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Which prosthetic system restores hip biomechanics more effectively? Comparison among three systems. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bjørdal F, Bjørgul K. The role of femoral offset and abductor lever arm in total hip arthroplasty. J Orthop Traumatol 2015; 16:325-30. [PMID: 26068583 PMCID: PMC4633429 DOI: 10.1007/s10195-015-0358-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 05/22/2015] [Indexed: 12/03/2022] Open
Abstract
Background In order to create a well-functioning total hip arthroplasty (THA), it is important to restore femoral off-set and thus the abductor lever arm. The aim of this study was to investigate the clinical effect of increasing the abductor lever arm to and beyond the anatomical native lever arm in minimally invasive total hip arthroplasty performed through a direct anterior approach. Materials and methods We compared the lever arm of the operated hip to the lever arm of the contralateral native hip on radiographs in 148 patients following THA. The patients were divided in two groups based on whether they kept their anatomical lever arm or had an increased lever arm. The clinical outcome was assessed using hip osteoarthritis outcome score (HOOS), Harris hip score and UCLA activity score. Results Patients who kept their anatomical lever arm did not experience a significantly better clinical outcome than the patients with an increased abductor lever arm. We found no significant difference in clinical scores at any of the follow-ups during the first year after THA. Conclusion The results of this study suggest that an increase in the abductor lever arm does not have major effects on the clinical outcome after THA. To avoid the potential negative effects of decreasing the lever arm, the surgeon should aim for an equal or slightly increased lever arm. Level of evidence Level 3, prospective cohort study.
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Affiliation(s)
- Filip Bjørdal
- University of Oslo, Hollandveien 26, 1555, Son, Norway.
| | - Kristian Bjørgul
- Østfold Hospital Trust, Aleris Health Oslo, Chr. Svendsens gate 6, 1771, Halden, Norway.
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Kamada T, Mashima N, Nakashima Y, Imai H, Takeba J, Miura H. Mid-term clinical and radiographic outcomes of porous tantalum modular acetabular components for hip dysplasia. J Arthroplasty 2015; 30:607-10. [PMID: 25443360 DOI: 10.1016/j.arth.2014.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 10/15/2014] [Accepted: 11/01/2014] [Indexed: 02/01/2023] Open
Abstract
It is still challenging to perform successful cementless cup fixation during total hip arthroplasty for hip dysplasia. In this multicenter study we evaluated the clinical results of porous tantalum modular acetabular cups (TM cups) in 45 dysplastic hips with a mean follow-up period of 9.8 years. The mean Japanese Orthopaedic Association hip score improved from 48.2 preoperatively to 92.1 at the most recent follow-up. All of the cups were radiographically stable with no evidence of progressive radiolucencies or osteolysis regardless of bone grafting. Sixteen hips with bone grafts showed the integration of grafted bone without any radiolucencies. There were no revisions of TM cups. The use of TM cups for dysplastic hips provided satisfactory 10-year clinical and radiographic results.
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Affiliation(s)
- Tomomi Kamada
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Naohiko Mashima
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Kyushu University School of Medicine, 1-3-3 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Hiroshi Imai
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Jun Takeba
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Hiromasa Miura
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
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Does rotational acetabular osteotomy affect subsequent total hip arthroplasty? Arch Orthop Trauma Surg 2015; 135:407-15. [PMID: 25577240 DOI: 10.1007/s00402-015-2154-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Rotational acetabular osteotomy (RAO) has been used successfully in patients with developmental dysplasia of the hip (DDH). However, some patients are forced to undergo total hip arthroplasty (THA) because of the progression of osteoarthritis. We evaluated the effect of previous RAO on the outcome of THA performed for degenerative arthritis secondary to DDH, comparing outcomes for patients with THA and prior RAO versus outcomes for patients with THA and no prior RAO. MATERIALS AND METHODS At an average follow-up point of 8.2 years (range 7-11 years), we compared outcomes in dysplastic hips for 22 hips (group R) in patients who underwent THA after successful RAO with outcomes for a well-matched control group of 30 hips in patients who underwent primary THA (group C) during the same period. RESULTS Both groups had similar midterm results. No acetabular or femoral components exhibited loosening or revision in either group. Harris hip scores (HHSs) at the most recent follow-up had not been compromised by RAO, and there were no significant differences in intraoperative blood loss and operative time between the two groups. Although there was a tendency toward superolateral placement of the acetabular component in group R, there were no significant differences in the mean steady-state linear and volumetric wear rates between the two groups. There were no infections, dislocations, intraoperative fractures, damaged nerves, or deep vein thromboses in either group. CONCLUSIONS Our midterm results demonstrated that RAO does not lead to higher revision rates, compromised HHSs, or shortened survivorship in eventual THA for DDH.
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Continued good results with modular trabecular metal augments for acetabular defects in hip arthroplasty at 7 to 11 years. Clin Orthop Relat Res 2015; 473:521-7. [PMID: 25123241 PMCID: PMC4294936 DOI: 10.1007/s11999-014-3861-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Reconstruction of large acetabular defects remains a substantial challenge in hip arthroplasty. There remains a paucity of data on the long-term results of acetabular trabecular metal augments. QUESTIONS/PURPOSES The purpose of this study was to assess the survivorship, clinical outcomes, restoration of center of rotation of the hip, and radiological signs of component fixation of trabecular metal augments in the context of reconstruction of acetabular defects. METHODS Between 2002 and 2005, we performed 56 revision (n=53) and primary (n=3) THAs using trabecular metal augments in combination with a trabecular metal acetabular component. Of the 56 patients, 16 (29%) died during followup. Of the 40 surviving patients, 37 (93%) had complete radiological followup, 23 (58%) had complete outcome questionnaire followup, and 17 (42%) provided partial questionnaire responses in the clinic or over the telephone. Median followup was 110 months (range, 88-128 months). During that period, we used these implants when preoperative templating indicated that an augment would be required to achieve acetabular implant stability with restoration of the hip center of rotation. We also chose during surgery to use an augment when we could not achieve a stable acetabular trial component without one. The combination of trabecular metal augments and trabecular metal shells was used in 18% (53 of 292) of our acetabular revisions during that time. Survivorship, functional outcome (WOMAC and Oxford hip score), health status (SF-12), and osseointegration according to the criteria of Moore and presence of radiolucencies were determined. RESULTS Survivorship of the augments at 10 years was 92% (95% confidence interval, 81%-97%). Four patients underwent cup revision, one for infection and three for loosening. The mean WOMAC global score was 79 (SD 17), the mean Oxford hip score 76 (SD 18), the mean physical component SF-12 score was 39 (SD 11), and the mean mental component SF-12 score was 52 (SD 9). The center of rotation was corrected from more than 35 mm above the inter-teardrop line in 48 of 56 patients preoperatively to only five of 46 postoperatively. One patient had radiographic findings suggestive of loosening, but this patient was asymptomatic. CONCLUSIONS The results of the acetabular trabecular metal augments continue to be encouraging in the medium to long term with low rates of revision or loosening in this complex group of patients. We continue to recommend the use of these augments in the reconstruction of complex acetabular defects. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Tezuka T, Inaba Y, Kobayashi N, Ike H, Kubota S, Kawamura M, Saito T. Effects of hip joint center location and femoral offset on abductor muscle strength after total hip arthroplasty. Mod Rheumatol 2014; 25:630-6. [DOI: 10.3109/14397595.2014.988863] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lazennec JY, Brusson A, Dominique F, Rousseau MA, Pour AE. Offset and anteversion reconstruction after cemented and uncemented total hip arthroplasty: an evaluation with the low-dose EOS system comparing two- and three-dimensional imaging. INTERNATIONAL ORTHOPAEDICS 2014; 39:1259-67. [DOI: 10.1007/s00264-014-2616-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 11/25/2014] [Indexed: 01/17/2023]
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Terrier A, Levrero Florencio F, Rüdiger HA. Benefit of cup medialization in total hip arthroplasty is associated with femoral anatomy. Clin Orthop Relat Res 2014; 472:3159-65. [PMID: 25030101 PMCID: PMC4160515 DOI: 10.1007/s11999-014-3787-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 06/24/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Medialization of the cup with a respective increase in femoral offset has been proposed in THA to increase abductor moment arms. Insofar as there are potential disadvantages to cup medialization, it is important to ascertain whether the purported biomechanical benefits of cup medialization are large enough to warrant the downsides; to date, studies regarding this question have disagreed. QUESTIONS/PURPOSES The purpose of this study was to quantify the effect of cup medialization with a compensatory increase in femoral offset compared with anatomic reconstruction for patients undergoing THA. We tested the hypothesis that there is a (linear) correlation between preoperative anatomic parameters and muscle moment arm increase caused by cup medialization. METHODS Fifteen patients undergoing THA were selected, covering a typical range of preoperative femoral offsets. For each patient, a finite element model was built based on a preoperative CT scan. The model included the pelvis, femur, gluteus minimus, medius, and maximus. Two reconstructions were compared: (1) anatomic position of the acetabular center of rotation, and (2) cup medialization compensated by an increase in the femoral offset. Passive abduction-adduction and flexion-extension were simulated in the range of normal gait. Muscle moment arms were evaluated and correlated to preoperative femoral offset, acetabular offset, height of the greater trochanter (relative to femoral center of rotation), and femoral antetorsion angle. RESULTS The increase of muscle moment arms caused by cup medialization varied among patients. Muscle moment arms increase by 10% to 85% of the amount of cup medialization for abduction-adduction and from -35% (decrease) to 50% for flexion-extension. The change in moment arm was inversely correlated (R(2) = 0.588, p = 0.001) to femoral antetorsion (anteversion), such that patients with less femoral antetorsion gained more in terms of hip muscle moments. No linear correlation was observed between changes in moment arm and other preoperative parameters in this series. CONCLUSIONS The benefit of cup medialization is variable and depends on the individual anatomy. CLINICAL RELEVANCE Cup medialization with compensatory increase of the femoral offset may be particularly effective in patients with less femoral antetorsion. However, cup medialization must be balanced against its tradeoffs, including the additional loss of medial acetabular bone stock, and eventual proprioceptive implications of the nonanatomic center of rotation and perhaps joint reaction forces. Clinical studies should better determine the relevance of small changes of moment arms on function and joint reaction forces.
