Walking Ability Score Research Articles

Cemented Vs Uncemented modular Bipolar hemiarthroplasty treatment for femoral neck fracture in elderly patients

ObjectivesFemoral neck fractures in the elderly are associated with high morbidity and mortality. The optimal treatment remains controversial regarding the use of cement in hemiarthroplasty when treating a displaced femoral neck fracture in elderly patients. The primary hypothesis of this study was that the use of cement would afford better visual analog pain and activity scores in elderly patients. MethodsThis study included 84 patients over 64 years of age with fracture neck femur treated with cemented and uncemented Modular Bipolar hemiarthroplasty. The patients (49 female, 35 male; mean age: 79.5 years; range: 64–95 years) included and were followed-up regularly till 02 years. Patients were divided equally into two groups: group A(n=42) was treated with cement; and group B(n=42) without cement. Both groups were compared in terms of preoperative features (demographics and associated diseases), pre- and postoperative complications, mortality rates, pain and activity levels, and hip scores. ResultsWe found no statically significant between-groups differences in terms of length of hospital stay, Harris Hip Score and complications. However in Uncemented group 03 patients developed loosening of implant at the end of 2year without any clinical of biochemical sign of infection. Walking ability and pain scores were better in the cemented group in the early follow-up period. ConclusionBased on our study we reached the conclusion that the use of cement during hip hemiarthroplasty in patients over 64 years of age who invariably has osteoporotic bone and wide femoral canal had no negative impact on mortality or morbidity. Hemodynamic changes during cement application are important, but it is noteworthy that patients fitted with cemented endoprostheses had increased levels of activity and lower pain levels.

Posterior locked lateral compression injury of the pelvis in geriatric patients: an infrequent and specific variant of the fragility fracture of pelvis.

Posterior locked lateral compression injury (PLLCI) of the pelvic ring is an infrequent variant of lateral compression injury, a condition described in only eight reported cases since 2000. Lateral compression injury usually results from high-energy trauma and is characterized by locking between the medially translated fractured ilium and the anterior border of the sacrum, regardless of whether the fractured ilium involves the sacroiliac joint. However, in our experience, lateral compression injury can also result from low-energy trauma as a manifestation of pelvic fragility fracture. The aim of the present study was to describe this rare form of PLLCI in a case series of geriatric patients. A retrospective analysis of consecutive patients with pelvic ring injuries who were admitted to our hospital from January 2008 to April 2015 identified seven geriatric patients (1 male and 6 females; median age 81years) with a form of PLLCI. All injuries were due to falls from a standing position onto the ground. All seven cases demonstrated characteristics of a locking fractured ilium over the anterior border of the sacrum on axial computed tomography images, but were not detected on plain radiographs. All underwent follow-up at 1year or later with improved mean visual analogue scale scores (range 0-3). Regarding Koval walking ability scores, patients who underwent pelvic brim plating with anterior external fixation were more likely to regain their pre-injury walking ability than patients who only underwent anterior external fixation or conservative treatment. Geriatric patients can experience PLCCIs of the pelvis due to low-energy trauma. These fractures have different characteristics from those associated with severe injuries due to high-energy trauma, and they comprise an infrequent form of Rommens fragility fracture of the pelvis (type IIIa). In these cases, appropriate surgical management that includes sacroiliac plating combined with anterior external fixation can yield good outcomes.

Bone cement dry prosthetic with internal fixation treat senile osteoporotic femoral fractures

