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Kußmaul AC, Bruder J, Greiner A, Woiczinski M, Thorwächter C, Dotzauer F, Rubenbauer B, Linhart C, Böcker W, Becker CA. Uncemented hip revision cup as an alternative for T-type acetabular fractures: A cadaveric study. Orthop Traumatol Surg Res 2024; 110:103797. [PMID: 38142779 DOI: 10.1016/j.otsr.2023.103797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/12/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The current rise in elderly patients with compromised bone quality complicates the surgical treatment of acetabular T-type fractures (AO type 62B2 fractures). There is on ongoing discussion about the treatment options, mostly consisting of an open reduction and internal fixation (ORIF) with or without primary or secondary total hip arthroplasty (THA). Yet, these patients are oftentimes unable to fulfil weight-bearing restrictions and mostly present with an unavailability of a stable anchor site. Consequently, this study investigates the feasibility of a cementless hip revision cup for acetabular T-type fractures and compares its biomechanical properties to ORIF. HYPOTHESIS The cementless hip revision cup provides sufficient biomechanical stability under the simulation of full weight-bearing. PATIENTS AND METHODS The study compared two groups of human cadaveric hip bones with T-type fractures, of whom 6 subjects were treated with ORIF (6 male; mean age: 62±17years; mean body weight: 75±15) versus 6 subjects treated with a cementless hip revision cup (2 male; 69±12 years; 73±15kg). The group-assignment was controlled for comparable BMD results (mean BMD: ORIF 110±37 mg Ca-Ha/mL versus hip revision cup 134±32 mg Ca-Ha/mL). To compare for biomechanical stability cyclic loading was applied measuring the force and dislocation of the fracture gap at standardized bone loci using an all-electric testing machine and a 3D-ultrasound measuring system. RESULTS Comparing superior pubic ramus versus iliac wing (cementless hip revision cup versus ORIF [mean±standard deviation]: 5.8±2.0 versus 7.0±3.2; p=0.032) as well as sacral ala versus iliac wing (4.6±2.2 versus 6.4±3.7; p=0.002), the cementless revision cup achieved a significantly higher stability than the plate osteosynthesis. CONCLUSION Revision cup and ORIF withstood biomechanical loading forces exceeding full weight-bearing in this biomechanical study. The results of our study suggest that the cementless hip revision cup might be promising alternative to the current standard care of ORIF with or without primary THA. LEVEL OF EVIDENCE III; case control experimental study.
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Affiliation(s)
- Adrian Cavalcanti Kußmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Jan Bruder
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Axel Greiner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christoph Thorwächter
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Fabian Dotzauer
- Department for Trauma and Orthopaedic Surgery, Kreiskliniken Dillingen Wertingen, Wertingen, Germany
| | - Bianka Rubenbauer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christoph Linhart
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christopher A Becker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany.
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Warmerdam E, Wolff C, Orth M, Pohlemann T, Ganse B. Long-term continuous instrumented insole-based gait analyses in daily life have advantages over longitudinal gait analyses in the lab to monitor healing of tibial fractures. Front Bioeng Biotechnol 2024; 12:1355254. [PMID: 38497053 PMCID: PMC10940326 DOI: 10.3389/fbioe.2024.1355254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction: Monitoring changes in gait during rehabilitation allows early detection of complications. Laboratory-based gait analyses proved valuable for longitudinal monitoring of lower leg fracture healing. However, continuous gait data recorded in the daily life may be superior due to a higher temporal resolution and differences in behavior. In this study, ground reaction force-based gait data of instrumented insoles from longitudinal intermittent laboratory assessments were compared to monitoring in daily life. Methods: Straight walking data of patients were collected during clinical visits and in between those visits the instrumented insoles recorded all stepping activities of the patients during daily life. Results: Out of 16 patients, due to technical and compliance issues, only six delivered sufficient datasets of about 12 weeks. Stance duration was longer (p = 0.004) and gait was more asymmetric during daily life (asymmetry of maximal force p < 0.001, loading slope p = 0.001, unloading slope p < 0.001, stance duration p < 0.001). Discussion: The differences between the laboratory assessments and the daily-life monitoring could be caused by a different and more diverse behavior during daily life. The daily life gait parameters significantly improved over time with union. One of the patients developed an infected non-union and showed worsening of force-related gait parameters, which was earlier detectable in the continuous daily life gait data compared to the lab data. Therefore, continuous gait monitoring in the daily life has potential to detect healing problems early on. Continuous monitoring with instrumented insoles has advantages once technical and compliance problems are solved.
