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At least 793 records · Page 44Linked to original sources
PubMed2006

Ten-year survival and clinical results of constrained components in primary total knee arthroplasty.

The use of constrained prostheses in primary total knee arthroplasty (TKA) is unusual. This is a study of the indications, clinical results, and 10-year survival of these components. Fifty-four knees (44 patients) were prospectively followed, and 42 knees (34 patients) had 5 to 16 years (mean, 9 years) of follow-up. The indications for the components were valgus deformity with incompetent medial collateral ligament in 27 knees, severe flexion contracture with inability to balance the knee in 12, and others in 3. Knees were evaluated by the Hospital for Special Surgery and Knee Society score systems. Statistical analysis included paired Student t test and survivorship analysis. Of the entire cohort of 54 knees, there were only 2 failures: a tibial loosening revised at 3 years and a femoral loosening (no stem) revised at 1 year. Of the 42 knees with minimum 5-year follow-up, 12 knees were rated as excellent, 24 good, 3 as fair, and 3 as poor. There was a significant improvement in postoperative knee score, but not in the function score. The mean flexion contracture preoperatively was 17 degrees; postoperatively, 1.7 degrees; and mean flexion preoperatively, 93 degrees; postoperatively, 97 degrees. The 10-year survival with failure, defined as component revision for loosening, was 96% (confidence interval, 90.6%-100%). In difficult primary TKAs, there were 86% good or excellent results and a 10-year survival of 96% despite the increased constraint. The constrained condylar TKA remains indicated for knees with severe valgus deformity, incompetent medial collateral ligament, or severe flexion contracture in which the knee cannot be properly balanced.

Adult↗
PubMed1985

The knee in arthrogryposis.

Of 104 patients with arthrogryposis multiplex congenita treated between 1952 and 1982, 74 had significant knee contractures, instability, or recurvatum. The minimum follow-up period was two years. Nonoperative treatment modalities included physical therapy, bracing, and serial casting in 43 patients (78 knees). Thirty-one other patients (46 knees) had 62 operative procedures, including hamstring and posterior capsular release, epiphysiodesis, distal femoral or proximal tibial osteotomy, arthrodesis, and knee disarticulation. Surgery was reserved for the more resistant causes and was recommended only as part of an overall treatment plan including the correction of foot and hip deformities. The average follow-up period for the surgically treated patients was 11 years, with a range of two to 20 years. Recurrence of deformity was frequent, with no one procedure being clearly favored. Physiotherapy alone rarely resulted in clinically significant improvement unless accompanied by prolonged casting and bracing. The most useful surgical procedure in the growing child was posterior capsular release performed in conjunction with hamstring tenotomy. Contractures treated by osteotomies before the completion of growth had a high rate of recurrence.

Arthrodesis↗
PubMedDate not supplied

Ludloff's open reduction of the hip: long-term results.

Long-term results of Ludloff's open reduction of the hip were studied in 62 joints of 56 children with an average follow-up of 11 years (range 5-18 years). Results were considered good in 76% and poor in 24%. A decisive factor in assessing long-term results was a proper centric reduction of the femoral head. The most frequent obstacles to proper reduction were a shortened inferomedial part of a joint capsule with the transverse ligament pulled into the joint cavity (14%), joint capsule contracture (100%), and an inverted limbus (92%), which was accompanied in 17% of patients by an impression of reflected head of the rectus femoris. Earlier nonoperative treatment affected the success of the reduction as well as long-term results.

Female↗
PubMed2003

Case for gait analysis as part of the management of incomplete spinal cord injury.

Incomplete spinal cord injury at ASIA (D) level often leads to major gait re-education attempts for patients and staff. Walking prognosis usually depends upon muscle power loss, degree of spasticity present, type of lower limb joint deformity developing and availability of treatment. As an adjunct to physical examination and observation, instrumented gait analysis can inform treatment, since three-dimensional dynamic joint range motion (kinematics) and estimation of joint forces occurring at the hip, knee and especially ankle/foot (kinetics) can be combined with walking EMG and energy cost tests to understand fully a gait deficit. This should then assist the clinical decision-making process. Knowledge of the effects of any dynamic contracture on the available redundancy within ipsilateral limb joints, and information about muscle actions obtained by calculating joint forces (including moments and powers) improves overall knowledge of gait cycle abnormality. Such gait analysis has revolutionised the management of spasticity in walking cerebral palsy children by guiding surgical and other treatments. Similar improvements could be looked for in incomplete SCI patients whose gait pattern is not ideal. Dynamic energy cost estimations could also be used as an outcome measure to study improvements after treatment: whether this is orthotic, pharmacological or following physiotherapy or surgical techniques.

