Methods. The expression of miRNAs was measured in the ATDC5 cell model of chondrogenesis using mi... more Methods. The expression of miRNAs was measured in the ATDC5 cell model of chondrogenesis using microarray and was verified using quantitative reverse transcription-polymerase chain reaction. MicroRNA expression was localized by in situ hybridization. Predicted miRNA target genes were validated using 3untranslated region-Luc reporter plasmids containing either wild-type sequences or mutants of the miRNA target sequence. Signaling through the Smad pathway was measured using a (CAGA) 12 -Luc reporter.
Methods. The expression of miRNAs was measured in the ATDC5 cell model of chondrogenesis using mi... more Methods. The expression of miRNAs was measured in the ATDC5 cell model of chondrogenesis using microarray and was verified using quantitative reverse transcription-polymerase chain reaction. MicroRNA expression was localized by in situ hybridization. Predicted miRNA target genes were validated using 3untranslated region-Luc reporter plasmids containing either wild-type sequences or mutants of the miRNA target sequence. Signaling through the Smad pathway was measured using a (CAGA) 12 -Luc reporter.
Background: In patients with patellar instability and severe trochlear dysplasia, trochleoplasty ... more Background: In patients with patellar instability and severe trochlear dysplasia, trochleoplasty has become increasingly used as part of its surgical management.
Revue de Chirurgie Orthopédique et Traumatologique
Anterior knee pain (AKP) encompasses a range of pathologies. As a result, there are a number of t... more Anterior knee pain (AKP) encompasses a range of pathologies. As a result, there are a number of therapeutic options used to treat AKP. The non-operative treatments have been analysed in a number of randomised controlled trials and systematic reviews. There is however a scarcity of such publications covering the surgical management of AKP. There are no systematic reviews that have investigated surgical interventions for AKP due to pathology of the infrapatellar fat pad (IFP). The aims of this study were to review the literature systematically, to establish which surgical procedures have been used to treat IFP disease and to determine their efficacy.
Background: Anterior knee pain (AKP) is a common musculoskeletal complaint. It has been suggested... more Background: Anterior knee pain (AKP) is a common musculoskeletal complaint. It has been suggested that one factor that may contribute to the presence of AKP is a delay in the recruitment of the vastus medialis oblique muscle (VMO) relative to the vastus lateralis muscle (VL). There is however little consensus within the literature regarding the existence or nature of any such delay in the recruitment of the VMO within the AKP population. The purpose of this systematic review and meta-analysis was to examine the relative timing of onset of the VMO and VL in those with AKP in comparison to the asymptomatic population.
This systematic review compares the clinical, radiological and kinematic outcomes of fixed compar... more This systematic review compares the clinical, radiological and kinematic outcomes of fixed compared to mobile bearing unicompartmental knee replacements (UKRs). A metaanalysis of pooled mean difference and relative risk data was undertaken following a review of electronic databases. Five studies were identified. Analysis suggested that there was no significant difference in clinical outcome or complication rate between mobile and fixed bearing UKR. However, the evidence reviewed presented with a number of methodological limitations. Areas for further study are recommended. Level of evidence: Level I. Published by Elsevier Masson SAS.
... Grelsamer [9] hypothesised that an excessively TO Smith (&) 4 ST Donell Institute of ... more ... Grelsamer [9] hypothesised that an excessively TO Smith (&) 4 ST Donell Institute of Orthopaedics, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK e-mail: [email protected] R ... injury. Holt et al. ...
The standard surgical treatment for patellar instability has been lateral release and medial reef... more The standard surgical treatment for patellar instability has been lateral release and medial reefing proximally, with a Roux-Goldthwaite tendon transfer distally. More recently, reconstruction of the medial patellofemoral ligament (MPFL) has become popular. The aim of this study was to determine whether MPFL reconstruction improved the functional outcomes over patients treated with medial reefing. A group of 28 knees in 25 patients treated with a MPFL reconstruction were identified and matched for age and gender with 28 operated knees in 27 patients treated with a medial reefing. Clinical assessment included pre-operative and 1 year Kujala scores. Radiological assessment used the Dejour protocol. The two groups were comparable with respect to gender, age, preoperative Kujala score, type of trochlear dysplasia, tibial tubercle-trochlear groove distance and patellar tilt angle. It was concluded that although there was better patellar tracking at 1 year with an MPFL reconstruction compared to medial reefing, there was no significant functional improvement as measured by the Kujala score.
