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Lane, Judith. "Knee joint stiffness and function following total knee arthroplasty." Thesis, University of Edinburgh, 2010. http://hdl.handle.net/1842/4790.
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Introduction: Studies show that Total Knee Arthroplasty (TKA) is successful for the majority of patients however some continue to experience some functional limitations and anecdotal evidence indicates that stiffness is a common complaint. Some studies have suggested an association between stiffness and functional limitations however there has been no previous work which has attempted to objectively quantify knee joint stiffness following TKA. The purpose of this study was to pilot and evaluate a method for the quantitative evaluation in joint stiffness in replaced knees, OA knees and healthy controls and to explore whether there is an association between stiffness and functional limitations post-TKA surgery. Methods: The first part of the study created a biomechanical model of knee stiffness and built a system from which stiffness could be calculated. A torque transducer was used to measure the resistance as the knee was flexed and extended passively and an electrogoniometer concurrently measured the angular displacement. Stiffness was calculated from the slope of the line relating the passive resistive torque and displacement. The torque and joint angle at which stiffness was seen to increase greatly was also noted. The system was bench tested and found to be reliable and valid. Further tests on 6 volunteers found stiffness calculations to have acceptable intra-day reliability. The second part was conducted on three groups: those with end-stage knee OA (n = 8); those who were 1 year post-TKA (n = 15) and age matched healthy controls (n = 12). Knee range of motion was recorded and participants then completed the WOMAC, the SF-12 and a Visual Analogue Score for stiffness as well as indicating words to describe their stiffness. Four performance based tests – the Timed Up and Go (TUG), the stair ascent/descent, the 13m walk and a quadriceps strength test were also undertaken. Finally, passive stiffness at the affected knee was measured. Results: 100% of OA, 80% of TKA and 58% of controls reported some stiffness at the knee. The OA group reported significantly higher stiffness than the OA or TKA groups. There was no difference in self-reported stiffness between the TKA and control groups. Of the total number of words used to describe stiffness, 52% related to difficulty with movement, 35% were pain related and 13% related to sensations. No significantly differences were found between groups in the objective stiffness measures. Significant differences were found however in threshold flexion stiffness angles between groups. When this angle was normalised, differences between groups were not significant. No significant differences were found between groups in the threshold stiffness torque. Greater self-reported stiffness was found to be associated with worse self-reported function. A higher flexion stiffness threshold angle was associated with slower timed tests of function but also with better quadriceps muscle strength. Conclusions: The results support anecdotal reports that perceived stiffness is a common complaint following TKA but there was no evidence to show that patients with TKA have greater stiffness than a control group. There was however evidence to show that patients’ were unable to distinguish between sensations of stiffness and other factors such as pain. Self-perceived increased stiffness was associated with worse functional performance. Greater stiffness however was not necessarily negative. Stiffness increases earlier in flexion range were associated with better functional performance. These results suggest that an ideal threshold range for stiffness may exist; above which negative perceptions of the knee result in worse function but below which, knee laxity and instability may also result in worse function.
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Benfayed, Rida A. "Kneeling function following total knee arthroplasty." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/33073.
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The ability to kneel is an important function of the knee joint, as it is required for many daily activities, including religious practices, professional occupations and recreational pursuits. The inability to kneel following total knee arthroplasty (TKA) is frequently a source of disappointment. This work investigates patients' understanding of the term 'kneeling' and what proportion of patients can kneel before and after TKA, as well as identifying the factors that can affect the ability to kneel following TKA. The underlying hypothesis tested was: 'There are no differences between kneeling ability before and after TKA'. Kneeling ability after TKA may be affected by many factors, including patient-specific factors, the extent of wear on RPC (Retro patellar Cartilage), postoperative AKP (Anterior Knee Pain) and post-operative ROM (Range of Motion). Thus a consecutive series of TKA patients were assessed to test the afore-mentioned hypothesis. In particular, the thesis has examined: • Interpretation of kneeling and perceptions of kneeling ability after TKA. • The extent of wear on Retro Patellar Cartilage (RPC) and its correlation to kneeling ability. • Sensory changes in the knee after TKA. • Preoperative and Postoperative Anterior Knee Pain (AKP) assessment. • The reality of kneeling ability before and after TKA. • Postoperative ROM of the knee and its correlation to kneeling function. The advice offered by healthcare professionals may contribute to a low postoperative rate of kneeling. The patellofemoral joint plays an essential role in knee function and a person's kneeling ability, may be greatly affected by the performance of this joint. Firstly, this study analysed the responses of two samples of participants drawn from diverse cultural backgrounds (Christian and Muslim), it examined their primary interpretation of what kneeling constitutes, along with a subjective assessment of the importance of kneeling in their everyday lives. Secondly, it explored patients' perceptions of their kneeling ability after TKA, with a comparative analysis of their responses to the kneeling questionnaire specifically constructed by the author and also the question in relation to kneeling in the Oxford Knee Score (OKS). The third component investigated retro-patellar cartilage (RPC) morphology using intraoperative examination and standardised photography. Fourthly, a cohort of patients listed for TKAs was followed prospectively, in order to assess their kneeling ability prior to and following treatment, along with identifying the factors that could affect this function, i.e. knee pain, range of motion, sensory changes and sensitivity to pain on the anterior aspect of the knee as assessed with dolorimetry. Differences were detected in the subjective interpretation of the kneeling function, as well as its importance, for the two diverse cultures involved in this study. Pain, as opposed to poor range of movement, was identified as the main reason which led to kneeling difficulties. The majority of respondents reported that it was either extremely difficult or impossible to kneel on the operated knee. The high flexed position (required for prayer in certain cultures) was the most difficult position to achieve for most of the patients. Prior to surgery, 30 patients were seen during this period, 15 (50%) out of 30 consecutive patients were unable to kneel in any position whatsoever. Of those who could kneel to some degree, the most common posture that they could achieve was the upright kneeling position. Considerable variations were found to occur in patients' understanding of the term 'kneeling'. Consequently, this has significant implications for the design and interpretation of questions in relation to kneeling for diverse cultures, which are characterised by distinct lifestyles. The current patient-based selfV administered questionnaires, such as the OKS, although useful as a simple measure of overall knee function, were found to have limitations as an effective assessment tool in the measurement of kneeling function either before or after TKA and indicate that there is a need for a culturally appropriate questionnaire to assess kneeling function. Retro-patellar cartilage lesions were very prevalent in patients undergoing TKA. However, no significant correlation existed between the total amount of retro-patellar cartilage wear and the ability to kneel. Patients were more likely to be able to kneel if the cartilage of the superior facets of the patella were disease free (P=0.02). At the six months post-surgery stage, of the 14 consecutive patients, who could kneel pre-operatively 6 were able to kneel post-operatively. Of the 13 consecutive patients who were unable to kneel pre-operatively, all were unable to kneel post-operatively. Knee pain was the main reason attributed to this difficulty. However, no link was found to occur between sensory changes and kneeling function in the patients who participated in the study, after TKA performed via an anterior midline incision.
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Al-Sobayel, Hana I. "Construction and validation of the Saudi Knee Function Scale, a knee osteoarthritis index." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq22264.pdf.
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Elmqvist, Lars-Gunnar. "Chronic anterior cruciate ligament tear : knee function and knee extensor muscle size, morphology and function before and after surgical reconstruction." Doctoral thesis, Umeå universitet, Ortopedi, 1988. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-102562.
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Knee function was evaluated by knee score, activity level, clinical findings and performance tests, muscle size by computerized tomography (CT), morphology by light (LM) and electron microscopy (EM), muscle function by electromyography (EMG) and isokinetic performance in 29 patients with chronic anterior cruciate ligament (ACL) tear. Preoperatively CT disclosed a significant mean atrophy of the quadriceps and nonsignificant changes of the other muscle areas of the injured leg. Morphology of m vastus lateralis of the injured leg was normal in more than half of the biopsies preoperatively, the rest showed signs of nonoptimal activation. Significant decreases in all isokinetic parameters were noticed together with significantly decreased EMG of the quadriceps muscle of the injured leg. Âfter surgical reconstruction the knees were immobilized in a cast for 6 weeks at either 30° or 70° of knee flexion. After cast removal CT showed significant decreases of all areas which also remained after training. The 30° group showed larger fibres (intracellular oedema) and more frequent morphological abnormalities than the 70° group. Fourteen weeks postoperatively the patients were allocated to either a combination of isometric and progressive resistance training or isokinetic training for 6 weeks. CT showed slightly larger areas at 20 weeks postoperatively than at 6 weeks. Morphological abnormalities were still prominent at 20 weeks postoperatively. Maximum isokinetic knee extensor mechanical output and endurance were markedly decreased at 14 weeks postoperatively but both improved progressively during the one year rehabilitation, mostly during the intensive 6 week training period but irrespective of training programme used. Fatiguability/endurance level improved over the preoperative level. Muscular work/integrated EMG was stable while EMG/t increased indicating neuromuscular relearning. The clinical result at 28 months foliowup was excellent or good in 93% of the patients and clinical stability improved in 66%. Independent upon primary knee immobilization angle or training programmes no differences could be demonstrated with respect to stability, range of motion, function or isokinetic mechanical output. Isokinetic performance was still significantly lower in the injured compared to the noninjured leg and not significantly different from the preoperative values. Morphology, only 6 cases, showed abnormalities similar to preoperative findings. In conclusion, the reason for the decreased maximum and total knee extensor performance in these patients with ACL tears is suggested to be nonoptimal activation of normal functioning muscle fibres depending on changes in knee joint receptor afferent inflow. No differences concerning the markedly improved postoperative clinical result could be seen between the different treatment modalities used. A nonoptimal muscular activation might explain the still decreased isokinetic performance present at followup.S. 1-40: sammanfattning, s. 43-137: 5 uppsatser
digitalisering@umu.se
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Wickham-Bruno, Robbin. "Assessment of strength, balance, and function before and after total knee arthroplasty." Virtual Press, 2008. http://liblink.bsu.edu/uhtbin/catkey/1395590.
