A Dual-Pivot Pattern Simulating Native Knee Kinematics Optimizes Functional Outcomes After Total Knee Arthroplasty

Background Kinematics after total knee arthroplasty (TKA) have been studied for decades; however, few studies have correlated kinematic patterns to patient reported outcomes. The purpose of this study was to determine if a pattern of lateral pivot motion in early flexion and medial pivot motion in high flexion, simulating native knee kinematics, produces superior clinical outcomes. A second study objective was to determine if a specific kinematic pattern throughout the various ranges of flexion produces superior function and patient satisfaction. Methods 120 consecutive TKAs were performed using sensor embedded tibial trials to record intraoperative knee kinematics through the full range of motion. Established criteria were used to identify lateral (L) or medial (M) pivot kinematic patterns based on the center of rotation within three flexion zones -- 0 to 45° (early flexion), 45 to 90° (mid flexion) and 90° to terminal flexion (late flexion). Knee Society Scores, pain scores, and patient satisfaction were analysed in relationship to kinematic patterns. Results Knee Society function scores were significantly higher in TKAs with early lateral pivot/late medial pivot intraoperative kinematics compared to all other kinematic patterns (p = 0.018) at minimum one-year follow-up. There was a greater decrease in the proportion of patients with early lateral/late medial pivot kinematics who reported that their knee never feels normal (p = 0.011). Higher mean function scores at minimum one-year follow-up (p < 0.001) and improvement from preoperative baseline (p = 0.008) were observed in patients with the most ideal “LLM” kinematic pattern (lateral pivot 0 to 45o and 45 to 90o; medial pivot beyond 90o) compared to those with the least ideal “MLL” kinematic pattern. All patients with the optimal “LLM” kinematic pattern compared to none of those with the “MLL” kinematic pattern reported that they were very satisfied with their TKA (p = 0.003). Conclusion Patients who exhibited an early flexion lateral pivot kinematic pattern accompanied by medial pivot motion in later flexion, as measured intraoperatively, reported higher functional outcome scores along with higher overall patient satisfaction. Replicating the dual-pivot kinematic pattern observed in native knees may improve function and satisfaction after TKA. Further study is warranted to explore a correlation with in-vivo kinematic patterns

Do Medial Pivot Kinematics Correlate With Patient-Reported Outcomes After Total Knee Arthroplasty?

Background Many total knee arthroplasty (TKA) implants are designed to facilitate a medial pivot kinematic pattern. The purpose of this study was to determine whether intraoperative medial pivot kinematic patterns are associated with improved patient outcomes. Methods A retrospective review of consecutive primary TKAs was performed. Sensor-embedded tibial trials determined kinematic patterns intraoperatively. The center of rotation (COR) was identified from 0° to 90° and from 0° to terminal flexion, and designated medial-pivot or non-medial pivot based on accepted criteria. Patient-reported outcomes were measured preoperatively and at minimum one-year follow-up. Results The analysis cohort consisted of 141 TKAs. Mean age and median BMI were 63.7 years and 33.8 kg/m2, respectively. Forty-percent of TKAs demonstrated a medial pivot kinematic pattern intraoperatively. A medial pivot pattern was more common with posterior cruciate-retaining (CR) and posterior cruciate-substituting/anterior lipped (CS) implants when compared to posterior stabilized (PS) TKAs (P ≤.0150). Regardless of bearing type, minimum one-year Knee Society scores and UCLA activity level did not significantly differ based on medial vs non-medial pivot patterns (P ≥.292). For patients with posterior cruciate-sacrificing implants, there were trends for greater median improvement in Knee Society objective (46 vs 31.5 points, P =.057) and satisfaction (23 vs 14 points, P =.067) scores in medial pivot knees. Conclusion A medial pivot pattern may not significantly govern clinical success after TKA based on intraoperative kinematics and modern outcome measures. Further research is warranted to determine if a particular kinematic pattern promotes optimal clinical outcomes

