L’objectif de ce travail de thèse était d’évaluer les bénéfices thérapeutiques d’un entraînement par imagerie motrice chez les patients ayant subi une prothèse totale de genou unilatérale. Combiner l’imagerie motrice avec la physiothérapie classique a permis de diminuer la douleur et d’augmenter la force du quadriceps durant la phase aiguë, au 1er mois postopératoire. Durant la phase chronique, au 6ème mois postopératoire, l’imagerie motrice permettrait de corriger l’asymétrie de la marche, d’une part en augmentant la force du quadriceps ipsilatéral et, par conséquent, en accentuant la charge sur le genou opéré, et d’autre part en augmentant la flexion maximale du genou durant la phase oscillante. L’imagerie motrice pourrait également aider les personnes âgées après la prothèse totale du genou à monter les escaliers plus rapidement, en toute sécurité. Cela peut atténuer le risque de chute dans les escaliers et, par conséquent, diminuer la fréquence des blessures graves. En conclusion, intégrer l’imagerie motrice dans les programmes de rééducation après prothèse totale du genou primaire unilatérale est pertinent et prometteur / The primary aim of the present work was to determine the therapeutic benefits of a specific motor imagery training. Combining motor imagery with classical physical therapy was found to be effective in reducing pain and increasing quadriceps strength after total knee arthroplasty during the acute phase at the first month postoperatively. During the chronic phase, at the 6th month postoperatively, motor imagery might contribute to correct the asymmetry of gait by increasing the strength of the ipsilateral quadriceps and, consequently accentuating the weight loading on the operated knee, as well as by improving knee proprioception through an increase in the maximum knee flexion during the swing phase. MI might also help elderly people after total knee arthroplasty to climb stairs more quickly, easily, and safely. This could attenuate the risk of falls on stairs, and consequently decrease the frequency of major injuries. In summary, the integration of motor imagery in clinical rehabilitation programs after primary unilateral total knee arthroplasty is relevant and promising

Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-10-04T13:09:23Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese Ricardo Bastos.pdf: 1699294 bytes, checksum: 9f66927af352d688894773afaee06cdd (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-10-04T13:09:37Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese Ricardo Bastos.pdf: 1699294 bytes, checksum: 9f66927af352d688894773afaee06cdd (MD5) / Made available in DSpace on 2017-10-04T13:09:37Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese Ricardo Bastos.pdf: 1699294 bytes, checksum: 9f66927af352d688894773afaee06cdd (MD5) Previous issue date: 2013 / Universidade Federal Fluminense / Osteotomia tibial alta (OTA) é um recurso frequentemente utilizado para o tratamento da artrose de joelho em pacientes jovens com o objetivo de retardar a necessidade de uma artroplastia total de joelho (ATJ). O objetivo do estudo foi de avaliar a influência da técnica de OTA (adição ou subtração) no resultado final da ATJ e comparar a sobrevida das cirurgias de osteotomias com a idade dos pacientes no momento do procedimento Nossa hipótese é que o alinhamento do membro, seguimento clínico dos pacientes e taxa de complicações sejam iguais em pacientes submetidos a ATJ após OTA de adição e subtração além de que as osteotomias de subtração apresentem uma maior duração até a ne-cessidade de realização da ATJ. Supomos também que a idade dos pacientes na época das osteotomias tenha uma relação linear positiva com a sobrevida desta cirurgia. Cento e quarenta e uma ATJs com antecedente de cirurgia de OTA (24 osteotomias de adição e 117 de subtração) foram selecionadas. Fatores intra-operatórios, resultados clínicos e alinhamento do membro foram analisados. A duração (sobrevida) das 2 diferentes técnicas de osteotomia até a realização da ATJ, assim como o impacto da idade dos pacientes na duração das duas técnicas desta cirurgia, também foram observados. Não foram observadas diferenças significativas nos escores IKS quando comparadas as duas técnicas cirúrgicas. Foi observada uma tendência a maior necessidade de uma osteo-tomia da tuberosidade anterior da tíbia (TAT) no grupo das osteotomias de