Introduction : L’influence de l’Index de Masse Corporelle (IMC) sur la récupération des paramètres de la marche après prothèse totale de hanche (PTH) et de genou (PTG) est méconnue. Peu d' étude se sont intéressées à l'influence de l’IMC sur la récupération des amplitudes articulaires actives à la marche (AAA) ou de la vitesse de marche après PTH et PTG. Notre objectif était d’évaluer cet impact en préopératoire et en post-opératoire par une évaluation clinique et biomécanique. Notre hypothèse était que l’obésité (IMC>30kg/m2) serait un facteur péjoratif de récupération des paramètres de marche.Matériel et méthodes : Après avoir effectué une revue systématique de la littérature sur la récupération fonctionnelle après prothèses totales du membre inférieur (PTH et PTG) afin de nous assurer de l’originalité de notre travail et de sa pertinence nous avons réalisé 2 études prospectives indépendantes : en incluant 76 PTH chez des patients coxarthrosiques d’une part et 79 PTG chez des patients gonarthrosiques d’autre part. Tous les patients bénéficiaient d’une analyse quantifiée de la marche en préopératoire et en post-opératoire (à 6 mois pour les PTH et à un an pour les PTG). Un groupe de témoins sains appariés suivait le même protocole. La vitesse de la marche, l’AAA de hanche et de genou, ainsi que des scores fonctionnels et de qualité de vie étaient évalués, pour tous les paramètres le gain était calculé. Les patients étaient répartis en 2 groupes : patients non-obèses (G1) : IMC<30 et patients obèses (G2) : IMC≥30 dans chacune des cohortes. Des t-tests appariés étaient utilisés pour évaluer (1) les différences pré- et post-opératoires entre G1 et G2, puis les différences de gain entre G1 et G2. Enfin une régression linéaire uni- et multivariée recherchait les associations entre l’IMC, la vitesse de la marche et les AAA.Résultats Pour les 2 cohortes : en préopératoire, la vitesse de la marche et les AAA étaient significativement plus bas chez les obèses. En post-opératoire la vitesse de la marche et les AAA étaient significativement plus bas pour tous les patients opérés d’une PTG ou d’une PTH comparativement au groupe témoin. En pré-opératoire les obèses étaient plus symptomatiques. Une différence significative était retrouvée entre G1 et G2 concernant l’amélioration de la douleur en faveur des obèses (sur le gain de WOMAC douleur pour les PTG et d’EVA pour les PTH). Pour tous les autres paramètres les gains n’étaient pas différents entre G1 et G2. La régression uni- et multivariée ne montrait pas de relation significative entre la vitesse de la marche, les AAA et l’IMC.Conclusion : L’IMC n’a pas d’effet délétère direct sur la récupération des paramètres de marche après une PTH ou une PTG. En effet malgré une symptomatologie pré-opératoire plus forte les patients obèses présentent une amélioration comparable en termes de gain aux patients non-obèses. Cependant les paramètres de marche post-opératoire après une PTH ou une PTG demeurent significativement plus bas que ceux des témoins et ce quel que soit l’IMC des patients opérés, sans récupération ad integrum clinique ou biomécanique de leur fonction de la hanche ou du genou. Ainsi l’obésité semble présenter un effet similaire sur la récupération des paramètres de marche après une PTH ou une PTG. / Introduction : Body Mass Index (BMI) impact on gait recovery after total hip and total knee arthroplasty (THA and TKA) remains misunderstood. Few studies have analyzed the influence of BMI on the recovery of hip and knee range of motion (ROM) during gait or walking speed after THA and TKA. Our objective was to assess this impact preoperatively and post-operatively using both 3D gait analysis and clinical assessment. Our hypothesis was that obesity (BMI> 30kg /m2) would be a negative factor in the recovery of gait parameters.Material and methods: After conducting a systematic review of the literature on functional recovery after total prostheses of the lower limb (THA and TKA) to ensure the originality of this work and its relevance we conducted 2 independent prospective studies: including 76 THA in hip osteoarthritis patients on the one hand and 79 TKA in knee osteoarthritis patients on the other hand. All patients had a quantified gait analysis of preoperatively and postoperatively (at 6 months for THA and 1 year for TKA). A control group of matched healthy people followed the same protocol. The gait speed, ROM hip and knee, as well as functional and quality of life scores were evaluated, for all parameters the gain was calculated. Patients were divided into 2 groups in each cohort: non-obese patients (G1): BMI <30kg/m2 and obese patients (G2): BMI≥30kg/m2. Paired t-tests were used to evaluate the pre- and post-operative differences between G1 and G2, then the differences in gain between G1 and G2. Finally, a uni- and multivariate linear regression sought associations between BMI, gait speed, and ROM.Results: In both cohorts: preoperatively, gait speed and ROM were significantly lower in obese patients. Postoperatively, walking speed and ROM were significantly lower for all patients undergoing TKA or THA compared with the control group. Preoperatively obese patients were more symptomatic. A significant difference was found between G1 and G2 regarding pain improvement in favor of the obese (on the gain of WOMAC pain for TKA and analogic pain scale for THA). For all other parameters the gains were not different between G1 and G2. Uni- and multivariate regression showed no significant relationship between gait speed, ROM and BMI.Conclusion: BMI has no direct negative effect on recovery of walking parameters after THA or TKA. Indeed despite a higher preoperative symptomatology obese patients show a comparable improvement in terms of gain to non-obese patients clinically and biomechanically. However, postoperative gait parameters after THA or TKA remain significantly lower than those of controls, regardless of the BMI of patients without full clinical or biomechanical recovery. Though, obesity appears to have a similar effect on the gait parameters recovery after THA or TKA.