Evaluation of a longitudinal family stress model in a population‐based cohort

The family stress model (FSM) is an influential family process model that posits that socioeconomic disadvantage impacts child outcomes via its effects on the parents. Existing evaluations of the FSM are constrained by limited measures of socioeconomic disadvantage, cross‐sectional research designs, and reliance on non‐population‐based samples. The current study tested the FSM in a subsample of the Fragile Families and Child Wellbeing Study (N = 2,918), a large population‐based study of children followed from birth through the age of nine. We employed a longitudinal framework and used measures of socioeconomic disadvantage beyond economic resources. Although the hypothesized FSM pathways were identified in the longitudinal model (e.g., economic pressure at the age of one was associated with maternal distress at the age of three, maternal distress at the age of three was associated with parenting behaviors at the age of five), the effects of socioeconomic disadvantage at childbirth on youth socioemotional outcomes at the age of nine did not operate through all of the hypothesized mediators. In longitudinal change models that accounted for the stability in constructs, multiple indicators of socioeconomic disadvantage at childbirth were indirectly associated with youth externalizing behaviors at the age of nine via either economic pressure at the age of one or changes in maternal warmth from ages 3 to 5. Greater economic pressure at the age of one, increases in maternal distress from ages 1 to 3, and decreases/increases in maternal warmth/harshness from ages 3 to 5 were also directly associated with increases in externalizing behaviors from ages 5 to 9. Results provide partial support for the FSM across the first decade of life.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163397/2/sode12446.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163397/1/sode12446_am.pd

Inhibitory Control Across the Preschool Years: Developmental Changes and Associations with Parenting

The normative developmental course of inhibitory control between 2.5 and 6.5 years, and associations with maternal and paternal sensitivity and intrusiveness were tested. The sample consisted of 383 children (52.5% boys). During four annual waves, mothers and fathers reported on their children’s inhibitory control using the Children\u27s Behavior Questionnaire. During the first wave, mothers’ and fathers’ sensitivity and intrusiveness were observed and coded with the Emotional Availability Scales. Inhibitory control exhibited partial scalar invariance over time, and increased in a decelerating rate. For both mothers and fathers, higher levels of sensitivity were associated with a higher initial level of children\u27s inhibitory control, whereas higher levels of intrusiveness predicted a slower increase in children\u27s inhibitory control

Tibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty

Background: In an effort to optimize clinical outcomes and enhance stability, ultracongruent bearings have been increasingly used in primary total knee arthroplasty (TKA). The importance of the posterior cruciate ligament (PCL) and optimal sagittal tibial baseplate position in ultracongruent bearing TKA remains unknown. This study sought to determine whether these modifiable, surgical-technique-dependent variables meaningfully impact patient-reported outcome measures. Methods: A total of 759 primary TKAs of the same dual-pivot design performed using a consistent surgical technique between January 2016 and April 2019 were retrospectively reviewed. PCL status was recorded, and anteroposterior (AP) tibial baseplate position and posterior tibial slope were measured by two independent blinded raters. Patient-reported outcomes related to pain, function, satisfaction, and activity level were analyzed in relationship to PCL status, posterior tibial slope, and AP tibial baseplate position, in addition to other pertinent covariates. Results: Median age and body mass index of the cohort were 68.3 years and 33.4 kg/m2, respectively, with 73% being female. In multivariate analysis, partial or full release of the PCL was predictive of a knee "always" feeling normal (odds ratio 1.42, P = .041). Furthermore, tibial baseplate position closer to the middle of the tibia was associated with greater improvements in pain with level walking, pain while climbing stairs, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement total scores (P ≤ .079). Conclusion: In congruent dual-pivot bearing TKA, partially or fully releasing the PCL and AP tibial baseplate position closer to the middle of the tibia may provide greater improvement in pain and function scores at minimum 1-year follow-up

Introducing a novel online observation of parenting behavior: reliability and validation

Objective. Observations of parents with their children are important for better understanding the critical role that parents play in their children’s adjustment, but resource limitations commonly compromise assessment. A novel online observation tool, Etch-a-Sketch Online (ESO), is introduced that allows resource-efficient observations in the family home. Design. Study 1 was a preliminary, cross-sectional study of 20 mothers with their singleton children (M = 5.96 years). Mothers were observed using both ESO (recorded via Skype) and a traditional Etch-a Sketch task recorded during a home-visit; mothers’ positive and negative parenting was coded from these observations. Study 2 was a longitudinal study of 119 mothers and their young twins. Mothers’ ESO-observed positive parenting and negative parenting at Time 1 (M = 5.51 years) were examined as predictors of children’s disruptive behavior at Time 2 (M = 6.04 years) controlling for mothers’ Time 2 self-reported positive and negative parenting. Results. Study 1 provided preliminary evidence of inter-rater reliability and convergent validity of ESO-observations. Study 2 supported this evidence of inter-rater reliability and ESO’s convergent validity as well as providing predictive validity. ESO-observed parenting at Time 1 was associated with children’s disruptive behavior at Time 2, over and above concurrent maternal reports of their own parenting. Conclusions. ESO shows promise in providing the means for detailed assessment of parenting processes in the home

