RESUMEN
PURPOSE: To investigate the effects of including balance training in a preoperative strengthening intervention on balance and functional outcomes in patients undergoing total knee replacement (TKR) and compare these effects to those induced by preoperative strengthening and no intervention. METHODS: Eighty-two subjects scheduled for TKR were randomly allocated into the strengthening (ST, n = 28) group: a preoperative lower limb strengthening intervention; the strengthening + balance (ST + B, n = 28) group: same intervention augmented with balance training; and the control group (n = 26). The Berg Balance Scale (BBS) and the function in daily living subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS-ADL) were the primary outcomes. The secondary measures included balance and mobility, self-reported status, and knee function. The outcomes were assessed at baseline, 1 week before surgery, and 2, (primary endpoint), 6 and 52 weeks after surgery. RESULTS: Compared with the controls, the participants in the ST and ST + B groups presented significant improvements from baseline to the end of the preoperative intervention in BBS (p = 0.005) and KOOS-ADL (p < 0.001). At 6 weeks post-surgery, the knee extensor strength values were similar in the two treatment groups and significantly higher than that in the controls. Overall, the participant outcomes in all groups stabilized at 1 year after surgery. CONCLUSION: A preoperative strengthening intervention, regardless of whether it is complemented with balance training, enhances strength but not balance or functional outcomes at 6 weeks after surgery. Patients are expected to present similar performance at 1 year postoperatively, but adequately statistically powered trials are needed to confirm the findings. LEVEL OF EVIDENCE: II. TRIAL REGISTRATION: NCT02995668.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Terapia por Ejercicio/métodos , Osteoartritis de la Rodilla/cirugía , Equilibrio Postural , Cuidados Preoperatorios/métodos , Entrenamiento de Fuerza , Anciano , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/rehabilitación , Femenino , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
INTRODUCTION: Even when total knee arthroplasty (TKA) is an extended treatment, most patients experience a suboptimal evolution after TKA. The objectives of this study are the following: (1) to determine the effectiveness of two different prosthesis stabilisation systems on the functionality in activities of daily life, and (2) to determine prognostic biomarkers of knee prosthesis function based on radiological information, quantification of cytokines, intra-articular markers and biomechanical functional evaluation to predict successful evolution. METHODS AND ANALYSIS: The PROKnee trial was designed as a randomised controlled patient-blinded trial with two parallel groups that are currently ongoing. The initial recruitment will be 99 patients scheduled for their first TKA, without previous prosthesis interventions in lower limbs, who will be randomly divided into two groups that differed in the stabilisation methodology incorporated in the knee prosthesis: the MEDIAL-pivot group and the CENTRAL-pivot group. The maximum walking speed will be reported as the primary outcome, and the secondary results will be patient-reported questionnaires related to physical status, cognitive and mental state, radiological test, laboratory analysis and biomechanical instrumented functional performance, such as the 6-minute walking test, timed up-and-go test, gait, sit-to-stand, step-over, and ability to step up and down stairs. All the results will be measured 1 week before TKA and at 1.5, 3, 6 and 12 months after surgery. ETHICS AND DISSEMINATION: All procedures were approved by the Ethical Committee for Research with Medicines of the University Clinical Hospital of Valencia on 8 October 2020 (order no. 2020/181). Participants are required to provide informed consent for the study and for the surgical procedure. All the data collected will be treated confidentially since they will be blinded and encrypted. The results from the trial will be published in international peer-reviewed scientific journals, regardless of whether these results are negative or inconclusive. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT04850300).