subtração. Foi encontrada uma maior necessidade de liberação de partes moles (release) medial mais extensa no grupo das osteotomias de adição e uma liberação de partes moles lateral mais importante no grupo das osteotomias de subtração. Não foram encontradas diferenças no tempo de is-quemia, taxas de complicação ou no eixo mecânico final do membro inferior entre os dois grupos. O alinhamento radiográfico, resultados funcionais, objetivos e taxas de complicações são iguais em pacientes que se submetem a uma ATJ após a realização de uma OTA de adição e de subtração. A cirurgia de osteotomia tibial alta de subtração parece apresentar uma longe-vidade (sobrevida) maior até a necessidade da realização de uma artroplastia total de joelho quando comparada a uma osteotomia tibial de adição. Existe uma relação positiva e significa-tiva entre a idade do paciente na época da realização da osteotomia e a duração dessa cirurgia até a necessidade de uma artroplastia / High tibial osteotomy (HTO) is frequently used to treat varus osteoarthritis in younger patients with the goal of delaying the need for total knee arthroplasty (TKA). While it has been reported that the results of TKA following HTO are worse than those in patients without prior knee surgery, the influence of osteotomy technique (medial opening-wedge versus lat-eral closing-wedge) has not been explored. The purpose of this study was to evaluate the in-fluence of HTO technique on the performance and results of TKA. Our hypothesis is that the limb alignment, clinical follow-up and rate of complications are equal in patients undergoing TKA after closing-wedge and opening-wedge osteotomies and that the closing-wedge osteotomies have a higher survival rate when compared to open-ing- wedge osteotomies. We also suppose that younger patients at the time of the osteotomies have a longer delay until the need of performing a TKA. A hundred and one TKA’s performed in 118 patients with prior HTO (24 opening wedge and 117 closing wedge) were reviewed at a mean follow-up of 2 years. Reviewed data included intra-operative factors (tourniquet time, the need for additional exposure, and intra-operative complications), clinical results (International Knee Score (IKS)), and radiographic assessment of limb alignment. There was no significant difference in IKS scores based on osteotomy technique. There was a trend toward an increased need for tibial tubercle osteotomy in the closing-wedge group. There was an increased need for extensive medial release in the opening-wedge group and extensive lateral release in the closing-wedge group. No differences in tourniquet time, complication rates, or hip-knee-ankle angle were noted between the two groups. Radiographic limb alignment, patient-reported outcomes, and complication rates are equal in patients undergoing TKA after opening and closing wedge HTO. Closing-wedge high tibial osteotomy has a longer survival until the necessity of a total knee arthroplasty when compared to an opening-wedge high tibial osteotomy. There is a posi-tive and significant relationship between the patient's age at the time of the osteotomy and the survival of this surgery

Biocompatible sensors have been demonstrated using traditional microfabrication techniques modified for polymer substrates and utilize only materials suitable for implantation or bodily contact. Sensor arrays for the measurement of the load condition of polyethylene spacers in the total knee arthroplasty (TKA) prosthesis have been developed. Arrays of capacitive sensors are used to determine the three-dimensional strain within the polyethylene prosthesis component. Data from these sensors can be used to give researchers a better understanding of component motion, loading, and wear phenomena for a large range of activities. This dissertation demonstrates both analytically and experimentally the fabrication of these sensor arrays using biocompatible polymer substrates and dielectrics while preserving industry-standard microfabrication processing for micron-level resolution. An array of sensors for real-time measurement of pressure profiles is the long-term goal of this research. A custom design using capacitive-based sensors is an excellent selection for such measurement, giving high spatial resolution across the sensing surface and high load resolution for pressures applied normal to that surface while operating at low power.

