Preoperative grip strength measurement and duration of hospital stay in patients undergoing total hip and knee arthroplasty.

PURPOSE: This study explored whether a relationship exists between preoperative pinch and power grip strength, and length of hospital stay in patients undergoing hip and knee arthroplasty at a busy UK hospital. We investigated whether handgrip dynamometry could be used preoperatively to identify patients at greater risk of longer inpatient stays. This would allow focussed intervention preoperatively and facilitate predictors of length of stay postoperatively. METHODS: One hundred and sixty-four patients (64 male, 100 female) undergoing lower limb arthroplasty (83 total knee replacement, 81 total hip replacement) were assessed in pre-admission clinic. Average measurements of pinch grip, power grip and grip endurance were taken from each patient using the Jamar hydraulic dynamometer (Jamar, USA). Duration of inpatient stay of each patient was recorded. RESULTS: Average duration of hospital stay was 9.4 days. Both average pinch grip strength and average power grip strength had a significant negative correlation with duration of inpatient stay. Those patients with a pinch grip strength less than 6.3 kg remained an inpatient for an average of 2 days longer than those with a pinch grip greater than 6.3 kg. CONCLUSIONS: This simple test may be highly beneficial preoperatively in identifying those patients likely to require longer inpatient stays and therefore those who would benefit from early nutritional intervention and focussed physiotherapy. It may also facilitate predictors of length of stay postoperatively. We believe this may effect significant cost reductions in the NHS.

A study of grip endurance and strengh in different elbow positions.

BACKGROUND: The aim of our study was twofold. The first was to investigate the optimum position of the elbow while measuring grip endurance. The second was to investigate the optimum position of the elbow while measuring peak grip strength. The American Society of Hand Therapists advocate estimation of grip strength with the elbow flexed at 90 degrees with the subject in the sitting position . As far as we are aware, there have been no reports in English literature regarding studies done to evaluate the position of the elbow while measuring grip endurance. MATERIALS AND METHODS: A total of 45 healthy adults (16 males, 29 females) participated in this study. A computerised handgrip analyser was used to measure the peak strength in the non-dominant hand, followed by measurement of the grip endurance. These measurements were conducted in 90 degrees of flexion and full extension of the elbow for each participant. RESULTS: Mean endurance in flexion was 71.0 N (SD 22.9) and in extension was 68.7 N (SD 27.4). Mean peak grip strength in flexion was 262.8 N (SD 73.1) and in extension was 264.1 N (SD 82.0). T test analysis showed no statistical significance for elbow positions for grip endurance (P = 0.67) and peak gip strength (P = 0.93). CONCLUSION: Practical implications from this study are that grip endurance training can be undertaken with the elbow in 90 degrees of flexion or full extension.

Dynamic posterior stabilization of shoulder hemiarthroplasty in long-standing neglected posterior dislocation of the glenohumeral joint.

Posterior dislocations of the shoulder are rare. They account for less than 3% of all shoulder dislocations. The treatment of neglected bilateral posterior dislocation of the shoulder is controversial. We present a novel operative technique to stabilize a shoulder hemiarthroplasty that we used in the treatment of a chronic posterior dislocation of a shoulder with an acute four-part fracture of the proximal humerus.

Comparison of accuracy of lag screw placement in cephalocondylic nails and sliding hip screw plate fixation for extracapsular fractures of the neck of femur.

This study compared the accuracy of lag screw placement between extracapsular femoral fractures fixed with sliding hip screw plate systems and those fixed with cephalocondylic nails. It involved 75 retrospective radiographs of fractures fixed with either a cephalocondylic nail (32) or a sliding hip screw plate system (43). Postoperative anteroposterior and lateral radiographs of the hip were scanned using a digital X-ray scanner and measured using computer software. Measurements were conducted by two independent observers, and the radiographs were calibrated to correct for magnification. Accuracy of lag screw placement was determined by "tip apex distance," described by Baumgaertner et al., and by the ratio method described by Parker. The mean tip apex distance was 24.0 mm in sliding hip screw plate systems and 21.1 mm in cephalocondylic nails. This was found to be statistically significant. Lag screw placement through cephalocondylic nails is more accurate and therefore has less chance of cut-out compared with sliding hip screw plate systems. There was no statistically significant difference using Parker's ratio method because this method quantifies the direction of the screw rather than the depth of penetration.