Fracturas de implantes de tibia. Consecuencias para los ensayos de los implantes

El objetivo de este trabajo es estudiar los modelos de fracturas de prótesis de tibia descritos en la literatura y, sobre la base de dichos conocimientos, desarrollar un ensayo para implantes en la cual se logren simular condiciones fisiológicas. El caso descrito con mayor frecuencia en la literatura es la migración de la parte medial de la prótesis, fenómeno que, a menudo, antecede a la fractura de la prótesis. La posición defectuosa resultante de dicha migración modifica el eje mecánico y provoca una sobrecarga en la parte medial de la prótesis. Se ha desarrollado un ensayo de implantes que simula el modelo de fallo in-vivo. Dos bases de material sintético de diferente dureza simulan la diferente densidad ósea medial y lateral, para permitir una migración del lado medial del platillo. En el ensayo dinámico el platillo tibial es sometido a una carga de un solo lado y el vástago de la prótesis se apuntala con un contrasoporte. Para simular el entorno fisiológico, todo el dispositivo se encuentra sumergido en una solución de Ringer a 37°. El implante de tibia es expuesto durante 10 millones de ciclos a una carga que corresponde al quíntuple del peso del cuerpo (4.000 N). El punto de aplicación de la fuerza fue tomado de datos de análisis del caminar (marcha en superficie plana, ascendente y descendente, subir escaleras). Con esta carga fisiológica se efectuaron los primeros ensayos. En éstas quedó demostrado que productos clínicamente exitosos podían superar el ensayo. Por el contrario, los productos con modelos de fracturas conocidos no la superaron. Los primeros resultados con estos productos demostraron también que el ensayo generaba muestras de fractura semejantes a las que se producen in vivo. Debido a la configuración fisiológica del dispositivo se somete el sistema completo es decir el platillo, el vástago de la prótesis y la unión - generalmente modular - entre ambos a ensayo. El "ensayo fisiológico de tibia " descrito ayuda a evaluar los diseños de tibia antes de que se autorice su venta. Nuevos implantes y modificaciones de diseño en implantes ya existentes son puestos a la venta después de cumplir con las exigencias del ensayo.Peer Reviewe

Predicting volleyball serve-reception at group level

In a group-serve-reception task, how does serve-reception become effective? We addressed "who" receives/passes the ball, what task-related variables predict action mode selection and whether the action mode selected was associated with reception efficacy. In 182 serve-receptions we tracked the ball and the receivers' heads with two video-cameras to generate 3D world-coordinates reconstructions. We defined receivers' reception-areas based on Voronoi diagrams (VD). Our analyses of the data showed that this approach was accurate in describing "who" receives the serve in 95.05% of the times. To predict action mode selection, we used variables related to: serve kinematics, receiver's movement and on-court positioning, the relation between receiver and his closest partner, and interactions between receiver-ball and receiver-target. Serve's higher initial velocities together with higher maximum height, as well as smaller longitudinal distances between receiver and target increased the chances for the use of the overhand pass. Conversely, decreasing alignment of the receiver with the ball and the target increased the chances of using the underhand-lateral pass. Finally, the use of the underhand-lateral pass was associated with lower quality receptions. Behavioural variability's relevance for serve-reception training is discussed

Evidence for Long-Term Impact of Pasos Adelante: Using a Community-Wide Survey to Evaluate Chronic Disease Risk Modification in Prior Program Participants

Effective community-level chronic disease prevention is critical to population health within developed and developing nations. Pasos Adelante is a preventive intervention that aims to reduce chronic disease risk with evidence of effectiveness in US-Mexico residing, Mexican origin, participants. This intervention and related ones also implemented with community health workers have been shown to improve clinical, behavioral and quality of life indicators; though most evidence is from shorter-term evaluations and/or lack comparison groups. The current study examines the impact of this program using secondary data collected in the community 3–6 years after all participants completed the program. A proportional household survey (N = 708) was used that included 48 respondents who indicated they had participated in Pasos. Using propensity score matching to account for differences in program participants versus other community residents (the program targeted those with diabetes and associated risk factors), 148 natural controls were identified for 37 matched Pasos participants. Testing a range of behavioral and clinical indicators of chronic disease risk, logistic regression models accounting for selection bias showed two significant findings; Pasos participants were more physically active and drank less whole milk. These findings add to the evidence of the effectiveness of Pasos Adalente and related interventions in reducing chronic disease risk in Mexican-origin populations, and illustrate the use of innovative techniques for using secondary, community-level data to complement prior evaluation research

Helical Axes of Skeletal Knee Joint Motion During Running

The purpose of this study was to determine the changes in the axis of rotation of the knee that occur during the stance phase of running. Using intracortical pins, the three-dimensional skeletal kinematics of three subjects were measured during the stance phase of five running trials. The stance phase was divided into equal motion increments for which the position and orientation of the finite helical axes (FHA) were calculated relative to a tibial reference frame. Results were consistent within and between subjects. At the beginning of stance, the FHA was located at the midepicondylar point and during the flexion phase moved 20mm posteriorly and 10mm distally. At the time of peak flexion, the FHA shifted rapidly by about 10–20mm in proximal and posterior direction. The angle between the FHA and the tibial transverse plane increased gradually during flexion, to about 15° of medial inclination, and then returned to zero at the start of the extension phase. These changes in position and orientation of FHA in the knee should be considered in analyses of muscle function during human movement, which require moment arms to be defined relative to a functional rotation axis. The finding that substantial changes in axis of rotation occurred independent of flexion angle suggests that musculoskeletal models must have more than one kinematic degree-of-freedom at the knee. The same applies to the design of knee prostheses, if the goal is to restore normal muscle function