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Affiliation(s)
- Elke Warmerdam
- Werner Siemens-Endowed Chair for Innovative Implant Development (Fracture Healing), Departments and Institutes of Surgery, Saarland University, Homburg, Germany
| | - Christian Wolff
- German Research Center for Artificial Intelligence (DFKI), Saarbrücken, Germany
| | - Marcel Orth
- Department of Trauma, Hand and Reconstructive Surgery, Departments and Institutes of Surgery, Saarland University, Homburg, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Departments and Institutes of Surgery, Saarland University, Homburg, Germany
| | - Bergita Ganse
- Werner Siemens-Endowed Chair for Innovative Implant Development (Fracture Healing), Departments and Institutes of Surgery, Saarland University, Homburg, Germany
- Department of Trauma, Hand and Reconstructive Surgery, Departments and Institutes of Surgery, Saarland University, Homburg, Germany
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Bender A, Schmidt H, Wellner DL, Duda GN, Brandl C, Damm P. In vivo load on knee, hip and spine during manual materials handling with two lifting techniques. J Biomech 2024; 163:111963. [PMID: 38286711 DOI: 10.1016/j.jbiomech.2024.111963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
It is generally accepted that the lifting technique strongly influences physical loads within the human body and, thus, the risk of musculoskeletal disorders. However, there is a lack of knowledge regarding whether particular lifting techniques are effective in reducing loads. Hence, this retrospective study quantified (partly published) in vivo loads at joints within the human body during two typical lifting techniques, stoop lifting and squat lifting. Patients who had received instrumented implants underwent in vivo load measurements at either the knee (two patients), the hip (eight patients), or the upper lumbar spine (four patients) while lifting a 10 kg weight frontally with either straight (stoop) or bent (squat) knees. Contact forces and moments and the orientation of the contact force vector were determined and examined using the paired t test of Statistical Parametric Mapping. The two lifting techniques did not differ in terms of load magnitudes but did differ in terms of directions: (i) at the hip joint, the load vector varied significantly (p < 0.05) in the frontal and sagittal planes, (ii) at the knee joint, the load vector differed significantly (p < 0.05) in the sagittal plane (iii) while the load vector and magnitude did not differ at the upper lumbar spine (p > 0.05). Our findings indicate that the lifting technique causes changes in the orientation rather than the magnitude of lower extremity joint contact loads. Even though this quantification could only be performed in a small group of patients, the quantification of the relevance of such lifting technique recommendations will hopefully guide future recommendations towards a more scientific interpretation.
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Affiliation(s)
- Alwina Bender
- Julius Wolff Institute, Berlin Institute of Health at Charité, Charité - Universitätsmedizin Berlin, Germany
| | - Hendrik Schmidt
- Julius Wolff Institute, Berlin Institute of Health at Charité, Charité - Universitätsmedizin Berlin, Germany
| | - Daniela L Wellner
- Julius Wolff Institute, Berlin Institute of Health at Charité, Charité - Universitätsmedizin Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité, Charité - Universitätsmedizin Berlin, Germany
| | - Christopher Brandl
- Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Aachen, Germany; Fraunhofer Institute for Communication, Information Processing and Ergonomics FKIE, Aachen, Germany
| | - Philipp Damm
- Julius Wolff Institute, Berlin Institute of Health at Charité, Charité - Universitätsmedizin Berlin, Germany.
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Zhou S, Bender A, Kutzner I, Dymke J, Maleitzke T, Perka C, Duda GN, Winkler T, Damm P. Loading of the Hip and Knee During Swimming: An in Vivo Load Study. J Bone Joint Surg Am 2023; 105:1962-1971. [PMID: 38079507 DOI: 10.2106/jbjs.23.00218] [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: 12/21/2023]
Abstract
BACKGROUND Swimming is commonly recommended as postoperative rehabilitation following total hip arthroplasty (THA) and total knee arthroplasty (TKA). So far, in vivo hip and knee joint loads during swimming remain undescribed. METHODS In vivo hip and knee joint loads were measured in 6 patients who underwent THA and 5 patients who underwent TKA with instrumented joint implants. Joint loads, including the resultant joint contact force (F Res ), torsional moment around the femoral shaft axis or the tibial axis (M Tors ), bending moment at the middle of the femoral neck (M Bend ), torsional moment around the femoral neck axis (M Tne ), and medial force ratio (MFR) in the knee, were measured during breaststroke swimming at 0.5, 0.6, and 0.7 m/s and the breaststroke and crawl kicks at 0.5 and 1.0 m/s. RESULTS The ranges of the median maximal F Res were 157% to 193% of body weight for the hip and 93% to 145% of body weight for the knee during breaststroke swimming. Greater maxima of F Res (hip and knee), M Tors (hip and knee), M Bend (hip), and M Tne (hip) were observed with higher breaststroke swimming velocities, but significance was only identified between 0.5 and 0.6 m/s in F Res (p = 0.028), M Tors (p = 0.028), and M Bend (p = 0.028) and between 0.5 and 0.7 m/s in F Res (p = 0.045) in hips. No difference was found in maximal MFR between different breaststroke swimming velocities. The maximal F Res was significantly positively correlated with the breaststroke swimming velocity (hip: r = 0.541; p < 0.05; and knee: r = 0.414; p < 0.001). The maximal F Res (hip and knee) and moments (hip) were higher in the crawl kick than in the breaststroke kick, and a significant difference was recognized in F Res Max for the hip: median, 179% versus 118% of body weight (p = 0.028) for 0.5 m/s and 166% versus 133% of body weight (p = 0.028) for 1.0 m/s. CONCLUSIONS Swimming is a safe and low-impact activity, particularly recommended for patients who undergo THA or TKA. Hip and knee joint loads are greater with higher swimming velocities and can be influenced by swimming styles. Nevertheless, concrete suggestions to patients who undergo arthroplasty on swimming should involve individual considerations. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sijia Zhou
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Brandenburg Center for Regenerative Therapies, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alwina Bender
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ines Kutzner
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jörn Dymke
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tazio Maleitzke
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health Charité Clinician Scientist Program, BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Brandenburg Center for Regenerative Therapies, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Winkler
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Brandenburg Center for Regenerative Therapies, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Damm
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
