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Sample records for knees comparative study

  1. A comparative evaluation of the Adaptive knee and Catech knee joints: a preliminary study.

    PubMed

    Jepson, F; Datta, D; Harris, I; Heller, B; Howitt, J; McLean, J

    2008-03-01

    The Adaptive knee joint is a microprocessor-controlled prosthetic knee that incorporates both pneumatic and hydraulic control in one electronic unit. Pneumatic control is said to provide control during swing phase and the hydraulic control during the stance phase of the gait. This hybrid controller is triggered by a computer contained within the knee that responds to input from force, time and angle sensors. The microprocessor then selects an appropriate speed and stability setting. The Catech knee joint is a conventional hydraulic knee joint. The aim of this study was to compare the Adaptive and Catech knee joints in established trans-femoral amputees. The patients meeting the inclusion criteria were all established trans-femoral amputees using the Catech knee joint. The study was carried out by performing gait analysis, assessing energy requirements using the Physiological Cost Index (PCI) and using questionnaires. There was no significant benefit gained from the use of the Adaptive knee over the Catech knee joint in our small study group.

  2. Effect of adductor canal block on medial compartment knee pain in patients with knee osteoarthritis: Retrospective comparative study.

    PubMed

    Lee, Doo-Hyung; Lee, Michael Y; Kwack, Kyu-Sung; Yoon, Seung-Hyun

    2017-03-01

    Knee osteoarthritis (KOA) is a common disease in middle-aged and elderly people. Pain is the chief complaint of symptomatic KOA and a leading cause of chronic disability, which is most often found in medial knees. The aim of this study is to evaluate the efficacy of pain relief and functional improvement in KOA patients treated with ultrasound-guided adductor canal block (ACB).This is a 3-month retrospective case-controlled comparative study. Two hundred patients with anteromedial knee pain owing to KOA that was unresponsive to 3-month long conservative treatments. Ninety-two patients received ACB with 9 mL of 1% of lidocaine and 1 mL of 10 mg triamcinolone acetonide (ACB group), and 108 continued conservative treatments (control group). The main outcome measure was visual analog scale (VAS) of the average knee pain level for the past one week. Secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the timed up and go test, numbers of analgesic ingestion per day, and opioid consumption per day.During the 3-month follow-up, 86 patients in ACB group and 92 in control group were analyzed. There was no significant difference, with the exception of the duration of symptoms, between the 2 groups in age, sex, body mass index, and Kellgren-Lawrence grade. Repeated-measures analysis of variance and post hoc tests showed improvement of VAS (at month 1), WOMAC (at month 1), and opioid consumption per day (at month 1 and 2) in ACB group. No adverse events were reported.To our knowledge, this is the first study to assess the efficacy of ACB for patients with KOA. ACB is an effective and safe treatment and can be an option for patients who are either unresponsive or unable to take analgesics.

  3. A longitudinal comparative study of falls in persons with knee arthroplasty and persons with or at high risk for knee osteoarthritis.

    PubMed

    L Riddle, Daniel; J Golladay, Gregory

    2016-11-01

    we determined the yearly prevalence of single and multiple falls in persons with or at risk of knee osteoarthritis (OA) and persons undergoing knee arthroplasty over an 8-year period. We also compared annual fall rates among persons with and without knee arthroplasty to determine if fall rates are associated with knee arthroplasty. we studied 4,200 persons from the Osteoarthritis Imitative (OAI), a National Institutes of Health funded prospective study of persons 45-79 years and conducted from 2004 to 2012. All either had knee OA or were at risk of developing knee OA but did not have knee arthroplasty. The surgical group comprised 413 persons who underwent knee arthroplasty. Key fall risk factors were assessed at yearly study visits. Graphical depictions illustrated single and multiple fall trajectories. Multinomial regression adjusted for potential confounders compared fall rates for those with and without knee arthroplasty. fall rate trajectories for the two samples were generally flat and fall rates were similar. For the arthroplasty sample, fall rates did not increase in the immediate perioperative period relative to earlier and later periods. No differences in fall rates were found among the arthroplasty and non-arthroplasty samples after adjustment for potential confounding (P > 0.05). fall rates were generally stable and similar over an 8-year period among persons with and without knee arthroplasty. Clinicians should not assume that persons undergoing knee arthroplasty are at greater risk for falls either before or after surgery as compared to persons with or at risk for knee OA. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Knee joint position sense of roller hockey players: a comparative study.

    PubMed

    Venâncio, João; Lopes, Diogo; Lourenço, Joaquim; Ribeiro, Fernando

    2016-06-01

    This study aimed to compare knee joint position sense of roller hockey players with an age-matched group of non-athletes. Forty-three male participants voluntarily participated in this cross-sectional study: 21 roller hockey players (mean age: 23.2 ± 4.2 years old, mean weight: 81.8 ± 9.8 kg, mean height: 180.5 ± 4.1 cm) and 22 age-matched non-athletes (mean age: 23.7 ± 3.9 years old, mean weight: 85.0 ± 6.2 kg, mean height: 181.5 ± 5.0 cm). Knee joint position sense of the dominant limb was evaluated using a technique of open-kinetic chain and active knee positioning. Joint position sense was reported using absolute, relative and variable angular errors. The main results indicated that the group of roller hockey players showed significantly lower absolute (2.4 ± 1.2º vs. 6.5 ± 3.2º, p ≤ 0.001) and relative (1.7 ± 2.1º vs. 5.8 ± 4.4º, p ≤ 0.001) angular errors in comparison with the non-athletes group. In conclusion, the results from this present study suggest that proprioceptive acuity, assessed by measuring joint position sense, is increased in roller hockey players. The enhanced proprioception of the roller hockey players could contribute to injury prevention and improved performance during sporting activities.

  5. Cumulative loads increase at the knee joint with slow-speed running compared to faster running: a biomechanical study.

    PubMed

    Petersen, Jesper; Sørensen, Henrik; Nielsen, Rasmus Østergaard

    2015-04-01

    Biomechanical cross-sectional study. To investigate the hypothesis that the cumulative load at the knee during running increases as running speed decreases. The knee joint load per stride decreases as running speed decreases. However, by decreasing running speed, the number of strides per given distance is increased. Running a given distance at a slower speed may increase the cumulative load at the knee joint compared with running the same distance at a higher speed, hence increasing the risk of running-related injuries in the knee. Kinematic and ground reaction force data were collected from 16 recreational runners, during steady-state running with a rearfoot strike pattern at 3 different speeds (mean ± SD): 8.02 ± 0.17 km/h, 11.79 ± 0.21 km/h, and 15.78 ± 0.22 km/h. The cumulative load (cumulative impulse) over a 1000-m distance was calculated at the knee joint on the basis of a standard 3-D inverse-dynamics approach. Based on a 1000-m running distance, the cumulative load at the knee was significantly higher at a slow running speed than at a high running speed (relative difference, 80%). The mean load per stride at the knee increased significantly across all biomechanical parameters, except impulse, following an increase in running speed. Slow-speed running decreases knee joint loads per stride and increases the cumulative load at the knee joint for a given running distance compared to faster running. The primary reason for the increase in cumulative load at slower speeds is an increase in number of strides needed to cover the same distance.

  6. COMPARATIVE STUDY OF SPINAL AND LOCAL ANESTHESIA WITH PROPOFOL INFUSION FOR KNEE ARTHROSCOPY

    PubMed Central

    da Silva, Robson Rocha; Matos, Marcos Almeida; Madureira, Gleise; dos Santos, Indiara Gouveia

    2015-01-01

    Spinal anesthesia for knee arthroscopy is a well-documented and safe procedure. However, some complications and higher costs have been reported. Also, many orthopaedic surgeons are reluctant to use local anesthesia for fear of having to convert to general anesthesia due to inadequate pain control. The purpose of this study is to compare local with spinal anesthesia in two groups of patients submitted to knee arthroscopy. Sixty-five patients were divided in two groups; based on the anesthesia method used, and submitted to the same surgical routine and postoperative analgesia protocol. They were evaluated for analgesia, level of postoperative pain, and level of satisfaction with the type of anesthetic. The two groups did not present any significant differences in relation to perioperative analgesia and pain on the first postoperative day, neither was there any difference in relation to emotional state. However, there was a significant difference in terms of acceptance of the procedure; 100% said they would accept the procedure again in the local anesthesia group, compared with 60.5% in the spinal anesthesia group; also, 100% in the local anesthesia group said they felt encouraged by the type of anesthesia, compared with 67.7% in the spinal anesthesia group. We can conclude that local anesthesia is similar to spinal anesthesia in almost all the aspects investigated, except in terms of acceptance and patients’ level of satisfaction with the procedure. Local anesthesia can be a good alternative to spinal anesthesia, especially in outpatient departments, or when patients have restrictions to traditional models of anesthesia. PMID:27027089

  7. Randomized Study of Noninferiority Comparing Prosthetic and Autologous Vein Above-Knee Femoropopliteal Bypasses.

    PubMed

    Midy, Dominique; Papon, Xavier; Patra, Philippe; Hassen Kodja, Réda; Feugier, Patrick; Plissonnier, Didier; Reix, Thierry; Chene, Geneviève; Berard, Xavier

    2016-02-01

    The main aim of this study was to compare the 5 years rates of secondary patency of above-knee femoropopliteal revascularizations with autologous veins or prosthetic grafts. The secondary objectives were to compare the rates of primary patency, limb salvage, morbidity, and mortality between the 2 groups. This was a single-blind randomized study of noninferiority (ratio 1:1), carried out in 11 centers of vascular surgery with 2 parallel groups between July 2002 and November 2005. Follow-up finished in May 2011. The monitoring protocol included a clinical examination and an ultrasound control at 1 month, 3 and 6 months, then annually. One hundred patients were included and randomized in the study, 52 in the prosthetic group and 48 in the autologous vein group. Four patients randomized in the vein group received a prosthetic graft. No patient was excluded from the analysis. In the in intent-to-treat analysis, the 5 years secondary patency was 84.6% in the prosthetic group (IC 95%, 71.9-93.1) and 70.8% in the autologous vein group (IC 95%: 55.9-83.1), and the difference in secondary patency between the prosthetic and the autologous vein groups was 13.8% (IC 95%, -4.4 to 32.0). In the under treatment analysis, the 5 years secondary patency was 96.2% among patients receiving a prosthesis (IC 95%, 80.4-99.9) and 90.5% among patients receiving an autologous vein (IC 95%, 66.9-98.9), and the difference in the rate of patency between prostheses and veins was 5.7% (IC 95%, -13.2 to 24.6). Although there was no significant difference at 5 years, the death rate and the rate of amputation were higher in the prosthetic group. Although it is impossible to conclude definitely to the noninferiority of prosthetic bypass compared with venous bypass because of the insufficient number of inclusions, this randomized study nevertheless showed at 5 years the satisfactory results obtained with prostheses compared with autologous vein for above-knee femoropopliteal bypasses. Copyright

  8. Serial casting versus stretching technique to treat knee flexion contracture in children with spina bifida: a comparative study.

    PubMed

    Al-Oraibi, S; Tariah, Hashem Abu; Alanazi, Abdullah

    2013-01-01

    Severe knee contractures that develop soon after muscle imbalance may not improve with stretching exercises and splinting. An alternative treatment is serial casting, which has been used to promote increased range of motion. The purpose of this study was to compare the effectiveness of using serial casting and passive stretching approaches to treat knee flexion contracture in children with spina bifida. In a pre/post randomized controlled study, ten participants were included in the serial casting group, while eight participants were included in the passive stretching intervention group. The degree of knee extension was measured at baseline, immediately after intervention, and at a one-year follow-up using a standard goniometer. Both groups showed significant improvements in the degree of flexion contracture at the post-treatment evaluation and the follow-up evaluation. The serial casting group showed significant improvements in knee flexion contracture at the post-treatment evaluation, t (9)=13.4, p < 0.001, and the one-year follow-up evaluation, t (9) = 7.46, p < 0.001. The passive stretching group also showed significant improvements in knee flexion contracture at the post-treatment evaluation, t (7) =2.6, p < 0.05, and the one-year follow-up evaluation, t (7) = 3.6, p < 0.05. However, statistically significant improvements in the serial casting group compared with passive stretching group in relation to the degree of flexion contracture were found at the immediate post-treatment evaluation, F(1, 15)=246, p=0.0001, and the one-year follow-up evaluation, F (1, 15)=51.5, p=0.0001. The outcomes of this study provide the first evidence that serial casting may be a useful intervention in treating knee flexion contracture in children with spina bifida. However, further investigations into serial casting, as well as investigations into the use of serial casting with other interventions, are warranted.

  9. Isokinetic knee muscle strength of individuals with mental retardation, a comparative study.

    PubMed

    Angelopoulou, N; Tsimaras, V; Christoulas, K; Kokaridas, D; Mandroukas, K

    1999-06-01

    The purpose of this study was to assess differences in isokinetic muscle torque in the knee among mentally retarded individuals with Down syndrome, mentally retarded individuals without Down syndrome, and sedentary subjects without mental retardation (ns of 7, 8, and 12, respectively). Subjects performed strength tests to knee extension and flexion on a Cybex II isokinetic dynamometer. The measure was peak torque at angular velocities of 60, 120, and 300 degrees/sec. For the Mentally Retarded subjects with and without Down syndrome, the test was performed on two separate days 24 hr. apart. For Sedentary subjects, testing was performed on one day. Their scores indicated significantly higher values of torque than the two other groups. Also, subjects with Down syndrome had inferior muscle torque of lower extremities than peers in the Mentally Retarded Group.

  10. Comparative study of tilidine-naloxone and pentazocine in knee and hip osteoarthritis.

    PubMed

    Van Cauwenberge, H; Ruhwiedel, M; Albert, A; Franchimont, P

    1992-01-01

    Fifty patients, twenty-five suffering from severe knee osteoarthritis and twenty-five from acute hip osteoarthritis, received pentazocine or a new preparation of tilidine-naloxone for a period of 2 weeks, in a double-blind study. The two drugs were found to have the same efficacy and tolerance in both diseases with a minor but not statistically significant superiority for tilidine-naloxone. Similar quantities of drugs were taken over the study period, while patients were allowed to take as many as 8 capsules per day to relieve pain. There were quite equivalent side-effects and no marked changes in laboratory tests.

  11. Team physician #7. A comparative study of functional bracing in the anterior cruciate deficient knee.

    PubMed

    Rink, P C; Scott, R A; Lupo, R L; Guest, S J

    1989-06-01

    We evaluated the ability of three functional knee braces, (CTI, OTI, and TS7) to control anterolateral rotary instability of the knee. Fourteen subjects, none of elite athletic status, with arthroscopically proven anterior cruciate deficient knees were selected. The subjects evaluated each brace after one-month periods, and then underwent testing with physical examinations, KT-1000 arthrometry, and timed running events. All braces reduced subjective symptoms of knee instability. Different subjects preferred different braces. KT-1000 testing showed a reduction in anterior tibial displacement for all braces; however, this reduction did not increase as forces increased. A timed figure-of-eight running event did not show any functional advantage of bracing. Five subluxation events occurred in four subjects while braced. Functional braces appear to have a role in the anterior cruciate deficient knee, but only in conjunction with activity modification.

  12. A comparative analysis of the clinical utility of the Staffelstein-score and the hospital for special surgery knee score (HSS) in monitoring physiotherapy of total knee replacement patients--preliminary study.

    PubMed

    Słupik, Anna; Białoszewski, Dariusz

    2009-01-01

    Treatment efficacy assessment lies at the basis of Evidence Based Medicine (EMB). Specialised scores have recently been developed to present the patient's functional status to the doctor or physiotherapist in a rapid and accessible manner and to allow treatment efficacy monitoring. The present study aimed to assess the sensitivity and utility of the Staffelstein Score and HSS Knee Score in monitoring the progress of rehabilitation following total knee replacement surgery. The study involved 24 patients who underwent knee replacement surgery due to degenerative disease of the knee joint. The HSS Knee Score and the Staffelstein Score (ST-score) were compared. Patients were assessed twice: prior to and after the completion of post-hospital rehabilitation. The mean results on admission and at discharge were: 50.1 (HSS) and 70.8 (ST), and 74.4 (HSS) and 99.5 (ST), respectively. There was a marked improvement according to both scales (p<0.005) both as regards overall scores as well as individual parameters. 1. The HSS and ST scores exhibit high sensitivity in assessing pain, difficulty performing activities of daily living and in assessing the results of physical examination of the knee joint in patients who following knee replacement surgery. 2. The sensitivity of the HSS Knee Score may be adversely affected by assessment of instability and varus or valgus deformity of the joint due to a low variability of those parameters over time. 3. The assessment of the ability to perform activities of daily living using the two scores makes it possible to tailor exercises and adjust the rehabilitation programme to solve patients' specific problems.

  13. A double-blind randomized comparative study of triamcinolone hexacetonide and dexamethasone intra-articular injection for the treatment of knee joint arthritis in rheumatoid arthritis.

    PubMed

    Hajialilo, Mehrzad; Ghorbanihaghjo, Amir; Valaee, Leyla; Kolahi, Sousan; Rashtchizadeh, Naderh; Amirkhiz, Maryam Bannazadeh; Malekmahdavi, Ida; Khabbazi, Alireza

    2016-12-01

    Intra-articular glucocorticoid (GC) injection has been used for more than half a century in the treatment of refractory synovitis in patients with rheumatoid arthritis (RA). There are limited data about the efficacy of intra-articular injection of various preparations of GCs on inflamed joint. The aim of this study was to compare the efficacy and side effects of intra-articular injection of dexamethasone (DEX) and triamcinolone hexacetonide (TH) in the treatment of knee joint arthritis in RA. In a double-blind randomized clinical trial, 70 patients with RA and knee joint arthritis were recruited to the study. Swelled knee joints were injected with 40 mg TH or 8 mg DEX randomly. The primary outcome measures were reduction of knee joint swelling and pain 1 and 3 weeks after joint injection. The secondary outcome measures were relapse of knee arthritis at 2, 4, and 6 months after injection and side effects of intra-articular injection. Difference in the knee circumferences between DEX and TH groups at weeks 1 and 3 was not significant. The average times of pain reduction after injection were 3.4 ± 2.3 and 2.3 ± 1.8 days in TH and DEX, respectively. There were no differences of knee pain between the two groups. Relapse of knee arthritis was occurred in two (6.7 %) and three (9.4 %) patients in the DEX and TH groups, respectively. Intra-articular injection of DEX like TH causes rapid and long-term reduction of knee pain and swelling in patients with RA and is safe.

  14. Intra-articular treatment of knee osteoarthritis. A comparative study between hyaluronic acid and 6-methyl prednisolone acetate.

    PubMed

    Leardini, G; Mattara, L; Franceschini, M; Perbellini, A

    1991-01-01

    The efficacy and tolerability of 20 mg of hyaluronic acid were compared in an open, randomized trial with that of 40 mg of 6-methylprednisolone acetate, administering them both by an intra-articular route once a week for 3 weeks to patients suffering from inflammatory knee osteoarthritis. The results of the study showed that for up to one week after the end of treatment hyaluronic acid's analgesic activity was comparable to that of the steroid, while at the end of the follow-up (45 days after the end of treatment) all the pain monitoring parameters presented significant differences in favour of the HA-treated group. Both treatments were well tolerated, since no local or systemic adverse reactions were observed.

  15. Three-dimensional component alignment and functional outcome in computer-navigated total knee arthroplasty: a prospective, randomized study comparing two navigation systems.

    PubMed

    Harvie, Paul; Sloan, Karen; Beaver, Richard J

    2011-12-01

    Computer navigation in total knee arthroplasty produces better component alignment than conventional techniques. Different navigation systems exist. We undertook a prospective, randomized study comparing 2 navigations systems (Stryker Full Navigation and Stryker Articular Surface Mounted [ASM] navigation systems). Three-dimensional component alignment (Perth computed tomographic knee protocol) and function at 1 year (Knee Society Scores) were assessed. Forty patients participated (20 fully navigated and 20 ASM-navigated total knee arthroplasties). Cohorts were well matched according to sex, age, and body mass index. No statistically significant difference was seen in any parameter of 3-dimensional component alignment or function between cohorts. Operative time for the ASM cohort was significantly less than the fully navigated cohort (P = .001). Both systems performed equally well, and therefore, surgeon preference should determine which system is used.

  16. Comparative study on isokinetic capacity of knee and ankle joints by functional injury

    PubMed Central

    Jeon, Kyoungkyu; Seo, Byoung-Do; Lee, Sang-Ho

    2016-01-01

    [Purpose] To collect basic data for exercise programs designed to enhance functional knee and ankle joint stability based on isokinetic measurement and muscle strength evaluations in normal and impaired functional states. [Subjects and Methods] Twenty-four subjects were randomly assigned to the athlete group and the control group (n = 12 each). Data were collected of isokinetic knee extensor and flexor strength at 60°/sec, 180°/sec, and 240°/sec and ankle plantar and dorsiflexor strength at 30°/sec and 120°/sec. [Results] Significant intergroup differences were observed in peak torque of the right extensors at 60°/sec, 180°/sec, and 240°/sec and the right flexors at 240°/sec. Significant differences were observed in peak torque/body weight in the right extensors at 60°/sec, 180°/sec, and 240°/sec and in the right flexors at 180°/sec and 240°/sec. Significant peak torque differences were noted in the left ankle joint dorsiflexor at 30°/sec and 120°/sec, right plantar flexor at 120°/sec, left plantar flexor at 30°/sec, left dorsiflexor at 30°/sec and 120°/sec, and right dorsiflexor at 120°/sec. [Conclusion] Isokinetic evaluation stimulates muscle contraction at motion-dependent speeds and may contribute to the development of intervention programs to improve knee and ankle joint function and correct lower-extremity instability. PMID:26957768

  17. Comparative study on isokinetic capacity of knee and ankle joints by functional injury.

    PubMed

    Jeon, Kyoungkyu; Seo, Byoung-Do; Lee, Sang-Ho

    2016-01-01

    [Purpose] To collect basic data for exercise programs designed to enhance functional knee and ankle joint stability based on isokinetic measurement and muscle strength evaluations in normal and impaired functional states. [Subjects and Methods] Twenty-four subjects were randomly assigned to the athlete group and the control group (n = 12 each). Data were collected of isokinetic knee extensor and flexor strength at 60°/sec, 180°/sec, and 240°/sec and ankle plantar and dorsiflexor strength at 30°/sec and 120°/sec. [Results] Significant intergroup differences were observed in peak torque of the right extensors at 60°/sec, 180°/sec, and 240°/sec and the right flexors at 240°/sec. Significant differences were observed in peak torque/body weight in the right extensors at 60°/sec, 180°/sec, and 240°/sec and in the right flexors at 180°/sec and 240°/sec. Significant peak torque differences were noted in the left ankle joint dorsiflexor at 30°/sec and 120°/sec, right plantar flexor at 120°/sec, left plantar flexor at 30°/sec, left dorsiflexor at 30°/sec and 120°/sec, and right dorsiflexor at 120°/sec. [Conclusion] Isokinetic evaluation stimulates muscle contraction at motion-dependent speeds and may contribute to the development of intervention programs to improve knee and ankle joint function and correct lower-extremity instability.

  18. Comparative study of excimer and erbium:YAG lasers for ablation of structural components of the knee

    NASA Astrophysics Data System (ADS)

    Vari, Sandor G.; Shi, Wei-Qiang; van der Veen, Maurits J.; Fishbein, Michael C.; Miller, J. M.; Papaioannou, Thanassis; Grundfest, Warren S.

    1991-05-01

    This study was designed to compare the efficiency and thermal effect of a 135 ns pulsed-stretched XeCl excimer laser (308 nm) and a free-running Erbium:YAG laser (2940 nm) with 200 microsecond(s) pulse duration for ablation of knee joint structures (hyaline and fibrous cartilage, tendon and bone). The radiant exposure used for tissue ablation ranged from 2 to 15 J/cm2 for the XeCl excimer and from 33 to 120 J/cm2 for Er:YAG. The excimer and Er:YAG lasers were operated at 4 and 5 Hz respectively. The ablative laser energy was delivered to tissue through fibers. Ablation rates of soft tissues (hyaline and fibrous cartilage, tendon) varied from 8.5 to 203 micrometers /pulse for excimer and from 8.2 to 273 micrometers /pulse for Er:YAG lasers. Ablation rates of soft tissues are linearly dependent on the radiant exposure. Within the range of parameters tested all the tissues except the bone could be rapidly ablated by both lasers. Bone ablation was much less efficient, requiring 15 J/cm2 and 110 J/cm2 radiant exposure for excimer and Er:YAG lasers to ablate 9.5 and 8.2 micrometers tissue per pulse. However, excimer laser ablation produced less thermal damage in the tissues studied compared to Er:YAG at the same laser parameters. The authors conclude that both lasers are capable of efficient knee joint tissue ablation. XeCl excimer laser requires an order of magnitude less energy than Er:YAG laser for comparable tissue ablation.

  19. Frontal alignment in total knee arthroplasty. Comparative study between radiographic measurement and surgical navigation.

    PubMed

    Hernandez-Vaquero, D; Noriega-Fernandez, A; Suarez-Vazquez, A; Roncero-Gonzalez, S; Sierra-Pereira, A A; Gil-Martinez, L; Fernandez-Carreira, J M

    To establish the concordance between angulation of the femoro-tibial mechanical axis measured with x-rays and surgical navigation in both the pre and postoperative period after a total knee arthroplasty (TKA) was implanted. Pre and postoperative measurements were analyzed in 88 TKA of the same model and all performed with the same surgical navigation system. The mechanical frontal angle (MFA) and femoro-tibial anatomic angle were measured before and after the TKA. The angulation was digitally measured with a teleradiography. In the navigation, the femoro-tibial angle at rest, forced varus and valgus were registered and the average of these three measurements was calculated. The mean preoperative MFA measured on the radiograph was 4.55°. The mean of the same angle measured on the postoperative radiograph was 1.72°, (p=0.05). The mean of the MFA measured with navigation before TKA was 3.12° and after the implant with navigation was 0.53 (P=.013). The concordance coefficient between the MFA in teleradiography and in navigation was 0.869 (P<.001) preoperatively and 0.709 postoperatively (P=.017). We found a strong concordance between radiographic and surgical navigation measurements of the MFA. This may imply that teleradiography is not necessary when using surgical navigation in TKA. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Outcome of Unicompartmental Knee Arthroplasty: A Systematic Review of Comparative Studies between Fixed and Mobile Bearings Focusing on Complications

    PubMed Central

    Ko, Young-Bong; Gujarathi, Manan Ramesh

    2015-01-01

    The purpose of this systematic review is to collate results of studies comparing fixed and mobile bearing unicompartmental knee arthroplasty (UKA), focusing on complications and timing for reoperations. Out of 723 results derived from PubMed, EMBASE and Cochrane database search engines on bearings in arthroplasty, 10 studies comparing clinical results of fixed bearings to mobile bearings in UKA were found eligible for analysis. The reoperation rate was calculated using a novel method such as reoperations per hundred component years, and the causes of specific reoperations were investigated. The overall reoperation rate per hundred component years was similar between the mobile bearings (1.392) and fixed bearings (1.377); however, mobile bearings were more susceptible to reoperations in cases with aseptic loosening (0.393>0.255), progression of arthritis (0.428>0.357) and implant dislocation (0.286>0). The overall incidence of complications is similar for fixed and mobile bearing designs in UKA. The discussion on complications presented above may assist surgeons in their choice of bearing design. PMID:26389066

  1. Effect of aqua-cycling on pain and physical functioning compared with usual care in patients with knee osteoarthritis: study protocol of a randomised controlled trial.

    PubMed

    Rewald, Stefanie; Mesters, Ilse; Lenssen, A F; Emans, Pieter J; Wijnen, Wiel; de Bie, Rob A

    2016-02-18

    Over the last decade aquatic exercise has become more and more popular. One of the latest trends is aqua-cycling, where participants sit on a water-resistant stationary bike and, while immersed chest deep in the water, combine continuous cycling with upper body exercises that utilise water resistance. Since stationary cycling and aquatic exercises are frequently recommended to patients with knee osteoarthritis, combining both would seem an obvious step, and an aqua-cycling exercise programme for patients with knee osteoarthritis has indeed been developed. This study protocol gives a detailed description of the exercise programme and the methodology of a study to compare this programme with treatment involving usual care only. The study is a single-blind, parallel-group, randomised controlled trial of Maastricht University Medical Centre+, the Netherlands. knee pain of four to seven on a 10-point pain rating scale; a Kellgren/Lawrence score between one to three; ability to cycle; good mental health; sufficient language skills; indication for physical therapy in conjunction with impairments due to OA. any contra-indication for aquatic exercise; planned total knee replacement; corticosteroid injection <3 months and/or hyaluronic acid injection <6 months; severe joint complaints (other than knee joint); symptomatic and radiological apparent hip OA; inflammatory joint diseases; inability to safely enter and exit the pool; fear of water. Participants will receive two 45-min moderate intense aqua-cycling sessions weekly over a period of 12 weeks in addition to usual care or usual care only. Usual care consists of an individual intervention plan comprising lifestyle recommendations, medication routine and referral to a physical therapist. Participants will be assessed at baseline, and at 12 and 24 weeks after baseline. The primary outcome is self-reported knee pain and physical functioning. Secondary outcomes are lower limb muscle strength, functional capacity, self

  2. High-Velocity Quadriceps Exercises Compared to Slow-Velocity Quadriceps Exercises Following Total Knee Arthroplasty: A Randomized Clinical Study.

    PubMed

    Doerfler, Deborah; Gurney, Burke; Mermier, Christine; Rauh, Mitchell; Black, Liza; Andrews, Ron

    2016-01-01

    Despite improvement in pain and perceived function in older adults following total knee arthroplasty (TKA), objective outcome measures of muscular impairment and ambulatory function demonstrate significant deficits. Evidence suggests that quadriceps power may play a greater role in ambulatory function than measures of strength alone following TKA. The purpose of this study was to compare the effect of high-velocity (HV) quadriceps exercises with that of slow-velocity (SV) quadriceps exercises on functional outcomes and quadriceps power following TKA. This study was a randomized clinical study conducted in an outpatient physical therapy clinic. Twenty-one participants who were 4 to 6 weeks post unilateral TKA were randomly assigned to an HV or SV group. Participants performed an evidence-based standardized progressive resistance exercise program in addition to HV quadriceps exercises or SV quadriceps exercises. Participants attended 2 sessions per week for 8 weeks. Before and after the 8-week exercise intervention, participants completed a functional questionnaire, health survey, functional testing, and underwent quadriceps strength and power testing. Both groups demonstrated improvements in ambulatory outcome measures, strength, speed, and power. The HV group demonstrated significantly greater improvements in distance walked and quadriceps strength than the SV group. These data should be considered preliminary because of a small sample size. HV quadriceps exercises may be an effective rehabilitation strategy in conjunction with a standardized progressive resistance exercise program beginning 4 to 6 weeks after TKA.

  3. A Prospective Study of Pain Reduction and Knee Dysfunction Comparing Femoral Skeletal Traction and Splinting in Adult Trauma Patients

    PubMed Central

    Bumpass, David B.; Ricci, William M.; McAndrew, Christopher M.; Gardner, Michael J.

    2014-01-01

    Objectives 1) Determine if distal femoral traction pins result in knee dysfunction in femoral or pelvic fracture patients, and 2) to determine if skeletal traction relieves pain more effectively than splinting for femoral shaft fractures. Design Prospective cohort trial. Setting Level I urban trauma center. Patients/Participants 120 adult patients with femoral shaft, acetabular, and unstable pelvic fractures. Intervention Patients with femoral shaft fractures were placed into distal femoral skeletal traction or a long-leg splint, based on an attending-specific protocol. Pelvic or acetabular fracture patients with instability or intra-articular bone fragments were placed into skeletal traction. Main Outcome Measurements An initial Lysholm knee survey was administered to assess pre-injury knee pain and function; the survey was repeated at 3- and 6-month follow-up visits. Also, a 10-point visual analog scale (VAS) was used to document pain immediately before, during, and immediately after fracture immobilization with traction or splinting. Results Thirty-five patients (29%) were immobilized with a long-leg splint, and 85 (71%) were immobilized with a distal femoral traction pin. Eighty-four patients (70%) completed 6-month follow-up. Lysholm scores decreased by a mean 9.3 points from pre-injury baseline to 6 months post-injury in the entire cohort (p<0.01); no significant differences were found between the splint and traction pin groups. During application of the immobilization, VAS pain scores were significantly lower in traction patients as compared to splinted patients (mean 1.9 points less, p<0.01). Traction pins caused no infections, neurovascular injuries, or iatrogenic fractures. Conclusions Distal femoral skeletal traction does not result in detectable knee dysfunction at six months post-insertion, and results in less pain during and after immobilization than long-leg splinting. PMID:25050750

  4. [Cemented total knee replacement: comparative study between the use or not of tourniquet on the inmediate results].

    PubMed

    Gutiérrez-García, J A; Sierra-Pérez, M; García-Velazco, R A; Salas-Mora, C A; Cisneros-González, V M

    2016-01-01

    Comparison of immediate postoperative results of patients undergoing cemented total knee arthroplasty with and without ischemia. Observational, cross-sectional, retrospective, analytical, single-center study that included 180 patients who underwent total knee arthroplasty from 2011 to 2014: 120 without ischemia, 60 with ischemia. Mean age was 70 years with SD ± 7. Criteria to assess the immediate postoperative results include intraoperative bleeding, hemoglobin differential and pain. Exclusion criteria comprised patients being treated at a pain clinic, those on anticoagulants, with a history of bleeding disorders, psychiatric conditions, kidney failure or those intolerant to NSAIDs. In total knee arthroplasty without ischemia there is better pain control (p = 0.026). The hemoglobin differential and intraoperative bleeding were less with ischemia (p = 0.008). 32.8% of patients required blood transfusion, but no statistically significant relationship was established with the use or non-use of ischemia (p = 0.301). The most commonly reported pain was within a VAS of 0-3; 62.2% of cases reported mild pain. Mean hemoglobin differential was 3.7 with SD ± 1.3 with a range from 0 to 7.4. Patients in whom no ischemia was used during the surgical procedure experienced less pain. There was less bleeding and hemoglobin differential with the use of ischemia. However, this did not result in a statistically significant difference in the need for blood transfusion. The use of ischemia with caution and according to the surgeons preference is recommended.

  5. The effect on knee-joint load of instruction in analgesic use compared with neuromuscular exercise in patients with knee osteoarthritis: study protocol for a randomized, single-blind, controlled trial (the EXERPHARMA trial).

    PubMed

    Clausen, Brian; Holsgaard-Larsen, Anders; Søndergaard, Jens; Christensen, Robin; Andriacchi, Thomas P; Roos, Ewa M

    2014-11-15

    Knee osteoarthritis (OA) is a mechanically driven disease, and it is suggested that medial tibiofemoral knee-joint load increases with pharmacologic pain relief, indicating that pharmacologic pain relief may be positively associated with disease progression. Treatment modalities that can both relieve pain and reduce knee-joint load would be preferable. The knee-joint load is influenced by functional alignment of the trunk, pelvis, and lower-limb segments with respect to the knee, as well as the ground-reaction force generated during movement. Neuromuscular exercise can influence knee load and decrease knee pain. It includes exercises to improve balance, muscle activation, functional alignment, and functional knee stability. The primary objective of this randomized controlled trial (RCT) is to investigate the efficacy of a NEuroMuscular EXercise (NEMEX) therapy program, compared with optimized analgesics and antiinflammatory drug use, on the measures of knee-joint load in people with mild to moderate medial tibiofemoral knee osteoarthritis. One hundred men and women with mild to moderate medial knee osteoarthritis will be recruited from general medical practices and randomly allocated (1:1) to one of two 8-week treatments, either (a) NEMEX therapy twice a week or (b) information on the recommended use of analgesics and antiinflammatory drugs (acetaminophen and oral NSAIDs) via a pamphlet and video materials. The primary outcome is change in knee load during walking (the Knee Index, a composite score of the first external peak total reaction moment on the knee joint from all three planes based on 3D movement analysis) after 8 weeks of intervention. Secondary outcomes include changes in the external peak knee-adduction moment and impulse and functional performance measures, in addition to changes in self-reported pain, function, health status, and quality of life. These findings will help determine whether 8 weeks of neuromuscular exercise is superior to optimized use

  6. Superior results with eccentric compared to concentric quadriceps training in patients with jumper's knee: a prospective randomised study

    PubMed Central

    Jonsson, P; Alfredson, H

    2005-01-01

    Background: A recent study reported promising clinical results using eccentric quadriceps training on a decline board to treat jumper's knee (patellar tendinosis). Methods: In this prospective study, athletes (mean age 25 years) with jumper's knee were randomised to treatment with either painful eccentric or painful concentric quadriceps training on a decline board. Fifteen exercises were repeated three times, twice daily, 7 days/week, for 12 weeks. All patients ceased sporting activities for the first 6 weeks. Age, height, weight, and duration of symptoms were similar between groups. Visual analogue scales (VAS; patient estimation of pain during exercise) and Victorian Institute of Sport Assessment (VISA) scores, before and after treatment, and patient satisfaction, were used for evaluation. Results: In the eccentric group, for 9/10 tendons patients were satisfied with treatment, VAS decreased from 73 to 23 (p<0.005), and VISA score increased from 41 to 83 (p<0.005). In the concentric group, for 9/9 tendons patients were not satisfied, and there were no significant differences in VAS (from 74 to 68, p<0.34) and VISA score (from 41 to 37, p<0.34). At follow up (mean 32.6 months), patients in the eccentric group were still satisfied and sports active, but all patients in the concentric group had been treated surgically or by sclerosing injections. Conclusions: In conclusion, eccentric, but not concentric, quadriceps training on a decline board, seems to reduce pain in jumper's knee. The study aimed to include 20 patients in each group, but was stopped at the half time control because of poor results achieved in the concentric group. PMID:16244196

  7. Clinical efficacy of intra-articular injections in knee osteoarthritis: a prospective randomized study comparing hyaluronic acid and betamethasone

    PubMed Central

    Trueba Davalillo, Cesáreo Ángel; Trueba Vasavilbaso, Cesáreo; Navarrete Álvarez, José Mario; Coronel Granado, Pilar; García Jiménez, Ozcar Alejandro; Gimeno del Sol, Mercedes; Gil Orbezo, Félix

    2015-01-01

    Background Osteoarthritis (OA) is the most common joint disease and leading cause of disability. Intra-articular (IA) administration of hyaluronic acid (HA) or corticosteroids (CS) have been previously studied, though using insufficient number of patients or short follow-up periods. Objective We evaluate HA and CS in patients with knee OA in terms of clinical efficacy over 12 months. Methods We used a prospective, randomized study with parallel groups. Randomized patients received IA injections of HA or betamethasone (BM). The primary outcomes were improvement in pain using Visual Analog Scale and function in the Western Ontario and McMaster University Osteoarthritis Index (Likert scale). Follow-up visits were scheduled at 3 months, 6 months, 9 months, and 12 months. Results A total of 200 patients were included. Pain was significantly reduced in both groups at the first follow-ups. At 12 months, the mean pain reduction in the HA group was 33.6% (95% CI: 31.1–36.1) compared to 8.2% (95% CI: 5.2–11.1) in BM (P<0.0001). Function improvement was higher in HA through every visit, and mean improvement at 12 months was 47.5% (95% CI: 45.6–49.3) in HA patients vs 13.2% (95% CI: 11.4–14.9) in the BM group (P<0.0001). All patients from both groups achieved the Minimal Clinically Important Improvement (MCII) for both pain and function up to 6 months. At 9 months and 12 months, the MCII figures were higher in HA group with ≥80% compared to ≤10% in BM group (P<0.0001). Adverse reactions were rare and related to the administration procedure. Conclusion Both treatments effectively controlled OA symptoms. BM showed higher short-term effectiveness, while HA showed better long-term effectiveness, maintaining clinical efficacy in a large number of patients 1 year after administration. PMID:27790040

  8. Distinctions of introarticular force distribution between genesis-II posterior stabilized and cruciate retaining total knee arthroplasty: An intraoperative comparative study of 45 patients.

    PubMed

    Tang, Hao; Chen, Hong; Yang, Dejin; Jiang, Yi; Zhang, Chunyu; Zhou, Yixin

    2017-02-01

    Although both the posterior stabilized and cruciate retaining total knee arthroplasty have been proven to effectively relieve pain and restore basic functions, the joint gap width during flexion was reported to be different due to the presence or absence of posterior cruciate ligament, which may lead to different intra-articular force distribution. In this study, we investigated the distinctions in intra-articular force distribution between the two types of TKA designs in patients with varus knee osteoarthritis. Forty five patients (50 knees) with varus knee osteoarthritis were prospectively included, with each 25 knees receiving cruciate retaining and posterior stabilized total knee arthroplasty, respectively. With an intra-articular force measurement system, the intra-articular force distribution with knee flexion at 0°, 30°, 45°, 60°, 90°, and 120° were recorded in all patients. The total force was similar for posterior stabilized and cruciate retaining knees at all flexion degrees. However, force in the medial compartment accounted for 59.8%-84.0% of total force in posterior stabilized knees, while 27.4%-65.7% in cruciate retaining knees. In cruciate retaining knees, no significant difference was found between forces in the two compartments at 30° flexion (P=0.444), but force was significantly concentrated in the lateral side during 45°-120° flexion (P=0.000-0.028). Although the entire intra-articular forces were similar between CR and PS knees at different flexion angles, medial part had higher force than lateral part when PS knee was used. The posterior cruciate ligament do a role in soft balance, and make the force more evenly distributed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study

    PubMed Central

    Kuptniratsaikul, Vilai; Dajpratham, Piyapat; Taechaarpornkul, Wirat; Buntragulpoontawee, Montana; Lukkanapichonchut, Pranee; Chootip, Chirawan; Saengsuwan, Jittima; Tantayakom, Kesthamrong; Laongpech, Supphalak

    2014-01-01

    Objective To determine the efficacy and safety of Curcuma domestica extracts in pain reduction and functional improvement. Methods 367 primary knee osteoarthritis patients with a pain score of 5 or higher were randomized to receive ibuprofen 1,200 mg/day or C. domestica extracts 1,500 mg/day for 4 weeks. The main outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, WOMAC pain, WOMAC stiffness, and WOMAC function scores. Adverse events (AEs) were also recorded. Results 185 and 182 patients were randomly assigned into C. domestica extracts and ibuprofen groups, respectively. The baseline characteristics were no different between groups. The mean of all WOMAC scores at weeks 0, 2, and 4 showed significant improvement when compared with the baseline in both groups. After using the noninferiority test, the mean difference (95% confidence interval) of WOMAC total, WOMAC pain, and WOMAC function scores at week 4 adjusted by values at week 0 of C. domestica extracts were noninferior to those for the ibuprofen group (P=0.010, P=0.018, and P=0.010, respectively), except for the WOMAC stiffness subscale, which showed a trend toward significance (P=0.060). The number of patients who developed AEs was no different between groups. However, the number of events of abdominal pain/discomfort was significantly higher in the ibuprofen group than that in the C. domestica extracts group (P=0.046). Most subjects (96%–97%) were satisfied with the treatment, and two-thirds rated themselves as improved in a global assessment. Conclusion C. domestica extracts are as effective as ibuprofen for the treatment of knee osteoarthritis. The side effect profile was similar but with fewer gastrointestinal AE reports in the C. domestica extracts group. PMID:24672232

  10. Comparative effectiveness of a complex Ayurvedic treatment and conventional standard care in osteoarthritis of the knee--study protocol for a randomized controlled trial.

    PubMed

    Witt, Claudia M; Michalsen, Andreas; Roll, Stephanie; Morandi, Antonio; Gupta, Shivnarain; Rosenberg, Mark; Kronpass, Ludwig; Stapelfeldt, Elmar; Hissar, Syed; Müller, Matthias; Kessler, Christian

    2013-05-23

    Traditional Indian Ayurvedic medicine uses complex treatment approaches, including manual therapies, lifestyle and nutritional advice, dietary supplements, medication, yoga, and purification techniques. Ayurvedic strategies are often used to treat osteoarthritis (OA) of the knee; however, no systematic data are available on their effectiveness in comparison with standard care. The aim of this study is to evaluate the effectiveness of complex Ayurvedic treatment in comparison with conventional methods of treating OA symptoms in patients with knee osteoarthritis. In a prospective, multicenter, randomized controlled trial, 150 patients between 40 and 70 years, diagnosed with osteoarthritis of the knee, following American College of Rheumatology criteria and an average pain intensity of ≥40 mm on a 100 mm visual analog scale in the affected knee at baseline will be randomized into two groups. In the Ayurveda group, treatment will include tailored combinations of manual treatments, massages, dietary and lifestyle advice, consideration of selected foods, nutritional supplements, yoga posture advice, and knee massage. Patients in the conventional group will receive self-care advice, pain medication, weight-loss advice (if overweight), and physiotherapy following current international guidelines. Both groups will receive 15 treatment sessions over 12 weeks. Outcomes will be evaluated after 6 and 12 weeks and 6 and 12 months. The primary endpoint is a change in the score on the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) after 12 weeks. Secondary outcome measurements will use WOMAC subscales, a pain disability index, a visual analog scale for pain and sleep quality, a pain experience scale, a quality-of-life index, a profile of mood states, and Likert scales for patient satisfaction, patient diaries, and safety. Using an adapted PRECIS scale, the trial was identified as lying mainly in the middle of the efficacy-effectiveness continuum. This trial

  11. Comparative effectiveness of a complex Ayurvedic treatment and conventional standard care in osteoarthritis of the kneestudy protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Traditional Indian Ayurvedic medicine uses complex treatment approaches, including manual therapies, lifestyle and nutritional advice, dietary supplements, medication, yoga, and purification techniques. Ayurvedic strategies are often used to treat osteoarthritis (OA) of the knee; however, no systematic data are available on their effectiveness in comparison with standard care. The aim of this study is to evaluate the effectiveness of complex Ayurvedic treatment in comparison with conventional methods of treating OA symptoms in patients with knee osteoarthritis. Methods and design In a prospective, multicenter, randomized controlled trial, 150 patients between 40 and 70 years, diagnosed with osteoarthritis of the knee, following American College of Rheumatology criteria and an average pain intensity of ≥40 mm on a 100 mm visual analog scale in the affected knee at baseline will be randomized into two groups. In the Ayurveda group, treatment will include tailored combinations of manual treatments, massages, dietary and lifestyle advice, consideration of selected foods, nutritional supplements, yoga posture advice, and knee massage. Patients in the conventional group will receive self-care advice, pain medication, weight-loss advice (if overweight), and physiotherapy following current international guidelines. Both groups will receive 15 treatment sessions over 12 weeks. Outcomes will be evaluated after 6 and 12 weeks and 6 and 12 months. The primary endpoint is a change in the score on the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) after 12 weeks. Secondary outcome measurements will use WOMAC subscales, a pain disability index, a visual analog scale for pain and sleep quality, a pain experience scale, a quality-of-life index, a profile of mood states, and Likert scales for patient satisfaction, patient diaries, and safety. Using an adapted PRECIS scale, the trial was identified as lying mainly in the middle of the efficacy

  12. The Comparative Role of the Anterior Cruciate Ligament and Anterolateral Structures in Controlling Passive Internal Rotation of the Knee: A Biomechanical Study.

    PubMed

    Ruiz, Nicolas; Filippi, German J; Gagnière, Bertrand; Bowen, Mark; Robert, Henri E

    2016-06-01

    To determine the respective functions of the anterior cruciate ligament (ACL) and the anterolateral structures (ALSs) in controlling the tibia's passive internal rotation (IR) with respect to the femur, under uniaxial rotation. To test the function of the ACL and the anterolateral ligament (ALL) in IR, we designed a sequential transection study of the ACL and the anterolateral structures (including the ALL) in 24 cadaveric knees divided in 2 groups. Two sequences were conducted successively: group 1 (12 knees) in which the ACL was sectioned first followed by the ALS, and group 2 (12 knees) with reversed transections. Each knee, in neutral rotation position and at flexion angle of 30°, was subjected to a 5 Nm torsion torque of IR. IR was measured using a rotatory laximeter, the Rotam with a gyroscope's measurement accuracy of 0.1°. Laxities were compared using paired t test within each group and using t test between groups. Fisher exact test was used to compare proportions. In group 1, IR increased from 22.1° ± 10.6° to 25.7° ± 10.9° after ACL transection then to 28.1° ± 10.5° after we sectioned the ALS. In group 2, IR increased from 22.5° ± 8.9° to 25.2° ± 8.4° after sectioning the ALS, then to 29.1° ± 8.8° after we sectioned the ACL. Total postsectioning increase in IR was 6.4° ± 2° in group 1, and 6.55° ± 0.9° in group 2. The IR increase after each stage of transection and final IR were statistically significant (P < .001). In a pure rotational cadaveric test model, the ACL and the ALS contribute to resistance to passive IR of the knee. In some specific clinical cases, peripheral lesions may be considered, and injuries to these structures may need to be addressed to improve results controlling postoperative IR. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  13. Can balneotherapy modify microRNA expression levels in osteoarthritis? A comparative study in patients with knee osteoarthritis

    NASA Astrophysics Data System (ADS)

    Giannitti, C.; De Palma, A.; Pascarelli, N. A.; Cheleschi, S.; Giordano, N.; Galeazzi, M.; Fioravanti, Antonella

    2017-08-01

    The aim of this study was to evaluate the whole-blood levels of miR-155, miR-223, miR-181a, miR-146a, and miR-let-7e in patients with bilateral knee osteoarthritis (OA) after a cycle of mud-bath therapy (MBT). Thirty-two patients with knee OA defined by the ACR criteria were included. Twenty-one patients (MBT group) were daily treated with a combination of local mud-packs at 42 °C and baths in mineral water, at 37 °C for 15 min, for 12 applications over a period of 2 weeks, in addition to standard therapy; 11 patients (control group) continued their conventional treatment alone. Global pain score evaluated by visual analog scale (VAS), WOMAC subscores, and microRNA expression were evaluated at baseline and after 2 weeks. Peripheral whole blood was collected into PAXgene™ Blood RNA tubes, stored at - 80 °C, and total RNA was extracted. The expression of miR-155, miR-223, miR-181a, miR-146a, and miR-let-7e was determined by qRT-PCR. After MBT, we observed a statistically significant improvement of clinical parameters and a significant decrease of miR-155, miR-181a, miR-146a (p < 0.001), and miR-223 (p < 0.01) expression levels. No clinical and biochemical modifications were detected in the control group. No significant variations of miR-let-7e were shown in both groups after 2 weeks. In conclusion, MBT can modify the expression of miR-155, miR-181a, miR-146a, and miR-223, which are upregulated in OA. It could be due to the heat stress and the hydrostatic pressure, since some miRNAs were found to be temperature- and mechano-responsive. Further studies are needed to better explain the mechanism of action of MBT and the role of miRNAs in OA.

  14. Comparative study of functional capacity and quality of life among obese and non-obese elderly people with knee osteoarthritis.

    PubMed

    Gomes-Neto, Mansueto; Araujo, Anderson Delano; Junqueira, Isabel Dayanne Almeida; Oliveira, Diego; Brasileiro, Alécio; Arcanjo, Fabio Luciano

    2016-01-01

    The association between osteoarthritis (OA) and obesity can lead to a reduced functional capacity, compromising the quality of life (QoL) of the elderly. To compare the functional capacity and QoL of obese and non-obese older adults with knee OA. The sample consisted of 35 subjects with OA divided into two groups, obese and non-obese subjects, according to their body mass index. To assess functional capacity, performance tests such as Timed Up and Go (TUG), gait speed test, and the six-minute walk test (6 MWT) were carried out. To assess QoL, WOMAC and SF-36 questionnaires were administered. We performed descriptive and inferential statistics using SPSS software version 20.0. Elderly patients with OA were divided into two groups (obese, n=16; non-obese, n=19). Socio-demographic characteristics were similar between groups (p>0.05). The obese group showed a worst performance in TUG, brisk walking speed and 6 MWT. A more severe pain was found in the following items: "performing heavy housework chores", "going down stairs", "bending to floor" and "getting up from bed" in the obese group (p<0.05). In addition, the obese group had more difficulty to perform tasks for the following items: "going down stairs", "rising from a chair", "standing" and "getting on/off toilet" (p<0.05). There was no statistically significant difference in the assessed domains of SF-36 between groups (p>0.05). OA associated with obesity caused a negative impact on functional capacity; however, quality of life scores were low, and no difference in obese and non-obese subjects was found. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

  15. Development and validation of self-reported line drawings for assessment of knee malalignment and foot rotation: a cross-sectional comparative study

    PubMed Central

    2010-01-01

    Background For large scale epidemiological studies clinical assessments and radiographs can be impractical and expensive to apply to more than just a sample of the population examined. The study objectives were to develop and validate two novel instruments for self-reported knee malalignment and foot rotation suitable for use in questionnaire studies of knee pain and osteoarthritis. Methods Two sets of line drawings were developed using similar methodology. Each instrument consisted of an explanatory question followed by a set of drawings showing straight alignment, then two each at 7.5° angulation and 15° angulation in the varus/valgus (knee) and inward/outward (foot) directions. Forty one participants undertaking a community study completed the instruments on two occasions. Participants were assessed once by a blinded expert clinical observer with demonstrated excellent reproducibility. Validity was assessed by sensitivity, specificity and likelihood ratio (LR) using the observer as the reference standard. Reliability was assessed using weighted kappa (κ). Knee malalignment was measured on 400 knee radiographs. General linear model was used to assess for the presence of a linear increase in knee alignment angle (measured medially) from self-reported severe varus to mild varus, straight, mild valgus and severe valgus deformity. Results Observer reproducibility (κ) was 0.89 and 0.81 for the knee malalignment and foot rotation instruments respectively. Self-reported participant reproducibility was also good for the knee (κ 0.73) and foot (κ 0.87) instruments. Validity was excellent for the knee malalignment instrument, with a sensitivity of 0.74 (95%CI 0.54, 0.93) and specificity of 0.97 (95%CI 0.94, 1.00). Similarly the foot rotation instrument was also found to have high sensitivity (0.92, 95%CI 0.83, 1.01) and specificity (0.96, 95%CI 0.93, 1.00). The knee alignment angle increased progressively from self reported severe varus to mild varus, straight, mild

  16. Low dose compared to variable dose Warfarin and to Fondaparinux as prophylaxis for thromboembolism after elective hip or knee replacement surgery; a randomized, prospective study.

    PubMed

    Bern, Murray M; Hazel, Diane; Deeran, Elizabeth; Richmond, John R; Ward, Daniel M; Spitz, Damon J; Mattingly, David A; Bono, James V; Berezin, Ronna H; Hou, Laura; Miley, Gerald B; Bierbaum, Benjamin E

    2015-01-01

    Deep vein thrombosis (DVT) and pulmonary emboli (PE), known together as venous thromboembolic (VTE) disease remain major complications following elective hip and knee surgery. This study compares three chemoprophylactic regimens for VTE following elective primary unilateral hip or knee replacement, one of which was designed to minimize risk of post-operative bleeding. Patients were randomized and stratified for hip vs. knee to receive A: variable dose warfarin (first dose on the night preceding surgery with subsequent target INR 2.0-2.5), B: 2.5 mg fondaparinux daily starting 6-18 h postoperatively, or C: fixed 1.0 mg dose warfarin daily starting 7 days preoperatively. All treatments continued until bilateral leg venous ultrasound day 28 ± 2 or earlier upon a VTE event. The study examined primary endpoints including leg DVT, PE or death due to VTE and secondary endpoints including effects on D-dimer, estimated blood loss (EBL) at surgery and hemorrhagic complications. Three hundred fifty-five patients were randomized. None was lost to follow-up. Taking 1.0 mg warfarin for seven days preoperatively did not prolong the prothrombin time (PT). Two patients in Arm C had asymptomatic distal DVT. One major bleed occurred in Arm B and one in Arm C (ischemic colitis). Elevated d-dimer did not predict delayed VTE for one year. Fixed low dose warfarin started preoperatively is equivalent to two other standards of care under study (95 % CI: -0.0428, 0.0067 for both) as VTE prophylaxis for the patients having elective major joint replacement surgery. ClinicalTrials.gov identifier # NCT00767559 FDA IND: 103,716.

  17. Extracorporeal Shock Wave Therapy Is Effective in the Treatment of Bone Marrow Edema of the Medial Compartment of the Knee: A Comparative Study.

    PubMed

    Sansone, Valerio; Romeo, Pietro; Lavanga, Vito

    2017-01-01

    To test the hypothesis that shock wave therapy can produce a statistically significant improvement in symptoms and imaging features of the knee bone marrow edema syndrome (BMES) within 6 months of treatment. Eighty-six consecutive patients suffering from BMES of the medial compartment of the knee were prescribed a course of high-energy extracorporeal shock wave therapy (ESWT) and clinically followed up at 3 and 6 months and finally from 14 to approximately 18 months after treatment. Thirty-one patients were unable to undergo ESWT but returned for the 6-month and final follow-up; these were referred to as the conservative (control) group, while the other 55 patients constituted the ESWT group. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Visual Analog Scale (VAS) score of each patient were calculated at every follow-up. The BME area was assessed using magnetic resonance imaging before treatment and at the 6-month follow-up. Statistically significant improvements were observed in clinical scores and in the BME area for both the ESWT and the control group (p < 0.05). The improvements in the ESWT group were statistically better in all parameters compared with the control group: the ESWT group had a reduction in the BME area of 86% versus 41% in the control group, the VAS pain score improved by 88% in the ESWT group versus 42% in the control group, and the WOMAC score improved by 65% in the ESWT group versus 22% in the control group. Clinical scores were significantly better for patients with medial tibial lesions in the ESWT group. In this study, ESWT reduced pain and the BME area in the knee, with significant clinical improvement noticed 3 months after treatment. © 2016 S. Karger AG, Basel.

  18. Management of severe valgus knee by total unconstrained arthroplasty: A comparative study with long-term follow-up.

    PubMed

    Paredes-Carnero, X; Fernández-Cortiñas, A B; Escobar, J; Galdo, J M; Babé, J G

    To evaluate the use of unconstrained implants in the correction of large valgus deformities using total knee arthroplasty (TKA). A total of 817 primary TKA operated between 1998 and 2006 were retrospectively assessed. 50 TKA were selected (group A) in 49 patients, with a minimum deformity of 15° of valgus, 41 cases were included. Another 50 ATR were selected (group B), with a maximum deformity of 15° of varus, finally including 44 cases in 42 patients. The same surgeon performed every operation. The minimum follow-up time was 10 years. The Knee Society Score (KS and FS), the Oxford Knee Score (OKS) and the Range of Mobility (ROM), both preoperative and postoperative at 1,.5 and 10 years, as well as radiographic evolution and complications were evaluated. Preoperative values of KS, FS and OKS were lower in group A (P<.0001, P<.01 and P<.05, respectively), but not ROM. Postoperatively, KS, FS, OKS and ROM were not different between the groups, neither year, nor 5, nor 10 years. There were also no radiological or complications between the two groups. The use of non-constricted implants in severe valgus was not inferior to the mild varus, implying, in addition, a saving in economic terms, with excellent postoperative results. Correction of severe valgus deformities can be performed with non-constrained primary implants, without obtaining worse results than those obtained in mild deformities. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Comparative responsiveness of outcome measures for total knee arthroplasty

    PubMed Central

    Giesinger, K.; Hamilton, D.F.; Jost, B.; Holzner, B.; Giesinger, J.M.

    2014-01-01

    Summary Objective The aim of this study was to compare the responsiveness of various patient-reported outcome measures (PROMs) and clinician-reported outcomes following total knee arthroplasty (TKA) over a 2-year period. Methods Data were collected in a prospective cohort study of primary TKA. Patients who had completed Forgotten Joint Score-12 (FJS-12), Western Ontario and McMaster Universities (WOMAC) osteoarthritis (OA) index, EQ-5D, Knee Society Score and range of movement (ROM) assessment were included. Five time points were assessed: pre-operative, 2 months, 6 months, 1 year and 2 years post-operative. Results Data from 98 TKAs were available for analysis. Largest effect sizes (ES) for change from pre-operative to 2-month follow-up were observed for the Knee Society Score (KSS) Knee score (1.70) and WOMAC Total (−1.50). For the period from 6 months to 1 year the largest ES for change were shown by the FJS-12 (0.99) and the KSS Function Score (0.88). The EQ-5D showed the strongest ceiling effect at 1-year follow-up with 84.4% of patients scoring the maximum score. ES for the time from 1- to 2-year follow-up were largest for the FJS-12 (0.50). All other outcome measures showed ES equal or below 0.30. Conclusion Outcome measures differ considerably in responsiveness, especially beyond one year post-operatively. Joint-specific outcome measures are more responsive than clinician-reported or generic health outcome tools. The FJS-12 was the most responsive of the tools assessed; suggesting that joint awareness may be a more discerning measure of patient outcome than traditional PROMs. PMID:24262431

  20. High Knee Valgus in Female Subjects Does Not Yield Higher Knee Translations During Drop Landings: A Biplane Fluoroscopic Study

    PubMed Central

    Torry, Michael R.; Shelburne, Kevin B.; Myers, Casey; Giphart, J. Erik; Pennington, W. Wesley; Krong, Jacob P.; Peterson, Daniel S.; Steadman, J. Richard; Woo, Savio L-Y.

    2012-01-01

    The goal of this study was to determine the effects of peak knee valgus angle and peak knee abductor moment on the anterior, medial, and lateral tibial translations (ATT, MTT, LTT) in the ‘at risk’ female knee during drop landing. Fifteen female subjects performed drop landings from 40 cm. 3D knee motion was simultaneously recorded using a high speed, biplane fluoroscopy system and a video-based motion analysis system. Valgus knee angles and knee abduction moments were stratified into low, intermediate and high groups and peak ATT, MTT and LTT were compared between these groups with ANOVA (α = .05). Significant differences were observed between stratified groups in peak knee valgus angle (p < .0001) and peak knee abduction moment (p < .0001). However, no corresponding differences in peak ATT, LTT and MTT between groups exhibiting low to high peak knee valgus angles (ATT: p = .80; LTT: p = .25; MTT: p = .72); or, in peak ATT (p = .61), LTT (p = .26) and MTT (p = .96) translations when stratified according to low to high knee abduction moments, were found. We conclude that the healthy female knee is tightly regulated with regard to translations even when motion analysis derived knee valgus angles and abduction moments are high. PMID:22968826

  1. High knee valgus in female subjects does not yield higher knee translations during drop landings: a biplane fluoroscopic study.

    PubMed

    Torry, Michael R; Shelburne, Kevin B; Myers, Casey; Giphart, J Erik; Pennington, W Wesley; Krong, Jacob P; Peterson, Daniel S; Steadman, J Richard; Woo, Savio L-Y

    2013-02-01

    The goal of this study was to determine the effects of peak knee valgus angle and peak knee abductor moment on the anterior, medial, and lateral tibial translations (ATT, MTT, LTT) in the "at risk" female knee during drop landing. Fifteen female subjects performed drop landings from 40 cm. Three-dimension knee motion was simultaneously recorded using a high speed, biplane fluoroscopy system, and a video-based motion analysis system. Valgus knee angles and knee abduction moments were stratified into low, intermediate, and high groups and peak ATT, MTT, and LTT were compared between these groups with ANOVA (α = 0.05). Significant differences were observed between stratified groups in peak knee valgus angle (p < 0.0001) and peak knee abduction moment (p < 0.0001). However, no corresponding differences in peak ATT, LTT, and MTT between groups exhibiting low to high-peak knee valgus angles (ATT: p = 0.80; LTT: p = 0.25; MTT: p = 0.72); or, in peak ATT (p = 0.61), LTT (p = 0.26) and MTT (p = 0.96) translations when stratified according to low to high knee abduction moments, were found. We conclude that the healthy female knee is tightly regulated with regard to translations even when motion analysis derived knee valgus angles and abduction moments are high.

  2. Predominance of synovial sensory nerve fibers in arthrofibrosis following total knee arthroplasty compared to osteoarthritis of the knee.

    PubMed

    Koeck, Franz Xaver; Schmitt, Miriam; Baier, Clemens; Stangl, Hubert; Beckmann, Johannes; Grifka, Joachim; Straub, Rainer H

    2016-02-17

    So far, there exists no golden standard for the treatment of arthrofibrosis (AF) following total knee arthroplasty (TKA). Although pain is a hallmark of AF, nociceptive nerve fibers have never been investigated in affected joint tissue. A total of 24 patients with osteoarthritis (OA) of the knee (n = 12) and post-TKA AF of the knee (n = 12) were included. Along evaluation of typical clinical signs and symptoms by using the Knee Society Clinical Rating System (KSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC index), the innervation of joint tissue was studied by semiquantitative immunofluorescence of nerve fibers. Patients with AF compared to OA had a lower KSS and lower KOOS. In all compartments (anterior, medial, and lateral recesses), the density of synovial sympathetic nerve fibers was significantly higher in OA compared to AF, which was also true for the density of sensory nerve fibers in the medial and lateral recesses. In synovial tissue of the anterior recess of patients with AF compared to OA, the density of nociceptive sensory nerve fibers was significantly higher relative to sympathetic nerve fibers. This was similarly observed in the neighboring infrapatellar fat pad of the knee. Similar as in many painful musculoskeletal diseases, this study indicates that patients with arthrofibrosis of the knee after TKA demonstrate a preponderance of profibrotic sensory nerve fibers over antifibrotic sympathetic nerve fibers. This could serve as a starting point for AF therapy with specific antifibrotic pain medication or regional anesthetic techniques.

  3. Function after through-knee compared with below-knee and above-knee amputation.

    PubMed

    Hagberg, E; Berlin, O K; Renström, P

    1992-12-01

    Fifty-nine amputees, 24 below-knee (BK), 17 through-knee (TK) and 18 above-knee (AK) who had prosthetic replacements, were evaluated using a questionnaire which provided a quantitative and qualitative assessment scale for the prosthetic function. The ability to apply or don the prosthesis was noted in 100% of the BK, 70% of the TK and 56% of the AK amputations (p < 0.001). Daily use of the prosthesis was recorded in 96% of the BK, 76% of the TK and 50% of the AK amputations (p < 0.001). A higher level of amputation resulted in a significantly lower degree of rehabilitation (p < 0.05). The qualitative evaluation shows that the higher the level of amputation, the lower the usefulness of the prosthesis. Four percent of the BK, 12% of the TK and 39% of the AK amputees had no use whatsoever of their prosthesis (p < 0.01). From a functional standpoint, TK amputation should always be considered as the primary alternative to AK amputation when a BK amputation is not feasible.

  4. Knee joint changes in patients with neglected developmental hip dysplasia: a prospective case-control study.

    PubMed

    Li, Qiwei; Kadhim, Muayad; Zhang, Lijun; Cheng, Xiangjun; Zhao, Qun; Li, Lianyong

    2014-12-01

    Few reports are available describing knee changes in neglected developmental dysplasia of the hip (DDH). The purpose of this study was to assess the radiographic morphology of knee joints in adults with neglected DDH. Thirty-seven patients (35 females and two males) with neglected DDH were prospectively recruited with an average age of 32.6 years. Twenty-three patients had unilateral and 14 patients had bilateral neglected DDH. Thirty-seven healthy individuals were recruited to form a matched control group. Three groups of knee joints were examined: affected knees (on the same side of the neglected DDH), unaffected knees (contralateral to the neglected DDH in patients with unilateral involvement), and control knees. A series of radiographic parameters of the knee joint were measured in the coronal and sagittal plane, and they were compared between patients and normal controls. In the coronal plane, the affected knees had increased valgus angulation related to increased height of the medial femoral condyle, decreased height of the lateral femoral condyle and decreased lateral distal femoral angle compared to control knees. In the sagittal plane, both distal femoral and proximal tibial joints of the affected knees developed a decrease in posterior angles. Additionally, the unaffected knees also developed radiographic changes compared to control knees. Patients with neglected DDH may develop changes in both knee joints. These changes should be considered during surgery to the hip, femur and knee to prevent potential complications. Level 2. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Safety and efficacy of multimodal thromboprophylaxis following total knee arthroplasty: a comparative study of preferential aspirin vs. routine coumadin chemoprophylaxis.

    PubMed

    Gesell, Mark W; González Della Valle, Alejandro; Bartolomé García, Sergio; Memtsoudis, Stavros G; Ma, Yan; Haas, Steven B; Salvati, Eduardo A

    2013-04-01

    Multimodal thromboprophylaxis encompasses preoperative VTE risk stratification, regional anesthesia, mechanical prophylaxis, and early mobilization. We determined if aspirin can be safely used for adjuvant chemoprophylaxis in patients who have a low thromboembolic risk. 1016 consecutive patients undergoing TKA received multimodal thromboprophylaxis. Aspirin was used in 67% of patients and Coumadin 33% (high risk patients, or who were on Coumadin before surgery). This study group was compared to 1001 consecutive patients who received multimodal thromboprophylaxis and routine Coumadin chemoprophylaxis. There was no significant difference in rates of VTE, PE, bleeding, complications, readmission and 90-day mortality between the two groups. There was a significantly higher rate of wound related complications in the control group (p=0.03). Multimodal thromboprophylaxis with aspirin given to the majority of patients at a low VTE risk is safe and effective in patients undergoing primary TKA.

  6. A prospective study comparing attempted weight bearing in fiberglass below-knee casts and prefabricated pneumatic braces.

    PubMed

    Mason, Lyndon W; Dodds, Alex

    2010-04-01

    Partial weight bearing is commonly advised after fracture of the lower extremity. Research has determined this to be inaccurate both in its instruction and its reproducibility. Many trauma departments are commonly using alternatives to plaster in the splintage of fractures, such as fiberglass and the prefabricated pneumatic braces. This study's null hypothesis is that there is no difference between partial weight bearing through a fiberglass cast as compared with a pneumatic walker. A prospective study was conducted in our department including all patients who had metatarsal or ankle fractures and could partially weight bear. Patients were excluded if they were not allowed to bear weight, had received operative fixation of their fracture, or were younger than age 16 years. The patients' total weight was measured first, and then they were trained to place 50% of their weight through the splinted limb. Three measurements were taken of their attempted weight bearing at 50%, and they were blinded to the results. Over a 16-month period, 117 patients were enrolled for this study: 72 in the pneumatic walker group and 45 in the fiberglass group. There was no significant difference in sex, age, or fracture type. There was a significant difference in percentage of weight placed through the splinted limb, with the pneumatic brace group placing much greater force than the fiberglass group. This may have been caused by altered proprioception from the walker. It is important to realize this when prescribing partial weight bearing in a particular splint as this may result in avoidable complications.

  7. Reproducibility of BMD measurements in the prosthetic knee comparing knee-specific software to traditional DXA software: a clinical validation.

    PubMed

    Tjørnild, Michael; Søballe, Kjeld; Bender, Thomas; Stilling, Maiken

    2011-01-01

    The aim of this study was to validate new knee-specific dual X-ray absorptiometry (DXA) software for cemented total knee arthroplasty (TKA) before initiation of a randomized controlled trial. Firstly, in a phantom study, we evaluated if cementation influenced the measured BMD (g/cm²), the scan reproducibility with the new knee-specific software, and the consequences of leg rotation around a vertical axis. Secondly, in a clinical study, we assessed the clinical reproducibility in repetitive scans performed with the new knee-specific software and with traditional spine-mode DXA software, and further compared the 2 softwares' ability to point type implant and bone edges correctly. Cementation increased the measured bone mineral density (BMD) (p < 0.01). For reproducibility, the coefficient of variation (CV) was 0.52-0.70% in vitro. Leg rotation around a vertical axis significantly changed the measured BMD in most scans. Automatic point typing of implant and bone edge was of varying quality with frequent need of manual correction for both softwares. CVs of clinical reproducibility ranged from 2.78% to 6.19% for knee-specific software and from 1.45% to 6.06% for spine-mode software. We found the new knee-specific software valid for BMD measurement of the bone in proximity of cemented TKA and with clinical reproducibility and corrections of point typing similar to traditional spine-mode software. Copyright © 2011 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  8. Wear analysis of unicondylar mobile bearing and fixed bearing knee systems: a knee simulator study.

    PubMed

    Kretzer, J Philippe; Jakubowitz, Eike; Reinders, Jörn; Lietz, Eva; Moradi, Babak; Hofmann, Kerstin; Sonntag, Robert

    2011-02-01

    Unicondylar knee arthroplasty is an attractive alternative to total knee arthroplasty for selected patients with osteoarthritis. Mobile bearing knee designs have been developed to improve knee kinematics, lower contact stresses and reduced wear of ultra-high molecular weight polyethylene compared with fixed bearing designs. This study compared in vitro wear behavior of fixed and mobile unicondylar bearing designs. Analysis was performed using a force-controlled AMTI knee simulator according to ISO 14243-1:2002(E). The wear volume of the implants was determined gravimetrically. Optical surface characterization and an estimation of wear particle size and morphology were performed. Implant kinematic data for both designs were determined. The wear rates averaged 10.7 ± 0.59 mg per 10(6) cycles for the medial and 5.38 ± 0.63 mg per 10(6) cycles for the lateral components of the mobile bearings, compared with 7.51 ± 0.29 mg per 10(6) cycles and 3.04 ± 0.35 mg per 10(6) cycles for the fixed bearings. The mobile bearings therefore exhibited higher wear rates (P<0.01) compared with the fixed bearings. The tibial polyethylene inserts of the mobile bearings showed pronounced backside wear at the inferior surface. The kinematics of both designs was similar. However, anterior-posterior translation was lower in the mobile bearings. The wear particles were mainly elongated and small in size for both designs (P=0.462). This study shows that wear may play an important role in unicondylar mobile bearing knee designs. Advantages of unicondylar mobile designs compared with fixed bearing designs, which have been proposed in terms of wear behavior and improved kinematics, could not be confirmed.

