Hip kinematics and kinetics in total hip replacement patients stratified by age and functional capacity

To examine functional differences in total hip replacement patients (THR) when stratified either by age or by functional ability as defined by self-selected walking speed. THR patients and a control group underwent three-dimensional motion analysis under self-selected normal and fast walking conditions. Patients were stratified into five age groups for comparison with existing literature. The THR cohort was also stratified into three functional groups determined by their self-selected gait speed (low function 1S.D; normal function within 1S.D). Hip kinematics, ground reaction forces, joint moments and joint powers in all three planes (x-y-z) were analysed. 137 THR and 27 healthy control patients participated. When stratified by age, during normal walking the youngest two age groups walked quicker than the oldest two groups (p<0.0001) but between-group differences were not consistent across age strata. The differences were diminished under the fast walking condition. When stratified by function, under normal walking conditions, the low function and normal function THR groups had a reduced extension angle (mean=1.75°, SD=±7.75, 1.26°±7.42, respectively) compared to the control group (-6.07°±6.43; p<0.0001). The low function group had a reduced sagittal plane hip power (0.75watts/kg±0.24), reduced flexor (0.60Nm/kg±0.85) and extensor moment (0.51Nm/kg±0.17) compared to controls (p<0.0001). These differences persisted under the fast walking condition. There were systematic differences between patients when stratified by function, in both walking conditions. Age related differences were less systematic. Stratifying by biomechanical factors such as gait speed, rather than age, might be more robust for investigating functional differences

Implementation of podiatry telephone appointments for people with rheumatic and musculoskeletal diseases

Abstract: Background: Foot health problems are common in the general population, and particularly so in people with rheumatic and musculoskeletal disorders (RMD). Several clinical guidelines state that people with RMDs should have access to foot health services, although service capacity is often limited. The current COVID-19 pandemic has increased the need for alternative ways to provide patient care. The aim of this clinical audit was to review a newly implemented telephone follow-up appointment service conducted within the Rheumatology Podiatry Department in Leeds, UK. Methods: Fifty-eight patients attending the Rheumatology Podiatry Department at Leeds Teaching Hospitals NHS Trust were contacted by telephone approximately 6–8 weeks following initial intervention. During the telephone consultation, all patients were asked pre-defined questions relating to their symptoms, intervention efficacy, the need for further appointments and their preference for the type of consultation. To assess the cost of the telephone consultation the number of attempts needed in order to make successful contact, the duration of the call and the number of telephone follow-up appointments completed in a working day were also recorded. Results: Twenty-five patients (43%) were successfully contacted within the 6–8 weeks stipulated time frame and were included in the analysis. Of the 25 contacted, twelve (48%) patients were successfully contacted on the first attempt. Ten (40%) were successfully contacted on the second attempt. The remaining three patients (12%) required 3 or more attempts to make successful contact. Telephone consultations were estimated not to last longer than 10 min, including notes screening and documentation. Eleven patients (44%) reported an improvement in their symptoms, thirteen (52%) reported no change and one patient (4%) reported their symptoms to be worse. Conclusion: Telephone follow-up consultations may be a potentially cost-effective alternative to face-to-face appointments when implemented in a Rheumatology Podiatry Department, and provide an alternative way of providing care, especially when capacity for face-to-face contact is limited. The potential cost saving and efficiency benefits of this service are likely to be enhanced when telephone consultations are pre-arranged with patients

Adoption of technology enabled care to support the management of children and teenagers in rheumatology services: a protocol for a mixed-methods systematic review

