Sensory-Motor Training Versus Resistance Training in the Treatment of Knee Osteoarthritis: A Randomized Controlled Trial

Objective To compare the effectiveness of sensory-motor training and resistance training in patients with knee osteoarthritis. Design Randomized controlled trial. Setting Istanbul University, Department of Physiotherapy and Rehabilitation. Subjects Forty-eight participants with knee osteoarthritis. Interventions Following baseline assessment, participants were randomly allocated to sensory-motor training (n = 24) and resistance training (n = 24). Both groups received training three times a week for 8 weeks. Main measures The primary outcome measure was the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The secondary outcome measures were pain level, muscle strength, proprioception, range of motion, quality of life, and patient satisfaction with treatment. Patients were assessed before and after four- and eight-week interventions. Results There was no significant difference between the groups' total WOMAC scores after four- and eight-week interventions (respectively, p = 0.415, p = 0.828). There was a significant improvement in pain level during movement and in the energy subscale SF-36 for resistance training after the four-week intervention (respectively, p = 0.012, p = 0.007). After the eight-week intervention, a significant difference was noted in favor of resistance training in the secondary outcome measure quality of life (QoL). No significant difference was found in other secondary outcomes. Conclusions At the end of the treatment, it was observed that sensory-motor training had a similar effect in the treatment of knee osteoarthritis symptoms to resistance training. These findings may suggest that sensory-motor training is an effective new method to treat patients with knee osteoarthritis

A comparison of two manual physical therapy approaches and electrotherapy modalities for patients with knee osteoarthritis: A randomized three arm clinical trial

A broad spectrum of physical therapy exercise programs provides symptom relief and functional benefit for patients with knee OA. Manual physical therapy, including tailored exercise programs provide relatively higher level benefit that persists to one year. It is currently unknown if there are important differences in the effects of different manual physical therapy techniques for patients with knee OA and there are virtually no studies comparing manual physical therapy and electrotherapy modalities. The aim of the study was to compare long-term results between three treatment groups (mobilization with movements [MWMs], passive joint mobilization [PJM], and electrotherapy) to determine which treatment is most effective in patients with knee OA. A single-blind randomized clinical trial with parallel design was conducted in patients with knee OA. Seventy-two consecutive patients (mean age 56.11 +/- 6.80years) with bilateral knee OA were randomly assigned to one of three treatment groups: MWMs, PJM, and electrotherapy. All groups performed an exercise program and received 12 sessions. The primary outcome measures of the functional assessment were the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Aggregated Locomotor Function (ALF) test scores. The secondary outcome measures were pain level, measured using a pressure algometer and a visual analogue scale (VAS), range of motion (ROM), measured using a digital goniometer, and muscle strength, evaluated with a handheld dynamometer. Patients were assessed before treatment, after treatment and after 1year of follow-up. Patients receiving the manual physical therapy interventions consisting of either MWM or PJM demonstrated a greater decrease in VAS scores at rest, during functional activities, and during the night compared to those in the electrotherapy group from baseline to after the treatment (p<0.05). This improvement continued at the 1-year follow-up (p<0.05). The MWMs and PJM groups also showed significantly improved WOMAC and ALF scores, knee ROM and quadriceps muscle strength compared to those in the electrotherapy group from baseline to 1-year follow-up (p<0.05). In the treatment of patients with knee OA, manual physical therapy consisting of either MWM or PJM provided superior benefit over electrotherapy in terms of pain level, knee ROM, quadriceps muscle strength, and functional level

Hallux Valgus Patients, Why Are They Happy?

Category: Bunion Introduction/Purpose: AOFAS score and angular changes are used widely to assess hallux valgus surgery. But our previous study showed us that these parameters do not reflect patient subjective satisfaction after surgery, angular changes do not correlate with patient satisfaction, and a subjective satisfaction scale must be used. So can we find a measurable parameter that reflects patient satisfaction? The purpose of the study was to evaluate the effect of percental reduction of first web space length (FWSL) on patient satisfaction, and if it can be used as a measurable parameter for this. Methods: Fifty feet of thirty-seven patients were included to the study. All patients were operated between 2010 and 2014. Same surgical technique (Lindgren-Turan osteotomy)used for operations. Patients were evaluated by using hallux valgus angle (HVA),1-2 intermetatarsal angle (IMA), first web space length (FWSL), AOFAS scores. On the final follow-up they were asked to scale their postoperative satisfaction between 1-10;as for 1-2 very unsatisfied, 3-4 unsatisfied, 5-6 neither unsatisfied nor satisfied, 7-8 satisfied, 9-10 very satisfied. The percental changes of HVA, IMA, and FWSL were compared with AOFAS score, and satisfaction scales. Results: Average age was 45,50±12,23 (22-68) years. Mean follow-up was 41,68±14,46 (24-68) months. 29 of 50 feet were right side, 21 were left. Preoperative HVAs have been changed from 32,52±5,19 to 11,58±4,70 degrees (p=0,001; p<0,01). Preoperative IMAs have been changed from 15,00±3,56 to 5,75±2,45 degrees (p=0,001; p<0,01). Preoperative AOFAS scores have been changed from 75,04±5,54 to 93,14±6,25 points (p=0,001; p<0,01). Preoperative FWSL changed from 14,5 (10-22) mm to 7,5 (5-14) mm (p=0,001; p<0,01). Postoperative satisfaction scale was 8,60±0,67 (7-10) points. When HVA and IMA percental changes were compared with AOFAS percental changes, they have shown a negative statistical significance according to Spearman’s Correlation Analysis. When AOFAS percental changes have been compared with satisfaction scale, they have shown a positive statistical significance. When FWSL percental changes were compared with AOFAS percental changes and satisfaction scale it has shown a positive statistical significance for both parameters according to Spearman’s Correlation Analysis. Conclusion: According to our results; we believe that the changes of FWSL have an influence on patient satisfaction. It is correlated both with AOFAS, and subjective satisfaction scale. It can be used as a measurable parameter to search for patients satisfaction. Angular changes do not have an influence on patients satisfaction. May be FWSL should also be used for surgical indications