Adverse effects of cyclooxygenase (COX) inhibitors on bone healing have previously been demonstrated in diaphyseal fracture models in animals. In spite of that, they are widely used as postoperative analgesics in orthopaedic surgery. After joint replacement, a bone repair process starts at the interface between bone and cement. If this process is disturbed, the prosthesis may never become rigidly fixed to the bone, leading to migration and with time loosening. This thesis investigates the effects of a selective COX-2 inhibitor (parecoxib or celecoxib) on bone healing in metaphyseal bone in a rat model and on knee prosthesis migration after total knee replacement, as measured with radiostereometric analysis. Blood loss, postoperative recovery, and the 2-year subjective outcome, were also measured. In addition, a hemoglobin dilution method for blood loss estimation, used in this thesis, was evaluated. In the first study, pull-out force of a screw inserted in metaphyseal bone of the tibia in rats was only marginally decreased by parecoxib after 7 days but not after 14 days. In the second and third study, celecoxib treatment resulted in less pain postoperatively in conjunction with total knee replacement (TKR), but no effects were seen on blood loss, range of motion, subjective outcome, or prosthesis migration after 2 years. Comparing the true blood loss of blood donors with the blood loss estimated by the hemoglobin dilution method, this method was found to underestimate the true blood loss. It is therefore not suitable for calculation of the absolute blood loss volume, but may be used for a rough estimate. In summary, celecoxib and presumably other cyclooxygenase inhibitors seems not likely to increase the risk of prosthesis loosening.

Osteoarthritis (OA) is the leading cause of disability in North American and has major economic consequences for society. People with knee OA experience the worst quality of life, among musculoskeletal conditions, with function and mobility being influenced by symptoms such as pain and stiffness. However, the impact of OA symptoms varies due to intrinsic and extrinsic factors, leading many researchers to employ biopsychosocial and other population health frameworks to study the disease. These population health approaches have not been adopted when studying knee OA outcomes in bioarchaeology, where a limited biological lens prevails due to the sole reliance on skeletal remains. The purpose of this research was to explore methods for identifying the impairment potential of knee OA in archaeological populations using a clinical sample and population health approaches. Clinical studies have the advantage of assessing not only the biological implications of knee OA but also the functional outcomes. By creating a knee OA grading system applicable for both MRI and dry bone femora samples (Clinical Archaeological Osteoarthritis Score) a link between clinical and archaeological populations was proposed. Using this link to infer functional deficits onto archaeological populations using population health frameworks, a theoretical analysis was performed with two populations; the 17th century Huron and the 19th century Inuit from the Igloolik region of Nunavut. The results demonstrated the increased impairment potential of knee OA in the Inuit population versus the Huron population, produced by contrasting factors captured by the determinants of health, including social and physical environments.

