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Dubé-Cyr R, Villemure I, Arnoux PJ, Rawlinson J, Aubin CÉ. Instrumentation of the sacroiliac joint with cylindrical threaded implants: A detailed finite element study of patient characteristics affecting fixation performance. J Orthop Res 2021; 39:2693-2702. [PMID: 33620100 DOI: 10.1002/jor.25012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/27/2021] [Accepted: 02/21/2021] [Indexed: 02/04/2023]
Abstract
The sacroiliac joint (SIJ) is a known pain generator that, in severe cases, may require surgical fixation to reduce intra-articular displacements and allow for arthrodesis. The objective of this computational study was to analyze how the number of implants affected SIJ stabilization with patient-specific characteristics such as the pelvic geometry and bone quality. Detailed finite element models were developed to account for three pelvises of differing anatomy. Each model was tested with a normal and low bone density (LD) under two types of loading: compression only and compression with flexion and extension moments. These models were instrumented with one to three cylindrical, threaded and fenestrated implants through a posterior oblique trajectory, requiring less muscle dissection than the more common lateral trajectory used with triangular implants. Compared with the noninstrumented pelvis, the change in range of motion (ROM) and stress distribution were used to characterize joint stabilization. Noninstrumented mobility ranged from 0.86 to 2.55 mm and from 1.37° to 6.11°. Across patient-specific characteristics, the ROM reduction with one implant varied from 3% to 21% for vertical and 15% to 47% for angular displacements. With two implants, the ROM reduction ranged from 12% to 41% for vertical and from 28% to 61% for angular displacements. Three implants, however, did not further improve the joint stability (14% to 42% for vertical and 32% to 63% for angular displacements). With respect to patient characteristics, an LD led to a decreased stabilization and a higher volume of stressed bone (>75% of yield stress). A better understanding of how patient characteristics affect the implant performance could help improve surgical planning of sacroiliac arthrodesis.
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Affiliation(s)
- Roxanne Dubé-Cyr
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Quebec, Canada.,Sainte-Justine University Hospital Center, Montreal, Quebec, Canada.,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Marseille, France.,Laboratoire de Biomécanique Appliquée, IFSTTAR, LBA UMR T24, Boulevard Pierre Dramard, Aix-Marseille Université, Marseille, France
| | - Isabelle Villemure
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Quebec, Canada.,Sainte-Justine University Hospital Center, Montreal, Quebec, Canada.,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Marseille, France
| | - Pierre-Jean Arnoux
- iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Marseille, France.,Laboratoire de Biomécanique Appliquée, IFSTTAR, LBA UMR T24, Boulevard Pierre Dramard, Aix-Marseille Université, Marseille, France
| | - Jeremy Rawlinson
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Quebec, Canada.,Medtronic, Spinal Applied Research, Memphis, Tennessee, USA
| | - Carl-Éric Aubin
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Quebec, Canada.,Sainte-Justine University Hospital Center, Montreal, Quebec, Canada.,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Marseille, France
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Hapa O, Gürsan O, Eroğlu ON, Özgül H, Akdoğan EK, Zhamilov V, Balcı A, Havitçioğlu H. Bony landmarks, distances and their correlations to each other, which can be used during periacetabular osteotomy: a CT study performed on dysplastic hips. J Hip Preserv Surg 2021; 8:119-124. [PMID: 34567606 PMCID: PMC8460167 DOI: 10.1093/jhps/hnab045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/28/2021] [Accepted: 04/14/2021] [Indexed: 11/12/2022] Open
Abstract
As a surgical technique for hip dysplasia, Bernese periacetabular osteotomy (PAO) still poses technical difficulties and unclear surgical steps like the depth of the first ‘ischial’ cut, the start of the iliac cut and the width of the retroacetabular cut to prevent either iatrogenic joint entrance or posterior column fracture. Twenty-seven dysplastic hips (CE < 25°) were randomly matched with nondysplastic hips (n: 27, CE > 25°). 3D CT sections of the hips were evaluated and the width of the ischium, the distance from the infra-acetabular groove to the ischial spine, from the anterior superior iliac spine (ASIS) to the joint or sciatic notch or the sciatic spine, from the most medial point at the acetabulum to the posterior column, ischial spine or sciatic notch were measured for each group and correlated. The distances (mm) from the infra-acetabular groove to the ischial spine (42 ± 4, 44 ± 4, P: 0.03), the anterior superior iliac spine to the joint (52 ± 6, 60 ± 3, P: 0.03), the most medial point at the acetabulum to the posterior column (34 ± 2, 36 ± 2, P: 0.005) were shorter in the dysplastic group. The distance from the ASIS to the sciatic notch was correlated with the distance from the infra-acetabular groove to the ischial spine, from the ASIS to the joint and the most medial point at the acetabulum to the posterior column. The distance from the ASIS to the sciatic notch can be used intraoperatively to guess the X-ray guided or blindly osteotomized stages to predict the width or depth of the osteotomy to prevent intraarticular extension or posterior column fracture.
