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Colyn W, Cleymans A, Bruckers L, Truijen J, Smeets K, Bellemans J. The pre-diseased coronal alignment can be predicted from conventional radiographs taken of the varus arthritic knee. Arch Orthop Trauma Surg 2023; 143:4425-4436. [PMID: 36494462 DOI: 10.1007/s00402-022-04709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The concept of restoring the constitutional, pre-diseased alignment has gained lots of interest among knee surgeons. Previous attempts to use the contralateral limb to bridge the gap between the arthritic and the constitutional alignment were unsuccessful. We investigated the usability of a mathematical formula to predict the constitutional (pre-diseased) coronal alignment once arthritis has occurred. It is our hypothesis that by using the KL grade, CPAK classification and four radiographic measurements of the arthritic knee, the pre-diseased coronal alignment could be predicted. MATERIAL AND METHODS Hundred arthritic patients with consecutive X-rays were used to determine a mathematical formula. Five alignment parameters were determined on full-length X-rays: HKA angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and the tibial joint line angle (TJLA). A refinement of the algorithm was implemented based on a reference cohort, consisted of 250 young adults aged between 20 and 27 years. Moreover, all knees were subdivided based on their CPAK-phenotype and the Kellgren-Lawrence scale (KL scale). An independent arthritic cohort of 289 patients scheduled for primary total knee arthroplasty was included to verify the accuracy of the predicted HKAs (HKAPRED). RESULTS In CPAK type 1, the HKAPRED was 3.86° varus (STD 1.39) and the HKAYHA was 4.0° varus. In CPAK type 2, the HKAPRED was 1.68° varus (STD 1.95) compared to a HKAYHA of 1.34° (STD 0.81). The average constitutional HKA is not different in both CPAK 1 (p = 0.61) and CPAK 2 (p = 0.25), and the difference in the mean is estimated to be equal to - 0.14 (95CI - 0.68 to 0.40) in CPAK 1 and 0.35 (95CI - 0.06 to 0.75) in CPAK 2. CONCLUSION Using the KL grade, CPAK classification and four radiographic measurements of the arthritic knee, the pre-diseased coronal alignment can be predicted in 80% of the varus knees with an accuracy of ≤ 0.5°. The predicted HKA (HKAPRED) can be very useful in the current and future clinical practice.
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Affiliation(s)
- William Colyn
- Department of Orthopedic Surgery, AZ Turnhout, Steenweg Op Merksplas 44, 2300, Turnhout, Belgium.
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
- Limburg Clinical Research Center, ZOL Genk, Genk, Belgium.
| | - A Cleymans
- Department of Orthopedic Surgery, AZ Turnhout, Steenweg Op Merksplas 44, 2300, Turnhout, Belgium
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - L Bruckers
- I-BioStat, University Hasselt, Hasselt, Belgium
| | - J Truijen
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Orthopedic Surgery, ZOL Genk, Genk, Belgium
| | - K Smeets
- Department of Orthopedic Surgery, AZ Vesalius, Tongeren, Belgium
- Faculty of Rehabilitation Science, Hasselt University, Diepenbeek, Belgium
- GRIT Belgian Sports Clinic, Leuven, Belgium
| | - J Bellemans
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Orthopedic Surgery, ZOL Genk, Genk, Belgium
- GRIT Belgian Sports Clinic, Leuven, Belgium
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Colyn W, Bruckers L, Scheys L, Truijen J, Smeets K, Bellemans J. Changes in coronal knee-alignment parameters during the osteoarthritis process in the varus knee. J ISAKOS 2023; 8:68-73. [PMID: 36646170 DOI: 10.1016/j.jisako.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/01/2022] [Accepted: 12/07/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The idea to aim for an "individualized" alignment, whereby the constitutional alignment is restored, has gained much interest among knee surgeons. This requires insight into the prediseased, natural alignment of our patients' knees. The aim of this study is (1) to determine how the hip-knee-ankle (HKA) angle is influenced during the arthritic process and (2) to investigate the correlation between joint line changes and the progression of osteoarthritis (OA). It is our hypothesis that the most pronounced coronal parameter changes appear at the proximal tibia and at the joint line. METHODS One hundred sequential full-length X-rays with a minimum follow-up of 1 year were retrospectively reviewed from a radiographic joint database. Patients had to be at least 50 years of age needed to have an HKA angle of more than 1.3° varus to be included. Patients with ipsilateral total hip arthroplasty, femoral or tibial fracture, osteotomy, or ligamentous repair were excluded. Fifteen alignment parameters were investigated on the sequential full-length X-rays. Moreover, the relationship between the alignment parameters and the Kellgren-Lawrence grade (KL grade) was determined by using linear mixed models. RESULTS A progressive KL grade is associated with an increase of the HKA (p < 0.001). Mostly, HKA differs due to decrease of the medial tibial plateau (MPTA) angle (0.93°) and an increase of the joint line angle (JLCA) (0.86°). The mLDFA demonstrated the most pronounced changes in the beginning of OA (KL grade 1-2) (p = 0.049). In particular, the MPTA becomes considerably smaller (p = 0.004) in the later stage of OA (KL grade 3). Also, a progressive increase of the JLCA (p < 0.001) is observed upwards of KL grade 3. CONCLUSION By comparing consecutive full-length X-rays in the same patients, it is possible to define the coronal alignment changes during the arthritic process. The HKA angle increases according the arthritic progression, whereby the most pronounced changes appear at the proximal tibia (MPTA) and at the joint line (JLCA).The alignment changes in varus OA knees can be divided in three stadia: (1) erosion of the distal medial femoral condyle, (2) erosion of the medial tibial plateau, and (3) a progressive increase of the joint line angle. LEVEL OF EVIDENCE Therapeutic Study, Level III.
