Is the May-Thurner Syndrome a Major Risk Factor for Deep Vein Thrombosis in Total Hip Arthroplasty?

Background: May-Thurner syndrome (MTS) is iliac vein compression syndrome associated with postoperative deep vein thrombosis (DVT) resulting from chronic compression of the left iliac vein against lumbar vertebrae by the overlying right or left common iliac artery. MTS is not well known as a risk factor for DVT after total hip arthroplasty (THA). We evaluated the incidence of DVT after THA and analyzed if the MTS is a risk factor for DVT after THA. We hypothesized that MTS would be associated with an increased risk of developing DVT after THA. Methods: All patients > 65 years of age who underwent THA between January 1, 2009, and January 12, 2017, were identified. Among them, the patients who presented for postoperative DVT of the lower extremity were reviewed with medical record data. MTS was diagnosed with computed tomography (CT) angiography of the lower extremity. We analyzed the demographic data, symptoms, diagnoses, and treatment of MTS patients. Results: A total of 492 consecutive patients aged > 65 years who underwent operation for THA were enrolled. Among them, 5 patients (1.0%) presented for postoperative DVT of the lower extremity. After reviewing the CT angiography of the lower extremity, 4 out of 5 DVT patients (80%) were identified as having MTS. All MTS patients were female and presented with pain and swelling of the left leg. All MTS patients were treated with systemic anticoagulation, aspiration thrombectomy, and percutaneous transluminal angioplasty. Complete resolution of thrombus was observed in all patients. Conclusions: If the diagnosis of MTS is delayed, the morbidity and mortality rates are significantly increased. Orthopedic surgeons should be aware of MTS as a risk factor for DVT after THA. Moreover, preoperative evaluation with duplex sonography or CT angiography to confirm MTS should be considered. In this regard, this study is considered to have sufficient clinical value for early diagnosis and appropriate treatment of MTS after THA.

Is there a difference between preoperative and postoperative delirium in elderly hip fracture patients?: A retrospective case control study.

Delirium is associated with greater morbidity, higher mortality, and longer periods of hospital day after hip fracture. There are number of studies on postoperative delirium after a hip fracture. However, few studies have made a distinction between preoperative and postoperative delirium. The purpose of this study is to compare risk factors and clinical outcome between preoperative and postoperative delirium in elderly patients with a hip fracture surgery. A total of 382 consecutive patients aged > 65 years who underwent operation for hip fracture were enrolled. Among them, the patients diagnosed with delirium were divided into 2 groups (a preoperative delirium group and a postoperative delirium group) according to the onset time of delirium. To evaluate risk factors for preoperative and postoperative delirium, we analyzed demographic data, preoperative laboratory data, and perioperative data. To compare clinical outcomes between preoperative and postoperative delirium, we analyzed postoperative complications, KOVAL score, regression, readmission, and 2-year survival rate. Delirium was diagnosed in 150 (39.3%) patients during hospitalization. Preoperative and postoperative delirium occurred in 67 (44.6%) and 83 (55.4%) patients, respectively. Independent risk factors of preoperative delirium included age (odds ratio: 1.47, 95% confidential interval [CI]: 1.13-2.23, P = .004), stroke (odds ratio [OR]: 2.70, 95% CI: 1.11-6.01, P = .015), American Society of Anesthesiologist (OR: 1.68, 95% CI: 1.137-2.24, P = .033), and time from admission to operation (OR: 1.08, 95% CI: 1.01-1.16, P = .031). There was no significant difference in preoperative KOVAL score between the 2 groups. However, postoperative KOVAL score (5.1 ±â€…2.0 vs 4.4 ±â€…2.1, P = .027) and regression rate (68.7% vs 44.6%, P = .029) were significantly higher in the preoperative delirium group than in the postoperative delirium group. Moreover, the 2-year survival rate was significantly lower in the preoperative delirium group than in the postoperative delirium group (62.7% vs 78.3%, P = .046). Characteristics, risk factors, and prognosis are different for patients with preoperative delirium and postoperative delirium. Preoperative delirium patients showed different risk factors with poorer prognosis and higher mortality. Therefore, hip fracture patients with risk factors for preoperative delirium should be monitored more carefully due to their greater risk of mortality.

