Effects of exercise training on bone mineral density and some health-related outcomes in HIV conditions: A randomized controlled trial.

INTRODUCTION: Human Immunodeficiency Virus (HIV) infection remains prevalent co-morbidity, and among fracture patients. Few studies have investigated the role of exercise interventions in preventing bone demineralization in people who have fractures and HIV. If exercise exposed, HIV-infected individuals may experience improved bone health outcomes (BMD), function, quality of life (QoL). The study will aim to assess the impact of home based exercises on bone mineral density, functional capacity, QoL, and some serological markers of health in HIV infection among Nigerians and South Africans. METHODS AND DESIGN: The study is an assessor-blinded randomized controlled trial. Patients managed with internal and external fixation for femoral shaft fracture at the study sites will be recruited to participate in the study. The participants will be recruited 2 weeks post-discharge at the follow-up clinic with the orthopaedic surgeon. The study population will consist of all persons with femoral fracture and HIV-positive and negative (HIV-positive medically confirmed) aged 18 to 60 years attending the above-named health facilities. For the HIV-positive participants, a documented positive HIV result, as well as a history of being followed-up at the HIV treatment and care center. A developed home based exercise programme will be implemented in the experimental group while the control group continues with the usual rehabilitation programme. The primary outcome measures will be function, gait, bone mineral density, physical activity, and QoL. DISCUSSION: The proposed trial will compare the effect of a home-based physical exercise-training programme in the management of femoral fracture to the usual physiotherapy management programmes with specific outcomes of bone mineral density, function, and inflammatory markers. TRIAL REGISTRATION: The study was prospectively registered with the Pan African Clinical Trials Registry (Reference number - PACTR201910562118957) on October 21, 2019. (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9425).

The patient results and satisfaction of knee arthroplasty in a validated grading system.

INTRODUCTION: The validated Knee Osteoarthritis Grading System (KOGS) was implemented and clinical results were compared with patient satisfaction data and implant survivorship in a multi-centre study with surgeons familiar with unicompartmental knee arthroplasty (UKA), patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA). This is also the first study to evaluate the prevalence of UKA and TKA in consecutive osteoarthritis (OA) knee arthroplasties assessed by this system.. METHOD: A consecutive cohort of knees was gathered at three different institutions as categorized by KOGS and surgically treated with the recommended implant unless clinical reasons or patient preference precluded such an option. One thousand one hundred seventy-seven consecutive knees were evaluated including 311 TKA (26%), 695 medial UKA (59%), 154 lateral UKA (13%) and 17 PFA (2%) and the results of the categories evaluated with the Oxford Knee Score (OKS) and the complications reflected in the different categories. RESULTS: The failure rate of the UKA (3.5%) or TKA (1.6%) is not higher than accepted results in the literature and the difference in complications is negligible between the UKA (72%) and TKA (26%) cohorts. Revision of a UKA to a TKA as an endpoint was 0.58% with ipsilateral progression at 0.8% over a period of five to 84 months (mean follow-up of 36 months) despite the 'excessive' proportion of UKA in this cohort. The Oxford Score improvement is significant in TKA and UKA and contributes to the acceptable outcomes (The OKS for TKA improved from 20 pre-operatively to 36 post-operatively and the UKA improved from 22 pre-operatively to 39 post-operatively). CONCLUSION: KOGS achieves acceptable early survival and functional results when implemented and is a suitable tool for identifying the preferred implant as was validated.