Lower Range Of Motion Research Articles

Predictors of Outcome in Patients with Cervical Spondylotic Myelopathy Undergoing Unilateral Open-Door Laminoplasty.

ObjectiveThis study aimed to analyze prognostic factors affecting surgical outcomes of expansive laminoplasty for cervical spondylotic myelopathy (CSM).MethodsUsing the Frankel scale and Japanese Orthopaedic Association (JOA) scale, we retrospectively reviewed the outcomes of 45 consecutive patients who underwent modified unilateral open-door laminoplasty using hydroxyapatite spacers and malleable titanium miniplates between June 2008 and May 2014. The patients were assigned to the good and poor clinical outcome groups, with good outcome defined as a JOA recovery rate >75%.ResultsThe mean preoperative JOA scale was significantly higher in the good outcome group (14.95±3.21 vs. 10.78±6.07, p<0.001), whereas the preoperative cervical range of motion (ROM) in this group was significantly lower (29.89°±10.11 vs. 44.35°± 8.88, p<0.001). In univariate analysis, a high preoperative JOA scale (odds ratio (OR) 1.271, 95% confidence interval (CI) 1.005-1.607) and low preoperative cervical ROM(OR 0.858, 95% CI 0.786-0.936) were statistically correlated with good outcomes. Furthermore, these factors demonstrated an independent association with clinical outcomes (preoperative JOA scale: OR 1.344, 95% CI 1.019-1.774, p=0.036; preoperative cervical ROM: OR 0.860, 95% CI 0.788-0.940, p=0.001).ConclusionIn this study, a high preoperative JOA scale was associated with good clinical outcome after laminoplasty, whereas a higher preoperative cervical spine ROM was associated with poor clinical outcome. This may suggests that cervical mobility and preoperative neurological status affect clinical outcomes of laminoplasty.

Fracture-dislocations of the proximal ulna.

To investigate the relationship between injury patterns, complications, and the functional outcomes of patients with proximal-ulna fracture-dislocations. Retrospective analysis of 15 patients (10 men, 5 women; mean age, 49.1 years; mean follow-up 49 months) with 6 anterior and 9 posterior fracture-dislocations of the proximal ulna. The proximal ulna was reconstructed with plates and screws in 13 patients and tension-band wiring in 2 patients. At the final follow-up, elbow range of motion (ROM) was measured and Mayo elbow scores (MEPS) were recorded. Broberg-Morrey criteria were used for osteoarthritis staging. Concomitant radial-head fracture was seen in all posterior fracture-dislocations. Four ligamentous injuries occurred in this group. All anterior dislocations had trochlear-notch fractures without associated injuries. Mean flexion ROM was 130.6° (100°-140°) and mean loss of extension ROM was 12.6° (0°-30°) in the study group. The mean MEPS score was 92.3 (70-100). Patients with posterior fracture-dislocations showed lower ROM and MEPS and higher level of osteoarthritis than patients with anterior fracture-dislocations. Recurrent dislocations occurred in 2 patients who had ulna fractures fixed with tension-band wiring. Radial-head fracture and ligamentous injury are specific components of posterior fracture-dislocations. The injury is limited to the trochlear notch in anterior fracture-dislocations. Posterior fracture-dislocations have lower functional outcomes. Proximal-ulna fractures should be fixed with rigid internal fixation (plate and screw) even if the fracture is a simple 2-part fracture.

Refining the idiom "functional range of motion" related to burn recovery.

The term "functional" in burn rehabilitation has gained widespread use to describe a patient's recovery after burn injury. But what truly is "functional" when applied to a patient recovering from burn injury? A literature search was performed for information defining "functional" range of motion (ROM). Maximum upper and lower ROM values to perform a variety of daily activities were abstracted and compared with published outcomes of patient groups recovered from burn injury. Seventy references were reviewed leading to categorizing 11 activities and 26 joint motions. Seven burn outcome articles were found that classified patient scar contracture severity based on ROM. In comparing the results, many burn survivors with severe burn scar contractures could be considered "functional." Refinement of the term "functional" is needed related to burn outcomes. Functional ROM of a particular joint to perform one specific task may be insufficient to perform a variety of other tasks when all planes of motion are considered. Use of the term "functional" to describe a patient's outcome should be used in a guarded manner.

