The effect of total knee arthroplasty on joint movement during functional activities and joint range of motion with particular regard to higher flexion users

Study aimed to evaluate active and functional knee excursion of patients before and after total knee arthroplasty (TKA) and to determine whether TKA restores quality of life related to functional activities of daily living. Found that although TKA offers excellent pain relief and contributes to the overall well-being of the patient, these results suggest that it also leads to a reduced range of active and functional motion in the majority of patients. This is associated with a lower-than-normal physical quality of life. The design of implants and rehabilitation programmes should be reconsidered so that better range of motion and quality of life can be achieved for patients

Preoperative predictors of knee range of motion during stair walking after total knee replacement

This paper discusses the preoperative predictors of knee range of motion during stair walking after total knee replacement. It was presented at the 17th Annual Meeting of the European Society of Movement Analysis for Adults and Children (ESMAC) in 2008

Short Term Recovery of Function following Total Knee Arthroplasty: A Randomised Study of the Medial Parapatellar and Midvastus Approaches

This pilot double blind randomised controlled study aimed to investigate whether the midvastus (MV) approach without patellar eversion in total knee arthroplasty (TKA) resulted in improved recovery of function compared to the medial parapatellar (MP) approach. Patients were randomly allocated to either the MV approach or the MP approach. Achievements of inpatient mobility milestones were recorded. Knee kinematics, muscle strength, Timed Up and Go, WOMAC, and daily step count were assessed before and up to six months after surgery. Cohen's effect sizesch_phy[1] W. G. Hamilton, S. Sritulanondha, and C. A. Engh Jr., Results of prospective, randomized clinical trials comparing standard and high-flexion posterior-stabilized TKA: a focused review,- Orthopedics, vol. 34, no. 9, pp. e500-e503, 2011. [2] T. Sumino, H. R. Gadikota, K. M. Varadarajan, Y.-M. Kwon, H. E. Rubash, and G. Li, Do high flexion posterior stabilised total knee arthroplasty designs increase knee flexion? A meta analysis,- International Orthopaedics, vol. 35, no. 9, pp. 1309- 1319, 2011. [3] Z. Liu and H. Yang, Comparison of the minimally invasive and standard medial parapatellar approaches for total knee arthroplasty: systematic review and meta-analysis,- The Journal of International Medical Research, vol. 39, no. 5, pp. 1607-1617, 2011. [4] I. Alcelik, M. Sukeik, R. Pollock, A. Misra, A. Naguib, and F. S. Haddad, Comparing the mid-vastus and medial parapatellar approaches in total knee arthroplasty: a meta-analysis of short term outcomes,- The Knee, vol. 19, no. 4, pp. 229-236, 2012. [5] C. R. Costa, A. J. Johnson, S. F. Harwin,M. A.Mont, and P.M. Bonutti, Critical review of minimally invasive approaches in knee arthroplasty,- The Journal of Knee Surgery, vol. 26, no. 1, pp. 41-50, 2013. [6] R. Juosponis, S. Tarasevicius, A. Smailys, and R. J. Kalesinskas, Functional and radiological outcome after total knee replacement performed with mini-midvastus or conventional arthrotomy: controlled randomised trial,- International Orthopaedics, vol. 33, no. 5, pp. 1233-1237, 2009. [7] F. R. Kolisek, P.M. Bonutti,W. J. Hozack et al., Clinical experience using a minimally invasive surgical approach for total knee arthroplasty : early results of a prospective randomized study compared to a standard approach,- Journal of Arthroplasty, vol. 22, no. 1, pp. 8-13, 2007. [8] R. R. Karpman and H. L. Smith, Comparison of the early results of minimally invasive vs standard approaches to total knee arthroplasty : a prospective, randomized study,- Journal of Arthroplasty, vol. 24, no. 5, pp. 681-688, 2009. [9] T. Karachalios, D. Giotikas, N. Roidis, L. Poultsides, K. Bargiotas, and K.N.Malizos, Total knee replacement performed with either a mini-midvastus or a standard approach: a prospective randomised clinical and radiological trial,- Journal of Bone and Joint Surgery Series B, vol. 90, no. 5, pp. 584-591, 2008. [10] B. J.Nestor, C. E. Toulson, S. I. Backus, S. L. Lyman,K. L. Foote, and R. E. Windsor, Mini- midvastus vs standard medial parapatellar approach: a prospective, randomized, double-blinded study in patients undergoing bilateral total knee arthroplasty,- The Journal of Arthroplasty, vol. 25, no. 6, pp. 5.e1-11.e1, 2010. [11] S. P. Guy, M. A. Farndon, J. L. Conroy, C. Bennett, A. J. Grainger, andN. J. London, A prospective randomised study of minimally invasive midvastus total knee arthroplasty compared with standard total knee arthroplasty,- The Knee, vol. 19, no. 6, pp. 866-871, 2012. [12] S. L. Jarvis, A. K. Johnson-Wo, B. R. Onstot et al., Differences between standard and minimally invasive parapatellar surgical approaches for total knee arthroplasty in the tasks of sitting and standing,- The Journal of Knee Surgery, vol. 26, no. 4, pp. 249- 256, 2013. [13] World Health Organization, International Classification of Functioning, Disability and Health,WHO, Geneva, Switzerland, 2001. [14] D. M. Kennedy, P. W. Stratford, J. Wessel, J. D. Gollish, and D. Penney, Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty,- BMC Musculoskeletal Disorders, vol. 6, article 3, 2005. [15] M. P. Kadaba, H. K. Ramakrishnan, and M. E.Wootten, Measurement of lower extremity kinematics during level walking,- Journal of Orthopaedic Research, vol. 8, no. 3, pp. 383-392, 1990. [16] P. M. Grant, P. M. Dall, S. L. Mitchell, and M. H. Granat, Activity-monitor accuracy in measuring step number and cadence in community-dwelling older adults,- Journal of Aging and Physical Activity, vol. 16, no. 2, pp. 201-214, 2008. [17] J. Cohen, Statistical Power Analysis for the Behavioural Sciences, Lawrence Erlbaum Associates, Hillsdale, NJ, USA, 2nd edition, 1988. [18] S. A. Bridgman, G. Walley, G. MacKenzie, D. Clement, D. Griffiths, and N. Maffulli, Sub-vastus approach is more effective than a medial parapatellar approach in primary total knee arthroplasty: a randomized controlled trial,- The Knee, vol. 16, no. 3, pp. 216-222, 2009. [19] P. Essving, K. Axelsson, L. Otterborg et al., Minimally invasive surgery did not improve outcome compared to conventional surgery following unicompartmental knee arthroplasty using local infiltration analgesia: a randomized controlled trial with 40 patients,- ActaOrthopaedica, vol. 83,no. 6, pp. 634-641, 2012. [20] P.Mukherjee, J. Press, andM. Hockings, Mid-vastus vs medial para-patellar approach in total knee replacement-time to discharge,- The Iowa Orthopaedic Journal, vol. 29, pp. 19-22, 2009. [21] M. Maru, G. Akra, I. McMurtry, and A. Port, A prospective comparative study of the midvastus and medial parapatellar approaches for total knee arthroplasty in the early postoperative period,- European Journal of Orthopaedic Surgery and Traumatology, vol. 19, no. 7, pp. 473-476, 2009. [22] R. E. White Jr., J. K. Allman, J. A. Trauger, and B. H. Dales, Clinical comparison of the midvastus and medial parapatellar surgical approaches,- Clinical Orthopaedics and Related Research, no. 367, pp. 117-122, 1999.2014pub3916pu

