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Kerry E. Costello, Janie L. Astephen Wilson, William D. Stanish, Nathan Urquhart and Cheryl L. Hubley-Kozey

arthroplasty may be indicated once nonsurgical interventions become ineffective. 4 Under this model, patients spend years living with pain and disability, and the underlying disease processes are not addressed. A better understanding of factors involved in OA progression is essential to inform interventions

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Scott Cheatham, Monique Mokha and Matt Lee


Hip-resurfacing arthroplasty (HRA) has become a popular procedure in the treatment of hip-joint arthritis in individuals under the age of 65 y. Although the body of literature examining operative procedures has grown, there is a lack of consistent reporting of the effectiveness of an HRA postoperative rehabilitation program. To date, no systematic reviews have evaluated the available evidence on postoperative rehabilitation programs.


To evaluate the available evidence on postoperative rehabilitation programs after HRA.

Evidence Acquisition:

A systematic review was conducted according to the PRISMA guidelines. A search of PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar was conducted in April 2014 using the following keywords alone and in combination: postoperative, postsurgical, rehabilitation, physical therapy, programs, hip resurfacing, arthroplasty, and metal-on-metal. The grading of studies was conducted using the PEDro and Oxford Centre for Evidence-Based Medicine scales.

Evidence Synthesis:

The authors identified 648 citations, 4 of which met the inclusion criteria. The qualifying studies yielded 1 randomized control trial, 2 case reports, and 1 case series, for a total of 90 patients. Patients were mostly male (n = 86), had a mean age of 48 ± 5.47 y, and had been physically active before HRA. Postoperative rehabilitation programs varied in length (range 8–24 wk) and consisted of at least 3 phases. The methodology to assess program effects varied, but all 4 studies did measure a combination of function, pain, and quality of life using written questionnaires, with follow-up ranging from 9 mo to 1 y. The most common questionnaire was the Harris Hip Score.


This review found postoperative rehabilitation programs after HRA to be underinvestigated. Limited results indicate that postoperative rehabilitation programs may be effective in improving gait (stride length, velocity, and cadence), hip range of motion, and pain and function, as measured by questionnaires, but not hip strength.

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Satoshi Hamai, Ken Okazaki, Satoru Ikebe, Koji Murakami, Hidehiko Higaki, Hiroyuki Nakahara, Takeshi Shimoto, Hideki Mizu-uchi, Yukio Akasaki and Yukihide Iwamoto

The purpose of this study was to investigate in vivo kinematics in healthy and osteoarthritic (OA) knees during stepping using image-matching techniques. Six healthy volunteers and 14 patients with a medial OA knee before undergoing total knee arthroplasty performed stepping under periodic anteroposterior radiograph images. We analyzed the three-dimensional kinematic parameters of knee joints using radiograph images and CT-derived digitally reconstructed radiographs. The average extension/flexion angle ranged 6°/53° and 16°/44° in healthy and OA knees, with significant difference in extension (P = .02). The average varus angle was –2° and 6° in healthy and OA knees, with a significant difference (P = .03). OA knees showed 1.7° of significantly larger varus thrust (P = .04) and 4.2 mm of significantly smaller posterior femoral rollback (P = .04) compared with healthy knees. Coronal limb alignment in OA knees significantly correlated with varus thrust (R 2 = .36, P = .02) and medial shift of the femur (R 2 = .34, P = .03). Both normal and OA knees showed no transverse plane instability, including anteroposterior, mediolateral directions, or axial rotation. In conclusion, OA knees demonstrated different kinematics during stepping from normal knees: less knee extension, larger varus thrust, less posterior translation, and larger medial shift.

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Cody B. Bremner, William R. Holcomb, Christopher D. Brown and Melanie E. Perreault

Clinical Scenario:

Orthopedic knee conditions are regularly treated in sports-medicine clinics. Rehabilitation protocols for these conditions are often designed to address the associated quadriceps strength deficits. Despite these efforts, patients with orthopedic knee conditions often fail to completely regain their quadriceps strength. Disinhibitory modalities have recently been suggested as a clinical tool that can be used to counteract the negative effects of arthrogenic muscle inhibition, which is believed to limit the effectiveness of therapeutic exercise. Neuromuscular electrical stimulation (NMES) is commonly accepted as a strengthening modality, but its ability to simultaneously serve as a disinhibitory treatment is not as well established.

Clinical Question:

Does NMES effectively enhance quadriceps voluntary activation in patients with orthopedic knee conditions?

Summary of Key Findings:

Four randomized controlled trials (RCTs) met the inclusion criteria and were included. Of those, 1 reported statistically significant improvements in quadriceps voluntary activation in the intervention group relative to a comparison group, but the statistical significance was not true for another study consisting of the same sample of participants with a different follow-up period. One study reported a trend in the NMES group, but the between-groups differences were not statistically significant in 3 of the 4 RCTs.

Clinical Bottom Line:

Current evidence does not support the use of NMES for the purpose of enhancing quadriceps voluntary activation in patients with orthopedic knee conditions.

Strength of Recommendation:

There is level B evidence that the use of NMES alone or in conjunction with therapeutic exercise does not enhance quadriceps voluntary activation in patients with orthopedic knee conditions (eg, anterior cruciate ligament injuries, osteoarthritis, total knee arthroplasty).

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in Patients with Right Cerebral Vascular Accidents Hsieh-ching Chen * Keh-chung Lin * Chia-ling Chen * Ching-yi Wu * 4 2008 12 2 122 135 10.1123/mcj.12.2.122 Quiet Postural Control of Patients with Total Hip Arthroplasty Following Joint Arthritis Patrice Rougier * Dalila Belaid * Sylvie

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Brian D. Street and William Gage

authors have no conflicts of interest to disclose. References 1. Finch E , Walsh M , Thomas SG , Woodhouse LJ . Functional ability perceived by individuals following total knee arthroplasty compared to age-matched individuals without knee disability . J Orthop Sports Phys Ther . 1998 ; 27

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.3.185 Research Hip Adduction Does not Affect VMO EMG Amplitude or VMO:VL Ratios during a Dynamic Squat Exercise Michelle Boling * Darin Padua * J. Troy Blackburn * Meredith Petschauer * Christopher Hirth * 8 2006 15 3 195 205 10.1123/jsr.15.3.195 Golf after Total Hip Arthroplasty: A Retrospective

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2009 18 1 33 46 10.1123/jsr.18.1.33 Sport Activity after Total Hip Arthroplasty: Changes in Surgical Technique, Implant Design, and Rehabilitation Cale A. Jacobs * Christian P. Christensen * Michael E. Berend * 2 2009 18 1 47 59 10.1123/jsr.18.1.47 Relationship between the Hip and Low Back Pain

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Training in Individuals With Total Knee Arthroplasty Elaine Trudelle-Jackson * Emerenciana Hines * Ann Medley * Mary Thompson * 1 03 2020 17 3 331 338 10.1123/jpah.2019-0233 jpah.2019-0233 BRIEF REPORTS Association of Decline in Physical Activity With Increased Negative Mood Following the Weight

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Kate N. Jochimsen, Margaret R. Pelton, Carl G. Mattacola, Laura J. Huston, Emily K. Reinke, Kurt P. Spindler, Christian Lattermann and Cale A. Jacobs

preoperative scores on the PCS have been linked to more intense 27 , 28 and persistent 29 postoperative pain following total knee arthroplasty, in our acute ACL injury population, preoperative PCS scores were not related with 6-month outcomes. Similar to our results, Chmielewski et al 12 found that PCS