ABSTRACT PurposeThe purpose of this study was to investigate the issues surrounding the cremation... more ABSTRACT PurposeThe purpose of this study was to investigate the issues surrounding the cremation of medical devices in deceased patients.Materials and methodsA systematic review was conducted of published and unpublished databases. All publications related to the cremation of patients with medical devices were included. Areas under investigation included the incidence of different types of medical devices cremated, detection of implants, the environmental and health dangers associated with cremation of various medical devices, and recommendations for clinical and crematorium practices to manage these possible hazards. Two authors independently assessed publication eligibility and extracted data. A narrative review was conducted based on the data extracted.ResultsTwenty publications were eligible. These indicated that pacemakers and expandable orthopaedic nails are two potential dangers to cremation staff. However, there remains confusion regarding the potential dangers of radionuclide exposure, especially with regard to the effect of time between the introduction of the radionuclide material and death with respect to its handling, storage and cremation. There is limited evidence of public health problems surrounding mercury emissions from the cremation of dental amalgams.Discussion/conclusionsThere is evidence that clinicians, funeral directors, mortuary and crematorium teams are well aware of the hazards of pacemakers and cremation. However the miniaturisation of pacemakers and other electronic devices, the increasing use of radioactive treatments in oncology and the use of expandable nails in orthopaedics need to be recognised to allow safe disposal should cremation be considered for the deceased where these materials have been used.
Unicompartmental knee arthroplasty (UKA) is widely performed in the United Kingdom for the manage... more Unicompartmental knee arthroplasty (UKA) is widely performed in the United Kingdom for the management of patients with symptomatic osteoarthritis of the medial compartment of the tibiofemoral joint. A limited number of papers have presented the findings of mid-term clinical and survival data with sufficiently large patient numbers following mobile-bearing UKA. The purpose of this study was to present the 6-
... Niitsu et al. [59] 4 4 4 U 4 4 4 4 4 X 4 4 4 X Polly et al. [60] 4 4 4 U 4 4 4 4 U 4 4 4 X 4 ... more ... Niitsu et al. [59] 4 4 4 U 4 4 4 4 4 X 4 4 4 X Polly et al. [60] 4 4 4 U 4 4 4 4 U 4 4 4 X 4 Rappeport et al. [61] 4 4 4 U 4 4 4 4 4 4 4 4 X 4 Rayan et al. [62] 4 4 4 4 4 4 4 4 4 4 X 4 X 4 Riel et al. [63] 4 4 4 4 4 4 4 X 4 4 U 4 4 X Sampson et al. [64] 4 4 4 4 4 4 4 4 4 4 U X 4 4 ...
The purpose of this study was to analyse the midterm outcomes of an accelerated rehabilitation pr... more The purpose of this study was to analyse the midterm outcomes of an accelerated rehabilitation programme for unicompartmental knee arthroplasty. One hundred and six patients (187 knees) underwent a minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty with an accelerated rehabilitation programme and were followed over the Wrst 5 years. The emphasis of the programme was pre-operative patient education, multidisciplinary discharge planning and early rehabilitation. On retrospective analysis, patients reported a signiWcant improvement in functional outcomes and quality of life in respect of Oxford knee score, American knee score and short form-12 outcomes (P < 0.05). These improved clinical outcomes were then maintained during the 5-year period. The results support the use of accelerated rehabilitation to optimise early hospital discharge without jeopardising early and midterm outcomes.
