Lower Extremity Activity Research Articles

The Effect of Comorbidities on Outcomes following Total Knee Arthroplasty.

To enhance the success of total knee arthroplasty (TKA), clinicians must identify factors that may impede functional recovery. Multiple comorbidities may affect outcomes, and our purpose was to identify the role of overall disease burden, as well as individual comorbidities, on post-TKA outcomes. We prospectively reviewed 283 TKA patients (172 women, 111 men). Preexisting comorbidities were weighted using the Charlson comorbidity index (CCI). Patients were divided into four groups: CCI score of 0 to 1, 2, 3, or 4 or more and followed up at 6 weeks, 3 months, 1 year, and annually until 5 years. The most prevalent comorbidities were also individually assessed at these follow-ups. The effect of these on outcomes was evaluated using the Knee Society Score (KSS), Short Form 36 (SF-36), and lower extremity activity scale (LEAS). Patients who had lower CCI scores had significant improvements in KSS at 2- and 5-year follow-up (+34 and +38 points, respectively; p < 0.01). CCI scores of 0 to l demonstrated significantly greater improvement in the SF-36 physical component score (PCS) at final follow-up (+16 points; p < 0.05) and higher LEAS scores at 2 years postoperatively (p = 0.001), compared with the remaining cohorts. Endocrine disease and hypertension yielded significantly lower KSS at follow-up (-5 and -5 points, respectively; p < 0.05). Patients who had hypertension or gastrointestinal disease had significantly lower SF-36 PCS at final follow-up compared with those who did not (45 vs. 48 points and 47 vs. 49 points; p < 0.035 and 0.041, respectively), as well as lower activity scores (11 vs. 12 points for both comorbidities; p < 0.05). Patients who had cardiovascular disease had significantly lower SF-36 MCS (53 vs. 56 points, respectively; p = 0.03) at 4 years postoperatively than those without, as well as lower activity scores (11 vs. 12 points, respectively; p = 0.024). Patients who have lower CCIs may have improved activity and functional levels following TKA. Hypertension, cardiovascular disease, endocrine disease, and gastrointestinal disease may correlate with poorer functional and activity outcomes postoperatively.

Effects of dance on upper extremity activities in underserved adults.

This secondary analysis examined the immediate and maintaining effects of a 12-week line-dancing intervention on upper and lower extremity activities in underserved adults who receive care from a nurse-managed clinic (NMC). This one-group, repeated measures, feasibility study consisted of 40 participants recruited from an urban apartment complex that housed a NMC. Of the 40 participants, 21 participants completed the 12-week line-dancing intervention. Physical function of the upper and lower extremities was measured with the Late Life Function and Disability Instrument at baseline, 12, and 18 weeks to determine the maintaining effects. Age ranged from 45 to 87 years (M = 63; SD = 7.8), body mass index (BMI) was 33.4 (SD = 7.8), 92% were female, and 75% were African American. At baseline, participants showed limitations in all aspects of physical function. Significant improvements in upper and lower extremity activities were noted at 12 weeks and maintained at 18 weeks. Although line-dancing mainly involves the lower body, there were significant improvements in upper extremity activities at 12 weeks, which were maintained at 18 weeks. The maintaining effects support line-dancing as an intervention to improve upper and lower extremity activities needed for independent living. NMCs are important settings for health promotion interventions in underserved adults.

A systems-level perspective of the biomechanics of the trunk flexion-extension movement: Part II – Fatigued low back conditions

Our companion paper demonstrated the importance of a systems-level perspective on spine biomechanics by showing the effects of lower extremity constraints during simple, trunk flexion-extension motions. This paper explores the impact of trunk muscle fatigue and stress-relaxation of lumbar passive tissues on this systems-level response. Twelve participants performed experimental protocols to achieve lumbar passive tissue stress-relaxation fatigue and lumbar muscle fatigue. Participants performed full range of sagittal-plane trunk flexion-extension under unconstrained stoop movement and pelvic/lower extremity constrained stoop movement. They performed these motions both before and after the fatigue protocols and trunk kinematics and muscle activities in trunk and lower extremity muscles were monitored. Under the condition of passive tissue fatigue, low back muscles and lower extremity muscles revealed significantly increased activation level (21% and 22%, respectively) in the free stoop condition but under the restricted stoop condition, there was no significant effect of the protocol. Under the lumbar muscle fatigue condition, a significant antagonistic and lower extremity activation effect (34% increase in abdominal muscles, 16% increase in lower extremity muscles) was observed in the free stooping condition while these variables were not affected by the protocol under the restricted stooping condition. Relevance to industryFatigue of the lumbar musculature and passive tissues is prevalent in jobs requiring full trunk flexion postures. Developing accurate biomechanical models of spinal stress in these full stooping postures can help in the development of appropriate interventions to reduce the prevalence of back injuries in these jobs.

