Sensitivity of Gait Parameters to the Effects of Anti-Inflammatory

Abstract The study aim was to address the need for objective markers of pain-modifying interventions by testing the hypothesis that selective gait measures of knee joint loading can distinguish differences between non-steroidal anti-inflammatory (NSAID), analgesic treatment (opioid-receptor agonist), and placebo in patients medial knee osteoarthritis (OA). A randomized, single-blind washout, double-blind treatment, double-dummy cross-over trial using three treatment arms placebo, opioid (Oxycodone), and NSAID (Celecoxib) in medial compartment knee OA patients. Six patients with Kellgren–Lawrence radiographic severity grades of 2 or 3 completed six testing sessions (gait and pain assessment) at 2-week intervals. A significant increase was found in the knee total reaction moment and vertical ground reaction force (GRF) for Celecoxib compared to placebo (p = 0.005, p = 0.003), but not for Oxycodone compared to placebo (p = 0.20, p = 0.27) treatments. Walking speed was significantly higher for the Celecoxib and Oxycodone compared to placebo treatment (p = 0.041 and p = 0.031, respectively). Self-reported function (WOMAC scores) was not different among treatments (p \u3e 0.05). The changes in total reaction moments and GRFs for only the NSAID suggest that greater increases in joint loading occurs when joint inflammation is treated in addition to pain. The total knee reaction moment, representing the magnitude of the extrinsic moment, appears to be a sensitive marker, more so than self-reported metrics, for evaluating knee OA treatment effects

MENISCECTOMIZED KNEES REGAIN NORMAL WALKING FLEXION RANGE OF MOTION WITH TIME PAST SURGERY

INTRODUCTION Meniscal tears are one of the most common knee injuries with an incidence rate of 60-70 per 100,000 person-years METHODS Six patients with unilateral partial medial mensciectomy were enrolled and their gait was measured at 6.2±2.7 months (mean±SD) and again at 31.8±2.5 months post-operation. At baseline, subject demographics were: age 36.0±7.5 years, height 180.3±6.0 cm, weight 79.4±10.3 kg, one female. All patients had no other knee ligament or articular injury or surgery and could walk without pain. Patients signed Institutional Review Board-approved consent documents. A group of 23 healthy age-, height-, and weight-matched control subjects were used for comparison; one randomly chosen limb was tested for each control subject. All participants were asked to perform several walking trials at a self-selected normal speed and an eight-camera optoelectronic motion capture system (Qualysis Medical AB) was used to determine knee flexion angle during gait following a previously described metho

Prediction Models for 30-Day Mortality and Complications After Total Knee and Hip Arthroplasties for Veteran Health Administration Patients With Osteoarthritis

BackgroundStatistical models to preoperatively predict patients' risk of death and major complications after total joint arthroplasty (TJA) could improve the quality of preoperative management and informed consent. Although risk models for TJA exist, they have limitations including poor transparency and/or unknown or poor performance. Thus, it is currently impossible to know how well currently available models predict short-term complications after TJA, or if newly developed models are more accurate. We sought to develop and conduct cross-validation of predictive risk models, and report details and performance metrics as benchmarks.MethodsOver 90 preoperative variables were used as candidate predictors of death and major complications within 30 days for Veterans Health Administration patients with osteoarthritis who underwent TJA. Data were split into 3 samples-for selection of model tuning parameters, model development, and cross-validation. C-indexes (discrimination) and calibration plots were produced.ResultsA total of 70,569 patients diagnosed with osteoarthritis who received primary TJA were included. C-statistics and bootstrapped confidence intervals for the cross-validation of the boosted regression models were highest for cardiac complications (0.75; 0.71-0.79) and 30-day mortality (0.73; 0.66-0.79) and lowest for deep vein thrombosis (0.59; 0.55-0.64) and return to the operating room (0.60; 0.57-0.63).ConclusionsModerately accurate predictive models of 30-day mortality and cardiac complications after TJA in Veterans Health Administration patients were developed and internally cross-validated. By reporting model coefficients and performance metrics, other model developers can test these models on new samples and have a procedure and indication-specific benchmark to surpass