  9. A comparative assessment of alternatives to the full-leg radiograph for determining knee joint alignment

    PubMed Central

    2012-01-01

    Background The purpose of this study was to assess the concurrent validity of alternative measures of frontal plane knee alignment, namely the radiographic anatomic axis and two clinical measures in patients complaining of knee malalignment as compared with the mechanical axis on full-length radiograph of lower limbs. Methods The knee-alignment angle was measured in 100 knees of 50 subjects with the chief complaint of frontal knee malalignment according to the following methods: lower-limb mechanical axis on radiograph, lower-limb anatomic axis on radiograph, distance between medial femoral condyles or medial malleoli using a calliper and lower-limb alignment using a goniometer. Data were analyzed using Pearson’s correlation coefficient and simple linear regression. Results The anatomic axis best correlated with the mechanical axis (r = 0.93, P<0.001), followed closely by the intercondylar/intermalleolar distance measured by calliper (r = 0.89, P<0.001). Significant correlation was also found between the mechanical-axis angle and the lower limb axis measured by goniometer (r = 0.67, P<0.001). Conclusions The anatomic axis on radiograph, the calliper method and to a lesser extent the goniometer measurement appear to be valid alternatives to the mechanical axis on full-leg radiograph for determining frontal plane knee alignment. These alternative measures have the potential to provide useful information regarding knee alignment and may increase the assessment of this parameter by clinicians and researchers. PMID:23110745

  10. International Comparative Evaluation of Knee Replacement with Fixed or Mobile Non-Posterior-Stabilized Implants

    PubMed Central

    Namba, Robert; Graves, Stephen; Robertsson, Otto; Furnes, Ove; Stea, Susanna; Puig-Verdié, Lluis; Hoeffel, Daniel; Cafri, Guy; Paxton, Elizabeth; Sedrakyan, Art

    2014-01-01

    Background: Mobile-bearing total knee prostheses were designed to reduce wear and improve implant survivorship following total knee arthroplasty. However, the benefit of mobile-bearing total knee arthroplasty remains unproven. Both mobile-bearing and fixed-bearing total knee arthroplasty implants are available in posterior-stabilized and non-posterior-stabilized designs. With the latter, the implant does not recreate the function of the posterior cruciate ligament (PCL) with a posterior-stabilizing cam mechanism. The purpose of the present study was to compare mobile-bearing, non-posterior-stabilized devices with fixed-bearing, non-posterior-stabilized devices used in total knee arthroplasty through a novel multinational study design. Methods: Through the use of a distributed health data network, primary total knee arthroplasties performed for osteoarthritis from 2001 to 2010 were identified from six national and regional total joint arthroplasty registries. Multivariate meta-analysis was performed with use of linear mixed models, with the primary outcome of interest being revision for any reason. Survival probabilities and their standard errors were extracted from each registry for each unique combination of the covariates. Results: A total of 319,616 patients (60% female) underwent non-posterior-stabilized total knee arthroplasty. A fixed-bearing, non-posterior-stabilized design was used in 258,190 (81%) of the knees and a mobile-bearing, non-posterior-stabilized design in 61,426 (19%) of the knees. Sixty-nine percent of the patients who received a fixed-bearing implant were over sixty-five years of age, compared with 63% of those who received a mobile-bearing implant. Mobile-bearing designs had a higher risk of revision, with a hazard ratio of 1.43 (95% confidence interval, 1.36 to 1.51; p < 0.001). Conclusions: Previous comparisons of mobile-bearing and fixed-bearing total knee arthroplasty outcomes have been inconclusive. The current study utilized an advanced

  11. The contribution of leg press and knee extension strength and power to physical function in people with knee osteoarthritis: A cross-sectional study.

    PubMed

    Tevald, Michael A; Murray, Amanda M; Luc, Brittney; Lai, Kafai; Sohn, David; Pietrosimone, Brian

    2016-12-01

    The purposes of this study were to 1) determine the additional contributions of leg press and knee extensor power, over and above that of strength, to the performance of physical function tasks in people with knee osteoarthritis, and 2) compare the ability of bilateral leg press to unilateral knee extensor strength and power to predict functional task performance.

  12. Prospective Study to compare Intra-articular versus Intravenous Tranexemic Acid in reducing Post-operative Blood Loss in staged bilateral Total Knee Arthroplasty.

    PubMed

    Balasubramanian, N; Natarajan, G B; Prakasam, S

    2016-11-01

    The number of total knee arthroplasties (TKA) performed is around two million annually worldwide and this number is expected to increase fivefold by 2025. The most common indication is osteoarthritis of the knee. Blood loss is significant during the post-operative period and blood transfusion when necessary has its own drawbacks. The use of intravenous tranexamic acid has significantly reduced blood loss. We analysed 35 patients who underwent staged bilateral TKA between August 2013 and February 2016 and had administered intra-articular tranexamic acid for one knee and intravenous tranexamic acid for the other knee. The results were analysed based on post-operative blood loss, change in haemoglobin (Hb) level and haematocrit (PCV) and the need for blood transfusion. The average postoperative blood loss was 129.57 ml and 277.71 ml for intra articular group and intravenous group respectively. A control group (no drug or placebo group) with age matched patients (n= 21) was chosen from medical records. The average blood loss in the control group was 493.81 ml. The fall in Hb level and PCV was 0.72 gm/dl and 2.62 % (Intra-articular Group), 1.36 gm/dl and 4.34 % (Intravenous Group) and 2.62 gm/dl and 5.52 % (Control). The number of transfusions were two (Intra-articular Group), five (Intravenous Group) and nine (Control). We conclude that when compared with intravenous route, intra-articular administration has significantly reduced blood loss, Hb level and PCV fall and the rate of blood transfusion.

  13. Comparative study of conventional hip-knee-ankle-foot orthoses versus reciprocating-gait orthoses for children with high-level paraparesis.

    PubMed

    Katz, D E; Haideri, N; Song, K; Wyrick, P

    1997-01-01

    We evaluated eight children with thoracic or high lumbar-level paraparesis for metabolic performance while ambulating with custom fabricated thermoplastic hip-knee-ankle-foot orthoses (HKAFOs) and reciprocating-gait orthoses (RGOs). Seven of the eight children had myelomeningocele. Each patient was tested in both systems at self-selected speeds in a crossover study design. At self-selected speeds, the level of exercise intensity for both thoracic and high-lumbar patients with either orthosis was lower than that for normal children. The average metabolic cost of walking in the RGO was twice that of normal children, as compared with six times normal in HKAFOs. For the four thoracic-level patients, there was a significantly higher oxygen cost of ambulation in using HKAFOs versus RGOs. No significant difference in metabolic performance was found for the high-lumbar patients. Velocity of ambulation was faster in the RGOs than in the HKAFOs. For thoracic-level patients, our data suggest that an RGO will provide a faster, more energy-efficient gait than a statically locked HKAFO. For high-lumbar patients, no significant difference was found between the two orthoses. Seven of eight children preferred the RGO over the HKAFO.

  14. Are static and dynamic kinematics comparable after total knee arthroplasty?

    PubMed

    Saevarsson, Stefan K; Romeo, Carolina I; Anglin, Carolyn

    2013-04-05

    Knee kinematics provide information about how the femoral, tibial and patellar bones or prosthetic components move relative to each other. Accurate knowledge of kinematics is valuable for implant design, comparisons between designs or surgical techniques, and to identify differences between patients with good and poor outcomes. Both static and dynamic imaging techniques have been used to evaluate kinematics. In general, static imaging is used to capture better quality images or to capture views that cannot be acquired by dynamic imaging, whereas dynamic imaging is used to capture real-life movements. How well static kinematics represent dynamic kinematics is subject to frequent debate and has not been adequately addressed, especially after total knee arthroplasty (TKA). We compared the static and dynamic weightbearing kinematics of 10 female subjects after TKA. Using the same clinical scanner for both methods, static images were taken using our standard protocol, sequential-biplane radiographs at multiple flexion angles, as well as with dynamic video fluoroscopy during a step up activity. The static method can reliably measure all 12 degrees of freedom (DOF) after TKA, however only seven were compared due to the poorer out-of-plane reliability in the single-plane dynamic imaging. No differences were found between the static and dynamic kinematics for nine out of ten subjects. For one subject, however, a difference of 5-8° in internal/external tibial rotation was found. The research question, study purpose and the advantages and disadvantages of each method need to be considered when determining which imaging method to use.

  15. Knee joint distraction compared with total knee arthroplasty: a randomised controlled trial.

    PubMed

    van der Woude, J A D; Wiegant, K; van Heerwaarden, R J; Spruijt, S; Emans, P J; Mastbergen, S C; Lafeber, F P J G

    2017-01-01

    Knee joint distraction (KJD) is a relatively new, knee-joint preserving procedure with the goal of delaying total knee arthroplasty (TKA) in young and middle-aged patients. We present a randomised controlled trial comparing the two. The 60 patients ≤ 65 years with end-stage knee osteoarthritis were randomised to either KJD (n = 20) or TKA (n = 40). Outcomes were assessed at baseline, three, six, nine, and 12 months. In the KJD group, the joint space width (JSW) was radiologically assessed, representing a surrogate marker of cartilage thickness. In total 56 patients completed their allocated treatment (TKA = 36, KJD = 20). All patient reported outcome measures improved significantly over one year (p < 0.02) in both groups. At one year, the TKA group showed a greater improvement in only one of the 16 patient-related outcome measures assessed (p = 0.034). Outcome Measures in Rheumatology-Osteoarthritis Research Society International clinical response was 83% after TKA and 80% after KJD. A total of 12 patients (60%) in the KJD group sustained pin track infections. In the KJD group both mean minimum (0.9 mm, standard deviation (sd) 1.1) and mean JSW (1.2 mm, sd 1.1) increased significantly (p = 0.004 and p = 0.0003). In relatively young patients with end-stage knee osteoarthritis, KJD did not demonstrate inferiority of outcomes at one year when compared with TKA. However, there is a high incidence of pin track infection associated with KJD. Cite this article: Bone Joint J 2017;99-B:51-8. ©2017 The British Editorial Society of Bone & Joint Surgery.

  16. Relationship of Buckling and Knee Injury to Pain Exacerbation in Knee Osteoarthritis: A Web-Based Case-Crossover Study

    PubMed Central

    Zobel, Isabelle; Erfani, Tahereh; Bennell, Kim L; Makovey, Joanna; Metcalf, Ben; March, Lyn; Zhang, Yuqing; Eckstein, Felix

    2016-01-01

    Background Knee osteoarthritis (OA) is one of the most frequent causes of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care and a recognized antecedent to disability and eventually joint replacement. Evidence shows that patients with symptomatic OA experience fluctuations in pain severity. Mechanical insults to the knee such as injury and buckling may contribute to pain exacerbation. Objective Our objective was to examine whether knee injury and buckling (giving way) are triggers for exacerbation of pain in persons with symptomatic knee OA. Methods We conducted a case-crossover study, a novel methodology in which participants with symptomatic radiographic knee OA who have had knee pain exacerbations were used as their own control (self-matched design), with all data collected via the Internet. Participants were asked to log-on to the study website and complete an online questionnaire at baseline and then at regular 10-day intervals for 3 months (control periods)—a total of 10 questionnaires. They were also instructed to go to the website and complete pain exacerbation questionnaires when they experienced an isolated incident of knee pain exacerbation (case periods). A pain exacerbation “case” period was defined as an increase of ≥2 compared to baseline. At each contact the pain exacerbation was designated a case period, and at all other regular 10-day contacts (control periods) participants were asked about knee injuries during the previous 7 days and knee buckling during the previous 2 days. The relationship of knee injury and buckling to the risk of pain exacerbation was examined using conditional logistic regression models. Results The analysis included 157 participants (66% women, mean age: 62 years, mean BMI: 29.5 kg/m2). Sustaining a knee injury was associated with experiencing a pain exacerbation (odds ratio [OR] 10.2, 95% CI 5.4, 19.3) compared with no injury. Knee

  17. Posterior tibial displacement in the PCL-deficient knee is reduced compared to the normal knee during gait.

    PubMed

    Orita, Naoya; Deie, Masataka; Shimada, Noboru; Iwaki, Daisuke; Asaeda, Makoto; Hirata, Kazuhiko; Ochi, Mitsuo

    2015-11-01

    Most individuals with an isolated posterior cruciate ligament (PCL) injury do not complain of disability even if posterior instability is objectively revealed by a static physical examination, such as the posterior drawer test. This suggests it is insufficient to only evaluate posterior instability under static conditions. Therefore, we have investigated the effect of isolated PCL injury on the detailed kinematics of the knee in a dynamic environment such as during gait. Eight unilateral PCL-deficient males and eight healthy control volunteers participated in this study. Isolated PCL injury was diagnosed by clinical examination. Stress X-ray imaging showed an average side-to-side difference of 12.7 ± 3.5 mm. Knee kinematics including anteroposterior tibial displacement were analysed during walking using the point cluster technique. Posterior tibial displacement from initial contact was significantly smaller during 9-22 % of the gait cycle by an average of 0.4 cm in the PCL group, compared to controls. In the PCL-deficient knee, the external rotational angle increased by an average of 3.3° at the loading response during 3-11 % of the gait cycle and the varus angle from initial contact increased by an average of 2.0° during 28-52 % of the gait cycle, compared to controls. Dynamic changes in the rotation and posterior translation patterns were seen after isolated PCL injury, suggesting the kinematics of PCL-deficient knees might be different to normal knees. These factors may contribute to long-term osteoarthritic change. Consequently, when choosing conservative treatment for PCL injury, these changes should be considered to prevent osteoarthritic change. III.

  18. Comparative biomechanical analysis of current microprocessor-controlled prosthetic knee joints.

    PubMed

    Bellmann, Malte; Schmalz, Thomas; Blumentritt, Siegmar

    2010-04-01

    To investigate and identify functional differences of 4 microprocessor-controlled prosthetic knee joints (C-Leg, Hybrid Knee [also called Energy Knee], Rheo Knee, Adaptive 2). Tested situations were walking on level ground, on stairs and ramps; additionally, the fall prevention potentials for each design were examined. The measuring technology used included an optoelectronic camera system combined with 2 forceplates as well as a mobile spiroergometric system. The study was conducted in a gait laboratory. Subjects with unilateral transfemoral amputations (N=9; mobility grade, 3-4; age, 22-49y) were tested. Participants were fitted and tested with 4 different microprocessor-controlled knee joints. Static prosthetic alignment, time distance parameters, kinematic and kinetic data and metabolic energy consumption. Compared with the Hybrid Knee and the Adaptive 2, the C-Leg offers clear advantages in the provision of adequate swing phase flexion resistances and terminal extension damping during level walking at various speeds, especially at higher walking speeds. The Rheo Knee provides sufficient terminal extension; however, swing phase flexion resistances seem to be too low. The values for metabolic energy consumption show only slight differences during level walking. The joint resistances generated for descending stairs and ramps relieve the contralateral side to varying degrees. When walking on stairs, safety-relevant technical differences between the investigated joint types can be observed. Designs with adequate internal resistances offer stability advantages when the foot is positioned on the step. Stumble recovery tests reveal that the different knee joint designs vary in their effectiveness in preventing the patient from falling. The patient benefits provided by the investigated electronic prosthetic knee joints differ considerably. The C-Leg appears to offer the amputee greater functional and safety-related advantages than the other tested knee joints. Reduced

  19. Revision of minimal resection resurfacing unicondylar knee arthroplasty to total knee arthroplasty: results compared with primary total knee arthroplasty.

    PubMed

    O'Donnell, Turlough M P; Abouazza, Omar; Neil, Michael J

    2013-01-01

    We compared a cohort of patients undergoing revision of a minimal resection resurfacing unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) with a cohort of patients undergoing primary TKA. Both cohorts were matched in terms of age, sex, and body mass index. We collected data on preoperative and postoperative range of motion, International Knee Society scores, and radiologic data. We also collected data on the modes of failure of the primary UKA. There were 55 patients in each cohort. The average time the UKA was in place was 48.3 months. The average follow-up period from the time of revision was 39.2 months. The most common reason for revision was subsidence of the tibial base plate (58%). Forty percent of patients required particulate bone grafting for contained defects. Two patients required metal augments, and 1 required stems. There was no significant difference between the 2 groups in terms of range of motion, functional outcome, or radiologic outcomes. Revision of these types of implants to TKA is associated with similar results to primary TKA and is superior to revision of other forms of UKA.

  20. Comparative Efficacy and Tolerability of 5-Loxin® and Aflapin® Against Osteoarthritis of the Knee: A Double Blind, Randomized, Placebo Controlled Clinical Study

    PubMed Central

    Sengupta, Krishanu; Krishnaraju, Alluri V.; Vishal, Amar A.; Mishra, Artatrana; Trimurtulu, Golakoti; Sarma, Kadainti VS; Raychaudhuri, Smriti K; Raychaudhuri, Siba P

    2010-01-01

    Aflapin® is a novel synergistic composition derived from Boswellia serrata gum resin (Indian Patent Application No. 2229/CHE/2008). Aflapin is significantly better as an anti-inflammatory agent compared to the Boswellia extracts presently available in the market. A 90-day, double-blind, randomized, placebo-controlled study was conducted to evaluate the comparative efficacy and tolerability of 5-Loxin® and Aflapin® in the treatment of osteoarthritis (OA) of the knee (Clinical trial registration number: ISRCTN80793440). Sixty OA subjects were included in the study. The subjects received either 100 mg (n=20) of 5-Loxin® or 100 mg (n=20) of Aflapin® or a placebo (n=20) daily for 90 days. Each patient was evaluated for pain and physical functions by using the standard tools (visual analog scale, Lequesne's Functional Index, and Western Ontario and McMaster Universities Osteoarthritis Index) at the baseline (day 0), and at days 7, 30, 60 and 90. A battery of biochemical parameters in serum, urine and hematological parameters in citrated whole blood were performed to assess the safety of 5-Loxin® and Aflapin® in OA subjects. Fifty seven subjects completed the study. At the end of the study, both 5-Loxin® and Aflapin conferred clinically and statistically significant improvements in pain scores and physical function scores in OA subjects. Interestingly, significant improvements in pain score and functional ability were recorded as early as 7 days after initiation of the study in the treatment group supplemented with 100 mg Aflapin. Corroborating the improvements in pain scores in treatment groups, our in vitro studies provide evidences that Aflapin® is capable of inhibiting cartilage degrading enzyme MMP-3 and has the potential to regulate the inflammatory response by inhibiting ICAM-1. Aflapin® and 5-Loxin® reduce pain and improve physical functions significantly in OA subjects. Aflapin exhibited better efficacy compared to 5-Loxin®. In comparison with placebo

  1. Antibacterial activity of joint fluid in cemented total-knee arthroplasty: an in vivo comparative study of polymethylmethacrylate with and without antibiotic loading.

    PubMed

    Ueng, Steve W N; Hsieh, Pang-Hsin; Shih, Hsin-Nung; Chan, Yi-Shan; Lee, Mel S; Chang, Yuhan

    2012-11-01

    The objective of this study was to evaluate the antibacterial activities of joint fluids of patients undergoing total-knee arthroplasty (TKA). Thirty patients who were scheduled for primary cemented TKA were enrolled in the study. The patients were grouped on the basis of whether the cement was without antibiotic loading (control group) or loaded with oxacillin (oxacillin group) or vancomycin (vancomycin group). Cefazolin was administered to every patient as the perioperative prophylactic antibiotic. Samples of joint fluids were collected from the knee joints at 8, 16, 24, 32, 40, and 48 h after prosthesis implantation. We assessed the bioactivities of the joint fluids against methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA). The antibiotic contents of the joint fluid samples were further evaluated by using high-performance liquid chromatography. Against MSSA, all joint fluid samples exhibited at least 24 h of bacterial inhibition activity. The oxacillin (43.2 h ± 2 h) and vancomycin (40.8 h ± 1.8 h) groups exhibited significantly longer durations of antibacterial activities than the control group (28 h ± 1.3 h; P < 0.05). However, antibacterial activity against MRSA was observed only in the vancomycin group. In conclusion, cefazolin, which was administered as a prophylactic antibiotic in TKA, exhibited good ability for knee joint penetration and was sufficient to inhibit MSSA during its administration. The use of antibiotic-loaded cement can prolong the antibacterial activity of joint fluid in TKA. Further, vancomycin-loaded cement had antibacterial activity against MRSA superior to that of cement loaded with oxacillin or without antibiotic loading.

  2. Comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis: a randomized trial

    USDA-ARS?s Scientific Manuscript database

    Background: Few remedies effectively treat long-term pain and disability from knee osteoarthritis. Studies suggest that Tai Chi alleviates symptoms, but no trials have directly compared Tai Chi with standard therapies for osteoarthritis. Objective: To compare Tai Chi with standard physical therapy f...

  3. Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing: a prospective, randomized study.

    PubMed

    Zha, Guo-Chun; Sun, Jun-Ying; Dong, Sheng-Jie

    2014-03-01

    Anterior knee pain is a major cause of complaint in total knee arthroplasty (TKA) without patellar resurfacing. The concept of improved patellar tracking and decreased retropatellar contact pressure for lateral retinacular release theoretically suggests that patients with lateral retinacular release in TKA would achieve a lower incidence of anterior knee pain when compared without lateral retinacular release. We sought to determine (1) whether those patients who received a routine lateral retinacular release in TKA would attain lower incidence of anterior knee pain as compared to patients who received TKA without lateral retinacular release and (2) whether lateral retinacular release would increase the lateral retinacular release-related complications. A total of 148 patients who underwent TKA with the use of the Gemini MK II mobile bearing were randomized to receive either routine lateral retinacular release (intervention group) or not (control group). Patients were assessed by the visual analogue scale for anterior knee pain, the Knee Society clinical scoring system of knee score and function score, and patellar score for clinical function. Patients' satisfaction and lateral retinacular release-related complications were also evaluated. The overall incidence of anterior knee pain in the intervention group at 18 months follow-up was 5.6%, while that of the control group was 20.6% (p = 0.009). No statistical difference was detected between the two groups in terms of lateral retinacular release-related complications (n.s.), patients' satisfaction (n.s.), knee score (n.s.), function score (n.s.), and patellar score (n.s.) at 18 months follow-up. The present study suggests that routine lateral retinacular release can reduce anterior knee pain and does not increase lateral retinacular release-related complications, in TKA with the use of the Gemini MK II mobile bearing without patellar resurfacing. Therapeutic, Level I.

  4. A novel, minimally-invasive technique of cartilage repair in the human knee using arthroscopic microfracture and injections of mesenchymal stem cells and hyaluronic acid--a prospective comparative study on safety and short-term efficacy.

    PubMed

    Lee, Kevin B L; Wang, Victor T Z; Chan, Yiong Huak; Hui, James H P

    2012-11-01

    Most current cell-based cartilage repair techniques require some form of scaffolds and 2 separate surgical procedures. We propose a novel, scaffold-less technique of cartilage repair in the human knee that combines arthroscopic microfracture and outpatient intra-articular injections of autologous bone marrow-derived mesenchymal stem cells (MSCs) and hyaluronic acid (HA). Seventy matched (age, sex, lesion size) knees with symptomatic cartilage defects underwent cartilage repair with the proposed technique (n = 35) or an open technique (n = 35) in which the MSCs were implanted beneath a sutured periosteal patch over the defect. Prospective evaluation of both groups were performed using the International Cartilage Repair Society (ICRS) Cartilage Injury Evaluation Package, which included questions from the Short-Form (SF-36) Health Survey, International Knee Documentation Committee (IKDC) subjective knee evaluation form, Lysholm knee scale, and Tegner activity level scale. Postoperative magnetic resonance imaging (MRI) evaluation was also performed at 1 year for most patients. There were no clinically significant adverse events reported through the course of our study. At the fi nal follow-up (mean = 24.5 months), there was significant improvement in mean IKDC, Lysholm, SF-36 physical component score and visual analogue pain scores in both treatment groups. In the short term, the results of this novel technique are comparable to the open procedure with the added advantages of being minimally invasive and requiring only a single operation under general anaesthesia. Its safety has been validated and its efficacy is currently being evaluated in an ongoing randomised controlled trial.

  5. Effect of patellar thickness on knee flexion in total knee arthroplasty: a biomechanical and experimental study.

    PubMed

    Abolghasemian, Mansour; Samiezadeh, Saeid; Sternheim, Amir; Bougherara, Habiba; Barnes, C Lowry; Backstein, David J

    2014-01-01

    A biomechanical computer-based model was developed to simulate the influence of patellar thickness on passive knee flexion after arthroplasty. Using the computer model of a single-radius, PCL-sacrificing knee prosthesis, a range of patella-implant composite thicknesses was simulated. The biomechanical model was then replicated using two cadaveric knees. A patellar-thickness range of 15 mm was applied to each of the knees. Knee flexion was found to decrease exponentially with increased patellar thickness in both the biomechanical and experimental studies. Importantly, this flexion loss followed an exponential pattern with higher patellar thicknesses in both studies. In order to avoid adverse biomechanical and functional consequences, it is recommended to restore patellar thickness to that of the native knee during total knee arthroplasty.

  6. [Arthro-scanner of the knee: current indication, examination of the femoro-tibial compartment. Comparative study with classical simple-contrast media arthrography].

    PubMed

    Pelousse, F; Olette, J

    1993-12-01

    The authors report on a series of 50 single contrast knee arthroscans and describe a method of examination in fine sections that allows for a detailed analysis of the femoro-tibial compartment. The authors compared the sensitivity of the single contrast arthrography with their arthroscanner technique. Thus they prove the major interest of the fine section arthroscanner in assessing chondropathies of all types, the frequency and stage of which are heavily underestimated in conventional arthrography, not only in respect of the patella but also where the other covering cartilages are concerned. They also demonstrate the additional interest of the arthroscanner for certain meniscus and ligament lesions as well as for detecting osteochondromatosis nodules.

  7. Patient directed self management of pain (PaDSMaP) compared to treatment as usual following total knee replacement: study protocol for a randomized controlled trial.

    PubMed

    Donell, Simon; Deane, Katherine; Swift, Louise; Barton, Garry; Balls, Paula; Darrah, Clare; Gray, Richard

    2012-11-05

    In 2009, 665 patients underwent total knee replacements (TKRs) at the Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH), representing nearly 1% of the national total. Pain control following the operation can be poor, and this can cause poor mobilization and potential long-term adverse events. Although high levels of pain are not associated with patient dissatisfaction, brief periods of pain may lead to neuronal remodeling and sensitization. Patient controlled oral analgesia (PCOA) may improve pain relief; however, the evidence to date has been inconclusive. Patient directed self management of pain (PaDSMaP) is a single center randomized controlled trial, which aims to establish if patient self-medication improves, or is equivalent to, treatment as usual and to create an educational package to allow implementation elsewhere. Patients eligible for a TKR will be recruited and randomized in the outpatient clinic. All patients will undergo their operations according to normal clinical practice but will be randomized into two groups. Once oral medication has commenced, one group will have pain relief administered by nursing staff in the usual way (treatment as usual; TAU), whilst the second group will self manage their pain medication (patient directed self management of pain; PaDSMaP). Those recruited for self-medication will undergo a training program to teach the use of oral analgesics according to the World Health Organization (WHO) pain cascade and how to complete the study documentation. The primary endpoint of the trial is the visual analogue scale (VAS) pain score at 3 days or discharge, whichever is sooner. The follow-up time is 6 weeks with a planned trial period of 3 years. The secondary objectives are satisfaction with the management of patient pain post-operatively whilst an inpatient after primary TKR; overall pain levels and pain on mobilization; satisfaction with pain management information provided; global outcomes, such as quality of

  8. Spitalfields knees study--a photographic challenge.

    PubMed

    Finan, Nicola; Oliver, Matthew; Shepperd, John

    2007-06-01

    This paper reports a study into human lower limb anatomy based on the Spitalfields collection of human skeletons at the Natural History Museum, London. The objective was to document knee alignment in a range of rotations, and also to define the topography of the knee surfaces. The work was a collaborative between the Medical Illustration department and the orthopaedic surgical team. This project involved photographic challenges that required development of versatile techniques in order to generate credible scientific data. The results have produced a valuable and unique record not previously available. It demonstrates the key role medical photography offers in this type of investigation.

  9. How does surgery compare with advanced intra-articular therapies in knee osteoarthritis: current thoughts

    PubMed Central

    Wehling, Peter; Moser, Carsten; Maixner, William

    2016-01-01

    The objectives of osteoarthritis (OA) management are to reduce pain and inflammation, slow cartilage degradation, improve function and reduce disability. Current strategies for managing knee OA include nonpharmacological interventions, oral pharmacological treatments, localized intra-articular injections, and surgery. It has become evident that the inflammatory response is a key contributor to the development and progression of knee OA. Signaling pathways involving growth factors and cytokines are being investigated for the development of new therapies that target the underlying biological processes causing the disease. This concept of ‘molecular orthopedics’ enables more patient-centered diagnostic and treatment strategies. In contrast to other conservative therapies, which ultimately only address OA symptoms, intra-articular injections, in particular autologous conditioned serum (ACS), provide benefits that have the potential to outweigh those of established pharmacological treatments and surgery. Surgery has historically been considered the final solution for treatment of knee OA, both by treating physicians and by patients; however, there are increasing concerns regarding the lack of randomized clinical trials providing evidence to support this opinion. Intra-articular injection of ACS has demonstrated efficacy as a treatment for knee OA in a number of studies, with a very low rate of adverse events and side effects, compared with surgery. Treatment with ACS utilizes the release of anti-inflammatory cytokines and regenerative growth factors to support the natural healing processes in the knee, and has the potential to provide a valuable alternative to surgical intervention. PMID:27247634

  10. Walking ability following knee arthroplasty: a prospective pilot study of factors affecting the maximal walking distance in 18 patients before and 6 months after total knee arthroplasty.

    PubMed

    Rosenberg, N; Nierenberg, G; Lenger, R; Soudry, M

    2007-12-01

    Functional assessment of patients before and after prosthetic knee arthroplasty is based on clinical examination, which is usually summarized in various knee scores. The present study proposes a different and more subject orientated assessment for functional grading of these patients by measuring their maximal distance of walking ability, which is not apparent from the conventional outcome scores. Eighteen consecutive patients with knee osteoarthritis were evaluated for their knee and knee functional scores (The Knee Society clinical rating system) and for the maximal distance of their walking ability before and 6 months after knee arthroplasty. Specially designed walking ability grading was used for evaluation of walking on walkway. The pre- and post-operative knee scores and maximal walking distance and grading were statistically compared. A significant improvement in the knee and functional scores following surgery was observed. But the maximal walking ability grades and distances did not change significantly following surgery, showing a high relation between pre- and post-operative values. The limitation in post-operative walking was due to the revealed additional health disabilities, not related to the affected knee. Therefore we suggest that pre-operative evaluation of walking abilities should be taken into consideration both for patients' selection and timing of surgery and also for matching of patients' expectation from outcome of prosthetic knee arthroplasty.

  11. Knee pain, knee injury, knee osteoarthritis & work.

    PubMed

    Dulay, Gurdeep S; Cooper, C; Dennison, E M

    2015-06-01

    Symptomatic knee osteoarthritis (OA) can be viewed as the end result of a molecular cascade which ensues after certain triggers occur and ultimately results in irreversible damage to the articular cartilage. The clinical phenotype that knee OA can produce is variable and often difficult to accurately predict. This is further complicated by the often poor relationship between radiographic OA and knee pain. As a consequence, it can be difficult to compare studies that use different definitions of OA. However, the literature suggests that while there are multiple causes of knee OA, two have attracted particular attention over recent years; occupation related knee OA and OA subsequent to previous knee injury. The evidence of a relationship, and the strength of this association, is discussed in this chapter.

  12. The influence of a powered knee-ankle-foot orthosis on walking in poliomyelitis subjects: A pilot study.

    PubMed

    Arazpour, Mokhtar; Moradi, Alireza; Samadian, Mohammad; Bahramizadeh, Mahmood; Joghtaei, Mahmoud; Ahmadi Bani, Monireh; Hutchins, Stephen W; Mardani, Mohammad A

    2016-06-01

    Traditionally, the anatomical knee joint is locked in extension when walking with a conventional knee-ankle-foot orthosis. A powered knee-ankle-foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. The purpose of this study was to determine differences of the powered knee-ankle-foot orthosis compared to a locked knee-ankle-foot orthosis in kinematic data and temporospatial parameters during ambulation. Quasi-experimental design. Subjects with poliomyelitis (n = 7) volunteered for this study and undertook gait analysis with both the powered and the conventional knee-ankle-foot orthoses. Three trials per orthosis were collected while each subject walked along a 6-m walkway using a calibrated six-camera three-dimensional video-based motion analysis system. Walking with the powered knee-ankle-foot orthosis resulted in a significant reduction in both walking speed and step length (both 18%), but a significant increase in stance phase percentage compared to walking with the conventional knee-ankle-foot orthosis. Cadence was not significantly different between the two test conditions (p = 0.751). There was significantly higher knee flexion during swing phase and increased hip hiking when using the powered orthosis. The new powered orthosis permitted improved knee joint kinematic for knee-ankle-foot orthosis users while providing knee support in stance and active knee motion in swing in the gait cycle. Therefore, the new powered orthosis provided more natural knee flexion during swing for orthosis users compared to the locked knee-ankle-foot orthosis. This orthosis has the potential to improve knee joint kinematics and gait pattern in poliomyelitis subjects during walking activities. © The International Society for Prosthetics and Orthotics 2015.

  13. A Randomized Controlled Study to Compare the Total and Hidden Blood Loss in Computer-Assisted Surgery and Conventional Surgical Technique of Total Knee Replacement

    PubMed Central

    Singla, Amit; Kumar, Vijay; Lekha, Chandra; Karthikeyan, G.; Malik, Vishwas

    2015-01-01

    Background Total knee arthroplasty (TKA) is associated with considerable blood loss. Computer-assisted surgery (CAS) is different from conventional TKA as it avoids opening the intramedullary canal. Hence, CAS should be associated with less blood loss. Methods Fifty-seven patients were randomized into two groups of CAS and conventional TKA. In conventional group intramedullary femoral and extramedullary tibial jigs were used whereas in CAS group imageless navigation system was used. All surgeries were done under tourniquet. Total and hidden blood loss was calculated in both groups and compared. Results The mean total blood loss was 980 mL in conventional group and 970 mL in CAS group with median of 1,067 mL (range, 59 to 1,791 mL) in conventional group and 863 mL (range, 111 to 2,032 mL) in CAS group. There was no significant difference in total blood loss between the two groups (p = 0.811). We have found significant hidden blood loss in both techniques, which is 54.8% of the total loss in the conventional technique and 59.5% in the computer-assisted navigation technique. Conclusions There is no significant difference in total and hidden blood loss in the TKA in CAS and conventional TKA. However, there is significant hidden blood loss in both techniques. There was no relation of tourniquet time with blood loss. PMID:26217468

  14. A Randomized Controlled Study to Compare the Total and Hidden Blood Loss in Computer-Assisted Surgery and Conventional Surgical Technique of Total Knee Replacement.

    PubMed

    Singla, Amit; Malhotra, Rajesh; Kumar, Vijay; Lekha, Chandra; Karthikeyan, G; Malik, Vishwas

    2015-06-01

    Total knee arthroplasty (TKA) is associated with considerable blood loss. Computer-assisted surgery (CAS) is different from conventional TKA as it avoids opening the intramedullary canal. Hence, CAS should be associated with less blood loss. Fifty-seven patients were randomized into two groups of CAS and conventional TKA. In conventional group intramedullary femoral and extramedullary tibial jigs were used whereas in CAS group imageless navigation system was used. All surgeries were done under tourniquet. Total and hidden blood loss was calculated in both groups and compared. The mean total blood loss was 980 mL in conventional group and 970 mL in CAS group with median of 1,067 mL (range, 59 to 1,791 mL) in conventional group and 863 mL (range, 111 to 2,032 mL) in CAS group. There was no significant difference in total blood loss between the two groups (p = 0.811). We have found significant hidden blood loss in both techniques, which is 54.8% of the total loss in the conventional technique and 59.5% in the computer-assisted navigation technique. There is no significant difference in total and hidden blood loss in the TKA in CAS and conventional TKA. However, there is significant hidden blood loss in both techniques. There was no relation of tourniquet time with blood loss.

  15. Comparative Effectiveness of the Deqi Sensation and Non-Deqi by Moxibustion Stimulation: A Multicenter Prospective Cohort Study in the Treatment of Knee Osteoarthritis

    PubMed Central

    Chen, Rixin; Chen, Mingren; Xiong, Jun; Su, Tongsheng; Zhou, Meiqi; Sun, Jianhua; Chi, Zhenhai; Zhang, Bo; Xie, Dingyi

    2013-01-01

    Substantial evidence has supported that moxibustion stimulates a unique phenomenon of Deqi, heat-sensitive moxibustion sensation. This study consisted of a multicenter, prospective cohort study with two parallel arms (A: heat-sensitive moxibustion sensation group; B: nonheat-sensitive moxibustion sensation group). All forms of moxibustion were applied unilaterally on the right leg with a triangle shape of three acupuncture points simultaneously (bilateral Xi Yan (EX-LE5) and He Ding (EX-LE2)). After one month the primary outcome parameter GPCRND-KOA showed significant differences between groups: trial group 5.23 ± 2.65 (adjusted mean ± SE) 95% CI [4.44~6.01] versus control group 7.43 ± 2.80 [6.59~8.26], P = 0.0001. Significant differences were manifested in total M-JOA score during the follow-up period (P = 0.0006). Mean knee circumference indicated significant difference between the groups (P = 0.03; P = 0.007). Overall, this evidence suggested that the effectiveness of the Deqi sensation group might be more superior than the non-Deqi sensation one in the treatment of KOA. This study was aimed at providing scientific evidence on the Deqi sensation of moxibustion and at showing that heat-sensitive moxibustion sensation is essential to achieve the preferable treatment effects of KOA. PMID:24027596

  16. Comparative effectiveness of the deqi sensation and non-deqi by moxibustion stimulation: a multicenter prospective cohort study in the treatment of knee osteoarthritis.

    PubMed

    Chen, Rixin; Chen, Mingren; Xiong, Jun; Su, Tongsheng; Zhou, Meiqi; Sun, Jianhua; Chi, Zhenhai; Zhang, Bo; Xie, Dingyi

    2013-01-01

    Substantial evidence has supported that moxibustion stimulates a unique phenomenon of Deqi, heat-sensitive moxibustion sensation. This study consisted of a multicenter, prospective cohort study with two parallel arms (A: heat-sensitive moxibustion sensation group; B: nonheat-sensitive moxibustion sensation group). All forms of moxibustion were applied unilaterally on the right leg with a triangle shape of three acupuncture points simultaneously (bilateral Xi Yan (EX-LE5) and He Ding (EX-LE2)). After one month the primary outcome parameter GPCRND-KOA showed significant differences between groups: trial group 5.23 ± 2.65 (adjusted mean ± SE) 95% CI [4.44~6.01] versus control group 7.43 ± 2.80 [6.59~8.26], P = 0.0001. Significant differences were manifested in total M-JOA score during the follow-up period (P = 0.0006). Mean knee circumference indicated significant difference between the groups (P = 0.03; P = 0.007). Overall, this evidence suggested that the effectiveness of the Deqi sensation group might be more superior than the non-Deqi sensation one in the treatment of KOA. This study was aimed at providing scientific evidence on the Deqi sensation of moxibustion and at showing that heat-sensitive moxibustion sensation is essential to achieve the preferable treatment effects of KOA.

  17. A randomised controlled trial comparing skin closure in total knee arthroplasty in the same knee: nylon sutures versus skin staples

    PubMed Central

    Iamthanaporn, K.; Hongnaparak, T.; Tangtrakulwanich, B.

    2016-01-01

    Objectives Nylon sutures and skin staples are used commonly in total knee arthroplasty (TKA) surgical wound closure. However, there is no study that compares the wound healing efficacy and patient satisfaction scores of both techniques in the same knee. Methods We randomised 70 patients who underwent primary TKA into two groups. In one group of 34 patients, the skin at the upper half of the wound was closed with skin staples and the lower half of the wound was closed with simple interrupted nylon sutures. In the other group of 36 patients, the skin at the upper half of the wound was closed with nylon stitches and the lower half of the wound was closed with skin staples. We recorded the wound closure time, pain score at the time of stitch removal, wound complication rate, patient satisfaction score, and the Hollander wound evaluation score at the post-operative periods of five days, 14 days, six weeks, three months, and six months. Each half wound was analysed separately. Results The mean patient body mass index was 26.8 kg/m2 (standard deviation 6.3). A total of 70 nylon stitched wounds and 70 skin stapled wounds were analysed. There were no significant differences in wound complication rates, patient satisfaction score, and the Hollander wound evaluation score between both types of wounds (p > 0.05). The wound closure time for skin stapled wounds was significantly lower than the nylon stitched wounds (p < 0.001). However, the skin stapled wounds had a significantly higher pain score at the time of stitch removal (p < 0.001). Conclusion Skin staples and nylon stitches had comparable results with respect to wound healing and patient satisfaction in TKA wound closure in non-obese patients. The benefit of skin staples over nylon stitches was a decrease in operative time, but was more painful upon removal. Cite this article: V. Yuenyongviwat. A randomised controlled trial comparing skin closure in total knee arthroplasty in the same knee: nylon sutures versus skin

  18. Tribology studies of the natural knee using an animal model in a new whole joint natural knee simulator.

    PubMed

    Liu, Aiqin; Jennings, Louise M; Ingham, Eileen; Fisher, John

    2015-09-18

    The successful development of early-stage cartilage and meniscus repair interventions in the knee requires biomechanical and biotribological understanding of the design of the therapeutic interventions and their tribological function in the natural joint. The aim of this study was to develop and validate a porcine knee model using a whole joint knee simulator for investigation of the tribological function and biomechanical properties of the natural knee, which could then be used to pre-clinically assess the tribological performance of cartilage and meniscal repair interventions prior to in vivo studies. The tribological performance of standard artificial bearings in terms of anterior-posterior (A/P) shear force was determined in a newly developed six degrees of freedom tribological joint simulator. The porcine knee model was then developed and the tribological properties in terms of shear force measurements were determined for the first time for three levels of biomechanical constraints including A/P constrained, spring force semi-constrained and A/P unconstrained conditions. The shear force measurements showed higher values under the A/P constrained condition (predominantly sliding motion) compared to the A/P unconstrained condition (predominantly rolling motion). This indicated that the shear force simulation model was able to differentiate between tribological behaviours when the femoral and tibial bearing was constrained to slide or/and roll. Therefore, this porcine knee model showed the potential capability to investigate the effect of knee structural, biomechanical and kinematic changes, as well as different cartilage substitution therapies on the tribological function of natural knee joints.

  19. Comparison of two hyaluronic acid formulations for safety and efficacy (CHASE) study in knee osteoarthritis: a multicenter, randomized, double-blind, 26-week non-inferiority trial comparing Durolane to Artz.

    PubMed

    Zhang, Heng; Zhang, Ke; Zhang, Xianlong; Zhu, Zhenan; Yan, Shigui; Sun, Tiansheng; Guo, Ai; Jones, John; Steen, R Grant; Shan, Bin; Zhang, Jenny; Lin, Jianhao

    2015-03-10

    Intra-articular injection of hyaluronic acid (HA) is often used as therapy for knee osteoarthritis because it is less expensive and less aggressive than total knee replacement. Therefore, it is important to document whether HA is safe and efficacious. We tested whether single and multiple injection viscosupplementation with HA is associated with clinically meaningful pain relief in a new randomized clinical trial (RCT). Our objective was to compare safety and efficacy of intra-articular HA in two formulations: one 3.0 ml injection of Durolane versus five 2.5 ml injections of Artz for the treatment of knee osteoarthritis pain. Patients (N=349) from the People's Republic of China were randomized to treatment (Durolane=175, Artz=174). The Durolane group received a 3.0 ml injection at week 0 (baseline), with sham skin punctures at weeks 1, 2, 3, and 4. The Artz group received one 2.5 ml injection at each of the same time points. The primary assessment tool was the Likert-type Western Ontario and McMaster University (WOMAC) pain scale at weeks 0, 6, 10, 14, 18, and 26. Secondary assessments were WOMAC physical function, knee stiffness, and global self-assessment, at identical time points. Statistically-controlled analyses were non-inferiority of Durolane over 18, then over 26 weeks, with a priori non-inferiority defined as 8% of the relevant scale. Acetaminophen was permitted as rescue analgesia and all adverse events (AEs) were recorded. Overall study retention was excellent; 332 patients (95.1%) completed 18 weeks and 319 (91.4%) completed 26 weeks, with no significant retention difference between treatment arms. All variables met non-inferiority criteria over 18 and 26 weeks. Efficacy response in both arms was >90%. Treatment-related AEs were 9.8% (17/174) for Artz and 13.1% (23/175) for Durolane. A single injection of Durolane is non-inferior to 5 injections of Artz over 18 and 26 weeks for pain, physical function, global self-assessment, and knee stiffness. Both

  20. Surgical treatment compared with eccentric training for patellar tendinopathy (Jumper's Knee). A randomized, controlled trial.

    PubMed

    Bahr, Roald; Fossan, Bjørn; Løken, Sverre; Engebretsen, Lars

    2006-08-01

    Although the surgical treatment of patellar tendinopathy (jumper's knee) is a common procedure, there have been no randomized, controlled trials comparing this treatment with forms of nonoperative treatment. The purpose of the present study was to compare the outcome of open patellar tenotomy with that of eccentric strength training in patients with patellar tendinopathy. Thirty-five patients (forty knees) who had been referred for the treatment of grade-IIIB patellar tendinopathy were randomized to surgical treatment (twenty knees) or eccentric strength training (twenty knees). The eccentric training group performed squats on a 25 degrees decline board as a home exercise program (with three sets of fifteen repetitions being performed twice daily) for a twelve-week intervention period. In the surgical treatment group, the abnormal tissue was removed by means of a wedge-shaped full-thickness excision, followed by a structured rehabilitation program with gradual progression to eccentric training. The primary outcome measure was the VISA (Victorian Institute of Sport Assessment) score (possible range, 0 to 100), which was calculated on the basis of answers to a symptom-based questionnaire that was developed specifically for patellar tendinopathy. The patients were evaluated after three, six, and twelve months of follow-up. There was no difference between the groups with regard to the VISA score during the twelve-month follow-up period, but both groups had improvement (p < 0.001). The mean combined VISA score for the two groups increased from 30 (95% confidence interval, 25 to 35) before the start of treatment to 49 (95% confidence interval, 42 to 55) at three months, 58 (95% confidence interval, 51 to 65) at six months, and 70 (95% confidence interval, 62 to 78) at twelve months. In the surgical treatment group, five knees had no symptoms, twelve had improvement but were still symptomatic, two were unchanged, and one was worse after twelve months (p = 0.49 compared

  1. Knee Pain and Driving Duration: A Secondary Analysis of the Taxi Drivers’ Health Study

    PubMed Central

    Chen, Jiu-Chiaun; Dennerlein, Jack T.; Shih, Tung-Sheng; Chen, Chiou-Jong; Cheng, Yawen; Chang, Wushou P.; Ryan, Louise M.; Christiani, David C.

    2004-01-01

    Objectives. We explored a postulated association between daily driving time and knee pain. Methods. We used data from the Taxi Drivers’ Health Study to estimate 1-year prevalence of knee pain as assessed by the Nordic musculoskeletal questionnaire. Results. Among 1242 drivers, the prevalence of knee pain, stratified by duration of daily driving (≤ 6, > 6 through 8, > 8 through 10, and > 10 hours), was 11%, 17%, 19%, and 22%, respectively. Compared with driving 6 or fewer hours per day, the odds ratio of knee pain prevalence for driving more than 6 hours per day was 2.52 (95% confidence interval = 1.36, 4.65) after we adjusted for socioeconomic, work-related, and personal factors in the multiple logistic regression. Conclusions. The dose-related association between driving duration and knee pain raises concerns about work-related knee joint disorders among professional drivers. PMID:15054008

  2. Anteroposterior Laxity After Bicruciate-Retaining Total Knee Arthroplasty Is Closer to the Native Knee Than ACL-Resecting TKA: A Biomechanical Cadaver Study.

    PubMed

    Halewood, Camilla; Traynor, Alison; Bellemans, Johan; Victor, Jan; Amis, Andrew A

    2015-12-01

    The purpose of this study was to examine whether a bicruciate retaining (BCR) TKA would yield anteroposterior (AP) laxity closer to the native knee than a posterior cruciate ligament retaining (CR) TKA. A BCR TKA was designed and compared to CR TKA and the native knee using cadaver specimens. AP laxity with the CR TKA was greater than the native knee (P=0.006) and BCR TKA (P=0.039), but no difference was found between the BCR TKA and the native knee. No significant differences were found in rotations between the prostheses and the native knee. BCR TKA was shown to be surgically feasible, reduced AP laxity versus CR TKA, and may improve knee stability without using conforming geometry in the implant design. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Different intraoperative kinematics with comparable clinical outcomes of ultracongruent and posterior stabilized mobile-bearing total knee arthroplasty.

    PubMed

    Kim, Tae Woo; Lee, Sang Min; Seong, Sang Cheol; Lee, Sahnghoon; Jang, Jak; Lee, Myung Chul

    2016-09-01

    There remains no consensus as to whether mobile total knee arthroplasty (TKA) should use a posterior cruciate ligament-sacrificing ultracongruent (UC) or a posterior cruciate ligament-substituting posterior stabilized (PS) prosthesis. The purpose of this study was to assess intraoperative kinematics and clinical outcomes of UC and PS rotating platform mobile-bearing TKA. In this randomized controlled study, mobile UC TKA prostheses (n = 45) were compared with mobile PS TKA prostheses (n = 45) with regard to intraoperative kinematics and clinical outcomes. The passive kinematic study using intraoperative navigation system included anterior/posterior translation, varus/valgus alignment and rotation of femur during flexion. The patients were clinically and radiographically evaluated over a 3-year follow-up. Paradoxical anterior translation of the femur was 10.8 ± 5.2 mm in the UC knee from 0° to 82° of knee flexion and 8.7 ± 3.0 mm in the PS knee from 0° to 70° of knee flexion (p = 0.027). Paradoxical internal rotation of the femur was 5.8° in the UC knees and 9.9° in the PS knees (p = 0.003). But, there was no significant difference between the groups in regard to the coronal alignment. There was no significant difference in the range of motion, KS knee scores, KS function scores, and WOMAC index scores. Despite different intraoperative kinematics between mobile UC and mobile PS TKA, neither design reproduced physiologic knee kinematics and there was no difference in clinical outcomes between the two groups. The clinical relevance of the study is that despite different intraoperative kinematics, UC design can be a considerable alternative to PS design in mobile-bearing TKA in respect of clinical outcomes. II.

  4. Randomized, double blinded comparative trial of intradermal injections of lignocaine versus N-saline around the knee to relieve pain in patients awaiting total knee replacement.

    PubMed

    Loughnan, Terence Edward; Taverner, Murray G; Webb, Ashley

    2009-05-01

    We report a randomized, double-blinded comparative study assessing the efficacy of local anesthetic with N-saline intradermal blocks around the knee to reduce pain and improve patient satisfaction while waiting for a total knee joint replacement. Patients were offered involvement in this study while on the hospital waiting list for a knee replacement. Eligible patients, after completing a prestudy assessment, received an average of 6.3 (range: 1 to 10) intradermal injections of 0.5 mL either saline or 1% lignocaine injections into tender points around the knee. Patients were assessed at 2 hours and 1 week after the injections. Pain was assessed using 0 to 100 visual analog pain scale. Global perceived effect (satisfaction) was measured on a 7-point Likert scale. Thirty-two of 34 patients attended at 1-week assessment, 24 (75%) felt that they were improved, and 8 (25%) considered they were unchanged or worse. In both the saline and lignocaine groups, 12 of 16 patients felt that they had improved. N-saline proved as effective as lignocaine in reducing knee pain when injected intradermally. Seventy-five percent of patients were improved at 1 week.

  5. Serum cytokines are increased and circulating micronutrients are not altered in subjects with early compared to advanced knee osteoarthritis.

    PubMed

    Barker, Tyler; Rogers, Victoria E; Henriksen, Vanessa T; Aguirre, Dale; Trawick, Roy H; Rasmussen, G Lynn; Momberger, Nathan G

    2014-08-01

    Knee osteoarthritis (OA) is a leading cause of physical disability. At the early stage of knee OA, the increase in synovial fluid cytokine concentrations could contribute to the pathogenesis of OA by degrading articular cartilage. It is unknown, however, if inflammatory cytokines increase systemically at the early or advanced stage of knee OA. The systemic increase of inflammatory cytokines could be detrimental to the endogenous status of micronutrients that protect against excessive inflammation and cytokine-mediated events. The purpose of this study was to test the hypothesis that an increase in serum cytokines associate with a decrease in circulating micronutrients in subjects with early compared to advanced knee OA. Advanced knee OA subjects (n=14) displayed radiographic, pain, and muscular weakness symptoms of knee OA. Early knee OA subjects (n=14) were matched (age, gender, and body mass index) to the advanced OA group and displayed one or two of the aforementioned symptoms of knee OA. Inflammatory cytokines, vitamins C (ascorbic acid), D (25-hydroxyvitamin D), and E (α- and γ-tocopherols), and β-carotene were measured in fasting blood samples. In the early OA group, serum tumor necrosis factor (TNF)-α, interleukin (IL)-5, IL-6, IL-12, and IL-13 concentrations were significantly (all p<0.05) increased. Circulating ascorbic acid, 25-hydroxyvitamin D, α- and γ-tocopherol's, and β-carotene concentrations were not significantly different between groups. Based on these preliminary results, we conclude that the systemic increase of inflammatory cytokines is not associated with a decrease in circulating micronutrients in subjects with early compared to advanced knee OA.

  6. Jumper's knee paradox--jumping ability is a risk factor for developing jumper's knee: a 5-year prospective study.

    PubMed

    Visnes, Håvard; Aandahl, Hans Åge; Bahr, Roald

    2013-05-01

    The 'jumper's knee paradox', where symptomatic athletes appear to perform better in a counter movement jump (CMJ) compared to asymptomatic controls in previous case-control studies is not fully understood. The aim was to examine the relationship between jumping ability and change of jumping ability as potential risk factors for developing jumper's knee. A 5-year prospective cohort study among elite volleyball players, aged 16-18. Jump tests were done on a portable force plate at the time of inclusion and semiannually. Jumper's knee was diagnosed based on a standardised clinical examination. All 150 students (68 males and 82 females) were included and 28 developed jumper's knee (22 males and 6 females). At the time of inclusion, male athletes who went on to develop jumper's knee had significantly better results in CMJ (38.0±5.8 cm) compared to asymptomatic males (34.6±5.5 cm, p=0.03), while no difference was detected in standing jump (SJ: jumper's knee: 30.3±7.4 cm, asymptomatic: 28.1±6.1 cm, p=0.23). In a multivariate logistic regression analysis corrected for gender and previous volleyball training, the OR was 2.09 (1.03-4.25) per cm difference in CMJ at the time of inclusion. Our results did not reveal any significant differences in the change in jumping ability between the groups, although both groups improved their jump performance. Volleyball players with a natural ability for jumping high are at an increased risk for developing jumper's knee.

  7. RAPID KNEE-EXTENSIONS TO INCREASE QUADRICEPS MUSCLE ACTIVITY IN PATIENTS WITH TOTAL KNEE ARTHROPLASTY: A RANDOMIZED CROSS-OVER STUDY

    PubMed Central

    Wilquin, Lousia; Jakobsen, Thomas Linding; Holsgaard-Larsen, Anders; Bandholm, Thomas

    2017-01-01

    Background Inhibition of the quadriceps muscle and reduced knee-extension strength is common shortly following total knee arthroplasty (weeks to months), due to reduced voluntary activation of the quadriceps muscle. In healthy subjects, strength training with heavy loads is known to increase agonist muscle activity, especially if the exercise is conducted using rapid muscle contractions. Purpose The purpose of this study was to examine if patients with total knee arthroplasty could perform rapid knee-extensions using a 10 RM load four to eight weeks after surgery, and the degree to which rapid knee-extensions were associated with greater voluntary quadriceps muscle activity during an experimental strength training session, compared to that elicited using slow knee-extensions. Study Design A randomized cross-over study. Methods Twenty-four patients (age 66.5) 4-8 weeks post total knee arthroplasty randomly performed one set of five rapid, and one set of five slow knee-extensions with the operated leg, using a load of their 10 repetition maximum, while surface electromyography recordings were obtained from the vastus medialis and lateralis of the quadriceps muscle. Results Data from 23 of the 24 included patients were analyzed. Muscle activity was significantly higher during rapid knee-extensions (120.2% [10th-90th percentile: 98.3-149.1]) compared to slow knee-extensions (106.0% [88.8-140.8]) for the vastus lateralis (p<0.01), but not for the vastus medialis (120.8% [90.4-134.0]) and (121.8% [93.0-133.0]) (p = 0.17), respectively. Slow and rapid knee-extensions were performed at a median angular velocity of 19.7 degrees/sec (13.7-24.4) and 51.4 degrees/sec (28.9-63.1), respectively Conclusion Four to eight weeks after their total knee arthroplasty, the patients in the present study were able to conduct rapid knee-extensions according to the experimental protocol with an approximately doubled angular velocity compared to slow knee-extensions. This was associated with

  8. Increased expression of damage-associated molecular patterns (DAMPs) in osteoarthritis of human knee joint compared to hip joint.

    PubMed

    Rosenberg, John H; Rai, Vikrant; Dilisio, Matthew F; Sekundiak, Todd D; Agrawal, Devendra K

    2017-06-01

    Osteoarthritis (OA) is a degenerative disease characterized by the destruction of cartilage. The greatest risk factors for the development of OA include age and obesity. Recent studies suggest the role of inflammation in the pathogenesis of OA. The two most common locations for OA to occur are in the knee and hip joints. The knee joint experiences more mechanical stress, cartilage degeneration, and inflammation than the hip joint. This could contribute to the increased incidence of OA in the knee joint. Damage-associated molecular patterns (DAMPs), including high-mobility group box-1, receptor for advanced glycation end products, and alarmins (S100A8 and S100A9), are released in the joint in response to stress-mediated chondrocyte and cartilage damage. This facilitates increased cartilage degradation and inflammation in the joint. Studies have documented the role of DAMPs in the pathogenesis of OA; however, the comparison of DAMPs and its influence on OA has not been discussed. In this study, we compared the DAMPs between OA knee and hip joints and found a significant difference in the levels of DAMPs expressed in the knee joint compared to the hip joint. The increased levels of DAMPs suggest a difference in the underlying pathogenesis of OA in the knee and the hip and highlights DAMPs as potential therapeutic targets for OA in the future.

  9. The effect of vitamin D status on pain, lower limb strength and knee function during balance recovery in people with knee osteoarthritis: an exploratory study.

    PubMed

    Levinger, Pazit; Begg, Rezaul; Sanders, Kerrie M; Nagano, Hanatsu; Downie, Calum; Petersen, Aaron; Hayes, Alan; Cicuttini, Flavia

    2017-09-23

    The association between vitamin D and muscle function associated with balance recovery and falls in people with knee osteoarthritis is unclear. Those with vitamin D insufficiency demonstrated poorer knee function during balance recovery, greater pain and locomotor dysfunction. Vitamin D insufficiency may have an adverse effect on muscle power function. Low vitamin D status in people with knee osteoarthritis (OA) is often reported to be associated with increased pain and locomotor dysfunction. However, despite the growing evidence of the effect of vitamin D on the pathogenesis of knee OA, its role remains conflicting. Importantly, muscle function is important for knee joint health; however, the association between vitamin D levels and muscle function associated with balance recovery and falls is unclear. This study investigated the effect of circulating 25-hydroxyvitamin D (25 (OH) D) on pain, quadriceps strength, lower limb muscle mass and knee power function during balance recovery in people with knee OA. Twenty-four participants with clinical symptoms of knee OA (68.6 ± 6.2 years) participated in the study. Serum levels of 25 (OH) D were assessed and participants were classified as follows: vitamin D insufficiency ≤ 50 nmol/L and vitamin D sufficiency > 50 nmol/L. The groups were compared on knee function during balance recovery tasks, lower limb strength and muscle mass as well as perceived pain and function. Seven patients (29.1%) were classified as vitamin D-insufficient. Vitamin D insufficiency was associated with reduced knee muscle function during the balance recovery task, increased pain (Western Ontario and McMasters University Osteoarthritis Index (WOMAC) subscore), dysfunction (WOMAC subscore) and total WOMAC score (p < 0.05). People with knee OA with vitamin D insufficiency demonstrated poorer knee function during balance recovery, greater pain and locomotor dysfunction. Vitamin D insufficiency may have an adverse effect on muscle power

  10. Early outcomes of twin-peg mobile-bearing unicompartmental knee arthroplasty compared with primary total knee arthroplasty

    PubMed Central

    Lum, Z. C.; Lombardi, A. V.; Hurst, J. M.; Morris, M. J.; Adams, J. B.; Berend, K. R.

    2016-01-01

    Aims Since redesign of the Oxford phase III mobile-bearing unicompartmental knee arthroplasty (UKA) femoral component to a twin-peg design, there has not been a direct comparison to total knee arthroplasty (TKA). Thus, we explored differences between the two cohorts. Patients and Methods A total of 168 patients (201 knees) underwent medial UKA with the Oxford Partial Knee Twin-Peg. These patients were compared with a randomly selected group of 177 patients (189 knees) with primary Vanguard TKA. Patient demographics, Knee Society (KS) scores and range of movement (ROM) were compared between the two cohorts. Additionally, revision, re-operation and manipulation under anaesthesia rates were analysed. Results The mean follow-up for UKA and TKA groups was 5.4 and 5.5 years, respectively. Six TKA (3.2%) versus three UKAs (1.5%) were revised which was not significant (p = 0.269). Manipulation was more frequent after TKA (16; 8.5%) versus none in the UKA group (p < 0.001). UKA patients had higher post-operative KS function scores versus TKA patients (78 versus 66, p < 0.001) with a trend toward greater improvement, but there was no difference in ROM and KS clinical improvement (p = 0.382 and 0.420, respectively). Conclusion We found fewer manipulations, and higher functional outcomes for patients treated with medial mobile-bearing UKA compared with TKA. TKA had twice the revision rate as UKA although this did not reach statistical significance with the numbers available. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):28–33. PMID:27694513

  11. Preliminary study of optimal measurement location on vibroarthrography for classification of patients with knee osteoarthritis

    PubMed Central

    Ota, Susumu; Ando, Akiko; Tozawa, Yusuke; Nakamura, Takuya; Okamoto, Shogo; Sakai, Takenobu; Hase, Kazunori

    2016-01-01

    [Purpose] The aims of the present study were to investigate the most suitable location for vibroarthrography measurements of the knee joint to distinguish a healthy knee from knee osteoarthritis using Wavelet transform analysis. [Subjects and Methods] Participants were 16 healthy females and 17 females with severe knee osteoarthritis. Vibroarthrography signals were measured on the medial and lateral epicondyles, mid-patella, and tibia using stethoscopes with a microphone while subjects stood up from a seated position. Frequency and knee flexion angles at the peak wavelet coefficient were obtained. [Results] Peak wavelet coefficients at the lateral condyle and tibia were significantly higher in patients with knee osteoarthritis than in the control group. Knee joint angles at the peak wavelet coefficient were smaller (more extension) in the osteoarthritis group compared to the control group. The area under the receiver operating characteristic curve on tibia assessment with the frequency and knee flexion angles was higher than at the other measurement locations (both area under the curve: 0.86). [Conclusion] The tibia is the most suitable location for classifying knee osteoarthritis based on vibroarthrography signals. PMID:27821959

  12. Does bracing influence brain activity during knee movement: an fMRI study.

    PubMed

    Thijs, Youri; Vingerhoets, Guy; Pattyn, Els; Rombaut, Lies; Witvrouw, Erik

    2010-08-01

    Studies have shown that proprioceptive inputs during active and passive arm movements are processed in the primary and secondary somatosensory cortex and supplementary motor area of the brain. At which level of the central nervous system proprioceptive signals coming from the knee are regulated remains to be elucidated. In order to investigate whether there is a detectable difference in brain activity when various proprioceptive inputs are exerted at the knee, functional magnetic resonance imaging (fMRI) was used. fMRI in 13 healthy, right leg-dominant female volunteers compared brain activation during flexion-extension movements of the right knee under three different conditions: with application of a tight knee brace, with application of a moderate tight knee sleeve, and without application of a brace or sleeve. Brain activation was detected in the primary sensorimotor cortex (left and right paracentral lobule) and in the left superior parietal lobule of the brain. There was a significantly higher level of brain activation with the application of the brace and sleeve, respectively, compared to the condition without a brace or sleeve. A significantly higher cortical activation was also seen when comparing the braced condition with the condition when a sleeve was applied. The results suggest that peripheral proprioceptive input to the knee joint by means of a brace or sleeve seems to influence brain activity during knee movement. The results of this study also show that the intensity of brain activation during knee movement can be influenced by the intensity of proprioceptive stimulation at the joint.

  13. Knee Joint Distraction Compared to Total Knee Arthroplasty for Treatment of End Stage Osteoarthritis: Simulating Long-Term Outcomes and Cost-Effectiveness

    PubMed Central

    van der Woude, J. A. D.; Nair, S. C.; Custers, R. J. H.; van Laar, J. M.; Kuchuck, N. O.; Lafeber, F. P. J. G.; Welsing, P. M. J.

    2016-01-01

    Objective In end-stage knee osteoarthritis the treatment of choice is total knee arthroplasty (TKA). An alternative treatment is knee joint distraction (KJD), suggested to postpone TKA. Several studies reported significant and prolonged clinical improvement of KJD. To make an appropriate decision regarding the position of this treatment, a cost-effectiveness and cost-utility analysis from healthcare perspective for different age and gender categories was performed. Methods A treatment strategy starting with TKA and a strategy starting with KJD for patients of different age and gender was simulated. To extrapolate outcomes to long-term health and economic outcomes a Markov (Health state) model was used. The number of surgeries, QALYs, and treatment costs per strategy were calculated. Costs-effectiveness is expressed using the cost-effectiveness plane and cost-effectiveness acceptability curves. Results Starting with KJD the number of knee replacing procedures could be reduced, most clearly in the younger age categories; especially revision surgery. This resulted in the KJD strategy being dominant (more effective with cost-savings) in about 80% of simulations (with only inferiority in about 1%) in these age categories when compared to TKA. At a willingness to pay of 20.000 Euro per QALY gained, the probability of starting with KJD to be cost-effective compared to starting with a TKA was already found to be over 75% for all age categories and over 90–95% for the younger age categories. Conclusion A treatment strategy starting with knee joint distraction for knee osteoarthritis has a large potential for being a cost-effective intervention, especially for the relatively young patient. PMID:27171268

  14. The influence of knee position on ankle dorsiflexion - a biometric study

    PubMed Central

    2014-01-01

    Background Musculus gastrocnemius tightness (MGT) can be diagnosed by comparing ankle dorsiflexion (ADF) with the knee extended and flexed. Although various measurement techniques exist, the degree of knee flexion needed to eliminate the effect of the gastrocnemius on ADF is still unknown. The aim of this study was to identify the minimal degree of knee flexion required to eliminate the restricting effect of the musculus gastrocnemius on ADF. Methods Bilateral ADF of 20 asymptomatic volunteers aged 18-40 years (50% female) was assessed prospectively at six different degrees of knee flexion (0°, 20°, 30°, 45°, 60°, 75°, Lunge). Tests were performed following a standardized protocol, non weightbearing and weightbearing, by two observers. Statistics comprised of descriptive statistics, t-tests, repeated measurement ANOVA and ICC. Results 20 individuals with a mean age of 27 ± 4 years were tested. No significant side to side differences were observed. The average ADF [95% confidence interval] for non weightbearing was 4° [1°-8°] with the knee extended and 20° [16°-24°] for the knee 75° flexed. Mean weightbearing ADF was 25° [22°-28°] for the knee extended and 39° [36°-42°] for the knee 75° flexed. The mean differences between 20° knee flexion and full extension were 15° [12°-18°] non weightbearing and 13° [11°-16°] weightbearing. Significant differences of ADF were only found between full extension and 20° of knee flexion. Further knee flexion did not increase ADF. Conclusion Knee flexion of 20° fully eliminates the ADF restraining effect of the gastrocnemius. This knowledge is essential to design a standardized clinical examination assessing MGT. PMID:25053374

  15. "Forgotten knee" after total knee replacement: A pragmatic study from a single-centre cohort.

    PubMed

    Eymard, Florent; Charles-Nelson, Anais; Katsahian, Sandrine; Chevalier, Xavier; Bercovy, Michel

    2015-05-01

    After total knee replacement (TKR), some patients find their operated knee totally natural and can be said to have "forgotten" it, while others, although satisfied with their results, remain conscious of their prosthesis. This is not well assessed on conventional end-points. Since 2001, we have studied the prevalence of "forgotten knee" (FK) after TKR in a prospective pragmatic cohort, with comparison to conventional scores. Patients undergoing TKR were enrolled between January 2001 and January 2008. Preoperative medical history and anthropometric and clinical data were recorded, and composite scores (Knee Society Score (KSS), Lequesne) were assessed. At each follow-up visit, FK acquisition was assessed by the closed question "Do you feel the operated knee to be always normal in all everyday activities?". Five hundred and eighty-four TKRs in 485 patients were included. Among the TKR, 91.6% were performed for severe osteoarthritis of the knee. FK frequency at a mean 75.8 months' follow-up was 42.9% while 86.1% of TKRs had excellent (KS Knee Score (KSKS)>80) or 34.9% perfect (KSKS=100) outcome. Only 66.1% of the 204 TKRs with perfect outcome on KSKS were reported as FK. Most patients achieved FK within 18 months. In this prospective study, 42.9% of TKRs were considered always forgotten in all everyday activities. Copyright © 2014 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  16. Patterns of knee osteoarthritis in Arabian and American knees.

    PubMed

    Hodge, W Andrew; Harman, Melinda K; Banks, Scott A

    2009-04-01

    This study illustrates differences in the cartilage degeneration in osteoarthritic knees in patients with more frequent hyperflexion activities of daily living compared with Western patients. Proximal tibial articular cartilage wear and cruciate ligament condition were assessed in Saudi Arabian and North American patients with varus osteoarthritis undergoing total knee arthroplasty. In anterior cruciate ligament (ACL) intact knees, there were significant differences in wear location, with a clearly more anterior pattern in Saudi Arabian knees. Complete ACL deficiency occurred in 25% of North American knees but only 14% of Saudi Arabian knees. These ACL-deficient knees showed the most severe cartilage wear in both groups and posterior medial wear patterns. Biomechanical descriptions of knee flexion and axial rotation during kneeling or squatting are consistent with the more pronounced anteromedial and posterolateral cartilage wear patterns observed on the Saudi Arabian knees. These observations provide insight into altered knee mechanics in 2 culturally different populations with different demands on knee flexion.

  17. Knee Biomechanics During Jogging After Arthroscopic Partial Meniscectomy: A Longitudinal Study.

    PubMed

    Hall, Michelle; Wrigley, Tim V; Metcalf, Ben R; Hinman, Rana S; Cicuttini, Flavia M; Dempsey, Alasdair R; Lloyd, David G; Bennell, Kim L

    2017-07-01

    Altered knee joint biomechanics is thought to play a role in the pathogenesis of knee osteoarthritis and has been reported in patients after arthroscopic partial meniscectomy (APM) while performing various activities. Longitudinally, understanding knee joint biomechanics during jogging may assist future studies to assess the implications of jogging on knee joint health in this population. To investigate knee joint biomechanics during jogging in patients 3 months after APM and a healthy control group at baseline and 2 years later at follow-up. Controlled laboratory study. Seventy-eight patients who underwent medial APM and 38 healthy controls underwent a 3-dimensional motion analysis during barefoot overground jogging at baseline. Sixty-four patients who underwent APM and 23 controls returned at follow-up. External peak moments (flexion and adduction) and the peak knee flexion angle during stance were evaluated for the APM leg, non-APM leg (nonoperated leg), and control leg. At baseline, the peak knee flexion angle was 1.4° lower in the APM leg compared with the non-APM leg ( P = .03). No differences were found between the moments in the APM leg compared with the control leg (all P > .05). However, the normalized peak knee adduction moment was 35% higher in the non-APM leg compared with the control leg ( P = .008). In the non-APM leg, the normalized peak knee adduction and flexion moments were higher compared with the APM leg by 16% and 10%, respectively, at baseline ( P ≤ .004). Despite the increase in the peak knee flexion moment in the APM leg compared with the non-APM leg ( P < .001), there were no differences in the peak knee flexion moment or any other parameter assessed at 2-year follow-up between the legs ( P > .05). Comparing the APM leg and control leg, no differences in knee joint biomechanics during jogging for the variables assessed were observed. Higher knee moments in the non-APM leg may have clinical implications for the noninvolved leg. Kinematic

  18. Reduced knee hyperextension after wearing a robotic knee orthosis during gait training--a case study.

    PubMed

    Mao, Yurong; Lo, Wai Leung; Xu, Guangqing; Li, Leonard Sheungwai; Li, Le; Huang, Dongfeng

    2015-01-01

    This case study describes the effects of a wearable dynamic knee orthosis to supplement walking training in a patient suffering knee hyperextension. The subject was a 57-year old female who was 3.5 years post-brain tumor surgery. She was presented with impaired right lower extremity muscle performance, increased lower extremity muscle tension, and right knee hyperextension. She reported pain at the right knee joint and tibialis anterior after 10 minutes of over-ground walk. Fifteen one-hour sessions of gait training with robotic knee orthosis (RKO) were provided an over 3 weeks period. The subject demonstrated improvement with right lower limb kinematic and kinetic measures of gait. Peak flexion degree and moment increased (from -4.99° to 13.47°, and from 0.18 Nm/kg to 0.20 Nm/kg respectively).Extension peak moment decreased from 1.03 Nm/kg to 0.53 Nm/kg. Knee joint force decreased from 0.68 N to 0.45 N. Ground reaction force (GRF) reduced from 11.06N to 10.11N. Berg Balance Scale (BBS) improved from 45/56 to 51/56. No difference was observed in Fugl-Meyer Assessment of the Lower limb (FMA-LE) scores. Gait training that integrates an intention-based RKO for correcting knee hyperextension can be clinically effective. The persistence and generalizability of these results need to be further investigated.

  19. History of knee injury and MRI-assessed knee structures in middle- and older-aged adults: a cross-sectional study.

    PubMed

    Khan, Hussain Ijaz; Aitken, Dawn; Blizzard, Leigh; Ding, Changhai; Pelletier, Jean-Pierre; Pelletier, Johanne Martel; Cicuttini, Flavia; Jones, Graeme

    2015-08-01

    The aim of this cross-sectional study was to describe the associations between history of knee injury and knee structure using magnetic resonance imaging (MRI). This study included two population-based samples: the Tasmanian Older Adult Cohort (TASOAC) study (n = 430; mean age, 63.0 years; range, 51-79 years; 51 % female) and the Offspring study (n = 372; mean age, 45.0 years; range, 26-61 years; 57.5 % female). In both studies, 1.5 T MRI scans of the right knee were performed to measure bone marrow lesions (BMLs), cartilage volume, tibial bone area, cartilage defects and meniscal pathology. History of knee injury was assessed using a self-administered questionnaire. The association between knee injury and knee structure was determined using multiple linear and log binomial regression models. Nineteen percent of the middle-aged and 12 % of the older adults reported a history of knee injury. In middle-aged adults, BML presence (prevalence ratio (PR) = 1.6 (95 % CI, 1.2; 2.1)), tibial bone area (difference of means (DM) = +86 (+23, +149)) and meniscal extrusion presence (PR = 2.7 (1.1, 6.8)) were significantly higher in those with knee injury. In older adults, cartilage defect presence (PR = 1.3 (1.0, 1.7)), lateral (DM = -265 (-439, -92)) and total tibial (DM = -325 (-600, -51)) cartilage volume, BML presence (PR = 1.4 (1.0, 1.9)) and tibial bone area (DM = +140 (+19, +260)) were significantly associated with knee injury. Meniscal tears showed no significant associations in either cohorts. The association between knee injury and MRI-assessed structural pathology in the knee joint is moderate and appears to be stronger in older adults compared to middle-aged adults.

