Short-term results of a new self-locking cementless femoral stem: a prospective cohort study of the Lima MasterSL.

BACKGROUND: Total hip arthroplasty is a successful treatment for hip osteoarthritis. Primary and secondary implant fixation is dependent on implant design and plays an important role in the longevity of an implant. In this study, we assessed the self-locking cementless MasterSL femoral stem. MATERIALS AND METHODS: In this single-centre prospective study, 50 consecutive hips with the indication for total hip arthroplasty, who met the inclusion criteria, received the MasterSL stem from LIMA Corporate. Patients had pre- and post-operative clinical and radiological assessment and completed patient-reported outcome measures [Oxford Hip Score (OHS), Harris Hip Score (HHS) and Forgotten Joint Score (FJS)] at the 6-week and 6-, 12- and 24-month mark. Post-operative X-rays were assessed for osteointegration (Engh Score), alignment and subsidence. RESULTS: After 2 years, aseptic survival was 100%. One hip had to be explanted due to early deep infection and was excluded from the study. At 2 years, the patients reported a significant improved HHS and OHS of 95.3 ± 5.8 and 46.1 ± 3.6 (mean ± standard deviation), respectively, compared to preoperatively. The mean ± standard deviation for the FJS was 86.4 ± 18.7 with two-thirds of the patients reporting a score above 85. The mean Engh score is 15.1 ± 5.9 (mean ± standard deviation) with no patient scoring below 1 which suggests good osteointegration in all femoral stems. CONCLUSIONS: The MasterSL femoral stem performed well in this short-term follow-up study, with high patient satisfaction and good signs of osteointegration. Long-term follow-up will be necessary to evaluate longevity. LEVEL OF EVIDENCE: Level 3, Prospective cohort study. TRIAL REGISTRATION: The study was registered on the 30.03.2016 with Australia New Zealand Clinical Trials Registry (ACTRN12617000550303).

Medial and lateral gap laxity differential in computer-assisted kinematic total knee arthroplasty.

AIMS: The results of kinematic total knee arthroplasty (KTKA) have been reported in terms of limb and component alignment parameters but not in terms of gap laxities and differentials. In kinematic alignment (KA), balance should reflect the asymmetrical balance of the normal knee, not the classic rectangular flexion and extension gaps sought with gap-balanced mechanical axis total knee arthroplasty (MATKA). This paper aims to address the following questions: 1) what factors determine coronal joint congruence as measured on standing radiographs?; 2) is flexion gap asymmetry produced with KA?; 3) does lateral flexion gap laxity affect outcomes?; 4) is lateral flexion gap laxity associated with lateral extension gap laxity?; and 5) can consistent ligament balance be produced without releases? PATIENTS AND METHODS: A total of 192 KTKAs completed by a single surgeon using a computer-assisted technique were followed for a mean of 3.5 years (2 to 5). There were 116 male patients (60%) and 76 female patients (40%) with a mean age of 65 years (48 to 88). Outcome measures included intraoperative gap laxity measurements and component positions, as well as joint angles from postoperative three-foot standing radiographs. Patient-reported outcome measures (PROMs) were analyzed in terms of alignment and balance: EuroQol (EQ)-5D visual analogue scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS Joint Replacement (JR), and Oxford Knee Score (OKS). RESULTS: Postoperative limb alignment did not affect outcomes. The standing hip-knee-ankle (HKA) angle was the sole positive predictor of the joint line convergence angle (JLCA) (p < 0.001). Increasing lateral flexion gap laxity was consistently associated with better outcomes. Lateral flexion gap laxity did not correlate with HKA angle, the JLCA, or lateral extension gap laxity. Minor releases were required in one third of cases. CONCLUSION: The standing HKA angle is the primary determinant of the JLCA in KTKA. A rectangular flexion gap is produced in only 11% of cases. Lateral flexion gap laxity is consistently associated with better outcomes and does not affect balance in extension. Minor releases are sometimes required as well, particularly in limbs with larger preoperative deformities. Cite this article: Bone Joint J 2019;101-B:331-339.

