To facilitate safer operations, we provided a preoperative rehabilitation and educational program covering exercise and diet for obese patients with severe osteoarthritis. Participants totaled 11 patients of which 9 had metabolic syndrome. Exercises included the usual muscle strengthening ones, a range of motion exercise and 30 minutes of walking within parallel bars four times a day. This was combined with a diet program. The averaged results showed that body weight changed from 73.5kg to 64.7kg, body mass index from 31 to 27, and waist size from 106 to 94cm. Blood tests indicated that the average triglyceride level changed from 219 to 127mg/dL and fasting blood glucose from 146 to 94 mg/dL. Total steps walked per day changed from 2840 to 6953 and SF36 improved in all items. Significant improvements were noted in all items tested. Our program provided an effective rehabilitation for patients before operation by reducing patient' symptoms due to metabolic syndrome, reducing leg pain and body weight - while increasing activity, and improving quality of life, while simultaneously decreasing the risk of postoperative venous thromboembolism.

The magnitude of mechanical stress at the shoulder and elbow appears to be directly correlated with the degree of maximum shoulder external rotation (MER) during throwing. Therefore, it is very important to prevent excessive MER to minimize the risk of throwing injuries. The purpose of this study was to investigate the relationships between MER during throwing and the kinematic parameters of throwing mechanics, shoulder muscle strength, and shoulder range of motion in high school baseball players. The subjects were 40 male high school baseball players with no elbow or shoulder joint problems. Three-dimensional analysis was performed to calculate the MER angle. Then, the shoulder and elbow angles at initial foot contact (IFC) were computed. ROM and muscle strength of shoulder joint were also measured in each subject. Multiple linear regression analysis was used to relate the MER angle to these factors. Significant correlations were observed between the MER angle and the external rotation (ER) angle (r=−0.51, p<0.001) at IFC, and the ER range of motion (r=0.84, p<0.01). The MER angle significantly correlated with shoulder internal rotation (IR) at IFC. This finding suggests that stress on the shoulder and elbow could be increased by the degree of shoulder IR angle at the moment of IFC. Further, excessive ER range of motion may also be a risk factor.