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The purpose of this research study was to evaluate pain, strength, balance, and function in subjects before and after total knee arthroplasty. Thirteen subjects were tested prior to total knee arthroplasty. Seven of the original subjects returned to the laboratory and were tested one month after knee replacement surgery. At each testing session subjects completed questionnaires including a pain visual analog scale (VAS), Falls questionnaire, global rating of knee function, Western Ontario McMaster Universities (WOMAC) osteoarthritis index, and Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS). Strength was tested via unilateral, isometric squat. Knee range of motion was measured using a standard goniometer. Functional activities including walking, sit to stand transfers, and stepping on and off a curb were assessed using the Balance Master Force Plate system (Neurocom International). Balance activities including tandem walk, modified clinical test of sensory interaction on balance (mCTSIB), limits of stability (LOS), and sensory organization tests (SOT) were also assessed using the SMART Equitest (Neurocom International). There was a trend towards decreased pain on VAS post- surgery although the results were not significantly different (p = 0.0585). Subjective rating of function was improved on the composite WOMAC Osteoarthritis Index score (p = 0.0313). No differences were found after surgery for strength in the involved limb, balance tasks, or ability to perform functional activities. From this study we conclude that total knee arthroplasty does not have a deleterious effect on function or balance in the immediate post-operative period even through the knee is still in an acutely inflamed state. Further testing is needed to evaluate the effect of TKA on more strenuous functional activities and balance tasks and at larger post-operative intervals.School of Physical Education, Sport, and Exercise Science
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Wilson, Jean-Marie J. "Lower limb muscle function during deep-knee bending." Thesis, University of Ottawa (Canada), 1989. http://hdl.handle.net/10393/5589.
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Herrington, Lee Carl. "Assessment of knee extensor mechanism function and the manipulation of that function." Thesis, University of Salford, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.490228.
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Dysfunction of the knee extensor mechanism resulting in patellofemoral pain (PFP) presents a significant challenge to those clinicians working in musculoskeletal medicine. The presence of the condition is believed to be related to changes in internal joint loading as a result of alteration in the position and tracking of the patellofemoral joint. One of the first challenges when assessing and treating this condition faced by the clinician is how to reliably and validly assess patella position.
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Mostertz, William C. "Quantifying antalgic gait knee function using inertial sensor technology." Connect to this title online, 2008. http://etd.lib.clemson.edu/documents/1219852146/.
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Al-Riyami, Masoud. "Traumatic Chondral Lesions of the Knee in Athletes with Emphasis on Arthroscopy, MRI, and Knee Function." Thesis, University of Sheffield, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.486789.
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Background: Traumatic chondral lesions of the knee are common in football and rugby players, The diagnosis is often confirmed by arthroscopy, considered appropriate because of persistent pain and effusion. The natural course of these injuries is not well known. Clinical diagnosis is difficult and MRI is not always reliable. Aims: 1. To introduce a simplified arthroscopic mapping system of the weight-bearing surfaces of the knee which can be used to describe the location of these chondral lesions. 2. To correlate the location and severity of these lesions with a novel knee function score designe~ to reflect the demands of football and rugby. 3. To assess the accuracy of different MRI sequences in diagnosing chondral lesions using the arthroscopic mapping system as a standard. 4. To evaluate the short-term functional outcome of microfractured lesions using MRI and function scores. Methods: Forty two consecutive football and rugby players with traumatic isolated chondral lesions observed at arthroscopy were included after appropriate consent. Lesion size and grade were recorded with the mapping system. All subjects were scanned two to three weeks after surgery using a 3-Tesla MRI. At eight to 12 weeks from surgery they were tested with the functional knee score. Twenty four out of 42 subjects with grade III IV lesions underwent microfracture at the time of arthroscopy. They were assessed at 3, 6, 12 and 18 months by functional knee score and MRI. A second look arthroscopy was carried out in 10 players five to seven months after surgery to evaluate lesion healing because there was discrepancy between. a 'normal' MRI and persistent clinical symptoms. Results: Fifty five lesions on weight-bearing surfaces were found in the 42 subjects. The average size of the lesion was 197 square mm. Pain, effusion, tenderness on palpation and positive compression rotation test were the predominant symptoms and signs. The medial femoral condyle (MFC) was affected most with 36 (65 %) of the lesions. the lesions were concentrated in the B areas (p < 0.05). Grade IV lesions were the most common with 26 lesions (47.3 %). These lesions were concentrated in the B areas (p < 0.05). Cartilage specific sequences (CSS) showed a sensitivity of 89 percent and specificity of 98 percent to identify the chondral lesions. Lesion location and grade determined by MRI were comparable to arthroscopy, but size was underestimated by MRI (p < 0.05). Both the functional knee score and MRI showed good correlation in assessing healing after microfracture at six, 12 and 18 months (r2 =0.993,0.986 and 0.993, respectively). Conclusion: The distribution of the traumatic chondral lesions over the weight-bearing surfaces of the knee is unequal, and neither location nor grade predict functional outcome. Cartilage specific sequences have relatively high sensitivity but are not reliable enough to replace arthroscopy in diagnosing cases with typical symptoms and signs. Microfracture shows excellent short term out-comes. Both the functional knee score and MRI are reliable enough on average to confirm healing at the defect site, and a second look arthroscopy may be required in some cases.
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Monk, Andrew Paul. "The patellofemoral joint : form and function." Thesis, University of Oxford, 2011. http://ora.ox.ac.uk/objects/uuid:96ce09f2-a72c-46ed-94fd-ed10213959fd.
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The patellofemoral joint (PFJ) is a common source of problems in Orthopaedics and is the source of poorly defined pain and poor function in both normal and replaced knees. Before problems of the PFJ can be fully comprehended a better understanding of the basic form and function of the PFJ is required. The aim of this thesis therefore is to investigate the shape and kinematics of the PFJ and their inter-relations in both normal and replaced knees. The first part of this thesis was concerned with the shape (or form) of the PFJ. Species from the human ancestry over the previous 400 million years were assembled and measurements taken from three dimensional, CT reconstructions, allowing the descriptions of evolutionary changes in the shape, and orientation of the patellofemoral joint in relation to the tibiofemoral compartments. The study chronicled the dramatic changes that occurred in relation to the adoption of the erect bipedal hominin stance which has resulted in varied anatomy at the PFJ, predisposing it to a wide range of pathologies. The articular surface geometry of normal human patellofemoral joints (bone and cartilage) were compared with those of total knee replacements, and patellofemoral joint replacements. Mapping of the trajectory of the apex of the trochlea groove revealed significant differences between native and replaced knees, with the trajectory being orientated laterally in normal knees and either centrally or medially in replaced knees. The second part of this work was concerned with the kinematics (or function) of the PFJ. With current technology it is impossible to measure coronal plane PFJ kinematics with any accuracy in both native and replaced knees. A novel method was developed combining Motion Analysis and UltraSound (MAUS). Validation experiments were undertaken that demonstrated acceptable error (1.8 mm). The MAUS technique was used to show statistically significant differences between the coronal plane kinematics of the patella in normal and replaced knees. In particular in some arthroplasty patients, the patella tracked in the opposite direction to that in normal subjects. The abnormal kinematics were a manifestation of non-anatomical joint replacements. This demonstrates that form and function are closely related. The interaction between form and function in the knee was further investigated using patients with anterior knee pain. Assessment was made of the relationship between patellar subluxation and multiple bony, cartilaginous and soft-tissue factors potentially predisposing to subluxation. The percentage of engagement of the patella in the trochlear groove in knee extension showed the strongest relationship with subluxation, with subjects less than 30% engaged tending to subluxate. This suggests that the most important factor in preventing subluxation is patellar engagement. A clinical study is now required to assess the effect of surgery aimed at improving engagement. The detailed insights into the variability of form and function in the PFJ obtained throughout this thesis will help address pathology in the native knee and guide decisions for new designs of knee replacements. A novel technology has been developed here for measuring patella kinematics which has great potential for future research. The MAUS technique will provide a clinical investigative tool and allow investigation into kinematic abnormalities in other joints.
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Freisinger, Gregory Martin. "Varus-Valgus Knee Laxity and Biomechanical Function in Patients with Severe Osteoarthritis and after Total Knee Arthroplasty." The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1429805221.
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Koslin, Aaron J. "Validation of an inertial sensor system for quantifying knee function." Connect to this title online, 2006. http://etd.lib.clemson.edu/documents/1175016110/.
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Moorehead, John David. "Analysis of knee function with a custom designed imaging system." Thesis, Liverpool John Moores University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.242155.