Biomechanical Phenomena↗
PubMed1975

The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance.

A system for evaluation of motor function, balance, some sensation qualities and joint function in hemiplegic patients is described in detail. The system applies a cumulative numerical score. A series of hemiplegic patients has been followed from within one week post-stroke and throughout one year. When initially nearly flaccid hemiparalysis prevails, the motor recovery, if any occur, follows a definable course. The findings in this study substantiate the validity of ontogenetic principles as applicable to the assessment of motor behaviour in hemiplegic patients, and foocus the importance of early therapeutic measures against contractures.

Ankle↗
PubMedDate not supplied

Unique use of botulinum toxin to decrease adductor tone and allow surgical excision of vulvar carcinoma.

Here, we present the case of an 86-year-old woman with vulvar carcinoma requiring surgical resection and with Parkinson's disease with severe spasticity and contractures of the lower extremities. Because of the patient's severe contractures and spasticity (her knees could only be separated by 2 cm with sustained abducting force), surgical positioning and access to the vulva were impossible. The patient was admitted, intending to undergo surgery after injection with botulinum toxin (BTX) to hip adductors and intensive physical therapy. After confirmed healed hip arthroplasty, the patient underwent BTX injection (400 U) to her bilateral adductor brevis, adductor longus, adductor magnus, and semimembranosus and semitendinosus muscles on day 2 of her hospital stay. On day 3, a physical therapist began a twice-a-day stretching program. An adjustable abduction brace was custom-made to provide sustained stretching. On day 9, the patient underwent wide local excision of vulvar carcinoma with the abductor brace in place. The patient tolerated the surgery well and was discharged home on day 11 with continuous physical therapy. Upon discharge, the distance between the patient's knees was 14 cm. This unique case demonstrated a new indication for BTX treatment in the preoperative setting to allow surgical positioning and access.

Aged↗
PubMed1982

Physical therapy and rehabilitation.

The literature on physical therapy and rehabilitation in osteoarthrosis of the hip and knee joint has been reviewed. The number of controlled clinical studies is rather limited and the clinical material is generally not clearly defined. It may be concluded, however, that the effect of short-wave, micro-wave and ultrasound on joint pain is not superior to that of sham treatment. Ice therapy and transcutaneous nerve stimulation appear to be of definite value, but the effect is transient. Controlled trials indicate that mobilization of joint and muscle contractures is facilitated by diathermy and ultrasound. Training of muscle function should include training of endurance and balance reaction. Technical aids and training of activities of daily living are an important part of the rehabilitation program, that has to be based on the functional problems experienced by the patient.

Bone Diseases↗
PubMed1980

Primary anterior congenital dislocation of the hip in infancy.

Primary anterior congenital dislocation of the hip can be diagnosed in infancy as an entity distinct from the more common posterior dislocation. Anterior dislocations are characterized by a visible and palpable fullness in the femoral triangle, marked limitation of abduction, a severe pelvic tilt or obliquity, marked apparent shortening of the linb on the involved side, absence of telescoping, and a rest position of external rotation. Conservative treatment is recommended. An abduction splint should be used to minimize the adduction contracture before a closed reduction is performed under general anesthesia. The position of a stable reduction is one of flexion, abduction, and internal rotation. Immobilization in a spica cast is required for six or seven months. Most patients will require a derotation osteotomy for correction of anteversion of the femoral neck during this time.

Casts, Surgical↗
PubMed1989

Arthrography in the evaluation of congenital dislocation of the hip.

