Browsing by Person "Rowe, P. J."

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A prospective randomised double-blind study of functional outcome and range of flexion following total knee replacement with the NexGen standard and high flexion components
(British Editorial Society of Bone and Joint Surgery, 2008-01) Nutton, R. W.; van der Linden, Marietta; Rowe, P. J.; Gaston, P.; Wade, F. A.
Modifications in the design of knee replacements have been proposed in order to maximise flexion. We performed a prospective double-blind randomised controlled trial to compare the functional outcome, including maximum knee flexion, in patients receiving either a standard or a high flexion version of the NexGen legacy posterior stabilised total knee replacement. A total of 56 patients, half of whom received each design, were assessed pre-operatively and at one year after operation using knee scores and analysis of range of movement using electrogoniometry. For both implant designs there was a significant improvement in the function component of the knee scores (p < 0.001) and the maximum range of flexion when walking on the level, ascending and descending a slope or stairs (all p < 0.001), squatting (p = 0.020) and stepping into a bath (p = 0.024). There was no significant difference in outcome, including the maximum knee flexion, between patients receiving the standard and high flexion designs of this implant.
Between-day repeatability of knee kinematics during functional tasks recorded using flexible electrogoniometry
(Elsevier, 2008-08) van der Linden, Marietta; Rowe, P. J.; Nutton, R. W.
The objective of this study was to assess the between-day repeatability of knee kinematics during activities of daily living recorded by electrogoniometry. One rater assessed the peak knee angles and knee excursion of 15 subjects during 13 activities twice with an average of 22 days (range 5-31) between the two assessments. The 15 subjects included four patients one year after total knee replacement (TKR) surgery, five patients before TKR surgery and six age-matched controls. Intra-class correlation coefficients and Bland and Altman coefficient of repeatability were derived to analyse the results. Only the most affected leg of the patients and the right leg of the controls were used for analysis. Different measures of repeatability showed different results. Intra-class correlation coefficients were higher than 0.75 for peak values of all functions except sitting down and rising from a standard chair. However, coefficients of repeatability ranged from 5.6 for the loading response in level walking to 39.8 for stepping out of a bath. Both of these values are higher than clinically significant changes seen after total knee surgery. It was concluded that for a single assessment on individual patients, the functional knee motion as performed in this study did not have sufficient repeatability. However, if the measurements are used to assess the average changes before and after surgery in a group of patients, the assessment of knee motion during activities such as level walking, and slope and stair ascending and descending were found to be sufficiently repeatable.
Gait kinematics and passive knee joint range of motion in children with hypermobility syndrome
(2011-03) Fatoye, F. E.; Palmer, S.; van der Linden, Marietta; Rowe, P. J.; Macmillan, Fiona
Hypermobility syndrome (HMS) is characterised by generalised joint laxity and musculoskeletal complaints. Gait abnormalities have been reported in children with HMS but have not been empirically investigated. The extent of passive knee joint range of motion (ROM) has also not been well reported in children with HMS. This study evaluated gait kinematics and passive knee joint ROM in children diagnosed with HMS and healthy controls.Thirty-seven healthy children (mean age SD. =11.5 2.6 years) and 29 children with HMS (mean age SD. =11.9 1.8 years) participated. Sagittal knee motion and gait speed were evaluated using a VICON 3D motion analysis system. Passive knee ROM was measured with a manual goniometer. Independent t-tests compared the values of sagittal knee motion and gait speed between the two groups. Mann-Whitney U tests compared passive knee ROM between groups.Passive ROM (extension and flexion) was significantly higher (both p<0.001) in children with HMS than the healthy controls. Peak knee flexion (during loading response and swing phase) during walking was significantly lower (both p<0.001) in children with HMS. Knee extension in mid stance during walking was significantly increased (p<0.001) in children with HMS. However, gait speed was not statistically (p=0.496) different between the two groups.Children with HMS had higher passive knee ROM than healthy children and also demonstrated abnormal knee motion during gait. Gait re-education and joint stability exercise programmes may be of value to children with HMS. 2010 Elsevier B.V.