Double metal tibial blocks augmentation in total knee arthroplasty

Severe uncontained tibial bone defects occurring during total knee arthroplasty are challenging, and which treatment method is the best remains unknown. In this study, clinical and radiographic outcomes of double metal blocks augmentation were examined. Between 2004 and 2012, double metal blocks augmentation was carried out in 17 patients with severe asymmetric uncontained tibial bone defects. The first block was attached to the tibial tray with screws, and then the second block was cemented to the first block. Out of 17 patients, 13 (8 primary, 5 revision) were available for final follow-up at a median of 69 months (range 24-99). For clinical assessment, range of motion and Knee Society score were evaluated preoperatively and annually thereafter. At the final follow-up, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford knee, Short Form-36, Lower extremity functional scale, and Lower extremity activity scale scores were evaluated. Radiographic assessment for radiolucent lines at the block-cement-bone interfaces and signs of failure was performed annually using fluoroscopy and standard radiographs. Range of motion and Knee Society score were significantly improved post-operatively. Other clinical outcomes were favourable. Radiolucent lines were seen on fluoroscopy in three knees, but no sign of failure, such as loosening, collapse, or instability, was observed at the final follow-up. Double metal blocks augmentation is a favourable and useful method, which does not cause mechanical failure or protrusion of the prosthetic because of its modularity, to manage severe asymmetric uncontained proximal tibial bone defects >15 mm in total knee arthroplasty. Case series, Level IV.

스트레칭 유형에 따라 하지의 체중지지율과 근활성에 미치는 영향

The Purpose of this study was to investigate the effect of different type on wright bearing and muscle activity in lower extremities. The subject of the study were ten healthy volunteers (n=10). For comparison the result of the effect of weight bearing and muscle activity in lower extremities on different stretching type were as followings : 1. The result of the test revealed that the effect of the static stretching for flexibility were statistically significant, while the dynamic stretching did not show differences. Both forefoot and right-heelfoot of platar foot pressure were not affected by static and dynamic stretching. However, left-heelfoot of platar foot pressure showed statistically significant. 2. The change of weight bearing between the standing position and walking showed no differences among groups. However, there were significant difference heelfoot in walking. 3. The result of RVC, there were significant difference after stretching between groups. Rectus femoris, Biceps femoris, Tibialis anterior and Gastrocnemius were affected by both static stretching and dynamic stretching. Especially, Rectus femorsis and Biceps femoris with static stretching showed significant differences and Tibialis anterior and Gastrocnemius with dynamic stretching showed significant differences. In conclusion, both static and dynamic stretching did not show differences in weight bearing. However, muscle activity was affected by the both stretching that might prevent early exercise injury.

Venous thromboembolism in amyotrophic lateral sclerosis: a prospective study.

To prospectively assess the incidence of both symptomatic and asymptomatic venous thromboembolism (VTE) in patients with amyotrophic lateral sclerosis (ALS) and to identify risk factors. Fifty outpatients with ALS were recruited consecutively and prospectively evaluated with bilateral venous duplex ultrasonography (VDU) of the proximal leg veins at enrollment and 6 and 12 months. The primary outcome measure was clinically important VTE, defined as asymptomatic proximal deep vein thrombosis (DVT) by screening VDU, symptomatically proven DVT or pulmonary embolism (PE), or fatal PE. For each patient, person-days of follow-up were recorded from enrollment until the date of VTE, death, loss to follow-up, or final 12-month visit. During the 1-year follow-up period, VTE was detected in 4 patients (1 symptomatic DVT, 1 symptomatic PE, and 2 asymptomatic DVTs) over 13,011 person-days of follow-up, representing an 11.2% 1-year incidence. Subjects with leg-onset ALS or significant leg weakness had a 1-year VTE incidence rate of 35.8% and 35.5%, respectively. VTE risk was significantly increased for those patients with decreased lower extremity Revised ALS Functional Rating Scale subscore (p = 0.03), decreased Lower Extremity Activity Scale score (p = 0.02), and decreased average lower limb Medical Research Council scale strength score (p = 0.03). Our data suggest that clinically important VTE is common in patients with ALS, particularly those with leg weakness and reduced mobility. Given these results, the potential benefits of routine VTE screening and primary prophylaxis in high-risk patients with ALS with leg weakness should be explored in future studies. In the meantime, physicians should have a low threshold for considering VTE in patients with ALS with leg weakness.