Asunto(s)
Actividades Cotidianas , Artroplastia de Reemplazo de Rodilla , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Prótesis de la Rodilla , Recuperación de la Función , Femenino , Masculino , Estudios de Seguimiento , Fenómenos Biomecánicos , Articulación de la Rodilla/cirugía , Articulación de la Rodilla/fisiopatologíaRESUMEN
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.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Humanos , Incidencia , Accidentes por Caídas , Estudios Retrospectivos , Estudios Prospectivos , Osteoartritis de la Rodilla/epidemiología , Osteoartritis de la Rodilla/cirugíaRESUMEN
Osteochondral injuries of the metacarpal head require anatomical restoration to prevent limitations in range of motion and osteoarthritis. Osteochondral bone grafting is a viable option, especially in younger patients. Central injuries allow for different types of grafting, but when the injured area is on the lateral portion of the metacarpal head, the graft must include both a cortical and a cartilaginous portion. We present here the pearls and pitfalls in the surgical technique of chondrocostal grating from the 6th rib and an example of its use within a case of comminuted fracture of the metacarpal head. This technique provides a graft with cortical bone that allows for a stable fixation, with few complications during its harvesting. The graft is viable in the long-term and shows similar magnetic resonance intensities in comparison to hand cartilage.
Asunto(s)
Fracturas Conminutas , Fracturas Intraarticulares , Huesos del Metacarpo , Trasplante Óseo , Humanos , Huesos del Metacarpo/diagnóstico por imagen , Huesos del Metacarpo/cirugía , Rango del Movimiento ArticularRESUMEN
Synovial osteochondromatosis consists of a synovial metaplasia which affects 1 per 100 000 people. It is a very rare disease among children. It typically affects large joints of the body, especially the knee. Due to the lack of specificity of the signs and symptoms and X-Ray images, imaging tests such as nuclear magnetic resonance or computerized tomography are frequently needed for diagnosis. We report a case of a ten-year-old female patient with a six months history of pain and deformity of left patella which was diagnosed with synovial osteochondromatosis. This case highlights the importance of clinical suspicion, not only because it is an extremely rare disease in children, but also because it needs a surgical treatment as soon as possible in order to avoid consequences it might have in pediatric age, as joint destruction or malignization to chondrosarcoma.
La osteocondromatosis sinovial es una metaplasia benigna de la membrana sinovial que afecta a 1 de cada 100 000 personas, en su mayoría adultos, y es extremadamente infrecuente en edad pediátrica. Predomina en grandes articulaciones, sobre todo la rodilla, y la sintomatología es, por lo general, inespecífica. Dado que la radiografía simple no suele ser concluyente, se recurre a la resonancia magnética nuclear y a la tomografía axial computarizada para orientar el diagnóstico. Se expone el caso de una paciente de 10 años de edad con gonalgia y dismorfia en la patela izquierda de seis meses de evolución, con diagnóstico de osteocondromatosis sinovial. Se presenta el caso dado que se trata de una entidad muy rara en niños, pero que requiere un tratamiento quirúrgico precoz para evitar sus posibles complicaciones, como la destrucción articular progresiva o la malignización a condrosarcoma.
Asunto(s)
Artralgia/etiología , Condromatosis Sinovial/complicaciones , Articulación de la Rodilla , Niño , Femenino , HumanosRESUMEN
Concern about polyethylene wear and related osteolysis after knee arthroplasty has developed in the last years. Mobile-bearing knee prostheses were designed in order to reduce the influence of this critical factor on long-term success of total knee replacement. We present a prospective study comparing clinical and radiological results with a mobile-bearing (Ceragyr) and a fixed-bearing knee prosthesis (posterior stabilized Hermes). Clinical results did not show any significant differences in Knee Society scores. We found better results in the mobile-bearing group for pain scores and subjective preference, but the difference did not reach statistical significance. Within the time limits of this study, radiological analysis showed no osteolysis in either group, but longer follow-up will be needed to confirm this.