To assess the value of intraoperative arthrography, 48 preoperative hip arthrograms of 35 children under 18 months of age treated for congenital dysplasia of the hip were reviewed. The frequency of the common arthrographic observations was assessed and was compared with the findings observed from the plain roentgenograms, and with the pathoanatomy seen at the time of open reduction. Arthrography proved reliable in identifying the depth of reduction (medial dye column, 100%), the configuration of the osteocartilaginous structures (96%), and the presence of potentially obstructing soft tissue (limbus, 98%, and ligamentum teres, 78%). Arthrography was less reliable in discerning psoas contracture (36%), despite its presence at all open reductions. Arthrography proved reliable in outlining the inverted limbus that can obstruct closed reduction. Because ossification of the femoral head was frequently eccentric, the center edge (CE) angle of Wiberg was calculated from arthrography more accurately than from roentgenograms.

Acetabulum↗
PubMedDate not supplied

[Arthrogryposis multiplex congenita--a rare congenital stiff joints syndrome].

INTRODUCTION: Arthrogryposis multiplex congenita is not a disease but a term describing multiple congenital contractures. Etiological factors include neurological and primary myogenic diseases. This rare syndrome is present at birth and is characterized by reduced mobility of many joints. The contractures involve two or more joints with ankylosis. The accompanying musculature is hypoplastic, but multiple pterygia are also present. Arthrogryposis multiplex congenita is a heterogeneous group of disorders with the incidence rate of 6.2/100000 liveborn infants. The true incidence cannot be established, because many cases result in spontaneous miscarriages or stillbirth. More than 90% of cases are associated with birth defects. The cause of this syndrome is unknown. Many forms are not hereditary, though there are hereditary forms as well. CASE REPORT: This paper presents a case with arthrogryposis multiplex congenita. The pregnancy was not controlled regularly. During the pregnancy, oligohydramnion was detected. Due to contractures, labor ended is cesarean section. The child was born in the 34th week of gestation. Flexion and extension joint contractures were observed. Active and passive mobility of the afflicted joints was reduced. There was a limited motor function in the shoulder, elbow and wrist joints with a slight internal rotation of the shoulder joint and lower arm joints during pronation. The hips were subluxated; the feet were in equinovarus position and the fingers in ulnar deviation with partial syndactyly of the 4th and 5th fingers on the left hand. The infant had abnormal dermatoglyphics. The neck was short, and the 2nd and 3rd cervical vertebrae were fused. There was also a slight left-sided thoracic scoliosis. Trismus was present due to the existing ankylosis of the temporomandibular joint. The karyotype was normal. The serum creatinine phosphokinase was slightly elevated The electromyographic picture indicate non-specific signs of myopathy. DISCUSSION AND CONCLUSION: This is a case report of a "stiff joint syndrome". Due to the fact that data from the family history were unavailable, we could not establish the type of syndrome. However, heredity, growth and development at later age, as well as IQ, might significantly help in definite differentiation of this syndrome. In pregnancy, oligohydramnion should indicate more detailed ultrasonographic examination, as ankylosed joints can be detected in utero.

Arthrogryposis↗
PubMed2001

[Anesthesia using propofol for a patient with arthrogryposis multiplex congenita].

Arthrogryposis multiplex congenita (AMC) is a syndrome with multiple persistent limb contractures, often accompanied by associated anomalies. Pediatric patients with AMC frequently require operations, necessitating general endotracheal anesthesia. We report on the anesthesia used for a 14-year-old male with AMC, who required the surgical removal of soft tissue from both hip joints. We used propofol and vecuronium bromide to induce anesthesia, and maintained anesthesia with 40% nitrous oxide, oxygen, and propofol at 6 mg.kg-1.1 hr-1. Both induction and maintenance were smooth, and no hyperthermia occurred perioperatively. Propofol can be safely used for anesthesia in AMC patients.

Adolescent↗
PubMed1992

Positioning of the stroke patient: a review of the literature.

