Postoperative Falls After Total Knee Arthroplasty in Patients With a Femoral Nerve Catheter: Can We Reduce the Incidence?

A femoral nerve catheter (FNC) is often used to minimize pain following total knee arthroplasty (TKA), but complications including inpatient falls, may increase as a result, despite fall prevention protocols. We evaluated the rate of falls in 707 primary TKAs performed with an FNC at a major academic center from May 2009 to September 2012. Despite a formalized fall prevention protocol, we found 19 falls (2.7%). Three patients required further operative intervention. At a rate of 2.7%, postoperative fall is one of the most common complications of TKA at our institution. While pain control may be good with the use of FNCs following primary TKA, improvements in fall prevention strategies or the use of alternative postoperative pain control modalities may need to be considered.     

Risk Stratification for 4,837 Individuals with Knee Pain Who Receive Physical Therapy Treatment

Risk stratification is a modelling method that is designed to target interventions toward patients with specific needs. The objective of the present study was to identify predictive characteristics related to patients with knee impairments who had a high risk of a bad prognosis (exceptional non‐responders) as well as those who were at low risk of a bad prognosis (exceptional responders). A cohort of 4,837 patients with knee pain seen for physical therapy was retrospective analysed using univariate and multivariate multinomial regression analyses. Modelling was used to identify characteristics associated with those who were exceptional responders and those who were exceptional non‐responders. Exceptional non‐responders were significantly associated with older age, female gender, longer duration of symptoms, surgical history, lower functional status at baseline and a payer type. Exceptional responders were significantly associated with younger age, no previous surgical history, higher functional status at baseline and a payer type. Findings may be used for managing processes involving intensity of care service and in understanding probable prognoses for each patient. Future research should continue to examine variables predictive of treatment response in patients with knee pain. Copyright © 2016 John Wiley & Sons, Ltd.     

Does Shoe Insole Modification Prevent Stress Fractures? A Systematic Review

Stress fractures can be debilitating in athletes and military personnel. Insoles may lower stress fracture rates by improving biomechanics, lessening fatigue, and attenuating impact. The objective of this study was to systematically review the best evidence on the use of insoles as a method of stress fracture prevention in a high-risk population. Using MEDLINE, Cochrane, Current Controlled Trials, UK National Research Register, ScienceDirect, CINAHL, and EMBASE, a review of randomized (level I) and quasi-randomized (level II) controlled trials was performed using an insole as the intervention and stress fracture incidence as the primary outcome measure. Five trials were included, and a random effects model was used to generate a summary estimate and an overall odds ratio. One study found a significant reduction in overall stress fracture incidence using a semirigid insole, while four studies found no overall reduction in military personnel. However, when the data are pooled, orthotic use was beneficial. When stratified by site, there was a reduction in femoral and tibial stress fracture incidence. Shoe insoles may reduce the overall femoral and tibial stress fracture incidence during military training. It is unclear if the use of insoles would prevent stress fractures in athletes. Additional studies are necessary to determine the efficacy of insoles in an athletic population.     

Intrinsic pedal musculature support of the medial longitudinal arch: an electromyography study

Much of the work describing support of the medial longitudinal arch has focused on the plantar fascia and the extrinsic muscles. There is little research concerning the function of intrinsic muscles in the maintenance of the medial longitudinal arch. Ten healthy volunteer adults served as subjects for this study, which was approved by the University Investigational Review Board. The height of the navicular tubercle above the floor was measured in both feet while subjects were seated with the foot in a subtalar neutral position and then when standing in a relaxed calcaneal stance. Subtalar neutral was found by palpating for talar congruency. Recordings of muscle activity from the abductor hallucis muscle were performed while the subjects maintained a maximal voluntary contraction in a supine position by plantarflexing their great toes. An injection of lidocaine (1% with epinephrine) was then administered by a Board-certified orthopedic surgeon in the region of the tibial nerve, posterior and inferior to the medial malleolus. Measurements were repeated and compared by using a paired t test. After the nerve block, the muscle activity was 26.8% of the control condition (P = .011). This corresponded with an increase in navicular drop of 3.8 mm. (P = .022). The observation that navicular drop increased when the activity of the intrinsic muscles decreased indicates that the intrinsic pedal muscles play an important role in support of the medial longitudinal arch.