Cost-effectiveness of specialised manual therapy orthopaedic care for musculoskeletal disorders: long-term follow-up and health economic model.

Background: Physiotherapy is usually the first line of treatment for musculoskeletal disorders. If pain persists, an appointment with an orthopaedic surgeon is indicated, but many disorders for which patients are placed on orthopaedic waiting lists cannot be treated in an orthopaedic clinic. Specialised manual therapy, although not mainstream, can be an effective alternative to orthopaedic care, although its cost-effectiveness beyond 12 months is unknown.

Naprapathy versus orthopaedic standard care for common musculoskeletal disorders: an 8-year follow-up of a pragmatic randomized controlled trial in Sweden.

Background: Musculoskeletal pain is among the most common reasons for seeking care, specialist competence for its treatment in primary care limited and waiting lists for orthopaedics often amongst the longest. Many referrals to orthopaedics do not concern disorders that benefit from surgery. Manual therapy is effective, yet not integrated in national health care systems, and there is a lack of research on other than neck and low back pain, and a lack of long-term follow-ups.

Musculoskeletal injuries in young ballet dancers.

Purpose: The aim of this study was to examine the incidence of musculoskeletal injuries, site and type of injury, and the most common injury diagnoses in young ballet dancers at the Royal Swedish Ballet School, a public school in Stockholm.

Methods: This retrospective study of 476 students (297 girls and 179 boys) aged 10-21 years was based on medical records for the period August 1988 to June 1995. Data on diagnosis, site of injury and type of injury were collected, and the injuries were classified as traumatic or due to overuse.

Naprapathic manual therapy or conventional orthopedic care for outpatients on orthopedic waiting lists?: A pragmatic randomized controlled trial.

Objectives: Traditionally, orthopedic outpatient waiting lists are long, and many referrals are for conditions that do not respond to interventions available at an orthopedic outpatient department. The overall objective of this trial was to investigate whether it is possible to reduce orthopedic waiting lists through integrative medicine. Specific aims were to compare the effects of naprapathic manual therapy to conventional orthopedic care for outpatients with nonurgent musculoskeletal disorders unlikely to benefit from surgery regarding pain, physical function, and perceived recovery.

A prospective study: hyperbaric oxygen therapy in diabetics with chronic foot ulcers.

Research suggests that hyperbaric oxygen therapy may have beneficial effects on ulcer healing and amputation rates in diabetic patients. This paper describes the design of a study that is evaluating its effects on chronic diabetic foot ulcers.

The injury panorama in a Swedish professional ballet company.

We performed a combined retro- and prospective study of injuries in a Swedish professional, classical ballet company during 5 consecutive years. There were 390 injuries incurred by 98 dancers over a 5-year period, i.e.

The response of primary rat and human osteoblasts and an immortalized rat osteoblast cell line to orthopaedic materials: comparative sensitivity of several toxicity indices.

When studying the biocompatibility of orthopaedic biomaterials it is often necessary to discriminate between responses which show mild cytotoxicity. It is therefore essential to use a very sensitive index of toxicity. We have compared the sensitivity of four well-established indices of toxicity: total cell protein content, leakage of lactate dehydrogenase (LDH), reduced glutathione content and the MTT assay, with that of a novel index, alkaline phosphatase (ALP) activity.

Proprioception in classical ballet dancers. A prospective study of the influence of an ankle sprain on proprioception in the ankle joint.

We studied prospectively the influence of ankle sprains on proprioception as measured by recording the postural sway of classical ballet dancers. Excellent balance and coordination are important for classical ballet dancers, and postural stability requires adequate proprioception from the ankle joint. Fifty-three professional dancers from the Royal Swedish Ballet, Stockholm, and 23 nonathletes, the control group, participated in the investigation.

In vitro biocompatibility testing of polymers for orthopaedic implants using cultured fibroblasts and osteoblasts.

The biocompatibility of two polymers for potential use as orthopaedic implant materials in an isoelastic hip prosthesis was investigated. The interactions of polyetheretherketone (PEEK) and epoxy resin polymers (with and without carbon fibre reinforcement) with both fibroblasts and osteoblasts were tested using cell protein, intracellular reduced glutathione (GSH), leakage of lactate dehydrogenase and the MTT assay as indices of cellular cytotoxicity. The epoxy resin polymer was slightly cytotoxic to and inhibited the growth rate of fibroblasts (as assessed by total cell protein), and depleted GSH in both cell types.

Low polymerization temperature with Boneloc. In vivo measurements in 11 hip replacements.