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Affiliation(s)
- William Colyn
- Dept. of Orthopedic Surgery, AZ Turnhout, Turnhout, 2300, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Ziekenhuis Oost-Limburg, Dept. Future Health, Genk, Belgium.
| | - L Bruckers
- I-BioStat, University Hasselt, Hasselt, Belgium
| | - L Scheys
- Dept. of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - J Truijen
- Dept. of Orthopedic Surgery, ZOL Genk, Genk, Belgium
| | - K Smeets
- Dept. of Orthopedic Surgery, AZ Vesalius, Tongeren, Belgium
| | - J Bellemans
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Dept. of Orthopedic Surgery, ZOL Genk, Genk, Belgium; GRIT Belgian Sports Clinic, Leuven, Belgium
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Smeets K, Bellemans J, Truijen J. A revisited technique for combined anterior cruciate ligament and anterolateral ligament reconstructions. Acta Orthop Belg 2020; 86:447-452. [PMID: 33581029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A new technique for combined anterior cruciate ligament and anterolateral ligament reconstructions is described. An iliotibial band strip is used as an ALL graft , leaving the distal insertion intact and fix it with a knotless anchor on the femoral origin, after tunneling it under the lateral collateral ligament.
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van der Straaten R, Wesseling M, Jonkers I, Vanwanseele B, Bruijnes AKBD, Malcorps J, Bellemans J, Truijen J, De Baets L, Timmermans A. Discriminant validity of 3D joint kinematics and centre of mass displacement measured by inertial sensor technology during the unipodal stance task. PLoS One 2020; 15:e0232513. [PMID: 32407415 PMCID: PMC7224481 DOI: 10.1371/journal.pone.0232513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 04/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background The unipodal stance task is a clinical task that quantifies postural stability and alignment of the lower limb joints, while weight bearing on one leg. As persons with knee osteoarthritis (KOA) have poor postural and knee joint stability, objective assessment of this task might be useful. Objective To investigate the discriminant validity of three-dimensional joint kinematics and centre of mass displacement (COM) between healthy controls and persons with knee KOA, during unipodal stance using inertial sensors. Additionally, the reliability, agreement and construct validity are assessed to determine the reproducibility and accuracy of the discriminating parameters. Methods Twenty healthy controls and 19 persons with unilateral severe KOA were included. Five repetitions of the unipodal stance task were simultaneously recorded by an inertial sensor system and a camera-based system (gold standard). Statistical significant differences in kinematic waveforms between healthy controls and persons with severe knee KOA were determined using one-dimensional statistical parametric mapping (SPM1D). Results Persons with severe knee KOA had more lateral trunk lean towards the contralateral leg, more hip flexion throughout the performance of the unipodal stance task, more pelvic obliquity and COM displacement towards the contralateral side. However, for the latter two parameters the minimum detectable change was greater than the difference between healthy controls and persons with severe knee KOA. The construct validity was good (coefficient of multiple correlation 0.75, 0.83 respectively) and the root mean squared error (RMSE) was low (RMSE <1.5°) for the discriminant parameters. Conclusion Inertial sensor based movement analysis can discriminate between healthy controls and persons with severe knee KOA for lateral trunk lean and hip flexion, but unfortunately not for the knee angles. Further research is required to improve the reproducibility and accuracy of the inertial sensor measurements before they can be used to assess differences in tasks with a small range of motion.