To determine the discriminative validity and reliability of the evidence base using meta-analysis... more To determine the discriminative validity and reliability of the evidence base using meta-analysis. A review of published sources using the databases AMED, CINHAL, EMBASE, MEDLINE, Scopus and the Cochrane Library, and for unpublished material was conducted. All studies assessing the reliability, validity, sensitivity or specificity of magnetic resonance imaging (MRI), computed tomography (CT) or ultrasound (US) of the patellofemoral joint of patients following patellar dislocation, subluxation or instability, were included. A meta-analysis was performed to assess the difference in radiological measurements between healthy controls and subjects with patellar instability in order to assess discrimination validity. A narrative assessment was used to evaluate the inter- and intra-observer reliability as well as the sensitivity and specificity of specific radiological measurements. A total of 27 studies were reviewed. The findings indicated that there was acceptable inter-observer and intra-observer reliability and validity for different methods of assessing patellar height and the sulcus angle with X-ray, MRI and CT methods, and the tibial tubercle-trochlear groove (TT-TG) assessed using CT. There was poor reliability or validity for the assessment of severity of trochlear dysplasia and the sulcus angle using US. There is insufficient evidence to determine the reliability, validity, sensitivity or specificity of tests such as the congruence angle, lateral patellar displacement, lateral patellar tilt, trochlear depth, boss height, the crossing sign or Wiberg patellar classification. A critical appraisal of the literature identified a number of recurrent methodological limitations. Further study is recommended to evaluate the reliability and validity of these radiological outcomes using well-designed radiological trials.
Little has been published about which physiotherapy interventions are used to treat patients with... more Little has been published about which physiotherapy interventions are used to treat patients with instability of the patella. The purpose of this study was to review the literature systematically to determine the clinical outcomes of rehabilitation for patients following a lateral patellar dislocation. AMED, CINHAL, Cochrane Library, EMBASE, MEDLINE, PEDro and Scopus database searches were performed from their inception to August 2009. A search of unpublished and grey literature databases was undertaken, in addition to contacting all authors of included publications. All publications presenting the outcomes of patients following a conservatively managed lateral patellar dislocation were included. All eligible articles were appraised critically using the Critical Appraisal Skills Programme appraisal tool. Data on interventions, cohort characteristics, outcome measures and results were extracted. A narrative research synthesis method approach was adopted. In total, 29 publications were eligible for inclusion in this review. Although a proportion of patients experienced recurrent instability and dislocation episodes after rehabilitation, a large proportion of patients reported acceptable outcomes following physiotherapy. No randomised controlled clinical trials were identified assessing different physiotherapy interventions. The evidence base included a number of under-powered studies which poorly described the specific physiotherapy interventions prescribed. Further, well-designed randomised controlled trials assessing different conservative management strategies with specific patient groups, to provide pre-intervention as well as follow-up data, are required to determine the optimal clinical outcomes of physiotherapy for patients following a lateral patellar dislocation.
To determine whether the addition of bed exercises after primary total hip replacement (THR) impr... more To determine whether the addition of bed exercises after primary total hip replacement (THR) improves functional outcomes and quality of life, in adult patients, during the first six postoperative weeks. Design Single-blind randomised controlled trial. Setting Inpatient and outpatient orthopaedic departments at a National Health Service hospital. Participants Sixty primary elective THR patients. Intervention Patients were assigned at random to receive either a standard gait re-education programme and bed exercises, or the standard gait re-education programme without bed exercises after THR. The bed exercises consisted of active ankle dorsiflexion/plantarflexion, active knee flexion, and static quadriceps and gluteal exercises. Main outcome measures Iowa Level of Assistance Scale (ILOA), the Short Form-12 Health Survey (SF-12), duration of hospital admission and postoperative complications were assessed at baseline, and 3 days and 6 weeks postoperatively. Results There was no statistically significant difference in ILOA scores between the two groups on the third postoperative day [gait reeducation and bed exercise group median 40.5, interquartile range (IQR) 17.5 to 44.5; gait re-education alone group median 38, IQR 22.0 to 44.5; P = 0.70]. Although there was a small difference between the median ILOA scores at Week 6 between the two groups (3.5, IQR 0 to 6.4 and 5.0, IQR 3.5 to 12.5; P = 0.05), this difference was not statistically or clinically significant. There was no difference between the groups in duration of hospital admission, SF-12 scores or postoperative complications at Week 6. Conclusion This study suggests that during the first six postoperative weeks, the addition of bed exercises to a standard gait re-education programme following THR does not significantly improve patient function or quality of life.
