Effects of a primary rehabilitation programme on arterial vascular adaptations in an individual with paraplegia

AbstractObjectiveEvaluation of the effects of 6 weeks of wheelchair endurance training on arterial stiffness in an individual with paraplegia.MethodsA 22-year-old male patient with complete (ASIA A) paraplegia (T11) was tested before and after training (30minutes three times per week). Physical performance and cardiorespiratory response were evaluated during a maximal progressive test. Heart rate (HR), blood pressure, stroke volume and arterial carotid–wrist and carotid–ankle pulse wave velocity (PWV) were measured at rest.ResultsMaximal responses registered (maximal tolerated power, V˙O2 peak) during the exercise test were increased after training. At rest, HR as PWV decreased, whereas cardiac output and blood pressure remained constant.ConclusionContinuous exposure of the subject to a repeated high intensity exercise bout for 6 weeks elevated fitness level. Such a regular practice might also constitute a major way to trigger vascular remodelling beyond to the trained body part

Primary total knee arthroplasty in the management of epiphyseal fracture around the knee

SummaryIntroductionOver the past few years the use of arthroplasty was broadened to treating complex epiphyseal fractures at the shoulder and elbow joints. Similar trends to treat this type of fractures at the knee are less documented. Based on a multicenter retrospective series study, the aims of this work is to evaluate the short term clinical results of total knee prostheses in the management of comminuted epiphyseal fractures around the knee, to identify the technical issues and fine tune the indications.Material and methodsFollowing the initiative of the French Hip and Knee Society (SFHG) and the Traumatology Study Group (GETRAUM), 26 charts from eight different centers in France were included in this multicenter retrospective series. Inclusion criteria were: primary total knee arthroplasty (TKA) in the management of complex articular fractures involving the proximal end of the tibia or distal end of the femur. Surgical features were identified and complications were analyzed. The assessment protocol at last follow-up was standardized and included patient demographic data, analysis of the Parker and IKS scores.ResultsDuring the immediate postoperative period, six patients (23%) reported a general complication and four patients (15%) a local arthroplasty-related complication. At last follow-up (mean 16.2 months), the overall final Parker score was 6.3 (a mean decrease of 1.7) and the mean IKS knee score was 82 points for a mean function score of 54 points.DiscussionPrimary TKA is a suitable management option for complex fractures in autonomous elderly patients suffering from knee osteoarthritis. The key technical details of this procedure should be respected and meticulously planned to achieve optimal results and limit the risk of complications. This risk in these acute complex fractures remains higher than after conventional TKA but comparable to that observed after TKA for post-traumatic arthritis.Level of evidenceIV; retrospective cohort study

Function and quality of life following medial unicompartmental knee arthroplasty in patients 60years of age or younger

SummaryIntroductionUKA is an appropriate bone-sparing solution for focal advanced knee osteoarthritis in young patients. As the expectations of patients younger than 60 years of age are different from those in an older population, we aimed to evaluate quality of life and the quality of sports activity after UKA in this population.Patients and methodsSixty-five UKAs in 62 patients younger than 60 (mean age: 54.7 years; mean BMI: 28kg/m2) performed between 1989 and 2006 were included. At last follow-up (minimum 2 years), before the objective evaluation, patients were asked to fill in a KOOS questionnaire and a specific sports questionnaire including the UCLA score and questions from the Mohtadi score.ResultsWith a mean follow-up of 11.2±5 years (range, 2–19 years), the KOOS score was higher than 75 points in 90% of the patients for the quality-of-life categories but also for the score's four other categories: 83.4% of the patients had resumed their sports activities and the mean UCLA score was 6.8 (range, 4–9); 90% of the patients reported no or slight limitation during sports activities. The function KSS improved from 52±4 to 95±3 points postoperatively and the Knee KSS from 50±4 to 94±4 points. With three patients undergoing revision for an isolated insert exchange, one for septic loosening and three for osteoarthritis in the external compartment, the 12-year Kaplan-Meier survivorship was 94%.Discussion and conclusionThese results confirmed that UKA can provide good patient-rated outcomes, which is very important in this demanding population. As for TKA, wear remains a problem in this active population.Level of evidenceTherapeutic study, level IV

Lower function, quality of life, and survival rate after total knee arthroplasty for posttraumatic arthritis than for primary arthritis

International audienceBackground and purpose - Total knee arthroplasty (TKA) for treatment of end-stage posttraumatic arthritis (PTA) has specific technical difficulties and complications. We compared clinical outcome, postoperative quality of life (QOL), and survivorship after TKA done for PTA with those after TKA performed for primary arthritis (PA). Patients and methods - We retrospectively reviewed patients who were operated on at our institution for PTA between 1998 and 2005 (33 knees), and compared them to a matched group of patients who were operated on for PA during the same period (407 knees). Clinical outcomes and postoperative QOL were compared in the 2 groups using Knee Society score (KSS), range of motion (ROM) of the knee, and the knee osteoarthritis outcomes score (KOOS). Implant survival rate was calculated using Kaplan-Meier analysis. Results - At a mean follow-up of 11 (5-15) years, KSS knee increased from mean 39 (SD 18) to 87 (SD 16) in the PA group (p = 0.003), and from 31 (SD 11) to 77 (SD 15) in the PTA group (p = 0.003). KSS function increased from 55 (12) to 89 (25) in the PA group (p = 0.008) and from 44 (SD 14) to 81 (SD 10) in the PTA group (p = 0.008). Postoperative ROM also improved in both groups, from 83 degrees to 108 degrees in the PTA group (p < 0.001) as opposed to 116 degrees to 127 degrees in the PA group (p = 0.001), with lower results in the PTA group (p < 0.001). KOOS was lower in the PTA group (p < 0.001). The survival rate of TKA at 10 years with an endpoint defined as "any surgery on the operated knee" showed better results in the PA group (99%, CI: 98-100 vs. 79%, CI: 69-89; p < 0.001). Interpretation - Patients and surgeons should be aware that clinical outcome and implant survival after TKA for PTA are lower than after TKA done for P

Clinical, ultrasonographic and CT markers for botulinum toxin injections into the piriformis muscle

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