The effects of preoperative balance training on balance and functional outcome after total knee replacement: a randomized controlled trial.

OBJECTIVE: To assess the effects of preoperative balance training on the early postoperative balance and functional outcomes after total knee replacement surgery and to test whether an outpatient intervention may be as effective as a domiciliary intervention. DESIGN: This is a three-arm randomized controlled trial. SETTING: University hospital. SUBJECTS: Eighty-six individuals were recruited. Seventy-seven were analysed, aged 72.1 (SD 7.6) years, of which 68% were women. OUTCOME MEASURES: Overall state of balance, as measured with the Berg Balance Scale, and patient-perceived functionality, as measured with the Knee Injury and Osteoarthritis Outcome Score Function in Activities in Daily Living (KOOS-ADL) questionnaire, were the primary outcomes. Secondary assessments targeted knee function, balance and mobility, quality of life, and self-reported outcomes. The primary end-point was six weeks after surgery. INTERVENTION: The hospital group implemented a four-week preoperative outpatient balance-oriented intervention. The home group implemented similar training, but this was domiciliary. The control group was instructed to keep performing their normal activities. RESULTS: Home and hospital groups presented a moderate effect against the control group (dhospital-control = 0.54; dhome-control = 0.63), both being similarly effective in improving the overall state of balance at six weeks after surgery (P = 0.013). KOOS-ADL scores showed no between-group differences and a small effect size (d < 0.5; P = 0.937). Secondary assessments suggested non-significant between-group differences. CONCLUSION: Preoperative balance training, conducted either as domiciliary or as an outpatient, is an effective approach to enhance early postoperative balance outcome but not the perceived functionality of individuals undergoing total knee replacement.

Total ankle replacement in patients with end-stage ankle osteoarthritis: clinical results and kinetic gait analysis.

BACKGROUND: Total ankle arthroplasty is being used more frequently as an alternative for arthrodesis in final stages of ankle osteoarthritis. However, there are few studies which describe the biomechanics of gait of these patients. METHODS: Between March 2006 and May 2011, 17 patients (n=18 ankles) suffering end-stage osteoarthritis of the ankle who underwent an ankle replacement (HINTEGRA) were evaluated retrospectively. We evaluated clinical, radiological and biomechanical gait parameters using the NedAMH/IBV dynamometric platform. RESULTS: At last follow-up (average: 37 months), the AOFAS score improved from 31 to 83 with a high rate of satisfaction (83.3%). Kinetic gait parameters were more similar to a healthy ankle. We detected a radiolucent line in 8 patients (44%) without any subsidence case. CONCLUSIONS: Our study showed a high rate of satisfaction and biomechanics of the gait similar to a healthy ankle. The complication rate was analogous to those previously published in the literature.

Fall classification, incidence and circumstances in patients undergoing total knee replacement.

To propose a fall-classification framework for patients undergoing total knee replacement (TKR). In addition, we reinforced the available evidence on fall incidence and circumstances and compared the characteristics of fallers versus. nonfallers. Retrospective and prospective data were collected from 253 subjects with severe knee osteoarthritis who were waiting for primary TKR. Falls were classified considering the location of the destabilizing force, source of destabilization and fall precipitating factor. Fall incidence and circumstances were described; the characteristics of fallers and nonfallers in terms of functional and balance performance were compared with F-tests (95% CI). The fall incidence before surgery was 40.3% (95% CI 34.2% to 46.6%). This figure decreased to 13.1% (95% CI 9.2% to 18.0%) and to 23.4% (95% CI 17.8% to 29.6%) at 6 and 12 months after surgery, respectively. Most falls were caused by destabilizations in the base of support (n = 102, 72%) and were due to extrinsic factors (n = 78, 76%) and trip patterns. Significant differences between fallers and nonfallers were found in knee extensor strength and monopodal stability in the surgical limb (p < 0.05). Falls are prevalent in patients with severe knee osteoarthritis. Symptoms and functional performance improve after surgery, and fall incidence is reduced. Most fall events originate from disruptions in the base of support and are precipitated by extrinsic factors, generally trips during walking activities.

The condition of the contralateral knee may induce different degrees of knee extensor strength asymmetry and affect functionality in individuals with unilateral or bilateral osteoarthritis.

BACKGROUND: Loss of knee extensor strength in individuals with knee osteoarthritis (KOA) may induce inter-limb strength asymmetries and alter functionality. The aims were to analyse whether the condition of the uninvolved knee (advanced to severe KOA or no affection) may induce different degrees of knee extensor strength asymmetry in individuals with KOA and to study whether functionality may differ in cases of unilateral or bilateral KOA. METHODS: Sixty-eight subjects with advance-to-severe KOA were categorized into two groups (unilateral or bilateral KOA). The knee extensor strength ratio (KESR), and self-reported and performance-based functionality were analysed and compared. Sex and age were independent factors. One- and two-way analysis of variance assessed for significant between-group differences (95% confidence interval (CI)). RESULTS: Participants with unilateral KOA presented with 20% knee extensor strength asymmetry. The mean difference with the bilateral KOA group in terms of Knee Extensors Strength Ratio was 0.2 (95% CI 0-0.3; P = 0.021), of the Oxford Knee Scale score was 4.2 (95% CI 3.4-5.1; P = 0.037), and of the Timed Up and Go was 1.3 s (95% CI 0.5-2.2; P > 0.05). There were significant sex and age interactions (P < 0.05). CONCLUSIONS: Individuals with unilateral or bilateral KOA present with different degrees of knee extensor strength asymmetry. The non-affected knee seems to help to better develop functional tasks in cases of unilateral condition. The findings may help the design of tailored strengthening interventions in which each knee condition in individuals with KOA should be considered.

Retrospective review of L3 myelomeningocele in three age groups: should posterolateral iliopsoas transfer still be indicated to stabilize the hip?

The data from 58 hips in 29 myelodysplastic children with L3 paralysis has been reviewed retrospectively. Posterolateral transfer of the iliopsoas (Sharrard technique) was performed on all hips to correct muscle imbalance between 1975 and 1992. The average length of follow-up was 21 years. Preoperatively, 58.6% of the hips were either subluxated or dislocated (these were surgically reduced at the same stage). Radiological assessment revealed that 91.4% of the hips were stable at preschool age and 84.5% in adolescence. Of the patients 86% were functional walkers at preschool age and 75.8% in adolescence. Downward transitions in seven patients were related to the presence of scoliosis, spasticity and obesity. All patients who were community walkers in adolescence maintained their function in adult life at the time of the review. We conclude that the procedure has value in obtaining hip stability and walking ability in carefully selected patients with myelomeningocele.