METAL ION RELEASE ACCORDING TO LEG LENGTH DISCREPANCY IN CERAMIC-ON-METAL HIP ARTHROPLASTY.

Objective: The ceramic-on-metal (CoM) bearing has the theoretical advantages over ceramic-on-ceramic (CoC) and metal-on-metal bearings. This study aimed to analyze factors affecting the metal ion release of CoM bearings and compare clinical performance with CoC bearings. Methods: The 147 patients were divided into 96 patients in group 1 (CoM group) and 51 patients in group 2 (CoC group). Additionally, within group1, 48 patients and 30 patients were sub-categorized into group 1-A with leg length discrepancy (LLD) less than 1cm and group 1-B greater than 1 cm. The level of serum metal ions, functional scores and plain radiographs were obtained for the analysis. Results: The level of cobalt (Co) 2-years after surgery and chromium (Cr) 1-year after surgery showed significantly higher in the group1 than the group2. LLD indicated statistically significant positive correlation between serum metal ion levels among CoM bearing THAs. In comparison of the average metal ions level changes, group 1-B showed higher level of metal ion than group 1-A. Conclusion: In patients underwent THA with CoM bearings, large LLD have a higher risk of complications associated to metal ions. Therefore, it is critical to reduce the LLD to 1 cm or less in using CoM bearing. Level of Evidence III; Case Control Study.

Objetivo: Uma superfície metalocerâmica (CoM) apresenta vantagens teóricas sobre as superfícies cerâmica-cerâmica (CoC) e metal-metal. Este estudo teve como objetivo analisar os fatores que afetam a liberação de íons metálicos das superfícies CoM e comparar o desempenho clínico com as superfícies CoC. Métodos: Os 147 pacientes foram divididos em 96 pacientes no grupo 1 (grupo CoM) e 51 pacientes no grupo 2 (grupo CoC). No grupo 1, 48 pacientes foram subcategorizados em grupo 1-A, com discrepância de comprimento das pernas (LLD) menor que 1 cm; e 30 pacientes no grupo1-B maior que 1 cm. O nível de íons metálicos séricos, escores funcionais e radiografias foram obtidas para a análise. Resultados: Os níveis de cobalto (Co) 2 anos após a cirurgia e de cromo (Cr), após o primeiro ano da cirurgia mostraram-se significativamente mais altos no grupo 1 do que no grupo 2. A LLD indicou correlação positiva estatisticamente significativa entre os níveis de íons do soro metálico entre os portadores de THA de CoM. Em comparação com as alterações médias dos níveis de íons metálicos, o grupo 1-B revelou um nível de íons metálicos mais alto do que o grupo 1-A. Conclusão: Em pacientes submetidos a THA com superfícies CoM e elevada LLD têm um maior risco de complicações associadas a íons metálicos. Sendo fundamental reduzir LLD para 1 cm ou menos no uso de superfícies CoM. Nível de Evidência III; Estudo de Controle de Caso.

Discovering Homogeneous Groups from Geo-Tagged Videos.

The popularity of intelligent devices with GPS and digital compasses has generated plentiful videos and images with text tags, timestamps, and geo-references. These digital footprints of travelers record their time and spatial movements and have become indispensable information resources, vital in applications such as how groups of videographers behave and in future-movement prediction. In this paper, first we propose algorithms to discover homogeneous groups from geo-tagged videos with view directions. Second, we extend the density clustering algorithm to support fields-of-view (FoVs) in the geo-tagged videos and propose an optimization model based on a two-level grid-based index. We show the efficiency and effectiveness of the proposed homogeneous-pattern-discovery approach through experimental evaluation on real and synthetic datasets.

