This study reports the outcome of patients who satisfied the recommended indications for the Oxford phase 3 unicom- partmental knee replacement : anteromedial osteoarthri- tis, spontaneous necrosis, the medial and anterior cruciate ligament should be functionally normal and the lateral tibio- femoral compartment should not be significantly affected. In anteromedial osteoarthritis there should be bone on bone contact. As the outcome shown in our evaluation is favour- able, these indications seem to be appropriate. However, Table 1 Outcome of UKA
Once we achieved a final cultural-adapted version of the ‘Hip and Knee Questionnaire’ , a multicenter and prospective study was conducted, in which we collected patient data that were tested before and after primary kneearthroplasty. This makes a large group of patients from different hospital centers around Spain, avoiding geographic bias. This evaluation test was implemented not only for the mentioned questionnaire, but for two validated scale; a specific one (WOMAC) and a generic (SF-36), widely used in our country. The SF-36 Health Questionnaire, [13,14] measures health-related quality of life, applicable to any group of population. Its Spanish version has already been validated [15-17]. The WOMAC questionnaire  is a specific instrument developed to evaluate the impact in quality of life of osteoarthritis. The questionnaire has been previously translated and validated in Spain . With these data, we proceeded to the ana- lysis of psychometric properties of the ‘Hip and Knee’: feasibility, reliability, validity and sensitivity to change.
Although numerous methods of providing postoperative analgesia after total kneearthroplasty have been reported, the optimal technique based on efficacy, number/type of side effects, surgical outcome, and resource utilization is unknown. Several European studies have suggested that aggressive postoperative analgesic techniques maintained for 48-72 hours result in a shorter rehabilitation period and increased joint mobility. Singelyn et al (Singelyn, 1998) assessed the influence of three analgesic techniques (pa- tient-controlled analgesia, continuous femoral 3-in-1 block, and epidural analgesia) on postoperative knee rehabilita- tion after TKA. Patients receiving regional analgesic tech- niques reported significantly lower pain scores, better knee flexion (until 6 weeks after surgery), faster ambulation, and shorter hospital stay compared to patients receiving intra- venous morphine. However, these benefits did not affect outcome at 3 months.
There is general agreement among physicians that pain should be considered the principal criterion for determining who is a candidate for primary hip or kneearthroplasty [15,38]. In line with this, the percentage of patients undergoing THR with severe “pain when walk- ing ” was over 90% in half of the hospitals we studied (82.1% in the hospital with the lowest rate). In the TKR group, the percentage of patients reporting severe pain when walking before the surgery was also above 90% in half of the hospitals, but the figure for one of the hospi- tals was as low as 52.9%. Nevertheless, the overall varia- bility was small (0.06-0.12) in both cases.
Introduction : Pharmacological prophylaxis for venous thromboembolism is recommended for the vast majority of patients undergoing major orthopedic surgery. Increased risk of bleeding after the use of these agents has been widely documented in general population. Conversely, the frequency of this complication has not been studied in the subpopulation of elderly patients. The purpose of this study is to determine whether the risk of major bleeding after major orthopedic surgery is higher in elderly patients, compared to those operated at a younger age. Methods : We performed a retrospective cohort study including patients who underwent total hip and total kneearthroplasty during five consecutive years. Patients with other causes of bleeding were excluded. Medical records were reviewed in order to determine the occurrence and manifestation of major bleeding. A nested case-control analysis was used to determine which age group had the greatest odds ratio (OR) for major bleeding. Then, we compared two cohorts grouped by age. Relative risks (RR) and confidence intervals (CI) were calculated and a multivariate analysis was performed. Results : A total of 1048 patients were included in the analysis. Of these, 56% corresponded to hip joint replacements and 44% to knee joint replacements. The case control analysis reported that patients who were 70 years or older at the time of surgery had the highest OR (2.61) for major bleeding, therefore a limit of 70 years old was established to create two cohorts. At the time of surgery 553 (53%) pa tients were 70 years or older while 495 (47%) were younger. Patients who were ≥70 years old showed an increased risk of major bleeding: RR 2,42 (95% CI: 1.54-3.81). After total hip arthroplasty the RR was 2,61 (95%CI: 1.50-4.53) and after total kneearthroplasty was 2.25 (95% CI: 1.03-4.94). After the multivariate analysis, age continued to be independently associated with a higher risk of major bleeding. Conclusion : This study allows to conclude that patients who are 70 years or older are at a higher risk of major bleeding after major orthopedic surgery than younger patients. Therefore, the use of appropriate strategies to mitigate the risk in this group of patients is encouraged.
