Postoperative Functional Activity Research Articles

Discussion on internal fixation of Hoffa fractures

Hoffa fracture is an unstable intra-articular fracture with significant redisplacement tendency. It is easy to be missed diagnosis when accompanied by distal intercondylar or supracondylar fracture of femur. CT scan is the gold standard for the diagnosis of Hoffa fracture. The treatment principles are anatomic reduction of the articular surface, reliable internal fixation, and early functional activity. At present, the main treatment is arthroscopic screw fixation. During screw fixation, the tail cap of screw should be buried, resulting in non-healing iatrogenic injury of articular cartilage. In the early postoperative functional activity of knee joint, fracture block was repeatedly subjected to backward and upward shear force under the action of the tibial plateau, which is the main reason for the failure of internal fixation. Plate assisted screw fixation could increase local mechanical stability, but it still cannot avoid the defects of iatrogenic cartilage injury. At the same time, plate molding is required during the operation due to the absence of special anatomical plates, resulting in increased surgical trauma and time-consuming surgery. The ideal fixation method for Hoffa fracture should include:(1) Avoid iatrogenic injury of articular surface cartilage. (2) With the rear anti-shear barrier plate function.(3) The internal fixator is closer to the load interface, so as to obtain greater load and better fixed strength.

The Outcomes of Cannulated Screws Versus Tension Band Wiring in Treatment of Transverse Patellar Fracture: A Comparative Study

BACKGROUND: For the treatment of displaced patella fractures by tension bands with cannulated screws and by K-wire are widely employed. The clinical efficacy of the two therapy regimens, however, remains a point of contention. AIM: The study goal was to assess the relative advantages and drawbacks of open reduction and internal fixation using tension band wiring versus cannulated screws with wiring in patients sustained displaced patellar fracture. PATIENTS AND METHODS: A clinical trial study conducted in the Orthopedics Department at Al-Yarmook Teaching Hospital during a period of 18 months from June 2020 to November 2021. It included 22 adult patients diagnosed with isolated displaced transverse patellar fracture and scheduled for operative fixation. They were divided randomly into two groups: Tension band technique group (TBT) included 11 patients underwent open reduction internal fixation (ORIF) with TBT and cannulated screws (CS) group included 11 patients underwent ORIF by cannulated screws with wiring. A postoperatively follow-up was continued for 6 months. In which patients were assessed clinically and radiographically 4 time, at the end of the 1st, 2nd, 3rd, and 6th months. RESULTS: After 1, 2, and 3 months, means of Lysholm score and range of flexion were significantly higher; while mean of VAS score of pain was significantly lower in CS group than that in TBT group. No statistical significant differences in postoperative complications were found between study groups. CONCLUSION: Tension band wire with cannulated screws is the most effective surgical approach for internally repairing transverse fractures of the patella which allows for an early start to postoperative functional activity and an improved quality of life.

Comparison of clinical and biomechanical outcomes between the kinematic and mechanical alignment methods in total knee arthroplasty: Protocol for a multicenter randomized controlled trial

IntroductionThe concept of anatomic restoration has garnered considerable interest in the form of kinematically aligned total knee arthroplasty (KA-TKA). KA-TKAs have been reported to reproduce natural alignment and kinematics. However, few randomized controlled trials (RCTs) have compared the biomechanical outcomes and the long-term clinical outcomes of KA-TKA with those of mechanically aligned TKA (MA-TKA). We aim to investigate the long-term clinical and biomechanical effects of KA-TKA and to determine whether KA-TKA or MA-TKA is more appropriate for primary TKA. MethodsThis trial will compare clinical and biomechanical outcomes of KA-TKA to those of MA-TKA. Two hundred patients will be enrolled in the RCT and randomized into KA-TKA or MA-TKA groups. Both the groups will be evaluated 1 week before the operation, on the day of the operation, 6 months after the operation, and 1, 5, and 10 years after the operation. The primary outcome is the difference between preoperative and 1-year postoperative functional activity scores of the 2011 Knee Society Score (2011 KSS) in both groups as well as the differences between the scores of both groups. The secondary outcomes will include differences in symptom, satisfaction, and expectation scores of the 2011 KSS, intraoperative kinematics evaluation, postoperative clinical outcomes and complications, pre- and postoperative gait analyses and radiograph evaluations between both KA-TKA and MA-TKA.

