Action Observation and Motor Imagery administered the day before surgery enhance functional recovery in patients after total hip arthroplasty: A randomized controlled trial.

OBJECTIVE: To investigate the effects of Action Observation and Motor Imagery administered the day before surgery on functional recovery in patients after total hip arthroplasty. DESIGN: Randomised controlled trial. SETTING: Humanitas Clinical and Research Center, Milan, Italy. PARTICIPANTS: Eighty inpatients with end-stage hip osteoarthritis undergoing total hip arthroplasty. INTERVENTIONS: All patients followed a standardized postoperative rehabilitation program. Experimental group (AO + MI) performed two 12-minute Action Observation and Motor Imagery sessions on the preoperative day, whereas control group underwent usual care consisting of education without any additional preoperative activity. OUTCOME MEASURES: A blinded physiotherapist assessed participants for functional mobility (Timed Up and Go - TUG) (primary outcome), maximum walking speed (10-Meter Walk Test - 10MWT), pain (Numeric Pain Rating Scale - NPRS) and fear of movement (Tampa Scale of Kinesiophobia - TSK) the day before and at four days after surgery. RESULTS: No between-group differences were found at baseline. Although TUG and 10MWT worsened in both groups (p < 0.001), better TUG was found for AO + MI group at four days (mean difference -5.8 s, 95% confidence interval from -11.3 to -0.3 s, p = 0.039). NPRS (p < 0.001) and TSK (p = 0.036 for AO + MI group, p = 0.003 for control group) improved after surgery without between-group differences. CONCLUSIONS: Patients undergoing Action Observation and Motor Imagery on the day before surgery showed less functional decline than control group in the first days after total hip arthroplasty. This intervention may contribute to a safer discharge with higher functional abilities in patients hospitalized for total hip arthroplasty.

Neuromuscular activation of quadriceps bellies during tasks performed in the same biomechanical condition in patients undergoing total knee arthroplasty.

OBJECTIVE: To investigate neuromuscular activation of quadriceps bellies during different tasks in patients before and after total knee arthroplasty (TKA). METHODS: Twenty-six patients scheduled for TKA and 16 control subjects performed three isometric tasks: knee extension (KE), hip flexion (HF), hip flexion with contralateral hip extension (HFE). Surface electromyography signals of rectus femoris, vastus medialis and vastus lateralis were collected the day before (T0), at one (T1) and three (T2) days after surgery, whereas control subjects underwent a single evaluation. The Root Mean Square peak normalized for its highest value during the three tasks (nRMS-peak) was used as index of maximum neuromuscular activation for each belly. Sixteen patients performed the postoperative assessment, due to the placement of an elastomeric pump aimed at reducing pain in 10 patients. RESULTS: Patients showed lower rectus femoris nRMS-peak during KE compared to HF and HFE before and after surgery (p < 0.001), as occurred in control subjects. Differently from control subjects, patients showed higher vastus medialis and vastus lateralis nRMS-peak during HF compared to KE at T1 (p = 0.008) and T2 (p = 0.039). CONCLUSION: TKA modified quadriceps neuromuscular activation during different tasks performed the same biomechanical condition. These findings may be considered in planning physiotherapy interventions after TKA.

Biomechanical analysis of a femur fracture in osteoarchaeology: Reconstruction of pathomechanics, treatment and gait.

In paleopathology, biomechanics allows us to investigate traumas in ancient skeletal remains. The aim of our current research is to reconstruct pathomechanics, treatment and gait of an individual from a Late Medieval femur with evident bone callus. In particular, to reconstruct the dynamic of the trauma that caused the injury and the adopted therapeutic measures, taking into account medical knowledges of that time. The femur was recovered during the archaeological investigation in the Sanctuary of Sacro Monte, Varese (Northern Italy). Classical physical anthropological methods and CT scans were used for macroscopic and radiological measurements of the bone. Finally, the reconstruction of the static and dynamic functional outcomes of the lesion were performed by Observation Gait Analysis (OGA) procedure. The femur shows an important callus at the middle third proximal of the shaft. The antemortem fracture was oblique and caused by a direct trauma probably related to occupational activities. The alignment of the segments in the frontal plane lead us to assume that the fracture was treated and the femur was immobilized with splints. The overlap and the angle of the segments indicate that the subject was not submitted to traction or fracture reduction. Good bone remodeling and consolidation of the fracture suggest that the subject had gradually led to the resumption of load and walking, although with important effects on posture and movement. The use of the OGA allows us to highlight the subject's kind of gait after healing.