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Moissenet F, Beauseroy V, Gasparutto X, Armand S, Hannouche D, Dumas R. Estimation of two wear factors for total hip arthroplasty: A simulation study based on musculoskeletal modelling. Clin Biomech (Bristol, Avon) 2023; 107:106035. [PMID: 37413813 DOI: 10.1016/j.clinbiomech.2023.106035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Primary causes of surgical revision after total hip arthroplasty are polyethylene wear and implant loosening. These factors are particularly related to joint friction and thus patients' physical activity. Assessing implant wear over time according to patients' morphology and physical activity level is key to improve follow-up and patients' quality of life. METHODS An approach initially proposed for tibiofemoral prosthetic wear estimation was adapted to compute two wear factors (force-velocity, directional wear intensity) using a musculoskeletal model. It was applied on 17 participants with total hip arthroplasty to compute joint angular velocity, contact force, sliding velocity, and wear factors during common daily living activities. FINDINGS Differences were observed between gait, sitting down, and standing up tasks. An incremental increase of both global wear factors (time-integral) was observed during gait from slow to fast speeds (p ≤ 0.01). Interestingly, these two wear factors did not result in same trend for sitting down and standing up tasks. Compared to gait, one cycle of sitting down or standing up tends to induce higher friction-related wear but lower cross-shear-related wear. Depending on the wear factor, significant differences can be found between sitting down and gait at slow speed (p ≤ 0.05), and between sitting down (p ≤ 0.05) or standing up (p ≤ 0.05) and gait at fast speed. Furthermore, depending on the activity, wear can be fostered by joint contact force and/or sliding velocity. INTERPRETATION This study demonstrated the potential of wear estimation to highlight activities inducing a higher risk of implant wear after total hip arthroplasty from motion capture data.
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Affiliation(s)
- Florent Moissenet
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Biomechanics Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Victor Beauseroy
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T_9406, F-69622 Lyon, France
| | - Xavier Gasparutto
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Didier Hannouche
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Raphaël Dumas
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T_9406, F-69622 Lyon, France
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Ledet EH, Caparaso SM, Stout M, Cole KP, Liddle B, Cady NC, Archdeacon MT. Smart fracture plate for quantifying fracture healing: Preliminary efficacy in a biomechanical model. J Orthop Res 2022; 40:2414-2420. [PMID: 34989023 DOI: 10.1002/jor.25254] [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: 03/08/2021] [Revised: 10/31/2021] [Accepted: 12/19/2021] [Indexed: 02/04/2023]
Abstract
The diagnosis of fracture nonunion following plate osteosynthesis is subjective and frequently ambiguous. Initially following osteosynthesis, loads applied to the bone are primarily transmitted through the plate. However, as callus stiffness increases, the callus is able to bear load proportional to its stiffness while forces through the plate decrease. The purpose of this study was to use a "smart" fracture plate to distinguish between phases of fracture healing by measuring forces transmitted through the plate. A wireless force sensor and small adapter were placed on the outside of a distal femoral locking plate. The adapter converts the slight bending of the plate under axial load into a transverse force which is measurable by the sensor. An osteotomy was created and then plated in the distal femur of biomechanical Sawbones. Specimens were loaded to simulate single-leg stance first with the osteotomy defect empty (acute healing), then sequentially filled with silicone (early callus) and then polymethyl methacrylate (hard callus). There was a strong correlation between applied axial load and force measured by the "smart" plate. Data demonstrate statistically significant differences between each phase of healing with as little as 150 N of axial load applied to the femur. Forces measured in the plate were significantly different between acute (100%), early callus (66.4%), and hard callus (29.5%). This study demonstrates the potential of a "smart" fracture plate to distinguish between phases of healing. These objective data may enable early diagnosis of nonunion and enhance outcomes for patients.
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Affiliation(s)
- Eric H Ledet
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute & Research and Development Service, Stratton VA Medical Center, Albany, New York, USA
| | - Sydney M Caparaso
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Madelyn Stout
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Keegan P Cole
- Division of Orthopaedic Surgery, Albany Medical College, Albany, New York, USA
| | - Benjamin Liddle
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Nathaniel C Cady
- Department of Nanobio Science, State University of New York Polytechnic Institute, Utica, New York, USA
| | - Michael T Archdeacon
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Haffer H, Bender A, Krump A, Hardt S, Winkler T, Damm P. Is Training With Gym Machines Safe After Hip Arthroplasty?—An In Vivo Load Investigation. Front Bioeng Biotechnol 2022; 10:857682. [PMID: 35402408 PMCID: PMC8989469 DOI: 10.3389/fbioe.2022.857682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Training with gym machines is one of the most popular physical activities after total hip arthroplasty (THA). However, to date, there are no evidence-based recommendations for physical activity after THA, worldwide. The aim of the study is to evaluate the in vivo hip joint loads during exercises on four widely used gym machines in order to provide a source for an evidence-based patient counselling for arthroplasty surgeons. Methods: The in vivo hip joint loads in seven patients (59.6 ± 6.4 years, 28.6 ± 2.1 kg/m2) with instrumented hip implants were assessed. The resulting force (Fres), bending moment (Mbend), and torsional moment (Mtors) were evaluated during the training on leg curl/leg extension machines (loads: 20, 30, and 40 kg), leg press machine [backrest: 10°, 30°, and 60°; load: 50, 75, and 100%BW (bodyweight)], and a rope pull machine (abduction/adduction/flexion/extension; each ipsi- and contralateral; load 10 kg). These loads were compared with the loads during walking on treadmill at 4 km/h (median peak values: Fres 303%BW, Mbend 4.25%BWm, and Mtors 2.70%BWm). Results: In each of the four performed exercises with a total of 23 different load conditions or exercise modes analyzed, a significantly lower or not different load was detected with respect to Fres, Mbend, and Mtors measured while walking with 4 km/h. Nevertheless, Fres and Mbend demonstrated a trend to increased loading during the ipsilateral monopod standing rope pull exercises hip flexion, extension, and abduction. Conclusion: Based on our investigation, we assume that the investigated gym machines and external loads can be considered mainly as low-impact sports (with some exceptions) and thus as safe physical activity after THA. Due to the fact that the examinations were conducted in the mean 17.4 months after THA, the applicability of the results to the immediate postoperative period is limited.