18.Cheng T, Zhu C, Guo Y, Shi S, Chen D, Zhang X. Patellar denervation with electrocau- tery in total kneearthroplasty without patellar resurfacing: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2014 Nov;22(11):2648-54. 19.Clarke HD, Scott CW, Insall JN, Pedersen HB, Math KR, Vigorita VJ, et al. Anatomy. En: Scott WN, editor. Insall & Scott Surgery of the knee. 5 th ed. Philadelphia: Elsevier; 2012. p. 37-40.
48. Leta TH, Lygre SH, Skredderstuen A, Hallan G, Gjertsen JE, Rokne B, et al. Outcomes of Unicompartmental KneeArthroplasty After Aseptic Revision to Total Knee Arthroplas- ty: A Comparative Study of 768 TKAs and 578 UKAs Revised to TKAs from the Norwe- gian Arthroplasty Register (1994 to 2011). J Bone Joint Surg Am. 2016 Mar;98(6):431 -40.
17.Bryceland JK, Powell AJ, Nunn T. Knee Me- nisci. Cartilage. 2017 Apr;8(2):99-104. 18.Jarraya M, Roemer FW, Englund M, Crema MD, Gale HI, Hayashi D, et al. Meniscus mor- phology: does tear type matter? A narrative re- view with focus on relevance for osteoarthritis research. Semin Arthritis Rheum. 2017 Apr;46 (5):552-61.
Objective: The aim of this study was to compare the differences in knee sensorimotor control between healthy men and women by measuring the joint position sense (JPS), sensation of muscle tension (steadiness), and onset of muscle activation (OMA). Meth- ods: Twenty-four healthy women and 27 healthy men were tested. Knee sensorimotor control was assessed using the JPS test with electrogoniometers in 3 different ranges of motion, sensation of muscle tension using the isometric steadiness technique, and OMA against a mechanical perturbation. Each assessment was compared by sex, physical activity level, and right or left lower limb. Results: The men obtained better values in the JPS test between 90º and 60º and between 30º and 0º than the women. The subjects with higher levels of physical activity also showed better values, between 90º and 60º and between 30º and 0º. The best results for steadiness were found in the women and the subjects with higher levels of physical activity. In the OMA test, no significant differences were found in the studied variables. Conclusion: The results suggest that higher levels of physical activity may determine better sensorimotor control. Men have better articular sensation, and women have better muscle strength control. Level of evidence III, Cross sectional study.
Consistent with previous results in the healthy knee (39 Y 41, 43, 44), the mean T SD T2 value was 37.0 T 6.8 ms (see Figure S4A, SDC, http://links.lww.com/TP/A811). Be- cause 95% of values should be smaller than (mean+2 SD), 50 was chosen as the threshold above which T2 values were considered inordinately high. To quantify T2 mapping, a Poor Cartilage Index (PCI) was estimated as the percentage of T2 values more than 50 ms. A PCI of 100 is the worst possi- ble value, and a value near 5 is considered healthy. A posi- tive correlation was identified between the baseline PCI and VAS scores (r=0.42; P G 0.001) (see Figure S4B, SDC, http://links.lww.com/TP/A811). Additionally, the mean PCI significantly decreased from 19.5 to 15.4 during the first 6 months after treatment and further decreased to 14.3 at 12 months after injection ( Fig. 2A). Figure S4C details individual patient F2
The missing information about uphill and downhill effects from some territories can lead to overload in knee joints, transducing to pain to daily activities. This justifies the definition of well-planned and scientifically tested hiking trails, to set the most appropriate paths for people’s plan their hike, always taking into consideration their fitness level and/or musculoskeletal limitations. Moreover, it is necessary to adopt preventive measures to reduce the gap of the inland territory in terms of demand for hiking practice. In this sense, this study aimed to characterize the knee joint forces in three trails from the Serra da Estrela territory with distinct characteristics.