Objective: To explore the treatment of senile osteoporotic femoral fractures after using internal fixation of bone cement dry prosthetic. Methods: Twelve patients aged from 74 to 94 years with mean age of (84.0±2.5) years with internal fixation of bone cement dry prosthetic surgery who were treated at Department of Orthopaedics in Nanjing Medical University Affiliated Wuxi Second Hospital between May 2013 and May 2015 were retrospectively analyzed. There were 8 male and 4 female, 10 cases of tumble and 2 cases of traffic injury. The fracture types with AO type included 1 case of A1 type, 5 cases of A2 type, 3 cases of A3 type, 1 case of B1 type, 2 cases of B2 type. The steel plate internal fixation with bone cement dry prosthetic method was chosen to treat senile severe femoral fracture. Postoperative observation of postoperative pain assessment, hip joint activity and walking ability were evaluated. Paired simple t test and Wilcoxon rank sum test were used to compare the differences of pain score and the ability to walk. Results: Twelve cases received an average of (16.0±3.6) months follow-up. The average hospitalization days are (9.0±1.4) days and average of intraoperative time was (68.0±10.6) minutes. Intraoperative blood loss compared to normal was (106.0±24.2) ml. Patients began walking load and activities in two weeks. The gait and joint activities gradually restored and there were no obvious deformity and no loose internal fixation. All of the patients didn't have fracture shift with breaking plates or screws deformation and have no bone cement reaction. The walking ability was (4.1±0.9) points, the hip joint activities were 98.5°±7.7° and pain scores were 1.22±0.58 by Holden grading standards. The differences of walking ability (Z=-3.126, P<0.05) and pain scores (t=23.047, P<0.001) between pre- and post-operative were statistically significant. One patient had contralateral hip pain, 2 patients had lateral thigh pain, 10 patients returned to preoperative level of activity. Postoperative function recovered satisfactorily, there were statistically differences. Conclusion: The treatment of severe osteoporosis fractures by internal fixation with bone cement dry prosthetic is a new and effective method, making patients less pain, improving joint function and walking ability.

Safety and Efficacy of Minimally Invasive Acetabular Stabilization for Periacetabular Metastatic Disease with Thermal Ablation and Augmented Screw Fixation

PurposeTo evaluate minimally invasive acetabular stabilization (MIAS) with thermal ablation and augmented screw fixation for impending or minimally displaced fractures of the acetabulum secondary to metastatic disease. Materials and MethodsBetween February 2011 and July 2014, 13 consecutive patients underwent thermal ablation, percutaneous screw fixation, and polymethyl methacrylate augmentation for impending or nondisplaced fractures of the acetabulum secondary to metastatic disease. Functional outcomes were evaluated before and after the procedure using the Musculoskeletal Tumor Society (MSTS) scoring system. Complications, hospital length of stay, and eligibility for chemotherapy and radiation therapy were assessed. ResultsAll procedures were technically successful with no major periprocedural complications. The mean total MSTS score improved from 23% ± 11 before MIAS to 51% ± 21 after MIAS (P < .05). The mean MSTS pain scores improved from 0% (all) to 32% ± 22 after MIAS (P < .05). The mean MSTS walking ability score improved from 22% ± 19 to 55% ± 26 after MIAS (P < .05). Two complications occurred; a patient had a minimally displaced fracture of the superior pubic ramus at the site of repair but remained ambulatory, and septic arthritis was diagnosed in another patient 12 months after repair. The average length of hospital stay was 2 days ± 3.6; six patients were discharged within 24 hours of the procedure. All patients were eligible for chemotherapy and radiation therapy immediately after the procedure. ConclusionsMIAS is feasible, improves pain and mobility, and offers a minimally invasive alternative to open surgical reconstruction.

Result of Internal Fixation for Stable Femoral Neck Fractures in Elderly Patients.

PurposeThis study was conducted to evaluate the results of internal fixation for stable femoral neck fractures occurring in patients over 65 years old.Materials and MethodsBetween 2008 and 2014, we evaluated 25 patients over 65 years old with Garden type 1 and 2 femoral neck fractures that were treated with internal fixation after a minimum follow up of 1 year. There were 5 males and 20 females and the average age was 72.3 years (range, 65-84 years) at the time of surgery. Fracture site union, horizontal shortening and complications were evaluated as radiographic parameters and change of walking ability (as measured using Koval walking ability score) was investigated as a clinical parameter.ResultsUnion of fracture site was achieved in 24 out of the 25 cases (96.0%). The average length of horizontal shortening was 6.5 mm (range, 0.2-19.7 mm). At final follow up, 3 cases experienced complications: nonunion (n=1), avascular necrosis (n=1), and subtrochanteric fracture after minor trauma (n=1). Walking ability decreased an average of 1 step at the final follow up.ConclusionInternal fixation for stable femoral neck fractures occurring in patients over 65 years showed satisfactory union rates. However, care should be taken with this technique given the possibility of decreased walking ability resulting from horizontal shortening.

Bipolar Hemarthroplasty Using Cementless Conical Stem for Treatment of Dorr Type B and C Femoral Neck Fracture.