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Affiliation(s)
- R. van der Straaten
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
- * E-mail:
| | - M. Wesseling
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | - I. Jonkers
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | - B. Vanwanseele
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | | | - J. Malcorps
- Department of Orthopaedic Surgery, Jessa Hospital, Hasselt, Belgium
| | - J. Bellemans
- Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - J. Truijen
- Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - L. De Baets
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - A. Timmermans
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
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Smeets K, Van Haver A, Van den Bempt S, Verheyden M, Bruckers L, Verdonk P, Truijen J, Bellemans J. Risk analysis of tunnel collision in combined anterior cruciate ligament and anterolateral ligament reconstructions. Knee 2019; 26:962-968. [PMID: 31431338 DOI: 10.1016/j.knee.2019.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/23/2019] [Accepted: 06/13/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND To assess the risk of tunnel collision in combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstructions. METHODS Three-dimensional (3D) CT reconstructions of 32 knees after transtibial (TT) (N = 16) or anteromedial portal (AMP) (N = 16) ACL reconstruction were used to simulate potential tunnel collision of the femoral ACL tunnel if combined with a virtual ALL reconstruction. The minimal distance between tunnels, the ALL tunnel length, and the lateral femoral condyle (LFC) width were measured. Moreover, the relationship between the ALL tunnel and the intercondylar notch, trochlear groove and posterior femoral cortex was determined. RESULTS The highest rate of tunnel collision (81%) was observed when the ALL tunnel was aimed at 20° in the coronal plane and 0° in the axial plane. However, by aiming the ALL tunnel at 0° coronal and 40° axial angulation, collision was avoided in all patients and no violation of the trochlea was observed. Tunnel collision rate was significantly higher (P = 0.002) when the ACL tunnel was drilled by the AMP technique. CONCLUSIONS Risk of tunnel collision was significantly increased when the tunnel was drilled at 0° in the axial plane. Tunnel collision was avoided by aiming the ALL tunnel 40° anteriorly and perpendicular to the anatomical axis of the femur. A more horizontal orientation of the ACL with the AMP technique is a risk factor for tunnel conflicts. CLINICAL RELEVANCE ALL tunnel orientation needs to be adjusted to avoid tunnel conflicts in combined ACL-ALL reconstructions.
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Affiliation(s)
- K Smeets
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; Department of Orthopedic Surgery, AZ Vesalius, Tongeren, Belgium; GRIT Belgian Sports Clinic, Leuven, Belgium.
| | - A Van Haver
- Monica Orthopedic Research (MoRe) Foundation, Monica Hospital, Antwerp, Belgium
| | - S Van den Bempt
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
| | - M Verheyden
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
| | - L Bruckers
- I-BioStat, University of Hasselt, Diepenbeek, Belgium.
| | - P Verdonk
- Monica Orthopedic Research (MoRe) Foundation, Monica Hospital, Antwerp, Belgium
| | - J Truijen
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; Department of Orthopedic Surgery, ZOL Genk, Genk, Belgium.
| | - J Bellemans
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; GRIT Belgian Sports Clinic, Leuven, Belgium; Department of Orthopedic Surgery, ZOL Genk, Genk, Belgium
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Hermans K, Vandenneucker H, Truijen J, Oosterbosch J, Bellemans J. Hinged versus CCK revision arthroplasty for the stiff total knee. Knee 2019; 26:222-227. [PMID: 30415974 DOI: 10.1016/j.knee.2018.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/12/2018] [Accepted: 10/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) remains the gold standard for end-stage knee osteoarthritis. The prevalence of stiffness after this procedure described in literature varies from 1.3% to 5.3%. The causes of arthrofibrosis after total knee arthroplasty are multifactorial. Revision TKA is a successful procedure when performed for loosening, instability, mechanical implant failure, or infection. The results of revision TKA for idiopathic arthrofibrosis and stiffening are however less favorable. PURPOSE It has been the authors' impression that the poor results in arthrofibrosis could be in part related to the use of traditional PS or CCK-type revision implants. Our hypothesis is that better results can be achieved in case a rotating hinge design (RHK) is used. The reason could be that RHK designs allow for much more aggressive capsuloligament debridement and therefore more adequate fibrosis removal, while securing optimal implant stability, tibiofemoral rotational freedom, and flexion-extension space stability. The purpose of our study was to investigate in our database whether this hypothesis is correct. METHODS Retrospectively, 40 patients with the defined range of knee motion were identified. Patients with underlying mechanical malalignment, component malposition, soft-tissue imbalance or infections were excluded. Twenty-two patients received a hinged-type prosthetic device (18 Zimmer RHK, four Stryker RHK) and 18 patients received a less constrained condylar type prosthetic device (17 Legion CCK, one Vanguard CCK). RESULTS Preoperative data were similar for RHK as CCK-type implants except for knee pain score, which was significantly worse for the RHK group (36 vs 44, p = 0.049). At two years of follow-up, compared to CCK, the RHK group demonstrated significantly better postoperative results for knee function scores (68.9 vs 54.2, p = 0.0015), knee function improvement (22.8 vs 4.8, p = 0.0015), knee pain improvement (26.4 vs 9.4, p = 0.0050), greater maximal flexion (99.9° vs 81.4°, p = 0.0005), better maximal extension (-1.9° vs -6.2°, p = 0.0447), greater flexion gain (35.8° vs 14.2°, p = 0.0002), and greater extension gain (8.6° vs 2.0°, p = 0.0083). CONCLUSION Our data show that revision arthroplasty of the stiff knee using a rotating hinged device can provide excellent results in selected cases. To date, this is the first study to describe the difference in outcome between revision total knee arthroplasty for idiopathic arthrofibrosis using a hinged or a constrained condylar knee device.