Instrumental assessment of cervical spine mobility in patients with whiplash injury for forensic application

Introduction: Residuals of whiplash injury (W.I.) represent one of most common causes of compensation claims in forensic medicine. Until 2012, clinical assessment was deemed sufficient to ascertain the reduction of neck mobility. A new law (n. 27 year 2012/3-ter;3-quarter) has established that in order to assess adamage it is now necessary to demonstrate it both with clinical and instrumental methods. As a consequence, the mere clinical assessment ofW.I. is not anymore accepted by the insurance companies. Sowe need an instrumental evaluationmethod, that should be non invasive, easy to perform, and guarantees a high reproducibility [2]. In forensic medicine there is also another problem: since the assessment of neck mobility has an effect on the economic compensation, the patients may be inclined to demonstrate a deeper damage. So the test should not rely on voluntary actions and should provide some indication of reliability. In our intention this can be achieved by quantifying the passive range of motion (PROM) and by analyzing its variability. Methods: An opto-electronic stereo-photogrammetric system (POSEIDON system BTS, Italy) was employed for obtaining the relative motion between head and upper trunk. Three retroreflective markers were applied to the temples and nasion respectively, and three on acromions and apex of sternum (six markers in total). Only 3-TV camera was sufficient to obtain a reliable acquisition of kinematics at 60 frames/s. While specific physical maneuvers were performed on the subject, the system computed the markers trajectories, the main rotation angles of the head in relation to the trunk (flexion–extension, lateral bending, axial rotation), speed and acceleration. The automatic output was a clinical report that integrates all data related to the morphology and kinematics of the analyzed body segment. Our preliminary study was carried out on 6 healthy, non symptomatic subjects and 6 subjects with history of W.I., whose evaluation was finalized to the insurance assessment. The test was performed in two steps: (1) pure clinical assessment; (2) instrumental assessment. In this second step the subjects were seated on a armchair, in front of the TV-cameras, while the examiner performed the maneuvers to test their PROM inflexion–extension, lateral bending and rotation of the head/neck. Each movement was repeated at least 6 times. The results were compared to age matched control data. Results: Our preliminary data collected on the healthy, asymptomatic subjectsmatched verywellwith data provided in literature [1,3]. Subjects who had residuals ofW.I., exhibited a lower range of motion and some asymmetries that well correlated to the reported symptoms. More interestingly, the standard deviation (SD) of the measured PROM ranged from 1.6◦ to 2.6◦ in the subjects that had no interest in the insurance compensation, and ranged from 3.5◦ to 4.0◦ in symptomatic subjects that were assessed for insurance purposes. In one of them, whose attempt to overstate his reduced mobility was evident clinically, the SD was 8.1. Another interesting observation was that left/right asymmetry for lateral bending and axial rotationwas in the range 0–3◦ in the healthy subjects and 6–21◦ in the W.I. subjects. Discussion: The analysis system adopted allows us to perform an instrumental non invasive, high reliability, easy to use assessment, does not require a large space around the subject and needs only few minutes to produce the written report. When comparing the results of the pure clinical method with results of the instrumental method, the higher resolution of the instrumental method proved to be a clear advantage and allowed us to better understand the clinical condition. It is our impression that this instrumental method offers a major possibility to recognize the simulation. Our aims isnowtocollect a largedatabaseof control subjects, in relation to age and sex, in order to obtain a reference formotion assessment in subjects with history of W.I.

Biomechanics of the lower thoracic spine after decompression and fusion: a cadaveric analysis