Metal ion release according to leg length discrepancy in ceramic-on-metal hip arthroplasty / Liberação de íons metálicos segundo discrepância no comprimento da perna após artroplastia metal-cerâmica total de quadril

ABSTRACT Objective The ceramic-on-metal (CoM) bearing has the theoretical advantages over ceramic-on-ceramic (CoC) and metal-on-metal bearings. This study aimed to analyze factors affecting the metal ion release of CoM bearings and compare clinical performance with CoC bearings. Methods The 147 patients were divided into 96 patients in group 1 (CoM group) and 51 patients in group 2 (CoC group). Additionally, within group1, 48 patients and 30 patients were sub-categorized into group 1-A with leg length discrepancy (LLD) less than 1cm and group 1-B greater than 1 cm. The level of serum metal ions, functional scores and plain radiographs were obtained for the analysis. Results The level of cobalt (Co) 2-years after surgery and chromium (Cr) 1-year after surgery showed significantly higher in the group1 than the group2. LLD indicated statistically significant positive correlation between serum metal ion levels among CoM bearing THAs. In comparison of the average metal ions level changes, group 1-B showed higher level of metal ion than group 1-A. Conclusion In patients underwent THA with CoM bearings, large LLD have a higher risk of complications associated to metal ions. Therefore, it is critical to reduce the LLD to 1 cm or less in using CoM bearing. Level of Evidence III; Case Control Study.

RESUMO Objetivo Uma superfície metalocerâmica (CoM) apresenta vantagens teóricas sobre as superfícies cerâmica-cerâmica (CoC) e metal-metal. Este estudo teve como objetivo analisar os fatores que afetam a liberação de íons metálicos das superfícies CoM e comparar o desempenho clínico com as superfícies CoC. Métodos Os 147 pacientes foram divididos em 96 pacientes no grupo 1 (grupo CoM) e 51 pacientes no grupo 2 (grupo CoC). No grupo 1, 48 pacientes foram subcategorizados em grupo 1-A, com discrepância de comprimento das pernas (LLD) menor que 1 cm; e 30 pacientes no grupo1-B maior que 1 cm. O nível de íons metálicos séricos, escores funcionais e radiografias foram obtidas para a análise. Resultados Os níveis de cobalto (Co) 2 anos após a cirurgia e de cromo (Cr), após o primeiro ano da cirurgia mostraram-se significativamente mais altos no grupo 1 do que no grupo 2. A LLD indicou correlação positiva estatisticamente significativa entre os níveis de íons do soro metálico entre os portadores de THA de CoM. Em comparação com as alterações médias dos níveis de íons metálicos, o grupo 1-B revelou um nível de íons metálicos mais alto do que o grupo 1-A. Conclusão Em pacientes submetidos a THA com superfícies CoM e elevada LLD têm um maior risco de complicações associadas a íons metálicos. Sendo fundamental reduzir LLD para 1 cm ou menos no uso de superfícies CoM. Nível de Evidência III; Estudo de Controle de Caso.

Differences in Acetabular Morphology Related to Sex and Side in South Korean Population.

Background: The normal references for acetabular parameters are important for the diagnosis of hip diseases and planning of total hip arthroplasty. There are wide interindividual differences in acetabular morphology in the normal population, and little is known about differences in acetabular morphology in the average South Korean population. The purpose of this study was to evaluate side and sex differences in acetabular morphology in the South Korean population. Methods: The acetabular parameters, including anteversion angle, abduction angle, center-edge angle, acetabular width and depth, and acetabular-head index, were measured on three-dimensional computed tomography images in 197 healthy Korean adults. Differences in acetabular parameters according to side and sex were evaluated. Results: The mean acetabular anteversion angle of men and women was 17.3° ± 5.2° and 20.1° ± 3.5°, respectively. The mean acetabular width of men and women was 61.5 ± 4.6 cm and 56.5 ± 4.0 cm, respectively. There were significant sex differences in acetabular anteversion angle (p = 0.001) and acetabular width (p = 0.036) when adjusted for age, body height, and weight. The mean acetabular width of the right side and the left side was 60.2 ± 5.2 cm and 57.8 ± 4.5 cm, respectively. There were significant side differences in acetabular width (p = 0.007) when adjusted for age, body height, weight, and sex. Conclusions: Differences and reference ranges of acetabular parameters are important for the diagnosis of acetabular deformity, such as femoroacetabular impingement and acetabular dysplasia. Moreover, these differences and reference ranges are useful for preoperative planning and safe positioning of acetabular components in total hip arthroplasty.

