Feasibility and initial efficacy of a multimodal swelling intervention after total knee arthroplasty: A prospective pilot study with historical controls.

BACKGROUND: Swelling after total knee arthroplasty (TKA) is often profound and persistent, increasing risks of DVT, infection, and wound dehiscence, and impairing rehabilitation. We investigated the feasibility and initial efficacy of a multimodal swelling control intervention (MSI), comprised of an inelastic adjustable compression garment (CG), manual lymph drainage (MLD) massage, and home exercise program (HEP) after total knee arthroplasty (TKA) compared to a control group. METHODS: Sixteen individuals (mean age 64.7 ± 7.1y) performed MSI for three weeks after TKA, through day 21 (D21). Outcome measures included patient satisfaction, safety, patient adherence, and swelling measured by Single Frequency Bioimpedance Assessment (SF-BIA). All outcomes were measured preoperatively and at postoperative D4, D7, D14, D21 and, three weeks after discontinuing MSI, on D42. Efficacy of MSI was calculated with Hedge's g effect size estimates using the SF-BIA ratios for MSI versus CONTROL (N = 56; mean age 64.3 ± 9.3y) at key post operative time points. RESULTS: Patient satisfaction was 93% with no adverse events. Adherence to CG, MLD, and HEP were 85%, 99%, and 97% respectively. Peak swelling reduction with MSI was at D21 (Hedges' g = 1.60 at D21 (95% CI 0.99, 2.21)). Minimal change in swelling was observed three weeks after cessation of MSI on D42. CONCLUSIONS: The self-administered MSI program is feasible and demonstrated strong initial efficacy to control swelling after TKA. Minimal rebound swelling was observed once MSI was withdrawn at D21. Future studies should examine the efficacy of inelastic adjustable compression in a randomized controlled trial.

Psychometric properties of the 4-meter walk test after total knee arthroplasty.

OBJECTIVE: To determine the reliability, responsiveness, and convergent validity of the Four-Meter Walk Test (4mWT) compared to the Six-Minute Walk Test (6MWT) surrounding total knee arthroplasty (TKA). DESIGN: Secondary analysis of a randomized controlled trial. SETTING: Research laboratory. PARTICIPANTS: One hundred sixty-two patients (aged 63.5 ± 7.4 (mean ± sd) years; 89 females) undergoing TKA participated. MAIN OUTCOME MEASURES: 4mWT (usual and fastest) and 6MWT were measured 1-2 weeks preoperatively, and 1, 2, 3, 6 and 12 months post-operatively. RESULTS: 4mWT demonstrated excellent test-retest reliability with Interclass Correlation Coefficients (ICC's) ranging from 0.80 to 0.93 s. 4mWT also demonstrated small measurement error with Standard Error of Measurement (SEM) ranging from 0.15 to 0.35 s. 4mWT (fastest) demonstrated similar responsiveness to 6mWT in the first 2 months after surgery and better responsiveness from 2 to 3 months after surgery. Convergent validity between 6MWT and 4mWT (fastest) was high, with Pearson correlation coefficients ranging from 0.73 to 0.81. CONCLUSIONS: The 4mWT (fastest) has excellent test-retest reliability, shows high responsiveness sufficient for clinical outcomes in the immediate postoperative time periods, and exhibits high convergent validity with 6MWT. Given space and time requirements to conduct each test, 4mWT may be preferred for routine clinical assessment.IMPLICATIONS FOR REHABILITATIONWalking ability•Walking is an important functional ability for patients who undergo total knee arthroplasty (TKA).•While the Six-Minute Walk Test is a validated measure of walking ability in the TKA population, its clinical utility is limited by the space and time it takes to perform the test.•The Four-Meter Walk Test (fastest speed) is a valid, reliable, and responsive alternative to the 6MWT and is recommended for routine clinical use after TKA.

EPIDEMIOLOGY of NECK INJURIES ACCOMPANYING SPORT CONCUSSIONS in YOUTH OVER a 13-YEAR PERIOD IN a COMMUNITY-BASED HEALTHCARE SYSTEM.

BACKGROUND: The same trauma that produces concussion may also produce neck injury. The signs of concussion and neck injury are similar, and symptoms after acceleration-deceleration trauma to the head-neck complex do not accurately discriminate between them. Research on the epidemiology of neck injury among sport-concussed youth is sparse. PURPOSE: The purpose of this study was to investigate the epidemiology of diagnosed neck injury in non-sport-related concussion (Non-SRC) versus sport-related concussion (SRC) in youth by age, sex, and sport. STUDY DESIGN: Cross-sectional epidemiologic study. METHODS: De-identified data from community-based electronic health records over 13 years were extracted to analyze rates and characteristics of neck injuries among non-SRCs and SRCs in youth aged five to 21. Neck injury diagnosis prevalence rates and odds ratios were calculated to estimate risk of neck injury among concussed youth, comparing non-SRCs to SRCs by age and sex. RESULTS: Sixteen thousand, eight hundred eighty-five concussion records were extracted, of which 3,040 SRCs and 2,775 non-SRCs in youth aged five to 21 were identified by cross-filtering sport-related keywords (e.g., football, basketball, soccer, running, swimming, batting, horseback riding, skiing, etc.) with all ICD-9 and ICD-10 concussion codes. The prevalence of neck injuries diagnosed among SRCs (7.2%) was significantly different than the prevalence of neck injuries diagnosed among non-SRCs (12.1%, p < 0.000). Neck injury diagnoses were significantly more prevalent in females overall (p < 0.000) and among non-SRCs (p < 0.000). The prevalence of neck injury diagnoses was not significantly higher in concussed females versus concussed males with SRC (p = 0.164).Among youth aged five to 21 exposed to concussions, non-SRCs were more likely to be accompanied by a neck injury diagnosis than SRCs (OR 1.66; 95% CI 1.39 to 1.98; p < 0.000). Similarly, female-to-male neck injury proportion ratios were significantly higher in females in non-SRCs compared to SRCs (IPR 1.90, 95% CI 1.60 to 2.25, p < 0.000).Sports with highest prevalence of concussion differ from sports with highest prevalence of concussion-related neck injury in both sexes. CONCLUSIONS: The overall prevalence of diagnosed neck injuries in youth was higher in non-SRCs compared to SRCs (12.1 vs. 7.2%, p < 0.001), with the highest prevalence at age 14 in both sexes. The risk of neck injury diagnosis accompanying concussion was significantly higher in females compared to males (6.1% difference; p < 0.000).

First rib fracture of unknown etiology: a case report.

OBJECTIVE: The purpose of this study is to describe the case of a patient with a first rib fracture discovered with advanced imaging once the patient did not respond to an initial course of care. CLINICAL FEATURES: A 24-year-old otherwise healthy male electrician had medial scapular, upper thoracic, and sternal pain while using a power drill in the overhead position. INTERVENTION AND OUTCOME: An initial trial of treatments consisting of spinal manipulation and modalities failed to alleviate the patient's symptoms. Chiropractic treatment was discontinued and further diagnostic testing with advanced imaging was performed. Once the pathology was identified, the patient was placed on light duty at work with restrictions limiting overhead activities. No other treatment was rendered. The patient was symptom-free approximately 10 months after the onset of pain. CONCLUSIONS: Patients with complaints of spine and scapular pain may commonly present to a chiropractor for care. When these types of symptoms do not respond to conservative therapy, other causes should be investigated. In this case, the patient's symptoms resulted from a nontraumatic fracture of the first rib. First rib fractures should be considered in the differential diagnosis of patients with upper quadrant pain that is not responsive to conservative care.