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Paz A, Lavikainen J, Turunen MJ, García JJ, Korhonen RK, Mononen ME. Knee-Loading Predictions with Neural Networks Improve Finite Element Modeling Classifications of Knee Osteoarthritis: Data from the Osteoarthritis Initiative. Ann Biomed Eng 2024; 52:2569-2583. [PMID: 38842728 PMCID: PMC11329407 DOI: 10.1007/s10439-024-03549-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
Physics-based modeling methods have the potential to investigate the mechanical factors associated with knee osteoarthritis (OA) and predict the future radiographic condition of the joint. However, it remains unclear what level of detail is optimal in these methods to achieve accurate prediction results in cohort studies. In this work, we extended a template-based finite element (FE) method to include the lateral and medial compartments of the tibiofemoral joint and simulated the mechanical responses of 97 knees under three conditions of gait loading. Furthermore, the effects of variations in cartilage thickness and failure equation on predicted cartilage degeneration were investigated. Our results showed that using neural network-based estimations of peak knee loading provided classification performances of 0.70 (AUC, p < 0.05) in distinguishing between knees that developed severe OA or mild OA and knees that did not develop OA eight years after a healthy radiographic baseline. However, FE models incorporating subject-specific femoral and tibial cartilage thickness did not improve this classification performance, suggesting there exists an optimal point between personalized loading and geometry for discrimination purposes. In summary, we proposed a modeling framework that streamlines the rapid generation of individualized knee models achieving promising classification performance while avoiding motion capture and cartilage image segmentation.
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Affiliation(s)
- Alexander Paz
- Department of Technical Physics, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland.
- Escuela de Ingeniería Civil y Geomática, Universidad del Valle, Cali, Colombia.
| | - Jere Lavikainen
- Department of Technical Physics, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland
- Diagnostic Imaging Center, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Mikael J Turunen
- Department of Technical Physics, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland
- Science Service Center, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - José J García
- Escuela de Ingeniería Civil y Geomática, Universidad del Valle, Cali, Colombia
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland
| | - Mika E Mononen
- Department of Technical Physics, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland
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Aitken HD, Goetz JE, Glass NA, Miller A, Rivas DJL, Westermann RW, McKinley TO, Willey MC. Persistently elevated joint contact stress after periacetabular osteotomy is associated with joint failure at minimum 10-year follow-up. J Orthop Res 2024. [PMID: 39030968 DOI: 10.1002/jor.25935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/21/2024] [Accepted: 06/27/2024] [Indexed: 07/22/2024]
Abstract
Periacetabular osteotomy (PAO) is a common treatment for prearthritic hip dysplasia. The goal of this investigation was to determine if computationally assessed hip contact mechanics are associated with joint failure at minimum 10-year follow-up. One hundred patients with hip dysplasia (125 hips) completed patient-reported outcomes an average of 13.8 years (range 10.0-18.0 years) after PAO. 63/125 hips were classified as having failed: 26 converted to total hip arthroplasty (THA) and 37 with significant disability indicated by modified Harris Hip Score (mHHS) ≤ 70. Differences in discrete element analysis-computed contact mechanics were compared between (1) preserved and failed hips, (2) preserved hips and hips that failed by THA, and (3) preserved hips and hips that failed by mHHS ≤ 70. Failed hips had significantly higher preoperative contact stress and exposure metrics (p < 0.001-0.009) than preserved hips. Failed hips also had significantly higher postoperative peak contact stress (p = 0.018), higher mean contact stress (p < 0.001), and smaller contact area (p = 0.044). When assessed based on type of failure, hips that failed by THA had significantly higher postoperative contact stress and exposure metrics than preserved hips (p < 0.001-0.020). In hips that failed by mHHS ≤ 70, mean postoperative contact stress exposure was significantly higher compared to preserved hips (p = 0.043). Despite improved radiographic measures of dysplasia after PAO, pathologic joint contact mechanics can persist and predict treatment failure at minimum 10 years after surgery. Operative and nonoperative techniques specifically intended to reduce harmful contact mechanics in dysplastic hips may have the potential to further improve clinical outcomes after PAO.