Objectives The purpose of this study was to determine how musculoskeletal physiotherapists in acu... more Objectives The purpose of this study was to determine how musculoskeletal physiotherapists in acute National Health Service (NHS) hospitals manage patients following a first time patellar dislocation. Design National survey study. Setting All NHS acute hospitals with an accident and emergency and/or an orthopaedic department were surveyed. Participants 306 institutions were surveyed. Interventions Each institution was sent a 14 question self-administered questionnaire pertaining to the assessment, treatment, evaluation and outcome of patients following a first time patellar dislocation. After 3 weeks, all non-respondents were sent a reminder letter. After a further 3 weeks, those who had not responded by this time were sent a final reminder and copy of the questionnaire. Results The survey response rate was 59%. The respondents indicated that first-time patellar dislocation was not a common musculoskeletal disorder managed by NHS physiotherapists, constituting an average of 2% of caseloads. The results suggested that physiotherapists most commonly assess for reduced quadriceps or VMO capacity, gait, patellar tracking and glide, and knee effusion when examining patients following a first-time patellar dislocation. The most common treatments adopted are reassurance, behaviour modification followed by proprioceptive, knee mobility, quadriceps and specific VMO exercises. Conclusions Generic lower limb assessment and treatment strategies are widely used to manage this patient group. Given the previous paucity in this literature, further study is now recommended to assess the efficacy of these interventions to provide UK physiotherapists with an evidence-base to justify their management strategies.
Methods. The expression of miRNAs was measured in the ATDC5 cell model of chondrogenesis using mi... more Methods. The expression of miRNAs was measured in the ATDC5 cell model of chondrogenesis using microarray and was verified using quantitative reverse transcription-polymerase chain reaction. MicroRNA expression was localized by in situ hybridization. Predicted miRNA target genes were validated using 3untranslated region-Luc reporter plasmids containing either wild-type sequences or mutants of the miRNA target sequence. Signaling through the Smad pathway was measured using a (CAGA) 12 -Luc reporter.
Methods. The expression of miRNAs was measured in the ATDC5 cell model of chondrogenesis using mi... more Methods. The expression of miRNAs was measured in the ATDC5 cell model of chondrogenesis using microarray and was verified using quantitative reverse transcription-polymerase chain reaction. MicroRNA expression was localized by in situ hybridization. Predicted miRNA target genes were validated using 3untranslated region-Luc reporter plasmids containing either wild-type sequences or mutants of the miRNA target sequence. Signaling through the Smad pathway was measured using a (CAGA) 12 -Luc reporter.
Background: In patients with patellar instability and severe trochlear dysplasia, trochleoplasty ... more Background: In patients with patellar instability and severe trochlear dysplasia, trochleoplasty has become increasingly used as part of its surgical management.
Revue de Chirurgie Orthopédique et Traumatologique
Anterior knee pain (AKP) encompasses a range of pathologies. As a result, there are a number of t... more Anterior knee pain (AKP) encompasses a range of pathologies. As a result, there are a number of therapeutic options used to treat AKP. The non-operative treatments have been analysed in a number of randomised controlled trials and systematic reviews. There is however a scarcity of such publications covering the surgical management of AKP. There are no systematic reviews that have investigated surgical interventions for AKP due to pathology of the infrapatellar fat pad (IFP). The aims of this study were to review the literature systematically, to establish which surgical procedures have been used to treat IFP disease and to determine their efficacy.
