RESUMEN

BACKGROUND: Cranio-cervico-mandibular (CCM) malalignment is associated with forward head posture (FHP) and temporomandibular joint (TMJ) disorders and affects masticatory muscles. OBJECTIVE: This randomized, double-blind controlled trial aimed to compare the efficacy of scapula-thoracic (ST) exercises on temporomandibular and cervical joint position sense and postural stability in individuals with CCM malalignment. METHODS: Fourty-nine participants with CCM malalignment were randomly assigned to the ST exercise group (STEG, n= 24) or the control group (CG, n= 25). STEG included progressive strengthening, proprioceptive, and stabilization exercises. All participants were assessed before treatment, at the end of the 8th week treatment period and at the 12th week post-treatment follow-up. Cranio-vertebral angle measurement, Fonseca's Questionnaire, Helkimo Clinical Dysfunction Index, TMJ position test, cervical joint position error test and postural stability assessment were used. RESULTS: The TMJ and cervical joint position sense, total sway degree, area gap percentage, sway velocity and antero-posterior body sway results showed significant improvement in the STEG compared to the CG (p< 0.05), however medio-lateral body sway did not differ between groups (p> 0.05). CONCLUSIONS: Postural stability, TMJ and cervical joint position sense appear to be affected in individuals with CCM malalignment. Our results showed that an exercise program including ST stabilization, proprioception and strengthening of the scapular muscles may be effective in the management of CCM malalignment and will allow clinicians to plan holistic treatment.

Asunto(s)

Terapia por Ejercicio , Equilibrio Postural , Propiocepción , Escápula , Humanos , Método Doble Ciego , Masculino , Femenino , Equilibrio Postural/fisiología , Propiocepción/fisiología , Terapia por Ejercicio/métodos , Adulto , Escápula/fisiopatología , Escápula/fisiología , Trastornos de la Articulación Temporomandibular/fisiopatología , Trastornos de la Articulación Temporomandibular/terapia , Trastornos de la Articulación Temporomandibular/rehabilitación , Adulto Joven , Resultado del Tratamiento , Vértebras Cervicales/fisiopatología , Articulación Temporomandibular/fisiopatología , Desviación Ósea/fisiopatología , Desviación Ósea/rehabilitación , Persona de Mediana Edad

RESUMEN

Talonavicular (TN) fusion is a common treatment for TN arthritis or deformity correction. There is incongruous evidence regarding remaining motion at the talocalcaneal and calcaneocuboid joints after TN fusion. Additionally, the effects of a malaligned TN fusion are not well understood and alignment of the fusion may be important for overall foot integrity. This project assessed the kinematic and kinetic effects of neutral and malaligned TN fusions. Ten cadaveric feet were tested on a gait simulator in four conditions: unfused, fused in neutral, fused in varus, and fused in valgus. The fusions were simulated with external fixation hardware. An eight-camera motion analysis system and a 10-segment foot model generated kinematic data, and a pressure mat captured pressure data. Simulated TN fusion was achieved in eight feet. From unfused to fused-neutral, range of motion (ROM) was not eliminated in the adjacent joints, but the positions of the joints changed significantly throughout stance phase. Furthermore, the ROM increased at the tibiotalar joint. Plantar pressure and center of pressure shifted laterally with neutral fusion. The malalignments marginally affected the ROM but changed joint positions throughout stance phase. Pressure patterns were shifted laterally in varus malalignment and medially in valgus malalignment. The residual motion and the altered kinematics at the joints in the triple joint complex after TN fusion may subsequently increase the incidence of arthritis. Clinical significance: This study quantifies the effects of talonavicular fusion and malalignment on the other joints of the triple joint complex.

Asunto(s)

Artrodesis , Cadáver , Pie , Presión , Humanos , Fenómenos Biomecánicos , Anciano , Femenino , Masculino , Rango del Movimiento Articular , Articulaciones Tarsianas , Persona de Mediana Edad , Marcha , Anciano de 80 o más Años , Astrágalo , Desviación Ósea/fisiopatología , Huesos Tarsianos

RESUMEN

CASE: An 18-year-old man with 48° of internal malrotation of the femur after nailing underwent derotational osteotomy with gait dynamics and electromyography data collected preoperatively and postoperatively. Hip abduction and internal foot progression angles were significantly deviated from normal preoperatively compared with the contralateral side. At 10 months postoperatively, the hip was abducted and externally rotated throughout the entire gait cycle. His Trendelenburg gait had resolved, and he reported no residual functional concerns. Before corrective osteotomy, walking velocity was significantly slower with shorter stride lengths. CONCLUSION: Significant internal malrotation of the femur impairs hip abduction and foot progression angles as well as gluteus medius activation during ambulation. Derotational osteotomy considerably corrected these values.

