Radiographic measurement of leg-length change in the nonoperative leg during total hip arthroplasty: a potential indicator of imaging error?

BACKGROUND: Anteroposterior (AP) pelvic radiographs are subject to errors that may cause measurement inaccuracy in total hip arthroplasty (THA). Such errors may be detected by measuring pre- to postoperative leg-length changes in the nonoperative leg, which experiences no physical changes during THA. METHODS: From AP pelvic radiographs, we measured pre- to postoperative leg-length changes (LLC) in the nonoperative legs of 67 patients who underwent primary THA using the trans-ischial line method. RESULTS: An LLC of 0 mm was observed in the nonoperative leg in only 14 cases (21%). A LLC ⩾ 2 mm was observed in 27% (18/67) of cases, including 13% (9/67) with LLC ⩾ 3 mm and 6% (4/67) with LLC ⩾ 4 mm. A post-hoc analysis used a validated method to measure change in pelvic tilt between pre- and postoperative images and found that changes in pelvic tilt ⩾ 4° in the anterior and posterior directions created apparent lengthening (2.0 ± 1.4 mm, p < 0.001 vs. 0-3° of tilt) and shortening (-2.1 ± 1.6 mm, p < 0.001 vs. 0-3° of tilt) of the nonoperative leg, respectively. CONCLUSIONS: The current study provides evidence of measurement errors in leg length using AP pelvic radiographs following THA. Changes in pelvic tilt may be in part responsible for these errors, with the direction of change in pelvic tilt influencing the apparent lengthening or shortening of the lower limb. Ultimately, these findings may influence the radiographic measurement and interpretation of leg-length changes following THA.

Encouraging older adults with pre-frailty and frailty to "MoveStrong": an analysis of secondary outcomes for a pilot randomized controlled trial. / Encourager les personnes âgées souffrant de préfragilité et de fragilité à participer au programme d'exercice et de nutrition « MoveStrong ¼ : analyse des résultats secondaires d'un essai pilote comparatif randomisé.

BACKGROUND: This 8-week pilot stepped-wedge randomized controlled trial evaluated the MoveStrong program for teaching adults who have frailty/pre-frailty about balance and functional strength training and sufficient protein intake to prevent falls and improve mobility. METHODS: We recruited individuals aged 60 years and over, with a FRAIL scale score of 1 or higher and at least one chronic condition, who were not currently strength training. The program included 16 exercise physiologist-led hour-long group sessions and two dietitian-led hour-long nutrition sessions. We analyzed secondary outcomes-weight, gait speed, grip strength, physical capacity (fatigue levels), sit-to-stand functioning, dynamic balance, health-related quality of life (HRQoL), physical activity levels and protein intake-using a paired t test and a generalized estimating equation (GEE). RESULTS: Of 44 participants (mean [SD] age 79 [9.82] years), 35 were pre-frail and 9 were frail. At follow-up, participants had significantly improved grip strength (1.63 kg, 95% CI: 0.62 to 2.63); sit-to-stand functioning (2 sit-to-stands, 95% CI: 1 to 3); and dynamic balance (1.68 s, 95% CI: 0.47 to 2.89). There were no significant improvements in gait speed, HRQoL index scores, self-rated health, physical activity levels (aerobic activity and strength training) or protein intake. GEE analysis revealed an interaction between exposure to MoveStrong and gait speed, sit-to-stand functioning, dynamic balance and HRQoL index scores. The total cost to administer the program and purchase equipment was CAD 14 700, equivalent to CAD 377 per participant. CONCLUSION: Exploratory analyses suggest MoveStrong exercises may improve gait speed, sit-to-stand functioning, dynamic balance and HRQoL index scores in older individuals who are frail and pre-frail.

Telephone Administration of the Automated Self-Administered 24-hour Dietary Assessment in Older Adults: Lessons Learned.

Automated Self-Administered 24-hour Dietary Assessment (ASA24) is an economical method of estimating dietary intake as nutrient analysis is automated, but its use in older adults is limited. The purpose of this work was to guide dietitians and future researchers on how to use the ASA24 with older adults, considering potential barriers encountered and strategies used to support completion based on our experience using this tool in a pilot clinical trial. ASA24 was completed by phone interview with 39 older adults. Challenges included: recalling food intake in detail, recording frequent eating occasions and complicated recipes, and general problems with communication. Strategies to support collection included making morning phone calls and suggesting that seniors write down the food consumed. Phone interviews were acceptable to older adults, but sufficient time was required. Dietitians and future researchers can use these findings to obtain dietary intake data from this hard-to-reach group.

Validation of a Novel Software Measurement Tool for Total Hip Arthroplasty.

Background Preoperative planning and postoperative evaluation of component position in total hip arthroplasty (THA) utilize specialized software that must be able to provide measurements that are both accurate and precise. A new software program for use in THA has recently been developed. We sought to evaluate the accuracy of this new software in comparison with two current, widely used software programs. Methodology Postoperative anteroposterior (AP) pelvic radiographs from 135 THA patients were retrospectively reviewed. Reference values for acetabular anteversion, inclination, and leg length were established using validated software programs (TraumaCad® as the primary reference value [PRV] and OsiriX LiteTM as the secondary reference value [SRV]). Measurements from the new software program (Intellijoint VIEWTM) were compared with reference values using Student's t-test and chi-square test. Results For anteversion, mean values for the PRV (27.34° ± 7.27°) and the new software (27.29° ± 7.21°) were not significantly different (p = 0.49). The new software differed from the PRV by a mean of 0.05° ± 0.93°. Similar results were noted for inclination, where the new software differed from the PRV and SRV by -0.13° ± 0.65° and 0.25° ± 1.26°, respectively (mean values: PRV: 43.62° ± 6.02°; SRV: 43.99° ± 6.27°; new software: 43.74° ± 6.17°; p = 0.87), and for leg length, where the new software differed from the PRV and SRV by 0.05 mm ± 0.46 mm and 0.22 mm ± 0.52 mm, respectively (mean values: PRV: 10.61 mm ± 11.60 mm; SRV: 10.77 mm ± 11.70 mm; new software: 10.56 mm - ± 11.61 mm; p = 0.98). Measurements were highly correlated across multiple reviewers (intraclass correlation coefficient ≥0.987). Conclusions The new software measurement tool is accurate and precise for assessing the acetabular component position and leg length measurements following THA in AP pelvic radiographs compared to currently used image measurement software.