Background: Anterior knee pain (AKP) is a common musculoskeletal complaint. It has been suggested... more Background: Anterior knee pain (AKP) is a common musculoskeletal complaint. It has been suggested that one factor that may contribute to the presence of AKP is a delay in the recruitment of the vastus medialis oblique muscle (VMO) relative to the vastus lateralis muscle (VL). There is however little consensus within the literature regarding the existence or nature of any such delay in the recruitment of the VMO within the AKP population. The purpose of this systematic review and meta-analysis was to examine the relative timing of onset of the VMO and VL in those with AKP in comparison to the asymptomatic population.
This systematic review compares the clinical, radiological and kinematic outcomes of fixed compar... more This systematic review compares the clinical, radiological and kinematic outcomes of fixed compared to mobile bearing unicompartmental knee replacements (UKRs). A metaanalysis of pooled mean difference and relative risk data was undertaken following a review of electronic databases. Five studies were identified. Analysis suggested that there was no significant difference in clinical outcome or complication rate between mobile and fixed bearing UKR. However, the evidence reviewed presented with a number of methodological limitations. Areas for further study are recommended. Level of evidence: Level I. Published by Elsevier Masson SAS.
... Grelsamer [9] hypothesised that an excessively TO Smith (&amp;) 4 ST Donell Institute of ... more ... Grelsamer [9] hypothesised that an excessively TO Smith (&amp;) 4 ST Donell Institute of Orthopaedics, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK e-mail: [email protected] R ... injury. Holt et al. ...
The standard surgical treatment for patellar instability has been lateral release and medial reef... more The standard surgical treatment for patellar instability has been lateral release and medial reefing proximally, with a Roux-Goldthwaite tendon transfer distally. More recently, reconstruction of the medial patellofemoral ligament (MPFL) has become popular. The aim of this study was to determine whether MPFL reconstruction improved the functional outcomes over patients treated with medial reefing. A group of 28 knees in 25 patients treated with a MPFL reconstruction were identified and matched for age and gender with 28 operated knees in 27 patients treated with a medial reefing. Clinical assessment included pre-operative and 1 year Kujala scores. Radiological assessment used the Dejour protocol. The two groups were comparable with respect to gender, age, preoperative Kujala score, type of trochlear dysplasia, tibial tubercle-trochlear groove distance and patellar tilt angle. It was concluded that although there was better patellar tracking at 1 year with an MPFL reconstruction compared to medial reefing, there was no significant functional improvement as measured by the Kujala score.
ABSTRACT PurposeThe purpose of this study was to investigate the issues surrounding the cremation... more ABSTRACT PurposeThe purpose of this study was to investigate the issues surrounding the cremation of medical devices in deceased patients.Materials and methodsA systematic review was conducted of published and unpublished databases. All publications related to the cremation of patients with medical devices were included. Areas under investigation included the incidence of different types of medical devices cremated, detection of implants, the environmental and health dangers associated with cremation of various medical devices, and recommendations for clinical and crematorium practices to manage these possible hazards. Two authors independently assessed publication eligibility and extracted data. A narrative review was conducted based on the data extracted.ResultsTwenty publications were eligible. These indicated that pacemakers and expandable orthopaedic nails are two potential dangers to cremation staff. However, there remains confusion regarding the potential dangers of radionuclide exposure, especially with regard to the effect of time between the introduction of the radionuclide material and death with respect to its handling, storage and cremation. There is limited evidence of public health problems surrounding mercury emissions from the cremation of dental amalgams.Discussion/conclusionsThere is evidence that clinicians, funeral directors, mortuary and crematorium teams are well aware of the hazards of pacemakers and cremation. However the miniaturisation of pacemakers and other electronic devices, the increasing use of radioactive treatments in oncology and the use of expandable nails in orthopaedics need to be recognised to allow safe disposal should cremation be considered for the deceased where these materials have been used.
