scholarly journals Three-Dimensional Gait Analysis Can Shed New Light on Walking in Patients with Haemophilia

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Sébastien Lobet ◽  
Christine Detrembleur ◽  
Firas Massaad ◽  
Cedric Hermans
Keyword(s):  
Gait Analysis ◽  
Functional Performance ◽  
Weight Bearing ◽  
Cartilage Damage ◽  
Three Dimensional ◽  
Joint Damage ◽  
Treatment Strategies ◽  
Gait Pattern ◽  
Metabolic Energy

In patients with haemophilia (PWH) (from Greek “blood love”), the long-term consequences of repeated haemarthrosis include cartilage damage and irreversible arthropathy, resulting in severe impairments in locomotion. Quantifying the extent of joint damage is therefore important in order to prevent disease progression and compare the efficacy of treatment strategies. Musculoskeletal impairments in PWH may stem from structural and functional abnormalities, which have traditionally been evaluated radiologically or clinically. However, these examinations are performed in a supine position (i.e., non-weight-bearing condition). We therefore suggest three-dimensional gait analysis (3DGA) as an innovative approach designed to focus on the functional component of the joint during the act of walking. This is of the utmost importance, as pain induced by weight-bearing activities influences the functional performance of the arthropathic joints significantly. This review endeavors to improve our knowledge of the biomechanical consequences of multiple arthropathies on gait pattern in adult patients with haemophilia using 3DGA. In PWH with arthropathy, the more the joint function was altered, the more the metabolic energy was consumed. 3DGA analysis could highlight the effect of an orthopedic disorder in PWH during walking. Indeed, mechanical and metabolic impairments were correlated to the progressive loss of active mobility into the joints.

Force Plate Analysis of Dogs with Bilateral Hip Dysplasia Treated with a Unilateral Triple Pelvic Osteotomy: A Long-term Review of Cases

1998 ◽  
Vol 11 (02) ◽  
pp. 85-93 ◽  
Author(s):  
Joanne R. Cockshutt ◽  
H. Dobson ◽  
C. W. Miller ◽  
D. L. Holmberg ◽  
Connie L. Taves ◽  
...  
Keyword(s):  
Gait Analysis ◽  
Hip Dysplasia ◽  
Weight Bearing ◽  
Force Plate ◽  
Case Series ◽  
Pelvic Osteotomy ◽  
Vertical Force ◽  
Long Term Outcome ◽  
Case Series Study

SummaryA retrospective case series study was done to determine the long-term outcome of operations upon dogs treated for canine hip dysplasia by means of a triple pelvic osteotomy (TPO). Twentyfour dogs with bilateral hip dysplasia, that received a unilateral TPO between January 1988 and June 1995, were re-examined at the Ontario Veterinary College. The assessment included physical, orthopedic and lameness examinations, standard blood work, pelvic radiographs and force plate gait analysis. They were compared to bilaterally dysplastic dogs that had not been treated, and also to normal dogs. Force plate data analysis demonstrated a significant increase in peak vertical force (PVF) and mean vertical force over stance (MVF) in the limb that underwent surgical correction by means of a TPO, when compared to the unoperated hip. It was determined that performing a unilateral TPO on a young dysplastic dog resulted in greater forces and weight bearing being projected through the TPO corrected limb when compared to the unoperated limb.Dogs with bilateral hip dysplasia treated with a unilateral triple pelvic osteotomy (TPO) were assessed by force plate gait analysis, radiographs and orthopedic examination. There was a significant increase in hip Norberg angles over time, although degenerative changes did progress. Limbs that had been operated upon had significantly greater peak and mean ground reaction forces than limbs that had not received an operation.

Custom Presurgical Planning for Midfacial Reconstruction

2020 ◽  
Vol 36 (06) ◽  
pp. 696-702
Author(s):  
Nolan B. Seim ◽  
Enver Ozer ◽  
Sasha Valentin ◽  
Amit Agrawal ◽  
Mead VanPutten ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Functional Performance ◽  
Three Dimensional ◽  
Free Tissue Transfer ◽  
Long Term Effects ◽  
Presurgical Planning ◽  
Dental Rehabilitation ◽  
Midface Reconstruction ◽  
Reconstructive Algorithm