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Affiliation(s)
- Holly D Aitken
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Jessica E Goetz
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Natalie A Glass
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Aspen Miller
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Dominic J L Rivas
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Robert W Westermann
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Todd O McKinley
- Methodist Hospital, Indiana University Health, Indianapolis, Indiana, USA
| | - Michael C Willey
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Aitken HD, Miller A, Rivas DJ, Tatum M, Westermann RW, Willey MC, Goetz JE. Providing a computationally derived, mechanically optimised target correction during preoperative planning can improve joint contact mechanics of hip dysplasia treated with periacetabular osteotomy. Hip Int 2024; 34:378-389. [PMID: 38073284 PMCID: PMC11073912 DOI: 10.1177/11207000231212403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
AIM Preoperative identification of acetabular corrections that optimally improve joint stability and reduce elevated contact stresses could further reduce osteoarthritis progression in patients with hip dysplasia who are treated with periacetabular osteotomy (PAO). The purpose of this study was to investigate how providing patient-specific, mechanically optimal acetabular reorientations to the surgeon during preoperative planning affected the surgically achieved correction. METHODS Preoperative CT scans were used to create patient-specific hip models for 6 patients scheduled for PAO. A simulated acetabular fragment was extracted from the preoperative pelvis model and computationally rotated to simulate candidate acetabular reorientations. For each candidate, discrete element analysis was used to compute contact stresses during walking, which were summed over the gait cycle and scaled by patient age to obtain chronic contact stress-time exposure. The ideal patient-specific reorientation was identified using a cost function that balances minimising chronic stress exposures and achieving surgically acceptable acetabular coverage angles. The optimal reorientation angles and associated contact mechanics were provided to the surgeon preoperatively. After PAO was performed, a model of the surgically achieved correction was created from a postoperative CT scan. Radiographic coverage and contact mechanics were compared between preoperative, optimal, and surgically achieved orientations. RESULTS While surgically achieved reorientations were not significantly different from optimal reorientations in radiographically measured lateral (p = 0.094) or anterior (p = 0.063) coverage, surgically achieved reorientations had significantly (p = 0.031) reduced total contact area compared to optimal reorientations. The difference in lateral coverage and peak chronic exposure between surgically achieved and optimal reorientations decreased with increasing surgeon experience using the models (R² = 0.758, R2 = 0.630, respectively). CONCLUSIONS Providing hip surgeons with a patient-specific, computationally optimal reorientation during preoperative planning may improve contact mechanics after PAO, which may help reduce osteoarthritis progression in patients with hip dysplasia.
