD: To detect abnormal muscle reactions, our team employed an Inertial Measurement Unit (IMU) sensor, comprising three tri-axial sensors (accelerometer, gyroscope, magnetometer) that capture movement data continuously and unobtrusively. IMU sensors are compact, cost-effective, and have low processing requirements, requiring attachment to the infant's body to measure inter-body part angles. Our team analyzed muscle activity and posture using IMU sensors, collecting tri-axial data from 43 infants in real-time. Additional factors like age, stride length, and leg length were incorporated into the dataset.&#x0D; RESULTS: Our team has applied various supervised machine learning approaches to predict CP in infants due to the limited dataset size, validating models through k-fold cross-validation. Among the models, Naive Bayes (NB) outperformed Logistic Regression (LR), Decision Tree (DT), Linear Discriminant Analysis (LDA), k-Nearest Neighbors (kNN), and Support Vector Machine (SVM), achieving an accuracy of 88%. CONCLUSION: This research contributes to the early detection and intervention of CP in infants, potentially improving their long-term outcomes.

Multifactor roadmap for designing low‐power‐consumed micro thermoelectric thermostats in a closed‐loop integrated 5G optical module

AbstractAs the core components of fifth‐generation (5G) communication technology, optical modules should be consistently miniaturized in size while improving their level of integration. This inevitably leads to a dramatic spike in power consumption and a consequent increase in heat flow density when operating in a confined space. To ensure a successful start‐up and operation of 5G optical modules, active cooling and precise temperature control via the Peltier effect in confined space is essential yet challenging. In this work, p‐type Bi0.5Sb1.5Te3 and n‐type Bi2Te2.7Se0.3 bulk thermoelectric (TE) materials are used, and a micro thermoelectric thermostat (micro‐TET) (device size, 2 × 9.3 × 1.1 mm3; leg size, 0.4 × 0.4 × 0.5 mm3; number of legs, 44) is successfully integrated into a 5G optical module with Quad Small Form Pluggable 28 interface. As a result, the internal temperature of this kind of optical module is always maintained at 45.7°C and the optical power is up to 7.4 dBm. Furthermore, a multifactor design roadmap is created based on a 3D numerical model using the ANSYS finite element method, taking into account the number of legs (N), leg width (W), leg length (L), filling atmosphere, electric contact resistance (Rec), thermal contact resistance (Rtc), ambient temperature (Ta), and the heat generated by the laser source (QL). It facilitates the integrated fabrication of micro‐TET, and shows the way to enhance packaging and performance under different operating conditions. According to the roadmap, the micro‐TET (2 × 9.3 × 1 mm3, W = 0.3 mm, L = 0.4 mm, N = 68 legs) is fabricated and consumes only 0.89 W in cooling mode (QL = 0.7 W, Ta = 80°C) and 0.36 W in heating mode (Ta = 0°C) to maintain the laser temperature of 50°C. This research will hopefully be applied to other microprocessors for precise temperature control and integrated manufacturing.

The Value of Computed Tomography Scan in Three-dimensional Planning and Intraoperative Navigation in Primary Total Hip Arthroplasty.

Total hip arthroplasty (THA) is a frequently performed procedure; the objective is restoration of native hip biomechanics and achieving functional range of motion (ROM) through precise positioning of the prosthetic components. Advanced three-dimensional (3D) imaging and computed tomography (CT)-based navigation are valuable tools in both the preoperative planning and intraoperative execution. The aim of this study is to provide a thorough overview on the applications of CT scans in both the preoperative and intraoperative settings of primary THA. Preoperative planning using CT-based 3D imaging enables greater accuracy in prediction of implant sizes, leading to enhancement of surgical workflow with optimization of implant inventory. Surgeons can perform a more thorough assessment of posterior and anterior acetabular wall coverage, acetabular osteophytes, anatomical landmarks, and thus achieve more functional implant positioning. Intraoperative CT-based navigation can facilitate precise execution of the preoperative plan, to attain optimal positioning of the prosthetic components to avoid impingement. Medial reaming can be minimized preserving native bone stock, which can enable restoration of femoral, acetabular, and combined offsets. In addition, it is associated with greater accuracy in leg length adjustment, a critical factor in patients' postoperative satisfaction. Despite the higher costs and radiation exposure, which currently limits its widespread adoption, it offers many benefits, and the increasing interest in robotic surgery has facilitated its integration into routine practice. Conducting additional research on ultra-low-dose CT scans and examining the potential for translation of 3D imaging into improved clinical outcomes will be necessary to warrant its expanded application.

Magnetically driven antegrade intramedullary lengthening nails for tibial lengthening.