Hip arthroplasty - study correlating intra operative stable range of motion with postoperative functional activity

<p class="abstract"><strong>Background:</strong> Squatting and sitting cross-legged is a part of lifestyle both for employment and for daily ablutions. When these activities can be allowed after hip arthroplasty is not documented. The aim of this study is to identify if patients having good intra-operative stability with the posterior approach, can start high flexion activities early.</p><p class="abstract"><strong>Methods:</strong> In this retrospective study, all hip arthroplasty patients done from 2013-2017 were considered for inclusion. Patients were evaluated for intra-operative stable range of motion and patients who were stable were encouraged to do cross-legged sitting from 2 weeks after surgery and squatting from 6 weeks after surgery. The follow-up visits were at 6-weeks, 3-months and 1-year after surgery. Parameters assessed were Harris hip score, short form survey-12 (SF-12) score, limb length discrepancy, range of motion and ability to sit cross-legged and squat. All the patients were again called for a follow-up visit and the parameters were reassessed.<strong></strong></p><p class="abstract"><strong>Results:</strong> Sixty patients were included in the study. Mean follow-up was 2 years 3 months. Mean Harris hip score and SF-12 showed improvement from 64.8 and 19.5 at 3 months to 88.3 and 37.8 respectively at last follow-up. At the end of 3 months, 85% patients could sit cross-legged and 50% could squat. At one year, the corresponding figures were 85% and 70%.</p><p class="abstract"><strong>Conclusions:</strong> If intra-operative range of motion testing is satisfactory, early initiation of high flexion hip activities is safe.</p>

3D correction over 2 years with anterior vertebral body growth modulation: A finite element analysis of screw positioning, cable tensioning and postoperative functional activities

BackgroundAnterior vertebral body growth modulation is a fusionless instrumentation to correct scoliosis using growth modulation. The objective was to biomechanically assess effects of cable tensioning, screw positioning and post-operative position on tridimensional correction. MethodsThe design of experiments included two variables: cable tensioning (150/200N) and screw positioning (lateral/anterior/triangulated), computationally tested on 10 scoliotic cases using a personalized finite element model to simulate spinal instrumentation, and 2years growth modulation with the device. Dependent variables were: computed Cobb angles, kyphosis, lordosis, axial rotation and stresses exerted on growth plates. Supine functional post-operative position was simulated in addition to the reference standing position to evaluate corresponding growth plate’s stresses. FindingsSimulated cable tensioning and screw positioning had a significant impact on immediate and after 2years Cobb angle (between 5°–11°, p<0.01). Anterior screw positioning significantly increased kyphosis after 2years (6°–8°, p=0.02). Triangulated screw positioning did not significantly impact axial rotation but significantly reduced kyphosis (8°–10°, p=0.001). Growth plates' stresses were increased by 23% on the curve's convex side with cable tensioning, while screw positioning rather affected anterior/posterior distributions. Supine position significantly affected stress distributions on the apical vertebra compared to standing position (respectively 72% of compressive stresses on convex side vs 55%). InterpretationThis comparative numerical study showed the biomechanical possibility to adjust the fusionless instrumentation parameters to improve correction in frontal and sagittal planes, but not in the transverse plane. The convex side stresses increase in the supine position may suggest that growth modulation could be accentuated during nighttime.

Does preoperative body weight affect early postoperative functional activities in patients with total hip arthroplasty?

This study aims to compare early postoperative functional activities of obese or non-obese patients who underwent total hip arthroplasty (THA). The study included 45 patients (17 males, 28 females; mean age 64.6±8.6 years; range 45 to 78 years) who were operated due to coxarthrosis. Patients were assigned to two groups as obese (body mass index [BMI] >30 kg/m2, n=21) and non-obese (BMI <30 kg/m2, n=24) based on their preoperative BMI. Obese and non-obese patients' functional movements (lie-to-sit, sit-to-stand, ambulation, stair climbing) were assessed with Iowa Level of Assistance Scale while ambulation velocity was assessed with Iowa Ambulation Velocity Scale preoperatively, on postoperative second and sixth days and at discharge. While there was significant difference between non-obese patients' intragroup functional movement levels preoperatively and at discharge (p<0.05), there were no difference in the same intragroup values of obese patients (p>0.05). There was no significant difference between obese and non-obese patients in terms of functional movements and ambulation velocities on postoperative second and sixth days and at discharge (p>0.05). According to our study findings, obesity has no effect in early postoperative period on functional activities in patients who underwent THA.

