BackgroundWhile magnetic resonance imaging contrast-enhancing lesions represent an excellent screening tool for disease-modifying treatments in relapsing–remitting multiple sclerosis (RRMS), this biomarker is insensitive for testing therapies against compartmentalized inflammation in progressive multiple sclerosis (MS). Therefore, alternative sensitive outcomes are needed. Using machine learning, clinician-acquired disability scales can be combined with timed measures of neurological functions such as walking speed (e.g. 25-foot walk; 25FW) or fine finger movements (e.g. 9-hole peg test; 9HPT) into sensitive composite clinical scales, such as the recently developed combinatorial, weight-adjusted disability scale (CombiWISE). Ideally, these complementary simplified measurements of certain neurological functions could be performed regularly at patients’ homes using smartphones.ObjectivesWe asked whether tests amenable to adaptation to smartphone technology, such as finger and foot tapping have comparable sensitivity and specificity to current non-clinician-acquired disability measures.ResultsWe observed that finger and foot tapping can differentiate RRMS and progressive MS in a cross-sectional study and can also measure yearly and two-year disease progression in the latter, with better power (based on z-scores) in comparison to currently utilized 9HPT and 25FW.ConclusionsReplacing the 9HPT and 25FW with simplified tests broadly adaptable to smartphone technology may enhance the power of composite scales for progressive MS.
In this study, we examine the contributions of periprosthetic impingement to a seldom recognized source of PE damage resulting in gouging, abrasion, and severe localized damage in cemented and cementless total knee replacement. One hundred sixty two tibial components of 34 different designs in a retrieval collection were examined. The presence and location of abrasive wear to the nonarticulating edges of the insert were measured, with representative specimens examined using SEM. Significant abrasive wear was observed in 35% of the retrievals with cemented femoral components and 25% from noncemented components. Within the group of worn inserts, abrasive scars were seen with a frequency of 75% on the extreme medial edge, 20% on the extreme lateral edge, 26% on the posteromedial edge, and 16% on the posterolateral edge. The role of extraarticular impingement in this damage mode was confirmed by examination of retrieved femoral components with overhanging cement or embedded osteophytes. In the majority of cases, this complication may be avoided by careful removal of excess cement and extracortical osteophytes.
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