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Affiliation(s)
- Henryk Haffer
- Center for Musculoskeletal Surgery Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alwina Bender
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander Krump
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tobias Winkler
- Center for Musculoskeletal Surgery Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philipp Damm
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- *Correspondence: Philipp Damm,
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Palmowski Y, Popovic S, Schuster SG, Hardt S, Damm P. In vivo analysis of hip joint loading on Nordic walking novices. J Orthop Surg Res 2021; 16:596. [PMID: 34649562 PMCID: PMC8515744 DOI: 10.1186/s13018-021-02741-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/21/2021] [Indexed: 01/26/2023] Open
Abstract
Objective To evaluate the influence of Nordic walking (NW) on hip joint loads in order to determine whether it can be safely performed during postoperative physiotherapy in patients after orthopeadic surgery of the hip. Methods Internal hip joint loads were directly measured in vivo in 6 patients using instrumented hip prostheses during NW and ordinary walking (OW). All patients received training in two different NW techniques (double-poling and the diagonal technique) by a certified NW instructor. Measurements were conducted on a treadmill at a speed of 4 km/h on level ground, at 10% inclination and at 10% slope as well as on a level lawn at a self chosen comfortable speed. Resultant contact force (Fres), bending moment (Mbend) and torsional torque (Mtors) were compared between NW and OW as well as between both NW techniques. Results Joint loads showed a double peak pattern during all setups. Neither NW technique significantly influenced hip joint loads at the time of the first load peak during contralateral toe-off (CTO), which was also the absolute load peak, in comparison to OW. Compared to OW, double-poling significantly reduced Fres and Mbend at the time of the second load peak during the contralateral heel strike (CHS) on level ground both on the treadmill (− 6% and − 7%, respectively) and on the lawn (− 7% and − 9%). At 10% inclination, the diagonal technique increased Fres and Mbend at CHS (by + 6% and + 7%), but did not increase the absolute load peak at CTO. Conclusion Joint loads during NW are comparable to those of OW. Therefore, NW can be considered a low-impact activity and seems to be safe for patients that are allowed full weight bearing, e.g. during postoperative rehabilitation after THA.
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Affiliation(s)
- Yannick Palmowski
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Chariteplatz 1, 10117, Berlin, Germany
| | - Srdan Popovic
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Simone G Schuster
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Chariteplatz 1, 10117, Berlin, Germany
| | - Philipp Damm
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany.
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Albareda J, Ibarz E, Mateo J, Suñer S, Lozano C, Gómez J, Redondo B, Torres A, Herrera A, Gracia L. Are the unreamed nails indicated in diaphyseal fractures of the lower extremity? A biomechanical study. Injury 2021; 52 Suppl 4:S61-S70. [PMID: 33707035 DOI: 10.1016/j.injury.2021.02.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Intramedullary nailing is generally accepted as the first choice for the treatment of diaphyseal fractures of femur and tibia, with a gradual incease in the use of unreamed nails. Different studies during last years show controversial outcomes. Some authors strongly favor unreamed nailing, but most of the authors conclude that reamed nailing have proved to be more successful. MATERIAL AND METHODS This study simulates unreamed intramedullary nailing of four femoral and three tibial fracture types by means of Finite Element (FE) models, at early postoperative stages with a fraction of physiological loads, in order to determine whether sufficient stability is achieved, and if the extent of movements and strains at the fracture site may preclude proper consolidation. RESULTS The behavior observed in the different fracture models is very diverse. In the new biomechanical situation, loads are only transmitted through the intramedullary nail. Mean relative displacement values of fractures in the femoral bone range from 0.30 mm to 0.82 mm, depending on the fracture type. Mean relative displacement values of the tibial fractures lie between 0.18 and 0.62 mm, depending on the type of fracture. Concerning mean strains, for femoral fractures the maximum strains ranged between 12.7% and 42.3%. For tibial fractures the maximum strains ranged between 10.9% and 40.8%. CONCLUSIONS The results showed that unreamed nailing provides a very limited mechanical stability, taking into account that analyzed fracture patterns correspond to simple fracture without comminution. Therefore, unreamed nailing is not a correct indication in femoral fractures and should be an exceptional indication in open tibial fractures produced by high-energy mechanism.
