Research education in residency programs.
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Canada↗
Biomedical subjects
T D Cooke
Publications and source records attributed to T D Cooke.
The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip.
Clinical criteria for the classification of patients with hip pain associated with osteoarthritis (OA) were developed through a multicenter study. Data from 201 patients who had experienced hip pain for most days of the prior month were analyzed. The comparison group of patients had other causes of hip pain, such as rheumatoid arthritis or spondylarthropathy. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop different sets of criteria to serve different investigative purposes. Multivariate methods included the traditional "number of criteria present" format and "classification tree" techniques. Clinical criteria: A classification tree was developed, without radiographs, for clinical and laboratory criteria or for clinical criteria alone. A patient was classified as having hip OA if pain was present in combination with either 1) hip internal rotation greater than or equal to 15 degrees, pain present on internal rotation of the hip, morning stiffness of the hip for less than or equal to 60 minutes, and age greater than 50 years, or 2) hip internal rotation less than 15 degrees and an erythrocyte sedimentation rate (ESR) less than or equal to 45 mm/hour; if no ESR was obtained, hip flexion less than or equal to 115 degrees was substituted (sensitivity 86%; specificity 75%). Clinical plus radiographic criteria: The traditional format combined pain with at least 2 of the following 3 criteria: osteophytes (femoral or acetabular), joint space narrowing (superior, axial, and/or medial), and ESR less than 20 mm/hour (sensitivity 89%; specificity 91%). The radiographic presence of osteophytes best separated OA patients and controls by the classification tree method (sensitivity 89%; specificity 91%). The "number of criteria present" format yielded criteria and levels of sensitivity and specificity similar to those of the classification tree for the combined clinical and radiographic criteria set. For the clinical criteria set, the classification tree provided much greater specificity. The value of the radiographic presence of an osteophyte in separating patients with OA of the hip from those with hip pain of other causes is emphasized.
Hip Joint↗
The physiological basis for a flexible condylar tibial plateau design.
Knee resurfacing is a successful treatment for osteo- and rheumatoid arthritis in elderly patients. The application of this treatment to younger more active and obese persons has the potential to produce premature wear, loosening, and undesirable bone remodelling. A new generation of more physiologically compatible components is required for these situations. This paper discusses the design and analysis of a prototype tibial base plate aimed at physiological load transfer. Incorporated in the design are mechanisms to alleviate lift-off phenomena, bone stress concentrations, stress shielding, and micromotion at the bone-implant interface. The design requires viable cancellous bone stock, so that the bone may respond by remodelling to the dynamic loading during normal ambulatory activities.
Alloys↗
A standardized technique for lower limb radiography. Practice, applications, and error analysis.
The normal standing radiograph, which provides a view of the knee only, is prone to errors of parallax and poor control of patient positioning. A standardized radiographic procedure was developed to control these sources of error. Anteroposterior and lateral views of the lower limb (hip and knee) are obtained without moving the patient from a standardized position; this includes control of ankle position and limb rotation. To correct for parallax error, radiopaque markers are positioned between the patient and the x-ray source. The locations of bone landmarks and reference markers on the radiographs are digitized, and a software package provides a display of key parameters. Error analysis of the method confirmed that most angles were sensitive to contrived positional variations, especially limb rotation and knee flexion. Load distribution between limbs was not critical. The greatest error was random. Most angles were reproducible within +/- 1.3 degrees or less at 95% confidence.
Aged↗
First metatarsophalangeal joint reaction forces during high-heel gait.
First metatarsophalangeal (MTP) joint reaction forces were calculated for 11 normal females during the toe-off phase of gait while walking in bare feet and in high heeled shoes. A biomechanical model was used to calculate the forces utilizing kinematic, kinetic, footprint, and radiographic data. The results showed that the MTP joint reaction forces (FJ), the metatarsal-sesamoid forces (FS), and the resultant of these forces (FRES), were twice as large in high heels compared to barefoot walking. The average peak forces for barefoot and high-heeled gait were FJ: 0.8 and 1.58 times body weight, FS: 0.44 and 1.03 times body weight, and FRES: 0.93 and 1.88 times body weight. Also, the kinematics changed when wearing high heels, making angles of application of forces and sesamoidal articulations less favorable.
Adult↗
A quantitative approach to radiography of the lower limb. Principles and applications.
A method is described which provides standardised reproducible radiographic images of the lower limb. Anteroposterior and lateral radiographs are digitised and processed by computer to provide graphic/numeric displays of angles and linear measurements, relating the centre points of the hip, knee, and ankle. Two cases illustrate how surgical planning is facilitated when standardised data are available. These data confirm the close relationship between postoperative limb alignment and positioning of prosthetic elements.
Aged↗
The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand.
