Search

Introduction: Telerehabilitation programmes have been attracting increasing attention as a potential alternative to conventional rehabilitation. Video conferencing can facilitate communication between healthcare professionals and patients. However, in certain cases, video conferencing may face practical limitations. As an alternative to real-time conferencing, sensor-based technologies can transmit the acquired data to healthcare providers. This study aimed to design and develop a sensor-based telerehabilitation programme and to outline the corresponding requirements for such a system., Development: The development of the sensor-based telerehabilitation programme was carried out based on user needs. The programme includes a portable platform for the patient as well as a web-based platform for the healthcare professional, thus allowing for an individualised rehabilitation programme. Communication, training, reporting, and information services were provided for the patients. Moreover, the portability and usability of the programme were enhanced by utilising the system in offline mode as well., Application: The programme is currently being tested in the North Denmark Region to assess the feasibility and acceptance of a telerehabilitation programme as an alternative solution to the self-training programme for patients who have been discharged from knee surgery. The preliminary results of our assessment showed a high level of acceptance among the users., Discussion: In this study, a semi-online sensor-based telerehabilitation programme was tested. It is argued that a similar sensor-based telerehabilitation programme can be utilised as an alternative solution for self-training rehabilitation in the future; however; further studies and development are required to ensure the quality and reliability of sensor-based services., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To follow a prospective cohort of consecutive patients with MRI-verified meniscal lesions to identify pre-treatment prognostic factors for long-term results following arthroscopic or conservative treatment., Methods: In the course of 1 year, 291 patients with knee pain and clinically suspected of meniscal lesion were referred to the regional orthopaedic division and subjected to MRI and clinical examination by an experienced surgeon. Patients with MRI-verified meniscal lesions were treated according to an arthroscopy restrictive strategy meaning that treatment was initiated by conservative treatment. Arthroscopy was only performed if satisfying pain relief was not obtained. The Lysholm score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were obtained at baseline and after 12-24 months. A multiple linear regression model was used to investigate which pre-treatment prognostic factors were associated with improvement in the KOOS subscale pain from baseline to follow-up., Results: An MRI-verified meniscal lesion was found in 185 patients (64%). Among these, 58% were treated successfully by conservative treatment. A high KOOS subscale pain score at baseline was associated with less improvement from baseline to follow-up. Bucket-handle lesions were associated with larger improvement from baseline to follow-up compared to flap-tear lesions., Conclusion: MRI findings and clinical status measured by KOOS subscale pain are prognostic for improvement among patients treated for MRI-verified meniscal lesions. Good results were observed for both operative and conservative treatment. The success rate for conservative treatment was 58%., Level of Evidence: Prospective cohort study, Level II.

Background and Purpose: Counselling patients for or against athletic activities after well performed total hip arthroplasty (THA) and total knee arthroplasty (TKA). Level of evidence is low, and the current international guidelines are based on North American expert opinions in 2001 and 2008. Could technical and operative development and social or cultural differences apply for different counselling?, Methods: All Danish experts in head of departments performing more than 100 THAs or TKAs per year, were invited to fill in a questionnaire regarding the most popular sport activities in the Danish 60-69 years old population, Results: Response rate was 74 and 89% for the TKA and THA departments, respectively. A pronounced variation between the departments was observed and compared to the latest published US recommendations in 2007, the present Danish recommendations are significantly more liberal. Athletic activities are now allowed by 87% of the Danish arthroplasty departments. Of these 55% allow for high-impact activities after THA compared to 21% in US in 2007 (p < 0.0001). Recommendations for TKA patients are less liberal. Only 38% of the departments allow for high-impact activities after TKA compared to the 55% after THA (p < 0.0001)., Interpretation: Based on the pronounced variation between departments and the fact that a highly significant trend was observed over 5 years on an undocumented basis it was concluded that there is an imminent need for a higher scientific level on this issue—which hopefully can develop in a few years using PROMs in large scale follow-up studies.