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Affiliation(s)
- Holly D. Aitken
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Aspen Miller
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Dominic J.L. Rivas
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
| | - Marcus Tatum
- Department of Industrial & Systems Engineering, University of Iowa, Iowa City, IA, 52242, USA
| | - Robert W. Westermann
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Michael C. Willey
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Jessica E. Goetz
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
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Aitken HD, Yen YM, Kiapour AM, Sailer WM, Holt JB, Goetz JE, Scott EJ. The Effects of Residual Femoral Deformity on Computed Contact Mechanics in Patients Treated With In Situ Fixation for Slipped Capital Femoral Epiphysis. J Pediatr Orthop 2024; 44:e218-e225. [PMID: 38108380 DOI: 10.1097/bpo.0000000000002596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
OBJECTIVE In situ fixation for treatment of slipped capital femoral epiphysis (SCFE) can stabilize the epiphysis and prevent further joint deformation but often leaves residual deformity that may adversely affect intra-articular contact mechanics. The purpose of this study was to investigate the relationship between residual deformity and contact mechanics in the post-SCFE hip. METHODS Patient-specific hip models were created for 19 patients with SCFE treated with in situ fixation. For each model, discrete element analysis was used to compute cumulative acetabular and femoral contact stress exposure during a walking gait cycle. Slip severity was evaluated for each patient using the two-dimensional Southwick angle and a novel three-dimensional (3D) assessment of multiplanar femoral deformity (3D slip angle). RESULTS Of the SCFE cases, 2/7 mild (Southwick angle ≤30 degrees) had peak cumulative femoral exposures equivalent to that of severe (Southwick angle ≥60 degrees) cases. Severe SCFE cases had higher peak ( P = 0.015) and mean ( P = 0.028) femoral contact stress exposure and lower cumulative femoral contact area ( P = 0.003) than mild (Southwick angle ≤30 degrees) SCFE cases. Mean femoral contact stress exposure was also higher in severe SCFE cases than in moderate SCFE cases ( P = 0.027). Acetabular and femoral contact mechanics metrics typically demonstrated stronger correlations with 3D slip angle than two-dimensional Southwick angle. CONCLUSIONS Increased slip severity adversely impacts intra-articular femoral contact mechanics. Contact mechanics metrics demonstrate higher correlations with 3D slip angle, indicating that this novel measurement may better describe global deformity and its relationship to intra-articular mechanics; however, the modest strength of these correlations may also imply that global impingement-generating deformity is not the primary factor driving contact mechanics in the post-SCFE hip. CLINICAL RELEVANCE Greater slip severity adversely impacts contact mechanics in the post-SCFE hip. However, focal regions of high contact stress were seen even in mild SCFE deformities, suggesting some type of deformity correction should be considered even for mild slips to alleviate secondary impingement, address focal incongruities, and reduce osteoarthritis development/progression.
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Affiliation(s)
| | - Yi-Meng Yen
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA
| | - Ata M Kiapour
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA
| | | | | | - Jessica E Goetz
- Department of Orthopedics and Rehabilitation
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA
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Chan JJ, Vogel MJ, Larson JH, Nho SJ. Cartilage Defects Are Negatively Associated With Long-Term Hip Survivorship Following Contemporary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity-Matched Analysis at Minimum 10-Year Follow-Up. Arthroscopy 2024:S0749-8063(24)00096-3. [PMID: 38331365 DOI: 10.1016/j.arthro.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To identify the timing and risk factors associated with secondary surgery following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) at 10-year minimum follow-up. METHODS A prospectively collected clinical repository was evaluated for cases of primary hip arthroscopy for FAIS between January 2012 and February 2013 with minimum 10-year follow-up. Patients who underwent secondary surgery were propensity matched 1:4 to patients who did not undergo secondary surgery, controlling for age, sex, and body mass index (BMI). The groups were compared on demographics, radiographs, intraoperative findings, operative procedures, and patient-reported outcomes. A Kaplan-Meier survivorship curve was generated. Among the reoperation-free survivors, minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) achievement were recorded for Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Specific (HOS-SS) subscales, modified Harris Hip Score (mHHS), 12-item international Hip Outcome Tool (iHOT-12), and Visual Analog Scale for Pain (VAS Pain). RESULTS Twenty-four reoperation patients (67% female; age 40.1 ± 14.3 years; BMI 27.2 ± 5.5) were matched to 96 reoperation-free patients (62% female; age 37.0 ± 10.8 years; BMI 25.2 ± 4.7, P ≥ .111). Mean follow-up was 10.3 ± 0.2 years. No preoperative demographic differences were found between groups. The reoperation group showed more high-grade cartilage defects on the acetabulum and femoral head (33% vs 8%, P = .004; 29% vs 7%, P = .007). A bimodal distribution of time to reoperation was evidenced independent of the secondary surgery performed. Among the reoperation-free survivors, MCID and PASS achievement was as follows: HOS-ADL (69.1%, 62.1%), HOS-SS (69.9%, 74.4%), mHHS (73.3%, 58.1%), iHOT-12 (n/a, 63.8%), and VAS-Pain (80.2%, 62.6%). CONCLUSIONS Patients requiring reoperation following primary hip arthroscopy for FAIS demonstrated more severe cartilage defects and a bimodal distribution of time to reoperation. LEVEL OF EVIDENCE Level III, retrospective comparative case series.