Asunto(s)
Prótesis de la Rodilla , Diseño de Prótesis , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/epidemiología , Estudios ProspectivosRESUMEN
BACKGOUND: Balance and proprioceptive deficits are frequently persistent after total joint replacement, limiting functionality and involving altered movement patterns and difficulties in walking and maintaining postural control among patients. RESEARCH QUESTION: The goal of this systematic review was to evaluate the short- and mid-term effects of proprioceptive and balance training for patients undergoing total knee and hip replacement. METHODS: This is a systematic review of literature. MEDLINE, Embase, Cochrane Library, PEDro, and Scopus were the databases searched. The review included randomized clinical trials in which the experimental groups underwent a training aimed at improving balance and proprioception, in addition to conventional care. The studies had to assess at least one of the following outcomes: self-reported functionality or balance (primary outcomes), knee function, pain, falls, or quality of life. RESULTS: Eight trials were included, involving 567 participants. The quantitative synthesis found a moderate to high significant effect of balance and proprioceptive trainings on self-reported functionality and balance after total knee replacement. The effects were maintained at mid-term in terms of balance alone. Conversely, preoperative training did not enhance outcomes after total hip arthroplasty. SIGNIFICANCE: The synthesis showed that, in clinical terms, balance trainings are a convenient complement to conventional physiotherapy care to produce an impact on balance and functionality after knee replacement. If outcomes such as improvement in pain, knee range of movement, or patient quality of life are to be promoted, it would be advisable to explore alternative proposals specifically targeting these goals. Further research is needed to confirm or discard the current evidence ultimately, predominantly in terms of the effects on the hips and those yielded by preoperative interventions.
Asunto(s)
Artroplastia de Reemplazo de Cadera/rehabilitación , Artroplastia de Reemplazo de Rodilla/rehabilitación , Modalidades de Fisioterapia , Equilibrio Postural/fisiología , Propiocepción/fisiología , Caminata/fisiología , Articulación de la Cadera/fisiopatología , Humanos , Articulación de la Rodilla/fisiopatologíaRESUMEN
BACKGROUND: Displaced intra-articular calcaneal fractures (DIACFs) can have long-term consequences in terms of foot pain and disability. This injury frequently occurs in the context of polytrauma patients and its influence in long-term functional prognosis is well known. The purpose of this study is to compare the etiology, severity, and functional outcome of the operated DIACFs between polytrauma patients and isolated cases. METHODS: Eighty-six patients with operated displaced intra-articular calcaneal fractures through open reduction and internal fixation (ORIF) were managed at our institution between January 1, 2008 and December 31, 2015. Eighty patients completed the follow-up, nine of them with both calcaneus operated (89 calcaneus) by ORIF with a plate. Two groups were established; one included 11 (14%) polytrauma patients, three of them with operated bilateral calcaneus, and 69 (86%) patients without polytrauma diagnosis. Severity of trauma, injury patterns, psychiatric background, associated fractures, second surgeries and functional questionnaire (adjusted American Orthopedic Foot and Ankle Society - AOFAS - ankle-hindfoot scale and SF-36) were collected. A detailed comparative statistical analysis is provided. RESULTS: There was significant statistical relationship between polytrauma patients and those with psychiatric comorbidities, severe trauma or severe injury, but not with second surgeries, later subtalar arthrodesis or outcome measures. Only calcaneal fractures with comminution according to Sanders classification was associated with second surgeries and later subtalar arthrodesis. The AOFAS score was solely related to trauma severity (71.5 vs 77; p = 0.29) and calcaneal fracture's comminution according to Sanders classification (79.4 type II and 79.3 type III vs 69.2 type IV; p = 0.000 and p = 0.008, respectively) and SF-36 score only with trauma severity (67.4 vs 78.1; p = 0.00) and psychiatric comorbidities (62.2 vs 75.8; p = 0.048). CONCLUSION: No differences in outcome measures and second surgeries were found between polytrauma patients and isolated fractures. For DIACFs, the severity of the impact was correlated with a higher number of second surgeries and worse functional outcomes. Following a DIACF, patients with psychiatric comorbidities presented worse health-related quality of life than people without this background.