Clinical criteria for the classification of symptomatic idiopathic (primary) osteoarthritis (OA) of the hands were developed from data collected in a multicenter study. Patients with OA were compared with a group of patients who had hand symptoms from other causes, such as rheumatoid arthritis and the spondylarthropathies. Variables from the medical history, physical examination, laboratory tests, and radiographs were analyzed. All patients had pain, aching, or stiffness in the hands. Patients were classified as having clinical OA if on examination there was hard tissue enlargement involving at least 2 of 10 selected joints, swelling of fewer than 3 metacarpophalangeal joints, and hard tissue enlargement of at least 2 distal interphalangeal (DIP) joints. If the patient had fewer than 2 enlarged DIP joints, then deformity of at least 1 of the 10 selected joints was necessary in order to classify the symptoms as being due to OA. The 10 selected joints were the second and third DIP, the second and third proximal interphalangeal, and the trapeziometacarpal (base of the thumb) joints of both hands. Criteria derived using the "classification tree" method were 92% sensitive and 98% specific. The "traditional format" classification method required that at least 3 of these 4 criteria be present to classify a patient as having OA of the hand. The latter sensitivity was 94% and the specificity was 87%. Radiography was of less value than clinical examination in the classification of symptomatic OA of the hands.
Adult↗
Joint reaction forces at the first MTP joint in a normal elderly population.
The calculation of net ankle, knee, and hip joint reaction forces is an often applied procedure in the analysis of gait. Except for very few studies, joint reaction forces have not been measured in other joints such as the fingers, wrist, elbow, shoulder and toes. In this study the joint reaction forces between the metatarsal head and the proximal phalanx and the metatarsal head and the sesamoids are calculated for the push off phase during gait. The results of ten normal elderly subjects show that the maximum resultant loads of the two articulations lie close to the longitudinal axis of the metatarsal. The knowledge of the magnitude and direction of the joint reaction forces of a normal elderly population will be essential for the design of an optimal fixation of an artificial anatomical first MTP joint.
Aged↗
Failure of a knee prosthesis accelerated by shedding of beads from the porous metal surface.
A 61-year-old man who received a porous-metal-coated knee implant returned eight months later with chronic synovitis, instability, and loosening of his artificial joint. Subsequently, metal beads were detected in the joint space and soft tissues and were also embedded in the articulating surface of the tibial component. There was scoring of the tibial surface, and polyethylene wear particles were noted in the synovial and fibroconnective-tissue membranes, which had formed beneath the tibial component. Many particles were seen inside giant cells and macrophages. Failure in this case was probably accelerated by the granulomatous response in the soft tissue to wear particles. There was osteolysis rather than new bone growth at the interface with the tibial component. Analysis indicated that poor bead-bonding strength may have initiated the problem. Careful appraisal of the outcome from use of beaded porous-metal-coated devices and assurance of their adequate bonding strength are essential for further progress.
Foreign Bodies↗
The inwardly pointing knee. An unrecognized problem of external rotational malalignment.
Twelve patients with inwardly pointing knees had chronic knee pain and disability suggestive of patellofemoral subluxation. None had responded well to conservative measures or surgical correction at the level of the soft tissues. Their pattern of limb alignment was studied roentgenographically and was found to differ significantly from the control group of 49 healthy young adults. The deformities primarily related to the tibia were external tibial torsion, excess varus angulation of the tibial plateau, and varus knees. Angulation of the femoral condyles was normal and femoral anteversion did not appear to contribute significantly to the deformity. Surgery in seven cases (nine knees) was by derotation valgus Maquet osteotomy of the tibia and lateral release realignment of the patellae. Outcome assessments after a three-year follow-up period (five knees) were excellent. Early results on the remaining cases were satisfactory.
Adolescent↗
Tibial anatomy and functional axes.
Articular geometry of the tibia has been studied in relation to the functional axis and extra-articular bone landmarks, using a Cartesian coordinate system. Thirty-one cadaver limbs were used, 26 of them paired. The donor age range was 61 to 89 years (17 females, 14 males), none of whom showed evidence of significant arthritic deterioration. Most linear parameters were greater in males than females (p less than 0.005), and correlations between these parameters were noted, e.g., tibial length versus plateau width (r = 0.7, p less than 0.01) with both genders combined. Gender differences occurred in only two of the angular parameters--tibial torsion (p less than 0.025) and foot rotation (p less than 0.005). For the latter, mean rotation was internal (-5 degrees) for males, and external (11 degrees) for females. No correlations between angular parameters were found. In the paired limbs, there was asymmetrical distribution of just two parameters--varus tilt of the tibial plateau margins (p less than 0.005) and lateral deviation of the tuberosity (p less than 0.025). The data complement a previous report on the femur. These studies are relevant to the kinematics of the lower limb, design and sizing of resurfacing components, and possibly to the pathogenesis of osteoarthritis.
Aged↗
Alignment of the first metatarsal-phalangeal joint: important criteria for a new joint replacement.