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Briem, Kristin. "Gait and function in knee osteoarthritis effects of hyaluronan injection /." Access to citation, abstract and download form provided by ProQuest Information and Learning Company; downloadable PDF file, 183 p, 2008. http://proquest.umi.com/pqdweb?did=1601513361&sid=6&Fmt=2&clientId=8331&RQT=309&VName=PQD.
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Scholes, Corey James. "The effects of muscle fatigue on knee function during landing." Thesis, Queensland University of Technology, 2010. https://eprints.qut.edu.au/39314/1/Corey_Scholes_Thesis.pdf.
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The human knee acts as a sophisticated shock absorber during landing movements. The ability of the knee to perform this function in the real world is remarkable given that the context of the landing movement may vary widely between performances. For this reason, humans must be capable of rapidly adjusting the mechanical properties of the knee under impact load in order to satisfy many competing demands. However, the processes involved in regulating these properties in response to changing constraints remain poorly understood. In particular, the effects of muscle fatigue on knee function during step landing are yet to be fully explored. Fatigue of the knee muscles is significant for 2 reasons. First, it is thought to have detrimental effects on the ability of the knee to act as a shock absorber and is considered a risk factor for knee injury. Second, fatigue of knee muscles provides a unique opportunity to examine the mechanisms by which healthy individuals alter knee function. A review of the literature revealed that the effect of fatigue on knee function during landing has been assessed by comparing pre and postfatigue measurements, with fatigue induced by a voluntary exercise protocol. The information is limited by inconsistent results with key measures, such as knee stiffness, showing varying results following fatigue, including increased stiffness, decreased stiffness or failure to detect any change in some experiments. Further consideration of the literature questions the validity of the models used to induce and measure fatigue, as well as the pre-post study design, which may explain the lack of consensus in the results. These limitations cast doubt on the usefulness of the available information and identify a need to investigate alternative approaches. Based on the results of this review, the aims of this thesis were to:
• evaluate the methodological procedures used in validation of a fatigue model
• investigate the adaptation and regulation of post-impact knee mechanics during repeated step landings
• use this new information to test the effects of fatigue on knee function during a step-landing task.
To address the aims of the thesis, 3 related experiments were conducted that collected kinetic, kinematic and electromyographic data from 3 separate samples of healthy male participants. The methodologies involved optoelectronic motion capture (VICON), isokinetic dynamometry (System3 Pro, BIODEX) and wireless surface electromyography (Zerowire, Aurion, Italy). Fatigue indicators and knee function measures used in each experiment were derived from the data. Study 1 compared the validity and reliability of repetitive stepping and isokinetic contractions with respect to fatigue of the quadriceps and hamstrings. Fifteen participants performed 50 repetitions of each exercise twice in randomised order, over 4 sessions. Sessions were separated by a minimum of 1 week’s rest, to ensure full recovery. Validity and reliability depended on a complex interaction between the exercise protocol, the fatigue indicator, the individual and the muscle of interest. Nevertheless, differences between exercise protocols indicated that stepping was less effective in eliciting valid and reliable changes in peak power and spectral compression, compared with isokinetic exercise. A key finding was that fatigue progressed in a biphasic pattern during both exercises. The point separating the 2 phases, known as the transition point, demonstrated superior between-test reliability during the isokinetic protocol, compared with stepping. However, a correction factor should be used to accurately apply this technique to the study of fatigue during landing. Study 2 examined alterations in knee function during repeated landings, with a different sample (N =12) performing 60 consecutive step landing trials. Each landing trial was separated by 1-minute rest periods. The results provided new information in relation to the pre-post study design in the context of detecting adjustments in knee function during landing. First, participants significantly increased or decreased pre-impact muscle activity or post-impact mechanics despite environmental and task constraints remaining unchanged. This is the 1st study to demonstrate this effect in healthy individuals without external feedback on performance. Second, single-subject analysis was more effective in detecting alterations in knee function compared to group-level analysis. Finally, repeated landing trials did not reduce inter-trial variability of knee function in some participants, contrary to assumptions underpinning previous studies. The results of studies 1 and 2 were used to modify the design of Study 3 relative to previous research. These alterations included a modified isokinetic fatigue protocol, multiple pre-fatigue measurements and singlesubject analysis to detect fatigue-related changes in knee function. The study design incorporated new analytical approaches to investigate fatiguerelated alterations in knee function during landing. Participants (N = 16) were measured during multiple pre-fatigue baseline trial blocks prior to the fatigue model. A final block of landing trials was recorded once the participant met the operational fatigue definition that was identified in Study 1. The analysis revealed that the effects of fatigue in this context are heavily dependent on the compensatory response of the individual. A continuum of responses was observed within the sample for each knee function measure. Overall, preimpact preparation and post-impact mechanics of the knee were altered with highly individualised patterns. Moreover, participants used a range of active or passive pre-impact strategies to adapt post-impact mechanics in response to quadriceps fatigue. The unique patterns identified in the data represented an optimisation of knee function based on priorities of the individual. The findings of these studies explain the lack of consensus within the literature regarding the effects of fatigue on knee function during landing. First, functional fatigue protocols lack validity in inducing fatigue-related changes in mechanical output and spectral compression of surface electromyography (sEMG) signals, compared with isokinetic exercise. Second, fatigue-related changes in knee function during landing are confounded by inter-individual variation, which limits the sensitivity of group-level analysis. By addressing these limitations, the 3rd study demonstrated the efficacies of new experimental and analytical approaches to observe fatigue-related alterations in knee function during landing. Consequently, this thesis provides new perspectives into the effects of fatigue in knee function during landing. In conclusion:
• The effects of fatigue on knee function during landing depend on the response of the individual, with considerable variation present between study participants, despite similar physical characteristics.
• In healthy males, adaptation of pre-impact muscle activity and postimpact knee mechanics is unique to the individual and reflects their own optimisation of demands such as energy expenditure, joint stability, sensory information and loading of knee structures.
• The results of these studies should guide future exploration of adaptations in knee function to fatigue. However, research in this area should continue with reduced emphasis on the directional response of the population and a greater focus on individual adaptations of knee function.
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Brunton, Luke R. "Assessing functional ability in patients with severe hip and knee osteoarthritis : an assessment of measures of function in hip and knee joint replacement." Thesis, University of Bristol, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.686424.
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Introduction/Background: Outcomes assessment in orthopaedics has advanced over the last decade. There are various different methods that can be used in a clinical setting to assess function and pain. During a clinical consultation, a simple, quick and restricted history, examination and review of investigations can be undertaken. Aim: I wished to ascertain whether function improved as a result of knee or hip joint replacement, and which of the commonly used existing methods of assessing function are of most value in this context. Methods: To achieve this aim, I recruited a broad spectrum of patients about to undergo primary or revision surgery for hip (n=42) or knee (n=51) joint disease. The study design was an observational cohort study, with data collection points pre-operatively and at 3 months post-operatively. Results: Most participants had less pain and better function 3 months after surgery than pre-operatively. However, the mean scores obscured the fact that several participants showed no improvement or worsening on some of the scores. Participants with the worst functional scores at baseline were most likely to improve. Performance tests showed less overall improvement than self-assessment measures. Overall walking times correlate well with all the other scores, with the exception of the Short Form-12 mental component score and American Knee Society Knee Score. However, in hip participants those with the best Harris Hip Scores did not have the best walking times, or the best Western Ontario and McMaster Arthritis Index or best Short Form-12 scores. Flexion beyond 90 degrees did not correlate with functional scores at the hip. Both inter and intra-rater reliability findings were good for both the Harris Hip Score and American Knee society score. Conclusions: Differences are identified in the outcome between different health status instruments commonly used in assessing function by self report questionnaires, surgeon based and performance based assessments. More research is needed to identify either the best method or more likely different instruments to identify important specific domains after hip and knee joint surgery.
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Hamilton, David Finlay. "Physiological and mechanical influences on muscle function following total knee arthroplasty." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/8744.
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End-stage osteoarthritis is characterised by pain and reduced physical function, for which total knee arthroplasty (TKA) is recognised to be a highly effective procedure. Post-operative outcome and resultant function however is variable. Many factors are thought to influence outcome; in particular quadriceps muscle strength is one of the strongest predictors of the patient’s ability to perform functional tasks. Muscle atrophy has been shown to account for only a third of the variance in muscle power, the remainder is currently unexplained. In this thesis it is hypothesised that physiological and mechanical factors will affect muscle power post TKA. A new design of prosthesis with an axis of rotation of the knee based on new kinematical observations has been suggested to confer a mechanical advantage to the knee extensor mechanism by lengthening its moment arm, and thus reducing the muscular effort required to extend the knee, however this has not as yet been clinically demonstrated. A strong extensor mechanism is recognised as being paramount to the patients return to functional activity following TKA, but there has been no consideration as to the mechanisms how and to what extent the muscle tissue actually recovers. It is known that muscle satellite cells are essential for the regeneration of skeletal muscle and that these cells are activated following damage, but these have not been considered in relation to recovery from orthopaedic procedures. It is hypothesised that the number of satellite cells in the extensor mechanism will vary in the patient population and will influence muscle recovery. A double blind randomised controlled trial of 212 TKA patients was conducted to compare the new implant design with a traditional model. Patient outcome was assessed at four points over a one year period. The new implant was superior in measures of knee flexion, lower limb power output and by patient report questionnaire (Oxford Knee Score) Two-way ANOVA, p = <0.001 in all cases. Extensor mechanism power was significantly increased between all four assessment points in the new implant group, the control group demonstrating change between the second and third assessment only (p= <0.001). Analysis of the outcome assessments used demonstrated a changing relationship between function and patient report of that function. Regression models demonstrated that patient report of function became more consistent with direct functional assessment as the influence of pain diminished post-operatively. A hierarchical model is presented that highlights the limitation of patient report data in isolation. Muscle satellite cells were isolated from biopsies of the quadriceps muscle of 18 patients at the time of surgery and counted by an immunofluorescent staining technique. The number of satellite cells detected accounted for a third of the postoperative variance in power output (R2 = 36.6%). This was confirmed in another cohort of 11 patients with a more sensitive qPCR technique. It was further found that the activated satellite cells accounted for around two thirds of the change in postoperative power output (R2 = 66.7%). In conclusion, both mechanical and physiological factors have a significant effect on muscle power post total knee arthroplasty.