Background contextFew studies have evaluated the extent of biomechanical destabilization of thoracic decompression on the upper and lower thoracic spine. The present study evaluates lower thoracic spinal stability after laminectomy, unilateral facetectomy, and unilateral costotransversectomy in thoracic spines with intact sternocostovertebral articulations. PurposeTo assess the biomechanical impact of decompression and fixation procedures on lower thoracic spine stability. Study designBiomechanical cadaveric study. MethodsSequential surgical decompression (laminectomy, unilateral facetectomy, unilateral costotransversectomy) and dorsal fixation were performed on the lower thoracic spine (T8–T9) of human cadaveric spine specimens with intact rib cages (n=10). An industrial robot was used to apply pure moments to simulate flexion-extension (FE), lateral bending (LB), and axial rotation (AR) in the intact specimens and after decompression and fixation. Global range of motion (ROM) between T1–T12 and intrinsic ROM between T7–T11 were measured for each specimen. ResultsThe decompression procedures caused no statistically significant change in either global or intrinsic ROM compared with the intact state. Instrumentation, however, reduced global motion for AR (45° vs. 30°, p=.0001), FE (24° vs. 19°, p=.02), and LB (47° vs. 36°, p=.0001) and for intrinsic motion for AR (17° vs. 4°, p=.0001), FE (8° vs. 1°, p=.0001), and LB (12° vs. 1°, p=.0001). No significant differences were identified between decompression of the upper versus lower thoracic spine, with trends toward significantly greater ROM for AR and lower ROM for LB in the lower thoracic spine. ConclusionsThe lower thoracic spine was not destabilized by sequential unilateral decompression procedures. Addition of dorsal fixation increased segment rigidity at intrinsic levels and also reduced overall ROM of the lower thoracic spine to a greater extent than did fusing the upper thoracic spine (level of the true ribs). Despite the lack of true ribs, the lower thoracic spine was not significantly different compared with the upper thoracic spine in FE and LB after decompression, although there were trends toward significance for greater AR after decompression. In certain patients, instrumentation may not be needed after unilateral decompression of the lower thoracic spine; further validation and additional clinical studies are warranted.

The effect of hydrotherapy treatment on gait characteristics of hereditary spastic paraparesis patients

BackgroundHereditary spastic paraparesis (HSP) is a group of neurological disorders characterised by slowly progressive increasing muscle tone, predominantly in the lower limbs, with relatively preserved power. This leads to progressive difficulties in motor control and walking. ObjectiveThe purpose of this study was to evaluate the effectiveness of hydrotherapy treatment when used as a means to increase locomotor function in individuals with late onset HSP. This paper discusses the analysis of the effect on gait characteristics. MethodsNine people with HSP were asked to participate in pre- and post-hydrotherapy gait analyses. Ground reaction force and motion trajectories were recorded and used to calculate spatiotemporal gait parameters, joint angles and moments. ResultsThe normalised joint kinematics and kinetics profile revealed that the biomechanics of people with HSP were similar to that of controls for most of the joints, but with lower range of motion. Walking speed increased significantly (11%) after the course of hydrotherapy. Though part of this was achieved through increased ROM there was also a further increase in hip internal rotation and in peak hip extension moment. ConclusionsAlthough participants had increased walking speed and step length, it appears that hydrotherapy increases the ability to perform compensatory strategies rather than resulting in a more typical kinematic and kinetic approach.

Do stand-alone interbody spacers with integrated screws provide adequate segmental stability for multilevel cervical arthrodesis?

Background contextSome postoperative complications after anterior cervical fusions have been attributed to anterior cervical plate (ACP) profiles and the necessary wide operative exposure for their insertion. Consequently, low-profile stand-alone interbody spacers with integrated screws (SIS) have been developed. Although SIS constructs have demonstrated similar biomechanical stability to the ACP in single-level fusions, their role as a stand-alone device in multilevel reconstructions has not been thoroughly evaluated. PurposeTo evaluate the acute segmental stability afforded by an SIS device compared with the traditional ACP in the setting of a multilevel cervical arthrodesis. Study designIn vitro human cadaveric biomechanical analysis. MethodsThirteen human cadaveric cervical spines (C2–T1) were nondestructively tested with a custom 6 df spine simulator under axial rotation, flexion-extension, and lateral bending loading. After intact analysis, eight single-levels (C4–C5/C6–C7) from four specimens were instrumented and tested with ACP and SIS. Nine specimens were tested with C5–C7 SIS, C5–C7 ACP, C4–C7 ACP, C4–C7 ACP+posterior fixation, C4–C7 SIS, and C4–C7 SIS+posterior fixation. Testing order was randomized with each additional level instrumented. Full range of motion (ROM) data were obtained and analyzed by each loading modality, using mean comparisons with repeated measures analysis of variance. Paired t tests were used for post hoc analysis with Sidak correction for multiple comparisons. ResultsNo significant difference in ROM was noted between the ACP and SIS for single-level fixation (p>.05). For multisegment reconstructions (two and three levels), the ACP proved superior to SIS and intact condition, with significantly lower ROM in all planes (p<.05). When either the three-level SIS or ACP constructs were supplemented with posterior lateral mass fixation, there was a greater than 80% reduction in ROM under all testing modalities (p<.05), with no significant difference between the ACP and SIS constructs (p>.05). ConclusionsThe SIS device may be a reasonable option as a stand-alone device for single-level fixation. However, SIS devices should be used with careful consideration in the setting of multilevel cervical fusion. However, when supplemented with posterior fixation, SIS devices are a sound biomechanical alternative to ACP for multilevel fusion constructs.