We have designed and examined a compliant knee mechanism that may offer solutions to problems that exist for infants and toddlers who are just learning to walk. Pediatric prosthetic knees on the market today are not well designed for infants and toddlers for various reasons. Children at this age need a prosthetic that is light in weight, durable, and stable during stance. Of the eleven knees on the market for children, all but three are polycentric or four-bar knees, meaning they have multiple points of movement. Polycentric knees are popular designs because they offer the added benefit of stable stance control and increased toe clearance, unfortunately this type of knee is often too heavy for young children to wear comfortably and is not well suited for harsh environments such as sand or water, common places children like to play. The remaining three knees do not offer a stance control feature and are equally vulnerable to harsh environments due to ball bearing hinges. Compliant mechanisms offer several design advantages that may make them suitable in pediatric prosthetic knees -- light weight, less susceptible to harsh environments, polycentric capable, low part count, etc. Unfortunately, they present new challenges that must be dealt with individually. For example compliant mechanisms are typically not well suited in applications that need adjustability. This problem was solved by mixing compliant mechanism design with traditional mechanism design methods. This paper presents a preliminary design concept for a compliant pediatric prosthetic knee. The carbon fiber composite spring steel design was first built and then evaluated using Finite Element Analysis. The prototype's instant center was plotted using the graphical method. From our analysis position, force and stress information was gathered for a deflection up to 120 degrees. The instant centers that were plotted indicate that the knee has good potential in offering adequate stability during stance.

Performance of a series of eccentric contractions produces adverse effects including muscle weakness, delayed onset muscle soreness (DOMS), fluid accumulation and decreased muscle function. The repeated bout effect is a physiological adaptation observed when a single-bout of eccentric exercise protects against muscle damage from subsequent eccentric bouts. Similar to the repeated bout effect, increases in flexibility have been linked to attenuations in acute muscle damage, muscle fatigue and strength loss after eccentric exercise. Purpose: The purpose of this study was to examine the muscle physiological responses to eccentric strength training after first priming the muscles with either a period of static flexibility training or a single intense bout of eccentric exercise performed weeks earlier; and compare these to the responses from eccentric strength training when no prior intervention is administered. Methods: Twenty-five participants were randomly assigned to a flexibility (F) (n=8), a single-bout (SB) (n=9), or a control (C) (n=8) group. The design consisted of two 4-week phases; 1) priming intervention, 2) eccentric training. The priming intervention included static stretching (3x/week; 30mins/day) (F), a single-bout of eccentric exercise (SB) or no priming intervention (C). All groups proceeded to complete eccentric training of the knee flexors using isotonic contractions (%load progressively increased over training period) on a dynamometer following the priming intervention phase. Testing was completed at baseline, post-priming intervention and post-eccentric training, in conjunction with data being collected during the acute eccentric training phase (0hr, 24hr, 48hr; post-bout 1 and 4). Dependent measures included muscle thickness, isometric maximal voluntary contraction (MVC), eccentric and concentric MVC, optimal angle, active range of motion (ROM), passive ROM, maximal power, electromyography (EMG) and delayed onset muscle soreness (DOMS). Results: Acute data during the eccentric training phase revealed a significant reduction in DOMS for both the F and SB groups compared to the C following the first bout of eccentric exercise (p<0.05). The F also had reduced soreness in comparison to both the SB and C post fourth bout of eccentric exercise (p<0.05). The F group demonstrated attenuated loss in isometric strength (post fourth bout) and maximal power (post first bout) during eccentric training compared to the C group (p<0.05). However, there was no significant difference between groups across all dependent variables following the eccentric training phase. Conclusion: This is the first study to directly compare the protective effects observed with static flexibility training to that of a single-bout of eccentric exercise throughout a subsequent eccentric training regime. Although differences in muscle soreness, strength and maximal power occurred during the acute stages of eccentric training, there appeared to be no significant advantage of either protective priming method at the end of eccentric training.

No description available.

No description available.

