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BackgroundKnee arthroplasty (KA) is a common and effective surgical procedure that allows patients with knee osteoarthritis to restore functional ability and relieve pain. Sit-to-stand is a common demanding task during activities of daily living and is performed more than 50 times per day. The purpose of this systematic review is to obtain a comprehensive understanding of biomechanical changes during sit-to-stand transfers following KA.MethodsRelevant articles were selected through MEDLINE (PubMed), Scopus, Embrace, and Web of Science. Articles were included if they met the following inclusion criteria: (1) underwent KA without restriction on the arthroplasty design, (2) involve kinematic, kinetic, or muscle activity variables as the primary outcome measure, (3) evaluated sit-to-stand, and (4) were written in English.ResultsA total of 13 articles were included in the current systematic review. The KA group exhibited altered movement patterns as compared to healthy controls. Considering the time course of recovery, improvement in knee joint kinematics was found up to 2 years but kinetic changes indicate intensified contralateral limb loading. For comparisons for limbs, limb differences were apparent, but those differences were resolved by 1 year.ConclusionDespite the inevitable changes in kinematics, kinetics, and muscle activity in sit-to-stand since KA, it appears to be important to restore quadriceps strength for the operative limb in order to minimize risk for subsequent joint problems.  相似文献   
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Background

Biomechanics after total knee arthroplasty (TKA) often remain abnormal and may lead to prolonged postoperative recovery. The purpose of this study is to assess a biomechanical therapy after TKA.

Methods

This is a randomized controlled trial of 50 patients after unilateral TKA. One group underwent a biomechanical therapy in which participants followed a walking protocol while wearing a foot-worn biomechanical device that modifies knee biomechanics and the control group followed a similar walking protocol while wearing a foot-worn sham device. All patients had standard physical therapy postoperatively as well. Patients were evaluated throughout the first postoperative year with clinical measures and gait analysis.

Results

Improved outcomes were seen in the biomechanical therapy group compared to the control group in pain scores (88% vs 38%, P = .011), function (86% vs 21%, P = .001), knee scores (83% vs 38%, P = .001), and walking distance (109% vs 47%, P = .001) at 1 year. The therapy group showed healthier biomechanical gait patterns in both the sagittal and coronal planes at 1 year.

