Kinesiologic measurements of functional performance before and after double compartment Marmor knee arthroplasty.
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Biomedical subjects
Publications and source records attributed to D R Gore.
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In order to identify the functional advantages or disadvantages between the anterolateral and the posterior approaches to total hip arthroplasty, measurements of prosthetic position, hip-muscle strength, and hip joint mobility were made after Müller total hip arthroplasty without osteotomy in 52 patents operated through a posterior approach and 41 patients operated through an anterolateral approach. Men and women who had the posterior approach had less prosthetic component anteversion and longer neck lengths, with resultant more lateral and distal placement of the greater trochanter than groups with the anterolateral approach. Groups with the posterior approach had more normal hip abductor-muscle strength and more inward rotation on the operated side than group with the anterolateral approach. Groups with the anterolateral approach had more outward rotation on the operated side than groups with the posterior approach. These differences in function were related to the surgical approach rather than to differences in component position. An understanding of these observations should be used for selection of the surgical approach for the patient on an individual basis.
Function of 37 patients with osteotomy of the greater trochanter during total hip replacement (41 hips) is compared to function of 38 patients (41 hips) without osteotomy. Subjective assessments and cane force measurements were slightly more favorable in the group without osteotomy. Objective measurement of hip motion, hip abductor and adductor muscle strength, weight distribution during standing, and multiple components of free-speed and fast walking showed no statistically significant differences between performance of the groups with and without osteotomy before surgery or 6 months or 2 years after. This suggests that osteotomy provides no functional advantages to the patient beyond those obtained in total hip replacements without osteotomy.
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From 1973 to 1977, 7,642 girls and 751 boys were screened for spinal deformity in a Wisconsin County with a population of approximately 100,000. Of 243 girls and 30 boys found to have scoliosis, 155 girls and 13 boys had curves 10 degrees or greater. The most common location and curve direction was right thoracic; 98% of those with scoliosis were classified as idiopathic. Eighteen girls required treatment when initially seen: ten with a Milwaukee brace and eight with spine fusion. Of those not treated and followed for six months or longer, 24 girls and one boy had a decrease in their curve of at least 5 degrees, and 21 girls and one boy had an increase in their curve of at least 5 degrees. Determination of which curves would progress was unpredictable and identification of progression was possible only by repeated examinations.
To help determine the duration of benefits in functional performance resulting from total hip arthroplasty (THA), multiple kinesiologic measurements were made before surgery and two and four years after 32 Charnley and 40 Müller THA procedures were done in 58 patients. There were no complications of loosening or infection, nor was there additional disability in other joints of the lower extremities. Measurements of functional performance included range of hip motion, hip abductor and adductor muscle strength, weight distribution between the feet during standing, forces applied to canes or crutches, and multiple components of free-speed and fast-walking performance. The average measurements showed significant improvement in almost all components of function from the time preceding surgery to two years afterward. The two-year level of function was then maintained without significant improvement or decline in function four years postoperation.
Measurements of functional performance in 35 cases with Charnley total hip replacement were compared with those of 54 cases with Müller replacement before surgery and at 6- and 24-month follow-up intervals. The measurements included strength of the hip abductor and adductor muscles, hip motion, the amount of weight borne on the involved limb during standing posture, multiple components of free-speed and fast walking, and force applied to canes and crutches. Both replacement groups improved significantly in most components of function. In fact, both groups reached or nearly reached the lower limits of normal variability in weight-bearing ability, cadence, and some components which relate to smoothness of walking performance. The groups with Müller and Charnley replacement differed most in some components of range of hip motion, hip muscle strength, and lateral lurching during walking.
In fifty-two patients with Müller total hip replacement, roentgenographic measurements of prosthetic component positioning were correlated with hip-muscle strength and mobility measurements. Compared with the normal side, the average position of the center of the prosthetic head was more medial and superior in the pelvis, and the greater trochanter was more distal and lateral. Increasing neck length (distance from the center of the prosthetic head to the lesser trochanter) and a more distal position of the greater trochanter were among the measurements that related favorably to measurements of patient function. More superior placement of the center of the prosthetic head in the pelvis was associated with a more superior position of the lesser trochanter, which related adversely to function.
Measurements of functional performance were made before and at six and twenty-four months after 100 McKee-Farrar total hip replacements in eighty-three patients. The measurements included: range of motion of the hip, hip-muscle torque, weight-bearing activity during standing, forces applied to canes or crutches, and multiple components of walking performance. In the absence of serious complications, most patients had improvement in most components of function, with greater gains occurring during the first six months and lesser but continued gains between the sixth and twenty-fourth postoperative months. Patients with serious operative complications, postoperative infections, or component loosening showed declines in almost every component of function tested.
The gait of men with unilateral hip fusion is somewhat slow, asymmetrical, and arrhythmic as compared with that of normal men. Compensation for absent hip motion is accomplished by increased transverse and sagittal rotation of the pelvis, increased motion in the sound hip, and increased flexion of the knee throughout the stance phase on the fused side. Relationships between the fusion position, certain physical traits, and walking performance suggest that the best gait can be expected in young patients who have free motion of the lumbar spine, the sound hip, and the knee on the side of fusion, and who have equal limb lengths and a hip fused in a position that does not include excessive adduction.
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This is a case report of a 13-year-old boy with an osteoid-osteoma located in the pedicle of the third lumbar vertebra. The lesion could not be visualized on routine roentgenograms but with the use of technetium polyphosphate bone scan as a guide a suggestive bone lesion was found with tomograms. Histologic examination confirmed the diagnosis of osteoid-osteoma. This case illustrates the value of skeletal scanning in occult bone lesions.
The purpose of this study was to determine the incidence and severity of degenerative changes seen on lateral roentgenograms in 200 asymptomatic men and women in five age groups with an age range of 20-65 years and to determine the normal values of cervical lordosis and spinal canal sagittal diameters and their relationship to degenerative changes. It was found that by age 60-65, 95% of the men and 70% of the women had at least one degenerative change on their roentgenograms. A small sagittal diameter correlated with the presence of degenerative changes at the same disc level, and the strongest correlation was with the size of the posterior osteophytes at C5-6 (r = 0.52). Cervical lordosis measurements did not relate to degenerative changes except for subjects over age 50 with moderate or severe intervertebral narrowing. It is important to realize that although roentgenographic abnormalities represent structural changes in the spine, they do not necessarily cause symptoms.
Two hundred five patients with neck pain were evaluated clinically and roentgenographically for a minimum of 10 years after onset of symptoms. Seventy-nine percent had a decrease in pain, and 43% were free of pain; however, 32% had moderate or severe residual pain. Patients who had been injured and initially had severe pain were the most likely to have an unsatisfactory outcome; however, no other clinical features were of value in predicting the final result. The presence or severity of pain was not related to the presence of degenerative changes, the sagittal diameter of the spinal canal, the degree of cervical lordosis, or to any changes in these measurements over the evaluation period.