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Affiliation(s)
- Alexandre Terrier
- />Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 19, 1015 Lausanne, Switzerland
| | - Francesc Levrero Florencio
- />Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 19, 1015 Lausanne, Switzerland , />Department of Orthopaedics and Traumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hannes A. Rüdiger
- />Department of Orthopaedics and Traumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Do jumbo cups cause hip center elevation in revision THA? A radiographic evaluation. Clin Orthop Relat Res 2014; 472:2793-8. [PMID: 24744132 PMCID: PMC4117877 DOI: 10.1007/s11999-014-3632-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 04/04/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acetabular revision THA with use of a large (jumbo) cup is an effective treatment for many cavitary and segmental peripheral bone defects. However, hip center elevation may occur with use of a jumbo cup owing to reaming superiorly and/or because of the increased diameter of the jumbo cup compared with the native acetabulum. QUESTIONS/PURPOSES In our jumbo cup revision THAs, we attempted to avoid hip center elevation by placing the inferior edge of the cup at the inferior acetabulum. In this study, we asked (1) how much of an elevation in the hip center is observed radiographically with use of jumbo cups, and (2) how effective was our technique in minimizing hip center elevation during revision THA in clinical practice? METHODS We retrospectively reviewed radiographic data for all patients, from one surgeon's practice, who received a jumbo cup (defined as cup size ≥ 66 mm in men, ≥ 62 mm in women) during an acetabular revision between 1998 and 2012 and who had an anatomically placed THA or no THA on the contralateral side (so as to be able to make comparisons); 98 patients were identified and included. The height of the revised hip center was measured relative to the contralateral normal hip. Cup elevation resulting from superior reaming was determined by measuring the distance from the inferior cup edge to the interteardrop line. The mean hip center elevation and cup position relative to the interteardrop line in male and female patients were compared using unpaired t-tests. RESULTS Radiographic analysis showed a mean hip center elevation of 11 mm. On average, 1 mm of the measured hip center elevation was the result of cup placement superior to its planned position at the interteardop line. CONCLUSIONS Our results indicate that revision THA with a jumbo cup is associated with hip center elevation despite placement of the cup at the inferior acetabulum. An increase in femoral head length may be needed to compensate for hip center elevation with use of a jumbo cup. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Shi HF, Xiong J, Chen YX, Wang JF, Wang YH. Radiographic analysis of the restoration of hip joint center following open reduction and internal fixation of acetabular fractures: a retrospective cohort study. BMC Musculoskelet Disord 2014; 15:277. [PMID: 25124773 PMCID: PMC4137070 DOI: 10.1186/1471-2474-15-277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/01/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Unfavorable reduction is considered one of the key factors leading to joint degeneration and compromised clinical outcome in acetabular fracture patients. Besides the columns, walls, and superior dome, the postoperative position of hip joint center (HJC), which is reported to affect hip biomechanics, should be considered during the assessment of quality of reduction. We aimed to evaluate the radiographic restoration of HJC in acetabular fractures treated with open reduction and internal fixation. METHODS Patients with a displaced acetabular fracture that received open reduction and internal fixation in the authors' institution during the past five years were identified from the trauma database. The horizontal and vertical shifts of HJC were measured in the standard anteroposterior view radiographs taken postoperatively. The radiographic quality of fracture reduction was graded according to Matta's criteria. The relationships between the shift of HJC and the other variables were evaluated. RESULTS Totally 127 patients with 56 elementary and 71 associated-type acetabular fractures were included, wherein the majority showed a medial (89.0%) and proximal (93.7%) shift of HJC postoperatively. An average of 2.8 mm horizontal and 2.2 mm vertical shift of HJC were observed, which correlated significantly with the quality of fracture reduction (P < 0.001 for both). The horizontal shift of HJC correlated with the fracture type (P = 0.022). CONCLUSIONS The restoration of HJC correlates with the quality of reduction in acetabular fractures following open reduction and internal fixation. Further studies are required to address the effects of HJC shift on the biomechanical changes and clinical outcomes of hip joint, especially in poorly reduced acetabular fractures.
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Affiliation(s)
| | | | - Yi-xin Chen
- Department of Orthopaedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No, 321 Zhongshan Road, Nanjing, China.
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Boissonneault A, Lynch JA, Wise BL, Segal NA, Gross KD, Murray DW, Nevitt MC, Pandit HG. Association of hip and pelvic geometry with tibiofemoral osteoarthritis: multicenter osteoarthritis study (MOST). Osteoarthritis Cartilage 2014; 22:1129-35. [PMID: 24971867 PMCID: PMC4195737 DOI: 10.1016/j.joca.2014.06.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/10/2014] [Accepted: 06/13/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Lateral tibiofemoral osteoarthritis (OA) is overall less common than medial tibiofemoral OA, but it is more prevalent in women. This may be explained by sex differences in hip and pelvic geometry. The aim of this study is to explore sex differences in hip and pelvic geometry and determine if such parameters are associated with the presence of compartment-specific knee OA. METHODS This case-control study reports on 1,328 hips/knees from 664 participants and is an ancillary to the Multicenter Osteoarthritis Study (MOST). Of the 1,328 knees, 219 had lateral OA, 260 medial OA, and 849 no OA. Hip and pelvic measurements were taken from full-limb radiographs on the ipsilateral side of the knee of interest. After adjusting for covariates, means were compared between sexes and also between knees with medial and lateral OA vs no OA using separate regression models. RESULTS Women were shown to have a reduced femoral offset (FO) (mean 40.9 mm vs 45.9 mm; P = 0.001) and more valgus neck-shaft angle (mean 128.4° vs 125.9°; P < 0.001) compared to men. Compared to those with no OA, knees with lateral OA were associated with a reduced FO (P = 0.012), increased height of hip centre (HHC) (P = 0.003), more valgus neck-shaft angle (P = 0.042), and increased abductor angle (P = 0.031). Knees with medial OA were associated with a more varus neck-shaft angle (P = 0.043) and a decreased abductor angle (P = 0.003). CONCLUSION These data suggest anatomical variations at the hip and pelvis are associated with compartment-specific knee OA and may help to explain sex differences in patterns of knee OA.