Older Adults without Radiographic Knee Osteoarthritis: Knee Alignment and Knee Range of Motion

This study describes knee alignment and active knee range of motion (ROM) in a community-based group of 78-year old adults (n = 143) who did not have radiographic evidence of knee osteoarthritis in either knee (KL < 2). Although knee malalignment is a risk factor for knee osteoarthritis, most women and men had either valgus or varus alignments. Notably, no men were valgus in both knees. Women with both knees valgus had significantly greater body mass index (P > 0.001) than women with varus or straight knees. Men and women with valgus or varus knee alignments had generally lower ROM than individuals with both knees straight. In summary, this study highlights the complex relationships among knee alignment, ROM, body mass index, and gender in elderly adults without radiographic knee osteoarthritis.

Intrinsic Predictive Factors of Noncontact Lateral Ankle Sprain in Collegiate Athletes: A Case-Control Study.

Background:Lateral ankle sprain (LAS) is one of the most common injuries in sports. Despite extensive research, intrinsic factors that predict initial and recurrent noncontact LAS remain undefined.Purpose:To identify the predictive factors of initial and recurrent noncontact LAS, focusing on ankle flexibility and/or alignment in collegiate athletes.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 191 athletes were assessed during the preseason for factors predictive of noncontact LAS. The baseline measurements included weightbearing dorsiflexion range of motion (ROM), leg-heel angle, foot internal rotation angle in plantar flexion, classification according to the mortise test, and navicular–medial malleolus (NMM) distance. Occurrence of noncontact LAS and participation in practice and games were prospectively recorded for 11 months.Results:Of the 191 athletes assessed, 169 (145 males, 24 females) completed the study; 125 athletes had a history of ankle sprain. During the observational period, 16 athletes suffered noncontact LAS (0.58 per 1000 athlete-exposures) consisting of 4 initial sprains and 12 recurrences. The hazard ratio estimated by a Cox regression analysis showed that athletes with an NMM distance ≥4.65 cm were 4.14 times more likely to suffer an initial noncontact LAS than were athletes with a shorter NMM distance (95% confidence interval, 1.12-14.30) and that athletes with a weightbearing dorsiflexion ROM >49.5° were 1.12 times as likely to suffer a recurrent noncontact LAS compared with athletes with a lower ROM (95% confidence interval, 1.05-1.20).Conclusion:NMM distance predicts initial noncontact LAS, and weightbearing dorsiflexion ROM predicts recurrent noncontact LAS.

The biomechanics of a multilevel lumbar spine hybrid using nucleus replacement in conjunction with fusion

Background contextDegenerative disc disease is commonly a multilevel pathology with varying deterioration severity. The use of fusion on multiple levels can significantly affect functionality and has been linked to persistent adjacent disc degeneration. A hybrid approach of fusion and nucleus replacement (NR) has been suggested as a solution for mildly degenerated yet painful levels adjacent to fusion. PurposeTo compare the biomechanical metrics of different hybrid implant constructs, hypothesizing that an NR+fusion hybrid would be similar to a single-level fusion and perform more naturally compared with a two-level fusion. Study designA cadaveric in vitro repeated-measures study was performed to evaluate a multilevel lumbar NR+fusion hybrid. MethodsEight cadaveric spines (L3–S1) were tested in a Spine Kinetic Simulator (Instron, Norwood, MA, USA). Pure moments of 8 Nm were applied in flexion/extension, lateral bending, and axial rotation as well as compression loading. Specimens were tested intact; fused (using transforaminal lumbar interbody fusion instrumentation with posterior rods) at L5–S1; with a nuclectomy at L4–L5 including fusion at L5–S1; with NR at L4–L5 including fusion at L5–S1; and finally with a two-level fusion spanning L4–S1. Repeated-measures analysis of variance and corrected t tests were used to statistically compare outcomes. ResultsThe NR+fusion hybrid and single-level fusion exhibited no statistical differences for range of motion (ROM), stiffness, neutral zone, and intradiscal pressure in all loading directions. Compared with two-level fusion, the hybrid affords the construct 41.9% more ROM on average. Two-level fusion stiffness was statistically higher than all other constructs and resulted in significantly lower ROM in flexion, extension, and lateral bending. The hybrid construct produced approximately half of the L3–L4 adjacent-level pressures as the two-level fusion case while generating similar pressures to the single-level fusion case. ConclusionsThese data portend more natural functional outcomes and fewer adjacent disc complications for a multilevel NR+fusion hybrid compared with the classical two-level fusion.