Age-related differences in the neck strength of adolescent rugby players: A cross-sectional cohort study of Scottish schoolchildren

ObjectivesTo evaluate the neck strength of school-aged rugby players, and to define the relationship with proxy physical measures with a view to predicting neck strength.MethodsCross-sectional cohort study involving 382 rugby playing schoolchildren at three Scottish schools (all male, aged between 12 and 18 years). Outcome measures included maximal isometric neck extension, weight, height, grip strength, cervical range of movement and neck circumference.ResultsMean neck extension strength increased with age (p = 0.001), although a wide inter-age range variation was evident, with the result that some of the oldest children presented with the same neck strength as the mean of the youngest group. Grip strength explained the most variation in neck strength (R2 = 0.53), while cervical range of movement and neck girth demonstrated no relationship. Multivariable analysis demonstrated the independent effects of age, weight and grip strength, and the resultant model explained 62.1% of the variance in neck strength. This model predicted actual neck strength well for the majority of players, although there was a tendency towards overestimation at the lowest range and underestimation at the highest.ConclusionA wide variation was evident in neck strength across the range of the schoolchild-playing population, with a surprisingly large number of senior players demonstrating the same mean strength as the 12-year-old mean value. This may suggest that current training regimes address limb strength but not neck strength, which may be significant for future neck injury prevention strategies. Age, weight and grip strength can predict around two thirds of the variation in neck strength, however specific assessment is required if precise data is sought

Tres medici, duo athei? The Physician as Atheist and the Medicalization of the Soul