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Abualhasan, Jawad Fadhel. "Assessing the stability and enhancing the function of the human knee." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6918/.
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Knee instability has been the focus of a large number of studies over the last decade; however, a high incidence rate still exists. The aim of this thesis is to better understand knee joint stability assessment and enhancement of knee function through rehabilitation strategies. A mixed methods approach was used, incorporating both a systematic review of the literature and two experimental studies. Chapter 3 presents evidence that there is no consensus in the literature on a single technique to detect knee instability and provide return-to-play criteria. Chapter 4 demonstrates that the response rate of the anterior cruciate ligament-hamstring reflex is too low for it to be reliably used in a clinical setting, and thus it has limited value in assessing the return of neuromuscular function following knee injuries. Chapter 5 shows that peripheral electrical and magnetic stimulation can be used as an adjunct to resistance training. Overall, the research reported in this thesis provides further evidence that knee stability assessment depends on multiple factors rather than a single measure. In addition, peripheral stimulation may be efficacious to enhancing knee function and a guide to return-to-play following injuries. This thesis highlights important points for future studies on knee stability assessment and rehabilitation; the necessity of a sensorimotor assessment of knee stability and the promising role of peripheral stimulation in knee rehabilitation.
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Westdorp, Clayton Mathew. "The Influence of Focal Knee Joint Cooling on Thigh Neuromechanical Function." University of Toledo / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1556626975273872.
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Hartigan, Erin. "Knee function after ACL rupture and reconstruction effects of neuromuscular training." Access to citation, abstract and download form provided by ProQuest Information and Learning Company; downloadable PDF file, 203 p, 2009. http://proquest.umi.com/pqdweb?did=1896910991&sid=7&Fmt=2&clientId=8331&RQT=309&VName=PQD.
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Walters, Yelena. "Task-orientated rehabilitation can improve knee function and satisfaction in patients 12 months after knee replacement surgery for osteoarthritis." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10045118/.
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End-stage osteoarthritis (OA) requires joint replacement surgery. Although total knee arthroplasty (TKA) usually relieves pain, some patients are disappointed with their mobility, which may result from an abnormal gait. Post-operative physiotherapy following TKA is essential, although little consensus exists regarding longer-term rehabilitation. Typical rehabilitation has an internal focus on specific muscles and joints, but task-orientated rehabilitation (TOR) may be more effective. This study tested the hypothesis that TOR can improve gait and patient reported functional outcome following TKA. Seventy six patients were studied 12 months after TKA during follow up at the Royal National Orthopaedic Hospital, Stanmore. Patient reported functional outcome was assessed using the Oxford Knee Score (OKS) and gait characteristics were measured using inertial measurement units (IMUs). A subset of 21 patients, exhibiting abnormal gait, entered a 4-week TOR programme, based on daily walking and stair climbing. Patients were re-assessed with OKS and IMUs, and gait quantity compared pre- and post-intervention using pedometers. A subset of 4 patients’ baseline gaits was compared to 5 controls, and to their own gait following the TOR, while subjected to differing treadmill conditions. Multiple regression analysis showed that stride duration significantly predicted OKS (p < 0.0001, n=76). Higher OKS was observed in patients who have shorter stride duration, which was in turn a result of greater RoM of the leg joints and segments in the sagittal plane. TKA patients’ response to the varying treadmill conditions was similar, but inferior in the gait parameters’ values as compared to the healthy participants. Following TOR, 21 patients exhibited a significantly higher OKS (p=0.001, n=21). Stride duration, thigh, knee and calf sagittal range of motion and knee flexion in stance significantly increased in both limbs following TOR. In conclusion, the results indicate that there is scope to improve rehabilitation of patients after TKA. TOR improves gait quality and therefore has the potential to improve satisfaction in TKA patients.
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Hurley, Michael V. "Muscle function, inhibition and rehabilitation following traumatic and degenerative joint damage." Thesis, King's College London (University of London), 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.321690.
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Ithurburn, Matthew P. "Associations among Knee Impairments, Patient-Reported Function, Landing Mechanics, and Knee Cartilage Integrity over Time after Anterior Cruciate Ligament Reconstruction." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1503059931724191.
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Watling, Daniel. "Development of novel methodologies to quantify, analyse and classify in-vivo knee function affected by aging, osteoarthritis and total knee replacement." Thesis, Cardiff University, 2014. http://orca.cf.ac.uk/67544/.
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Total knee replacement is effective at reducing pain resulting from end stage knee osteoarthritis but patient clinical outcome remains poor. This study develops methodologies for the assessment and classification of knee function to further the understanding of the mechanical effects of osteoarthritis, identify targets for treatment and objectively evaluate patient functional recovery. This study additionally develops methodologies to investigate how internal knee structures function during dynamic in-vivo activities using novel approaches to MRI. The uncertainties in the assessment of patients’ knee function were first investigated. Stair gait analysis was investigated to complement traditional level gait analysis. Measurements with the force plate interacting with step one displayed lowest inter-subject variability and were carried forwards to patient assessments. The level and stair gait of three age groups of healthy volunteers was investigated to select a healthy control group. A trend of peak sagittal moments at the hip, knee and ankle all decreasing with aging and frontal plane joint moments at the hip and ankle increase with aging was found. Age related changes were non-linear becoming more prominent towards old age. Young and middle aged healthy volunteers were combined to form a larger, homogenous cohort for patient comparisons. Inter-subject variability is neither helped nor hindered by the inclusion stair gait analysis when compared to level gait ensuring no adverse affects in distinguishing functional changes from naturally occurring individual variation. Patient completion of stair gait was unfortunately very poor however and the practicalities of stair gait in the patient population were found to be preventative. The accuracy of using principal component analysis over traditional parameterisation to classify osteoarthritic or healthy knee function was found to improve classification accuracy when using the Cardiff Dempster Shafer Theory Classifier. Knee measures were found to have poor classification accuracy with hip and ankle adaptations best discriminating healthy and patient gait. The adaptations to lower limb biomechanics observed in older healthy adults appear to become magnified with osteoarthritis. The classification methodology developed throughout the study resulted in an in and out of sample classification accuracy of 97.9% in determining osteoarthritic or healthy knee function. The hip, knee, ankle and ground reaction force biomechanical data of 12 patients before total knee replacement and one year post surgery were assessed using principal component analysis and the Cardiff Demspter Shafer Classifier. 42% of patients experience no functional benefit and 25% of patients recovered lower limb function characteristic of young and middle aged healthy volunteers. Classification of total knee replacement outcome was found to correlate with clinical outcome measures but implant type, BMI, weight loss and presence of comorbidities were poor indicators of patient outcome. Patient age and pre surgery function were found to correlate to the function observed post surgery, indicating that the earlier timing of intervention (and visualisation of this using the classification methodology) may improve functional and clinical outcome of patients with end stage knee arthritis. Novel, high resolution MR imaging and analysis techniques to quantify 3D, patient specific, invivo menisco-tibial kinematics and meniscus shape change were created. Repeatability was high with largest errors due to MRI image quality. Posterior translations of both menisci were found with increasing knee flexion angle and large meniscus translations, as much as 3.4mm in the anterior-posterior direction and 4mm in the medial-lateral direction were observed with changing transverse plane knee joint rotations. Load bearing introduced substantial additional posterior motion of both menisci, up to 4.6mm (medial meniscus) and 5.2mm (lateral meniscus) in the flexed knee. Large variability was observed between subjects suggesting patient specific response to load bearing is an important consideration in the treatment and rehabilitation of soft tissue injuries and prevention of early onset arthritis. Flexion of the knee was found to introduce compression in the menisci while loading contributed greatest posterior translation of both menisci. The posterior horns of both menisci were also found to rotate towards the centre of the tibial plateau during flexion and maintaining this during treatment of soft tissue injuries may aid the prevention of secondary pathologies.
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Gibson, Kyle. "Pain and function in knee osteoarthritis are they related to local intrinsic factors? /." Diss., Columbia, Mo. : University of Missouri-Columbia, 2008. http://hdl.handle.net/10355/5550.
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Thesis (Ph. D.)--University of Missouri-Columbia, 2008.The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on June 4, 2009) Vita. Includes bibliographical references.
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Smale, Kenneth. "Relating Subjective and Objective Knee Function After Anterior Cruciate Ligament Injury Through Biomechanical and Neuromusculoskeletal Modelling Approaches." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37947.
