Patients' perceived walking abilities, daily-life gait behavior and gait quality before and 3 months after total knee arthroplasty.

INTRODUCTION: Functional outcome and patients' daily-life activities after total knee arthroplasty are becoming more important with a younger and more active patient population. In addition to patient-reported outcome measures (PROMs), trunk-based accelerometry has shown to be a promising method for evaluating gait function after total knee arthroplasty. The aim of this study was to evaluate daily-life perceived walking abilities, gait behavior and gait quality before and 3 months after total knee arthroplasty, using PROMs and trunk-based accelerometry. MATERIALS AND METHODS: A cohort of 38 patients completed questionnaires including the Oxford Knee Score and modified Gait Efficacy Scale before and 3 months after primary unilateral total knee arthroplasty. At both time points, they wore a tri-axial accelerometer at the lower back for seven consecutive days and nights. Gait behavior was calculated using gait quantity and walking speed, and multiple gait quality parameters were calculated. RESULTS: Significant improvements were seen after 3 months in the Oxford Knee Score [median (interquartile range) 29 (10) vs 39 (8), p < 0.001] and modified Gait Efficacy Scale [median (interquartile range) 67 (24) vs 79 (25), p = 0.001]. No significant changes were observed in gait behavior (quantity and speed) or gait quality variables. CONCLUSIONS: In contrast to the significant improvements in patients' perception of their walking abilities and PROMs, patients did not show improvements in gait behavior and gait quality. This implies that after 3 months patients' perceived functional abilities after total knee arthroplasty do not necessarily represent their actual daily-life quantity and quality of gait, and that more focus is needed on postoperative rehabilitation to improve gait and functional behavior.

Survival and functional outcome of high tibial osteotomy for medial knee osteoarthritis: a 10-20-year cohort study.

BACKGROUND: The primary aim of this study was to identify independent predictors of long-term survivorship after high tibial osteotomy (HTO). The secondary aims were to describe the functional outcome of surviving HTO 10-20 years after surgery. METHODS: A retrospective cohort of 223 HTO that were performed for the treatment of medial osteoarthritis was identified. Details were recorded from the patient notes. All surviving patients were contacted and asked to complete a Tegner Activity Scale, Lysholm Knee Score and rate pain using the Visual Analogue Scale (VAS). Survival analysis was performed, using conversion to arthroplasty as the definition of failure. RESULTS: The mean age was 54 years (24-80 years). There were 123 (55.2%) in males and 100 (44.8%) in females. The mean BMI was 27.2 (SD 3.9). Twenty (9%) patients were lost to follow-up. The mean follow-up was 12 (SD 4) years. Survival at 10 years was 75 and 55% at 15 years and less than 40% at 20 years. Cox regression analysis demonstrated age of 50 years or more, female gender and surgical technique to be significant independent predictors of failure. The median Tegner score was 3 (inter-quartile range (IQR) 1-3). The mean Lysholm score was 75.5 (SD 18.4). The median VAS was 5 (IQR 0-6). CONCLUSIONS: The medium- to long-term survival and functional outcome after HTO was good to excellent at 10-20 years of follow-up. Age, gender, surgeon and surgical technique were identified as independent predictors of failure.

A prospective 24 months follow-up of a three component press-fit prosthesis for hallux rigidus.

BACKGROUND: The aim of this study was to evaluate the results following total first metatarsophalangeal (FMTP) joint replacement arthroplasty using a modular three component press fit prosthesis at two year follow up. METHODS: All patient data was collected in a prospective way in four study centres. Both preoperative and postoperative evaluation consisted of an assessment using the AOFAS-HMI score, visual analogue scale for pain, evaluation of the range of motion and patient satisfaction scores. Postoperative X-rays were reviewed for loosening and radiolucency up to two years. RESULTS: Fifty-five feet were available for analysis at 24 months. Two implants were removed during the study. Six more feet had additional surgery due to stiffness or malalignment. Postoperative AOFAS-HMI scores improved significantly by 32.4 points at two year follow-up (p<0.001). The visual analogue scale for pain improved significantly from 6.8 (std 1,6) preoperatively to 1.6 (std 1,9) postoperatively (p<0.0001). Mean dorsiflexion improved from 12.6 (std 10,1) degrees preoperatively to 31.2 (std 16,8) degrees postoperatively. Eighty-seven percent of patients were moderately to well satisfied with the end result. Eighteen prostheses showed radiolucency at 24 months. CONCLUSION: Implantation of a Metis® modular three component press fit prosthesis for the metatarsophalangeal joint in hallux rigidus shows significant improvement in AOFAS-HMI scores and a decrease in pain. Concerns remain with regard to early reoperation rate (14.5%) and long term survival of the implant. Future studies will have to address these aspects.