The effects of massage therapy to induce sleep in infants born preterm.

The aim of this study was to determine whether massage therapy can be used as an adjunct intervention to induce sleep in infants born preterm. Thirty infants born at a minimum of 28 weeks gestational age, who were at the time of the study between 32 and 48 weeks adjusted gestational age, were randomly assigned to receive massage therapy on 1 day and not receive massage on an alternate day. The Motionlogger Micro Sleep Watch Actigraph recorded lower extremity activity on the morning of each day. No significant difference was found between groups for sleep efficiency (P = .13) during the time period evaluated. Groups differed significantly during the time period after the massage ended with more infants sleeping on the nonmassage day (χ = 4.9802, P = .026). Massage is well tolerated in infants born preterm and infants do not fall asleep faster after massage than without massage.

Orthotopic Kidney Transplantation in Mice: Technique Using Cuff for Renal Vein Anastomosis

Mouse renal transplantation is a technically challenging procedure. Although the first kidney transplants in mice were performed over 34 years ago and refined some years later, the classical techniques of mouse renal transplantation required clamping both vena cava and aorta simultaneously and carry out suture anastomoses of the renal artery and vein in a heterotopic position. In our laboratory, we have successfully developed mouse orthotopic kidney transplantation for the first time, using a rapid “cuffed” renal vein technique for vessel anastomosis, wherein the donor’s renal vein was inserted through an intravenous catheter, folded back and tied. During grafting, the cuffed renal vein was directly inserted into the recipient’s renal vein without the need for the clamping vena cava and suturing of renal vein. This technique allowed for the exact transplantation of the kidney into the original position, compared to the classical technique, and has significantly shortened the clamping time due to a quicker and precise anastomosis of renal vein as described. This also allowed for a quicker recovery of the lower extremity activity, reduction in myoglobinuria with resultant kidney graft survival of 88.9%. Thus we believe that the cuffed renal vein technique simplifies microvascular anastomoses and affords important additional benefits.

Clinical Results and Functional Outcomes of Primary and Revision Spinal Deformity Surgery in Adults

Few studies have examined the postsurgical functional outcomes of adults with spinal deformities, and even fewer have focused on the functional results and complications among older adults who have undergone primary or revision surgery for spinal deformity. Our goal was to compare patient characteristics, surgical characteristics, duration of hospitalization, radiographic results, complications, and functional outcomes between adults forty years of age or older who had undergone primary surgery for spinal deformity and those who had undergone revision surgery for spinal deformity. We retrospectively reviewed the cases of 167 consecutive patients forty years of age or older who had undergone surgery for spinal deformity performed by the senior author (K.M.K.) from January 2005 through June 2009 and who were followed for a minimum of two years. We divided the patients into two groups: primary surgery (fifty-nine patients) and revision surgery (108 patients). We compared the patient characteristics (number of levels arthrodesed, type of procedure, estimated blood loss, and total operative time), duration of hospitalization, radiographic results (preoperative, six-week postoperative, and most recent follow-up Cobb angle measurements for thoracic and lumbar curves, thoracic kyphosis, and lumbar lordosis), major and minor complications, and functional outcome scores (Scoliosis Research Society-22 Patient Questionnaire and Oswestry Disability Index). The groups were comparable with regard to most parameters. However, the revision group had more patients with sagittal plane imbalance and more frequently required pedicle subtraction osteotomies (p &lt; 0.01). Patients in the primary group required more correction in the coronal plane than did patients in the revision group, whereas patients in the revision group required more correction in the sagittal plane. We found no significant difference between the two groups in the rate of major complications or in the Scoliosis Research Society-22 Patient Questionnaire functional outcome scores. There were significant improvements in many functional outcome scores in both groups between the preoperative and early (six-week) postoperative periods and between the early postoperative period and the time of final follow-up. Revision surgery for spinal deformity in adults, although technically challenging and considered to present a higher risk than primary surgery, was shown to have a complication rate and outcomes that were comparable with those of primary spinal deformity surgery in adults. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Surgical Treatment of Hip Abductor Tendon Tears