As an alternative to external fixators, intramedullary lengthening nails (ILNs) can be employed for distraction osteogenesis. While previous studies have demonstrated that typical complications of external devices, such as soft-tissue tethering, and pin site infection can be avoided with ILNs, there is a lack of studies that exclusively investigated tibial distraction osteogenesis with motorized ILNs inserted via an antegrade approach. A total of 58 patients (median age 17 years (interquartile range (IQR) 15 to 21)) treated by unilateral tibial distraction osteogenesis for a median leg length discrepancy of 41 mm (IQR 34 to 53), and nine patients with disproportionate short stature treated by bilateral simultaneous tibial distraction osteogenesis, with magnetically controlled motorized ILNs inserted via an antegrade approach, were retrospectively analyzed. The median follow-up was 37 months (IQR 30 to 51). Outcome measurements were accuracy, precision, reliability, bone healing, complications, and patient-reported outcome assessed by the Limb Deformity-Scoliosis Research Society Score (LD-SRS-30). A median tibial distraction of 44 mm (IQR 31 to 49) was achieved with a mean distraction index of 0.5 mm/day (standard deviation 0.13) and median consolidation index of 41.2 days/cm (IQR 34 to 51). Accuracy, precision, and reliability were 91%, 92%, and 97%, respectively. New temporary range of motion limitations occurred in 51% of segments (34/67). Distraction-related equinus deformity treated by Achilles tendon lengthening was the most common major complication recorded in 16% of segments (11/67). In 95% of patients (55/58) the distraction goal was achieved with 42% unplanned additional interventions per segment (28/67). The median postoperative LD-SRS-30 score was 4.0 (IQR 3.6 to 4.3). Tibial distraction osteogenesis using motorized ILNs inserted via an antegrade approach appears to be a reliable and precise procedure. Temporary joint stiffness of the knee or ankle should be expected in up to every second patient. A high rate and wide range of complications of variable severity should be anticipated.

Comparative Outcomes of Elastic Stable Intramedullary Nailing vs. Plate Fixation in Pediatric Femoral Shaft Fractures. A Prospective Study.

Pediatric femoral fractures are common in emergency rooms, with treatment options varying by age. This study compares elastic stable intramedullary nailing (ESIN) and plate fixation for diaphyseal femoral fractures in children aged 5-10. Conducted at Al-Kindi Teaching Hospital, Baghdad, from December 2017 to December 2019, this prospective study included 32 children with closed transverse diaphyseal femoral fractures. Patients were divided into two groups: 16 treated with ESIN (Group 1) and 16 with plate fixation (Group 2). Criteria excluded comminuted, open, or pathological fractures. Group 1 had a mean age of 7.1 years and weight of 23.7 kg; Group 2 had a mean age of 7.8 years and weight of 30.9 kg. ESIN resulted in shorter operative times (58.4 minutes), earlier weight-bearing, and quicker fracture union (8.8 weeks) compared to plate fixation (76.3 minutes, 11.9 weeks). Blood loss was significantly less in Group 1 (32.8 ml) versus Group 2 (205.0 ml). No significant differences in wound healing or leg length discrepancies were observed. 1. Our study indicates a preference for Elastic Stable Intramedullary Nailing (ESIN) over plate fixation for pediatric femoral shaft fractures in children aged 5-10 years. 2. ESIN is associated with shorter operative times and faster commencement of weight-bearing, critical in pediatric recovery. 3. While ESIN is generally preferable, plate fixation may be better suited in certain clinical scenarios, emphasizing the importance of personalized treatment. 4. Based on our findings, ESIN is recommended for treating transverse diaphyseal femur fractures in the specified pediatric age group. 5. Recommends further studies, including randomized controlled trials, for a more comprehensive understanding of these treatments' long-term outcomes.

Numerical study of transient supercooling performance and thermal stress analysis of segmented annular thermoelectric cooler

A multiphysics-coupled numerical simulation of a segmental annular thermoelectric cooler (SATEC) was performed using a three-dimensional finite element method. A coupling model of the temperature, stress, and electric fields was established based on the three-dimensional transient states. Moreover, the effects of different pulse width (τ), pulse current amplitude (Pa), pulse current shape parameter (m), heat transfer coefficient (h), angle (θ), and length (H) of the thermoelectric leg on the SATEC transient properties and von Mises stress were studied. The results show that τ and Pa are the key influencing factors of SATEC. The larger the h, the more optimized the heat transfer effect of the SATEC hot end. However, when h increased to a certain value, the changes in the transient performance were insignificant. The optimal pulse can be achieved when the input pulse current Iop = 6.47 A and pulse width τ = 20 s. When the length of the thermoelectric leg H4 was 3 mm and the thermoelectric leg angle θ2 was 7°, the performance of SATEC was optimal, with Tc,min being 249.57 K, Tc,max being 279.50 K, thold being 5.5 s, and the maximum von Mises stress being 37.48 MPa. The results show that different supercooling indices and von Mises stresses could be obtained for different pulse current shapes. Geometric optimization of SATEC can improve the cooling performance and reduce the von Mises stress, thereby providing a theoretical reference for practical engineering applications and thermoelectric cooling research.