Asunto(s)
Calcáneo/lesiones , Traumatismos de los Pies/fisiopatología , Fijación Interna de Fracturas , Fracturas Óseas/fisiopatología , Fracturas Óseas/rehabilitación , Reducción Abierta , Recuperación de la Función/fisiología , Adolescente , Adulto , Anciano , Calcáneo/fisiopatología , Calcáneo/cirugía , Comorbilidad , Femenino , Estudios de Seguimiento , Traumatismos de los Pies/rehabilitación , Traumatismos de los Pies/cirugía , Fracturas Óseas/cirugía , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple , Calidad de Vida , Estudios Retrospectivos , Índices de Gravedad del Trauma , Resultado del Tratamiento , Adulto JovenRESUMEN
Ossifying fibroma (osteofibrous dysplasia) is a rare fibro-osseous lesion made up of fibrous tissue with woven bone formation. It is most commonly found in the tibia and fibula of children ten years of age or younger. The most important differential diagnosis is monostotic fibrous dysplasia, which is radiologically similar but without woven bone rimmed by active osteoblasts like ossifying fibroma on histological examination. No epitheloid cells are found as in adamantinoma. We report the case of a 45-year-old woman who had a 12-month history of pain and slight swelling. Radiographs showed a multilocular radiolucent lesion with sclerotic rim in the proximal tibia. The lesion was curetted and the defect was packed with bone graft and acrylic cement. Microscopic examination showed active osteoblasts rimming the irregulary woven bone. One-year follow-up showed good functional recovery without recurrence of the lesion.
Asunto(s)
Neoplasias Óseas/diagnóstico , Fibroma Osificante/diagnóstico , Tibia , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/patología , Neoplasias Óseas/cirugía , Sustitutos de Huesos/uso terapéutico , Legrado , Femenino , Fibroma Osificante/diagnóstico por imagen , Fibroma Osificante/patología , Fibroma Osificante/cirugía , Humanos , Persona de Mediana Edad , Radiografía , Tibia/diagnóstico por imagen , Tibia/cirugíaRESUMEN
La osteocondromatosis sinovial es una metaplasia benigna de la membrana sinovial que afecta a 1 de cada 100 000 personas, en su mayoría adultos, y es extremadamente infrecuente en edad pediátrica. Predomina en grandes articulaciones, sobre todo la rodilla, y la sintomatología es, por lo general, inespecífica. Dado que la radiografía simple no suele ser concluyente, se recurre a la resonancia magnética nuclear y a la tomografía axial computarizada para orientar el diagnóstico. Se expone el caso de una paciente de 10 años de edad con gonalgia y dismorfia en la patela izquierda de seis meses de evolución, con diagnóstico de osteocondromatosis sinovial. Se presenta el caso dado que se trata de una entidad muy rara en niños, pero que requiere un tratamiento quirúrgico precoz para evitar sus posibles complicaciones, como la destrucción articular progresiva o la malignización a condrosarcoma.
Synovial osteochondromatosis consists of a synovial metaplasia which affects 1 per 100 000 people. It is a very rare disease among children. It typically affects large joints of the body, especially the knee. Due to the lack of specificity of the signs and symptoms and X-Ray images, imaging tests such as nuclear magnetic resonance or computerized tomography are frequently needed for diagnosis.We report a case of a ten-year-old female patient with a six months history of pain and deformity of left patella which was diagnosed with synovial osteochondromatosis. This case highlights the importance of clinical suspicion, not only because it is an extremely rare disease in children, but also because it needs a surgical treatment as soon as possible in order to avoid consequences it might have in pediatric age, as joint destruction or malignization to chondrosarcoma.
Asunto(s)
Humanos , Femenino , Niño , Condromatosis Sinovial/cirugía , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/terapia , Condrosarcoma/prevención & control , Articulación de la Rodilla/anomalías , MetaplasiaRESUMEN
Serum C-Reactive Protein was measured serially in 45 patients treated with uncomplicated primary total hip and knee arthroplasty (24 THR y 21 TKR). Blood specimens were obtained before surgery, on surgery day and on the 2nd, 3rd, 5th, 13th, 42nd and 150th postoperative days. In both groups serum CRP levels increased rapidly after surgery, with maximum levels on second postoperative day, higher in the TKR group and decreased gradually to preoperative levels on day 150, but still high on 42nd day. Levels returned to normal after surgery at the same time in both groups and no significant differences were found. Rising CRP levels after the third postoperative day may suggest a surgery complication such as infection.