Background: Around 20% of patients with osteoarthritis (OA) have chronic post-operative pain after total knee arthroplasty (TKA) and often undergo revision surgery with unfavourable pain outcome. This study compared sensitization in pain patients with knee OA and after revision TKA (re-TKA)., Methods: Median pressure pain thresholds (PPTs) assessed from the most affected knee (localized sensitization) were used to subgroup 53 patients with OA pain and 20 patients with pain after re-TKA: group 1: OA and high-knee PPT; group 2: OA and low-knee PPT; group 3: re-TKA and high-knee PPT; group 4: re-TKA and low-knee PPT. Clinical pain intensity was assessed using a visual analogue scale (VAS). Bilateral PPTs were measured from the lower leg and forearm (spreading sensitization). Furthermore, the pain intensities evoked by 10 repeated pressure pain stimuli (temporal summation) at the knee and lower leg were assessed on an electronic VAS., Results: The mean clinical pain intensity was not significantly different between groups. The PPTs from both lower leg and forearm were significantly lower in group 4 compared to groups 1, 2, and 3 and in groups 2 and 3 compared to group 1 (p < 0.05). Temporal summations from the knee and lower leg were significantly facilitated in groups 3 and 4 compared to groups 1 and 2 (p < 0.05)., Conclusions: Despite similar pain intensities, facilitated temporal summation is worse in re-TKA than in OA and patients with high local knee hyperalgesia show more prominent spreading sensitization. The study suggests that sensitization should be considered in knee OA especially before re-TKA., (© 2013 European Pain Federation - EFIC®)

Background: Radiography is often used routinely by the general practitioner (GP) in knee osteoarthritis (KOA), even though the diagnosis can be made based on clinical findings. However, radiography may also be requested when serious pathology is suspected. The agreement between the radiographic and the GPs clinical diagnosis and the ability of radiography to rule out serious pathology in clinical KOA is unknown, despite that this is important to evaluate the clinical value of radiography., Objectives: The objectives were to evaluate agreement between the radiographic and clinical diagnosis in KOA; and to describe radiographic features in patients referred from their GP with clinical KOA., Methods: Referral forms from GPs and radiographs of 1 334 consecutive patients above 40 years not previously diagnosed with KOA were evaluated. The agreement between primary indication for radiographic referral (± clinical KOA; according to the recommendations from the European League Against Rheumatism) and the radiographic diagnosis (± radiographic KOA; Kellgren and Lawrence score ≥ 1) was estimated using Cohen's Κ statistics. Furthermore, an evaluation of radiographic features was carried out in patients with clinical KOA (n = 997)., Results: The strength of the agreement was 0.106 to 0.298 with the lowest agreement in the youngest patients and the highest in the oldest patients. Five radiographs (0.5%) revealed conditions needing further investigation or specific treatment (osteonecrosis, osteochondral lesion, fracture and subluxation)., Conclusion: In patients with clinical KOA, the radiography seems only indicated if the clinical assessment cannot rule out other diagnoses or serious pathology.

Pain and sensitization are major issues in patients with osteoarthritis both before and after total knee arthroplasty (TKA) and revision TKA (re-TKA). The aim of this study was to assess sensitization in patients with and without chronic pain after re-TKAs. Twenty patients with chronic knee pain and 20 patients without pain after re-TKA participated. Spreading of pain was evaluated as the number of pain sites using a region-divided body chart. The pressure pain threshold (PPT) and pressure pain tolerance (PTT) were assessed by cuff algometry at the lower leg. Temporal summation of pain was assessed by recordings of the pain intensity on a visual analog scale (VAS) during repeated cuff pressure stimulations. Conditioning pain modulation (CPM) was recorded by experimental tonic arm pain by cuff pressure stimulation and assessment of PPTs on the knee, leg, and forearm using handheld pressure algometry. Participants with pain after re-TKA compared to participants without pain demonstrated: (1) significantly more pain sites (P=.004), (2) decreased cuff PPTs and PTTs at the lower leg (P<.001), (3) facilitated temporal summation (P<.001), and (4) impaired CPM (P<.001). Additionally, significant correlations between knee pain intensity and cuff PPTs, temporal summation, and CPM and between total duration of knee pain and temporal summation were found (P<.05). This study demonstrated widespread sensitization in patients with pain after re-TKA and highlighted the importance of ongoing nociceptive input for the chronification process. This has important implications for future revisions, and precautions should be taken if patients have widespread sensitization., (Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

Assessment of the mechanical axis is routine during the examination of patients with lower extremity pain. Long-leg radiographic examination is the gold standard for exact measurement, but it is associated with a significant radiation dose. An alternative method to examine the mechanical axis has been warranted. This article validates a newly developed computerized photograph method to calculate the mechanical axis using a digital photograph. The location of the center of the femoral head was calculated using ink marks on both superior iliac spines. Twenty-five patients (10 women and 15 men) had both legs examined using the photographic method and long-leg radiography examination. The digital photograph method was found to be highly reliable. The interobserver absolute mean difference was 0.99°±0.85°, and the intraobserver absolute mean difference (day-to-day variation) was 1.04°±0.81°. The mechanical axis determined by the 2 methods was highly correlated (R=0.943). The long-leg radiography method was within an average of ±1.88° of the photographic method, with a 95% probability. The photographic method appears to be an effective alternative to conventional long-leg radiography. The photographic method seems convenient in the routine examination of patients with leg pain and children with suspected axial deformity and for follow-up after treatment for malalignment. Calculation coefficients for children and a possible racial difference remain to be studied., (Copyright 2013, SLACK Incorporated.)