  20. Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial.

    PubMed

    van der Woude, J A D; Wiegant, K; van Heerwaarden, R J; Spruijt, S; van Roermund, P M; Custers, R J H; Mastbergen, S C; Lafeber, F P J G

    2017-03-01

    Both, knee joint distraction as a relatively new approach and valgus-producing opening-wedge high tibial osteotomy (HTO), are knee-preserving treatments for knee osteoarthritis (OA). The efficacy of knee joint distraction compared to HTO has not been reported. Sixty-nine patients with medial knee joint OA with a varus axis deviation of <10° were randomized to either knee joint distraction (n = 23) or HTO (n = 46). Questionnaires were assessed at baseline and 3, 6, and 12 months. Joint space width (JSW) as a surrogate measure for cartilage thickness was determined on standardized semi-flexed radiographs at baseline and 1-year follow-up. All patient-reported outcome measures (PROMS) improved significantly over 1 year (at 1 year p < 0.02) in both groups. At 1 year, the HTO group showed slightly greater improvement in 4 of the 16 PROMS (p < 0.05). The minimum medial compartment JSW increased 0.8 ± 1.0 mm in the knee joint distraction group (p = 0.001) and 0.4 ± 0.5 mm in the HTO group (p < 0.001), with minimum JSW improvement in favour of knee joint distraction (p = 0.05). The lateral compartment showed a small increase in the knee joint distraction group and a small decrease in the HTO group, leading to a significant increase in mean JSW for knee joint distraction only (p < 0.02). Cartilaginous repair activity, as indicated by JSW, and clinical outcome improvement occurred with both, knee joint distraction and HTO. These findings suggest that knee joint distraction may be an alternative therapy for medial compartmental OA with a limited mechanical leg malalignment. Randomized controlled trial, Level I.

  1. Knee rotation associated with dynamic knee valgus and toe direction.

    PubMed

    Ishida, Tomoya; Yamanaka, Masanori; Takeda, Naoki; Aoki, Yoshimitsu

    2014-03-01

    Dynamic knee valgus contributes to injuries of the anterior cruciate ligament (ACL). However, it is unclear how the knee rotates during dynamic knee valgus. Knee rotation significantly affects ACL strain. To understand knee rotation during dynamic knee valgus should help the clinician evaluate dynamic alignment. The purpose of this study was to determine how the knee rotates during dynamic knee valgus and whether the knee rotation is affected by toe direction (foot rotation). Sixteen females performed dynamic knee valgus in three toe directions (neutral, toe-out, and toe-in) while maintaining the knee flexion angle at 30°. The knee rotation angle was evaluated using a 7-camera motion analysis system. Knee rotation was compared between the start position and the dynamic knee valgus position, as well as among the three toe directions, using repeated measures ANOVA models. The knee significantly rotated externally in the dynamic knee valgus position compared with the start position in two toe directions (neutral and toe-out). A similar tendency was observed with the toe-in condition. Toe direction significantly affected the knee rotation angle. For toe-out and toe-in conditions, external and internal shifts of knee rotation compared with neutral were observed. The knee rotates externally during dynamic knee valgus, and the knee rotation is affected by toe direction. Because of knee abduction and external rotation, the ACL may impinge on the femoral condyle in the case of dynamic valgus, especially in the toe-out position. Copyright © 2012 Elsevier B.V. All rights reserved.

  2. Comparative Effectiveness of Tai Chi Versus Physical Therapy for Knee Osteoarthritis: A Randomized Trial.

    PubMed

    Wang, Chenchen; Schmid, Christopher H; Iversen, Maura D; Harvey, William F; Fielding, Roger A; Driban, Jeffrey B; Price, Lori Lyn; Wong, John B; Reid, Kieran F; Rones, Ramel; McAlindon, Timothy

    2016-07-19

    Few remedies effectively treat long-term pain and disability from knee osteoarthritis. Studies suggest that Tai Chi alleviates symptoms, but no trials have directly compared Tai Chi with standard therapies for osteoarthritis. To compare Tai Chi with standard physical therapy for patients with knee osteoarthritis. Randomized, 52-week, single-blind comparative effectiveness trial. (ClinicalTrials.gov: NCT01258985). An urban tertiary care academic hospital. 204 participants with symptomatic knee osteoarthritis (mean age, 60 years; 70% women; 53% white). Tai Chi (2 times per week for 12 weeks) or standard physical therapy (2 times per week for 6 weeks, followed by 6 weeks of monitored home exercise). The primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 12 weeks. Secondary outcomes included physical function, depression, medication use, and quality of life. At 12 weeks, the WOMAC score was substantially reduced in both groups (Tai Chi, 167 points [95% CI, 145 to 190 points]; physical therapy, 143 points [CI, 119 to 167 points]). The between-group difference was not significant (24 points [CI, -10 to 58 points]). Both groups also showed similar clinically significant improvement in most secondary outcomes, and the benefits were maintained up to 52 weeks. Of note, the Tai Chi group had significantly greater improvements in depression and the physical component of quality of life. The benefit of Tai Chi was consistent across instructors. No serious adverse events occurred. Patients were aware of their treatment group assignment, and the generalizability of the findings to other settings remains undetermined. Tai Chi produced beneficial effects similar to those of a standard course of physical therapy in the treatment of knee osteoarthritis. National Center for Complementary and Integrative Health of the National Institutes of Health.

  3. Comparative Effectiveness of Tai Chi Versus Physical Therapy for Knee Osteoarthritis

    PubMed Central

    Wang, Chenchen; Schmid, Christopher H.; Iversen, Maura D.; Harvey, William F.; Fielding, Roger A.; Driban, Jeffrey B.; Price, Lori Lyn; Wong, John B.; Reid, Kieran F.; Rones, Ramel; McAlindon, Timothy

    2016-01-01

    Background Few remedies effectively treat long-term pain and disability from knee osteoarthritis. Studies suggest that Tai Chi alleviates symptoms, but no trials have directly compared Tai Chi with standard therapies for osteoarthritis. Objective To compare Tai Chi with standard physical therapy for patients with knee osteoarthritis. Design Randomized, 52-week, single-blind comparative effectiveness trial. (ClinicalTrials.gov: NCT01258985) Setting An urban tertiary care academic hospital. Patients 204 participants with symptomatic knee osteoarthritis (mean age, 60 years; 70% women; 53% white). Intervention Tai Chi (2 times per week for 12 weeks) or standard physical therapy (2 times per week for 6 weeks, followed by 6 weeks of monitored home exercise). Measurements The primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 12 weeks. Secondary outcomes included physical function, depression, medication use, and quality of life. Results At 12 weeks, the WOMAC score was substantially reduced in both groups (Tai Chi, 167 points [95% CI, 145 to 190 points]; physical therapy, 143 points [CI, 119 to 167 points]). The between-group difference was not significant (24 points [CI, −10 to 58 points]). Both groups also showed similar clinically significant improvement in most secondary outcomes, and the benefits were maintained up to 52 weeks. Of note, the Tai Chi group had significantly greater improvements in depression and the physical component of quality of life. The benefit of Tai Chi was consistent across instructors. No serious adverse events occurred. Limitation Patients were aware of their treatment group assignment, and the generalizability of the findings to other settings remains undetermined. Conclusion Tai Chi produced beneficial effects similar to those of a standard course of physical therapy in the treatment of knee osteoarthritis. Primary Funding Source National Center for Complementary and Integrative Health of

  4. Premorbid knee osteoarthritis is not characterised by diffuse thinness: the Framingham Osteoarthritis Study

    PubMed Central

    Hunter, D J; Niu, J B; Zhang, Y; LaValley, M; McLennan, C E; Hudelmaier, M; Eckstein, F; Felson, D T

    2013-01-01

    Objective It is hypothesised that, like low bone density and fracture, thin cartilage predisposes to osteoarthritis (OA). Inferences about the effects of cartilage thickness on the development of OA can be made by evaluating the status of an unaffected non-diseased contralateral knee, in persons with unilateral OA, which we shall label the “premorbid knee”. The primary objective of this analysis was to compare cartilage thickness in premorbid knees with non-OA knees drawn from persons without any knee OA to determine if cartilage in the premorbid knee was thinner than in the knee drawn from someone without OA in either knee. Methods From 2002 to 2005, The Framingham Osteoarthritis Study recruited subjects without respect to OA from the community. We obtained posteroanterior, semiflexed and lateral films of both knees and knee magnetic resonance imaging to quantify cartilage volume in one knee. The cartilage plates of the patella, medial and lateral femur, medial and lateral tibia were quantified, using a 3D FLASH-water excitation sequence (in plane resolution 0.3×0.3 mm, 512 matrix, slice thickness 1.5 mm) and digital post-processing, involving three-dimensional reconstruction. Radiographs were used to define the OA status of knees with disease defined as Kellgren and Lawrence grade ≥2 and or patellofemoral OA on the lateral film. Of 1020 participants included in this analysis, 720 had no OA in either knee (no-knee OA sample), and 55 subjects had no OA in the knee that was examined using magnetic resonance imaging and OA in the contralateral knee (premorbid knee OA sample). We compared cartilage thickness and percentage of cartilage coverage (total bone interface covered with cartilage) between these groups. After initial plate-specific univariate comparisons we performed a multiple regression to assess the association between OA status (premorbid versus no OA knee) and cartilage thickness adjusting for age, sex and body mass index. We used the Generalised

  5. Pre-radiographic MRI findings are associated with onset of knee symptoms: the most study

    PubMed Central

    Javaid, M. K.; Lynch, J. A.; Tolstykh, I.; Guermazi, A.; Roemer, F.; Aliabadi, P.; McCulloch, C.; Curtis, J.; Felson, D.; Lane, N. E.; Torner, J.; Nevitt, M.

    2010-01-01

    Summary Objective Magnetic resonance imaging (MRI) has greater sensitivity to detect osteoarthritis (OA) damage than radiographs but it is uncertain which MRI findings in early OA are clinically important. We examined MRI abnormalities detected in knees without radiographic OA and their association with incident knee symptoms. Method Participants from the Multicenter Osteoarthritis Study (MOST) without frequent knee symptoms (FKS) at baseline were eligible if they also lacked radiographic features of OA at baseline. At 15 months, knees that developed FKS were defined as cases while control knees were drawn from those that remained without FKS. Baseline MRIs were scored at each subregion for cartilage lesions (CARTs); osteophytes (OST); bone marrow lesions (BML) and cysts. We compared cases and controls using marginal logistic regression models, adjusting for age, gender, race, body mass index (BMI), previous injury and clinic site. Results 36 case knees and 128 control knees were analyzed. MRI damage was common in both cases and controls. The presence of a severe CART (P = 0.03), BML (P = 0.02) or OST (P = 0.02) in the whole knee joint was more common in cases while subchondral cysts did not differ significantly between cases and controls (P > 0.1). Case status at 15 months was predicted by baseline damage at only two locations; a BML in the lateral patella (P = 0.047) and at the tibial subspinous subregions (P = 0.01). Conclusion In knees without significant symptoms or radiographic features of OA, MRI lesions of OA in only a few specific locations preceded onset of clinical symptoms and suggest that changes in bone play a role in the early development of knee pain. Confirmation of these findings in other prospective studies of knee OA is warranted. PMID:19919856

  6. A comparative analysis between fixed bearing total knee arthroplasty (PFC Sigma) and rotating platform total knee arthroplasty (PFC-RP) with minimum 3-year follow-up.

    PubMed

    Jawed, Akram; Kumar, Vijay; Malhotra, R; Yadav, C S; Bhan, S

    2012-06-01

    Since the introduction of mobile bearing total knee designs nearly 30 years back, many studies have been done to evaluate its long-term result. Comparison with fixed bearing designs has been done in the past, but the studies were confounded by variables such as disease, surgeon, bone quality, pain tolerance, etc. We attempt to eliminate these variables in this study. A total of 50 patients who had bilateral arthritis of the knee with similar deformity and pre-operative range of motion on both sides agreed to have one knee replaced with mobile bearing total knee design (PFC-RP) and the other with a fixed bearing design (PFC Sigma) were prospectively evaluated. Comparative analysis of both the designs was done at a mean follow-up of 40 months, minimizing patient, surgeon and observer related bias. Clinical and radiographic outcome, survival and complication rates were compared. At a mean follow-up of 40 months (range 36-47 months), no benefit of mobile bearing (PFC-RP) over fixed bearing design (PFC Sigma) could be demonstrated with respect to Knee Society scores, pain scores, range of flexion, subject preference or patello-femoral complication rates. Radiographs showed no difference in prosthetic alignment. No patient required a revision surgery till last follow-up. Our study demonstrated no advantage of the mobile-bearing arthroplasty over fixed bearing arthroplasty with regard to clinical results at short-term follow-up. However, longer follow-up is necessary to confirm whether these results are sustained.

  7. Immobilisation of the knee and ankle and its impact on drivers' braking times: a driving simulator study.

    PubMed

    Waton, A; Kakwani, R; Cooke, N J; Litchfield, D; Kok, D; Middleton, H; Irwin, L

    2011-07-01

    The purpose of this study was to investigate the effects of right leg restriction at the knee, ankle or both, on a driver's braking times. Previous studies have not investigated the effects of knee restriction on braking performance. A total of 23 healthy drivers performed a series of emergency braking tests in a driving simulator in either an above-knee plaster cast, a below-knee cast, or in a knee brace with an increasing range of restriction. The study showed that total braking reaction time was significantly longer when wearing an above-knee plaster cast, a below-knee plaster cast or a knee brace fixed at 0°, compared with braking normally (p < 0.001). Increases in the time taken to move the foot from the accelerator to the brake accounted for some of the increase in the total braking reaction time. Unexpectedly, thinking time also increased with the level of restriction (p < 0.001). The increase in braking time with an above-knee plaster cast in this study would increase the stopping distance at 30 miles per hour by almost 3 m. These results suggest that all patients wearing any lower-limb plaster cast or knee brace are significantly impaired in their ability to perform an emergency stop. We suggest changes to the legislation to prevent patients from driving with lower-limb plaster casts or knee braces.

  8. Unicompartmental knee prosthesis implantation with a non-image-based navigation system: rationale, technique, case-control comparative study with a conventional instrumented implantation.

    PubMed

    Jenny, Jean-Yves; Boeri, Cyril

    2003-01-01

    The accuracy of implantation is an accepted prognostic factor for the long-term survival of unicompartmental knee prostheses (UKP). We developed a non-image-guided navigation system for UKP implantation without any extramedullary or intramedullary guiding device. The 30 patients operated on with the navigation system (group A) were matched to 30 patients operated on with the conventional technique (group B) using age, sex, body mass index, preoperative coronal mechanical femorotibial angle, and severity of the preoperative degenerative changes. All patients had a complete radiological examination in the first 3 months after the index procedure, with anteroposterior and lateral plain knee radiographs and anteroposterior and lateral long leg radiographs. Coronal femorotibial mechanical angle and both coronal and sagittal orientations of the femoral and tibial components were measured. There were no significant differences in the mean numerical values of all measured angles except for the sagittal orientation of the tibial component, with a significant excessive posterior tibial slope in group B. There was a significant increase in the rate of prostheses implanted in the desired angular range for all criteria except the coronal mechanical femorotibial angle in group A. An optimal implantation with all optimal items was obtained by 18 cases in group A and 6 cases in group B. Navigated implantation of a UKP with the used, non-image-based system improved the accuracy of the radiological implantation without any significant inconvenience and with little change in the conventional operative technique. The only inconvenience was a 20-min longer operative time. This improvement could be related to a longer survival of such implanted prostheses.

  9. Olympic weightlifting training causes different knee muscle-coactivation adaptations compared with traditional weight training.

    PubMed

    Arabatzi, Fotini; Kellis, Eleftherios

    2012-08-01

    The purpose of this study was to compare the effects of an Olympic weightlifting (OL) and traditional weight (TW) training program on muscle coactivation around the knee joint during vertical jump tests. Twenty-six men were assigned randomly to 3 groups: the OL (n = 9), the TW (n = 9), and Control (C) groups (n = 8). The experimental groups trained 3 d · wk(-1) for 8 weeks. Electromyographic (EMG) activity from the rectus femoris and biceps femoris, sagittal kinematics, vertical stiffness, maximum height, and power were collected during the squat jump, countermovement jump (CMJ), and drop jump (DJ), before and after training. Knee muscle coactivation index (CI) was calculated for different phases of each jump by dividing the antagonist EMG activity by the agonist. Analysis of variance showed that the CI recorded during the preactivation and eccentric phases of all the jumps increased in both training groups. The OL group showed a higher stiffness and jump height adaptation than the TW group did (p < 0.05). Further, the OL showed a decrease or maintenance of the CI recorded during the propulsion phase of the CMJ and DJs, which is in contrast to the increase in the CI observed after TW training (p < 0.05). The results indicated that the altered muscle activation patterns about the knee, coupled with changes of leg stiffness, differ between the 2 programs. The OL program improves jump performance via a constant CI, whereas the TW training caused an increased CI, probably to enhance joint stability.

  10. Knee joint laxity and passive stiffness in meniscectomized patients compared with healthy controls.

    PubMed

    Thorlund, Jonas B; Creaby, Mark W; Wrigley, Tim V; Metcalf, Ben R; Bennell, Kim L

    2014-10-01

    Passive mechanical behavior of the knee in the frontal plane, measured as angular laxity and mechanical stiffness, may play an important role in the pathogenesis of knee osteoarthritis (OA). Little is known about knee laxity and stiffness prior to knee OA onset. We investigated knee joint angular laxity and passive stiffness in meniscectomized patients at high risk of knee OA compared with healthy controls. Sixty patients meniscectomized for a medial meniscal tear (52 men, 41.4 ± 5.5 years, 175.3 ± 7.9 cm, 83.6 ± 12.8 kg, mean ± SD) and 21 healthy controls (18 men, 42.0 ± 6.7 years, 176.8 ± 5.7 cm, 77.8 ± 13.4 kg) had their knee joint angular laxity and passive stiffness assessed twice ~2.3 years apart. Linear regression models including age, sex, height and body mass as covariates in the adjusted model were used to assess differences between groups. Greater knee joint varus (-10.1 vs. -7.3°, p<0.001), valgus (7.1 vs. 5.6°, p=0.001) and total (17.2 vs. 12.9°, p<0.001) angular laxity together with reduced midrange passive stiffness (1.71 vs. 2.36 Nm/°, p<0.001) were observed in patients vs. healthy controls. No differences were observed in change in stiffness over time between patients and controls, however a tendency towards increased laxity in patients was seen. Meniscectomized patients showed increased knee joint angular laxity and reduced passive stiffness ~3 months post surgery compared with controls. In addition, the results indicated that knee joint laxity may increase over time in meniscectomized patients. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Effects of methods of descending stairs forwards versus backwards on knee joint force in patients with osteoarthritis of the knee: a clinical controlled study.

    PubMed

    Hasegawa, Masaki; Chin, Takaaki; Oki, Sadaaki; Kanai, Shusaku; Shimatani, Koji; Shimada, Tomoaki

    2010-06-11

    The aim of this study was to investigate the kinetic characteristics of compensatory backward descending movement performed by patients with osteoarthritis of the knee. Using a three-dimensional motion analysis system, we investigated lower extremity joint angles, joint moments, joint force of the support leg in forward and backward descending movements on stairs, and joint force of the leading leg at landing in 7 female patients with osteoarthritis of the knee. Compared with the forward descending movement, knee joint angle, joint moment and joint force of the support leg all decreased in the backward descending movement. Joint force of the leading leg at landing was also reduced in the backward descending movement. In addition, we confirmed that the center of body mass was mainly controlled by the knee and ankle joints in the forward descending movement, and by the hip joint in the backward descending movement. Since it has been reported that knee flexion angle and extensor muscle strength are decreased in patients with osteoarthritis of the knee, we believe that backward descending movement is an effective method to use the hip joint to compensate for these functional defects. In addition, due to the decreased knee joint force both in the leading and support legs in backward descending movement, the effectiveness of compensatory motion for pain control and knee joint protection was also suggested.

  12. In vivo knee laxity in flexion and extension: a radiographic study in 30 older healthy subjects.

    PubMed

    Heesterbeek, P J C; Verdonschot, N; Wymenga, A B

    2008-01-01

    In order to determine how "tight" a total knee prosthesis should be implanted, it is important to know the amount of laxity in a healthy knee. The objective of this study was to determine knee laxity in extension and flexion in healthy, non-arthritic knees of subjects similar in age to patients undergoing a total knee arthroplasty and to provide guidelines for the orthopaedic surgeon in his attempt to restore the stability of an osteoarthritic knee to normal. Thirty healthy subjects (15 male, 15 female), mean age 62 (SD 6.4) years, were included in the study. For each subject one, randomly selected, knee was stressed in extension and in 70 degrees flexion (15 Nm). Varus and valgus laxity were measured on radiographs. The passive range of motion and active flexion was assessed. Mean valgus laxity in extension was 2.3 degrees (SD 0.9, range 0.2 degrees -4.1 degrees ). In extension mean varus laxity was 2.8 degrees (SD 1.3, range 0.6 degrees -5.4 degrees ). In flexion, mean valgus laxity was 2.5 degrees (SD 1.5, range 0.0 degrees -6.0 degrees ) and mean varus laxity was 3.1 degrees (SD 2.0, range 0.1 degrees -7.0 degrees ). Varus and valgus knee laxity in extension and in flexion were comparable. This study shows that the normal knee in this age group has an inherent degree of varus-valgus laxity. Whether the results of the present study can be used to optimise the total knee arthroplasty implantation technique requires further investigation.

  13. Individual magnetic resonance imaging and radiographic features of knee osteoarthritis in subjects with unilateral knee pain: the health, aging, and body composition study.

    PubMed

    Javaid, M K; Kiran, A; Guermazi, A; Kwoh, C K; Zaim, S; Carbone, L; Harris, T; McCulloch, C E; Arden, N K; Lane, N E; Felson, D; Nevitt, M

    2012-10-01

    Strong associations between radiographic features of knee osteoarthritis (OA) and pain have been demonstrated in persons with unilateral knee symptoms. This study was undertaken to compare radiographic and magnetic resonance imaging (MRI) features of knee OA and assess their ability to discriminate between painful and nonpainful knees in persons with unilateral symptoms. The study population included 283 individuals ages 70-79 years with unilateral knee pain who were enrolled in the Health, Aging, and Body Composition Study, a study of weight-related diseases and mobility. Radiographs of both knees were read for Kellgren/Lawrence (K/L) grade and individual radiographic features, and 1.5T MRIs were assessed using the Whole-Organ Magnetic Resonance Imaging Score. The association between structural features and pain was assessed using a within-person case-control design and conditional logistic regression. Receiver operating characteristic (ROC) analysis was then used to test the discriminatory performance of structural features. In conditional logistic analyses, knee pain was significantly associated with both radiographic features (any joint space narrowing grade ≥ 1) (odds ratio 3.20 [95% confidence interval 1.79-5.71]) and MRI features (any cartilage defect scored ≥ 2) (odds ratio 3.67 [95% confidence interval 1.49-9.04]). However, in most subjects, MRI revealed osteophytes and cartilage and bone marrow lesions in both knees, and using ROC analysis, no individual structural feature discriminated well between painful and nonpainful knees. The best-performing MRI feature (synovitis/effusion) was not significantly more informative than K/L grade ≥ 2 (P = 0.42). In persons with unilateral knee pain, MRI and radiographic features were associated with knee pain, confirming that structural abnormalities in the knee have an important role in the etiology of pain. However, no single MRI or radiographic finding performed well in discriminating between painful and

  14. The Transseptal Arthroscopic Knee Portal Is in Close Proximity to the Popliteal Artery: A Cadaveric Study.

    PubMed

    Cancienne, Jourdan M; Werner, Brian C; Burrus, M Tyrrell; Kandil, Abdurrahman; Conte, Evan J; Gwathmey, Frank W; Miller, Mark D

    2017-03-10

    The purpose of this study was to use fluoroscopy to measure the distance between the transseptal portal and the popliteal artery under arthroscopic conditions with an intact posterior knee capsule, and to determine the difference between 90 degrees of knee flexion and full extension. The popliteal artery of eight fresh-frozen cadaveric knees was dissected and cannulated proximal to the knee joint. The posterolateral, posteromedial, and transseptal portals were then established at 90 degrees of flexion. A 4-mm switching stick was placed through the transseptal portal, and barium contrast was injected into the popliteal artery. A lateral fluoroscopic image was taken with the knee in 90 degrees of flexion and full extension, and the distance between the popliteal artery and the switching stick was measured and compared using a paired t-test. In knee flexion, the average distance between the transseptal portal and the anterior aspect of the popliteal artery for the eight cadaveric specimens was 12.0 mm ± 3.3 mm; in extension, this decreased to 9.0 mm ± 2.7 mm. The distance between the transseptal portal and popliteal artery was significantly higher at 90 degrees of knee flexion as compared with extension (p = 0.0005). The transseptal posterior knee arthroscopic portal must be carefully created due to the close proximity to the popliteal artery, and may be closer to the artery than previously reported in specimens with an intact posterior knee capsule. Creating the portal with the knee in flexion significantly displaces the popliteal artery away from the portal reducing the risk of arterial injury.

  15. Associations of isokinetic and isotonic knee strength with knee function and activity level after anterior cruciate ligament reconstruction: a prospective cohort study.

    PubMed

    Pua, Yong-Hao; Ho, Jia-Ying; Chan, Suelyn Ai-Sim; Khoo, Shin-Jiun; Chong, Hwei-Chi

    2017-07-21

    Although isokinetic dynamometry often serves as a reference to assess the concurrent validity of weight-machine isotonic strength testing, it is unknown whether isokinetic knee strength is associated with knee function and activity level more strongly than isotonic knee strength in patients with an anterior cruciate ligament reconstruction (ACLR). This study aimed to compare the associations of isokinetic and isotonic knee strength with knee function and work-and-sports activity levels in patients with ACLR. One-hundred and six patients with a unilateral ACLR participated. At three months post-ACLR, isokinetic quadriceps and hamstrings strength was measured using an isokinetic dynamometer whilst isotonic strength was measured using weight machines. At six months post-ACLR, patients performed the single-leg hop-for-distance test. Self reported knee function and work-and-sports activity levels were assessed by the Lysholm Knee Score and Tegner Activity Score, respectively. In multivariable analyses, isotonic and isokinetic quadriceps strength limb symmetry indices (LSIs) were significantly associated with all outcomes (P≤0.03) and had comparable predictive performance. Isotonic and isokinetic hamstrings strength LSIs were significantly associated with Lysholm scores (P≤0.03) and isotonic hamstrings strength was additionally significantly associated with hop-for-distance LSI (P=0.01). Weight machine-derived isotonic quadriceps strength was independently and consistently associated with knee function and work-and-sport activity level post-ACLR. Isokinetic knee strength was not more strongly associated than isotonic knee strength with the various outcomes. These findings have logistic and economic implications because the isokinetic dynamometer system is relatively expensive and its operation requires more logistic effort and technical skills. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Knee injuries and the use of prophylactic knee bracing in off-road motorcycling: results of a large-scale epidemiological study.

    PubMed

    Sanders, Mark S; Cates, Robert A; Baker, Michael D; Barber-Westin, Sue D; Gladin, Wesley M; Levy, Martin S

    2011-07-01

    The effectiveness of prophylactic knee bracing in preventing knee injuries during sports has been evaluated; however, because of the variability in study conclusions, the topic remains controversial. Despite a paucity of data, the authors believe that prophylactic knee bracing is frequently used in off-road motorcycling. No statistically significant difference exists in the frequency and types of knee injuries incurred between braced and nonbraced riders using commercially available knee braces in off-road motorcycling. Descriptive epidemiology study. Data from 2115 off-road motorcycle riders was obtained using an Internet-based survey over a 1-year period. Participants were grouped by use or nonuse of prophylactic knee bracing, and an incidence rate ratio was used for injury rate comparison. Participants recorded 39 611 riding hours over the study period. A total of 57 riders (2.7%) sustained at least 1 knee injury, for a total of 89 injuries. The most common injuries involved the anterior cruciate ligament, menisci, and medial collateral ligament. There was a significantly higher rate of overall injuries in the nonbraced group versus the braced group (3.675 vs 1.587 per 1000 rider hours, P < .001). Significantly higher incidence rates of anterior cruciate ligament rupture (1.518 vs 0.701 per 1000 rider hours, P = .0274) and medial collateral ligament injury (0.799 vs 0.111 per 1000 rider hours, P = .002) were found among nonbraced riders compared with braced riders. The most common knee injuries in off-road motorcycling involve the anterior cruciate ligament, menisci, and medial collateral ligament. The use of prophylactic knee bracing appears to have a beneficial effect in preventing medial collateral ligament and anterior cruciate ligament injuries as well as overall knee injury occurrence. These findings may be applicable to other sports that involve similar forces and mechanics.

  17. Comparing the efficacy of intra-articular application of morphine and tramadol on postoperative pain after arthroscopic knee surgery.

    PubMed

    Jazayeri, Seyed Mohammad; Mosaffa, Faramarz; Abbasian, Mohammadreza; Hosseinzadeh, Hamid Reza

    2012-01-01

    Intra-articular analgesia is a pain reliever that is frequently administered following arthroscopic knee surgery. The purpose of this study was to compare the efficacy of intra-articular application of morphine and tramadol on postoperative pain after arthroscopic knee surgery. For this randomized double blinded clinical trial, 132 patients undergoing minor arthroscopic knee surgery were randomly assigned to receive either; 5 mg morphine or 50 mg tramadol intra-articularly. Pain was evaluated by means of the verbal pain rating score (VRS) preoperatively (at rest and on movement of the knee joint) and postoperatively at 0, 1, 2, 3, 4, 6, 12 and 24 hours. Meanwhile, the time of the first analgesic request and need for supplemental analgesic were also recorded. There was no statistically significant difference in VRS scoring between the two groups during the preoperative period either at rest or on knee movement. Meanwhile, VRS scores did not differ significantly between the morphine and tramadol treated groups postoperatively, except for in the one-hour post-operative scores in which the tramadol-treated group experienced less pain (P < 0.007). Post-operative VRS scores at 6, 12, and 24 hours were significantly decreased when compared with previous scores in both morphine and tramadol prescribed subjects (P < 0.001), hence, both local analgesics can significantly reduce pain after minor knee surgery. We have found a postoperative analgesic effect of intra-articularly administered morphine and tramadol following minor arthroscopic knee surgeries with a maximum effect 6 hours post injection.

  18. Comparing the Efficacy of Intra-Articular Application of Morphine and Tramadol on Postoperative Pain After Arthroscopic Knee Surgery

    PubMed Central

    Jazayeri, Seyed Mohammad; Mosaffa, Faramarz; Abbasian, Mohammadreza; Hosseinzadeh, Hamid Reza

    2012-01-01

    Background: Intra-articular analgesia is a pain reliever that is frequently administered following arthroscopic knee surgery. Objectives: The purpose of this study was to compare the efficacy of intra-articular application of morphine and tramadol on postoperative pain after arthroscopic knee surgery. Patients and Methods: For this randomized double blinded clinical trial, 132 patients undergoing minor arthroscopic knee surgery were randomly assigned to receive either; 5 mg morphine or 50 mg tramadol intra-articularly. Pain was evaluated by means of the verbal pain rating score (VRS) preoperatively (at rest and on movement of the knee joint) and postoperatively at 0, 1, 2, 3, 4, 6, 12 and 24 hours. Meanwhile, the time of the first analgesic request and need for supplemental analgesic were also recorded. Results: There was no statistically significant difference in VRS scoring between the two groups during the preoperative period either at rest or on knee movement. Meanwhile, VRS scores did not differ significantly between the morphine and tramadol treated groups postoperatively, except for in the one-hour post-operative scores in which the tramadol-treated group experienced less pain (P < 0.007). Post-operative VRS scores at 6, 12, and 24 hours were significantly decreased when compared with previous scores in both morphine and tramadol prescribed subjects (P < 0.001), hence, both local analgesics can significantly reduce pain after minor knee surgery. Conclusions: We have found a postoperative analgesic effect of intra-articularly administered morphine and tramadol following minor arthroscopic knee surgeries with a maximum effect 6 hours post injection. PMID:24223330

  19. Gait patterns during different walking conditions in older adults with and without knee osteoarthritis--results from the Baltimore Longitudinal Study of Aging.

    PubMed

    Ko, Seung-uk; Ling, Shari M; Schreiber, Catherine; Nesbitt, Mark; Ferrucci, Luigi

    2011-02-01

    Biomechanical analysis of lower extremity activities while walking at different speeds and in challenging conditions may help to identify specific gait patterns associated with knee osteoarthritis (knee-OA). We hypothesized that individuals with asymptomatic knee-OA have lower ankle activity, while individuals with symptomatic knee-OA have similar or higher ankle activity compared to individuals without knee-OA, and that such differences are enhanced during challenging gait tasks. We tested this hypothesis by examining gait characteristics in multiple gait tasks using data from 153 Baltimore Longitudinal Study of Aging (BLSA) participants (112 without knee-OA, 41 with knee-OA; 53-87 years, 52% women). All participants who could walk unassisted were evaluated in the BLSA gait lab while walking at self-selected speed (usual-walking), at maximum speed (fast-walking) and again at self-selected speed after 30-min of walking activities (usual-walking-after-30 min). Knee range of motion was lower for knee-OA participants in the fast-walking and usual-walking-after-30 min tasks (p<0.030). Ankle range of motion for symptomatic knee-OA was greater compared to asymptomatic knee-OA for all walking tasks (p<0.050). Symptomatic knee-OA had greater generative MWE of the ankle compared to asymptomatic knee-OA (p=0.034), while keeping similar absorptive MWE of the knee when compared to no-OA controls (p=0.151). Symptomatic knee-OA individuals seem to adapt an ankle kinematic gait pattern aimed at avoiding knee pain, by enhancing forward propulsion so to minimize knee joint load. Whether these conditions represent subsequent steps in the causal pathway from knee-OA to changes in gait is still not clear.

  20. International Comparative Evaluation of Knee Replacement with Fixed or Mobile-Bearing Posterior-Stabilized Prostheses

    PubMed Central

    Graves, Stephen; Sedrakyan, Art; Baste, Valborg; Gioe, Terence J.; Namba, Robert; Cruz, Olga Martínez; Stea, Susanna; Paxton, Elizabeth; Banerjee, Samprit; Isaacs, Abby J.; Robertsson, Otto

    2014-01-01

    Background: Posterior-stabilized total knee prostheses were introduced to address instability secondary to loss of posterior cruciate ligament function, and they have either fixed or mobile bearings. Mobile bearings were developed to improve the function and longevity of total knee prostheses. In this study, the International Consortium of Orthopaedic Registries used a distributed health data network to study a large cohort of posterior-stabilized prostheses to determine if the outcome of a posterior-stabilized total knee prosthesis differs depending on whether it has a fixed or mobile-bearing design. Methods: Aggregated registry data were collected with a distributed health data network that was developed by the International Consortium of Orthopaedic Registries to reduce barriers to participation (e.g., security, proprietary, legal, and privacy issues) that have the potential to occur with the alternate centralized data warehouse approach. A distributed health data network is a decentralized model that allows secure storage and analysis of data from different registries. Each registry provided data on mobile and fixed-bearing posterior-stabilized prostheses implanted between 2001 and 2010. Only prostheses associated with primary total knee arthroplasties performed for the treatment of osteoarthritis were included. Prostheses with all types of fixation were included except for those with the rarely used reverse hybrid (cementless tibial and cemented femoral components) fixation. The use of patellar resurfacing was reported. The outcome of interest was time to first revision (for any reason). Multivariate meta-analysis was performed with linear mixed models with survival probability as the unit of analysis. Results: This study includes 137,616 posterior-stabilized knee prostheses; 62% were in female patients, and 17.6% had a mobile bearing. The results of the fixed-effects model indicate that in the first year the mobile-bearing posterior-stabilized prostheses had

  1. Outcome of Unicondylar Knee Arthroplasty vs Total Knee Arthroplasty for Early Medial Compartment Arthritis: A Randomized Study.

    PubMed

    Kulshrestha, Vikas; Datta, Barun; Kumar, Santhosh; Mittal, Gaurav

    2017-05-01

    With increasing number of patients with early osteoarthritis of knee opting for total knee arthroplasty (TKA), there has been increase in patients dissatisfied with surgical outcomes. It is being presumed that offering unicondylar knee arthroplasty (UKA) to them would improve outcomes. Primary objective of our study was to look for any difference in patient-reported outcome and function at 2-year follow-up in patients undergoing UKA as compared to TKA. Our study was a randomized study with parallel assignment conducted at a high-volume specialized arthroplasty center. Eighty patients with bilateral isolated medial compartment knee arthritis were randomized into simultaneous 2-team bilateral TKA (n = 40) and UKA (n = 40) group. We finally analyzed 36 patients in each group. Main outcome measure was improvement in Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and High Activity Arthroplasty Score (HAAS) obtained at 2-year follow-up. Improvement in KOS-ADLS and HAAS at 2 years was similar (P = .2143 and .2010) in both groups. Performance as assessed with Delaware index was also similar. Length of hospital stay was less in UKA group (6.6 days as against 5.4 days). Complications and readmission rates were more in TKA group (nil in UKA group; 08 in TKA group). At 2-year follow-up, UKA provides similar improvement in patient-reported outcomes, function, and performance as compared to TKA when performed in patients with early arthritis. However, UKA patients have shorter hospital stay and fewer complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Comparative Effectiveness of B and E Vitamins with Diclofenac in Reducing Pain Due to Osteoarthritis of the Knee

    PubMed Central

    Dehghan, Morteza

    2015-01-01

    Background: Knee osteoarthritis is one of the most prevalent chronic disorders. Several pharmacological and non pharmacological approaches are used to treat this disease. Today, the effect of B and E vitamins on rheumatology diseases is being discussed. In this study, the efficacy of B and E vitamins accompanied with diclofenac on pain relief in patients with knee osteoarthritis was investigated and compared. Methods: In this double-blinded clinical trial, 120 patients with knee osteoarthritis referring training Rheumatology and Orthopedics Clinic of Shahrekord University of Medical sciences were investigated. Of these patients, 12 were excluded throughout the study. The patients underwent treatment in three groups (oral diclofenac + oral B vitamin, oral diclofenac + oral vitamin E, and oral diclofenac + placebo). Pain relief was assessed by visual analogue scale (VAS) questionnaire and morning stiffness and physical function were assessed by WOMAC standard questionnaire at three times; the first examination, two weeks, and three weeks after referring. Results: The mean score of WOMAC questionnaire at VASs of knee pain, total pain severity, knee joint stiffness, and function of the last 48 hours decreased significantly in all three groups (diclofenac, E and B vitamins) from the first to third examination (P<0.001). Decrease in VAS of knee pain and function of the last 48 hours was higher in B vitamin group than the diclofenac and E vitamin group (P=0.008) and decrease in total pain severity was reported higher in B vitamin group than E vitamin and diclofenac group (P=0.019). Decrease in knee joint stiffness underwent a similar trend in the three groups. Conclusion: In view similar analgesic and anti-inflammatory properties, as well as very few, non prevalent complications of B and E vitamins, use of two or more drugs with a different mechanism of effect seems necessary to enhance their effect on osteoarthritis treatment. PMID:26005259

  3. Comparing analgesic effects of a topical herbal mixed medicine with salicylate in patients with knee osteoarthritis.

    PubMed

    Zahmatkash, Mohsen; Vafaeenasab, Mohammad Reza

    2011-07-01

    Knee osteoarthritis is the most common cause of disability among people and it is a common disease of joints that can lead to cartilage damage. In this study the analgesic effects of a herbal ointment containing cinnamon, ginger, mastic (Saghez) and sesame oil is compared with Salicylate ointment in patients suffering from knee osteoarthritis. It was a double-blind randomized controlled trail study. Patients with diagnosed arthritis were involved in the study and they were divided in two groups via block randomization method. For six weeks, twice a day, intervention group applied herbal ointment and control group used Salicylate ointment. The severity of pain, morning stiffness and limited motion were measured using Visual Analog Pain Scale. In order to analyze the trends of these three indexes, repeated measurement test was used. Ninety two participates with the mean age of 52.2 (+/- 12.4) years and with the mean disease period of 30.45 (+/- 30.3) months were involved in the study. There was no significant difference between two groups regarding the distribution of sex, weight, height, BMI and the duration of illness. No statistical difference was observed between two groups regarding pain relief, morning stiffness and limited motion; nevertheless in repeated measurements during second, forth and sixth weeks in both groups the decreasing trend of these three indexes had been statistically significant (p < 0.0001). It seems that using this herbal combination is clinically effective for patients suffering from knee osteoarthritis in order to decrease their pain, morning stiffness and limited motion; its effect is comparable with Salicylate ointment.

  4. Evolution of knee kinematics three months after total knee replacement.

    PubMed

    Alice, Bonnefoy-Mazure; Stéphane, Armand; Yoshisama, Sagawa Junior; Pierre, Hoffmeyer; Domizio, Suvà; Hermes, Miozzari; Katia, Turcot

    2015-02-01

    In patients with debilitating knee osteoarthritis, total knee replacement is the most common surgical procedure. Numerous studies have demonstrated that knee kinematics one year after total knee replacement are still altered compared to the healthy joint. However, little is known regarding impairments and functional limitations of patients several months after total knee replacement. The aim of this study was to describe the evolution of the knee gait kinematic in patients with knee osteoarthritis before and three months after a total knee replacement. Ninety patients who were to undergo total knee replacement were included in this study. Twenty-three subjects were recruited as the control group. Three-dimensional gait analysis was performed before and three months after surgery. The spatio-temporal parameters and three-dimensional knee kinematics for the operated limb were evaluated during a comfortable gait and compared between groups (the before and after surgery groups and the control group). Three months after surgery, patients always walk with a slower gait velocity and lower knee flexion-extension movements compared to the control group. However, a degree of progress was observed in term of the stride and step length, gait velocity and knee alignment in the coronal plane. Our results suggest that the disability is still significant for most patients three months after total knee replacement. A better understand of the impairments and functional limitations following surgery would help clinicians design rehabilitation programs. Moreover, patients should be informed that rehabilitation after total knee replacement is a long process.

  5. Prospective Study of the Relation between Landing Biomechanics and Jumper's Knee.

    PubMed

    der Worp, H van; van der Does, H T D; Brink, M S; Zwerver, J; Hijmans, J M

    2016-03-01

    The literature on the relation between jump biomechanics and jumper's knee indicates that a jump with horizontal displacement poses a threat for developing jumper's knee. Subjects with jumper's knee have been shown to display a stiff landing pattern characterized by a small range of motion. However, up to now only cross-sectional studies have been conducted. 6 teams from sports involving repetitive landing were followed prospectively for 2 years. At baseline athletes performed the Landing Error Scoring System jump and 3D kinematics and kinetics were obtained. A comparison was made between subjects who developed jumper's knee and those who did not develop it. 3 subjects developed jumper's knee during the study. Leg stiffness during landing was high compared to the mean of the healthy controls. No common kinematic patterns could be identified in these 3 subjects. The results suggest that athletes with high leg stiffness during landing might have an increased risk for developing jumper's knee, yet this conclusion is based on a very small sample. Subjects who develop jumper's knee do not show a common landing technique. Further research is needed to investigate whether leg stiffness can be used to identify athletes at risk and as a target variable to be used in prevention.

  6. Effects of intraarticular 32P colloid in the treatment of hemophilic synovitis of the knee: A short term clinical study

    PubMed Central

    Zhang, Wen-Qiang; Han, Shao-Qin; Yuan, Zhen; He, Ye-Teng; Zhang, Hu; Zhang, Ming

    2016-01-01

    Background: Chronic synovitis is a consequence of recurrent intraarticular hemorrhage in patients with hemophilia. Eventually, synovitis leads to degeneration of the articular cartilage, with serious consequences that impact the quality-of-life in hemophiliacs. The aim of our study was to investigate the short term clinical effects of intraarticular injection of the radionuclide preparation32P colloid (32P-labelled colloidal chromic phosphate suspension) on recurrent intraarticular hemorrhages in patients with hemophilic synovitis of the knee. Materials and Methods: Patients who met the inclusion criteria (n = 22) were enrolled in an open-label study between October 2011 and September 2012.32P colloid was injected into the knee joint and patients were followed up over 6 months after treatment. Hemorrhage frequency, visual analog scale pain score, hospital for special surgery knee score, knee circumference, upper knee circumference, knee diameter, and knee range of motion (ROM) were compared before and after treatment with intraarticular32P colloid injection. Results: In 24 knees evaluated in 22 participating patients, there was a significant reduction in the number of hemorrhages after32P colloid treatment, along with significant pain relief. However, there were no statistically significant changes in the degree of joint swelling, degree of muscle atrophy and knee ROM between the pre and post treatment evaluations. Conclusion: The frequency of joint hemorrhage in patients with hemophilic knee synovitis can be significantly reduced and local symptoms can be improved in the short term by intraarticular injection of32P colloid. PMID:26955177

  7. Comparative Effectiveness of Intra-Articular Hyaluronic Acid and Corticosteroid Injections on the Time to Surgical Knee Procedures.

    PubMed

    Shewale, Anand R; Barnes, C Lowry; Fischbach, Lori A; Ounpraseuth, Songthip T; Painter, Jacob T; Martin, Bradley C

    2017-07-14

    Use of intra-articular hyaluronic acid (HA) injections to manage knee osteoarthritis (OA) remains controversial because of weak and conflicting evidence. The objective was to evaluate the effectiveness of intra-articular HA injections for knee OA management. A nested cohort of persons with knee OA seeing a specialist was created using a 10% random sample of LifeLink Plus claims (2010-2015) to compare the risk of composite (any) knee surgical interventions, total (TKA)/unicompartmental knee arthroplasty (UKA) and TKA only among HA users and 2 comparison groups: corticosteroid (CS) users and HA/CS nonusers. A high-dimensional propensity score (hdPS) was used to match HA users with CS users and with HA/CS nonusers on background covariates. The risk of surgical interventions among HA users relative to the comparison groups was assessed using Cox proportional hazard models. Among 13,849 patients, 797 were HA users, 5327 were CS users, and 7725 were HA/CS nonusers. After hdPS matching, the risk of composite surgical interventions did not differ between HA users and HA/CS nonusers (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.67-1.16) and CS users (HR, 0.89; 95% CI, 0.65-1.12). Seven of the 8 sensitivity analyses demonstrated no significant benefit among HA users compared to CS users and HA/CS nonusers. A sensitivity analysis that restricted the study cohort to those who ultimately have knee surgery showed a lower risk of surgery of HA (HR, 0.87; 95% CI, 0.79-0.95). There were no significant differences in the risk of surgical interventions among HA users compared to HA/CS nonusers and CS users after accounting for residual confounding using an hdPS. Copyright © 2017. Published by Elsevier Inc.

  8. Comparing different data collection and analysis techniques for quantifying healthy knee joint function during stair ascent and descent.

    PubMed

    Whatling, G M; Evans, S L; Holt, C A

    2009-11-01

    There is currently no standard data collection or analysis method for the assessment of stair gait using motion analysis. This makes the comparison of results from different studies difficult. It is important to gain an appreciation of the discrepancies in kinematic and kinetic information generated by employing different computational approaches, as these differences may be critical in cases where methodologies were to change over a long-term study. This study explores the effect of using different methodologies for the assessment of non-pathological knee function of ten subjects during stair ascent and descent. Two methods of computing knee kinematics were compared: (a) using in-house software and a pointer method of anatomical calibration and (b) using commercial software, Visual3D (C-motion, Inc.) and skin-mounted markers. Significant differences were found between the two methods when calculating a frontal plane range of motion (p < 0.05). Three methods of computing knee moments were compared. Knee moments computed using the inverse dynamic analysis (IDA) approach of Visual3D (C-motion, Inc.) were significantly different (p < 0.05) to those calculated using in-house IDA software that ignores the foot and ankle and to those computed using a vector cross-product approach. This study highlights the implications of comparing data generated from different collection and analysis methods.

  9. Short-stretch inelastic compression bandage in knee swelling following total knee arthroplasty study (STICKS): study protocol for a randomised controlled feasibility study.

    PubMed

    Brock, Timothy M; Sprowson, Andrew P; Muller, Scott; Reed, Mike R

    2015-03-11

    Enhanced recovery programmes in total knee arthroplasty are well established. Post-operative knee swelling is common and impairs early post-operative function. The use of a short-stretch, inelastic compression bandage is hypothesised to reduce knee swelling and improve pain and early function. A study was designed to test feasibility with a view to informing a larger, future trial and to provide preliminary data. This is a randomised controlled feasibility study. Fifty consecutive patients selected for primary total knee arthroplasty will be enrolled in the trial. Patients with a BMI >35, latex allergy or neurological or peripheral vascular disease are excluded. Patients are randomised by distance randomisation to receive a compression bandage for 24 hours after surgery or a standard wool and crepe bandage. The bandages are applied by one of two consultant surgeons who have had training with their application. Knee swelling, range of motion and pain scores will be compared pre-operatively and at day 1, day 2 and at 6 weeks between groups. The Oxford knee score and EQ-5D health status will be compared pre-operatively and at 6 months between groups. Recruitment rates, retention rates, resource allocation, completeness of data collection, and tolerance and complications with the compression bandage are recorded. Descriptive statistics are used to calculate a standard deviation for post-operative knee swelling in the groups and to perform a power calculation incorporating anticipated patient retention rates to inform a future trial. Preliminary data will be analysed using the independent samples t-test for equal distributions and the Mann-Whitney U for unequal distributions with the significance denoted at P <0.05. Enhanced recovery programmes have revolutionized the management of total knee arthroplasty. There is a paucity of clinical data regarding the efficacy of compression bandages. Large, randomised controlled trials are uncommon in orthopaedic surgery. The

  10. Comparative gravimetric wear analysis in mobile versus fixed-bearing posterior stabilized total knee prostheses.

    PubMed

    Delport, Hendrik P; Sloten, Jos Vander; Bellemans, Johan

    2010-06-01

    Polyethylene (PE) wear is the limiting factor for the longevity of a conventional total knee arthroplasty (TKA). Excessive wear leads to loosening and eventual implant failure. The aim of our in vitro study was to investigate wear of a PE tibial insert on a rotating platform as compared to the same insert fixed to the tibial baseplate and articulating with a similar femoral component. All tests were performed at Endolab Laboratories, Rosenheim, Germany using a knee joint simulator following ISO 14243-1. Three specific configurations were tested and compared to a loaded soak control: (1) the rotating platform using machined polyethylene (PE), (2) fixed bearing using machined PE, (3) fixed bearing using compression-moulded PE. Calf serum with a high protein concentration of 30 g/l was chosen as test lubricant. PE wear was measured gravimetrically using the ISO 14243-2 protocol. The total wear rates found for all systems tested were low. The mean wear rate was 1.40 mg per million cycles for the moulded fixed bearing, 4.07 mg per million cycles for the machined fixed bearing type and 0.82 mg per million cycles for the machined rotating platform bearing type. We conclude that the TKA system we tested (Performance, Biomet, Warsaw, IND, USA) demonstrated very low gravimetric wear. The wear rate of the same implant in the fixed mode compared to the rotating platform mode was four times higher.

  11. Knee Bursitis

    MedlinePlus

    ... make a diagnosis of knee bursitis during a physical exam. Your doctor will inspect your knee by: Comparing the condition of both knees, particularly if only one is painful Gently pressing on different areas of your knee to detect warmth, swelling and the source of pain Carefully moving ...

  12. Comparative analysis of clinical usefulness of the Staffelstein Score and the Hospital for Special Surgery Knee Score (HSS) for evaluation of early results of total knee arthroplasties. Preliminary report.

    PubMed

    Słupik, Anna; Białoszewski, Dariusz

    2007-01-01

    Introduced and developed in the second half of the last century, joint arthroplasty has become a method of choice in the treatment of advanced degenerative knee joint disease. The aim of study was to compare the usefulness of the Hospital for Special Surgery Knee Score and the Staffelstein Score in the assessment of early treatment outcome, including rehabilitation, in patients who underwent knee arthroplasty due to gonarthrosis. A total of 24 patients who had undergone an arthroplasty procedure for degenerative changes in knee joints were examined in the study. The analysis included forty-four sets of results from examinations performed on average 13 days (SD 7) after knee arthroplasty. Treatment results were evaluated using the Hospital for Special Surgery Knee Score (HSS) and the Staffelstein Score (ST Score). The HSS Knee Score averaged 59.5 points (SD 19.8). The mean ST score was 82.0 points (SD 22.5). There was a strong correlation (p< 0.005) between the results obtained using both scores and their subscales (activities of daily living, clinical examination, and pain evaluation). 1. The analyzed scores seem to be a reliable source of information on the functional status of patients after knee arthroplasty and may be helpful tools in clinical evaluation also at an early postoperative stage. 2. Introducing a two-dimensional pain evaluation component, modeled on the HSS Knee Score, into the Staffelstein Score might improve its reliability. 3. A lower sensitivity of the HSS score in comparison with the ST Score that was revealed in the study requires further investigations in order to develop a questionnaire in the future that will combine the advantages of both scores.

  13. Comparison of Diagnostic Performance of Semi-Quantitative Knee Ultrasound and Knee Radiography with MRI: Oulu Knee Osteoarthritis Study

    PubMed Central

    Podlipská, Jana; Guermazi, Ali; Lehenkari, Petri; Niinimäki, Jaakko; Roemer, Frank W.; Arokoski, Jari P.; Kaukinen, Päivi; Liukkonen, Esa; Lammentausta, Eveliina; Nieminen, Miika T.; Tervonen, Osmo; Koski, Juhani M.; Saarakkala, Simo

    2016-01-01

    Osteoarthritis (OA) is a common degenerative musculoskeletal disease highly prevalent in aging societies worldwide. Traditionally, knee OA is diagnosed using conventional radiography. However, structural changes of articular cartilage or menisci cannot be directly evaluated using this method. On the other hand, ultrasound is a promising tool able to provide direct information on soft tissue degeneration. The aim of our study was to systematically determine the site-specific diagnostic performance of semi-quantitative ultrasound grading of knee femoral articular cartilage, osteophytes and meniscal extrusion, and of radiographic assessment of joint space narrowing and osteophytes, using MRI as a reference standard. Eighty asymptomatic and 79 symptomatic subjects with mean age of 57.7 years were included in the study. Ultrasound performed best in the assessment of femoral medial and lateral osteophytes, and medial meniscal extrusion. In comparison to radiography, ultrasound performed better or at least equally well in identification of tibio-femoral osteophytes, medial meniscal extrusion and medial femoral cartilage morphological degeneration. Ultrasound provides relevant additional diagnostic information on tissue-specific morphological changes not depicted by conventional radiography. Consequently, the use of ultrasound as a complementary imaging tool along with radiography may enable more accurate and cost-effective diagnostics of knee osteoarthritis at the primary healthcare level. PMID:26926836

  14. Comparison of Diagnostic Performance of Semi-Quantitative Knee Ultrasound and Knee Radiography with MRI: Oulu Knee Osteoarthritis Study.

    PubMed

    Podlipská, Jana; Guermazi, Ali; Lehenkari, Petri; Niinimäki, Jaakko; Roemer, Frank W; Arokoski, Jari P; Kaukinen, Päivi; Liukkonen, Esa; Lammentausta, Eveliina; Nieminen, Miika T; Tervonen, Osmo; Koski, Juhani M; Saarakkala, Simo

    2016-03-01

    Osteoarthritis (OA) is a common degenerative musculoskeletal disease highly prevalent in aging societies worldwide. Traditionally, knee OA is diagnosed using conventional radiography. However, structural changes of articular cartilage or menisci cannot be directly evaluated using this method. On the other hand, ultrasound is a promising tool able to provide direct information on soft tissue degeneration. The aim of our study was to systematically determine the site-specific diagnostic performance of semi-quantitative ultrasound grading of knee femoral articular cartilage, osteophytes and meniscal extrusion, and of radiographic assessment of joint space narrowing and osteophytes, using MRI as a reference standard. Eighty asymptomatic and 79 symptomatic subjects with mean age of 57.7 years were included in the study. Ultrasound performed best in the assessment of femoral medial and lateral osteophytes, and medial meniscal extrusion. In comparison to radiography, ultrasound performed better or at least equally well in identification of tibio-femoral osteophytes, medial meniscal extrusion and medial femoral cartilage morphological degeneration. Ultrasound provides relevant additional diagnostic information on tissue-specific morphological changes not depicted by conventional radiography. Consequently, the use of ultrasound as a complementary imaging tool along with radiography may enable more accurate and cost-effective diagnostics of knee osteoarthritis at the primary healthcare level.

  15. The physiological cost index of walking with a powered knee-ankle-foot orthosis in subjects with poliomyelitis: A pilot study.

    PubMed

    Arazpour, Mokhtar; Ahmadi Bani, Monireh; Samadian, Mohammad; Mousavi, Mohammad E; Hutchins, Stephen W; Bahramizadeh, Mahmood; Curran, Sarah; Mardani, Mohammad A

    2016-08-01

    A powered knee-ankle-foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. The purpose of this study was to determine its effect on the physiological cost index, walking speed and the distance walked in people with poliomyelitis compared to when walking with a knee-ankle-foot orthosis with drop lock knee joints. Quasi experimental study. Seven subjects with poliomyelitis volunteered for the study and undertook gait analysis with both types of knee-ankle-foot orthosis. Walking with the powered knee-ankle-foot orthosis significantly reduced walking speed (p = 0.015) and the distance walked (p = 0.004), and also, it did not improve physiological cost index values (p = 0.009) compared to walking with the locked knee-ankle-foot orthosis. Using a powered knee-ankle-foot orthosis did not significantly improve any of the primary outcome measures during walking for poliomyelitis subjects. This powered knee-ankle-foot orthosis design did not improve the physiological cost index of walking for people with poliomyelitis when compared to walking with a knee-ankle-foot orthosis with drop lock knee joints. This may have been due to the short training period used or the bulky design and additional weight of the powered orthosis. Further research is therefore warranted. © The International Society for Prosthetics and Orthotics 2015.

  16. Do cartilage volume or thickness distinguish knees with and without mild radiographic osteoarthritis? The Framingham Study

    PubMed Central

    Reichenbach, Stephan; Yang, Mei; Eckstein, Felix; Niu, Jingbo; Hunter, David J.; McLennan, Christine E.; Guermazi, Ali; Roemer, Frank; Hudelmaier, Martin; Aliabadi, Piran; Felson, David T.

    2009-01-01

    Objectives To examine whether the quantity of cartilage or semiquantitative scores actually differ in knees with mild radiographic osteoarthritis (OA) compared with knees without OA. Methods Framingham OA Study participants had knee tibiofemoral MRI-based measurements of cartilage. Using 3D FLASH-water excitation sequences, cartilage volume (VC), thickness (ThCtAB) and subregional ThCtAB were measured and cartilage scored semiquantitatively (using WORMS). Using weight bearing radiographs, we defined mild OA as K/L=2 and nonOA as K/L=0. Differences between OA and nonOA knees in median cartilage measurements were tested using the Wilcoxon rank sum test. Results Among 948 participants (one knee each), neither VC nor regional thickness (ThCtAB) were different in mild versus nonOA knees. In mild OA, cartilage erosions in focal areas were missed when cartilage was quantified over large regions like the medial tibia. For some but not all subregions of cartilage, especially among men, ThCtAB was lower (p<.05) in mild OA than nonOA knees. Because semiquantitative scores captured focal erosions, median WORMS scores were higher in mild OA than nonOA (all p<.05). In moderate/severe OA (K/L grades 3 or 4), OA knees had much lower ThCtAB and higher WORMS scores than knees with nonOA. Conclusions In mild OA, the focal loss of cartilage is missed by quantitative measures of cartilage volume or thickness over broad areas. Regional cartilage volume and thickness (e.g. medial tibia) are not different in mild OA versus nonOA. Subregional thickness may be decreased in mild OA. Semiquantitative scoring which assesses focal cartilage damage differentiates mild OA from nonOA. PMID:19193659

  17. Elevated corticospinal excitability in patellar tendinopathy compared with other anterior knee pain or no pain.

    PubMed

    Rio, E; Kidgell, D; Moseley, G L; Cook, J

    2016-09-01

    Anterior knee pain (AKP) is a frequent clinical presentation in jumping athletes and may be aggravated by sustained sitting, stair use, and loading of the quadriceps. Corticospinal activation of the quadriceps in athletes with AKP has not yet been investigated, but is important in guiding efficacious treatment. This cross-sectional study assessed corticospinal excitability (CSE) of the quadriceps in jumping athletes using transcranial magnetic stimulation (TMS). Groups consisted of Control (no knee pain); patellar tendinopathy (PT) [localized inferior pole pain on single-leg decline squat (SLDS)]; and other AKP (nonlocalized pain around the patella). SLDS (numerical score of pain 0-10), Victorian Institute of Sport Assessment Patellar tendon (VISA-P), maximal voluntary isometric contraction (MVIC), active motor threshold (AMT), CSE, and Mmax were tested. Twenty nine athletes participated; control n = 8, PT n = 11, AKP n = 10. There were no group differences in age (P = 0.23), body mass index (P = 0.16), MVIC (P = 0.38) or weekly activity (P = 0.22). PT had elevated CSE compared with controls and other AKP (P < 0.001), but no differences were detected between AKP and controls (P = 0.47). CSE appears to be greater in PT than controls and other AKP. An improved understanding of the corticospinal responses in different sources of knee pain may direct better treatment approaches. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. The effect of instruction in analgesic use compared with neuromuscular exercise on knee-joint load in patients with knee osteoarthritis: a randomized, single-blind, controlled trial.

    PubMed

    Holsgaard-Larsen, A; Clausen, B; Søndergaard, J; Christensen, R; Andriacchi, T P; Roos, E M

    2017-04-01

    To investigate the effect of a neuro-muscular exercise (NEMEX) therapy program compared with instructions in optimized analgesics and anti-inflammatory drug use (PHARMA), on measures of knee-joint load in people with mild to moderate knee osteoarthritis (OA). We hypothesized that knee joint loading during walking would be reduced by NEMEX and potentially increased by PHARMA. Single-blind, randomized controlled trial (RCT) comparing NEMEX therapy twice a week with PHARMA. Participants with mild-to-moderate medial tibiofemoral knee OA were randomly allocated (1:1) to one of two 8-week treatments. Primary outcome was change in knee load during walking (Knee Index, a composite score from all three planes based on 3D movement analysis) after 8 weeks of intervention. Secondary outcomes were frontal plane peak knee adduction moment (KAM), Knee Injury and Osteoarthritis Outcome Scores (KOOS) and functional performance tests. Ninety three participants (57% women, 58 ± 8 years with a body mass index [BMI] of 27 ± 4 kg/m(2) (mean ± standard deviation [SD])) were randomized to NEMEX group (n = 47) or PHARMA (n = 46); data from 44 (94%) and 41 (89%) participants respectively, were available at follow-up. 49% of the participants in NEMEX and only 7% in PHARMA demonstrated good compliance. We found no difference in the primary outcome as evaluated by the Knee Index -0.07 [-0.17; 0.04] Nm/%BW HT. Secondary outcomes largely supported this finding. We found no difference in the primary outcome; knee joint load change during walking from a NEMEX program vs information on the recommended use of analgesics and anti-inflammatory drugs. ClinicalTrials.gov Identifier: NCT01638962 (July 3, 2012). Ethical Committee: S-20110153. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  19. Knee Kinematics Estimation Using Multi-Body Optimisation Embedding a Knee Joint Stiffness Matrix: A Feasibility Study.

    PubMed

    Richard, Vincent; Lamberto, Giuliano; Lu, Tung-Wu; Cappozzo, Aurelio; Dumas, Raphaël

    2016-01-01

    The use of multi-body optimisation (MBO) to estimate joint kinematics from stereophotogrammetric data while compensating for soft tissue artefact is still open to debate. Presently used joint models embedded in MBO, such as mechanical linkages, constitute a considerable simplification of joint function, preventing a detailed understanding of it. The present study proposes a knee joint model where femur and tibia are represented as rigid bodies connected through an elastic element the behaviour of which is described by a single stiffness matrix. The deformation energy, computed from the stiffness matrix and joint angles and displacements, is minimised within the MBO. Implemented as a "soft" constraint using a penalty-based method, this elastic joint description challenges the strictness of "hard" constraints. In this study, estimates of knee kinematics obtained using MBO embedding four different knee joint models (i.e., no constraints, spherical joint, parallel mechanism, and elastic joint) were compared against reference kinematics measured using bi-planar fluoroscopy on two healthy subjects ascending stairs. Bland-Altman analysis and sensitivity analysis investigating the influence of variations in the stiffness matrix terms on the estimated kinematics substantiate the conclusions. The difference between the reference knee joint angles and displacements and the corresponding estimates obtained using MBO embedding the stiffness matrix showed an average bias and standard deviation for kinematics of 0.9±3.2° and 1.6±2.3 mm. These values were lower than when no joint constraints (1.1±3.8°, 2.4±4.1 mm) or a parallel mechanism (7.7±3.6°, 1.6±1.7 mm) were used and were comparable to the values obtained with a spherical joint (1.0±3.2°, 1.3±1.9 mm). The study demonstrated the feasibility of substituting an elastic joint for more classic joint constraints in MBO.

  20. Anthropometric study of the knee in patients with osteoarthritis: intraoperative measurement versus magnetic resonance imaging.

    PubMed

    Loures, Fabrício Bolpato; Carrara, Renato Janetti; Góes, Rogério Franco de Araújo; Albuquerque, Rodrigo Sattamini Pires E; Barretto, João Maurício; Kinder, André; Gameiro, Vinicius Schott; Marchiori, Edson

    2017-01-01

    To compare intraoperative measurements of the knee with those obtained by magnetic resonance imaging, in order to validate the latter method for use in anthropometric studies. We studied 20 knees in 20 patients with osteoarthritis, all of whom underwent total arthroplasty between August and December of 2013. We took six measurements in the distal femur and two in the proximal tibia. Using the information system of the institution, we made the measurements on magnetic resonance imaging scans that had been obtained in the axial plane. Intraoperative measurements were obtained using a caliper, after the initial cuts made during the arthroplasty. The anatomical parameters determined by magnetic resonance imaging were the same as those determined by intraoperative measurement. The intraclass correlation coefficient was used in order to assess the level of agreement in anthropometric measurements of the knee performed by magnetic resonance imaging and by intraoperative measurement. Statistical analysis revealed a highly significant correlation between the knee anthropometric parameters of the knee determined by intraoperative measurement and those determined by magnetic resonance imaging. The dimensions of osteoarthritic knees measured by magnetic resonance imaging were similar to those measured intraoperatively. Therefore, magnetic resonance imaging can be considered a reliable method for use in large-scale anthropometric studies that will allow the available implants to be adapted and improved.

  1. Anthropometric study of the knee in patients with osteoarthritis: intraoperative measurement versus magnetic resonance imaging

    PubMed Central

    Loures, Fabrício Bolpato; Carrara, Renato Janetti; Góes, Rogério Franco de Araújo; Albuquerque, Rodrigo Sattamini Pires e; Barretto, João Maurício; Kinder, André; Gameiro, Vinicius Schott; Marchiori, Edson

    2017-01-01

    Objective: To compare intraoperative measurements of the knee with those obtained by magnetic resonance imaging, in order to validate the latter method for use in anthropometric studies. Materials and Methods: We studied 20 knees in 20 patients with osteoarthritis, all of whom underwent total arthroplasty between August and December of 2013. We took six measurements in the distal femur and two in the proximal tibia. Using the information system of the institution, we made the measurements on magnetic resonance imaging scans that had been obtained in the axial plane. Intraoperative measurements were obtained using a caliper, after the initial cuts made during the arthroplasty. The anatomical parameters determined by magnetic resonance imaging were the same as those determined by intraoperative measurement. The intraclass correlation coefficient was used in order to assess the level of agreement in anthropometric measurements of the knee performed by magnetic resonance imaging and by intraoperative measurement. Results: Statistical analysis revealed a highly significant correlation between the knee anthropometric parameters of the knee determined by intraoperative measurement and those determined by magnetic resonance imaging. Conclusion: The dimensions of osteoarthritic knees measured by magnetic resonance imaging were similar to those measured intraoperatively. Therefore, magnetic resonance imaging can be considered a reliable method for use in large-scale anthropometric studies that will allow the available implants to be adapted and improved. PMID:28670028

  2. Mobile-bearing medial unicompartmental knee arthroplasty restores limb alignment comparable to that of the unaffected contralateral limb

    PubMed Central

    Mullaji, Arun B; Shah, Siddharth; Shetty, Gautam M

    2017-01-01

    Background and purpose — Medial unicompartmental knee arthroplasty (UKA) is undertaken in patients with a passively correctable varus deformity. We investigated whether restoration of natural soft tissue tension would result in a lower limb alignment similar to that of the contralateral unaffected lower limb after mobile-bearing medial UKA. Patients and methods — In this retrospective study, hip-knee-ankle (HKA) angle, position of the weight-bearing axis (WBA), and knee joint line obliquity (KJLO) after mobile-bearing medial UKA was compared with that of the unaffected (clinically and radiologically) contralateral lower limb in 123 patients. Results — Postoperatively, HKA angle was restored to within ±3° of the contralateral lower limb in 87% of the patients and the WBA passed within ±1 Kennedy and White’s tibial zone of the unaffected contralateral lower limb in 95% of the patients. The mean KJLO in the operated limbs was not significantly different from that in the unaffected lower limbs (p = 0.07) and the KJLO in the operated limb was restored to within ±3° of that in the contralateral lower limb in 96% of the patients. Interpretation — Lower limb alignment and knee joint line obliquity after mobile-bearing medial UKA were comparable to that of the unaffected contralateral limb in most patients. Comparison with the contralateral unaffected lower limb is a reliable method for evaluation and validation of limb mechanical alignment after mobile-bearing medial UKA. PMID:27794622

  3. Mobile-bearing medial unicompartmental knee arthroplasty restores limb alignment comparable to that of the unaffected contralateral limb.

    PubMed

    Mullaji, Arun B; Shah, Siddharth; Shetty, Gautam M

    2017-02-01

    Background and purpose - Medial unicompartmental knee arthroplasty (UKA) is undertaken in patients with a passively correctable varus deformity. We investigated whether restoration of natural soft tissue tension would result in a lower limb alignment similar to that of the contralateral unaffected lower limb after mobile-bearing medial UKA. Patients and methods - In this retrospective study, hip-knee-ankle (HKA) angle, position of the weight-bearing axis (WBA), and knee joint line obliquity (KJLO) after mobile-bearing medial UKA was compared with that of the unaffected (clinically and radiologically) contralateral lower limb in 123 patients. Results - Postoperatively, HKA angle was restored to within ±3° of the contralateral lower limb in 87% of the patients and the WBA passed within ±1 Kennedy and White's tibial zone of the unaffected contralateral lower limb in 95% of the patients. The mean KJLO in the operated limbs was not significantly different from that in the unaffected lower limbs (p = 0.07) and the KJLO in the operated limb was restored to within ±3° of that in the contralateral lower limb in 96% of the patients. Interpretation - Lower limb alignment and knee joint line obliquity after mobile-bearing medial UKA were comparable to that of the unaffected contralateral limb in most patients. Comparison with the contralateral unaffected lower limb is a reliable method for evaluation and validation of limb mechanical alignment after mobile-bearing medial UKA.

  4. Measuring physiotherapy performance in patients with osteoarthritis of the knee: A prospective study

    PubMed Central

    Jamtvedt, Gro; Dahm, Kristin Thuve; Holm, Inger; Flottorp, Signe

    2008-01-01

    Background Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews. Methods We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. Results A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching. Conclusion Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be

  5. Measuring physiotherapy performance in patients with osteoarthritis of the knee: a prospective study.

    PubMed

    Jamtvedt, Gro; Dahm, Kristin Thuve; Holm, Inger; Flottorp, Signe

    2008-07-08

    Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews. We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching. Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated.

  6. Total knee arthroplasty following tibial plateau fracture: a matched cohort study.

    PubMed

    Scott, C E H; Davidson, E; MacDonald, D J; White, T O; Keating, J F

    2015-04-01

    Radiological evidence of post-traumatic osteoarthritis (PTOA) after fracture of the tibial plateau is common but end-stage arthritis which requires total knee arthroplasty is much rarer. The aim of this study was to examine the indications for, and outcomes of, total knee arthroplasty after fracture of the tibial plateau and to compare this with an age and gender-matched cohort of TKAs carried out for primary osteoarthritis. Between 1997 and 2011, 31 consecutive patients (23 women, eight men) with a mean age of 65 years (40 to 89) underwent TKA at a mean of 24 months (2 to 124) after a fracture of the tibial plateau. Of these, 24 had undergone ORIF and seven had been treated non-operatively. Patients were assessed pre-operatively and at 6, 12 and > 60 months using the Short Form-12, Oxford Knee Score and a patient satisfaction score. Patients with instability or nonunion needed total knee arthroplasty earlier (14 and 13.3 months post-injury) than those with intra-articular malunion (50 months, p < 0.001). Primary cruciate-retaining implants were used in 27 (87%) patients. Complication rates were higher in the PTOA cohort and included wound complications (13% vs 1% p = 0.014) and persistent stiffness (10% vs 0%, p = 0.014). Two (6%) PTOA patients required revision total knee arthroplasty at 57 and 114 months. The mean Oxford knee score was worse pre-operatively in the cohort with primary osteoarthritis (18 vs 30, p < 0.001) but there were no significant differences in post-operative Oxford knee score or patient satisfaction (primary osteoarthritis 86%, PTOA 78%, p = 0.437). Total knee arthroplasty undertaken after fracture of the tibial plateau has a higher rate of complications than that undertaken for primary osteoarthritis, but patient-reported outcomes and satisfaction are comparable. Cite this article: Bone Joint J 2015;97-B:532-8.

  7. Does a tensioning device pinned to the tibia improve knee anterior-posterior load-displacement compared to manual tensioning of the graft following anterior cruciate ligament reconstruction? A cadaveric study of two tibial fixation devices.