Identification of Stem Cell Related Gene Expression from the Osteosarcoma Cell Core Side.

Osteosarcoma is the most frequent primary malignant bone tumor with higher incidences in children and adolescents. Despite clinical evolutions, patients with osteosacoma have had a poor prognosis. There has been increasing evidence that cancer is a stem cell disease. This study sought to isolate and characterize cancer stem cells from human osteosarcoma with relevant literature reviews. Here we show that the emerging evidence suggests osteosarcoma should be regarded as a differentiation disease such as stem cell disease. Two human osteosarcoma cell lines were cultured in non-adherent culture conditions as sarcospheres. Sarcospheres were observed using histomorphology and alkaline phosphatase (ALP) staining. Expression of the embryonic stem cell marker was analyzed with use of reverse transcriptase-PCR. Sarcospheres could be reproduced consistently throughout multiple passages and produced adherent osteosarcoma cell cultures. Expression of stem cell-associated genes such as those encoding Nanog, octamer-binding transcription factor 3/4, sex determining region Y box 2 , c-Myc and ALP indicated pluripotent stem-like cells. These results support the extension of the cancer stem cell theory to include osteosarcoma. Understanding the cancer stem cell derived from human osteosarcoma could lead to the evolution of diagnosis and treatment for osteosarcoma patients.

EEG Emotion Recognition Applied to the Effect Analysis of Music on Emotion Changes in Psychological Healthcare.

Music therapy is increasingly being used to promote physical health. Emotion semantic recognition is more objective and provides direct awareness of the real emotional state based on electroencephalogram (EEG) signals. Therefore, we proposed a music therapy method to carry out emotion semantic matching between the EEG signal and music audio signal, which can improve the reliability of emotional judgments, and, furthermore, deeply mine the potential influence correlations between music and emotions. Our proposed EER model (EEG-based Emotion Recognition Model) could identify 20 types of emotions based on 32 EEG channels, and the average recognition accuracy was above 90% and 80%, respectively. Our proposed music-based emotion classification model (MEC model) could classify eight typical emotion types of music based on nine music feature combinations, and the average classification accuracy was above 90%. In addition, the semantic mapping was analyzed according to the influence of different music types on emotional changes from different perspectives based on the two models, and the results showed that the joy type of music video could improve fear, disgust, mania, and trust emotions into surprise or intimacy emotions, while the sad type of music video could reduce intimacy to the fear emotion.

Preoperative Vitamin D Deficiency is Associated with Postoperative Functional Recovery and Complications after Hip Fracture Surgery.

BACKGROUND: Low concentrations of vitamin D are considered one of the risk factors for hip fracture and are associated with worse outcomes. The purpose of this retrospective study was to compare vitamin D deficient group and vitamin D sufficient group and assess the association preoperative vitamin D deficiency and postoperative walking ability after hip fracture surgery. METHODS: Between January 2014 and January 2020, 1,029 elderly patients with hip fracture (243 in men and 785 in women) were measured preoperative serum 25-hydroxy-vitamin D3 levels. Among 1,029 elderly patients, 702 patients were classified as Vitamin D deficient group (<20 ng/mL). Outcome parameters for functional recovery were the length of the hospital stay and KOVAL score, and those for complications were delirium, pneumonia, and thromboembolism. RESULTS: The mean length of the hospital stay in the vitamin D deficient group was significantly longer than in the vitamin D sufficient group (27.7±17.8 vs. 2.9±11.8 days; odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05; P=0.001). The mean postoperative KOVAL score in the deficient group was significantly higher than in the sufficient group (4.0±2.1 vs. 3.1±1.9 days; OR, 1.21; 95% CI, 1.11-1.32; P=0.001). Vitamin D deficiency was significantly associated with a higher risk of delirium and pneumonia in deficiency group. CONCLUSIONS: Preoperative vitamin D deficiency in hip fractures patients was associated with prolonged duration of hospital stay and decrease of postoperative ambulatory status, and may increase the risk of delirium and pneumonia. Therefore, it is necessary to evaluate the preoperative vitamin D level and recommend vitamin D supplementation in elderly patients with a high probability of hip fracture.