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Affiliation(s)
- J Albareda
- Department of Surgery, University of Zaragoza. Zaragoza, Spain, Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital
| | - E Ibarz
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain
| | - J Mateo
- Department of Surgery, University of Zaragoza. Zaragoza, Spain, Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital. Zaragoza, Spain
| | - S Suñer
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain
| | - C Lozano
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain
| | - J Gómez
- Department of Surgery, University of Zaragoza. Zaragoza, Spain, Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital.
| | - B Redondo
- Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital
| | - A Torres
- Department of Surgery, University of Zaragoza. Zaragoza, Spain, Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital
| | - A Herrera
- Department of Surgery, University of Zaragoza. Zaragoza, Spain, Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain
| | - L Gracia
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain
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10
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Haffer H, Popovic S, Martin F, Hardt S, Winkler T, Damm P. In vivo loading on the hip joint in patients with total hip replacement performing gymnastics and aerobics exercises. Sci Rep 2021; 11:13395. [PMID: 34183711 PMCID: PMC8239021 DOI: 10.1038/s41598-021-92788-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/09/2021] [Indexed: 01/17/2023] Open
Abstract
A further increase in the number of total hip arthroplasty (THA) is predicted, in particular the number of young THA patients has raised and with it their demands. There is no standardized evidence-based rehabilitation program and no reliable guidelines for sports activities after THA. Stretching and strengthening gymnastics are routinely performed in rehabilitation and aerobics as a sport after THA. The aim of the investigation was to determine the in vivo force and moments acting on the hip prosthesis during gymnastics and aerobic exercises to provide a source for evidence-based recommendations. Hip joint loads were measured in six patients with instrumented hip implants. The resulting force FRes, bending moment MBend at the neck and torsional moment MTors at the stem were examined during seven strengthening (with two different resistance bands) and four stretching gymnastic exercises and seven aerobic exercises with and without an aerobic step board compared to the loads during the reference activity walking. The stretching and strengthening gymnastics exercises and the aerobic exercises with and without a board demonstrated in their median peak force and moments mostly lower or similar values compared to walking. Significantly increased loads were recorded for the flexor stretching exercise in monopod stand (Fres and MBend), the strengthening abduction exercise on the chair (MTors) and the strengthening flexion exercise with the stronger resistance band (MTors). We also found a significant increase in median peak values in aerobic exercises with a board for the "Basic Step" (ipsilateral started Fres and MTors; contralateral started MTors), "Kickstep ipsilateral started" (Fres and MTors) and "Over the Top contralateral started" (Fres). The in vivo loads in THA patients during frequently performed stretching, strengthening and aerobic exercises were demonstrated for the first time. It was proved that stretching gymnastic exercises are safe in terms of resulting force, bending and torque moments for THA patients, although an external assistance for stabilization may be considered. Strengthening gymnastics exercises are reliable in terms of Fres, MBend and MTors, but, based on our data, we recommend to adhere to the communicated specific postoperative restrictions and select the resistance bands with lower tension. Aerobic exercises without an aerobic board can be considered as reliable activity in terms of force and moments for THA patients. Aerobic exercises with a board are not recommended for the early postoperative period and in our opinion need to be adapted to the individual muscular and coordinative resources.
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Affiliation(s)
- Henryk Haffer
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Srdan Popovic
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Franziska Martin
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tobias Winkler
- Berlin-Institute of Health, Center for Regenerative Therapies, Center for Musculoskeletal Surgery, Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Damm
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.
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11
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Influence of different anteversion alignments of a cementless hip stem on primary stability and strain distribution. Clin Biomech (Bristol, Avon) 2020; 80:105167. [PMID: 32977213 DOI: 10.1016/j.clinbiomech.2020.105167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stem anteversion in total hip arthroplasty is well known to have a high impact on dislocation, but empirical data regarding the clinical and biomechanical influence is lacking. Therefore, we evaluated the impact of different anteversion alignments on the primary stability and strain distribution of a cementless stem. METHODS The cementless CLS Spotorno stem was implanted in 3 different groups (each group n = 6, total n = 21) with different anteversion alignments: reference anteversion (8°), +15° torsion in anteversion (+23°), -15° torsion in retroversion (-7°) using composite femurs (Sawbones). Primary stability was determined by 3-dimensional micromotions using a dynamic loading procedure simulating walking on level ground. Additionally, surface strains were registered before and after stem insertion in the 3 different groups, using one composite femur for each group (total n = 3). FINDINGS The micromotion measurements did not show a significant difference between the 3 evaluated alignments. Moreover, determination of the strain distribution did also not reveal an obvious difference. INTERPRETATION This biomechanical study simulating walking on level ground indicates that there is no considerable influence of stem ante-/retroversion variation (±15°) on the initial stability and strain distribution when evaluating the cementless CLS Spotorno in composite femora.
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12
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Alves SA, Ehrig RM, Raffalt PC, Bender A, Duda GN, Agres AN. Quantifying Asymmetry in Gait: The Weighted Universal Symmetry Index to Evaluate 3D Ground Reaction Forces. Front Bioeng Biotechnol 2020; 8:579511. [PMID: 33195140 PMCID: PMC7644861 DOI: 10.3389/fbioe.2020.579511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/18/2020] [Indexed: 11/13/2022] Open
Abstract
Though gait asymmetry is used as a metric of functional recovery in clinical rehabilitation, there is no consensus on an ideal method for its evaluation. Various methods have been proposed to analyze single bilateral signals but are limited in scope, as they can often use only positive signals or discrete values extracted from time-scale data as input. By defining five symmetry axioms, a framework for benchmarking existing methods was established and a new method was described here for the first time: the weighted universal symmetry index (wUSI), which overcomes limitations of other methods. Both existing methods and the wUSI were mathematically compared to each other and in respect to their ability to fulfill the proposed symmetry axioms. Eligible methods that fulfilled these axioms were then applied using both discrete and continuous approaches to ground reaction force (GRF) data collected from healthy gait, both with and without artificially induced asymmetry using a single instrumented elbow crutch. The wUSI with a continuous approach was the only symmetry method capable of identifying GRF asymmetry differences in different walking conditions in all three planes of motion. When used with a continuous approach, the wUSI method was able to detect asymmetries while avoiding artificial inflation, a common problem reported in other methods. In conclusion, the wUSI is proposed as a universal method to quantify three-dimensional GRF asymmetries, which may also be expanded to other biomechanical signals.