Traditionally, orthopaedic surgical training has primarily taken place in the operating room. Given the growing trend of decreasing resident work hours in North America and globally due to political mandate, training time in the operating room has generally been decreased. This has led to less operative exposure, teaching, and feedback for orthopaedic surgery residents. To solve this problem, a 3D serious game that was designed for the purpose of training orthopaedic surgery residents the steps comprising the total knee replacement procedure. Real-time, 3D graphical and sound rendering technologies are employed to provide sensory realism ensuring that the knowledge gained within the serious game can be more easily recalled and applied a real world scenario. A usability study to address user perceptions of the game’s ease of use, and the potential for learning and engagement was conducted. Results indicate that the serious game is easy to use, intuitive, and stimulating. / UOIT

Source: Masters Abstracts International, Volume: 47-06, page: 3565. Adviser: Benjamin Amick. Includes bibliographical references.

Introduction: Knee osteoarthritis is one of the common causes leading to musculoskeletal disability of the elderly around the world. Total knee replacement (TKR) is an effective and common treatment for end stage knee arthritis. Most papers suggest that early rehabilitation could improve postoperative knee function. However, postoperative pain and local swelling are the complications that diminish range of motion (ROM) and inhibit patients’ recovery. A comprehensive review of the literature reveals that cryotherapy is an effective and safe method to overcome these complications. In this paper, a guideline of using cryotherapy in reducing postoperative pain and knee swelling so as to improve the ROM of patients and promote recovery after TKR has been developed. Objectives: The objectives of this translational research are: (1) to look for relevant papers that related to cryotherapy in reducing postoperative pain and knee swelling so as to improve the ROM of patients after TKR; (2) to gather and criticize the data obtained; (3) to develop a guideline of using cryotherapy in reducing pain, knee swelling and improving ROM of patients after TKR based on the evidence from the reviewed literature; (4) to assess the implementation potential of the newly developed guidelines; and (5) to establish the implementation and evaluation plans for the new innovation. Methods: An empirical literature search published from 2001 to 2011 by several searching engines regarding cryotherapy in reducing postoperative pain and knee swelling with the aim to improve the ROM of patients after TKR has been conducted. After that, the qualities of relevant studies were retrieved and criticized by using the appraisal checklist of the SIGN (2004). The derived evidences were then be summarized and synthesized. An evidence-based guideline was established with reference to the evidence from the reviewed literatures and the results of the quality assessment. Recommendations are graded by SIGN (2004). The implementation potential including transferability, feasibility and cost-benefit ratio of the innovation were assessed as well. Lastly, implementation and evaluation plans have been developed to assess and appraise the effectiveness of the new guideline. Results: Finally, seven studies were chosen as final references after methodological quality assessment. Four main types of comparison were made from these seven reviews including: (1) continuous compressive cryotherapy vs. compressive crepe bandage; (2) comparison in different temperature of cryotherapy; (3) outcome measures; and (4) complications in cryotherapy. After the summary, six main categories of recommendations were synthesized: (1) continuous compression cryotherapy; (2) effective temperature; (3) potential complications; (4) regular assessment; (5) duration; and (6) intermitted ice pack regimen. Based on these syntheses and recommendations, a guideline of using cryotherapy for patients after having TKR was developed. Conclusion: With the implementation of the newly developed evidence-based cryotherapy guidelines for patients after having TKR in local clinical settings, the improvement in the ROM of the knee joint will be anticipated as a result of the reduction in postoperative pain and knee swelling. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Pasaulyje operacijos minimaliai invazine metodika tampa vis labiau populiaresnės. Literatūroje galima rasti argumentų ,,už” ir ,,prieš” šia metodiką.. Minimalios invazijos šalininkai teigia, kad pagrindinis metodikos privalumas — greitesnė pacientų reabilitacija. Oponentų teigimu minimalios invazijos totalinis kelio sąnario endoprotezavimas nėra pranašesnis už įprastinį, netgi mano, jog tai padidina komponentų padėties klaidų tikimybę, bei komplikacijų riziką. 