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

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

Does Somatosensory Loss Induce Adaptation of the Gait Initiation Process?

International audienceGait initiation (GI) is the transient period between posture and movement. Its central programming takes into account the environmental constraints as well as the constraints induced by the body itself. Patients with peripheral sensory neuropathies display a severe proprioceptive deficit leading to balance and gait impairments and rely on a variety of compensatory mechanisms and are known to be dependent on vision. GI was studied on eight healthy subjects and five patients in order to assess the effect of somatosensory loss on the different phases of GI, combined with a manipulation of the visual inputs. Our main hypothesis is that the proprioceptive deficit would induce an adaptation of the GI process, especially when modifying the lower part of peripheral vision. The results show that the pathology induces some adaptations of the GI process, characterized by a decrease of the motor performance (assessed by the maximal anteroposterior velocity of the center of gravity at the end of the first step), a decrease in the spatial parameters (assessed by the peak amplitude of the backward shift of the center of foot pressure during the anticipation phase and the length of the first step), and a non-modification of the temporal parameters (assessed by the duration of the anticipation phase and of the first step). The suppression of the lower part of peripheral vision has no effect on the GI process. The role of the lower part of peripheral vision seems therefore to be less critical for GI, than for balance and locomotion

Acupunture et douleurs musculaires dans les dystrophies musculaires

Les douleurs musculaires ou myofasciales en relation avec une dystrophie musculaire peuvent-elles être soulagées par une acupuncture centrée sur le muscle ? Après un rappel sur les notions-clés de « trigger points myofasciaux » et de manipulations spécifiques des aiguilles d’acupuncture, nous rapportons quelques cas cliniques complexes parmi les patients atteints de maladies musculaires (MNM) et de la maladie de Charcot Marie Tooth (CMT) chez qui les douleurs myofasciales n’ont pas pu être contrôlées par des traitements médicamenteux et/ou par des techniques physiques. Ces patients ont été vus en consultation externe entre 2010 et 2017 à l’hôpital Rothschild, dans le service de Médecine Physique et de Réadaptation (MPR), en lien avec le Centre de Référence neuromusculaire « Paris-Nord/Est/Île-de-France ». Après la consultation initiale, plusieurs protocoles de soins ont été proposés, parmi lesquels figurait l’acupuncture effectuée par un médecin MPR

The relationship of childhood sexual and physical abuse with adulthood disability

International audienceObjective: The aim of this study was to examine the association of childhood sexual and physical abuse with disability in adulthood, and to assess how several demographic, physical, behavioral, psychosocial, and psychiatric factors may influence this association. Methods: This study used nationally representative cross-sectional data from 7403 people aged ≥ 16 years who participated in the 2007 Adult Psychiatric Morbidity Survey. Information on childhood sexual talk, sexual touching, sexual intercourse, and physical abuse occurring before the age of 16, and disability in activities of daily living and instrumental activities of daily living in adulthood were collected. Multivariable logistic regression analyses were conducted. Results: After adjusting for age, sex, and ethnicity, we found a positive association between different types of childhood abuse and adulthood disability: sexual talk (OR 1.54; 95% CI 1.27–1.85); sexual touching (OR 1.82; 95% CI 1.49–2.22); sexual intercourse (OR 2.58; 95% CI 1.75–3.81); physical abuse (OR 2.84; 95% CI 2.20–3.68). Increasing number of types of childhood abuse was associated with increased odds of adulthood disability. The odds of adulthood disability was increased for individuals who experienced all types of childhood abuse versus no childhood abuse (OR 3.59; 95% CI 1.64–7.84). Finally, the association between any childhood abuse and adulthood disability was largely explained by anxiety disorder, number of chronic physical conditions, and loneliness. Conclusions: Childhood abuse is positively associated with adulthood disability in England. Future longitudinal studies are warranted to understand the potentially complex interplay of factors that may increase risk for disability in individuals who experienced childhood abuse

Incidence sur la fonction motrice d'un programme d'exercices de renforcement réalisés sur plateforme mobile

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Influence of the cervical muscles fatigue on the head-neck segment musculo-tendinous stiffness

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Modélisation du segment tête-cou sous forme d'un segment corporel mono-articulé autour d'un centre de rotation variable lors de l'application de détentes rapides : étude de la raideur musculo-tendineuse sous l'effet de la fatigue musculaire

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Musculo-tendinous stiffness of head-neck segment in the sagittal plane: An optimization approach for modeling the cervical spine as a single-joint system

International audienceDespite the multi-linked architecture of the cervical spine, all previous studies that have made estimations of mechanical properties of the neck have considered the head–neck segment as a rigid link, with a fixed center of rotation at C7. The aim of this study was to consider the head–neck segment as a changeable geometry system for locating the resultant center of rotation and for calculating the musculo-tendinous stiffness by the quick-release method. Head kinematics during quick-releases was analyzed by recording the trajectory of surface markers. With an optimization procedure, the position of the resultant center of rotation of the head–neck segment was estimated. Thereafter, the angular displacement and acceleration of the head, together with the isometric torque developed by the cervical muscles were used to calculate the segment's stiffness. The results showed a consistent center of rotation and a significant increase of the musculo-tendinous stiffness with increasing torque