Greater trochanteric pain syndrome is a common orthopaedic condition related to underlying bursitis, but it may reflect gluteal tendinopathy with tendon disruption from the greater trochanter. Our goal was to evaluate our clinical experience with surgical repair of these tears. We retrospectively evaluated a consecutive series of twenty-two patients (twenty-three hips) with a tear of the hip abductor tendons who underwent surgical reconstruction and were followed for a minimum of five years. The preoperative evaluation revealed chronic lateral hip pain, a positive Trendelenburg sign, and a tear documented by magnetic resonance imaging (MRI). The tears were defined intraoperatively with a four-tiered scheme that accounted for the dimension of the tear ranging from partial-thickness undersurface tears to complete tears of the gluteus muscle tendon insertion. The mean Harris hip score improved from 53 points preoperatively to 87 points at one year and 88 points at five years. The mean Lower-Extremity Activity Scale score improved from 6.7 points preoperatively to 8.9 points at one year and 8.8 points at five years. With the numbers available, no significant difference in the degree of clinical improvement was found on the basis of the severity of the tear. However, the three patients with poor results were in the group with the largest tears. Overall, sixteen of nineteen patients were satisfied with their surgical result and were willing to undergo the procedure again if necessary. Surgical repair of torn abductor tendons of the hip is a viable option when MRI and clinical findings are consistent with tendon disruption and weakness. There was substantial and durable improvement in strength and clinical performance in most cases. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Intermediate Outcome of a Cruciate-retaining Tibia

The use of an all-polyethylene tibia in total knee arthroplasty is being revisited as a means to decrease backside polyethylene wear and lessen cost. The Depuy Sigma all-polyethylene tibia (Depuy Orthopedics, Warsaw, Indiana) has been reported with good outcomes at a greater than 10-year interval, whereas the Biomet AGC I beam design (Biomet, Warsaw, Indiana) has had a high failure rate at an early interval. This is a retrospective review of another design. One hundred seventy patients (190 cruciate-retaining total knee replacements) with a Scorpio (Stryker, Mahwah, New Jersey) all-polyethylene implant and tibia were identified in the authors' registry. This implant was chosen for all octogenarians deemed fit for a cruciate-retaining knee and a few septuagenarians who were deemed likely to remain inactive postoperatively for reasons other than knee arthritis. Mean follow-up was 38 months (range, 24-83 months). Mean patient age was 83.1 years (range, 72.7-93.8 years). Twenty-seven patients (29 knees) were lost to follow-up. Nineteen patients (24 knees) died before 24-month follow-up; all implants were in place, and no deaths were associated with the index procedure. Fifty-one patients (55 knees) were followed by telephone interview only and 75 patients (81 knees) by an office visit with radiograph analysis. One tibia revision was performed 2 months postoperatively for an implant placed in extension and varus. No infections, component wear, radiolucent lines, or impending revisions of the remaining cohort occurred. Lower Extremity Activity Scale scores ranged from 2 to 10 (mean score, 6.8), which demonstrated success even in patients with an active lifestyle. This previously unreported design is a promising all-polyethylene tibia alternative for total knee arthroplasty in older patients.

Effect of total knee arthroplasty on type II diabetes mellitus and hypertension: A prospective study

