Introduction. Modern forearm crutches have evolved little since their invention last century. We evaluated comfort and user satisfaction of 2 spring-loaded crutches compared with existing crutch designs. Methods. 25 healthy subjects (11 male, average age 26.2 years; 14 female, average age 22.7 years) participated. Each used 5 different crutches in a randomly allocated order:. standard forearm crutch (ergonomic grip);. spring-loaded crutch (soft spring, ergonomic grip);. spring-loaded crutch (firm spring, ergonomic grip);. standard forearm crutch (normal grip);. axillary crutch. Participants completed a purpose built course at the Pedestrian Accessibility and Movement LAboratory, UCL (PAMELA). The course consisted of a mixture of slopes (transverse and longitudinal), sprint, slalom, and a slow straight. All participants completed questionnaires relating to crutch user preference and design features. Results. Crutches were ranked in order of preference. The crutch least favoured was the axillary design, irrespective of subject weight, followed by the standard forearm crutch with normal grip. The 3 crutches with ergonomic handles all scored similarly. Preferences were also analysed in two weight controlled groups and compared against the soft and firm spring-loaded crutches. Of the lighter group 80% preferred the softer spring. Of the heavier group 56% preferred the firmer spring. Over 50% of subjects rated handle/cuff comfort as a key feature in crutch design. Conclusions. Preference for different spring tensions depended on subject weight, which should be the focus of further research. The least favoured crutches were the axillary and standard issue forearm grip crutch. Comfort was the most important feature in crutch design with preference for ergonomic handles, followed by cuff design ranked the most important. Spring-loaded crutches performed comparably to the other crutches with ergonomic handles

Introduction. In the US over half a million people are prescribed crutches each year. More than 750,000 wheelchair users exist in the UK and wheelchair and crutch users commonly develop shoulder pathology. The purpose of this study was to determine the influence of complex topographies on heart rate (HR) and thus energy expenditure, using a wheelchair and differing crutch designs on the exertional body stress. Method. Two Paralympics Athletes from the GB amputee football squad were assessed in a Lomax Active wheelchair and 5 different types of crutches in a randomly allocated order over a course representing everyday complex terrains at the Pedestrian Accessibility and Movement Environment Laboratory (PAMELA), University College London. In addition results were compared over the same course with the athletes using their own personal pair of crutches. The PAMELA course consisted of a mixture of 4% and 2.5% cross falls (transverse) and a simulated road crossing, sprint, slalom and a slow straight. Results. Initial findings show both athletes needed to work harder, thus spend more energy (13% more) to cope with the wheelchair tasks (2.6) than with the crutches(2.3). The Total Heart Beat Index (THBI) revealed that trying to ambulate with the crutches was more difficult in 4% cross fall (3.3) than on the longitudinal slopes (3.2), followed by 2.5% cross fall (2.85), slalom (2.1) and sprint (1.8). For the same tasks executed using a wheelchair the 2.5% gradient was shown to be the higher energy demanding (3.8), followed by the 4% (3.5), slopes (2.9), slalom (2.2) and sprint (2.1). Both participants reached a lower THBI (2.2) during the same task when using their own crutches. Conclusion. The results of this study imply that ambulation with crutches puts less burden than wheelchair. This might be due to the time these athletes spend with crutches, either in training or activities of daily living. Furthermore, the physical strain which they underwent during the complex terrains was clearly reflected on their heart rate. The setting of longer distances to collect more consistent HR data should be the focus of further research. The comparison in performance between athletes and the general population should also be investigated

