A Strong Correlation Between the Severity of Flatfoot and Symptoms of Knee Osteoarthritis in 95 Patients.

Objective: The purpose of this study is to assess the association between the presence and severity of flatfoot and symptoms of knee OA. Methods: 95 participants with knee OA were recruited from a patient cohort at a regional hospital. Symptoms of knee OA, including knee degeneration, femorotibial alignment, pain, stiffness and dysfunction were assessed using the Kellgren-Lawrence (K-L) grading system, femoral-tibial angle (FTA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Participants were divided into groups with flatfoot (mild, moderate and severe) and without flatfoot based on the Clarke's angle. Linear regression and ordinal logistic regression were used for statistical analysis, as appropriate. Results: Having flatfoot was associated with a significantly increased risk of having a higher K-L grade (OR: 20.03; 95% CI, 5.88, 68.27; p < 0.001), smaller FTA (Beta: -2.96; 95% CI, -4.41, -1.50; p < 0.001), higher pain score (Beta: 0.47; 95% CI, 0.24, 0.69; p < 0.001) and greater loss of function (Beta: 0.25; 95% CI, 0.02, 0.48; p = 0.03). Severe grades of flat feet were associated with a higher K-L grade (OR: 0.19; 95% CI, 0.08, 0.44; p < 0.001), smaller FTA (Beta: 1.51; 95% CI, 0.66, 2.35; p = 0.001), higher pain score (Beta: -0.25; 95% CI, -0.39, -0.11; p = 0.001), greater stiffness (Beta: -0.24; 95% CI, -0.38, -0.09; p = 0.002) and greater loss of function (Beta: -0.27; 95% CI, -0.41, -0.14; p < 0.001). Conclusion: The results indicated that the severity of flattening is significantly associated with symptoms of knee OA. For the conservative management of knee OA, both flatfoot and its severity should be carefully considered.

The Three-Dimensional Morphology of Femoral Medullary Cavity in the Developmental Dysplasia of the Hip.

OBJECTIVE: This study aimed to assess the morphology of the femoral medullary canal in subjects with developmental dysplasia of the hip (DDH) with the intent of improving the design of femoral stems in total hip arthroplasty. METHODS: Computed tomography images of 56 DDH hips, which were classified into Crowe I to Crowe IV, and 30 normal hips were collected and used to reconstruct three-dimensional morphology of the femoral medullary cavity. Images of twenty-one cross sections were taken from 20 mm above the apex of the lesser trochanter to the isthmus. The morphology of femoral cavity was evaluated on each cross section for the longest canal diameter, the femoral medullary torsion angle (FMTA), and the femoral medullary roundness index (FMRI). RESULTS: The Crowe IV group displayed the narrowest medullary canal in the region superior to the end of the lesser trochanter, but then gradually aligned with the medullary diameter of the other groups down to the isthmus. The FMTA along the femoral cavity increased with the severity of DDH, but the rate of variation of FMTA along the femoral canal was consistent in the DDH groups. The DDH hips generally showed a larger FMRI than the normal hips, indicating more elliptical shapes. CONCLUSION: A femoral stem with a cone shape in the proximal femur and a cylindrical shape for the remainder down to the isthmus may benefit the subjects with severe DDH. This design could protect bone, recover excessive femoral anteversion and facilitate the implantation in the narrow medullary canal.

Association Between the Morphology of Proximal Tibiofibular Joint and the Presence of Knee OA.