Asunto(s)

Desviación Ósea , Fémur , Fijación Intramedular de Fracturas , Osteotomía , Adolescente , Humanos , Masculino , Desviación Ósea/diagnóstico , Desviación Ósea/etiología , Desviación Ósea/fisiopatología , Desviación Ósea/cirugía , Electromiografía , Fémur/diagnóstico por imagen , Fémur/fisiopatología , Fémur/cirugía , Fijación Intramedular de Fracturas/efectos adversos , Marcha/fisiología , Análisis de la Marcha , Extremidad Inferior/diagnóstico por imagen , Extremidad Inferior/fisiopatología , Extremidad Inferior/cirugía , Osteotomía/métodos , Rotación , Caminata/fisiología , Imagenología Tridimensional

RESUMEN

BACKGROUND: Orthopaedic surgeons aim for mechanical alignment when performing total knee arthroplasty (TKA) as malalignment is associated with loosening. Loosening may be predicted by migration as measured with radiostereometric analysis (RSA), but previous RSA studies on postoperative alignment have shown contradictory results and have been limited to cemented implants and small numbers of patients. Therefore, we performed a secondary analysis of 10 previously published randomized controlled trials (RCTs) to compare migration between postoperative in-range and out-of-range cemented and uncemented TKA implants among patients with a preoperative varus or valgus knee. METHODS: All RCTs involving the use of RSA that had been conducted at 2 centers were included. Alignment was classified, with use of the hip-knee-ankle angle (HKA), as in-range (0° ± 3°) or out-of-range (<-3° or >3°). The fixation methods included cemented, uncemented-coated, and uncemented-uncoated. Migration was measured at 3, 12, and 24 months. A linear mixed model was used, with adjustment for fixation method and clustering of patients within centers. RESULTS: Of 476 TKA implants that had been out-of-range preoperatively, 290 were in-range postoperatively and 186 were out-of-range in either varus (n = 143) or valgus (n = 43) postoperatively. The mean migration at 3, 12, and 24 months was 0.73 mm (95% confidence interval [CI], 0.66 to 0.79 mm), 0.92 mm (95% CI, 0.85 to 1.00 mm), and 0.97 mm (95% CI, 0.90 to 1.05 mm), respectively, for the in-range group and 0.80 mm (95% CI, 0.72 to 0.87 mm), 0.98 (95% CI, 0.90 to 1.07 mm), and 1.04 mm (95% CI, 0.95 to 1.13 mm), respectively, for the out-of-range group (p = 0.07). The fixation method significantly influenced migration, with uncemented-uncoated implants migrating more than cemented and uncemented-coated implants (p < 0.001). CONCLUSIONS: Postoperative alignment did not influence migration of TKAs in the first 2 postoperative years in patients with preoperative varus or valgus alignment of the knee. However, the fixation method significantly influenced migration, with uncemented-uncoated implants showing the greatest migration. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Asunto(s)

Artroplastia de Reemplazo de Rodilla/efectos adversos , Desviación Ósea/complicaciones , Articulación de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/cirugía , Falla de Prótesis , Anciano , Artroplastia de Reemplazo de Rodilla/instrumentación , Desviación Ósea/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla/efectos adversos , Masculino , Persona de Mediana Edad , Análisis Radioestereométrico , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento

RESUMEN

PURPOSE: Gait and posture disorder severely impedes the quality of life of affected patients with lumbar spinal canal stenosis (LSCS). Despite the major health concern, there is a paucity of literature about the relationships among spatiotemporal gait parameters and spinal sagittal parameters. This is a cross sectional study performed in a single tertiary referral center to determine the relationships among spatiotemporal gait parameters and spinal sagittal parameters in patients with LSCS. METHODS: A total of 164 consecutive patients with LSCS, 87 men and 77 women with mean age of 70.7 years, were enrolled. Spatiotemporal gait parameters were studied using a gait analysis system. Spinal sagittal parameters were studied including sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic inclination (PI), and pelvic tilt (PT) both in the neutral and stepped positions. RESULTS: SVA was significantly larger in the stepped position than in the neutral position (neutral position, 72.5 mm; stepped position, 96.8 mm; p = 0.003). Parameters regarding the pelvis exhibited significant differences, which could represent pelvic anteversion in the stepped position. By stepwise multiple regression analysis, the prediction models, containing SVA (neutral) and PT (stepped) for double supporting phase, exhibited statistical significance, and accounted for approximately 50% of the variance. CONCLUSIONS: The present study provides statistically established evidence of correlation among spatiotemporal gait parameters and spinal sagittal parameters. Differences between sagittal parameters in neutral and stepped position may stand for the postural control during gait cycle, and increased SVA in neutral position and increased PT in stepped position may correlate with prolonged double supporting phase.