Gait stability in response to platform, belt, and sensory perturbations in young and older adults
(Springer, 2018-06-27) Roeles, S.; Rowe, P. J.; Bruijn, S. M.; Childs, C. R.; Tarfali, Georgia; Steenbrink, F.; Pijnappels, M.
Perturbation-based gait assessment has been used to quantify gait stability in older adults. However, knowledge on which perturbation type is most suitable to identify poor gait stability is lacking. We evaluated the effects of ipsi- and contra-lateral sway, belt acceleration and deceleration, and visual and auditory perturbations on medio-lateral (ML) and anterior-posterior (AP) margins of stability (MoS) in young and older adults. We aimed to evaluate (1) which perturbation type disturbed the gait pattern substantially, (2) how participants recovered, and (3) whether recovery responses could discriminate between young and older adults. Nine young (25.1 ± 3.4 years) and nine older (70.1 ± 7.6 years) adults walked on the CAREN Extended (Motek BV, The Netherlands). The perturbation effect was quantified by deviation in MoS over six post-perturbation steps compared to baseline walking. Contra-lateral sway and deceleration perturbations resulted in the largest ML (1.9–4 times larger than other types) and AP (1.6–5.6 times larger than other types) perturbation effects, respectively. After both perturbation types, participants increased MoS by taking wider, shorter, and faster steps. No differences between young and older adults were found. We suggest to evaluate the potential of using contra-lateral sway and deceleration perturbations for fall risk identification by including both healthy and frail older adults.
Knee kinematics in functional activities seven years after total knee arthroplasty
(Elsevier, 2007-03) van der Linden, Marietta; Rowe, P. J.; Myles, C.; Burnett, R.; Nutton, R. W.
Background. Detailed knowledge of knee kinematics during functional activities is lacking in current studies on the long-term outcome of total knee replacement surgery. The aim of this study was to assess functional knee kinematics using flexible electrogoniometry in patients seven years after unilateral primary total knee arthroplasty for osteoarthritis. Methods. The knee joint functional movement of a cohort of patients (n = 19) with knee osteoarthritis was assessed using electrogoniometry before surgery and 18-24 months and seven years after total knee surgery. The mean age of the patients (11 women and 8 men) at the time of the pre-surgery assessment was 67 years old (SD 8.0). Patient function was also assessed using the Knee Society Score and WOMAC osteoarthritis Index. Findings. The function components of the Knee Society and WOMAC scores were significantly decreased at seven years compared to 18-24 months after surgery (both P < 0.05). However, the majority of the functional knee flexion values derived from electrogoniometry did not decrease. Seven years after surgery, knee excursion during ascending and descending stairs was significantly improved compared to 18-24 months after surgery (both P < 0.01). Interpretation. The finding that functional knee motion continues to improve between 18-24 months and seven years post-surgery is of interest to both patients and those responsible for their treatment planning. Further, it was shown that the WOMAC and Knee Society Scores do not follow the same trends as the patients' functional knee kinematics seven years after total knee replacement surgery.
Preoperative predictors of knee range of motion during stair walking after total knee replacement
(2008-09) van der Linden, Marietta; Roche, Patricia; Rowe, P. J.; Nutton, R. W.
Summary: Hierarchical Multiple Regression was performed on the pre and postoperative measures of 56 patients with end-stage osteoarthritis. Post-operative range of knee motion during stair ascent and descent was predicted by pre-operative measures in different domain blocks. Conclusions: Pre-operative variables predicting post-operative stair walking differ between stair ascent and descent. This has consequences for the treatment of patients waiting for a total knee replacement.