pero hubo diferencia signifi cativa después de seis meses para los tres puntajes. Las mujeres presentaron mejoría signifi cativa en sólo una de seis posibles combinaciones de evolución- tratamiento (índice WOMAC), mientras que los hombres evidenciaron mejoría signifi cativa en cinco de seis (todas las mediciones, excepto la Knee Society Score). Conclusión: Se detecta- ron diferencias entre los pacientes tratados con y sin diacereína con respecto al alivio de dolor o mejoría de la función al cabo de seis meses de seguimiento. Las mujeres tuvieron menor respuesta al tratamiento en comparación con los hombres en las tres escalas de valoración. Palabras clave: Artrosis, rodilla, antiinfl ama- torio, dolor, tratamiento.
En la dirección longitudinal el sistema columna-armadura no presenta estabilidad suficiente para fuerzas sísmicas perpendiculares a su plano. Dado ello, se propuso dos sistemas estructurales, pórtico ordinario resistente a momento y pórticos tipo “knee braced moment frame” (pórtico con riostra de esquina), Figura 1.4. Tener dos soluciones nos permite realizar una comparación, el cual se ha basado en: comportamiento estructural y economía.
Our experience with the ARPE thumb CMC joint replacement has been good. The survivorship rate at 10 years of the implants that remain functional was 93.9%. This result was better than the 82% and 89% published in series of the cemented Caffiniere pros- thesis with similar follow-up (Amillo et al., 2002; Chakrabarti et al., 1997; Sondergaard et al., 1991), and better than the results at longer follow-up of 89% (16 years) and 73.9% (26 years) as expected (Johnston et al., 2012). The results of this study are close to that achieved with total hip arthroplasty (standard refer- ence) of 93.1% (Allami et al., 2006).
Force steadiness was not altered in the HT or BPTP groups in comparison to the controls. To our knowledge, this is the first study comparing this variable between patients with different ACL surgical grafts. Force fluctuation is dependent on the interaction of multiple features of motor unit behavior, which change as a function of contraction intensity . Alterations in motor unit recruitment and rate coding properties or adaptations in the activation pattern of the motor unit population (e.g., motor unit synchronization and coherence) would affect force variability . Impairments in force steadiness have been associated with ACL injury and ACLR . Considering this, the obtained steadiness results suggest that, by 6–12 months post-surgery, both assessed patient groups (HT and BPTP) had adequately adapted neuromo- tor control of the knee muscles and were, therefore, able to reduce force fluctuations during isometric contractions. While the exact mechanisms of this adaptation are unknown, several hypotheses can be postulated. First, the post-operative period (i.e., 6–12 months) may have been enough for muscle contraction to recover. Although ACL injury and the degree of graft regeneration are linked to muscle weakness [16, 28], quadriceps and hamstrings strength recovers early during the rehabilitation period after ACLR  regardless of the degree of graft regeneration [23, 59] probably due to neuromuscular adaptations such as enhanced ligament- muscular reflex arc excitability . Second, neuromuscular adaptations such as increased antagonist coactivation may increase fine muscle control and force steadiness, thus increasing muscle stiffness and joint stability [11, 12]. Moreover, lower limb training such as within the rehabilitation process, may improve force steadiness directly  or indirectly through increased muscle coactivation . Therefore, the results of the present study suggest that commonly used rehabilitation protocols (as used with the assessed patient groups ) may restore force steadiness 6 to 12 months after ACL surgery, independent of the type of graft used in the surgery. Future studies may use prospective designs to clarify the effect of the reha- bilitation protocols in force steadiness.
