The purpose of this thesis was to explore the use of cost effectiveness for interventions in orthopaedics. This was done through three cost effectiveness articles that have been published by the author. In each of these articles, similar methodologies were used. Decision models were constructed for cost-effectiveness analyses of competing orthopaedic interventions. Outcome probabilities and effectiveness values were derived from the literature. Effectiveness was expressed in quality adjusted life years gained. Cost data were compiled and verified from either hospital cost data or from Medicare data. Costs and utilities were discounted in accord with the United States Panel on Cost Effectiveness in Health and Medicine. Principal outcome measures were average incremental costs, incremental effectiveness, incremental quality-adjusted life years, and, in the case of one article, net health benefits. In particular the articles compared the following: 1. Core decompression versus conservative management for osteonecrosis of the hip as a way to delay hip replacement; 2. Total knee arthroplasty versus unicompartmental knee arthroplasty; and 3. Periacetabular osteotomy versus total hip arthroplasty for a young adult with developmental dysplasia of the hip. The more cost effective intervention was identified in each case, along with implications of the results for clinical and operative decision-making. Cost effectiveness was found to be a useful tool in orthopaedic surgery under limited circumstances of either scarce data on new interventions or the need to use more resources to achieve greater effectiveness. It also can provide excellent insight into ways to direct future clinical research.

Thesis (M.S.)--Worcester Polytechnic Institute. / Keywords: DFA; fractal analysis; knee pads. Includes bibliographical references (p. 61-62).

Thesis (M. Sc.)--York University, 2001. Graduate Programme in Kinesiology and Health Science. / Typescript. Includes bibliographical references. Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ71585.

A Wearable Motion Analysis System (WMAS) was developed to evaluate gait, particularly parameters that are indicative of mild traumatic brain injury. The WMAS consisted on six Opal IMUs attached on the sternum, waist, left and right thigh and left and right shank. Algorithms were developed to calculate the knee flexion angle, stride length and cadence parameters during slow, normal and fast gait speeds. The WMAS was validated for repeatability using a robotic arm and accuracy using the Vicon motion capture system, the gold standard for gait analysis. The WMAS calculated the gait parameters to within a clinically acceptable range and is a powerful tool for gait analysis and potential concussion diagnosis outside of a laboratory setting.

After Total Knee Arthroplasty, contact stresses at the surface and stresses at the implant-cement-bone interface are directly related to the joint contact forces. These stresses are a major factor in wear and fatigue, aseptic loosening, stress shielding and osteoporosis. Implant contact stresses influence the wear and fatigue damage of the Ultra High Molecular Weight Polyethylene (UHMWPE) articulating surface, decreasing the longevity of the implant. The contact stresses are influenced by the kinematics, the bearing congruency of the articulating surfaces and insert thickness. Thus, various studies have focused on the prediction and optimization of kinematics at the joint interface, contact areas, and stresses in different knee implant designs. As a result, the successful total knee replacement designs depend on joint kinematics and the contact stresses. The objective of this study was to perform contact stress analysis on a newly designed surface guided knee implant, in order to evaluate the design with respect to the potential of polyethylene wear. In order to test the performance of this design, Finite Element Modeling (FEM) was used as a good medium to analyze the design’s specifications, and to evaluate the results of the stress analysis of the design. For validation and also comparison with previous studies, results of this study were compared with those of related work with similar loading and constraints. Based on the gathered data from FE analysis of the design, it can be concluded that the new surface guided knee implant shows lower peak contact pressure than other previously evaluated implants. / October 2015

No description available.

Vertical jumping ability is an important fundamental skill for many athletic activities. The present work is focused on developing an understanding of the role of various movement strategies on vertical jump performance. The overall objective of this study was to determine if higher hip than knee joint contribution was more effective in enhancing vertical jump height. Additionally, the study explored possible links between the muscle activity and mechanical outputs, and to develop understanding of the role of the lumbar spine and hip. Twenty male university varsity athletes performed ten repetitions of three jumping strategies: preferred, hip dominant and knee dominant. Kinematics, kinetics and muscle activity of the lower limb and trunk were collected. The main observation was that the vertical jump height was positively associated with higher hip than knee work done. However, the within-subject comparisons between the trained hip and knee dominant tasks did not provide additional support for the importance of the hip. Higher hip work appeared associated with greater biceps femoris than gluteus maximus activity. The knee work increased with higher activity of the vastus lateralis and rectus femoris. Finally, higher trunk muscle activity and tighter coupling were associated with the vertical jump height and the max force. This study provides some evidence that encouraging hip dominance together with higher spine stiffness may improve two-foot vertical jump performance. This work has potential implications for training protocols that may be used to improve vertical jump performance.

Total knee arthroplasty (TKA) is a common surgical procedure for the treatment of patients with pain and immobility as a result of osteoarthritis or rheumatoid arthritis. Pain-related interference, pain and nausea are recovery-limiting in these patients in the immediate postoperative period. Preoperative educational interventions that include pain communication and management information have been shown to decrease pain in joint replacement patients (McDonald & Molony, 2004). This randomized controlled trial compared usual preoperative education to an individually delivered preoperative education program. Participants (N=143) were randomized to intervention or usual care groups during routine preadmission testing. The usual care group received the usual preoperative teaching. The treatment group received the usual care teaching, a booklet containing content specific to symptom management after TKA, an individual teaching session during the preadmission testing visit and a telephone follow-up support call during the week before surgery. The primary outcome for this study was pain-related interference with activity and was measured using the Brief Pain Inventory Interference subscale (BPI-I) (Cleeland et al., 1994) on postoperative day three. Secondary outcomes were pain, nausea and expected postoperative activity and were measured on postoperative days one, two and three. There were no differences between groups in any of the outcomes for this study. BPI-I total scores were 24.4±14.4 in the intervention group and 22.4±15.1 in the usual care group (P=0.5) on the third postoperative day. Overall results demonstrated that although TKA patients had severe postoperative pain and severe nausea, they received inadequate doses of analgesia and anti-emetics. Available evidenced based protocols and practices in the health care environment were not followed Individualizing education content was not sufficient to produce a change in postoperative symptoms for these patients. Further research involving the modification of environmental and system factors affecting the provision of symptom management interventions is warranted.