Context:Advanced osteoarthritis of knee joint if bilateral, severely restricts patient mobility. This acts as an aggravating factor for pre existing comorbid elements of metabolical syndrome (MS) like Type II diabetes mellitus and hypertension as patients are unable to carry out therapeutic walks. Successfully implanted total knee arthroplasty (TKA) increases physical activity and enables to carry out therapeutic walks thus may help in better control of type II diabetes mellitus and hypertension. The objective of this prospective study was to find whether TKA for osteoarthritis knee had any effect to improve blood glucose levels and reduce blood pressure.Materials and Methods:A prospective study was done in which patients operated for tricompartmental osteoarthritis of knee with associated comorbidities like Type II diabetes mellitus or hypertension during a period of 2008 and 2009 were studied. One hundred and twenty patients were enrolled (55 diabetics, 65 hypertensives) who met our inclusion criteria. Preoperative knee society score, lower extremity activity scale fasting blood glucose level and systolic and diastolic blood pressure were compared with one year followup values. The KSS and LEAS scores were analysed by the Wilcoxon signed ranked test, while the fasting blood glucose (FBG) levels and systolic and diastolic blood pressure levels were analysed by paired ‘t’ test.Results:The reduction of systolic blood pressure by 8 mmHg (t = 5.6, P value < 0.05) and diastolic blood pressure by 6 mmHg (t = 7.6, P value < 0.05) was recorded which was statistically significant. However, no statistically significant effect on fasting blood glucose levels was observed (t = -0.77, P value = 0.442). KSS improved in DM from preoperative 29 to 86 and LEAS improved from 6.7 to 11.3.Conclusions:Authors are of the opinion that successful total knee replacement results in increased physical activity and reduces blood pressure (systolic and diastolic) in hypertensives. However, the same is not seen in blood glucose level. Increased physical activity and reduced dependence on NSAIDS postoperatively, may be contributing in reduction of systolic and diastolic blood pressure. Further studies in this aspect are necessary.

How should we train the upper limbs?

The article by McKeough and colleagues in this issue of Chronic Respiratory Disease is the first study to compare different modes of upper extremity training in individuals with chronic obstructive pulmonary disease (COPD). Limitations during exercise and daily activity in individuals with COPD are not limited to lower extremity activities such as walking or stair climbing; most of the patients experience difficulty during activities that involve their arms due to the sensation of dyspnea and/or arm fatigue. Upper extremity training for patients with COPD is an important component of pulmonary rehabilitation (PR), resulting in improvements in arm exercise capacity, arm function and muscle strength. However, there is limited evidence on what type of training should be performed. The study by McKeough and colleagues adds to the growing body of evidence in the area of upper extremity training in COPD and provides support for the inclusion of arm endurance and strength training as a part of PR. The study is a randomized controlled trial (RCT) that aimed to compare the effects of arm endurance training; arm strength training, a combination of arm endurance and strength training; and no arm training (control group) on endurance arm exercise capacity, functional arm exercise capacity and health-related quality of life (HRQL) in individuals with mild-tovery severe COPD. The authors found a significant improvement in arm endurance time (arm endurance capacity) between the endurance group and control group. There were nonsignificant trends in arm endurance time favoring the strength training and combined groups compared with the control group. In terms of symptoms, the authors demonstrated that the combined group had a significantly greater reduction in dyspnea and rate of perceived exertion at the end of the functional arm exercise test compared with the control and with each of the intervention groups. When the combined group was compared with the other two intervention groups, the improvement in HRQL (measured using the St George’s Respiratory Questionnaire) exceeded the minimum clinically important difference of 4 units, although it did not reach statistical significance. Until the beginning of the century, several RCTs had been conducted to examine the effects of upper extremity training in individuals with COPD. However, there were considerable variations in the exercise protocols rendering it impossible to determine the optimal training regimen for these patients. Moreover, the impact of upper extremity training on other clinical outcomes besides arm exercise capacity was unclear as shown consistently by four systematic reviews. More recently, four RCTs examining the effects of arm exercise training in individuals with COPD have been published. Holland and colleagues compared the effects of unsupported upper limb endurance training with lower extremity training alone. The authors found that unsupported upper limb endurance training improved upper limb exercise capacity but had no additional effects on the symptoms or HRQL compared with lower extremity training alone. Costi and colleagues examined the effects of upper extremity resistance training in patients with COPD compared with standard PR. The authors demonstrated improvement in arm functional exercise capacity (measured using the 6-minute pegboard and ring test) and in performance during activities of daily living (ADL) measured by an ADL field test. In addition, the authors found a decrease in arm fatigue at the end of the ADL test in the intervention group. Our