Asunto(s)

Trastornos Neurológicos de la Marcha/fisiopatología , Marcha/fisiología , Vértebras Lumbares , Equilibrio Postural/fisiología , Estenosis Espinal , Caminata/fisiología , Adulto , Anciano , Desviación Ósea/diagnóstico por imagen , Desviación Ósea/fisiopatología , Estudios Transversales , Femenino , Análisis de la Marcha , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/fisiopatología , Postura/fisiología , Calidad de Vida , Estudios Retrospectivos , Curvaturas de la Columna Vertebral/diagnóstico por imagen , Curvaturas de la Columna Vertebral/fisiopatología , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/fisiopatología , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/fisiopatología

RESUMEN

OBJECTIVE: Frontal plane knee alignment plays an integral role in tibiofemoral knee osteoarthritis development and progression. Accessible methods for obtaining direct or indirect measures of knee alignment may help inform clinical decision making when specialized equipment is unavailable. The present study evaluated the concurrent validity, as well as intersession (within-rater) and interrater (within-session) reliability of smartphone inclinometry for measuring static frontal plane tibial alignment-a known proxy of frontal plane knee alignment. METHODS: Twenty healthy individuals and 38 patients with knee osteoarthritis were measured for frontal plane tibial alignment by a pair of raters using smartphone inclinometry, manual inclinometry, and 3-dimensional motion capture simultaneously. Healthy participants were measured on 2 separate days. Bland-Altman analysis, supplemented with intraclass correlation coefficient (ICC)(2,k), was used to assess concurrent validity. ICC(2,k), SEM, and minimum detectable change with 95% confidence limits (MDC95) were used to assess measurement reliability. RESULTS: Compared against motion capture, smartphone inclinometry measured frontal plane tibial alignment with a mean difference of 0.7 and 1.1 degrees (biased toward varus) for healthy participants and participants with knee osteoarthritis, respectively (ICC[2,k] ≥ 0.87). Smartphone inclinometry measurements demonstrated adequate intersession (within-rater) relative (ICC[2,k] = 0.91) and absolute (SEM = 0.7 degrees; MDC95 = 1.8 degrees) reliability, which outperformed manual inclinometry (ICC[2,k] = 0.85; SEM = 1.0 degrees; MDC95 = 2.6 degrees). Interrater (within-session) reliability of smartphone inclinometry was acceptable in both cohorts (ICC[2,k] = 0.93; SEM = 0.4 degrees to 1.2 degrees; MDC95 = 1.2 degrees to 3.2 degrees). CONCLUSION: Smartphone inclinometry is sufficiently valid and reliable for measuring frontal plane tibial alignment in healthy individuals and patients with medial tibiofemoral knee osteoarthritis. IMPACT: Smartphones are readily accessible by clinicians and researchers. Our assessment of measurement validity and reliability supports the use of smartphone inclinometry as a clinically available tool to measure frontal plane tibial alignment without medical imaging or specialized equipment.

Asunto(s)

Desviación Ósea/fisiopatología , Aplicaciones Móviles/estadística & datos numéricos , Osteoartritis de la Rodilla/fisiopatología , Rango del Movimiento Articular/fisiología , Teléfono Inteligente/normas , Tibia/fisiología , Adulto , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Adulto Joven

RESUMEN

AIMS: A comprehensive classification for coronal lower limb alignment with predictive capabilities for knee balance would be beneficial in total knee arthroplasty (TKA). This paper describes the Coronal Plane Alignment of the Knee (CPAK) classification and examines its utility in preoperative soft tissue balance prediction, comparing kinematic alignment (KA) to mechanical alignment (MA). METHODS: A radiological analysis of 500 healthy and 500 osteoarthritic (OA) knees was used to assess the applicability of the CPAK classification. CPAK comprises nine phenotypes based on the arithmetic HKA (aHKA) that estimates constitutional limb alignment and joint line obliquity (JLO). Intraoperative balance was compared within each phenotype in a cohort of 138 computer-assisted TKAs randomized to KA or MA. Primary outcomes included descriptive analyses of healthy and OA groups per CPAK type, and comparison of balance at 10° of flexion within each type. Secondary outcomes assessed balance at 45° and 90° and bone recuts required to achieve final knee balance within each CPAK type. RESULTS: There was similar frequency distribution between healthy and arthritic groups across all CPAK types. The most common categories were Type II (39.2% healthy vs 32.2% OA), Type I (26.4% healthy vs 19.4% OA) and Type V (15.4% healthy vs 14.6% OA). CPAK Types VII, VIII, and IX were rare in both populations. Across all CPAK types, a greater proportion of KA TKAs achieved optimal balance compared to MA. This effect was largest, and statistically significant, in CPAK Types I (100% KA vs 15% MA; p < 0.001), Type II (78% KA vs 46% MA; p = 0.018). and Type IV (89% KA vs 0% MA; p < 0.001). CONCLUSION: CPAK is a pragmatic, comprehensive classification for coronal knee alignment, based on constitutional alignment and JLO, that can be used in healthy and arthritic knees. CPAK identifies which knee phenotypes may benefit most from KA when optimization of soft tissue balance is prioritized. Further, it will allow for consistency of reporting in future studies. Cite this article: Bone Joint J 2021;103-B(2):329-337.

