Effect of a walking program on gait characteristics in patients with osteoarthritis.

This paper reports the results of a study of the gait of 102 patients with osteoarthritis of the knee. Functional status was measured by a 6-min test of walking distance; the stride characteristics associated with the walk test were assessed. Stride characteristics were measured by a Stride Analyzer. Patients were randomized to an 8-week educational and walking program (the intervention group) or to a weekly telephone survey (the control group). The intervention group patients had a 15% increase in walking distance (P < 0.0001) and increases of 9.1% in stride length at free walking speeds (P < 0.007) and 17% in stride length at fast walking speeds (P < 0.01) compared to the control group. The results of this study have shown that the walking and educational program was effective in improving gait function in patients with osteoarthritis of the knee.

The Van Nes tibial rotationplasty. A functionally viable reconstructive procedure in children who have a tumor of the distal end of the femur.

Twelve patients who had a malignant tumor of the distal end of the femur were treated with a Van Nes tibial rotationplasty. The survival rates were comparable with those for above-the-knee amputees and patients who had an endoprosthetic replacement. The results of functional testing showed that these patients performed as well as those who had endoprosthetic replacement and better than those who had above-the-knee amputation. Rotationplasty is therefore a favorable alternative to amputation or endoprosthetic replacement, either as a primary or as a salvage procedure.

New advances and concepts in amputee management after treatment for bone and soft-tissue sarcomas.

Amputation is still necessary to achieve disease-free margins in some patients with osteogenic sarcoma. Improving the quality of life for this largely young patient population has become increasingly important considering the dramatic increase in their survival rate. A multidisciplinary approach should include prosthetic devices that are comfortable and lightweight, and produce an energy-efficient gait, an aggressive postoperative rehabilitation, and an objective evaluation of progress. This approach will help improve the high net energy expenditure of ambulation and the asymmetrical stance time experienced by this group of individuals and allow them to gain equal status in society.

The relationship of stride characteristics to pain before and after total knee arthroplasty.

The relationship between the changes in stride characteristics and the changes in pain that occurred before and after total knee arthroplasty (TKA) were examined in 18 patients with a diagnosis of osteoarthritis. The patients were observed after either bilateral or unilateral TKA. Measurements of stride characteristics by footswitch analysis and assessments of pain by visual analog scale were performed preoperatively and at five months and at 13 months postoperatively. Stride characteristics improved and pain diminished after surgery. Improvements, from preoperative to five months postoperative, were noted in seven of eight stride characteristics. The improvements in velocity and stride length were related to the decreases in pain over that period. Improvements from five months to 13 months postoperative were independent of the decrease in pain over that period and independent of the increase in active knee flexion angle. When evaluating stride characteristics after TKA, it is necessary to consider the effect of pain relief and to monitor the patient's ambulatory progress after pain diminishes.

Abnormalities in quadriceps-hamstring strength. Relationships in polymyositis and dermatomyositis.

Muscle strength determined as torque was measured in patients with dermatomyositis and polymyositis. Patients demonstrated weakness in both quadriceps and hamstring muscle groups. The ratio of quadriceps to hamstring torque (Q:H) was 1.93 +/- 0.38 in controls and 1.60 +/- 0.62 in patients. Patients with Q:H ratios that were below this mean were older, weaker, and were treated with greater doses of prednisone. Fifty-six percent of patients studied initially had low Q:H ratios, and 64% of all patients had low Q:H ratios at some time. The Q:H ratio in patients with steroid and thyroid myopathy, however, was not different than controls. It is hypothesized, therefore, that preferential involvement of the quadriceps group characterizes patients with inflammatory muscle disease.

Measurement of plantar flexor spasticity during treatment with tone-reducing casts.

The purpose of this study was to examine the hypothesis that treatment with short-leg, tone-reducing casts will alter resistance of the plantar flexors to dynamic and static stretch. The torque resisting passive dorsiflexion was measured at angular velocities of 0, 12, 60, and 120 degrees/s for 16 spastic extremities. The short-term changes in dynamic sensitivity and static sensitivity were not significant. Longer-term wearing resulted in significant decreases in both dynamic sensitivity and static sensitivity. Thus, a change in resistance to stretch did occur with longer-term casting.

Energy cost during gait in osteosarcoma patients after resection and knee replacement and after above-the-knee amputation.

We determined the energy cost during gait by measuring the oxygen consumption of twenty-six patients after treatment for osteosarcoma about the knee. Fourteen had had an en bloc resection of the distal end of the femur and proximal end of the tibia followed by segmental replacement with a custom-made knee prosthesis and twelve had had an above-the-knee amputation followed by fitting with an artificial limb. Comparisons of free-walking velocity, oxygen consumption per meter traveled, and per cent of maximum aerobic capacity used during walking demonstrated that patients with resection and prosthetic knee replacement had a lower energy cost during gait.

Biomechanical measurement of spastic plantarflexors.

A study was conducted to determine the feasibility of quantifying spasticity in plantarflexors by measuring the resistance to passive dorsiflexion of the ankle joint at several constant angular speeds. Repeated testing was conducted on normal subjects and spastic patients. Good repeatability was found for both groups and both groups were found to differ significantly from each other with respect to the measurement variable. The method will provide a useful tool for quantifying alterations in plantarflexor spasticity which result from various surgical and non-surgical treatments.