Dimensional synthesis of an Inspection Robot for SG tube-sheet

To ensure the operational safety of nuclear power plants, we present a Quadruped Inspection Robot that can be used for many types of steam generators. Since the Inspection Robot relies on the Holding Modules to grip the tube-sheet, it can be regarded as a hybrid robot with variable configurations, switching between 4-RRR-RR, 3-RRR-RR, and two types of 2-RRR-RR, and the variable configurations bring a great challenge to dimensional synthesis. In this paper, the kinematic model of the Inspection Robot in multiple configurations is established, and the analytical solution is given. The workspace mapping is analyzed by the solution-space, and the workspace of multiple configurations is decomposed into the workspace of 2-RRR to reduce the analysis complexity, and the workspace calculation is simplified by using the envelope rings. The optimization problem of the manipulator is transformed into the calculation of the shortest contraction length of the swing leg. The switching performance of the Inspection Robot is evaluated by stride-length, turning-angle, and workspace overlap-ratio. The performance indexes are classified and transformed based on the proportions and variation trends of dimensional parameters to reduce the number of optimization objective functions, and Pareto optimal solutions are obtained using an intelligent optimization algorithm.

Biomechanics of a collum-fixated short stem in total hip arthroplasty

BackgroundBiomechanical reconstruction of the hip significantly impacts the clinical outcome and implant survival. Our knowledge is limited of the ability of neck-stabilised prostheses to restore hip biomechanics. We hypothesised that hip biomechanics, specifically leg length and global offset (GO), may be restored to an acceptable range using the Primoris™ stem. Methods and materialIn this retrospective study, we analysed 152 patients who underwent total hip replacement (THA) using the short collum-fixated stem Primoris™.The primary outcomes were hip parameters measured by x-ray following THA using the Primoris™ stem. After surgery, the biomechanical parameters used were measured at the arthroplasty and the native contralateral side of the same x-ray. The X-rays were taken one year after the patient's surgery.1. GO.2. Leg length discrepancy (LLD).3. Neck shaft angle (NSA). ResultsWe recorded an average GO of −3.4 mm (standard deviation (SD) 7.2) and an average LLD of +3.8 mm (SD 6.4). Furthermore, we registered an average 14-degree NSA increase (SD 7.4). ConclusionThe Primoris™ neck-stabilised stem enabled hip anatomy restoration to a favourable range with respect to GO and LLD as the average difference fell within ±5 mm. However, the stem tended to be implanted in valgus.

Can Machine Learning Predict Running Kinematics Based on Upper Trunk GPS-Based IMU Acceleration? A Novel Method of Conducting Biomechanical Analysis in the Field Using Artificial Neural Networks

This study aimed to investigate whether running kinematics can be accurately estimated through an artificial neural network (ANN) model containing GPS-based accelerometer variables and anthropometric data. Thirteen male participants with extensive running experience completed treadmill running trials at several speeds. Participants wore a GPS device containing a triaxial accelerometer, and running kinematics were captured by an 18-camera motion capture system for each trial. Multiple multilayer perceptron neural network models were constructed to estimate participants’ 3D running kinematics. The models consisted of the following input variables: 3D peak accelerometer acceleration during foot stance (g), stance time (s), running speed (km/h), participant height (cm), leg length (cm), and mass (kg). Pearson’s correlation coefficient (r), root mean squared error (RMSE), and relative root mean squared error (rRMSE) showed that ANN models provide accurate estimations of joint/segment angles (mean rRMSE = 13.0 ± 4.3%) and peak segment velocities (mean rRMSE = 22.1 ± 14.7%) at key gait phases across foot stance. The highest accuracies were achieved for flexion/extension angles of the thorax, pelvis, and hip, and peak thigh flexion/extension and vertical velocities (rRMSE &lt; 10%). The current findings offer sports science and medical practitioners working with this data a method of conducting field-based analyses of running kinematics using a single IMU.

Direct anterior approach with conventional instruments versus robotic posterolateral approach in elective total hip replacement for primary osteoarthritis: a case-control study.