L’objectif de cette étude est de vérifier si un ciment ostéoconducteur résorbable utilisé comme technique de fixation de greffons ostéochondraux permet d'obtenir une stabilité initiale supérieure à celle obtenue avec la technique de mosaicplastie originalement décrite. Il s’agit d’une étude biomécanique effectuée sur des paires de fémurs cadavériques bovins. Pour chaque paire de fémurs, des greffons ostéochondraux autologues ont été insérés et stabilisés au moyen d’un ciment biorésorbable (Kryptonite, DRG inc.) sur un fémur alors qu’au fémur controlatéral, les greffons ont été implantés par impaction selon la technique usuelle de mosaicplastie. Des greffons uniques ainsi que des greffons en configuration groupée ont été implantés et soumis à une évaluation biomécanique. Les charges axiales nécessaires pour enfoncer les greffons de 1, 2 et 3 mm ont été comparées en fonction de la technique de stabilisation utilisée, ciment ou impaction, pour chaque configuration de greffons. Les résultats démontrent que les greffons ostéochondraux cimentés uniques et groupés ont une stabilité initiale supérieure à celle de greffons non cimentés sur des spécimens cadavériques bovins. L’obtention d’une plus grande stabilité initiale par cimentation des greffons ostéochondraux pourrait permettre une mise en charge précoce post-mosaicplastie et mener à une réhabilitation plus rapide. / The objective of this project is to compare the primary stability of osteochondral autografts stabilized with a resorbable osteoconductive bone cement to that of bottomed press fit grafts inserted according to the original mosaicplasty technique. Biomechanical testing was conducted on pairs of cadaveric bovine femurs. For each femoral pair, osteochondral grafts were inserted and stabilized with an osteoconductive bone cement (Kryptonite, DRG inc.) on one bone whereas on the controlateral femur, grafts were inserted in a press fit fashion. Grafts were inserted in 2 different configurations, single grafts as well as groups of 3 adjacent grafts, and submitted to biomechanical testing. Axial loads needed to sink the grafts to 1, 2 and 3 millimeters below cartilage level were recorded and compared according to the fixation technique, cement or press-fit impaction, for each graft configuration. According to those results, cemented osteochondral autografts appear more stable than press fit grafts for both single and 3-in-a-row configurations. Using such a cementation technique could potentially prevent the initial loss of stability that has been shown to occur with osteochondral grafts in the post-operative period, allowing patients to perform early weight bearing and rehabilitation.

Temos aktualumas: Siekiant įvertinti kelio sąnario funkciją po priekinio kryžminio raiščio plyšimo naudojami įvairūs metodai: izokinetinis testavimas dinamometru (Kannus et al., 1992; Risberg et al., 2009), judesio analizė (Risberg et al., 2009), elektromiografija, klinikiniai testai (Irrgang, 2003; Lee et al., 2008) ir klausimynai (Irrgang, 2001; Lee et al., 2008). Ieškodami patikimesnių būdų įvertinti žmogaus nervų- raumenų sistemos valdymo efektyvumą, Kauno technologijos universiteto ir UAB „Katra“ specialistai kartu su Lietuvos kūno kultūros akademija sukūrė naują originalų prietaisą – žmogaus rankų ir kojų judesių dinaminių parametrų analizatorių (DPA–1). Tyrimo objektas: DPA testų patikimumas ir informatyvumas. Tyrimo tikslas: Nustatyti DPA–1 testų patikimumą ir informatyvumą po priekinio kryžminio raiščio rekonstruojamosios operacijos. Tyrimo uždaviniai: 1. Nustatyti DPA–1 testų patikimumą, atliekant standartines ir variabilias užduotis po priekinių kryžminių raiščių rekonstruojamosios operacijos. 2. Nustatyti DPA–1 testų informatyvumą, atliekant standartines ir variabilias užduotis po priekinių kryžminių raiščių rekonstruojamosios operacijos. Tyrimas atliktas Lietuvos kūno kultūros akademijoje „Žmogaus motorikos“ laboratorijoje. Jame dalyvavo 34 tiriamieji, kurie buvo suskirstyti į dvi grupes. Pirmąją grupę sudarė pacientai, patyrę kelio sąnario priekinio kryžminio raiščio rekonstruojamąją operaciją (n=17). Šių tiriamųjų amžiaus vidurkis – 31,3 ± 7,8 metai, ūgis –... [toliau žr. visą tekstą] / Relevancy: Different methods are used to assess capabilities of knee function after ACL injury including isokinetic dynamometry (Kannus et al., 1992, Risberg et al., 2009), motion analysis (Chmielewski et al., 2005, Risberg et al., 2009), electromyography (Chmielewski et al., 2005), clinical testing (Irrgang, 2003, Lee et al., 2008) and questionnaires (Irrgang, 2001, Lee et al., 2008). In order to devise more reliable methods to evaluate the efficiency of human neuromuscular control, the dynamic parameters’ analyzer of human’s hands and legs movements (DPA-1, Patent No. 5251; 2005 08 25) was constructed by Kaunas Technology University and „Katra“ engineers in collaboration with Lithuanian Academy of Physical Education. The object of the study: the reliability and validity of DPA-1 testing procedures. The aim of the study is to establish the reliability and validity of DPA-1 testing procedures after anterior cruciate ligaments reconstructive surgery. The goals of the study are the following: 1. To establish the reliability of DPA-1 testing procedures while performing standard and variable tasks after anterior cruciate ligaments reconstructive surgery. 2. To establish the validity of DPA-1 testing procedures while performing standard and variable tasks after anterior cruciate ligaments reconstructive surgery. The recearch was performed in the Laboratory of Human Motorics at the Lithuanian Academy of Physical Education. 34 participants, who were divided into two groups... [to full text]