70 kelio sąnario artroze sergančių pacientų buvo įtraukta į atsitiktinių imčių tyrimą. 35 pacientai operuoti minimaliai invazine metodika, 35 įprastine. Mes tyrėme operacijos laiką, kelio sąnario judesius. Po 6 ir 12 savaičių kelio sąnario funkcija buvo vertinta pagal Kelio Sąnario draugijos skalę. Rentgenologiniam ištyrimui priekinę, šoninę kelio bei priekinę visos kojos rentgenogramas. Ligonių pasiskirstymas pagal, lytį amžių, kūno masės indeksą bei kelio sąnario pakitimus statistiškai reikšmingai tarp grupių nesiskyrė. Tyrimo metu nustatėme minimaliai invazinė metodika operuotų pacientų greitesnį kelio judesių atsistatymą, geresnius funkcinius rezultatus po 6 sav., bei ilgesnę operacijos trukmę. Po 12 savaičių skirtumo tarp grupių nenustatėme. Taip pat nenustatėme protezo komponentų padėties skirtumų tarp grupių. / Minimally invasive surgery is getting more interest in literature recently. However the reports regarding the effectiveness of this particular technique are controversial. There are reports in the literature that minimally invasive technique is associated with increased number of technical mistakes. Advantages of this technique are faster rehabilitation. In randomized controlled trial we analyzed 70 knee osteoarthritis patients admitted for elective total knee replacement. All patients were randomized to do surgery using minimally invasive or conventional technique. We analyzed operation time, range of motions 1-6 days after surgery. After 6 and 12 week we evaluated total knee replacement patiens according KSS score. For radiographic examination we performed anterior, lateral and long standing x-rays after the surgery. Preoperative data such as severity of osteoarthirtis, sex, age, and functional score did not differ within the groups. Minimally invasive group was associated with longer operation time, faster recovery of range of motions, better knee function 6 weeks after surgery. 12 week after total knee replacement we did not find any differences between the groups. Component position and leg axis deviation did not differ between the groups.

Total knee replacement is the gold standard treatment for restoring mobility and relieving pain associated with osteoarthritis when other medical therapy has failed. Revision surgery is necessary when the replaced knee fails, which is often a result of implant damage (such as wear) or poor kinematics. Design optimization is a method for finding the best shape for a component using an optimization approach considering one or multiple performance metrics. The shape of a parametric candidate design can be manipulated by an optimization algorithm, which seeks to minimize an objective function subject to performance constraints and design space limitations. During multiobjective design optimization, multiple performance measures are minimized simultaneously, the relative importance of each determined using a weighted sum. This approach can also be used to derive a Pareto curve or frontier which graphically describes the relationships (or trade-offs) between the performance measures. It was hypothesized that a trade-off exists between wear and kinematics performance in total knee replacements. The objective of this research was to test this hypothesis by using multiobjective design optimization to describe this relationship with a Pareto curve. It was first necessary to develop and validate numerical frameworks for wear and kinematics simulations, using models constructed using a parametric modeller. The Pareto curve was then generated using a combination of single objective and multiobjective design optimizations considering these two performance measures. Single objective optimization for wear yielded a theoretical design with superior wear resistance when compared to a typical commercially available knee design. Single objective optimization for kinematics yielded a theoretical design capable of higher flexion, as well as more natural laxity characteristics. After performing multiobjective design optimization, the resulting Pareto curve showed that there is, in fact, a trade-off between wear and kinematics performance. When considering optimum designs, in order to improve the wear performance it was necessary to sacrifice kinematics performance, and vice-versa. This previously suspected but never verified nor quantified relationship can be used to improve total knee replacement designs, as well as help healthcare providers select the best implants for their patients. / Thesis (Ph.D, Mechanical and Materials Engineering) -- Queen's University, 2010-04-14 13:43:42.639