PurposeThe current study aims to evaluate the clinical and the radiological outcome of bipolar hemiarthroplasty using cementless cone stem to treat osteoporotic femoral neck fracture and compare the results according to the proximal femur geometry.Materials and MethodsSeventy-five hips (75 patients) that underwent bipolar hemiarthroplasty with cementless cone stem between September 2006 and December 2011 were analyzed. The minimum follow-up period was 3 years. Thirty-three hips were classified as type B and 41 as type C. The clinical outcome was assessed using Harris hip score and the walking ability score. Radiographic evaluation was performed to evaluate the stability of the prosthesis.ResultsAt the most recent follow up, the mean Harris hip score was 86 (range, 70-92) and 65% recovered to preoperative ambulatory status. In the radiographic exam, stable stem fixation was achieved in all cases. For the complications, eight hips developed deep vein thrombosis while three hips showed heterotopic ossification. Dislocation and delayed deep infection occurred in one hip resepectively. There were no significance differences in Harris hip score and walking ability score when the type B group was compare with the type C.ConclusionBipolar hemiarthroplasty with cementless cone stem showed an excellent early outcome both clinically and radiographically regardless of the shape of the proximal femur. We believe this prosthesis can provide early stability to the Dorr type B and C femur and is an effective treatment for treating osteoporotic femoral neck fracture.

Effect of excision of peripheral sympathetic nerve network in common carotid artery in children with cerebral palsy and its effect on their cognitive function

Objective To explore the clinical effect of excision of peripheral sympathetic nerve network in common carotid artery on children with cerebral palsy (CP)and the effect on their cognitive function. Methods A retrospective study method was admitted to preschool children with CP in 69 cases in Center of Brain Disease, the Third Hospital Affiliated to Xinxiang Medical University from July 2008 to August 2014, the common carotid artery sympathetic with the surrounding network stripping off resection treatment of 43 cases (surgery group), without the use of surgery in the treatment of children with 26 cases (no operation group). The muscle tension improved, movement to improve the ability of 2 groups before and after treatment 6 months were detected and compared.Developmental quotient (DQ), intelligence quotient (IQ), bilateral middle cerebral artery (MCA) hemodynamic index difference were determined between 2 groups before and after treatment 6 months. Results After treatment 6 months, the muscle tension score and walking ability score of the surgery group were significantly better than those of no operation group [(2.2±1.1) scores vs (4.5±0.6)scores, (3.5±0.7) scores vs (2.7±0.8) scores, all P<0.05], and significantly improved compared with before treatment[(4.8±0.6)scores, (2.2±0.9)scores, all P<0.05]. After treatment 6 months, the IQ score, fine motor, social adaptation, personal social, language score and MCA mean velocity (MV), peak velocity (PV), resistance index (RI), pulsatility index (PI) determination value of the surgery group were significantly higher than those of no operation group and before treatment (all P<0.05). Conclusions Excision of peripheral sympathetic nerve network on common carotid artery has a good clinical effect in the treatment of CP, and can significantly improve the cognitive function of children with CP. Key words: Excision of peripheral sympathetic nerve network in common carotid artery; Cerebral palsy; Clinical effect; Cognitive function

Functional independence measure in patients with intermittent claudication

Of this study were to evaluate the functional independence of patients with intermittent claudication and to verify its association with sociodemographic and clinical variables, walking ability and physical activity level. This was a descriptive, exploratory, cross-sectional study with a quantitative approach. Fifty participants (66.4 years; 68% male) were recruited from Claudication Unit of a tertiary hospital. Functional Independence Measure were used to evaluate functional incapacity; the Baltimore Activity Scale, to estimate the physical activity level and the Walking Impairement Questionnaire, the walking ability. Participants had complete functional independence (124.8 + 2.0), low levels of physical activity (4.2 + 2.0), and impairment of walking ability; the worst performance was found in walking velocity domain (21.2 + 16.4). The functional independence score was associated with physical activity (r=0,402) and walking ability scores (distance, r=0,485; speed, r=0,463; stairs, r=0,337). In conclusion, the level of functionality is associated with functional capacity in these patients.

Is cemented bipolar hemiarthroplasty a safe treatment for femoral neck fracture in elderly patients?