    PubMed

    Thompson, Dustin M; Hull, M L; Howell, S M

    2006-09-01

    Devices that are pinned to the tibia to tension an anterior cruciate ligament (ACL) graft produce joint reaction loads that in turn can affect the maintenance of graft initial tension after tibial fixation and hence knee anterior-posterior (AP) load-displacement. However, the effect of these devices on AP load-displacement is unknown. Our objectives were to determine whether tensioning by device versus tensioning by hand causes differences in AP load-displacement and intraarticular graft tension for two commonly used tibial fixation devices: a bioresorbable interference screw and a WasherLoc. AP load-displacement and intraarticular graft tension were measured in 20 cadaveric knees using a custom arthrometer. An initial tension of 110 N was applied to a double-looped tendon graft with the knee at extension using a tensioning device pinned to the tibia and a simulated method of tensioning by hand. After inserting the tibial fixation device, the 134 N anterior limit (i.e., anterior position of the tibia with respect to the femur with a 134 N anterior force applied to the tibia) and 0 N posterior limit (i.e., AP position of the tibia relative to the femur with a 0 N force applied to the tibia) were measured with the knee in 25 degrees flexion. Intraarticular graft tension was measured at extension. These limits and intraarticular graft tension were also measured after cyclically loading the knee 300 times. Compared to a simulated method of tensioning by hand, tensioning with a device pinned to the tibia did not decrease the 134 N anterior limit and did not cause posterior tibial translation. However, intraarticular graft tension was maintained better with a tensioning device pinned to the tibia for the Washerloc, but not the interference screw. For two commonly used tibial fixation devices, a tensioning device pinned to the tibia does not improve AP load-displacement at 25 degrees flexion over tensioning by hand when the graft is tensioned at full extension, but does

  8. Gender difference in symptomatic radiographic knee osteoarthritis in the Knee Clinical Assessment--CAS(K): a prospective study in the general population.

    PubMed

    Lacey, Rosie J; Thomas, Elaine; Duncan, Rachel C; Peat, George

    2008-06-11

    A recent study of adults aged >or=50 years reporting knee pain found an excess of radiographic knee osteoarthritis (knee ROA) in symptomatic males compared to females. This was independent of age, BMI and other clinical signs and symptoms. Since this finding contradicts many previous studies, our objective was to explore four possible explanations for this gender difference: X-ray views, selection, occupation and non-articular conditions. A community-based prospective study. 819 adults aged >or=50 years reporting knee pain in the previous 12 months were recruited by postal questionnaires to a research clinic involving plain radiography (weight-bearing posteroanterior semiflexed, supine skyline and lateral views), clinical interview and physical examination. Any knee ROA, ROA severity, tibiofemoral joint osteoarthritis (TJOA) and patellofemoral joint osteoarthritis (PJOA) were defined using all three radiographic views. Occupational class was derived from current or last job title. Proportions of each gender with symptomatic knee ROA were expressed as percentages, stratified by age; differences between genders were expressed as percentage differences with 95% confidence intervals. 745 symptomatic participants were eligible and had complete X-ray data. Males had a higher occurrence (77%) of any knee ROA than females (61%). In 50-64 year olds, the excess in men was mild knee OA (particularly PJOA); in >or=65 year olds, the excess was both mild and moderate/severe knee OA (particularly combined TJOA/PJOA). This male excess persisted when using the posteroanterior view only (64% vs. 52%). The lowest level of participation in the clinic was symptomatic females aged 65+. Within each occupational class there were more males with symptomatic knee ROA than females. In those aged 50-64 years, non-articular conditions were equally common in both genders although, in those aged 65+, they occurred more frequently in symptomatic females (41%) than males (31%). The excess of knee

  9. A pilot study of the effect of Kinesiology tape on knee proprioception after physical activity in healthy women.

    PubMed

    Hosp, Simona; Bottoni, Giuliamarta; Heinrich, Dieter; Kofler, Philipp; Hasler, Michael; Nachbauer, Werner

    2015-11-01

    Kinesiology tape has gained significant popularity in recent years and is widely used as an adjunct for treatment and prevention of musculoskeletal injuries. However, evidence regarding its influence on knee proprioception is scarce. The purpose of this study was to evaluate the effect of Kinesiology tape on knee proprioception after physical activity in healthy women. It was hypothesized that Kinesiology tape enhances knee proprioception. Longitudinal analysis, pretest-posttest design. Twelve young women with healthy knees were tested for knee proprioception without the use of Kinesiology tape and wearing Kinesiology tape at the knee. The joint position sense was measured at the start and after a 30-min uphill walking protocol on a treadmill. Outcome was the knee angle deviation. No significant difference of proprioceptive performance between the application with Kinesiology tape and without Kinesiology tape was found after uphill walking (p > 0.05). However, when the participants' results for knee angle deviation were graded into good (< 6.1°) and poor ( > 6.1°), Kinesiology tape significantly enhanced those with poor proprioceptive ability after uphill walking, compared to the untaped knee (p = 0.002). This study has shown that the application of Kinesiology tape did not improve knee proprioception in a group of healthy young women. However, it also has demonstrated that Kinesiology tape provided significant proprioceptive enhancement at the knee joint after uphill walking in healthy women with poor proprioceptive ability. This may support its use in sports medicine for preventing knee injuries. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  10. Squat exercise to estimate knee megaprosthesis rehabilitation: a pilot study.

    PubMed

    Lovecchio, Nicola; Zago, Matteo; Sciumè, Luciana; Lopresti, Maurizio; Sforza, Chiarella

    2015-07-01

    [Purpose] This study evaluated a specific rehabilitation protocol using a half squat after total knee reconstruction with distal femur megaprosthesis and tibial allograft-prosthesis composite. [Subject and Methods] Squat execution was recorded by a three-dimensional system before and after a specific rehabilitation program on a 28-year-old patient. Squat duration, body center of mass trajectory, and vertical range of motion were determined. Step width and joint angles and symmetry (hip flexion, extension, and rotation, knee flexion, and ankle dorsal and plantar flexion) were estimated. Knee and hip joint symmetry was computed using a bilateral cyclogram technique. [Results] After rehabilitation, the squat duration was longer (75%), step width was similar, and vertical displacement was higher. Hip flexion increased by over 20%, and ankle dorsiflexion diminished by 14%. The knee had the highest symmetry gain (4.1-3.4%). Angle-angle plot subtended areas decreased from 108° to 40°(2) (hip) and from 204° to 85°(2) (knee), showing improvement in movement symmetry. [Conclusion] We concluded that the squat is an effective multifactorial exercise to estimate rehabilitation outcomes after megaprosthesis, also considering that compressive and shear forces are minimal up to 60-70° of knee flexion.

  11. Squat exercise to estimate knee megaprosthesis rehabilitation: a pilot study

    PubMed Central

    Lovecchio, Nicola; Zago, Matteo; Sciumè, Luciana; Lopresti, Maurizio; Sforza, Chiarella

    2015-01-01

    [Purpose] This study evaluated a specific rehabilitation protocol using a half squat after total knee reconstruction with distal femur megaprosthesis and tibial allograft-prosthesis composite. [Subject and Methods] Squat execution was recorded by a three-dimensional system before and after a specific rehabilitation program on a 28-year-old patient. Squat duration, body center of mass trajectory, and vertical range of motion were determined. Step width and joint angles and symmetry (hip flexion, extension, and rotation, knee flexion, and ankle dorsal and plantar flexion) were estimated. Knee and hip joint symmetry was computed using a bilateral cyclogram technique. [Results] After rehabilitation, the squat duration was longer (75%), step width was similar, and vertical displacement was higher. Hip flexion increased by over 20%, and ankle dorsiflexion diminished by 14%. The knee had the highest symmetry gain (4.1–3.4%). Angle-angle plot subtended areas decreased from 108° to 40°2 (hip) and from 204° to 85°2 (knee), showing improvement in movement symmetry. [Conclusion] We concluded that the squat is an effective multifactorial exercise to estimate rehabilitation outcomes after megaprosthesis, also considering that compressive and shear forces are minimal up to 60–70° of knee flexion. PMID:26311992

  12. Aspartic Acid Racemization Reveals a High Turnover State in Knee Compared with Hip Osteoarthritic Cartilage

    PubMed Central

    Catterall, Jonathan B; Zura, Robert D; Bolognesi, Michael P; Kraus, Virginia Byers

    2016-01-01

    Objective We investigated tissue turnover in healthy and osteoarthritic cartilage. We challenge long held views that osteoarthritis (OA) is dominated by a similar turnover process in all joints and present evidence that hip and knee cartilage respond very differently to OA. Methods D- and L-Aspartate (Asp) were quantified for whole cartilage, collagen and non-collagenous components of cartilage obtained at the time of joint replacement. We computed the Asp racemization ratio (Asp-RR=D/D+L Asp), reflecting the proportion of old to total protein, for each component. Results Compared with hip OA, knee OA collagen fibrils (P<0.0001), collagen (p=0.007), and non-collagenous proteins (p=0.0003) had significantly lower age-adjusted mean Asp-RRs consistent with elevated protein synthesis in knee OA. Knee OA collagen had a mean hydroxyproline/proline (H/P) ratio of 1.2 consistent with the presence of type III collagen whereas hip OA collagen had a mean H/P ratio of 0.99 consistent with type II collagen. Based on Asp-RR, the relative age was significantly different in knee and hip OA (p<0.0005); on average OA knees were estimated to be 30yrs ‘younger’, and OA hips 10yrs ‘older’ than non-OA. Conclusions The metabolic response to OA was strikingly different by joint site. Knee OA cartilage evinced an anabolic response that appeared to be absent in hip OA cartilage. These results challenge the long held view that OA cartilage is capable of only minimal repair and that collagen loss is irreversible. PMID:26417696

  13. Multicenter randomized controlled trial comparing early versus late aquatic therapy after total hip or knee arthroplasty.

    PubMed

    Liebs, Thoralf R; Herzberg, Wolfgang; Rüther, Wolfgang; Haasters, Jörg; Russlies, Martin; Hassenpflug, Joachim

    2012-02-01

    To evaluate if the timing of aquatic therapy influences clinical outcomes after total knee arthroplasty (TKA) or total hip arthroplasty (THA). Multicenter randomized controlled trial with 3-, 6-, 12-, and 24-month follow-up. Two university hospitals, 1 municipal hospital, and 1 rural hospital. Patients (N=465) undergoing primary THA (n=280) or TKA (n=185): 156 men, 309 women. Patients were randomly assigned to receive aquatic therapy (pool exercises aimed at training of proprioception, coordination, and strengthening) after 6 versus 14 days after THA or TKA. Primary outcome was self-reported physical function as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 3-, 6-, 12-, and 24-months postoperatively. Results were compared with published thresholds for minimal clinically important improvements. Secondary outcomes included the Medical Outcomes Study 36-Item Short-Form Health Survey, Lequesne-Hip/Knee-Score, WOMAC-pain and stiffness scores, and patient satisfaction. Baseline characteristics of the 2 groups were similar. Analyzing the total study population did not result in statistically significant differences at all follow-ups. However, when performing subanalysis for THA and TKA, opposite effects of early aquatic therapy were seen between TKA and THA. After TKA all WOMAC subscales were superior in the early aquatic therapy group, with effect sizes of WOMAC physical function ranging from .22 to .39. After THA, however, all outcomes were superior in the late aquatic therapy group, with WOMAC effect sizes ranging from .01 to .19. However, the differences between treatment groups of these subanalyses were not statistically significant. Early start of aquatic therapy had contrary effects after TKA when compared with THA and it influenced clinical outcomes after TKA. Although the treatment differences did not achieve statistically significance, the effect size for early aquatic therapy after TKA had the same magnitude as the

  14. Qualitative Study Exploring the Meaning of Knee Symptoms to Adults Ages 35-65 Years.

    PubMed

    MacKay, Crystal; Sale, Joanna; Badley, Elizabeth M; Jaglal, Susan B; Davis, Aileen M

    2016-03-01

    While osteoarthritis (OA) has mainly been viewed as a disease affecting older people, its prevalence in younger adults is substantial. However, there is limited research on how younger adults understand knee symptoms. This article explores the meaning of knee symptoms to adults ages 35-65 years. This qualitative study comprised 6 focus groups and 10 one-on-one interviews with 51 participants (median age 49, 61% female), who self-reported knee OA or reported knee symptoms (i.e., pain, aching, or stiffness) on most days of the past month. Constructivist grounded theory guided the sampling, data collection, and analysis. Data were analyzed using a constant comparative method. Central to participants' understanding of knee symptoms was the perception that symptoms were preventable, meaning that there was the potential to prevent the onset of symptoms and to alter the course of symptoms. This understanding was demonstrated in participants' explanation of symptoms. Participants commented on the cause, prevention, and course of symptoms. Moreover, participants reflected on their experience with symptoms, indicating that symptoms made them feel older than their current age. However, they did not perceive their symptoms as normal or acceptable. Participants interpreted knee symptoms as potentially preventable, suggesting that they may be open to primary and secondary prevention strategies. © 2016 The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.

  15. Qualitative Study Exploring the Meaning of Knee Symptoms to Adults Ages 35–65 Years

    PubMed Central

    Sale, Joanna; Badley, Elizabeth M.; Jaglal, Susan B.; Davis, Aileen M.

    2016-01-01

    Objective While osteoarthritis (OA) has mainly been viewed as a disease affecting older people, its prevalence in younger adults is substantial. However, there is limited research on how younger adults understand knee symptoms. This article explores the meaning of knee symptoms to adults ages 35–65 years. Methods This qualitative study comprised 6 focus groups and 10 one‐on‐one interviews with 51 participants (median age 49, 61% female), who self‐reported knee OA or reported knee symptoms (i.e., pain, aching, or stiffness) on most days of the past month. Constructivist grounded theory guided the sampling, data collection, and analysis. Data were analyzed using a constant comparative method. Results Central to participants’ understanding of knee symptoms was the perception that symptoms were preventable, meaning that there was the potential to prevent the onset of symptoms and to alter the course of symptoms. This understanding was demonstrated in participants’ explanation of symptoms. Participants commented on the cause, prevention, and course of symptoms. Moreover, participants reflected on their experience with symptoms, indicating that symptoms made them feel older than their current age. However, they did not perceive their symptoms as normal or acceptable. Conclusion Participants interpreted knee symptoms as potentially preventable, suggesting that they may be open to primary and secondary prevention strategies. PMID:26238409

  16. The Association of Obesity with Walking Independent of Knee Pain: The Multicenter Osteoarthritis Study

    PubMed Central

    White, Daniel K.; Neogi, Tuhina; Zhang, Yuqing; Felson, David; LaValley, Michael; Niu, Jingbo; Nevitt, Michael; Lewis, Cora E.; Torner, James; Douglas Gross, K.

    2012-01-01

    Practice guidelines recommend addressing obesity for people with knee OA, however, the association of obesity with walking independent of pain is not known. We investigated this association within the Multicenter Osteoarthritis Study, a cohort of older adults who have or are at high risk of knee OA. Subjects wore a StepWatch to record steps taken over 7 days. We measured knee pain from a visual analogue scale and obesity by BMI. We examined the association of obesity with walking using linear regression adjusting for pain and covariates. Of 1788 subjects, the mean steps/day taken was 8872.9 ± 3543.4. Subjects with a BMI ≥35 took 3355 fewer steps per day independent of knee pain compared with those with a BMI ≤25 (95% CI −3899, −2811). BMI accounted for 9.7% of the variability of walking while knee pain accounted for 2.9%. BMI was associated with walking independent of knee pain. PMID:22645666

  17. The natural history of knee osteoarthritis: India-based knee osteoarthritis evaluation (iKare): a study protocol.

    PubMed

    Gilbert, Alexa; Li, Chuan Silvia; Sancheti, Parag; Hanson, Beate; Dhillon, Mandeep S; Naik, Rajeev; Shah, Nishith V; Shetty, Vijay D; Reddy, Gurava; Jagiasi, Jairam; Reddy, Anil Kumar; Ganguly, Utsav; Jhangiani, Neelam; Bhandari, Mohit

    2013-01-01

    Multi-center, cross-sectional, observational study. STUDY CENTER(S): Multiple centers in India. NUMBER OF PARTICIPANTS: 1,000. PRIMARY RESEARCH OBJECTIVE: To characterize patients and treatment utilized for orthopedic patients presenting to both private and public hospital centers in India with knee pain and symptoms suggestive of knee arthritis. All patients 18 years of age or older who present to a recruiting hospital for treatment of knee pain will be eligible for participation. The subjects must be able to understand and complete the questionnaire. Patients with total knee replacement, open wound or evidence of recent surgery, or with a current or a history of tumor and/or fracture in the tibial plateau, femoral condyle or patella, in the affected knee are not eligible. This study aims to characterize the following: general demographics of patients presenting with knee pain, severity of knee symptoms at time of presentation, severity of knee pathology at time of presentation, factors associated with the decision to seek medical care, previous treatments and health care contacts, planned treatment, and gaps in treatment perceived by the patient and treating surgeons.

  18. Adipose derived mesenchymal stem cell therapy in the treatment of isolated knee chondral lesions: design of a randomised controlled pilot study comparing arthroscopic microfracture versus arthroscopic microfracture combined with postoperative mesenchymal stem cell injections

    PubMed Central

    Freitag, Julien; Ford, Jon; Bates, Dan; Boyd, Richard; Hahne, Andrew; Wang, Yuanyuan; Cicuttini, Flavia; Huguenin, Leesa; Norsworthy, Cameron; Shah, Kiran

    2015-01-01

    Introduction The management of intra-articular chondral defects in the knee remains a challenge. Inadequate healing in areas of weight bearing leads to impairment in load transmission and these defects predispose to later development of osteoarthritis. Surgical management of full thickness chondral defects include arthroscopic microfracture and when appropriate autologous chondrocyte implantation. This latter method however is technically challenging, and may not offer significant improvement over microfracture. Preclinical and limited clinical trials have indicated the capacity of mesenchymal stem cells to influence chondral repair. The aim of this paper is to describe the methodology of a pilot randomised controlled trial comparing arthroscopic microfracture alone for isolated knee chondral defects versus arthroscopic microfracture combined with postoperative autologous adipose derived mesenchymal stem cell injections. Methods and analysis A pilot single-centre randomised controlled trial is proposed. 40 participants aged 18–50 years, with isolated femoral condyle chondral defects and awaiting planned arthroscopic microfracture will be randomly allocated to a control group (receiving no additional treatment) or treatment group (receiving postoperative adipose derived mesenchymal stem cell treatment). Primary outcome measures will include MRI assessment of cartilage volume and defects and the Knee Injury and Osteoarthritis Outcome Score. Secondary outcomes will include further MRI assessment of bone marrow lesions, bone area and T2 cartilage mapping, a 0–10 Numerical Pain Rating Scale, a Global Impression of Change score and a treatment satisfaction scale. Adverse events and cointerventions will be recorded. Initial outcome follow-up for publication of results will be at 12 months. Further annual follow-up to assess long-term differences between the two group will occur. Ethics and dissemination This trial has received prospective ethics approval through

  19. Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls.

    PubMed

    Fältström, Anne; Hägglund, Martin; Kvist, Joanna

    2017-02-01

    Good functional performance with limb symmetry is believed to be important to minimize the risk of injury after a return to pivoting and contact sports after anterior cruciate ligament reconstruction (ACLR). This study aimed to investigate any side-to-side limb differences in functional performance and movement asymmetries in female soccer players with a primary unilateral anterior cruciate ligament (ACL)-reconstructed knee and to compare these players with knee-healthy controls from the same soccer teams. Cross-sectional study; Level of evidence, 3. This study included 77 active female soccer players at a median of 18 months after ACLR (interquartile range [IQR], 14.5 months; range, 7-39 months) and 77 knee-healthy female soccer players. The mean age was 20.1 ± 2.3 years for players with an ACL-reconstructed knee and 19.5 ± 2.2 years for controls. We used a battery of tests to assess postural control (Star Excursion Balance Test) and hop performance (1-legged hop for distance, 5-jump test, and side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using 2-dimensional analyses. The reconstructed and uninvolved limbs did not differ in any of the tests. In the 5-jump test, players with an ACL-reconstructed knee performed worse than controls (mean 8.75 ± 1.05 m vs 9.09 ± 0.89 m; P = .034). On the drop vertical jump test, the ACL-reconstructed limb had significantly less knee valgus motion in the frontal plane (median 0.028 m [IQR, 0.049 m] vs 0.045 m [IQR, 0.043 m]; P = .004) and a lower probability of a high knee abduction moment (pKAM) (median 69.2% [IQR, 44.4%] vs 79.8% [IQR, 44.8%]; P = .043) compared with the control players' matched limb (for leg dominance). Results showed that 9% to 49% of players in both groups performed outside recommended guidelines on the different tests. Only 14 players with an ACL-reconstructed knee (18%) and 15 controls (19%) had results that met the recommended

  20. Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

    PubMed Central

    Kasch, Richard; Merk, Sebastian; Assmann, Grit; Lahm, Andreas; Napp, Matthias; Merk, Harry; Flessa, Steffen

    2017-01-01

    Background The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available. Questions/Purposes A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations. Methods A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes. Results Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p <.001). On the level of the separate hospitalizations the mean direct costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they

  1. Assessing the comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis: design and rationale for a randomized trial.

    PubMed

    Wang, Chenchen; Iversen, Maura D; McAlindon, Timothy; Harvey, William F; Wong, John B; Fielding, Roger A; Driban, Jeffrey B; Price, Lori Lyn; Rones, Ramel; Gamache, Tressa; Schmid, Christopher H

    2014-09-08

    Knee osteoarthritis (OA) causes pain and long-term disability with annual healthcare costs exceeding $185 billion in the United States. Few medical remedies effectively influence the course of the disease. Finding effective treatments to maintain function and quality of life in patients with knee OA is one of the national priorities identified by the Institute of Medicine. We are currently conducting the first comparative effectiveness and cost-effectiveness randomized trial of Tai Chi versus a physical-therapy regimen in a sample of patients with symptomatic and radiographically confirmed knee OA. This article describes the design and conduct of this trial. A single-center, 52-week, comparative effectiveness randomized controlled trial of Tai Chi versus a standardized physical-therapy regimen is being conducted at an urban tertiary medical center in Boston, Massachusetts. The study population consists of adults ≥ 40 years of age with symptomatic and radiographic knee OA (American College of Rheumatology criteria). Participants are randomly allocated to either 12 weeks of Tai Chi (2x/week) or Physical Therapy (2x/week for 6 weeks, followed by 6 weeks of rigorously monitored home exercise). The primary outcome measure is pain (Western Ontario and McMaster Universities WOMAC) subscale at 12 weeks. Secondary outcomes include WOMAC stkiffness and function domain scores, lower extremity strength and power, functional balance, physical performance tests, psychological and psychosocial functioning, durability effects, health related quality of life, and healthcare utilization at 12, 24 and 52 weeks. This study will be the first randomized comparative-effectiveness and cost-effectiveness trial of Tai Chi versus Physical Therapy in a large symptomatic knee OA population with long-term follow up. We present here a robust and well-designed randomized comparative-effectiveness trial that also explores multiple outcomes to elucidate the potential mechanisms of mind

  2. [Studies of the neuromuscular system of the knee joint].

    PubMed

    Börnert, K; Dippold, A

    1990-02-01

    The paper analysis the therapeutic effects of isometric training and electromechanic therapy (EMT) of the quadriceps muscles on subjects. The effects of the training practised with the knee joint bent was to be compared with previous results of training with the knee joint stretched. 36 subjects were trained and the increase in strength was measured with the help of a strain gauge dynamometer. Again a marked superiority of the EMT over sole isometric training could be demonstrated. More over, the results showed that the increase of the isometric maximal strength following an EMT is not influenced by the position of the angle of the joint.

  3. Importance of the different posterolateral knee static stabilizers: biomechanical study

    PubMed Central

    Lasmar, Rodrigo Campos Pace; Marques de Almeida, Adriano; Serbino, José Wilson; da Mota Albuquerque, Roberto Freire; Hernandez, Arnaldo José

    2010-01-01

    PURPOSE The purpose of this study was to evaluate the relative importance of the different static stabilizers of the posterolateral corner of the knee in cadavers. METHODS Tests were performed with the application of a varus and external rotation force to the knee in extension at 30 and 60 degrees of flexion using 10 cadaver knees. The forces were applied initially to an intact knee and then repeated after a selective sectioning of the ligaments into the following: section of the lateral collateral ligament; section of the lateral collateral ligament and the popliteofibular complex; and section of the lateral collateral ligament, the popliteofibular complex and the posterolateral capsule. The parameters studied were the angular deformity and stiffness when the knees were submitted to a 15 Newton-meter varus torque and a 6 Newton-meter external tibial torque. Statistical analysis was performed using the ANOVA (Analysis of Variance) and Tukey’s tests. RESULTS AND CONCLUSION Our findings showed that the lateral collateral ligament was important in varus stability at 0, 30 and 60 degrees. The popliteofibular complex was the most important structure for external rotation stability at all angles of flexion and was also important for varus stability at 30 and 60 degrees. The posterolateral capsule was important for varus stability at 0 and 30 degrees and for external rotation stability in extension. Level of evidence: Level IV (cadaver study). PMID:20454502

  4. Hyaluronic Acid (HA) Viscosupplementation on Synovial Fluid Inflammation in Knee Osteoarthritis: A Pilot Study

    PubMed Central

    Vincent, Heather K; Percival, Susan S; Conrad, Bryan P; Seay, Amanda N; Montero, Cindy; Vincent, Kevin R

    2013-01-01

    Objective: This study examined the changes in synovial fluid levels of cytokines, oxidative stress and viscosity six months after intraarticular hyaluronic acid (HA) treatment in adults and elderly adults with knee osteoarthritis (OA). Design: This was a prospective, repeated-measures study design in which patients with knee OA were administered 1% sodium hyaluronate. Patients (N=28) were stratified by age (adults, 50-64 years and elderly adults, ≥65 years). Ambulatory knee pain values and self-reported physical activity were collected at baseline and month six. Materials and Methods: Knee synovial fluid aspirates were collected at baseline and at six months. Fluid samples were analyzed for pro-inflammatory cytokines (interleukins 1β, 6,8,12, tumor necrosis factor-α, monocyte chemotactic protein), anti-inflammatory cytokines (interleukins 4, 10 13), oxidative stress (4-hydroxynonenal) and viscosity at two different physiological shear speeds 2.5Hz and 5Hz. Results: HA improved ambulatory knee pain in adults and elderly groups by month six, but adults reported less knee pain-related interference with participation in exercise than elderly adults. A greater reduction in TNF-α occurred in adults compared to elderly adults (-95.8% ± 7.1% vs 19.2% ± 83.8%, respectively; p=.044). Fluid tended to improve at both shear speeds in adults compared to the elderly adults. The reduction in pain severity correlated with the change in IL-1β levels by month six (r= -.566; p=.044). Conclusion: Reduction of knee pain might be due to improvements in synovial fluid viscosity and inflammation. Cartilage preservation may be dependent on how cytokine, oxidative stress profiles and viscosity change over time. PMID:24093052

  5. Loss of neuromuscular control related to motion in the acutely ACL-injured knee: an experimental study.

    PubMed

    Bonsfills, N; Gómez-Barrena, E; Raygoza, J J; Núñez, A

    2008-10-01

    Ligamentomuscular and muscular stretch reflexes are known to contribute to knee joint stability. After anterior cruciate ligament (ACL) injury, a more intense and adjusted muscular response is required to maintain joint stability, but this neuromuscular control of the knee has not been clearly proved. The aim of the study is to record electromyography (EMG) signal and muscular fibre length variations in quadriceps and hamstrings of the knee with and without ACL, and to analyze and integrate the ligament strain and the muscular reaction to forced anterior tibial translation (ATT). In 17 knees from 12 cats, EMG electrodes and ultrasonomicrometry crystals were inserted into four main periarticular muscles, with strain gauges on periarticular ligament insertions. Their output signal was compared before and after ACL surgical section in series of ATT (at 90 degrees and 30 degrees knee flexion), and also during knee flexion and extension. Linear regression analysis was performed between the EMG signal and muscular fibre length variations, and between the EMG signal and the strain on ligament insertions, in the search of this reflex neuromuscular response. In the ACL deficient knees, the studied muscles showed a poor adjustment to motion of EMG firing, inversely to controls. The muscle stretch reflexes showed poorer correlation with post-peak EMG activity than the ligaments. ATT control depended mainly on hamstrings activity in control knees, whereas in unstable knees, quadriceps activity was associated with more tibial translation. Acute ACL-deficient knees showed poor neuromuscular control with weak ligamentomuscular reflexes and no muscular stretch reflexes, suggesting the ineffectiveness of acute muscular reaction to provide early mechanical knee stabilization after injury.

  6. Symptomatic knee disorders in floor layers and graphic designers. A cross-sectional study

    PubMed Central

    2012-01-01

    Background Previous studies have described an increased risk of developing tibio-femoral osteoarthritis (TF OA), meniscal tears and bursitis among those with a trade as floor layers. The purpose of this study was to analyse symptomatic knee disorders among floor layers that were highly exposed to kneeling work tasks compared to graphic designers without knee-demanding work tasks. Methods Data on the Knee injury and Osteoarthritis Outcome Score (KOOS) were collected by questionnaires. In total 134 floor layers and 120 graphic designers had a bilateral radiographic knee examination to detect TF OA and patella-femoral (PF) OA. A random sample of 92 floor layers and 49 graphic designers had Magnetic Resonance Imaging (MRI) of both knees to examine meniscal tears. Means of the subscales of KOOS were compared by analysis of variance. The risk ratio of symptomatic knee disorders defined as a combination of radiological detected knee OA or MRI-detected meniscal tears combined with a low KOOS score was estimated by logistic regression in floor layers with 95% confidence interval (CI) and adjusted for age, body mass index, traumas, and knee-straining sports activities. Symptomatic knee OA or meniscal tears were defined as a combination of low KOOS-scores and radiographic or MRI pathology. Results Symptomatic TF and medial meniscal tears were found in floor layers compared to graphic designers with odds ratios 2.6 (95%CI 0.99-6.9) and 2.04 (95% CI 0.77-5.5), respectively. There were no differences in PF OA. Floor layers scored significantly lower on all KOOS subscales compared to graphic designers. Significantly lower scores on the KOOS subscales were also found for radiographic TF and PF OA regardless of trade but not for meniscal tears. Conclusions The study showed an overall increased risk of developing symptomatic TF OA in a group of floor layers with a substantial amount of kneeling work positions. Prevention would be appropriate to reduce the proportion of kneeling

  7. Symptomatic knee disorders in floor layers and graphic designers. A cross-sectional study.

    PubMed

    Jensen, Lilli Kirkeskov; Rytter, Søren; Bonde, Jens Peter

    2012-09-25

    Previous studies have described an increased risk of developing tibio-femoral osteoarthritis (TF OA), meniscal tears and bursitis among those with a trade as floor layers. The purpose of this study was to analyse symptomatic knee disorders among floor layers that were highly exposed to kneeling work tasks compared to graphic designers without knee-demanding work tasks. Data on the Knee injury and Osteoarthritis Outcome Score (KOOS) were collected by questionnaires. In total 134 floor layers and 120 graphic designers had a bilateral radiographic knee examination to detect TF OA and patella-femoral (PF) OA. A random sample of 92 floor layers and 49 graphic designers had Magnetic Resonance Imaging (MRI) of both knees to examine meniscal tears. Means of the subscales of KOOS were compared by analysis of variance. The risk ratio of symptomatic knee disorders defined as a combination of radiological detected knee OA or MRI-detected meniscal tears combined with a low KOOS score was estimated by logistic regression in floor layers with 95% confidence interval (CI) and adjusted for age, body mass index, traumas, and knee-straining sports activities. Symptomatic knee OA or meniscal tears were defined as a combination of low KOOS-scores and radiographic or MRI pathology. Symptomatic TF and medial meniscal tears were found in floor layers compared to graphic designers with odds ratios 2.6 (95%CI 0.99-6.9) and 2.04 (95% CI 0.77-5.5), respectively. There were no differences in PF OA. Floor layers scored significantly lower on all KOOS subscales compared to graphic designers. Significantly lower scores on the KOOS subscales were also found for radiographic TF and PF OA regardless of trade but not for meniscal tears. The study showed an overall increased risk of developing symptomatic TF OA in a group of floor layers with a substantial amount of kneeling work positions. Prevention would be appropriate to reduce the proportion of kneeling postures e.g. by working with tools used

  8. Distal femur reconstruction with modular tumour prostheses: a single Institution analysis of implant survival comparing fixed versus rotating hinge knee prostheses.

    PubMed

    Pala, Elisa; Trovarelli, Giulia; Angelini, Andrea; Ruggieri, Pietro

    2016-10-01

    To evaluate the incidence of complications in distal femur reconstructions with modular prostheses, comparing fixed vs rotating hinge knee. Retrospective analysis of implant survival, complications, and functional results of the Rizzoli series on distal femur megaprosthesis. Between 1983 and 2010, 687 distal femur tumour modular prostheses were implanted: 491 fixed hinge and 196 rotating hinge knee prostheses. Failures of the prostheses were classified in five types: type 1, soft tissue failure; type 2, aseptic loosening; type 3, structural failure; type 4, infection; type 5, tumour progression. Failure rate was 27 % (185/687). Implant survival to all types of failure was 70 % at ten years and 50 % at 20 years with no significant difference between fixed and rotating hinge knee prostheses (p = 0.0928). When excluding type 5 and type 1 failures, the overall survival was 78 % and 58 % at ten and 20 years. There was not a significant difference in implant survival to aseptic loosening (p = 0.5) and infection (p = 0.2) between fixed and rotating hinge knee prostheses. All cases of breakage of prosthetic components occurred in fixed hinge knee prostheses. Functional results, evaluated in 536 pts, were satisfactory in 91.4 % of cases with a mean score of 23.3 with a significantly better function for rotating hinge knee prostheses (p < 0.001). The most frequent cause of failure was infection followed by aseptic loosening. Even if better results were expected for rotating hinge knee prostheses, there is no significant difference in overall implant survival. No cases of breakage of prosthetic components occurred in rotating hinge knee prosthesis. Functional results were significantly better for the rotating hinge knee prostheses. Therapeutic study, level IV (case series).

  9. Knee sports injury is associated with an increased prevalence of unilateral knee replacement: a case-controlled study.

    PubMed

    Tjoumakaris, Fotios Paul; Van Kleunen, Jonathan; Weidner, Zachary; Huffman, George Russell

    2012-11-01

    Injury to the knee during athletics is common and may limit future sports participation, but its long-term effects on patients are less well characterized. Examining the development of end-stage osteoarthritis (OA) in these patients may help better clarify this relationship. We hypothesize that sports-related knee injuries are associated with subsequent unilateral knee OA and need for total knee arthroplasty (TKA) relative to bilateral knee replacement. We present a single-hospital case-control study of 124 consecutive patients undergoing primary TKA over a 6-month period for end-stage OA. Patients were interviewed at the time of surgery using a standardized questionnaire to detect and characterize a history of athletic knee injury. The presence of contralateral knee arthritis based on preoperative assessment was noted for all patients. A control population was derived from patients with diagnosed or known bilateral OA undergoing TKA. Patients were all assessed for exposure to earlier sports or athletic injury. Prestudy power analysis and uni- and multivariate statistical analyses were performed. Of the 124 patients, 27 (22%) recorded a history of athletic knee injury. Evidence of bilateral significant knee OA was found in 73 patients and unilateral arthritis in 51 patients. Patients with unilateral OA were found to have an increased likelihood of previous athletic injury relative to those with bilateral disease (odds ratio: 6.08, p = 0.0001). There is a significant prevalence of sports-related injuries in patients with unilateral knee OA. This study suggests that patients with such injuries may develop arthritis via a different process, sports-related trauma, than patients with bilateral nontraumatic OA.

  10. Genetic mechanisms of knee osteoarthritis: a population based case–control study

    PubMed Central

    Jones, G; Ding, C; Scott, F; Cicuttini, F

    2004-01-01

    Objective: To compare subjects who had at least one parent with a total knee replacement for severe primary knee osteoarthritis with age and sex matched controls who had no family history of knee osteoarthritis Design: Population based case–control study of 188 matched pairs (mean age 45 years, range 26 to 60). Methods: Articular cartilage volume and bone size were determined at the patella and at the medial tibial and lateral tibial compartments by processing images acquired using T1 weighted, fat saturated magnetic resonance imaging. Radiographic osteoarthritis (ROA) was assessed from a standing semiflexed radiograph scored for joint space narrowing and osteophytosis. Knee pain was assessed by questionnaire. Height, weight, body mass index (BMI), lower limb muscle strength, and endurance fitness were measured by standard protocols. Results: Compared with the controls, index offspring had higher BMI (27.8 v 26.0 kg/m2, p = 0.02), weaker lower limb muscles (127 v 135 kg, p = 0.006), more knee pain (47% v 22%, p<0.001), and greater medial tibial bone area (17.6 v 17.1 cm2, p = 0.01). With the exception of BMI, these differences persisted in multivariate analysis. There was a non-significant trend to higher cartilage volume at tibial sites and increased ROA in the offspring in the total and subgroup analyses, but no difference in height and endurance fitness. Conclusions: BMI, muscle strength, knee pain, and medial tibial bone area, but not cartilage volume, appear to play a role in the genetic regulation and development of knee osteoarthritis. PMID:15361382

  11. It's not just a knee, but a whole life: A qualitative descriptive study on patients' experiences of living with knee osteoarthritis and their expectations for knee arthroplasty.

    PubMed

    Nyvang, Josefina; Hedström, Margareta; Gleissman, Sissel Andreassen

    2016-01-01

    Knee arthroplasties are an increasingly common treatment for osteoarthritis (OA) and the main indication is pain. Previous research states, however, that 15-20% of the operated patients are dissatisfied and 20-30% have persistent pain after surgery. This study is aimed at describing patients' experiences of living with knee OA when scheduled for surgery and further their expectations for future life after surgery. We interviewed 12 patients with knee OA scheduled for arthroplasty, using semi-structured qualitative interviews. The interviews were recorded and transcribed verbatim and analyzed using qualitative thematic analysis. Three categories were formulated with an overriding theme: "It's not just a knee, but a whole life." The three categories were "Change from their earlier lives," "Coping with knee problems," and "Ultimate decision to undergo surgery." The main finding was that knee OA affects the whole body and self, ultimately affecting the patients' lives on many levels. Further findings were that knee OA was considered to be the central focus in the participants' lives, which limited their level of activity, their ability to function as desired, their quality of life, and their mental well-being. Although surgery was considered to be the only solution, the expectations regarding the outcome differed. The participants were forced to change how they previously had lived their lives resulting in a feeling of loss. Thus, the experienced loss and expectations for future life must be put into the context of the individual's own personality and be taken into account when treating individuals with knee OA. The experience of living with knee OA largely varies between individuals. This mandates that patients' assessment should be considered on individual basis with regard to each patient.

  12. Nonsurgical or Surgical Treatment of ACL Injuries: Knee Function, Sports Participation, and Knee Reinjury: The Delaware-Oslo ACL Cohort Study.

    PubMed

    Grindem, Hege; Eitzen, Ingrid; Engebretsen, Lars; Snyder-Mackler, Lynn; Risberg, May Arna

    2014-08-06

    While there are many opinions about the expected knee function, sports participation, and risk of knee reinjury following nonsurgical treatment of injuries of the anterior cruciate ligament (ACL), there is a lack of knowledge about the clinical course following nonsurgical treatment compared with that after surgical treatment. This prospective cohort study included 143 patients with an ACL injury. Isokinetic knee extension and flexion strength and patient-reported knee function as recorded on the International Knee Documentation Committee (IKDC) 2000 form were collected at baseline, six weeks, and two years. Sports participation was reported monthly for two years with use of an online activity survey. Knee reinjuries were reported at the follow-up evaluations and in a monthly online survey. Repeated analysis of variance (ANOVA), generalized estimating equation (GEE) models, and Cox regression analysis were used to analyze group differences in functional outcomes, sports participation, and knee reinjuries, respectively. The surgically treated patients (n = 100) were significantly younger, more likely to participate in level-I sports, and less likely to participate in level-II sports prior to injury than the nonsurgically treated patients (n = 43). There were no significant group-by-time effects on functional outcome. The crude analysis showed that surgically treated patients were more likely to sustain a knee reinjury and to participate in level-I sports in the second year of the follow-up period. After propensity score adjustment, these differences were nonsignificant; however, the nonsurgically treated patients were significantly more likely to participate in level-II sports during the first year of the follow-up period and in level-III sports over the two years. After two years, 30% of all patients had an extensor strength deficit, 31% had a flexor strength deficit, 20% had patient-reported knee function below the normal range, and 20% had experienced knee

  13. Pilot Study of Massage in Veterans with Knee Osteoarthritis

    PubMed Central

    Juberg, Michael; Allen, Kelli D.; Dmitrieva, Natalia O.; Keever, Teresa

    2015-01-01

    Abstract Objectives: To (1) assess the feasibility and acceptability of Swedish massage among Department of Veterans Affairs (VA) health care users with knee osteoarthritis (OA) and (2) collect preliminary data on efficacy of Swedish massage in this patient group. Design: Experimental pilot study. Setting: Duke Integrative Medicine clinic and VA Medical Center, Durham, North Carolina. Patients: Twenty-five veterans with symptomatic knee OA. Interventions: Eight weekly 1-hour sessions of full-body Swedish massage. Outcome measures: Primary: Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and global pain (Visual Analog Scale [VAS]). Secondary: National Institutes of Health Patient Reported Outcomes Measurement Information System-Pain Interference Questionnaire 6b (PROMIS-PI 6b), 12-Item Short-Form Health Survey (SF-12 v1) and the EuroQol health status index (EQ-5D-5L), knee range of motion (ROM), and time to walk 50 feet. Results: Study feasibility was established by a 92% retention rate with 99% of massage visits and 100% of research visits completed. Results showed significant improvements in self-reported OA-related pain, stiffness and function (30% improvement in Global WOMAC scores; p=0.001) and knee pain over the past 7 days (36% improvement in VAS score; p<0.001). PROMIS-PI, EQ-5D-5L, and physical composite score of the SF-12 also significantly improved (p<0.01 for all), while the mental composite score of the SF-12 and knee ROM showed trends toward significant improvement. Time to walk 50 feet did not significantly improve. Conclusions: Results of this pilot study support the feasibility and acceptability of Swedish massage among VA health care users as well as preliminary data suggesting its efficacy for reducing pain due to knee OA. If results are confirmed in a larger randomized trial, massage could be an important component of regular care for these patients. PMID:25966332

  14. Comparing the mechanical properties of the porcine knee meniscus when hydrated in saline versus synovial fluid.

    PubMed

    Lakes, Emily H; Kline, Courtney L; McFetridge, Peter S; Allen, Kyle D

    2015-12-16

    As research progresses to find a suitable knee meniscus replacement, accurate in vitro testing becomes critical for feasibility and comparison studies of mechanical integrity. Within the knee, the meniscus is bathed in synovial fluid, yet the most common hydration fluid in laboratory testing is phosphate buffered saline (PBS). PBS is a relatively simple salt solution, while synovial fluid is a complex non-Newtonian fluid with multiple lubricating factors. As such, PBS may interact with meniscal tissue differently than synovial fluid, and thus, the hydration fluid may be an important factor in obtaining accurate results during in vitro testing. To evaluate these effects, medial porcine menisci were used to evaluate tissue mechanics in tension (n=11) and compression (n=15). In all tests, two samples from the same meniscus were taken, where one sample was hydrated in PBS and the other was hydrated in synovial fluid. Statistical analysis revealed no significant differences between the mean mechanical properties of samples tested in PBS compared to synovial fluid; however, compressive testing revealed the variability between samples was significantly reduced if samples were tested in synovial fluid. For example, the compressive Young׳s Modulus was 12.69±7.49MPa in PBS versus 12.34±4.27MPa in synovial fluid. These results indicate testing meniscal tissue in PBS will largely not affect the mean value of the mechanical properties, but performing compression testing in synovial fluid may provide more consistent results between samples and assist in reducing sample numbers in some experiments.

  15. Tibial tubercle osteotomy or quadriceps snip in two-stage revision for prosthetic knee infection? A randomized prospective study.

    PubMed

    Bruni, Danilo; Iacono, Francesco; Sharma, Bharat; Zaffagnini, Stefano; Marcacci, Maurilio

    2013-04-01

    Although 7% to 38% of revision total knee arthroplasties (RTKAs) are attributable to prosthetic knee infections, controversy exists regarding the best surgical approach while reducing the risk of extensor mechanism complications and the reinfection rate. We compared The Knee Society Score(©) (KSS), incidences of complications, maximum knee flexion, residual extension lag, and reinfection rate in patients with prosthetic knee infections treated with two-stage RTKAs using either the tibial tubercle osteotomy (TTO) or the quadriceps snip (QS) for exposure at the time of reimplantation. We prospectively followed 81 patients with chronic prosthetic knee infections treated between 1997 and 2004. Patients were randomized to receive a TTO or QS for exposure at the time of reimplantation. All patients had the same rehabilitation protocol. The minimum followup was 8 years (mean, 12 years; range, 8-15 years). Patients in the TTO group had a higher mean KSS than the QS group (88 versus 70, respectively). Mean maximum knee flexion was greater in the TTO group (113° versus 94°); with a lower incidence of extension lag (45% versus 13%). We observed no differences in reinfection rate between groups. We found the TTO combined with an early rehabilitation protocol associated with superior KSS did not impair extensor mechanism function or increase the reinfection rate. We believe a two-stage RTKA with TTO is a reasonable approach for treating prosthetic knee infections. Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  16. Comparable outcomes after total knee arthroplasty in patients under 55 years than in older patients: a matched prospective study with minimum follow-up of 10 years.

    PubMed

    Lizaur-Utrilla, Alejandro; Martinez-Mendez, Daniel; Miralles-Muñoz, Francisco A; Marco-Gómez, Luis; Lopez-Prats, Fernando A

    2016-12-27

    To compare outcomes after TKA for osteoarthritis between patients younger than 55 years and older patients. A cohort of 61 patients aged 55 years or younger was prospectively matched for gender, body mass index and knee function with patients with median age of 66 (range 60-70) years. Clinical evaluation was performed by the Knee Society scores (KSS), reduced Western Ontario and McMasters Universities (WOMAC) and Short-Form 12 (SF12) questionnaires. Radiological evaluation was also performed. The median follow-up was 12 (range 10-14) years. Survival at 14 years was 96.7% (95% CI 92-100%) in the younger group and 98.2% (95% CI 95-100%) in the older group (n.s.). There was no deep infection or loosening of femoral or patellar component in either group. In the younger group, 2 patients required revision (aseptic tibial loosening at 8 years, and polyethylene wear at 10 years). In the older group, there was 1 revision (aseptic tibial loosening). Revision rate was not significantly different (n.s.). Multivariate analysis showed no significant relationship between revision and age, gender or BMI. At 5-year follow-up, there were no significant differences between groups in KSS knee or function, WOMAC pain or function, or SF12 physical or mental, but in the last evaluation there were better results in younger patients for KSS-function (p = 0.018), WOMAC-function (p = 0.028), SF12-physical (p = 0.001) and SF12-mental (p = 0.035), although these differences were not clinically relevant. A significant decline was noted for KSS-function in either group from 5-year to at last follow-up. The TKA survival in younger patients was comparable to older active patients, without increased complications or revisions at a minimum follow-up of 10 years. Primary hybrid TKA can provide successful pain relief, function and quality of life in younger patients than 55 years with osteoarthritis. TKA is a suitable option for these young patients with appropriate surgical

  17. Analgesic drug consumption increases after knee arthroplasty: a pharmacoepidemiological study investigating postoperative pain.

    PubMed

    Fuzier, Régis; Serres, Isabelle; Bourrel, Robert; Palmaro, Aurore; Montastruc, Jean-Louis; Lapeyre-Mestre, Maryse

    2014-07-01

    Knee arthroplasty remains the gold standard in the treatment of severe osteoarthritis. Chronic postoperative pain has been reported with a prevalence ranging from 15% to 47%. The aim of this study was to compare analgesic drug consumption before and after surgery as an indicator of pain after knee surgery. A pharmacoepidemiological method comparing analgesics and antineuropathic issues 1 year before and 1 year after surgery was used. All patients who underwent knee arthroplasty in the Midi-Pyrenees region (2.5 million inhabitants) were identified through the Health Insurance System Database. Increase of drug issues (all analgesics, antineuropathic drugs, strong opioids) was calculated and compared between several periods surrounding the surgery (12 months, 2 months, and 10 months before and after the knee arthroplasty). A multivariate logistic regression model was used to identify factors associated with chronic postoperative pain. The study included 1939 patients. An increase in analgesic, antineuropathic, and opioid drug consumption was observed the year after the surgery in 47.3%, 8.6%, and 5.6% of patients, respectively. Multivariate analysis found a significant association between type of surgery (total knee vs unicompartmental arthroplasty) and analgesic consumption 1 year after surgery, and between preoperative pain and psychiatric vulnerability and increase in neuropathic drug dispensing. Conversely, older age was considered as a protective factor. This study revealed that an increase in the issue of different analgesic drugs is present in half of patients 1 year after knee arthroplasty. Several associated factors of drug consumption (preoperative pain, type of surgery, and psychiatric disorder) were identified.

  18. Efficacy of a novel iPod-based navigation system compared to traditional navigation system in total knee arthroplasty.

    PubMed

    Mullaji, Arun B; Shetty, Gautam M

    2017-12-01

    This prospective study aimed to verify the efficacy of a novel, hand-held, iPod-based navigation system in comparison to traditional navigation system for total knee arthroplasty (TKA). Limb alignment, tibial and distal femoral bone cut thickness and plane were recorded intraoperatively using both iPod-based and traditional navigation system in 36 knees undergoing primary TKAs. Intraoperatively, the iPod-based navigation system showed good to excellent correlation and reliability for tibial and distal femoral bone cut thickness, plane of the femoral cut and limb alignment when compared to the traditional navigation system. Despite its quick registration feature, the iPod-based system has an efficacy similar to traditional navigation system and is a positive step towards making navigation systems for TKA more compact, user-friendly, time and cost-effective.

  19. Ethnic differences in the prevalence of knee pain among adults of a community in a cross-sectional study

    PubMed Central

    Beh, Hooi Chin; Ng, Chirk Jenn; Teng, Cheong Lieng; Hanafi, Nik Sherina; Choo, Wan Yuen

    2016-01-01

    Objective To determine the prevalence of knee pain among 3 major ethnic groups in Malaysia. By identifying high-risk groups, preventive measures can be targeted at these populations. Design and setting A cross-sectional survey was carried out in rural and urban areas in a state in Malaysia. Secondary schools were randomly selected and used as sampling units. Participants Adults aged ≥18 years old were invited to answer a self-administered questionnaire on pain experienced over the previous 6 months. Out of 9300 questionnaires distributed, 5206 were returned and 150 participants who did not fall into the 3 ethnic groups were excluded, yielding a total of 5056 questionnaires for analysis. 58.2% (n=2926) were women. 50% (n=2512) were Malays, 41.4% (n=2079) were Chinese and 8.6% (n=434) were Indians. Results 21.1% (n=1069) had knee pain during the previous 6 months. More Indians (31.8%) experienced knee pain compared with Malays (24.3%) and Chinese (15%) (p<0.001). The odds of Indian women reporting knee pain was twofold higher compared with Malay women. There was a rising trend in the prevalence of knee pain with increasing age (p<0.001). The association between age and knee pain appeared to be stronger in women than men. 68.1% of Indians used analgesia for knee pain while 75.4% of Malays and 52.1% of Chinese did so (p<0.001). The most common analgesic used for knee pain across all groups was topical medicated oil (43.7%). Conclusions The prevalence of knee pain in adults was more common in Indian women and older women age groups and Chinese men had the lowest prevalence of knee pain. Further studies should investigate the reasons for these differences. PMID:27909033

  20. Between-group differences in infra-patellar fat pad size and signal in symptomatic and radiographic progression of knee osteoarthritis vs non-progressive controls and healthy knees - data from the FNIH Biomarkers Consortium Study and the Osteoarthritis Initiative.

    PubMed

    Ruhdorfer, A; Haniel, F; Petersohn, T; Dörrenberg, J; Wirth, W; Dannhauer, T; Hunter, D J; Eckstein, F

    2017-07-01

    To examine cross-sectional and longitudinal between-group differences of infra-patellar fat pad (IPFP) size and magnetic resonance imaging (MRI) signal from fat-suppressed intermediate-weighted images with clinically relevant symptomatic and radiographic progression of knee osteoarthritis (OA), vs healthy references. We studied 110 case knees (Kellgren-Lawrence Grade [KLG1-3]) with radiographic (≥0.7 mm loss in joint space width [JSW]) and symptomatic progression (≥+9/100 units on the Western Ontario and McMasters Universities Osteoarthritis Index [WOMAC] knee pain subscale) vs 118 control knees without progression from the Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium cohort. We further studied 88 knees from the Osteoarthritis Initiative (OAI) healthy reference cohort without (risk factors) of knee OA. The IPFP was manually segmented using baseline and year-2 sagittal fat-suppressed intermediate-weighted spin-echo 3 T MRIs. Baseline measures and longitudinal change in IPFP volume and 3D MRI signal (mean, standard deviation [SD]) were compared between groups. No statistically significant baseline differences in IPFP volume, 3D MRI signal mean or signal heterogeneity (SD) were observed between progressor and non-progressor OA knees. Yet, the IPFP 3D MRI signal SD, but not its volume, was statistically significantly greater in OA vs healthy knees. No statistically significant 2-year changes in IPFP volume were observed in either group, but the increase in 3D MRI signal heterogeneity (SD) was greater in progressor vs non-progressor knees, and was greater in OA vs healthy knees. Whereas IPFP-related morphometric measures did not statistically significantly differ between groups, a stronger increase in 3D IPFP MRI signal and signal heterogeneity may be associated with radiographic/symptomatic progression of OA, when compared to non-progressive OA or healthy knees. Copyright © 2017 Osteoarthritis Research Society International

  1. Knee Kinematics Estimation Using Multi-Body Optimisation Embedding a Knee Joint Stiffness Matrix: A Feasibility Study

    PubMed Central

    Richard, Vincent; Lamberto, Giuliano; Lu, Tung-Wu; Cappozzo, Aurelio; Dumas, Raphaël

    2016-01-01

    The use of multi-body optimisation (MBO) to estimate joint kinematics from stereophotogrammetric data while compensating for soft tissue artefact is still open to debate. Presently used joint models embedded in MBO, such as mechanical linkages, constitute a considerable simplification of joint function, preventing a detailed understanding of it. The present study proposes a knee joint model where femur and tibia are represented as rigid bodies connected through an elastic element the behaviour of which is described by a single stiffness matrix. The deformation energy, computed from the stiffness matrix and joint angles and displacements, is minimised within the MBO. Implemented as a “soft” constraint using a penalty-based method, this elastic joint description challenges the strictness of “hard” constraints. In this study, estimates of knee kinematics obtained using MBO embedding four different knee joint models (i.e., no constraints, spherical joint, parallel mechanism, and elastic joint) were compared against reference kinematics measured using bi-planar fluoroscopy on two healthy subjects ascending stairs. Bland-Altman analysis and sensitivity analysis investigating the influence of variations in the stiffness matrix terms on the estimated kinematics substantiate the conclusions. The difference between the reference knee joint angles and displacements and the corresponding estimates obtained using MBO embedding the stiffness matrix showed an average bias and standard deviation for kinematics of 0.9±3.2° and 1.6±2.3 mm. These values were lower than when no joint constraints (1.1±3.8°, 2.4±4.1 mm) or a parallel mechanism (7.7±3.6°, 1.6±1.7 mm) were used and were comparable to the values obtained with a spherical joint (1.0±3.2°, 1.3±1.9 mm). The study demonstrated the feasibility of substituting an elastic joint for more classic joint constraints in MBO. PMID:27314586

  2. [Subclinical findings in the knees of taekwondo athletes: diagnostic ultrasound study].

    PubMed

    Martínez Hernández, Luis Enrique; Hernández Díaz, Cristina; Pegueros Pérez, Andrea; Franco Sánchez, José Gilberto; Pineda Villaseñor, Carlos

    2014-12-01

    Taekwondo is associated with an increased incidence of musculoskeletal injuries such as tendinopathy, synovitis, chondropathy, and ligament and meniscus injuries that may have an asymptomatic course in their initial stages, especially those located in the knee. To describe the presence of morphostructural abnormalities in asymptomatic taekwondo athletes' (TKD) knees through the use of diagnostic ultrasound (US). A cross-sectional, descriptive and comparative study. We evaluated 32 knees of 16 subjects (8 TKD and 8 recreational athletes). All subjects underwent sport-medical history and knee US. A variety of intra- and extra-articular morphostructural abnormalities were observed; the most frequent were synovitis, meniscal extrusion, and enthesopathy. The practice of Taekwondo abnormalities associated with an increased risk of knee injuries that may go unnoticed in the early stages. The use of US as an auxiliary tool in the diagnosis of these injuries and/or advisable since it can define in detail the anatomical structures subject to overuse, biomechanical stress, or repetitive trauma, and contribute to early detection of asymptomatic morphostructural alterations that may ensure timely preventive and therapeutic interventions.

  3. Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research.

    PubMed

    Johnson, R L; Kopp, S L; Burkle, C M; Duncan, C M; Jacob, A K; Erwin, P J; Murad, M H; Mantilla, C B

    2016-02-01

    This systematic review evaluated the evidence comparing patient-important outcomes in spinal or epidural vs general anaesthesia for total hip and total knee arthroplasty. MEDLINE, Ovid EMBASE, EBSCO CINAHL, Thomson Reuters Web of Science, and the Cochrane Central Register of Controlled Trials from inception until March 2015 were searched. Eligible randomized controlled trials or prospective comparative studies investigating mortality, major morbidity, and patient-experience outcomes directly comparing neuraxial (spinal or epidural) with general anaesthesia for total hip arthroplasty, total knee arthroplasty, or both were included. Independent reviewers working in duplicate extracted study characteristics, validity, and outcomes data. Meta-analysis was conducted using the random-effects model. We included 29 studies involving 10 488 patients. Compared with general anaesthesia, neuraxial anaesthesia significantly reduced length of stay (weighted mean difference -0.40 days; 95% confidence interval -0.76 to -0.03; P=0.03; I2 73%; 12 studies). No statistically significant differences were found between neuraxial and general anaesthesia for mortality, surgical duration, surgical site or chest infections, nerve palsies, postoperative nausea and vomiting, or thromboembolic disease when antithrombotic prophylaxis was used. Subgroup analyses failed to find statistically significant interactions (P>0.05) based on risk of bias, type of surgery, or type of neuraxial anaesthesia. Neuraxial anaesthesia for total hip or total knee arthroplasty, or both appears equally effective without increased morbidity when compared with general anaesthesia. There is limited quantitative evidence to suggest that neuraxial anaesthesia is associated with improved perioperative outcomes. Future investigations should compare intermediate and long-term outcome differences to better inform anaesthesiologists, surgeons, and patients on importance of anaesthetic selection. © The Author 2016. Published

  4. A 12-week randomized study of topical therapy with three dosages of ketoprofen in Transfersome® gel (IDEA-033) compared with the ketoprofen-free vehicle (TDT 064), in patients with osteoarthritis of the knee

    PubMed Central

    Kneer, Werner; Rother, Matthias; Mazgareanu, Stefan; Seidel, Egbert J

    2013-01-01

    Objective To evaluate the safety and efficacy of ketoprofen in Transfersome® gel (IDEA-033) in comparison with a ketoprofen-free vehicle (TDT 064) for the treatment of osteoarthritis (OA) of the knee. Methods Patients with knee OA (N = 866) were randomly assigned to receive topical IDEA-033 containing 100, 50, or 25 mg ketoprofen, or TDT 064 twice daily for 12 weeks, in a double-blind trial. The primary efficacy endpoint was the change in the Western Ontario and McMaster Universities (WOMAC®) Osteoarthritis Index pain subscale score. The coprimary efficacy endpoints were the WOMAC function subscale score and the patient global assessment of response to therapy. The secondary endpoints included the numeric pain rating for the first 14 days of treatment and the Outcome Measures in Rheumatology (OMERACT)-Osteoarthritis Research Society International (OARSI) responder rates. Results The WOMAC pain scores were reduced by approximately 50% or more in all four groups. The 100 and 50 mg ketoprofen groups, but not the 25 mg group, showed a superior reduction in the WOMAC pain score versus the TDT 064 group (100 mg: −57.4% [P = 0.0383]; 50 mg: −57.1% [P = 0.0204]; and 25 mg: −53.4% [P = 0.3616] versus TDT 064: −49.5%). The superiority of the ketoprofen-containing formulations was not demonstrated for the WOMAC function subscale score, whereas the patient global assessment of 50 mg ketoprofen group, but not the 100 or 25 mg group, was superior to that of the TDT 064 group (P = 0.0283). Responder rates were significantly higher for all the IDEA-033 groups versus the TDT 064 group, but were high in all groups (100 mg: 88.6%; 50 mg: 86.8%; 25 mg: 88.6%; and TDT 064: 77.5%). Dermal reactions were the only relevant drug-related adverse events in all four groups. Conclusion The 50 and 100 mg ketoprofen doses of IDEA-033 were only marginally superior to TDT 064 for reducing pain associated with knee OA. The study indicates a high treatment response to the topical

  5. A Yoga Strengthening Program Designed to Minimize the Knee Adduction Moment for Women with Knee Osteoarthritis: A Proof-Of-Principle Cohort Study

    PubMed Central

    2015-01-01

    People with knee osteoarthritis may benefit from exercise prescriptions that minimize knee loads in the frontal plane. The primary objective of this study was to determine whether a novel 12-week strengthening program designed to minimize exposure to the knee adduction moment (KAM) could improve symptoms and knee strength in women with symptomatic knee osteoarthritis. A secondary objective was to determine whether the program could improve mobility and fitness, and decrease peak KAM during gait. The tertiary objective was to evaluate the biomechanical characteristics of this yoga program. In particular, we compared the peak KAM during gait with that during yoga postures at baseline. We also compared lower limb normalized mean electromyography (EMG) amplitudes during yoga postures between baseline and follow-up. Primary measures included self-reported pain and physical function (Knee injury and Osteoarthritis Outcome Score) and knee strength (extensor and flexor torques). Secondary measures included mobility (six-minute walk, 30-second chair stand, stair climbing), fitness (submaximal cycle ergometer test), and clinical gait analysis using motion capture synchronized with electromyography and force measurement. Also, KAM and normalized mean EMG amplitudes were collected during yoga postures. Forty-five women over age 50 with symptomatic knee osteoarthritis, consistent with the American College of Rheumatology criteria, enrolled in our 12-week (3 sessions per week) program. Data from 38 were analyzed (six drop-outs; one lost to co-intervention). Participants experienced reduced pain (mean improvement 10.1–20.1 normalized to 100; p<0.001), increased knee extensor strength (mean improvement 0.01 Nm/kg; p = 0.004), and increased flexor strength (mean improvement 0.01 Nm/kg; p = 0.001) at follow-up compared to baseline. Participants improved mobility on the six-minute walk (mean improvement 37.7 m; p<0.001) and 30-second chair stand (mean improvement 1.3; p = 0.006) at

  6. Knee osteoarthritis in traumatic knee symptoms in general practice: 6-year cohort study

    PubMed Central

    Kastelein, Marlous; Luijsterburg, Pim A J; Koster, Ingrid M; Verhaar, Jan A N; Koes, Bart W; Vroegindeweij, Dammis; Bierma-Zeinstra, Sita M A; Oei, Edwin H G

    2016-01-01

    Aim To identify degenerative knee abnormalities using MRI and radiography 6 years after knee trauma, their relation with persistent knee symptoms and baseline prognostic factors. Methods Adults (18–65 years) with incident traumatic knee symptoms visiting their general practitioner were followed up for 6 years and underwent baseline MRI and 6-year follow-up MRI and radiography. Logistic regression was used to analyse associations between various degenerative abnormalities on 6-year MRI and radiography, persistent knee symptoms and baseline prognostic factors for knee osteoarthritis (OA) on 6-year MRI. Results On 6-year radiography, 60% of patients showed no OA, 28% showed OA with Kellgren&Lawrence (K&L) grade 1 and 13% showed with K&L grade 2. On 6-year MRI, 55% of patients showed cartilage defect(s), 45% showed osteophyte(s), 36% showed subchondral cyst(s), 40% showed bone marrow oedema, 21% showed meniscal subluxation, 83% showed meniscal degeneration,11% showed effusion and 11% showed a Baker's cyst. Of these, most were significantly related with 6-year radiographic K&L grade, while only lateral cartilage defect(s), medial osteophyte(s) and medial meniscal subluxation were significantly related with persistent knee symptoms. 32% of patients showed new onset or progressive knee OA on 6-year MRI, for which age, history of non-traumatic knee symptoms and bone marrow oedema at baseline were independent prognostic factors. Conclusions Degenerative knee abnormalities on MRI are related to the K&L score; however, not all abnormalities are reflected in clinical outcome. Age, history of non-traumatic knee symptoms and bone marrow oedema predict knee OA 6 years after knee trauma, present in 32% of the patients. PMID:27900195

  7. A pilot study of post-total knee replacement gait rehabilitation using lower limbs robot-assisted training system.

    PubMed

    Li, Jianhua; Wu, Tao; Xu, Zhisheng; Gu, Xudong

    2014-02-01

    The aim of this study was to explore the application value of the lower limbs robot-assisted training system for post-total knee replacement (TKR) gait rehabilitation. A total of 60 patients with osteoarthritis of the knee were equally randomized into the traditional and robot-assisted rehabilitation training groups within 1 week after TKR. All patients received 2-week training. Scores of hospital for special surgery (HSS), knee kinesthesia grades, knee proprioception grades, functional ambulation (FAC) scores, Berg balance scores, 10-m sitting-standing time, and 6-min walking distances were compared between the groups. The HSS score, Berg score, 10-m sitting-standing time, and 6-min walking distance of the robot-assisted training group were significantly higher than the control group (P < 0.05). Its knee kinesthesia grade, knee proprioception grade, and FAC score were better than the control group but not significantly (P > 0.05). Lower limbs robot-assisted rehabilitation training improves post-TKR patients' knee proprioception and stability more effectively compared with the traditional method. It improves patients' gait and symptoms, increases their walking speed, and prolongs their walking distances, which benefit their return to family and society.

  8. Qualitative Assessment of Patients Receiving Prolotherapy for Knee Osteoarthritis in a Multimethod Study.

    PubMed

    Rabago, David; van Leuven, Laura; Benes, Lane; Fortney, Luke; Slattengren, Andrew; Grettie, Jessica; Mundt, Marlon

    2016-12-01

    Randomized and open-label studies assessing prolotherapy for knee osteoarthritis have found quantitative improvement on the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC) compared with baseline status and control therapies. This study assessed the qualitative response of participants receiving prolotherapy, an injection-based complementary treatment for symptomatic knee osteoarthritis (OA). Qualitative study using semi-structured in-depth interviews at 52 weeks after enrollment; transcribed responses were discussed by coauthors to identify themes; disagreement was resolved by consensus. Outpatient. Twenty-two participants treated with prolotherapy for symptomatic knee OA who were exited from three randomized and open-label studies. Intra- and extra-articular hypertonic dextrose injection (prolotherapy). Patient narrative and composite WOMAC questionnaire (0-100 points) scores. Participants had baseline demographic and knee OA severity similar to those of participants in three prior intervention trials, as well as similar robust follow-up WOMAC score change (19.9 ± 12.6 points), suggesting a representative subsample. Seven themes were identified from participant narratives: (1) improvement in knee-specific quality of life (n = 18), (2) safety and comfort, (3) pretreatment counseling enhanced treatment adherence and optimism, (4) overall positive experience with prolotherapy, (5) limited response to prolotherapy (n = 4), (6) consistency with anecdotal clinical prolotherapy experience; and (7) functional improvement without pain reduction. Most participants reported substantially improved knee-specific effects, resulting in improved quality of life and activities of daily living; four participants reported minimal or no effect. Clear, complete description of procedural rationale may enhance optimism about and adherence to treatment appointments.

  9. Functional ability perceived by individuals following total knee arthroplasty compared to age-matched individuals without knee disability.

    PubMed

    Finch, E; Walsh, M; Thomas, S G; Woodhouse, L J

    1998-04-01

    A comparison of function of individuals 1 year after total knee arthroplasty (TKA) with healthy control subjects (controls) meaningfully describes outcome in these patients. Perception of function measured by two questionnaires, the Lower Extremity Activity Profile (LEAP) and the Western Ontario McMaster Osteoarthritis Index (WOMAC), and walking and stair performance was compared between 29 patients, 1 year after TKA, and 40 controls. There was significantly greater perceived difficulty with function in patients with TKA than in controls. In TKA men, LEAP and WOMAC scores correlated respectively with self-paced walk speed (r = -.71 and -.55) and stair performance time (r = 0.70 and 0.68). In TKA women, LEAP difficulty score correlated with self-paced walk speed (r = -.41) and stair performance time (r = -0.71). By 1 year, TKA subjects regained 80% of the function of controls. Perception of function after TKA can be measured by either questionnaire in men; however, the LEAP is the preferable questionnaire with women.

  10. The complexity of human walking: a knee osteoarthritis study.

    PubMed

    Kotti, Margarita; Duffell, Lynsey D; Faisal, Aldo A; McGregor, Alison H

    2014-01-01

    This study proposes a framework for deconstructing complex walking patterns to create a simple principal component space before checking whether the projection to this space is suitable for identifying changes from the normality. We focus on knee osteoarthritis, the most common knee joint disease and the second leading cause of disability. Knee osteoarthritis affects over 250 million people worldwide. The motivation for projecting the highly dimensional movements to a lower dimensional and simpler space is our belief that motor behaviour can be understood by identifying a simplicity via projection to a low principal component space, which may reflect upon the underlying mechanism. To study this, we recruited 180 subjects, 47 of which reported that they had knee osteoarthritis. They were asked to walk several times along a walkway equipped with two force plates that capture their ground reaction forces along 3 axes, namely vertical, anterior-posterior, and medio-lateral, at 1000 Hz. Data when the subject does not clearly strike the force plate were excluded, leaving 1-3 gait cycles per subject. To examine the complexity of human walking, we applied dimensionality reduction via Probabilistic Principal Component Analysis. The first principal component explains 34% of the variance in the data, whereas over 80% of the variance is explained by 8 principal components or more. This proves the complexity of the underlying structure of the ground reaction forces. To examine if our musculoskeletal system generates movements that are distinguishable between normal and pathological subjects in a low dimensional principal component space, we applied a Bayes classifier. For the tested cross-validated, subject-independent experimental protocol, the classification accuracy equals 82.62%. Also, a novel complexity measure is proposed, which can be used as an objective index to facilitate clinical decision making. This measure proves that knee osteoarthritis subjects exhibit more

  11. Obesity, physically demanding work and traumatic knee injury are major risk factors for knee osteoarthritis--a population-based study with a follow-up of 22 years.

    PubMed

    Toivanen, Arto T; Heliövaara, Markku; Impivaara, Olli; Arokoski, Jari P A; Knekt, Paul; Lauren, Hanna; Kröger, Heikki

    2010-02-01

    Several studies have shown that knee OA is associated with obesity, physical stress at work, traumatic knee injuries, heredity and female gender. However, the body of such evidence comes from cross-sectional or case-control studies, and from only a few follow-up studies, mostly of short duration. Based on the nationwide Mini-Finland Health Survey, we analysed the potential risk factors for prediction of incident knee OA in the long term. Focused on major health problems, the survey was carried out in 1978-80 in a sample of 8000 subjects, representative of the Finnish population aged > or =30 years. Altogether 823 subjects free from knee OA at the baseline were re-examined in 2000-01, and after the intervening 22 years 94 new cases of knee OA were found. Knee OA was diagnosed on both occasions by physicians using information on disease histories, symptoms and standardized clinical examinations. The risk of developing knee OA was strongly associated with BMI (kg/m(2)); adjusted for age and gender and other covariates, and compared with the reference category (BMI < 25.0); the relative odds ratios (ORs) with 95% CIs were 1.7 (95% CI 1.0, 2.8) and 7.0 (95% CI 3.5, 14.10) for subjects with BMIs 25.0-29.9 and > or =30.0, respectively. Similarly, the adjusted OR for the heaviest category of physical stress at work was 18.3 (95% CI 4.2, 79.4) compared with the lightest category, and 5.1 (95% CI 1.4, 19.0) for permanent complaints due to past knee injury. This prospective study confirms the roles of obesity, heavy work load and knee injury in the aetiology of knee OA.

  12. Comparison of Revision Rates of Non-modular Constrained Versus Posterior Stabilized Total Knee Arthroplasty: a Propensity Score Matched Cohort Study.

    PubMed

    Moussa, Mohamed E; Lee, Yuo-Yu; Westrich, Geoffrey H; Mehta, Nabil; Lyman, Stephen; Marx, Robert G

    2017-02-01

    Attaining stability during total knee arthroplasty (TKA) is essential for a successful outcome. Although traditional constrained total knee prostheses have generally been used in conjunction with intramedullary stems, some devices have been widely used without the use of stems, referred to as non-modular constrained condylar total knee arthroplasty (NMCCK). The aim of this study was to compare revisions rates after total knee replacement with a non-modular constrained condylar total knee (NMCCK) compared to a posterior-stabilized (PS) design. Between 2007 and 2012, primary PS total knees were compared with NMCCK implants from the same manufacturer. Propensity score matching was performed, and implant survivorship was examined using a Cox proportional hazards model. The cohort consisted of 817 PS knees and 817 NMCCKs matched for patient demographics, surgeon volume, and pre-operative diagnosis. All cause revisions occurred in 11 of 817 (1.35%) in the PS group compared to 28 of 817 (3.43%) in the NMCCK group (p = 0.0168). Excluding revisions for infection and fracture, 8 of 817 (0.98%) PS knees required revision for mechanical failure compared to 18 of 817 (2.20%) NMCCK knees (p = 0.0193). While revisions rates in both cohorts were low, there was a significantly higher revision rate with NMCCKs. Given that cases requiring the use of NMCCK implants are likely more complex than those in which PS implants are used, our findings support the judicious use of NMCCK prostheses.