Unicompartmental knee arthroplasty (UKA) is widely performed in the United Kingdom for the manage... more Unicompartmental knee arthroplasty (UKA) is widely performed in the United Kingdom for the management of patients with symptomatic osteoarthritis of the medial compartment of the tibiofemoral joint. A limited number of papers have presented the findings of mid-term clinical and survival data with sufficiently large patient numbers following mobile-bearing UKA. The purpose of this study was to present the 6-
... Niitsu et al. [59] 4 4 4 U 4 4 4 4 4 X 4 4 4 X Polly et al. [60] 4 4 4 U 4 4 4 4 U 4 4 4 X 4 ... more ... Niitsu et al. [59] 4 4 4 U 4 4 4 4 4 X 4 4 4 X Polly et al. [60] 4 4 4 U 4 4 4 4 U 4 4 4 X 4 Rappeport et al. [61] 4 4 4 U 4 4 4 4 4 4 4 4 X 4 Rayan et al. [62] 4 4 4 4 4 4 4 4 4 4 X 4 X 4 Riel et al. [63] 4 4 4 4 4 4 4 X 4 4 U 4 4 X Sampson et al. [64] 4 4 4 4 4 4 4 4 4 4 U X 4 4 ...
The purpose of this study was to analyse the midterm outcomes of an accelerated rehabilitation pr... more The purpose of this study was to analyse the midterm outcomes of an accelerated rehabilitation programme for unicompartmental knee arthroplasty. One hundred and six patients (187 knees) underwent a minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty with an accelerated rehabilitation programme and were followed over the Wrst 5 years. The emphasis of the programme was pre-operative patient education, multidisciplinary discharge planning and early rehabilitation. On retrospective analysis, patients reported a signiWcant improvement in functional outcomes and quality of life in respect of Oxford knee score, American knee score and short form-12 outcomes (P < 0.05). These improved clinical outcomes were then maintained during the 5-year period. The results support the use of accelerated rehabilitation to optimise early hospital discharge without jeopardising early and midterm outcomes.
To determine the discriminative validity and reliability of the evidence base using meta-analysis... more To determine the discriminative validity and reliability of the evidence base using meta-analysis. A review of published sources using the databases AMED, CINHAL, EMBASE, MEDLINE, Scopus and the Cochrane Library, and for unpublished material was conducted. All studies assessing the reliability, validity, sensitivity or specificity of magnetic resonance imaging (MRI), computed tomography (CT) or ultrasound (US) of the patellofemoral joint of patients following patellar dislocation, subluxation or instability, were included. A meta-analysis was performed to assess the difference in radiological measurements between healthy controls and subjects with patellar instability in order to assess discrimination validity. A narrative assessment was used to evaluate the inter- and intra-observer reliability as well as the sensitivity and specificity of specific radiological measurements. A total of 27 studies were reviewed. The findings indicated that there was acceptable inter-observer and intra-observer reliability and validity for different methods of assessing patellar height and the sulcus angle with X-ray, MRI and CT methods, and the tibial tubercle-trochlear groove (TT-TG) assessed using CT. There was poor reliability or validity for the assessment of severity of trochlear dysplasia and the sulcus angle using US. There is insufficient evidence to determine the reliability, validity, sensitivity or specificity of tests such as the congruence angle, lateral patellar displacement, lateral patellar tilt, trochlear depth, boss height, the crossing sign or Wiberg patellar classification. A critical appraisal of the literature identified a number of recurrent methodological limitations. Further study is recommended to evaluate the reliability and validity of these radiological outcomes using well-designed radiological trials.
