Biomedical subjects
Publications and source records attributed to I Goldie.
Changes in postural stability were recorded before and after total hip replacement using a specially designed computer-assisted forceplate system. Twenty-one patients with unilateral osteoarthritis of the hip were randomised into two groups after operation with either a cemented Charnley or a non-cemented HP-Garches prosthesis. Postural stability was improved in both groups one year after operation and the sway pattern became normal.
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In an in vivo investigation of eight healthy volunteers, three dimensional ankle/foot kinematics were analyzed by roentgen stereophotogrammetry in 10 degrees steps of motion from 30 degrees of plantar flexion to 30 degrees of dorsiflexion of the foot. The study included all of the joints between the tibia and the first metatarsal, as well as the talocalcaneal joint, and was performed under full body load. Although the talocrural joint was found to account for most of the rotation around the transverse axis occurring from 30 degrees of plantar flexion to 30 degrees of dorsiflexion, there was a substantial contribution from the joints of the arch. This was seen particularly in the input arc from 30 degrees of plantar flexion to the neutral position, where the dorsiflexion motion of these joints amounted to 10% to 41% of the total transverse axis rotation.
The influence of pronation and supination of the foot on the joints of the ankle/foot complex was analyzed three dimensionally by roetgen stereophotogrammetry in eight healthy volunteers. Radiopaque markers were introduced into the tibia, talus, calcaneus, navicular, medial cuneiform, and first metatarsal bones. The subjects stood on a platform that was tilted in 10 degree-steps from 20 degrees of pronation to 20 degrees of supination. Pairs of x-ray exposure were made in each position. Calculation of resulting joint deviations from the neutral position showed that the largest amounts of motion occurred in the talonavicular joint followed by the talocalcaneal joint, in the latter case mainly in supination. The joints proximal and distal to the medial cunriform also participated substantially in the total motion registered. The tibia showed an average of 0.2 degrees of external rotation for each degree of supination of the foot.
Eight patients with gonarthrosis were operated on with a noncemented all-polyethylene ICLH endoprosthesis. Radiographic examination up to 2 years postoperatively included roentgen stereophotogrammetric analysis (RSA), which demonstrated micromotion of all the implants. However, the mean subsidence was only 0.4 mm for both the tibial and the femoral components.
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A prospective study of acute injuries from sports and physical exercise was carried out during 1 year in a total population of a municipality with 31,620 inhabitants. Data on exposure were collected: the number of participants in each sport, the hours of participation, and number of weeks in the season per year. The number of injuries was used as numerator and the exposure data as denominator in a formula modified from Chambers for the calculation of population at risk in sports. A total of 571 injuries occurred in 28 different sports: 65% of the injured were males. The majority of the injuries were from soccer: 50% of the males and 27% of the females. Incidence rates in 17 sports are presented. The ranking order differs, when calculating not only the number, but also the exposure. Ice hockey and handball were then found to have the highest risk followed by soccer. Team and contact sports on the whole had the highest rates in both genders. As a group, intercompany players had the highest rate, especially in soccer. The lowest rates were found in individual sports such as downhill skiing, horseback riding, racket sports, and running. Gymnastics, except in school physical education, had no injuries at all. Sprains and strains were diagnosed in nearly half of the cases and the foot and ankle were the most frequent sites. Preventive measures are proposed.
Roentgen stereophotogrammetric analysis was used in the evaluation of subsidence in eight noncemented femoral components of the HP-Garches prosthesis. After 2 years, seven components had subsided 0.6-3.9 mm, i.e., more than observed in some cemented prostheses. No distinct symptoms related to the micromotion appeared.
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In 119 patients with total hip replacement (THR) 61 were operated on with cemented (Charnley) and 58 with non-cemented (HP Garches) fixation. The assessment was performed by clinical examination and objective registration by gait analysis 6 and 12 months postoperatively. The group with cemented fixation (Charnley) demonstrated better results in all variables. The greatest difference between the groups was found at the 6 months' follow-up. The gait analysis was valuable in the assessment of locomotor function.
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Over the years, orthopedic surgery has become more involved in the care of the rheumatoid patient. A more active and aggressive attitude by orthopedic surgeons has thrown new light on the handling of the rheumatoid patient. Currently, the surgical treatment of rheumatoid arthritis is evaluated not only by the outcome of a procedure on a single skeletal part but also by the generalized effects of the disease on the activity of the patient and the function of neighboring joints. Soft-tissue procedures, such as synovectomy and release operations, have been beneficial. Prosthetic surgery yields satisfactory results, and every effort should be made to give the rheumatoid patient as long a period as possible with relief of pain and increased mobility.
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When conservative treatment in the management of the painful rheumatoid forefoot fails, surgery should be advocated. The aim is to relieve the sole from pressure on the metatarsal heads, which causes callosities on and pain in the forefoot. Various surgical procedures have been described, but they have in common to replace or remove the fat pad under the metatarsal phalangeal joints, to resect the metatarsal heads and, in doing this, restore the metatarsal ends to a flat arc. For if the intermediate metatarsals are left too long, new pressure points may develop, with ensuing pain. In this investigation a 4 1/2-year follow-up is presented of 32 patients operated on with metatarsal head resection in 59 feet. Twenty-two patients representing 39 feet were very satisfied, whereas 8 patients representing 15 feet were dissatisfied. Walking ability improved considerably; standing on toes improved; muscle power of toes improved. Despite attempting to maintain the metatarsal arc as a flat curve, this proved to be uneven in 25 feet, but did not jeopardize the results. The complications were minor and did not influence the final results. These, however, were decidedly influenced by the functional class of the patient at the time for investigation. Surgical management of the painful rheumatoid forefoot appears to be a recommendable procedure.
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