The Effect of Total Knee Replacement on Dual-Task Gait Performance in Older Adults.

OBJECTIVE: Total knee replacement (TKR) is a common solution for patients with advanced knee osteoarthritis. Still, fall rates remain relatively high after surgery. TKR may alter pain and knee function, balance control, and proprioception. However, given the role of complex (dual-task) walking in fall prediction for older adults, it is unknown how TKR alters the attentional demand of walking in older adults. The goal of this study was to examine the effect of TKR on dual-task walking among older adults. METHODS: Participants were evaluated 1 month before surgery and 4.5 months after surgery. Participants walked along an instrumented 7-meter path for 1 minute with and without a cognitive task (serial-3 subtraction). Pain and knee function, knee proprioception, dynamic balance, and balance confidence, as well as dual-task costs (DTC) were compared before and after the surgery and factors associated with change in gait DTCs were assessed. RESULTS: Thirty-eight participants completed the study (age 72.6 years, SD = 4.9; 11 men). A significant decrease in pain was found following TKR, with no change in balance, balance confidence, or proprioception. There were no differences in gait DTCs before and after the surgery. However, change in dynamic balance, specifically reactive postural control and dynamic gait, predicted changes in gait speed and stride time DTCs. CONCLUSION: The absence of an effect of TKR on gait DTCs can potentially underlie increased fall risk after TKR. Results from this study emphasize the significance of balance as a measure and focal point for rehabilitation after TKR. IMPACT: This study contributes to our understanding of the attentional cost of walking in people before and after TKR, as well as to factors associated with it. Results from this work can assist formulation of rehabilitation programs for people with knee osteoarthritis.

The optimal duration for the wrinkle test in a clinical setting.

To determine the time needed or the development of a positive result on the wrinkle test among patients with complete laceration of a digital nerve in a clinical setting. We prospectively recruited 20 patients who had undergone surgery for digital nerve laceration. The wrinkle test was conducted at a follow-up session up to 2 months after surgery, and the time to a positive wrinkling result was recorded. The wrinkle test was compared between the patient's injured versus uninjured contralateral finger. The average time required for a positive result on the wrinkle test was 24.5 min (± 11), with 25% patients requiring 40 min to obtain a positive result. When evaluating a patient with digital nerve injury in a "non-laboratory" environment, the wrinkle test may require up to 40 min to obtain a positive result. Our study suggests that if tests are completed following the generally accepted time limit reported in the literature (30 min), up to 25% of tests may produce false negative results.

Perilunate Dislocation Above the Age of 65 Years: Case Series and Review of Literature.

INTRODUCTION: Perilunate and fracture dislocations predominantly follow a high-energy mechanism. Perilunate dislocations have an incidence of 0.5/105 individuals/year, occurring at a mean age of 26 years and are frequently seen in men. This study aimed to describe the characteristics of this injury in elderly population of patients using literature review and our experience with four cases aged >65 years. MATERIALS AND METHODS: We treated four patients with perilunate dislocation aged >65 years. All the patients' medical records were reviewed retrospectively. A literature review for case studies of perilunate dislocation was conducted with the purpose of finding cases including patients aged >65 years. RESULTS: Three of our patients had injuries that were missed in the first visit in the emergency department. The mechanism of injury was high energy in only two patients. Two patients had posterior perilunate dislocation, while the other two had transradial perilunate dislocation. Three patients were available for follow-up. The overall outcome was satisfaction according the Mayo wrist score and minimal disability according to the Disabilities of the Arm, Shoulder and Hand score. All patients reported that pain was absent and they were able to return to their regular activities. The literature review found only seven papers documenting treatment of patients aged >65 years. DISCUSSION: Perilunate dislocation is extremely rare in the population aged >65 years. Although the rate of missed diagnosis in our cohort was extremely high, the overall satisfaction and return to function was high. CONCLUSIONS: This case series and literature review highlight the unique characteristics of this injury in the age group of patients aged >65 years. Although perilunate dislocation in patients aged >65 years is rare, clinicians should be aware of the presentation of this condition in the elderly.