Gait oscillation analysis during gait and stair-stepping in elder patients with knee osteoarthritis.

BACKGROUND: Evaluation of knee and lower limb function alone is not sufficient to assess gait. For accurate assessment of gait abnormality, gait oscillation should also be measured. The goal of this analysis was to assess the influence of the knee joint on gait oscillation during gait and stair-stepping in patients with osteoarthritis of the knee. METHODS: In 33 patients diagnosed with knee osteoarthritis and 33 healthy adults as the control group, we examined acceleration (anterior and lateral directions) and gait barycentric factors (single-support phase and ratio of center of gravity maximum values) during gait and stair-stepping. RESULTS: Acceleration in the anterior direction in the sacral region was greater in healthy adults than in osteoarthritis (OA) patients during gait and stair-down. Acceleration in the anterior direction in the dorsal vertebral region was greater in OA patients than in healthy adults during (up and down) stair-stepping. Acceleration in the lateral direction in the sacral region was greater in healthy adults than in OA patients during stair-up. Acceleration in the lateral direction in the dorsal vertebral region was greater in OA patients than in healthy adults during stair-stepping. The single-support phase was close to 1 for gait and stair-stepping in healthy adults and OA patients. The single-support time was largely the same for gait and stair-stepping in healthy adults. On the other hand, the single-support time was longer for stair-stepping than for gait in OA patients. The ratio of the center of gravity maximum values was greater for the sacral region than for the dorsal vertebral region. There was a significant difference in the stair-stepping ratio of the center of gravity maximum values between healthy adults and OA patients for the sacral region. CONCLUSION: We considered that knee OA influenced acceleration in the anterior and lateral direction in the dorsal vertebral and the ratio of the center of gravity maximum values on gait oscillation.

Kinematic analysis of posterior-stabilized total knee arthroplasty during standing up from and sitting down on a chair.

BACKGROUND: Total knee arthroplasty is effective to regain quality of life. Standing up from and sitting down on a chair and stair stepping motion are important in daily living. We previously reported in vivo kinematics of this implant during a stepping exercise. The purpose of this analysis was to assess in vivo knee motion during standing up from and sitting down on a chair and determine the motion pattern in patients with the unique knee prosthesis. METHODS: A total of 15 patients implanted with Bi-Surface PS were assessed during standing up from and sitting down on a chair. The Bi-Surface PS knee is a posterior-cruciate substitute prosthesis with a unique ball-and-socket joint in the mid-posterior portion of the femoral and tibial components. Patients were examined during standing up from and sitting down on a chair using a two-dimensional to three-dimensional registration technique. RESULTS: During standing up from and sitting down on a chair from minimum to 30° knee flexion, anterior femoral translation was slight. From 30° knee flexion to maximum flexion, the kinematic pattern was a medial pivot and rollback. CONCLUSIONS: This study demonstrated that the knee motion kinematic patterns observed in this study were not similar to normal knee kinematics and derived from the unique design of the Bi-Surface PS.

The Role of Complete Suprapatellar Plicae.

Shelf syndrome mainly affects younger people, often athletes. Cases of complete suprapatellar plica syndrome are rare. Arthroscopic inspection is necessary to diagnose complete suprapatellar plicae. The patients' symptoms improve after removal of the plicae. Our technique is an easy, completely arthroscopic procedure that has yielded good clinical outcomes in patients who have complete suprapatellar plicae. Although cases of complete suprapatellar plica syndrome are rare, it should be considered in patients with moderate knee pain.

In vivo kinematics of a unique posterior-stabilized knee implant during a stepping exercise.

BACKGROUND: Stair-stepping motion is important in daily living, similar to gait. Knee prostheses need to have even more superior performance and stability in stair-stepping motion than in gait. The purpose of this analysis was to estimate in vivo knee motion in stair stepping and determine if this unique knee prosthesis function as designed. METHODS: A total of 20 patients with Bi-Surface posterior-stabilizing (PS) implants were assessed. The Bi-Surface PS knee is a posterior-cruciate substitute prosthesis with a unique ball-and-socket joint in the mid-posterior portion of the femoral and tibial components. Patients were examined during stair-stepping motion using a 2-dimensional to 3-dimensional registration technique. RESULTS: The kinematic pattern in step up was a medial pivot, in which the level of anteroposterior translation was very small. In step down, the kinematic pattern was neither a pivot shift nor a rollback. From minimum to maximum flexion, anterior femoral translation occurred slightly. CONCLUSIONS: In this study, this unique implant had good joint stability during stair stepping. The joint's stability during stair stepping was affected by the design of the femorotibial joint rather than post/cam engagement or the ball-and-socket joint.

