Considerable variety in usual care rehabilitation after knee arthroplasty : a survey amongst physiotherapists.

Knee arthroplasty (KA) is increasingly performed, but rehabilitation and the possibility of returning to sports after KA are understudied areas. A web-based survey amongst physiotherapists was conducted to obtain insight in current rehabilitation methods and their return to sports advice after KA. 82 physiotherapists (62%) completed the survey. Broad agreement existed concerning important goals of rehabilitation, including the improvement of ROM, muscle strength, coordination and gait pattern. However, physiotherapists use a wide variety of treatment strategies to achieve these goals. Return to low-impact sports is mostly recommended, while return to intermediate- and high-impact sports is either advised against or considered impossible. The development of new evidence-based guidelines on physiotherapy after KA could lead to a more uniform approach in the rehabilitation for KA patients. Furthermore, investigating effects of individualization in the rehabilitation may prove valuable in optimising both patient outcomes and cost-effectiveness of this worldwide increasingly performed intervention.

Nationwide partial knee replacement uptake is influenced by volume and supplier--A Dutch arthroplasty register study.

BACKGROUND: Despite the established advantages of partial knee replacements (PKR), their usage remains limited. We investigated the effect of hospital knee arthroplasty (KA) volume and the availability of a frequently used PKR by the total KA supplier on the use of PKRs in a hospital. METHODS: A total of 190,204 total knee replacements (TKR) and 18,134 PKRs were identified in the Dutch Arthroplasty Register (LROI) from 2007 to 2016. For each hospital we determined the annual absolute KA volume (TKR+PKR) into quartiles (<103, 103-197, 197-292, >292 knee replacements/year), and determined whether the TKR supplier provided a frequently used PKR. Hospitals were divided in routine PKR users (≥13 PKRs/year) or occasional/non PKR users (<13 PKRs/year). Based on these parameters, the effect of total KA volume and supplier on PKR usage was investigated, using chi-square tests. Logistic regression analysis was performed to evaluate the influence of the combination of these factors. RESULTS: In the lowest volume group, around 15% of the hospitals used PKRs, compared to 75% in the highest volume group. Having a TKR supplier that also provides a frequently used PKR resulted in a higher likelihood of performing PKR, especially in low volume hospitals. CONCLUSIONS: Hospitals' total KA volume and the availability of a frequently used PKR appear to influence the use of PKR.

A registry study on radial head arthroplasties in the Netherlands: Indications, types and short-term survival.

BACKGROUND: This study aims to use the Dutch Arthroplasty Register data to report an overview of the contemporary indications and implant designs, and report the short-term survival of radial head arthroplasty. METHODS: From the Dutch Arthroplasty Register, data on patient demographics, surgery and revision were extracted for radial head arthroplasties performed from January 2014 to December 2019. Implant survival was calculated using the Kaplan-Meier method. RESULTS: Two hundred fifty-eight arthroplasties were included with a median follow-up of 2.2 years. The most common indication was a fracture of the radial head (178, 69%). One hundred thirty-nine (68%) of the prostheses were of bipolar design, and the most commonly used implant type was the Radial Head System (Tornier; 134, 51%). Of the 258 included radial head arthroplasties, 16 were revised at a median of six months after surgery. Reason for revision was predominantly aseptic loosening (9). The overall implant survival was 95.8% after one year, 90.5% after three years and 89.5% after five years. DISCUSSION: For radial head arthroplasties, acute trauma is the most common indication and Radial Head System the most commonly used implant. The implant survival is 89.5% after five years.

The Accolade TMZF stem fulfils the demands of modern stem design: Minimum 5-year survival in a cohort of 937 patients.

PURPOSE: Modern hip stem design includes a prosthesis that has a predictable outcome in all total hip arthroplasty (THA) patients, regardless of approach, surgeon or patient characteristics. Introduction without a learning curve and, in cases of problems, the possibility for a simple revision are other prerequisites. The purpose of this study is to evaluate whether the Accolade TMZF stem (Stryker Orthopedics, Mahwah, New Jersey, USA) is suitable to fulfil these demands. We report our mid-term survival of the Accolade TMZF hip stem in all patients from the first implantation at our institute. METHODS: From the start of using the Accolade TMZF stem (March 2009) until February 2011, 937 THA were performed by 12 surgeons using a posterolateral or anterolateral approach. Survival of the stem was calculated using Kaplan-Meier analysis. Effect of approach, patient age and comorbidity were analysed with a Cox proportional hazards' model. The learning effect was determined by comparing the number of revisions in the surgeons' first 20 THAs with their next 30 THAs and the subsequent THAs. RESULTS: At 5 years, cumulative stem survival was 97.9% based on revisions for all reasons and 98.8% with aseptic loosening as endpoint. We found no effect of surgical approach, patient age or comorbidity on stem survival. No learning effect was found. CONCLUSION: The Accolade TMZF stem fulfilled the demands of modern stem design.