Sagittal spinopelvic alignment predicts hip function after total hip arthroplasty

The aim of this study was to investigate the association between preoperative sagittal spinopelvic alignment and postoperative clinical outcomes after total hip arthroplasty (THA). This retrospective study included 92 patients with hip osteoarthritis who underwent primary THA between May 2013 and October 2015. Patients’ characteristics, radiographic sagittal spinopelvic parameters and modified Harris Hip Scores, including function scores (gait scores and functional activities scores), were investigated. Multivariate linear regression analysis was performed to determine the associations between each preoperative sagittal spinopelvic parameter and postoperative hip function The preoperative sagittal spinopelvic parameters that were associated with postoperative gait scores were sagittal vertical axis (adjusted β-coefficient=−0.28, P=0.02), lumbar lordosis angle (adjusted β-coefficient=0.29, P=0.0089), pelvic tilt (adjusted β-coefficient=−0.25, P=0.045), sacral slope (adjusted β-coefficient=0.27, P=0.017) and pelvic incidence minus lumbar lordosis angle (adjusted β-coefficient=−0.31, P=0.01). The preoperative sagittal spinopelvic parameters that were related to the postoperative functional activities scores were sagittal vertical axis (adjusted β-coefficient=−0.38, P=0.0051) and pelvic incidence minus lumbar lordosis angle (adjusted β-coefficient=−0.39, P=0.0033). Patients with preoperative imbalanced sagittal alignment such as larger sagittal vertical axis, larger pelvic incidence minus lumbar lordosis and retroversion of pelvis had poorer clinical outcomes than others after THA. While, those preoperative imbalanced patients with anteversion of pelvis may have a compensatory ability which could correct the abnormal sagittal alignment after THA. Preoperative sagittal spinopelvic alignment affected postoperative clinical outcomes after THA.

Are Younger Patients Undergoing TKAs Appropriately Characterized As Active?

The use of TKAs in young patients is increasing. Demographic characteristics and activity levels among this patient group may affect implant selection, performance, and survivorship. Patient age (≤ 55 years) and preoperative diagnosis have been used to define this patient group, with the presumption that these patients are more active than older patients with similar indications for TKA. We questioned whether (1) demographic features of young patients support high activity expectations after TKA, and (2) preoperative or postoperative functional activity measures support projections that young patients are active after TKA. We retrospectively compared demographic characteristics (gender, BMI, diagnosis) and functional activity profile (as determined by preoperative and postoperative UCLA activity score and functional subscores of The Knee Society and WOMAC instruments) for 150 patients 55 years old or younger (181 TKAs) and 262 patients who were between 65 to 75 years old (314 TKAs) at the time of surgery. Younger patients having TKAs were significantly more likely than older patients to be female (74% versus 60%, p < 0.001) and to have diagnoses other than osteoarthritis (18% versus 3%, p < 0.001). BMI was significantly greater among younger female patients than among other age and gender combinations (35 kg/m(2) versus 31 kg/m(2), p < 0.001). Male patients had higher mean postoperative UCLA activity scores (5.5 versus 4.4, p < 0.001), Knee Society function subscores (80.2 versus 66.4, p < 0.001), and WOMAC function subscores (82.8 versus 74.2, p < 0.01) compared with female patients, but these were not different in older versus younger patients. Sustained high activity levels are not likely to be a principal cause of revision TKAs among younger patients when considering age and diagnosis alone. Determining the effect of activity on survivorship of prosthetic designs and techniques should be based on measured functional activity instead of using age and diagnosis as surrogates for activity. Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