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Affiliation(s)
- Sónia A Alves
- Julius Wolff Institute, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Rainald M Ehrig
- Julius Wolff Institute, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Zuse Institute Berlin, Berlin, Germany
| | - Peter C Raffalt
- Julius Wolff Institute, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Alwina Bender
- Julius Wolff Institute, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alison N Agres
- Julius Wolff Institute, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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13
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Seo H, Lee GJ, Shon HC, Kong HH, Oh M, Cho H, Lee CJ. Factors Affecting Compliance With Weight-Bearing Restriction and the Amount of Weight-Bearing in the Elderly With Femur or Pelvic Fractures. Ann Rehabil Med 2020; 44:109-116. [PMID: 32392649 PMCID: PMC7214136 DOI: 10.5535/arm.2020.44.2.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/08/2019] [Accepted: 09/17/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the factors affecting the amount of weight-bearing during gait training in the elderly patients who underwent internal fixation after femur or pelvic fractures and how well they performed the weight-bearing restriction as directed by the physiatrist. METHODS In this retrospective chart review study, we measured the amount of weight-bearing on the affected side in 50 patients undergoing internal fixation surgery and rehabilitation after femur or pelvic fracture using a force plate. Patients receiving non-weight-bearing or partial weight-bearing education were considered to perform weight-bearing restriction well when the amount of weight-bearing was <50 lb. Furthermore, regression analysis was performed to determine the effects of postoperative complications, age, cognitive function, and pain on weightbearing restriction. RESULTS Variables affecting the amount of weight-bearing were age (r=0.581, p<0.001), weight-bearing education type (r=0.671, p<0.001), manual muscle strength of hip flexion on the non-affected side (r=-0.296, p=0.037), hip abduction (r=-0.326, p=0.021), knee extension (r=-0.374, p=0.007), ankle plantar flexion (r=-0.374, p=0.008), right hand grip strength (r=-0.535, p<0.001), Korean version of Mini-Mental State Examination (r=-0.496, p<0.001), Clinical Dementia Rating (r=0.308, p=0.03), and pain visual analog scale scores (r=0.318, p=0.024). The significant predictor of the amount of weight-bearing among these variables was age (β=0.448, p=0.001). The weight-bearing restriction adherence rate was significantly lower, at 22%, for patients aged ≥65 years as compared to 73% for those <65 years. CONCLUSION Age was a major variable affecting the amount of weight-bearing. Compliance with weight-bearing restriction was significantly lower in patients aged ≥65 years than in patients <65 years.
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Affiliation(s)
- Hyeunsuk Seo
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Hyun-Chul Shon
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyun Ho Kong
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Minwoo Oh
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Hangyeol Cho
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Chang Jun Lee
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju, Korea
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14
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Acetabulum Cup Stability in an Early Weight-Bearing Cadaveric Model of Geriatric Posterior Wall Fractures. J Orthop Trauma 2020; 34:55-61. [PMID: 31436615 DOI: 10.1097/bot.0000000000001627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Primary total hip arthroplasty (THA) has been suggested for posterior wall (PW) fractures with unfavorable features in the geriatric population. There is a paucity of studies reporting on postoperative protocols for primary THA after PW fractures. The purpose of this study was to test the biomechanical effect of immediate assisted weight-bearing on acetabulum THA cup fixation in an osteoporotic PW fracture model. METHODS Computed tomography scans of 18 geriatric PW fractures (mean age, 77 ± 8 years) were used to generate representative PW fracture. This fracture pattern, comprising 50% of the PW and 25% of the acetabulum rim, was then created in 6 female cadaveric pelves. A multihole acetabulum THA cup was implanted with line-to-line reaming and fixed with four 5-mm screws. The pelves were cyclically loaded to up to 1.8× body weight (BW) in the intact form, after fracture creation and fracture fixation. Optical markers were used to determine acceptable cup motion of less than 150 μm. RESULTS Five specimens withstood 3.6× BW loading after implantation and before fracture creation. At 1.8× BW load, cup motion was nonfractured: 50 ± 24 µm (range, 5-128 µm), fractured with no fixation: 37 ± 22 µm (range, 8-74 µm), or fractured with fixation: 62 ± 39 µm (range, 5-120 µm) (P = 0.0097). Cup motion was <150 µm for all groups. CONCLUSION This study supports the practice of allowing immediate assisted weight-bearing in patients undergoing THA with PW fractures involving up to 50% of the PW and up to 25% of the acetabular rim, with or without fixation of the PW fragment.