  13. How accurate are lockable orthotic knee braces? An objective gait analysis study.

    PubMed

    Khan, W S; Jones, R K; Nokes, L; Johnson, D S

    2007-12-01

    There has been an increasing use of orthotic knee braces in the management of knee injuries but, to our knowledge, there is no gait analysis study assessing the accuracy of these braces. Eight healthy male subjects were studied to determine the accuracy of immobilisation or splintage provided by a lockable orthotic knee brace using gait analysis. Six types of immobilisation were studied: locked at 0, 10, 20, 30 degrees and unlocked in an orthotic knee brace, and without a brace. The knee flexion angles measured using the kinematic instruments at 0 and 10 degrees were significantly greater than those set at the knee brace. The knee flexion angle measured using the unlocked knee brace was significantly greater than that measured in the absence of a brace. This study highlights inaccuracies in a knee brace at low knee flexion angles. The higher actual angles alter the biomechanics of the knee joint and result in greater forces across the knee joint and especially the extensor mechanism.

  14. Does increasing applied load lead to contact changes indicative of knee osteoarthritis? A subject-specific FEA study.

    PubMed

    Boyd, Jennifer L; Zavatsky, Amy B; Gill, Harinderjit S

    2016-04-01

    This study investigated whether increased loading (representing obesity) in the extended knee and flexed knee led to increased stresses in areas of typical medial and lateral osteoarthritis cartilage lesions, respectively. We created two paired sets of subject-specific finite element models; both sets included models of extended knees and of flexed knees. The first set represented normal loading; the second set represented increased loading. All other variables were held constant. The von Mises stresses and contact areas calculated on the tibial cartilage surfaces of the paired models were then compared. In the extended knee models, applying a larger load led to increased stress in the anterior and central regions of the medial tibial cartilage. These are the typical locations of medial osteoarthritis cartilage lesions. Therefore, the results support that increased loading in the extended knee may result in medial osteoarthritis. In the flexed knee models, applying a larger load increased stress in the anterior and central regions of the lateral tibial cartilage. Lateral osteoarthritis cartilage lesions typically occur centrally and posteriorly. Therefore, these results do not support our hypothesis. Shear stress was increased in areas of typical lateral lesions, however, and should be investigated in future studies.

  15. Differential knee skin temperature following total knee arthroplasty and its relationship with serum indices and outcome: A prospective study.

    PubMed

    Zeng, Yirong; Feng, Wenjun; Qi, Xinyu; Li, Jie; Chen, Jinlun; Lu, Lu; Deng, Peng; Zeng, Jianchun; Li, Feilong

    2016-10-01

    Objectives To monitor knee skin temperature changes for 12 months following total knee arthroplasty (TKA) and identify potential reasons for any differences in skin temperature and to investigate if there is a relationship between the differential temperature and clinical outcome. Methods Patients who attended for a unilateral TKA due to primary osteoarthritis between August 2012 and August 2014 were eligible for this prospective study. The skin temperature of both knees was monitored preoperatively and postoperatively using an infrared thermometer. Serum indices and Hospital for Special Surgery (HSS) knee scores were assessed. Results Thirty-nine patients were involved in the study. The skin temperature of both knees as well as the differential temperature increased following TKA. Serum haemoglobin, haematocrit and days from surgery showed inverse correlations with the differential temperature, while body mass index and American Society of Anesthesiologists scores showed positive correlations. There was a strong inverse correlation between the differential temperature and HSS. score. Conclusions Differential knee skin temperature elevation 12 months post-TKA may be a normal surgical response.

  16. Transfemoral Amputation After Failure of Knee Arthroplasty: A Nationwide Register-Based Study.

    PubMed

    Gottfriedsen, Tinne B; Schrøder, Henrik M; Odgaard, Anders

    2016-12-07

    Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty in a nationwide population. Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. With use of individual data linkage, 92,785 primary knee arthroplasties performed from 1997 to 2013 were identified. Of these, 258 were followed by amputation. Hospital records of all identified cases were reviewed. A competing-risk model was used to estimate the cumulative incidence of amputation. Differences in cumulative incidences were analyzed with use of the Gray test. A total of 115 amputations were performed for causes related to failed knee arthroplasty. The 15-year cumulative incidence of amputation was 0.32% (95% confidence interval [CI], 0.23% to 0.48%). The annual incidence of amputation following arthroplasties performed from 1997 to 2002 was 0.025% compared with 0.018% following arthroplasties performed from 2008 to 2013 (p = 0.06). The causes of the amputation were periprosthetic infection in 95 cases (83%), soft-tissue deficiency in 26 (23%), severe bone loss in 21 (18%), extensor mechanism disruption in 11 (10%), intractable pain in 11 (10%), periprosthetic fracture in 10 (9%), and vascular complications in 9 (8%). In 92 (80%) of the cases, there were ≥2 indications for amputation. The cumulative incidence of amputation within 15 years after primary knee arthroplasty was 0.32%, with a tendency toward a decreasing incidence in the last part of the study period. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  17. The post-operative analgesic efficacy of celecoxib compared with placebo and parecoxib after total hip or knee arthroplasty.

    PubMed

    Ittichaikulthol, Wichai; Prachanpanich, Naruemol; Kositchaiwat, Chutima; Intapan, Theerayut

    2010-08-01

    Nonsteroidal antiinflammatory drugs (NSAIDs) in combination with opioids is a model of multimodal analgesia. NSAIDs have the oral and parenteral forms. The aim of the present study was to evaluate the efficacy of celecoxib compared with placebo and parecoxib after total hip or knee arthroplasty. A total of 120, ASA 1-2, aged 18-75 years, patients were randomly assigned to receive one of the three groups: Group I (control) received placebo (n=40), group II received 400 mg celecoxib orally (n=40) and group III received 40 mg parecoxib intravenously (n=40). The present study medication was administered I hour before surgery. All patients had access to patient-controlled analgesia (PCA) with intravenous morphine. Patients were studied at 0, 1, 6, 12 and 24 hours postoperatively for verbal numerical rating scale (VNRS), morphine consumption, satisfaction score and side effects. The intraoperatively fentayl requirement were similar among the three groups (p < 0.00). Celecoxib and parecoxib significantly decreased the amount of morphine requirement after total hip or knee arthroplasty compared to placebo at 1, 6, 12 and 24 hours (p < 0.00). The celecoxib group required more morphine than the parecoxib group at 1, 6, 12 and 24 hours (p < 0.00). The VNRS score in parecoxib group was significantly lower than the celecoxib and control groups at 1, 6, 12 but not at 24 hours. The VNRS score was lower in the celecoxib group compared to the control group at I and 6 hours postoperatively (p = 0.01, p < 0. 01 respectively). The placebo group had a higher sedation score (p = 0.008) but not for nausea vomiting (p = 0.36) and pruritus (p = 0.12) compared to the treatment groups. Within 12 hours after total hip and knee arthroplasty, pre-operative administration of parenteral parecoxib 40 mg was more effective than oral celecoxib 400 mg and placebo in terms of morphine consumption and VNRS score.

  18. Prevalence of Knee Osteoarthritis in 100 Athletically Active Veteran Soccer Players Compared With a Matched Group of 100 Military Personnel.

    PubMed

    Paxinos, Odysseas; Karavasili, Alexandra; Delimpasis, Georgios; Stathi, Afroditi

    2016-06-01

    Although knee injuries in professional soccer (football) have been extensively studied, the prevalence of knee osteoarthritis (OA) in veteran players is not well documented. To investigate the prevalence of knee OA in retired professional soccer players in comparison with a group of athletically active military personnel. Cross-sectional study; Level of evidence, 3. A group of 100 veteran Greek soccer players aged 35 to 55 years (mean [±SD] age, 46.90 ± 5.9 years) were examined for knee OA and were administered the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. A matched group of 100 athletically active military personnel served as a comparison group. The sonographic prevalence of OA was significantly higher in the veteran soccer group (52%) than in the military group (33%) (n = 200; P = .010). This difference remained significant even after excluding participants with a history of knee surgery (44.1% vs 25.3%, respectively) (n = 151; P = .010). Femoral cartilage thickness was similar between the 2 groups (P = .473), while altered knee alignment had no effect on the prevalence of OA (P = .740). With the exception of perceived pain being more prevalent in the military group, there were no other statistically significant differences between the 2 groups in KOOS values. Veteran soccer players had a higher sonographic prevalence of knee OA but better pain scores than a matched group of athletically active military personnel. © 2016 The Author(s).

  19. Knee joint kinematics after dynamic intraligamentary stabilization: cadaveric study on a novel anterior cruciate ligament repair technique.

    PubMed

    Schliemann, Benedikt; Lenschow, Simon; Domnick, Christoph; Herbort, Mirco; Häberli, Janosch; Schulze, Martin; Wähnert, Dirk; Raschke, Michael J; Kösters, Clemens

    2017-04-01

    Dynamic intraligamentary stabilization (DIS) has been introduced for the repair of acute anterior cruciate ligament (ACL) tears as an alternative to delayed reconstruction. The aim of the present study was to compare knee joint kinematics after DIS to those of the ACL-intact and ACL-deficient knee under simulated Lachman/KT-1000 and pivot-shift tests. We hypothesized that DIS provides knee joint kinematics equivalent to an intact ACL. With the use of a robotic knee simulator, knee kinematics were determined in simulated Lachman/KT-1000 and pivot-shift tests at 0°, 15°, 30°, 60°, and 90° of flexion in eight cadaveric knees under the following conditions: (1) intact ACL, (2) ACL deficiency, (3) DIS with a preload of 60 N, and (4) DIS with a preload of 80 N. Statistical analyses were performed using two-factor repeated-measures analysis of variance. The significance level was set at a p value of <0.05. After DIS with a preload of either 60 N or 80 N, the anterior translation was significantly reduced in the simulated Lachman/KT-1000 and pivot-shift tests when compared to the ACL-deficient knee (p < 0.05). No significant differences were observed between the DIS reconstruction with a preload of 80 N and the intact ACL with regard to anterior laxity in either test. However, DIS with a preload of only 60 N was not able to restore knee joint kinematics to that of an intact knee in all degrees of flexion. DIS with a preload of 80 N restores knee joint kinematics comparable to that of an ACL-intact knee and is therefore capable of providing knee joint stability during ACL healing. DIS therefore provides a new technique for primary ACL repair with superior biomechanical properties in comparison with other techniques that have been described previously, although further clinical studies are required to determine its usefulness in clinical settings.

  20. Moxibustion for treating knee osteoarthritis: study protocol of a multicentre randomised controlled trial

    PubMed Central

    2013-01-01

    Background The treatment of knee osteoarthritis, which is a major cause of disability among the elderly, is typically selected from multidisciplinary options, including complementary and alternative medicine. Moxibustion has been used in the treatment of knee osteoarthritis in Korea to reduce pain and improve physical activity. However, there is no sufficient evidence of its effectiveness, and it cannot therefore be widely recommended for treating knee osteoarthritis. We designed a randomised controlled clinical trial to evaluate the effectiveness, safety, cost-effectiveness, and qualitative characteristics of moxibustion treatment of knee osteoarthritis compared to usual care. Methods/designs This is a protocol for a multicentre, pragmatic, randomised, assessor-blinded, controlled, parallel-group study. A total of 212 participants will be assigned to the moxibustion group (n = 106) and the usual care group (n = 106) at 4 clinical research centres. The participants assigned to the moxibustion group will receive moxibustion treatment of the affected knee(s) at 6 standard acupuncture points (ST36, ST35, ST34, SP9, Ex-LE04, and SP10) 3 times per week for 4 weeks (a total of 12 sessions). Participants in the usual care group will not receive moxibustion treatment during the study period. Follow-up will be performed on the 5th and 13th weeks after random allocation. Both groups will be allowed to use any type of treatment, including surgery, conventional medication, physical treatment, acupuncture, herbal medicine, over-the-counter drugs, and other active treatments. Educational material that explains knee osteoarthritis, the current management options, and self-exercise will be provided to each group. The global scale of the Korean Western Ontario and McMaster Osteoarthritis Index (K-WOMAC) will be the primary outcome measurement used in this study. Other subscales (pain, stiffness, and function) of the K-WOMAC, the Short-Form 36v2 Health Survey, the Beck

  1. Moxibustion for treating knee osteoarthritis: study protocol of a multicentre randomised controlled trial.

    PubMed

    Lee, Seunghoon; Kim, Kun Hyung; Kim, Tae-Hun; Kim, Jung-Eun; Kim, Joo-Hee; Kang, Jung Won; Kang, Kyung-Won; Jung, So-Young; Kim, Ae-Ran; Park, Hyo-Ju; Shin, Mi-Suk; Hong, Kwon-Eui; Song, Ho-Sueb; Choi, Jin-Bong; Kim, Hyung-Jun; Choi, Sun-Mi

    2013-03-13

    The treatment of knee osteoarthritis, which is a major cause of disability among the elderly, is typically selected from multidisciplinary options, including complementary and alternative medicine. Moxibustion has been used in the treatment of knee osteoarthritis in Korea to reduce pain and improve physical activity. However, there is no sufficient evidence of its effectiveness, and it cannot therefore be widely recommended for treating knee osteoarthritis. We designed a randomised controlled clinical trial to evaluate the effectiveness, safety, cost-effectiveness, and qualitative characteristics of moxibustion treatment of knee osteoarthritis compared to usual care. This is a protocol for a multicentre, pragmatic, randomised, assessor-blinded, controlled, parallel-group study. A total of 212 participants will be assigned to the moxibustion group (n = 106) and the usual care group (n = 106) at 4 clinical research centres. The participants assigned to the moxibustion group will receive moxibustion treatment of the affected knee(s) at 6 standard acupuncture points (ST36, ST35, ST34, SP9, Ex-LE04, and SP10) 3 times per week for 4 weeks (a total of 12 sessions). Participants in the usual care group will not receive moxibustion treatment during the study period. Follow-up will be performed on the 5th and 13th weeks after random allocation. Both groups will be allowed to use any type of treatment, including surgery, conventional medication, physical treatment, acupuncture, herbal medicine, over-the-counter drugs, and other active treatments. Educational material that explains knee osteoarthritis, the current management options, and self-exercise will be provided to each group. The global scale of the Korean Western Ontario and McMaster Osteoarthritis Index (K-WOMAC) will be the primary outcome measurement used in this study. Other subscales (pain, stiffness, and function) of the K-WOMAC, the Short-Form 36v2 Health Survey, the Beck Depression Inventory, the Physical

  2. Risk Factors for Knee Injuries in Children 8 to 15 Years: The CHAMPS Study DK.

    PubMed

    Junge, Tina; Runge, Lisbeth; Juul-Kristensen, Birgit; Wedderkopp, Niels

    2016-04-01

    Knee injuries are frequent in children, with most studies reporting traumatic knee injuries. Evidence of risk factors for knee injuries in children is sparse. The purpose of this study was to report the extent of traumatic and overuse knee injuries in children and to evaluate intrinsic and extrinsic factors for risk of these injuries. Weekly musculoskeletal pain, sport participation, and sports type were reported by 1326 school children (8-15 yr). Knee injuries were classified as traumatic or overuse. Multinomial logistic regression was used for analyses. During the study period, 952 (15% traumatic and 85% overuse) knee injuries were diagnosed. Period prevalence for traumatic and overuse knee injuries were 0.8/1000 and 5.4/1000 sport participations, respectively. Participation in tumbling gymnastics was a risk factor for traumatic knee injuries (OR, 2.14). For overuse knee injuries, intrinsic risk factors were sex (girls OR, 1.38) and previous knee injury (OR, 1.78), whereas participation in soccer (OR, 1.64), handball (OR, 1.95), basket (OR, 2.07), rhythmic (OR, 1.98), and tumbling gymnastics (OR, 1.74) were additional risk factors. For both injury types, sport participation above two times per week increased odds (OR, 1.46-2.40). Overuse knee injuries were the most frequent injury type. For traumatic knee injuries, participation in tumbling gymnastics was a risk factor. Risk factors for overuse knee injuries were being a girl; previous knee injury; and participation in soccer, handball, basket, and rhythmic and tumbling gymnastics. Further risk factors for both types of injury were participation in sports above two times per week. Although growth-related overuse knee injuries are a self-limiting condition, a major part of children are affected by these injuries with unknown short- and long-term consequences.

  3. Comparing the effects of manual therapy versus electrophysical agents in the management of knee osteoarthritis.

    PubMed

    Ali, Syed Shahzad; Ahmed, Syed Imran; Khan, Muhammad; Soomro, Rabail Rani

    2014-07-01

    To evaluate the effectiveness of Manual Therapy in comparison to Electrophysical agents in Knee Osteoarthritis. Total 50 patients with knee osteoarthritis were recruited from OPD of orthopedics civil hospital and Institute Of Physical Medicine & Rehabilitation, Dow University of Health Sciences Karachi. All those patients who fulfilled inclusion criteria were selected on voluntary basis. Selected patients were equally divided and randomly assigned into two groups with age and gender matching. The Manual therapy group received program of Maitland joint mobilization whereas Electrophysical Agent group received a program of TENS and cold pack. Both group received a program of exercise therapy as well. Patients received 3 treatment sessions per week for 4 successive weeks. Clinical assessment was performed using WOMAC index at baseline and on 12th treatment session. Both study groups showed clinically and statistically considerable improvements in WOMAC index. However, Related 2 sample t-test showed better clinical results in Manual Therapy group (p = 0.000) than Electrophysical Agents group (p = 0.008). The mean improvement in total WOMAC index was relatively higher in Manual Therapy group (22.36 ± 13.91) than Electrophysical Agent group (9.72 ± 6.10). This study concluded that manual therapy is clinically more effective in decreasing pain, stiffness and improving physical function in knee osteoarthritis.

  4. Agonist-antagonist active knee prosthesis: a preliminary study in level-ground walking.

    PubMed

    Martinez-Villalpando, Ernesto C; Herr, Hugh

    2009-01-01

    We present a powered knee prosthesis with two series-elastic actuators positioned in parallel in an agonist-antagonist arrangement. To motivate the knee's design, we developed a prosthetic knee model that comprises a variable damper and two series-elastic clutch units that span the knee joint. Using human gait data to constrain the model's joint to move biologically, we varied model parameters using an optimization scheme that minimized the sum over time of the squared difference between the model's joint torque and biological knee values. We then used these optimized values to specify the mechanical and control design of the prosthesis for level-ground walking. We hypothesized that a variable-impedance control design could produce humanlike knee mechanics during steady-state level-ground walking. As a preliminary evaluation of this hypothesis, we compared the prosthetic knee mechanics of an amputee walking at a self-selected gait speed with those of a weight- and height-matched nonamputee. We found qualitative agreement between prosthetic and human knee mechanics. Because the knee's motors never perform positive work on the knee joint throughout the level-ground gait cycle, the knee's electrical power requirement is modest in walking (8 W), decreasing the size of the onboard battery required to power the prosthesis.

  5. Posterior cruciate-substituting total knee replacement recovers the flexion arc faster in the early postoperative period in knees with high varus deformity: a prospective randomized study.

    PubMed

    Öztürk, Alpaslan; Akalın, Yavuz; Çevik, Nazan; Otuzbir, Ali; Özkan, Yüksel; Dostabakan, Yasin

    2016-07-01

    Posterior cruciate retention (CR) and substitution (PS) has been controversial in knee replacement surgery. Satisfactory medium and long-term results have been reported in knees with and without deformity but there are limited studies about early functional comparison in terms of recovery of flexion arc, stair activity, walking ability and straight leg raising, especially, in early postoperative period in knees with deformity. Therefore, we aimed to compare the flexion arc in CR and PS knees in postoperative first year including early postoperative days prospectively. Consecutive patients with a deformity of >10° were included and allocated to CR and PS groups randomly. KSS and Feller-patella scores were recorded both preoperatively and postoperatively (1st, 2nd, 3rd and 12th months). Flexion and extension were measured both preoperatively and postoperatively (1st, 2nd, 3rd day and discharge day as well as 1st, 2nd, 3rd and 12th months). Visual analog scale (VAS) was recorded postoperatively at the 1st, 2nd, 3rd and discharge day and at 1st, 2nd, 3rd and 12th months. The walking ability, stair activity and straight leg raising were recorded. Patients were also examined at the last visit with minimum 7-year follow-up with KSS, Feller-patella and VAS scores. Their mean flexion arcs were measured and recorded. There were 61 TKR evaluated. KSS knee and function scores at the 3rd month and KSS Knee Score at 1st year were superior in PS knees (p = 0.029, p = 0.046, p = 0.026). Flexion arc was found larger on day 1, 2, 3 and discharge day, and at 1st, 2nd, 3rd and 12th month in PS group (p = 0.048, p = 0.002, p = 0.027, p = 0.043, p = 0.014, p = 0.003, p = 0.002, p = 0.018). Walking and stair activity showed no difference but straight leg raising was better in CR knees (p = 0.02). Mean flexion arc was larger in PS knees at the last visit after 7 years (119.0° ± 7.5° in PS and 113.8° ± 8.7° in CR, p = 0.02). There was no revision

  6. [Multicentre study of infection incidence in knee prosthesis].

    PubMed

    Jaén, F; Sanz-Gallardo, M I; Arrazola, M P; García de Codes, A; de Juanes, A; Resines, C

    2012-01-01

    To determine the incidence of surgical site infection in knee prosthesis surgical procedure for a follow-up period of one year in twelve hospitals in Madrid region. A prospective study was carried out from January to December 2009 using a national surveillance system called Indicadores Clínicos de Mejora Continua de Calidad. Primary and revision knee joint replacements in patients operated on in the previous year were included. Criteria used to define surgical site infection and patient risk index categories were those established by the Centers for Disease Control and Prevention and National Nosocomial Infections Surveillance. The incidence rates were worked out crude and adjusted by hazard ratio. 2,088 knee prosthesis procedures were analyzed. The overall incidence of surgical site infection was 2.1%. Sixty-five percent of the infections were organ/space. Sixty percent of the infections were identified in the early postoperative period. Of all surgical site infections, 41.9% were microbiologically confirmed. Antibiotic prophylaxis was implemented correctly in 63.3% of the cases. The most important cause of inappropriate prophylaxis was an unsuitable duration in 85.7% of the cases. The presurgical preparation was carried out correctly in 50.3% of surgical operations. The incidence of knee arthroplasty infection was twice as high as in the National Healthcare Safety Network and similar to national rates. In this study, the incidence of infection was within the range of infection rates in other published European studies. Surveillance and control strategies of health care for associated infections allow us to assess trends and the impact of preventive measures. Copyright © 2011 SECOT. Published by Elsevier Espana. All rights reserved.

  7. The effect of orthotic devices on knee adduction moment, pain and function in medial compartment knee osteoarthritis: a literature review.

    PubMed

    Baghaei Roodsari, Roshanak; Esteki, Ali; Aminian, Gholamreza; Ebrahimi, Ismaeil; Mousavi, Mohammad Ebramim; Majdoleslami, Basir; Bahramian, Fatemeh

    2016-03-15

    Background Knee braces and foot orthoses are commonly used to improve knee adduction moment, pain and function in subjects with knee osteoarthritis (OA). However, no literature review has been performed to compare the effects of foot orthoses and knee braces in this group of patients. Purpose The aim of this review was to evaluate the effects of foot orthoses and knee braces on knee adduction moment, pain and function in individuals with knee OA. Study design Literature review. Method The search strategy was based on the Population Intervention Comparison Outcome method. A search was performed in PubMed, Science Direct, Google Scholar and ISI web of knowledge databases using the PRISMA method and based on selected keywords. Thirty-one related articles were selected for final evaluation. Results The results of the analysis of these studies demonstrated that orthotic devices reduce knee adduction moment and also improve pain and function in individuals with knee OA. Conclusion Foot orthoses may be more effective in improving pain and function in subjects with knee OA. Both knee braces and foot orthoses reduce the knee adduction moment in knee OA and consequently patients typically do not need to use knee braces for a long period of time. Also, foot orthoses and knee braces may be more effective for medial compartment knee OA patients due to the fact that this treatment helps improve pain and function. Implications for Rehabilitation Knee braces and foot orthoses are commonly used for improving knee adduction moment, pain and function in subjects with knee osteoarthritis (OA). Orthotic devices can reduce knee adduction moment, pain and improve function in knee OA. The combined use of a knee braces and foot orthoses can provide more improvement in knee adduction moment, reduced pain and increased function.

  8. The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset.

    PubMed

    Patel, A; Pavlou, G; Mújica-Mota, R E; Toms, A D

    2015-08-01

    Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are recognised and proven interventions for patients with advanced arthritis. Studies to date have demonstrated a steady increase in the requirement for primary and revision procedures. Projected estimates made for the United States show that by 2030 the demand for primary TKA will grow by 673% and for revision TKA by 601% from the level in 2005. For THA the projected estimates are 174% and 137% for primary and revision surgery, respectively. The purpose of this study was to see if those predictions were similar for England and Wales using data from the National Joint Registry and the Office of National Statistics. Analysis of data for England and Wales suggest that by 2030, the volume of primary and revision TKAs will have increased by 117% and 332%, respectively between 2012 and 2030. The data for the United States translates to a 306% cumulative rate of increase between 2012 and 2030 for revision surgery, which is similar to our predictions for England and Wales. The predictions from the United States for primary TKA were similar to our upper limit projections. For THA, we predicted an increase of 134% and 31% for primary and revision hip surgery, respectively. Our model has limitations, however, it highlights the economic burden of arthroplasty in the future in England and Wales as a real and unaddressed problem. This will have significant implications for the provision of health care and the management of orthopaedic services in the future.

  9. Relationship between joint gap difference and range of motion in total knee arthroplasty: a prospective randomised study between different platforms.

    PubMed

    Higuchi, Hiroshi; Hatayama, Kazuhisa; Shimizu, Masaki; Kobayashi, Atsushi; Kobayashi, Tsutomu; Takagishi, Kenji

    2009-08-01

    The objective of this study was to investigate the range of motion (ROM) of the knee before and four years after total knee arthroplasty (TKA) with a mobile or fixed type of platform and to prospectively evaluate whether there was a difference in ligament balance between the platform types. The subjects were 68 patients involving 76 joints. The mobile type was used in 31 joints and fixed type in 45 joints by employing a prospective randomised method. The passive maximum ROM was measured using a goniometer before and four years after surgery. Also, the intraoperative knee ligament balance was measured. The postoperative extension ROM was significantly improved after TKA using a mobile bearing type compared with that employing a fixed bearing type. In TKA using the former, the intraoperative gap difference was not related to the postoperative flexion angle of the knee. However, they were related in TKA using a fixed bearing type, with a positive correlation regarding the flexion gap.

  10. Biomechanical study of the tibia in knee replacement revision.

    PubMed

    Quílez, M P; Pérez, M A; Seral-García, B

    2015-01-01

    The best management of severe bone defects following total knee replacement is still controversial. Metal augments, tantalum cones and porous tibial sleeves could help the surgeon to manage any type of bone loss, providing a stable and durable knee joint reconstruction. Five different types of prostheses have been analysed: one prosthesis with straight stem; two prostheses with offset stem, with and without supplement, and two prostheses with sleeves, with and without stem. The purpose of this study is to report a finite element study of revision knee tibial implants. The main objective was to analyse the tibial bone density changes and Von Misses tension changes following different tibial implant designs. In all cases, the bone density decreases in the proximal epiphysis and medullary channels, with a bone density increase also being predicted in the diaphysis and at the bone around the stems tips. The highest value of Von Misses stress has been obtained for the straight tibial stem, and the lowest for the stemless metaphyseal sleeves prosthesis. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  11. Influence of tibial rotation in total knee arthroplasty on knee kinematics and retropatellar pressure: an in vitro study.

    PubMed

    Steinbrück, Arnd; Schröder, Christian; Woiczinski, Matthias; Müller, Tatjana; Müller, Peter E; Jansson, Volkmar; Fottner, Andreas

    2016-08-01

    Although continuous improvements have been made, there is still a considerable amount of unsatisfied patients after total knee arthroplasty (TKA). A main reason for this high percentage is anterior knee pain, which is supposed to be provoked by post-operative increased retropatellar peak pressure. Since rotational malalignment of the implant is believed to contribute to post-operative pain, the aim of this study was to examine the influence of tibial component rotation on knee kinematics and retropatellar pressure. Eight fresh-frozen knee specimens were tested in a weight-bearing knee rig after fixed-bearing TKA under a loaded squat from 20° to 120° of flexion. To examine tibial components with different rotations, special inlays with 3° internal rotation and 3° external rotation were produced and retropatellar pressure distribution was measured with a pressure-sensitive film. The kinematics of the patella and the femorotibial joint were recorded with an ultrasonic-based motion analysis system. Retropatellar peak pressure decreased significantly from 3° internal rotation to neutral position and 3° external rotation of the tibial component (8.5 ± 2.3 vs. 8.2 ± 2.4 vs. 7.8 ± 2.5 MPa). Regarding knee kinematics femorotibial rotation and anterior-posterior translation, patella rotation and tilt were altered significantly, but relative changes remained minimal. Changing tibial rotation revealed a high in vitro influence on retropatellar peak pressure. We recommend the rotational alignment of the tibial component to the medial third of the tibial tuberosity or even more externally beyond that point to avoid anterior knee pain after TKA.

  12. Quadriceps function after TKA--an in vitro study in a knee kinematic simulator.

    PubMed

    Ostermeier, S; Hurschler, C; Stukenborg-Colsman, C

    2004-03-01

    The purpose of this in vitro study was to investigate the amount of quadriceps force required to extend the knee during an isokinetic extension cycle before and after total knee arthroplasty. The magnitude of the extension torque used in simulating a constant moment extension exercise was derived from tests made using a dynamometer on patients who had received a total knee arthroplasty. Quadriceps force needed to extend the knee was measured. Human knee specimens (n=8, mean age=65 SD 7 years, all male) were tested in a kinematic knee simulating machine untreated and after implantation of two different knee prosthesis. During simulation, a hydraulic cylinder applied sufficient force to the quadriceps tendon to produce an extension moment of 31 Nm about the knee. The quadriceps forces needed to extend the knee during the physiologic simulation reached levels as high as 1238.9 N (SD 46.6). After implantation the Interax-prosthesis, quadriceps force increased up to 13.9% (P=0.003), in conjunction with resurfacing of the patella 11.9% (P=0.01). With the LCS-prosthesis implanted, quadriceps force showed a somewhat smaller increase of up to 6.6% (P=0.007). The following study helps to clarify postoperative problems related to the extensor mechanisms of the knee after implantation of total knee arthroplasty.

  13. Intra-Articular, Single-Shot Hylan G-F 20 Hyaluronic Acid Injection Compared with Corticosteroid in Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial.

    PubMed

    Tammachote, Nattapol; Kanitnate, Supakit; Yakumpor, Thanasak; Panichkul, Phonthakorn

    2016-06-01

    The treatment of knee osteoarthritis with hyaluronic acid or corticosteroid injection has been widely used. The purpose of this study was to compare the efficacy of hyaluronic acid (hylan G-F 20) with triamcinolone acetonide as a single intra-articular injection for knee osteoarthritis. This study was a prospective, randomized, double-blind clinical trial. Participants with symptomatic knee osteoarthritis were recruited. They were randomized to receive a single-shot, intra-articular injection of either 6 mL of hylan G-F 20 or 6 mL of a solution comprising 1 mL of 40-mg triamcinolone acetonide and 5 mL of 1% lidocaine with epinephrine. The primary outcomes were knee pain severity, knee function, and range of motion at 6 months. Ninety-nine patients were assessed before injection and underwent a 6-month follow-up. Patients and evaluators were blinded. Multilevel regression models were used to estimate differences between the groups. At the 6-month follow-up, compared with patients who took hylan G-F 20, patients who took triamcinolone acetonide had similar improvement in knee pain, knee function, and range of motion. The difference in mean outcome scores between groups was, with regard to knee pain, a visual analog scale (VAS) score of 3 points (95% confidence interval [95% CI], -6 to 11 points); with regard to knee function, a modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score of 0 points (95% CI, -8 to 6 points); and, with regard to range of motion, flexion of -1° (95% CI, -5° to 2°) and extension of 0° (95% CI, -0.5° to 0.5°). However, patients who took triamcinolone acetonide had better pain improvement from 24 hours until 1 week after injection; the mean difference between groups with regard to the VAS score was 12 points (95% CI, 5 to 20 points; p = 0.002) at 24 hours and 9 points (95% CI, 1 to 15 points; p = 0.018) at 1 week. At 2 weeks after injection, patients who took triamcinolone acetonide also had better knee

  14. Posterior femoral condylar offset after total knee replacement in the risk of knee flexion contracture.

    PubMed

    Onodera, Tomohiro; Majima, Tokifumi; Nishiike, Osamu; Kasahara, Yasuhiko; Takahashi, Daisuke

    2013-08-01

    The aim of this study was to clarify the risk of knee flexion contracture associated with a posterior femoral condylar offset after total knee replacement (TKR). Radiographs from 100 healthy Japanese volunteers were included in the study. We evaluated femoral component posterior offset in various implants and compared them with the normal Japanese knee. Posterior offset of the femoral condyle is up to a maximum of 4.7 times greater than that of the healthy Japanese knee in all knee implants. Excess posterior offset of the femoral condyle in TKR prostheses may cause knee joint flexion contracture due to the relative shortening of the posterior soft tissue.

  15. Analgesic effect of intra-articular tramadol compared with morphine after arthroscopic knee surgery.

    PubMed

    Akinci, Seda B; Saricaoğlu, Fatma; Atay, Ozgur Ahmet; Doral, Mahmut Nedim; Kanbak, Meral

    2005-09-01

    The aim of the study was to compare the analgesic effect of 5 mg intra-articular (IA) morphine with 50 mg IA tramadol. Prospective double-blind randomized trial. Seventy-five patients having elective arthroscopic surgery of the knee were randomized to receive IA tramadol 50 mg (tramadol group), IA morphine 5 mg (morphine group), or IA normal saline (control group), in equivalent volumes (20 mL). The tourniquet was released 10 minutes after analgesic administration. Verbal pain rating score between 0 and 10 (VRS), supplemental analgesic requirements, and incidence of side effects were recorded postoperatively. Results are given as (median [5-95 percentiles]). The control group had a significantly shorter time to first analgesic request (25 min [15-55]) than morphine group, (34 min [15-158], P < .008) and the tramadol group, (33 min [17-728], P < .008). The patients in the control group complained of more severe pain (VRS 7 [4-10]) when they arrived at the postanesthesia care unit compared with the morphine group (VRS 1 [0-9], P = .002) and with the tramadol group (VRS 0 [0-9], P = .002). These treatment benefits were especially prominent in the patients who had meniscectomy or in the subgroup of patients with more than 6 months of preoperative pain. There was no statistical difference between the tramadol and morphine groups in the time to first analgesia, postoperative pain scores after arrival at the postanesthesia care unit, consumption of rescue analgesic, or side effects. We conclude that 50 mg IA tramadol provides analgesia equivalent to 5 mg IA morphine. Level II, randomized controlled trial that shows no significant difference and lacks narrow confidence intervals.

  16. Assessment of Knee Proprioception in the Anterior Cruciate Ligament Injury Risk Position in Healthy Subjects: A Cross-sectional Study.

    PubMed

    Mir, Seyed Mohsen; Talebian, Saeed; Naseri, Nasrin; Hadian, Mohammad-Reza

    2014-10-01

    [Purpose] Knee joint proprioception combines sensory input from a variety of afferent receptors that encompasses the sensations of joint position and motion. Poor proprioception is one of the risk factors of anterior cruciate ligament injury. Most studies have favored testing knee joint position sense in the sagittal plane and non-weight-bearing position. One of the most common mechanisms of noncontact anterior cruciate ligament injury is dynamic knee valgus. No study has measured joint position sense in a manner relevant to the mechanism of injury. Therefore, the aim of this study was to measure knee joint position sense in the noncontact anterior cruciate ligament injury risk position and normal condition. [Subjects and Methods] Thirty healthy male athletes participated in the study. Joint position sense was evaluated by active reproduction of the anterior cruciate ligament injury risk position and normal condition. The dominant knees of subjects were tested. [Results] The results showed less accurate knee joint position sense in the noncontact anterior cruciate ligament injury risk position rather than the normal condition. [Conclusion] The poorer joint position sense in non-contact anterior cruciate ligament injury risk position compared with the normal condition may contribute to the increased incidence of anterior cruciate ligament injury.

  17. Septic arthritis of the knee: Presentation of a novel irrigation-suction system tested in a cadaver study

    PubMed Central

    2011-01-01

    Background The established treatment for bacterial arthritis of the knee joint is arthroscopic surgery with irrigation and debridement. The aim of this article is to summarize the relevant data in treating bacterial arthritis of the knee joint, and based on these findings to present a novel irrigation suction system, tested in a cadaver study, as an additional tool in the postoperative treatment phase of arthroscopic surgery for knee joint infections. Method The novel automated irrigation-suction system presented here was compared to conventional continuous suction irrigation in a total of six knee joints. All knee joints were filled with 80 ml methylene blue stain and rinsed by two different methods. Fluid specimens were taken after ten and twenty minutes to be compared by photometric extinction measurement at a wave length of 500 nm. Results After ten minutes, the average extinction was e1C = 0.8 for the continuous suction irrigation and e1N = 0.4 for the novel irrigation-suction system. After twenty minutes, we recorded an average extinction of e2C = 0.3 for continuous suction irrigation and e2N = 0.001 for the novel irrigation-suction system. The students t-test revealed superior results after ten and twenty minutes of washing out the knee joints with a p < 0.001 for the novel irrigation-suction system. Conclusion A novel irrigation-suction system may be an effective tool for postoperative knee joint irrigation in arthroscopic therapy for bacterial arthritis of the knee. Further animal studies are needed to verify the effects in vivo. PMID:21819619

  18. Difference in knee rotation between total and unicompartmental knee arthroplasties during stair climbing.

    PubMed

    Jung, Myung-Chul; Chung, Jun Young; Son, Kwang-Hyun; Wang, Hui; Hwang, Jaejin; Kim, Jay Joong; Kim, Joon Ho; Min, Byoung-Hyun

    2014-08-01

    The purpose of this study was to compare knee kinematics during stair walking in patients with simultaneous total knee arthroplasty (TKA) and unicompartmental knee arthroplasties (UKA). It was hypothesized that UKA would reproduce more normalized knee kinematics than TKA during stair ascent and descent. Six patients who received UKA in one knee and TKA in the other knee were included in the study. For this study, a four-step staircase was assembled with two force platforms being positioned at the centre of the second and third steps. Each patient was attached with 16 reflective markers at both lower extremities and was asked to perform five roundtrip trials of stair climbing. Kinematic parameters including stance duration, knee angle, vertical ground reaction force (GRF), joint reaction force, and moments were obtained and analysed using a10-camera motion system (VICON, Oxford, UK). Nonparametric Friedman test was used to compare the results between two arthroplasty methods and between stair ascent and descent. Compared to TKA, UKA knees exhibited significantly greater degree of rotation in transverse planes (5.0 degrees during ascent and 6.0 degrees during descent on average), but showed no difference in terms of the other parameters. When comparing the results during stair ascent with descent, overall greater knee angle, vertical GRF, joint reaction force, and moment were observed during stair descent. Both UKA and TKA knees have shown overall similar knee kinematics, though UKA knee may allow greater degree of rotation freedom, which resembles normal knee kinematics during stair walking.

  19. Cost-effectiveness analysis of arthroscopic surgery compared with non-operative management for osteoarthritis of the knee

    PubMed Central

    Marsh, Jacquelyn D; Birmingham, Trevor B; Giffin, J Robert; Isaranuwatchai, Wanrudee; Hoch, Jeffrey S; Feagan, Brian G; Litchfield, Robert; Willits, Kevin; Fowler, Peter

    2016-01-01

    Objective To determine the cost-effectiveness of arthroscopic surgery in addition to non-operative treatments compared with non-operative treatments alone in patients with knee osteoarthritis (OA). Design, setting and participants We conducted an economic evaluation alongside a single-centre, randomised trial among patients with symptomatic, radiographic knee OA (KL grade ≥2). Interventions Patients received arthroscopic debridement and partial resection of degenerative knee tissues in addition to optimised non-operative therapy, or optimised non-operative therapy only. Main outcome measures Direct and indirect costs were collected prospectively over the 2-year study period. The effectiveness outcomes were the Western Ontario McMaster Osteoarthritis Index (WOMAC) and quality-adjusted life years (QALYs). Cost-effectiveness was estimated using the net benefit regression framework considering a range of willingness-to-pay values from the Canadian public payer and societal perspectives. We calculated incremental cost-effectiveness ratios and conducted sensitivity analyses using the extremes of the 95% CIs surrounding mean differences in effect between groups. Results 168 patients were included. Patients allocated to arthroscopy received partial resection and debridement of degenerative meniscal tears (81%) and/or articular cartilage (97%). There were no significant differences between groups in use of non-operative treatments. The incremental net benefit was negative for all willingness-to-pay values. Uncertainty estimates suggest that even if willing to pay $400 000 to achieve a clinically important improvement in WOMAC score, or ≥$50 000 for an additional QALY, there is <20% probability that the addition of arthroscopy is cost-effective compared with non-operative therapies only. Our sensitivity analysis suggests that even when assuming the largest treatment effect, the addition of arthroscopic surgery is not economically attractive compared with non

  20. Accuracy and repeatability of Roentgen stereophotogrammetric analysis (RSA) for measuring knee laxity in longitudinal studies.

    PubMed

    Fleming, B C; Peura, G D; Abate, J A; Beynnon, B D

    2001-10-01

    Roentgen stereophotogrammetric analysis (RSA) can be used to assess temporal changes in anterior-posterior (A-P) knee laxity. However, the accuracy and precision of RSA is dependent on many factors and should be independently evaluated for a particular application. The objective of this study was to evaluate the use of RSA for measuring A-P knee laxity. The specific aims were to assess the variation or "noise" inherent to RSA, to determine the reproducibility of RSA for repeated A-P laxity testing, and to assess the accuracy of these measurements. Two experiments were performed. The first experiment utilized three rigid models of the tibiofemoral joint to assess the noise and to compare digitization errors of two independent examiners. No differences were found in the kinematic outputs of the RSA due to examiner, repeated trials, or the model used. In a second experiment, A-P laxity values between the A-P shear load limits of +/-60 N of five cadaver goat knees were measured to assess the error associated with repeated testing. The RSA laxity values were also compared to those obtained from a custom designed linkage system. The mean A-P laxity values with the knee 30 degrees, 60 degrees, and 90 degrees of flexion for the ACL-intact goat knee (+/-95% confidence interval) were 0.8 (+/-0.25), 0.9 (+/-0.29), and 0.4 (+/-0.22) mm, respectively. In the ACL-deficient knee, the A-P laxity values increased by an order of magnitude to 8.8 (+/-1.39), 7.6 (+/-1.32), and 3.1 (+/-1.20)mm, respectively. No significant differences were found between the A-P laxity values measured by RSA and the independent measurement technique. A highly significant linear relationship (r(2)=0.83) was also found between these techniques. This study suggests that the RSA method is an accurate and precise means to measure A-P knee laxity for repeated testing over time.

  1. An exploratory study into the effects of a 20 minute crushed ice application on knee joint position sense during a small knee bend.

    PubMed

    Alexander, Jill; Selfe, James; Oliver, Ben; Mee, Daniel; Carter, Alexandra; Scott, Michelle; Richards, Jim; May, Karen

    2016-03-01

    The effect of cryotherapy on joint positioning presents conflicting debates as to whether individuals are at an increased risk of injury when returning to play or activity immediately following cryotherapy application at the knee. The aim of this study was to investigate whether a 20 min application of crushed ice at the knee immediately affects knee joint position sense during a small knee bend. Pre- and post-intervention. University movement analysis laboratory. Eleven healthy male participants. Kinematics of the knee were measured during a weight bearing functional task pre and post cryotherapy intervention using three-dimensional motion analysis (Qualisys Medical AB Gothenburg, Sweden). Tissue cooling was measured via a digital thermometer at the knee. Results demonstrated significant reductions in the ability to accurately replicate knee joint positioning in both sagittal (P = .035) and coronal (P = .011) planes during the descent phase of a small knee bend following cryotherapy. In conclusion a 20 min application of crushed ice to the knee has an adverse effect on knee joint repositioning. Team doctors, clinicians, therapists and athletes should consider these findings when deciding to return an athlete to functional weight bearing tasks immediately following ice application at the knee, due to the potential increase risk of injury. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Identifying the Functional Flexion-extension Axis of the Knee: An In-Vivo Kinematics Study

    PubMed Central

    Yin, Li; Chen, Kaining; Guo, Lin; Cheng, Liangjun; Wang, Fuyou; Yang, Liu

    2015-01-01

    Purpose This study aimed to calculate the flexion-extension axis (FEA) of the knee through in-vivo knee kinematics data, and then compare it with two major anatomical axes of the femoral condyles: the transepicondylar axis (TEA) defined by connecting the medial sulcus and lateral prominence, and the cylinder axis (CA) defined by connecting the centers of posterior condyles. Methods The knee kinematics data of 20 healthy subjects were acquired under weight-bearing condition using bi-planar x-ray imaging and 3D-2D registration techniques. By tracking the vertical coordinate change of all points on the surface of femur during knee flexion, the FEA was determined as the line connecting the points with the least vertical shift in the medial and lateral condyles respectively. Angular deviation and distance among the TEA, CA and FEA were measured. Results The TEA-FEA angular deviation was significantly larger than that of the CA-FEA in 3D and transverse plane (3.45° vs. 1.98°, p < 0.001; 2.72° vs. 1.19°, p = 0.002), but not in the coronal plane (1.61° vs. 0.83°, p = 0.076). The TEA-FEA distance was significantly greater than that of the CA-FEA in the medial side (6.7 mm vs. 1.9 mm, p < 0.001), but not in the lateral side (3.2 mm vs. 2.0 mm, p = 0.16). Conclusion The CA is closer to the FEA compared with the TEA; it can better serve as an anatomical surrogate for the functional knee axis. PMID:26039711

  3. Influence of offset stem couplers in femoral revision knee arthroplasty: a radiographic study.

    PubMed

    Brilhault, Jean M; Ries, Michael D

    2012-03-01

    We questioned whether the use of offset femoral stem would result in modifying the posterior femoral condylar offset (PFCO) in revision knee arthroplasty (RTKA). We measured both PFCO and stem alignment on lateral radiographs of two cohorts: 91 knees with straight stems and 35 knees with offset coupled stems. A higher PCOR was observed in knees with an offset stem compared to knees with straight stem. Knees with an offset stem had a better alignment within the intramedullary canal. Our conclusion is that the use of a modular offset coupler with femoral stem in RTKA compared to a modular straight stem both increases the posterior condylar offset and improves alignment of the stem within the intramedullary canal.

  4. Intra-articular hyaluronic acid after knee arthroscopy: a two-year study.

    PubMed

    Hempfling, Harald

    2007-05-01

    Arthroscopic knee joint lavage is used when conservative treatment of knee osteoarthritis is unsatisfactory and a joint prosthesis is not yet indicated. The potentially negative effect of irrigation fluids on cartilage metabolism and structure has led to the development of a temporary synovial fluid substitute containing hyaluronic acid. The short and long-term effects of this synovial fluid substitute were investigated in a total of 80 patients with persistent knee pain. Forty patients underwent arthroscopic knee joint lavage, in some cases combined with careful cartilage debridement (group A) while a further 40 patients underwent the same procedure which, after final joint lavage, was immediately followed by a single instillation of 10 ml of the synovial fluid substitute (0.5% sodium hyaluronate) into the joint (A + HA group). After the procedure, pain on walking and restricted ability to walk 100 m were markedly reduced to a comparable extent in both groups. Three months later, the effect of the treatment assessed using various parameters (CGI, restricted ability to walk 100 m, pain on walking, night pain) had decreased in group A, while it remained stable or even improved slightly in the A + HA group. The Mann-Whitney statistics revealed a descriptive superiority for the A + HA group at this time point. One year after treatment the superiority of the A + HA group was confirmed using the same assessment parameters. No side effects or adverse events were observed for either treatment procedure. This study shows that arthroscopic knee joint lavage leads to a lasting improvement in pain and functional impairment. The post-arthroscopic instillation of a HA-based synovial fluid substitute into the joint is a suitable way of achieving long-term stabilisation of the treatment outcome. This was supported by findings of a survey of 66 patients at 2 years after treatment in this study. Level I prospective, randomised controlled double-blind study.

  5. Knee Pain during Strength Training Shortly following Fast-Track Total Knee Arthroplasty: A Cross-Sectional Study

    PubMed Central

    Bandholm, Thomas; Thorborg, Kristian; Lunn, Troels Haxholdt; Kehlet, Henrik; Jakobsen, Thomas Linding

    2014-01-01

    Background Loading and contraction failure (muscular exhaustion) are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA). It is unknown how these exercise variables influence knee pain after TKA. Objective To investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA. Design Cross-sectional study. Setting Consecutive sample of patients from the Copenhagen area, Denmark, receiving a TKA, between November 2012 and April 2013. Participants Seventeen patients, no more than 3 weeks after their TKA. Main outcome measures: In a randomized order, the patients performed 1 set of 4 standardized knee extensions, using relative loads of 8, 14, and 20 repetition maximum (RM), and ended with 1 single set to contraction failure (14 RM load). The individual loadings (kilograms) were determined during a familiarization session >72 hours prior. The patients rated their knee pain during each repetition, using a numerical rating scale (0–10). Results Two patients were lost to follow up. Knee pain increased with increasing load (20 RM: 3.1±2.0 points, 14 RM: 3.5±1.8 points, 8 RM: 4.3±2.5 points, P = 0.006), and repetitions to contraction failure (10% failure: 3.2±1.9 points, 100% failure: 5.4±1.6 points, P<0.001). Resting knee pain 60 seconds after the final repetition (2.7±2.4 points) was not different from that recorded before strength training (2.7±1.8 points, P = 0.88). Conclusion Both loading and repetitions performed to contraction failure during knee- extension strength-training, increased post-operative knee pain during strength training implemented shortly following TKA. However, only the increase in pain during repetitions to contraction failure exceeded that defined as clinically relevant, and was very short-lived. Trial Registration

  6. A preliminary assessment of a novel pneumatic unloading knee brace on the gait mechanics of patients with knee osteoarthritis.

    PubMed

    Della Croce, Ugo; Crapanzano, Fausto; Li, Ling; Kasi, Patrick K; Patritti, Benjamin L; Mancinelli, Chiara; Hunter, David J; Stamenović, Dimitrije; Harvey, William F; Bonato, Paolo

    2013-10-01

    To determine whether a knee brace incorporating inflatable air bladders can alter the net peak external knee adduction moment in persons with medial compartment knee osteoarthritis. Prospective cohort study. Motion analysis laboratory. Subjects (n = 18) diagnosed with knee osteoarthritis as defined by the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Instrumented gait analysis was performed while subjects walked with and without the knee brace. When subjects wore the knee brace, the air bladders were either uninflated or inflated to 7 psi. The net external knee adduction moment was obtained by subtracting the abduction moment produced by the knee brace (estimated using a finite element analysis model) from the external knee adduction moment (estimated using a camera-based motion analysis system). The net external knee adduction moment was compared across all testing conditions. A 7.6% decrease in net peak external knee adduction moment was observed when subjects wore the knee brace uninflated compared with when they did not wear the brace. Inflation of the bladders to 7 psi led to a 26.0% decrease in net peak external knee adduction moment. The results of the study suggest that the effects of an unloading knee brace may be enhanced by incorporating inflatable air bladders into the design of the brace, thus leading to an improved correction of the excessive peak external knee adduction moment observed in patients with medial compartment knee osteoarthritis. Copyright © 2013. Published by Elsevier Inc.

  7. Analgesic Effect of Intra-articular Morphine or Dexmedetomidine Added with Levobupivacaine in Arthroscopic Knee Surgeries - A Comparative Evaluation

    PubMed Central

    Agarwal, Rajat Kumar; Chopra, Gaurav; Agrawal, Atul

    2017-01-01

    Introduction Knee arthroscopy is associated with variable amount of postoperative pain. In an attempt to improve postoperative analgesia, intra-articular injection of local anaesthetic in combination with other agent have been studied. However, the best combination is not known. Aim To compare the analgesic efficacy of intra-articular injection of morphine and dexmedetomidine when added with levobupivacaine in arthroscopic knee surgeries. Materials and Methods Seventy eight patients, scheduled to undergo elective arthroscopic procedure under spinal anaesthesia were recruited for the study. All the patients received 18 ml of 0.25% levobupivacaine however in addition to this Group M patients received 8 mg (2 ml) morphine, Group D patients received 100μg (2 ml) of dexmedetomidine while Group C patients received 2 ml of isotonic saline intra-articularly. Postoperatively the intensity of pain was assessed using Numerical Rating Scale (NRS). Rescue analgesia was given at NRS ≥ 4. The duration of analgesia and total diclofenac consumption was noted. Results The mean duration of analgesia was longest in Group M (576.20±67.09 minutes) followed by Group D (460.93±38.95 minutes) and Group C (370.27±58.80 minutes) statistically this difference was found to be highly significant (p-value < 0.001). Total consumption of diclofenac in 24 hours was found lowest in group M (86.25±27.48 mg) followed by group D (110.87±44.48 mg) and group C (141.35±44.13 mg) this difference was found to be highly significant (p-value < 0.001). Conclusion Morphine when added with levobupivacaine in patients undergoing arthroscopic knee surgery improves the quality and prolongs the duration of postoperative analgesia. PMID:28571238

  8. Comparative assessment of intrinsic mechanical stimuli on knee cartilage and compressed agarose constructs.

    PubMed

    Completo, A; Bandeiras, C; Fonseca, F

    2017-06-01

    A well-established cue for improving the properties of tissue-engineered cartilage is mechanical stimulation. However, the explicit ranges of mechanical stimuli that correspond to favorable metabolic outcomes are elusive. Usually, these outcomes have only been associated with the applied strain and frequency, an oversimplification that can hide the fundamental relationship between the intrinsic mechanical stimuli and the metabolic outcomes. This highlights two important key issues: the firstly is related to the evaluation of the intrinsic mechanical stimuli of native cartilage; the second, assuming that the intrinsic mechanical stimuli will be important, deals with the ability to replicate them on the tissue-engineered constructs. This study quantifies and compares the volume of cartilage and agarose subjected to a given magnitude range of each intrinsic mechanical stimulus, through a numerical simulation of a patient-specific knee model coupled with experimental data of contact during the stance phase of gait, and agarose constructs under direct-dynamic compression. The results suggest that direct compression loading needs to be parameterized with time-dependence during the initial culture period in order to better reproduce each one of the intrinsic mechanical stimuli developed in the patient-specific cartilage. A loading regime which combines time periods of low compressive strain (5%) and frequency (0.5Hz), in order to approach the maximal principal strain and fluid velocity stimulus of the patient-specific cartilage, with time periods of high compressive strain (20%) and frequency (3Hz), in order to approach the pore pressure values, may be advantageous relatively to a single loading regime throughout the full culture period. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

  9. Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study.

    PubMed

    McAlindon, T E; Wilson, P W; Aliabadi, P; Weissman, B; Felson, D T

    1999-02-01

    Because osteoarthritis may be caused by "wear and tear," we examined the association between level of physical activity and risk of knee osteoarthritis in the elderly. Eligible subjects were participants in the Framingham Heart Study cohort who had radiographically normal knees at biennial exam 18 (1983-1985) and who also completed a physical activity questionnaire at exam 20 (1988-1989). Follow-up knee radiographs were obtained at biennial exam 22 (1992-1993). The study outcomes were the development of incident radiographic or symptomatic knee osteoarthritis between the baseline and follow-up exams. The number of hours per day of heavy physical activity was associated with the risk of incident radiographic knee osteoarthritis (odds ratio = 1.3 per hour, 95% confidence limits 1.1-1.6, P for trend = 0.006). Adjustment for age, sex, body mass index, weight loss, knee injury, health status, total calorie intake, and smoking strengthened this association (eg, odds ratio for > or = 4 hours heavy physical activity/day compared with no heavy physical activity = 7.0, 95% confidence limits 2.4-20, P for trend = 0.0002). Risk was greatest among individuals in the upper tertile of body mass index (odds ratio for > or = 3 hours/day of heavy physical activity = 13.0, 95% confidence limits 3.3-51). For incident symptomatic knee osteoarthritis, the results were similar, although the number of cases was small. No effects on these outcomes were observed from moderate and light physical activity, number of blocks walked, or number of flights of stairs climbed daily. Heavy physical activity is an important risk factor for the development of knee osteoarthritis in the elderly, especially among obese individuals. Light and moderate activities do not appear to increase risk.

  10. "We're all looking for solutions": a qualitative study of the management of knee symptoms.

    PubMed

    MacKay, Crystal; Badley, Elizabeth M; Jaglal, Susan B; Sale, Joanna; Davis, Aileen M

    2014-07-01

    While the prevalence of osteoarthritis (OA) increases with age, the first signs begin in the fourth or fifth decade. Little is known about how younger adults respond to OA. This study explores how people ages 35-65 years manage knee symptoms. Six focus groups were conducted with 41 participants (mean age 50.9 years, 63% women) who self-reported a diagnosis of OA or reported knee symptoms (i.e., pain, aching, or stiffness) on most days of the past month. Purposive sampling was used, seeking variation in age and sex. The principles of constructivist grounded theory guided data collection and analysis. Data were analyzed using a constant comparative method. Participants engaged in a process of proactively trying to find ways to control knee symptoms and disease progression. Their approach to management was not linear, but rather a process that moved back and forth between searching for "solutions" and active management (ongoing use of strategies). During the process, participants consulted health care providers, but often perceived that medical care offered limited options and guidance. Management was constructed as a "never-ending" process that entailed effort and personal resources. Participants were proactive in seeking ways to manage knee OA symptoms. There is a mismatch between participants' proactive approach and the reactive approach of the health care system that has focused on late-stage disease. Programs and supports within the formal and informal health care system are required to enable people to successfully manage knee symptoms across their lifespan. Copyright © 2014 by the American College of Rheumatology.

  11. Assessment of isometricity before and after total knee arthroplasty: a cadaver study.

    PubMed

    Kuster, Markus S; Jeffcote, Benjamin O; Schirm, Andreas C; Jacob, Hilaire; Nicholls, Rochelle L

    2009-10-01

    Total knee arthroplasty (TKA) relies on soft tissue to regulate joint stability after surgery. In practice, the exact balance of the gaps can be difficult to measure, and various methods including intra-operative spreaders or distraction devices have been proposed. While individual ligament strain patterns have been measured, no data exist on the isometricity of the soft tissue envelope as a whole. In this study, a novel device was developed and validated to compare isometricity in the entire soft tissue envelope for both the intact and TKA knee. A spring-loaded rod was inserted in six cadaver knee joints between the tibial shaft and the tibial plateau or tibial tray after removing a 7 mm slice of bone. The displacement of the rod during passive flexion represented variation in tissue tension around the joint. The rod position in the intact knee remained within 1 mm of its initial position between 15 degrees and 135 degrees of flexion, and within 2 mm (+/-1.2 mm) throughout the entire range of motion (0-150 degrees). After insertion of a mobile-bearing TKA, the rod was displaced a mean of 6 mm at 150 degrees (p<0.001). The results were validated using a force transducer implanted in the tibial baseplate of the TKA, which showed increased tibiofemoral force in the parts of the flexion range where the rod was most displaced. The force measurements were highly correlated with the displacement pattern of the spring-loaded rod (r=-0.338; p=0.006). A simple device has been validated to measure isometricity in the soft tissue envelope around the knee joint. Isometricity measurements may be used in the future to improve implantation techniques during TKA surgery.

  12. Tibial rotation influences anterior knee stability--a robot-aided in-vitro study.

    PubMed

    Lorenz, Andrea; Röttgerkamp, Heike; Bobrowitsch, Evgenij; Leichtle, Carmen I; Leichtle, Ulf G

    2016-02-01

    Anterior cruciate ligament rupture can lead to symptomatic instability, especially during pivoting activities, which are often associated with increased anterior and rotational tibial loading. Therefore, the purpose of our robot-aided in-vitro study was to analyze the influence of tibial rotation on anterior knee stability under three anterior cruciate ligament conditions. Ten human knee specimens were examined using a robotic system. Anterior tibial translations were measured during anterior force application at internally and externally rotated positions of the tibia (5° steps until 4 Nm was reached) at 20°, 60°, and 90° of flexion. The native knee was compared with the knee with deficient and replaced anterior cruciate ligament. Tibial rotation significantly influenced anterior tibial translation (P<0.001), with differences of up to 12 mm between the largest and smallest anterior translation in the deficient knee. The largest influence of the anterior cruciate ligament on anterior translation was found in slightly externally rotated positions of the tibia (5°-10° at 20° of flexion; 0°-5° at 90° of flexion). Significantly increased anterior tibial translation (up to 7 mm) was measured after anterior cruciate ligament resection, which could be almost completely restored by the replacement (remaining difference<1mm) over a wide range of tibial rotations. Tibial rotation clearly influences anterior tibial translation. Because the greatest effect of the anterior cruciate ligament was found in slightly externally rotated positions of the tibia, increased attention to tibial rotation should be paid when performing the Lachman and anterior drawer tests. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. The extent and risk of knee injuries in children aged 9-14 with Generalised Joint Hypermobility and knee joint hypermobility - the CHAMPS-study Denmark.

    PubMed

    Junge, Tina; Larsen, Lisbeth Runge; Juul-Kristensen, Birgit; Wedderkopp, Niels

    2015-06-12

    Generalised Joint Hypermobility (GJH) is suggested as an aetiological factor for knee injuries in adolescents and adults. It is presumed that GJH causes decreased joint stability, thereby increasing the risk of knee injuries during challenging situations like jumping and landing. The aim was to study the extent and risk of knee injuries in children with GJH and knee hypermobility. In total, 999 children (9-14 years) were tested twice during spring 2012 and 2013 with Beighton's Tests (BT) for hypermobility, a 0-9 scoring system. GJH was classified with cut-point ≥5/9 on both test rounds. On basis of weekly cell phone surveys of knee pain, children requiring clinical examination were seen. Traumatic and overuse knee injuries were registered by WHO ICD-10 diagnoses. Logistic regression and Poisson regression models with robust standard errors were used to examine the association between GJH and knee injuries, taking into account clustering on school class levels. Totally, 36 children were classified GJH on both test rounds. Overuse knee injuries were the most frequent injury type (86 %), mainly apophysitis for both groups (61 %), other than patella-femoral pain syndrome for the control group (13 %). For traumatic knee injuries, distortions and contusions were most frequent in both groups (51 % resp. 36 %), besides traumatic lesions of knee tendons and muscles for the control group (5 %). No significant association was found between overuse knee injuries and GJH with/without knee hypermobility (OR 0.69, p = 0.407 resp. OR 0.75, p = 0.576) or traumatic knee injuries and GJH with/without knee hypermobility (OR 1.56, p = 0.495 resp. OR 2.22, p = 0.231). Apophysitis, distortions and contusions were the most frequent knee injuries. Despite the relatively large study, the number of children with GJH and knee injuries was low, with no significant increased risk for knee injuries for this group. This questions whether GJH is a clinically relevant risk factor for knee

  14. Primary Total Knee Arthroplasty in Super-obese Patients: Dramatically Higher Postoperative Complication Rates Even Compared to Revision Surgery.

    PubMed

    Werner, Brian C; Evans, Cody L; Carothers, Joshua T; Browne, James A

    2015-05-01

    This study utilized a national database to evaluate 90 day postoperative complication rates after total knee arthroplasty (TKA) in super obese (BMI > 50 kg/m(2)) patients (n = 7666) compared to non-obese patients (n = 1,212,793), obese patients (n = 291,914), morbidly obese patients (n = 169,308) and revision TKA patients (n = 28,812). Super obese patients had significantly higher rates of local and systemic complications compared to all other BMI groups as well as those undergoing revision TKA with higher rates of venous thromboembolism (VTE), infection, and medical complications. Super obesity is associated with dramatically increased rates of postoperative complications after TKA compared to non-obese, obese, and morbidly obese patients as well as those undergoing revision TKA.

  15. Relationship between bony tunnel and knee function in patients after patellar dislocation triple surgeries—a CT-based study

    PubMed Central

    Qin, Le; Li, Mei; Yao, Weiwu; Shen, Ji

    2017-01-01

    We aimed to assess the CT-based bony tunnel valuations and their correlation with knee function after patellar dislocation triple surgeries. A retrospective study was performed on 66 patients (70 knees) who underwent patellar dislocation triple surgeries. The surgery was MPFL reconstruction primarily, combined with lateral retinaculum release and tibial tubercle osteotomy. CT examinations were performed to determine the femoral tunnel position, along with the patellar and femoral tunnel width 3 days and more than 1 year after operation for follow-up. Functional evaluation based on Kujala and Lysholm scores was also implemented. We compared tunnel width of the first and last examinations and correlated femoral tunnel position of the last examination with knee function. At the last follow-up, femoral tunnel position in the anterior-posterior direction was moderately correlated with knee function. Femoral tunnel position in the proximal-distal direction was not associated with postoperative knee function. Patellar and femoral tunnel width increased significantly at the last follow-up. However, no significant functional difference was found between patients with and without femoral tunnel enlargement. Our results suggested that the tunnel malposition in anterior-posterior position based on CT was related to impaired knee function during the follow-ups. PMID:28120923

  16. Relationship between bony tunnel and knee function in patients after patellar dislocation triple surgeries—a CT-based study

    NASA Astrophysics Data System (ADS)

    Qin, Le; Li, Mei; Yao, Weiwu; Shen, Ji

    2017-01-01

    We aimed to assess the CT-based bony tunnel valuations and their correlation with knee function after patellar dislocation triple surgeries. A retrospective study was performed on 66 patients (70 knees) who underwent patellar dislocation triple surgeries. The surgery was MPFL reconstruction primarily, combined with lateral retinaculum release and tibial tubercle osteotomy. CT examinations were performed to determine the femoral tunnel position, along with the patellar and femoral tunnel width 3 days and more than 1 year after operation for follow-up. Functional evaluation based on Kujala and Lysholm scores was also implemented. We compared tunnel width of the first and last examinations and correlated femoral tunnel position of the last examination with knee function. At the last follow-up, femoral tunnel position in the anterior-posterior direction was moderately correlated with knee function. Femoral tunnel position in the proximal-distal direction was not associated with postoperative knee function. Patellar and femoral tunnel width increased significantly at the last follow-up. However, no significant functional difference was found between patients with and without femoral tunnel enlargement. Our results suggested that the tunnel malposition in anterior-posterior position based on CT was related to impaired knee function during the follow-ups.

  17. Effectiveness of hamstring knee rehabilitation exercise performed in training machine vs. elastic resistance: electromyography evaluation study.

    PubMed

    Jakobsen, Markus Due; Sundstrup, Emil; Andersen, Christoffer H; Persson, Roger; Zebis, Mette K; Andersen, Lars L

    2014-04-01

    The aim of this study was to evaluate muscle activity during hamstring rehabilitation exercises performed in training machine compared with elastic resistance. Six women and 13 men aged 28-67 yrs participated in a crossover study. Electromyographic (EMG) activity was recorded in the biceps femoris and the semitendinosus during the concentric and the eccentric phase of hamstring curls performed with TheraBand elastic tubing and Technogym training machines and normalized to maximal voluntary isometric contraction-EMG (normalized EMG). Knee joint angle was measured using electronic inclinometers. Training machines and elastic resistance showed similar high levels of muscle activity (biceps femoris and semitendinosus peak normalized EMG >80%). EMG during the concentric phase was higher than during the eccentric phase regardless of exercise and muscle. However, compared with machine exercise, slightly lower (P < 0.05) normalized EMG values were observed using elastic resistance at 30- to 50-degree knee joint angle for the semitendinosus and the biceps femoris during the concentric and the eccentric phase, respectively. Perceived loading (Borg CR10) was significantly higher (P < 0.001) during hamstring curl performed with elastic resistance (7.58 ± 0.08) compared with hamstring curl performed in a machine (5.92 ± 0.03). Hamstring rehabilitation exercise performed with elastic resistance induces similar peak hamstring muscle activity but slightly lower EMG values at more extended knee angles and with higher perceived loading as hamstring curls using training machines.

  18. Immediate effect of Masai Barefoot Technology shoes on knee joint moments in women with knee osteoarthritis.

    PubMed

    Tateuchi, Hiroshige; Taniguchi, Masashi; Takagi, Yui; Goto, Yusuke; Otsuka, Naoki; Koyama, Yumiko; Kobayashi, Masashi; Ichihashi, Noriaki

    2014-01-01

    Footwear modification can beneficially alter knee loading in patients with knee osteoarthritis. This study evaluated the effect of Masai Barefoot Technology shoes on reductions in external knee moments in patients with knee osteoarthritis. Three-dimensional motion analysis was used to examine the effect of Masai Barefoot Technology versus control shoes on the knee adduction and flexion moments in 17 women (mean age, 63.6 years) with radiographically confirmed knee osteoarthritis. The lateral and anterior trunk lean values, knee flexion and adduction angles, and ground reaction force were also evaluated. The influence of the original walking pattern on the changes in knee moments with Masai Barefoot Technology shoes was evaluated. The knee flexion moment in early stance was significantly reduced while walking with the Masai Barefoot Technology shoes (0.25±0.14Nm/kgm) as compared with walking with control shoes (0.30±0.19 Nm/kgm); whereas the knee adduction moment showed no changes. Masai Barefoot Technology shoes did not increase compensatory lateral and anterior trunk lean. The degree of knee flexion moment in the original walking pattern with control shoes was correlated directly with its reduction when wearing Masai Barefoot Technology shoes by multiple linear regression analysis (adjusted R2=0.44, P<0.01). Masai Barefoot Technology shoes reduced the knee flexion moment during walking without increasing the compensatory trunk lean and may therefore reduce external knee loading in women with knee osteoarthritis.

  19. The basic science of continuous passive motion in promoting knee health: a systematic review of studies in a rabbit model.

    PubMed

    Knapik, Derrick M; Harris, Joshua D; Pangrazzi, Garett; Griesser, Michael J; Siston, Robert A; Agarwal, Sudha; Flanigan, David C

    2013-10-01

    To determine whether the basic science evidence supports the use of continuous passive motion (CPM) after articular cartilage injury in the knee. A systematic review was performed identifying and evaluating studies in animal models that focused on the basic science of CPM of the knee. Databases included in this review were PubMed, Biosis Previews, SPORTDiscus, PEDro, and EMBASE. All functional, gross anatomic, histologic, and histochemical outcomes were extracted and analyzed. Primary outcomes of CPM analyzed in rabbit animal models (19 studies) included histologic changes in articular cartilage (13 studies), biomechanical changes and nutrition of intra-articular tissue (3 studies), and anti-inflammatory biochemical changes (3 studies). Nine studies specifically examined osteochondral defects, 6 of which used autogenous periosteal grafts. Other pathologies included were antigen-induced arthritis, septic arthritis, medial collateral ligament reconstruction, hemarthrosis, and chymopapain-induced proteoglycan destruction. In comparison to immobilized knees, CPM therapy led to decreased joint stiffness and complications related to adhesions while promoting improved neochondrogenesis with formation and preservation of normal articular cartilage. CPM was also shown to create a strong anti-inflammatory environment by effectively clearing harmful, inflammatory particles from within the knee. Current basic science evidence from rabbit studies has shown that CPM for the knee significantly improves motion and biological properties of articular cartilage. This may be translated to potentially improved outcomes in the management of articular cartilage pathology of the knee. If the rabbit model is relevant to humans, CPM may contribute to improved knee health by preventing joint stiffness, preserving normal articular tissue with better histologic and biologic properties, and improving range of motion as compared with joint immobilization and intermittent active motion. Copyright

  20. Comparison of knee gait kinematics of workers exposed to knee straining posture to those of non-knee straining workers.

    PubMed

    Gaudreault, Nathaly; Hagemeister, Nicola; Poitras, Stéphane; de Guise, Jacques A

    2013-06-01

    Workers exposed to knee straining postures, such as kneeling and squatting, may present modifications in knee gait kinematics that can make them vulnerable to osteoarthritis. In this study, knee kinematics of workers exposed to occupational knee straining postures (KS workers) were compared to those of non-knee straining (non-KS) workers. Eighteen KS workers and 20 non-KS workers participated in the study. Three-dimensional gait kinematic data were recorded at the knee using an electromagnetic motion tracking system. The following parameters were extracted from flexion/extension, adduction/abduction and internal/external rotation angle data and used for group comparisons: knee angle at initial foot contact, peak angles, minimal angles and angle range during the entire gait cycle. Group comparisons were performed with Student t-tests. In the sagittal plane, KS workers had a greater knee flexion angle at initial foot contact, a lower peak knee flexion angle during the swing phase and a lower angle range than non-KS workers (p<0.05). In the frontal plane, all parameters indicated that KS workers had their knees more adducted than non-KS workers. External/internal rotation range was greater for KS workers. This study provides new knowledge on work related to KS postures and knee kinematics. The results support the concept that KS workers might exhibit knee kinematics that are different from those of non-KS workers.

  1. Cost Analysis and Surgical Site Infection Rates in Total Knee Arthroplasty Comparing Traditional vs. Single-Use Instrumentation.

    PubMed

    Siegel, Geoffrey W; Patel, Neil N; Milshteyn, Michael A; Buzas, David; Lombardo, Daniel J; Morawa, Lawrence G

    2015-12-01

    Surgical site infections (SSIs) are a significant complications in total knee arthroplasty (TKA). The purpose of this study was to evaluate if traditional vs. single-use instrumentation had an effect on SSI's. We compared SSI rates and costs of TKAs performed with single-use (449) and traditional (169) TKA instrumentation trays. Total OR Time was, on average, 30 min less when single-use instrumentation was used. SSIs decreased in the single-use group (n=1) compared to the traditional group (n=5) (P=0.006). Single-use instrumentation added $490 in initial costs; however it saved between $480 and $600. Single-use instrumentation may provide a benefit to the patient by potentially decreasing the risk of infection and reducing the overall hospital costs.

  2. On extracting design principles from biology: II. Case study-the effect of knee direction on bipedal robot running efficiency.

    PubMed

    Haberland, M; Kim, S

    2015-02-02

    Comparing the leg of an ostrich to that of a human suggests an important question to legged robot designers: should a robot's leg joint bend in the direction of running ('forwards') or opposite ('backwards')? Biological studies cannot answer this question for engineers due to significant differences between the biological and engineering domains. Instead, we investigated the inherent effect of joint bending direction on bipedal robot running efficiency by comparing energetically optimal gaits of a wide variety of robot designs sampled at random from a design space. We found that the great majority of robot designs have several locally optimal gaits with the knee bending backwards that are more efficient than the most efficient gait with the knee bending forwards. The most efficient backwards gaits do not exhibit lower touchdown losses than the most efficient forward gaits; rather, the improved efficiency of backwards gaits stems from lower torque and reduced motion at the hip. The reduced hip use of backwards gaits is enabled by the ability of the backwards knee, acting alone, to (1) propel the robot upwards and forwards simultaneously and (2) lift and protract the foot simultaneously. In the absence of other information, designers interested in building efficient bipedal robots with two-segment legs driven by electric motors should design the knee to bend backwards rather than forwards. Compared to common practices for choosing robot knee direction, application of this principle would have a strong tendency to improve robot efficiency and save design resources.