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Affiliation(s)
- Jimmy J Chan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Michael J Vogel
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Jordan H Larson
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
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6
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Rivas DJ, Aitken HD, Dibbern KN, Willey MC, Westermann RW, Goetz JE. Incorporating patient-specific hip orientation from weightbearing computed tomography affects discrete element analysis-computed regional joint contact mechanics in individuals treated with periacetabular osteotomy for hip dysplasia. Proc Inst Mech Eng H 2024; 238:237-249. [PMID: 38229467 PMCID: PMC10985972 DOI: 10.1177/09544119231221023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Computational models of the hip often omit patient-specific functional orientation when placing imaging-derived bony geometry into anatomic landmark-based coordinate systems for application of joint loading schemes. The purpose of this study was to determine if this omission meaningfully alters computed contact mechanics. Discrete element analysis models were created from non-weightbearing (NWB) clinical CT scans of 10 hip dysplasia patients (11 hips) and oriented in the International Society of Biomechanics (ISB) coordinate system (NWB-ISB). Three additional models were generated for each hip by adding patient-specific stance information obtained via weightbearing CT (WBCT) to each ISB-oriented model: (1) patient-specific sagittal tilt added (WBCT-sagittal), (2) coronal and axial rotation from optical motion capture added to (1; WBCT-combo), and (3) WBCT-derived axial, sagittal, and coronal rotation added to (1; WBCT-original). Identical gait cycle loading was applied to all models for a given hip, and computed contact stress and contact area were compared between model initialization techniques. Addition of sagittal tilt did not significantly change whole-joint peak (p = 0.922) or mean (p = 0.871) contact stress or contact area (p = 0.638). Inclusion of motion-captured coronal and axial rotation (WBCT-combo) decreased peak contact stress (p = 0.014) and slightly increased average contact area (p = 0.071) from WBCT-sagittal models. Including all WBCT-derived rotations (WBCT-original) further reduced computed peak contact stress (p = 0.001) and significantly increased contact area (p = 0.001). Variably significant differences (p = 0.001-1.0) in patient-specific acetabular subregion mechanics indicate the importance of functional orientation incorporation for modeling applications in which local contact mechanics are of interest.
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Affiliation(s)
- Dominic J.L. Rivas
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
| | - Holly D. Aitken
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Kevin N. Dibbern
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Michael C. Willey
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Robert W. Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Jessica E. Goetz
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
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Paz A, García JJ, Korhonen RK, Mononen ME. Towards a Transferable Modeling Method of the Knee to Distinguish Between Future Healthy Joints from Osteoarthritic Joints: Data from the Osteoarthritis Initiative. Ann Biomed Eng 2023; 51:2192-2203. [PMID: 37284996 PMCID: PMC10518288 DOI: 10.1007/s10439-023-03252-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023]
Abstract
Computational models can be used to predict the onset and progression of knee osteoarthritis. Ensuring the transferability of these approaches among computational frameworks is urgent for their reliability. In this work, we assessed the transferability of a template-based modeling strategy, based on the finite element (FE) method, by implementing it on two different FE softwares and comparing their results and conclusions. For that, we simulated the knee joint cartilage biomechanics of 154 knees using healthy baseline conditions and predicted the degeneration that occurred after 8 years of follow-up. For comparisons, we grouped the knees using their Kellgren-Lawrence grade at the 8-year follow-up time and the simulated volume of cartilage tissue that exceeded age-dependent thresholds of maximum principal stress. We considered the medial compartment of the knee in the FE models and used ABAQUS and FEBio FE softwares for simulations. The two FE softwares detected different volumes of overstressed tissue in corresponding knee samples (p < 0.01). However, both programs correctly distinguished between the joints that remained healthy and those that developed severe osteoarthritis after the follow-up (AUC = 0.73). These results indicate that different software implementations of a template-based modeling method similarly classify future knee osteoarthritis grades, motivating further evaluations using simpler cartilage constitutive models and additional studies on the reproducibility of these modeling strategies.