Objective: The aim of this study was to evaluate the association between the morphology of the proximal tibiofibular joint (PTFJ) and the presence of knee osteoarthritis (OA). Methods: Twenty-eight OA subjects and 30 healthy subjects were enrolled in this study. A 3D model of the lower limb of each subject was constructed from CT scans and used to measure the characteristics of the PTFJ, including the shape of the articular facets, articular surface area, joint inclination, relative articular height, and joint declination. The association between the characteristics of the PTFJ and presence of knee OA was assessed using binomial logistic regression analysis. Results: There was a significant difference between the OA and healthy groups in terms of the inclination (p = 0.028) and declination (p = 0.020) of the PTFJ and relative articular height (p = 0.011). A greater inclination angle (OR: 1.463, 95% CI: 1.124-1.582, p = 0.021), greater declination angle (OR: 1.832, 95% CI: 1.691-2.187, p = 0.009), and lower relative articular height (OR: 0.951, 95% CI: 0.826-0.992, p = 0.008) were found to be associated with an increased likelihood of knee OA being present. Conclusion: The results of this study suggest that abnormal PTFJ morphology is associated with the presence of knee OA.

Biomechanical Comparison of Three Internal Fixation Techniques for Stabilizing Posterior Pelvic Ring Disruption: A 3D Finite Element Analysis.

OBJECTIVE: To compare the biomechanical stability and compatibility of two iliosacral screws (ISS), a tension band plate (TBP), and a minimally invasive adjustable plate (MIAP) for treating Tile C pelvic fractures. METHODS: Three groups of finite element models of the intact pelvis, including the main ligament and the proximal one-third of both femurs, were developed to simulate vertical sacral fractures and treated with the three abovementioned internal fixation techniques. A 500 N vertical load, a 500 N vertical load plus a 10 Nm moment of forward sagittal direction, and 500 N vertical load plus a 10 Nm moment of right lateral direction were applied to the sacrum to simulate standing status, bending status, and flexion status, respectively. The maximum displacement value, the stress value, and the stress value of the fracture interface were compared among the three internal fixation techniques. RESULTS: The results showed that all three internal fixation techniques effectively restored the biomechanical transmission of the injured pelvis. The stress on the implants in the TBP model was 167.47% and 53.41% higher than that in the ISS model and the MIAP model, respectively, and the stress shielding phenomenon of the TBP model was more obvious than in the other two models. Meanwhile, the stress between the fracture interfaces in the TBP fixation models was apparently higher than that in the other two models. However, the vertical displacement of the MIAP model was not significantly different from that in the ISS and TBP model; therefore, strong fixation could be obtained in all three models. CONCLUSION: Based on our results, we believe that the stability of Tile C pelvic fracture fixed with MIAP was similar to that of fractures fixed with ISS and TBP, but the stress shielding phenomenon and safety of implants in the TBP models were inferior to those in the MIAP and ISS fixation models. Meanwhile, MIAP and ISS fixation were more helpful to the healing processing than was TBP fixation, especially at the fracture interface of the second and third vertebral body levels.

Influence of Different Boundary Conditions in Finite Element Analysis on Pelvic Biomechanical Load Transmission.

OBJECTIVE: To observe the effects of boundary conditions and connect conditions on biomechanics predictions in finite element (FE) pelvic models. METHODS: Three FE pelvic models were constructed to analyze the effect of boundary conditions and connect conditions in the hip joint: an intact pelvic model assumed contact of the hip joint on both sides (Model I); and a pelvic model assumed the hip joint connecting surfaces fused together with (Model II) or without proximal femurs (Model III). The model was validated by bone surface strains obtained from strain gauges in an in vitro pelvic experiment. Vertical load was applied to the pelvic specimen, and the same load was simulated in the FE model. RESULTS: There was a strong correlation between the FE analysis results of Model I and the experimental results (R 2 = 0.979); meanwhile, the correlation coefficient and the linear regression function increased slightly with increasing load force. Comparing the three models, the stress values in the point near the pubic symphysis in Model III were 48.52 and 39.1% lower, respectively, in comparison with Models I and II. Furthermore, the stress values on the dome region of the acetabulum in Models II and III were 103.61 and 390.53% less than those of Model I. Besides, the posterior acetabular wall stress values of Model II were 197.15 and 305.17% higher than those of Models I and III, respectively. CONCLUSIONS: These findings suggest that the effect of the connect condition in the hip joint should not be neglected, especially in studies related to clinical applications.