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Showing papers by "Nuffield Orthopaedic Centre published in 2001"


Journal ArticleDOI
TL;DR: A protocol for evaluation of foot kinematics during barefoot walking based on a multi-segment foot model is developed and it is found that repeatability is primarily subject to variability of marker placement more than inter-tester variability or skin movement.

527 citations


Journal ArticleDOI
TL;DR: Accuracy of implantation, assessed from 11 variables seen on fluoroscopically centered postoperative radiographs, was the same after UCA by the short-incision approach as after the open approach, suggesting that theshort-term advantage of increased speed of recovery was gained without affecting the long-term results.
Abstract: Forty Oxford medial unicompartmental arthroplasties (UCAs) were performed through a short incision medial to the patellar tendon, without dislocation of the patella, using updated instruments (Oxford Knee Phase III, Biomet Ltd., Bridgend, UK). The rate of recovery of these knees (measured by the time taken to achieve straight-leg raising, 70° of flexion, and independent stair climbing) was compared with that of 20 Oxford UCAs performed through an open approach with dislocation of the patella. Both groups were compared with 40 AGC (Biomet) total knee arthroplasties performed for osteoarthritis during the same time period. The average rate of recovery after the short-incision UCA was twice as fast as after open UCA and 3 times as fast as after total knee arthroplasty. Accuracy of implantation, assessed from 11 variables seen on fluoroscopically centered postoperative radiographs, was the same after UCA by the short-incision approach as after the open approach, suggesting that the short-term advantage of increased speed of recovery was gained without affecting the long-term results. We now employ the short incision with the phase III instruments for all UCAs.

377 citations


Journal ArticleDOI
TL;DR: The outcome of a series of 124 Oxford meniscal-bearing unicompartmental arthroplasties carried out for osteoarthritis of the medial compartment in Sweden is described, showing that this implant is a reliable treatment for anteromedial osteo arthritis of the knee.
Abstract: We describe the outcome of a series of 124 Oxford meniscal-bearing unicompartmental arthroplasties carried out for osteoarthritis of the medial compartment. They had been undertaken more than ten years ago in a non-teaching hospital in Sweden by three surgeons. All the knees had an intact anterior cruciate ligament, a correctable varus deformity and full-thickness cartilage in the lateral compartment. Thirty-seven patients had died; the mean time since operation for the remainder was 12.5 years (10.1 to 15.6). Using the endpoint of revision for any cause, the outcome for every knee was established. Six had been revised (4.8%). At ten years there were 94 knees still at risk and the cumulative survival rate was 95.0% (95% confidence interval 90.8 to 99.3). This figure is similar to that reported by the designers of the prosthesis and to the best published results for independent series of total knee replacement. If patients are selected appropriately, this implant is a reliable treatment for anteromedial osteoarthritis of the knee.

371 citations


Journal ArticleDOI
TL;DR: Examination of muscle connective tissue in children with spastic cerebral palsy suggests that collagen may be involved in increases in muscle stiffness observed in spasticity, and it is suggested that future treatments should consider including prevention of muscle fibrosis.
Abstract: Muscle function often becomes progressively more compromised in children with spastic cerebral palsy, leading to reduced mobility. This study aimed to examine the role that muscle connective tissue plays in this process. Severity of spasticity as determined by a range of clinical measures was assessed in 26 children (14 males 12 females; age range 4 to 17 years) with either diplegic or quadriplegic cerebral palsy (CP). Muscle biopsies from the vastus laeralis muscle were obtained for biomedical and histological analysis during orthopaedic surgery as part of the child's ongoing care. Total collagen was quantified by hydroxyproline determination. Two clinical measures of severity, Modified Ashworth Scale and Balance, were shown to have a highly significant correlation with collagen content, and Ambulatory Status, Clonus, and Selective Muscle Control all showed positive trends. Collagen I accumulated in spastic muscle's endomysium which appeared to be thickened, and fibrotic regions with sparse muscle fibres were evident in more severe cases. This suggests that collagen may be involved in increases in muscle stiffness observed in spasticity. Once developed, these changes are essentially irreversible and we suggest that future treatments should consider including prevention of muscle fibrosis.