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Background: Knee injuries have a considerable impact on both the person’s psychological and physical health. We currently have tools to address each of these aspects but they are often considered independent of each other. Little work has been done to consolidate the subjective and objective functional ability of anterior cruciate ligament (ACL) injured individuals, which can be detrimental when implementing a return-to-play decision-making scheme. The lack of understanding concerning the relationship of these two measures may account for the high incidence of re-injury rates and lower quality of life exhibited by so many of these patients.
Purpose: The purpose of this doctoral thesis is to investigate the relationship between subjective and objective measures of functional ability in ACL deficient and ACL reconstructed conditions through biomechanical and neuromusculoskeletal modelling approaches.
Methods: This thesis is comprised of five studies based on a single in vivo data collection protocol, medical imaging and in silico data analyses. The in vivo data collection was of test-retest design where ACL deficient patients participated prior to their operation and approximately ten months post-reconstruction. This experimental group was matched to a healthy, uninjured control group, which was tested a single time.
The first study of this thesis involved a descriptive analysis of spatiotemporal, neuromuscular, and biomechanical patterns during hopping and side cut tasks in addition to subjective functional ability questionnaires. Then, two novel measures of dynamic knee joint control were developed and applied along with a third measure to determine if changes in joint control exist between the three groups (Study 2). The relationships of these objective measures of functional ability to subjective measures were then examined through correlation and regression models (Study 3). Following this, a method of including magnetic resonance imaging to construct patient-specific models was developed and implemented to determine realistic kinematic and ligament lengthening profiles (Study 4). These patient-specific models were then applied to quantify knee joint loading in the form of contact and ligament forces, which were correlated to subjective measures of functional ability (Study 5).
Results: Even though no major differences in neuromuscular patterns were observed between all three groups, it was found that subjective patient-reported outcome measures scores and biomechanical measures in the form of knee flexion angles and extensor moments were lower in the ACL deficient group compared to healthy controls. These differences continued to exist 10 months post-operation as the ACL reconstructed group had not fully recovered to patterns observed in the healthy controls. The current findings also suggest a possible hierarchy in the relationships between objective and subjective measures of functional ability. Basic kinematic objective measures such as knee flexion angle show small to moderate correlations, while more comprehensive measures such as stiffness and joint compressive force show moderate to strong correlations to subjective questionnaires. Finally, this thesis developed patient-specific OpenSim models that were used to produce appropriate kinematics and ligament lengthening with the reduction in soft tissue artefact.
Conclusion:
This thesis demonstrated that patients who are high-functioning in the ACL deficient state show greater improvements in subjective outcome scores after ACL reconstruction compared to objective measures. Biomechanical and neuromusculoskeletal modelling approaches identified important differences between the healthy and ACL deficient groups that were not resolved post-operatively. Our results also demonstrate that certain subjective and objective measures of functional ability are strongly correlated. The knowledge gained from this test-retest design and novel patient-specific in silico models aids clinicians in managing their expectations regarding the effectiveness of reconstruction and the respective long-term sequelae.
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Poursaeidi, Reihaneh. "An investigation of the design and function of knee joint-sparing massive endoprostheses." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10045208/.
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Distal femoral and proximal tibial joint-sparing bone tumour implants allow to preserve the knee, in limb salvage surgery. The aim of this thesis was to compare implant survival, functional outcomes, acceptance, proprioception and gait in patients with knee sparing implants and conventional knee sacrificing implants. Using FEA, a distal femoral implant and cadaver bone were modelled and parametrised to find the design that improves implant fixation. A survivorship study of 104 consecutive patients following knee sparing surgery (mean follow-up 36.1 ± 11.0 months) found an implant survival rate of 78% and this is comparable to the reported survival for joint sacrificing prostheses. Younger patients showed improved implant survival compared to older individuals. Plate fracture was not observed and aseptic loosening was the main reason for revision. Radiographic analysis indicated that implantation accuracy increased implant survival. Patient questionnaires showed that patients with knee sparing implants had more normal functional outcome and acceptance compared with patients with knee sacrificing implants. However, proprioception (joint position sense) was reduced in these patients. Using optoelectronic gait analysis system, hip, knee and ankle joint angle in 19 patients and 3 healthy subjects were measured. Ground reaction force and time in stance were also investigated. Joint symmetry in the joint sacrificing group was improved compared to the joint-sparing group, however overall, the joint-sparing tibial group demonstrated a more normal gait pattern. FEA results indicated that lower resection levels, reduced plate thickness and implant materials with lower modulus, decreased the stresses in the bone adjacent to the implant while loaded the bone more to reduce risk of stress shielding. To conclude, knee sparing endoprostheses provide a reliable alternative to knee sacrificing implants in limb reconstruction in selected patients. However, the current design of joint-sparing implants can be optimised to potentially improve bone remodelling and implant fixation.
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Sturnieks, Daina Louise. "Variations in gait patterns and recovery of function following arthroscopic partial meniscectomy." University of Western Australia. School of Human Movement and Exercise Science, 2004. http://theses.library.uwa.edu.au/adt-WU2004.0034.
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[Truncated abstract] Previous research has found that full recovery of knee function following arthroscopic partial meniscectomy (APM) is often not achieved, and in the long-term, over 50% of these patients will develop knee osteoarthritis (OA). Mechanical factors are believed to contribute largely to the development of knee OA. High frequency loading has been shown to lead to degenerative joint changes in animal models. In human gait, the knee adduction moment during stance phase, which tends to load the medial articular surface of the tibiofemoral joint, has been associated with the presence, severity and progression of knee OA. Quadriceps weakness, which is common in people with knee pathology, has been associated with abnormal sagittal plane knee moments during gait, yet no studies have investigated the effect of knee strength on frontal plane kinetics. This work aimed to investigate gait mechanics in a post-APM population, determine the influence of neuromuscular factors on gait, and assess recovery of function over 12 months while examining factors associated with recovery. One hundred and six APM subjects were examined between one and three months postsurgery. Data were compared to an age-matched control group of 49 healthy adults. Subjects were aged 20 to 50 years and had been screened for: clinical and radiographic evidence of knee OA; previous or current knee joint disease or injury (other than the current meniscus pathology); or any other previous or existing disease or injury that may have an effect on gait, or predispose to joint disease. Three-dimensional gait analysis was performed at a freely-chosen walking velocity, using a 50 Hz VICON three-dimensional motion analysis system, instrumented with two force platforms and 10-channel electromyography system. Subjects also underwent knee strength testing on a Biodex isokinetic dynamometer. Information was collected regarding subject’s physical activity levels, general health and knee function, as well as patient’s surgery specifics and rehabilitation regime.
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Engholm, Johanna, and Ouzair Youssef Abdel-Illah Mahi. "Individuals’ Experienced Osteoarthritis-associated Pain & Function while using a Knee Brace : A Qualitative Study." Thesis, Hälsohögskolan, Jönköping University, HHJ, Avd. för rehabilitering, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-50109.
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Background: Osteoarthritis of the knee is a condition that can emerge without any known reason, though most commonly it is caused by previous damage to the anatomical structures inside the joint. The most common symptom is pain during rest and activity. Individuals diagnosed with osteoarthritis often experience difficulties with performing certain types of movements and activities due to pain. Aim: Based upon a qualitative inductive content analysis, the aim is to investigate on a subjective level how individuals diagnosed with medial osteoarthritis experience pain and function, in relation to brace usage. Method: This study is based on recorded semi structured open-ended interviews with three individuals diagnosed with medial osteoarthritis whom uses a knee brace or knee orthosis. Results: The study generated six sub-categories which created two main categories describing the experience of medial osteoarthritis by the individuals. The results showed experience of affected physical ability and adaptation to pain. Conclusion: Individuals diagnosed with medial osteoarthritis experience limitation in activity and ADL mostly due to pain, though decreased function of the knee joint seems to be a contributing factor to limitation as well. Using a knee brace eases pain to some degree and enable individuals to perform some activities in comparison to when not using a knee brace. These conclusions should be considered with caution since the number of individuals interviewed in this study is small and may not provide the same information as of a larger number of individuals with medial osteoarthritis.
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Baldwin, G. "Isokinetic force ratios, muscle function and anaerobic performance of the knee extensors and flexors." Thesis, Bangor University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273567.
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Jones, Lianne. "Development of a novel method for the classification of osteoarthritic and normal knee function." Thesis, Cardiff University, 2004. http://orca.cf.ac.uk/55949/.
