Efficacy of Electromechanically-Assisted Rehabilitation of Upper Limb Function in Post-Stroke Patients: A Randomized Controlled Study.

OBJECTIVE: To investigate the efficacy of electromechanically-assisted rehabilitation of upper limb function in post-stroke patients. DESIGN: Randomized controlled trial. SUBJECTS: Forty-eight stroke patients. METHODS: Patients were randomly assigned to control and experimental groups. The control group underwent occupational therapy training with conventional methods. The experimental group underwent electromechanically-assisted training using an end effector robot (Camillo®). Interventions were provided for 30 min per day, 5 days a week, for 4 weeks. Primary outcome was change in Fugl-Meyer Assessment (FMA) before and after training. Secondary outcomes were changes in hand function, upper limb strength, spasticity, mental status and quality of life. RESULTS: Mean improvement in FMA was 1.17 (standard deviation (SD) 4.18) in the control group and 2.52 (SD 5.48) in the experimental group. Although FMA in the experimental group improved significantly after training, the improvement in FMA did not differ significantly between groups. Among the secondary outcomes, the Motricity Index (MI) improved significantly after training in the experimental group, and the change in MI between groups was statistically significant. CONCLUSION: Electromechanically-assisted rehabilitation using Camillo® was not more effective than conventional occupation therapy for upper arm function.

Subtrochanteric femoral fracture during trochanteric nailing for the treatment of femoral shaft fracture.

We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.

Primary total knee arthroplasty using rotating-hinge prosthesis in severely affected knees.

PURPOSE: A rotating-hinge total knee prosthesis may be utilized for the treatment of global instability or severe bone loss around the knee. The outcome of primary total knee arthroplasty (TKA) using Endo-Modell (Link(®)) rotating-hinge prosthesis was evaluated. METHODS: Retrospectively, review of 50 cases (40 patients) at a mean follow-up of 15 years (range, 10-18) who underwent primary TKA using Endo-Modell (Link(®)) was performed. Indications included severe primary osteoarthritis with substantial ligament laxity, severe rheumatic arthritis with extreme ligament instability and bone loss, supracondylar nonunion, charcot arthropathy, and posttraumatic arthritis. Knee Society Score (KSS) and radiographic analysis were done for preoperative and at latest follow-up. Statistical analysis was done using the Student's t test with the level of significance of p < 0.05. RESULTS: Overall, the rotating-hinge arthroplasty resulted in improved knee functioning. The KSS improved (p < 0.001) from a preoperative mean of 38 ± 14.3 (SD) points to a postoperative mean of 73 ± 12.8 points; the functional score improved (n.s.) from 36 ± 19.5 points to 47 ± 23.5 points. Mean range of motion at the most recent clinical follow-up evaluation was 102 ± 9°. However, all (100%) patients needed some form of assisted devices for walking and a relatively large number of deep infections (14%) were encountered. CONCLUSIONS: Reconstruction with a rotating-hinge total knee prosthesis provided substantial improvement in function and reduction in pain. However, the possibility of assisted walking and high rate of deep infection should be encountered. LEVEL OF EVIDENCE: Retrospective therapeutic study, Level IV.

Hybrid component fixation in total knee arthroplasty: minimum of 10-year follow-up study.

Hybrid total knee arthroplasty (TKA) (uncemented femur with cemented tibia and patella) was introduced in the late 1980s to gain the theoretical advantage of durable cementless femoral fixation while avoiding the problems noted with cementless tibial fixation. From December 1992 to July 2000, 215 patients (235 knees) who underwent hybrid TKA were enrolled in this study. Five types of prosthesis (AGC, Maxim, LCS-M, LCS-APG, and Scorpio) were used. Revision rate for aseptic loosening was 16 (6.8%) of 235 knees. At 10 and 15 years, survivorship with tibial or femoral revision as the end point was 0.95 and 0.92, respectively. Hybrid TKA provides durable fixation with clinical and radiographic performance at minimum 10 years comparable with cemented series.