ObjectivesControversy exists regarding the use of cement in hemiarthroplasty when treating a displaced femoral neck fracture in elderly patients. The primary hypothesis of this study was that the use of cement would afford better visual analog pain and activity scores in elderly patients.MethodsThis study included 133 patients over 65 years of age admitted to our clinics from 2006 to 2012 for the surgical treatment of a displaced femoral neck fracture. All patients were treated via hemiarthroplasty. The patients (66 males, 67 females; mean age: 78.16 years; range: 60–110 years) were followed-up regularly. All patients were divided into one of two groups: group A was treated with cement; and group B without. Both groups were compared in terms of preoperative features (demographics and associated diseases), pre- and postoperative complications, mortality rates, pain and activity levels, and hip scores. Hospitalization time, average surgical duration, and time from fracture to operation were also recorded. Mean follow-up duration was 30.9 (range: 5–51) months.ResultsWe found no significant between-groups differences in terms of length of hospital stay, Harris Hip Score, complications, or follow-up mortality rates. Walking ability and pain scores were better in the cemented group in the early follow-up period. Duration of surgery and perioperative mortality rates were somewhat lower in the cementless group, but the difference was not statistically significant.ConclusionThe use of cement during hip hemiarthroplasty in patients over 65 years of age had no negative impact on mortality or morbidity. Hemodynamic changes during cement application are important, but it is noteworthy that patients fitted with cemented endoprostheses had increased levels of activity and lower pain levels.

Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures.

PurposeTo introduce the concept of fracture reduction with positive medial cortical support and its clinical and radiological correlation in geriatric unstable pertrochanteric fractures.MethodsA retrospective analysis of 127 patients (32 men and 95 women, with mean age 78.7 years) with AO/OTA 31A2.2 and 2.3 hip fractures treated with cephalomedullary nail (PFNA-II or Gamma-3) between July 2010 and June 2013 was performed. They were classified into three groups according the grade of medial cortical support in postoperative fracture reduction (positive, neutral, and negative). The positive cortex support was defined that the medial cortex of the head–neck fragment displaced and located a little bit superomedially to the medial cortex of the shaft. If the neck cortex is located laterally to the shaft, it is negative with no cortical buttress, and if the two cortices contact smoothly, it is in neutral position. The demographic baseline, postoperative radiographic femoral neck–shaft angle and neck length, rehabilitation progress and functional recovery scores of each group were recorded and compared.ResultsThere were 89 cases (70 %) in positive, 26 in neutral, and 12 in negative support. No statistical differences were found between the three groups among patient age, sex ratio, prefracture score of activity of daily living, walking ability score, ASA physical risk score, number of medical comorbidities, osteoporosis Singh index, fracture reduction quality (Garden alignments), and the position of lag screw or helical blade in femoral head (TAD). In follow-up, patients in positive medial cortical support reduction group had the least loss in neck–shaft angle and neck length, and got ground-walking much earlier than negative reduction group, with good functional outcomes and less hip–thigh pain presence.ConclusionFracture reduction with nonanatomic positive medial cortical support allows limited sliding of the head–neck fragment to contact with the femur shaft and achieve secondary stability, providing a good mechanical environment for fracture healing.

Anesthesia and postoperative analgesia after percutaneous hallux valgus repair in ambulatory patients

BackgroundPostoperative pain is often severe after hallux valgus repair. Sciatic nerve blocks with long-acting local anesthetics have been recommended for surgical anesthesia and postoperative analgesia. However, a novel percutaneous approach may require less analgesia and make the procedure suitable for ambulatory care. We thus tested the hypothesis that mid-foot block and sciatic nerve blocks provide comparable surgical anesthesia and postoperative analgesia, but that patients ambulate independently sooner after mid-foot block. Study designProspective, randomized study. MethodsForty patients scheduled for ambulatory percutaneous hallux valgus repair were randomly assigned to two anesthesia and analgesia blocks: foot infiltration achieved by a mild foot block, or sciatic nerve block (30mL of 7.5% ropivacaine for each block). Surgery was performed without sedation or additional analgesia. Both groups were given oral paracetamol/codeine and ketoprofene systematically; tramadol was added if necessary. Walking ability and pain scores were assessed for 48 postoperative hours. ResultsDemographic and morphometric characteristics, and duration of surgery were similar in each group. Pain scores were comparable and low in each group at rest and while walking. The time to ambulation without assistance was significantly less for patients in the infiltration group (3.8±1.4hours) than patients in the sciatic group (19.2±9.5hours; P<0.0001). ConclusionAfter percutaneous hallux valgus repair, mid-foot block and sciatic nerve block provided comparable postoperative analgesia. However, mid-foot block seems preferable since the time to ambulation without assistance is much reduced.