Background: Knee osteoarthritis (KOA) is a prevalent degenerative disease in older adults. Treatment strategies, including insoles, focus on reducing pain and physical disability. In medial KOA, insoles have been studied extensively with conflicting results, possibly due to heterogeneity in outcome measures and the intervention. We sought to investigate the effect of custom-made laterally wedged insoles on pain, function, and quality of life in patients with medial KOA., Methods: Fifty-one consecutive patients with medial KOA were prescribed custom-made insoles with arch support and a 5.0° to 8.7° lateral wedge. At follow-up, 42 of the 51 participants (22 men; mean age, 63 years; mean Kellgren-Lawrence, 3.4) participated. Retrospectively, participants were asked to rate the pain intensity in their affected knee before and after the intervention measured on a visual analog scale after 30 min of physical activity (primary outcome), at rest, at night, and after 50 m of walking. Additionally, they completed the Oxford Knee Score and the EQ-5D. The paired-samples t test was applied in the statistics., Results: The visual analog scale score after 30 min of physical activity was significantly reduced after the intervention (mean, 3.3 cm; 95% confidence interval, 2.1-4.5 cm; P < .001). The same significant changes were found in all of the secondary outcomes., Conclusions: There was a significant reduction in pain and improvements in function and quality of life with custom-made laterally wedged insoles with arch support in older adults with mild-to-severe medial KOA. The customization of laterally wedged insoles may be essential for the effect in medial KOA.

Background: There is a lack of high quality evidence concerning the efficacy of total knee arthroplasty (TKA). According to international evidence-based guidelines, treatment of knee osteoarthritis (KOA) should include patient education, exercise and weight loss. Insoles and pharmacological treatment can be included as supplementary treatments. If the combination of these non-surgical treatment modalities is ineffective, TKA may be indicated. The purpose of this randomised controlled trial is to examine whether TKA provides further improvement in pain, function and quality of life in addition to optimised non-surgical treatment in patients with KOA defined as definite radiographic OA and up to moderate pain., Methods/design: The study will be conducted in The North Denmark Region. 100 participants with radiographic KOA (K-L grade ≥2) and mean pain during the previous week of ≤ 60 mm (0-100, best to worst scale) who are considered eligible for TKA by an orthopaedic surgeon will be included. The treatment will consist of 12 weeks of optimised non-surgical treatment consisting of patient education, exercise, diet, insoles, analgesics and/or NSAIDs. Patients will be randomised to either receiving or not receiving a TKA in addition to the optimised non-surgical treatment. The primary outcome will be the change from baseline to 12 months on the Knee Injury and Osteoarthritis Outcome Score (KOOS)(4) defined as the average score for the subscale scores for pain, symptoms, activities of daily living, and quality of life. Secondary outcomes include the five individual KOOS subscale scores, EQ-5D, pain on a 100 mm Visual Analogue Scale, self-efficacy, pain pressure thresholds, and isometric knee flexion and knee extension strength., Discussion: This is the first randomised controlled trial to investigate the efficacy of TKA as an adjunct treatment to optimised non-surgical treatment in patients with KOA. The results will significantly contribute to evidence-based recommendations for the treatment of patients with KOA., Trial Registration: Clinicaltrials.gov reference: NCT01410409.

Background: Medial tibial stress syndrome (MTSS) is a common diagnosis. Several studies have demonstrated that excessive static navicular drop (ND) is related to the diagnosis. However, no studies have yet investigated ND and the velocity of ND during dynamic conditions. The aim of this study was to evaluate ND characteristics in patients with MTSS in dynamic and static conditions., Methods: In a case-control study, 14 patients diagnosed as having MTSS were included from an orthopedic outpatient clinic. A control group consisting of 14 healthy participants was matched regarding age, sex, and typical sporting activity. Navicular drop was evaluated during treadmill walking by a two-dimensional video analysis. Static foot posture, static ND, dynamic ND (dND), and velocity of dND were compared., Results: The two groups were comparable in relation to age, sex, height, weight, and foot size. No significant difference was found in static foot posture. Static ND showed a mean difference of 1.7 mm between the groups (P = .08). During treadmill walking, patients with MTSS had, on average, a 1.5-mm-larger dND (P =.004) and a 2.4-mm/sec-larger mean velocity of dND (P = .03)., Conclusions: Patients with MTSS display a larger ND and a higher ND velocity during treadmill walking. Increased ND velocity may be important to this condition. Future studies should include velocity of dND to investigate the mechanisms of dND in relation to overuse injuries.