Comparison of isometric triceps brachii force measurement in different elbow positions.

PURPOSE: Objective and reliable force measurement is necessary to monitor the rehabilitation after triceps brachii pathology, injuries, and posterior approach-based surgery. It is unclear at which amount of extension the triceps is best tested and if comparison to the uninjured sided is reliable. This study aims to identify the most reliable elbow position at which elbow extension force is measured using a dynamometer. Furthermore, it aims to compare the extension strength of the dominant arm with that of the nondominant arm. METHODS: Isometric elbow extension force of the dominant and nondominant arms of healthy subjects was measured. The measurements were taken in three sequences per arm in 0, 30, 60, 90, and 120 degrees of flexion. A subgroup repeated the measurements to analyze test-retest reliability using intraclass correlation. RESULTS: We included a total of 176 volunteers. The repeated measures analysis of variance for within-subject effect showed the lowest variation coefficient at 30 degrees of flexion. Extension forces showed a mean difference of 3.2-6.9 N in advantage of the dominant arm, resulting in ratios from 1.05 to 1.09. Learning curve analysis showed that during the first session in dominant and nondominant arms, less forces were exerted. CONCLUSION: The most reliable isometric triceps brachii muscle strength measurement was at 30 degrees of flexion of the elbow. Considering the learning curve, a first tryout session for both arms is indicated. Then, a second measurement suffices as no further learning curve is observed.

The reliability and validity of goniometric elbow measurements in adults: A systematic review of the literature.

BACKGROUND: The universal goniometer is a simple measuring tool. With this review we aimed to investigate the reliability and validity of the universal goniometer in measurements of the adults' elbow. METHODS: Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed and our study protocol was published online at PROSPERO. A literature search was conducted on relevant studies. Methodological quality was assessed using the Quality Appraisal of Diagnostic Reliability (QAREL) scoring system. RESULTS: Out of 697 studies yielded from our literature search, 12 were included. Six studies were rated as high quality. The intrarater reliability intraclass correlation coefficient ranged from 0.45 to 0.99, the interrater reliability ranged from intraclass correlation coefficient 0.53-0.97. One study providing instructions on goniometric alignment did not find a difference in expert versus non-expert examiners. Another study in which examiners were not instructed found a higher interrater reliability in expert examiners. One study investigating the validity of the goniometer in elbow measurements found a maximum standard error of the mean of 11.5° for total range of motion. DISCUSSION: Overall, the studies showed high intra- and interrater reliability of the universal goniometer. The reliability of the universal goniometer in non-expert examiners can be increased by clear instructions on goniometric alignment.

Assessing the Efficacy of an Educational Smartphone or Tablet App With Subdivided and Interactive Content to Increase Patients' Medical Knowledge: Randomized Controlled Trial.

BACKGROUND: Modern health care focuses on shared decision making (SDM) because of its positive effects on patient satisfaction, therapy compliance, and outcomes. Patients' knowledge about their illness and available treatment options, gained through medical education, is one of the key drivers for SDM. Current patient education relies heavily on medical consultation and is known to be ineffective. OBJECTIVE: This study aimed to determine whether providing patients with information in a subdivided, categorized, and interactive manner via an educational app for smartphone or tablet might increase the knowledge of their illness. METHODS: A surgeon-blinded randomized controlled trial was conducted with 213 patients who were referred to 1 of the 6 Dutch hospitals by their general practitioner owing to knee complaints that were indicative of knee osteoarthritis. An interactive app that, in addition to standard care, actively sends informative and pertinent content to patients about their illness on a daily basis by means of push notifications in the week before their consultation. The primary outcome was the level of perceived and actual knowledge that patients had about their knee complaints and the relevant treatment options after the intervention. RESULTS: In total, 122 patients were enrolled in the control group and 91 in the intervention group. After the intervention, the level of actual knowledge (measured on a 0-36 scale) was 52% higher in the app group (26.4 vs 17.4, P<.001). Moreover, within the app group, the level of perceived knowledge (measured on a 0-25 scale) increased by 22% during the week within the app group (from 13.5 to 16.5, P<.001), compared with no gain in the control group. CONCLUSIONS: Actively offering patients information in a subdivided (per day), categorized (per theme), and interactive (video and quiz questions) manner significantly increases the level of perceived knowledge and demonstrates a higher level of actual knowledge, compared with standard care educational practices. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number ISRCTN98629372; http://www.isrctn.com/ISRCTN98629372 (Archived by WebCite at http://www.webcitation.org/73F5trZbb).