240 citations


Journal ArticleDOI
TL;DR: A survival analysis was performed to determine the time of the recurrence of infection, and found that in group 2 there was a higher rate of recurrence in type-B hosts (p < 0.05); no type-A hosts had recurrence.
Abstract: We studied prospectively a consecutive series of 50 patients with chronic osteomyelitis. Patients were allocated to the following treatment groups: 1) wide resection, with a clearance margin of 5 mm or more; 2) marginal resection, with a clearance margin of less than 5 mm; and 3) intralesional biopsy, with debulking of the infected area. All patients had a course of antibiotics, intravenously for six weeks followed by orally for a further six weeks. No patients in group 1 had recurrence. In patients treated by marginal resection (group 2), 8 of 29 (28%) had recurrence. All patients who had debulking had a recurrence within one year of surgery. We performed a survival analysis to determine the time of the recurrence of infection. In group 2 there was a higher rate of recurrence in type-B hosts (p < 0.05); no type-A hosts had recurrence. This information is of use in planning surgery for chronic osteomyelitis.

167 citations


Journal ArticleDOI
TL;DR: The results indicate that the increase in osteoclast formation in GSD is due to an increase in the sensitivity of these precursors to humoral factors which promote osteoc last formation and bone resorption.
Abstract: Gorham–Stout disease (GSD) is a rare, massively osteolytic condition which is associated with increased vascularity and an increase in osteoclast numbers. To determine the cellular and humoral mechanisms underlying the increase in osteoclast numbers and osteolysis in GSD, this study analysed circulating osteoclast precursor numbers and sensitivity to osteoclastogenic factors in a GSD patient and age/sex-matched controls. Monocytes were cultured with M-CSF (25 ng/ml) and RANKL (30 ng/ml) and osteoclast formation was assessed in terms of the formation of TRAP+ and VNR+ multinucleated cells and the extent of lacunar resorption. There was no increase in the proportion of circulating osteoclast precursors in GSD relative to controls, but lacunar resorption was consistently greater in GSD monocyte cultures. Increased osteoclast formation in GSD was noted when monocytes were incubated with IL-1β (1 ng/ml), IL-6/sIL-6R (100 ng/ml), and TNFα (10 ng/ml). An increase in osteoclast differentiation and bone resorption was also noted in control monocyte cultures in the presence of GSD serum. These results indicate that the increase in osteoclast formation in GSD is due not to an increase in the number of circulating osteoclast precursors, but rather to an increase in the sensitivity of these precursors to humoral factors which promote osteoclast formation and bone resorption. Copyright © 2001 John Wiley & Sons, Ltd.

124 citations


Journal ArticleDOI
TL;DR: The authors think this technique for opening wedge high tibial osteotomy using hemicallotasis techniques is safer than, and the outcome comparable with, conventional techniques.
Abstract: High tibial osteotomy is an accepted treatment for unicompartmental osteoarthritis of the knee. Conventional osteotomy can be a demanding procedure with potential for complications. Opening wedge high tibial osteotomy using an external fixator is an alternative that may have advantages in comparison with classic methods. The aims of the current study were to determine if opening wedge osteotomy using hemicallotasis techniques is safer than, and the outcome comparable with that of, conventional techniques. Seventy-six high tibial osteotomies were performed in 65 patients for primary osteoarthritis. The mean age of the patients was 54.8 years (range, 36-70 years). The mean followup was 6 years. The only serious complication occurred in one patient, who had chronic osteomyelitis develop 2 years after surgery. There were no neurologic or vascular complications. The authors think this technique is safer than conventional techniques. Survivorship at 5 and 10 years was 89% and 63%, respectively. The mean knee score in osteotomies was 26.6 (maximum possible score, 48). The outcome is comparable with, or better than, that of other techniques for osteotomy. Subsequent knee replacement, in cases requiring conversion, was straightforward. The mean score in knees that had osteotomies that were converted to total knee replacements was 33.7.

116 citations


Journal ArticleDOI
TL;DR: The authors carried out a prospective study of 93 patients undergoing surgery for conditions of the rotator cuff during 1994 and 1995 They were assessed before operation and after six months, and four years, using the patient-based Oxford Shoulder Score (OSS), the SF-36 questionnaire and the Constant shoulder score.
Abstract: We carried out a prospective study of 93 patients undergoing surgery for conditions of the rotator cuff during 1994 and 1995 They were assessed before operation and after six months, and four years, using the patient-based Oxford Shoulder Score (OSS), the SF-36 questionnaire and the Constant shoulder score The response rates were higher for the OSS and SF-36 The correlation coefficients were high (r > 05) between all scores at each stage of the study While all scores improved substantially at six months, the Constant score was reduced significantly at four years This did not correlate with the patients’ judgement of the change in symptoms or of the success of the operation Our study suggests that patient-based measures of pain and function can reliably assess outcomes in the medium term after surgery to the shoulder

107 citations


Journal ArticleDOI
01 Sep 2001-Robotica
TL;DR: The range of mechanical solutions adopted to address the conditions of prosthetic hands is detailed, and the solutions compared with other solutions are compared.
Abstract: The design of prosthetic hands is constrained by a series of strict conditions. Despite this, many different design strategies have been explored. One particular form is the Southampton Hand system. This is a hierarchically controlled, electrically driven hand, with multiple axes, in an anthropomorphic form. This paper details the range of mechanical solutions adopted to address the conditions. It also compares them with other solutions.