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Affiliation(s)
- K Hermans
- Department of Orthopaedics, University Hospitals Leuven, Belgium.
| | - H Vandenneucker
- Department of Orthopaedics, University Hospitals Leuven, Belgium
| | - J Truijen
- Department of Orthopaedics, Hospital Genk, University of Hasselt, Belgium
| | - J Oosterbosch
- Department of Orthopaedics, Hospital Genk, University of Hasselt, Belgium
| | - J Bellemans
- Department of Orthopaedics, Hospital Genk, University of Hasselt, Belgium
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Truijen J, Westerhof BE, Kim YS, Stok WJ, de Mol BA, Preckel B, Hollmann MW, van Lieshout JJ. The effect of haemodynamic and peripheral vascular variability on cardiac output monitoring: thermodilution and non-invasive pulse contour cardiac output during cardiothoracic surgery. Anaesthesia 2018; 73:1489-1499. [DOI: 10.1111/anae.14380] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J. Truijen
- Laboratory for Clinical Cardiovascular Physiology; Department of Medical Biology, section Systems Physiology; Academic Medical Center; University of Amsterdam; The Netherlands
| | - B. E. Westerhof
- Department of Pulmonary Diseases; VU University Medical Center; Amsterdam The Netherlands
| | - Y.-S. Kim
- Department of Nephrology; VU University Medical Center; Amsterdam The Netherlands
| | - W. J. Stok
- Laboratory for Clinical Cardiovascular Physiology; Department of Medical Biology, section Systems Physiology; Academic Medical Center; University of Amsterdam; The Netherlands
| | - B. A. de Mol
- Department of Cardiothoracic Surgery; Academic Medical Center; University of Amsterdam; The Netherlands
| | - B. Preckel
- Department of Anaesthesiology; Academic Medical Center; University of Amsterdam; The Netherlands
| | - M. W. Hollmann
- Department of Anaesthesiology; Academic Medical Center; University of Amsterdam; The Netherlands
| | - J. J. van Lieshout
- MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research; School of Life Sciences; University of Nottingham Medical School; Queen's Medical Centre; Nottingham UK
- Department of Internal Medicine; Academic Medical Center; University of Amsterdam; The Netherlands
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Truijen J, Rasmussen LS, Kim YS, Stam J, Stok WJ, Pott FC, van Lieshout JJ. Cerebral autoregulatory performance and the cerebrovascular response to head-of-bed positioning in acute ischaemic stroke. Eur J Neurol 2018; 25:1365-e117. [PMID: 29935041 PMCID: PMC6220945 DOI: 10.1111/ene.13737] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/19/2018] [Indexed: 11/28/2022]
Abstract
Background and purpose Cerebrovascular responses to head‐of‐bed positioning in patients with acute ischaemic stroke are heterogeneous, questioning the applicability of general recommendations on head positioning. Cerebral autoregulation is impaired to various extents after acute stroke, although it is unknown whether this affects cerebral perfusion during posture change. We aimed to elucidate whether the cerebrovascular response to head position manipulation depends on autoregulatory performance in patients with ischaemic stroke. Methods The responses of bilateral transcranial Doppler ultrasound‐determined cerebral blood flow velocity (CBFV) and local cerebral blood volume (CBV), assessed by near‐infrared spectroscopy of total hemoglobin tissue concentration ([total Hb]), to head‐of‐bed lowering from 30° to 0° were determined in 39 patients with acute ischaemic stroke and 17 reference subjects from two centers. Cerebrovascular autoregulatory performance was expressed as the phase difference of the arterial pressure‐to‐CBFV transfer function. Results Following head‐of‐bed lowering, CBV increased in the reference subjects only ([total Hb]: + 2.1 ± 2.0 vs. + 0.4 ± 2.6 μM; P < 0.05), whereas CBFV did not change in either group. CBV increased upon head‐of‐bed lowering in the hemispheres of patients with autoregulatory performance <50th percentile compared with a decrease in the hemispheres of patients with better autoregulatory performance ([total Hb]: +1.0 ± 1.3 vs. −0.5 ± 1.0 μM; P < 0.05). The CBV response was inversely related to autoregulatory performance (r = −0.68; P < 0.001) in the patients, whereas no such relation was observed for CBFV. Conclusion This study is the first to provide evidence that cerebral autoregulatory performance in patients with acute ischaemic stroke affects the cerebrovascular response to changes in the position of the head.