37.Kyung HS, Lee BJ, Kim JW, Yoon SD. Biplanar open wedge high tibial osteotomy in the medial compartment osteoarthritis of the knee joint: comparison between the Aescula and TomoFix plate. Clin Orthop Surg. 2015 Jun;7(2):185-90. 38.Ramanoudjame M, Vandenbussche E, Baring T, Solignac N, Augereau B, Gregory T. Fibular nonunion after closed-wedge high tibial osteoto- my. Orthop Traumatol Surg Res. 2012 Dec;98 (8):863-7.
GI- Grupo de intervención. GC- Grupo control. Dx- Diagnóstico. IMC- Índice de masa corporal. EVA- Escala analógica visual. K/L- Índice de Kellgren Lawrence. WOMAC- Cuestionario Western Ontario and McMaster Universities Arthritis Index. CRP- Proteína “C” reactiva. IL-6- Interleukina 6. TNF- Factor de necrosis tumoral. mg/L- Miligramos por litro. CV- Cardiovascular. PA- Presión arterial. VLED- Dieta muy hipocalórica. LED- Dieta hipocalórica. ALF- Aggregated Locomotor Function. MSM- Metil-sulfonil-metano. LI- Índice Likert. KOOS- Knee injury and Osteoarthritis Outcome Score. TUG- Test Up and Go. MRI- Resonancia nuclear magnética. AVD- Actividades de la vida diaria. ADL- Actividades de la vida diaria. Rx- Radiografía. HA- Ácido hialurónico. C2C- Degradación de colágeno tipo II.
9. Bruyere O, Ethgen O, Neuprez A, Zégels B, Gillet P, Huskin JP, et al. Health- related quality of life after total knee or hip replacement for osteoarthritis: a 7- year prospective study. Arch Orthop Trauma Surg. 2012 Nov;132(11):1583-7. 10. Engelhart L, Nelson L, Lewis S, Mordin M, Demuro-Mercon C, Uddin S, et al. 11. Validation of the Knee Injury and Osteoarthritis Outcome Score subscales for
función, la estabilidad y el grado de movilidad, y de la corrección de la deformidad. Estas áreas se analizan mediante la valoración subjetiva del paciente (tabla de la British Association of the Knee, AICHROTH, 1978), los síntomas (el dolor se registra en relación con la actividad o durante el descanso), la función (es la parte más difícil de la evaluación debido a la compleja interacción entre la función de la rodilla y la función del paciente, ya que la población que se somete a cirugía protésica de la rodilla es normalmente mayor, y es probable que su nivel de función se deteriore con el incremento de la edad, y posteriormente pueda también desarrollar problemas médicos que afectarán a la función), la valoración de los factores limitantes (la afectación sistémica, la participación de otras articulaciones-como por ejemplo sucede en la artritis reumatoide-), la exploración clínica (grado de movilidad, alineación y laxitud en los planos coronal y sagital), los datos radiológicos (la alineación de la rodilla y los tres criterios establecidos en la actualidad hay para obtener una evidencia radiológica del fracaso: la migración de un componente, la fractura del cemento o de un componente y una línea radiotransparente completa alrededor del mismo), y el análisis de la supervivencia (es decir, que la mejoría debe permanecer durante un periodo aceptable de tiempo y preferiblemente durante toda la vida del paciente (SWANSON, 1980).
Therefore, the mimetic active orthosis has been developed to be used as a rehabilitation tool to generate similar gait movements on a function modified lower limb. We kept in mind that a com- fortable active orthosis might be developed to avoid patient rejection before conceiving a rehabilitation tool. These movements are induced by an artificial pattern formed from the information provided by the instrumentation placed on the non-altered lower limb. The orthosis was designed and constructed for hip and lower limbs. Metallic bars, commonly pre- scribed in prosthetics and orthotics were used to build an exoskeleton that was attached to lower limbs and around pelvis and thorax. One part of the ex- oskeleton included sensors based on deformation properties for plantar pressure points and angle measurement devices to generate reference pa- rameters for the artificial gait pattern (AGP). Pneu- matic actuators for hip and knee articulations, com- manded by the AGP, were placed on the contralateral side.