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Affiliation(s)
- A Boissonneault
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - JA Lynch
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, USA
| | - BL Wise
- Center for Musculoskeletal Health, University of California, Davis School of Medicine, Davis, California, USA
| | - NA Segal
- Department of Orthopaedics and Rehabilitation, The University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
| | - KD Gross
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - DW Murray
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - MC Nevitt
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, USA
| | - HG Pandit
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Nie Y, Pei F, Li Z. Effect of high hip center on stress for dysplastic hip. Orthopedics 2014; 37:e637-43. [PMID: 24992059 DOI: 10.3928/01477447-20140626-55] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 12/20/2013] [Indexed: 02/03/2023]
Abstract
High hip center reconstruction has been advocated in treating deficient acetabulum. However, there is no consensus on the clinical outcome of this technique. In addition, it remains unclear to what extend this technique restores the normal hip biomechanics. The goal of this study was to investigate stress above the acetabular dome in response to a range of high hip center positioning for Crowe type I and II hip dysplasia. This study consisted of 2 main parts, radiologic and biomechanical. Pelvic radiographs of 18 patients were studied to determine the amount of displacement of the hip center in the superior direction compared with the normal side. Second, qualitative and quantitative changes in stress on cortical and trabecular bone in the region of the acetabular dome as a result of superior displacement of the hip center were analyzed with subject-specific finite element models. The results showed that the range of the hip center position in the superior direction for Crowe type I and II hip dysplasia was 0 to 15 mm above the contralateral femoral head center. When superior displacement of the hip center exceeded 5 mm above the anatomic hip center, cortical bone mass on the 2 thickest cross-sections above the acetabular dome decreased quickly and the stress value on posterolateral cortical bone was obviously lower than the normal level. This study showed that to restore the normal load above the acetabular dome, there is a limit of 5 mm above the anatomic hip center for high hip center acetabular reconstruction for Crowe type I and II hip dysplasia.
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Callado VM, de Sandes Kimura O, de Carvalho Leal D, Teixeira de Sousa Filho PG, Cury Fernandes MB, Carvalho de Almendra Freitas EH. Evaluation of the fixation of the trabecular metal wedge in patients undergoing revision of total hip arthroplasty. Rev Bras Ortop 2014; 49:364-9. [PMID: 26229828 PMCID: PMC4511618 DOI: 10.1016/j.rboe.2014.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 07/30/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE this study aimed to evaluate the fixation of the trabecular metal wedge in patients undergoing revision of total hip arthroplasty. METHODS twenty-three cases with minimum grading of Paprosky II-B that were operated between July 2008 and February 2013 were evaluated. These cases were evaluated based on radiographs before the operation, immediately after the operation and later on after the operation. Loss of fixation was defined as a change in the abduction angle of the component greater than 10° or any mobilization greater than 6 mm. RESULTS it was found that there was 100% fixation of the acetabula after a mean of 29.5 months. One case underwent removal of the implanted components due to infection. CONCLUSIONS there is still no consensus regarding the best option for reconstructing hips with bone loss. However, revision using a trabecular metal wedge has presented excellent short- and medium-term results. This qualifies it as an important tool for achieving a fixed and stable acetabular component.
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Avaliação da fixação da cunha de metal trabeculado em pacientes submetidos à revisão de artroplastia total de quadril. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2014.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Drexler M, Dwyer T, Kosashvili Y, Chakravertty R, Abolghasemian M, Gollish J. Acetabular cup revision combined with tensor facia lata reconstruction for management of massive abductor avulsion after failed total hip arthroplasty. J Arthroplasty 2014; 29:1052-7. [PMID: 24210308 DOI: 10.1016/j.arth.2013.09.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/26/2013] [Accepted: 09/30/2013] [Indexed: 02/01/2023] Open
Abstract
We report on 17 patients with massive abductor avulsions after total hip arthroplasty (THA) treated with medialization of the acetabular component and tensor fascia lata (TFL) reconstruction. All patients had severe limp, positive Trendelenburg sign, and avulsion of the abductor insertion confirmed on MRI. Mean age was 69 years (range, 50-83 years), and mean follow-up period was 36 months (range, 18-78 months). After surgery, 9 patients had no limp (47%), 8 patients had a mild limp, and abductor power improved from mean 2.5/5 to mean 3.8 (P < 0.0001). At latest follow-up, the Harris Hip Score was excellent in 6 hips (37%), good in 7 (43%) hips, and fair or poor in 3 (23%). Two patients with mild limp were not satisfied with their procedure.
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Affiliation(s)
- Michael Drexler
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Tim Dwyer
- Women's College Hospital, University of Toronto Orthopaedic Sports Medicine, Toronto, Canada
| | - Yona Kosashvili
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | | | - Jeffrey Gollish
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
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Nwankwo C, Dong NN, Heffernan CD, Ries MD. Do jumbo cups cause hip center elevation in revision THA? A computer simulation. Clin Orthop Relat Res 2014; 472:572-6. [PMID: 23884801 PMCID: PMC3890160 DOI: 10.1007/s11999-013-3169-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acetabular revision THA with use of a large (jumbo) cup is an effective treatment for many cavitary and segmental peripheral bone defects. However, the jumbo cup may result in elevation of the hip center and protrusion through the anterior acetabular wall as a result of the oversized geometry of the jumbo cup compared with the physiologic acetabulum. QUESTIONS/PURPOSES The purpose of this computer simulation was to determine how much elevation of the hip center and anterior wall protrusion occurs in revision THA with use of a jumbo cup technique in which the inferior edge of the jumbo cup is placed at the inferior acetabular rim and the superior edge of the jumbo cup is placed against host bone at the superior margin of a posterosuperior bone defect. METHODS Two hundred sixty-five pelvic CT scans were analyzed by custom CT analytical software. The computer simulated oversized reaming. The vertical and anterior reamer center shifts were measured, and anterior column bone removal was determined. RESULTS The computer simulation demonstrated that the hip center shifted 0.27 mm superiorly and 0.02 mm anteriorly, and anterior column bone removal increased 0.86 mm for every 1-mm increase in reamer diameter. CONCLUSIONS Our results indicate that the jumbo cup technique results in hip center elevation despite placement of the cup adjacent to the inferior acetabulum. For a hypothetical increase from a 54-mm socket to a 72-mm socket, as one might see in the context of the revision of a failed THA, our model would predict an elevation of the hip center of approximately 5 mm and loss of approximately 15 mm of anterior column bone. This suggests that an increase in femoral head length may be needed to compensate for the hip center elevation caused by the use of a large jumbo cup in revision THA. A jumbo cup may also result in protrusion through the anterior wall.
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Affiliation(s)
- Chima Nwankwo
- />Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA USA
| | - Nick N. Dong
- />Stryker Orthopaedics, Inc, 325 Corporate Drive, Mahwah, NJ 07430 USA
| | | | - Michael D. Ries
- />Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA USA , />Tahoe Fracture and Orthopaedic Clinic, 973 Mica Dr, Carson City, NV 89705 USA
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How far above the true anatomic position can the acetabular cup be placed in total hip arthroplasty? Hip Int 2013; 23:129-34. [PMID: 23543468 DOI: 10.5301/hipint.5000010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 02/04/2023]
Abstract
INTRODUCTION There is controversy about which is more suitable for determining correct socket position in patients with severe bone deficiency of the acetabular roof because of developmental dysplasia of the hip (DDH): the anatomic centre of hip rotation or a high centre.
METHOD We evaluated the relationship, in 200 hips, between the centre of rotation and presence of the Trendelenburg sign to determine the upper limit of cup position from the standpoint of hip-abductor strength.
RESULTS Of the 200 hips, 20 (10%) showed a positive Trendelenburg sign. There were no statistically significant differences between parameters (the centre of rotation, femoral offset, abductor lever arm) regarding the presence of the Trendelenburg sign except for age at surgery. Patients with a positive Trendelenburg sign were significantly older (64.1 ± 9.4 years) than those with a negative Trendelenburg sign (58.8 ± 7.7 years) (P = 0.01).
CONCLUSIONS Our findings indicate that a high centre of hip rotation of up to approximately 30 mm from the inter-teardrop line is a feasible option for patients with DDH from the standpoint of hip-abductor strength if stems are used that allow the restoration of femoral offset and the abductor lever arm.
