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Cemented revision Charnley low-friction arthroplasty in patients with rheumatoid arthritis.

We assessed 41 patients with rheumatoid arthritis (47 hips) who had had revision hip arthroplasty, at an average follow-up of 7 years 4 months (2 to 19). The clinical results were excellent or satisfactory in 43 hips. Radiologically, 45 stems were secure. Fifteen sockets (36.6%) were radiologically loose. Three hips required rerevision. Socket failure is the predominant problem in rheumatoid patients after cemented revision arthroplasty.

Adult↗

Predisposing factors in fixation failure of femoral prostheses following primary Charnley low friction arthroplasty. A 10- to 20-year followup study.

To identify factors affecting radiologically detected loosening of the Charnley femoral prosthesis, 326 femoral prostheses with 10- to 20-year followup were studied. After observation of postoperative radiological changes, the criteria for fixation failure detected radiologically, of femoral prostheses were defined as progression or accompanying occurrences of subsidence, demarcation, separation of the prosthesis from cement, cement fracture, or endosteal cavitation. Sixteen femoral prostheses (4.9%) developed radiologically detected fixation failure. Male gender, low canal flare index, low femoral score, large medullary canal width, low implant (cement and stem)/canal ratio, low stem/canal ratio, and varus orientation of the stem affected fixation failure. Inadequate cementing techniques such as low implant/canal and stem/canal ratios and varus stem orientation might be within the surgeon's control and should be avoided. An unfavorable canal geometry (stovepipe canal) and osteopenia of the femur, indicated by a low femoral score, are risk factors that might be out of the surgeon's control, and require future research.

Activities of Daily Living↗

Risk factors affecting radiological failure of the socket in primary Charnley low friction arthroplasty. A 10- to 20-year followup study.

To identify the factors affecting Hodgkinson Type 3 or 4 radiological demarcation (presence of complete demarcation or migration, respectively) of the Charnley socket, 328 sockets with 10- to 20-year followup were studied. Fifty-five sockets (16.8%) developed Type 3 or 4 demarcation. In the osteoarthrosis group (237 sockets), removal of eburnated bone at the acetabular roof, the presence of large acetabular angles before and after surgery, and high placement of the socket were related to development of Type 3 or 4 demarcation. In the rheumatoid group (32 sockets), young patient age predisposed the socket to Type 3 or 4 demarcation. Rapid polyethylene wear, correlated with young age, male gender, and thin cement mantle in Zones I and II, was another important factor related to Type 3 or 4 demarcation in both groups and in the entire series. These risk factors should be taken into account when assessing the indications for arthroplasty, when performing arthroplasty, and when educating the patient.

Acetabulum↗

Control of forces applied by individual fingers engaged in restraint of an active object.

We investigated the coordination of fingertip forces in subjects who used the tips of two fingers to restrain an instrumented manipulandum with horizontally oriented grip surfaces. The grip surfaces were subjected to tangential pulling forces in the distal direction in relation to the fingers. The subjects used either the right index and middle fingers (unimanual grasp) or both index fingers (bimanual grasp) to restrain the manipulandum. To change the frictional condition at the digit-object interfaces, either both grip surfaces were covered with sandpaper or one was covered with sandpaper and the other with rayon. The forces applied normally and tangentially to the grip surfaces were measured separately at each plate along with the position of the plates. Subjects could have performed the present task successfully with many different force distributions between the digits. However, they partitioned the load in a manner that reflected the frictional condition at the local digit-object interfaces. When both digits contacted sandpaper, they typically partitioned the load symmetrically, but when one digit made contact with rayon and the other with sandpaper, the digit contacting the less slippery material (sandpaper) took up a larger part of the load. The normal forces were also influenced by the frictional condition, but they reflected the average friction at the two contact sites rather than the local friction. That is, when friction was low at one of the digit-object interfaces, only the applied normal forces increased at both digits. Thus sensory information related to the local frictional condition at the respective digit-object interfaces controlled the normal force at both digits. The normal:tangential force ratio at each digit appeared to be a controlled variable. It was adjusted independently at each digit to the minimum ratio required to prevent frictional slippage, keeping an adequate safety margin against slippage. This was accomplished by the scaling of the normal forces to the average friction and by partitioning of the load according to frictional differences between the digit-object interfaces. In conclusion, by adjusting the normal:tangential force ratios to the local frictional condition, subjects avoided excessive normal forces at the individual digit-object interfaces, and by partitioning the load according the frictional difference, subjects avoided high normal forces. Thus the local frictional condition at the separate digit-object interfaces is one factor that can strongly influence the distribution of forces across digits engaged in a manipulative act.

Adult↗

Effect of sock on biomechanical responses of foot during walking.

BACKGROUND: Except the plantar pressure and gross joint motion, we know little about the mechanical state of a foot during walking. This study aimed at investigating the effect of wearing socks with different frictional properties on plantar shear, which is a possible mechanical risk factor of foot lesion development. METHOD: A 3-D finite element model for simulating the foot-sock-insole contact was developed to investigate the biomechanical effects of wearing socks with different combinations of frictional properties on the plantar foot contact. The dynamic plantar pressure and shear stress during the stance phases of gait were studied through finite element computations. Three cases were simulated, a barefoot with a high frictional coefficient against the insole (0.54) and two socks, one with a high frictional coefficient against the skin (0.54) and a low frictional coefficient against the insole (0.04) and another with an opposite frictional properties assignment. FINDINGS: Wearing sock of low friction against the insole to allow more relative sliding between the plantar foot and footwear was found to reduce the shear force significantly: at the rearfoot from 3.1 to 0.88 N, and at the forefoot from 10.61 to 1.61 N. The shear force can be further reduced to 0.43 N at the rearfoot, and 1.18 N at the forefoot, when wearing the sock with low friction against the foot skin and high friction set against the insole. INTERPRETATION: Wearing sock with low friction against the foot skin was found to be more effective in reducing plantar shear force on the skin than the sock with low friction against the insole. The risk of barefoot walking in developing plantar shear related blisters and ulcers might be reduced by socks wearing especially those with low friction against the foot skin.

Biomechanical Phenomena↗

The effect of subject awareness and prior slip experience on tribometer-based predictions of slip probability.

Prior knowledge of potentially slippery conditions has been shown to alter normal human gait in slip and fall experiments. We sought to quantify how the empirical relationship between slip probability and available floor friction was affected by subject awareness and prior slip experience. Sixty-eight subjects (40 females, 28 males) walked over three different low-friction surfaces inserted periodically between non-slip control trials. Three increasing levels of prior knowledge were used: deceived (unaware of the slippery surface), aware (20% chance of a slippery surface, but no prior slip experience) and experienced (aware with prior slip experience). Available friction was measured using a drag sled and a variable incidence tribometer. Of 620 low-friction trials, 124 generated slips greater than 27mm. The proportion of slips, the slip distance and the required friction (taken from the control trial immediately before a low-friction trial) generally decreased with increasing levels of prior knowledge. These adaptations were accommodated by logistically regressing slip outcome (yes/no) against the normalized friction (available friction minus required friction) rather than against available friction alone. The regressions showed that subject awareness biased the slip probability curve toward a lower slip risk for a given normalized friction, but that the subsequent addition of slip experience generated a slip risk curve that was not significantly different from that of deceived (and presumably unprepared) subjects. These findings suggest that data to validate a tribometer's ability to predict the risk of slipping (but not falling) can be acquired from subjects with prior slip experience.

Accidental Falls↗