Introduction COVID-19 catalysed a rapid move to provide care away from the hospital using online communication platforms. Technology enabled care (TEC) continues to be an important driver in progressing future healthcare services. Due to the complex and chronic nature of conditions seen within paediatric rheumatology, TEC may lead to better outcomes. Despite some growth in published literature into the adoption of TEC in paediatric rheumatology, there is limited synthesis. The aim of this review is to provide a comprehensive understanding and evaluation of the adoption of TEC by patients in paediatric rheumatology services, to establish best practices. Methods and analysis This proposed mixed-methods systematic review will be conducted by searching a wide variety of healthcare databases, grey literature resources and associated charities and societies, for articles reported in English language. Data extraction will include population demographics, technology intervention, factors affecting adoption of intervention and consequent study outcomes. A parallel-results convergent synthesis design is planned, with independent syntheses of quantitative and qualitative data, followed by comparison of the findings of each synthesis using a narrative approach. Normalisation process theory will be used to identify, characterise and explain implementation factors. The quality of included articles will be assessed using the Mixed Methods Appraisal Tool for research papers and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for grey literature. Overall confidence in quality and strength of evidence will be assessed using the Confidence in the Evidence from Reviews of Qualitative Research tool. Ethics and dissemination Ethical approval is not required due to the nature of this mixed-methods systematic review. The findings will be disseminated via a peer-reviewed journal, relevant conferences and any other methods (eg, via NHS Trust or NIHR YouTube channels) as advised by paediatric rheumatology patients

Clinical consensus recommendations for the non-surgical treatment of children with Perthes’ disease in the UK

Aims The aim of this study was to produce clinical consensus recommendations about the non-surgical treatment of children with Perthes’ disease. The recommendations are intended to support clinical practice in a condition for which there is no robust evidence to guide optimal care. Methods A two-round, modified Delphi study was conducted online. An advisory group of children’s orthopaedic specialists consisting of physiotherapists, surgeons, and clinical nurse specialists designed a survey. In the first round, participants also had the opportunity to suggest new statements. The survey included statements related to ‘Exercises’, ‘Physical activity’, ‘Education/information sharing’, ‘Input from other services’, and ‘Monitoring assessments’. The survey was shared with clinicians who regularly treat children with Perthes’ disease in the UK using clinically relevant specialist groups and social media. A predetermined threshold of ≥ 75% for consensus was used for recommendation, with a threshold of between 70% and 75% being considered as ‘points to consider’. Results A total of 40 participants took part in the first round, of whom 31 completed the second round. A total of 87 statements were generated by the advisory group and included in the first round, at the end of which 31 achieved consensus and were removed from the survey, and an additional four statements were generated. A total of 60 statements were included in the second round and 45 achieved the threshold for consensus from both rounds, with three achieving the threshold for ‘points to consider’. The recommendations predominantly included self-management, particularly relating to advice about exercise and education for children with Perthes’ disease and their families. Conclusion Children’s orthopaedic specialists have reached consensus on recommendations for non-surgical treatment in Perthes’ disease. These statements will support decisions made in clinical practice and act as a foundation to support clinicians in the absence of robust evidence. The dissemination of these findings and the best way of delivering this care needs careful consideration, which we will continue to explore

Older parents of people who have a learning disability : perceptions of future accomodation needs

The aim of this qualitative study was to provide an insight into the perceptions of older parents of learning disabled people on the future accommodation needs of their adult children. Semi-structured interviews were used to seek parental awareness of residential options available, concerns in relation to future accommodation and the preferred accommodation options for their offspring. Four couples who shared the family home with an adult who has a learning disability took part in the study and data was analysed using a step by step form of content analysis as described by Burnard (1991). Emergent themes from transcripts were then organised into main categories The results of this study suggest that older parents are dissatisfied with both statutory and private services, that they have concerns for their non-disabled children and their own ageing. Being a parent to a person who has a learning disability is seen to be a difficult task and yet parents may want to provide support at home for as long a possible. Of the parents who participated in this study, three couples wanted to maintain their adult child at home for as long as possible and the parents who were actively seeking accommodation outside the family home expected to be involved in all aspects of their daughter�s care for the long term future

Which patellofemoral joint imaging features are associated with patellofemoral pain? Systematic review and meta-analysis