Performance-based physical function correlates with walking speed and distance at 3 months post unilateral total knee arthroplasty.

BACKGROUND: After total knee arthroplasty (TKA), walking speed and distance are main concerns of patients. RESEARCH QUESTION: Which physical functions affect walking speed and distance after TKA? METHODS: Cross-sectional data from 149 patients who underwent unilateral primary TKA and completed performance-based physical function tests. Instrumental gait evaluation for spatiotemporal parameters, isometric knee extensor and flexor strength of both knees, 6-minute walk test (6MWT), timed up-and-go (TUG) test, timed stair climbing test (SCT), and knee flexion and extension range of motion (ROM) of surgical knee were examined. Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and EuroQol five dimensions (EQ-5D) questionnaires were also performed. RESULTS: Univariate analyses revealed that post-operative walking speed showed significant positive correlations with cadence, stride length, propulsion index of surgical and non-surgical knee, peak torque (PT) of the extensor of surgical and non-surgical knee and flexor of surgical and non-surgical knee, 6MWT, EQ-5D, and significant negative correlations with gait cycle duration, TUG, SCT-ascent and descent, and WOMAC-pain scores. Post-operative walking distance had significant positive correlations with walking speed, cadence, stride length, swing phase duration, propulsion index of surgical and non-surgical knee, PT of the extensor of surgical and non-surgical knee, EQ-5D, and significant negative correlation with gait cycle duration, double support duration, TUG, SCT-ascent and descent. In the multivariate linear regression analyses, TUG, cadence, stride length and propulsion index of non-surgical knee were factor correlated with post-operative walking speed. The SCT-ascent and descent, TUG and propulsion index of surgical knee were factor correlated with post-operative walking distance. SIGNIFICANCE: Physical performance factors correlated with walking speed and distance at 3 months after surgery. Based on these observations, rehabilitation of bilateral muscle strength and functional mobility would be important for functional recovery after unilateral TKA.

Influence of Comorbidities on Short-Term Functional Outcomes After Unilateral Total Knee Arthroplasty.

OBJECTIVE: The aim of the study was to determine the effect of comorbidities on physical function and quality of life of patients at 3 mos after total knee arthroplasty. DESIGN: Data from 140 patients who underwent a primary unilateral total knee arthroplasty were examined retrospectively. Comorbidities were osteoporosis, presarcopenia, degenerative spine disease, diabetes, and hypertension. All patients completed the following: range of motion, stair climbing test, 6-min walk test, Timed Up and Go Test, peak torque of the knee extensor and flexor, instrumental gait analysis, Western Ontario McMaster Universities Osteoarthritis Index, and EuroQoL five-dimension questionnaire. RESULTS: Univariate analyses revealed that osteoporosis led to a significantly longer time to complete the stair climbing test-ascent, stair climbing test-descent, and Timed Up and Go Test and to lower scores for the 6-min walk test and peak torque of the knee extensor. Patients with degenerative spine disease showed significant negative scores for knee extension range of motion. Diabetes showed a negative correlation with peak torque of the knee extensor and knee flexion range of motion, as well as a higher Western Ontario McMaster Universities Osteoarthritis Index-stiffness score. Multivariable linear regression analysis showed that Western Ontario McMaster Universities Osteoarthritis Index-stiffness remained independently associated with diabetes. Six-minute walk test, Timed Up and Go Test, stair climbing test-ascent, and peak torque of the knee extensors showed a significant association with osteoporosis. CONCLUSIONS: Comorbidities, particularly osteoporosis and diabetes, affect short-term functional outcomes 3 mos after total knee arthroplasty.