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Abolghasemian M, Samiezadeh S, Jafari D, Bougherara H, Gross AE, Ghazavi MT. Displacement of the hip center of rotation after arthroplasty of Crowe III and IV dysplasia: a radiological and biomechanical study. J Arthroplasty 2013; 28:1031-5. [PMID: 23541865 DOI: 10.1016/j.arth.2012.07.042] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 07/10/2012] [Accepted: 07/20/2012] [Indexed: 02/01/2023] Open
Abstract
To study the direction and biomechanical consequences of hip center of rotation (HCOR) migration in Crowe type III and VI hips after total hip arthroplasty, post-operative radiographs and CT scans of several unilaterally affected hips were evaluated. Using a three-dimensional model of the human hip, the HCOR was moved in all directions, and joint reaction force (JRF) and abductor muscle force (AMF) were calculated for single-leg stance configuration. Comparing to the normal side, HCOR had displaced medially and inferiorly by an average of 23.4% and 20.8%, respectively, of the normal femoral head diameter. Significant decreases in JRF (13%) and AMF (46.13%) were observed in a presumptive case with that amount of displacement. Isolated inferior displacement had a small, increasing effect on these forces. In Crowe type III and IV hips, the HCOR migrates inferiorly and medially after THA, resulting in a decrease in JRF, AMF, and abductor muscle contraction force.
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Affiliation(s)
- Mansour Abolghasemian
- Department of Orthopedic Surgery, Shafa Hospital, Tehran University of Medical Sciences, Tehran, Iran
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69
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Initial implant stability predicts migration but not failure in cementless acetabular revision with bone grafting. J Arthroplasty 2013; 28:832-7. [PMID: 23489733 DOI: 10.1016/j.arth.2012.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 07/31/2012] [Accepted: 10/12/2012] [Indexed: 02/01/2023] Open
Abstract
Host bone contact of less than 50% is perceived but not proven to cause migration and loosening after acetabular revision. A prospective analysis of cementless acetabular revision cases with impaction grafting was performed to determine if this was an independent risk factor for these events. Sixty-two hips in 54 patients were assessed at a mean follow-up of 84.5 months (range 61-112) yielding a probability of 94.6% of retaining the acetabular component using revision for aseptic loosening as the end point. No single factor was independently causative for loosening, although Type III fixation was associated with migration (p=0.0159); subanalysis suggested that achieving host-bone contact in at least part of the dome and posterior column is important.
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70
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Preininger B, Schmorl K, von Roth P, Winkler T, Matziolis G, Perka C, Tohtz S. [More muscle mass in men: explanatory model for superior outcome after total hip arthroplasty]. DER ORTHOPADE 2013; 42:107-13. [PMID: 23381894 DOI: 10.1007/s00132-012-2042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Men show better functional results after total hip arthroplasty (THA). The aim of this study was a patient-specific analysis of the hip joint muscles in comparison to the joint geometry. METHODS In this study 93 computed tomography (CT) scans of the pelvis (45 men, 48 women) were analyzed to determine hip joint geometry and the volume of the gluteus medius (GMV), gluteus maximus (GXV) and tensor fasciae latae (TFL) muscles. The abduction muscle volumes were analyzed with respect to patient-specific adduction moments. RESULTS The absolute total volume of the hip muscular system (TMV) was larger in men than in women (1913 ccm vs. 1479 ccm; p <0.0001). Men exhibited a more progressive increase of muscle volume as the adduction moment increases. CONCLUSIONS Men have a greater abduction muscle mass in order to balance adduction moments occurring in the hip joint and therefore have more muscle mass to compensate the inevitable intraoperative muscle damage during THA. This argument supports the extraordinary importance of muscle sparing surgical techniques in women.
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Affiliation(s)
- B Preininger
- Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Deutschland.
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71
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Abolghasemian M, Tangsataporn S, Sternheim A, Backstein D, Safir O, Gross AE. Combined trabecular metal acetabular shell and augment for acetabular revision with substantial bone loss. Bone Joint J 2013; 95-B:166-72. [PMID: 23365023 DOI: 10.1302/0301-620x.95b2.30608] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Trabecular metal (TM) augments are a relatively new option for reconstructing segmental bone loss during acetabular revision. We studied 34 failed hip replacements in 34 patients that were revised between October 2003 and March 2010 using a TM acetabular shell and one or two augments. The mean age of the patients at the time of surgery was 69.3 years (46 to 86) and the mean follow-up was 64.5 months (27 to 107). In all, 18 patients had a minor column defect, 14 had a major column defect, and two were associated with pelvic discontinuity. The hip centre of rotation was restored in 27 patients (79.4%). The Oxford hip score increased from a mean of 15.4 points (6 to 25) before revision to a mean of 37.7 (29 to 47) at the final follow-up. There were three aseptic loosenings of the construct, two of them in the patients with pelvic discontinuity. One septic loosening also occurred in a patient who had previously had an infected hip replacement. The augments remained stable in two of the failed hips. Whenever there was a loose acetabular component in contact with a stable augment, progressive metal debris shedding was evident on the serial radiographs. Complications included another deep infection treated without revision surgery. Good clinical and radiological results can be expected for bone-deficient acetabula treated by a TM cup and augment, but for pelvic discontinuities this might not be a reliable option. Cite this article: Bone Joint J 2013;95-B:166–72.
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Affiliation(s)
- M. Abolghasemian
- Mount Sinai Hospital, University
of Toronto, 600 University Street, Suite
476 (A), Toronto, Ontario
M5G 1X5, Canada
| | - S. Tangsataporn
- Mount Sinai Hospital, University
of Toronto, 600 University Street, Suite
476 (A), Toronto, Ontario
M5G 1X5, Canada
| | - A. Sternheim
- Mount Sinai Hospital, University
of Toronto, 600 University Street, Suite
476 (A), Toronto, Ontario
M5G 1X5, Canada
| | - D. Backstein
- Mount Sinai Hospital, University
of Toronto, 600 University Street, Suite
476 (A), Toronto, Ontario
M5G 1X5, Canada
| | - O. Safir
- Mount Sinai Hospital, University
of Toronto, 600 University Street, Suite
476 (A), Toronto, Ontario
M5G 1X5, Canada
| | - A. E. Gross
- Mount Sinai Hospital, University
of Toronto, 600 University Street, Suite
476 (A), Toronto, Ontario
M5G 1X5, Canada
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72
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Takigami I, Ito Y, Matsumoto K, Ogawa H, Terabayashi N, Shimizu K. Primary total hip arthroplasty with a spongy metal surface acetabular component for hip dysplasia. J Arthroplasty 2013; 28:172-7. [PMID: 22682038 DOI: 10.1016/j.arth.2012.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 04/04/2012] [Indexed: 02/01/2023] Open
Abstract
We evaluated the clinical and radiographic results of primary total hip arthroplasty for 81 dysplastic hips (71 patients) using cementless Spongiosa Metal II cups (ESKA Implants, Lübeck, Germany). The mean follow-up period was 6.4 years (minimum 5 years), and the preoperative mean Japanese Orthopaedic Association hip score had improved from 45.2 to 87.4 points at the latest follow-up. The radiographic outcome was no aseptic loosening in all 81 hips. The hip center was located significantly more superior than in the contralateral normal hip in 45 patients, but the difference was less than 10 mm; however, there was no significant difference in the lateral position of the hip center. The use of a Spongiosa Metal II cup for dysplastic hips provided satisfactory 5- to 10-year clinical and radiographic results.
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Affiliation(s)
- Iori Takigami
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Bouffard V, Begon M, Champagne A, Farhadnia P, Vendittoli PA, Lavigne M, Prince F. Hip joint center localisation: A biomechanical application to hip arthroplasty population. World J Orthop 2012; 3:131-6. [PMID: 22919569 PMCID: PMC3425632 DOI: 10.5312/wjo.v3.i8.131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 12/15/2011] [Accepted: 08/07/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine hip joint center (HJC) location on hip arthroplasty population comparing predictive and functional approaches with radiographic measurements.
METHODS: The distance between the HJC and the mid-pelvis was calculated and compared between the three approaches. The localisation error between the predictive and functional approach was compared using the radiographic measurements as the reference. The operated leg was compared to the non-operated leg.
