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The fibula is a valuable source of a bone graft, but because the fibula has a role in lower extremity function, it is important to determine whether partial removal results in dysfunction or other problems. Forty-one patients (48 +/- 10 years of age) had a portion of their fibula removed for a bone graft. At evaluation 27 +/- 8 months later, 24 had no pain, 11 mild pain, and six moderate or severe pain. Sixteen had no complaints of any kind, but four without pain had minor difficulties with vigorous activities, and three complained of ankle swelling. There were no differences in range of motion between the operated and nonoperated side. Average muscle torque was lower on the operated than on the nonoperated side, but this difference was statistically significant only for ankle evertors in men. This study demonstrates that most patients will have subjective complaints and mild muscular weakness after removal of a portion of the fibula.

Measurements of functional performance were compared before and at 6 months after 58 McKee-Farrar, 50 Charnley, and 57 Muller total hip replacements in 143 patients. The measurment included: range of motion of the hip, hip abductor and adductor-muscle torque, weight-bearing activity during standing, forces applied to canes or crutches, and multiple components of walking performance. Each group of patients improved significantly after surgery in all of the components measured. Early postoperative differences among the 3 groups were found with respect to pain ratings, impressions of hip status, hip motions, muscle torque, the number of patients using assistive devices, and certain components of walking performance. There is nothing to suggest that the performance of any 1 group is distinctly better or worse than that of any other group 6 months after surgery. On the basis of average values, each group improved in every component of function and it is gratifying that, except for a few patients who developed postoperative infection, each patient could be considered to have successful reconstruction.

Normal age- and sex-related standards for shoulder range of motion (ROM) and muscle strength are unavailable in the literature. Active range of shoulder motion and maximum isometric strength (torque) of several shoulder muscle groups were measured in normal healthy men and women between 25 and 36 and between 55 and 66 years of age. Values for joint motion were similar for the two age and sex groups. The strength of the women was 45% to 66% of that in men, and strength of the older subjects was 66% to 93% of that in younger subjects. Strength of the second attempt at contraction was greater than that of the first attempt. Arm dominance did not significantly affect strength values.

To help determine the duration of benefits in functional performance resulting from total hip arthroplasty (THA), multiple kinesiologic measurements were made before surgery and two and four years after 32 Charnley and 40 Müller THA procedures were done in 58 patients. There were no complications of loosening or infection, nor was there additional disability in other joints of the lower extremities. Measurements of functional performance included range of hip motion, hip abductor and adductor muscle strength, weight distribution between the feet during standing, forces applied to canes or crutches, and multiple components of free-speed and fast-walking performance. The average measurements showed significant improvement in almost all components of function from the time preceding surgery to two years afterward. The two-year level of function was then maintained without significant improvement or decline in function four years postoperation.

Because of the known high complication rate, it is important for both the patient and physician to know as much as possible about the outcome of revision operations for loosened total hip arthroplasties. This study evaluates the changes in subjective ratings and objective kinesiologic measurements from before revision operations through two years after revision operations. The object is to compare these measurements with the measurements of a group of patients with primary replacements. Both groups of patients showed significant improvement in most parameters from before to after surgery. These parameters included walking performance, hip muscle strength, range of motion, forces applied to canes, and the amount of weight borne on the operated limb during quiet standing. Compared to the control group with primary replacements, the group with revision used more assistive devices, had less pain relief, walked slower, had less hip motion, and had more lateral lurch. While results after revision surgery were not as gratifying as those after primary hip replacement, patients requiring revision can still anticipate substantial improvement.

Kinesiologic measurements were made in patients with severe arthritis before and after geometric total knee replacements to evaluate the nature, rate and extent of change in their functional ability. Preoperatively, patients with rheumatoid arthritis functioned at lower levels than patients with osteoarthritis. Most patients with rheumatoid arthritis improved steadily after surgery, while progress of those with osteoarthritis was often irregular. The group with rheumatoid arthritis improved more than those with osteoarthritis, but they did not generally reach the functional level attained by the patients with osteoarthritis, and neither group reached the lower limits of normal variability 1 year postoperatively. On the average, both groups gained knee extensions, lost knee flexion, and gained isometric knee flexor muscle strength postoperatively. Every patient with osteoarthritis lost extensor muscle strength 1 year after surgery, while most with rheumatoid arthritis gained. During quiet standing, most patients had straighter knees postoperatively and bore a greater percent of body weight on the operated limb. Patients with rheumatoid arthritis improved more than patients with osteoarthritis in the type and amount of force applied to canes and crutches. Most patients walked faster postoperatively, took longer and more rapid steps, improved the pattern of knee motion used, and had smoother forward, lateral and vertical head motion.

In order to identify the functional advantages or disadvantages between the anterolateral and the posterior approaches to total hip arthroplasty, measurements of prosthetic position, hip-muscle strength, and hip joint mobility were made after Müller total hip arthroplasty without osteotomy in 52 patents operated through a posterior approach and 41 patients operated through an anterolateral approach. Men and women who had the posterior approach had less prosthetic component anteversion and longer neck lengths, with resultant more lateral and distal placement of the greater trochanter than groups with the anterolateral approach. Groups with the posterior approach had more normal hip abductor-muscle strength and more inward rotation on the operated side than group with the anterolateral approach. Groups with the anterolateral approach had more outward rotation on the operated side than groups with the posterior approach. These differences in function were related to the surgical approach rather than to differences in component position. An understanding of these observations should be used for selection of the surgical approach for the patient on an individual basis.

The gait of men with unilateral knee disability has not been quantified previously. Interrupted-light photography was used to quantify the gait abnormalities of 35 men whose major disability was unilateral knee pain. The following antalgic maneuvers were found to be common to the gait of these patients: slow and uneven forward progression with lateral lurching toward the painful side, asymmetry in stride and temporal components, and abnormalities in the displacement patterns of most body segments. Subnormal knee motion was found during the stance and swing phases. Because treatment of patients with knee problems is usually directed toward pain relief, an understanding of how pain affects walking performance is important to the clinician when assessing a patient's problem.