Total knee arthroplasty (TKA) is a common surgical procedure for the treatment of patients with pain and immobility as a result of osteoarthritis or rheumatoid arthritis. Pain-related interference, pain and nausea are recovery-limiting in these patients in the immediate postoperative period. Preoperative educational interventions that include pain communication and management information have been shown to decrease pain in joint replacement patients (McDonald & Molony, 2004). This randomized controlled trial compared usual preoperative education to an individually delivered preoperative education program. Participants (N=143) were randomized to intervention or usual care groups during routine preadmission testing. The usual care group received the usual preoperative teaching. The treatment group received the usual care teaching, a booklet containing content specific to symptom management after TKA, an individual teaching session during the preadmission testing visit and a telephone follow-up support call during the week before surgery. The primary outcome for this study was pain-related interference with activity and was measured using the Brief Pain Inventory Interference subscale (BPI-I) (Cleeland et al., 1994) on postoperative day three. Secondary outcomes were pain, nausea and expected postoperative activity and were measured on postoperative days one, two and three. There were no differences between groups in any of the outcomes for this study. BPI-I total scores were 24.4±14.4 in the intervention group and 22.4±15.1 in the usual care group (P=0.5) on the third postoperative day. Overall results demonstrated that although TKA patients had severe postoperative pain and severe nausea, they received inadequate doses of analgesia and anti-emetics. Available evidenced based protocols and practices in the health care environment were not followed Individualizing education content was not sufficient to produce a change in postoperative symptoms for these patients. Further research involving the modification of environmental and system factors affecting the provision of symptom management interventions is warranted.

Osteoartrozė – viena dažniausių vyresnio amžiaus žmones varginančių ligų. Progresuojanti liga luošina ligonius, labai nukenčia jų gyvenimo kokybė ir yra viena neįgalumo priežasčių. Ligos gydymas reikalauja ypatingos sveikatos apsaugos sistemos dėmesio ir lėšų. Kadangi ligos paplitimas tiesiogiai susijęs su amžiumi, prognozuojama, kad ateityje, didėjant vyresnio amžiaus žmonių skaičiui, sergamumas osteoartroze dar labiau padidės, atitinkamai didės ir gydymo išlaidos. Gydant ligą, kartu su kitais metodais, taikoma kineziterapija. Sergant kelių sąnarių osteoartroze, ligonių mokymas ir kineziterapijos taikymas mažina skausmo intensyvumą ir gerina funkcines galimybes (Dieppe et al, 2001). Tyrimo metodai ir organizavimas. Tyrime dalyvavo sergantieji kelių sąnarių osteoartroze, savanoriškai sutikę dalyvauti. Jiems taikytas ambulatorinės reabilitacijos gydymo kompleksas. Tiriamieji buvo suskirstyti į dvi skirtingo amžiaus grupes: iki 60 metų (n=12) ir virš 60 metų (n=18). Abiem grupėms taikyta tokia pati kineziterapijos programa. Tiriamiesiems skirtos 5 kineziterapijos procedūros po 30 min. Dėl mažo kineziterapijos procedūrų skaičiaus ir tiriamųjų nesistemingo procedūrų lankymo, rekomenduota kineziterapiją atlikti ir savarankiškai, namuose. Vertintas skausmo stiprumas pagal VAS skalę, funkcinė būklė – pagal modifikuotą Keitel indeksą, kelio sąnario lenkimo judesio amplitudė, blauzdos raumenų – tiesėjų jėga – pagal 5 balų Lovett skalę. Visi tyrimai atlikti per pirmą ir pakartoti per... [toliau žr. visą tekstą] / Osteoarthritis is one the most common illnesses amongst elderly people. An ingravescent illness maims patients, exacerbating quality of their lives and therefore this is one of the causes of their physical disability. Treatment of this illness requires a special attention of the health service system and funds. Since pervasion of the illness is directly related with age, there are some predictions that with an increasing number of the elderly people, morbidity of osteoarthritis will increase also; medical costs will be increasing respectively. This illness, together with the other methods, is being cured by the physiotherapy. If the patients suffer of the kneel joints osteoarthritis, patients training and application of the physiotherapy decreases intensity of the pain and improves functional capabilities. (Dieppe et al, 2001). Methods of the research and organization. Volunteers, having knee joint osteoarthritis, attended this research process. They received an ambulatory treatment complex. Exploratory group was divided into two parts: under 60 years (n =12) and over 60 years (n =18). Both groups received the same type of the program – 5 physiotherapy procedures up to 30 minutes. Due to the little number of the procedures and facultative attendance of the patients, there were made recommendations to perform physiotherapy procedures at home. There were evaluated the following facets – pain intensity according to the VAS scale, functional state according to the modified... [to full text]