Proprioception and muscle torque deficits in children with hypermobility syndrome
(Oxford University Press, 2008-12-16) Fatoye, Francis A.; Palmer, S.; Macmillan, Fiona; Rowe, P. J.; van der Linden, Marietta
Objectives. Sensorimotor deficits such as impaired joint proprioception and muscle weakness have been found in association with hypermobility syndrome (HMS) in adults. HMS is more common in children than adults, yet such deficits have not been adequately investigated in paediatric populations. It is therefore uncertain as to what sensorimotor deficits are present in children with HMS. This study investigated knee joint proprioception and muscle torque in healthy children and those with HMS. Methods. Thirty-seven healthy children (mean age S.D._11.52.6 yrs) and 29 children with HMS (mean age S.D._11.91.8 yrs) participated in this study. Knee joint kinaesthesia (JK) and joint position sense (JPS) were measured, with the absolute angular error (AAE) calculated as the absolute difference between the target and perceived angles. Knee extensor and flexor muscle torque was assessed and normalized to body mass. Mann-Whitney U-tests were performed to compare JK, JPS and muscle torque between the two groups. Results. Children with HMS had significantly poorer JK and JPS compared with the controls (both P<0.001). Knee extensor and flexor muscle torque was also significantly reduced (both P<0.001) in children with HMS compared with their healthy counterparts. Conclusions. The findings of this study demonstrated that knee joint proprioception was impaired in children with HMS. They also had weaker knee extensor and flexor muscles than healthy controls. Clinicians should be aware of these identified deficits in children with HMS, and a programme of proprioceptive training and muscle strengthening may be indicated.
Repeatability of joint proprioception and muscle torque assessment in healthy children and in children diagnosed with hypermobility syndrome
(2008-03-17) Fatoye, Francis A.; Macmillan, Fiona; Rowe, P. J.; van der Linden, Marietta
Background: Impairment of joint proprioception in patients with hypermobility syndrome (HMS) has been well documented. Both joint proprioception and muscle torque are commonly assessed in patients with musculoskeletal complaints. It is unknown, however, if these measures change significantly on repeated application in healthy children and in children with HMS. Aim: To investigate the between-days repeatability of joint proprioception and muscle torque in these groups. Methods: Twenty children (10 healthy and 10 with HMS), aged eight to 15 years, were assessed on two separate occasions (one week apart) for joint kinaesthesia (JK), joint position sense (JPS), and the extensor and knee flexor muscle torque of the knee. JK was measured using threshold to detection of passive movement. JPS was measured using the absolute angular error (AAE; the absolute difference between the target and perceived angles). Knee extensor and flexor muscle torque was normalized to body weight. Results: Intra-class correlation coefficients (ICC) for JK, extensor and flexor muscle torque excellent in both groups (range 0.83 to 0.98). However, ICC values for JPS tests were poor to moderate in the two groups (range 0.18 to 0.56). 95% limits of agreement (LOA) were narrow in both cohorts for JK and muscle torque (indicating low systematic error) but wide for the JPS tests. 95% LOA also demonstrated that the measuring instruments used in this study had low between-days systematic error. Conclusions: Based on ICC and 95% LOA, the repeatability of JK and muscle torque measurements was excellent in both healthy children and those with HMS. The JPS test can only be assessed with poor to moderate repeatability. The use of the JPS test in these children should be undertaken with caution. Copyright 2008 John Wiley & Sons, Ltd.
Ultrasound Measurement of Femoral Anteversion and Tibial Torsion
(Scottish Executive, 2002) Kirby, Alanah; Rowe, P. J.
This project aimed to establish a method of measuring femoral anteversion and tibial torsion using real time ultrasound images and a new system of electronic inclinometry. The inclinometry system was carefully calibrated and proved accurate to within 1 degree and precise to with 0.2 of a degree. Individual inclinometers were attached firmly to both a 5MHz and a 7.5MHz linear array ultrasonic transducer using a specially produced clamp which gripped the front and rear of the probe head. Two low profile flexible switches linked by wire to a data collection computer were used to start and stop recording of the output of the inclinometers at 50Hz