The purpose of this study was to determine the effectiveness of the Augmented Soft Tissue Mobilization (A.S.T.M.) Rehabilitation Technique on total knee replacement patients. The specific measurements assessed were stride length (SL), stride frequency (SF), walking velocity, support time (ST), total time (TT), static and walking range of motion (ROM) of the hip, knee, and ankle, ground reaction forces (GRF), and torques. Fourteen subjects (Female = 7, Male = 7) completed the study. Subjects were randomly assigned to two experimental groups, the Traditional Therapy treatment or the A.S.T.M. treatment. There were five testing sessions: pre operation, 8 weeks, 12 weeks, 16 weeks, and 24 weeks post operation. On the 12 week test, the subject had completed their assigned of treatment protocol. Static ROM was derived from gonimetric measurements before each testing session. Stride length, stride frequency, velocity, time, and walking ROM were derived from accelerometer data. Statistical analysis using ANOVA revealed a significant change in all static ROM, SL, and ST. The data indicated that both groups of the Total Knee Replacement patients did improve their functional status from their status prior to surgery. In addition, the data indicated that the Augmented Soft Tissue Mobilization program and the Traditional Therapy program are equally acceptable rehabilitation techniques. / School of Physical Education

Background: Cryotherapy is commonly used during physiotherapeutic rehabilitation of patients following total knee replacement (TKR). Evidence for treatment effectiveness within the current literature is contradictory and there are no clinical guidelines to inform cryotherapy treatment within this particular patient group. This study surveys current cryotherapy treatment efficacy in the acute post-operative management of TKR patients. Methods: In total 263 senior physiotherapists completed and returned a postal questionnaire, which, using open and closed questions investigated the use of cryotherapy following TKR. Survey results were used to inform a pragmatic randomized clinical trial (RCT) involving 133 consecutive TKR patients. The RCT investigated cryotherapy treatment efficacy in the acute post-operative management of TKR patients. Patients were randomized into three groups; no cryotherapy (NC), delayed cryotherapy (DC) and immediate cryotherapy (IC). The primary outcome measure was post-operative pain with knee swelling, active range of motion (AROM), function and levels of physiotherapy input assessed as secondary outcome measures. Observations were taken pre-operatively and at 3, 7 and 42 days post-operatively. Results: The survey reported that 33% of respondents used some form of cryotherapy routinely following TKR surgery. The two main methods of cryotherapy application were Cryocuff (59%) and crushed ice (30%). Treatments were most frequently applied between 24 hrs and 48 hrs post-surgery for 20 minutes, twice a day. Chi square analysis indicated significant differences (p<0.01) in between NHS and private sites relating to a lack of cryotherapy resources and treatment time for cryotherapy in the NHS. A lack of proven efficacy was the most cited reason for not applying cryotherapy treatment, and swelling the most common treatment indicator. There was particular uncertainty regarding the cleaning and sterilization of the Cryocuff device. The RCT indicated that patients in IC group had significantly less post-operative pain than the NC and DC groups at 3 days. Mean difference (p <0.05, 95% CI) in post-operative analogue scores (VAS, scale 0-10) was -1.6 (p <0.01, CI -2.49- to -0.707) for IC and NC; and -0.922 (p= 0.044, CI -0.183 to -0.009) for IC and DC groups. At 7 and 42 days there were significant reductions in VAS scores for both cryotherapy groups compared to the NC group. There was significant improvement in knee swelling, AROM, ability to transfer and need for additional physiotherapy in both cryotherapy treatment groups although no significant reduction in opiate requirement was found. Conclusions: In current clinical practice there was little consensus regarding treatment indicators, method of application and management of cryotherapy following TKR. However, in a RCT the use of cryotherapy combined with compression, as compared to a no cryotherapy control, led to significant reductions in patient reported pain, less post-operative swelling, greater recovery of AROM, faster return of function and less reliance on OPD physiotherapy treatment. It is concluded that cryotherapy combined with compression has an important role to play in the acute rehabilitation of TKR and should be considered as part of routine management.