[Registration of assessments in orthopaedic residents' portfolios is falling short]. / Praktijktoetsen van aiossen onvoldoende geregistreerd.

OBJECTIVE: To evaluate of the number of registered competency assessments in the portfolios of orthopaedic residents in the Netherlands, for whom a competency-based training programme is mandatory. DESIGN: National cohort study. METHOD: We collected data regarding the registered assessments of all orthopaedic residents who finished their training between 2012-2015. We determined the number of registered assessments of 'standard orthopaedic treatments' (evaluating residents' competency in 70 different orthopaedic treatments), objective structured clinical skills evaluations (OSCEs), critically appraised topics (CATs), and 360 degree feedback appraisals. We compared the number of registered assessments in the portfolios with the minimum requirements laid down by the training curriculum. RESULTS: A total of 196 residents finished their training between 2012 and 2015. These residents finished their training with a mean (i.e., percentage of minimally required number of assessments) of 17.0 (34%) 'standard orthopaedic treatments' (level 4 or 5), 13.6 (34%) OSCEs, 2.6 (33%) CATs and 0.2 (4%) 360 degree feedback. CONCLUSION: On average, only one-third of the minimally required number of assessments were registered in the portfolios of orthopaedic residents (OSCEs and standard orthopaedic treatments level 4 or 5). These revelations show that action is needed to improve the way in which the progress of residents is monitored. These findings are going to have an effect on the new curriculum which must be more practical and less complex. Additionally, external quality control will focus more on residents at the end of their training and on the training region involved. This information may serve as a framework for postgraduate training programmes in other scientific associations which also find themselves in the same process of modernisation.

No differences between fixed- and mobile-bearing total knee arthroplasty.

PURPOSE: For years, numerous studies have been performed to determine whether mobile-bearing total knee arthroplasty (MB-TKA) or fixed-bearing total knee arthroplasty (FB-TKA) is the preferential design in total knee arthroplasty. Reviews and meta-analyses on this subject have focused on a relatively small number of randomised controlled trials, possibly missing important results of smaller studies. The goal of this review was to provide a comprehensive overview of all literature comparing MB-TKA and FB-TKA in the treatment of osteoarthritis of the knee. METHODS: An extensive literature search was performed in the PubMed database. All studies that compared MB-TKA with FB-TKA and looked at one of four theorised advantages (insert wear, signs of loosening, survival rate of the prosthesis and clinical outcome) were included. RESULTS: The initial search yielded 258 articles, of which 127 were included after the first screening. The included studies consisted of 9 meta-analyses, 3 systematic reviews, 48 RCT's, 44 comparative studies, 10 reviews and 13 studies that examined patients who received bilateral TKA (one MB-TKA and one FB-TKA). Combining the results of all studies showed that almost all studies found no difference between MB-TKA and FB-TKA. CONCLUSIONS: Even when examining all different types of studies on MB-TKA and FB-TKA, the results of this review showed no difference in insert wear, risk of loosening, survivorship or clinical outcome. In daily practice, the choice between MB-TKA and FB-TKA should be based on the experience and judgment of the surgeon, since no clear differences are observed in the scientific literature. LEVEL OF EVIDENCE: III.

First metatarsophalangeal joint replacement: long-term results of a double stemmed flexible silicone prosthesis.

BACKGROUND: The aim of this retrospective study was to evaluate the long-term results of a Swanson type silicone prosthesis used for the first metatarsophalangeal (FMTP) joint replacement. It compares implants with and without the use of grommets. METHODS: Fifty-nine FMTP joints were replaced. The average follow-up period was 9 years. Subjective and clinical findings were scored according to the AOFAS-HMI (American Orthopedic Foot and Ankle Society-Hallux Metatarsophalangeal-Interphalangeal) score. X-ray examination was carried out by evaluation of the presence of reactive bone areas around the implant. RESULTS: Ninety-five percent of patients had relief of pain. Clinical findings showed a reasonable function (range of motion >30°) in 77% of the FMTP joints. A trend for decrease in radiolucency and lytic bone was seen in areas around the implant with the use of grommets. CONCLUSION: The prosthesis shows good results concerning pain relief and a reasonable to good function (>30° range of motion) of the FMTP joint in most patients. Reactive bone areas around the implant decreased by the use of grommets.

[Measuring the length of newborn infants]. / Lengtemeting bij de pasgeborene.

Since 1985, measurement of the length of neonates has been practically abandoned in the Netherlands because it was thought that stretching the legs and knees briefly in order to measure the length immediately after birth could be harmful for the development of the hip joint. However, this fear seems unjustified. Measuring the length of the neonate provides useful information regarding the general condition and has predictive value for the final adult height. If an infant is disproportionately small in comparison with its weight or small for its gestational age with insufficient catch-up growth, this may be an indication of underlying pathology. As a rule, the length of all neonates should be measured immediately after birth and length measurement should be re-introduced as part of standard care. Length measurement can be done with sufficient accuracy after proper instruction. For babies born after incomplete breech presentation, length measurement should be postponed for about a week.