RESULTS: A significant difference was found for the distance between the HJC and the mid-pelvis when comparing the predictive and functional method. The functional method leads to fewer errors. A statistical difference was found for the localization error between the predictive and functional method. The functional method is twice more precise.
CONCLUSION: Although being more individualized, the functional method improves HJC localization and should be used in three-dimensional gait analysis.
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74
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Yang S, Cui Q. Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes. World J Orthop 2012; 3:42-8. [PMID: 22655221 PMCID: PMC3364316 DOI: 10.5312/wjo.v3.i5.42] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 02/20/2012] [Accepted: 05/13/2012] [Indexed: 02/06/2023] Open
Abstract
Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) presents many challenges to the reconstructive surgeon. The complex femoral and acetabular anatomy makes standard reconstruction technically challenging. Acetabular coverage can be improved by medialization of the component or augmentation of the deficient areas with bone graft. Femoral shortening osteotomies are considered in cases of severe dysplasia and frankly dislocated hips. Each patient’s unique anatomy dictates what options of reconstruction are available. The functional outcomes of THA in DDH are generally excellent, though higher rates of mechanical failure have been reported in this group. This article reviews the anatomy, classification, technical considerations, and outcomes of THA in patients with DDH.
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75
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Taddei F, Martelli S, Valente G, Leardini A, Benedetti MG, Manfrini M, Viceconti M. Femoral loads during gait in a patient with massive skeletal reconstruction. Clin Biomech (Bristol, Avon) 2012; 27:273-80. [PMID: 22015265 DOI: 10.1016/j.clinbiomech.2011.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 09/08/2011] [Accepted: 09/13/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Biological massive skeletal reconstructions in tumours adopt a long rehabilitation protocol aimed at minimising the fracture risk. To improve rehabilitation and surgical procedures it is important to fully understand the biomechanics of the reconstructed limb. The aim of the present study was to develop a subject-specific musculoskeletal model of a patient with a massive biological skeletal reconstruction, to investigate the loads acting on the femur during gait, once the rehabilitation protocol was completed. METHODS A personalised musculoskeletal model of the patient's lower limbs was built from a CT exam and registered with the kinematics recorded in a gait analysis session. Predicted activations for major muscles were compared to EMG signals to assess the model's predictive accuracy. FINDINGS Gait kinematics showed only minor discrepancies between the two legs and was compatible with normality data. External moments showed slightly higher differences and were almost always lower on the operated leg exhibiting a lower variability. In the beginning of the stance phase, the joint moments were, conversely, higher on the operated side and showed a higher variability. This pattern was reflected and amplified on the femoral forces where the differences became important: on the hip, a maximum difference of 1.6 BW was predicted. The variability of the forces seemed, generally, lower on the operated leg than on the contralateral one. INTERPRETATION Small asymmetries in kinematic patterns might be associated, in massive skeletal reconstruction, to significant difference in the skeletal loads (up to 1.6 BW for the hip joint reaction) during gait.
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Affiliation(s)
- Fulvia Taddei
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10,Bologna, Italy.
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Queen RM, Watters TS, Abbey AN, Sabesan VJ, Vail TP, Bolognesi MP. Gait symmetry: a comparison of hip resurfacing and jumbo head total hip arthroplasty patients. J Arthroplasty 2011; 26:680-5. [PMID: 20884168 DOI: 10.1016/j.arth.2010.07.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 07/30/2010] [Indexed: 02/01/2023] Open
Abstract
Proponents of large femoral head total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) have touted the potential for restoration of more normal hip kinematics. This study examined 20 patients (10 THA and 10 HRA patients) approximately 18 months after surgery. Subjects were evaluated at a self-selected pace, while bilateral spatial-temporal gait variables, hip flexion/extension kinematics, and ground reaction forces were collected. For both groups, swing time was increased on the surgical side, whereas peak hip flexion, peak extension, and flexion at heel strike were decreased. Peak hip extension and peak vertical ground reaction forces were decreased in THA subjects compared with HRA subjects. After a large-diameter THA or HRA, subjects do not display symmetric gait approximately 18 months postoperatively. Total hip arthroplasty subjects demonstrated restricted hip extension and reduced limb loading when compared with HRA subjects.
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Affiliation(s)
- Robin M Queen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Takao M, Nakamura N, Ohzono K, Sakai T, Nishii T, Sugano N. The results of a press-fit-only technique for acetabular fixation in hip dysplasia. J Arthroplasty 2011; 26:562-8. [PMID: 20647158 DOI: 10.1016/j.arth.2010.05.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 05/25/2010] [Indexed: 02/01/2023] Open
Abstract
The purpose of the present study was to evaluate the 6- to 11-year follow-up results of hemispherical porous-coated cups implanted into dysplastic hips using press-fit technique without screws focusing on the amount of host bone coverage. There were 87 patients who underwent 98 primary total hip arthroplasties. Bony coverage was measured as the angle between the vertical line and the line drawn from the cup center to the lateral edge of the acetabulum, which was named the cup center-edge angle (cup-CE angle). All 98 cups were judged to be bone ingrown. The minimum cup-CE angle was 8.4° (mean, 26.3°). Bone-cup contact of more than 8.4° of the cup-CE angle was large enough for press-fit cups to resist superior directed loads during this follow-up period.
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Affiliation(s)
- Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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78
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The use of fibre-based demineralised bone matrix in major acetabular reconstruction: surgical technique and preliminary results. INTERNATIONAL ORTHOPAEDICS 2010; 35:283-8. [PMID: 21057788 DOI: 10.1007/s00264-010-1145-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 10/16/2010] [Accepted: 10/16/2010] [Indexed: 10/18/2022]
Abstract
Acetabular osteolysis associated with socket loosening is one of the main long-term complications of total hip arthroplasty. In case of major bone loss, where <50% host bone coverage can be obtained with a porous-coated cementless cup, it is generally agreed that a metal ring or cage in association with a cemented component and allograft bone should be used. In order to promote allograft bone consolidation and incorporation, we have associated demineralised bone matrix (DBM, Grafton® A Flex) to the construct ion. Here we describe the technical details of major acetabular reconstruction using the Kerboull acetabular reinforcement device with allograft bone and DBM. This device has a hook that must be placed under the teardrop of the acetabulum and a plate for iliac fixation. The main advantages of this device are help in restoring the normal centre of hip rotation, guiding the reconstruction and partially unloading the graft. The Kerboull acetabular reinforcement device has provided a 92% survival rate free of loosening at 13-year follow-up in a consecutive series of 60 type III and IV deficiencies. Our preliminary results using DBM indicate faster allograft consolidation and remodelling.
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79
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Christodoulou NA, Dialetis KP, Christodoulou AN. High hip center technique using a biconical threaded Zweymüller cup in osteoarthritis secondary to congenital hip disease. Clin Orthop Relat Res 2010; 468:1912-9. [PMID: 20049571 PMCID: PMC2882016 DOI: 10.1007/s11999-009-1203-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 12/08/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND The high hip center technique used for a deficient acetabulum is reconstruction of the hip at a high center of rotation. In the literature, there is no consensus regarding the value of this technique. QUESTIONS/PURPOSES We investigated whether the new-generation biconical threaded Zweymüller cup fixed in a high nonanatomic position in patients with arthritis secondary to congenital hip disease experienced different rates of polyethylene wear and long-term survivorship when compared with anatomically positioned cups. PATIENTS AND METHODS We studied the polyethylene wear rate and Kaplan-Meier survivorship of 104 titanium threaded Zweymüller cups in 88 patients (81 females), placed in 70 hips at near-normal hip center and in 34 hips at a high hip center position at a distance of 31.1 to 60 mm (mean, 39.7 mm) from the interteardrop line. Minimum followup was 2 years (mean +/- SD, 8.6 +/- 3.5 years; range, 2-15 years). RESULTS The mean linear polyethylene wear rates in the near-normal and high hip center groups were not different (0.110 +/- 0.050 mm and 0.113 +/- 0.057 mm, respectively). The Kaplan-Meier 15-year cup survivorship rates with revision for any reason as an event of interest in the near-normal and high hip center groups also were not different (97.2% [95% confidence interval, 88.5%-99.3%] and 97.1% [95% confidence interval, 73.8%-99.3%], respectively). CONCLUSIONS The high hip center technique using a biconical threaded Zweymüller cup in patients with arthritis secondary to congenital hip disease results in a polyethylene wear rate and long-term cup survivorship comparable to those observed in anatomically positioned cups. LEVEL OF EVIDENCE Level III, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.