There is controversy regarding the effect of different approaches on recovery after THR. Collecting detailed relevant data with satisfactory compliance is difficult. Our retrospective observational multi-center study aimed to find out if the data collected via a remote coaching app can be used to monitor the speed of recovery after THR using the anterolateral (ALA), posterior (PA) and the direct anterior approach (DAA). 771 patients undergoing THR from 13 centers using the moveUP platform were identified. 239 had ALA, 345 DAA and 42 PA. There was no significant difference between the groups in the sex of patients or in preoperative HOOS Scores. There was however a significantly lower age in the DAA (64,1y) compared to ALA (66,9y), and a significantly lower Oxford Hip Score in the DAA (23,9) compared to PA(27,7). Step count measured by an activity tracker, pain killer and NSAID use was monitored via the app. We recorded when patients started driving following surgery, stopped using crutches, and their HOOS and Oxford hip scores at 6 weeks. Overall compliance with data request was 80%. Patients achieved their preoperative activity level after 25.8, 17,7 and 23.3 days, started driving a car after 33.6, 30.3 and 31.7 days, stopped painkillers after 27.5, 20.2 and 22.5 days, NSAID after 30.3, 25.7, and 24.7 days for ALA, DAA and PA respectively. Painkillers were stopped and preoperative activity levels were achieved significantly earlier favoring DAA over ALA. Similarly, crutches were abandoned significantly earlier (39.9, 29.7 and 24.4 days for ALA, DAA and PA respectively) favoring DAA and PA over ALA. HOOS scores and Oxford Hip scores improved significantly in all 3 groups at 6 weeks, without any statistically significant difference between groups in either Oxford Hip or HOOS subscores. No final conclusion can be drawn as to the superiority of either approach in this study but the remote coaching platform allowed the collection of detailed data which can be used to advise patients individually, manage expectations, improve outcomes and identify areas for further research

Introduction. seeking full compliance with the Tissue Sparing Surgery principles, we introduced this new surgical approach to the coxa-femoral joint via the medial inguinal region. Patients/Materials and Methods. we performed total hip arthroplasty on 20 patients suffering from hip arthritis while 15 cases of medial femoral fracture received hemiarthroplasty with bipolar prostheses implants. Results. reduced surgery times, lower blood loss, zero complications and significantly speedier recovery were observed in all the above cases. Discussion/ Conclusion. this new surgical approach we devised enables a quick, safe and easy replacement of the hip. The muscles of the hip remain totally unharmed; maximum exposure is gained, with visualization of the acetabulum, directly fronting the surgeon, at its very best, favourably comparing with any other known approach. No particular equipment is needed and no special operating table. And it does not in the least imply a steep learning curve. Dislocation risks are non-existent allowing the patient any position in bed immediately after surgery. It is aesthetically preferable, the scar remaining almost invisible in between the inguinal skin lines. The patient can at once resume a steady walk, Canadian crutches being needed only for the first few days. It is the authors' opinion that such a technique, thanks to its being safe, fast, economical and easy to replicate, results in undoubted benefits for the patient, not least because it requires much shorter and far easier rehabilitation; and it can be counted as a valid alternative for surgeons to the most common approaches currently in use

Objectives

The purpose of this study was to compare the results and complications of tibial lengthening over an intramedullary nail with treatment using the traditional Ilizarov method.

Objectives

Acetabular retractors have been implicated in damage to the femoral and obturator nerves during total hip replacement. The aim of this study was to determine the anatomical relationship between retractor placement and these nerves.

We used a biodegradable mesh to convert an acetabular defect into a contained defect in six patients at total hip replacement. Their mean age was 61 years (46 to 69). The mean follow-up was 32 months (19 to 50). Before clinical use, the strength retention and hydrolytic in vitro degradation properties of the implants were studied in the laboratory over a two-year period. A successful clinical outcome was determined by the radiological findings and the Harris hip score.

All the patients had a satisfactory outcome and no mechanical failures or other complications were observed. No protrusion of any of the impacted grafts was observed beyond the mesh. According to our preliminary laboratory and clinical results the biodegradable mesh is suitable for augmenting uncontained acetabular defects in which the primary stability of the implanted acetabular component is provided by the host bone. In the case of defects of the acetabular floor this new application provides a safe method of preventing graft material from protruding excessively into the pelvis and the mesh seems to tolerate bone-impaction grafting in selected patients with primary and revision total hip replacement.