Objectives: To review the association between patellofemoral joint (PFJ) imaging features and patellofemoral pain (PFP). Design: A systematic review of the literature from AMED, CiNAHL, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PEDro, EMBASE and SPORTDiscus was undertaken from their inception to September 2014. Studies were eligible if they used magnetic resonance imaging (MRI), computed tomography (CT), ultrasound (US) or x-ray (XR) to compare PFJ features between a PFP group and an asymptomatic control group in people < 45 years of age. A pooled meta-analysis was conducted and data was interpreted using a best evidence synthesis. Results: Forty studies (all moderate to high quality) describing 1,043 people with PFP and 839 controls were included. Two features were deemed to have a large standardised mean difference (SMD) based on meta-analysis: an increased MRI bisect offset at 0° knee flexion under load (0.99; 95% CI: 0.49, 1.49) and an increased CT congruence angle at 15° knee flexion, both under load (1.40 95% CI: 0.04, 2.76) and without load (1.24; 95% CI: 0.37,2.12). A medium SMD was identified for MRI patella tilt and patellofemoral contact area. Limited evidence was found to support the association of other imaging features with PFP. A sensitivity analysis showed an increase in the SMD for patella bisect offset at 0° knee flexion (1.91; 95% CI: 1.31,2.52) and patella tilt at 0° knee flexion (0.99; 95% CI: 0.47,1.52) under full weight bearing. Conclusion: Certain PFJ imaging features were associated with PFP. Future interventional strategies may be targeted at these features

Masculinities, affect and the (re)place(ment) of stardom in Formula One fan leisure practices

Writing from an autoethnographic perspective, this article explores male leisure practices via the mediated relationships fans enter into with stars. More specifically, my own fandom for Formula One driver Jacques Villeneuve is the locus of study, revealing how this affective investment shapes and furnishes my corresponding leisure practices. Notions of gendered 'performativity' come to the fore, with my own displays evoking, enacting and revealing oscillating performances of masculinity. Moreover, there are interesting gendered dynamics that such fan leisure practices flag in terms of the intersection of female/male relationships and the potential 'fantasy' and/or narcissistic readings that a male fan identifying with and performing as another male sport star afford. Finally, my research reveals paradoxes for contemporary masculinities, with fans reliant upon mediation and commodification to facilitate and sustain their performative roles. © 2011 Taylor & Francis

Distribution and effect of joint pain in people with hypermobility syndrome: pilot results By Redmond, AC., Hain,J (married name Tranter)Bird, H.A.

Background: Joint hypermobility syndrome (HMS) is thought to be associated with increased pain and reduced health status and quality of life. Good quantitative data are rare however, and no studies exist comparing HMS patients with directly matched controls. Objectives: The aim of the current study was to pilot a large national prevalence study of the effects of HMS on joint pain and health status. Methods: 39 people with a diagnosis of hypermobility completed survey forms covering general health status (EuroQoL EQ5D, Manchester Foot Pain and Disability Questionnaire), foot pain (Visual Analogue Scale) and distribution of symptoms. Age and gender matched controls completed a modified version of the same survey forms. Results: The sample comprised 39 hypermobiles (36F, 3M) and 37 controls (28F, 9M). The mean ages were 38 years (HMS) and 36 years (controls). Within the HMS group 16 (41%) knew their HMS type to be benign familial, three reported a diagnosis of EDS type 1, and five EDS type 3. Fifteen did not know. People with HMS had significantly worse general health measured by EQ-5D (65pts vs 90**), much greater foot impairment (MFPDQ scores 16/33 vs 0/33**) and greater foot pain VAS scores (34mm vs 0.4mm**)(where ** represents P<0.001). Respondents provided data on Likert-type scales reporting frequency of symptoms in various joints and limb segments. The measures employed five point scales labelled with ranks "never", "seldom", "sometimes", "much of the time", and "constantly". With the exception of headache, people with HMS reported significantly higher rates of symptoms in all axial and upper limb segments or joints. The most commonly affected joints were the shoulders, hands and lower back (see Table). Frequency and location of symptoms: N (%) of HMS group reporting Median score HMS Median score control symptoms 'sometimes' group (+ descriptor) group (+ descriptor) Neck 27 (69%) 2 (sometimes) 1 (seldom)** Shoulders 30 (77%) 3 (much of the time) 0 (never) ** Elbows 18 (46%) 1 (seldom) 0 (never) ** Hands 31 (79%) 3 (much of the time) 0 (never) ** Lower back 29 (74%) 3 (much of the time) 1 (seldom) ** Hips 30 (77%) 3 (much of the time) 0 (never) ** Knees 34 (87%) 3 (much of the time) 0 (never) ** Ankles 29 (74%) 3 (much of the time) 0 (never) ** Feet 28 (72%) 3 (much of the time) 0 (never) ** **Significantly different, adjusted P<0.001 In the lower limb the hips, knees, ankles and feet all returned medians of three indicating impairment "much of the time". All responses were significantly worse than those of the control group. Conclusion: Nearly 9/10 people with HMS report joint symptoms, most commonly affecting the knees, hands, shoulders, wrists and hips. Symptoms associated with HMS were significantly more frequent than in the control group and were associated with increased pain and significantl

