Effect of self-calf massage on the prevention of deep vein thrombosis after total knee arthroplasty: A randomized clinical trial.

OBJECTIVE: Deep vein thrombosis (DVT) is a severe complication after total knee arthroplasty (TKA). Performing self-calf massage may decrease the incidence of DVT. The purpose of this study was to investigate whether self-calf massage is effective for preventing DVT after TKA. METHOD: In all, 165 patients participated in the present study. Patients were randomized to one of two groups: the self-calf massage group or the control group. In the control group, patients started regular physical therapy. In the self-calf massage group, in addition to regular physical therapy, patients were instructed to massage their calf muscles 30 times from the distal to proximal side. This procedure was repeated three times and was completed in 2 mins during the 2 days following TKA. All patients were evaluated for DVT on postoperative day 3 using lower limb vein ultrasonography. RESULTS: The incidence of DVT was significantly lower in the self-calf massage group than in the control group. Self-calf massage was associated with a lower incidence of DVT, whereas age and female sex were risk factors for DVT. CONCLUSION: This study showed that the self-calf massage may be beneficial for the prevention of DVT after TKA.

Tibial shape and size predicts the risk of tibial plateau fracture after cementless unicompartmental knee arthroplasty in Japanese patients.

AIMS: Cementless unicompartmental knee arthroplasty (UKA) has advantages over cemented UKA, including improved fixation, but has a higher risk of tibial plateau fracture, particularly in Japanese patients. The aim of this multicentre study was to determine when cementless tibial components could safely be used in Japanese patients based on the size and shape of the tibia. METHODS: The study involved 212 cementless Oxford UKAs which were undertaken in 174 patients in six hospitals. The medial eminence line (MEL), which is a line parallel to the tibial axis passing through the tip of medial intercondylar eminence, was drawn on preoperative radiographs. Knees were classified as having a very overhanging medial tibial condyle if this line passed medial to the medial tibial cortex. They were also classified as very small if a size A/AA tibial component was used. RESULTS: The overall rate of fracture was 8% (17 out of 212 knees). The rate was higher in knees with very overhanging condyles (Odds ratio (OR) 13; p < 0.001) and with very small components (OR 7; p < 0.001). The OR was 21 (p < 0.001) in those with both very overhanging condyles and very small components. In all, 69% of knees (147) had neither very overhanging nor very small components, and the fracture rate in these patients was 1.4% (2 out of 147 knees). Males had a significantly reduced risk of fracture (OR 0.13; p = 0.002), probably because no males required very small components and females were more likely to have very overhanging condyles (OR 3; p = 0.013). 31% of knees (66) were in males and in these the rate of fracture was 1.5% (1 out of 66 knees). CONCLUSION: The rate of tibial plateau fracture in Japanese patients undergoing cementless UKA is high. We recommend that cemented tibial fixation should be used in Japanese patients who require very small components or have very overhanging condyles, as identified from preoperative radiographs. In the remaining 69% of knees cementless fixation can be used. This approach should result in a low rate of fracture. Cite this article: Bone Joint J 2020;102-B(7):861-867.

Gait Variability in Women With Hip Osteoarthritis Before and After Total Hip Replacement: A Prospective Cohort Study.

OBJECTIVE: Gait variability changes before and after total hip arthroplasty are unclear. This study aimed to investigate gait variability changes in hip osteoarthritis patients before and after total hip arthroplasty and to examine the relationships between gait variability changes and hip function. DESIGN: Twenty-three female patients with hip osteoarthritis (61.0 ± 7.1 yrs) and 10 healthy female participants (57.8 ± 3.9 yrs) were assessed 1 mo before and 12 mos after surgery. Heel and lower trunk accelerations were measured using two triaxial accelerometers. The coefficient of variation of stride time for gait variability of lower limb motions and the harmonic ratio for trunk variability were calculated. Radiographic leg-length discrepancy, hip abductor strength, hip abduction, extension range of motion, and pain level during gait were measured. RESULTS: The coefficient of variation was significantly decreased after total hip arthroplasty and was comparable with that in healthy individuals. Although postoperative harmonic ratios were greater than preoperative harmonic ratios, they were not comparable with those in healthy individuals. The coefficient of variation changes were associated with pain relief during gait. Harmonic ratio changes were associated with hip abductor strength, extension range of motion, and limb lengthening. CONCLUSION: Gait variability improved after total hip arthroplasty due to improved hip function. However, trunk variability was insufficient compared with that in healthy individuals.

Root mean square of lower trunk acceleration during walking in patients with unilateral total hip replacement.

Although several studies have described abnormal trunk motion before and after total hip arthroplasty (THA) surgery, few studies have examined trunk motion using accelerometry. The aim of this study was to determine whether abnormal trunk motion persisted after THA using accelerometry. A total of 24 female patients (61.0±6.9years) and 20 healthy female subjects (59.9±6.8years) participated in this study. Patients were assessed at 1 month prior to surgery and 12 months after surgery. Trunk acceleration during gait was measured using a triaxial accelerometer attached to the L3 spinous process. We calculated the root mean square (RMS) and RMS ratio (RMSR) in the vertical (VT), medio-lateral (ML), and anterior-posterior (AP) directions. Results revealed that the RMS in the VT and AP directions postoperatively was greater than that preoperatively, whereas there was no difference in the RMS in the ML direction. In addition, the preoperative RMSR in the ML direction was significantly greater compared with that of healthy individuals and the postoperative RMSR. There was no difference in the RMSR in the ML direction between healthy individuals and postoperatively. These findings suggested that the trunk motion in the frontal plane prior to surgery had improved and was comparable to that of healthy individuals following THA.