The Effect of Femoral Stem Length on Inpatient Rehabilitation Outcomes

Thrust plate prosthesis (TPP) has load-transferring characteristics different from those of conventional intramedullary stemmed prostheses (ISP). We investigate whether prosthesis type (intramedullary or extramedullary application) can improve early functional activities in hospital patients with hip arthroplasty. Early postoperative functional activities of 30 patients with TPP were compared with 31 patients treated by ISP. Each group received same rehabilitation programmes: TPP patients with early full weight bearing and ISP patients with early full weight bearing. Patients were evaluated postoperatively (on the second, sixth and discharge days). Their functional activities were assessed with Iowa Level of Assistance Scale (ILAS), walking speed with Iowa Ambulation Velocity Scale (IAVS), hip functions with Harris Hip Scoring System, and hip motions with goniometer. TPP patients achieved higher scores for total functional activities on the second and sixth postoperative days and during discharge than did ISP patients (p<0.05). Comparison of the walking speed of the patients on the second and sixth postoperative days and during discharge showed that TPP patients walked faster than did ISP patients (p<0.05). TPP patients had higher Harris hip scores and a higher hip motion degree than did ISP patients during discharge (p<0.05). We conclude that patients with TPP gain their independence in functional activities earlier than do patients with ISP.

Validation of the activities assessment scale in women undergoing pelvic reconstructive surgery.

The Activities Assessment Scale (AAS) is a 13-item postoperative functional activity scale validated in men who underwent hernia surgery. We evaluated the psychometric characteristics of the AAS in women who underwent vaginal surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Participants included 163 women with POP and SUI enrolled in a randomized trial comparing sacrospinous ligament fixation to uterosacral vault suspension with and without perioperative pelvic floor muscle training. Participants completed the AAS and SF-36 at baseline and 2 weeks and 6 months postoperatively. Internal reliability of the AAS was evaluated using Cronbach α. Construct validity and responsiveness were examined in cross-sectional and longitudinal data using Pearson correlation coefficient and analysis of variance. The AAS is scored from zero to 100 (higher scores=better function). Mean (SD) baseline AAS score was 87 (17.3) (range, 25-100). Functional activity declined from baseline to 2 weeks postoperatively (mean change, -4.5; 95% confidence interval, -7.6 to -1.42) but improved above baseline at 6 months (mean change, +10.9; 95% confidence interval, 7.8-14.0). Internal reliability of the AAS was excellent (Cronbach α=0.93). Construct validity was demonstrated by a correlation of 0.59 to 0.60 between the AAS and SF-36 physical functioning scale (P<0.0001) and lower correlations between the AAS and other SF-36 scales. Patients who improved in physical functioning based on the SF-36 between 2 weeks and 6 months postoperatively showed an effect size of 0.86 for change in the AAS over the same period. The AAS is a valid, reliable, and responsive measure for evaluation of physical function in women after pelvic reconstructive surgery.

Comparison of early postoperative functional activity levels of patients undergoing unilateral and bilateral total knee arthroplasty

We compared early postoperative functional activities of patients undergoing unilateral and bilateral total knee arthroplasty (TKA). A total of 241 patients underwent bilateral (n=130; 12 men, 118 women; mean age 67.5+/-7.6 years) or unilateral (n=111; 7 men, 104 women; mean age 66.3+/-9.0 years) primary TKA for gonarthrosis. All the patients had indications for bilateral TKA and received the same rehabilitation program postoperatively. Functional activities and walking speed of the patients were assessed with the Iowa Level of Assistance Scale and Ambulation Velocity Scale, respectively, before surgery and on the second and sixth postoperative days and during discharge. In addition, knee range of motion and HSS (Hospital for Special Surgery) knee scores were measured. There were no significant differences between the two groups preoperatively (p>0.05). Compared to baseline, functional activity levels during discharge showed significant improvement in both groups (p<0.05), whereas improvement in walking speed was significant only in the unilateral TKA group (p<0.05). Comparison of postoperative functional activity levels favored unilateral over bilateral TKA in all instances (p<0.05). The two groups did not differ significantly with respect to postoperative walking speed, HSS knee scores, range of motion of the knee, and mean hospital stay (p>0.05). Complications included knee hematoma (n=2) and deep vein thrombosis (n=1) in the unilateral TKA group, and knee hematoma (n=1) in the bilateral TKA group. Postoperative physiotherapy programs should consider decreases in functional activities of patients undergoing bilateral TKA.