End-range mobilization techniques in adhesive capsulitis of the shoulder joint: A multiple-subject case report.

BACKGROUND AND PURPOSE: The purpose of this case report is to describe the use of end-range mobilization techniques in the management of patients with adhesive capsulitis. CASE DESCRIPTION: Four men and 3 women (mean age=50.2 years, SD=6.0, range=41-65) with adhesive capsulitis of the glenohumeral joint (mean disease duration=8.4 months, SD=3.3, range=3-12) were treated with end-range mobilization techniques, twice a week for 3 months. Indexes of pain, joint mobility, and function were measured by the same observer before treatment, after 3 months of treatment, and at the time of a 9-month follow-up. In addition, arthrographic assessment of joint capacity (ie, the amount of fluid the joint can contain) and measurement of range of motion of glenohumeral abduction on a plain radiograph were conducted initially and after 3 months of treatment. OUTCOMES: After 3 months of treatment, there were increases in active range of motion. Mean abduction increased from 91 degrees (SD=16, range=70-120) to 151 degrees (SD=22, range=110-170), mean flexion in the sagittal plane increased from 113 degrees (SD=17, range=90-145) to 147 degrees (SD=18, range=115-175), and mean lateral rotation increased from 13 degrees (SD=13, range=0-40) to 31 degrees (SD=11, range=15-50). There were also increases in passive range of motion: Mean abduction increased from 96 degrees (SD=18, range=70-125) to 159 degrees (SD=24, range 110-180), mean flexion in the sagittal plane increased from 120 degrees (SD=16, range=95-145) to 154 degrees (SD=19, range=120-180), and mean lateral rotation increased from 21 degrees (SD=11, range=10-45) to 41 degrees (SD=8, range=35-55). The mean capacity of the glenohumeral joint capsule (its ability to contain fluid) increased from 10 cc (SD=3, range=6-15) to 15 cc (SD=3, range=10-20). Four patients rated their improvement in shoulder function as excellent, 2 patients rated it as good, and 1 patient rated it as moderate. All patients maintained their gain in joint mobility at the 9-month follow-up. DISCUSSION: There seems to be a role for intensive mobilization techniques in the treatment of adhesive capsulitis. Controlled studies regarding the effectiveness of end-range mobilization techniques in the treatment of adhesive capsulitis are warranted.

Frejka pillow and Becker device for congenital dislocation of the hip. Prospective 6-year study of 104 late-diagnosed cases.

During the period 1974-1986, 107 consecutive 1-9 month-old children with late-diagnosed congenital dislocation of the hip (CDH) were treated with a Frejka pillow primarily, followed by a Becker device. Treatment was initially successful in 96 cases with 2 not reduced, 4 failed stabilization, 4 persisting dysplasia, and 1 avascular necrosis. No correlation was found between age at the time of diagnosis or the severity of the dislocation and the duration or the result of treatment. In those initially successful, 14 percent had slight dysplasia 6 months later. The last follow-up, at the mean age of 7 years, excluding the 11 children needing supplementary treatment, showed that 84 percent had normal hips on radiography, based on measurements of the acetabular angles and the center-edge angles. The clinical findings were normal.

Neonatal screening and staggered early treatment for congenital dislocation or dysplasia of the hip.

In 14 264 consecutive newborn babies the results of screening and early treatment for congenital dislocation and/or dysplasia of the hip (CDH) were evaluated in a prospective follow-up study. Barlow's test was done and the family history was recorded. Babies who were positive (n = 140) were immediately given abduction treatment. If the screening result was doubtful (133) or if the test was negative but the family history positive (685) the child was radiographed at 5 months and abduction treatment was started if any form of CDH was seen. Among Barlow-negative children with no family history (13,306), two reference groups were selected--at age 5 months (596) and at age 2 years (4365). Dislocation was missed at screening in 0.02%. Dysplasia was seen at 5 months in 15% of Barlow-negative children with a positive family history and in 2-3% of the reference group children. Crude estimates of the lower limits of validity indices for the screening test showed that the test is efficient in the identification of dislocation but probably has no value for dysplasia. Of the babies in whom treatment was started immediately 17% had relapse dysplasia after withdrawal of therapy, 3% had avascular necrosis, and 78% were normal at 2 years. When treatment was started at 5 months we found no relapse dysplasia, only 1% avascular necrosis, and 53-63% success at 2 years. In children with dislocatable hips we propose a wait-and-see treatment strategy, with early ultrasonography or radiography at 5 months.