Diabetes is a Risk Factor for Restricted Range of Motion and Poor Clinical Outcome After Total Knee Arthroplasty.

BACKGROUND: We investigated the effects of diabetes mellitus on knee range of motion, muscle strength, and functional outcome after total knee arthroplasty. METHODS: A total of 20 patients with type 2 diabetes and 20 patients without diabetes matched for age, body mass index, knee range of motion, and muscle strength at baseline participated in this study. We examined knee range of motion and muscle strength and assessed functional activities using the new Knee Society Score questionnaire for each patient 1 month preoperatively and at 6 and 12 months postoperatively. RESULTS: Patients with diabetes had significantly lower knee flexion and smaller improvements in the new Knee Society Score than patients without diabetes. CONCLUSION: Our results suggest that clinicians should treat and monitor patients with diabetes closely to prevent restricted knee range of motion and poorer functional recovery after total knee arthroplasty.

Gait variability before surgery and at discharge in patients who undergo total knee arthroplasty: a cohort study.

This study aimed to determine gait ability at hospital discharge in patients undergoing total knee arthroplasty (TKA) as an indicator of the risk of falling. Fifty-seven patients undergoing primary TKA for knee osteoarthritis participated in this study. Gait variability measured with accelerometers and physical function including knee range of motion (ROM), quadriceps strength, walking speed, and the Timed Up and Go (TUG) test were evaluated preoperatively and at discharge from the hospital (1 month before and 5 days after surgery). All patients were discharged directly home at 5 days after surgery. Knee flexion of ROM, quadriceps strength, walking speed, and the TUG test results were significantly worse at hospital discharge than preoperatively (p < 0.001). However, gait variability was not significantly different before and after TKA. This result indicated that patients following TKA surgery could walk at hospital discharge as stably as preoperatively regardless of the decrease in physical function, including knee ROM, quadriceps strength, and gait speed after surgery.

Two stage hip revision in periprosthetic infection: results of 41 cases.

BACKGROUND: two-stage revision is considered the best treatment approach for the eradication of chronic joint infection. We report the outcome of 41 consecutive patients with infected hip prostheses, treated between 2000 and 2005, with two-stage revision using an antibiotic-loaded cement spacer. METHODS: Patients underwent a treatment protocol which included clinical and radiographic evaluation, laboratory investigations, hip aspiration, 99mTc-MDP and 99mTc-leukocyte-labeled scintigraphy and intraoperative assessment. All patients were diagnosed with a late chronic infection and classified as B-host according to the Cierny-Mader classification system. 9 patients out of 41 (22%) required a second interim treatment period, with exchange of the spacer. The proportion of methicillin-resistant Staphylococcus was similar between the one-spacer group and two-spacer group (28% vs 33%), whereas the proportion of patients with three or more risk factors was significantly higher in the two-spacer group than in the one-spacer group (28% vs 55%, respectively). RESULTS: Forty patients had final reimplantation, one patient had a resection arthroplasty. At an average follow-up of 5.3 years no recurrence of infection occurred. The average post-operative Harris hip score improved from 41 to 80. CONCLUSIONS: In the treatment of two-stage revision arthroplasty the adherence to the protocol proved to be effective for infection eradication and final reimplantation.

[A patient with recurrent rectal cancer in whom pulmonary metastasis disappeared by FOLFOX 4 therapy].

We performed FOLFOX 4 therapy in a patient with lung metastasis (a 62-year-old woman) after surgery for rectal cancer and observed both normalization of tumor markers and disappearance of the metastasis. Low anterior resection was performed for progressive rectal cancer, and treatment with UFT and folinate was started one month after surgery. However, tumor markers increased after 2 months of treatment and CT scans showed metastases to both lungs. FOLFOX 4 therapy was started, and tumor markers became normal after four courses, while the lung metastases disappeared after 10 courses. The dosage of FOLFOX 4 was reduced after three courses due to neutropenia and diarrhea. This treatment appeared to be effective for the inhibition of lung metastasis associated with colorectal cancer.

Massive melena caused by a carcinoid of the small intestine: report of a case.

We report a case of massive melena caused by a carcinoid of the small intestine. A 28-year-old woman was admitted to our department after presenting with massive melena. The source of the bleeding could not be localized by upper or lower gastrointestinal endoscopy, computed tomography (CT), or labeled red blood cell scintigraphy. Enteroscopy allowed visualization only up to the jejunum, and we could not localize the lesion. The melena subsided with conservative treatment, but the patient was readmitted 4 months later when she suffered another episode of massive melena. A contrast CT scan performed immediately showed extravascular leakage and the retention of contrast medium in the ileum. Thus, she underwent an emergency surgery, during which endoscopy confirmed a small ileal tumor accompanied by pulsating bleeding from the exposed blood vessels at its center. The small intestine was partially resected, including the swollen lymph nodes, the size of small beans. Pathological examination confirmed a carcinoid tumor 1 cm in diameter, with an arterial rupture at its center and lymph node metastasis.