AbstractResection and reconstruction of midface involve complex ablative and reconstructive tools in head and oncology and maxillofacial prosthodontics. This region is extraordinarily important for long-term aesthetic and functional performance. From a reconstructive standpoint, this region has always been known to present challenges to a reconstructive surgeon due to the complex three-dimensional anatomy, the variable defects created, combination of the medical and dental functionalities, and the distance from reliable donor vessels for free tissue transfer. Another challenge one faces is the unique features of each individual resection defect as well as individual patient factors making each preoperative planning session and reconstruction unique. Understanding the long-term effects on speech, swallowing, and vision, one should routinely utilize a multidisciplinary approach to resection and reconstruction, including head and neck reconstructive surgeons, prosthodontists, speech language pathologists, oculoplastic surgeons, dentists, and/or craniofacial teams as indicated and with each practice pattern. With this in mind, we present our planning and reconstructive algorithm in midface reconstruction, including a dedicated focus on dental rehabilitation via custom presurgical planning.

scholarly journals Talar process fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 85-92 ◽  
Author(s):  
Haroon Majeed ◽  
Donald J. McBride
Keyword(s):  
Subtalar Joint ◽  
Avulsion Fracture ◽  
Weight Bearing ◽  
Cartilage Damage ◽  
Flexor Hallucis Longus ◽  
High Clinical Suspicion ◽  
Significant Disability ◽  
Missed Diagnosis ◽  
And Inversion

Fractures of the lateral and the posterior processes of the talus are uncommon and frequently missed because of a low level of suspicion and difficulty in interpretation on plain radiographs. Missed fractures can lead to persistent pain and reduced function. Lateral process fractures are usually a consequence of forced dorsiflexion and inversion of fixed pronated foot. These are also commonly known as snowboarder’s fractures. The posterior process of the talus is composed of medial and lateral tubercles, separated by the groove for the flexor hallucis longus tendon. The usual mechanism of injury is forced hyperplantarflexion and inversion causing direct compression of the posterior talus, or an avulsion fracture caused by the posterior talofibular ligament. CT scans are helpful in cases of high clinical suspicion. There is a lack of consensus regarding optimal management of these fractures; however, management depends on the size, location and displacement of the fragment, the degree of cartilage damage and instability of the subtalar joint. Non-operative treatment includes immobilization and protected weight-bearing for six weeks. Surgical treatment includes open reduction and internal fixation or excision of the fragments, depending on the size. Fractures of the lateral and the posterior processes of the talus are uncommon but important injuries that may result in significant disability in cases of missed diagnosis or delayed or inadequate treatment. Early diagnosis and timely management of these fractures help to avoid long-term complications, including malunion, nonunion or severe subtalar joint osteoarthritis. Cite this article: EFORT Open Rev 2018;3:85-92. DOI: 10.1302/2058-5241.3.170040

scholarly journals Using Three-Dimensional Gait Data for Foot/Ankle Orthopaedic Surgery

2009 ◽  
Vol 3 (1) ◽  
pp. 89-95 ◽  
Author(s):  
Gwyneth de Vries ◽  
Kevin Roy ◽  
Victoria Chester
Keyword(s):  
Gait Analysis ◽  
Motion Capture ◽  
Tendon Transfer ◽  
Treatment Effectiveness ◽  
Treatment Plan ◽  
Three Dimensional ◽  
Gait Pattern ◽  
Posterior Tibial Tendon ◽  
Post Surgery ◽  
Stiff Knee

We present the case of a forty year old male who sustained a torn carotid during strenuous physical activity. This was followed by a right hemispheric stroke due to a clot associated with the carotid. Upon recovery, the patient’s gait was characterized as hemiparetic with a stiff-knee pattern, a fixed flexion deformity of the toe flexors, and a hindfoot varus. Based on clinical exams and radiographs, the surgical treatment plan was established and consisted of correction of the forefoot deformities, possible hamstrings lengthening, and tendon transfer of the posterior tibial tendon to the dorsolateral foot. To aid in surgical planning, a three-dimensional gait analysis was conducted using a state-of-the-art motion capture system. Data from this analysis provided insight into the pathomechanics of the patient’s gait pattern. A forefoot driven hindfoot varus was evident from the presurgical data and the tendon transfer procedure was deemed unnecessary. A computer was used in the OR to provide surgeons with animations of the patient’s gait and graphical results as needed. A second gait analysis was conducted 6 weeks post surgery, shortly after cast removal. Post-surgical gait data showed improved foot segment orientation and position. Motion capture data provides clinicians with detailed information on the multisegment kinematics of foot motion during gait, before and during surgery. Further, treatment effectiveness can be evaluated by repeating gait analyses after recovery.