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Affiliation(s)
- Alexander Paz
- Department of Technical Physics, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland.
- Escuela de Ingeniería Civil y Geomática, Universidad del Valle, Cali, Colombia.
| | - José J García
- Escuela de Ingeniería Civil y Geomática, Universidad del Valle, Cali, Colombia
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland
| | - Mika E Mononen
- Department of Technical Physics, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland
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Gaffney BMM, Williams ST, Todd JN, Weiss JA, Harris MD. A Musculoskeletal Model for Estimating Hip Contact Pressure During Walking. Ann Biomed Eng 2022; 50:1954-1963. [PMID: 35864367 PMCID: PMC9797423 DOI: 10.1007/s10439-022-03016-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/07/2022] [Indexed: 12/31/2022]
Abstract
Cartilage contact pressures are major factors in osteoarthritis etiology and are commonly estimated using finite element analysis (FEA). FEA models often include subject-specific joint geometry, but lack subject-specific joint kinematics and muscle forces. Musculoskeletal models use subject-specific kinematics and muscle forces but often lack methods for estimating cartilage contact pressures. Our objective was to adapt an elastic foundation (EF) contact model within OpenSim software to predict hip cartilage contact pressures and compare results to validated FEA models. EF and FEA models were built for five subjects. In the EF models, kinematics and muscle forces were applied and pressure was calculated as a function of cartilage overlap depth. Cartilage material properties were perturbed to find the best match to pressures from FEA. EF models with elastic modulus = 15 MPa and Poisson's ratio = 0.475 yielded results most comparable to FEA, with peak pressure differences of 4.34 ± 1.98 MPa (% difference = 39.96 ± 24.64) and contact area differences of 3.73 ± 2.92% (% difference = 13.4 ± 11.3). Peak pressure location matched between FEA and EF for 3 of 5 subjects, thus we do not recommend this model if the location of peak contact pressure is critically important to the research question. Contact area magnitudes and patterns matched reasonably between FEA and EF, suggesting that this model may be useful for questions related to those variables, especially if researchers desire inclusion of subject-specific geometry, kinematics, muscle forces, and dynamic motion in a computationally efficient framework.
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Affiliation(s)
- Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, USA
- Center of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Spencer T Williams
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Jocelyn N Todd
- Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey A Weiss
- Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Michael D Harris
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, 4444 Forest Park Ave., Suite 1101, St. Louis, MO, 63108, USA.
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, USA.