Until recently, examinations of the ‘mind-body problem’ in historical context paid only cursory attention to its specifically medical dimension, if at all. At best, some ‘folk physiology’ was entertained, usually to laugh at it (the pineal gland, animal spirits). Conversely, historians of neuroscience or of artificial intelligence (Jeannerod 1985, Dupuy 2000) often present figures like La Mettrie as heroic early cases of ‘naturalization’, giving an experimental basis to materialism: their symmetrically inverse mistake is to take professions of medical authority too literally (although there are genuine cases where all of the above does coalesce – where ‘actors’ categories mysteriously transcend historiographic projections –, such as Hieronymus Gaub’s reflections on the ‘regimen of the mind’ in the mid-eighteenth century, or, more theoretically, Guillaume Lamy’s Epicurean-inflected Anatomical Discourses on the Soul, eighty years earlier). Contrary to the denial of the relevance of medicine in early modern philosophy, as regards issues such as the body-soul (then body-mind) relation among others, it seems patently difficult to separate medical theory, medically nourished philosophical speculation, and metaphysics. This is the case, whether in Descartes, Gaub, the ‘animist’ Georg-Ernest Stahl, or materialists such as Guillaume Lamy and La Mettrie: medicine, or rather ‘a certain idea of medicine’, is everywhere. Here I focus on the motif of a radical medicine – a medical precursor of the Radical Enlightenment (Israel 2001, 2006, 2007), symbolized negatively by the slogan, tres medici, duo athei, or ‘where there are three doctors, there are two atheists’, i.e. medicine as a basis for atheism. This theme runs through various works of medical or medico-theological propaganda: Thomas Browne’s 1643 De religio medici begins with Browne regretting rumors of doctors being atheists as the “general scandal of my Profession”; Germain de Bezançon’s 1677 Les médecins à la censure works hard at rebutting the saying, “Bon Physicien, mauvais chrétien.” But these are examples of the fear of a radical medicine – a medicine that denies the existence of an immortal soul, or even defends materialism and atheism. Are there positive statements of this doctrine? Indeed, attacks on it are much more common than statements identifying with it, like medical versions of natural theology in general. In fact, just as there were theologically motivated medical works, there were also medically motivated works of radical or heretical theology, like William Coward’s Second Thoughts on the Human Soul (Coward 1702, building on Overton 1644), which engaged in polemics concerning the nature of the soul – mortal or immortal? (Thomson 2008). Parallel to the mortalist trend, but flowing into a common genre of radical, medico-materialist texts (sometimes anonymous, such as L’Âme Matérielle, from the 1720s) are at least two other strands of radical medicine: a post-Cartesian focus on medicina mentis and the nature of the mind (Henricus Regius, Hieronymus Gaub, Antoine Le Camus), and an Epicurean medicine, in which mind and body are organismically united, with an additional hedonistic component, notably in Lamy, Mandeville and La Mettrie (Wright 1991, Wolfe and van Esveld 2014). The focus on a medicine of the mind (Corneanu, ms. 2013) is obviously connected to a ‘medicalization of the soul’: there was a body-soul problem in and for medicine, a sort of medicalized ‘pneumatology’. Radical medicine is located somewhere in between the early forms of ‘naturalization’ or ‘medicalization’ of the soul and the pose of scientific neutrality that is characteristic of early nineteenth-century medicine (as in Cabanis, Bichat or Bernard): it is a short-lived episode. I seek to reconstruct this intellectual figure, in which mortalist, post-Cartesian and Epicurean strands intersect and sometimes come together. I suggest that medically influenced materialism in the Radical Enlightenment (e.g. in the later French cases, La Mettrie, Ménuret and Diderot), is different from later, more experimentally focused and more quantitatively oriented forms of medical materialism, precisely because of its radical dimension. This radical medicine often insists on vitality, as opposed to “anatomie cadavérique”: it is vital and hedonistic, a medicine concerned with maintaining bodily pleasure.Until recently, examinations of the 'mind-body problem' in historical context paid only cursory attention to its specifically medical dimension, if at all. At best, some 'folk physiology' was entertained, usually to laugh at it (the pineal gland, animal spirits). Conversely, historians of neuroscience or of artificial intelligence (Jeannerod M, The brain machine. The development of neurophysiological thought, trans. D. Urion, Harvard University Press, Cambridge, 1985; Dupuy J-P, The mechanization of the mind: on the origins of cognitive science, trans. M.B. DeBevoise, Princeton University Press, Princeton, 2000) often present figures like La Mettrie as heroic early cases of 'naturalization', giving an experimental basis to materialism: their symmetrically inverse mistake is to take professions of medical authority too literally (although there are genuine cases where all of the above does coalesce where 'actors' categories mysteriously transcend historiographic projections -, such as Hieronymus Gaub's reflections on the 'regimen of the mind' in the mid-eighteenth century, or, more theoretically, Guillaume Lamy's Epicurean-inflected Anatomical Discourses on the Soul, eighty years earlier). Contrary to the denial of the relevance of medicine in early modern philosophy, as regards issues such as