An enhanced protocol to reduce error in electromagnetic tracking of first metatarsophalangeal joint motions

Background: Error associated with markers or sensors surface-mounted onto skin reduces the validity of kinematic models. Extensor tendon excursion at the first metatarsophalangeal joint (MTPJ) has been noted previously to be especially problematic. An enhanced skin mounting protocol is described and validated. Methods: A Fastrak� system was used to obtain kinematic data concurrently from two pairs of sensors mounted on either side of the first MTPJ of nine freshly frozen cadaveric feet. One sensor pair was mounted directly into the medulla of each of the first metatarsal and proximal phalanx of the hallux, with the second pair attached to the skin over the same segments, using each of two mounting protocols. A standard mounting protocol was compared to a new enhanced protocol that secured the sensor on the hallux with a stabilizing cuff. Results: The addition of a stabilizing cuff on the hallux sensor reduced root mean square error in first MTPJα rotations by 1.45°during passive rotation and 1.61°during active rotation compared with the standard protocol (P = 0.008 and 0.028, respectively). The cuff protocol improved CMC reliability coefficients for α rotations from 0.918 to 0.973 for passive MTPJ motion, and from 0.922 to 0.973 for active motion. Conclusion: Securing the hallux mounted sensor with a stabilizing cuff reduced error by more than one-third without reducing first MTPJ total range of motion. © 2005 Elsevier B.V. All rights reserved

AB0991 The role of metal artefact correction techniques in patients with metallic joint prostheses

Background Magnetic Resonance (MR) offers the potential to identify early loosening and assess peri-articular soft tissue structures in patients with metal joint prostheses. Unfortunately, conventional MR is currently incapable of assessing the prosthesis-bone interface in patients with joint replacements because of field inhomogeneity resulting from metal related paramagnetic and ferromagnetic effects. New Slice-Encoding Metal Artefact Correction (SEMAC) techniques have been developed that may allow visualisation of the bone and soft tissues close to metal work. Objectives In order to explore the clinical utility of the technique, we conducted a retrospective audit of conventional MR and the newer metal suppression techniques. Methods Patients who had previously received hip prostheses and were undergoing clinical review were imaged using both conventional and metal suppression MR techniques using a Siemens Avanto 1.5T MR scanner as part of their routine clinical care. T1 TSE and STIR coronal and T1 and STIR SEMAC sequences were assessed. The femoral and acetebaular components were consensus scored by two experienced musculoskeletal radiologists for diagnostic quality. Each prosthesis zone was scored using a five point scale: (0) definitely non-diagnostic; (1) probably non-diagnostic; (2) possibly diagnostic; (3) probably diagnostic; (4) definitely diagnostic. Abnormalities were assessed on both radiographs and MRI using a four point scale: (0) none; (1) mild; (2) moderate; (3) severe. Effusion and bone-cement interface were assessed by prosthesis zone. These abnormalities were defined as increased signal on STIR sequences with intermediate signal on T1 scans. Results Images were reviewed from 19 patients (mean age = 64; SD = 12 years) with a variety of hip prostheses (Charnley = 4, Corail = 7, Furlong = 1, Metal-on-Metal = 7). SEMAC increased the number of diagnostically useful images (defined as ≥2) in all Gruen zones for both STIR and T1 images. Importantly, this also translated into to an increased ability to identify abnormalities: Use of SEMAC enabled identification of more abnormalities in all Gruen zones and doubled the number of effusions visible. Conclusions The use of SEMAC sequences substantially improved image quality and enabled identification of more peri-prosthetic complications in patients with metallic joint prostheses