Long-term Effects of Femoral Derotation Osteotomies: An Evaluation Using Three-Dimensional Gait Analysis

2002 ◽  
Vol 22 (2) ◽  
pp. 139-145 ◽  
Author(s):  
Sylvia Õunpuu ◽  
Peter DeLuca ◽  
Roy Davis ◽  
Mark Romness
Keyword(s):  
Gait Analysis ◽  
Three Dimensional ◽  
Long Term Effects

Functional assessment of outcome of surgery to correct patellofemoral instability in human patients

2020 ◽  
Vol 16 (3) ◽  
pp. 161-167
Author(s):  
D.A. Clark ◽  
D.L. Simpson ◽  
J.D. Eldridge ◽  
V. Pai ◽  
G.R. Colborne
Keyword(s):  
Knee Joint ◽  
Gait Analysis ◽  
Patellar Instability ◽  
Weight Bearing ◽  
Patellofemoral Instability ◽  
Knee Extensor ◽  
Gait Pattern ◽  
Joint Moments ◽  
Normal Gait ◽  
Gait Function

A case-control study with 6 months of patient follow up. This study sought to determine if surgery followed by rehabilitation for patellar instability could restore normal gait function. A previous study has established abnormalities in gait pattern and joint congruence in patients with a history of patellar instability. We hypothesised that surgery for patellofemoral instability would improve knee function. Eight human patients (mean age 29, range 17-42) who were awaiting patella stabilisation surgery (5 tibial tuberosity osteotomy, 2 medial patellofemoral ligament reconstruction, 1 trochleoplasty) were compared against eight normal Controls (mean age 28, range 19-31). Patients were assessed pre-operatively and six months after surgery by biomechanical gait analysis. Gait trials involved simultaneous collection of kinematic and force data. Patients were grouped into two subgroups pre-operatively based on knee joint net moment during stance, and their joint moments during stance pre- and post-operatively were compared against the Control subjects. In pre-operative gait analysis, four patients (P1) produced some extensor moment in early stance and four (P2) demonstrated a severe gait deficiency with failure to generate a knee extensor moment during stance. Normalisation in gait pattern was observed in all patients post-operatively. Those who had the most severe gait abnormality (P2) demonstrated the most improvement in their knee joint moments. Improvements were observed in the milder (P1) cases, but these were less dramatic. Patella stabilisation by surgery can restore normal gait function. Normalising the anatomy of the knee extensor mechanism is the objective of surgery. Normal anatomy facilitates the rehabilitation objectives of optimising extensor function during the weight-bearing phase of gait.

scholarly journals Does cartilage volume or thickness distinguish knees with and without mild radiographic osteoarthritis? The Framingham Study

2009 ◽  
Vol 69 (01) ◽  
pp. 143-149 ◽  
Author(s):  
S Reichenbach ◽  
M Yang ◽  
F Eckstein ◽  
J Niu ◽  
D J Hunter ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Weight Bearing ◽  
Cartilage Damage ◽  
Three Dimensional ◽  
Cartilage Volume ◽  
Cartilage Thickness ◽  
Resonance Imaging ◽  
Radiographic Osteoarthritis ◽  
Study Participants

Objectives:To examine whether the quantity of cartilage or semiquantitative scores actually differ in knees with mild radiographic osteoarthritis compared with knees without osteoarthritis.Methods:Framingham Osteoarthritis Study participants had knee tibiofemoral magnetic resonance imaging-based measurements of cartilage. Using three-dimensional FLASH-water excitation sequences, cartilage volume, thickness and subregional cartilage thickness were measured and cartilage scored semiquantitatively (using the whole-organ magnetic resonance imaging score; WORMS). Using weight-bearing radiographs, mild osteoarthritis was defined as Kellgren/Lawrence (K/L) grade 2 and non-osteoarthritis as K/L grade 0. Differences between osteoarthritis and non-osteoarthritis knees in median cartilage measurements were tested using the Wilcoxon rank sum test.Results:Among 948 participants (one knee each), neither cartilage volume nor regional thickness were different in mild versus non-osteoarthritis knees. In mild osteoarthritis, cartilage erosions in focal areas were missed when cartilage was quantified over large regions such as the medial tibia. For some but not all subregions of cartilage, especially among men, cartilage thickness was lower (p<0.05) in mild osteoarthritis than non-osteoarthritis knees. Because semiquantitative scores captured focal erosions, median WORMS scores were higher in mild osteoarthritis than non-osteoarthritis (all p<0.05). In moderate/severe osteoarthritis (K/L grades 3 or 4), osteoarthritis knees had much lower cartilage thickness and higher WORMS scores than knees without osteoarthritis.Conclusions:In mild osteoarthritis, the focal loss of cartilage is missed by quantitative measures of cartilage volume or thickness over broad areas. Regional cartilage volume and thickness (eg, medial tibia) are not different in mild osteoarthritis versus non-osteoarthritis. Subregional thickness may be decreased in mild osteoarthritis. Semiquantitative scoring that assesses focal cartilage damage differentiates mild osteoarthritis from non-osteoarthritis.

