Good vs Poor Results After Total Hip Arthroplasty: An Analysis Method Using Implant and Anatomic Parameters With the EOS Imaging System

Background: Existing imaging techniques and single-parameter analyses, in nonfunctional positions, fail to detect the differences between patients with good vs poor results after total hip arthroplasty. Methods: The present study developed an analysis method using the EOS full-body, low-dose, biplanar, weightbearing imaging system to compare good vs poor patients after total hip arthroplasty and to report on our preliminary experiences (17 good, 18 poor). Results: All revision cases were found to have at least 4 high or low implant or anatomic parameters relative to the good group. These included acetabular cup orientation, sagittal pelvic tilt, sacral slope, femoral offset, and neckeshaft angle. Acetabular cup orientation differed significantly between groups. Conclusion: With the EOS system, a large cohort can be studied relatively quickly and at low dose, which could lead to patient-specific guidelines

A critical appraisal of guidelines for the management of knee osteoarthritis using Appraisal of Guidelines Research and Evaluation criteria

Clinical practice guidelines have been elaborated to summarize evidence related to the management of knee osteoarthritis and to facilitate uptake of evidence-based knowledge by clinicians. The objectives of the present review were summarizing the recommendations of existing guidelines on knee osteoarthritis, and assessing the quality of the guidelines using a standardized and validated instrument – the Appraisal of Guidelines Research and Evaluation (AGREE) tool. Internet medical literature databases from 2001 to 2006 were searched for guidelines, with six guidelines being identified. Thirteen clinician researchers participated in the review. Each reviewer was trained in the AGREE instrument. The guidelines were distributed to four groups of three or four reviewers, each group reviewing one guideline with the exception of one group that reviewed two guidelines. One independent evaluator reviewed all guidelines. All guidelines effectively addressed only a minority of AGREE domains. Clarity/presentation was effectively addressed in three out of six guidelines, scope/purpose and rigour of development in two guidelines, editorial independence in one guideline, and stakeholder involvement and applicability in none. The clinical management recommendation tended to be similar among guidelines, although interventions addressed varied. Acetaminophen was recommended for initial pain treatment, combined with exercise and education. Nonsteroidal anti-inflammatory drugs were recommended if acetaminophen failed to control pain, but cautiously because of gastrointestinal risks. Surgery was recommended in the presence of persistent pain and disability. Education and activity management interventions were superficially addressed in most guidelines. Guideline creators should use the AGREE criteria when developing guidelines. Innovative and effective methods of knowledge translation to health professionals are needed

Healthy vs. osteoarthritic hips: A comparison of hip, pelvis and femoral parameters and relationships using the EOS® system

Osteoarthritis is a debilitating disease, for which the development path is unknown. Hip, pelvis and femoral morphological and positional parameters relate either to individual differences or to changes in the disease state, both of which should be taken into account when diagnosing and treating patients. These have not yet been comprehensively quantified. Previous imaging studies have been limited by a number of factors: supine rather than standing measurements; high radiation dose; a limited field of view; and 2D rather than 3D measurements. EOS®, a new radiographic imaging modality that acquires simultaneous frontal and lateral (sagittal) X-ray images of the full body, allows 3D reconstruction of the hip, pelvis and lower limb. The aim of the study was to explore similarities and differences between healthy and osteoarthritis groups

Treatment of progressive multiple sclerosis: what works, what does not, and what is needed.

Disease-modifying drugs have mostly failed as treatments for progressive multiple sclerosis. Management of the disease therefore solely aims to minimise symptoms and, if possible, improve function. The degree to which this approach is based on empirical data derived from studies of progressive disease or whether treatment decisions are based on what is known about relapsing-remitting disease remains unclear. Symptoms rated as important by patients with multiple sclerosis include balance and mobility impairments, weakness, reduced cardiovascular fitness, ataxia, fatigue, bladder dysfunction, spasticity, pain, cognitive deficits, depression, and pseudobulbar affect; a comprehensive literature search shows a notable paucity of studies devoted solely to these symptoms in progressive multiple sclerosis, which translates to few proven therapeutic options in the clinic. A new strategy that can be used in future rehabilitation trials is therefore needed, with the adoption of approaches that look beyond single interventions to concurrent, potentially synergistic, treatments that maximise what remains of neural plasticity in patients with progressive multiple sclerosis

The effects of prolonged wear of textured shoe insoles on gait, foot sensation and proprioception in people with Multiple Sclerosis: protocol for a randomised controlled trial

Background: Many people with multiple sclerosis experience problems with walking, which can make daily activities difficult and often leads to falls. Foot sensation plays an important role in keeping the body balanced whilst walking; however, people with multiple sclerosis often have poor sensation on the soles of their feet. Wearing a specially designed shoe insole, which enhances plantar sensory information, could help people with multiple sclerosis to walk better. This study will explore whether long-term wear of a textured insole can improve walking in people with multiple sclerosis

Evaluation des propriétés mécaniques des muscles cervicaux (analyse du comportement dynamique du segment tête-cou lors de l'application de détentes rapides)

La stabilisation de la tête détermine l équilibre corporel, la prise d informations sensorielles et la protection des centres nerveux. Elle est régulée en partie par la raideur musculo-tendineuse des muscles cervicaux qui n a jamais été étudiée auparavant. Par ailleurs, la méthode de détentes rapides élaborée pour évaluer la raideur musculo-tendineuse n a jamais été appliquée à des segments corporels multi-articulaires. Les objectifs de ce travail sont de développer une méthode d évaluation de la raideur musculo-tendineuse du segment tête-cou par application de détentes rapides, de modéliser le segment tête-cou en un système mono-articulaire et d étudier les effets de la fatigue périphérique sur la raideur musculo-tendineuse du segment tête-cou. L analyse cinématique de la tête par accélérométrie montre que la relation entre le déplacement angulaire lors de détentes rapides et le niveau de force est reproductible. Les résultats n ont montré aucune relation entre la raideur musculo-tendineuse et le niveau de force. L analyse de la cinématique du segment tête-cou par un procédé d optimisation nous a permis de mettre en évidence une augmentation de la raideur musculo-tendineuse avec le niveau de force. D autre part, la fatigue périphérique ne semble pas générer de modifications de la raideur musculo-tendineuse des muscles cervicaux. Les résultats montrent que l application de détentes rapides, associée à une modélisation du segment tête-cou en un système mono-articulaire, semble aboutir à une estimation fiable de la raideur musculo-tendineuse du segment tête-couPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Relation between walking speed and muscle strength is affected by somatosensory loss in multiple sclerosis

Methods: Gait evaluation and isokinetic testing of muscular function were performed in 20 patients with unaided gait (expanded disability status scale < 6). Patients were separated into two groups in relation to the occurrence of somatosensory involvement: pyramidal group (8 patients) and sensory-pyramidal group (12 patients). Ten healthy subjects of similar age, sex, and height constituted a control group to evaluate gait parameters. Results: In the whole patient group, gait speed was reduced and strongly related to hamstring peak torque but not with quadriceps peak torque. The gait speed and peak torques of quadriceps and hamstrings were similar in both groups of patients. However, in the patients with proprioceptive loss there was both a strong correlation between gait speed and hamstring torque and a significant correlation with quadriceps torque. In the pyramidal group there was poor or no correlation. Conclusion: In patients with undifferentiated MS there is some correlation between gait speed and muscle strength. In the case of sensory loss, a higher contribution of both flexor and extensors of the lower limbs was observed, suggesting that muscular compensation occurred in this situation to maintain gait speed. These results are relevant to assess rehabilitation modalities in MS