Pain is the dominant symptom in osteoarthritis (OA) and sensitization may contribute to the pain severity. This study investigated the role of sensitization in patients with painful knee OA by measuring (1) pressure pain thresholds (PPTs); (2) spreading sensitization; (3) temporal summation to repeated pressure pain stimulation; (4) pain responses after intramuscular hypertonic saline; and (5) pressure pain modulation by heterotopic descending noxious inhibitory control (DNIC). Forty-eight patients with different degrees of knee OA and twenty-four age- and sex-matched control subjects participated. The patients were separated into strong/severe (VAS>or=6) and mild/moderate pain (VAS<6) groups. PPTs were measured from the peripatellar region, tibialis anterior (TA) and extensor carpi radialis longus muscles before, during and after DNIC. Temporal summation to pressure was measured at the most painful site in the peripatellar region and over TA. Patients with severely painful OA pain have significantly lower PPT than controls. For all locations (knee, leg, and arm) significantly negative correlations between VAS and PPT were found (more pain, more sensitization). OA patients showed a significant facilitation of temporal summation from both the knee and TA and had significantly less DNIC as compared with controls. No correlations were found between standard radiological findings and clinical/experimental pain parameters. However, patients with lesions in the lateral tibiofemoral knee compartment had higher pain ratings compared with those with intercondylar and medial lesions. This study highlights the importance of central sensitization as an important manifestation in knee OA.

Background: The navicular drop test is a measure to evaluate the function of the medial longitudinal arch, which is important for examination of patients with overuse injuries. Conflicting results have been found with regard to differences in navicular drop between healthy and injured participants. Normal values have not yet been established as foot length, age, gender, and Body Mass Index (BMI) may influence the navicular drop. The purpose of the study was to investigate the influence of foot length, age, gender, and BMI on the navicular drop during walking., Methods: Navicular drop was measured with a novel technique (Video Sequence Analysis, VSA) using 2D video. Flat reflective markers were placed on the medial side of the calcaneus, the navicular tuberosity, and the head of the first metatarsal bone. The navicular drop was calculated as the perpendicular distance between the marker on the navicular tuberosity and the line between the markers on calcaneus and first metatarsal head. The distance between the floor and the line in standing position between the markers on calcaneus and first metatarsal were added afterwards., Results: 280 randomly selected participants without any foot problems were analysed during treadmill walking (144 men, 136 women). Foot length had a significant influence on the navicular drop in both men (p < 0.001) and women (p = 0.015), whereas no significant effect was found of age (p = 0.27) or BMI (p = 0.88). Per 10 mm increase in foot length, the navicular drop increased by 0.40 mm for males and 0.31 mm for females. Linear models were created to calculate the navicular drop relative to foot length., Conclusion: The study demonstrated that the dynamic navicular drop is influenced by foot length and gender. Lack of adjustment for these factors may explain, at least to some extent, the disagreement between previous studies on navicular drop. Future studies should account for differences in these parameters.

Introduction: When the aim is for high quality, efficiency and a balanced allocation of resources in health services, there is a constant demand for optimisation of the quality of registration regarding diagnosis, treatment and DRG-values (DRG = Diagnosis Related Groups). Since the mid-nineties the DRG-system has been used to shed light on productivity in Danish hospitals. This study investigates the quality of registrations after the introduction of an organization for registrations in the county of Northern Jutland., Material and Methods: The registrations from 554 orthopaedic patients, both in-patient and day case surgery, during a two-week period, were scrutinised critically and changed as appropriate, based on a thorough examination of the medical records., Results: In 37% of the courses registrations were found insufficient or incorrect. In 27% of the cases there was a need for a change in either the diagnosis taken action on, a secondary diagnosis or the treatment registration. 10% had two or three changes. In 11% of the courses of treatment the DRG-value was changed. On average DKK 974 were added, constituing in total only 0.4% of the total DRG-value. But single variations from deductions of DKK 56,000 to an addition of DKK 39,000 were observed. The gravest mistakes are elucidated., Conclusion: Locally, there is a need for continuous instruction of both doctors and secretaries regarding correct registration of diagnosis and treatment as well as an improvement of the registration facilities. On a national basis more precise recommendations are required within the medical specialist areas in order to secure an unambiguous registration.