The purpose of this study is to compare peri-operative and short-term outcomes in patients who underwent elective total hip replacement (THA) for primary osteoarthritis (OA) with direct anterior approach (DAA) versus a pair-matched cohort of patients who underwent robotic-assisted THA with posterolateral approach. Data from consecutive patients who underwent elective hip replacement from 2021 to 2023 for primary OA were retrospectively retrieved and divided into two groups: the DAA group, who underwent THA with the DAA approach using conventional instruments, and the robotic posterolateral (R-PL group), who underwent robot arm-assisted THA with the posterolateral approach. Comparative assessed outcomes were: operative time, radiographical implant positioning, intake of rescue analgesics, blood loss, transfusion rate, leg length discrepancy and functional outcomes (Harris hip score and forgotten joint score). A total of 100 pair-matched patients were retrieved with a mean age of 66.7 ± 10.7 (range: 32-85) years and a mean follow-up of 12.8 ± 3.6 (range: 7-24) months. No differences in patients' characteristics were detected. Patients in the R-PL group required less rescue tramadol (p > 0.001), ketorolac (p = 0.028) and acetaminophen (p < 0.001). There was no significant difference in the operative time between (MD = 5.0min; p = 0.071). Patients in the DAA group had significantly lower Hb levels at day 1 (p = 0.002) without significant differences in transfusion rate (p = 0.283). Patients in the R-PL group had shorter length of stay (LOS) with a mean difference of 1.8days [p < 0.001; 95% confidence interval (CI) 1.4-2.3]. No difference in clinical outcomes was found [leg length discrepancy (LLD), p = 0.572; HHS, p = 0.558; forgotten joint score (FJS), p = 0.629]. No radiographical differences were measured in cup inclination (MD = 2.0°, p = 0.069), malpositioning [odd ratio (OR) = 0.2; p = 0.141], stem alignment (OR = 0.3; p = 0.485) and stem sizing (OR = 1.5; p = 1.000). There was no difference in complication rate except for lateral femoral cutaneous nerve damage, which was higher in DAA group (p < 0.001). R-PL and DAA THA had comparable short-term clinical and radiological outcomes along with similar complication rates. The R-PL group showed significantly lower Hb drop, rescue analgesic consumption and shorter LOS. This is a preliminary study and no strong recommendation can be provided. Further prospective randomized trials are requested to further investigate the cost-effectiveness of robotic surgery in THA. Level IV, case-control study.

Rehabilitation for Marfan Syndrome

Abstract: Marfan syndrome is a spectrum of disorders caused by a heritable genetic defect of connective tissue that has an autosomal dominant mode of transmission. The defect itself has been isolated to the FBN1 gene on chromosome 15, which codes for the connective tissue protein fibrillin. Abnormalities in this protein cause a myriad of distinct clinical problems, of which the musculoskeletal, cardiac, and ocular system problems predominate. The skeleton of patients with Marfan syndrome typically displays multiple deformities. Mitral valve prolapses that requires valve replacement can occur as well. Given the variable expressivity of Marfan Syndrome, no single sign is pathognomonic; the diagnosis is made on clinical grounds on the basis of typical abnormalities. We reported a boy, 12 years old, referred from surgeon with diagnosis pectus carinatum pro brace. Chest protusion appeared since age 6, getting bigger without any complaint but cosmetic. Other complaints on feet which looked flat, sometimes ankle sore after long distance running or futsal. He was the first child and no family history had a condition like him. His hobby was playing futsal, and daily activities were independent without assistive devices. General appearance and vital signs were normal, cardiorespiratory assessment was normal, BMI on percentile 10-25, arm span to height ratio 1.09, lens subluxation of left eye, lens dislocation of right eye, poor standing balance, inadequate toe off, thoracic hyperkyphotic, positive wrist sign, true leg length discrepancy of 1 cm (left&gt;right), bilateral ankle ROM limitation, rigid flat feet suspected bilateral vertical talus, left hallux valgus, Marfan syndrome score 9, and normal echocardiography. In this patient, we gave semi rigid thoraco-lumbo-sacral orthosis (TLSO) with 3 points pressure system and rigid bar on protution area (custom molded). resistance exercise (F: 3x/week, I: moderate fatigue, Borg scale 13-15/20, T: 8-15 reps/ set, 2-3 set/ session, T: major muscle group upper and lower extremities aerobic exercise (F: 3x/week, I: moderate to vigorous, borg scale 13-15/20, T: ≥60 min/session, @5-10 min warming up and cooling down (stretching), T: sport (swimming, running, cycling). The patient was referred to a surgeon for a brace. In conclusion, this case report highlights the multidisciplinary management of patients with Marfan syndrome. Keywords: Marfan syndrome; typical abnormalities; multiple deformities