Asunto(s)

Artroplastia de Reemplazo de Rodilla , Desviación Ósea/clasificación , Articulación de la Rodilla/patología , Osteoartritis de la Rodilla/cirugía , Atención Perioperativa/métodos , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/métodos , Fenómenos Biomecánicos , Desviación Ósea/complicaciones , Desviación Ósea/diagnóstico , Desviación Ósea/fisiopatología , Estudios de Casos y Controles , Femenino , Humanos , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/patología , Osteoartritis de la Rodilla/fisiopatología , Equilibrio Postural , Estudios Prospectivos , Resultado del Tratamiento

RESUMEN

The purpose of this work is to identify the resting stance of the torso, defined as the position of the C7 vertebral body relative to the sacrum in a 'birds eye view', as the coronal and sagittal offset, in those without spinal deformity, those with pre and post-operative AIS, and those with Scheuermann's kyphosis (SK). Using ISIS2 surface topography, the coronal and sagittal offset were measured in a prospective manner in all groups. With bivariate ellipses, a mean and 95% confidence ellipse of the data was developed. Statistical analyses was performed to examine the distribution of the data from the groups. A graphical representation of the data was developed. There were 829 without spinal deformity, 289 in both the pre and post-operative with AIS and 59 with SK. The results showed that the mean coronal offset for all groups was between 2 and 6 mm and the sagittal offset was 12 and 26 mm. Statistically significance was seen for both measures between the non-scoliotic and both AIS groups, along with the pre-operative AIS coronal offset and post-operative AIS sagittal offset and the SK measures. However, all mean values were within the 95% confidence ellipse for all of the groups. Regardless of the size or type of spinal deformity, the position of the C7 vertebral body and sacrum remain within the 95% confidence ellipse of that seen in those without spinal deformity. This work defines the Minimally Clinically Important Difference for all of the groups.

Asunto(s)

Enfermedades de la Columna Vertebral/fisiopatología , Torso/fisiopatología , Adolescente , Desviación Ósea/fisiopatología , Femenino , Humanos , Cifosis/fisiopatología , Lordosis/fisiopatología , Masculino , Escoliosis/fisiopatología

RESUMEN

PURPOSE: This study aimed to use MRI to evaluate the fibula and talus position difference in functional and mechanical ankle stability patients. METHODS: 61 and 68 patients with functional and mechanical instability, and 60 healthy volunteers were involved. Based on the axial MRI images, the rotation of the talus was identified through the Malleolar Talus Index (MTI). The position relative to the talus (Axial Malleolar Index, AMI) and medial malleolus (Intermalleolar Index, IMI) were used to evaluated the displacement of the fibula. RESULTS: Post hoc analysis showed that the values of malleolar talus index was significantly larger among mechanical instability (89.18° ± 2.31°) than that in functional instability patients (86.55° ±61.65°, P < 0.001) and healthy volunteers (85.59° ± 2.42°, P < 0.001). The axial malleolar index of the mechanical instability patients (11.39° ± 1.41°) were significantly larger than healthy volunteers (7.91° ± 0.83°) (P < 0.0001). There were no statistically significant differences in the above three indexes between the functional instability patients and healthy volunteers. CONCLUSION: The functional instability patients didn't have a posteriorly positioned fibula and an internally rotated talus. The malleolar talus index was significantly larger among mechanical instability patients than that in functional instability patients. Increased malleolar talus index may become a new indirect MRI sign for identifying functional and mechanical instability patients.

Asunto(s)

Articulación del Tobillo/diagnóstico por imagen , Desviación Ósea/diagnóstico por imagen , Peroné/diagnóstico por imagen , Inestabilidad de la Articulación/diagnóstico por imagen , Astrágalo/diagnóstico por imagen , Adulto , Anatomía Transversal , Traumatismos del Tobillo/etiología , Traumatismos del Tobillo/fisiopatología , Articulación del Tobillo/fisiopatología , Desviación Ósea/fisiopatología , Femenino , Peroné/fisiopatología , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Rotación , Astrágalo/fisiopatología , Adulto Joven

RESUMEN

PURPOSE: In cases of suspected rotational deformity of the lower limb, in particular in post-traumatic malalignment following closed nailing, there is a lack of adequate reference values. Available publications on leg rotation have either small sample sizes or do not include bilateral or whole leg rotation of healthy legs. This study aimed to determine side-specific reference values of lower limb rotation in a large healthy sample. This may be helpful in acute clinical settings as well as for medical expert opinion. METHODS: 226 consecutive bilateral lower limb computed tomography (CT) angiographies were screened. 105 patients (210 legs) were included (40 females, 65 males, mean age 67 ± 12 years). Bilateral axial femoral and tibial rotation alignment were independently measured and overall leg rotation was computed by two methods. Distributions, sex, and side differences were analyzed. RESULTS: Two-sided paired t tests showed significant differences between right and left for all measurements. The left side showed a more pronounced mean anteversion in the femur of 2.2° (p = 0.002) and the right side higher mean external rotation in the tibia of 2.8° (p < 0.001). Overall leg rotation showed 5.1° more mean external rotation on the right side (p < 0.001) with both methods. Absolute side-to-side whole leg rotation difference was 9.5°. Absolute differences between both methods were 3.3°. The variance was high. 23 femora were retroverted, 1 tibia internally rotated, and 9 legs were overall internally rotated. No variables differed between female and male subjects except for femoral version (right p = 0.003 and left p = 0.002). Correlation coefficients were high (rho 0.550-0.934, all p < 0.001). CONCLUSION: There is a significant prevalence of side-to-side asymmetry in femoro-tibial torsion. Although side-to-side differences are not extraordinary, comparative axial femoro-tibial rotation alignment should always be interpreted with caution. LEVEL OF EVIDENCE: Diagnostic, retrospective cohort study, level III.