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Affiliation(s)
- Nikolaos A. Christodoulou
- Department of Orthopaedics, Karpenissi General Hospital, 2 P Mpakoyanni Street, Karpenissi, 36100 Greece
| | - Konstantinos P. Dialetis
- Department of Orthopaedics, Karpenissi General Hospital, 2 P Mpakoyanni Street, Karpenissi, 36100 Greece
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80
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Kurtz WB, Ecker TM, Reichmann WM, Murphy SB. Factors affecting bony impingement in hip arthroplasty. J Arthroplasty 2010; 25:624-34.e1-2. [PMID: 19559561 DOI: 10.1016/j.arth.2009.03.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 03/28/2009] [Indexed: 02/01/2023] Open
Abstract
Computer modeling of 10 patients' computed tomographic scans was used to study the variables affecting hip arthroplasty range of motion before bony impingement (ROMBI) including acetabular offset and height, femoral offset, height and anteversion, and osteophyte removal. The ROMBI was compared with the ROM before component impingement and the native hip ROM. The ROMBI decreased with decreased total offset and limb shortening. Acetabular offset and height had a greater effect on ROMBI than femoral offset and height. The ROMBI lost with decreased acetabular offset was not fully recoverable with an increase in femoral offset or osteophyte removal. Bony impingement increased and component impingement decreased with decreased acetabular offset and increased head diameter.
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81
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Taylor CA, Draney MT, Ku JP, Parker D, Steele BN, Wang K, Zarins CK. Predictive Medicine: Computational Techniques in Therapeutic Decision-Making. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929089909148176] [Citation(s) in RCA: 198] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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82
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Foucher KC, Hurwitz DE, Wimmer MA. Relative importance of gait vs. joint positioning on hip contact forces after total hip replacement. J Orthop Res 2009; 27:1576-82. [PMID: 19514072 DOI: 10.1002/jor.20935] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Implant loosening is a common indication for total hip replacement (THR) revision. High contact forces and implant twisting moments are thought to be associated with implant loosening. Relationships between joint positioning and hip forces, or outcomes, have been investigated through in vivo and in vitro modalities. Relationships between hip forces and gait are less understood, despite repeated findings that gait following a THR does not fully return to normal. We tested the hypothesis that gait parameters would be better predictors of implant force (peak contact forces and peak twisting moment during walking) than joint positioning parameters. Subjects underwent gait analysis, hip force modeling, and measurement of clinical radiographs 1 year after successful THR surgery. Gait parameters were consistently more influential in determining hip forces. Alone, gait explained as much as 67% of the variation in force, compared to a maximum of 33% by joint geometry. Combinations of gait and joint positioning parameters together explained up to 86% of the variation in hip force parameters. Results suggest that gait may provide a valuable postoperatively modifiable target to improve hip loads and potentially reduce the risk for implant loosening.
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Affiliation(s)
- Kharma C Foucher
- Department of Orthopedic Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, Illinois 60612, USA.
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83
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Lenaerts G, Bartels W, Gelaude F, Mulier M, Spaepen A, Van der Perre G, Jonkers I. Subject-specific hip geometry and hip joint centre location affects calculated contact forces at the hip during gait. J Biomech 2009; 42:1246-51. [PMID: 19464012 DOI: 10.1016/j.jbiomech.2009.03.037] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 01/21/2009] [Accepted: 03/11/2009] [Indexed: 10/20/2022]
Abstract
Hip loading affects the development of hip osteoarthritis, bone remodelling and osseointegration of implants. In this study, we analyzed the effect of subject-specific modelling of hip geometry and hip joint centre (HJC) location on the quantification of hip joint moments, muscle moments and hip contact forces during gait, using musculoskeletal modelling, inverse dynamic analysis and static optimization. For 10 subjects, hip joint moments, muscle moments and hip loading in terms of magnitude and orientation were quantified using three different model types, each including a different amount of subject-specific detail: (1) a generic scaled musculoskeletal model, (2) a generic scaled musculoskeletal model with subject-specific hip geometry (femoral anteversion, neck-length and neck-shaft angle) and (3) a generic scaled musculoskeletal model with subject-specific hip geometry including HJC location. Subject-specific geometry and HJC location were derived from CT. Significant differences were found between the three model types in HJC location, hip flexion-extension moment and inclination angle of the total contact force in the frontal plane. No model agreement was found between the three model types for the calculation of contact forces in terms of magnitude and orientations, and muscle moments. Therefore, we suggest that personalized models with individualized hip joint geometry and HJC location should be used for the quantification of hip loading. For biomechanical analyses aiming to understand modified hip joint loading, and planning hip surgery in patients with osteoarthritis, the amount of subject-specific detail, related to bone geometry and joint centre location in the musculoskeletal models used, needs to be considered.
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Affiliation(s)
- G Lenaerts
- Department of Biomedical Kinesiology, Katholieke Universiteit Leuven, Tervuursevest 101, Heverlee, Belgium.
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Upward and inward displacements of the acetabular component increase stress on femoral head in single endoprothesis models. INTERNATIONAL ORTHOPAEDICS 2009; 34:479-83. [PMID: 19424694 DOI: 10.1007/s00264-009-0788-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 04/08/2009] [Accepted: 04/09/2009] [Indexed: 10/20/2022]
Abstract
The centre of rotation of the hip can be displaced in hip dysplasia and revision arthroplasty. This study examined the effect of artificial femoral head load after acetabular component displacement in total hip arthroplasty. Sixteen total hip arthroplasty models of human cadaver specimens were reconstructed, and under different acetabular component position, the load around the femoral head was evaluated by strain gages. The results showed that the load was higher in the same specimens when the cup was moved 2 mm inward or upward, especially after the cup was moved more than 6 mm, and the load had an increasing effect in the inward group. In the upward group, an increasing effect happened at 8 mm upward displacement, but the stress value decreased from 4 mm to 6 mm upward displacement. In the same moving distance, the stress of inward displacement is obviously higher than upward displacement. Altogether, the results suggested that for both inward displacement and upward displacement of the acetabular cup, the load around the femoral head increased gradually, while the distance of the inward displacement and the superior displacement was increased. The greater the displacement, the bigger the loading contact stress. The upward displacement caused less stress change on the femoral head. The stress of the 6 mm upward position was lower than nearby positions; perhaps this site represented a stress buffering zone.
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85
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Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res 2009; 95:210-9. [PMID: 19423418 DOI: 10.1016/j.otsr.2009.03.010] [Citation(s) in RCA: 246] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Revised: 10/28/2008] [Accepted: 03/09/2009] [Indexed: 02/02/2023]
Abstract
UNLABELLED BACKGROUND OBJECTIVE: Femoral offset is supposed to influence the results of hip replacement but little is known about the accurate method of measure and the true effect of offset modifications. MATERIAL AND METHODS This article is a collection of independent anatomic, radiological and clinical works, which purpose is to assess knowledge of the implications of femoral offset for preoperative templating and total hip arthroplasty. RESULTS There is a strong correlation between femoral offset, abductors lever arm and hip abductor strength. Hip lateralization is independent of the femoral endomedullary characteristics. The abductors lever arm is highly correlated to the gluteus medius activation angle. There were correlations between femoral offset and endomedullary shape. The hip center was high and medial for stovepipe metaphysis while it was lower and lateralized for champagne - flute upper femur. A study was performed to compare the femoral offset measured by X-ray and CT-scan in 50 patients, demonstrated that plain radiography underestimates offset measurement. The 2D templating cannot appreciate the rotation of the lower limb. Taking into account the horizontal plane is essential to obtain proper 3D planning of the femoral offset. A randomized study was designed to compare femoral offset measurements after hip resurfacing and total hip arthroplasty. This study underlined hip resurfacing reduced the femoral offset, while hip replacement increased offset. However, the reduction of femoral offset after hip resurfacing does not affect the function. A pilot study was designed to assess the results of 120 hip arthroplasties with a modular femoral neck. This study showed that the use of a modular collar ensures an easier restoration of the femoral offset. A cohort of high offset stems (Lubinus 117 degrees) was retrospectively assessed. The survival rate was slightly lower that the standard design reported in the Swedish register. Finally, the measurement of offset and leg length was assessed with the help of computer assistance. The software changed the initial schedule (obtained by templating) in 29%. CONCLUSION Therefore, femoral offset restoration is essential to improve function and longevity of hip arthroplasty. CT-scan is more accurate than plain radiography to assess femoral offset. Hip resurfacing decreases offset without effect on function. Modular neck and computer assistance may improve intraoperative calculation and reproduction of femoral offset. Increasing offset with a standard cemented design may decrease long-term fixation. Level IV: Retrospective or historical series.
