Early Recovery Outcomes in Patients Undergoing Total Hip Arthroplasty Through a Posterior Approach With Modified Postoperative Precautions.

BACKGROUND: Recent data suggest that a modified, more lenient set of precautions after total hip arthroplasty (THA) performed through the posterolateral approach may safely allow more patient movement and exercise in the immediate postoperative period. We hypothesize that 1) patients undergoing THA given modified precautions will demonstrate a fast-track return to functional activity and 2) wrist-based activity trackers will provide valuable information on postoperative activity levels. METHODS: We prospectively enrolled patients undergoing THA. Patients were given a wrist-based, commercially available activity tracker to wear 1 week preoperatively and 6 weeks postoperatively. Postoperative hip precautions included only the avoidance of the "leg-shaving" position of combined hip flexion, adduction, and internal rotation. Linear mixed models were used to analyze the change in steps and Hip Disability and Osteoarthritis Outcome Score-Junior (HOOS)-JR data. Pearson correlation coefficients were used to describe the relationship between average steps and HOOS-JR scores over time. RESULTS: Eighty-two patients were enrolled. Seventy-four percent returned to work by week 4. Seventy-six percent of left THA patients returned to driving by week 4. At 6 weeks, 23% of survey respondents were taking pain medication and 26% were using assistive devices. Average daily steps were 1098 at week 1, 2491 at week 2, 4130 at week 3, 4850 at week 4, 5712 at week 5, and 6069 at week 6. A significant correlation (R: -0.981) was found between increased weekly steps and improved HOOS-JR scores after THA (P < .001). CONCLUSION: Defining expected recovery timelines for patients undergoing THA helps surgeons counsel their patients preoperatively. Our study demonstrates an expected pathway for recovery after THA by using modified precautions that will be more clearly outlined with ongoing clinical data analysis.

Dynamic Loading Assessment at the Fifth Metatarsal in Elite Athletes With a History of Jones Fracture.

OBJECTIVE: We hypothesize that athletes who have suffered Jones fractures will apply significantly higher loads at the fifth metatarsal base during athletic activities compared with matched uninjured athletes. DESIGN: Sixteen athletes were recruited to participate. Eight athletes had a history of Jones fracture, and 8 age, gender, and position-matched athletes without a history of foot injury were recruited as controls. SETTING: Institutional study at Stanford University. PARTICIPANTS: Sixteen athletes with/without a history of foot injury from Stanford University. INTERVENTIONS: Athletes performed a standardized series of movements while wearing calibrated, wireless pressure mapping insoles, and then again with their custom corrective insoles. MAIN OUTCOME MEASURES: Peak pressure, mean pressure, maximum force, and force-time integral (ie, impulse) were recorded for each activity. RESULTS: Athletes with a history of Jones fracture showed a significantly increased peak pressure (183 ± 23 vs 138 ± 7 kPA), mean pressure (124 ± 14 vs 95 ± 4 kPA), and maximum force (15 ± 1.2 vs 12 ± 1.2%BW) at the fifth metatarsal base during walking and running compared with uninjured matched controls (all P < 0.05). CONCLUSIONS: Athletes with a history of Jones fracture exert significantly increased peak and mean forces at the base of the fifth metatarsal during common athletic activities. Custom orthoses do not seem to offload this region in all cases. Increased loads may contribute to the development of stress injury to the fifth metatarsal during repetitive loading, and ultimately fracture of the bone.

Correction to: At the US Epicenter of the COVID-19 Pandemic, an Orthopedic Residency Program Reorganizes.

[This corrects the article DOI: 10.1007/s11420-020-09765-5.].

Ankle Joint Contact Loads and Displacement With Progressive Syndesmotic Injury.