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Advances in our understanding of human locomotion can be futile if no practical use is made of them. For the long-term benefit of patients in a clinical setting, scientists and engineers need to forge stronger links with orthopaedic surgeons to make the most use of the recent developments in motion analysis technology. With this requirement as a driving-force, an objective classification tool was developed that uses motion analysis for an application to clinical diagnostics and monitoring, namely knee osteoarthritis (OA) progression and total knee replacement (TKR) recovery. The classification tool is based around the Dempster-Shafer (DS) theory, and as such is built upon the sound foundations of Bayesian statistics. The tool expands on the work of Safranek et al. (1990) and Gerig et al. (2000) who developed and used parts of the classification method in the areas of vision and medical image analysis respectively. Using the data collected during a clinical knee trial, this novel approach enables the objective classification of subjects into an OA or normal group. Each piece of data is transformed into a set of belief values: a level of belief that a subject has OA knee function, a level of belief that a subject has NL knee function and an associated level of uncertainty. The belief values are then represented on a simplex plot, which enables the final classification of a subject, and the level of benefit achieved by TKR surgery to be visualised. The DS method can be used as a fully or partially automated tool. The input variables and control parameters, which are an intrinsic part of the tool, can be chosen by an expert or an optimisation approach. Using a leave-one-out (LOO) approach, the tool was able to classify new subjects with an accuracy of 97.62%. This compares with the 63.89% and 95.24% LOO accuracies of two well-established methods---the Artificial Neural Network and the Linear Discriminant Analysis classifiers respectively. The tool also provides an objective indication of the variables that are the most influential in distinguishing OA and NL knee function. In this case, the variables identified by the tool as important are often cited as clinically relevant variables, which enhances the appeal of the tool to the clinical community and allows for more effective comparison with clinical approaches to diagnosis. Using Simulated Annealing to select the control parameters reduced the LOO accuracy to 95.24%. Automated feature selection using a Genetic Algorithm and Sequential Forward Selection increased the LOO accuracy to 100%. However, further work is required to improve the effect of this process on the overall level of uncertainty in the classification. Initial studies have demonstrated a practical and visual approach that can discriminate between the characteristics of NL and OA knee function with a high level of accuracy. Further development will enable the tool to assist orthopaedic surgeons and therapists in making clinical decisions, and thus promote increased confidence in a patient's medical care.
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BIJU, NIMMI. "RELATIONSHIP BETWEEN DIETARY SUPPLEMENT USE AND JOINT FUNCTION IN INDIVIDUALS WITH SELF-REPORTED KNEE OSTEOARTHRITIS." University of Cincinnati / OhioLINK, 2007. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1186616127.
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Worsley, Peter. "Assessment of short-term knee arthroplasty function using clinical measures, motion analysis, and musculoskeletal modelling." Thesis, University of Southampton, 2011. https://eprints.soton.ac.uk/188515/.
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Zhao, Dong. "Analysis of in vitro and in vivo function of total knee replacements using dynamic contact models." [Gainesville, Fla.] : University of Florida, 2006. http://purl.fcla.edu/fcla/etd/UFE0013600.
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Lahiff, Christina-Anne Kathleen. "Simulation of Hemiparetic Function Using a Knee Orthosis with Variable Impedance and a Proprioception Interference Apparatus." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/6623.
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Individuals with stroke have neuromuscular weakness or paralysis on one side of the body caused by some muscles disengaging and overexciting other muscles. Hyperextension of the knee joint and complete lack of plantar flexion of the ankle joint are common symptoms of stroke. This thesis encompasses the simulation of hemiparetic function using both a knee orthosis with variable impedance, specifically in terms of stiffness and damping, and the Proprioception Interference Apparatus.
The section regarding the knee orthosis with variable impedance focuses on the creation and implementation of a small, lightweight, and adjustable orthotic device to be positioned around the knee of an able-bodied person to simulate hemiparetic gait. Force and range of motion data from able-bodied subjects fitted with the orthosis, inducing hemiparetic gait, was collected using the Computer Assisted Rehabilitation ENvironment (CAREN) system. The four parameters that the design focused on are damping, catch, hysteresis, and stiffness. The main goal of the project was to discern whether this device could be utilized as a viable research instrument to simulate hemiparetic gait. It was hypothesized that the device has the potential to be utilized in the future as a research device to be used on able-bodied persons to study asymmetries in gait and eventually quantify the Modified Ashworth Scale. It was also believed that it could serve as a possible rehabilitation device for people with stroke since it has been designed to induce larger knee flexion as an after effect. However, this would require the proper clinical evaluation and experimentation procedures to be successfully concluded. A comparison between how the dominant leg was affected by the orthosis and how the non-dominant leg was affected was investigated as well. The results show that the device affected the velocities, knee angles, and force profiles of the subject’s gait.
The second section involving the Proprioception Interference Apparatus involved the creation and implementation of a haptic apparatus that utilizes vibration as well as transcutaneous electrical nerve stimulation (TENS) in various combinations with and without visual feedback to induce a proprioceptive illusion around the knee joint, as if a subject has a version of hemiparesis. The main goal of the project was to discern whether a device of relatively the same design could be utilized as a viable research instrument to simulate stroke-like balance in able-bodied subjects.
Comparison between how the root mean square (RMS) values of each marker location, the average of the standard deviations of the forces, and RMS of the center of pressure affected the various conditions was investigated as well. It was hypothesized and concluded that the RMS values and average of the standard deviations when subjects had no visual feedback would have a significant difference from when they had visual feedback. It was also hypothesized that Proprioceptive Interference Apparatus (PIA) would have a significant effect on the RMS and standard deviation values since it was meant to disrupt the motor control function of the knee, however, this was proved false after data analysis. It was also surmised that the application of the TENS had more of an effect on the RMS and standard deviation values, whether it was used on its own or in combination with the vibrations, than the vibration stimulation alone. However, once again, this was not statistically significant.
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Carroll, Chad C. "Skeletal muscle function and myosin heavy chain expression with Multiple Sclerosis." Virtual Press, 2001. http://liblink.bsu.edu/uhtbin/catkey/1221317.
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The purpose of this investigation was to examine the effects of Multiple Sclerosis (MS) on the structural and functional characteristics of skeletal muscle. More specifically, we analyzed the myosin heavy chain (MHC) and fiber type distribution of the vastus lateralis, measured single fiber cross sectional area (CSA), and determined the isokinetic and isotonic strength of the knee extensor muscles. Six sedentary subjects with MS (age: 44 ± 2 yrs) and six sedentary gender-matched controls (age: 46 ± 4) were evaluated. EachMS subject was rated on the Kurtzke's Expanded Disability Status Scale (EDSS) and performed an 8-meter walk test to determine gait speed. Furthermore, the spasticity of the knee extensors was evaluated in each MS subject and weekly energy expenditure was estimated using the Yale Physical Activity Survey. Concentric and eccentric isokinetic strength of the right knee extensors (left in one MS subject) was determined at 60 and 180°/sec and a bilateral isotonic one-repetition maximum (1-RM) was evaluated in eachsubject. Muscle biopsies were taken from the right vastus lateralis (left in one MS subject) and individual fibers were dissected from these samples. Fibers were submitted to SDSPAGE with silver staining to determine MHC expression. Densitometry was performed on MHC hybrid fibers to determine the degree of co-expression. An additional section ofthe biopsy was stained for mATPase activity and further analyzed for single fiber CSA and fiber type. The mean EDSS score for the MS subjects was 5.4 ± 0.6 (range 3.5-6.5) and MS patients were slower than controls (p < 0.05) on the walk-test. AshworthSpasticity Scores ranged from 0 - 2. No differences were noted in weekly energy expenditure. The controls were 45 and 56% stronger than the MS group at isokinetic concentric velocities of 60 and 180°/sec (p < 0.05), respectively. The isotonic 1-RM andthe eccentric isokinetic contractions were not different between the two groups. There were no differences noted in any of the MHC isoforms or percentage of hybrid fibers. Furthermore, mATPase fiber type distribution and single fiber CSA were not different between the groups. There was a greater proportion of MHC IIx dominant MHC IIa/IIx fibers in the MS groups (p < 0.05). Multiple Sclerosis appears to result in large strengthdeficits, when compared to healthy individuals. Based on our findings, these strength differences cannot be explained by alterations in MHC/fiber type expression or decreases in fiber CSA.School of Physical Education
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Hannah, Ricci. "The influence of sex-differences and exercise on knee joint neuromuscular function: implications for dynamic joint stabilisation." Thesis, Nottingham Trent University, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.657623.
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Tengman, Eva. "Long-term consequences of anterior cruciate ligament injury : knee function, physical activity level, physical capacity and movement pattern." Doctoral thesis, Umeå universitet, Sjukgymnastik, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-86715.
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Knee function after more than 20 years post injury is rarely described and none of the few follow-up studies have evaluated functional performance tasks. This thesis investigated self-reported knee function, physical activity level, physical capacity and movement pattern in the long-term perspective (on average 23 years) in persons who had suffered a unilateral ACL injury, treated either with physiotherapy in combination with surgery (ACLR, n=33) or physiotherapy alone (ACLPT, n=37) and compared to age-and-gender matched controls (n=33). This thesis shows that regardless of treatment, there are significant negative long-term consequences on self-reported knee function and physical activity more than 20 years after injury. In comparison to the controls, the ACL-groups (ACLR and ACLPT) had lower knee function as measured by the Lysholm score and the Knee injury and Osteoarthritis Outcome Score (KOOS). The persons with an ACL injury also had a lower knee-specific physical activity level (Tegner activity scale), while no differences were seen in general physical activity level (International Physical Activity Questionnaire, IPAQ) compared to healthy controls. Regarding physical capacity, both ACL groups showed inferior jump capacity in the injured leg compared to the non-injured leg. However, compared to controls the ACL-injured had a relatively good jump performance. Knee extension peak torque, concentric and eccentric, was also lower for the injured leg compared to the non-injured leg for both ACLR and ACLPT. In addition, the ACLPT group showed reduced eccentric knee flexion torque of the injured leg. The non-injured leg, on the other hand, showed almost equal jump capacity and strength as controls. Balance in single-limb stance (30s) was inferior in persons who had an ACL injury. This was true for both the injured and non-injured leg and regardless of treatment. Movement pattern during the one-leg hop was analysed by a set of kinematic variables consisting of knee angles (flexion, abduction, rotation) and Centre of Mass (CoM) placement in relation to the knee and ankle joints. Both ACLR and ACLPT displayed movement pattern asymmetries between injured and non-injured legs. In comparison to controls, the ACLR group had a similar movement pattern with the exception of larger external knee rotation at Initial contact and less maximum internal rotation during the Landing. ACLPT showed several differences compared to controls both regarding knee angles and CoM placement. The ACL-injured persons with no-or-low knee osteoarthritis (OA) had better knee function as reflected by higher scores on Lysholm and KOOS subscale ‘symptom’ compared to those with moderate-to-high OA. The degree of OA had no influence on reported physical activity level, jump capacity, peak torque or the kinematic variables. In conclusion, this thesis indicates that persons with a unilateral ACL injury, regardless of treatment, have some negative long-term consequences e.g. self-reported knee function, knee-specific activity level, strength and balance deficits, when compared to age-and-gender matched controls. The results, however, also indicate that the ACL-injured can manage reasonably well in some jumps and general activity level but have an inferior performance in more knee-demanding tasks. The ACLR group had similar movement pattern with the exception of knee rotation, indicating that a reconstruction may restore the knee biomechanics to some extent. The ACLPT group on the other hand, seem to use compensatory movement strategies showing several differences compared to controls.