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86
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Doheny EP, Lowery MM, O'Malley MJ, Fitzpatrick DP. The effect of elbow joint centre displacement on force generation and neural excitation. Med Biol Eng Comput 2009; 47:589-98. [PMID: 19399543 DOI: 10.1007/s11517-009-0488-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 04/05/2009] [Indexed: 11/27/2022]
Abstract
Joint centre displacement may occur following total elbow replacement due to aseptic loosening or surgical misalignment, and has been linked to implant failure. In this study, the effects of joint centre displacement were examined using a neuromusculoskeletal model of the elbow joint. Isometric contractions were simulated at a range of joint angles during elbow flexion and extension. Displacement of the joint centre affected the force-generating capacity about the joint, due to changes in both muscle lengths and moment arms. The magnitude and direction of the maximum joint reaction force were also altered, potentially contributing to aseptic loosening and compromising joint stability. The relationship between force generated and the level of neural excitation to the elbow flexor and extensor muscles was also affected, suggesting that altered neural control patterns could be required following joint centre displacement.
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87
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Can the acetabular position be derived from a pelvic frame of reference? Clin Orthop Relat Res 2009; 467:886-93. [PMID: 18551348 PMCID: PMC2650052 DOI: 10.1007/s11999-008-0336-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 05/21/2008] [Indexed: 01/31/2023]
Abstract
Acetabular center positioning has an effect on hip function. However, reported clinical and plain radiographic methods are inaccurate and unreliable for ascertaining acetabular implant location. In an exploratory study we asked whether the normal acetabular position can be derived from simple radiographically measurable pelvic dimensions. We analyzed computed tomographic scans of 37 normal hips using a pelvic frame of reference centered on the ipsilateral anterior-superior iliac spine. We defined the x-, y-, and z-coordinates of the hip center (C(x),C(y),C(z)) as a percentage of the corresponding pelvic dimensions (D(x),D(y),D(z)). C(x)/D(x) averaged 9%, C(y)/D(y) 34%, and C(z)/D(z) 37%. These ratios had narrow distributions with small confidence intervals. Interobserver agreement tests showed a mean intraclass correlation coefficient of 0.95. We observed gender differences in the ratios of as much as 4%, which correspond to differences of as much as 9 mm in the hip center position. The ratios provide a simple and reliable way of deriving the normal position of the hip center from the pelvic dimensions alone. This gives the surgeon a simple way of planning where the hip center should be and may be particularly helpful in revision hip arthroplasty or in cases involving extensive osteophytes, dysplasia, or protrusio.
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88
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Nantel J, Termoz N, Vendittoli PA, Lavigne M, Prince F. Gait Patterns After Total Hip Arthroplasty and Surface Replacement Arthroplasty. Arch Phys Med Rehabil 2009; 90:463-9. [DOI: 10.1016/j.apmr.2008.08.215] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 06/29/2008] [Accepted: 08/21/2008] [Indexed: 11/26/2022]
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89
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Minimum ten-year results of a porous acetabular component for Crowe I to III hip dysplasia using an elevated hip center. J Arthroplasty 2009; 24:187-94. [PMID: 18534384 DOI: 10.1016/j.arth.2007.08.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Accepted: 08/02/2007] [Indexed: 02/01/2023] Open
Abstract
We conducted a retrospective study of the placement of porous-coated acetabular components using screws at more than 20 mm above the teardrop without structural bone graft for dysplastic hips to determine long-term outcome. Thirty hips (29 patients) were monitored for a mean of 15.2 years (range, 10.4-18.3 years) after surgery. Compared with 12 contralateral normal hips, the distance of the hip center from the teardrop was significantly high (26.8 +/- 4.8 and 13.4 +/- 2.7 mm P < .001); however, it was not laterally different (31. 5 +/- 5.1 and 31.7 +/- 5.0 mm). No acetabular components showed loosening. One metal shell was revised for wear and osteolysis. Morselized bone grafted in 25 hips was incorporated in all cases. Slight elevation of the hip center without lateralization in cementless cups fixed with screws was well tolerated for dysplastic hips.
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90
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Kiyama T, Naito M, Shitama H, Maeyama A. Effect of superior placement of the hip center on abductor muscle strength in total hip arthroplasty. J Arthroplasty 2009; 24:240-5. [PMID: 18835515 DOI: 10.1016/j.arth.2008.08.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 08/28/2008] [Indexed: 02/01/2023] Open
Abstract
We evaluated 100 limbs in 50 patients who had undergone unilateral primary total hip arthroplasty with a normal contralateral hip. The 50 patients were divided into 2 groups by postoperative acetabular cup position, specifically by inferior and superior placement (inferior and superior groups). Hip abductor muscle strength was evaluated qualitatively by the modified Trendelenburg test and quantitatively by handheld dynamometer. The ratio of normalized strength of the reconstruction side to that of the nonoperated side was calculated (strength ratio). The modified Trendelenburg test was positive in 5 of 23 patients in the inferior group and 11 of 27 in the superior group (P < .05). The strength ratio of the superior group was decreased by 7.7% in comparison with that of the inferior group (P < .01).
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Affiliation(s)
- Takahiko Kiyama
- Department of Orthopaedic Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
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91
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Evaluation of the hip center in total hip arthroplasty for old developmental dysplasia. J Arthroplasty 2008; 23:1189-96. [PMID: 18534475 DOI: 10.1016/j.arth.2007.10.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 08/25/2007] [Accepted: 10/08/2007] [Indexed: 02/01/2023] Open
Abstract
We describe the problems with positioning the hip center according to the severity of dislocation in 97 cementless total hip arthroplasty for developmental dysplasia of the hip. The mean location of the hip center from the interteardrop was 30.4 +/- 8.7 mm horizontally and 23.4 +/- 5.4 mm vertically. The presence of a limp correlated with a superior placement of the cup. Four cups were revised, 2 of which with a significant high hip center. The survival rate of the acetabular component was 95% at 12 years. Craniopodal repositioning was easy in class 1. In class 2, the cup was the largest. In class 3, the greatest variations of the hip center were found. In class 4, the smallest implants were necessary for positioning in the true acetabulum.
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92
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Koulouvaris P, Stafylas K, Sculco T, Xenakis T. Distal femoral shortening in total hip arthroplasty for complex primary hip reconstruction. A new surgical technique. J Arthroplasty 2008; 23:992-8. [PMID: 18534497 DOI: 10.1016/j.arth.2007.09.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 09/06/2007] [Indexed: 02/01/2023] Open
Abstract
Successful total hip arthroplasty (THA) in congenital dislocated hips demands anatomical reduction in the normal center of rotation without overstretching the sciatic nerve and without excessive compression or abnormal forces across the joint. Proximal femoral and subtrochanteric shortening osteotomy has been described for THA for the treatment of dislocated hips. However, these osteotomies are demanding, associated with deformation of femoral canal and nonunion, and may increase the femoral stem stress. This study reports excellent results in 24 patients with a new surgical technique that combines THA with a distal femoral shortening in severely deformed hips using customized components.
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Affiliation(s)
- Panagiotis Koulouvaris
- Orthopaedic Department, University of Ioannina, Greece University Hospital of Ioannina, Greece
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93
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Lenaerts G, De Groote F, Demeulenaere B, Mulier M, Van der Perre G, Spaepen A, Jonkers I. Subject-specific hip geometry affects predicted hip joint contact forces during gait. J Biomech 2008; 41:1243-52. [PMID: 18346745 DOI: 10.1016/j.jbiomech.2008.01.014] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 12/20/2007] [Accepted: 01/18/2008] [Indexed: 11/28/2022]
Affiliation(s)
- G Lenaerts
- Department of Biomedical Kinesiology, Katholieke Universiteit Leuven, Tervuursevest 101, B-3001 Heverlee, Belgium.