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15
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Bergmann G, Kutzner I, Bender A, Dymke J, Trepczynski A, Duda GN, Felsenberg D, Damm P. Loading of the hip and knee joints during whole body vibration training. PLoS One 2018; 13:e0207014. [PMID: 30540775 PMCID: PMC6291191 DOI: 10.1371/journal.pone.0207014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/23/2018] [Indexed: 11/18/2022] Open
Abstract
During whole body vibrations, the total contact force in knee and hip joints consists of a static component plus the vibration-induced dynamic component. In two different cohorts, these forces were measured with instrumented joint implants at different vibration frequencies and amplitudes. For three standing positions on two platforms, the dynamic forces were compared to the static forces, and the total forces were related to the peak forces during walking. A biomechanical model served for estimating muscle force increases from contact force increases. The median static forces were 122% to 168% (knee), resp. 93% to 141% (hip), of the body weight. The same accelerations produced higher dynamic forces for alternating than for parallel foot movements. The dynamic forces individually differed much between 5.3% to 27.5% of the static forces in the same positions. On the Powerplate, they were even close to zero in some subjects. The total forces were always below 79% of the forces during walking. The dynamic forces did not rise proportionally to platform accelerations. During stance (Galileo, 25 Hz, 2 mm), the damping of dynamic forces was only 8% between foot and knee but 54% between knee and hip. The estimated rises in muscle forces due to the vibrations were in the same ranges as the contact force increases. These rises were much smaller than the vibration-induced EMG increases, reported for the same platform accelerations. These small muscle force increases, along with the observation that the peak contact and muscle forces during vibrations remained far below those during walking, indicate that dynamic muscle force amplitudes cannot be the reason for positive effects of whole body vibrations on muscles, bone remodelling or arthritic joints. Positive effects of vibrations must be caused by factors other than raised forces amplitudes.
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Affiliation(s)
- Georg Bergmann
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ines Kutzner
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Alwina Bender
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jörn Dymke
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Adam Trepczynski
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Georg N. Duda
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Dieter Felsenberg
- Center for Muscle and Bone Research, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Damm
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany
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16
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Trepczynski A, Kutzner I, Schwachmeyer V, Heller MO, Pfitzner T, Duda GN. Impact of antagonistic muscle co-contraction on in vivo knee contact forces. J Neuroeng Rehabil 2018; 15:101. [PMID: 30409163 PMCID: PMC6225620 DOI: 10.1186/s12984-018-0434-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/12/2018] [Indexed: 11/17/2022] Open
Abstract
Background The onset and progression of osteoarthritis, but also the wear and loosening of the components of an artificial joint, are commonly associated with mechanical overloading of the structures. Knowledge of the mechanical forces acting at the joints, together with an understanding of the key factors that can alter them, are critical to develop effective treatments for restoring joint function. While static anatomy is usually the clinical focus, less is known about the impact of dynamic factors, such as individual muscle recruitment, on joint contact forces. Methods In this study, instrumented knee implants provided accurate in vivo tibio-femoral contact forces in a unique cohort of 9 patients, which were used as input for subject specific musculoskeletal models, to quantify the individual muscle forces during walking and stair negotiation. Results Even between patients with a very similar self-selected gait speed, the total tibio-femoral peak forces varied 1.7-fold, but had only weak correlation with static alignment (varus/valgus). In some patients, muscle co-contraction of quadriceps and gastrocnemii during walking added up to 1 bodyweight (~ 50%) to the peak tibio-femoral contact force during late stance. The greatest impact of co-contraction was observed in the late stance phase of stair ascent, with an increase of the peak tibio-femoral contact force by up to 1.7 bodyweight (66%). Conclusions Treatment of diseased and failed joints should therefore not only be restricted to anatomical reconstruction of static limb axes alignment. The dynamic activation of muscles, as a key modifier of lower limb biomechanics, should also be taken into account and thus also represents a promising target for restoring function, patient mobility, and preventing future joint failure. Trial registration German Clinical Trials Register: ID: DRKS00000606, date: 05.11.2010. Electronic supplementary material The online version of this article (10.1186/s12984-018-0434-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adam Trepczynski
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Ines Kutzner
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Verena Schwachmeyer
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Markus O Heller
- Bioengineering Sciences Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Tilman Pfitzner
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Clinic for Adult Hip and Knee Reconstruction, Vivantes Spandau Hospital, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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17
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Bergmann G, Bender A, Dymke J, Duda GN, Damm P. Physical Activities That Cause High Friction Moments at the Cup in Hip Implants. J Bone Joint Surg Am 2018; 100:1637-1644. [PMID: 30277993 DOI: 10.2106/jbjs.17.01298] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND High friction moments in hip implants contribute to the aseptic loosening of cementless cups, of which there are approximately 100,000 cases per year; sustained joint loading may cause such high moments. The most "critical" physical activities associated with sustained joint loading were identified in this study. METHODS Friction moments in the cup were telemetrically measured about 33,000 times in the endoprostheses of 9 subjects during >1,400 different activities. The highest moments were compared with the cup's fixation stability limit of approximately 4 Nm. RESULTS A total of 124 different activities caused friction moments meeting or exceeding the critical limit, with the highest value of 11.5 Nm. Most involved sustained high contact forces before or during the activity. The highest peak moments (6.3 to 11.5 Nm) occurred when moving the contralateral leg during 1-legged stance, during breaststroke swimming, muscle stretching, 2-legged stance with muscle contraction, and during static 1-legged stance. The median moments were highest (3.4 to 3.9 Nm) for unstable 1-legged stance, whole-body vibration training, 2-legged stance with an unexpected push at the upper body, 1-legged stance while exercising the contralateral leg, and running after 2-legged stance. CONCLUSIONS Frequent unloading plus simultaneous movement of the joint are required to maintain good joint lubrication and keep the friction moments low. Frequent, sustained high loads before or during an activity may cause or contribute to aseptic cup loosening. During the first months after hip arthroplasty, such activities should be avoided or reduced as much as possible. This especially applies during postoperative physiotherapy. Whether these guidelines also apply for subjects with knee implants or arthrotic hip or knee joints requires additional investigation. CLINICAL RELEVANCE The risk of aseptic cup loosening may be reduced by avoiding sustained loading of hip implants without periodic joint movement.