The posterior tibialis tendon is the most important dynamic stabilizer of the medial longitudinal arch of the foot. Posterior tibial tendon dysfunction (PTTD) may result from an acute trauma or a progressive degeneration of the tendon and should be suspected in painful flatfoot. The diagnosis is largely clinical, based on pain, tenderness and swelling along the tendon underneath the medial malleolus, the too-many-toes sign and persistant hindfoot valgus during heel rise. Untreated PTTD often results in total collapse of the longitudinal arch and severe osteoarthritis of the ankle or hindfoot. In traumatic cases acute repair of the tendon should be considered.

To assess the results of general muscle training for home helpers and home nurses we followed 40 women who completed a six month strength training program. All participants were employees at the home care district Skovgården Hjørring. The training program consisted of exercises for all parts of the body. It was a general rehabilitation program and consisted of a teeterboard, a rubberband and a weight bag adjustable from one to six kg. The duration of the program was one hour. All participants were instructed in the training program by author Ulla Willadsen. The period of training lasted six months and was performed twice a week.

The aim of this study was to examine the clinical effect of naproxen sodium after knee arthroscopy. The design was randomized, prospective, and double-blind, with a placebo control group. Patients with preoperative synovial reaction were excluded. One hundred twenty consecutive arthroscopies were performed in 77 men and 43 women, median age 34 (range 18-65) years. General anesthesia was used. Ninety-one arthroscopies were operative, whereas 29 were diagnostic. Postoperatively the patients received either 550 mg naproxen sodium twice daily or placebo for 10 days. Patients were given 500 mg acetaminophen to use if needed. Clinical examinations were performed 10 and 20 days postoperation. The results were analyzed using the Mann-Whitney test and chi 2 test. No operative complications were registered. All but two patients completed the study. Six patients had slight gastrointestinal symptoms. At 10 days' follow-up, in patients who had undergone operative arthroscopy naproxen sodium demonstrated a statistically significant effect on synovial effusion (p < 0.01), range of motion (p < 0.001), quadriceps strength (p < 0.05), pain (p < 0.001), walking activity (p < 0.05), and use of crutches (p < 0.01). In patients who had undergone diagnostic arthroscopy naproxen sodium demonstrated a beneficial effect on pain (p < 0.01). At 20 days' follow-up, in the operative group naproxen sodium affected synovial effusion (p < 0.05), range of motion (p < 0.01) and pain (p < 0.05), and walking activity (p < 0.05). No effect was seen in the diagnostic group at 20 days' follow-up.

The significance of the extent of transurethral prostatic resection for benign prostatic hypertrophy was evaluated as regards early and late postoperative complications in a prospective, randomized study. The two treatment groups were preoperatively comparable in age, incidence of urinary retention and estimated prostatic weight. In 83 cases the median weight of resected tissue was 18 (range 4-118) g, while in 84 cases the resection was less extensive--median weight 7 (1-40) g. No significant intergroup difference was found in incidence of bladder tamponade, bladder perforation, urinary tract infection or pneumonia. The blood transfusion need was greatest among the patients with complete transurethral adenomectomy of the prostate. Concerning late postoperative complications, the groups did not differ in incidence of urethral stricture, bladder neck contracture or reoperation for benign prostatic hypertrophy. Patients with preoperative urethral instrumentation had heightened risk of developing postoperative urethral stricture.

81 otherwise healthy men with an average age of 67 years and verified prostatic hypertrophy were randomized into two groups for either 'minimal' or 'total' transurethral prostatic resection (TUR-P). Interviews on sexual life were made preoperatively and 6 and 12 months postoperatively. 58 men (72%) were prior to the operation sexually active. 18 (31%), mainly men of advanced age, discontinued sexual activity following TUR-P. 40 (69%) remained active. 19 had retrograde ejaculation. No significant difference was found between 'minimal' and 'total' TUR-P concerning the effect on sexual activity and the occurrence of retrograde ejaculation.

The ultrastructural localization of gold in the ovary of rats injected intraperitoneally with sodium aurothiomalate has been demonstrated using a histochemical technique that visualizes minute traces of gold. Gold was visualized in the oocyte within the cortical granules and in lysosomes of theca interna cells and interstitial cells.