106 citations


Journal ArticleDOI
TL;DR: The results confirm the value of the OHS in assessing outcome after RHR and suggest that it is particularly sensitive to improvements after R HR.
Abstract: The Oxford hip score (OHS) is a patient-based instrument for assessment of outcome which is often used after total hip replacement, and the EuroQol 5D (EQ5D) is a patient-based generic questionnaire for health assessment. In an analysis of the outcome at one year of 609 revision hip replacements (RHRs), we compared the OHS and EQ5D scores, postoperative patient satisfaction and change in pain. About 25% of the operations were repeat RHRs. At one year, 57% of patients were very pleased with their operation. The correlation between preoperative and postoperative scores and change scores for the OHS and EQ5D was high. For both instruments the effect sizes were large, but the greater effect size of the OHS suggests that it is particularly sensitive to improvements after RHR. The effect scores of the OHS declined with the number of previous RHRs, while those for the EQ5D seemed less sensitive. Our results confirm the value of the OHS in assessing outcome after RHR.

101 citations


Journal ArticleDOI
01 Mar 2001-Knee
TL;DR: The study indicates that the 1 year results for either technique are equally favourable, and the functional scores, activity level, muscle strength and anterior tibial translation improved in both groups.
Abstract: A randomised controlled trial was performed to evaluate early outcome for two types of anterior cruciate ligament reconstruction. Sixty patients undergoing cruciate reconstruction were randomized into two groups. Group PT underwent reconstruction using a patella tendon autograft, whereas Group (SG) had a semitendinosus/gracilis autograft (SG). IKDC, Lysholm, and Tegner scores, KT1000 values and muscle strength were recorded pre-operatively, at 6 months and 1 year follow up. The functional scores, activity level, muscle strength and anterior tibial translation improved in both groups. No significant difference between groups was found for any measurement at 6 months and 1 year despite adequate study power. The study indicates that the 1 year results for either technique are equally favourable.

Journal ArticleDOI
01 Mar 2001-Bone
TL;DR: It is confirmed that M-CSF is essential for human osteoclast formation from circulating mononuclear precursors, and shows that IL-3 and GM- CSF may support osteoplast differentiation via the stimulation of M- CSf production by human monocytes.

Journal ArticleDOI
TL;DR: It is suggested that most patients already diagnosed with HIV infection at the time of surgery should derive many years of symptomatic relief after a successful joint replacement, and survivorship analysis strongly suggests this.
Abstract: Joint replacement in HIV-positive patients remains uncommon, with most experience gained in patients with haemophilia. We analysed retrospectively the outcome of 102 replacement arthroplasties in 73 HIV-positive patients from eight specialist haemophilia centres. Of these, 91 were primary procedures. The mean age of the patients at surgery was 39 years, and the median follow-up was for five years. The overall rate of deep sepsis was 18.7% for primary procedures and 36.3% for revisions. This is a much higher rate of infection than that seen in normal populations. A total of 44% of infections resolved fully after medical and/or surgical treatment. The benefits of arthroplasty in haemophilic patients are well established but the rates of complications are high. As this large study has demonstrated, high rates of infection occur, but survivorship analysis strongly suggests that most patients already diagnosed with HIV infection at the time of surgery should derive many years of symptomatic relief after a successful joint replacement. Careful counselling and education of both patients and healthcare workers before operation are therefore essential.

Journal ArticleDOI
01 Oct 2001-Bone
TL;DR: It is shown that human skeletal muscle connective tissue contains osteogenic progenitor cells, which are identified as pericytes, perivascular cells with established osteogenic potential, suggesting a cellular link between angiogenesis and bone formation in muscle tissue.

Journal ArticleDOI
TL;DR: It is shown that rifampicin, at these concentrations, can inhibit the proliferation of osteoblast‐like cells in vitro and further studies should be carried out to assess whether rifampsicin is detrimental to the bone repair process in vivo.