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94
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A method of calculating physiologically relevant joint reaction forces during forward dynamic simulations of movement from an existing knee model. J Biomech 2008; 41:1143-6. [DOI: 10.1016/j.jbiomech.2007.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 11/29/2007] [Accepted: 11/29/2007] [Indexed: 11/18/2022]
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95
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Delp SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT, Guendelman E, Thelen DG. OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE Trans Biomed Eng 2007; 54:1940-50. [PMID: 18018689 DOI: 10.1109/tbme.2007.901024] [Citation(s) in RCA: 2176] [Impact Index Per Article: 128.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dynamic simulations of movement allow one to study neuromuscular coordination, analyze athletic performance, and estimate internal loading of the musculoskeletal system. Simulations can also be used to identify the sources of pathological movement and establish a scientific basis for treatment planning. We have developed a freely available, open-source software system (OpenSim) that lets users develop models of musculoskeletal structures and create dynamic simulations of a wide variety of movements. We are using this system to simulate the dynamics of individuals with pathological gait and to explore the biomechanical effects of treatments. OpenSim provides a platform on which the biomechanics community can build a library of simulations that can be exchanged, tested, analyzed, and improved through a multi-institutional collaboration. Developing software that enables a concerted effort from many investigators poses technical and sociological challenges. Meeting those challenges will accelerate the discovery of principles that govern movement control and improve treatments for individuals with movement pathologies.
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Affiliation(s)
- Scott L Delp
- Department of Bioengineering, Stanford University, Clark Center, Room S-170, 318 Campus Drive, Stanford, CA 94305-5450, USA.
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96
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Flecher X, Parratte S, Aubaniac JM, Argenson JN. Three-dimensional custom-designed cementless femoral stem for osteoarthritis secondary to congenital dislocation of the hip. ACTA ACUST UNITED AC 2007; 89:1586-91. [DOI: 10.1302/0301-620x.89b12.19252] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A clinical and radiological study was conducted on 97 total hip replacements performed for congenital hip dislocation in 79 patients between 1989 and 1998 using a three-dimensional custom-made cementless stem. The mean age at operation was 48 years (17 to 72) and the mean follow-up was for 123 months (83 to 182). According to the Crowe classification, there were 37 class I, 28 class II, 13 class III and 19 class IV hips. The mean leg lengthening was 25 mm (5 to 58), the mean pre-operative femoral anteversion was 38.6° (2° to 86°) and the mean correction in the prosthetic neck was −23.6° (−71° to 13°). The mean Harris hip score improved from 58 (15 to 84) to 93 (40 to 100) points. A revision was required in six hips (6.2%). The overall survival rate was 89.5% (95% confidence interval 89.2 to 89.8) at 13 years when two hips were at risk. This custom-made cementless femoral component, which can be accommodated in the abnormal proximal femur and will correct the anteversion and frontal offset, provided good results without recourse to proximal femoral corrective osteotomy.
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Affiliation(s)
- X. Flecher
- Service de Chirurgie Orthopedique, Hopital Sainte-Marguerite, 270 Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - S. Parratte
- Service de Chirurgie Orthopedique, Hopital Sainte-Marguerite, 270 Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - J.-M. Aubaniac
- Service de Chirurgie Orthopedique, Hopital Sainte-Marguerite, 270 Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - J.-N. Argenson
- Service de Chirurgie Orthopedique, Hopital Sainte-Marguerite, 270 Boulevard de Sainte-Marguerite, 13009, Marseille, France
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97
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Radiographic geometric measures of the hip joint and abductor muscle function in patients after total hip replacement. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2007. [DOI: 10.1007/s00590-007-0207-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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98
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Blemker SS, Asakawa DS, Gold GE, Delp SL. Image-based musculoskeletal modeling: Applications, advances, and future opportunities. J Magn Reson Imaging 2007; 25:441-51. [PMID: 17260405 DOI: 10.1002/jmri.20805] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Computer models of the musculoskeletal system are broadly used to study the mechanisms of musculoskeletal disorders and to simulate surgical treatments. Musculoskeletal models have historically been created based on data derived in anatomical and biomechanical studies of cadaveric specimens. MRI offers an abundance of novel methods for acquisition of data from living subjects and is revolutionizing the field of musculoskeletal modeling. The need to create accurate, individualized models of the musculoskeletal system is driving advances in MRI techniques including static imaging, dynamic imaging, diffusion imaging, body imaging, pulse-sequence design, and coil design. These techniques apply to imaging musculoskeletal anatomy, muscle architecture, joint motions, muscle moment arms, and muscle tissue deformations. Further advancements in image-based musculoskeletal modeling will expand the accuracy and utility of models used to study musculoskeletal and neuromuscular impairments.
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Affiliation(s)
- Silvia S Blemker
- Department of Mechanical & Aerospace Engineering, University of Virginia, Charlottesville 22904-4746, USA.
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99
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Mont MA, Seyler TM, Ragland PS, Starr R, Erhart J, Bhave A. Gait analysis of patients with resurfacing hip arthroplasty compared with hip osteoarthritis and standard total hip arthroplasty. J Arthroplasty 2007; 22:100-8. [PMID: 17197316 DOI: 10.1016/j.arth.2006.03.010] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 03/27/2006] [Indexed: 02/01/2023] Open
Abstract
Patients with standard total hip arthroplasties may have reduced hip abduction and extension moments when compared with normal nonosteoarthritic hips. In comparison, patients after resurfacing total hip arthroplasty appear to have a near-normal gait. The authors evaluated temporal-spatial parameters, hip kinematics, and kinetics in hip resurfacing patients compared with patients with unilateral osteoarthritic hips and unilateral standard total hip arthroplasties. Patients with resurfacing walked faster (average 1.26 m/s) and were comparable with normals. There were no significant differences in hip abductor and extensor moments of patients with resurfacing compared with patients in the standard hip arthroplasty group. This study showed more normal hip kinematics and functionality in resurfacing hip arthroplasty, which may be due to the large femoral head.
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Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA
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100
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Girard J, Lavigne M, Vendittoli PA, Roy AG. Biomechanical reconstruction of the hip: a randomised study comparing total hip resurfacing and total hip arthroplasty. ACTA ACUST UNITED AC 2006; 88:721-6. [PMID: 16720762 DOI: 10.1302/0301-620x.88b6.17447] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have compared the biomechanical nature of the reconstruction of the hip in conventional total hip arthroplasty (THA) and surface replacement arthroplasty (SRA) in a randomised study involving 120 patients undergoing unilateral primary hip replacement. The contralateral hip was used as a control. Post-operatively, the femoral offset was significantly increased with THA (mean 5.1 mm; -2.8 to 11.6) and decreased with SRA (mean -3.3 mm; -8.9 to 8.2). Femoral offset was restored within sd 4 mm in 14 (25%) of those with THA and in 28 (57%) of the patients receiving SRA (p < 0.001). In the THA group, the leg was lengthened by a mean of 2.6 mm (-6.04 to +12.9), whereas it was shortened by a mean of 1.9 mm (-7.1 to +2.05) in the SRA group, compared with the contralateral side. Leg-length inequality was restored within sd 4 mm in 42 (86%) of the SRA and 33 (60%) of the THA patients. The radiological parameters of acetabular reconstruction were similar in both groups. Restoration of the normal proximal femoral anatomy was more precise with SRA. The enhanced stability afforded by the use of a large-diameter femoral head avoided over-lengthening of the limb or increased offset to improve soft-tissue tension as occurs sometimes in THA. In a subgroup of patients with significant pre-operative deformity, restoration of the normal hip anatomy with lower pre-operative femoral offset or significant shortening of the leg was still possible with SRA.
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Affiliation(s)
- J Girard
- Department of Orthopaedics, The Maisonneuve-Rosemont Hospital, 5345 Boul L'Assomption, Suite 55, Montréal, Québec H1T 4B3, Canada
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