Asunto(s)

Fémur/diagnóstico por imagen , Tibia/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Anciano , Desviación Ósea/fisiopatología , Desviación Ósea/cirugía , Femenino , Fémur/fisiología , Fémur/cirugía , Fijación Intramedular de Fracturas/métodos , Voluntarios Sanos , Humanos , Pierna/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Valores de Referencia , Estudios Retrospectivos , Rotación , Tibia/fisiología , Tibia/cirugía

RESUMEN

OBJECTIVE: Although mechanically-induced inflammation is an appealing explanation linking different etiologic factors in osteoarthritis (OA), clinical research investigating changes in both biomechanics and joint inflammation is limited. The purpose of this study was to evaluate the association between change in surrogate measures of knee load and knee effusion-synovitis in patients with medial compartment knee OA undergoing high tibial osteotomy (HTO). METHODS: Thirty-six patients with medial compartment knee OA and varus alignment underwent 3D gait analysis and 3T magnetic resonance imaging (MRI) preoperatively and 1 year after medial opening wedge HTO. Primary outcome measures were the change in the external knee adduction moment impulse during walking and change in knee suprapatellar effusion-synovitis volume manually segmented on MRI by one blinded assessor. RESULTS: Mean (SD) knee adduction moment impulse [24.0 (6.5) Nm•s] and knee effusion-synovitis volume [8976.7 (8016.9) mm3] suggested substantial preoperative medial knee load and inflammation. 1-year postoperative changes in knee adduction moment impulse [-10.1 Nm•s (95%CI: -12.7, -7.4)], and knee effusion-synovitis volume [-1856 mm3 (95%CI: -3830, 117)] were positively correlated [r = 0.60 (95% CI 0.34, 0.78)]. Simple linear regression suggested a 448 mm3 (95%CI: 241, 656) reduction in knee effusion-synovitis volume per 1 Nm•s reduction in knee adduction moment impulse. Change in knee adduction moment impulse explained 36% (R2 = 0.36) of the variance of change in knee effusion-synovitis volume. CONCLUSIONS: Reduction in medial knee load is positively associated with reduction in knee inflammation after HTO, suggesting the phenomenon of mechano-inflammation in patients with knee OA.

Asunto(s)

Desviación Ósea/cirugía , Genu Varum/cirugía , Inflamación/diagnóstico por imagen , Osteoartritis de la Rodilla/cirugía , Sinovitis/diagnóstico por imagen , Soporte de Peso , Fenómenos Biomecánicos , Desviación Ósea/diagnóstico por imagen , Desviación Ósea/fisiopatología , Femenino , Análisis de la Marcha , Genu Varum/diagnóstico por imagen , Genu Varum/fisiopatología , Humanos , Inflamación/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/fisiopatología , Osteotomía , Sinovitis/fisiopatología , Tibia/cirugía , Resultado del Tratamiento

RESUMEN

BACKGROUND: The accuracy of targeted lower limb alignment correction following HTO is closely related to patients' pain relief and knee joint survival time. How to accurately perform osteotomy and how to obtain the ideal target limb alignment to maximize the curative effect are the difficulty in HTO practice. The purpose of this study is to evaluate the predictive and application value of osteotomy master software (OsteoMaster) in coronal plane preoperative planning of high tibial osteotomy. METHOD: Sixty-seven patients with medial compartment osteoarthritis and varus deformity treated by medial open-weight high tibial osteotomy were enrolled and divided into observation group (31 cases) and control group (36 cases). The observation group was planned by OsteoMaster, while the control group was planned by Miniaci. The preoperative predicted values of osteotomy depth, open height, correction angle, WBL ratio, and FTA of the observation group were compared with the actual intraoperative values to study their accuracy. The operative time, blood loss, number of fluoroscopy, and WBL ratio were compared between the observation group and the control group to study its application value. RESULT: There was no significant difference between two groups in preoperative prediction and intraoperative reality of osteotomy depth, open height, correction angle, FTA, and WBL ratio (P > 0.05). The operation time and number of fluoroscopy in the observation group were significantly less than those in the control group (P < 0.05), while the difference in blood loss was not statistically significant (P > 0.05). The good rate of WBL ratio was 87.1% in the observation group and 75% in the control group. CONCLUSION: OsteoMaster has predictive value in osteotomy depth, open height, correction angle, FTA, and WBL ratio of HTO, which is also helpful to reduce the number of fluoroscopy, shorten the operation time, and improve the accuracy of target limb alignment. The drawback of this approach is 2-dimensional approach in contrast to 3-dimensional preoperative planning that is including the more real study.