Knee Arthritis Without Other Joint Symptoms in the Elderly With Seronegative Elderly Onset Rheumatoid Arthritis.

Elderly onset Rheumatoid arthritis (EORA) has important clinical distinctions when compared with younger onset RA (YORA). In knee arthritis of elderly patients, infection, crystal-induced arthritis or EORA should be suspected if elevation of CRP in the preoperative examination and turbid joint effusion in their knee joint are found. Furthermore, if joint swelling and effusion remain after performing total knee arthroplasty (TKA), the infection after TKA, implant debris-related arthritis and EORA should be considered. However, it is difficult to diagnose patients as EORA if Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) are negative. The differential diagnosis is very important.

Gait parameters in women with bilateral osteoarthritis after unilateral versus sequential bilateral total knee arthroplasty.

PURPOSE: To compare gait parameters in women after unilateral total knee arthroplasty (TKA) versus sequential bilateral TKA to determine the need for sequential TKA. METHODS: 35 women aged 60 to 74 (mean, 70) years with bilateral varus knee osteoarthritis (OA) underwent unilateral (n=23) or sequential bilateral (n=12) TKA by a single surgeon. All patients underwent unilateral TKA; 12 patients then underwent sequential TKA after 3 to 6 months of the first TKA. Gait parameters (step length, step width, gait velocity, single support phase value, and the maximum centre of gravity ratio) were compared before and after TKA, and between patients with unilateral versus bilateral TKA. RESULTS: Patients with sequential bilateral TKA had more severe OA in their contralateral knee than patients with unilateral TKA. In patients with unilateral and sequential bilateral TKA respectively, the mean step width differed at postoperative one month (12.9 vs. 19.1, p<0.01) and 3 months (11.9 vs. 16, p=0.03), and the mean maximum centre of gravity ratio differed at postoperative 3 months (2.43 vs. 1.75, p=0.02), whereas the mean step length, mean gait velocity, and mean single support phase values did not differ significantly between groups. CONCLUSION: After unilateral TKA, contralateral TKA may not be necessary in some patients whose gait has improved.

Prolonged survival of experimental extremity allografts: a new protocol with total body irradiation, granulocyte-colony stimulation factor, and FK506.

The induction of a high-level of chimerism (macrochimerism) may be the most reliable strategy for achieving donor-specific tolerance. The purpose of this study was to evaluate the efficacy of a new protocol using total-body irradiation (TBI) and granulocyte-colony stimulation factor (G-CSF) to induce high-level chimerism following rat whole-limb allotransplantation. In this study, we investigated whether the timing of TBI influenced the period of graft survival. In total, 50 whole-limb allotransplants from LacZ transgenic rats to LEW rats were performed. TBI was performed at days 0 and 14, and G-CSF was given for 4 days after TBI. FK506 was given for 28 days after transplant. Nontreated limb allografts were rejected after 4.2 days. The survival time was prolonged to 64 days in the FK506 monotherapy group. In the group receiving TBI at day 14, limb allograft survival was significantly prolonged to 81 days. In the group receiving TBI at day 0, 26% of recipients died but in the surviving recipients the grafts survived for longer than 1 year without lethal graft-versus-host disease (GVHD). Polymerase chain reaction (PCR) analysis revealed a high level of intrabone marrow chimerism in the recipient, thus demonstrating successful induction of macrochimerism. A new protocol of pretransplant TBI followed by treatment with G-CSF and FK506 was found to induce a high level of chimerism and to significantly prolong the survival of limb allografts in recipients without lethal GVHD.

Intragraft chimerism following composite tissue allograft.

Until now, more than 35 hand transplants have been performed in humans and have generated much public interest. Cell traffic from the recipient into the graft, so-called intragraft chimerism, appears to play a major role in graft acceptance and graft rejection. Little is known about cell migration following extremity allografts. In this review, recent experimental studies are presented for intragraft chimerism of the extremity allograft. Technical tools for detecting recipient cells in the graft were: (1) immunohistochemistry, (2) karyotyping, (3) fluorescent in situ hybridization, (4) polymerase chain reaction, and (5) transgenic animals. This study demonstrates that recipient-derived cells gradually repopulate into grafted skin, bone tissues, bone marrow, and endothelial cells, but muscle, periosteum, and cartilage tissues retain donor cell origin.