Analysis of Thoracic Spine Thrust Manipulation for Reducing Neck Pain

[Purpose] The cervical spine is a common site of pain, which may arise from different parts of the upper limbs or dysfunctions of the upper thoracic spine. The different sections of the spinal column are interlinked, and one region exerts an influence over another. Thus, a low range of motion (hypomobility) in the thoracic spine is an indicator of neck pain, and alterations in the cervical spine can occur due to dysfunctions of the thoracic region. The aim of the present study was to assess the efficacy of upper thoracic spine (T1–T4) thrust manipulation with regard to reduction of pain and disability in patients with neck pain. [Subjects and Methods] Twenty-five individuals with persistent neck pain upon movement participated in this study. The individuals were evaluated using the Neck Disability Index and a visual analog scale for pain. Each individual underwent five sessions of thoracic spine thrust manipulation. Data analysis involved the Student’s t-test. [Results] Significant improvements were found in neck pain and disability. [Conclusion] Based on the results of the present study, thoracic spine thrust manipulation proved effective in the treatment of individuals with neck pain, leading to a reduction in both pain and disability.

Painful hemiplegic shoulder in stroke patients: Causes and management

IntroductionThe hemiplegic shoulder pain is common after a stroke. Its appearance brings pain and limits daily living activities as well as participation in specific Neuro-rehabilitation programs. All this leads to a worse functional outcome. Good management of patients can reduce both the frequency and intensity of shoulder pain, improving functional outcome. DevelopmentWe conducted a literature search of various databases between 1980 and 2008. The articles were evaluated using the PEDro scoring system. Five evidence levels were established for the conclusions. ConclusionsShoulder subluxation occurs at an early stage after stroke and is associated with subluxation of the shoulder joint and spasticity (mainly subscapularis and pectoralis). Slings prevent subluxation of the shoulder. It is preferable to move within a lower range of motion and without aggression to prevent the occurrence of shoulder pain. The injection of corticosteroids does not improve pain and range of motion in hemiplegic patients, while botulinum toxin combined with physical therapy appears to reduce hemiplegic shoulder pain.

Following ergonomics guidelines decreases physical and cardiovascular workload during cleaning tasks

The aim was to investigate the effect of ergonomics guidelines on muscular activity, postural and cardiovascular load during cleaning. Eighteen cleaners performed 10 min of cleaning tasks in two locations; three min in a laboratory and seven min in a lecture room. All participants performed the task with or without focusing on ergonomics guidelines (ergonomics/non-ergonomics session). Bipolar surface electromyography was recorded bilaterally from upper trapezius and erector spinae muscles. A tri-axial accelerometer package was mounted on the low back (L5-S1) to measure postural changes, and the cardiovascular load was estimated by electrocardiogram. Ergonomics sessions resulted in lower muscular load, a more complex pattern of muscular activity, lower range of motion and angular velocity of the trunk as well as lower cardiovascular load compared with non-ergonomics sessions (p < 0.05). The study highlighted the multiple musculoskeletal and cardiovascular benefits of following ergonomics guidelines during cleaning tasks. Practitioner Summary: This study investigated the effects of following instructive ergonomics guidelines during cleaning tasks (daily curriculum of cleaning including mopping, sweeping, changing trash bins and cleaning of desks and blackboards). Following the ergonomics guidelines reduces the general workload and induces a more complex pattern of muscular activity. The study contributes with novel knowledge concerning ergonomics guidelines and work techniques.