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Dall, Philippa Margaret. "The function of orthotic hip and knee joints during gait for individuals with thoracic level spinal cord injury." Thesis, University of Strathclyde, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.401337.
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Zachmann, Kaden L. "How Muscle Function Relates to the 6-Minute Walk Test in Patients 24 Months Following Total Knee Arthroplasty." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1543513039902221.
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WORKIE, DAGNACHEW WALELIGN. "PHARMACOKINETIC MODELING OF DYNAMIC MR IMAGING IN THE KNEE OF CHILDREN WITH JUVENILE RHEUMATOID ARTHRITIS." University of Cincinnati / OhioLINK, 2005. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1115403758.
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Whatling, Gemma Marie. "Contribution to the clinical validation of a generic method for the classification of osteoarthritic and non-pathological knee function." Thesis, Cardiff University, 2009. http://orca.cf.ac.uk/54813/.
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The Cardiff Dempster-Shafer (DS) classifier is a generic automated technique for analysing motion analysis (MA) data. It can accurately discriminate between level gait characteristics of non-pathological (NP) and osteoarthritic (OA) knee function. It can also quantify and visualise the functional outcome of a total knee replacement (TKR). A number of studies were undertaken to explore and enhance this method. The training set for the classifier was increased by 48% by collecting additional knee function data for level gait. Knee function for nine new patients was classified pre and post-TKR surgery. At 12 months post-TKR, two patients exhibited non-dominant NP knee function. The remaining patients did not recover NP gait. This finding is similar to previous classifications of level gait. To improve the distinction between varying degrees of knee function, stair gait was introduced into the trial. A staircase was designed and validated. Adduction and flexion moments acting about the knee joint and medial component of the ground reaction force were found to be important in the classification of OA and NP knee function from stair gait. Using a combination of these variables the DS classifier was able to characterise OA and NP function for 15 subjects correctly with 100% accuracy, determined using a leave-one-out method of cross validation. The variables were tested to assess the outcome of TKR surgery. The patient assessed recovered NP stair gait post surgery. An image based study was undertaken to investigate the quality of the MA data used in the DS classifier. A step up/down activity for 5 NP and 5 TKR subjects was recorded using non-simultaneous MA and dynamic fluoroscopy. Accurate knee kinematics were computed from the fluoroscopy images using KneeTrack image registration software. MA measured significantly larger knee joint translations and non-sagittal plane rotations. The largest errors in MA derived kinematics were 9.53 for adduction-abduction range of motion (ROM) measured from the NP cohort and 2.63cm compression-distraction ROM of the tibio-femoral joint, measured from the TKR cohort. The generic nature of the DS classifier was tested by its application to distinguish hip function following a lateral (LA) and posterior (PA) approach to total hip arthroplasty. The use of different variables was investigated with the classifier. The best classifier was able to distinguish between NP and LA function with 96.7% accuracy, LA and NP with 86.2% accuracy and between LA and PA with 81.5% accuracy. The PA approach was found to lead to more characteristic NP hip function than LA. These studies show that variables from stair gait should be included in addition to level gait in the classifier. Due to errors when measuring non-sagittal plane rotations using MA, these should be interpreted with caution. The generic nature of the classifier has been proven by its application to another joint, thus answering another orthopaedic question.
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Åström, William. "Knee kinematics during a novel hop test with an unanticipated change of direction for female floorball athletes and controls : Evaluation of within-session and test-retest reliability and assessment of knee function." Thesis, Umeå universitet, Idrottsmedicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-122467.
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Introduction: The incidence of anterior cruciate ligament (ACL) injuries in female floorball is relativley high, and the risk for sustaining a second ACL injury is greater compared to previously uninjured. Existing evaluation tests in rehabilition may not be discriminative enough to guide decisions on return to sport Aim: To evaluate the withinAsession and testAretest reliability of knee kinematics in floorball athletes and controls during a hop encompassing a sudden unanticipated change of direction. A second aim was to investigate the discriminative validity by comparing the test outcomes between the athletes and a control group of nonAathletes. Method: 11 elite floorball athletes and 8 controls were tested on two occassions separated by one to three weeks. Knee kinematics, ground contact time and number of succesfull hops were analyzed. Relative reliability was quantifyed by Intraclass correlation coefficient (ICC) and absolute reliability by standard error of measurement (SEM). Results: ICCs for knee kinematics withinAsession reliability were excellent (0.83A0.96) for athletes and poor to excellent (0.40A0.94) for the controls. For the testAretest reliability, the athletes had good to excellent (0.56A0.96) reliability and the controls had poor to excellent (0.26A0.93) reliability. Only two measured kinematic variables were significantly different between the groups. Conclusion: This pilot study indictate good to excellent reliability for the majority of the kinematic variables tested and, therefore, it could be assumed to be adequatley reliable. Discriminative validity needs to be further evaluated in a larger material.
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Whitehouse, Sarah L. "Outcome following total knee replacement : a review of the available methods of assessment of outcome following total knee replacement and the development of a shorter, but fully validated version of the WOMAC function scale." Thesis, University of Bristol, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.340081.
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Fehr, Guilherme Lotierso. "Efetividade dos exercicios em cadeia cinetica aberta e cadeia cinetica fechada no tratamento da sindrome da dor femoropatelar." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309810.
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Orientador: João Batista de MirandaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: O objetivo deste estudo foi analisar os efeitos dos exercícios em cadeia cinética aberta (CCA) e cadeia cinética fechada (CCF) no tratamento da síndrome da dor femoropatelar (SDFP). Para tanto, 24 voluntários portadores de SDFP foram aleatoriamente divididos em dois grupos: grupo I (n=12): realizou exercícios em CCA; Grupo II (n=12): realizou exercícios em CCF. Os grupos foram submetidos a oito semanas consecutivas de tratamento, que consistiu de três sessões semanais realizadas em dias alternados. Para análise dos padrões de ativação dos músculos vasto medial oblíquo (VMO) e vasto lateral (VL) os sinais eletromiográficos (EMG) foram adquiridos com eletrodos bipolares de superfície, quantificados pela raiz quadrada da média (rot mean square ¿ RMS) e normalizados pela contração isométrica voluntária máxima do quadríceps. Por meio de escalas avaliou-se a intensidade da dor e funcionalidade dos voluntários. A análise dos valores da razão VMO/VL nos grupos I e II demonstrou que não houve diferenças significativas entre os tempos pré e pós-tratamento nas fases concêntrica (p>0,05) e excêntrica (p>0,05) dos exercícios em CCA e CCF. Apesar disso, o músculo VMO apresentou menor taxa de ativação em relação ao VL na fase excêntrica do exercício em CCF. Foram encontrados aumentos significativos na funcionalidade (p<0,05) e redução da intensidade da dor (p<0,05) entre os tempos pré e pós-tratamento em ambos os grupos, porém, o grupo II mostrou-se superior ao grupo I nestas duas variáveis. Os resultados deste estudo sugerem que, de acordo com as condições experimentais utilizadas, os exercícios em CCA e CCF não provocaram mudanças nos padrões de ativação EMG dos músculos VMO e VL, entretanto, mostraram-se efetivos no tratamento da SDFP e promoveram melhora da funcionalidade e redução da intensidade da dor após oito semanas de intervenção, sendo que os exercícios em CCF foram superiores aos em CCA
Abstract: The aim of this study was to analyze the effects of exercises in open kinetic chain (OKC) and closed kinetic chain (CKC) in patellofemoral pain syndrome (PFPS). Therefore, 24 volunteers with FPPS were randomly divided in two groups: group I (n=12): exercised in OKC; group II (n=12): exercised in CKC. The groups were under treatment for eight weeks in a row, having three sessions a week, carried out every other day. In order to assess the activation patterns of vastus medialis oblique (VMO) and vastus lateralis (VL) muscles, the electromyographic signs (EMG) were received by bipolar surface electrodes, quantified by root mean square (RMS) and normalized by the maximum voluntary isometric contraction of the quadriceps. The intensity of the pain and the volunteers¿ functionality were evaluated by scales. The analysis of the VMO/VL ratio in groups I and II showed that there weren¿t any significant differences between pre and post treatment periods in the concentric (p>0.05) and eccentric (p>0.05) phases of the exercises in OKC and CKC. Besides that the VMO muscle showed lower activation rate in relation to VL, in the eccentric phase of CKC exercises. Significant increases in functionality (p<0.05) and reduction in pain intensity (p<0.05) were found between pre and post treatment periods in both groups, however, group II was superior to group I in both variables. The results of this study suggest that, according to the experimental conditions used, OKC and CKC exercises did not stimulate changes in EMG activation patterns of VMO and VL muscles; nevertheless they were effective in PFPS treatment and promoted the functionality improvement and the reduction of the pain intensity after eight weeks of intervention, but CKC were better than OKC
Mestrado
Cirurgia
Mestre em Cirurgia
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Wood, Laurence Richard James. "The physical examination of older people with knee pain : a study of reliability and relationship to self-reported function in primary care." Thesis, Keele University, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.411891.