Journal ArticleDOI
TL;DR: The anatomy, standard examination technique, indications, pitfalls and potential errors, and suggested imaging algorithms for a range of shoulder pathology are described.

Journal ArticleDOI
TL;DR: The purpose of this review is to outline the current status of the imaging assessment of recalcitrant anterior knee pain with particular reference to patellar maltracking.
Abstract: Anterior knee pain is a common complaint in the orthopaedic clinic. The differential diagnosis is wide and the principal goal of initial assessment is to detect remediable causes. The majority of patients do not have a specific disease and increasingly interest has focused on the role of patello-femoro-tibial morphology and of patellar maltracking in the aetiology of anterior knee pain. Classification in this group of patients is poor and there is no uniform agreement on which patient groups benefit from treatment and which treatment is best. Much of the literature involves relatively small numbers of patients, is poorly controlled and there is little agreement on outcome measures [1, 2]. The purpose of this review is to outline the current status of the imaging assessment of recalcitrant anterior knee pain with particular reference to patellar maltracking.

Journal ArticleDOI
TL;DR: In this article, the use of a modified technique to shorten wounds in ten consecutive patients undergoing acute shortening of a limb as part of an Ilizarov procedure was described, which gave good exposure, easy closure of the wound and fewer problems with healing than standard incisions.
Abstract: Z-plasty is used to lengthen scars and wounds. We describe the use of a modified technique to shorten wounds in ten consecutive patients undergoing acute shortening of a limb as part of an Ilizarov procedure. The modified technique gave good exposure, easy closure of the wound and fewer problems with healing than standard incisions.

Journal ArticleDOI
01 Jan 2001
TL;DR: Assessment of tetrahedral solid finite elements with linear and quadratic displacement functions when they are used to mesh the human femur in conjunction with automatic mesh generator methods concluded that linear tetrahedron elements should be avoided and quadrahedral elements ought to be chosen for the purposes of finite element analysis of the human Femur.
Abstract: Finite element models of bone segments generated from computed tomography data using automatic mesh generation algorithms are becoming common not only in research but also in clinical applications such as computer aided orthopaedic surgery. Especially in the case of the latter application, the models cannot be verified against an experimental measurement, therefore their inherent accuracy should be well known before drawing conclusions based on the calculated results. This study was carried out to assess the performance of tetrahedral solid finite elements with linear and quadratic displacement functions when they are used to mesh the human femur in conjunction with automatic mesh generator methods. Ten-node quadratic tetrahedra (T10) having parabolic displacement functions were compared with four-node linear tetrahedron elements (T4) on the basis of accuracy and central processing unit (CPU) time. From the analyses of 11 finite element meshes, it was concluded that linear tetrahedral elements should be avoided and quadratic tetrahedral elements ought to be chosen for the purposes of finite element analysis of the human femur. When incremental loading and iterative solution is necessary, the coarsest possible T10 mesh compatible with accuracy is needed to minimize computer capacity and CPU time.

Journal ArticleDOI
TL;DR: In patients with worrying symptoms, MRI with a limited protocol detects a greater number of abnormalities than previously reported studies using plain radiographs and has replaced plain radiography in the authors' hospital.

Journal ArticleDOI
TL;DR: In this article, the authors assessed the effectiveness of ACL reconstruction in reducing functional tibial translation (TT) in 11 ACL-deficient patients using Vicon equipment before and after surgery.
Abstract: We have assessed the effectiveness of reconstruction of the anterior cruciate ligament (ACL) in reducing functional tibial translation (TT). The gait of 11 ACL-deficient patients was studied using Vicon equipment before and after surgery. Measurements of the angle between the patellar tendon and the long axis of the tibia were obtained in order to calculate TT in the sagittal plane relative to the uninjured limb during standing and walking. Before surgery, patients did not show abnormal TT on the injured side, but after surgery significant anterior TT was found in the operated limb for every parameter of gait. Abnormal anterior TT occurring during activity does not seem to be reduced by reconstruction; rather, it increases. It may be that the increased translation results from relaxation of excess contraction of the hamstring muscles, since compensatory muscle activity no longer is required in a reconstructed knee. The reduction of TT may not be an appropriate objective in surgery on the ACL.