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9
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Zhang W, Zhao Q, Yang G, Han N, Peng C, Chen H. Efficacy and safety of preoperative versus postoperative NSAIDs on pain relief in patients undergoing hip arthroscopy surgery: A multicentre, randomized, controlled trial. J Clin Pharm Ther 2022; 47:2091-2100. [PMID: 36054477 DOI: 10.1111/jcpt.13755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/07/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Postoperative pain relief is a critical issue for hip arthroscopy surgery (HAS). This study aimed to investigate the effect of preemptive non-steroidal anti-inflammatory drugs (NSAIDs) for postoperative analgesia in femoroacetabular impingement (FAI) patients receiving HAS. METHODS This multicenter, randomized, controlled study enrolled 204 FAI patients receiving HAS, then assigned them to preoperative (PRE, N = 103) or postoperative (POS, N = 101) group as a 1:1 ratio; the PRE group administrated NSAIDs from 24 h pre-surgery to day 7 (D7) post-surgery, while the POS group administrated NSAIDs from 12 h post-surgery to D7 post-surgery. RESULTS AND DISCUSSION Pain at rest was reduced at D1 (p = 0.016) and D2 (p = 0.023); pain at movement was decreased at D1 (p = 0.002), D2 (p = 0.020), and D3 (p = 0.030) in the PRE group compared with POS group, but not at other time points (all p > 0.05). Patient's satisfaction was increased at D1 (p = 0.013) and D3 (p = 0.029) in the PRE group compared to the POS group, but not at D7 (p = 0.145). Pethidine was less consumed at D3 (p = 0.038) and D7 (p = 0.017) in the PRE group in contrast with the POS group. Harris hip scores were similar at D7 (p = 0.124), month 1 (M1) (p = 0.273), and M3 (p = 0.360) between groups. Adverse events incidence was similar between groups (all p > 0.05). Besides, subgroup analysis discovered that pain was not influenced by the types of NSAID in both groups (all p > 0.05). WHAT IS NEW AND CONCLUSION Starting NSAIDs before HAS provides better short-term pain relief and improves patient's satisfaction compared with its postoperative utilization, while does not induce additional adverse events in FAI patients.
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Affiliation(s)
- Wei Zhang
- Department of Joint Orthopedics and Sports Medicine, Hengshui People's Hospital, Hengshui, China
| | - Qian Zhao
- Sports Injury Department, Tianjin Hospital, Tianjin, China
| | - Guang Yang
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Nan Han
- Department of Joint Orthopedics, Shuangyashan People's Hospital, Shuangyashan, China
| | - Chao Peng
- Department of Joint Orthopedics and Sports Medicine, Hengshui People's Hospital, Hengshui, China
| | - Hong Chen
- Department of Joint Orthopedics and Sports Medicine, Hengshui People's Hospital, Hengshui, China
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10
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Aitken HD, Westermann RW, Bartschat NI, Clohisy JC, Willey MC, Goetz JE. Effect of modeling femoral version and head-neck offset correction on computed contact mechanics in dysplastic hips treated with periacetabular osteotomy. J Biomech 2022; 141:111207. [PMID: 35764011 PMCID: PMC9747059 DOI: 10.1016/j.jbiomech.2022.111207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 12/15/2022]
Abstract
While correction of dysplastic acetabular deformity has been a focus of both clinical treatment and research, concurrent femoral deformities have only more recently received serious attention. The purpose of this study was to determine how including abnormalities in femoral head-neck offset and femoral version alter computationally derived contact stresses in patients with combined dysplasia and femoroacetabular impingement (FAI). Hip models with patient-specific bony anatomy were created from preoperative and postoperative CT scans of 20 hips treated with periacetabular osteotomy and femoral osteochondroplasty. To simulate performing only a PAO, a third model was created combining each patient's postoperative pelvis and preoperative femur geometry. These three models were initialized with the femur in two starting orientations: (1) standardized template orientation, and (2) using patient-specific anatomic landmarks. Hip contact stresses were computed in all 6 model sets during an average dysplastic gait cycle, an average FAI gait cycle, and an average stand-to-sit activity using discrete element analysis. No significant differences in peak contact stress (p = 0.190 to 1), mean contact stress (p = 0.273 to 1), or mean contact area (p = 0.050 to 1) were identified during any loading activity based on femoral alignment technique or inclusion of femoral osteochondroplasty. These findings suggest that presence of abnormal femoral version and/or head-neck offset deformities are not themselves predominant factors in intra-articular contact mechanics during gait and stand-to-sit activities. Inclusion of modified movement patterns caused by these femoral deformities may be necessary for models to adequately capture the mechanical effects of these clinically recognized risk factors for negative outcomes.
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Affiliation(s)
- Holly D Aitken
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Robert W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Nicholas I Bartschat
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Michael C Willey
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Jessica E Goetz
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA; Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA.
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