PNF 결합패턴이 뇌졸중 환자의 하지 근 활성도 및 보행능력에 미치는 영향

The purpose of present study was to determine effects of a PNF combination pattern training on muscle activity of lower extremities and gait ability in hemiparetic subjects. Twenty chronic stroke patients participated. Participants were randomly divided into either control group and experimental group. Experimental group received PNF combination pattern training, four times per a week for six weeks and control group received general exercise training. For the lower limbs muscle activity, RMS of action potential were analyzed and gait ability tests was conducted with 10MWT, DGI and F8WT. For the significance test of control and experimental group for measuring time by exercise application method, two-way repeated measure ANOVA. As the result, muscle activity of RF(p

Recovery expectations of hip resurfacing compared to total hip arthroplasty: A matched pairs study

Expectations of higher activity levels associated with hip resurfacing arthroplasty (HRA) may be driving better outcomes in this group compared to total hip arthroplasty (THA). Previous studies evaluated patient expectations before consulting with the surgeon, although these expectations were likely unrealistic and would change after the consultation. We compared HRA and THA patient expectations after consultation with the surgeon. In a prospective registry setting, patients awaiting HRA were matched to THA patients by age, sex, and a preoperative Lower Extremity Activity Scale score (range 1-18, with 18 indicating levels of highest activity). Patients completed preoperatively a validated 18-item expectations survey. Mean overall expectation scores were first compared. Exploratory factor analysis (EFA) was then performed to determine if the grouping of individual expectations items represented meaningfully different underlying factors in the 2 groups. We matched 123 pairs. The mean ± SD expectation scores were similar (85.2 ± 15.5 for HRA and 87.3 ± 13.9 for THA; P = 0.249). The EFA showed that HRA and THA patients shared the common expectations of pain relief and improvement in daily activities (9 items) and eliminating pain medications, the need for a cane, and improving sexual activity (3 items). THA patients perceived the remaining 6 items as an overall third expectation of participation in higher-level activities. However, HRA patients perceived a fourth expectation of normal range of motion (2 items) independent of the other higher-level activities (4 items). Even after consulting with a surgeon, patients' expectations differed between HRA and THA patients regarding higher-level activities. More counseling for patients seeking hip arthroplasty is therefore needed.

A Short Tapered Stem Reduces Intraoperative Complications in Primary Total Hip Arthroplasty

While short-stem design is not a new concept, interest has surged with increasing utilization of less invasive techniques. Short stems are easier to insert through small incisions. Reliable long-term results including functional improvement, pain relief, and implant survival have been reported with standard tapered stems, but will a short taper perform as well? We compared short, flat-wedge, tapered, broach-only femoral stems to standard-length, double-tapered, ream and broach femoral stems in terms of intraoperative complications, short-term survivorship, and pain and function scores. We retrospectively reviewed the records of 606 patients who had 658 THAs using a less invasive direct lateral approach from January 2006 to March 2008. Three hundred sixty patients (389 hips) had standard-length stems and 246 (269 hips) had short stems. Age averaged 63 years, and body mass index averaged 30.7 kg/m(2). We recorded complications and pain and function scores and computed short-term survival. Minimum followup was 0.8 months (mean, 29.2 months; range, 0.8-62.2 months). We observed a higher rate of intraoperative complications with the standard-length stems (3.1%; three trochanteric avulsions, nine femoral fractures) compared with the shorter stems (0.4%; one femoral fracture) and managed all complications with application of one or more cerclage cables. There were no differences in implant survival, Harris hip score, and Lower Extremity Activity Scale score between groups. Fewer intraoperative complications occurred with the short stems, attesting to the easier insertion of these devices. While longer followup is required, our early results suggest shortened stems can be used with low complication rates and do not compromise the survival and functional outcome of cementless THA. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Joint health and functional ability in children with haemophilia who receive intensive replacement therapy