Effectiveness of Lumbar Stabilization Exercises for Reducing Chronic Low Back Pain and Improving Quality-of-Life

[Purpose] Therapeutic exercise for chronic low back pain is one of the most important conservative treatments. Recently, lumbar stabilization exercise focused on deep trunk muscles has attracted considerable attention. This study investigated the effectiveness of lumbar stabilization exercises for treating CLBP. [Subjects] The subjects were 18 patients with CLBP. CLBP was defined as pain that persisted for more than 3 months. [Methods] The therapeutic exercises involved the abdominal drawing-in maneuver (hereafter referred to as drawing-in) and prone kneeling (hereafter referred to as hand-knee). The exercises were performed during a 3-month intervention period. Pain was evaluated using a Visual Analog Scale (hereafter referred to as VAS), while quality-of-life (hereafter referred to as QOL) was estimated using the Japanese Orthopaedic Association Back Pain Examination Questionnaire (hereafter referred to as JOABPEQ). Pain and QOL were assessed prior to the intervention (T0), and at one (T1), three (T3), and six months (T6) after the intervention. The Steel-Dwass test was used to investigate differences between values prior to and after performance of the therapeutic exercise regime. Significance was defined as p<0.05. [Results] The median low back pain value was significantly improved at T3 and T6 compared to T0. At T1, patients reported significant improvement in the lumbar functions score in comparison with T0. This change was still observed at T3 and T6. At T3, scores of all items had significantly increased. At T6, the changes in low back pain score and walking ability score were no longer significant, however their tendencies remained. [Conclusions] These results suggest that performance of lumbar stabilization exercises is an effective method for improving comfort and QOL of patients with CLBP.

Long proximal femoral nails versus short proximal femoral nails for the management of proximal femoral fractures: a retrospective study of 124 patients

The objective of this study is to compare the results of the Long Proximal Femoral Nail versus Short Proximal Femoral Nail in the management of proximal femoral fractures. This is a retrospective study of 124 patients with proximal femoral fracture in adult age group treated with Long Proximal Femoral Nail and Short Proximal Femoral Nail and followed up for minimum period of 6 months at last follow-up. Pain, walking ability, complications, revision surgery, and Harris Hip Score are seen in final follow-up. The conclusion of the study is that complications of Short Proximal Femoral Nail like thigh pain and femoral shaft fracture distal to the nail tips are mostly prevented by the use of Long Proximal Femoral Nail.

Functioning of patients with multifocal motor neuropathy

Patients with multifocal motor neuropathy (MMN) have slowly progressive, predominantly distal asymmetric limb weakness without sensory loss. While previous studies have investigated the impact of MMN on body functions and structures, relatively little is known about the impact of patients' weakness on daily functioning. The aim of the present cross-sectional study, involving 47 patients with MMN, was to evaluate determinants of patients' functioning. Most patients showed not only muscle weakness but also fatigue, limited dexterity, and limited walking ability. Regression models showed that age, hand aids, and muscle strength scores together explained 54% of the variance in dexterity scores, which in turn explained 8% of the variance in patients' scores for autonomy indoors. Age, the use of walking aids, and muscle strength scores together explained 58% of the variance in walking ability scores, which in turn explained 18% of the variance in patients' scores for autonomy indoors and 7% of the variance in patients' scores for autonomy outdoors. Assessment of determinants of patient functioning may make it possible to tailor interventions to address these aspects and thereby improve patients' functioning in daily life.

Evaluation of lower limb rehabilitation training effects in the patients with free fibula flap

To evaluate the effects of lower limb rehabilitation training of the patients with free fibula flap. Fifth-nine patients with free fibula flap were assigned to the intervention group (28 cases) and control group (31 cases). The patients in the intervention group underwent the lower limb rehabilitation training, but there was no training plan for the control group. The function of lower limbs were evaluated by Enneking questionnaire and physical examinations before operation, and 2 weeks and each month after operation till six months. The rate of ankle swelling in the intervention group (61%) was significantly lower than in the control group (84%) at the 3rd month after operation (P < 0.05). In the intervention group, the scores of ankle varus, valgus, muscle power of the great toe, the Enneking scores of self-feeling, walking ability and total scores were significantly higher than in the control group (P < 0.05). Postoperative rehabilitation training can promote the recovery of lower limb function for the patients with free fibula flap.

