Randomized Controlled Trial Comparing Early Mobilization vs Six Weeks of Immobilization in a Walking Cast Following Total Ankle Replacement.

Rehabilitation for patients after total ankle replacement traditionally involves weeks of immobilization in a plaster cast followed by progressive mobilization. In a small randomized trial, we compared teh outcomes of patients who received a 3-component cementless, unconstrained, mobile-bearing prosthesis and were initially immobilised in a plaster cast for 6 weeks to thoese who received the same prosthesis but were allowed to mobilise early. Gait, clinical, patient-reported, and radiologic outcomes were measured. The study included 20 patients, 10 in the plaster cast group and 10 in the early mobilization group, and the demographics of the groups did not differ significantly. All patients were followed-up for 24 months. There were no significant differences between the 2 groups 2 years after surgery in ankle dorsiflexion, spatiotemporal gait characteristics, American Orthopaedic Foot and Ankle Society ankle-hindfoot scores, Timed Up and Go Test times, WOMAC (pain, stiffness, function) scores, SF-36 (quality-of-life) scores, or patient satisfaction (pain relief, daily-living, recreational activities, and overall) (all p > .05). Bone mineral density decrease of the medial malleolus and increase at middle tibia, calculated with DEXA scans, was significantly better in early mobilization than plaster cast group at one and 2 years postoperatively, but this was also the case preoperatively. The lack of differences in outcomes suggests that early ankle mobilization may be a safe and reliable method to enhance recovery following ankle arthroplasty with a 3-component cementless, unconstrained, mobile-bearing prosthesis. Compared to traditional plaster casting, patients who are engaged in early mobilization after arthroplasty may enjoy similar functional, mobility, quality-of-life, pain relief, activity level, and satisfaction outcomes.

Factors associated with internal hip rotation gait in patients with cerebral palsy.

Internal rotation gait is common in children with cerebral palsy. Factors thought to contribute include femoral anteversion, hip flexor tightness, imbalance of hip rotators, and hamstring and adductor tightness. The exact cause of internal rotation must be defined before contemplating surgery. We investigated the prevalence of internal hip rotation and associated factors, which are considered to influence this walking pattern, in patients with cerebral palsy. Gait laboratory data of 222 patients with cerebral palsy were studied retrospectively. Two groups were selected; those with maximum dynamic hip internal rotation of more than 27 degrees and those with less than 20 degrees. Of 222 patients, 27.0% (diplegia, 61.7%; hemiplegia, 38.3%) had at least one hip with dynamic internal rotation of more than 27 degrees. This study suggests that dynamic hip internal rotation is multifactorial in origin. The most significant differences in clinical measures were found in values of passive hip external rotation range, femoral anteversion and hip flexor contracture. We discuss the role of early treatment of hip flexion contracture.