  3. The effect of vitamin D supplementation on knee osteoarthritis, the VIDEO study: a randomised controlled trial

    PubMed Central

    Arden, Nigel K; Cro, Suzie; Sheard, Sally; Doré, Caroline J; Bara, Anna; Tebbs, Susan A; Hunter, David J; James, Samuel; Cooper, Cyrus; O’Neill, Terence W; Macgregor, Alexander; Birrell, Fraser; Keen, Richard

    2016-01-01

    Objective Knee osteoarthritis (OA) is a common problem with increasing prevalence in an ageing population. There are no licensed treatments to modify disease progression. Epidemiological data suggest that low serum 25-hydroxyvitamin D3 (25-OH-D3) levels are associated with radiological progression of knee OA. This study aimed to assess whether vitamin D supplementation can prevent the radiological progression of knee OA. Design A 3 year, double-blind, randomised, placebo-controlled trial 474 patients aged over 50 with knee OA comparing 800 IU cholecalciferol daily with placebo. The primary outcome was rate of joint space narrowing (JSN) in the medial compartment over three years. Secondary outcomes included WOMAC pain, function and stiffness. Results Vitamin D supplementation increased 25-OH-D3 from an average of 20·7 (8·9) μg/L to 30·4 (7·7) μg/L, compared to 20·7 (8·1) μg/L and 20·3 (8·1) μg/L in the placebo group. A non-significant decrease of 0.08 mm/year (95% CI -0·14 to 0·29, p=0.49) in the rate of JSN was observed in the treatment group relative to the control. No significant interactions were found between baseline vitamin D levels and treatment effects. There were no significant differences in any of the secondary outcome measures. Conclusions Vitamin D supplementation at a dose sufficient to elevate serum vitamin D3 levels by almost 10 μg/L in one year, when compared with placebo, does not slow the rate of JSN or lead to reduced pain, stiffness or functional loss over a three year period. PMID:27264058

  4. 3D intersegmental knee loading in below-knee amputees across steady-state walking speeds.

    PubMed

    Fey, Nicholas P; Neptune, Richard R

    2012-05-01

    Unilateral below-knee amputees often develop comorbidities that include knee joint disorders (e.g., intact leg knee osteoarthritis), with the mechanisms leading to these comorbidities being poorly understood. Mechanical knee loading of non-amputees has been associated with joint disorders and shown to be influenced by walking speed. However, the relationships between amputee knee loading and speed have not been identified. This study examined three-dimensional mechanical knee loading of amputees across a wide range of steady-state walking speeds. Fourteen amputees and 10 non-amputee control subjects were analyzed at four overground walking speeds. At each speed, intersegmental joint moment and force impulses (i.e., time-integrals over the stance phase) were compared between the control, intact and residual knees using repeated-measures ANOVAs. There were no differences in joint force impulses between the intact and control knees. The intact knee abduction moment impulse was lower than the non-amputees at 0.6 and 0.9 m/s. The intact knee flexion moment impulses at 0.6, 1.2 and 1.5m/s and knee external rotation moment impulses at all speeds were greater than the residual knee. The residual knee extension moment and posterior force impulses were insensitive to speed increases, while these quantities increased in intact and control knees. These results suggest the intact knees of asymptomatic and relatively new amputees are not overloaded during walking compared to non-amputees. Increased knee loads may develop in response to prolonged prosthesis usage or joint disorder onset. Further study is needed to determine if the identified bilateral loading asymmetries across speeds lead to diminished knee joint health. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Study of the control strategy of the quadriceps muscles in anterior knee pain.

    PubMed

    Cesarelli, M; Bifulco, P; Bracale, M

    2000-09-01

    Anterior knee pain (AKP) is a common pathological condition, particularly among young people and athletes, associated to an abnormal motion of the patella during the bending of the knee and possibly dependent on a muscular or structural imbalance. A lack of synergy in the quadriceps muscles results in a dynamic misalignment of the patella, which in turn produces pain. AKP rehabilitative therapy consists of conservative treatment whose main objective is to strengthen the Vastus Medialis. The aim of this article is to study the quadriceps muscle control strategy in AKP patients during an isokinetic exercise. Analysis of the muscle activation strategy is important for an objective measurement of the knee functionality in that it helps to diagnose and monitor the rehabilitative treatment. Surface electromyography (EMG) from the three superficial muscles of the femoral quadriceps during a concentric isokinetic exercise has been analyzed along with the signals of knee joint position and torque. A group of 12 AKP patients has been compared with a group of 30 normal subjects. Analysis of the grand ensemble average of the EMG linear envelopes in AKP patients reveals significant modifications in Vastus Medialis activity compared to the other quadriceps muscles. In order to study the synergy of the muscles, temporal identifiers have been associated to the EMG linear envelopes. To this end, EMG linear envelope decomposition in Gaussian pulses turned out to be effective and the results highlight an appreciable delay in the activation of the Vastus Medialis in AKP patients. This muscular unbalance can explain the abnormal motion of the patella.

  6. Risk factors for knee osteoarthritis in Morocco. A case control study.

    PubMed

    Mounach, Aziza; Nouijai, Abderrazak; Ghozlani, Imad; Ghazi, Mirieme; Achemlal, Lahsen; Bezza, Ahmed; El Maghraoui, Abdellah

    2008-03-01

    Osteoarthritis (OA) of the knee is the most common form of arthritis. A positive association between obesity and several occupational factors and knee OA has been observed in previous studies in populations of different ethnicity. The aim of this study was to examine the relation between knee OA and body weight and occupational factors in a Moroccan sample of patients with knee OA. Our cases were consecutive patients diagnosed in our department with knee OA utilizing radiography in a 1-year period. No cases displayed established causes of secondary OA. Controls were selected randomly from the general population and were individually matched to each case for age and sex. Interviews were obtained from 95 cases and controls. Detailed information on general health status, height, weight, smoking habits, specific physical loads from occupation and housework, and sports activities was collected. The risk of knee OA increased with higher body mass index, odds ratio (OR) = 3.12 (95% confidence interval [CI] = 1.67-5.81; p < 0.0001). Sitting more than 3 h/day and climbing stairs more than 50 steps/day were associated with decreased risk of knee OA, OR = 0.29 (95% CI = 0.15-0.56; p = 0.02) and 0.48 (95% CI = 0.26-0.91; p < 0.0001), respectively. Overweight is a risk factor for knee OA, whereas sitting and climbing stairs are inversely associated with knee OA.

  7. A mid-term clinical outcome study of the Advance Medial Pivot knee arthroplasty.

    PubMed

    Karachalios, Theofilos; Roidis, Nikolaos; Giotikas, Dimitrios; Bargiotas, Konstantinos; Varitimidis, Socrates; Malizos, Konstantinos N

    2009-12-01

    The Advance Medial Pivot Total Knee Arthroplasty (Wright Medical Technology, Arlington, Tennessee, USA) has been designed to reproduce modern ideas of knee kinematics. We report a prospective clinical outcome study of 284 arthroplasties in 225 consecutive patients with a mean follow-up of 6.7 years (range 4 to 9 years). For evaluation, both objective and subjective clinical rating systems and serial radiographs were used. At final follow-up, 10 (4.4%) patients (10 knees) only were lost from follow-up and four (1.8%) patients (five knees) had died for reasons unrelated to the surgery with their knees performing well. There was an 82% compliance in the intervals of follow-up evaluation. All patients showed a statistically significant improvement (p=0.01) in the Knee Society clinical rating system, WOMAC questionnaire, SF-12 questionnaire, and Oxford knee score. The majority of patients (92%) were able to perform age-appropriate activities with a mean knee flexion of 117 degrees (range 85 degrees to 135 degrees) at final follow-up. Survival analysis showed a cumulative success rate of 99.1% at 5 years. Two (0.7%) arthoplasties, in which patient selection and surgical errors were identified, were revised due to aseptic loosening, one due to infection and one due to a traumatic dislocation. This study demonstrates satisfactory mid-term clinical results for this knee design.

  8. Associations of knee muscle force, bone malalignment, and knee-joint laxity with osteoarthritis in elderly people

    PubMed Central

    Nakagawa, Kazumasa; Maeda, Misako

    2017-01-01

    [Purpose] From the viewpoint of prevention of knee osteoarthritis, the aim of this study was to verify how muscle strength and joint laxity are related to knee osteoarthritis. [Subjects and Methods] The study subjects consisted of 90 community-dwelling elderly people aged more than 60 years (22 males, 68 females). Femorotibial angle alignment, knee joint laxity, knee extensors and flexor muscle strengths were measured in all subjects. In addition, the subjects were divided into four groups based on the presence of laxity and knee joint deformation, and the muscle strength values were compared. [Results] There was no significant difference in knee extensor muscle strength among the four groups. However, there was significant weakness of the knee flexor muscle in the group with deformation and laxity was compared with the group without deformation and laxity. [Conclusion] Decreased knee flexor muscle strengths may be involved in knee joint deformation. The importance of muscle strength balance was also considered. PMID:28356631

  9. Associations of knee muscle force, bone malalignment, and knee-joint laxity with osteoarthritis in elderly people.

    PubMed

    Nakagawa, Kazumasa; Maeda, Misako

    2017-03-01

    [Purpose] From the viewpoint of prevention of knee osteoarthritis, the aim of this study was to verify how muscle strength and joint laxity are related to knee osteoarthritis. [Subjects and Methods] The study subjects consisted of 90 community-dwelling elderly people aged more than 60 years (22 males, 68 females). Femorotibial angle alignment, knee joint laxity, knee extensors and flexor muscle strengths were measured in all subjects. In addition, the subjects were divided into four groups based on the presence of laxity and knee joint deformation, and the muscle strength values were compared. [Results] There was no significant difference in knee extensor muscle strength among the four groups. However, there was significant weakness of the knee flexor muscle in the group with deformation and laxity was compared with the group without deformation and laxity. [Conclusion] Decreased knee flexor muscle strengths may be involved in knee joint deformation. The importance of muscle strength balance was also considered.

  10. A longitudinal study of the reliability of acupuncture deqi sensations in knee osteoarthritis.

    PubMed

    Spaeth, Rosa B; Camhi, Stephanie; Hashmi, Javeria A; Vangel, Mark; Wasan, Ajay D; Edwards, Robert R; Gollub, Randy L; Kong, Jian

    2013-01-01

    Deqi is one of the core concepts in acupuncture theory and encompasses a range of sensations. In this study, we used the MGH Acupuncture Sensation Scale (MASS) to measure and assess the reliability of the sensations evoked by acupuncture needle stimulation in a longitudinal clinical trial on knee osteoarthritis (OA) patients. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used as the clinical outcome. Thirty OA patients were randomized into one of three groups (high dose, low dose, and sham acupuncture) for 4 weeks. We found that, compared with sham acupuncture, real acupuncture (combining high and low doses) produced significant improvement in knee pain (P = .025) and function in sport (P = .049). Intraclass correlation analysis showed that patients reliably rated 11 of the 12 acupuncture sensations listed on the MASS and that heaviness was rated most consistently. Overall perceived sensation (MASS Index) (P = .014), ratings of soreness (P = .002), and aching (P = .002) differed significantly across acupuncture groups. Compared to sham acupuncture, real acupuncture reliably evoked stronger deqi sensations and led to better clinical outcomes when measured in a chronic pain population. Our findings highlight the MASS as a useful tool for measuring deqi in acupuncture research.

  11. A Longitudinal Study of the Reliability of Acupuncture Deqi Sensations in Knee Osteoarthritis

    PubMed Central

    Spaeth, Rosa B.; Camhi, Stephanie; Hashmi, Javeria A.; Vangel, Mark; Wasan, Ajay D.; Edwards, Robert R.; Gollub, Randy L.; Kong, Jian

    2013-01-01

    Deqi is one of the core concepts in acupuncture theory and encompasses a range of sensations. In this study, we used the MGH Acupuncture Sensation Scale (MASS) to measure and assess the reliability of the sensations evoked by acupuncture needle stimulation in a longitudinal clinical trial on knee osteoarthritis (OA) patients. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used as the clinical outcome. Thirty OA patients were randomized into one of three groups (high dose, low dose, and sham acupuncture) for 4 weeks. We found that, compared with sham acupuncture, real acupuncture (combining high and low doses) produced significant improvement in knee pain (P = .025) and function in sport (P = .049). Intraclass correlation analysis showed that patients reliably rated 11 of the 12 acupuncture sensations listed on the MASS and that heaviness was rated most consistently. Overall perceived sensation (MASS Index) (P = .014), ratings of soreness (P = .002), and aching (P = .002) differed significantly across acupuncture groups. Compared to sham acupuncture, real acupuncture reliably evoked stronger deqi sensations and led to better clinical outcomes when measured in a chronic pain population. Our findings highlight the MASS as a useful tool for measuring deqi in acupuncture research. PMID:23935656

  12. Total knee arthroplasty kinematics may be assessed using computer modeling: a feasibility study.

    PubMed

    Mihalko, William M; Williams, John L

    2012-10-01

    The next generational leap in computer navigation will hopefully aid surgeons in personalizing surgical techniques to patients' individual anatomical variables to optimize outcomes. To effectively use the information obtained in the operating room, a multitude of kinematic variables must be conveyed to the orthopedic surgeon in a usable and coherent manner. This study used an intraoperative navigation system to record passive knee kinematics after a total knee arthroplastyperformed. The clinical measures were taken via research software with the ability to record kinematic data in 10-second intervals. The data from 10 consecutive clinical cases were averaged, and the translation (anterior/posterior) and rotation (internal/external) were recorded and compared from 0° to 100° of flexion to allow for comparison with the previously recorded computer model. Model and clinical curves compared favorably, with less than 1° rotational and 1.5-mm differences, on average. The comparison of information and analyses were reviewed to indicate how they might be interpreted in the operating room for future use during surgery to allow a more personalized approach to improving functional outcomes after total knee arthroplasty.

  13. The associations between quadriceps muscle strength, power, and knee joint mechanics in knee osteoarthritis: A cross-sectional study.

    PubMed

    Murray, Amanda M; Thomas, Abbey C; Armstrong, Charles W; Pietrosimone, Brian G; Tevald, Michael A

    2015-12-01

    Abnormal knee joint mechanics have been implicated in the pathogenesis and progression of knee osteoarthritis. Deficits in muscle function (i.e., strength and power) may contribute to abnormal knee joint loading. The associations between quadriceps strength, power and knee joint mechanics remain unclear in knee osteoarthritis. Three-dimensional motion analysis was used to collect peak knee joint angles and moments during the first 50% of stance phase of gait in 33 participants with knee osteoarthritis. Quadriceps strength and power were assessed using a knee extension machine. Strength was quantified as the one repetition maximum. Power was quantified as the peak power produced at 40-90% of the one repetition maximum. Quadriceps strength accounted for 15% of the variance in peak knee flexion angle (P=0.016). Quadriceps power accounted for 20-29% of the variance in peak knee flexion angle (P<0.05). Quadriceps power at 90% of one repetition maximum accounted for 9% of the variance in peak knee adduction moment (P=0.05). These data suggest that quadriceps power explains more variance in knee flexion angle and knee adduction moment during gait in knee osteoarthritis than quadriceps strength. Additionally, quadriceps power at multiple loads is associated with knee joint mechanics and therefore should be assessed at a variety of loads. Taken together, these results indicate that quadriceps power may be a potential target for interventions aimed at changing knee joint mechanics in knee osteoarthritis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Immediate effect of valgus bracing on knee joint moments in meniscectomised patients: An exploratory study.

    PubMed

    Thorning, Maria; Thorlund, Jonas B; Roos, Ewa M; Wrigley, Tim V; Hall, Michelle

    2016-12-01

    Patients undergoing medial arthroscopic partial meniscectomy are at increased risk of developing and/or progressing knee osteoarthritis, with increased medial compartment load being a potential contributor. The aim of this study was to evaluate the immediate effect of a valgus unloader knee brace on knee joint moments in patients following medial arthroscopic partial meniscectomy. Within-participant design. Twenty-two patients (age 35-55 years) who had undergone medial arthroscopic partial meniscectomy within the previous 8-15 months completed three-dimensional analysis of gait, forward lunge and one-leg rise during two conditions: with and without a valgus unloader knee brace. Outcome measures included the peak and impulse of the knee adduction moment and the peak knee flexion moment. The peak knee flexion moment increased during brace condition for forward lunge (mean difference [95% CI]) 0.54 [0.27-0.82] (Nm/(BW×HT)%), p<0.001 and one-leg rise (mean difference 0.45 [95% CI 0.08-0.82] (Nm/(BW×HT)%), p=0.022). No other significant differences were found between conditions in any of the included tasks. A significant effect of the knee brace was detected in terms of an increase in peak knee flexion moment during the more demanding tasks such as forward lunge and one-leg rise. This increase implies enhanced stability of the knee provided by the brace, which may induce increased knee function and knee-related confidence during strenuous tasks. Future research is required to explore the structural implications. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  15. Differences in body fat mass, muscular endurance, coordination and proprioception in woman with and without knee pain: a cross-sectional study.

    PubMed

    Ozer Kaya, Derya; Düzgün, Irem; Baltacı, Gül

    2014-01-01

    The aim of this study was to compare body fat mass, muscular endurance, multi-joint coordination and proprioception between sedentary adult women with and without knee pain. This cross-sectional study included 149 women. All participants were evaluated using the Visual Analog Scale to determine knee pain during specific functions and divided into 2 groups accordingly. The knee pain group (n=52; mean age: 42.6±4.1 years; mean height: 1.56±5.11 m; mean weight: 75.2±14.1 kg) included patients with mild to moderate knee pain scores. The without knee pain group (n=97; mean age: 41.7±4.2 years; mean height: 1.58±5.06 m; mean weight: 73.4±10.6 kg) included cases who reported no pain. Body composition was assessed using the TANITA Body Composition Analyzer. Concentric maximal torque of the knee flexor and extensor muscles was recorded using an Isomed 2000 isokinetic dynamometer at 180 deg/s. Coordination and proprioception were assessed using the Functional Squat System. There was no significant difference in terms of physical characteristics, body composition parameters and coordination results between groups (p>0.05). Peak torque of flexion (0.65±0.21 N/kg) and extension (0.88±0.23 N/kg) of the affected side in the knee pain group were significantly lower than the without knee pain group dominant side flexion (0.74±0.19 N/kg) and extension (0.98±0.19 N/kg) (p<0.05). A significant difference in knee extension was observed between the affected (0.88±0.23 N/kg) and non-affected sides (0.93±0.21 N/kg) of the knee pain group (p<0.05). There were no significant differences for both legs between groups in terms of coordinative concentric side-to-side deficits and eccentric deficits (p>0.05). The deviation on visible movement for proprioception was significantly higher in the knee pain group (3.23±1.01 cm) than in the without knee pain group (2.78±1.03 cm) (p=0.012). Knee pain impairs flexor and extensor peak torques of knee endurance and multi-joint proprioceptive

  16. The Patient's Perception Does Not Differ Following Subvastus and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Simultaneous Bilateral Randomized Study.

    PubMed

    Koh, In Jun; Kim, Min Woo; Kim, Man Soo; Jang, Sung Won; Park, Dong Chul; In, Yong

    2016-01-01

    This simultaneous bilateral randomized study investigated whether patients would perceive the difference between the subvastus approach (SVA) and the medial parapatellar approach (MPA) after total knee arthroplasty (TKA). In 50 patients scheduled to undergo same-day bilateral TKA, one knee was randomly assigned to SVA and the other to MPA. Patient-reported measures (pain, Western Ontario McMaster University Osteoarthritis Index score, and side preference) and physician-assessed measures (isokinetic muscle strength, range of motion, and Knee Society score) were compared. No differences were observed in the patient-reported measures and physician-assessed measures, with the exception of greater quadriceps strength at postoperative 1 week in knees that underwent SVA. Patients receiving contemporary perioperative management after same-day bilateral TKA do not perceive any difference between knees that underwent SVA or MPA.

  17. [Clinical study on the treatment of knee osteoarthritis by acupuncture plus manipulative regulation of knee muscle].

    PubMed

    Sun, Kui; Bao, Xue-Mei; Song, Yang-Chun; Liu, De-Chun

    2010-12-01

    To investigate and research the appraisal scores of the symptoms and physical signs index for the evaluation of the clinical efficacy of acupuncture and manipulative regulation of knee muscle balance for the treatment of knee osteoarthritis, and provide clinical basis for the treatment. From January 2008 to December 2009, 121 patients with knee osteoarthritis were randomly divided into two groups. In the treatment group there were 63 cases of 83 knees including 16 males and 47 females, with an average age of (59.88 +/- 7.97) years; in the control group there were 58 cases of 73 knees including 13 males and 45 females, with an average age of (57.95 +/- 10.37) years. The patients in the treatment group were treated with acupuncture plus manipulative regulation of knee muscle balance, and the patients in the control group were treated with Diclofenac Sodium Sustained Release Tablets. The appraisal scores of the symptoms and physical signs index, numerical rating scale of pain, joint function, joint swelling were evaluated before and after the treatment, as well as 3 months after the treatment. All data were statistical analyzed by package SPSS 10.0. 1) In the treatment group, before and after treatment the appraisal scores of the symptoms and physical signs index were (39.81 +/- 3.92) and (9.69 +/- 8.08); numerical rating scale of pain were (7.61 +/- 0.97) and (2.17 +/- 2.09); joint function were (1.47 +/- 0.50) and (0.61 +/- 0.58); joint swelling were (1.23 +/- 0.79) and (0.42 +/- 0.52). As well in the control group, above data were (39.89 +/- 3.78), (13.62 +/- 7.83), (7.55 +/- 0.71), (3.34 +/- 2.32), (1.33 +/- 0.47), (0.93 +/- 0.67), an (0.97 +/- 0.88), (0.58 +/- 0.52) respectively. Both group had obvious differences in the appraisal scores of the symptoms and physical signs index, numerical rating scale of pain, joint function, joint swelling between after and before treatment. The comparison between the two groups suggested that after the treatments the treatment

  18. Comparative safety profile of hyaluronic acid products for knee osteoarthritis: a systematic review and network meta-analysis.

    PubMed

    Bannuru, R R; Osani, M; Vaysbrot, E E; McAlindon, T E

    2016-12-01

    Intra-articular (IA) hyaluronic acid (HA) is considered a safer alternative to oral Non-Steroidal Antiinflammatory Drugs (NSAIDs) and opioids for knee osteoarthritis (OA). A recent review raised potential safety concerns about HA, warranting further review of safety outcomes. We examined the risks of HA compared with IA placebo and investigated whether the risks vary among individual HA preparations. We searched all relevant databases from inception to October 2015 and sought unpublished data. We included all knee OA trials which compared any of the 18 HA products and reported on adverse events (AEs) and withdrawals. We calculated odds ratios for safety data reported at the longest follow-up. Network meta-analysis was performed using a Bayesian hierarchical random effects model for mixed multiple treatment comparisons. We identified 74 studies involving 13,032 participants aged between 45 and 75 years. The proportion of women ranged from 28% to 100%. The overall incidence of local reactions reported across all products was 8.5%. Commonly reported AEs were transient local reactions, such as pain, swelling and arthralgia, which subsided rapidly. None of the HA products were statistically significantly different from IA placebo or from each other with regard to incidence of AEs. Three treatment-related serious adverse events (SAEs) were reported among 9214 participants. Given the very low incidence of any particular AEs, we conclude that HA products are relatively well tolerated. These products have a similar safety profile compared to each other. This information along with the comparative effectiveness profile and relative cost would be helpful for clinicians in delivering individualized patient care. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  19. A randomised controlled trial of tidal irrigation vs corticosteroid injection in knee osteoarthritis: the KIVIS Study.

    PubMed

    Arden, N K; Reading, I C; Jordan, K M; Thomas, L; Platten, H; Hassan, A; Ledingham, J

    2008-06-01

    Patients with knee osteoarthritis (OA) often suffer pain that is not fully controlled by analgesics and often require intra-articular therapies. The aim of this study was to compare the benefits of intra-articular corticosteroid injections (CSIs) and tidal irrigation (TI) in patients with OA of the knee. We performed a dual-centre, single blind, randomised, parallel group trial comparing TI and CSI. Patients with knee OA were randomised to either irrigation using a 3.2mm arthroscope under local anaesthesia or an intra-articular injection of 40 mg triamcinolone acetonide and 1% lidocaine. Patients were followed for 6 months. The primary outcome measure was the Western Ontario and McMaster Universities OA Index total pain score (visual analogue scale, VAS). One hundred and fifty patients were recruited of whom 71 received TI and 79 CSI. In both treatment groups, over 80% of patients reported improvement at 2 and 4 weeks. After this time, the benefit of CSI decreased whereas that of TI was maintained: at 26 weeks the pain relief afforded by TI was significantly greater than that of CSI. At 26 weeks 29% of the CSI group reported improvement vs 64% of the TI group (P<0.001). Patients with a knee effusion responded better to both treatments, however, this was most apparent for CSI. Patients with less severe radiographic OA also obtained the greatest improvement from both treatments. Both procedures lead to significant short-term pain relief of at least 4 weeks, however, TI displayed a significantly greater duration of benefit. Patients with effusions and milder radiographic change obtained the best response to treatment.

  20. Group physical therapy for veterans with knee osteoarthritis: study design and methodology.

    PubMed

    Allen, Kelli D; Bongiorni, Dennis; Walker, Tessa A; Bartle, John; Bosworth, Hayden B; Coffman, Cynthia J; Datta, Santanu K; Edelman, David; Hall, Katherine S; Hansen, Gloria; Jennings, Caroline; Lindquist, Jennifer H; Oddone, Eugene Z; Senick, Margaret J; Sizemore, John C; St John, Jamie; Hoenig, Helen

    2013-03-01

    Physical therapy (PT) is a key component of treatment for knee osteoarthritis (OA) and can decrease pain and improve function. Given the expected rise in prevalence of knee OA and the associated demand for treatment, there is a need for models of care that cost-effectively extend PT services for patients with this condition. This manuscript describes a randomized clinical trial of a group-based physical therapy program that can potentially extend services to more patients with knee OA, providing a greater number of sessions per patient, at lower staffing costs compared to traditional individual PT. Participants with symptomatic knee OA (n = 376) are randomized to either a 12-week group-based PT program (six 1 h sessions, eight patients per group, led by a physical therapist and physical therapist assistant) or usual PT care (two individual visits with a physical therapist). Participants in both PT arms receive instruction in an exercise program, information on joint care and protection, and individual consultations with a physical therapist to address specific functional and therapeutic needs. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and the secondary outcome is the Short Physical Performance Test Protocol (objective physical function). Outcomes are assessed at baseline and 12-week follow-up, and the primary outcome is also assessed via telephone at 24-week follow-up to examine sustainability of effects. Linear mixed models will be used to compare outcomes for the two study arms. An economic cost analysis of the PT interventions will also be conducted.

  1. High- compared to low-arched athletes exhibit smaller knee abduction moments in walking and running.

    PubMed

    Powell, Douglas W; Andrews, Samantha; Stickley, Cris; Williams, D S Blaise

    2016-12-01

    High- (HA) and low-arched athletes (LA) experience distinct injury patterns. These injuries are the result of the interaction of structure and biomechanics. A suggested mechanism of patellofemoral pain pertains to frontal plane knee moments which may be exaggerated in LA athletes. We hypothesize that LA athletes will exhibit greater peak knee abduction moments than high-arched athletes.

  2. Isolation and Characterization of Synovial Mesenchymal Stem Cell Derived from Hip Joints: A Comparative Analysis with a Matched Control Knee Group

    PubMed Central

    Hatakeyama, Akihisa; Utsunomiya, Hajime; Tsukamoto, Manabu; Nakashima, Hirotaka; Nakamura, Eiichiro; Pascual-Garrido, Cecilia; Sekiya, Ichiro; Sakai, Akinori

    2017-01-01

    Purpose. To determine the characteristics of MSCs from hip and compare them to MSCs from knee. Methods. Synovial tissues were obtained from both the knee and the hip joints in 8 patients who underwent both hip and knee arthroscopies on the same day. MSCs were isolated from the knee and hip synovial samples. The capacities of MSCs were compared between both groups. Results. The number of cells per unit weight at passage 0 of synovium from the knee was significantly higher than that from the hip (P < 0.05). While it was possible to observe the growth of colonies in all the knee synovial fluid samples, it was impossible to culture cells from any of the hip samples. In adipogenesis experiments, the frequency of Oil Red-O-positive colonies and the gene expression of adipsin were significantly higher in knee than in hip. In osteogenesis experiments, the expression of COL1A1 and ALPP was significantly less in the knee synovium than in the hip synovium. Conclusions. MSCs obtained from hip joint have self-renewal and multilineage differentiation potentials. However, in matched donors, adipogenesis and osteogenesis potentials of MSCs from the knees are superior to those from the hips. Knee synovium may be a better source of MSC for potential use in hip diseases. PMID:28115945

  3. Isolation and Characterization of Synovial Mesenchymal Stem Cell Derived from Hip Joints: A Comparative Analysis with a Matched Control Knee Group.

    PubMed

    Hatakeyama, Akihisa; Uchida, Soshi; Utsunomiya, Hajime; Tsukamoto, Manabu; Nakashima, Hirotaka; Nakamura, Eiichiro; Pascual-Garrido, Cecilia; Sekiya, Ichiro; Sakai, Akinori

    2017-01-01

    Purpose. To determine the characteristics of MSCs from hip and compare them to MSCs from knee. Methods. Synovial tissues were obtained from both the knee and the hip joints in 8 patients who underwent both hip and knee arthroscopies on the same day. MSCs were isolated from the knee and hip synovial samples. The capacities of MSCs were compared between both groups. Results. The number of cells per unit weight at passage 0 of synovium from the knee was significantly higher than that from the hip (P < 0.05). While it was possible to observe the growth of colonies in all the knee synovial fluid samples, it was impossible to culture cells from any of the hip samples. In adipogenesis experiments, the frequency of Oil Red-O-positive colonies and the gene expression of adipsin were significantly higher in knee than in hip. In osteogenesis experiments, the expression of COL1A1 and ALPP was significantly less in the knee synovium than in the hip synovium. Conclusions. MSCs obtained from hip joint have self-renewal and multilineage differentiation potentials. However, in matched donors, adipogenesis and osteogenesis potentials of MSCs from the knees are superior to those from the hips. Knee synovium may be a better source of MSC for potential use in hip diseases.

  4. Temperature-Controlled Continuous Cold Flow Device after Total Knee Arthroplasty: A Randomized Controlled Trial Study.

    PubMed

    Ruffilli, Alberto; Castagnini, Francesco; Traina, Francesco; Corneti, Isabella; Fenga, Domenico; Giannini, Sandro; Faldini, Cesare

    2016-11-30

    Total knee arthroplasty (TKA) is a widely accepted and successful procedure for end-stage arthritis. Nevertheless, fast-track may be compromised by many factors, such as pain, edema, and blood loss. Cryotherapy has been advocated as a safe and effective strategy to improve the postoperative results, acting on pain, edema, and blood loss. This study is a prospective randomized controlled study, involving 50 patients after primary TKA. A power analysis was performed preoperatively. Twenty-four patients were addressed to a postoperative treatment with a continuous cold flow device (Hilotherm, Hilotherm GmbH, Germany). Twenty-six patients represented the control group, treated with crushed ice packs. All the patients shared the same analgesic strategy and the same rehabilitation protocol. Pain, analgesic consumption, active knee range of motion, drain output, transfusion requirement, and total blood loss were evaluated at different follow-ups (postoperative first, third, and seventh days). The two groups were homogenous for preoperative and intraoperative features. The groups showed no statistically significant differences in all the evaluated parameters. A modest reduction of knee volume was evident after 7 days from surgery (trend). No differences in blood loss were noticed. Continuous cold flow device in the acute postoperative setting after TKA did not show superiority in reducing edema, pain, and blood loss, compared with traditional icing regimen. Thus, due to the costs, it should be reserved to selected cases.

  5. Factors influencing outcome of knee bone marrow oedema: a clinical study.

    PubMed

    Berkem, Levent; Turkmen, Ismail; Unay, Koray; Akcal, Mehmet Akif; Aydemir, Nadir

    2013-10-01

    Bone marrow oedema has a long recovery time. Conservative and surgical treatments have been used. This study aimed at identifying a profile of patients who may benefit from nonsurgical management. We compared the results of periodic clinical and radiological examinations of patients who visited our clinic with knee pain and were diagnosed with bone marrow oedema following magnetic resonance imaging (MRI) examinations. Clinically, the patients were evaluated using the Lysholm knee score and a visual analogue scale. The study included 67 patients (31 males, 36 females) who were followed for 6-24 months. Patient age, gender, body mass index, affected area, and concomitant intra-articular pathology were analysed. Of the 67 patients, 63 were treated conservatively, and four underwent decompression. Patients with involvement of both the medial femoral condyle and tibial plateau were found to be more resistant to treatment than those in which only the tibial plateau was affected. Intra-articular pathologies were frequently noted together with bone marrow oedema, causing knee pain to persist after the bone marrow oedema had subsided.

  6. The relationship between three-dimensional knee MRI bone shape and total knee replacement—a case control study: data from the Osteoarthritis Initiative

    PubMed Central

    Barr, Andrew J.; Dube, Bright; Hensor, Elizabeth M. A.; Kingsbury, Sarah R.; Peat, George; Bowes, Mike A.; Sharples, Linda D.

    2016-01-01

    Objective. There is growing understanding of the importance of bone in OA. Our aim was to determine the relationship between 3D MRI bone shape and total knee replacement (TKR). Methods. A nested case-control study within the Osteoarthritis Initiative cohort identified case knees with confirmed TKR for OA and controls that were matched using propensity scores. Active appearance modelling quantification of the bone shape of all knee bones identified vectors between knees having or not having OA. Vectors were scaled such that −1 and +1 represented the mean non-OA and mean OA shapes. Results. Compared to controls (n = 310), TKR cases (n = 310) had a more positive mean baseline 3D bone shape vector, indicating more advanced structural OA, for the femur [mean 0.98 vs −0.11; difference (95% CI) 1.10 (0.88, 1.31)], tibia [mean 0.86 vs −0.07; difference (95% CI) 0.94 (0.72, 1.16)] and patella [mean 0.95 vs 0.03; difference (95% CI) 0.92 (0.65, 1.20)]. Odds ratios (95% CI) for TKR per normalized unit of 3D bone shape vector for the femur, tibia and patella were: 1.85 (1.59, 2.16), 1.64 (1.42, 1.89) and 1.36 (1.22, 1.50), respectively, all P < 0.001. After including Kellgren–Lawrence grade in a multivariable analysis, only the femur 3D shape vector remained significantly associated with TKR [odds ratio 1.24 (1.02, 1.51)]. Conclusion. 3D bone shape was associated with the endpoint of this study, TKR, with femoral shape being most associated. This study contributes to the validation of quantitative MRI bone biomarkers for OA structure-modification trials. PMID:27185958

  7. A novel physiological testing device to study knee biomechanics in vitro.

    PubMed

    van de Bunt, Fabian; Emanuel, Kaj S; Wijffels, Thomas; Kooren, Peter N; Kingma, Idsart; Smit, Theodoor H

    2017-08-01

    To properly study knee kinetics, kinematics and the effects of injury and surgical treatment in vitro, the knee should be constrained as little as possible, while imposing physiological loads. A novel dynamic biomechanical knee system (BKS) is presented here. The aim of this study was to test the feasibility and reproducibility of the system and demonstrate its features with an Anterior Cruciate Ligament (ACL) lesion model. Six goat knees were used in the current study. Flexion and extension simulating gait was imposed by a servo-motor, while normal joint load was applied by two artificial muscles. Intra-class correlation coefficients (ICCs) were assessed for inter-test measures, while paired t-tests were performed for comparison between intact knees and knees with ACL-lesion. The ICC's for inter-test measures based on all six goat knees were excellent: varus/valgus: ICC=0.93; rotation: ICC=0.94 (all p<0.01), and translation in frontal (x)-, side (y)- and upward (z)-direction (ICC=0.90, 0.88 & 0.94) (all p<0.01). A significant increase in joint center movement was found in knees after creating an ACL-lesion (p=0.018): translation increased more than two-fold in frontal (p=0.016), side (p=0.004) and upward (p=0.018) direction. Five degrees of motion were reproducibly assessed in the intact joint, suggesting that the goat knee may find its natural pathway when loaded in the BKS. The novel five-degrees-of-freedom knee system allows a detailed study of the effect of a diversity of defects and surgical treatments on knee biomechanics under physiological loading conditions. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. The relationship between external knee moments and muscle co-activation in subjects with medial knee osteoarthritis.

    PubMed

    Selistre, Luiz Fernando Approbato; Mattiello, Stela Márcia; Nakagawa, Theresa Helissa; Gonçalves, Glaucia Helena; Petrella, Marina; Jones, Richard Keith

    2017-04-01

    External knee moments are reliable to measure knee load but it does not take into account muscle activity. Considering that muscle co-activation increases compressive forces at the knee joint, identifying relationships between muscle co-activations and knee joint load would complement the investigation of the knee loading in subjects with knee osteoarthritis. The purpose of this study was to identify relationships between muscle co-activation and external knee moments during walking in subjects with medial knee osteoarthritis. 19 controls (11 males, aged 56.6±5, and BMI 25.2±3.3) and 25 subjects with medial knee osteoarthritis (12 males, aged 57.3±5.3, and BMI 28.2±4) were included in this study. Knee adduction and flexion moments, and co-activation (ratios and sums of quadriceps, hamstring, and gastrocnemius) were assessed during walking and compared between groups. The relationship between knee moments and co-activation was investigated in both groups. Subjects with knee osteoarthritis presented a moderate and strong correlation between co-activation (ratios and sums) and knee moments. Muscle co-activation should be used to measure the contribution of quadriceps, hamstring, and gastrocnemius on knee loading. This information would cooperate to develop a more comprehensive approach of knee loading in this population. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Comparative Effectiveness Review of Cooled Versus Pulsed Radiofrequency Ablation for the Treatment of Knee Osteoarthritis: A Systematic Review.

    PubMed

    Gupta, Anita; Huettner, Daniel P; Dukewich, Matthew

    2017-03-01

    Patients suffering from osteoarthritis of the knee and patients post total knee arthroplasty often develop refractory, disabling chronic knee pain. Radiofrequency ablation, including conventional, pulsed, and cooled, has recently become more accepted as an interventional technique to manage chronic knee pain in patients who have failed conservative treatment or who are not suitable candidates for surgical treatment. This systematic review aimed to analyze published studies on radiofrequency ablation to provide an overview of the current knowledge regarding variations in procedures, nerve targets, adverse events, and temporal extent of clinical benefit. A systematic review of published studies investigating conventional, pulsed, or cooled radiofrequency ablation in the setting of chronic knee pain. Medline, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were reviewed for studies on radiofrequency ablation for patients with chronic knee pain through July 29, 2016. From the studies, the procedural details, outcomes after treatment, follow-up points, and complications were compiled and analyzed in this literature review. Included studies were analyzed for clinical relevance and strength of evidence was graded using either the NHLBI Quality assessment of controlled intervention studies or the NHLBI quality assessment for before-after (pre-post) studies with no control group. Seventeen total publications were identified in the search, including articles investigating conventional, pulsed, or cooled radiofrequency ablation. These studies primarily targeted either the genicular nerves or used an intraarticular approach. Of the studies, 5 were small-sized randomized controlled trials, although one involved diathermy radiofrequency ablation. There were 8 retrospective or prospective case series and 4 case reports. Utilizing the strength of evidence grading, there is a low level of certainty to suggest a superior benefit between

  10. [Meniscal injuries of the knee: arthrographic and echographic study].

    PubMed

    Corbetti, F; Tomasella, G

    1989-03-01

    In order to evaluate the diagnostic capabilities of sonography (US) in meniscal lesions of the knee, 65 unquestionable cases of meniscopathy at arthrography were studied with high-resolution US. In 92% of the cases, inhomogeneous echo structure was demonstrated in correspondence with pathological meniscus, with irregular hyperechoic areas and, in some cases, with hyperechoic lines corresponding to the tear. 40% of patients presented with tumefaction and external bulging of the parameniscal region, while in 87% of the cases the articular capsule was thickened. These results confirm that, as reported by some authors, US is a promising method for the study of meniscopathies. We therefore believe that US could nowadays be at least employed as a complement to clinical examination, while its diagnostic capabilities are further assessed through other studies.

  11. Three trajectories of activity limitations in early symptomatic knee osteoarthritis: a 5-year follow-up study.

    PubMed

    Holla, Jasmijn F M; van der Leeden, Marike; Heymans, Martijn W; Roorda, Leo D; Bierma-Zeinstra, Sita M A; Boers, Maarten; Lems, Willem F; Steultjens, Martijn Pm; Dekker, Joost

    2014-07-01

    Knee osteoarthritis (OA) is a leading cause of activity limitations. The knee OA population is likely to consist of subgroups. The aim of the present study was to identify homogeneous subgroups with distinct trajectories of activity limitations in patients with early symptomatic knee OA and to describe characteristics of these subgroups. Follow-up data over a period of 5 years of 697 participants with early symptomatic knee OA from the Cohort Hip and Cohort Knee (CHECK) were used. Activity limitations were measured yearly with the Western Ontario and McMaster Universities Osteoarthritis Index. Latent class growth analyses identified homogeneous subgroups with distinct trajectories of activity limitations. Multivariable regression analyses examined differences in characteristics between the subgroups. Three subgroups were identified. Participants in Subgroup 1 ('good outcome'; n=330) developed or displayed slight activity limitations over time. Participants in Subgroup 2 ('moderate outcome'; n=257) developed or displayed moderate activity limitations over time. Participants in subgroup 3 ('poor outcome'; n=110) developed or displayed severe activity limitations over time. Compared with the 'good outcome' subgroup, the 'moderate outcome' and 'poor outcome' subgroups were characterised by: younger age, higher body mass index, greater pain, bony tenderness, reduced knee flexion, hip pain, osteophytosis, ≥3 comorbidities, lower vitality or avoidance of activities. Based on the 5-year course of activity limitations, we identified homogeneous subgroups of knee OA patients with good, moderate or poor outcome. Characteristics of these subgroups were consistent with existing knowledge on prognostic factors regarding activity limitations, which supports the validity of this classification. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Multicenter study of hyaluronic acid obtained by biotechnology to evaluate clinical efficacy and safety in knee osteoarthritis.

    PubMed

    Novaes, A C; Schaiquevich, P; Nasswetter, G

    2005-01-01

    Viscosuppplementation with intra-articular hyaluronic acid (hyaluronan [HA]) is a relatively new option for improving pain and articular function in patients with symptomatic knee osteoarthritis. An open multi-center study was performed in 365 patients with definite and symptomatic knee osteoarthritis from seven Latin American countries. Five doses of HA were administered once a week. The parameters studied were pain (six items), stiffness (two items) and functional capacity (17 items). The parameters were evaluated 1 week after the corresponding injection. Statistical differences were found when basal determinations of the three parameters were compared with the results of the first and fourth administration (p < 0.05). Intra-articular HA administration was well tolerated. Treatment-related nonserious adverse events were registered in 2.5% of administrations. Based on the results obtained, HA is a useful and well-tolerated symptomatic treatment for knee osteoarthritis with a rapid onset of action.

  13. Role of MRI in detecting early physeal changes due to acute osteoarticular infection around the knee joint: a pilot study

    PubMed Central

    Gill, Shivinder; Wardak, Mussa; Sen, Ramesh; Singh, Paramjeet; Kumar, Vishal; Saini, Raghav; Jha, Namita

    2008-01-01

    Physeal changes of any aetiology in children are usually diagnosed once the deformity is clinically evident. Between January 2006 and June 2007, 15 children who suffered from acute osteoarticular infection around the knee joint were studied. They were called up for follow-up six months after the onset of infection. All patients were evaluated by clinical and roentgenographic examination before undergoing magnetic resonance imaging (MRI) study of both knees “with the unaffected knee serving as control”. Abnormal findings in the physis, metaphysis and/or epiphysis on MRI were observed in five children. This group of five children was compared with the other ten children for clinical presentation and course of disease. We believe that MRI is a useful tool in the evaluation of growth plate insult in the early period following acute osteoarticular infection, and we can diagnose and prevent the catastrophic complications of the same. PMID:18670775

  14. A longitudinal study of quality of life and functional status in total hip and total knee replacement patients.

    PubMed

    Mandzuk, Lynda L; McMillan, Diana E; Bohm, Eric R

    2015-05-01

    Primary total hip and primary total knee surgeries are commonly performed to improve patients' quality of life and functional status. This longitudinal retrospective study (N = 851) examined self-reported quality of life and functional status over the preoperative and postoperative periods: 12 months prior to surgery, one month prior to surgery and 12 months following surgery. A linear mixed effects model was used to analyze the changes in quality of life and functional status over the sampling period. Patients in the convenience sample reported improvements in quality of life and functional status utilizing the SF-12 and Oxford Hip and Oxford Knee, although differences were noted by procedure and gender. Total hip patients tended to demonstrate greater improvement than total knee patients and males reported higher levels of physical and mental quality of life as well as functional status when compared to females. Of particular note was that mental health scores were consistently lower in both total hip and total knee replacement patients across the perioperative period and up to one year postoperative. This study identifies an opportunity for health care providers to proactively address the mental health of total hip and total knee replacement patients throughout their joint replacement trajectory. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Does decrease of the thoracic kyphosis influence decrease knee adduction moment during gait? A preliminary study of a healthy population.

    PubMed

    Ota, Susumu; Kano, Rika; Fukuta, Shoya; Miyai, Ryo; Masaoka, Nao; Yoshida, Akihiro

    2015-10-01

    [Purpose] The purpose of this study was to investigate the influence of a decrease in thoracic kyphosis angle on the knee adduction moment during gait in healthy young individuals. [Subjects and Methods] Twenty-nine healthy adults, consisting of 15 males and 14 females (21.6 ± 1.1 years old), participated. The draw-in maneuver was used to decrease thoracic kyphosis, and thoracic kyphosis was measured using a SpinalMouse during normal standing and standing with the draw-in maneuver. The participants were required to maintain the draw-in maneuver during gait. A 3-D motion analysis system and a force plate were used to obtain knee adduction moment. [Results] Thoracic kyphosis angles during the draw-in maneuver (41.0 ± 7.4 degrees) were significantly decreased compared with the angles during normal standing (43.0 ± 7.9 degrees). Although the knee adduction moment during gait with the draw-in maneuver was not significantly decreased compared with that during level gait, in the 20 subjects who had decreased kyphosis due to the draw-in maneuver, the 1st peak knee adduction moment (55.7 ± 24.3 × 10(-3)) with the draw-in maneuver was significantly decreased compared with the knee adduction moment (57.0 ± 16.3 × 10(-3)) during level gait. [Conclusion] Knee adduction moment in the case of a decreased thoracic kyphosis angle due to the draw-in maneuver was decreased compared with that during level gait.

  16. Simultaneous bilateral total knee arthroplasty with robotic and conventional techniques: a prospective, randomized study.

    PubMed

    Song, Eun-Kyoo; Seon, Jong-Keun; Park, Sang-Jin; Jung, Woo Bin; Park, Hyeong-Won; Lee, Geon Woo

    2011-07-01

    The authors performed this study to compare the outcomes of robotic-assisted and conventional TKA in same patient simultaneously. It was hypothesized that the robotic-assisted procedure would produce better leg alignment and component orientation, and thus, improve patient satisfaction and clinical and radiological outcomes. Thirty patients underwent bilateral sequential total knee replacement. One knee was replaced by robotic-assisted implantation and the other by conventional implantation. Radiographic results showed significantly more postoperative leg alignment outliers of conventional sides than robotic-assisted sides (mechanical axis, coronal inclination of the femoral prosthesis, and sagittal inclination of the tibial prosthesis). Robotic-assisted sides had non-significantly better postoperative knee scores and ROMs. Robotic-assisted sides needed longer operation times (25 min, SD ± 18) and longer skin incisions. Nevertheless, postoperative bleeding was significantly less for robotic-assisted sides. The better alignment accuracy of robotic TKA and the good clinical results achieved may favorably influence clinical and radiological outcomes.

  17. Does lateral versus medial exposure influence total knee tibial component final external rotation? A CT based study.

    PubMed

    Passeron, D; Gaudot, F; Boisrenoult, P; Fallet, L; Beaufils, P

    2009-10-01

    A previous study demonstrated that performing a total knee arthroplasty through a lateral approach including anterior tibial tuberosity (ATT) osteotomy (refixed in its original position) presented numerous advantages: correcting the preoperative patella lateral tilt and improving postoperative patella tracking. We hypothesized that these improvements in patella centering were, at least in part, due to an increased external rotation of the tibial component. Postoperative scannographic studies were, therefore, undertaken to measure tibial component rotation and analyze the results according the medial and lateral exposure used. Rotational positioning of the tibial component is influenced by the lateral or medial approach selected at surgery. Forty-five CAT scans, performed according to the protocol criteria of the French Hip and Knee Society (SFHG), were studied 3 months postoperatively: 15 knees operated through the lateral approach and 30 knees operated through a standard medial approach. The total knee utilized in all these cases was a posteriorly stabilized, fixed-bearing, design. We measured first the angle formed between the perpendicular to the transverse axis of the tibial component and the axis joining the ATT to the center of the knee; second we also measured the coronal distance between the center of the component and the anterior tibial tuberosity (ATT). In the group using the medial approach, the lateral position of the ATT was 7 + or - 3mm with a rotation angle of 18 degrees . In the group using the lateral approach these measurements were respectively 1 + or - 4mm and 2 degrees (p<0.0001). External rotation of the tibial component is substantially increased by the lateral approach compared to the medial approach. Better exposure of the lateral tibial plateau is probably responsible of this difference. This increased external rotation improves postoperative patella tracking. Prospective; comparative; non-randomized study; level 3. 2009 Elsevier Masson

  18. Gait assessment as a functional outcome measure in total knee arthroplasty: a cross-sectional study.

    PubMed

    Rahman, Jeeshan; Tang, Quen; Monda, Maureen; Miles, Jonathan; McCarthy, Ian

    2015-03-22

    The aim of the study was to assess gait in total knee arthroplasty (TKA) patients, using a technique that can to be used on a routine basis in a busy orthopaedic clinic. A total of 103 subjects were recruited: 29 pre-op TKA patients; 17 TKA patients at 8 weeks post-op; 28 TKA patients at 52 weeks post-op; and 29 age-matched controls. Inertial measurement units (IMUs) were used to assess gait. Limb segment angles, knee angle and temporal parameters of gait were calculated. Specific gait parameters were quantified, and data analysed using MANOVA and discriminant analysis. The gait of TKA patients as a group was only slightly improved at 12 months when compared with the pre-operative group, and both groups were significantly different to controls in several variables. Knee flexion range in stance was the most important variable in discriminating between patients and controls; knee flexion range in swing was the only variable that showed a significant difference between pre- and post-operative patients. When considered individually, only 1/29 patient was within the normal range for this variable pre-operatively, but 9/28 patients were within the normal range 12 months post-operatively. Even after 12 months after surgery, many TKA patients have not improved their gait relative to pre-operative patients. Routine gait assessment may be used to guide post-operative rehabilitation, and to develop strategies to improve mobility of these patients.

  19. Is there a causal link between knee loading and knee osteoarthritis progression? A systematic review and meta-analysis of cohort studies and randomised trials

    PubMed Central

    Henriksen, Marius; Creaby, Mark W; Lund, Hans; Juhl, Carsten; Christensen, Robin

    2014-01-01

    Objective We performed a systematic review, meta-analysis and assessed the evidence supporting a causal link between knee joint loading during walking and structural knee osteoarthritis (OA) progression. Design Systematic review, meta-analysis and application of Bradford Hill's considerations on causation. Data sources We searched MEDLINE, Scopus, AMED, CINAHL and SportsDiscus for prospective cohort studies and randomised controlled trials (RCTs) from 1950 through October 2013. Study eligibility criteria We selected cohort studies and RCTs in which estimates of knee joint loading during walking were used to predict structural knee OA progression assessed by X-ray or MRI. Data analyses Meta-analysis was performed to estimate the combined OR for structural disease progression with higher baseline loading. The likelihood of a causal link between knee joint loading and OA progression was assessed from cohort studies using the Bradford Hill guidelines to derive a 0–4 causation score based on four criteria and examined for confirmation in RCTs. Results Of the 1078 potentially eligible articles, 5 prospective cohort studies were included. The studies included a total of 452 patients relating joint loading to disease progression over 12–72 months. There were very serious limitations associated with the methodological quality of the included studies. The combined OR for disease progression was 1.90 (95% CI 0.85 to 4.25; I2=77%) for each one-unit increment in baseline knee loading. The combined causation score was 0, indicating no causal association between knee loading and knee OA progression. No RCTs were found to confirm or refute the findings from the cohort studies. Conclusions There is very limited and low-quality evidence to support for a causal link between knee joint loading during walking and structural progression of knee OA. Trial registration number CRD42012003253 PMID:25031196

  20. Computer-assisted surgery patterns of ligamentous deformity of the knee: a clinical and cadaveric study.

    PubMed

    Schwarzkopf, Ran; Hadley, Scott; Abbasi, Mohammed; Meere, Patrick A

    2013-08-01

    Knee malalignment during total knee arthroplasty (TKA) is commonly classified as either varus or valgus on the basis of a standing anteroposterior radiograph. Computer-assisted surgery (CAS) navigation TKA provides precise dynamic evaluation of knee alignment throughout the full range of motion (FROM). The goal of this study was to classify patterns of CAS-generated knee deformity curves that match specific soft tissue contracture combinations. This can then be applied as an algorithm for soft tissue balancing on the basis of the preoperative knee deformity curve. Computer navigation-generated graphs from 65 consecutive TKA procedures performed by a single surgeon were analyzed. A stress-strain curve of the coronal alignment of the knee was recorded throughout FROM before bony resection. All graphs were classified into groups according to their pattern. Cadaveric knee models were then used to test the correlation between isolated and combined ligamentous contractures and identified CAS deformity curves. An analysis of the intraoperative knee alignment graphs revealed four distinct patterns of coronal deformity on the basis of intraoperative data: 13% diagonal, 18.5% C-shaped, 43.5% comma shaped, and 25% S-shaped. Each represents the change in varus and valgus alignment during FROM. All patterns were reproduced with cadaveric knees by recreating specific contracture constellations. A tight posterior capsule gave an S-shaped curve, a tight lateral collateral ligament gave a C-shaped curve, tight medial collateral ligament gave a diagonal curve, and a tight posterior lateral corner gave a comma-shaped curve. Release of the specific contractures resulted in correction of all patterns of deformity as measured by CAS. We propose a new classification system for coronal plane knee deformity throughout FROM. This system intends to match individual and combined soft tissue pathological contractures to specific stress-strain curves obtained through routine knee CAS

  1. Retrospective Cohort Study of 207 Cases of Osteochondritis Dissecans of the Knee

    PubMed Central

    Green, Daniel W.; Arbucci, John; Silberman, Jason; Luderowski, Eva; Uppstrom, Tyler J.; Nguyen, Joseph; Tuca, Maria

    2016-01-01

    Objectives: Describe the clinical characteristics, image findings, and outcomes of patients with juvenile osteochondritis dissecans (JOCD) of the knee. To our knowledge, this is the largest single-surgeon cohort of JOCD patients. Methods: Retrospective cohort study of knee JOCD patients assessed by a single pediatric orthopaedic surgeon at a tertiary care center between 2005-2015. All diagnoses were confirmed by magnetic resonance imaging (MRI). Patients with patellar dislocations or osteochondral fractures were excluded. Demographic data, sports played, comorbidities, surgical procedures, and clinical data were extracted from charts. Images were analyzed to identify the location and size of lesions. Chi-square or Fisher’s exact tests were used to compare discrete variables, and Mann-Whitney U and Kruskal Wallis tests to compare continuous variables between groups. P-values of <0.05 were considered significant. Results: Sample consisted of 180 patients (207 knees), 124 boys and 56 girls. Average age at diagnosis was 12.8 years (7.5-17.5). Majority were active in sports (80.8%), primary soccer (36.7%) and basketball (29.4%). JOCD was present bilaterally in 27 patients (15%), 14 knees had bifocal OCD (6.8%), and only 1 patient had bifocal lesions in both knees. Most common location was medial femoral condyle (56.3%) followed by lateral femoral condyle (23.1%), trochlea (11.4%), patella (9%), and tibia (0.5%). In the sagittal view, most common location was the middle third of the condyles (48.7%). Surgery was performed in 72 knees (34.8%), with an average age at surgery of 14.1 years (9.3-18.1). Bilateral JOCD was present in 13 surgical patients (18.8%), but only 3 patients had bilateral surgery. Two operative patients had bifocal JOCD (2.7%) and surgery on both lesions. Location distribution did not differ between surgical and non-surgical lesions. The average normalized area of non-surgical JOCD lesions was 6.8 (0.1-18), whereas surgical lesions averaged a

  2. Joint space narrowing, body mass index, and knee pain: the ROAD study (OAC1839R1).

    PubMed

    Muraki, S; Akune, T; En-Yo, Y; Yoshida, M; Suzuki, T; Yoshida, H; Ishibashi, H; Tokimura, F; Yamamoto, S; Tanaka, S; Nakamura, K; Kawaguchi, H; Oka, H; Yoshimura, N

    2015-06-01

    The objective of the present study was to clarify the association of joint space narrowing with knee pain in Japanese men and women using a large-scale population-based cohort of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study. This study examined the association between minimum joint space width (mJSW) in the medial compartment and pain at the knee. mJSW was measured in the medial and lateral compartments of the knee using a knee osteoarthritis (OA) computer-aided diagnosis system. From the 3040 participants in the ROAD study, the present study analyzed 2733 participants who completed the radiographic examinations and questionnaires regarding knee pain (975 men and 1758 women; mean age, 69.9 ± 11.2 years). Subjects with lateral knee OA were excluded. After adjustment for age and Body mass index (BMI), medial mJSW, as well as medial mJSW/lateral mJSW, was significantly associated with knee pain. Sex and BMI affected the association of medial mJSW with knee pain. The threshold of medial mJSW was approximately 3 mm in men and 2 mm in women, while that of medial mJSW/lateral mJSW was approximately 60% in both men and women. BMI was found to have a distinct effect on the association of mJSW with pain. The present cross-sectional study using a large-scale population from the ROAD study showed that joint space narrowing had a significant association with knee pain. The thresholds of joint space narrowing for knee pain were also established. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  3. [Evaluation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees].

    PubMed

    Brazier, J; Migaud, H; Gougeon, F; Cotten, A; Fontaine, C; Duquennoy, A

    1996-01-01

    We compared on lateral X-rays of 83 healthy knees, 6 methods measuring the tibial sagittal slope. Each method determined the tibial slope according to an independent anatomical axis. The goals of the study were to: 1) detect the differences between the 6 methods; 2) determine if any mathematical relation could be observed between the 6 methods; 3) compare accuracy of proximal anatomical axis versus long anatomical axis to evaluate the tibial slope. 50 healthy patients (83 knees) knees were included in the study. The patients (26 male and 24 females) were 39.3 +/- 15.8 years old. We obtained true lateral X-rays orientated with an image intensifier in order to obtain the exact superposition of the femoral condyles. The measurements were carried out by an observer according to two procedures: 1) by manual goniometric measurements twice; the mean value between both lectures was recorded; 2) with a digitizer (Orthographics TM, Salt Lake City, Ut). We measured the angle between the tangent to the medial tibial plateau and the perpendicular direction to each of the studied anatomical axis: tibial proximal anatomical axis (TPAA); tibial shaft anatomical axis (TSAA); posterior tibial cortex (PTC); fibular proximal anatomical axis (FPAA); fibular shaft axis (FSA); anterior tibial cortex (ATC). The values obtained with the digitizer were used to compare the six methods. The values obtained with the TSAA were considered as reference. Tibial slope values were different with the 6 methods. ATC gave the higher values and PTC the smaller. The difference could be 5 degrees between two methods measuring the same posterior tibial slope. However different, the values obtained with the 6 methods were strongly correlated (R > 0.85; p = 0.0001). We determined mathematical relationships between the values obtained with the 6 methods according to the regression analysis. The correlation with the values obtained with TSAA (reference values) was stronger for TPAA and TPC (respectively R = 0

  4. Is there a causal link between knee loading and knee osteoarthritis progression? A systematic review and meta-analysis of cohort studies and randomised trials.

    PubMed

    Henriksen, Marius; Creaby, Mark W; Lund, Hans; Juhl, Carsten; Christensen, Robin

    2014-07-15

    We performed a systematic review, meta-analysis and assessed the evidence supporting a causal link between knee joint loading during walking and structural knee osteoarthritis (OA) progression. Systematic review, meta-analysis and application of Bradford Hill's considerations on causation. We searched MEDLINE, Scopus, AMED, CINAHL and SportsDiscus for prospective cohort studies and randomised controlled trials (RCTs) from 1950 through October 2013. We selected cohort studies and RCTs in which estimates of knee joint loading during walking were used to predict structural knee OA progression assessed by X-ray or MRI. Meta-analysis was performed to estimate the combined OR for structural disease progression with higher baseline loading. The likelihood of a causal link between knee joint loading and OA progression was assessed from cohort studies using the Bradford Hill guidelines to derive a 0-4 causation score based on four criteria and examined for confirmation in RCTs. Of the 1078 potentially eligible articles, 5 prospective cohort studies were included. The studies included a total of 452 patients relating joint loading to disease progression over 12-72 months. There were very serious limitations associated with the methodological quality of the included studies. The combined OR for disease progression was 1.90 (95% CI 0.85 to 4.25; I(2)=77%) for each one-unit increment in baseline knee loading. The combined causation score was 0, indicating no causal association between knee loading and knee OA progression. No RCTs were found to confirm or refute the findings from the cohort studies. There is very limited and low-quality evidence to support for a causal link between knee joint loading during walking and structural progression of knee OA. CRD42012003253. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Hydrotherapy after total knee arthroplasty. A follow-up study.

    PubMed

    Giaquinto, S; Ciotola, E; Dall'Armi, V; Margutti, F

    2010-01-01

    The study evaluated the subjective functional outcome following total knee arthroplasty (TKA) in participants who underwent hydrotherapy (HT) six months after discharge from a rehabilitation unit. A total of 70 subjects, 12 of which were lost at follow-up, were randomly assigned to either a conventional gym treatment (N=30) or HT (N=28). A prospective design was performed. Participants were interviewed with Western-Ontario McMasters Universities Osteoarthritis Index (WOMAC) at admission, at discharge and six months later. Kruskal-Wallis and Wilcoxon tests were applied for statistical analysis. Both groups improved. The WOMAC subscales, namely pain, stiffness and function, were all positively affected. Statistical analysis indicates that scores on all subscales were significantly lower for the HT group. The benefits gained by the time of discharge were still found after six months. HT is recommended after TKA in a geriatric population. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  6. Evaluation of the effects of a physiotherapy program on quality of life in females after unilateral total knee arthroplasty: a prospective study

    PubMed Central

    Hudáková, Zuzana; Zięba, Halina Romualda; Lizis, Paweł; Dvořáková, Vlasta; Cetlová, Lada; Friediger, Teresa; Kobza, Wojciech

    2016-01-01

    [Purpose] Osteoarthritis is a chronic and degenerative joint disease and is considered to be one of the most common musculoskeletal disorders. This study evaluated the differences in the quality of life of females treated with supervised physiotherapy and a standardized home program after unilateral total knee arthroplasty. [Subjects and Methods] From January 2012 to May 2015, a total of 40 females were examined at the Central Military Hospital in Ruzomberk, Slovakia. Quality of life was assessed with the Short Form-36. Quality of life and intensity of pain after normal daily activity, according to the visual analog scale, were assessed before total knee arthroplasty, immediately after physiotherapy, 3 months after total knee arthroplasty, and 6 months after total knee arthroplasty. [Results] We found statistically significant improvement of the quality of life results and a decreased intensity of pain at each time point compared with before total knee arthroplasty. [Conclusions] The results of this study provide further evidence indicating that patients who undergo total knee arthroplasty for primary osteoarthritis of the knee can achieve a significant improvement in the quality of life by using supervised physiotherapy compared with a standardized home program. PMID:27313341

  7. Evaluation of the effects of a physiotherapy program on quality of life in females after unilateral total knee arthroplasty: a prospective study.

    PubMed

    Hudáková, Zuzana; Zięba, Halina Romualda; Lizis, Paweł; Dvořáková, Vlasta; Cetlová, Lada; Friediger, Teresa; Kobza, Wojciech

    2016-05-01

    [Purpose] Osteoarthritis is a chronic and degenerative joint disease and is considered to be one of the most common musculoskeletal disorders. This study evaluated the differences in the quality of life of females treated with supervised physiotherapy and a standardized home program after unilateral total knee arthroplasty. [Subjects and Methods] From January 2012 to May 2015, a total of 40 females were examined at the Central Military Hospital in Ruzomberk, Slovakia. Quality of life was assessed with the Short Form-36. Quality of life and intensity of pain after normal daily activity, according to the visual analog scale, were assessed before total knee arthroplasty, immediately after physiotherapy, 3 months after total knee arthroplasty, and 6 months after total knee arthroplasty. [Results] We found statistically significant improvement of the quality of life results and a decreased intensity of pain at each time point compared with before total knee arthroplasty. [Conclusions] The results of this study provide further evidence indicating that patients who undergo total knee arthroplasty for primary osteoarthritis of the knee can achieve a significant improvement in the quality of life by using supervised physiotherapy compared with a standardized home program.

  8. Location of the Common Peroneal Nerve in Valgus Knees-Is the Reported Safe Zone for Well-Aligned Knees Applicable?

    PubMed

    Yang, Dejin; Shao, Hongyi; Zhou, Yixin; Tang, Hao; Guo, Shengjie

    2017-06-02

    Lateral soft-tissue release can jeopardize the common peroneal nerve (CPN) in total knee arthroplasty for valgus knees. Previous studies reporting safe zones to protect the CPN were based on well-aligned knees. We conducted this study to compare the localization of the CPN in well-aligned knees and in valgus knees. We conducted a consecutive 3-dimensional radiographic study on magnetic resonance images of 58 well-aligned knees and 39 valgus knees. We measured the distance between the CPN and the tibia, as well as the mediolateral, anteroposterior, and angular location of the CPN. We compared the results between well-aligned knees and valgus knees. We found that there is an increased distance between the CPN and the tibia at the level of the tibial cut, but not at the joint line in valgus knees. It is safer to release the posterolateral capsule at the tibial side than at the level above this. The angular location and the mediolateral or anteroposterior location of the CPN in valgus knees are similar to those of well-aligned knees. The location of the CPN in valgus knees is similar to that in well-aligned knees. The previously reported safe zone in well-aligned knees is applicable in valgus knees to protect the CPN. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. No associations between self-reported knee joint instability and radiographic features in knee osteoarthritis patients prior to Total Knee Arthroplasty: A cross-sectional analysis of the Longitudinal Leiden Orthopaedics Outcomes of Osteo-Arthritis study (LOAS) data.

    PubMed

    Leichtenberg, Claudia S; Meesters, Jorit J L; Kroon, Herman M; Verdegaal, Suzan H M; Tilbury, Claire; Dekker, Joost; Nelissen, Rob G H H; Vliet Vlieland, Thea P M; van der Esch, Martin

    2017-08-01

    To describe the prevalence of self-reported knee joint instability in patients with pre-surgery knee osteoarthritis (OA) and to explore the associations between self-reported knee joint instability and radiological features. A cross-sectional study including patients scheduled for primary Total Knee Arthroplasty (TKA). Self-reported knee instability was examined by questionnaire. Radiological features consisted of osteophyte formation and joint space narrowing (JSN), both scored on a 0 to three scale. Scores >1 are defined as substantial JSN or osteophyte formation. Regression analyses were provided to identify associations of radiological features with self-reported knee joint instability. Two hundred and sixty-five patients (mean age 69years and 170 females) were included. Knee instability was reported by 192 patients (72%). Substantial osteophyte formation was present in 78 patients (41%) reporting and 33 patients (46%) not reporting knee joint instability. Substantial JSN was present in 137 (71%) and 53 patients (73%), respectively. Self-reported knee instability was not associated with JSN (relative to score 0, odds ratios (95% CI) of score 1, 2 and 3 were 0.87 (0.30-2.54), 0.98 (0.38-2.52), 0.68 (0.25-1.86), respectively) or osteophyte formation (relative to score 0, odds ratios (95% CI) of score 1, 2 and 3 were 0.77 (0.36-1.64), 0.69 (0.23-1.45), 0.89 (0.16-4.93), respectively). Stratified analysis for pain, age and BMI showed no associations between self-reported knee joint instability and radiological features. Self-reported knee joint instability is not associated with JSN or osteophyte formation. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Y-TZP zirconia run against highly crosslinked UHMWPE tibial inserts: knee simulator wear and phase-transformation studies.

    PubMed

    Tsukamoto, Riichiro; Williams, Paul A; Clarke, Ian C; Pezzotti, Giuseppe; Shoji, Hiromu; Akagi, Masao; Yamamoto, Kengo

    2008-07-01

    Zirconia (ZrO(2)) ceramics combined with highly cross-linked polyethylene appears to be a promising approach to minimize wear in artificial knee joints. The wear performance of yttria-stabilized zirconia (YZr) femoral condyles on 7-Mrad tibial inserts was compared in a knee simulator to CoCr bearing on 3.5-Mrad inserts. The knee design was the Bi-Surface type with a 9-year clinical history in Japan (JMM, Japan). A displacement-controlled knee simulator was used with kinematics that included 20 degrees flexion, +/-5 degrees rotation, and 6 mm anterior/posterior translation. Lubricant was alpha-calf serum, test duration was 10 million cycles (10 Mc), and wear was measured by weight-loss techniques. The wear zones were studied by laser interferometry, scanning electron microscopy, and Raman microprobe spectroscopy. At 10 Mc the wear rates of the CoCr controls averaged 4.5 mm(3)/Mc. This was within 7% of the prior estimate at 5-Mc duration and comparable to Bi-Surface wear data from another laboratory. The CoCr condyles increased in roughness (R(a)) from <50 nm to average R(a) = 250 nm due to linear scratching. The ceramic condyles remained pristine throughout the wear study (R(a) <7 nm). With the YZr/7-Mrad combination, the weight change had a positive slope over at 10 Mc, which meant that the actual polyethylene wear was unmeasurable. Microscopic examinations at 10 Mc showed that the zirconia surfaces were intact and there was no detectable change from tetragonal to monoclinic phase. Our laboratory knee wear simulation appeared very supportive of the 9-year YZr/PE clinical results with Bi-Surface total knee replacements in Japan. 2007 Wiley Periodicals, Inc.

  11. Cartilage Loss Occurs in the Same Subregions as Subchondral Bone Attrition: A Within-Knee Subregion-Matched Approach From the Multicenter Osteoarthritis Study

    PubMed Central

    Neogi, T.; Felson, D.; Niu, J.; Lynch, J.; Nevitt, M.; Guermazi, A.; Roemer, F.; Lewis, C. E.; Wallace, B.; Zhang, Y.

    2009-01-01

    Objective By magnetic resonance imaging (MRI), subchondral bone attrition (SBA) can be seen in early osteoarthritis (OA), but the significance of this is unknown. We therefore evaluated whether SBA was associated with cartilage loss within the same subregion of the knee. Methods The Multicenter Osteoarthritis Study is a cohort of individuals who have or are at high risk for knee OA. At baseline and 30 months, participants’ knee MRIs were graded using the Whole-Organ Magnetic Resonance Imaging Score in the 10 subregions of the tibiofemoral joint for cartilage morphology and SBA. We conducted analyses within a knee to eliminate between-person confounding, using an M:N (cases:controls) matched case–control approach with the 10 subregions of a person’s knee forming a matched set. Cases within a knee were defined as subregions with cartilage loss, while controls were subregions in that same knee without cartilage loss. We evaluated the association of cartilage loss over 30 months with the presence of baseline SBA in the same subregion within that knee using conditional logistic regression. Results SBA was associated with an odds ratio of 7.5 (95% confidence interval 5.6 –9.9, P < 0.0001) for cartilage loss in the same subregion compared with subregions without any baseline SBA in our sample of 459 knees from participants, 64% of whom were women, with a mean age of 63 years and a mean body mass index of 30.5 kg/m2. Conclusion SBA is strongly associated with cartilage loss within the same subregion of a knee. SBA may directly influence overlying cartilage loss or serve as a marker of an area undergoing great compressive stress and in which cartilage loss is inevitable. PMID:19877101

  12. Kinematic and kinetic analysis of a stepping-in-place task in below-knee amputee children compared to able-bodied children.

    PubMed

    Centomo, Hugo; Amarantini, David; Martin, Luc; Prince, François

    2007-06-01

    It has been demonstrated that below-knee amputee (BKA) subjects use specific compensation strategies to overcome their physical limitations. Biomechanical studies emphasize that the motor strategies adopted by BKA adults differ between their amputated limb and their nonamputated limb and from those employed by able-bodied (AB) subjects. The purpose of this investigation was to compare the motor solutions used by control AB and BKA children during a stepping-in-place (SIP) task and to assess how they regulate the coordination of their nonamputated and amputated limbs during this task. Eight BKA children and eight AB children paired for gender, age, weight and height participated in our study. One-way analysis of variances (ANOVAs) were performed on peaks of angular excursion, moment, and power at the hip, knee, and ankle to compare motor strategies between the BKA and AB groups. The main results of our experiment showed that even if BKA and AB children did the task with almost the same kinematics, the kinetic data revealed completely different mechanisms of the two groups to achieve the SIP task, and BKA children had a symmetrical interlimb strategy. SIP, a simple task compared to gait at the level of neuro-musculoskeletal demands, could thus offer a transition task to physical therapists for below-knee recently-amputated children.

  13. Levels of biomarkers correlate with magnetic resonance imaging progression of knee cartilage degeneration: a study on canine.