Comparative study of trochanteric fracture treated with the proximal femoral nail anti-rotation and the third generation of gamma nail

ObjectivesTo compare the results between the proximal femoral nail anti-rotation (PFNA) and the third generation gamma nail (TGN) in the treatment of trochanteric fractures. MethodsBetween April 2007 and May 2008, 107 consecutive patients older than 60 years with trochanteric femoral fractures were treated with PFNA or TGN. The preoperative variables including patient age, gender, fracture classification, walking ability and American Society of Anaesthesiologists (ASA) rating of operative risk were summarised. Operative time, fluoroscopy time, blood loss, and any intra-operative complication were recorded for each patient. Follow-up was undertaken at 3, 6, and 12 postoperative months, and yearly thereafter. Plain AP and lateral radiographs were obtained at all visits. All changes in the position of the implant, complications, or fixation failure were recorded. Hip range of motion, pain about the hip and the thigh, walking ability score and return to work status were used to compare the outcomes. ResultsThere were 55 patients in the PFNA group and 52 in the TGN group. The two groups were comparable with regard to the preoperative variables. The mean follow-up time was 17.5 months (range 12–24). Patients treated with a PFNA experienced a shorter fluoroscopy time and less blood loss. Sixteen patients were lost during the follow-up period. All the other fractures were radiographically healed at the last visit. There were no significant differences between the groups in terms of functional outcomes, hospital stay, intra-operative and postoperative complications. ConclusionsPFNA provides less blood loss and shorter fluoroscopy time but no advantages in functional outcome, intra-operative and postoperative complications when compared with TGN. These two implants were comparable in the treatment of trochanteric fractures.

Results After Total Hip Arthroplasty With a Large Head and Bipolar Arthroplasty in Patients With Displaced Femoral Neck Fractures

The authors studied the short-term outcomes of total hip arthroplasty (THA) performed using large diameter femoral heads or bipolar arthroplasty (BA) in physiologically active elderly patients with displaced intracapsular femoral neck fractures. The THA group included 14 males and 66 females with a mean age of 75.5 years, and the BA group included 16 males and 73 females with a mean age of 77.6 years. Surgical procedures were performed by one surgeon using a modified Hardinge approach. Mean operation times were significantly longer in the THA groups. Pain, mobility, and walking ability scores were significantly better in the THA group than in the BA group. Despite no range of motion limitation during the early postoperative period, no dislocation was encountered in either group. The present study suggests that for displaced femoral neck fractures, THA with a large diameter femoral head results in less pain and better function than BA.

Evaluation of low back pain using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire for lumbar spinal disease in a multicenter study: differences in scores based on age, sex, and type of disease

BackgroundThe Japanese Orthopaedic Association (JOA) has investigated the JOA Back Pain Evaluation Questionnaire (JOABPEQ) to evaluate several aspects of low back pain in patients. The score includes five categories (25 items) selected from the Roland Morris Disability Questionnaire and Short Form 36, and a visual analogue scale. Japanese physicians have recently used these scores to evaluate back pain; however, the efficacy has not been fully explored in large-scale studies. In the current study, we used the JOABPEQ to evaluate lumbar spinal disease in 555 patients (with lumbar disc herniation, lumbar spinal stenosis, and lumbar disc degeneration/spondylosis) in multiple spine centers and compared the results based on age, sex, and type of disease. MethodsA total of 555 patients who had low back or leg pain were selected in 22 hospitals in Chiba Prefecture. Spine surgeons diagnosed their disease type based on symptoms, physical examination, radiography images, and magnetic resonance imaging. In all, 486 patients were diagnosed with spinal stenosis (239 patients), disc degeneration/spondylosis (143 patients), or disc herniation (104 patients). The other 69 patients were diagnosed with spondylolysis (16 patients) or other diseases (53 patients). The pain score in all patients was evaluated using the JOABPEQ (from 0 to 100, with 0 indicating the worst pain). ResultsThe age of the patients was 56.1 ± 13.3 years (mean ± SD); the age of patients in the disc herniation and disc degeneration/spondylosis group was significantly lower than that in the spinal stenosis group. The average JOABPEQ scores in all patients were, for low back pain, 47.1; lumbar function, 53.6; walking ability, 54.8; social life function, 48.7; and mental health, 48.3. The low back pain score in men was significantly worse than that in women. In contrast, the mental health score in women was significantly higher than that in men. The low back pain score in patients <40 years old and the walking ability score in patients >65 years old were significantly lower than those scores in other patients. Based on the disease type, low back pain, lumbar function, social life function, and mental health scores for patients with disc herniation were significantly worse than for those with spinal stenosis. ConclusionJOABPEQ scores were evaluated for several lumbar diseases. The average of five categories of JOABPEQ scores in all patients was similarly distributed. However, the average scores in the five categories were significantly different depending on age, sex, and type of disease. Compared with prior mass data (baseline data on the observational cohort of the Spine Patient Outcomes Research Trial in the United States), many data were similar based on the type of disease in the current study. Furthermore, the JOABPEQ is easy to use compared with the SF-36. Hence, we concluded that the JOABPEQ could be used worldwide as a tool for evaluating low back pain.