Chimerism studies as an approach for the induction of tolerance to extremity allografts.

SUMMARY: Recent advances in the field of transplant immunology and reconstructive surgery have resulted in an increased interest in extremity allograft. Until now, more than 20 hand transplants have been performed in humans. Rejection is well controlled by currently available immunosuppressive drugs. The hand transplant, however, is not a life-supporting organ transplant and these drugs are unlikely to represent the final solution for hand transplantation due to serious adverse effects. The ultimate goal of extremity allograft is the induction of donor-specific immunotolerance. The major strategies for tolerance induction are: (1) T-cell costimulation blockade, (2) induction of mixed chimerism, (3) T-cell depletion, and (4) tolerance mediated by regulatory T cells. Amongst these, the establishment of a high level of chimerism may be the most stable strategy for donor-specific tolerance, and our laboratory has been investigating the induction of macrochimerism following extremity allotransplantation. Recently, some studies demonstrated that macrochimerism induces immunotolerance for extremity allograft in the rodent model. We made a new protocol using cyclophosphamide (CYP) and granulocyte colony-stimulation factor (G-CSF) to induce high-level chimerism following rat whole-limb allotransplantation. Limb allografting could function as a vascularised carrier for bone marrow transplantation, providing a continuous source of donor cells and contributing to a high level of chimerism in the recipient. Pretransplant CYP followed by G-CSF and FK506 treatment significantly prolong the survival of limb allografts, but frequently cause chronic graft-versus-host disease in the recipients. In this review, recent experimental chimerism studies are presented for tolerance induction and we review the prospect of clinical applicability in extremity allograft.

Repopulation of donor cells from the recipient following extremity graft: studies using the LACZ transgenic rat.

Cell traffic from the recipient into the graft, so called graft chimerism, appears to play a major role in graft acceptance. This study was conducted using LacZ transgenic rats to define recipient cell migration into whole-limb grafts. Eighteen hind limb transplants were performed across LacZ+ transgenic and LacZ- rats. LacZ expression was evaluated by X-gal staining. Intense LacZ expression was observed at the interfollicular epidermis in the skin component of LacZ- limb grafts 48 weeks after transplant. Muscle fibers and cartilage showed intense LacZ expression in LacZ+ limb grafts at 48 weeks but no expression in LacZ- grafts. Polymerase chain reaction studies confirmed the presence of the LacZ gene in the bone and skin of LacZ- limb grafts and in the muscle of LacZ+ grafts. Our results demonstrate that there is a gradual increase in repopulation of recipient cells in grafted skin and bone tissues, but muscle and cartilage tissues retain donor cell origin.

Gradual graft-cell repopulation with recipient cells following vascularized bone and limb allotransplantation.

Little is known about the fate of graft cells following vascularized bone allografting. This study was conducted to define the process of graft-cell repopulation with recipient cells. Sixty-five vascularized tibial bone and 50 limb allotransplantations were performed in rat sex-mismatched pairs. FK 506 was used for immunosuppression. The ratio of donor and recipient cells in the graft was evaluated by semiquantitative polymerase chain reaction, using the Y-chromosome primers. Allografted bones had no rejection episodes. In the vascularized bone allograft model, donor-derived cells were gradually replaced by cells of recipient origin, such that by 24 weeks, they comprised only 10% of total cells. In the limb allograft model, male recipient cells were detected in female grafts not at 1 week but at 48 weeks posttransplantation. The ratio of recipient cells was more than 10% in the femur and tibia. Recipient-derived cells gradually migrated into the grafted bone cells with the passage of time.

Functional recovery of rat hind-limb allografts.

Few papers have assessed the long-term functional recovery of animal limb allografts. In this study, the functional recovery of rat limb allografts was serially and quantitatively investigated for a period of 1 year. The donor's hind limb was orthotopically transplanted into the recipient. Fifteen recipients with allografts were treated with FK506. Functional recovery of the grafted limb was assessed serially by cutaneous reaction test, walking track analysis, and electrophysiologic evaluation. Sensibility improved to a similar extent in both isografts and allografts, and the recovery rate at 1 year was 68 percent, compared to the normal side. Sciatic function index significantly improved to - 70 points after 1 year. The amplitude recorded from the gastrocnemius muscle significantly improved, and the ratio compared to the normal side was 43 percent. Limb isografts and allografts treated with FK506 showed no significant differences in functional recovery. The data can be used as a reference standard for future investigations.