Effectiveness of a Home-Based Fragility Fracture Integrated Rehabilitation Management (FIRM) Program in Patients Surgically Treated for Hip Fractures.

BACKGROUND: The purpose of this study was to investigate the effectiveness of a home-based fragility fracture integrated rehabilitation management (H-FIRM) program following an inpatient FIRM (I-FIRM) program in patients surgically treated for hip fracture. METHODS: This nonrandomized controlled trial included 32 patients who underwent hip surgery for a fragility hip fracture. The patients were divided into two groups: a prospective intervention group (n = 16) and a historical control group (n = 16). The intervention group performed a nine-week H-FIRM program combined with the I-FIRM program. The historical control group performed the I-FIRM program only. Functional outcomes included Koval's grade, Functional Ambulatory Category (FAC), Functional Independence Measure (FIM) locomotion, Modified Rivermead Mobility Index (MRMI), 4 m walking speed test (4MWT), and the Korean version of Modified Barthel Index (K-MBI). All functional outcomes were assessed one week (before I-FIRM), three weeks (before I-FIRM), and three months (after H-FIRM) after surgery. RESULTS: Both groups showed significant and clinically meaningful improvements in functional outcomes over time. Compared with the control group, the intervention group showed clinically meaningful improvements in Koval's grade, FAC, FIM locomotion, MRMI, 4MWT, and K-MBI from baseline to three months. CONCLUSION: H-FIRM may be an effective intervention for improving functional outcomes in older people after fragility hip fractures.

Unique Form of Atypical Subtrochanteric Femoral Fracture at the Medial Cortex: A Report of 3 Cases.

CASE: Three women with unique subtrochanteric femoral fracture occurring at the medial cortex of the femur are presented. One patient had been on drug holiday for the past 2 years after 3 years of risedronate use; the other patients had been taking alendronate for osteoporosis for 4 years and 20 years without drug holiday. CONCLUSION: The fractures met all major criteria for the revised case definition of atypical femoral fracture (AFF) provided by the American Society of Bone and Mineral Research task force except for the location. Hence, we report 3 cases of AFFs developing in the subtrochanteric medial femoral cortex.

Physical Performance Correlates with Self-Reported Physical Function and Quality of Life in Patients at 3 Months after Total Knee Arthroplasty.

BACKGROUND: Although total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis, assessment of postoperative outcomes remains unclear. This study aimed to identify postoperative physical performance factors that are correlated with self-reported physical function and quality of life (QoL) at 3 months after unilateral TKA. METHODS: In total, 158 patients who underwent unilateral primary TKA completed performance-based physical function tests at 3 months after surgery, including Stair Climbing Tests (SCT), 6-Minute Walk Tests (6MWT), Timed Up and Go tests (TUG), and instrumental gait analysis. We also measured the isometric knee flexor and extensor strengths of the operated and non-operated knees. Self-reported physical function and QoL were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Euro-QoL Five Dimensions (EQ-5D) questionnaire, respectively. RESULTS: Bivariate analyses showed that WOMAC function and EQ-5D were correlated with age, other self-reported measures, and performance-based measures. The WOMAC pain (r=0.71, p<0.001) showed a high positive correlation. While the EQ-5D (r=-0.7, p<0.001) showed a highly negative correlation with WOMAC function, WOMAC pain (r=-0.67, p<0.001) showed a moderately negative correlation with EQ-5D. In multivariate linear regression analyses, WOMAC pain, peak torque of the flexor of the non-operated knee, and reductions in extensor and stride length were associated with self-reported physical function, whereas WOMAC pain, SCT ascent, and cadence were associated with postoperative QoL. CONCLUSIONS: Physical performance factors were significantly associated with self-reported physical function and QoL in patients at 3 months after unilateral TKA. These findings suggest that performance-based physical function could be used to assess outcomes after TKA.

Preoperative physical factors that predict stair-climbing ability at one month after total knee arthroplasty.