    PubMed

    Qi, Chang; Changlin, Huang

    2007-07-01

    To examine the association between levers of cartilage oligomeric matrix protein (COMP), matrix metalloproteinases-1 (MMP-1), matrix metalloproteinases-3 (MMP-3), tissue inhibitor of matrix metalloproteinases-1 (TIMP-1) in serum and synovial fluid, and MR imaging of cartilage degeneration in knee joint, and to understand the effects of movement training with different intensity on cartilage of knee joint. 20 adult canines were randomly divided into three groups (8 in the light training group; 8 in the intensive training group; 4 in the control group), and canines of the two training groups were trained daily at different intensity. The training lasted for 10 weeks in all. Magnetic resonance imaging (MRI) examinations were performed regularly (2, 4, 6, 8, 10 week) to investigate the changes of articular cartilage in the canine knee, while concentrations of COMP, MMP-1, MMP-3, TIMP-1 in serum and synovial fluid were measured by ELISA assays. We could find imaging changes of cartilage degeneration in both the training groups by MRI examination during training period, compared with the control group. However, there was no significant difference between these two training groups. Elevations of levels of COMP, MMP-1, MMP-3, TIMP-1, MMP-3/TIMP-1 were seen in serum and synovial fluid after training, and their levels had obvious association with knee MRI grades of cartilage lesion. Furthermore, there were statistically significant associations between biomarkers levels in serum and in synovial fluid. Long-time and high-intensity movement training induces cartilage degeneration in knee joint. Within the intensity extent applied in this study, knee cartilage degeneration caused by light training or intensive training has no difference in MR imaging, but has a comparatively obvious difference in biomarkers level. To detect articular cartilage degeneration in early stage and monitor pathological process, the associated application of several biomarkers has a very good practical

  14. Frontal plane knee mechanics and medial cartilage MR relaxation times in individuals with ACL reconstruction : A pilot study

    PubMed Central

    Kumar, Deepak; Kothari, Abbas; Souza, Richard B.; Wu, Samuel; Ma, C. Benjamin; Li, Xiaojuan

    2014-01-01

    Background The objective of this pilot study was to evaluate cartilage T1ρ and T2 relaxation times and knee mechanics during walking and drop-landing for individuals with anterior cruciate ligament reconstruction (ACL-R). Methods Nine patients (6 men and 3 women, Age 35.8±5.4 years, BMI 23.5±2.5 kg/m2) participated 1.5±0.8 years after single-bundle two-tunnel ACL reconstruction. Peak knee adduction moment (KAM), flexion moment (KFM), extension moment (KEM), and peak varus were calculated from kinematic and kinetic data obtained during walking and drop-landing tasks. T1ρ and T2 times were calculated for medial femur (MF), and medial tibia (MT) cartilage and compared between subjects with low KAM and high KAM. Biomechanical variables were compared between limbs. Results The high KAM group had higher T1ρ for MT (p = 0.01), central MT (p = 0.05), posterior MF (p = 0.04), posterior MT (p = 0.01); and higher T2 for MT (p = 0.02), MF (p = 0.05) posterior MF (p = 0.002) and posterior MT (p = 0.01). During walking, ACL-R knees had greater flexion at initial contact (p =0.04), and lower KEM (p = 0.02). During drop-landing, the ACL-R knees had lower KAM (p = 0.03) and KFM (p = 0.002). Conclusion Patients with ACL-R who have higher KAM during walking had elevated MR relaxation times in the medial knee compartments. These data suggest that those individuals who have undergone ACL-R and have higher frontal plane loading, may be at a greater risk of knee osteoarthritis. PMID:24993277

  15. Relationship between knee adduction moment patterns extracted using principal component analysis and discrete measures with different amplitude normalizations: Implications for knee osteoarthritis progression studies.

    PubMed

    Hatfield, Gillian L; Stanish, William D; Hubley-Kozey, Cheryl L

    2015-12-01

    Knee adduction moment discrete features (peaks and impulses) are commonly reported in knee osteoarthritis gait studies, but they do not necessarily capture loading patterns. Principal component analysis extracts dynamic patterns, but can be difficult to interpret. This methodological study determined relationships between external knee adduction moment discrete measures and principal component analysis features, and examined whether amplitude-normalization methods influenced differences in those with knee osteoarthritis who progressed to surgery versus those that did not. 54 knee osteoarthritis patients had three-dimensional biomechanical measures assessed during walking. Knee adduction moments were calculated and non-normalized and amplitude-normalized waveforms using two common methods were calculated. Patterns were extracted using principal component analysis. Knee adduction moment peak and impulse were calculated. Correlation coefficients were determined between two knee adduction moment patterns extracted and peak and impulse. T-tests evaluated between-group differences. An overall magnitude pattern was correlated with peak (r=0.88-0.90, p<0.05) and impulse (r=0.93, p<0.05). A pattern capturing a difference between early and mid/late -stance knee adduction moment was significantly correlated with peak (r=0.27-0.40, p<0.05), but explained minimal variance. Between-group peak differences were only affected by amplitude-normalization method. Findings suggest that the overall magnitude knee adduction moment principal pattern does not provide unique information from peak and impulse measures. However, low correlations and minimal variance explained between the pattern capturing ability to unload the joint during mid-stance and the two discrete measures, suggests that this pattern captured a unique waveform feature. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis.

    PubMed

    O'Connell, Megan; Farrokhi, Shawn; Fitzgerald, G Kelley

    2016-01-01

    The association between high mechanical knee joint loading during gait with onset and progression of knee osteoarthritis has been extensively studied. However, less attention has been given to risk factors related to increased pain during gait. The purpose of this study was to evaluate knee joint moments and clinical characteristics that may be associated with gait-related knee pain in patients with knee osteoarthritis. Sixty-seven participants with knee osteoarthritis were stratified into three groups of no pain (n=18), mild pain (n=27), or moderate/severe pain (n=22) based on their self-reported symptoms during gait. All participants underwent three-dimensional gait analysis. Quadriceps strength, knee extension range of motion, radiographic knee alignment and self-reported measures of global pain and function were also quantified. The moderate/severe pain group demonstrated worse global pain (P<0.01) and physical function scores (P<0.01) compared to the no pain and the mild pain groups. The moderate/severe pain group also walked with greater knee flexion moments during the midstance phase of gait compared to the no pain group (P=0.02). Additionally, the moderate/severe pain group demonstrated greater varus knee malalignment (P=0.009), which was associated with higher weight acceptance peak knee adduction moments (P=0.003) and worse global pain (P=0.003) and physical function scores (P=0.006). Greater knee flexion moment is present during the midstance phase of gait in patients with knee osteoarthritis and moderate/severe pain during gait. Additionally, greater varus malalignment may be a sign of increased global knee joint dysfunction that can influence many activities of daily living beyond gait. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Stance time variability during stair stepping before and after total knee arthroplasty: a pilot study

    PubMed Central

    Smith, Jessica W.; Marcus, Robin L.; Tracy, Brian L.; Foreman, K. Bo; Christensen, Jesse C.; LaStayo, Paul C.

    2015-01-01

    The main objectives of this pilot study were to: 1) investigate stance time variability (STV) during stair stepping in older adults with osteoarthritis (OA) before and after total knee arthroplasty (TKA), and compare to an age- and sex-matched group of healthy controls with native knees and 2) evaluate the relationship between quadriceps strength and STV during stair stepping before and after TKA. A prospective, observational, pilot study was carried out on 13 individuals (15% male, mean age 62.71 ± 6.84 years) before and after TKA using an instrumented stairway, patient-reported outcomes, timed stair stepping test, and quadriceps strength measures. At 6-months post-operatively, STV during stair descent was significantly greater in the TKA-GROUP compared to the CONTROL-GROUP, but was not significantly different at 12-months compared to controls. There were no significant differences in STV for stair ascent between the pre- and post-operative visits, or compared to controls. There was a trend toward significance for the relationship between quadriceps strength and STV during stair ascent (P=0.059) and descent (P=0.073). Variability during stair stepping may provide an important, short-term rehabilitation target for individuals following TKA and may represent another parameter to predict declines in functional mobility. PMID:26590484

  18. Biochemical (T2, T2* and magnetisation transfer ratio) MRI of knee cartilage: feasibility at ultra-high field (7T) compared with high field (3T) strength.

    PubMed

    Welsch, Goetz H; Apprich, Sebastian; Zbyn, Stefan; Mamisch, Tallal C; Mlynarik, Vladimir; Scheffler, Klaus; Bieri, Oliver; Trattnig, Siegfried

    2011-06-01

    This study compares the performance and the reproducibility of quantitative T2, T2* and the magnetisation transfer ratio (MTR) of articular cartilage at 7T and 3T. Axial MRI of the patella was performed in 17 knees of healthy volunteers (25.8 ± 5.7 years) at 3T and 7T using a comparable surface coil and whole-body MR systems from the same vendor, side-by-side. Thirteen knee joints were assessed once, and four knee joints were measured three times to assess reproducibility. T2 relaxation was prepared by a multi-echo, spin-echo sequence and T2* relaxation by a multi-echo, gradient-echo sequence. MTR was based on a magnetisation transfer-sensitized, steady-state free precession approach. Statistical analysis-of-variance and coefficient-of-variation (CV) were prepared. For T2 and T2*, global values were significantly lower at 7T compared with 3T; the zonal evaluation revealed significantly less pronounced stratification at 7T (p < 0.05). MTR provided higher values at 7T (p < 0.05). CV, indicating reproducibility, showed slightly lower values at 7T, but only for T2 and T2*. Although lower T2 and T2* relaxation times were expected at 7T, the differences in stratification between the field strengths were reported for the first time. The assessment of MT is feasible at 7T, but requires further investigation.

  19. The effect of knee brace on coordination and neuronal leg muscle control: an early postoperative functional study in anterior cruciate ligament reconstructed patients.

    PubMed

    Rebel, M; Paessler, H H

    2001-09-01

    Two studies were carried out after anterior cruciate ligament (ACL) reconstruction to determine the effect of a knee brace on coordination (test 1) and electromyographic muscle activity in drop jumps (test 2). Test 1 studied 25 patients with ACL reconstruction under three test conditions (one-leg static, two-legged static, two-legged dynamic) compared with a control (n=30). The results showed highly significant improvements in all braced conditions. In test 2 ten patients with ACL reconstruction and ten healthy subjects performed a two-legged drop-jump; this was repeated 15 times and again 15 times with a knee brace worn on the reconstructed limb. Changes in electromyographically determined muscle activity (vastus medialis, vastus lateralis, biceps femoris, gastrocnemius) were observed, but they were significant in only few cases because of high variability. Drop-jumps with knee brace improved jumping height, increased the maximum knee angle in the ground contact phase, and reduced the maximum knee angle in the landing phase. Patients thus develop an increased confidence in the stability of their knees. We conclude that the benefits of the knee brace are due to the mechanical action, an enhanced coordination, and a psychological effect.

  20. Anthropometric study of the knee and its correlation with the size of three implants available for arthroplasty.

    PubMed

    Loures, Fabrício Bolpato; de Araújo Góes, Rogério Franco; da Palma, Idemar Monteiro; Labronici, Pedro José; Granjeiro, José Mauro; Olej, Beni

    2016-01-01

    To define the anthropometric profile of the knee in a Brazilian population with gonarthrosis using intraoperative measurements; and to evaluate the compatibility of three implants available for total knee arthroplasty. Morphometric data were collected prospectively from 117 subjects with gonarthrosis. Six dimensions in the distal femur and two in the proximal tibia were documented in 118 knees while performing total arthroplasty. These data were compared with the dimensions of three implants available for total knee arthroplasty. The statistical analysis showed that more than a quarter of the patients presented an unsatisfactory relationship between the knee and prosthesis. The implants evaluated need to be adjusted to better fit Brazilian patients.

  1. Posterior cruciate ligament balancing in total knee arthroplasty: a numerical study with a dynamic force controlled knee model

    PubMed Central

    2014-01-01

    Background Adequate soft tissue balancing is a key factor for a successful result after total knee arthroplasty (TKA). Posterior cruciate ligament (PCL) is the primary restraint to posterior translation of the tibia after cruciate retaining TKA and is also responsible for the amount of joint compression. However, it is complex to quantify the amount of ligament release with its effects on load bearing and kinematics in TKA and limited both in vivo and in vitro. The goal of this study was to create a dynamic and deformable finite element model of a full leg and analyze a stepwise release of the PCL regarding knee kinematics, pressure distribution and ligament stresses. Methods A dynamic finite element model was developed in Ansys V14.0 based on boundary conditions of an existing knee rig. A cruciate retraining knee prosthesis was virtually implanted. Ligament and muscle structures were simulated with modified spring elements. Linear elastic materials were defined for femoral component, inlay and patella cartilage. A restart algorithm was developed and implemented into the finite element simulation to hold the ground reaction force constant by adapting quadriceps force. After simulating the unreleased PCL model, two models were developed and calculated with the same boundary conditions with a 50% and 75% release of the PCL stiffness. Results From the beginning of the simulation to approximately 35° of flexion, tibia moves posterior related to the femur and with higher flexion anteriorly. Anterior translation of the tibia ranged from 5.8 mm for unreleased PCL to 3.7 mm for 75% PCL release (4.9 mm 50% release). A decrease of maximum von Mises equivalent stress on the inlay was given with PCL release, especially in higher flexion angles from 11.1 MPa for unreleased PCL to 8.9 MPa for 50% release of the PCL and 7.8 MPa for 75% release. Conclusions Our study showed that dynamic FEM is an effective method for simulation of PCL balancing in knee arthroplasty. A tight

  2. Study of Wearable Knee Assistive Instruments for Walk Rehabilitation

    NASA Astrophysics Data System (ADS)

    Zhu, Yong; Nakamura, Masahiro; Ito, Noritaka; Fujimoto, Hiroshi; Horikuchi, Kenichi; Wakabayashi, Shojiro; Takahashi, Rei; Terada, Hidetsugu; Haro, Hirotaka

    A wearable Knee Assistive Instrument for the walk rehabilitation was newly developed. Especially, this system aimed at supporting the rehabilitation for the post-TKA (Total Knee Arthroplasty) which is a popular surgery for aging people. This system consisted of an assisting mechanism for the knee joint, a hip joint support system and a foot pressure sensor system. The driving system of this robot consisted of a CPU board which generated the walking pattern, a Li-ion battery, DC motors with motor drivers, contact sensors to detect the state of foot and potentiometers to detect the hip joint angle. The control method was proposed to reproduce complex motion of knee joint as much as possible, and to increase hip or knee flexion angle. Especially, this method used the timing that heel left from the floor. This method included that the lower limb was raised to prevent a subject's fall. Also, the prototype of knee assisting system was tested. It was confirmed that the assisting system is useful.

  3. Endogenous parathyroid hormone and knee osteoarthritis: a cross-sectional study.

    PubMed

    Lee, Sunggun

    2016-03-01

    Although animal studies have shown that parathyroid hormone (PTH) analogs can have disease-modifying effect on experimental osteoarthritis, there is little human data. This study aimed to analyze the association between endogenous PTH and knee osteoarthritis in humans. This was a cross-sectional study including 5880 participants of The Fifth Korean National Health and Nutrition Examination Survey. Serum intact PTH was measured by chemiluminescence assay. Radiographic knee osteoarthritis was defined as a Kellgren-Lawrence grade of ≥ 2. The association between knee osteoarthritis and natural log-transformed PTH (lnPTH) was modeled using logistic regression analyses adjusting for age, body mass index categories, calcium intake and serum 25-hydroxyvitamin D in both sexes. The prevalence of radiographic knee osteoarthritis tended to be higher in the highest quartile of PTH in women. In men, there was no clear trend across the quartiles of PTH. In multivariable analyses, there was no significant association between lnPTH and radiographic knee osteoarthritis in either sex (odds ratio [95% confidence interval]): 0.81 (0.64-1.02) in women and 0.88 (0.67-1.16) in men. Analyses on symptomatic radiographic knee osteoarthritis showed no significant association. Although there was a trend for a negative association in women, no statistically significant association was found between endogenous PTH and knee osteoarthritis. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  4. Is coxa valga a predictor for the severity of knee osteoarthritis? A cross-sectional study.

    PubMed

    Coskun Benlidayi, Ilke; Guzel, Rengin; Basaran, Sibel; Aksungur, Erol H; Seydaoglu, Gulsah

    2015-05-01

    In the present study, we aimed to evaluate the affect of the variations in hip anatomy and pelvic geometry on the severity of knee OA. Idiopathic knee OA patients fulfilling the clinical criteria of American College of Rheumatology for OA were enrolled in the study. Several measurements regarding the hip and pelvis were performed on pelvic radiographs. Each knee was graded according to the Kellgren and Lawrence (KL) radiographic system (0-4) along with a categorization in accordance with the medial tibiofemoral joint space widths (JSW). The study group consisted of 111 subjects. The inner and outer pelvic diameters were getting wider as the JSW grade increased. Likewise, among the hip measurements, femoral head, neck and shaft diameters and hip axis lengths were linked with KL grade. There were significant differences in neck-shaft angle (NSA) between groups of JSW with a highest NSA in JSW grade 3. The optimal cut-off value for NSA in predicting the severity of knee OA was 134.4°. Furthermore, NSA beyond 134.4° was found to increase the risk of severe knee OA eightfold. Variations in pelvic geometry and hip anatomy are associated with the severity of knee OA. People with NSA of above 134.4° have eightfold increased risk of developing severe knee OA. Pelvic radiographies could be evaluated at younger ages-particularly in people with high genetic predispositions-to identify the individuals at high risk and in turn, to tailor the preventive measures to these subjects.

  5. Runner's Knee

    MedlinePlus

    ... Surgery? A Week of Healthy Breakfasts Shyness Runner's Knee KidsHealth > For Teens > Runner's Knee A A A ... told he had runner's knee. What Is Runner's Knee? Runner's knee is the term doctors use for ...

  6. An 11- to 15-year clinical outcome study of the Advance Medial Pivot total knee arthroplasty: pivot knee arthroplasty.

    PubMed

    Karachalios, Th; Varitimidis, S; Bargiotas, K; Hantes, M; Roidis, N; Malizos, K N

    2016-08-01

    The Advance Medial-Pivot total knee arthroplasty (TKA) was designed to reflect contemporary data regarding the kinematics of the knee. We wished to examine the long-term results obtained with this prosthesis by extending a previous evaluation. We retrospectively evaluated prospectively collected data from 225 consecutive patients (41 men and 184 women; mean age at surgery 71 years, 52 to 84) who underwent 284 TKAs with a mean follow-up of 13.4 years (11 to 15). Implant failure, complication rate, clinical (both subjective and objective) and radiological outcome were assessed. Pre- and post-operative clinical and radiographic data were available at regular intervals for all patients. A total of ten patients (4.4%; ten TKAs) were lost to follow-up. Survival analysis at 15 years showed a cumulative success rate of 97.3% (95% confidence interval (CI) 96.7 to 97.9) for revision for any reason, of 96.4% (95% CI 95.2 to 97.6) for all operations, and 98.8% (95% CI 98.2 to 99.4) for aseptic loosening as an end point. Three TKAs (1.06%) were revised due to aseptic loosening, two (0.7%) due to infection, one (0.35%) due to instability and one (0.35%) due to a traumatic dislocation. All patients showed a statistically significant improvement on the Knee Society Score (p = 0.001), Western Ontario and McMaster University Osteoarthritis Index (p = 0.001), Short Form-12 (p = 0.01), and Oxford Knee Score (p = 0.01). A total of 207 patients (92%) were able to perform age appropriate activities with a mean flexion of the knee of 117° (85° to 135°) at final follow-up. This study demonstrates satisfactory functional and radiographic long-term results for this implant. Cite this article: Bone Joint J 2016;98-B:1050-5. ©2016 The British Editorial Society of Bone & Joint Surgery.

  7. The impact of simulated ankle plantarflexion contracture on the knee joint during stance phase of gait: a within-subject study.

    PubMed

    Leung, Joan; Smith, Richard; Harvey, Lisa Anne; Moseley, Anne M; Chapparo, Joseph

    2014-04-01

    Ankle plantarflexion contractures are common in adults with neurological disorders and known to cause secondary gait deviations. However, their impact on the knee joint is not fully understood. The aims of this study are to describe the effect of simulated plantarflexion contractures on knee biomechanics during the stance phase and on the spatiotemporal characteristics of gait. Mild (10-degree plantarflexion) and severe (20-degree plantarflexion) ankle contractures were simulated in thirteen able-bodied adults using an ankle-foot-orthosis. A no contracture condition was compared with two simulated contracture conditions. There was an increase in knee extension, sometimes resulting in hyperextension, throughout stance for the two contracture conditions compared to the no contracture condition (mean increase in knee extension ranged from 5° to 9°; 95% CI 0° to 17°). At the same time, there were reductions in extension moment and power generation at the knee. Simulated plantarflexion contractures also reduced gait velocity, bilateral step length and cadence. All these changes were more pronounced in the severe contracture condition than mild contracture condition. While the majority of participants adopted a foot-flat pattern on landing and exhibited an increase in knee extension during stance, two participants used a toe-walking pattern and exhibited an increase in knee flexion. Ankle plantarflexion contractures are associated with an increase in knee extension during stance phase. However, some people with simulated ankle contractures may walk with an increase in knee flexion instead. Ankle plantarflexion contractures also adversely affect gait velocity, step length and cadence. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Knee stability, athletic performance and sport-specific tasks in non-professional soccer players after ACL reconstruction: comparing trans-tibial and antero-medial portal techniques

    PubMed Central

    Tudisco, Cosimo; Bisicchia, Salvatore; Cosentino, Andrea; Chiozzi, Federica; Piva, Massimo

    2015-01-01

    Summary Background a wrong position of bone tunnels, in particular on the femur, is one of the most frequent causes of a failed anterior cruciate ligament (ACL) reconstruction. Several studies demonstrated that drilling the femoral tunnel through the antero-medial portal (AMP) allows a more anatomical placement on the lateral femoral condyle and higher knee stability, compared to trans-tibial (TT) technique. The aim of this study was to retrospectively evaluate two groups of soccer players operated on for ACL reconstruction according to either one of these two techniques. Methods two groups of non-professional soccer players operated on for a single bundle ACL reconstruction with hamstrings autograft using either a TT (20 patients) or an AMP (23 patients) technique were retrospectively evaluated with KT-1000 arthrometer, manual pivot shift test, isokinetic test, the incremental treadmill-running test, athletic and sport specific tasks, and knee scores (IKDC, Lysholm and KOOS). Results the AMP group showed better results at pivot shift test and KOOS, but lower flexion angles at single leg squat test. There were no differences in all the other considered outcomes. Conclusions the better rotational stability of the knee achieved in AMP group did not lead to significantly better clinical and functional results in our patients. Level of evidence III. Treatment study Case-control study. PMID:26605191

  9. Proprioceptive acuity in the frontal and sagittal planes of the knee: a preliminary study

    PubMed Central

    Dhaher, Yasin Y.

    2012-01-01

    Though the knee experiences three-dimensional loading during everyday tasks, assessment of proprioceptive acuity has typically been limited to the primary direction of movement, knee flexion and extension. While loading in the constrained directions (varus/valgus and internal/external rotation) may contribute to injury and joint disease, little information is available regarding proprioceptive acuity in these planes of movement. The primary aim of this study was to characterize proprioceptive acuity in the frontal plane (varus/valgus) and to compare it with sagittal plane (flexion/extension) proprioceptive acuity in healthy subjects. Proprioception was assessed in 17 young, healthy subjects (11 females, 6 males, ages 21–33 years) using the threshold to detection of passive movement (TDPM). TDPM was found to be significantly (P < 0.001) lower in the frontal plane [valgus: mean (SD) 0.60 (0.20)° and varus: 0.58 (0.23)°] compared with the sagittal plane [extension: 0.78 (0.34)°, flexion: 0.82 (0.48)°]; however, no significant differences were noted within the same plane of movement. Results from this preliminary study may suggest more accurate proprioceptive acuity in the frontal plane compared with the sagittal plane. While further examination is necessary to confirm this relationship, more accurate frontal plane acuity may reflect a protective neural mechanism which enables more precise neuromuscular control of the joint in this constrained plane of movement. PMID:21140163

  10. Evaluation of MRI acquisition workflow with lean six sigma method: case study of liver and knee examinations.

    PubMed

    Roth, Christopher J; Boll, Daniel T; Wall, Lisa K; Merkle, Elmar M

    2010-08-01

    The purpose of this investigation was to assess workflow for medical imaging studies, specifically comparing liver and knee MRI examinations by use of the Lean Six Sigma methodologic framework. The hypothesis tested was that the Lean Six Sigma framework can be used to quantify MRI workflow and to identify sources of inefficiency to target for sequence and protocol improvement. Audio-video interleave streams representing individual acquisitions were obtained with graphic user interface screen capture software in the examinations of 10 outpatients undergoing MRI of the liver and 10 outpatients undergoing MRI of the knee. With Lean Six Sigma methods, the audio-video streams were dissected into value-added time (true image data acquisition periods), business value-added time (time spent that provides no direct patient benefit but is requisite in the current system), and non-value-added time (scanner inactivity while awaiting manual input). For overall MRI table time, value-added time was 43.5% (range, 39.7-48.3%) of the time for liver examinations and 89.9% (range, 87.4-93.6%) for knee examinations. Business value-added time was 16.3% of the table time for the liver and 4.3% of the table time for the knee examinations. Non-value-added time was 40.2% of the overall table time for the liver and 5.8% for the knee examinations. Liver MRI examinations consume statistically significantly more non-value-added and business value-added times than do knee examinations, primarily because of respiratory command management and contrast administration. Workflow analyses and accepted inefficiency reduction frameworks can be applied with use of a graphic user interface screen capture program.

  11. Validation of varus stress radiographs for anterior cruciate ligament and posterolateral corner knee injuries: A biomechanical study.

    PubMed

    McDonald, Lucas S; Waltz, Robert A; Carney, Joseph R; Dewing, Christopher B; Lynch, Joseph R; Asher, Dean B; Schuett, Dustin J; LeClere, Lance E

    2016-12-01

    The purpose of this study was to determine the effect of isolated anterior cruciate ligament (ACL) insufficiency on the radiographic varus stress test, and to provide reference data for the increase in lateral compartment opening under varus stress for a combined ACL and PLC injury. Ten cadaveric lower extremities were fixed to a jig in 20° of knee flexion. Twelve Newton-meter (Nm) and clinician-applied varus loads were tested, first with intact knee ligaments, followed by sequential sectioning of the ACL, fibular collateral ligament (FCL), popliteus tendon and the popliteofibular ligament (PFL). Lateral compartment opening was measured after each sequential sectioning. Maximum increase in lateral compartment opening for an isolated ACL deficient knee was 1.06mm with mean increase of 0.52mm (p=0.021) for the clinician-applied load. Mean increase in lateral compartment opening in an ACL and FCL deficient knee compared to the intact knee was 1.48mm (p<0.005) and 1.99mm (p<0.005) for the 12-Nm and clinician-applied loads, respectively, increasing to 1.94mm (p<0.005) and 2.68mm (p<0.005) with sectioning of the ACL and all PLC structures. Anterior cruciate ligament deficiency contributes to lateral compartment opening on varus stress radiographs though not sufficiently to confound previously established standards for lateral ligament knee injuries. We did not demonstrate the same magnitude of lateral compartment opening with sectioning of the PLC structures as previously reported, questioning the reproducibility of varus stress radiographic testing among institutions. Clinicians are cautioned against making surgical decisions based solely on current standards for radiographic stress examinations. Published by Elsevier B.V.

  12. In vivo knee kinematics in patients with bilateral total knee arthroplasty of 2 designs.

    PubMed

    Okamoto, Nobukazu; Breslauer, Leigh; Hedley, Anthony K; Mizuta, Hiroshi; Banks, Scott A

    2011-09-01

    Many younger and highly active patients desire to achieve high flexion after total knee arthroplasty. This study's purpose was to determine if a contemporary total knee arthroplasty design improved functional knee flexion compared with a traditional total knee arthroplasty in patients living a Western lifestyle. Ten patients with bilateral total knee arthroplasty of 2 types were studied during weight-bearing lunge, kneeling, and stair activities using fluoroscopic imaging. There were no differences in maximum knee flexion during lunging or kneeling. Statistically significant differences in tibial rotation and condylar translation were observed during the 3 activities. Although several joint kinematic differences were observed, no important functional differences were observed in clinically excellent, high performing subjects with bilateral total knee arthroplasty of 2 types.

  13. Biofeedback to Promote Movement Symmetry After Total Knee Arthroplasty: A Feasibility Study

    PubMed Central

    ZENI, JOSEPH; ABUJABER, SUMAYAH; FLOWERS, PORTIA; POZZI, FEDERICO; SNYDER-MACKLER, LYNN

    2014-01-01

    STUDY DESIGN Prospective analysis of a longitudinal cohort with an embedded comparison group at a single time point. OBJECTIVES To determine the feasibility and effectiveness of an outpatient rehabilitation protocol that includes movement symmetry biofeedback on functional and biomechanical outcomes after total knee arthroplasty (TKA). BACKGROUND TKA reduces pain and improves functional ability, but many patients experience strength deficits and movement abnormalities in the operated limb, despite outpatient rehabilitation. These asymmetries increase load on the nonoperated limb, and greater asymmetry is related to worse functional outcomes. METHODS Biomechanical and functional metrics were assessed 2 to 3 weeks prior to TKA, at discharge from outpatient physical therapy, and 6 months after TKA in 11 patients (9 men, 2 women; mean ± SD age, 61.4 ± 5.8 years; body mass index, 33.1 ± 5.4 kg/m2) who received 6 to 8 weeks of outpatient physical therapy that included specialized symmetry training. Six-month outcomes were compared to a control group, matched by age, body mass index, and sex (9 men, 2 women; mean ± SD age, 61.8 ± 5 years; body mass index, 34.3 ± 5.1 kg/m2), that did not receive specialized symmetry retraining. RESULTS Of the 11 patients who received added symmetry training, 9 demonstrated clinically meaningful improvements that exceeded the minimal detectable change for all performance-based functional tests at 6 months post-TKA compared to pre-TKA. Six months after TKA, when walking, patients who underwent symmetry retraining had greater knee extension during midstance and had mean sagittal knee moments that were more symmetrical, biphasic, and more representative of normal knee kinetics compared to patients who did not undergo symmetry training. No patients experienced adverse events as the result of the protocol. CONCLUSION Adding symmetry retraining to postoperative protocols is clinically viable, safe, and may have additional benefits compared

  14. Superior long-term survival for fixed bearing compared with mobile bearing in ligament-balanced total knee arthroplasty.

    PubMed

    Heesterbeek, P J C; van Houten, A H; Klenk, J S; Eijer, H; Christen, B; Wymenga, A B; Schuster, A J

    2017-04-07

    Only few long-term data on ligament-balanced cruciate-retaining total knee arthroplasty (CR TKA) are currently available. Either a mobile- or fixed-bearing insert can be chosen, which showed good mid-term outcome and few complications and revisions. This multi-centre retrospective cross-sectional cohort study investigated the 12-year results of primary TKA using a balancing gap technique and compared survival and clinical outcome between fixed and mobile inserts. In this retrospective cross-sectional cohort study, 557 cases of three clinics (2 Swiss, 1 Dutch) operated between 1998 and 2003 with the first series of a TKA implanted with a balanced gap technique (433 (77.7%) fixed, 124 (22.3%) mobile (anterior-posterior gliding (7-9 mm) and rotational (15°) degrees of freedom) inserts) were included for survival analysis (Kaplan-Meier, by insert type). At the 12-year follow-up (FU) examination of 189 cases, range of motion, knee society score (KSS), numeric rating scale (NRS) for pain and satisfaction were determined and radiographs were evaluated by median tests, by insert type. Of 521 cases available for analysis, 28 (5.4%; 11 fixed, 17 mobile bearing) were revised. Mean cumulative survival after 12.4 years was 97.0% (95% CI 94.7-98.4) for fixed bearings and 85.4% (95% CI 77.5-90.7) after 12.2 years for mobile bearings, p < 0.0001. Patients' mean age at 11.0 years FU (n = 189) was 78.0 (range 54.5-97.3) years. Mean total KSS was 157.8 (24-200) points, and mean passive flexion was 114° (45-150); no clinical score differed significantly between fixed and mobile bearings. This study showed a superior survival for fixed bearing compared with mobile bearing in a CR TKA using a ligament-balanced technique after more than 12 years. Clinical outcomes are excellent to good after long-term follow-up, and similar for fixed and mobile bearing. Therapeutic studies-retrospective cohort study, Level III.

  15. Knee vs hip single-joint intra-articular hyaluronic acid injection in patients with both hip and knee osteoarthritis: a pilot study.

    PubMed

    Diraçoğlu, Demirhan; Alptekin, Kerem; Teksöz, Bahar; Yağci, Ilker; Ozçakar, Levent; Aksoy, Cihan

    2009-09-01

    This paper aims to compare the results of single-joint knee vs hip hyaluronic acid (HA) injections in patients with osteoarthritis (OA) involving both the knee and hip joints. Thirty-eight patients who were diagnosed to have both hip and knee OA were enrolled. Patients were divided into two groups to receive HA injection three times at 1-week intervals either to the hip or knee joints. Pain level during activities and rest was measured by using visual analog scale (VAS). Western Ontario and McMaster University Osteoarthritis Index (WOMAC 5-point Likert 3.0) was also used prior to the injections and 1 month after the 3rd injection. In the knee injection group, the intragroup analysis revealed significant improvements in VAS activity pain, VAS rest pain, and WOMAC pain values following injection when compared with preinjection values, while no significant difference was detected in WOMAC stiffness, WOMAC physical function, and WOMAC total values. In the hip injection group, VAS activity pain, VAS rest pain, WOMAC pain, WOMAC stiffness, WOMAC physical function, and WOMAC total values showed significant improvement after the injection when compared with preinjection values. Although statistically not significant (p > 0.05), the comparison of the differences (preinjection-postinjection) between the groups demonstrated higher values in the hip injection group. We imply that intra-articular single-joint HA injections either to the knee or hip joints in OA patients with involvement of both of these joints are effective with regard to pain and functional status.

  16. Association between hypertension and risk of knee osteoarthritis: A meta-analysis of observational studies.

    PubMed

    Zhang, Yi-Min; Wang, Jun; Liu, Xiao-Guang

    2017-08-01

    Evidence from observational studies shows that hypertension may be a risk factor for knee osteoarthritis (OA). However, the relationship between hypertension and knee OA risk remains controversial. This study aimed to quantitatively assess the relationship between hypertension and risk of knee OA.Three electronic databases (PubMed, Embase, and Cochrane Library) were searched up to July 25, 2016. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were extracted from the included observational studies. Publication bias, heterogeneity test, and subgroup analyses were performed.Eight studies including 2 cohort studies and 6 cross-sectional studies with 9762 participants were finally included in this meta-analysis. The results showed that hypertension was significantly associated with higher radiographic knee OA and symptomatic knee OA risks of 2.01 (95% CI, 1.28-3.15, I = 90.2%, P for heterogeneity <.001) and 1.49 (95% CI, 1.26-1.77, I = 0%, P for heterogeneity <.412), respectively. No publication bias was detected. The subgroup analysis showed that the study design did not influence the results (radiographic knee OA: OR = 1.42, 95% CI, 1.19-1.71 for cross-sectional studies and OR = 2.17, 95% CI, 1.30-3.63 for cohort studies; and symptomatic knee OA: OR = 1.85, 95% CI, 1.10-3.13) for cross-sectional studies and OR = 2.74, 95% CI, 1.81-4.16 for cohort studies).This meta-analysis showed that there was a significant relationship between hypertension and knee OA (both radiographic and symptomatic). However, further original studies are needed that use a better design.

  17. Comparing hybrid hyaluronic acid with PRP in end career athletes with degenerative cartilage lesions of the knee.

    PubMed

    Papalia, R; Zampogna, B; Russo, F; Vasta, S; Tirindelli, M C; Nobile, C; Di Martino, A C; Vadalà, G; Denaro, V

    2016-01-01

    Cartilage lesions are very common causes of chronic knee pain in athletes. Current treatment options consist in conservative strategies, such as viscosupplementation and platelet-rich plasma injections. This randomized controlled trial aims to investigate the effect of intra-articular Hybrid Hyaluronic Acid injections compared to PRP for the treatment of cartilage lesions among athletes at the end of their career. Since March 2015, 48 professional soccer players were randomized into two groups: 24 patients received 3 injections of HHA and 23 patients received 3 intra-articular injections of PRP. All patients achieved a statistically significant clinical improvement from preoperative to postoperative time in both groups. Patients in the HHA group showed a significant superiority compared to PRP group at 3 and 6 months. Intergroup differences decrease gradually until loss of significance at 12 months follow-up. Athletes with chronic degenerative cartilage lesions of the knee responded positively both to HHA and PRP until last follow up.

  18. English Premiership Academy knee injuries: lessons from a 5 year study.

    PubMed

    Moore, Oliver; Cloke, David J; Avery, Peter J; Beasley, Ian; Deehan, David J

    2011-11-01

    This study addresses the epidemiology of knee injuries in adolescent males. Data were collected prospectively from 41 Premiership soccer academies over a 5 year period from July 2000 to June 2005. A total of 12,306 player seasons were registered in the U9 to the U16 age categories with a total of 1750 recordable injuries specific to the knee joint. There was a mean incidence of 0.71 (95% confidence interval ± 0.05) knee injuries per player per year, and a median of 17 (inter-quartile range 9-38) training days and 2 (inter-quartile range 1-4) matches missed per knee injury. Knee injuries were found to be most common in the 14-16 year age group. Six hundred and nine (35% of total) injuries were classed as severe resulting in more than 28 days' absence. Injuries were more likely to be sustained in a competitive or match-play environment (862 or 52%) than in training (796 or 48%), and a non-contact mechanism was implicated in 823 (55%) of recorded cases. Peaks in injury numbers were seen in early season and subsequent to the winter break. Sprain was the most common diagnosis recorded, with the medial collateral ligament affected in 23% of all knee injuries. Knee injuries are common in elite youth footballers. In this uninsured age group, it could be argued that earlier medical intervention may reduce long-term damage to the immature skeleton.

  19. Fixation techniques and stem dimensions in hinged total knee arthroplasty: a finite element study.

    PubMed

    El-Zayat, Bilal Farouk; Heyse, Thomas J; Fanciullacci, Nelson; Labey, Luc; Fuchs-Winkelmann, Susanne; Innocenti, Bernardo

    2016-12-01

    No evidence-based guidelines are available to determine the appropriate stem length, and whether or not to cement stems in revision total knee arthroplasty (TKA). Therefore, the objective of this study was to compare stresses and relative movement of cemented and uncemented stems of different lengths using a finite element analysis. A finite element model was created for a synthetic tibia. Two stem lengths (95 and 160 mm) and two types of fixation (cemented or press fit) of a hinged TKA were examined. The average compressive stress distribution in different regions of interest, as well as implant micromotions, was determined and compared during lunge and squat motor tasks. Both long and short stems in revision TKA lead to high stresses, primarily in the region around the stem tip. The presence of cement reduces the stresses in the bone in every region along the stem. Short stem configurations are less affected by the presence of cement than the long stem configuration. Press-fit stems showed higher micromotions compared to cemented stems. Lowest stresses and micromotion were found for long cemented stems. Cementless stems showed more micromotion and increased stress levels especially at the level of the stem tip, which may explain the clinical phenomenon of stem-end pain following revision knee arthroplasty. These findings will help the surgeon with optimal individual implant choice.

  20. Efficacy of kinesio taping on isokinetic quadriceps torque in knee osteoarthritis: a double blinded randomized controlled study.

    PubMed

    Anandkumar, Sudarshan; Sudarshan, Shobhalakshmi; Nagpal, Pratima

    2014-08-01

    Double blind pre-test post-test control group design. To compare the isokinetic quadriceps torque, standardized stair-climbing task (SSCT) and pain during SSCT between subjects diagnosed with knee osteoarthritis pre and post kinesio tape (KT) application with and without tension. Strength of the quadriceps and torque producing capability is frequently found to be compromised in knee osteoarthritis. The efficacy of KT in improving isokinetic quadriceps torque in knee osteoarthritis is unknown, forming the basis for this study. Forty subjects were randomly allocated to either the experimental (therapeutic KT with tension) or control group (sham KT without tension) with the allocation being concealed. Pre and post test measurements of isokinetic quadriceps torque, SSCT and pain during SSCT were carried out by a blinded assessor. A large effect size with significant improvements in the peak quadriceps torque (concentric and eccentric at angular velocities of 90° per second and 120° per second), SSCT and pain were obtained in the experimental group when compared to the control group. Application of therapeutic KT is effective in improving isokinetic quadriceps torque, SSCT and reducing pain in knee osteoarthritis.

  1. Efficacy and safety of topical diclofenac containing dimethyl sulfoxide (DMSO) compared with those of topical placebo, DMSO vehicle and oral diclofenac for knee osteoarthritis.

    PubMed

    Simon, Lee S; Grierson, Lisa M; Naseer, Zahid; Bookman, Arthur A M; Zev Shainhouse, J

    2009-06-01

    While topical non-steroidal anti-inflammatory drugs are considered safe, their long-term efficacy for osteoarthritis has been suspect. We conducted a 12-week, double-blind, double-dummy, randomized controlled trial of topical diclofenac (TDiclo) in a vehicle solution containing dimethyl sulfoxide (DMSO) in 775 subjects with radiologically confirmed, symptomatic primary osteoarthritis of the knee. This 5-arm study compared TDiclo with a placebo solution, the DMSO vehicle, oral diclofenac (ODiclo) and the combination of TDiclo+ODiclo for relieving the signs and symptoms of knee osteoarthritis. Subjects applied study solution, 40 drops four times daily, and took one study tablet daily for 12 weeks. Co-primary efficacy variables were WOMAC pain and physical function and a patient overall health assessment. Secondary variables were WOMAC stiffness and patient global assessment (PGA) of the knee osteoarthritis. TDiclo was superior to placebo for pain (-6.0 vs. -4.7, P=0.015), physical function (-15.8 vs. -12.3, P=0.034), overall health (-0.95 vs. -0.37, P<0.0001), and PGA (-1.36 vs. -1.01, P=0.016), and was superior to DMSO vehicle for all efficacy variables. No significant difference was observed between DMSO vehicle and placebo or between TDiclo and ODiclo. The commonest adverse event associated with TDiclo was dry skin (18.2%). Fewer digestive system and laboratory abnormalities were observed with TDiclo than with ODiclo. Addition of TDiclo to ODiclo did not increase the incidence of systemic adverse events. TDiclo in DMSO vehicle is an effective treatment option for knee osteoarthritis with efficacy similar to, but tolerability better than ODiclo. DMSO vehicle was no more efficacious than placebo.

  2. Unicompartmental knee arthroplasty modes of failure: wear is not the main reason for failure: a multicentre study of 418 failed knees.

    PubMed

    Epinette, J-A; Brunschweiler, B; Mertl, P; Mole, D; Cazenave, A

    2012-10-01

    This study originated from a symposium held by the French Hip and Knee Society (Société française de la hanche et du genou [SFHG]) and was carried out to better assess the distribution of causes of unicompartmental knee arthroplasty (UKA) failures, as well as cause-specific delay to onset. Our working hypothesis was that most failures were traceable to wear occurring over a period of many years. A multicentre retrospective study (25 centres) was conducted in 418 failed UKAs performed between 1978 and 2009. We determined the prevalence and time to onset of the main reasons for revision surgery based upon available preoperative findings. Additional intraoperative findings were analysed. The results were compared to those of nation wide registries to evaluate the representativeness of our study population. Times to revision surgery were short: 19% of revisions occurred within the first year and 48.5% within the first 5 years. Loosening was the main reason for failure (45%), followed by osteoarthritis progression (15%) and, finally, by wear (12%). Other reasons were technical problems in 11.5% of cases, unexplained pain in 5.5%, and failure of the supporting bone in 3.6%. The infection rate was 1.9%. Our results were consistent with those of Swedish and Australian registries. Our hypothesis was not confirmed. The short time to failure in most cases suggests a major role for surgical technique issues. Morbidity related to the implant per se may be seen as moderate and not greater than with total knee prostheses. The good agreement between our data and those of nationwide registries indicates that our population was representative. A finer analysis is needed, indicating that the establishment of a French registry would be of interest. Copyright © 2012. Published by Elsevier Masson SAS.

  3. Knee rotation influences the femoral tunnel angle measurement after anterior cruciate ligament reconstruction: a 3-dimensional computed tomography model study.

    PubMed

    Tang, Jing; Thorhauer, Eric; Marsh, Chelsea; Fu, Freddie H; Tashman, Scott

    2014-07-01

    Femoral tunnel angle (FTA) has been proposed as a metric for evaluating whether ACL reconstruction was performed anatomically. In clinic, radiographic images are typically acquired with an uncertain amount of internal/external knee rotation. The extent to which knee rotation will influence FTA measurement is unclear. Furthermore, differences in FTA measurement between the two common positions (0° and 45° knee flexion) have not been established. The purpose of this study was to investigate the influence of knee rotation on FTA measurement after ACL reconstruction. Knee CT data from 16 subjects were segmented to produce 3D bone models. Central axes of tunnels were identified. The 0° and 45° flexion angles were simulated. Knee internal/external rotations were simulated in a range of ± 20°. FTA was defined as the angle between the tunnel axis and femoral shaft axis, orthogonally projected into the coronal plane. Femoral tunnel angle was positively/negatively correlated with knee rotation angle at 0°/45° knee flexion. At 0° knee flexion, FTA for anterio-medial (AM) tunnels was significantly decreased at 20° of external knee rotation. At 45° knee flexion, more than 16° external or 19° internal rotation significantly altered FTA measurements for single-bundle tunnels; smaller rotations (± 9° for AM, ± 5° for PL) created significant errors in FTA measurements after double-bundle reconstruction. Femoral tunnel angle measurements were correlated with knee rotation. Relatively small imaging malalignment introduced significant errors with knee flexed 45°. This study supports using the 0° flexion position for knee radiographs to reduce errors in FTA measurement due to knee internal/external rotation.

  4. Comparative Packaging Study

    NASA Technical Reports Server (NTRS)

    Perchonok, Michele; Antonini, David

    2008-01-01

    This viewgraph presentation describes a comparative packaging study for use on long duration space missions. The topics include: 1) Purpose; 2) Deliverables; 3) Food Sample Selection; 4) Experimental Design Matrix; 5) Permeation Rate Comparison; and 6) Packaging Material Information.

  5. An in vivo study of the effect of distal femoral resection on passive knee extension.

    PubMed

    Smith, Conrad K; Chen, Justin A; Howell, Stephen M; Hull, Maury L

    2010-10-01

    A previous study showed that 1 mm of distal femoral resection restored knee extension 4.5°. We determined the relationship with a more accurate measurement technique. Twenty-six subjects treated with total knee arthroplasty were studied. Digital photographs of the extended knee with and without 1.5 and 3.0 mm thick augments placed between the femoral component and distal femur were analyzed, and knee extension was measured. One millimeter of distal femoral resection restored 1.8° of extension that is less correction than the previous study reported. Because an attempt to correct a 10° extension deficit by resecting the distal femur could require 5 mm or more of bone removal that moves the joint line too proximal, we recommend exploring other techniques before resecting the femur.

  6. A randomised controlled trial in comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position in China.

    PubMed

    Zhang, Hongyu; Huang, Shurong; Guo, Xiaolan; Zhao, Ningning; Lu, Yujing; Chen, Min; Li, Yingxia; Wu, Junqin; Huang, Lihua; Ma, Fenglan; Yang, Yuhong; Zhang, Xiaoli; Zhou, Xiaoyu; Guo, Renfei; Cai, Wenzhi

    2017-07-01

    the supine position is the most frequently offered for birth delivery in China and many other countries, but the hands-and-knees position is now gaining prominence with doctors in China. This study aims to examine the differences in maternal and neonatal outcomes among low-risk women who gave birth either in the hands-and-knees position or the supine position. a randomised controlled trial was conducted in 11 hospitals in China from May to December in 2012. In total, 1400 women were recruited and randomly allocated to either the experimental group (n=700, 446 completed the protocol) who delivered in hands-and-knees position and the control group (n=700, 440 completed the protocol) who delivered in supine position. Women who could not maintain the randomised position during the second stage of labour were allowed to withdraw from the study. The primary maternal outcome measured was rate of episiotomy. Secondary outcomes included degree of perineum laceration, rate of emergency caesarean section, rate of shoulder dystocia, and duration of labour, postpartum bleeding, neonatal Apgar score, and the rate of neonatal asphyxia. Because outcome data were only collected for women who gave birth in the randomised position, per-protocol analyses were used to compare groups. The primary outcome, episiotomy, was also compared between groups using logistic regression adjusting for maternal age,gestational age at birth, whether the woman was primiparous, the process of second stage of labour and birthweight. as compared with the control group, the experimental group had lower rates of episiotomy and second-degree perineum laceration (including episiotomy), and higher rates of intact perineum and first-degree perineum laceration, with a longer duration of second stage of labour. No significant differences were found in the amount of postpartum bleeding, shoulder dystocia, neonatal asphyxia and neonatal Apgar scores at 1minute and 5minutes. Adjusted for maternal age, gestational

  7. Comparative Fixation and Subsidence Profiles of Cementless Unicompartmental Knee Arthroplasty Implants.

    PubMed

    Yildirim, Gokce; Gopalakrishnan, Ananthkrishnan; Davignon, Robert A; Parker, John W; Chawla, Harshvardhan; Pearle, Andrew D

    2016-09-01

    Aseptic loosening is the primary cause of failure for both cemented and cementless unicondylar knee replacements (UKRs). Micromotion and subsidence of tibial baseplate are two causes of failure, due to poor fixation and misalignment, respectively. Stair ascent activity profiles from Bergmann et al and Li et al were used. Biphasic Sawbones models were prepared according to the surgical techniques of traditional and novel cementless UKRs. Implants were tested for 10,000 cycles representing post-operative bone interdigitation period, and micromotion was observed using speckle pattern measurements, which demonstrated sufficient resolution. Additionally, the test method proposed by Liddle et al was used to measure subsidence with pressure sensors under increasingly lateralized loading. Mean displacement due to micromotion for mediolateral and anteroposterior plane was consistently greater for traditional cementless UKR. Mean displacement for axial micromotion was significantly higher for traditional UKR at the anterior aspect of the implant; however, values were lower for the medial periphery of the implant. Subsidence was significantly lower for the novel design with increasingly lateralized loading, and indentation was not observed on the test substrate, when compared to the traditional design. Our findings demonstrate that the novel cementless design is capable of fixation and elimination of subsidence in laboratory test settings. Both designs limit micromotion to below the established loosening micromotion value of 150 μm. The L-shaped keel design resists both micromotion and subsidence and may prevent failure modes that can lead to aseptic loosening for UKRs. These findings are highly relevant for clinical application. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Immediate Effects of an Elastic Knee Sleeve on Frontal Plane Gait Biomechanics in Knee Osteoarthritis

    PubMed Central

    Schween, Raphael; Gehring, Dominic; Gollhofer, Albert

    2015-01-01

    Introduction Osteoarthritis of the knee affects millions of people. Elastic knee sleeves aim at relieving symptoms. While symptomatic improvements have been demonstrated as a consequence of elastic knee sleeves, evidence for biomechanical alterations only exists for the sagittal plane. We therefore asked what effect an elastic knee sleeve would have on frontal plane gait biomechanics. Methods 18 subjects (8 women, 10 men) with osteoarthritis of the medial tibiofemoral joint walked over ground with and without an elastic knee sleeve. Kinematics and forces were recorded and joint moments were calculated using an inverse dynamics approach. Conditions with sleeve and without sleeve were compared with paired t-Tests. Results With the sleeve, knee adduction angle at ground contact was reduced by 1.9±2.1° (P = 0.006). Peak knee adduction was reduced by 1.5±1.6° (P = 0.004). The first peak knee adduction moment and positive knee adduction impulse were decreased by 10.1% (0.74±0.9 Nm•kg-1; P = 0.002) and 12.9% (0.28±0.3 Nm•s•kg-1; P < 0.004), respectively. Conclusion Our study provides evidence that wearing an elastic knee sleeve during walking can reduce knee adduction angles, moments and impulse in subjects with knee osteoarthritis. As a higher knee adduction moment has previously been identified as a risk factor for disease progression in patients with medial knee osteoarthritis, we speculate that wearing a knee sleeve may be beneficial for this specific subgroup. PMID:25621488

  9. Immediate effects of an elastic knee sleeve on frontal plane gait biomechanics in knee osteoarthritis.

    PubMed

    Schween, Raphael; Gehring, Dominic; Gollhofer, Albert

    2015-01-01

    Osteoarthritis of the knee affects millions of people. Elastic knee sleeves aim at relieving symptoms. While symptomatic improvements have been demonstrated as a consequence of elastic knee sleeves, evidence for biomechanical alterations only exists for the sagittal plane. We therefore asked what effect an elastic knee sleeve would have on frontal plane gait biomechanics. 18 subjects (8 women, 10 men) with osteoarthritis of the medial tibiofemoral joint walked over ground with and without an elastic knee sleeve. Kinematics and forces were recorded and joint moments were calculated using an inverse dynamics approach. Conditions with sleeve and without sleeve were compared with paired t-Tests. With the sleeve, knee adduction angle at ground contact was reduced by 1.9 ± 2.1° (P = 0.006). Peak knee adduction was reduced by 1.5 ± 1.6° (P = 0.004). The first peak knee adduction moment and positive knee adduction impulse were decreased by 10.1% (0.74 ± 0.9 Nm • kg-1; P = 0.002) and 12.9% (0.28 ± 0.3 Nm • s • kg-1; P < 0.004), respectively. Our study provides evidence that wearing an elastic knee sleeve during walking can reduce knee adduction angles, moments and impulse in subjects with knee osteoarthritis. As a higher knee adduction moment has previously been identified as a risk factor for disease progression in patients with medial knee osteoarthritis, we speculate that wearing a knee sleeve may be beneficial for this specific subgroup.

  10. I-ONE therapy in patients undergoing total knee arthroplasty: a prospective, randomized and controlled study

    PubMed Central

    2012-01-01

    Background Total knee arthroplasty (TKA) is often associated with a severe local inflammatory reaction which, unless controlled, leads to persistent pain up to one year after surgery. Standard and accelerated rehabilitation protocols are currently being implemented after TKA, but no consensus exists regarding the long-term effects. Biophysical stimulation with pulsed electromagnetic fields (PEMFs) has been demonstrated to exert an anti-inflammatory effect, to promote early functional recovery and to maintain a positive long-term effect in patients undergoing joint arthroscopy. The aim of this study was to evaluate whether PEMFs can be used to limit the pain and enhance patient recovery after TKA. Methods A prospective, randomized, controlled study in 30 patients undergoing TKA was conducted. Patients were randomized into experimental PEMFs or a control group. Patients in the experimental group were instructed to use I-ONE stimulator 4hours/day for 60days. Postoperatively, all patients received the same rehabilitation program. Treatment outcome was assessed using the Knee Society Score, SF-36 Health-Survey and VAS. Patients were evaluated pre-operatively and one, two, six and 12 months after TKA. Joint swelling and Non Steroidal Anti Inflammatory Drug (NSAID) consumption were recorded. Comparisons between the two groups were carried out using a two-tail heteroschedastic Student’s t-test. Analysis of variance for each individual subject during the study was performed using ANOVA for multiple comparisons, applied on each group, and a Dunnet post hoc test. A p value < 0.05 was considered statistically significant. Results Pre-operatively, no differences were observed between groups in terms of age, sex, weight, height, Knee-Score, VAS, SF-36 and joint swelling, with the exception of the Functional Score. The Knee-Score, SF-36 and VAS demonstrated significantly positive outcomes in the I-ONE stimulated group compared with the controls at follow-ups. In the I

  11. Abduction dislocation of the knee joint--a case study.

    PubMed

    Wójcik, Krzysztof; Bielecki, Tomasz; Polak, Damian; Skowron, Lukasz

    2013-10-31

    The paper presents a case of untypical, not included in existing classifications, knee joint dislocation in a young man. An MRI scan confirmed a rupture of both cruciate ligaments and damage to the ligamento-capsular complex on the medial side of the knee joint. Two weeks after injury, an arthroscopy was performed with joint lavage followed by repair of the damaged ligamento-capsular complex. A very good functional result was obtained three years after the injury, in spite of the patient not having consented to an elective cruciate ligament reconstruction.

  12. The Role of the Peripheral Passive Rotation Stabilizers of the Knee With Intact Collateral and Cruciate Ligaments: A Biomechanical Study

    PubMed Central

    Vap, Alexander R.; Schon, Jason M.; Moatshe, Gilbert; Cruz, Raphael S.; Brady, Alex W.; Dornan, Grant J.; Turnbull, Travis Lee; LaPrade, Robert F.

    2017-01-01

    Background: A subset of patients have clinical internal and/or external knee rotational instability despite no apparent injury to the cruciate or collateral ligaments. Purpose/Hypothesis: The purpose of this study was to assess the effect of sequentially cutting the posterolateral, anterolateral, posteromedial, and anteromedial structures of the knee on rotational stability in the setting of intact cruciate and collateral ligaments. It was hypothesized that cutting of the iliotibial band (ITB), anterolateral ligament and lateral capsule (ALL/LC), posterior oblique ligament (POL), and posteromedial capsule (PMC) would significantly increase internal rotation, while sectioning of the anteromedial capsule (AMC) and the popliteus tendon and popliteofibular ligament (PLT/PFL) would lead to a significant increase in external knee rotation. Study Design: Controlled laboratory study. Methods: Ten pairs (N = 20) of cadaveric knees were assigned to 2 sequential cutting groups (group 1: posterolateral-to-posteromedial [PL → PM] and group 2: posteromedial-to-posterolateral [PM → PL]). Specimens were subjected to applied 5-N·m internal and external rotation torques at knee flexion angles of 0°, 30°, 60°, and 90° while intact and after each cut state. Rotational changes were measured and compared with the intact and previous cut states. Results: Sectioning of the ITB significantly increased internal rotation at 60° and 90° by 5.4° and 6.2° in group 1 (PL → PM) and 3.5° and 3.8° in group 2 (PM → PL). PLT/PFL complex sectioning significantly increased external rotation at 60° and 90° by 2.7° and 2.9° in group 1 (PL → PM). At 60° and 90° in group 2 (PM → PL), ALL/LC sectioning produced significant increases in internal rotation of 3.1° and 3.5°, respectively. In group 2 (PM → PL), POL sectioning produced a significant increase in internal rotation of 2.0° at 0°. AMC sectioning significantly increased external rotation at 30° to 90° of flexion

  13. It’s not just a knee, but a whole life: A qualitative descriptive study on patients’ experiences of living with knee osteoarthritis and their expectations for knee arthroplasty

    PubMed Central

    Nyvang, Josefina; Hedström, Margareta; Gleissman, Sissel Andreassen

    2016-01-01

    Aim Knee arthroplasties are an increasingly common treatment for osteoarthritis (OA) and the main indication is pain. Previous research states, however, that 15–20% of the operated patients are dissatisfied and 20–30% have persistent pain after surgery. This study is aimed at describing patients’ experiences of living with knee OA when scheduled for surgery and further their expectations for future life after surgery. Methods We interviewed 12 patients with knee OA scheduled for arthroplasty, using semi-structured qualitative interviews. The interviews were recorded and transcribed verbatim and analyzed using qualitative thematic analysis. Findings Three categories were formulated with an overriding theme: “It's not just a knee, but a whole life.” The three categories were “Change from their earlier lives,” “Coping with knee problems,” and “Ultimate decision to undergo surgery.” The main finding was that knee OA affects the whole body and self, ultimately affecting the patients’ lives on many levels. Further findings were that knee OA was considered to be the central focus in the participants’ lives, which limited their level of activity, their ability to function as desired, their quality of life, and their mental well-being. Although surgery was considered to be the only solution, the expectations regarding the outcome differed. Conclusions The participants were forced to change how they previously had lived their lives resulting in a feeling of loss. Thus, the experienced loss and expectations for future life must be put into the context of the individual's own personality and be taken into account when treating individuals with knee OA. The experience of living with knee OA largely varies between individuals. This mandates that patients’ assessment should be considered on individual basis with regard to each patient. PMID:27036130

  14. Asymmetric loading and bone mineral density at the asymptomatic knees of subjects with unilateral hip osteoarthritis

    PubMed Central

    Shakoor, Najia; Dua, Anisha; Thorp, Laura; Mikolaitis, Rachel A.; Wimmer, Markus A.; Foucher, Kharma C.; Fogg, Louis F.; Block, Joel A.

    2011-01-01

    Objective The contralateral knee of those with unilateral endstage hip OA is known to be at greater risk for endstage knee OA compared to the ipsilateral, same side knee. Likewise, in endstage hip OA, this contralateral knee is known to have increased dynamic joint loads compared to the ipsilateral knee. Here, we study a population with unilateral hip OA, who are asymptomatic at the knees, for early asymmetries in knee loading. Methods Data from 62 subjects with unilateral hip OA were evaluated. Subjects underwent gait analyses for evaluation of dynamic knee loads as well as dual energy X-ray absorptiometry for evaluation of bone mineral density (BMD) at both knees. Differences between knees were compared. Results Peak dynamic knee loads were significantly higher at the contralateral knee compared to the ipsilateral knee (2.46±0.71 vs 2.23±0.81 %BW*ht, p=0.029). Similarly, medial compartment tibial BMD was significantly higher at the contralateral knee compared to the ipsilateral knee (0.897±0.208 vs 0.854±0.206 gm/c2, p=0.033). Interestingly, there was a direct correlation between contralteral:ipsilateral dynamic knee load and contralateral:ipsilateral medial compartment tibial BMD (Spearman’s rho= 0.287, p=0.036). Conclusions This study demonstrates that at the contralateral knees of patients with unilateral hip OA, which are at higher risk of developing progressive symptomatic OA compared to the ipsilateral knees, loading and structural asymmetries appear early in the disease course, while the knees are still asymptomatic. These early biomechanical asymmetries may have corresponding long term consequences, providing further support for the potential role of loading in OA onset and progression. PMID:22127702

  15. A comparison of registration errors with imageless computer navigation during MIS total knee arthroplasty versus standard incision total knee arthroplasty: a cadaveric study.

    PubMed

    Davis, Edward T; Pagkalos, Joseph; Gallie, Price A M; Macgroarty, Kelly; Waddell, James P; Schemitsch, Emil H

    2015-01-01

    Optimal component alignment in total knee arthroplasty has been associated with better functional outcome as well as improved implant longevity. The ability to align components optimally during minimally invasive (MIS) total knee replacement (TKR) has been a cause of concern. Computer navigation is a useful aid in achieving the desired alignment although it is limited by the error during the manual registration of landmarks. Our study aims to compare the registration process error between a standard and a MIS surgical approach. We hypothesized that performing the registration error via an MIS approach would increase the registration process error. Five fresh frozen lower limbs were routinely prepared and draped. The registration process was performed through an MIS approach. This was then extended to the standard approach and the registration was performed again. Two surgeons performed the registration process five times with each approach. Performing the registration process through the MIS approach was not associated with higher error compared to the standard approach in the alignment parameters of interest. This rejects our hypothesis. Image-free navigated MIS TKR does not appear to carry higher risk of component malalignment due to the registration process error. Navigation can be used during MIS TKR to improve alignment without reduced accuracy due to the approach.

  16. Are Western Knee Designs Dimensionally Correct for Korean Women? A Morphometric Study of Resected Femoral Surfaces during Primary Total Knee Arthroplasty

    PubMed Central

    Lyu, Suk-Joo; Kang, Hyung Wook

    2016-01-01

    Background The purpose of this study was to determine the shape of the distal femur of Korean women compared with the prostheses currently available in Korea. Methods Morphometric data (5 parameters) were measured in 356 resected femurs of Korean women undergoing primary total knee arthroplasty (TKA) utilizing the LCS knee implant (DePuy). The data were then compared with 5 additional contemporary TKA implant systems. Results Implant designs based on Caucasian population data do not ideally match the distal femoral morphology of Korean women. Overhang at the anterior mediolateral width was observed in 84.8% for the LCS while a gender-specific implant resulted in undercoverage of the bone in 86%. Posterior overhang was observed in up to 51.2%. Most implant designs have a narrower intercondylar notch than the morphologic data of Korean women. Conclusions Since there is some difference between the shape of distal femur of Korean women and that of the implants, surgeons should have this in mind when selecting an implant for a patient. These data may also be used as a guideline for future prosthetic design options for Korean women population. PMID:27583107

  17. Reasons for Treatment Choices in Knee and Hip Osteoarthritis: A Qualitative Study.

    PubMed

    Selten, Ellen M; Vriezekolk, Johanna E; Geenen, Rinie; van der Laan, Willemijn H; van der Meulen-Dilling, Roelien G; Nijhof, Marc W; Schers, Henk J; van den Ende, Cornelia H

    2016-09-01

    Conservative treatment modalities in osteoarthritis (OA) of the hip or knee are underused, whereas the demand for surgery is rising substantially. To improve the use of conservative treatment modalities, a more in-depth understanding of the reasons for patients' treatment choices is required. This study identifies the reasons for choice of treatment in patients with hip or knee OA. Semistructured in-depth interviews with 24 OA patients were held. Stratified purposive sampling was used to enrich data variation. Interviews were transcribed verbatim and subsequently coded using a thematic approach. Two independent researchers reflected on, compared, discussed, and adjusted the coding. Various treatment modalities were discussed by respondents: medication, exercise, physical therapy, injections, surgery, complementary, and alternative treatment. Four key themes underlying the choice for or against a treatment modality for OA were identified: 1) treatment characteristics: expectations about its effectiveness and risks, the degree to which it can be personalized to a patient's needs and wishes, and the accessibility of a treatment; 2) personal investment in terms of money and time; 3) personal circumstances: age, body weight, comorbidities, and previous experience with a treatment; and 4) support and advice from the patient's social environment and health care providers. The 4 identified key themes enhance the insight of health care providers into the widespread reasons influencing patients' treatment choices for knee or hip OA. This knowledge can be used in clinical practice to aid shared decision making, which may lead to optimized treatment choices for both conservative and surgical treatment. © 2016, American College of Rheumatology.

  18. Lateral Meniscus Posterior Root and Meniscofemoral Ligaments as Stabilizing Structures in the ACL-Deficient Knee: A Biomechanical Study

    PubMed Central

    Frank, Jonathan M.; Moatshe, Gilbert; Brady, Alex W.; Dornan, Grant J.; Coggins, Ashley; Muckenhirn, Kyle J.; Slette, Erik L.; Mikula, Jacob D.; LaPrade, Robert F.

    2017-01-01

    Background: The biomechanical effects of lateral meniscal posterior root tears with and without meniscofemoral ligament (MFL) tears in anterior cruciate ligament (ACL)–deficient knees have not been studied in detail. Purpose: To determine the biomechanical effects of the lateral meniscus (LM) posterior root tear in ACL-intact and ACL-deficient knees. In addition, the biomechanical effects of disrupting the MFLs in ACL-deficient knees with meniscal root tears were evaluated. Study Design: Controlled laboratory study. Methods: Ten paired cadaveric knees were mounted in a 6-degrees-of-freedom robot for testing and divided into 2 groups. The sectioning order for group 1 was (1) ACL, (2) LM posterior root, and (3) MFLs, and the order for group 2 was (1) LM posterior root, (2) ACL, and (3) MFLs. For each cutting state, displacements and rotations of the tibia were measured and compared with the intact state after a simulated pivot-shift test (5-N·m internal rotation torque combined with a 10-N·m valgus torque) at 0°, 20°, 30°, 60°, and 90° of knee flexion; an anterior translation load (88 N) at 0°, 30°, 60°, and 90° of knee flexion; and internal rotation (5 N·m) at 0°, 30°, 60°, 75°, and 90°. Results: Cutting the LM root and MFLs significantly increased anterior tibial translation (ATT) during a pivot-shift test at 20° and 30° when compared with the ACL-cut state (both Ps < .05). During a 5-N·m internal rotation torque, cutting the LM root in ACL-intact knees significantly increased internal rotation by between 0.7° ± 0.3° and 1.3° ± 0.9° (all Ps < .05) except at 0° (P = .136). When the ACL + LM root cut state was compared with the ACL-cut state, the increase in internal rotation was significant at greater flexion angles of 75° and 90° (both Ps < .05) but not between 0°and 60° (all Ps > .2). For an anterior translation load, cutting the LM root in ACL-deficient knees significantly increased ATT only at 30° (P = .007). Conclusion: The LM

  19. A new ambulatory system for comparative evaluation of the three-dimensional knee kinematics, applied to anterior cruciate ligament injuries.

    PubMed

    Favre, J; Luthi, F; Jolles, B M; Siegrist, O; Najafi, B; Aminian, K

    2006-07-01

    The aim of this study was to develop an ambulatory system for the three-dimensional (3D) knee kinematics evaluation, which can be used outside a laboratory during long-term monitoring. In order to show the efficacy of this ambulatory system, knee function was analysed using this system, after an anterior cruciate ligament (ACL) lesion, and after reconstructive surgery. The proposed system was composed of two 3D gyroscopes, fixed on the shank and on the thigh, and a portable data logger for signal recording. The measured parameters were the 3D mean range of motion (ROM) and the healthy knee was used as control. The precision of this system was first assessed using an ultrasound reference system. The repeatability was also estimated. A clinical study was then performed on five unilateral ACL-deficient men (range: 19-36 years) prior to, and a year after the surgery. The patients were evaluated with the IKDC score and the kinematics measurements were carried out on a 30 m walking trial. The precision in comparison with the reference system was 4.4 degrees , 2.7 degrees and 4.2 degrees for flexion-extension, internal-external rotation, and abduction-adduction, respectively. The repeatability of the results for the three directions was 0.8 degrees , 0.7 degrees and 1.8 degrees . The averaged ROM of the five patients' healthy knee were 70.1 degrees (standard deviation (SD) 5.8 degrees), 24.0 degrees (SD 3.0 degrees) and 12.0 degrees (SD 6.3 degrees for flexion-extension, internal-external rotation and abduction-adduction before surgery, and 76.5 degrees (SD 4.1 degrees), 21.7 degrees (SD 4.9 degrees) and 10.2 degrees (SD 4.6 degrees) 1 year following the reconstruction. The results for the pathologic knee were 64.5 degrees (SD 6.9 degrees), 20.6 degrees (SD 4.0 degrees) and 19.7 degrees (8.2 degrees) during the first evaluation, and 72.3 degrees (SD 2.4 degrees), 25.8 degrees (SD 6.4 degrees) and 12.4 degrees (SD 2.3 degrees) during the second one. The performance of the

  20. Knee Dislocations

    PubMed Central

    Schenck, Robert C.; Richter, Dustin L.; Wascher, Daniel C.

    2014-01-01

    Background: Traumatic knee dislocation is becoming more prevalent because of improved recognition and increased exposure to high-energy trauma, but long-term results are lacking. Purpose: To present 2 cases with minimum 20-year follow-up and a review of the literature to illustrate some of the fundamental principles in the management of the dislocated knee. Study Design: Review and case reports. Methods: Two patients with knee dislocations who underwent multiligamentous knee reconstruction were reviewed, with a minimum 20-year follow-up. These patients were brought back for a clinical evaluation using both subjective and objective measures. Subjective measures include the following scales: Lysholm, Tegner activity, visual analog scale (VAS), Short Form–36 (SF-36), International Knee Documentation Committee (IKDC), and a psychosocial questionnaire. Objective measures included ligamentous examination, radiographic evaluation (including Telos stress radiographs), and physical therapy assessment of function and stability. Results: The mean follow-up was 22 years. One patient had a vascular injury requiring repair prior to ligament reconstruction. The average assessment scores were as follows: SF-36 physical health, 52; SF-36 mental health, 59; Lysholm, 92; IKDC, 86.5; VAS involved, 10.5 mm; and VAS uninvolved, 2.5 mm. Both patients had excellent stability and were functioning at high levels of activity for their age (eg, hiking, skydiving). Both patients had radiographic signs of arthritis, which lowered 1 subject’s IKDC score to “C.” Conclusion: Knee dislocations have rare long-term excellent results, and most intermediate-term studies show fair to good functional results. By following fundamental principles in the management of a dislocated knee, patients can be given the opportunity to function at high levels. Hopefully, continued advances in the evaluation and treatment of knee dislocations will improve the long-term outcomes for these patients in the

  1. Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study.

    PubMed

    Orozco, Lluis; Munar, Anna; Soler, Robert; Alberca, Mercedes; Soler, Francesc; Huguet, Marina; Sentís, Joan; Sánchez, Ana; García-Sancho, Javier

    2013-06-27

    Osteoarthritis is the most prevalent joint disease and a frequent cause of joint pain, functional loss, and disability. Osteoarthritis often becomes chronic, and conventional treatments have demonstrated only modest clinical benefits without lesion reversal. Cell-based therapies have shown encouraging results in both animal studies and a few human case reports. We designed a pilot study to assess the feasibility and safety of osteoarthritis treatment with mesenchymal stromal cells (MSCs) in humans and to obtain early efficacy information for this treatment. Twelve patients with chronic knee pain unresponsive to conservative treatments and radiologic evidence of osteoarthritis were treated with autologous expanded bone marrow MSCs by intra-articular injection (40×10 cells). Clinical outcomes were followed for 1 year and included evaluations of pain, disability, and quality of life. Articular cartilage quality was assessed by quantitative magnetic resonance imaging T2 mapping. Feasibility and safety were confirmed, and strong indications of clinical efficacy were identified. Patients exhibited rapid and progressive improvement of algofunctional indices that approached 65% to 78% by 1 year. This outcome compares favorably with the results of conventional treatments. Additionally, quantification of cartilage quality by T2 relaxation measurements demonstrated a highly significant decrease of poor cartilage areas (on average, 27%), with improvement of cartilage quality in 11 of the 12 patients. MSC therapy may be a valid alternative treatment for chronic knee osteoarthritis. The intervention is simple, does not require hospitalization or surgery, provides pain relief, and significantly improves cartilage quality.

  2. Does meniscus removal affect ACL-deficient knee laxity? An in vivo study.

    PubMed

    Zaffagnini, S; Signorelli, C; Bonanzinga, T; Grassi, A; Galán, H; Akkawi, I; Bragonzoni, L; Cataldi, F; Marcacci, M

    2016-11-01

    The purpose of the present study was to determine, in vivo, the effect of different types of meniscectomy on an ACL-deficient knee. Using a computer-assisted navigation system, 56 consecutive patients (45 men and 11 women) were subjected to a biomechanical testing with Lachman test (AP30), drawer test (AP90), internal/external rotation test, varus/valgus rotation test and pivot-shift test. The patients were divided into three groups according to the status of the medial meniscus. Group BH, 8 patients with bucket-handle tear of medial meniscus underwent a subtotal meniscectomy; Group PHB, 19 patients with posterior horn body of medial meniscus tear underwent a partial meniscectomy; and Group CG with isolated ACL rupture, as a control group, with 29 patients. A significant difference in anterior tibial translation was seen at 30 grades and in 90 grades between BH and PHB groups compared to the CG. In response to pivot-shift test, no significant differences in terms of AREA and POSTERIOR ACC were found among the three groups (n.s). Concerning the anterior displacement of the pivot shift a statistically significant differences among the three tested groups was found. The present study shows that meniscal defects significantly affect the kinematics of an ACL-deficient knee in terms of anterior tibial translation under static and dynamic testing.