Asunto(s)

Desviación Ósea/cirugía , Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Planificación de Atención al Paciente , Cuidados Preoperatorios/métodos , Programas Informáticos , Tibia/cirugía , Desviación Ósea/diagnóstico por imagen , Desviación Ósea/fisiopatología , Femenino , Fluoroscopía , Humanos , Extremidad Inferior/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tempo Operativo , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/fisiopatología , Valor Predictivo de las Pruebas , Rango del Movimiento Articular , Tibia/diagnóstico por imagen , Soporte de Peso

RESUMEN

BACKGROUND: Windswept deformity is a condition of the lower limbs with a valgus knee on one side and a varus knee on the other. We present a case series of bilateral unicompartmental knee arthroplasty (UKA) for windswept knee osteoarthritis (WSKO). METHODS: We analysed the outcomes of 26 knees of 13 consecutive patients with WSKO treated with bilateral UKA. The mean age was 73.0 years and the mean follow up period was 2.6 years. Pre- and postoperative Oxford Knee Score (OKS) and Japanese Orthopaedic Association (JOA) score, radiological measurements and postoperative complications were evaluated. No knees required revision for either infection or loosening. RESULTS: The mean preoperative OKS was 25.3 ± 9.7, which increased to 34.9 ± 5.8 at the latest follow up. The mean preoperative JOA scores for the varus and the valgus sides were 64.6 ± 12.5 and 66.9 ± 14.1, which increased to 85.0 ± 11.3 and 84.6 ± 11.2, respectively, after operation. CONCLUSIONS: Our results show that good short-term clinical results can be achieved by bilateral UKA in cases of WSKO. Bilateral UKA may be an effective treatment for WSKO if indications are met.

Asunto(s)

Artroplastia de Reemplazo de Rodilla , Desviación Ósea/cirugía , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Anciano , Desviación Ósea/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/fisiopatología , Masculino , Osteoartritis de la Rodilla/fisiopatología , Evaluación del Resultado de la Atención al Paciente

RESUMEN

PURPOSE: Surgical techniques for total knee arthroplasty (TKA) require femoral rotational corrections that alter the position of the surface of the posterior femoral joint especially in kinematic alignment. However, preoperative planning of TKA based on computed tomography (CT), without knowing the femoral cartilage thickness, may cause post-surgery failures in femoral rotation. Therefore, this study aimed to evaluate the effects of posterior condyle cartilage thickness on rotational alignment in the femoral component. METHODS: Three-dimensional magnetic resonance imaging (MRI) scans were obtained for 139 male and 531 female osteoarthritis patients. The angles defined by the femoral posterior condylar axis (PCA) and the surgical transepicondylar axis (TEA) were evaluated with respect to the presence of cartilage. Additionally, these effects were evaluated with respect to patient gender and varus/valgus condition. RESULTS: In all patients, the angle between the TEA and PCA was significantly greater in the presence of cartilage than in the absence of cartilage. This result was also seen in female patients. However, there was no difference in the TEA/PCA angle in male patients based on the presence of cartilage. The TEA/PCA angle was significantly greater in the presence of cartilage than in the absence of cartilage in the female varus group. However, there were no differences in the TEA/PCA angle based on the presence of cartilage in the male varus/valgus and female valgus groups. Cartilage thickness in the posterior femoral condyle was significantly greater on the lateral side than on the medial side in all and male patients. However, there was no difference between the genders regarding cartilage thickness. CONCLUSION: Surgical planning for TKA based on CT does not consider articular cartilage and could lead to external malrotation of the femoral implant. Therefore, the effect of the remaining posterior condylar cartilage should be considered by surgeons to prevent over-rotation of the femoral component, especially in female varus knees.

Asunto(s)

Desviación Ósea/fisiopatología , Desviación Ósea/cirugía , Cartílago Articular/cirugía , Fémur/fisiopatología , Fémur/cirugía , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Rotación , Anciano , Artroplastia de Reemplazo de Rodilla/métodos , Desviación Ósea/diagnóstico por imagen , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/patología , Femenino , Fémur/diagnóstico por imagen , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/patología , Caracteres Sexuales , Tomografía Computarizada por Rayos X

RESUMEN

BACKGROUND: Previous studies focusing on the effects of knee surgery on hindfoot alignment have suggested some degree of compensation between the knee and the hindfoot. However, these studies did not investigate a preoperative relationship in patients without end-stage knee osteoarthritis using 3-dimensional (3D) biometrics. The purpose of this study was to investigate the relationship between knee and hindfoot alignment using 3D weightbearing imaging. METHODS: This retrospective comparative study included 95 lower limbs with weightbearing computed tomography and low-dose biplanar radiograph investigations. Cases with a history that may have caused a change in lower limb alignment were excluded. Hindfoot and knee alignments were measured using foot ankle offset (FAO) and hip-knee-ankle (HKA) angle, respectively. Patients were separated into 3 groups according to the knee deformity to investigate the distribution of FAO in each group. RESULTS: The mean (SD) FAO was 2% (7%) for the knee varus group, 1% (6%) for the neutral knee group, and 4% (5%) for the valgus knee group (P = .12). Fifty-three percent of patients with knee valgus showed a pathological hindfoot valgus (P = .04). We found a positive but moderate correlation between hindfoot valgus and HKA (ρ = 0.53; P = .01). Female sex was associated with higher FAO (3% ± 4% vs 0.6% ± 6%; P = .009). CONCLUSION: This feasibility study suggests a new opportunity using 3D biometrics to understand the relationship between knee and hindfoot alignment and to highlight different patterns of combined deformities in further investigations. LEVEL OF EVIDENCE: Level III, comparative study.