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Affiliation(s)
- J Truijen
- Department of Internal Medicine, Waterlandziekenhuis, Purmerend.,Medical Biology, Laboratory for Cardiovascular Physiology, AMC Center for Heart Failure Research, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - L S Rasmussen
- Bispebjerg Hospital Research Unit for Anesthesia and Intensive Care, University of Copenhagen, Copenhagen, Denmark
| | - Y S Kim
- Medical Biology, Laboratory for Cardiovascular Physiology, AMC Center for Heart Failure Research, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Nephrology, VU University Medical Center, Amsterdam
| | - J Stam
- Stroke Unit, Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam
| | - W J Stok
- Medical Biology, Laboratory for Cardiovascular Physiology, AMC Center for Heart Failure Research, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - F C Pott
- Bispebjerg Hospital Research Unit for Anesthesia and Intensive Care, University of Copenhagen, Copenhagen, Denmark
| | - J J van Lieshout
- Medical Biology, Laboratory for Cardiovascular Physiology, AMC Center for Heart Failure Research, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, The Medical School, Queen's Medical Centre, University of Nottingham Medical School, Nottingham, UK
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Truijen J, Kim YS, Krediet CTP, Stok WJ, Kölgen RS, Colier WN, Secher NH, van Lieshout JJ. Orthostatic leg blood volume changes assessed by near-infrared spectroscopy. Exp Physiol 2011; 97:353-61. [PMID: 22090063 DOI: 10.1113/expphysiol.2011.061051] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Standing up shifts blood to dependent parts of the body, and blood vessels in the leg become filled. The orthostatic blood volume accumulation in the small vessels is relatively unknown, although these may contribute significantly. We hypothesized that in healthy humans exposed to the upright posture, volume accumulation in small blood vessels contributes significantly to the total fluid volume accumulated in the legs. Considering that near-infrared spectroscopy (NIRS) tracks postural blood volume changes within the small blood vessels of the lower leg, we evaluated the NIRS-determined changes in oxygenated (Δ[O(2)Hb]), deoxygenated (Δ[HHb]) and total haemoglobin tissue concentration (Δ[tHb]) and in total leg volume by strain-gauge plethysmography during 70 deg head-up tilt (HUT; n = 7). In a second experiment, spatial and temporal reproducibility were evaluated with three NIRS probes applied on two separate days (n = 8). In response to HUT, an initially fast increase in [O(2)Hb] was followed by a gradual decline, while [HHb] increased continuously. The increase in [tHb] during HUT was closely related to the increase in total leg volume (r(2) = 0.95 ± 0.03). After tilt back, [O(2)Hb] declined below and [HHb] remained above baseline, whereas all NIRS signals gradually returned to baseline. Spatial heterogeneity was observed, and for two probes [tHb] was highly correlated between days (r(2) = 0.92 ± 0.09 and 0.91 ± 0.12), but less for the third probe (r(2) = 0.44 ± 0.36). The results suggest a non-linear accumulation of blood volume in the small vessels of the leg, with an initial fast phase followed by a more gradual increase at least partly contributing to the relocation of fluid during orthostatic stress.
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Affiliation(s)
- J Truijen
- Department of Internal Medicine, Center for Heart Failure Research, Academic Medical Center, University of Amsterdam, The Netherlands
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Van Den Bogaard B, De Peuter O, Truijen J, Kamphuisen P, Van Den Born BJ. THE EFFECT OF CARVEDILOL VERSUS METOPROLOL ON PERIPHERAL AND CENTRAL HEMODYNAMICS IN HEART FAILURE PATIENTS WITH GENETIC VARIANTS OF THE BETA2-RECEPTOR. J Hypertens 2011. [DOI: 10.1097/00004872-201106001-01576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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