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Affiliation(s)
- Onur Hapa
- Department of Orthopedic Surgery, Dokuz Eylül University, 35330, Balçova, İzmir, Turkey
| | - Onur Gürsan
- Department of Orthopedic Surgery, Dokuz Eylül University, 35330, Balçova, İzmir, Turkey
| | - Osman Nuri Eroğlu
- Department of Orthopedic Surgery, Dokuz Eylül University, 35330, Balçova, İzmir, Turkey
| | - Hakan Özgül
- Department of Radiology, Dokuz Eylül University, 35330, Balçova, İzmir, Turkey
| | - Efe Kemal Akdoğan
- Department of Orthopedic Surgery, Dokuz Eylül University, 35330, Balçova, İzmir, Turkey
| | - Vadym Zhamilov
- Department of Orthopedic Surgery, Tepecik Training Hospital, 35180, Konak, İzmir, Turkey
| | - Ali Balcı
- Department of Radiology, Dokuz Eylül University, 35330, Balçova, İzmir, Turkey
| | - Hasan Havitçioğlu
- Department of Orthopedic Surgery, Dokuz Eylül University, 35330, Balçova, İzmir, Turkey
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Andronic O, Rahm S, Fritz B, Singh S, Sutter R, Zingg PO. External snapping hip syndrome is associated with an increased femoral offset. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1481-1489. [PMID: 34550475 PMCID: PMC9587962 DOI: 10.1007/s00590-021-03123-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022]
Abstract
Background External snapping hip syndrome (ESH) is postulated to be one of the causes of greater trochanteric pain syndrome, which also includes greater trochanteric bursitis and tendinopathy or tears of the hip abductor mechanism. However, it was not yet described what kind of bony morphology can cause the snapping and whether symptomatic and asymptomatic individuals have different imaging features. Purpose It was the purpose of this study to look for predisposing morphological factors for ESH and to differentiate between painful and asymptomatic snapping. Methods A consecutive cohort with ESH and available magnetic resonance imaging (MRI) between 2014 and 2019 was identified. The control group consisted of patients that underwent corrective osteotomies around the knee for mechanical axis correction and never complained of hip symptoms nor had undergone previous hip procedures. The following parameters were blindly assessed for determination of risk factors for ESH: CCD (corpus collum diaphysis) angle; femoral and global offset; femoral antetorsion; functional femoral antetorsion; translation of the greater trochanter (GT); posterior tilt of the GT; pelvic width/anterior pelvic length; intertrochanteric width. Hip and pelvic offset indexes were calculated as ratios of femoral/global offset and intertrochanteric/pelvic width, respectively. For the comparison of symptomatic and asymptomatic snapping, the following soft-tissue signs were investigated: presence of trochanteric bursitis or gluteal tendinopathy; presence of surface bony irregularities on trochanter major and ITB (Iliotibial band) thickness. Results A total of 31 hips with ESH were identified. The control group (n = 29) consisted of patients matched on both age (± 1) and gender. Multiple regression analysis determined an increased hip offset index to be independent predictor of ESH (r = + 0.283, p = 0.025), most likely due to the higher femoral offset in the ESH group (p = 0.031). Pearson correlation analysis could not identify any significant secondary factors. No differences were found between painful and asymptomatic snapping on MRI. Conclusions A high hip offset index was found as an independent predictor for external snapping hip in our cohort, mainly due to increased femoral offset. No imaging soft-tissue related differences could be outlined between symptomatic and asymptomatic external snapping. Level of evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00590.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sarvpreet Singh