Asunto(s)

Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/fisiopatología , Desviación Ósea/diagnóstico por imagen , Desviación Ósea/fisiopatología , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiopatología , Soporte de Peso/fisiología , Adulto , Anciano , Fenómenos Biomecánicos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Tomografía Computarizada por Rayos X

RESUMEN

BACKGROUND: Interest in operative management of scapular fractures is increasing based upon defined radiographic displacement criteria and growing awareness that certain extra-articular fractures will not do well and result in dysfunction and deformity (slumped shoulder). We intend to quantify clinical deformity, analyze correlations of these novel measures with defined radiographic measures of fracture displacement and with the patients' reported perception of their deformity. METHODS: Prospectively enrolled patients underwent standardized questioning regarding their perception of the deformity. Radiographs were utilized to measure glenopolar angle medial/lateral displacement, and angulation of the displaced scapula fracture. Novel measurements of clinical deformity (shoulder area, shoulder angle and shoulder height difference) were calculated. All measurements were repeated post-operatively for patients undergoing operative treatment. RESULTS: Fifty-one patients (39 operative) were examined within 30 days of injury. Follow-up (≥2 months post-op) was obtained for 31/39 (79%). Medial-lateral displacement significantly correlated with all measures of clinical deformity and with patient reported shoulder appearance bothersome score. Angulation significantly correlated with patient perception and two clinical measures (shoulder area and shoulder angle difference). All post-operative radiographic measures, clinical measures of deformity, and patient reported scores statistically improved from baseline measures. DISCUSSION: Patients with scapula fracture do perceive deformity, and there is a significant correlation between the patients' perception, radiographic and clinical measurements of deformity after scapula fracture. All measures statistically improved in patients with operative treatment compared to baseline measurements. This study reinforces the importance of the clinicians' clinical examination and observation of shoulder deformity in the scapula fracture patient. LEVEL OF EVIDENCE: IV.

Asunto(s)

Desviación Ósea/diagnóstico por imagen , Fracturas Óseas/cirugía , Fracturas Mal Unidas/diagnóstico por imagen , Articulación del Hombro/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Desviación Ósea/fisiopatología , Femenino , Fracturas Óseas/diagnóstico por imagen , Fracturas Mal Unidas/fisiopatología , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Rango del Movimiento Articular , Escápula/lesiones , Escápula/cirugía , Articulación del Hombro/fisiopatología

RESUMEN

BACKGROUND: Noticeable in-toeing gait is present in most children with internal rotational malalignment and often a reason to consult an orthopedic specialist. The risk of tripping may be higher for these patients. RESEARCH QUESTION: The aim of this study was to determine compensatory mechanisms adopted by children with internal rotational deformities to avoid tripping and falling during walking and running. METHODS: Sixty-nine patients between 5-18 years with idiopathic internal rotational malalignment were retrospectively included and subdivided into three groups: 18 patients with internal tibial torsion (ITT), 25 patients with internal femoral torsion (ITF) and 26 patients with both (ITB). Twenty-two typically developing age-matched children (TD) were analyzed for comparison. Three-dimensional gait data were evaluated. ANOVA's on two factors, group (ITT, ITF, ITB, TD) and movement (walking, running) with post-hoc t-tests were used to identify significant differences between groups. RESULTS: All groups had significantly greater step width than TD during walking (P ≤ .002) and all torsional groups had significantly greater step width during running (P ≤ .001). Similarly, all torsional groups showed greater peak ankle dorsiflexion in swing during running than TD (P ≤ .006). Only the ITT group showed significantly greater external hip rotation than TD. When compared to TD, the ITF and ITB group had a significantly lower hip abduction moment in stance during running, but not for walking (P ≤ .032). SIGNIFICANCE: Compensatory mechanisms in children with internal rotational deformities were mostly dependent on the location of rotational malalignment. All children with internal rotational malalignment had greater ankle dorsiflexion and greater step width during running. Especially in active patients, this greater ankle dorsiflexion during running may result in overuse of the ankle dorsiflexor muscles, while greater step width may have beneficial effects in normalizing knee adduction moments.