Pour répondre aux exigences du gouvernement fédéral quant aux temps d’attente pour les chirurgies de remplacement du genou et de la hanche, les établissements canadiens ont adopté des stratégies de gestion des listes d’attentes avec des niveaux de succès variables. Notre question de recherche visait à comprendre Quels facteurs ont permis de maintenir dans le temps un temps d’attente répondant aux exigences du gouvernement fédéral pendant au moins 6-12 mois? Nous avons développé un modèle possédant quatre facteurs, inspiré du modèle de Parsons (1977), afin d’analyser les facteurs comprenant la gouvernance, la culture, les ressources, et les outils. Trois études de cas ont été menées. En somme, le 1er cas a été capable d’obtenir les exigences pendant six mois mais incapable de les maintenir, le 2e cas a été capable de maintenir les exigences > 18 mois et le 3e cas a été incapable d’atteindre les objectifs. Des documents furent recueillis et des entrevues furent réalisées auprès des personnes impliquées dans la stratégie. Les résultats indiquent que l’hôpital qui a été en mesure de maintenir le temps d’attente possède certaines caractéristiques: réalisation exclusive de chirurgie de remplacement de la hanche et du genou, présence d’un personnel motivé, non distrait par d’autres préoccupations et un esprit d’équipe fort. Les deux autres cas ont eu à faire face à une culture médicale moins homogène et moins axés sur l’atteinte des cibles; des ressources dispersées et une politique intra-établissement imprécise. Le modèle d’hôpital factory est intéressant dans le cadre d’une chirurgie surspécialisée. Toutefois, les patients sont sélectionnés pour des chirurgies simples et dont le risque de complication est faible. Il ne peut donc pas être retenu comme le modèle durable par excellence. / In response to federal government requirements regarding wait times for elective hip and knee surgery, hospitals have adopted wait list management strategies, with variable success. This research examined organizational and systemic factors that made it possible to keep wait times within federally established limits of 6-12 months. We used a model based on Parsons’ model. Four dimensions were used to analyze the following factors: governance, culture, resources, and tools. Three cases studies were done: Case 1 was able to meet the requirements for six months but unable to sustain this level; Case 2 was able to maintain compliance with requirements for > 18 months; and Case 3 was never able to meet the requirements. Documents were collected and interviews conducted with people involved in the strategies. In all, eight interviews were conducted at each site and all documents related to each strategy were collected. The results indicated that the one hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit. The two other cases had to contend with a medical culture that was less homogeneous and they were less focused on meeting targets and had resources that were dispersed as well as unclear inter-organizational policies. In the end, the hospital factory model is appealing in the context of superspecialized surgery. However, because patients are selected for simple surgeries, with little risk of complications, it cannot be promoted as a sustainable model of excellence.