Joint replacement is one of many options for the treatment of the first metatarsophalangeal (MTP) joint. Studies of the geometry of that joint have shown that it consists of two distinct articulations, the metatarsophalangeal and the MT-sesamoidal. Both are important, but the MT-sesamoidal tolerates only small deviations from an ideal alignment. The aim of this study was to investigate the alignment of the first MTP joint of a potential patient population, in order to design an optimal surface replacement. One measurement, the extension angle between the MT and the proximal phalanx was found to be the most important alignment criterion for the successful design of an implant and the necessary instruments. This angle controls the delicate interplay between the metatarsal head and the sesamoids and tolerates only small deviations from the normal range before the chance of sesamoidal subluxation increases significantly. The pre-operative knowledge of this and other alignment criteria is important for the ideal placement of an anatomical implant.
Humans↗
Studies in the pathogenesis of rheumatoid arthritis. 1: Immunogenetic associations.
The critical role of CMI in the pathogenesis of RA has been reinforced, if not entirely illuminated, by recent information about the immunogenetic basis for individual susceptibility, in regard to genes of the HLA-D locus that control expression of MHC II determinants. An aberration in the T-cell response to cells presenting antigen is strongly implied, and must therefore be characterized. We will need to know what types of antigen trigger aberrant responses in those that are susceptible, and whether continuous presence of antigen is necessary to sustain chronic inflammation. The second part of this article will review immunological injury to joint tissues as an off-shoot of the CMI and HI responses of RA. Using data from animal models we shall examine criteria for establishing chronic joint inflammation, and consider their relevance to RA. We shall also consider the problem of why some joints are more susceptible than others to immunological injury.
Antibody Formation↗
Studies in the pathogenesis of rheumatoid arthritis. 2: Antigen/antibody reactions with avascular joint tissues.
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Animals↗
Surgical implications of varus deformity of the knee with obliquity of joint surfaces.
Some arthritic knees with varus deformity show excessive valgus angulation of the femoral joint surface with proximal tibia vara. This causes a downward and medial inclination of the articular surfaces in the coronal plane. The patients we studied had a medial shift of the standing load-bearing axis, and arthritic changes mainly in the medial compartment. Some also had lateral tibial subluxation with twisting of the distal femur and proximal tibia in opposite directions. We assessed the articular geometry by precise radiographic analysis, and compared the results with those in normal volunteers and a group of osteoarthritic patients. The prevalence of this type of deformity in our osteoarthritic patients was 11.5%; its recognition allows the use of specific operative correction that may include double osteotomy or the precise orientation of prosthetic components.
Adolescent↗
Inflammatory cell changes in haversian canals. A possible cause of osteoporosis in rheumatoid arthritis.
We studied the morphology of the haversian canals in the osteopenic cortical bone of the medial femoral neck from patients with rheumatoid arthritis and compared the findings with those in patients with osteoarthritis and with uncomplicated coxa valga. In the rheumatoid bone, the diameters of the canals were larger and many more contained osteoclasts. Fewer haversian canals showed only lining cells than in the osteoarthritic or coxa valga patients. In bone from rheumatoid patients, especially in canals with osteoclasts, small blood vessels were frequently lined by tall endothelial cells with an infiltration of mononuclear cells. These morphological differences are discussed with reference to the possible mechanisms of loss of cortical bone in rheumatoid arthritis and other conditions.
Adolescent↗
Prone examination for anterior cruciate ligament insufficiency.
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Humans↗
High tibial osteotomy compared with high tibial and Maquet procedures in medial and patellofemoral compartment osteoarthritis.
The effect of adding the Maquet tibial tubercle elevating procedure to a valgus high tibial osteotomy (HTO) in combined medial and patellofemoral disease had not been established. This prospective study evaluates clinically and roentgenographically the use of this osteotomy combination versus HTO alone in dual-compartment arthritis. Forty-four patients (46 knees) with dual-compartment disease from 1979 to 1984 were evaluated. Twenty-two patients were treated with 23 HTOs by a senior surgeon, and 22 were treated with 23 combined procedures by another surgeon. The two groups were matched according to age, sex, and preoperative clinical and roentgenographic disability. The minimum follow-up period was two years. All had more than 5 degrees valgus alignment at the follow-up evaluation, with an average of 11.2 degrees in the HTO group and 10.2 degrees in the combined osteotomy group. A modified Hospital for Special Surgery assessment (maximum, 100 points) was used with an optimum pain score of 30 points. All were followed roentgenographically with grading of the three knee compartments. In both groups, the total and pain scores improved significantly postoperatively. There was no statistical difference between the two groups in terms of mean postoperative femorotibial shaft alignment or clinical and roentgenologic outcome. Although HTO was a good procedure for pain relief for dual-compartment disease, the addition of Maquet procedure did not improve the results.
Aged↗