Journal ArticleDOI
TL;DR: In this article, the characteristics of dysplasia and coxa valga in hereditary multiple exostoses (HME) were defined by radiological analysis of 24 hips in 12 patients.
Abstract: We defined the characteristics of dysplasia and coxa valga in hereditary multiple exostoses (HME) by radiological analysis of 24 hips in 12 patients. The degree and effect of the 'osteochondroma load' around the hip were quantified. We investigated the pathology of the labrum and the incidence of osteoarthritis and of malignant change in these patients. Coxa valga and dysplasia were common with a median neck-shaft angle of 156 degrees, a median centre-edge angle of 23 degrees and Sharp's acetabular angle of 44 degrees. There was overgrowth of the femoral neck with a significantly greater ratio of the neck/shaft diameter in HME than in the control hips (p < 0.05), as well as correlations between the proximal femoral and pelvic osteochondroma load (p < 0.05) and between the proximal femoral osteochondroma load and coxa valga (p < 0.01). Periacetabular osteochondromas are related to Sharp's angle as an index of dysplasia (p < 0.05), but not coxa valga. No correlation was found between dysplasia and coxa valga. These data suggest that HME may cause anomalies of the hip as a reflection of a generalised inherited defect, but also support the theory that osteochondromas may themselves precipitate some of the characteristic features of HME around the hip.

Journal ArticleDOI
TL;DR: The unexpected loss of movement observed in the prelengthening period indicates that physical therapy efforts must be directed to this phase in order to accelerate the recovery of joint range and reduce the muscle-related complications that can occur during limb lengthening.
Abstract: Study Design Prospective longitudinal study Objectives To determine factors predictive of loss of movement in a cohort of patients undergoing femoral lengthening Background Loss of joint movement due to poor adaptation of the muscle is a major problem during limb lengthening but remains poorly documented in the literature Methods and Materials A validated technique using a modified goniometer was used to measure knee motion Measurements were taken before surgery, prelengthening, during lengthening, and at 6 and 12 months post frame removal The subjects were 35 patients with a mean age of 22 years (±128 years), 23 men and 12 women, undergoing femoral lengthening by the Ilizarov method Results The pattern of recovery of knee range of movement that was observed showed that 88% of knee flexion was regained by 6 months, 92% of patients regained their knee flexion by 12 months, and 97% by 18 months Significant loss of knee flexion occurred in the latent period prior to lengthening, mean loss 79° (±228°

Journal ArticleDOI
TL;DR: The frequency of revision of the Oxford medial unicompartmental arthroplasty in knees previously treated for anteromedial osteoarthritis by high tibial osteotomy is reported and it is recommended that the Oxford UCA should not be used in knees which have previously undergone an HTO.
Abstract: Satisfactory selection criteria are essential for the successful outcome of unicompartmental knee arthroplasty (UCA). We report the frequency of revision of the Oxford medial unicompartmental arthroplasty in knees previously treated for anteromedial osteoarthritis by high tibial osteotomy (HTO). The combined results from three sources were used to allow statistical analysis of this uncommon subgroup. In the combined series of 631 knees (507 patients) which had medial unicompartmental replacement, 613 were primary procedures and 18 were for a failed HTO. The mean follow-up times of the two groups were similar (5.8 years and 5.4 years, respectively). At review, 19 (3.1%) of the primary procedures and five (27.8%) of those undertaken for a failed HTO had been revised to total knee replacement. Survival analysis revealed the ten-year cumulative survivals to be 96% and 66%, respectively. The log-rank comparison of these survivals revealed a highly significant difference (p < 0.0001). We recommend that the Oxford UCA should not be used in knees which have previously undergone an HTO.

Journal ArticleDOI
TL;DR: Growth was particularly rapid at the ischial growth plates directed towards the centre and the articular cartilage, add on both sides of the anterior limb of the triradiate cartilage.
Abstract: The anatomy and development of the growing acetabulum are not clearly understood. We dissected and studied histologically two acetabula from the pelvis of a three-month-old infant. Relative rates of growth at the different growth plates were assessed by comparing the height of the proliferative layer with that of the hypertrophic layer. The three bones which form the acetabulum are surrounded by growth plates on all sides except medially. These face towards the centre of the triradiate cartilage, the limbs of the triradiate cartilage and the articular surface and each may be divided into four distinct areas according to the orientation of its cell columns which reflect the direction of growth. Growth was particularly rapid at the ischial growth plates directed towards the centre and the articular cartilage, add on both sides of the anterior limb of the triradiate cartilage. These findings may explain the mechanism by which the acetabulum changes orientation and inclination with growth.