Neuromuscular Adaptations to Same-Session Combined Endurance and Strength Training in Recreational Endurance Runners.

This study examined neuromuscular adaptations in recreational endurance runners during 24 weeks of same-session combined endurance and strength training (E+S, n=13) vs. endurance training only (E, n=14). Endurance training was similar in the 2 groups (4-6x/week). Additional maximal and explosive strength training was performed in E+S always after incremental endurance running sessions (35-45 min, 65-85% HRmax). Maximal dynamic leg press strength remained statistically unaltered in E+S but decreased in E at week 24 (-5±5%, p=0.014, btw-groups at week 12 and 24, p=0.014 and 0.011). Isometric leg press and unilateral knee extension force, EMG of knee extensors and voluntary activation remained statistically unaltered in E+S and E. The changes in muscle cross-sectional (CSA) differed between the 2 groups after 12 (E+S+6±8%, E -5±6%, p<0.001) and 24 (E+S+7±7%, E -6±5%, p<0.001) weeks. 1 000 m running time determined during an incremental field test decreased in E+S and E after 12 (-7±3%, p<0.001 and -8±5%, p=0.001) and 24 (-9±5%, p=0.001 and -13±5%, p<0.001) weeks. Strength training performed always after an endurance running session did not lead to increased maximal strength, CSA, EMG or voluntary activation. This possibly contributed to the finding of no endurance performance benefits in E+S compared to E.

The use of spatial manipulation to examine goalkeepers' anticipation.

This study investigated whether anticipation and search strategies of goalkeepers are influenced by temporally and spatially manipulated video of a penalty. Participants were clustered into three groups depending on skill: goalkeepers (n = 17), field players (n = 20) and control group (n = 20). An eye tracker was worn whilst watching 40 videos of a striker kicking to four corners of a goal in random order. All 40 videos were temporally occluded at foot-to-ball contact, and the non-kicking leg of 20 videos was spatially manipulated. Results showed that goalkeepers had significantly better predictions than the two groups with no differences between the two testing conditions. According to effect size, the percentage of fixation location and viewing time of the kicking leg and ball were greater for the goalkeepers and field players group than the control group irrespective of testing conditions. The fixations on the kicking leg and ball in conjunction with comparable predictions between spatially manipulated and control conditions suggest that goalkeepers may not rely on the non-kicking leg. Furthermore, goalkeepers appear to use a global perceptual approach by anchoring on a distal fixation point/s of the penalty taker whilst using peripheral vision to obtain additional information.

The reliability of lower extremity and thoracic kinematics at various running speeds.

Whilst various studies have examined lower extremity joint kinematics during running, there is limited investigation on joint kinematics at steady-state running and at intensities close to exhaustion. Subsequently, the purpose of this study was to determine whether the reliability of kinematics in the lower extremity and thorax is affected by varying the running speeds during a running economy test. 14 trained and moderately trained runners undertook 2 running economy tests with each test incorporating 3 intensity stages: 70-, 90- and 110% of the second ventilatory threshold, respectively. The participants ran for 10 min during each of the first 2 stages and to exhaustion during the last stage. Kinematics of the ankle, knee, hip, pelvis and thorax were recorded using a 3-dimensional motion analysis system. Intra-class correlation coefficient (ICC), limits of agreement (LOA) and coefficient of variation (CV) were used to calculate reliability. The ICC, LOA and CV of the lower extremity and thoracic kinematic variables ranged from 0.33-0.97, 1.03-1.39 and 2.0-18.6, respectively. Whilst the reliability did vary between the kinematic variables, the majority of results showed minimal within-subject variation and moderate to high reliability. In conclusion, examining thoracic and lower extremity kinematics is useful in determining whether running kinematics is altered with varying running intensities.