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Tateda K, Nagoya S, Suzuki D, Kosukegawa I, Yamashita T. Acetabular Morphology in Patients with Developmental Dysplasia of the Hip with High Dislocation. Hip Pelvis 2021; 33:25-32. [PMID: 33748023 PMCID: PMC7952268 DOI: 10.5371/hp.2021.33.1.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose The current study aimed to investigate the morphology of the true acetabulum in developmental dysplasia of the hip (DDH) with high dislocation. A secondary was to evaluate the acetabular cup placement in patients with high dislocation who were treated with total hip arthroplasty (THA). Materials and Methods Using a retrospective design, 23 hips with DDH with high dislocation in patients who were treated with THA were included in this study. We measured the depth, width and thickness of the anterior and posterior walls of the original acetabulum using preoperative computed tomography images and investigated the cup size applied in these cases. Results The mean depth and width of the acetabulum was 18.4 and 16.2 mm proximal end, 18.4 and 24.3 mm in the middle, and 15.8 and 27.6 mm at the distal part. Mean thickness of the anterior and posterior walls was 10.9 and 23.9 mm at the proximal end, 10.3 and 22.2 mm in the middle, and 10.9 and 22.7 mm at the distal part. A 42-mm cup was using in one hip, a 46-mm cup in three hips, a 48-mm cup in 13 hips, and a 50-mm cup in six hips. Conclusion In patients with Crowe IV DDH, the morphology of the acetabulum comprises a triangle that broadens from proximal to distal points, with a relatively thick posterior wall. Reaming the acetabulum posteriorly and inferiorly may enable the placement of a relatively larger cup to achieve stable fixation.
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Affiliation(s)
- Kenji Tateda
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Nagoya
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ima Kosukegawa
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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Iwanaga J, Puffer RC, Watanabe K, Spinner RJ, Tubbs RS. Division of Sacrospinous and Sacrotuberous Ligaments Expands Access Through Greater Sciatic Foramen: Anatomic Study with Application to Resection of Greater Sciatic Foramen Tumors. World Neurosurg 2019; 128:e970-e974. [PMID: 31100516 DOI: 10.1016/j.wneu.2019.05.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Tumors of the greater sciatic foramen remain difficult to treat. They often have both intrapelvic and extrapelvic components that may limit visualization and make safe resection of the tumor difficult. Therefore the goal of the present anatomic study was to quantitate how much additional surgical working space could be gained by transection of the sacrospinous and sacrotuberous ligaments. METHODS Sixteen sides from 9 fresh-frozen Caucasian cadaveric torsos underwent transgluteal dissection and exposure of the greater sciatic foramen and associated liagments. With the piriformis in place, the vertical and horizontal diameters of the greater sciatic foramen were measured. Next, the sacrotuberous and sacrospinous ligaments were cut at their ischial attachments. The vertical diameter of the now confluent greater and lesser sciatic foramina (V2) was measured. RESULTS The mean vertical diameter of the greater sciatic foramen (V1) was 54.8 ± 9.7 mm. The horizontal diameter of the greater sciatic foramen had a mean of 44.3 ± 6.1 mm with a range of 30-52 mm. After transection of the sacrotuberous and sacrospinous ligaments, the vertical distance of the greater and lesser sciatic foramina (V2) had a mean of 74.8 ± 6.8 mm with a range of 60.1-90 mm. The mean ratio of V2 to V1 was 1.40. CONCLUSIONS The vertical length of the greater sciatic foramen increased, on average, 40% after resection of the sacrotuberous and sacrospinous ligaments. The results of this study support an alternative technique for resecting large intrapelvic tumors via a transgluteal approach.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Ross C Puffer
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Robert J Spinner
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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