Journal ArticleDOI
TL;DR: The findings suggest that the development of atrophic non-union is not directly due to a lack of these four growth factors, as previously suggested.
Abstract: The aim of the study was to determine, for the first time, the distribution of expression of several important growth factors during the development of atrophic non-unions using an animal model. The sites of expression of TGFβ, PDGF, FGFb, and BMP 2/4 were determined at the osteotomy sites of both normally healing bones and within atrophic non-unions at 1 and 8 weeks after operation using immunolocalization techniques. At 1 week after operation, the osteotomy gaps of the control group contained fracture haematoma and surrounding granulation tissue, whereas the osteotomy gaps of the non-union group contained only haematoma. The tissues of both the non-union and control groups demonstrated the same presence and distribution of growth factors. By 8 weeks after the operation, the control group osteotomy gaps were filled with bone within which the active osteoblasts stained positively for each of the growth factors. At 8 weeks, the osteotomy gaps of the non-union group contained only fibrous tissue, which failed to stain positively for any of the factors. These findings suggest that the development of atrophic non-union is not directly due to a lack of these four growth factors.

Journal ArticleDOI
TL;DR: The shuttle walking test is a reliable and responsive test within a group of patients with low back pain, with or without sciatica and provides a quick method of measuring one aspect of a patient's physical function.
Abstract: Background and Purpose Walking is an important functional activity and the shuttle walking test has been shown to be a useful test for patients with chronic airways obstruction and heart failure. The test has been used in low back pain research over recent years and has increasingly been used as an outcome measure to investigate treatment efficacy in patients with low back pain. The aim of the present study was to determine the reliability and responsiveness of the shuttle walking test within a group of patients with low back pain (with or without sciatica). Method Reliability of the shuttle walking test was determined on a group of patients with low back pain (n = 44) using the Bland and Altman (1986) limits of agreement and the intraclass correlation coefficient (ICC). Responsiveness was assessed using the standardized effect size. The mean distance walked within a patient population (n = 337) was compared with an age- and sex-matched group of healthy subjects (n = 122). Results The shuttle walking test obtained an ICC score of 0.99, whereas the limits of agreement test gave a mean difference of 2.5 m with upper and lower limits of agreement of 52 m and −47 m, respectively. Patients undertaking fitness training reached an effect size of 1.2 compared to a control group of 0.23 and 0.94 for a group undergoing various orthopaedic treatments. Conclusions The present study has shown that the shuttle walking test is a reliable and responsive test within a group of patients with low back pain, with or without sciatica. It is simple to administer and provides a quick method of measuring one aspect of a patient's physical function. Copyright © 2001 Whurr Publishers Ltd.

Journal ArticleDOI
TL;DR: In this article, beam angulation is used to overcome the potential pitfall of anisotropy in ultrasound assessment of peripheral tendons, which is the property of tendons to vary in their ultrasound appearance depending on the angle of insonation of the incident ultrasound beam.
Abstract: Anisotropy is the property of tendons, nerves and muscles to vary in their ultrasound appearance depending on the angle of insonation of the incident ultrasound beam. Loss of reflectivity in tendons may also denote underlying disease. We describe beam angulation, a simple technique available with most modern ultrasound machines, which allows the operator to overcome the potential pitfall of anisotropy in ultrasound assessment of peripheral tendons.

Journal ArticleDOI
TL;DR: The objective was to investigate which lower limb amputees are using Alpha polyurethane gel liners and the effects of these on comfort and suspension of their prosthesis and some of the locking liner users reported improvedcomfort and suspension but this was not universally the case.
Abstract: The objective was to investigate which lower limb amputees are using Alpha polyurethane gel liners and the effects of these on comfort and suspension of their prosthesis. A retrospective study was carried out of case records of all patients issued with Alpha cushion and locking liners between 1997 and the end of January 1999. The type of liner used was compared with age, sex, level and cause of amputation, time since amputation, comfort and suspension. Modified Stanmore/Harold-Wood mobility grades; duration of use and number of liners issued per patient were recorded. Sixteen (16) patients were identified who had been prescribed Alpha cushion liners. Improved comfort was reported by all. Forty (40) patients were identified who had been prescribed Alpha locking liners. Twenty (20) of these reported improved comfort and 10 improved suspension. The average time since amputation was 18.5 years for those using cushion liners and 14.1 years for locking liner users. Fifty-two (52) of all 56 patients using Alpha cushion and locking liners had mobility grades of 4 or more. Trauma was the most common cause of amputation. This group is a relatively mobile group of amputees. All those using cushion liners reported improved comfort. Some of the locking liner users reported improved comfort and suspension but this was not universally the case.