Stroke is a common and disabling illness, adversely affecting the quality of life of hundreds of people each year. While there are many therapeutic approaches to stroke patient rehabilitation, encouraging patients to adopt "reflex-inhibiting" patterns of posture is a widely advocated strategy for helping patients to avoid complications of hemiplegia such as spasticity and contractures. However, while the central role of nurses in thus helping patients is recognized, the influence of posture on recovery from stroke has never been evaluated. Prior to undertaking such an evaluative study, texts on stroke patient care were reviewed to clarify the received view about the recommended positioning for patients with hemiplegia. Consensus on some issues was evident (such as positioning the patient with the affected shoulder protracted, spine straight, fingers extended and avoiding external rotation of the affected hip). However, opinion was divided on others and a number of potentially important aspects were ill-covered. This paper integrates a summary of the findings of this review with the physiological rationale for the recommendations. The main areas of agreement are highlighted and issues as yet unanswered are raised for further consideration.

Cerebrovascular Disorders↗
PubMed2000

Follow-up study after treatment of knee flexion contractures in spina bifida patients.

Knee flexion contractures in spina bifida patients are seen in all levels of paralysis. The majority is encountered in children with thoracolumbar lesions. Positional deformation, spinal reflex activity, fractures around the knee joint and a weak quadriceps are the main causes of the flexion deformity of the knee. One hundred and forty-five knee flexion contractures in 80 children have been treated between 1980 and 1995; 15 with unilateral contracture, 65 with bilateral involvement. The age at the time of correction in 38 patients with thoracolumbar lesions was between 24 months and 11 years (average, 7.7 years). In 42 patients with sacral or lumbosacral lesions, the age at the time of correction was between 10 and 19 years (average, 16.3 years). Associated surgery was mainly carried out on hip flexors, adductors and triceps surae. Complete posterior release was practiced in thoracolumbar lesions including posterior capsulotomy and release of the posterior cruciate ligament. In lumbosacral lesions, the lengthened tendons are sutured to prevent flexor weakness in the postoperative course. Vascular and neurologic structures are spared. Postoperative serial casts are helpful to achieve full extension without vascular or skin troubles. The long-term results were very good in 59 patients with 106 knees, good in 16 patients with 29 knees, and unsatisfactory in 5 patients with 10 knees. Slow deterioration years after surgery can be anticipated. The main causes are lack of personal initiative to stand and to walk, and obesity.

Adolescent↗
PubMed1977

Heterotopic ossification mimicking acute arthritis after neurologic catastrophes.

Three patients developed periarticular heterotopic new bone formation during the first two months after a CNS disorder. In each patient warmth, swelling, and tenderness around one or two joints initially resembled severe arthritis. Diagnosis was aided by roentgenograms of the involved areas that showed the ossification. While no treatment has been clearly demonstrated to interrupt the ossification and resultant contracture, a course of cautious physical therapy and antiinflammatory medication is probably indicated.

Adult↗
PubMed1999

Gait pattern in patients with spastic diplegic cerebral palsy who underwent staged operations.

Fifteen patients with spastic diplegic cerebral palsy (CP) were monitored for a mean length of 9.5 years after they underwent staged operations and were evaluated by gait analysis, including joint motion in the sagittal plane and the ground reaction force (GRF) in three dimensions. Results showed an increased hip flexion (132%) at midstance, a reduction of peak knee flexion (PKF) during swing (45%) accompanied by an augmented time of PKF during swing (50%), and an increased dorsiflexion of the ankle during swing (293%) as well as its time during the gait cycle, in comparison with normal values. Moreover, significant decreases of the vertical GRF at the terminal stance and the forward and backward GRF were present. Additionally, it was found that a bilateral popliteal angle < 20 degrees is acceptable in spastic CP. Staged operations gave unpredictable results in the correction of contracture of the hamstrings, the Achilles tendon, and the iliopsoas. The authors are convinced that gait analysis is useful in evaluating these patients and enhances the results of operative treatment, and they have since changed their approach toward multilevel simultaneous corrections.

Adolescent↗
PubMed1999

[Variability of the femoral head and neck antetorsion angle in ultrasonographic measurements of healthy children and in selected diseases with hip disorders treated surgically].