the body-soul (then body-mind) relation among others, it seems patently difficult to separate medical theory, medically nourished philosophical speculation, and metaphysics. This is the case, whether in Descartes, Gaub, the 'animist' Georg-Ernest Stahl, or materialists such as Guillaume Lamy and La Mettrie: medicine, or rather 'a certain idea of medicine', is everywhere.Here I focus on the motif of a radical medicine - a medical precursor of the Radical Enlightenment (Israel J, Radical enlightenment. Philosophy and the making of modernity, 1650-1750, Oxford University Press, Oxford, 2001; Israel J, Enlightenment contested. Oxford University Press, Oxford, 2006, Israel J, Enlightenment, radical enlightenment and the "medical revolution" of the late seventeenth and eighteenth centuries. In: Grell OP, Cunningham A (ed) Medicine and religion in enlightenment Europe. Ashgate, Aldershot, pp 5-28, 2007), symbolized negatively by the slogan, tres medici, duo athei, or 'where there are three doctors, there are two atheists', i.e. medicine as a basis for atheism. This theme runs through various works of medical or medico-theological propaganda: Thomas Browne's 1643 De religio medici begins with Browne regretting rumors of doctors being atheists as the "general scandal of my Profession"; Germain de Bezancon's 1677 Les medecins a la censure works hard at rebutting the saying, "Bon Physicien, mauvais chretien." But these are examples of the fear of a radical medicine - a medicine that denies the existence of an immortal soul, or even defends materialism and atheism. Are there positive statements of this doctrine? Indeed, attacks on it are much more common than statements identifying with it, like medical versions of natural theology in general.In fact, just as there were theologically motivated medical works, there were also medically motivated works of radical or heretical theology, like William Coward's Second Thoughts on the Human Soul (Coward W, Second thoughts on the human soul. R. Basset, London, 1702, building on Overton 1644), which engaged in polemics concerning the nature of the soul - mortal or immortal? (Thomson A, Bodies of thought: science, religion, and the soul in the early enlightenment. Oxford University Press, Oxford, 2008). Parallel to the mortalist trend, but flowing into a common genre of radical, medico-materialist texts (sometimes anonymous, such as L'Ame Materielle, from the 1720s) are at least two other strands of radical medicine: a post-Cartesian focus on medicina mentis and the nature of the mind (Henricus Regius, Hieronymus Gaub, Antoine Le Camus), and an Epicurean medicine, in which mind and body are organismically united, with an additional hedonistic component, notably in Lamy, Mandeville and La Mettrie (Wright JP, Locke, Willis, and the seventeenth-century epicurean soul. In: Osler MJ (ed) Atoms, Pneuma, and Tranquillity: Epicurean and stoic themes in European thought. Cambridge University Press, Cambridge, pp 239-258, 1991; Wolfe CT, van Esveld M, The material soul: strategies for naturalising the soul in an early modern epicurean context. In: Kambaskovic D (ed) Conjunctions: body, soul and mind from Plato to the enlightenment. Springer, Dordrecht, pp 371-421, 2014). The focus on a medicine of the mind (Corneanu, (ms. 2013), The care of the whole man: medicine and theology in the late renaissance, 2013) is obviously connected to a 'medicalization of the soul': there was a body-soul problem in and for medicine, a sort of medicalized 'pneumatology'. Radical medicine is located somewhere in between the early forms of 'naturalization' or 'medicalization' of the soul and the pose of scientific neutrality that is characteristic of early nineteenth-century medicine (as in Cabanis, Bichat or Bernard): it is a short-lived episode. I seek to reconstruct this intellectual figure, in which mortalist, post-Cartesian and Epicurean strands intersect and sometimes come together. I suggest that medically influenced materialism in the Radical Enlightenment (e.g. in the later French cases, La Mettrie, Menuret and Diderot), is different from later, more experimentally focused and more quantitatively oriented forms of medical materialism, precisely because of its radical dimension. This radical medicine often insists on vitality, as opposed to "anatomie cadaverique": it is vital and hedonistic, a medicine concerned with maintaining bodily pleasure

Fluids and barriers of the CNS: a historical viewpoint

Tracing the exact origins of modern science can be a difficult but rewarding pursuit. It is possible for the astute reader to follow the background of any subject through the many important surviving texts from the classical and ancient world. While empirical investigations have been described by many since the time of Aristotle and scientific methods have been employed since the Middle Ages, the beginnings of modern science are generally accepted to have originated during the 'scientific revolution' of the 16th and 17th centuries in Europe. The scientific method is so fundamental to modern science that some philosophers consider earlier investigations as 'pre-science'. Notwithstanding this, the insight that can be gained from the study of the beginnings of a subject can prove important in the understanding of work more recently completed. As this journal undergoes an expansion in focus and nomenclature from cerebrospinal fluid (CSF) into all barriers of the central nervous system (CNS), this review traces the history of both the blood-CSF and blood-brain barriers from as early as it was possible to find references, to the time when modern concepts were established at the beginning of the 20th century