The primary stability of angle-stable versus conventional locked intramedullary nails

The aim of this study was to compare the initial biomechanical characteristics of the angle-stable locking system for intramedullary nails using the new biodegradable sleeve with conventional locking in the treatment of unstable distal tibial fractures. Eight pairs of fresh, frozen porcine tibiae were used for this study. The expert tibial nail (Synthes) was equipped with either conventional locking screws (CL) or the angle-stable locking system (AS). This system consists of a special ASLS screw with a biodegradable sleeve. For this investigation distal tibias (5.5 cm) were used and the nails were locked with three screws in both groups. Biomechanical testing included non-destructive torsional and axial loading. The AS group showed a significantly higher torsional stiffness (70%) compared to the CL group. The range of motion was 0.5 times smaller for the AS constructs. The neutral zone was eight times higher in the CL group (p < 0.001). In axial loading the AS group also showed a 10% higher axial stiffness and a 12% lower range of motion (p < 0.001). The angle-stable locking system (ASLS) using a special screw and sleeve locking for intramedullary nails provides a significantly higher primary stability. The differences determined in this study may have clinical relevance particularly for torsional loads. For the new biodegradable angle-stable sleeve we found a comparable stability to the PEEK-based sleeve system. This system has the potential to decrease complications such as secondary loss of reduction and mal-/non-union.

Hombro doloroso hemipléjico en pacientes con ictus: causas y manejo

IntroductionThe hemiplegic shoulder pain is common after a stroke. Its appearance brings pain and limits daily living activities as well as participation in specific Neuro-rehabilitation programs. All this leads to a worse functional outcome. Good management of patients can reduce both the frequency and intensity of shoulder pain, improving functional outcome. DevelopmentWe conducted a literature search of various databases between 1980 and 2008. The articles were evaluated using the PEDro scoring system. Five evidence levels were established for the conclusions. ConclusionsShoulder subluxation, occurs at an early stage after stroke and is associated with subluxation of the shoulder joint and spasticity (mainly subscapularis and pectoralis). Slings prevent subluxation of the shoulder. It is preferable to move within a lower range of motion and without aggression to prevent the occurrence of shoulder pain. The injection of corticosteroids does not improve pain and range of motion in hemiplegic patients, while botulinum toxin combined with physical therapy appears to reduce hemiplegic shoulder pain.

The longitudinal effect of body adiposity on joint mobility in young males with Haemophilia A

Although body adiposity and disease severity in haemophilia have been found in cross-sectional studies to be negatively associated with joint mobility, it is not clear how these two factors affect the rate of joint mobility loss over time. Over a 10-year period, repeated measures of joint range of motion (ROM) were collected annually using universal goniometers on bilateral hip, knee, ankle, shoulder and elbow joints in 6131 young males with haemophilia A aged ≤ 20 years. Body mass index (BMI) was calculated using data on weight and height during follow up. The effect of body adiposity, adjusted for disease severity, on the rate of joint mobility loss over time was assessed using a longitudinal model. Compared with haemophilia males with normal BMI, those who were obese had lower ROM at initial visit and a faster rate of joint mobility loss in the lower limbs. Overweight subjects experienced similar loss in ROM, although to a lesser degree. A decline in ROM with age was also observed in upper limb joints but the rate was not significantly affected by body adiposity. Haemophilia severity, joint bleeding and the presence of an inhibitor were other significant contributors to joint mobility loss in both upper and lower limb joints. Excess body adiposity accelerates joint mobility loss in weight bearing joints particularly among those with severe haemophilia. Our findings suggest that body weight control and effective treatment of bleeds should be implemented together to achieve better joint ROM outcomes in males with haemophilia.

Effect of Body Mass Index on Range of Motion and Manipulation After Total Knee Arthroplasty

This study evaluates the effects of increased body mass index (BMI) on postoperative range of motion (ROM) and rate of manipulation under anesthesia (MUA) after total knee arthroplasty (TKA) in 391 primary TKAs. Range of motion and incidence of MUA were retrospectively collected and compared between 4 BMI groups (I, BMI <25; II, BMI 25-29.9; III, BMI 30-34.9; IV, BMI >35) using χ 2 or Fisher exact tests. Patients with higher BMIs had a greater incidence of MUA (I, 9.7%; II, 19%; III, 20%; IV, 15%) and lower preoperative and postoperative ROM. Women had lower ROM and a higher rate of MUA. Age was not a significant predictor of ROM or rate of MUA. Patients at greater risk of complications after TKA should be counseled about realistic surgical outcomes.

