Minimally invasive total hip and knee arthroplasty-implications for the elderly patient

Human-Robot Cooperative Strength Training Based on Robust Admittance Control Strategy

A stroke is a common disease that can easily lead to lower limb motor dysfunction in the elderly. Stroke survivors can effectively train muscle strength through leg flexion and extension training. However, available lower limb rehabilitation robots ignore the knee soft tissue protection of the elderly in training. This paper proposes a human-robot cooperative lower limb active strength training based on a robust admittance control strategy. The stiffness change law of the admittance model is designed based on the biomechanics of knee joints, and it can guide the user to make force correctly and reduce the stress on the joint soft tissue. The controller will adjust the model stiffness in real-time according to the knee joint angle and then indirectly control the exertion force of users. This control strategy not only can avoid excessive compressive force on the joint soft tissue but also can enhance the stimulation of quadriceps femoris muscles. Moreover, a dual input robust control is proposed to improve the tracking performance under the disturbance caused by model uncertainty, interaction force and external noise. Experiments about the controller performance and the training feasibility were conducted with eight stroke survivors. Results show that the designed controller can effectively influence the interaction force; it can reduce the possibility of joint soft tissue injury. The robot also has a good tracking performance under disturbances. This control strategy also can enhance the stimulation of quadriceps femoris muscles, which is proved by measuring the muscle electrical signal and interaction force. Human-robot cooperative strength training is a feasible method for training lower limb muscles with the knee soft tissue protection mechanism.

The design of a randomised controlled trial to evaluate the (cost-) effectiveness of the posterolateral versus the direct anterior approach for THA (POLADA - trial)

Background

Total hip arthroplasty (THA) is one of the most successful orthopaedic procedures. Because of the increasing number of THAs, a growing demand for faster recovery and a greater emphasis on cost-effectiveness, minimally invasive THAs have been introduced in the last decades. The direct anterior approach is a minimally invasive, tissue-sparing approach in which intermuscular planes are used. Theoretically, this approach should result in a faster recovery of physical functioning and higher health-related quality of life.

Methods/design

A randomised controlled trial will be performed. Patients will be randomly allocated to undergo THA by means of the anterior or posterolateral approach. Both the intervention and control group will consist of two subgroups: 1) patients with a good bone stock who will receive an uncemented femoral stem, and 2) patients with a poor bone stock who will receive a cemented femoral stem. Patients between 18 and 90 years with primary or secondary osteoarthritis will be included. Physical functioning and health-related quality of life will be assessed by means of questionnaires. Additionally, performance based tests will be performed to objectively assess the physical functioning. Cost-effectiveness will be assessed by obtaining data on medical costs in and outside the hospital and other nonmedical costs. Measurements will take place preoperatively, two and six weeks, three months and one year postoperatively.

Discussion

There is some evidence that the anterior approach results in reduced tissue damage and faster recovery in the direct postoperative period, compared to the posterolateral approach. However, there is still a lack of well-designed studies that have confirmed the better outcomes and cost-effectiveness of the anterior approach. Therefore, the purpose of this study is to assess the physical functioning, health related quality of life and the cost-effectiveness of the anterior approach, compared to the conventional posterolateral approach.

Trial registration

Netherlands Trial Registry, number 5343 (registration date April 12, 2015)

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-1322-2) contains supplementary material, which is available to authorized users.