Conclusion

A postoperative biomechanical therapy improves outcomes following TKA and should be considered as an additional therapy postoperatively.  相似文献   
4.
ContextResearchers have traditionally used motion capture to quantify discrete data points (peak values) during hop testing. However, these analyses restrict the evaluation to a single time point (ie, certain percentage of stance) and provide only a narrow view of movement. Applying more comprehensive analyses may help investigators identify important characteristics that are masked by discrete analyses often used to screen patients for activity.ObjectiveTo examine the utility of functional data analyses to reveal asymmetries that are undetectable using discrete (ie, single time point) evaluations in participants with a history of anterior cruciate ligament reconstruction (ACLR) who achieved clinical hop symmetry.DesignCross-sectional study.SettingLaboratory.Patients or Other ParticipantsFifteen participants with unilateral ACLR (age = 21 ± 3 years, time from surgery = 4 ± 3 years) and 15 control participants without ACLR (age = 23 ± 2 years).Intervention(s)Lower extremity biomechanics during the triple–hop-for-distance task for the ACLR and contralateral limbs of patients and a representative limb of control participants were measured.Main Outcome Measure(s)Peak sagittal-plane joint power, joint work, and power profiles were determined.ResultsUsing discrete analyses, we identified lower peak knee power and work in the ACLR limb compared with the contralateral and control limbs (P < .05) but were unable to demonstrate differences at the ankle or hip. Using functional data analyses, we observed asymmetries at the ankle, knee, and hip between the ACLR and contralateral or control limbs throughout stance (P < .05), and it was revealed that these asymmetries stemmed from knee power deficits that were prominent during early loading.ConclusionsDespite achieving hop-distance symmetry, the ACLR knees absorbed less power. Although this information was revealed using discrete analyses, underlying asymmetries at the ankle and hip were masked. Using functional data analyses, we found interlimb asymmetries at the ankle, knee, and hip. Importantly, we found that functional data analyses more fully elucidated the extent and source of asymmetries, which can be used by clinicians and researchers alike to aid in clinical decision making.  相似文献   
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BackgroundAnterior cruciate ligament reconstructed (ACLR) athletes show increased hamstrings activation and decreased knee flexion moments (KFMs) during single leg landing tasks at time of return-to-sport (RTS). Although these landing alterations seem protective in the short term, they might become undesirable if they persist after RTS. Therefore, the main aim of this study was to investigate whether those landing alterations persist in the months following RTS.MethodsSixteen athletes who had an ACLR performed five unilateral landing tasks at three different time points (at RTS, and at 3 and 6 months after RTS) while KFMs and hamstrings activation were recorded. The following clinical parameters were registered: isokinetic strength of quadriceps and hamstrings, ACL return-to-sport after injury scale (ACL-RSI), Tampa scale of kinesiophobia, self-reported instability and single leg hop distance. A one-way repeated measures analysis of variance (ANOVA) was used to assess whether landing deficits changed over time. Additionally, an explorative analysis was performed to assess whether those athletes whose deficits persisted the most could be identified based on baseline clinical parameters.ResultsThe ANOVA showed no differences in landing deficits between sessions, indicating persisting reduced KFMs and increased hamstrings activation in the injured leg compared with the contralateral leg. A significant improvement of the quadriceps concentric strength (at 120°/s), ACL-RSI score and jump distance of the single leg hop was found over time.ConclusionsLanding alterations were not resolved 6 months after RTS. Additional interventions may be needed to normalize landing alterations prior to return to sport.  相似文献   
7.
BackgroundAdequate footwear is an important factor for reducing the risk of slipping; as shoe outsoles wear down, friction decreases, and slip and fall risk increases. Wear theory suggests that gait kinetics may influence rate of tread wear.Research questionDo the kinetics of walking (i.e., the shoe-floor force interactions) affect wear rate?MethodsFourteen participants completed dry walking trials during which ground reaction forces were recorded across different types of shoes. The peak normal force, shear force, and required coefficient of friction (RCOF) were calculated. Participants then wore alternating pairs of shoes in the workplace each month for up to 24 months. A pedometer was used to track the distance each pair of shoes was worn and tread loss was measured. The wear rate was calculated as the volumetric tread loss divided by the distance walked in the shoes. Three, mixed linear regression models were used to assess the impact of peak normal force, shear force, and RCOF on wear rate.ResultsWear rate was positively associated with peak RCOF and with peak shear force, but was not significantly related to peak normal forces.SignificanceThe finding that shear forces and particularly the peak RCOF are related to wear suggests that a person’s gait characteristics can influence wear. Therefore, individual gait kinetics may be used to predict wear rate based on the fatigue failure shoe wear mechanism.  相似文献   
8.
Poly(ε-caprolactone) (PCL) was mixed with submicron particles of barium sulfate to obtain biodegradable radiopaque composites. X-ray images comparing with aluminum samples show that 15 wt.% barium sulfate (BaSO4) is sufficient to present radiopacity. Thermal studies by differential scanning calorimetry (DSC) show a statistically significant increase in PCL degree of crystallinity from 46% to 52% for 25 wt.% BaSO4. Non-isothermal crystallization tests were performed at different cooling rates to evaluate crystallization kinetics. The nucleation effect of BaSO4 was found to change the morphology and quantity of the primary crystals of PCL, which was also corroborated by the use of a polarized light optical microscope (PLOM). These results fit well with Avrami–Ozawa–Jeziorny model and show a secondary crystallization that contributes to an increase in crystal fraction with internal structure reorganization. The addition of barium sulfate particles in composite formulations with PCL improves stiffness but not strength for all compositions due to possible cavitation effects induced by debonding of reinforcement interphase.  相似文献   
9.

Purpose

Although current Delphi Consensus guidelines do not recommend a specific definition of biochemical recurrence after partial gland therapy, these guidelines acknowledge that serial prostate-specific antigen (PSA) tests remain the best marker for monitoring disease after treatment. The purpose of this study was to determine whether PSA velocity at failure per the Phoenix (nadir + 2 ng/mL) definition is associated with metastasis and prostate cancer-specific mortality (PCSM) in a cohort of patients who experienced PSA failure after partial gland therapy.

Methods

Between 1997 and 2007, 285 patients with favorable risk prostate cancer underwent partial prostate brachytherapy to the peripheral zone. PSA velocity was calculated for 94 patients who experienced PSA failure per the Phoenix (nadir + 2) definition. Fine and Gray competing risks regression was performed to determine whether PSA velocity and other clinical factors were associated with metastasis and PCSM.

Results

The median time to PSA failure was 4.2 years (interquartile range: 2.2, 7.9), and the median followup time after PSA failure was 6.5 years (3.5–9.7). Seventeen patients developed metastases, and five experienced PCSM. On multivariate analysis, PSA velocity ≥3.0 ng/mL/year (adjusted hazard ratio 5.97; [2.57, 13.90]; p < 0.001) and PSA nadir (adjusted hazard ratio 0.39; [0.24, 0.64]; p < 0.001) were significantly associated with metastasis. PSA velocity ≥3.0 ng/mL/year was also associated with PCSM (HR 15.3; [1.8, 128.0]; p = 0.012) on univariate analysis.

Conclusions

Rapid PSA velocity at PSA failure after partial gland treatment may be prognostic for long-term outcomes.  相似文献   
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