The Effect of Postoperative Range of Motion on Functional Activities After Posterior Cruciate-Retaining Total Knee Arthroplasty

Range of motion is recognized as an important indicator of the success of a total knee replacement; however, an optimal range of motion has yet to be defined. This study was designed to determine the optimal range of motion for knee function after total knee arthroplasty with a posterior cruciate-retaining prosthesis. We retrospectively reviewed 5556 primary total knee arthroplasties performed with posterior cruciate-retaining prostheses between 1983 and 2003. The relationship between postoperative range of motion and pain, walking ability, stair-climbing ability, and knee function scores was examined at three to five years postoperatively. The relationship between a postoperative flexion contracture or hyperextension and knee function was also examined. Patients with 128 degrees to 132 degrees of motion obtained the highest scores for pain, walking, and knee function and the highest Knee Society scores. The outcomes became substantially compromised with motion of <118 degrees . Patients with 133 degrees to 150 degrees of motion had the highest scores for stair-climbing. A postoperative flexion contracture and hyperextension were associated with lower scores for pain, walking, stair-climbing, and knee function. The best functional results following total knee arthroplasty are achieved with 128 degrees to 132 degrees of motion. A postoperative flexion contracture and hyperextension of >or=10 degrees are associated with a poorer outcome except that stair-climbing is improved with more motion.

Genetic variation in pure lines and crosses of large-bodied turkey lines. 3. Growth-related measurements on live birds

An experimental line (F) selected over 34 generations for increased 16-wk BW was reciprocally crossed with a primary breeding sire line (C) from a large international turkey breeder to study the inheritance of growth-related traits measured on live birds. All genetic groups were grown intermingled in confinement with sexes reared in different houses. The traits measured included BW at 8, 16, and 20 wk of age and shank length, shank width, shank depth, breast width, and walking ability scores at 16 wk of age. Walking ability was rated from 1 to 5 with 1 representing birds with no leg defects and no difficulty walking and 5 indicating birds with extreme lateral deviations of the legs and great difficulty walking. Ratings of 2, 3, and 4 represented intermediate values. The F line had a different growth pattern than the C line with the F line being larger than the C line at 8 wk of age, but the reverse was true at 16 and 20 wk of age. The difference in BW between the C and F lines increased from 16 to 20 wk of age. The C line had wider breasts than the F line at 16 wk of age. The F line had longer shanks than the C line. Shank width was larger in the C line than the F line for females but not males. No line difference in shank depth was observed. Walking ability scores at 16 wk of age were lower (better) in the C line than in the F line for males but not females. Significant heterosis in BW of the crosses of the F and C lines was observed at all ages in males (range = 3.3 to 5.6%) and only at 8 wk of age in females (3.6%). These results were similar to an earlier study in which the F line was crossed with a primary-breeding sire line from 2 other international turkey breeders. No significant heterosis in the crosses of the C and F line was observed for breast width and shank measurements. Heterosis was significant for walking ability scores of females (-3.0%) but not males. Reciprocal effects, a measure of sex linkage and maternal influences, were noted only for shank length and the direction of the difference was not the same in the 2 sexes.