OBJECTIVE: To identify preoperative physical performance factors that predict stair-climbing ability at 1 month after total knee arthroplasty. DESIGN: Prospective cohort study. SETTING: University-based rehabilitation centre. SUBJECTS: Eighty-four patients who underwent a primary unilateral total knee arthroplasty Methods: Before and 1 month post-operation, the patients completed physical performance tests, including a stair-climbing test, a 6-minute walk test, a Timed Up-and-Go test, tests of the isometric flexor and extensor strength of the operated and non-operated knees, and instrumental gait analysis. Disease-specific physical function was measured by the Western Ontario McMaster Universities Osteoarthritis Index. RESULTS: Correlation analysis showed that postoperative stair-climbing test scores were significantly correlated with preoperative physical performance and function. Linear regression analysis showed that postoperative stair-ascent scores were correlated with preoperative Timed Up-and-Go test scores and peak torque of the extensor of the operated knee. Postoperative stair-descent scores were positively correlated with preoperative stair-descent scores and age. CONCLUSION: The results show that preoperative balance ability and quadriceps strength in the operated knee could influence postoperative stair-climbing ability at 1 month after total knee arthroplasty. These findings will be useful for developing pre- and post-operative rehabilitation strategies for improving stair-climbing ability in the early stages after total knee arthroplasty.

Effects of body weight support and gait velocity via antigravity treadmill on cardiovascular responses early after total knee arthroplasty.

To investigate the effects of body weight support (BWS) and gait velocity on cardiovascular responses during walking on an antigravity treadmill early after unilateral and bilateral total knee arthroplasty (TKA).This study was a cross-sectional study design. Fifty patients (7 males and 43 females; average age, 72.0 ±â€Š5.1 years) at 4 weeks after unilateral (n = 25) and bilateral (n = 25) primary TKA were enrolled in the study. Subjects walked on an antigravity treadmill at speeds of 2.5 km/hour and 3.5 km/hour with 3 levels (50%, 25%, and 0%) of BWS. Cardiovascular responses were monitored by measuring oxygen consumption (VO2), heart rate (HR), systolic and diastolic blood pressure (SBP/DBP), the respiratory exchange ratio (RER), and rate pressure product (RPP). Borg rating of perceived exertion (RPE) and a visual analog scale (VAS) of knee pain were recorded immediately after each trial.There were no significant differences in cardiovascular responses between the unilateral and bilateral TKA groups. In the repeated measures Analysis of Variance, VO2 levels, HR, RPP, RPE, RER, and VAS were significantly increased in proportion to 3 levels (50%, 25%, and 0%) of BWS for unilateral and bilateral TKA groups, respectively. Meanwhile, SBP and DBP were unaffected by differences in BWS. At 3.5 km/hour, VO2, RPE, and RER values were statistically greater than those at 2.5 km/hour under the same BWS conditions.We found that the reduction in the metabolic demand of activity, coupled with positive pressure on the lower extremities, reduced VO2 and HR values as BWS increased.Cardiovascular responses vary according to BWS and gait velocity during antigravity treadmill walking. BWS rather than gait velocity had the greatest effect on cardiovascular responses and knee pain.

Post-operative Physical Performance Factors Associated With Gait Speed in Patients Surgically Treated for Hip Fracture: A Cross-Sectional Study.

OBJECTIVE: To determine post-operative physical performance factors associated with gait speed in patients surgically treated for hip fracture. METHODS: Cross-sectional data from 59 patients (16 males and 43 females; mean age, 79.2±9.1 years) who underwent hip fracture surgery were enrolled. Patients completed a 10-meter walk test (10MWT) to assess gait speed. Additional physical performance tests included the Timed Up and Go test (TUG), the Berg Balance Scale (BBS), maximum voluntary isometric contraction (MVIC) of the knee extensors and flexors on the operated and non-operated sides as well as of the hip abductors (all tested using air-resistance weight machines), and analysis of spatio-temporal gait parameters at about 6 weeks after hip surgery. RESULTS: Bivariate analyses revealed a significant positive correlation between the post-operative 10MWT and the post-operative TUG, age, swing phase duration, and gait cycle duration along with a significant negative correlation between post-operative BBS score, MVIC of the knee extensors and flexors on the operated and non-operated sides, MVIC of the hip abductors, and cadence and stance phase duration. Linear regression analyses revealed that the post-operative TUG (ß=0.85, p<0.01), gait cycle duration (ß=0.17, p=0.02), and osteoporosis (ß=-0.18, p=0.02) were associated with the post-operative 10MWT. CONCLUSION: The presence of osteoporosis, post-operative balance, and isometric muscle strength in the operated and non-operated legs were statistically associated with post-operative gait speed early after hip fracture surgery.