scholarly journals POS1477-HPR GOUT PATIENTS IN REMISSION, AND THEIR PERSPECTIVES ON URATE LOWERING THERAPY TREATMENT STOP OR CONTINUATION STRATEGIES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1023.2-1024
Author(s):  
I. R. Peeters ◽  
S. A. C. Wanten ◽  
L. M. Verhoef ◽  
A. Den Broeder ◽  
N. Van Herwaarden ◽  
...  
Keyword(s):  
General Practice ◽  
Side Effects ◽  
The Netherlands ◽  
Medication Use ◽  
Joint Damage ◽  
Treatment Strategies ◽  
Serum Urate ◽  
The Body ◽  
Treat To Target

Background:Urate lowering therapies (ULT) are used to reduce hyperuricemia in gout patients (1). When gout remission is reached, patients often ask if ULT should be continued lifelong (treat to target strategy, T2T), or if tapering or stopping (a treat to symptom approach, T2S) can be attempted. In fact, although current rheumatology guidelines (1,2) suggest continuation, conclusive evidence for this is absent. Since ULT therapy adherence also remains suboptimal, exploring gout patients’ beliefs on different long term ULT treatment strategies is of great value.Objectives:To identify cognitions and emotions on ULT treatment strategies (T2T continuation and T2S cessation) of gout patients in remission with current or previous ULT use.Methods:Purposive sampling (3) was used to recruit patients from a general practice and a rheumatology department (Nijmegen, the Netherlands), with a clinical diagnosis of gout, current or previous ULT use and remission according to adapted (without serum urate criterion) preliminary gout remission criteria(4). Semi-structured interviews were conducted by two interviewers and audio-records were fully transcribed. Inductive thematic analysis (5) was used to analyse and interpret our data using the ATLAS.ti. software.Results:From a total of 18 patients (16 male/2 female), 14 patients were treated by a rheumatologist (10 currently using ULT, 1 intermittent and 3 previously) and 4 were treated by a general practitioner (all currently using ULT). Patients were satisfied with a T2T strategy, due to the absence of flares, a feeling of certainty and the reassurance of serum urate monitoring. Reluctance towards medication was reported, the importance of indefinite ULT use was questioned and its chronic use was addressed as a drawback. Reducing medication use by a T2S strategy was assessed positively and this strategy was considered less burdensome. A wish for and the willingness to follow a T2S approach was expressed. Fear and concerns of flaring after ULT cessation were expressed and were deemed both acceptable and unacceptable. See Table 1 for a schematic overview of the results.Table 1.Overview of patients’ perspectives on ULT treatment strategiesMotivation for a T2T strategyDrawbacks of a T2T strategy1. Being free of flares2. Acceptance of and contentment with chronic ULT use3. Feels secure due to regular SU monitoring4. No desire for change1. Resistance to (any) medication use2. Side effects of ULT3. Possibly detrimental to healthcare costsMotivation for a T2S strategyDrawbacks of a T2S strategy1. Doubt if chronic ULT use is necessary a. Possible restorative capacity of the body b. Curious to effects of ULT cessation2. Being free of ULT side effects3. Long term damage ULT unknown4. Less burdensome for patient and body5. Wish for minimization of (any) medication use1. Fear and insecurities on a. Flaring and not being able to function b. Joint damage2. Feels uncontrolled3. Hassle with visits, blood tests and medication adjustments when a flare occurs.Conclusion:This study provides an overview of perspectives on ULT treatment strategies of gout patients in remission. These results must be considered in developing educational material for patients and in future research on gout management, particularly in designing randomised clinical trials on this subject.References:[1]Richette P et al. Ann Rheum Dis. 2017;76(1):29-42.[2]FitzGerald JD et al. Arthritis Care Res (Hoboken). 2020;72(6):744-60.[3]Pope C et al. Qual Saf Health Care. 2002;11(2):148-52.[4]de Lautour H et al. Arthritis Care Res (Hoboken). 2016;68(5):667-72.[5]Pope C et al. Bmj. 2000;320(7227):114-6.Acknowledgements:We would like to thank dr. Erik Bischoff for his cooperation and help in including primary care patients from his general practice UGC Heyendael, Nijmegen the Netherlands.Disclosure of Interests:None declared

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