Little has been published about which physiotherapy interventions are used to treat patients with... more Little has been published about which physiotherapy interventions are used to treat patients with instability of the patella. The purpose of this study was to review the literature systematically to determine the clinical outcomes of rehabilitation for patients following a lateral patellar dislocation. AMED, CINHAL, Cochrane Library, EMBASE, MEDLINE, PEDro and Scopus database searches were performed from their inception to August 2009. A search of unpublished and grey literature databases was undertaken, in addition to contacting all authors of included publications. All publications presenting the outcomes of patients following a conservatively managed lateral patellar dislocation were included. All eligible articles were appraised critically using the Critical Appraisal Skills Programme appraisal tool. Data on interventions, cohort characteristics, outcome measures and results were extracted. A narrative research synthesis method approach was adopted. In total, 29 publications were eligible for inclusion in this review. Although a proportion of patients experienced recurrent instability and dislocation episodes after rehabilitation, a large proportion of patients reported acceptable outcomes following physiotherapy. No randomised controlled clinical trials were identified assessing different physiotherapy interventions. The evidence base included a number of under-powered studies which poorly described the specific physiotherapy interventions prescribed. Further, well-designed randomised controlled trials assessing different conservative management strategies with specific patient groups, to provide pre-intervention as well as follow-up data, are required to determine the optimal clinical outcomes of physiotherapy for patients following a lateral patellar dislocation.
To determine whether the addition of bed exercises after primary total hip replacement (THR) impr... more To determine whether the addition of bed exercises after primary total hip replacement (THR) improves functional outcomes and quality of life, in adult patients, during the first six postoperative weeks. Design Single-blind randomised controlled trial. Setting Inpatient and outpatient orthopaedic departments at a National Health Service hospital. Participants Sixty primary elective THR patients. Intervention Patients were assigned at random to receive either a standard gait re-education programme and bed exercises, or the standard gait re-education programme without bed exercises after THR. The bed exercises consisted of active ankle dorsiflexion/plantarflexion, active knee flexion, and static quadriceps and gluteal exercises. Main outcome measures Iowa Level of Assistance Scale (ILOA), the Short Form-12 Health Survey (SF-12), duration of hospital admission and postoperative complications were assessed at baseline, and 3 days and 6 weeks postoperatively. Results There was no statistically significant difference in ILOA scores between the two groups on the third postoperative day [gait reeducation and bed exercise group median 40.5, interquartile range (IQR) 17.5 to 44.5; gait re-education alone group median 38, IQR 22.0 to 44.5; P = 0.70]. Although there was a small difference between the median ILOA scores at Week 6 between the two groups (3.5, IQR 0 to 6.4 and 5.0, IQR 3.5 to 12.5; P = 0.05), this difference was not statistically or clinically significant. There was no difference between the groups in duration of hospital admission, SF-12 scores or postoperative complications at Week 6. Conclusion This study suggests that during the first six postoperative weeks, the addition of bed exercises to a standard gait re-education programme following THR does not significantly improve patient function or quality of life.
Objectives The purpose of this study was to determine how musculoskeletal physiotherapists in acu... more Objectives The purpose of this study was to determine how musculoskeletal physiotherapists in acute National Health Service (NHS) hospitals manage patients following a first time patellar dislocation. Design National survey study. Setting All NHS acute hospitals with an accident and emergency and/or an orthopaedic department were surveyed. Participants 306 institutions were surveyed. Interventions Each institution was sent a 14 question self-administered questionnaire pertaining to the assessment, treatment, evaluation and outcome of patients following a first time patellar dislocation. After 3 weeks, all non-respondents were sent a reminder letter. After a further 3 weeks, those who had not responded by this time were sent a final reminder and copy of the questionnaire. Results The survey response rate was 59%. The respondents indicated that first-time patellar dislocation was not a common musculoskeletal disorder managed by NHS physiotherapists, constituting an average of 2% of caseloads. The results suggested that physiotherapists most commonly assess for reduced quadriceps or VMO capacity, gait, patellar tracking and glide, and knee effusion when examining patients following a first-time patellar dislocation. The most common treatments adopted are reassurance, behaviour modification followed by proprioceptive, knee mobility, quadriceps and specific VMO exercises. Conclusions Generic lower limb assessment and treatment strategies are widely used to manage this patient group. Given the previous paucity in this literature, further study is now recommended to assess the efficacy of these interventions to provide UK physiotherapists with an evidence-base to justify their management strategies.
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