  3. Lateral Meniscus Posterior Root and Meniscofemoral Ligaments as Stabilizing Structures in the ACL-Deficient Knee: A Biomechanical Study.

    PubMed

    Frank, Jonathan M; Moatshe, Gilbert; Brady, Alex W; Dornan, Grant J; Coggins, Ashley; Muckenhirn, Kyle J; Slette, Erik L; Mikula, Jacob D; LaPrade, Robert F

    2017-06-01

    The biomechanical effects of lateral meniscal posterior root tears with and without meniscofemoral ligament (MFL) tears in anterior cruciate ligament (ACL)-deficient knees have not been studied in detail. To determine the biomechanical effects of the lateral meniscus (LM) posterior root tear in ACL-intact and ACL-deficient knees. In addition, the biomechanical effects of disrupting the MFLs in ACL-deficient knees with meniscal root tears were evaluated. Controlled laboratory study. Ten paired cadaveric knees were mounted in a 6-degrees-of-freedom robot for testing and divided into 2 groups. The sectioning order for group 1 was (1) ACL, (2) LM posterior root, and (3) MFLs, and the order for group 2 was (1) LM posterior root, (2) ACL, and (3) MFLs. For each cutting state, displacements and rotations of the tibia were measured and compared with the intact state after a simulated pivot-shift test (5-N·m internal rotation torque combined with a 10-N·m valgus torque) at 0°, 20°, 30°, 60°, and 90° of knee flexion; an anterior translation load (88 N) at 0°, 30°, 60°, and 90° of knee flexion; and internal rotation (5 N·m) at 0°, 30°, 60°, 75°, and 90°. Cutting the LM root and MFLs significantly increased anterior tibial translation (ATT) during a pivot-shift test at 20° and 30° when compared with the ACL-cut state (both Ps < .05). During a 5-N·m internal rotation torque, cutting the LM root in ACL-intact knees significantly increased internal rotation by between 0.7° ± 0.3° and 1.3° ± 0.9° (all Ps < .05) except at 0° (P = .136). When the ACL + LM root cut state was compared with the ACL-cut state, the increase in internal rotation was significant at greater flexion angles of 75° and 90° (both Ps < .05) but not between 0°and 60° (all Ps > .2). For an anterior translation load, cutting the LM root in ACL-deficient knees significantly increased ATT only at 30° (P = .007). The LM posterior root was a significant stabilizer of the knee for ATT

  4. Topical analgesics for knee arthrosis: a parallel study of ketoprofen gel and diclofenac emulgel.

    PubMed

    Waikakul, S; Penkitti, P; Soparat, K; Boonsanong, W

    1997-09-01

    The clinical efficacy of the two topical analgesics, ketoprofen hydroalcoholic gel (Fastum gel) and diclofenac emulgel, for osteoarthritis of the knee was studied. There were 85 patients who underwent the trial. They were randomly allocated into 2 groups, the diclofenac group, 42 patients (4 males and 38 females) receiving the diclofenac emulgel at the painfull site four times a day for 4 weeks, and the ketoprofen group, 43 patients (9 males and 34 females) receiving the ketoprofen hydroalcoholic gel four times a day for 4 weeks at the painful knee. Golberg's knee scoring was used to evaluate the patients before the trial, at the end of the first, second and fourth weeks. The ketoprofen group had poorer a score before the trial, however, both groups had improvement in their knee functions, knee score and pain. There was no significant difference between the groups at the end of the study. There was no serious side effect in both groups. Ketoprofen hydroalcoholic gel gave persuasive results in the treatment of knee arthrosis stage I and II.

  5. Comparative assessment of knee extensor and flexor muscle strength measured using a hand-held vs. isokinetic dynamometer.

    PubMed

    Muff, Guillaume; Dufour, Stéphane; Meyer, Alain; Severac, François; Favret, Fabrice; Geny, Bernard; Lecocq, Jehan; Isner-Horobeti, Marie-Eve

    2016-09-01

    [Purpose] To compare measurements of knee extensor and flexor muscle strength performed using a hand-held dynamometer and an isokinetic dynamometer in apparently healthy subjects. [Subjects and Methods] Thirty adult volunteers underwent knee muscle strength evaluation using an isokinetic or a hand-held dynamometer. [Results] Strong positive correlations were found between the 2 methods, with correlation coefficients r ranging from 0.72 (95% confidence interval [CI], 0.48-0.86) to 0.87 (95% CI, 0.75-0.94), depending on the muscle group and the isokinetic evaluation mode. The reproducibility of the hand-held dynamometer findings was good, judged by a coefficient of variation of 3.2-4.2%. However, the correlation between the 2 methods for the assessment of flexor/extensor ratios ranged from -0.04 to 0.46. [Conclusion] Knee extensor and flexor muscle strength recorded with a hand-held dynamometer is reproducible and significantly correlated with the isokinetic values, indicating that this method may in some cases be a useful replacement for isokinetic strength measurement. However, for strength ratio assessment, and when judged against the isokinetic standard, a hand-held dynamometer is not a valid option.

  6. Comparative assessment of knee extensor and flexor muscle strength measured using a hand-held vs. isokinetic dynamometer

    PubMed Central

    Muff, Guillaume; Dufour, Stéphane; Meyer, Alain; Severac, François; Favret, Fabrice; Geny, Bernard; Lecocq, Jehan; Isner-Horobeti, Marie-Eve

    2016-01-01

    [Purpose] To compare measurements of knee extensor and flexor muscle strength performed using a hand-held dynamometer and an isokinetic dynamometer in apparently healthy subjects. [Subjects and Methods] Thirty adult volunteers underwent knee muscle strength evaluation using an isokinetic or a hand-held dynamometer. [Results] Strong positive correlations were found between the 2 methods, with correlation coefficients r ranging from 0.72 (95% confidence interval [CI], 0.48−0.86) to 0.87 (95% CI, 0.75−0.94), depending on the muscle group and the isokinetic evaluation mode. The reproducibility of the hand-held dynamometer findings was good, judged by a coefficient of variation of 3.2–4.2%. However, the correlation between the 2 methods for the assessment of flexor/extensor ratios ranged from −0.04 to 0.46. [Conclusion] Knee extensor and flexor muscle strength recorded with a hand-held dynamometer is reproducible and significantly correlated with the isokinetic values, indicating that this method may in some cases be a useful replacement for isokinetic strength measurement. However, for strength ratio assessment, and when judged against the isokinetic standard, a hand-held dynamometer is not a valid option. PMID:27799667

  7. Comparison of quantitative evaluation between cutaneous and transosseous inertial sensors in anterior cruciate ligament deficient knee: A cadaveric study.

    PubMed

    Murase, Atsunori; Nozaki, Masahiro; Kobayashi, Masaaki; Goto, Hideyuki; Yoshida, Masahito; Yasuma, Sanshiro; Takenaga, Tetsuya; Nagaya, Yuko; Mizutani, Jun; Okamoto, Hideki; Iguchi, Hirotaka; Otsuka, Takanobu

    2017-09-01

    Recently several authors have reported on the quantitative evaluation of the pivot-shift test using cutaneous fixation of inertial sensors. Before utilizing this sensor for clinical studies, it is necessary to evaluate the accuracy of cutaneous sensor in assessing rotational knee instability. To evaluate the accuracy of inertial sensors, we compared cutaneous and transosseous sensors in the quantitative assessment of rotational knee instability in a cadaveric setting, in order to demonstrate their clinical applicability. Eight freshly frozen human cadaveric knees were used in this study. Inertial sensors were fixed on the tibial tuberosity and directly fixed to the distal tibia bone. A single examiner performed the pivot shift test from flexion to extension on the intact knees and ACL deficient knees. The peak overall magnitude of acceleration and the maximum rotational angular velocity in the tibial superoinferior axis was repeatedly measured with the inertial sensor during the pivot shift test. Correlations between cutaneous and transosseous inertial sensors were evaluated, as well as statistical analysis for differences between ACL intact and ACL deficient knees. Acceleration and angular velocity measured with the cutaneous sensor demonstrated a strong positive correlation with the transosseous sensor (r = 0.86 and r = 0.83). Comparison between cutaneous and transosseous sensor indicated significant difference for the peak overall magnitude of acceleration (cutaneous: 10.3 ± 5.2 m/s(2), transosseous: 14.3 ± 7.6 m/s(2), P < 0.01) and for the maximum internal rotation angular velocity (cutaneous: 189.5 ± 99.6 deg/s, transosseous: 225.1 ± 103.3 deg/s, P < 0.05), but no significant difference for the maximum external rotation angular velocity (cutaneous: 176.1 ± 87.3 deg/s, transosseous: 195.9 ± 106.2 deg/s, N.S). There is a positive correlation between cutaneous and transosseous inertial sensors. Therefore, this study indicated that

  8. Comparative Risk of Transfusion and Incremental Total Hospitalization Cost for Primary Unilateral, Bilateral, and Revision Total Knee Arthroplasty Procedures.

    PubMed

    Nichols, Christine I; Vose, Joshua G

    2016-03-01

    This study evaluated the comparative risk of autologous and allogenic blood transfusion, inhospital complications, and incremental total hospitalization costs for primary unilateral, simultaneous bilateral, and revision total knee arthroplasty (TKA) procedures. Using the Premier Perspective database, we identified adults who underwent primary unilateral, simultaneous bilateral, or revision TKA procedures. Logistic regression, controlling for patient and hospital characteristics, was used to determine the risk of autologous or allogeneic blood transfusion. Controlling for the same factors, generalized linear models predicted incremental total hospitalization cost associated with transfusion. Between January 2008 and June 2014, 513,558 primary unilateral, 33,977 bilateral, and 32,494 revision TKA patients met selection criteria. The overall percentage receiving a transfusion was 14.1% for unilateral, 36.3% for bilateral, and 20.0% for revision procedures. Logistic regression showed patients aged >65 years, female gender, Northeastern location, large hospitals, and higher Charlson score to be significantly associated with higher transfusion risk. Although overall risk of transfusion decreased over the study period, patients with Charlson score ≥3 were at 2.27 (primary unilateral), 1.88 (bilateral), and 2.44 (revision) greater odds of transfusion compared with healthy controls (Charlson score = 0). Generalized linear models showed an incremental total hospitalization cost among those receiving a transfusion of $2477, $4235, and $8594, respectively, compared with those without transfusion. Transfusion risk remains a significant burden in select patient populations and procedures. The incremental cost of receiving a transfusion is significant, including not only direct costs but also staff time and increased hospital resource use. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Cigarette smoking and risk of total knee replacement for severe osteoarthritis among Chinese in Singapore - The Singapore Chinese Health Study

    PubMed Central

    Leung, Ying-Ying; Ang, Li-Wei; Thumboo, J; Wang, Renwei; Yuan, Jian-min; Koh, Woon-Puay

    2014-01-01

    Purpose Data on the effects of cigarette smoking with osteoarthritis (OA) are inconsistent and no study has examined the effect of smoking cessation. We examined smoking status, duration, dosage and cessation in association with risk of total knee replacement (TKR) for severe knee OA among elderly Chinese in Singapore. Methods We used data from the Singapore Chinese Health Study, a population-based prospective cohort of 63,257 Chinese men and women aged 45 to 74 years during enrolment between 1993 and 1998. Detailed information on smoking, current diet and lifestyle factors were obtained through in-person interviews. As of 31 December 2011, 1,973 incident TKR cases for severe knee OA had been identified via linkage with nationwide hospital discharge database. We used Cox regression methods to examine smoking in relation to TKR risk with adjustment for age, gender, education, body mass index, comorbidities and physical activity level. Results Compared to never smokers, current smokers had a 51% decrease in risk of TKR [Hazards ratio (HR) =0.49; 95% confidence interval (CI) =0.40-0.60]. Among current smokers, there was a very strong dose-dependent association between increasing duration and dosage of smoking with decreasing risk of TKR (p for trend<0.0001). Among former smokers, there was a dose-dependent response between decrease in duration of smoking cessation and reduction in TKR risk (p for trend=0.034). Conclusion Our findings strongly implicate smoking as a protective factor for total knee replacement indicated for severe knee OA. This concurs with experimental data that nicotine promotes proliferation and collagen synthesis in chondrocytes. PMID:24680935

  10. Tranexamic Acid in a Multimodal Blood Loss Prevention Protocol to Decrease Blood Loss in Revision Total Knee Arthroplasty: A Cohort Study#

    PubMed Central

    Ortega-Andreu, Miguel; Talavera, Gloria; Padilla-Eguiluz, Norma G.; Perez-Chrzanowska, Hanna; Figueredo-Galve, Reyes; Rodriguez-Merchán, Carlos E.; Gómez-Barrena, Enrique

    2016-01-01

    Purpose: To clarify if blood loss and transfusion requirements can be decreased in revision knee surgery through a multimodal blood loss approach with tranexamic acid (TXA) Patients and Methods: A retrospective study was designed in 87 knees (79 patients) that received a knee revision between 2007 and 2013. To avoid heterogeneity in the surgical technique, only revisions with one single implant system were included. A treatment series of 44 knees that received TXA and other techniques in a multimodal blood loss protocol was compared to a control series of 43 knees that received neither TXA nor the rest of the multimodal blood loss protocol. No differences in the complexity of surgeries or case severity were detected. Results: A significant decrease was observed from 58% transfusion rate in the control group to 5% in the treated group. The postoperative haemoglobin drop was also significantly different. Although the use of a blood loss prevention approach including TXA was the most relevant factor in the transfusion risk (OR=15), longer surgical time also associated an increased risk of transfusion (OR=1.15). Conclusion: This study supports the use of a two-dose intravenous TXA under a multimodal blood loss prevention approach in revision knee replacement with significant reduction in the transfusion rate, postoperative blood loss and haemoglobin drop. PMID:27708740

  11. Effect studies of Uyghur sand therapy on the hemodynamics of the knee-joint arteries.

    PubMed

    Fu, Rongchang; Mahemut, Dilinaer; Tiyipujiang, Rexiati; Aihemaiti, Kuwahan; Ainiwaierjiang, Nuerya

    2014-01-01

    This paper studies the effect of Uyghur sand therapy on dynamics of arterial flow of knee joints via experiments and numerical simulations. Experiments have been carried out on 30 volunteers, with their diameter and flow rate of arteries of knee joints measured before and after Uyghur sand therapy. It has been found that Uyghur sand therapy will increase the inner diameter of knee arteries and speed up the blood flow. Experimental results show that Uyghur sand therapy can help relieve obstacles in local blood flow. By choosing one volunteer for CT scanning, three-dimensional reconstruction of knee-joint arteries via MIMICS software is achieved. Calculation model is the established with numerical calculations performed by ANSYS software. According to the calculations, the blood flow of the knee arteries speeds up and the uniform distribution of velocity enlarges after Uyghur sand therapy, which further confirms the experimental results. Besides, the research also suggests that Uyghur sand therapy has stronger effect on blood flow of knee-joint arteries than the inner diameter.

  12. Strength, balance, and the modifying effects of obesity and knee pain: results from the Observational Arthritis Study in Seniors (oasis).

    PubMed

    Jadelis, K; Miller, M E; Ettinger, W H; Messier, S P

    2001-07-01

    To examine the relationship between muscular strength and dynamic balance in a sample of older adults with knee pain and to determine the role that obesity and severity of knee pain play in the ability to maintain balance. Cross-sectional study designed to examine the association between strength and balance in a cohort of older adults with chronic knee pain. A university health and exercise science center. A cohort of 480 adults age 65 and older with knee pain. Force platform dynamic balance measure of the center of pressure excursion during a forward and subsequent backward lean. Isokinetic strength measures of concentric and eccentric knee flexion and extension and concentric ankle plantar flexion and dorsiflexion. Body mass index (BMI) and a knee pain scale were used to measure obesity and knee pain, respectively. A regression model was developed to investigate the relationship between dynamic balance and muscular strength while controlling for gender, BMI, radiographic severity, knee pain, and foot length. Knee strength alone explained 18.4% of the variability in dynamic balance. The addition of knee pain, BMI, radiographic severity, gender, and foot length explained an additional 6.7%. When the knee-ankle interaction, ankle strength, and knee strength--pain interaction variables were added to the regression model, 28.9% of the variability in dynamic balance was explained. Strength appears to play a significant role in maintaining balance in an older, osteoarthritic population. We found that mean knee strength accounted for approximately 19% of the variability in dynamic balance. Hence, greater knee strength was associated with better dynamic balance. The best dynamic balance performances occurred in participants that had a combination of strong knees and strong ankles. However, knee osteoarthritic patients with weak knee strength could still maintain high levels of dynamic balance by having strong ankle strength. Moreover, we have shown that obesity is

  13. Low-tech rehabilitation of bilateral patellofemoral knee pain in a runner: a case study.

    PubMed

    Stefanick, Gary F

    2004-12-01

    Patellofemoral pain is a common ailment within both the running and general populations. Many of the structures of the anterior knee that comprise the patellofemoral joint can be the source of chronic pain and inflammation that is associated with this condition. Much of the evidence in the literature points to a delay in activation of the vastus medialis oblique muscle as compared to the vastus lateralis, vastus medialis weakness, and ultimately faulty patellar tracking as the chief causative factors in the development of patellofemoral pain. This is a single case study of a 51-year-old recreational runner with an 18-month history of bilateral patellofemoral knee pain. Treatment included the use of low-tech in office rehabilitation strategies known to affect those causative factors responsible for patellofemoral pain. Evidence based treatment modalities were utilized in combination, which included patellar mobilization, spinal manipulation, proprioceptive and strength training, and semi-rigid orthotic use, to effect vastus medialis oblique vs. vastus lateralis activation, vastus medialis strength, and patellar movement. The patient responded very well to a 12 week course of treatment and resumed recreational running with minimal to no pain at the six month, one and two year follow-ups.

  14. Brief report: symmetricity of radiographic and MRI-detected structural joint damage in persons with knee pain--the Joints on Glucosamine (JOG) Study.

    PubMed

    Roemer, F W; Jarraya, M; Kwoh, C K; Hannon, M J; Boudreau, R M; Green, S M; Jakicic, J M; Moore, C; Guermazi, A

    2015-08-01

    Most MRI-based osteoarthritis (OA) studies have focused on a single knee per person and thus, data on bilaterality is sparse. Study aim was to describe symmetricity of MRI-detected OA features in a cohort of subjects with knee pain. Participants were 169 subjects with chronic knee pain who had 3 T MRI of both knees using the same protocol as in the Osteoarthritis Initiative. Knees were read for cartilage damage, bone marrow lesions (BMLs), and meniscal damage according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS) system. Chi(2) tests were used to compare the proportion of knees with unilateral tissue pathology to the proportion what would be expected if both knees were independent. We further used percent agreement and linear weighted kappa statistics to describe agreement of cartilage damage and BMLs in the same articular plates. 51.2% of participants were men, mean age was 52.1 (±6.2), mean BMI was 29.0 kg/m(2) (±4.1). All plates showed a significant higher degree of symmetricity for cartilage damage as evidenced by weighted kappas ranging from 0.32 to 0.59. For BMLs the degree of symmetricity was higher for the patella, trochlea, medial tibia, lateral femur, and medial femur; for meniscal damage the degree of unilaterality was lower for all medial meniscal subregions but not all lateral. Kappas ranged between 0.52 and 0.68 for cartilage and 0.30 and 0.55 for BMLs for the four subregions with highest agreement. A higher degree of symmetricity of tissue damage than expected by chance was observed in this cohort of subjects with knee pain. Copyright © 2015. Published by Elsevier Ltd.

  15. Knee movement patterns of injured and uninjured adolescent basketball players when landing from a jump: A case-control study

    PubMed Central

    Louw, Quinette; Grimmer, Karen; Vaughan, Christopher

    2006-01-01

    Background A common knee injury mechanism sustained during basketball is landing badly from a jump. Landing is a complex task and requires good coordination, dynamic muscle control and flexibility. For adolescents whose coordination and motor control has not fully matured, landing badly from a jump can present a significant risk for injury. There is currently limited biomechanical information regarding the lower limb kinetics of adolescents when jumping, specifically regarding jump kinematics comparing injured with uninjured adolescents. This study reports on an investigation of biomechanical differences in landing patterns of uninjured and injured adolescent basketball players. Methods A matched case-control study design was employed. Twenty-two basketball players aged 14–16 years participated in the study: eleven previously knee-injured and eleven uninjured players matched with cases for age, gender, weight, height and years of play, and playing for the same club. Six high-speed, three-dimensional Vicon 370 cameras (120 Hz), Vicon biomechanical software and SAS Version 8 software were employed to analyse landing patterns when subjects performed a "jump shot". Linear correlations determined functional relationships between the biomechanical performance of lower limb joints, and paired t-tests determined differences between the normalised peak biomechanical parameters. Results The average peak vertical ground reaction forces between the cases and controls were similar. The average peak ground reaction forces between the cases and controls were moderately correlated (r = -0.47). The control (uninjured) players had significantly greater hip and knee flexion angles and significantly greater eccentric activity on landing than the uninjured cases (p < 0.01). Conclusion The findings of the study indicate that players with a history of knee injuries had biomechanically compromised landing techniques when compared with uninjured players matched for gender, age and club

  16. Effects of jump and balance training on knee kinematics and electromyography of female basketball athletes during a single limb drop landing: pre-post intervention study

    PubMed Central

    2011-01-01

    Background Some research studies have investigated the effects of anterior cruciate ligament (ACL) injury prevention programs on knee kinematics during landing tasks; however the results were different among the studies. Even though tibial rotation is usually observed at the time of ACL injury, the effects of training programs for knee kinematics in the horizontal plane have not yet been analyzed. The purpose of this study was to determine the effects of a jump and balance training program on knee kinematics including tibial rotation as well as on electromyography of the quadriceps and hamstrings in female athletes. Methods Eight female basketball athletes participated in the experiment. All subjects performed a single limb landing at three different times: the initial test, five weeks later, and one week after completing training. The jump and balance training program lasted for five weeks. Knee kinematics and simultaneous electromyography of the rectus femoris and Hamstrings before training were compared with those measured after completing the training program. Results After training, regarding the position of the knee at foot contact, the knee flexion angle for the Post-training trial (mean (SE): 24.4 (2.1) deg) was significantly larger than that for the Pre-training trial (19.3 (2.5) deg) (p < 0.01). The absolute change during landing in knee flexion for the Post-training trial (40.2 (1.9) deg) was significantly larger than that for the Pre-training trial (34.3 (2.5) deg) (p < 0.001). Tibial rotation and the knee varus/valgus angle were not significantly different after training. A significant increase was also found in the activity of the hamstrings 50 ms before foot contact (p < 0.05). Conclusions The jump and balance training program successfully increased knee flexion and hamstring activity of female athletes during landing, and has the possibility of producing partial effects to avoid the characteristic knee position observed in ACL injury, thereby

  17. Kinematic analysis of anterior cruciate ligament reconstruction in total knee arthroplasty.

    PubMed

    Liu, Hua-Wei; Ni, Ming; Zhang, Guo-Qiang; Li, Xiang; Chen, Hui; Zhang, Qiang; Chai, Wei; Zhou, Yong-Gang; Chen, Ji-Ying; Liu, Yu-Liang; Cheng, Cheng-Kung; Wang, Yan

    2016-01-01

    This study aims to retain normal knee kinematics after knee replacement surgeries by reconstructing anterior cruciate ligament during total knee arthroplasty. We use computational simulation tools to establish four dynamic knee models, including normal knee model, posterior cruciate ligament retaining knee model, posterior cruciate ligament substituting knee model, and anterior cruciate ligament reconstructing knee model. Our proposed method utilizes magnetic resonance images to reconstruct solid bones and attachments of ligaments, and assemble femoral and tibial components according representative literatures and operational specifications. Dynamic data of axial tibial rotation and femoral translation from full-extension to 135 were measured for analyzing the motion of knee models. The computational simulation results show that comparing with the posterior cruciate ligament retained knee model and the posterior cruciate ligament substituted knee model, reconstructing anterior cruciate ligament improves the posterior movement of the lateral condyle, medial condyle and tibial internal rotation through a full range of flexion. The maximum posterior translations of the lateral condyle, medial condyle and tibial internal rotation of the anterior cruciate ligament reconstructed knee are 15.3 mm, 4.6 mm and 20.6 at 135 of flexion. Reconstructing anterior cruciate ligament in total knee arthroplasty has been approved to be an more efficient way of maintaining normal knee kinematics comparing to posterior cruciate ligament retained and posterior cruciate ligament substituted total knee arthroplasty.

  18. Kinematic analysis of anterior cruciate ligament reconstruction in total knee arthroplasty

    PubMed Central

    Liu, Hua-Wei; Ni, Ming; Zhang, Guo-Qiang; Li, Xiang; Chen, Hui; Zhang, Qiang; Chai, Wei; Zhou, Yong-Gang; Chen, Ji-Ying; Liu, Yu-Liang; Cheng, Cheng-Kung; Wang, Yan

    2016-01-01

    Background: This study aims to retain normal knee kinematics after knee replacement surgeries by reconstructing anterior cruciate ligament during total knee arthroplasty. Method: We use computational simulation tools to establish four dynamic knee models, including normal knee model, posterior cruciate ligament retaining knee model, posterior cruciate ligament substituting knee model, and anterior cruciate ligament reconstructing knee model. Our proposed method utilizes magnetic resonance images to reconstruct solid bones and attachments of ligaments, and assemble femoral and tibial components according representative literatures and operational specifications. Dynamic data of axial tibial rotation and femoral translation from full-extension to 135 were measured for analyzing the motion of knee models. Findings: The computational simulation results show that comparing with the posterior cruciate ligament retained knee model and the posterior cruciate ligament substituted knee model, reconstructing anterior cruciate ligament improves the posterior movement of the lateral condyle, medial condyle and tibial internal rotation through a full range of flexion. The maximum posterior translations of the lateral condyle, medial condyle and tibial internal rotation of the anterior cruciate ligament reconstructed knee are 15.3 mm, 4.6 mm and 20.6 at 135 of flexion. Interpretation: Reconstructing anterior cruciate ligament in total knee arthroplasty has been approved to be an more efficient way of maintaining normal knee kinematics comparing to posterior cruciate ligament retained and posterior cruciate ligament substituted total knee arthroplasty. PMID:27347334

  19. The effect of a knee ankle foot orthosis incorporating an active knee mechanism on gait of a person with poliomyelitis.

    PubMed

    Arazpour, Mokhtar; Chitsazan, Ahmad; Bani, Monireh Ahmadi; Rouhi, Gholamreza; Ghomshe, Farhad Tabatabai; Hutchins, Stephen W

    2013-10-01

    The aim of this case study was to identify the effect of a powered stance control knee ankle foot orthosis on the kinematics and temporospatial parameters of walking by a person with poliomyelitis when compared to a knee ankle foot orthosis. A knee ankle foot orthosis was initially manufactured by incorporating drop lock knee joints and custom molded ankle foot orthoses and fitted to a person with poliomyelitis. The orthosis was then adapted by adding electrically activated powered knee joints to provide knee extension torque during stance and also flexion torque in swing phase. Lower limb kinematic and kinetic data plus data for temporospatial parameters were acquired from three test walks using each orthosis. Walking speed, step length, and vertical and horizontal displacement of the pelvis decreased when walking with the powered stance control knee ankle foot orthosis compared to the knee ankle foot orthosis. When using the powered stance control knee ankle foot orthosis, the knee flexion achieved during swing and also the overall pattern of walking more closely matched that of normal human walking. The reduced walking speed may have caused the smaller compensatory motions detected when the powered stance control knee ankle foot orthosis was used. The new powered SCKAFO facilitated controlled knee flexion and extension during ambulation for a volunteer poliomyelitis person.

  20. The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study

    PubMed Central

    van Raaij, Tom M; Bakker, Wouter; Reijman, Max; Verhaar, Jan AN

    2007-01-01

    Background We performed a matched case control study to assess the effect of prior high tibia valgus producing osteotomy on results and complications of total knee arthroplasty (TKA). Methods From 1996 until 2003 356 patients underwent all cemented primary total knee replacement in our institution. Twelve patients with a history of 14 HTO were identified and matched to a control group of 12 patients with 14 primary TKA without previous HTO. The match was made for gender, age, date of surgery, body mass index, aetiology and type of prosthesis. Clinical and radiographic outcome were evaluated after a median duration of follow-up of 3.7 years (minimum, 2.3 years). The SPSS program was used for statistical analyses. Results The index group had more perioperative blood loss and exposure difficulties with one tibial tuberosity osteotomy and three patients with lateral retinacular releases. No such procedures were needed in the control group. Mid-term HSS, KSS and WOMAC scores were less favourable for the index group, but these differences were not significant. The tibial slope of patients with prior HTO was significantly decreased after this procedure. The tibial posterior inclination angle was corrected during knee replacement but posterior inclination was significantly less compared to the control group. No deep infection or knee component loosening were seen in the group with prior HTO. Conclusion We conclude that TKA after HTO seems to be technically more demanding than a primary knee arthroplasty, but clinical outcome was almost identical to a matched group that had no HTO previously. PMID:17683549

  1. “We’re All Looking for Solutions”: A Qualitative Study of the Management of Knee Symptoms

    PubMed Central

    MacKay, Crystal; Badley, Elizabeth M; Jaglal, Susan B; Sale, Joanna; Davis, Aileen M

    2014-01-01

    Objective While the prevalence of osteoarthritis (OA) increases with age, the first signs begin in the fourth or fifth decade. Little is known about how younger adults respond to OA. This study explores how people ages 35–65 years manage knee symptoms. Methods Six focus groups were conducted with 41 participants (mean age 50.9 years, 63% women) who self-reported a diagnosis of OA or reported knee symptoms (i.e., pain, aching, or stiffness) on most days of the past month. Purposive sampling was used, seeking variation in age and sex. The principles of constructivist grounded theory guided data collection and analysis. Data were analyzed using a constant comparative method. Results Participants engaged in a process of proactively trying to find ways to control knee symptoms and disease progression. Their approach to management was not linear, but rather a process that moved back and forth between searching for “solutions” and active management (ongoing use of strategies). During the process, participants consulted health care providers, but often perceived that medical care offered limited options and guidance. Management was constructed as a “never-ending” process that entailed effort and personal resources. Conclusion Participants were proactive in seeking ways to manage knee OA symptoms. There is a mismatch between participants’ proactive approach and the reactive approach of the health care system that has focused on late-stage disease. Programs and supports within the formal and informal health care system are required to enable people to successfully manage knee symptoms across their lifespan. PMID:24403242

  2. Knee mechanics after repair of the anterior cruciate ligament. A cadaver study of ligament augmentation.

    PubMed

    Engebretsen, L; Lew, W D; Lewis, J L; Hunter, R E

    1989-12-01

    An experimental knee-testing system was used to investigate the immediate postoperative mechanical state in knees with nonaugmented and augmented repairs of the anterior cruciate ligament. Ligament, repair tissue, and augmentation forces were measured using buckle transducers, and joint motion was measured using an instrumented spatial linkage during the application of 90 N anteriorly-directed tibial loads to seven fresh knee specimens at 0-90 degrees of flexion. Force and motion data were collected from each knee with an intact and excised anterior cruciate ligament, and after performing (1) a nonaugmented repair and an augmented repair using the Ligament Augmentation Device (3M Company) placed either (2) anatomically through the lateral femoral condyle or (3) in the over-the-top position. The forces in the nonaugmented repair and the repair with the augmentation in the two positions were greater than the forces in the intact anterior cruciate ligament with the knee under the same anterior loads; this difference from normal was not significant with the over-the-top augmentation. With the augmentation anatomically placed, the load sharing did not reduce the force in the repair tissue as compared with the nonaugmented case. The over-the-top augmentation, on the other hand, lowered the repair tissue forces at extension while avoiding high repair tissue forces in flexion. The tibia was consistently in an externally rotated configuration compared with normal in both the unloaded and anterior load states with all three repair procedures.

  3. Skin surface pressure beneath an above-the-knee cast: plaster casts compared with fiberglass casts.

    PubMed

    Davids, J R; Frick, S L; Skewes, E; Blackhurst, D W

    1997-04-01

    Complications related to immobilization in a cast after an injury or an operation may be related to the materials used for the cast or to the techniques of application, or to both. To evaluate the widely held clinical opinion that the use of a fiberglass cast is dangerous and inappropriate when subsequent swelling of the extremity is anticipated, we studied the skin surface pressures that were generated beneath above-the-knee casts made with different materials and applied with different techniques. A prosthetic model of the lower extremity was designed with an expandable calf compartment to simulate swelling after an injury or an operation. With use of this model, we measured the skin surface pressure beneath a plaster-of-Paris cast, a fiberglass cast that had been applied with a standard technique, and a fiberglass cast that had been applied with a stretch-relax technique. The highest mean skin surface pressure after application of the cast (p < 0.001) and after simulated swelling of the limb (p = 0.04) was generated by the fiberglass cast that had been applied with a standard technique. The lowest mean skin surface pressure after application of the cast (p = 0.006), simulated swelling of the limb (p < 0.001), and all subsequent steps of the experimental protocol (p < 0.001) was generated by the fiberglass cast that had been applied with the stretch-relax technique. The mean skin surface pressure generated by the plaster cast and by the fiberglass cast applied with the standard technique did not return to the value before application of the cast until anterior and posterior longitudinal cuts had been made in the cast and the cast had been spread at those cuts. When the fiber-glass cast had been applied with the stretch-relax technique, the mean pressure returned to the baseline value after only an anterior longitudinal cut and spreading at that cut. The principal pitfall of the use of a fiberglass cast is related to the technique of application. When the

  4. Comparative assessment of knee joint models used in multi-body kinematics optimisation for soft tissue artefact compensation.

    PubMed

    Richard, Vincent; Cappozzo, Aurelio; Dumas, Raphaël

    2017-01-31

    Estimating joint kinematics from skin-marker trajectories recorded using stereophotogrammetry is complicated by soft tissue artefact (STA), an inexorable source of error. One solution is to use a bone pose estimator based on multi-body kinematics optimisation (MKO) embedding joint constraints to compensate for STA. However, there is some debate over the effectiveness of this method. The present study aimed to quantitatively assess the degree of agreement between reference (i.e., artefact-free) knee joint kinematics and the same kinematics estimated using MKO embedding six different knee joint models. The following motor tasks were assessed: level walking, hopping, cutting, running, sit-to-stand, and step-up. Reference knee kinematics was taken from pin-marker or biplane fluoroscopic data acquired concurrently with skin-marker data, made available by the respective authors. For each motor task, Bland-Altman analysis revealed that the performance of MKO varied according to the joint model used, with a wide discrepancy in results across degrees of freedom (DoFs), models and motor tasks (with a bias between -10.2° and 13.2° and between -10.2mm and 7.2mm, and with a confidence interval up to ±14.8° and ±11.1mm, for rotation and displacement, respectively). It can be concluded that, while MKO might occasionally improve kinematics estimation, as implemented to date it does not represent a reliable solution to the STA issue.

  5. Walking Exercise Simultaneously Combined With Neuromuscular Electrical Stimulation of Antagonists Resistance Improved Muscle Strength, Physical Function, and Knee Pain in Symptomatic Knee Osteoarthritis: A Single-Arm Study.

    PubMed

    Matsuse, Hiroo; Hashida, Ryuki; Takano, Yoshio; Omoto, Masayuki; Nago, Takeshi; Bekki, Masafumi; Shiba, Naoto

    2017-01-01

    Matsuse, H, Hashida, R, Takano, Y, Omoto, M, Nago, T, Bekki, M, and Shiba, N. Walking exercise simultaneously combined with neuromuscular electrical stimulation of antagonists resistance improved muscle strength, physical function, and knee pain in symptomatic knee osteoarthritis: a single-arm study. J Strength Cond Res 31(1): 171-180, 2017-A hybrid training system (HTS) was developed as a way to combine the application of electrical stimulation and voluntary contraction. Moreover, we developed a novel training method using HTS during walking (HTSW). This study was designed to evaluate the effect of HTSW on muscle strength, physical function, and knee pain in knee osteoarthritis (KOA). Eleven subjects (age: 74.0 ± 8.5 years) participated and performed HTSW for 30 minutes 3 times a week for 12 weeks. Isokinetic knee extension/knee flexion torque, muscle volume, one-leg standing test (OST), functional reach test, 10-m maximum gait speed, timed up and go test, 6-minute walking test, knee pain using Visual Analog Scale (VAS), and Japan Knee Osteoarthritis Measure (JKOM) were assessed. Knee extension torque significantly increased from 1.02 ± 0.29 N·m·kg pretraining to 1.23 ± 0.33 N·m·kg posttraining (P < 0.01, ES = 0.68). Knee flexion torque significantly increased from 0.65 ± 0.18 N·m·kg pretraining to 0.78 ± 0.17 N·m·kg posttraining (p < 0.01). Muscle volume significantly increased from 9.00 ± 2.84 mm pretraining to 10.37 ± 3.16 mm at the end of training (p ≤ 0.05). All the physical functions except OST were significantly improved. The JKOM score improved from 26.7 ± 18.30 pretraining to 17.2 ± 14.02 at the end of training (p < 0.01). The VAS score significantly decreased from 35.4 ± 22.59 pretraining to 16.5 ± 19.73 at the end of training (p ≤ 0.05). Hybrid training system during walking may be an effective training method for the treatment of people with KOA.

  6. MRI Based Comparison of Tibial Bone Coverage by Five Knee Prosthesis: Anthropometric Study in Indians.

    PubMed

    Shah, Sourabh; Agarwal, Naresh; Jain, Anuj; Srivastav, Shekhar; Thomas, Simon; Agarwal, Shekhar

    2015-09-01

    This MRI based study evaluates morphological differences of proximal tibia (total cross-sectional area, mediolateral and anteroposterior distance) 8-10 mm distal to the lateral tibial plateau. We evaluated the difference in the coverage of the tibial surface between symmetric and asymmetric tibial trays and difference in coverage between males and females. 150 patients who underwent MRI scans for sports related soft tissue injury without osteoarthritis were studied. The tibial trays of the 5 total knee arthroplasty designs (4 symmetric and 1 asymmetric) were scanned. Mean total tibial coverage of all designs was more than 80%. Asymmetric baseplate had maximum total tibial coverage and maximum rate of optimal fit, with only 2% absolute overhang posterolaterally. Females had better tibial coverage as compared to males.

  7. Variability of Measurement of Patellofemoral Indices with Knee Flexion and Quadriceps Contraction: An MRI-Based Anatomical Study

    PubMed Central

    Laugharne, Edward; Bali, Navi; Purushothamdas, Sanjay; Almallah, Faris; Kundra, Rik

    2016-01-01

    Purpose The purpose of this study was to investigate the impact of varying knee flexion and quadriceps activity on patellofemoral indices measured on magnetic resonance imaging (MRI). Materials and Methods MRI of the knee was performed in 20 patients for indications other than patellar or patellofemoral pathology. Axial and sagittal sequences were performed in full extension of the knee with the quadriceps relaxed, full extension of the knee with the quadriceps contracted, 30° flexion of the knee with the quadriceps relaxed, and 30° flexion with the quadriceps contracted. Bisect offset, patella tilt angle, Insall-Salvati ratio and Caton-Deschamps index were measured. Results With the knee flexed to 30° and quadriceps relaxed, the mean values of patellar tilt angle, bisect offset, Insall-Salvati ratio and Caton-Deschamps index were all within normal limits. With the knee extended and quadriceps contracted, the mean patellar tilt angle (normal value, <15°) was 14.6° and the bisect offset (normal value, <65%) was 65%, while the Caton-Deschamps index was 1.34 (normal range, 0.6 to 1.3). With the knee extended and quadriceps relaxed, the mean Caton-Deschamps index was 1.31. Conclusions MRI scanning of the knee in extension with the quadriceps contracted leads to elevated patellofemoral indices. MRI taken with the knee in 30° of flexion allows more reliable assessment of the patellofemoral joint and minimises the confounding effect of quadriceps contraction. PMID:27894177

  8. Anterior knee pain and cold knees: a possible association in women.

    PubMed

    Selfe, James; Sutton, Chris; Hardaker, Natalie J; Greenhalgh, Sue; Karki, Anne; Dey, Paola

    2010-10-01

    Abnormal reactions to environmental cold have been observed in some patients with Anterior Knee Pain (AKP). The aims of this study were to investigate whether palpation of the knee could classify patients into those with and those without cold knees; whether this classification could be objectively validated using thermal imaging; whether the cold and not cold knee groups varied in response to a cold stress test and in patient-reported measures. Fifty eight patients were recruited; palpation classified them into cold and not cold groups. Twenty-one (36%) patients were classified as having a cold knee by palpation: fourteen (36%) females and seven males (37%). Preliminary analysis suggested gender might be an effect modifier and the number of men was small, therefore the analysis focussed on females. Women with cold knees had a significantly smaller patellar skin fold, lower levels of activity and worse scores on the MFIQ, there also appeared to be an association with a traumatic onset. Women with cold knees were more likely to report cold weather affected their knees and they preferred a hot water bottle compared to an ice-pack on their knee; there was also a trend towards having to wear extra tights/long johns in the winter. This study has helped to define a clinical profile for a group of females with AKP and cold knees. This group appears to demonstrate a mild form of Reflex Sympathetic Dystrophy.

  9. A Study of Epiphyses in the Young Prepubescent Knee Using Magnetic Resonance Imaging

    PubMed Central

    Davis, Derik L.; Chen, Lina; Ehinger, Melanie

    2014-01-01

    Background: Questions have been raised concerning the safety of intra-articular anterior cruciate ligament (ACL) reconstruction in prepubescent children aged <7 years. However, normal values for the width of the lateral femoral condylar epiphysis and height of the tibial epiphysis have yet to be established through the use of magnetic resonance imaging (MRI). Purpose: To determine normal values for the width of the lateral femoral condylar epiphysis and height of the tibial epiphysis at the knee in prepubescent children aged <7 years by use of MRI and to compare this age group with an older cohort of prepubescent children aged <10 years. Study Design: Cross-sectional study; Level of evidence, 3. Methods: An electronic search was conducted for pediatric knee MRI examinations at the authors’ institution from March 2003 to March 2013. The total and ossified lateral femoral condylar widths were determined on coronal proton density–weighted images. The total and ossified tibial epiphyseal heights were recorded on the sagittal T1-weighted image best containing the ACL footplate. The intraclass correlation coefficient (ICC) was calculated to determine interobserver agreement. Knees were stratified by age into 2 groups: children between the ages of 3 and 6 years (group 1) and children between the ages of 7 and 9 years (group 2). Each cohort was further stratified by sex. Results: Group 1 consisted of 10 children (mean age, 4.3 years) and group 2 consisted of 10 children (mean age, 8.5 years). There were a total of 20 knees. There was a statistically significant difference between groups 1 and 2 for the ossified lateral femoral condylar width where femoral tunnel location would be expected (20.00 ± 4.20 vs 26.27 ± 4.12 mm, respectively; P = .0035) and for total lateral femoral condylar width (25.57 ± 3.47 vs 29.43 ± 4.04 mm, respectively; P = .0339). No difference was found for total tibial epiphyseal height between the 2 groups. However, there was a difference

  10. Continuous femoral nerve blockade and single-shot sciatic nerve block promotes better analgesia and lower bleeding for total knee arthroplasty compared to intrathecal morphine: a randomized trial.

    PubMed

    Álvarez, Nora Elizabeth Rojas; Ledesma, Rosemberg Jairo Gomez; Hamaji, Adilson; Hamaji, Marcelo Waldir Mian; Vieira, Joaquim Edson

    2017-05-12

    Knee arthroplasty leads to postoperative pain. This study compares analgesia and postoperative bleeding achieved by intrathecal morphine with a continuous femoral plus single-shot sciatic nerve block. A randomized non-blinded clinical trial enrolled patients aged over 18 years old, ASA I to III who underwent total knee arthroplasty. All patients underwent spinal anesthesia with isobaric bupivacaine, 20 mg. One group received 100 mcg of intrathecal morphine (M group), and the other received a femoral nerve block by continuous infusion plus a "single shot" block of the sciatic nerve at the end of the surgery (FI group). Pain score from verbal numeric rating scale (VNRS) and morphine consumption during the first 72 h, as well as motor blockade, adverse effects, and postoperative bleeding were recorded. Analysis of variance of repeated measures with Bonferroni post-test, t-test and Fisher exact test were used for statistical analysis. Thirty nine patients completed the study (M = 20; FI = 19 patients) and were similar except for higher age in the FI group. Motor blockade as well as movement pain during postanesthesia care unit (PACU) staying were not different between the groups, but movement pain was significantly lower in FI group after 24 h. Postoperative bleeding (ml) was lower in FI group. Continuous femoral nerve block combined with sciatic nerve block provides effective for postoperative analgesia in patients undergoing total knee arthroplasty, with lower pain scores after 24 h and a lower incidence of adverse effects and bleeding compared to intrathecal morphine. Retrospectively registered on https://clinicaltrials.gov/ under identifier NCT02882152 , 23(rd) December, 2016.

  11. A study of pre-operative presence of micro-organisms in affected knee joints of rheumatoid arthritis patients who need total knee arthroplasty.

    PubMed

    Luo, Jiang-Ming; Guo, Lin; Chen, Hao; Yang, Peng-Fei; Xiong, Ran; Peng, Yang; Yang, Liu

    2017-03-01

    To evaluate, by way of intraoperative tissue culture and pathological study, the pre-operative presence of micro-organisms in knee joints of patients with rheumatoid arthritis (RA) who need total knee arthroplasty (TKA). From November 2012 to January 2014, 47 patients with RA (53 knees) who needed TKA were included in this study. Patients received routine pre-operative examination and joint fluid routine and culture. Each RA patient was match-paired with one osteoarthritis (OA) patient. During arthrotomy, synovial tissue was reserved and portioned for culture, frozen section, and routine pathologic examination. Pre-operative infection in all knees was ruled out. There were 12 RA patients (13 knees) with positive culture results: two Escherichia coli, two Staphylococcus epidermidis, two Staphylococcus aureus, one Proteus mirabilis, one Staphylococcus warneri, one Enterococcus faecalis, one Acinetobacter baumannii, one Candida albicans, one Ochrobactrum anthropi, and one Candida glabrata. Except for microabscess found in one RA patient, all pathological sections showed mild chronic inflammation but no infection. All patients with positive culture results were administered sensitive antibiotics for six weeks after surgery. Two patients had deep infection: one had a fused knee after a failed debridement, and the second was previously treated with an amphotericin injection. Pre-operative presence of micro-organism in knee joints of RA patients is common (24.5%). This finding of a high incidence of pre-operative presence of micro-organism in joints of RA patients before arthroplasty may suggest a role of micro-organism in the pathogenesis of prosthetic joint infection (PJI). Intraoperative synovial tissue culture is valuable for diagnosis of this condition and in instruction of antibacterial treatment. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. Kinematic Analysis of a Posterior-stabilized Knee Prosthesis

    PubMed Central

    Zhao, Zhi-Xin; Wen, Liang; Qu, Tie-Bing; Hou, Li-Li; Xiang, Dong; Bin, Jia

    2015-01-01

    Background: The goal of total knee arthroplasty (TKA) is to restore knee kinematics. Knee prosthesis design plays a very important role in successful restoration. Here, kinematics models of normal and prosthetic knees were created and validated using previously published data. Methods: Computed tomography and magnetic resonance imaging scans of a healthy, anticorrosive female cadaver were used to establish a model of the entire lower limbs, including the femur, tibia, patella, fibula, distal femur cartilage, and medial and lateral menisci, as well as the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments. The data from the three-dimensional models of the normal knee joint and a posterior-stabilized (PS) knee prosthesis were imported into finite element analysis software to create the final kinematic model of the TKA prosthesis, which was then validated by comparison with a previous study. The displacement of the medial/lateral femur and the internal rotation angle of the tibia were analyzed during 0–135° flexion. Results: Both the output data trends and the measured values derived from the normal knee's kinematics model were very close to the results reported in a previous in vivo study, suggesting that this model can be used for further analyses. The PS knee prosthesis underwent an abnormal forward displacement compared with the normal knee and has insufficient, or insufficiently aggressive, “rollback” compared with the lateral femur of the normal knee. In addition, a certain degree of reverse rotation occurs during flexion of the PS knee prosthesis. Conclusions: There were still several differences between the kinematics of the PS knee prosthesis and a normal knee, suggesting room for improving the design of the PS knee prosthesis. The abnormal kinematics during early flexion shows that the design of the articular surface played a vital role in improving the kinematics of the PS knee prosthesis. PMID:25591565

  13. EFFECTS OF THE GENIUM MICROPROCESSOR KNEE SYSTEM ON KNEE MOMENT SYMMETRY DURING HILL WALKING

    PubMed Central

    Highsmith, M. Jason; Klenow, Tyler D.; Kahle, Jason T.; Wernke, Matthew M.; Carey, Stephanie L.; Miro, Rebecca M.; Lura, Derek J.

    2016-01-01

    Use of the Genium microprocessor knee (MPK) system reportedly improves knee kinematics during walking and other functional tasks compared to other MPK systems. This improved kinematic pattern was observed when walking on different hill conditions and at different speeds. Given the improved kinematics associated with hill walking while using the Genium, a similar improvement in the symmetry of knee kinetics is also feasible. The purpose of this study was to determine if Genium MPK use would reduce the degree of asymmetry (DoA) of peak stance knee flexion moment compared to the C-Leg MPK in transfemoral amputation (TFA) patients. This study used a randomized experimental crossover of TFA patients using Genium and C-Leg MPKs (n = 20). Biomechanical gait analysis by 3D motion tracking with floor mounted force plates of TFA patients ambulating at different speeds on 5° ramps was completed. Knee moment DoA was significantly different between MPK conditions in the slow and fast uphill as well as the slow and self-selected downhill conditions. In a sample of high-functioning TFA patients, Genium knee system accommodation and use improved knee moment symmetry in slow speed walking up and down a five degree ramp compared with C-Leg. Additionally, the Genium improved knee moment symmetry when walking downhill at comfortable speed. These results likely have application in other patients who could benefit from more consistent knee function, such as older patients and others who have slower walking speeds. PMID:28066523

  14. EFFECTS OF THE GENIUM MICROPROCESSOR KNEE SYSTEM ON KNEE MOMENT SYMMETRY DURING HILL WALKING.

    PubMed

    Highsmith, M Jason; Klenow, Tyler D; Kahle, Jason T; Wernke, Matthew M; Carey, Stephanie L; Miro, Rebecca M; Lura, Derek J

    2016-09-01

    Use of the Genium microprocessor knee (MPK) system reportedly improves knee kinematics during walking and other functional tasks compared to other MPK systems. This improved kinematic pattern was observed when walking on different hill conditions and at different speeds. Given the improved kinematics associated with hill walking while using the Genium, a similar improvement in the symmetry of knee kinetics is also feasible. The purpose of this study was to determine if Genium MPK use would reduce the degree of asymmetry (DoA) of peak stance knee flexion moment compared to the C-Leg MPK in transfemoral amputation (TFA) patients. This study used a randomized experimental crossover of TFA patients using Genium and C-Leg MPKs (n = 20). Biomechanical gait analysis by 3D motion tracking with floor mounted force plates of TFA patients ambulating at different speeds on 5° ramps was completed. Knee moment DoA was significantly different between MPK conditions in the slow and fast uphill as well as the slow and self-selected downhill conditions. In a sample of high-functioning TFA patients, Genium knee system accommodation and use improved knee moment symmetry in slow speed walking up and down a five degree ramp compared with C-Leg. Additionally, the Genium improved knee moment symmetry when walking downhill at comfortable speed. These results likely have application in other patients who could benefit from more consistent knee function, such as older patients and others who have slower walking speeds.

  15. ASSOCIATIONS OF LEG LENGTH INEQUALITY WITH PREVALENT, INCIDENT, AND PROGRESSIVE KNEE OSTEOARTHRITIS: A COHORT STUDY

    PubMed Central

    Harvey, WF; Yang, M; Cooke, TDV; Segal, N; Lane, N; Lewis, CE; Felson, DT

    2010-01-01

    Background Leg length inequality is common in the general population and may accelerate development of knee osteoarthritis. Objective To determine if leg length inequality is associated with prevalent, incident and progressive knee osteoarthritis, Design Prospective observational cohort study. Setting Subjects recruited from the community in Birmingham, AL and Iowa City, IA Patients 3026 subjects, age 50-79, with or at high risk for knee osteoarthritis. Measurements The exposure was leg length inequality measured from full limb radiographs. The outcomes were prevalent, incident, and progressive knee osteoarthritis. Radiographic osteoarthritis was defined as Kellgren and Lawrence grade ≥2 and symptomatic osteoarthritis was defined as radiographic disease in a consistently painful knee. Results Leg length inequality ≥1 cm was associated with prevalent radiographic (53% vs. 36%, OR 1.9, 95%CI 1.5-2.4) and symptomatic (30% vs. 17%, OR 2.0, 95%CI 1.6-2.6) osteoarthritis in the shorter limb. Inequality ≥1 cm was associated with incident symptomatic osteoarthritis in the shorter (15% vs. 9%, OR 1.7, 95%CI 1.2-2.4) and longer (13% vs. 9%, OR 1.5, 95%CI 1.0-2.1) limb. Inequality ≥1 cm was associated with increased odds (29% vs. 24%, OR 1.3, 95%CI 1.0-1.7) of progressive osteoarthritis in the shorter limb. Limitations The duration of follow-up may not be long enough to adequately identify cases of incidence and progression. Measurements of leg length, including radiographic, have measurement error which could result in misclassification. Conclusions Radiographic leg length inequality was associated with prevalent, incident symptomatic and progressive knee osteoarthritis. These results point to leg length inequality as a potentially modifiable risk factor for knee osteoarthritis. Primary Funding Source National Institute on Aging PMID:20194234

  16. The cemented twin-peg Oxford partial knee replacement survivorship: a cohort study.

    PubMed

    White, Stephen H; Roberts, Sharon; Kuiper, Jan Herman

    2015-09-01

    A new twin-peg version of the Oxford knee was introduced in 2003. However, until now there has been no information about its survivorship. The aim of this study was to determine the survivorship, and the patients' perception of outcome over time. A cohort of all patients treated from 2003 until 2009 using the twin-peg Oxford partial knee was contacted. The main indication for treatment was anteromedial osteoarthritis (AMOA). The Oxford Knee Score (OKS), American Knee Society Functional (AKS-F) score and satisfaction rate were obtained, and the time-to-failure was used to perform a survival analysis. There were 249 patients treated, with 288 medial cemented implants. Of these, 248 patients with 287 implants could be contacted and implant survival or failure was verified. Their mean age was 67years (range: 34-94). The mean follow-up time was 5.1years (maximum: 9.2). The nine years cumulative implant survival rate for all cases using revision for any reason to define failure was 98% (95% CI, 84 to 100). There were no cases of femoral loosening. The mean OKS was 22 pre-operatively, 41 at two years, and 41 at final review, at which point 96% of patients were very or fairly pleased with the result. The survivorship of the twin-peg knee was better than that of the single peg knee at our centre, and appeared no worse than the results of the single peg knee at the originating centre. It can offer secure femoral fixation, sustained clinical benefit and patient satisfaction. Level IV case-series. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study.

    PubMed

    Duivenvoorden, T; Vissers, M M; Verhaar, J A N; Busschbach, J J V; Gosens, T; Bloem, R M; Bierma-Zeinstra, S M A; Reijman, M

    2013-12-01

    A subset of patients with total hip arthroplasty (THA) or total knee arthroplasty (TKA) has suboptimal postoperative results in terms of Patient Reported Outcomes (PROs), and psychological factors could contribute to these suboptimal results. To examine the prevalence of anxiety and depressive symptoms in patients undergoing primary THA or TKA preoperatively and postoperatively, and the relationship between preoperative anxiety and depressive symptoms on PROs of THA and TKA. In this prospective study patients were measured preoperatively, and 3 and 12 months postoperatively. Patients filled in the Hospital Anxiety and Depression Scale, Knee injury and Osteoarthritis Outcome Score (KOOS) or Hip disability and Osteoarthritis Outcome Score (HOOS) and a satisfaction questionnaire. Data were obtained from 149 hip and 133 knee patients. The prevalence of anxiety symptoms decreased significantly from 27.9% to 10.8% 12 months postoperatively in hip patients, and from 20.3% to 14.8% in knee patients. Depressive symptoms decreased significantly from 33.6% to 12.1% 12 months postoperatively in hip patients, and from 22.7% to 11.7% in knee patients. In hip and knee patients, preoperative depressive symptoms predicted smaller changes in different HOOS or KOOS subscales and patients were less satisfied 12 months postoperatively. Preoperatively, the prevalence of anxiety and depressive symptoms was high. At 3 and 12 months postoperatively, the prevalence of anxiety and depressive symptoms was decreased in both hip and knee patients. However, patients with preoperative anxiety and depressive symptoms had worse PROs 3 and 12 months after THA and TKA and were less satisfied than patients without anxiety or depressive symptoms. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  18. A Randomized Trial Comparing the Safety and Efficacy of Intravenous Ibuprofen versus Ibuprofen and Acetaminophen in Knee or Hip Arthroplasty.

    PubMed

    Gupta, Anita; Abubaker, Hawa; Demas, Eleni; Ahrendtsen, Leigh

    2016-07-01

    All surgical procedures are associated with a degree of pain. The experience of uncontrolled post-operative pain can have significant implications on health care costs. Recent studies have demonstrated that intravenous (IV) ibuprofen is an effective, safe, well-tolerated analgesic when administered for both abdominal hysterectomy and orthopedic surgery. The use of ibuprofen leads to a reduction in pain severity at rest and with movement and also decreases narcotic consumption. IV acetaminophen has also been shown to be effective in alleviating pain for surgical procedures. Given the established safety and efficacy of IV ibuprofen and IV acetaminophen for perioperative pain, we were interested in determining if any potential synergies are afforded by the simultaneous administration of both medications in orthopedic surgery patients. Compare the safety and efficacy of the perioperative administration of IV ibuprofen alone and in combination with IV acetaminophen in total knee or hip arthroplasty. Randomized, single center, trial. Tertiary care center in Philadelphia, Pennsylvania, United States. Seventy-eight patients undergoing elective knee or hip arthroplasty were randomized into 2 groups. Group 1 received 800 mg of IV ibuprofen at induction, and 800 mg of IV ibuprofen every 6 hours until discharge or for up to 5 days. Group 2 received 800 mg IV ibuprofen at induction and 1000 mg IV acetaminophen at closure, and 800 mg IV ibuprofen plus 1000 mg IV acetaminophen every 6 hours until discharge for up to 5 days. The primary endpoint was demonstrated using the visual analog scale (VAS) pain scores. Secondary endpoints included opioid requirements, quality of recovery scale (QoR), length of post-anesthesia care unit (PACU) stay, antiemetic consumption, opioid consumption, and opioid related adverse events. Patients in Group 2 had lower VAS scores (P < 0.002) by day 3 only. Opioid requirements and adverse events were significantly less in Group 2 which was also

  19. Unicondylar knee arthroplasty: a cementless perspective

    PubMed Central

    Forsythe, Michael E.; Englund, Roy E.; Leighton, Ross K.

    2000-01-01

    Objective To compare the results of cementless unicondylar knee arthroplasty (UKA) with those already reported in a similar study on cemented UKA. Design A case-series cross-sectional study. Setting The Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax. Patients Fifty-one patients who underwent a total of 57 UKAs between May 1989 and May 1997. Inclusion criteria were osteoarthritis involving the predominantly the medial compartment of the knee, relative sparing of the other compartments, less than 15° of varus, minimal knee instability, and attendance at the postoperative clinical visit. Intervention Cementless UKA. Main outcome measures Clinical parameters that included pain, range of motion and the Knee Society Clinical Knee Score. Roentgenographic parameters that included α, β, γ and σ angles and the presence of periprosthetic radiolucency or loose beads. Results Age, weight, gender and follow-up interval did not significantly affect the clinical results in terms of pain, range of motion or knee score. Knees with more than 1 mm of radiolucency had significantly lower knee scores than those with no radiolucency. Knees that radiologically had loose beads also had significantly lower knee scores. The clinical outcomes of cementless UKA were comparable to those already reported on cemented UKA. Cementless femurs had less radiolucency than the cemented femurs, whereas cementless tibias had more radiolucency than their cemented counterparts. Conclusions Cementless UKA seems to be as efficacious as cemented UKA. However, there is some concern about the amount of radiolucency in the cementless tibial components. A randomized clinical trial comparing both cementless and cemented tibial components with a cementless femur (hybrid knee) is needed to further assess this controversial issue in UKA. PMID:11129829

  20. Assistive walking device use and knee osteoarthritis: results from the Health, Aging and Body Composition Study (Health ABC Study).

    PubMed

    Carbone, Laura D; Satterfield, Suzanne; Liu, Caiqin; Kwoh, Kent C; Neogi, Tuhina; Tolley, Elizabeth; Nevitt, Michael

    2013-02-01

    To identify factors that predicted incident use of assistive walking devices (AWDs) and to explore whether AWD use was associated with changes in osteoarthritis of the knee. Prospective cohort study. Community. Older adults (N=2639) in the Health, Aging and Body Composition (Health ABC) Study including a subset of 874 patients with prevalent knee pain. Not applicable. Incident use of AWDs, mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores, and the frequency of joint space narrowing on knee radiographs over a 3-year time period. AWD use was initiated by 9% of the entire Health ABC cohort and 12% of the knee pain subset. Factors that predicted use in both groups were age ≥73 (entire cohort: odds ratio [OR]=2.07; 95% confidence interval [CI], 1.43-3.01; knee pain subset: OR=1.87; 95% CI, 1.16-3.03), black race (entire cohort: OR=2.95; 95% CI, 2.09-4.16; knee pain subset: OR=3.21; 95% CI, 2.01-5.11), and lower balance ratios (entire cohort: OR=3.18; 95% CI, 2.21-4.59; knee pain subset: OR=3.77; 95% CI, 2.34-6.07). Mean WOMAC pain scores decreased slightly over time in both AWD and non-AWD users. Twenty percent of non-AWD users and 28% of AWD users had radiographic progression in joint space narrowing of the tibiofemoral joint in at least 1 knee. Fourteen percent of non-AWD users and 12% of AWD users had radiographic progression in joint space narrowing in the patellofemoral joint in at least 1 knee. AWDs are frequently used by older adults. Knee pain and balance problems are significant reasons why older adults initiate use of an AWD. In an exploratory analysis, there was no consistent relation between the use or nonuse of an AWD and WOMAC pain scores or knee joint space narrowing progression. Further studies of the relation of use of AWDs to changes in knee osteoarthritis are needed. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. Assistive Walking Device Use and Knee Osteoarthritis: the Health, Aging, and Body Composition Study (Health ABC Study)

    PubMed Central

    Carbone, Laura D.; Satterfield, Suzanne; Liu, Caiqin; Kwoh, Kent C.; Neogi, Tuhina; Tolley, Elizabeth; Nevitt, Michael

    2012-01-01

    Objectives To identify factors that predicted incident use of assistive walking devices (AWDs) and to explore whether AWD use was associated with changes in osteoarthritis of the knee. Design Prospective cohort study. Setting 2,639 elderly men and women in the Health ABC (Health, Aging and Body Composition). Study followed for incident use of AWDs, including a subset of 874 with prevalent knee pain. Participants NA Interventions NA Main Outcome Measures Incident use of AWDs, mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores and frequency of joint space narrowing on knee radiographs over a three year time period. Results AWD use was initiated by 9% of the entire Health ABC cohort and 12% of the knee pain subset. Factors that predicted use in both groups were age ≥73 [entire cohort: OR 2.07 (95% CI 1.43, 3.01); knee pain subset: OR 1.87 (95% CI 1.16, 3.03)], black race [entire cohort: OR 2.95 (95% CI 2.09, 4.16); knee pain subset: OR 3.21 (95% CI 2.01, 5.11)] and lower balance ratios [entire cohort: OR 3.18 (95% CI 2.21, 4.59); knee pain subset: OR 3.77 (95% CI 2.34, 6.07)]. Mean WOMAC pain scores decreased slightly over time in both AWD and non-AWD users. 20% of non-AWD users and 28% of AWD users had radiographic progression in joint space narrowing of the tibiofemoral joint in at least one knee. 14% of non-AWD users and 12% of AWD users had radiographic progression in joint space narrowing in the patellofemoral joint in at least one knee. Conclusions Assistive walking devices are frequently used by elderly men and women. Knee pain and balance problems are significant reasons why elderly individuals initiate use of an assistive walking device. In an exploratory analysis, there was no consistent relationship between use or nonuse of an AWD and WOMAC pain scores or knee joint space narrowing progression. Further studies of the relationship of use of AWDs to changes in knee osteoarthritis are needed. PMID:23041146

  2. Six degree-of-freedom knee joint kinematics in obese individuals with knee pain during gait.

    PubMed

    Li, Jing-Sheng; Tsai, Tsung-Yuan; Felson, David T; Li, Guoan; Lewis, Cara L

    2017-01-01

    Knee joint pain is a common symptom in obese individuals and walking is often prescribed as part of management programs. Past studies in obese individuals have focused on standing alignment and kinematics in the sagittal and coronal planes. Investigation of 6 degree-of-freedom (6DOF) knee joint kinematics during standing and gait is important to thoroughly understand knee function in obese individuals with knee pain. This study aimed to investigate the 6DOF knee joint kinematics in standing and during gait in obese patients using a validated fluoroscopic imaging system. Ten individuals with obesity and knee pain were recruited. While standing, the knee was in 7.4±6.3°of hyperextension, 2.8±3.3° of abduction and 5.6±7.3° of external rotation. The femoral center was located 0.7±3.1mm anterior and 5.1±1.5mm medial to the tibial center. During treadmill gait, the sagittal plane motion, i.e., flexion/extension and anterior-posterior translation, showed a clear pattern. Specifically, obese individuals with knee pain maintained the knee in more flexion and more anterior tibial translation during most of the stance phase of the gait cycle and had a reduced total range of knee flexion when compared to a healthy non-obese group. In conclusion, obese individuals with knee pain used hyperextension knee posture while standing, but maintained the knee in more flexion during gait with reduced overall range of motion in the 6DOF analysis.

  3. Six degree-of-freedom knee joint kinematics in obese individuals with knee pain during gait

    PubMed Central

    Li, Jing-Sheng; Tsai, Tsung-Yuan; Felson, David T.; Li, Guoan; Lewis, Cara L.

    2017-01-01

    Knee joint pain is a common symptom in obese individuals and walking is often prescribed as part of management programs. Past studies in obese individuals have focused on standing alignment and kinematics in the sagittal and coronal planes. Investigation of 6 degree-of-freedom (6DOF) knee joint kinematics during standing and gait is important to thoroughly understand knee function in obese individuals with knee pain. This study aimed to investigate the 6DOF knee joint kinematics in standing and during gait in obese patients using a validated fluoroscopic imaging system. Ten individuals with obesity and knee pain were recruited. While standing, the knee was in 7.4±6.3°of hyperextension, 2.8±3.3° of abduction and 5.6±7.3° of external rotation. The femoral center was located 0.7±3.1mm anterior and 5.1±1.5mm medial to the tibial center. During treadmill gait, the sagittal plane motion, i.e., flexion/extension and anterior-posterior translation, showed a clear pattern. Specifically, obese individuals with knee pain maintained the knee in more flexion and more anterior tibial translation during most of the stance phase of the gait cycle and had a reduced total range of knee flexion when compared to a healthy non-obese group. In conclusion, obese individuals with knee pain used hyperextension knee posture while standing, but maintained the knee in more flexion during gait with reduced overall range of motion in the 6DOF analysis. PMID:28339477

  4. Development of a Valid and Reliable Knee Articular Cartilage Condition–Specific Study Methodological Quality Score

    PubMed Central

    Harris, Joshua D.; Erickson, Brandon J.; Cvetanovich, Gregory L.; Abrams, Geoffrey D.; McCormick, Frank M.; Gupta, Anil K.; Verma, Nikhil N.; Bach, Bernard R.; Cole, Brian J.

    2014-01-01

    Background: Condition-specific questionnaires are important components in evaluation of outcomes of surgical interventions. No condition-specific study methodological quality questionnaire exists for evaluation of outcomes of articular cartilage surgery in the knee. Purpose: To develop a reliable and valid knee articular cartilage–specific study methodological quality questionnaire. Study Design: Cross-sectional study. Methods: A stepwise, a priori–designed framework was created for development of a novel questionnaire. Relevant items to the topic were identified and extracted from a recent systematic review of 194 investigations of knee articular cartilage surgery. In addition, relevant items from existing generic study methodological quality questionnaires were identified. Items for a preliminary questionnaire were generated. Redundant and irrelevant items were eliminated, and acceptable items modified. The instrument was pretested and items weighed. The instrument, the MARK score (Methodological quality of ARticular cartilage studies of the Knee), was tested for validity (criterion validity) and reliability (inter- and intraobserver). Results: A 19-item, 3-domain MARK score was developed. The 100-point scale score demonstrated face validity (focus group of 8 orthopaedic surgeons) and criterion validity (strong correlation to Cochrane Quality Assessment score and Modified Coleman Methodology Score). Interobserver reliability for the overall score was good (intraclass correlation coefficient [ICC], 0.842), and for all individual items of the MARK score, acceptable to perfect (ICC, 0.70-1.000). Intraobserver reliability ICC assessed over a 3-week interval was strong for 2 reviewers (≥0.90). Conclusion: The MARK score is a valid and reliable knee articular cartilage condition–specific study methodological quality instrument. Clinical Relevance: This condition-specific questionnaire may be used to evaluate the quality of studies reporting outcomes of

  5. Impact of Patellar Tendinopathy on Knee Proprioception: A Cross-Sectional Study.

    PubMed

    Torres, Rui; Ferreira, João; Silva, Diogo; Rodrigues, Elisa; Bessa, Isabel M; Ribeiro, Fernando

    2017-01-01

    To determine whether high-level athletes with patellar tendinopathy have diminished knee proprioceptive acuity. Cross-sectional study. University research laboratory (institutional). Twenty-one basketball and volleyball players with patellar tendinopathy (13 men and 8 women; mean age 24.5 ± 3.6; body mass index = 22.5 ± 2.0 kg/m) and an equal number of athletes without symptoms of patellar tendinopathy injury were included in this study. Participants underwent knee proprioception assessments on a single day. Furthermore, age, sex, height, weight, VISA-P (Victorian Institute of Sport Assessment) questionnaire sports participation, medical history, knee injuries, previous treatment, and medication were obtained. Knee proprioception was evaluated by assessing sense of resistance, using a weight discrimination protocol, and joint position sense (JPS). No significant differences were observed in JPS at 30 and 60 degrees of knee flexion between groups (P = 0.165 and 0.481, respectively). In regard to the ability to discriminate weight, significant differences between the 2 groups were found with the tendinopathy group showing a higher percentage of error (P = 0.009), namely when the set of incremental weights varied by 10% from the standard weight. Athletes with patellar tendinopathy have a diminished perception of force signals required for weight discrimination, whereas JPS remains unaffected in these athletes.

  6. Relationship between radiological grading and clinical status in knee osteoarthritis. a multicentric study

    PubMed Central

    2012-01-01

    Background Controversy exists regarding the relationship between radiographic findings and clinical status in knee osteoarthritis. Although the surgical indication for total knee arthroplasty (TKA) should be based on pain, clinical status, and the deterioration of quality of life, the radiographic study is the most commonly used criterion for preoperative evaluation. The objective of this study is to find out the relationship between the Ahlbäck classification and clinical status in patients undergoing TKA. Methods 1329 protocols were collected from preoperative studies in four multicentric working groups (the Interax, Duracon, Scorpio, and Triathlon Spanish groups) in 30 Spanish hospitals. Mean age was 70.4 years (SD: 6.8; range: 35 to 98); 76.3% of patients were women. Patients entered the study whenever the surgeon found that medical treatment was insufficient to control pain and functional limitation. Data were collected using electronic Case Report Forms, and included Ahlbäck grading scores, Hospital for Special Surgery Knee Score (HSS), SF-12, and other clinical and epidemiologic variables. Results According to the Ahlbäck grading system, patients were divided as follows: 243 grade I (18.3%), 358 grade II (26.9%), 416 grade III (31.3%), 241 grade IV (18.1%), and 71 grade V (5.3%). As for HSS, the following scores were obtained: <60 points in 925 patients (69.6%), 60 to 69 points in 286 patients (21.5%), 70 to 84 points in 112 patients (8.4%) and 85 to 100 points in 6 patients (0.5%). Scores showed a statistically significant difference depending on Ahlbäck grade, with a clear tendency towards decrease in HSS scores as the Ahlbäck grade increases (p<0.001). However, the HSS score difference between Ahlbäck grades I and V was of 9.56 points only. Comparing the status of the patients at the start (1994) and at the end (2010) of the data collection process, we observed that patients who underwent surgery in the last years were older and showed a lower Ahlb

  7. Operations dashboard: comparative study

    NASA Astrophysics Data System (ADS)

    Ramly, Noor Nashriq; Ismail, Ahmad Zuhairi; Aziz, Mohd Haris; Ahmad, Nurul Haszeli

    2011-10-01

    In this present days and age, there are increasing needs for companies to monitor application and infrastructure health. Apart from having proactive measures to secure their application and infrastructure, many see monitoring dashboards as crucial investment in disaster preparedness. As companies struggle to find the best solution to cater for their needs and interest for monitoring their application and infrastructure's health, this paper summarizes the studies made on several known off-the-shelf operations dashboard and in-house developed dashboard. A few criteria of good dashboard are collected from previous studies carried out by several researchers and rank them according to importance and business needs. The finalized criteria that will be discussed in later sections are data visualization, performance indicator, dashboard personalization, audit capability and alert/ notification. Comparative studies between several popular dashboards were then carried out to determine whether they met these criteria that we derived from the first exercise. The findings hopefully can be used to educate and provide an overview of selecting the best IT application and infrastructure operations dashboard that suit business needs, thus become the main contribution of this paper.

  8. Unicompartmental Knee Osteoarthritis (UKOA): Unicompartmental Knee Arthroplasty (UKA) or High Tibial Osteotomy (HTO)?

    PubMed Central

    Rodriguez-Merchan, E. Carlos

    2016-01-01

    The aim of this review article is to analyze the results of high tibial osteotomy compared to unicompartmental knee arthroplasty in patients with unicompartmental knee osteoarthritis. The search engine used was PubMed. The keywords were: “high tibial osteotomy versus unicompartmental knee arthroplasty”. Twenty-one art