Helical Axes of Skeletal Knee Joint Motion During Running

The purpose of this study was to determine the changes in the axis of rotation of the knee that occur during the stance phase of running. Using intracortical pins, the three-dimensional skeletal kinematics of three subjects were measured during the stance phase of five running trials. The stance phase was divided into equal motion increments for which the position and orientation of the finite helical axes (FHA) were calculated relative to a tibial reference frame. Results were consistent within and between subjects. At the beginning of stance, the FHA was located at the midepicondylar point and during the flexion phase moved 20mm posteriorly and 10mm distally. At the time of peak flexion, the FHA shifted rapidly by about 10–20mm in proximal and posterior direction. The angle between the FHA and the tibial transverse plane increased gradually during flexion, to about 15° of medial inclination, and then returned to zero at the start of the extension phase. These changes in position and orientation of FHA in the knee should be considered in analyses of muscle function during human movement, which require moment arms to be defined relative to a functional rotation axis. The finding that substantial changes in axis of rotation occurred independent of flexion angle suggests that musculoskeletal models must have more than one kinematic degree-of-freedom at the knee. The same applies to the design of knee prostheses, if the goal is to restore normal muscle function

Efficacy of customised foot orthoses in the treatment of achilles tendinopathy : study protocol for a randomised trial

BACKGROUND: Achilles tendinopathy is a common condition that can cause marked pain and disability. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. The exception to this is eccentric calf muscle exercises, which have become a standard non-surgical intervention for Achilles tendinopathy. Foot orthoses have also been advocated as a treatment for Achilles tendinopathy, but the long-term efficacy of foot orthoses for this condition is unknown. This manuscript describes the design of a randomised trial to evaluate the efficacy of customised foot orthoses to reduce pain and improve function in people with Achilles tendinopathy. METHODS: One hundred and forty community-dwelling men and women aged 18 to 55 years with Achilles tendinopathy (who satisfy inclusion and exclusion criteria) will be recruited. Participants will be randomised, using a computer-generated random number sequence, to either a control group (sham foot orthoses made from compressible ethylene vinyl acetate foam) or an experimental group (customised foot orthoses made from semi-rigid polypropylene). Both groups will be prescribed a calf muscle eccentric exercise program, however, the primary difference between the groups will be that the experimental group receive customised foot orthoses, while the control group receive sham foot orthoses. The participants will be instructed to perform eccentric exercises 2 times per day, 7 days per week, for 12 weeks. The primary outcome measure will be the total score of the Victorian Institute of Sport Assessment - Achilles (VISA-A) questionnaire. The secondary outcome measures will be participant perception of treatment effect, comfort of the foot orthoses, use of co-interventions, frequency and severity of adverse events, level of physical activity and health-related quality of life (assessed using the Short-Form-36 questionnaire - Version two). Data will be collected at baseline, then at 1, 3, 6 and 12 months. Data will be analysed using the intention to treat principle. DISCUSSION: This study is the first randomised trial to evaluate the long-term efficacy of customised foot orthoses for the treatment of Achilles tendinopathy. The study has been pragmatically designed to ensure that the study findings are generalisable to clinical practice. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Number: ACTRN12609000829213

Effects of Foot Orthoses on Skeletal Motion During Running

Objective. To quantify the effects of medial foot orthoses on skeletal movements of the calcaneus and tibia during the stance phase in running. Design. Kinematic effects of medial foot orthoses (anterior, posterior, no support) were tested using skeletal (and shoe) markers at the calcaneus and tibia. Background. Previous studies using shoe and skin markers concluded that medially placed orthoses control/reduce foot eversion and tibial rotation. However, it is currently unknown if such orthoses also affect skeletal motion at the lower extremities. Methods. Intracortical Hofman pins with reflective marker triads were inserted under standard local anesthetic into the calcaneus and tibia of five healthy male subjects. The three-dimensional tibiocalcaneal rotations were determined using a joint coordinate system approach. Eversion (skeletal and shoe) and tibial rotation were calculated to study the foot orthoses effects. Results. Orthotic effects on eversion and tibial rotations were found to be small and unsystematic over all subjects. Differences between the subjects were significantly larger (pp\u3c0.05). Conclusions. This in vivo study showed that medially placed foot orthoses did not change tibiocalcaneal movement patterns substantially during the stance phase of running. Relevance Orthoses may have only small kinematic effects on the calcaneus and tibia (measured with bone pins) as well as on the shoes (measured with shoe markers) during running of normal subjects. Present results showed that orthotic effects were subject specific and unsystematic across conditions. It is speculated that orthotic effects during the stance phase of running may be mechanical as well as proprioceptive