Asunto(s)

Desviación Ósea/fisiopatología , Marcha/fisiología , Extremidad Inferior/fisiopatología , Rotación , Carrera/fisiología , Caminata/fisiología , Adolescente , Articulación del Tobillo , Fenómenos Biomecánicos , Niño , Preescolar , Femenino , Articulación de la Cadera , Humanos , Articulación de la Rodilla , Masculino , Movimiento , Estudios Retrospectivos

RESUMEN

BACKGROUND: Lower limb malalignment in the frontal plane is one of the major causes of developing knee osteoarthritis. Growing children can be treated by temporary hemiepiphysiodesis when diagnosed with lower limb malalignment. RESEARCH QUESTION: Is there a difference between medial or lateral knee contact force (KCF) before (PRE) and after (POST) hemiepiphysiodesis in patients with valgus malalignment and compared to a typically developed control group (TD)? Does a linear relationship exist between the static radiographic mechanical axis angle and dynamic medial/lateral KCF? METHODS: In this prospective study, an OpenSim full body model with an adapted knee joint was used to calculate KCFs in the stance phase of 16 children with diagnosed genu valgum and 16 age- and sex-matched TDs. SPM was applied to compare KCFs before and after guided growth and to test a linear relationship between the mechanical axis angle and KCFs. RESULTS: After the intervention, POST revealed a significantly increased medial KCF (p < 0.001, 4-97 % of stance) and decreased lateral KCF (p < 0.001, 6-98 %) compared to PRE. Comparing POST with TD, short phases with a significant difference were found (medial: p = 0.039, 84-88 %; lateral: p = 0.019, 3-11 %). The static mechanical axis angle showed a longer phase of a significant relation to KCFs for POST compared to PRE. SIGNIFICANCE: This study showed that temporary hemiepiphysiodesis in patients with valgus malalignment reduces the loading in the lateral compartment of the knee and thus the risk of developing osteoarthritis in this compartment. The determination of dynamic KCFs can be clinically relevant for the treatment of lower limb malalignment, especially for decision making before surgery, when compensatory mechanisms may play an important role. Additionally, the static radiographic mechanical axis angle does not necessarily represent the dynamic loading of the lateral knee compartment.

Asunto(s)

Desviación Ósea/fisiopatología , Marcha , Genu Valgum/fisiopatología , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/complicaciones , Adolescente , Estudios de Casos y Controles , Niño , Femenino , Humanos , Rodilla , Pierna/fisiopatología , Extremidad Inferior , Masculino , Estudios Prospectivos

RESUMEN

STUDY DESIGN: A repeated-measurement, single-center, prospective study. OBJECTIVE: To compare the spatiotemporal and kinematic data using gait analysis in adult degenerative scoliosis (ADS) patients using walking sticks (WS) versus rolling walkers (RW). ADS patients undergo compensatory changes that can result in an altered gait pattern. RW are frequently prescribed, but result in a forward flexed kyphotic posture during ambulation. Gait using WS allows for more upright alignment in ADS patients. METHODS: Fifty-three ADS patients with symptomatic degenerative scoliosis performed over-ground walking at self-selected speed with WS and with a RW. Trunk and lower extremity angles along with spatiotemporal parameters were measured and compared. RESULTS: When using WS, patients exhibited less flexion at the head (WS: - 4.8° vs. RW: 11.0°, p = 0.001), and lumbar spine (WS: - 0.9° vs. RW: 4.2°, p = 0.001); while there was significantly more extension, of the cervical spine (WS: - 1.6° vs. RW: - 7.4°, p = 0.002) when using the RW. At the initial contact phase of gait, patients using WS showed decreased flexion at the ankle (WS 0.7° vs. RW: 3.8°, p = 0.018), knee (WS: 0.3° vs. RW: 4.8°, p = 0.001), hip (WS: 22.6° vs. RW: 27.3°, p = 0.001), and pelvis (WS: 10.2° vs. RW: 14.8°, p = 0.001). In contrast, the use of WS resulted in slower ambulation (WS: 0.6 m/s vs. RW: 0.7 m/s, p = 0.001). CONCLUSIONS: In ADS patients who have not undergone surgical correction, the use of WS resulted in a more upright posture, which may be more beneficial to the compensatory changes that lead to gait disturbance in ADS patients. Ambulation using WS resulted in slower gait versus a RW, due to the momentum induced by the forward flexed posture when using a RW. We recommend the use of WS for patients with ADS as it improves gait kinematics and may be a safer option.

Asunto(s)

Fenómenos Biomecánicos/fisiología , Bastones , Marcha/fisiología , Postura/fisiología , Escoliosis/fisiopatología , Andadores , Anciano , Desviación Ósea/etiología , Desviación Ósea/fisiopatología , Vértebras Cervicales/fisiopatología , Femenino , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/prevención & control , Humanos , Vértebras Lumbares/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Rango del Movimiento Articular , Escoliosis/complicaciones

RESUMEN

Limb alignment is a critically important factor to consider in the management of the patient with knee arthritis. Abnormal alignment is associated with the accelerated progression of osteoarthritis and, if not addressed at the time of surgery, may contribute to early failure of knee replacement implants. The contribution of the hindfoot to overall limb alignment has received limited attention in the context of deformity correction in total knee arthroplasty (TKA). In this review, we present evidence supporting the inclusion of the hindfoot in the consideration of overall limb alignment for TKA and propose a management algorithm.

Asunto(s)

Artroplastia de Reemplazo de Rodilla , Desviación Ósea/cirugía , Pie/cirugía , Osteoartritis/cirugía , Algoritmos , Fenómenos Biomecánicos , Desviación Ósea/fisiopatología , Pie/fisiopatología , Marcha , Humanos , Osteoartritis/fisiopatología , Soporte de Peso