We investigated the thermal properties of a new bone cement, Boneloc, during total hip replacement, using a thermocouple connected to a digital thermometer. In 10 of 11 cases the maximum temperature was below 43 degrees C at the bone-cement interface in the acetabulum. This is a considerable reduction in the polymerization temperature in comparison with earlier studies of conventional bone cement.

Hallux valgus in ballet dancers: a myth?

Among dancers it is widely believed that ballet dancing induces hallux valgus. Revision of radiographs of 63 active and 38 retired dancers of both sexes showed no increase in the valgus angulation of the hallux compared with that of nondancers.

Biodegradable fixation of ankle fractures. A roentgen stereophotogrammetric study of 32 cases.

We performed a prospective randomized study comparing fixation with biodegradable polyglycolic acid (PGA) rods (n 15) or screws (n 17) in 32 selected displaced supination-eversion fractures. Immediate postoperative weight bearing in a walking cast was encouraged. An exact reconstruction of the ankle mortise was achieved in 26/32 ankles.

Knee motion after tibial osteotomy for arthrosis. Kinematic analysis of 7 patients.

The in vivo kinematics of the knee in 7 patients with moderate medial gonarthrosis was analyzed before and 6 months after high tibial osteotomy using roentgen stereophotogrammetric analysis. The inclination of the femorotibial helical axis of rotation did not change with knee flexion or after surgery. The femorotibial rotation increased after surgery.

Spinal sagittal mobility and joint laxity in young ballet dancers. A comparative study between first-year students at the Swedish Ballet School and a control group.

The present study compares spinal configuration, spinal range of motion and joint mobility in first-year students of the Swedish Ballet School and in nondancing students of corresponding age and sex in a state school. The study comprises all the first-year (fourth grade) students (n = 23) at the Swedish Ballet School: 11 boys and 12 girls. Their dance practice time was 10 h per week.

Ankle sprain and postural sway in basketball players.

The present study compares postural ankle stability between previously injured basketball players, uninjured players and a control/group. Postural sway was recorded and analysed by stabilometry using a specially designed computer-assisted forceplate. Recordings were obtained for 60 s on each foot.

Acetabular cement temperature in arthroplasty. Effect of water cooling in 19 cases.

In 19 patients who underwent total hip arthroplasty the temperature was studied at the bone-cement interface in the acetabulum during the polymethyl methacrylate curing process. To evaluate the effect of fluid cooling, the patients were randomized into two groups: one group with no irrigation, the other with continuous irrigation with Ringer solution during cement curing. The temperature was recorded with a thermocouple at the bone-cement interface.

Subsidence of porous coated noncemented femoral components in total hip arthroplasty. A roentgen stereophotogrammetric analysis.

Roentgen stereophotogrammetric analysis was used in the evaluation of subsidence in nine noncemented femoral components of the Biomet Taperloc prosthesis. After 2 years three components had subsided 0.7-0.

Walking ability after total hip replacement. A comparison of gait analysis in unilateral and bilateral cases.

We studied 50 patients before and after unilateral total hip replacement, and compared them, using gait analysis, with 22 having staged bilateral operations. The average age of the patients was 65 years at the first operation. The mean follow-up was 53 months for the unilateral cases and 27 months, after the second THR, for the bilateral cases.

Total hip arthroplasty. A comparison between cemented and press-fit noncemented fixation.

This study compares cemented (Charnley) with noncemented (Honart Patel-Garches) total hip arthroplasty. 150 patients with osteoarthritis, rheumatoid arthritis, and miscellaneous conditions were randomized into either group with 75 in each. Patients were evaluated over 5 postoperative years with examinations at 6 months, at 1 year, and then annually.

Postural stability after total hip replacement.

Changes in postural stability were recorded before and after total hip replacement using a specially designed computer-assisted forceplate system. Twenty-one patients with unilateral osteoarthritis of the hip were randomised into two groups after operation with either a cemented Charnley or a non-cemented HP-Garches prosthesis. Postural stability was improved in both groups one year after operation and the sway pattern became normal.

Subsidence of the femoral component in the noncemented total hip. A roentgen stereophotogrammetric analysis.

Roentgen stereophotogrammetric analysis was used in the evaluation of subsidence in eight noncemented femoral components of the HP-Garches prosthesis. After 2 years, seven components had subsided 0.6-3.

Influence of acetabular component position in non-cemented total hip arthroplasty. A radiologic and clinical study.

Radiologic grading of non-cemented acetabular components in HP Garches total hip replacements was used to evaluate the relationship between a lack of supero-lateral cover of the acetabular component and clinical outcome. In 63 hips, three to five years after total hip arthroplasty, we observed that the acetabular component was partially uncovered in 56 per cent of cases. The fact that several components were partially uncovered did not influence the clinical outcome.