Bicolumnar 90–90 plating of AO 13C type fractures

Objective: The aim of this study was to evaluate functional results and complication rate of patients who underwent medial-dorsolateral plating for intra-articular distal humeral fracture (Müller AO type 13C). Methods: Twenty-four patients (14 men, 10 women; mean age: 47 years) with AO type 13C distal humerus fracture were included in the study. Mean follow-up time was 28 months. Nine patients were in 13C1 subgroup, according to AO classification system, 11 patients were categorized as 13C2, and 4 patients were 13C3. Final follow-up assessment of outcomes included Broberg and Morrey radiological criteria; Mayo Elbow Performance Score, disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure, score based on Jupiter criteria; and range of motion (ROM) values. Results: The mean carrying angle of operated elbows was 11.37° (range: 0-20°). According to Broberg and Morrey radiological criteria, 14 patients, had radiologically normal elbow, 4 patients had mild change, 3 patients had moderate change, and 3 patients had severe radiological change. Mean DASH score was 21.91 (range: 0-50), and mean Mayo rating was 83.37 (range: 55-100). Jupiter criteria evaluation revealed excellent results in 10 cases, good in 12, and fair results in 2. One patient with fair result had open fracture, and the other had previous hemiparesis in the same extremity. There was no instance of nonunion observed at follow-up. Conclusion: Osteosynthesis with medial-dorsolateral plating is a safe and effective method for the treatment of intra-articular fractures of distal humerus. Level of evidence: Level IV, Therapeutic study. Keywords: Distal humerus, Fracture, Type C, Surgical treatment, Internal fixatio

Efficiency and Cost Analysis of Cell Saver Auto Transfusion System in Total Knee Arthroplasty

WOS: 000338061900008PubMed: 25207187Background: Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Aims: Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Study Design: Retrospective comparative study. Methods: Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA) were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. Results: No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (p<0.05) and cost was higher in Group 1 (p<0.05). Conclusion: Cell saver systems do not decrease the amount of allogenic blood transfusion and costs more. Therefore, the routine usage of the auto-transfusion systems is a controversial issue. Cell saver system usage does not affect allogenic blood transfusion incidence or allogenic blood transfusion volume. It was found that preoperative haemoglobin and body mass index rates may affect allogenic blood transfusion. Therefore, it is foreseen that auto-transfusion systems could be useful in patients with low haemoglobin level and body mass index

Peroneus quartus: prevalance and clinical importance

The most common variant muscle of the ankle, peroneus quartus muscle, is located in the lateral leg compartment. In literature there is ambiguous nomenclature of this muscle because of its different origin and insertion sides. It is related to many pathologic conditions in the lateral ankle compartment but also it can be used as a tendon graft for reconstructive procedures

Arthroscopic Technique for Treatment of Schatzker Type III Tibia Plateau Fractures Without Fluoroscopy

Accurate reduction and maintenance of the stability with correct implant positioning is critical for surgical treatment of tibial plateau fractures. Our technique includes an arthroscopic reduction and fixation of Schatzker type III tibial plateau fractures with a bulls-eye screw placement without fluoroscopy control. With the arthroscopic guidance, an anterior cruciate ligament drill guide is placed and a K-wire sent to the midpoint of the depressed fragment through the guide at a 40° angle to the coronal axis of the tibia. A tunnel is created with the drill over the K-wire. The depressed fragment is further augmented with gentle impacts over the K-wire. After arthroscopic reduction control, an appropriate-sized iliac graft is pushed until it is below the depressed fragment. The targeting device is adjusted at 130° so that it is parallel to the joint line and a K-wire sent through the device so that it would pass just below the graft. The graft is then supported with cannulated screws sent over the K-wire. This technique provides an arthroscopic reduction of the chondral surface and precise placement of the rafting screws without fluoroscopy

Medial mini-open versus percutaneous pin fixation for type III supracondylar fractures in children

WOS: 000378681000008PubMed: 27598607BACKGROUND: The present objective was to compare medial mini-open and percutaneous treatment of pediatric supracondylar fractures according to fluoroscopy time, duration of surgery, and iatrogenic ulnar nerve injury. METHODS: A total of 104 Gartland type III supracondylar humerus fractures were prospectively evaluated between 2011 and 2013. Patients were divided into 2 groups according to type of fixation. In Group A (41 patients), medial pin was inserted with mini-open incision with 2 lateral pins inserted percutaneously. In Group B (63 patients), all pins were inserted percutaneously. Mean follow-up time was 14.1 +/- 1.2 months in Group A, and 14.6 +/- 2.1 months in Group B. All patients were postoperatively evaluated for nerve injury with both motor and sensory function assessment. Length of surgery, total fluoroscopy time, fluoroscopy time for medial pin insertion, Baumann's angle, humeral capitellum angle, final carrying angle, and range of motion were recorded. RESULTS: Sensorial evaluation showed that Group A had 3 poor, and 1 fair results, and Group B had 2 poor, and 1 fair results. No statistically significant differences were observed, including no differences in either surgery or total fluoroscopy times between groups. However, fluoroscopy time during medial pin placement was significantly lower in the mini-open group. CONCLUSION: In conclusion, similar results of both techniques were observed, and both carry risk of iatrogenic ulnar nerve injury. Medial pin placement is easier and less demanding when used with mini-open technique