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Potvin, Brigitte. "Predicting Muscle Activations in a Forward-Inverse Dynamics Framework Using Stability-Inspired Optimization and an In Vivo-Based 6DoF Knee Joint." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/34647.
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Modeling and simulations are useful tools to help understand knee function and injuries. As there are more muscles in the human knee joint than equations of motion, optimization protocols are required to solve a problem. The purpose of this thesis was to improve the biofidelity of these simulations by adding in vivo constraints derived from experimental intra-cortical pin data and stability-inspired objective functions within an OpenSim-Matlab forward-inverse dynamics simulation framework on lower limb muscle activation predictions.
Results of this project suggest that constraining the model knee joint’s ranges of motion with pin data had a significant impact on lower limb kinematics, especially in rotational degrees of freedom. This affected muscle activation predictions and knee joint loading when compared to unconstrained kinematics. Furthermore, changing the objective will change muscle activation predictions although minimization of muscle activation as an objective remains more accurate than the stability inspired functions, at least for gait. /// La modélisation et les simulations in-silico sont des outils importants pour approfondir notre compréhension de la fonction du genou et ses blessures. Puisqu’il y a plus de muscles autour du genou humain que d’équations de mouvement, des procédures d’optimisation sont requises pour résoudre le système. Le but de cette thèse était d’explorer l’effet de changer l’objectif de cette optimisation à des fonctions inspirées par la stabilité du genou par l’entremise d’un cadre de simulation de dynamique directe et inverse utilisant MatLab et OpenSim ainsi qu'un model musculo-squelétaire contraint cinématiquement par des données expérimentales dérivées de vis intra-corticales, sur les prédictions d’activation musculaire de la jambe. Les résultats de ce projet suggèrent que les contraintes de mouvement imposées sur le genou modélisé ont démontré des effets importants sur la cinématique de la jambe et conséquemment sur les prédictions d'activation musculaire et le chargement du genou. La fonction objective de l'optimisation change aussi les prédictions d’activations musculaires, bien que la fonction minimisant la consommation énergétique soit la plus juste, du moins pour la marche.
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Jutman, Magnus, and Carl Lejervik. "Effekter av att använda infrapatellar rem vid patellar tendinopati : En systematisk litteraturöversikt." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-47602.
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Bakgrund: Patellar tendinopati (PT) är framförallt en vanlig diagnos bland aktiva inom idrotter där hopprörelser ofta förekommer. Diagnosen innebär ofta överbelastning av knäskålsenan, vilket leder till smärta och nedsatt funktionsförmåga. Fysioterapeutisk behandling syftar till att minska smärtan och återställa funktionsförmågan. Infrapatellara remmar (IPR) har använts sedan många år för symptomlindring vid idrottsaktiviteter men det saknas forskning som har sammanställt effekter av användning, vilket föranleder behovet av en systematisk litteraturöversikt. Syftet var att genom en systematisk litteraturstudie beskriva hur IPR används och utvärderas i studier vid PT, rapporterade effekter samt studiekvalitet och preliminär evidensstyrka. Metod: Artikelsökning genomfördes i databaserna PubMed och PEDro. Fem studier analyserades utifrån litteraturstudiens syfte och frågeställningar samt kvalitetsgranskades enligt SBU:s granskningsmallar. Resultat: Av studierna undersökte tre IPR:s effekt på smärtintensitet, två proprioception och två indirekt uppmätt senbelastning. Endast kortsiktiga utfall mättes och när dessa var statistiskt signifikanta var kliniska relevansen ofta oklar. Sammantagen preliminär evidensstyrka bedömdes som måttligt stark. Slutsatser: Studierna visade på varierande effekt av att använda IPR avseende förbättring av proprioception, smärtintensitet och indirekt uppmätt senbelastning. Fler högkvalitativa randomiserade studier behövs och framtida forskning bör undersöka långsiktiga effekter vid användning av IPR.Background: Patellar tendinopathy (PT) is common in jumping athletes. It’s mostly related to excessive loading of the patellar tendon, which leads to pain and decreased functional capacity. Physiotherapy treatment aims to reduce pain and restore functional capacity. Infrapatellar straps (IPS) have been utilized for many years to alleviate symptoms during sports activities but there is a lack of research that has compiled reports on effects of usage, which leads to the need of a systematic review. Objective: To describe use and evaluation of IPS in studies on patients with PT and describe reported effects, study quality and preliminary strength of evidence. Method: The PubMed and PEDro databases were searched for articles. Five studies were analyzed considering the review’s objective. Study quality was assessed according to SBU’s checklists. Results: Among the studies three investigated the effect of IPS on pain intensity, two on proprioception and two on indirectly measured tendon load. Short-term outcomes were investigated and the clinical relevance was often unclear when outcomes were statistically significant. Total preliminary strength of evidence was assessed as moderate. Conclusion: Variable effects are shown from IPS usage regarding pain intensity, proprioception and indirectly measured tendon load. More high-quality randomized trials and investigations of long-term effects are needed.
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Mulligan, Tessa Marie. "What are the Effects of Open and Closed Kinetic Chain Exercises on Knee Laxity, Functional Performance, Self-Report Function Questionnaires, and Muscle Strength of ACL Deficient or Reconstructed Patients? A Systematic Review." Walsh University Honors Theses / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=walshhonors1524153672782129.
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Van, der Linde Lavinia. "The effect of ballet exercise classes on BMI, perceived pain, physical function and quality of life in patients with osteoarthritis (OA) of the hip and knee." University of the Western Cape, 2012. http://hdl.handle.net/11394/5290.
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Magister Scientiae (Physiotherapy) - MSc(Physio)Introduction: Osteoarthritis (OA) is one of the prevalent debilitating diseases in South Africa, often leading to activity limitations, participation restrictions and a poor quality of life. Older people often lead more sedentary lifestyles, which may further aggravate their symptoms. Exercise therapy has demonstrated good outcomes in the OA population. Many dance interventions have become popular in OA treatment and results suggest their effects to be more successful than traditional physiotherapy exercises regimes. Ballet dance exercises have not yet been explored in the treatment of OA, even though it has been proposed to have positive effects on the body. Purpose: to determine the effect of a program of ballet dance exercise classes on BMI, perceived pain, physical function and quality of life in patients with osteoarthritis (OA) of the hip and knee, compared to the existing Midros Clinic program of exercise classes. Methods: The study used a randomized, cross-sectional, quantitative, experimental study using pre- and post-intervention as well as multiple time-point testing. A sample of 52 males and females were recruited in Midros, Middelburg Cape. The inclusion criteria of the study were persons aged 65 years and older, with OA of the hip and/or knee, clinically diagnosed according to the criteria of the American College of Rheumatology. The VAS, Timed Up and Go Test (TUGT), WOMAC and the SF-8 Index, respectively measured reported perceived pain, physical function, quality of life and health status in the study groups. BMI, pulse and blood pressure were also recorded to further monitor the effects of the interventions. A comparable number of scores were obtained over six weeks of bi-weekly ballet exercise classes (intervention group = IG), and nine weeks of two-weekly exercise classes at the Midros Clinic (comparison group = CG). Descriptive statistics were used to analyse the demographic information and inferential statistics were used to determine the associations for parametric data; a two tailed p-value was calculated; the 95% CI was calculated using the approximation of Katz. The p-value was classified as significant if p<0.05. Results: The demographics and baseline measurements of the IG and CG were comparable. A series of five exercise classes (over nine weeks) had a significantly beneficial effect on BMI and systolic BP, perceived and actual physical function, and QOL, whereas a series of 12 ballet exercise classes ( over six weeks) had a significant positive effect on BMI and diastolic BP, perceived pain, perceived physical function, and QOL. The comparison of responses to the outcome measures by male and female participants demonstrated that, contrary to findings in the reviewed literature, females held more positive perceptions than males on their perceived severity of joint pain and function, physical and mental health, and well being. A series of the existing exercise classes of Midros Clinic brought about more significant changes than a program of ballet exercise classes in the research parameters measured, despite exercise classes taking place much less frequently than the ballet classes. Conclusion: Although both interventions were found to both bring about positive changes in older persons with OA, a series of ballet exercises classes did not result in better outcomes than the currently existing Midros Clinic group exercise classes. The results of the current study demonstrate that exercise interventions are found to be the most beneficial in improving the quality of life of OA sufferers.