BACKGROUND: Ligamentous injuries to the distal tibiofibular syndesmosis are predictive of long-term ankle dysfunction. Mild and moderate syndesmotic injuries are difficult to stratify, and the impact of syndesmosis injury on the magnitude and distribution of forces within the ankle joint during athletic activities is unknown. METHODS: Eight below-knee cadaveric specimens were tested in the intact state and after sequential sectioning of the following ligaments: anterior-inferior tibiofibular, anterior deltoid (1 cm), interosseous/transverse (IOL/TL), posterior-inferior tibiofibular, and whole deltoid. In each condition, specimens were loaded in axial compression to 700 N and then externally rotated to 20 N·m torque. RESULTS: During axial loading and external rotation, both the fibula and the talus rotated significantly after each ligament sectioning as compared to the intact condition. After IOL/TL release, a significant increase in posterior translation of the fibula was observed, although no syndesmotic widening was observed. Mean tibiotalar contact pressure increased significantly after IOL/TL release, and the center of pressure shifted posterolaterally, relative to more stable conditions, after IOL/TL release. There were significant increases in mean contact pressure and peak pressure along with a reduction in contact area with axial loading and external rotation as compared to axial loading alone for all 5 conditions. CONCLUSION: Significant increases in tibiotalar contact pressures occur when external rotation stresses are added to axial loading. Moderate and severe injuries are associated with a significant increase in mean contact pressure combined with a shift in the center of pressure and rotation of the fibula and talus. CLINICAL RELEVANCE: Considerable changes in ankle joint kinematics and contact mechanics may explain why moderate syndesmosis injuries take longer to heal and are more likely to develop long-term dysfunction and, potentially, ankle arthritis.

Site-specific loading at the fifth metatarsal base in rehabilitative devices: implications for Jones fracture treatment.

BACKGROUND: Fractures of the fifth metatarsal base are a relatively common injury. Whether treated surgically or nonsurgically, injury rehabilitation typically involves immobilization in a rigid sandal or short controlled ankle movement (CAM) walker boot. OBJECTIVE: To determine the peak pressure, contact pressure, and impulse at the base of the fifth metatarsal in 3 common footwear devices during common gait activities. DESIGN: This was a retrospective comparative study. SETTING: Research was conducted in a sports performance laboratory at a university. PARTICIPANTS: Twenty subjects without a recent history of foot injuries volunteered to participate. METHODS: Each subject performed 3 common gait activities (walking, heel walking, and pivoting) in 3 footwear devices (short CAM walker boot, postoperative sandal, running shoe). Pressure data were sampled (100 Hz) using individually sized plantar pressure insoles and software (Tekscan). Walking trials were collected at 1.0 m/s ± 5% (FusionSport Timing Gates). OUTCOME MEASUREMENTS: Peak pressure, contact pressure, and impulse at the fifth metatarsal base region were determined for all trials for all subjects. Mixed-effect regression models were used to compare pairwise differences in outcome variables between footwear devices. RESULTS: The CAM walker boot resulted in significantly lower peak pressure at the fifth metatarsal during walking and heel-walking relative to the postoperative sandal (P < .01) and during heel-walking (P < .01) relative to the standard athletic shoe. The CAM walker boot significantly reduced contact pressures at the fifth metatarsal during walking and heel-walking relative to the postoperative sandal (P < .01), and during heel-walking relative to the standard athletic shoe (P < .001). CONCLUSIONS: Our results suggest that the short CAM walker boot more effectively offloads the fifth metatarsal during common gait activities than a postoperative sandal or a standard athletic shoe. A short CAM walker boot may be a beneficial rehabilitative tool for patients undergoing rehabilitation after treatment of Jones fractures and other base of fifth metatarsal fractures.

The F-box protein MEC-15 (FBXW9) promotes synaptic transmission in GABAergic motor neurons in C. elegans.

Ubiquitination controls the activity of many proteins and has been implicated in almost every aspect of neuronal cell biology. Characterizing the precise function of ubiquitin ligases, the enzymes that catalyze ubiquitination of target proteins, is key to understanding distinct functions of ubiquitination. F-box proteins are the variable subunits of the large family of SCF ubiquitin ligases and are responsible for binding and recognizing specific ubiquitination targets. Here, we investigated the function of the F-box protein MEC-15 (FBXW9), one of a small number of F-box proteins evolutionarily conserved from C. elegans to mammals. mec-15 is widely expressed in the nervous system including GABAergic and cholinergic motor neurons. Electrophysiological and behavioral analyses indicate that GABAergic synaptic transmission is reduced in mec-15 mutants while cholinergic transmission appears normal. In the absence of MEC-15, the abundance of the synaptic vesicle protein SNB-1 (synaptobrevin) is reduced at synapses and increased in cell bodies of GABAergic motor neurons, suggesting that MEC-15 affects the trafficking of SNB-1 between cell bodies and synapses and may promote GABA release by regulating the abundance of SNB-1 at synapses.