Changes in the angle of femoral head and neck antetorsion during childhood play an important role in the physiological development of the hip joint. In the course of some diseases the angle increases pathologically, necessitating surgical treatment. Recent technical advances have enabled the application of ultrasonography (USG) for the measurement of antetorsion angle. In this study the results of USG have been verified by comparison with results of direct measurement during varus derotational osteotomy of 163 femoral proximal ends in 104 children. Values for femoral head and neck antetorsion obtained by USG correlated closely with those obtained during surgery, justifying the use of ultrasonography for the further part of this study. An increase in antetorsion was observed in 56 joints (77%) in a group of 38 children with spastic cerebral palsy subjected to surgery. Mean angle of antetorsion was 37 degrees (SD +/- 11). The angle returned to its pre-operative values within 2-3 years from surgery. In the group of 25 children with Perthes disease, increased antetorsion was found in 11 (44%) joints subjected to surgery and in 8 (32%) normal joints. The angle changed during the observation period, confirming the opinion that the increase is a secondary event in this disease. The angle was much greater than normal for age in the group of 21 children with congenital hip dysplasia. Basing on the results of surgery it is concluded that corrective osteotomy of femoral proximal end in cases of increased antetorsion and valgity of femoral neck is not a sufficient procedure to prevent the angle from reverting to pre-operative values and should be supplemented by osteotomy of the pelvis. Furthermore, ultrasonography has emerged as the best method currently available for measurement of femoral head and neck antetorsion. The correlation coefficient for USG vs. direct (intraoperative) measurement was 0.9 in all groups, reaching 0.93 in the spastic cerebral palsy group, in which contractures and limited mobility are responsible for very low coefficients in the case of other methods. The use of USG for assessment of femoral antetorsion has revealed, particularly after longer observation periods, that the angle in the apparently normal contralateral extremity exceeded values normal for age.

Adolescent↗
PubMed1984

Clinical application of basic research on continuous passive motion for disorders and injuries of synovial joints: a preliminary report of a feasibility study.

Since 1970, when the concept of continuous passive motion (CPM) was originated by one of the authors (R.B.S.), he and a succession of his research fellows have investigated its biological effects on the healing and regeneration of articular tissues in a wide variety of experimental models in rabbits. From this basic research he concluded that CPM is well tolerated, seems to be painless, stimulates the healing and regeneration of articular tissues, prevents joint stiffness, and permits the normal healing of arthrotomy incisions. Beginning in 1975, one of the authors (H.W.H.), and in 1978, the remaining authors, (from two additional Canadian cities) applied the knowledge from the basic research on CPM to the orthopaedic care of human patients. The CPM devices for humans (CPM Mobilimbs), which have been designed in collaboration with University of Toronto engineers, include, to date, devices for the ankle-knee-hip, the elbow, and the finger. Indications for CPM in patients have been the immediate postoperative management following such operative procedures as open reduction and internal fixation of fractures, arthrotomy and arthrolysis for post-traumatic arthritis, synovectomy, surgical drainage for septic arthritis, release of extraarticular contractures, metaphyseal osteotomies, total joint replacement, and ligamentous reconstruction. The case reports of nine selected patients are presented as examples of the clinical application of CPM. These patients have been relatively free of pain, have maintained the increased motion gained at operation, and have accepted the application of CPM well. There have been no complications of CPM; the operative wounds have healed well and the period of hospitalization has not been prolonged. The authors believe that the clinical application of CPM is feasible and that the clinical and radiographic results of CPM in these patients are encouraging. Long-term, prospective clinical investigations (including control patients in whom CPM is not used) will be required to assess the efficacy of CPM in relation to the various stated indications.

Adolescent↗
PubMed2006

[A case of pigmented villonodular synovitis of the elbow joint with bone invasion].

Pigmented villonodular synovitis is a benign proliferative disorder of the joint and of the tendon sheath synovium. It has a predilection for the lower extremities, particularly the knee and the hip. The elbow joint is rarely affected. A 56-year-old woman had complaints of pain and swelling in the left elbow for three years. She had no history of trauma. On physical examination, she had swelling of the left elbow, varus deformity, and flexion contracture of 20 degrees. Active and passive joint movements were painful. Magnetic resonance imaging showed synovial thickening and signal changes. An incisional biopsy yielded a diagnosis of pigmented villonodular synovitis. She underwent subtotal synovectomy and excision of the radius head. No evidence of clinical or radiologic recurrence was detected within a follow-up of 16 months.

Diagnosis, Differential↗