Joint physical examination is an important outcome in haemophilia; however its relationship with functional ability is not well established in children with intensive replacement therapy. Boys aged 4-16 years were recruited from two European and three North American treatment centres. Joint physical structure and function was measured with the Haemophilia Joint Health Score (HJHS) while functional ability was measured with the revised Childhood Health Assessment Questionnaire (CHAQ₃₈. Two haemophilia-specific domains were created by selecting items of the CHAQ₃₈ that cover haemophilia-specific problems. Associations between CHAQ, HJHS, cumulative number of haemarthroses and age were assessed. A total of 226 subjects - mean 10.8 years old (SD 3.8) - participated; the majority (68%) had severe haemophilia. Most severe patients (91%) were on prophylactic treatment. Lifetime number of haemarthroses [median=5; interquartile range (IQR)=1-12] and total HJHS (median = 5; IQR=1-12) correlated strongly (ρ = 0.51). Total HJHS did not correlate with age and only weakly (ρ=-0.19) with functional ability scores (median=0; IQR=-0.06-0). Overall, haemarthroses were reported most frequently in the ankles. Detailed analysis of ankle joint health scores revealed moderate associations (ρ=0.3-0.5) of strength, gait and atrophy with lower extremity tasks (e.g. stair climbing). In this population, HJHS summating six joints did not perform as well as individual joint scores, however, certain elements of ankle impairment, specifically muscle strength, atrophy and gait associated significantly with functional loss in lower extremity activities. Mild abnormalities in ankle assessment by HJHS may lead to functional loss. Therefore, ankle joints may warrant special attention in the follow up of these children.

Relationship Between Demographic Variables and Preoperative Pain and Disability in 5945 Total Joint Arthroplasties at a Single Institution

Using a prospective institutional registry, 5945 total joint arthroplasty patients were evaluated for the following preoperative variables: sex, age, living situation, pain (visual analog scale), and activity level (lower extremity activity scale). Univariate analysis was performed with χ 2, t test, and Pearson correlation coefficient. Patient age was inversely correlated with visual analog scale and lower extremity activity scale scores ( P < .0001). Whereas total hip arthroplasty was performed as equally in women and men, total knee arthroplasty was more frequent in women. Women were more likely to live alone, experience severe pain, and have limited activity ( P < .0001). Patients who lived alone were more likely to experience severe pain or limited activity ( P < .0001). Women and patients who live alone experience more pain and disability before surgery, potentially placing them at risk for inferior surgical outcomes.

Reliability and Validity of Bilateral Ankle Accelerometer Algorithms for Activity Recognition and Walking Speed After Stroke

Outcome measures of mobility for large stroke trials are limited to timed walks for short distances in a laboratory, step counters and ordinal scales of disability and quality of life. Continuous monitoring and outcome measurements of the type and quantity of activity in the community would provide direct data about daily performance, including compliance with exercise and skills practice during routine care and clinical trials. Twelve adults with impaired ambulation from hemiparetic stroke and 6 healthy controls wore triaxial accelerometers on their ankles. Walking speed for repeated outdoor walks was determined by machine-learning algorithms and compared to a stopwatch calculation of speed for distances not known to the algorithm. The reliability of recognizing walking, exercise, and cycling by the algorithms was compared to activity logs. A high correlation was found between stopwatch-measured outdoor walking speed and algorithm-calculated speed (Pearson coefficient, 0.98; P=0.001) and for repeated measures of algorithm-derived walking speed (P=0.01). Bouts of walking >5 steps, variations in walking speed, cycling, stair climbing, and leg exercises were correctly identified during a day in the community. Compared to healthy subjects, those with stroke were, as expected, more sedentary and slower, and their gait revealed high paretic-to-unaffected leg swing ratios. Test-retest reliability and concurrent and construct validity are high for activity pattern-recognition Bayesian algorithms developed from inertial sensors. This ratio scale data can provide real-world monitoring and outcome measurements of lower extremity activities and walking speed for stroke and rehabilitation studies.

Functional Outcome of Matrix-Associated Autologous Chondrocyte Implantation in the Ankle

The technique of Matrix-associated autologous chondrocyte implantation (MACI) is well established with satisfactory outcomes up to 5 years in the knee. Fewer series describe the outcomes of this technique in the ankle. We present the functional outcomes of the technique for a single surgeon series in a general hospital setting. Twenty-seven patients, mean age 41, were reviewed at 3.7 (range, 1 to 5) years. Patients were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale, Tegener activity score and University of California lower extremity activity scale. MRI findings were also reviewed. While most patients report a significant improvement in symptoms with full return to activities of daily living, 36% of those under 40 and 78% of those over 40 reported restricted recreational activity. Of the patients under 40 years of age, 86% were able to run compared with 23% of those over 40. Of patients over 40, 64% continued to have moderate or severe pain. Careful preoperative counseling is required for patients of all ages regarding likely outcomes. In patients over 40, the procedure is unlikely to give good pain relief and alternative options should be considered.