Bilateral Quadriceps Muscle Strength and Pain Correlate With Gait Speed and Gait Endurance Early After Unilateral Total Knee Arthroplasty: A Cross-sectional Study.

OBJECTIVE: The aim of this study was to determine the correlations between objective performance-based physical function, self-reported physical function, quality of life, and gait function at 1 mo after unilateral total knee arthroplasty. DESIGN: Cross-sectional data from 195 patients who underwent unilateral primary total knee arthroplasty were analyzed. The isometric knee extensor and flexor strength of both knees, gait parameters, 6-min walk test, timed up-and-go test, timed stair-climbing test, knee flexion and extension range of motion of surgical knee, Western Ontario McMaster Universities Osteoarthritis Index pain, stiffness, and functional levels, EuroQol five-dimensions questionnaire, and visual analog scale for knee pain were assessed. RESULTS: In bivariate analyses, both postoperative gait speed and gait endurance had significant positive correlations with postoperative peak torque of the extensor and flexor of both knees, cadence, stride length, and significant negative correlation with timed up-and-go, stair-climbing test ascent, stair-climbing test descent, visual analog scale, Western Ontario McMaster Universities Osteoarthritis Index pain, stiffness, and function levels. In the linear regression analyses, postoperative peak torque of the extensors of both knees and VAS for knee pain were factors correlated with postoperative gait speed and gait endurance. CONCLUSIONS: Quadriceps muscle strength of both knees and knee pain were important factors correlated with gait function early after total knee arthroplasty.

Comorbidities in Patients With End-Stage Knee OA: Prevalence and Effect on Physical Function.

OBJECTIVE: To investigate the prevalence of comorbidities and their effect on physical function, quality of life (QOL), and pain, in patients with end-stage knee osteoarthritis (OA). DESIGN: A cross-sectional study. SETTING: A rehabilitation facility at university hospital. PARTICIPANTS: Patients (N=577; 503 women and 74 men) diagnosed with end-stage knee OA between October 2013 and June 2018. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Comorbidities were as follows: osteoporosis, presarcopenia, degenerative spine disease, diabetes, and hypertension. All patients completed the following performance-based physical function tests: stair-climbing test (SCT), 6-minute walk test (6MWT), timed Up and Go (TUG) test, and gait analysis. Self-reported physical function and pain were measured using Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and a visual analog scale (VAS), respectively, and self-reported QOL was measured using EuroQoL 5 dimensions (EQ-5D) questionnaire. RESULTS: Univariate analyses revealed that patients with osteoporosis had significantly higher scores in SCT ascent, SCT descent, TUG, WOMAC pain tests, and lower scores in 6MWT, gait speed, and cadence tests than those without osteoporosis. Patients with presarcopenia recorded higher scores in SCT ascent, TUG, EQ-5D, and lower scores in 6MWT and gait speed tests than those without presarcopenia. Patients with degenerative spine disease showed higher scores in WOMAC pain and lower scores in gait speeds than those without degenerative spine disease. Patients with diabetes showed higher scores in SCT ascent than those without diabetes, and patients with hypertension showed lower scores in 6MWT than those without hypertension. After adjusting age, sex, and body mass index, SCT descent retained significant association with osteoporosis, SCT ascent showed independent association with presarcopenia and diabetes, and WOMAC pain revealed significant association with degenerative spine disease. CONCLUSION: The results confirm associations between comorbidities, performance-based and self-reported physical functions, and QOL in patients with end-stage knee OA.