Prospective community study of family stress and anxiety in (pre)adolescents: the TRAILS study

For prevention of anxiety in children and adolescents, it is important to know whether family stress is a predictor of anxiety. We studied this in 1,875 adolescents from the Tracking Adolescents’ Individual Lives Survey (TRAILS) who were followed up for 2 years, from age 10–12 to 12–14 years. Adolescents reported anxiety and depression symptoms at both assessments, and parents reported family stress (family dysfunction and parenting stress) at the first assessment. Family dysfunction was not associated with future anxiety, whereas high parenting stress was. Furthermore, family dysfunction was more strongly associated with anxiety than with depression, whereas parenting stress was more strongly associated with depression. Level of parental psychopathology explained part of the association of family stress with anxiety. The associations were modest and the understanding of the origins of adolescents’ anxiety will require identifying other factors than family stress that account for more of the variance

Gene-Environment Interaction in the Etiology of Mathematical Ability Using SNP Sets

Mathematics ability and disability is as heritable as other cognitive abilities and disabilities, however its genetic etiology has received relatively little attention. In our recent genome-wide association study of mathematical ability in 10-year-old children, 10 SNP associations were nominated from scans of pooled DNA and validated in an individually genotyped sample. In this paper, we use a ‘SNP set’ composite of these 10 SNPs to investigate gene-environment (GE) interaction, examining whether the association between the 10-SNP set and mathematical ability differs as a function of ten environmental measures in the home and school in a sample of 1888 children with complete data. We found two significant GE interactions for environmental measures in the home and the school both in the direction of the diathesis-stress type of GE interaction: The 10-SNP set was more strongly associated with mathematical ability in chaotic homes and when parents are negative

Corporal Punishment of Children in Nine Countries as a Function of Child Gender and Parent Gender

Background. The purpose of this paper is to contribute to a global perspective on corporal punishment by examining differences between mothers' and fathers' use of corporal punishment with daughters and sons in nine countries. Methods. Interviews were conducted with 1398 mothers, 1146 fathers, and 1417 children (age range = 7 to 10 years) in China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States. Results. Across the entire sample, 54% of girls and 58% of boys had experienced mild corporal punishment, and 13% of girls and 14% of boys had experienced severe corporal punishment by their parents or someone in their household in the last month. Seventeen percent of parents believed that the use of corporal punishment was necessary to rear the target child. Overall, boys were more frequently punished corporally than were girls, and mothers used corporal punishment more frequently than did fathers. There were significant differences across countries, with reports of corporal punishment use lowest in Sweden and highest in Kenya. Conclusion. This work establishes that the use of corporal punishment is widespread, and efforts to prevent corporal punishment from escalating into physical abuse should be commensurately widespread

Externalizing behaviors in preadolescents: familial risk to externalizing behaviors and perceived parenting styles

The aim was to investigate the contribution of familial risk to externalizing behaviors (FR-EXT), perceived parenting styles, and their interactions to the prediction of externalizing behaviors in preadolescents. Participants were preadolescents aged 10–12 years who participated in TRAILS, a large prospective population-based cohort study in the Netherlands (N = 2,230). Regression analyses were used to determine the relative contribution of FR-EXT and perceived parenting styles to parent and teacher ratings of externalizing behaviors. FR-EXT was based on lifetime parental externalizing psychopathology and the different parenting styles (emotional warmth, rejection, and overprotection) were based on the child’s perspective. We also investigated whether different dimensions of perceived parenting styles had different effects on subdomains of externalizing behavior. We found main effects for FR-EXT (vs. no FR-EXT), emotional warmth, rejection, and overprotection that were fairly consistent across rater and outcome measures. More specific, emotional warmth was the most consistent predictor of all outcome measures, and rejection was a stronger predictor of aggression and delinquency than of inattention. Interaction effects were found for FR-EXT and perceived parental rejection and overprotection; other interactions between FR-EXT and parenting styles were not significant. Correlations between FR-EXT and perceived parenting styles were absent or very low and were without clinical significance. Predominantly main effects of FR-EXT and perceived parenting styles independently contribute to externalizing behaviors in preadolescents, suggesting FR-EXT and parenting styles to be two separate areas of causality. The relative lack of gene–environment interactions may be due to the epidemiological nature of the study, the preadolescent age of the subjects, the measurement level of parenting and the measurement level of FR-EXT, which might be a consequence of both genetic and environmental factors