Day 2 :
Keynote Forum
Diana Hodgins
European Technology for Business
UK
Keynote: How gait is affected by joint replacement
Time : 09:00 - 09:30
Biography:
Diana obtained her degree in Mechanical Engineering and her PhD in solid state gyroscopes from the University of Hertfordshire (UH). Diana has 30 patents granted on solid state sensors and more recently on medical applications relating to the use of these sensors. In 2000 Diana was awarded an MBE for services to SMEs in the region and in 2002 she won the Women Inventor of the Year Award for Industry. In 2005 Diana was awarded an Honorary doctorate from the UH for services to innovation. In 1995 Diana and her husband established their own business, ETB and in 2009 ETB launched their sensor based gait monitoring product, GaitSmart. This is now a world leading product used in wide range of medical and sports applications around the world. One of the sectors where it is applied is orthopaedics and a number of papers have been published on this topic. Diana is currently a visiting professor at the UH and helped to establish a new MEng course in Biomedical Engineering and in 2014 was awarded Alumni of the year at the UH.
Abstract:
It is recognised and clearly visible by the human eye that subjects who have osteoarthritis of the hip or knee joint adapt their gait sub-consciously to minimise pain. This does result in abnormal joint loading and incorrect muscle usage. However, there is no objective measurement pre-operatively that identifies the type and extent of this abnormal movement, which would need to be corrected post surgery. Once the patient has received their implant, the joint pain is removed, but there is considerable pain from the surrounding muscles and ligaments. Physiotherapy is provided for the first 6 weeks and then, provided the wound has healed and the subject is walking adequately, they are left to just continue exercising, with the hope that a normal gait would eventually be resumed. No objective measurements are taken at any stage in this process to ensure that they have resumed a normal gait. Studies on hip and knee replacement patients using a sensor based tool (GaitSmart) one year post op have shown that 50% of hip patients and 60% of knee patients do not resume a normal gait one year post op. These are supported by other complementary research studies, which also show that an abnormal gait does have an effect on other joints, due to the incorrect biomechanics of the lower limbs and this can result in further surgery. It is hypothesised that individuals can be retrained to walk properly after surgery, thus reducing the likeliness of further surgery if they are provided with objective measurement to guide the rehabilitation phase. This paper will present results on hip and knee patients who have been monitored following joint replacement.
Keynote Forum
Pawel Szulc
University of Lyon
France
Keynote: Risk of sarcopenia in patients with Rheumatoid Arthritis.
Biography:
Pawel Szulc, M.D., Ph.D., graduated from the Medical Faculty in Warsaw, 1986. Degree in internal medicine, Warsaw, 1989. MD degree obtained at the Medical Center for Postgraduate Education, Warsaw, Poland. Clinical and research assistant in the Dept of Endocrinology, Medical Center for Postgraduate Education, Warsaw, Poland (1986-90, 1993-94). Degrees of PhD and DSc obtained at the University of Lyon, France. Researcher in the INSERM UMR 1033, Lyon, France. Member of the Committee of Scientific Advisors of the International Osteoporosis Foundation. Member of the Editorial Board of Osteoporosis International. Member of the Editorial Board of Journal of Bone and Mineral Research. Member of ASBMR, Member of the Thematic Network on the Osteoporosis in Male at the European Community (2001-06). Scientific interests: osteoporosis, aging and aging-related diseases in men, bone turnover markers, vertebral fracture, sarcopenia, relationship between osteoporosis and cardiovascular diseases. Author/co-author of more than 100 papers and textbook chapters on osteoporosis and related subjects.
Abstract:
Sarcopenia (low muscle mass) and dynapenia (low muscle strength) are consequences of rheumatoid arthritis (RA). However, their risk factors have been poorly studied. RA is more frequent in women who have lower muscle mass. RA starts early (fourth decade) and its negative effects accumulate over long years. Long RA duration is associated with high risk of sarcopenia. Acute inflammatory episodes and chronic inflammation are characterized by increased secretion of inflammatory cytokines stimulating muscle catabolism. Inflammatory episodes are characterized by joint stiffness, muscle weakness and pain, which are associated with low physical activity. Long-lasting RA is associated with joint deformities and reduced amplitude of joint movements. This chronic status may impose sedentary lifestyle, which increases the risk of sarcopenia. Reduced joint movements and voluntary limitation of the use of the affected limb result in local muscle loss. Furthermore, RA treatment (high doses of glucocorticoids) stimulates muscle catabolism and increases the risk of sarcopenia.rnThis risk of sarcopenia is higher in patients in RA who did not receive appropriate treatment or were not compliant. The risk of sarcopenia is higher in elderly patients who could not receive modern therapy in the initial phase of the disease. Moreover, the risk of sarcopenia in RA differs between the countries according to the availability of the up-to-date treatment. rnPatients with sarcopenia limit their physical activity, which further aggravates muscle loss. Moreover, RA is associated with higher risk of osteoporosis. In these patients, osteoporosis and higher risk of fall due to sarcopenia jointly increase the risk of fracture.rnThus, female sex, long duration of the disease, high activity of the inflammatory status, low physical activity, joint deformities and long-term glucocorticoid therapy increase the risk of sarcopenia in patients with RA. Sarcopenia is associated with further reduction of physical activity and higher risk of fall and fracture.