Distal femur fractures of the elderly—Different treatment options in a biomechanical comparison

Background Fractures of the distal femur, especially in the elderly patient, are an unsolved problem in orthopaedic and trauma surgery. Poor bone stock quality caused by osteoporosis often results in bad implant anchorage in the distal part with a high risk of secondary failures such as cutout. This study investigates the biomechanical characteristics of four implants with different distal locking options under quasi-static torsional and cyclic axial loading. Therefore, an osteoporotic bone model simulating severe osteoporotic conditions was used. Methods Four different implants (T2 intramedullary nail, supracondylar nail (SCN), distal femoral nail (DFN) and the AxSOS angular stable plate) with different distal locking options were instrumented using an osteoporotic bone model. Five specimens per implant and per loading type (torsional and axial) were used. Mechanical testing was performed under physiologic loading conditions. First, a torsional test was performed in internal and external rotation (10 Nm), with a new specimen; a stepwise cyclic axial loading was conducted until failure of the construct. Findings For torsional loading, the lowest range of motion (ROM) and neutral zone (NZ) was found for the AxSOS plate construct. The SCN and T2 constructs showed similar results, and the highest ROM and NZ were found for the constructs treated with the DFN. Axial stiffness was highest for SCN constructs and in the same range for DFN and T2. The lowest stiffness showed in the AxSOS plate constructs with 47% of SCN stiffness. Under cyclic axial loading, the SCN constructs showed the highest number of cycles to failure, followed by AxSOS (70%), DFN (69%) and T2 (48%). Interpretation In conclusion of this biomechanical study, we can clinically suggest that, if, in general, torsional stability is required (e.g., for bedridden patients) the AxSOS plate will be sufficient. By contrast, the findings of this study support the fact that the SCN should be considered for mobile patients where early postoperative mobilisation for rehabilitation is desired.

The role of prosthesis design on segmental biomechanics

The purpose of this study was to evaluate the influence of different implant designs of total lumbar disc replacements on the segmental biomechanics of the lumbar spine. The unconstrained Charité, the semi-constrained Prodisc and a semi-constrained Prototype with more posterior centre of rotation than the Prodisc were tested in vitro using six human, lumbar spines L2-L5. The segmental lordosis was measured on plain radiographs and the range of motion (ROM) for all six degrees of freedom with a previously described spine tester. All prostheses were implanted at level L3-L4. Compared with the intact status all prostheses resulted in a significant increase of segmental lordosis (intact 5.1°; Charité 10.6°, p = 0.028; Prodisc 9.5°, p = 0.027; Prototype 8.9°, p = 0.028), significant increase of flexion/extension (intact 6.4°, Charité 11.3°, Prodisc 12.2°, Prototype 12.2°) and axial rotation (intact 1.3°, Charité 5.4°, Prodisc 3.9°, Prototype 4.2°). Lateral bending increased significantly only for the Charité (intact 7.7°; Charité 11.6°, p = 0.028; Prodisc 9.6°, Prototype 9.8°). The segmental lordosis after Prototype implantation was significantly lower compared with Charité (p = 0.024) and Prodisc (p = 0.044). No significant difference could be observed for segmental lordosis between Charité and Prodisc and for ROM between the two semi-constrained prosthesis Prodisc and Prototype. The axial rotation for the unconstrained Charité was significantly higher than for the semi-constrained prosthesis Prodisc and Prototype, flexion/extension and lateral bending did not differ. Summarizing, the unconstrained prosthesis design increased segmental lordosis and showed a tendency towards higher ROM for axial rotation/lateral bending and lower ROM for flexion/extension than a semi-constrained prosthesis. A more anterior centre of rotation in a semi-constrained prosthesis resulted in a higher increase of segmental lordosis after TDR than a semi-constrained prosthesis with more posterior centre of rotation. The location of the centre of rotation in a semi-constrained prosthesis did not alter the magnitude of ROM. Despite the different alterations of ROM and segmental lordosis due to implant design, these differences were negligible compared with the overall increase of ROM and segmental lordosis by the implantation of a TDR compared with the physiologic state.

Pain and Function in Patients with Rheumatic Disease and Elbow Arthroplasty: Clinical and Methodological Aspects

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 &lt; 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.