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Affiliation(s)
- Georg Bergmann
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alwina Bender
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jörn Dymke
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Damm
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
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18
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Varus malalignment of cementless hip stems provides sufficient primary stability but highly increases distal strain distribution. Clin Biomech (Bristol, Avon) 2018; 58:14-20. [PMID: 30005422 DOI: 10.1016/j.clinbiomech.2018.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 06/24/2018] [Accepted: 07/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Varus position of cementless stems is a common malalignment in total hip arthroplasty. Clinical studies have reported a low rate of aseptic loosening but an increased risk for thigh pain. This in vitro study aimed to evaluate these clinical observations from a biomechanical perspective. METHODS A conventional cementless stem (CLS Spotorno) was implanted in a regular, straight (size 13.75) as well as in a varus position (size 11.25) in 6 composite femora (Sawbones), respectively. Primary stability was assessed by recording 3-dimensional micromotions under dynamic load bearing conditions and stress shielding was evaluated by registering the surface strain before and after stem insertion. FINDINGS Primary stability for stems in varus malposition revealed significantly lower micromotions (p < 0.05) for most regions compared to stems in neutral position. The greatest difference was observed at the tip of the stem where the straight aligned implants exceeded the critical upper limit for osseous integration of 150 μm. The surface strains for the varus aligned stems revealed a higher load transmission to the femur, resulting in a clearly altered strain distribution. INTERPRETATION This biomechanical study confirms the clinical findings of a good primary stability of cementless stems in a varus malposition, but impressively demonstrates the altered load transmission with the risk for postoperative thigh pain.
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Ledet EH, Liddle B, Kradinova K, Harper S. Smart implants in orthopedic surgery, improving patient outcomes: a review. ACTA ACUST UNITED AC 2018; 5:41-51. [PMID: 30246037 PMCID: PMC6145822 DOI: 10.2147/ieh.s133518] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Smart implants are implantable devices that provide not only therapeutic benefits but also have diagnostic capabilities. The integration of smart implants into daily clinical practice has the potential for massive cost savings to the health care system. Applications for smart orthopedic implants have been identified for knee arthroplasty, hip arthroplasty, spine fusion, fracture fixation and others. To date, smart orthopedic implants have been used to measure physical parameters from inside the body, including pressure, force, strain, displacement, proximity and temperature. The measurement of physical stimuli is achieved through integration of application-specific technology with the implant. Data from smart implants have led to refinements in implant design, surgical technique and strategies for postoperative care and rehabilitation. In spite of decades of research, with very few exceptions, smart implants have not yet become a part of daily clinical practice. This is largely because integration of current sensor technology necessitates significant modification to the implants. While the technology underlying smart implants has matured significantly over the last several decades, there are still significant technical challenges that need to be overcome before smart implants become part of mainstream health care. Sensors for next-generation smart implants will be small, simple, robust and inexpensive and will necessitate little to no modification to existing implant designs. With rapidly advancing technology, the widespread implementation of smart implants is near. New sensor technology that minimizes modifications to existing implants is the key to enabling smart implants into daily clinical practice.
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Affiliation(s)
- Eric H Ledet
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA.,R&D Service, Stratton VA Medical Center, Albany, NY, USA
| | - Benjamin Liddle
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Katerina Kradinova
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Sara Harper
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
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Haversath M, Klebingat S, Jäger M. Abriebanalyse mit virtuellen CAD-basierten Röntgenaufnahmen in der Endoprothetik. DER ORTHOPADE 2018; 47:811-819. [DOI: 10.1007/s00132-018-3602-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karipott SS, Nelson BD, Guldberg RE, Ong KG. Clinical potential of implantable wireless sensors for orthopedic treatments. Expert Rev Med Devices 2018; 15:255-264. [PMID: 29558820 DOI: 10.1080/17434440.2018.1454310] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Implantable wireless sensors have been used for real-time monitoring of chemicals and physical conditions of bones, tendons and muscles to diagnose and study orthopedic diseases and injuries. Due to the importance of these sensors in orthopedic care, a critical review, which not only analyzes the underlying technologies but also their clinical implementations and challenges, will provide a landscape view on their current state and their future clinical role. AREAS COVERED By conducting an extensive literature search and following the leaders of orthopedic implantable wireless sensors, this review covers the battery-powered and battery-free wireless implantable sensor technologies, and describes their implementation for hips, knees, spine, and shoulder stress/strain monitoring. Their advantages, limitations, and clinical challenges are also described. EXPERT COMMENTARY Currently, implantable wireless sensors are mostly limited for scientific investigations and demonstrative experiments. Although rapid advancement in sensors and wireless technologies will push the reliability and practicality of these sensors for clinical realization, regulatory constraints and financial viability in medical device industry may curtail their continuous adoption for clinical orthopedic applications. In the next five years, these sensors are expected to gain increased interest from researchers, but wide clinical adoption is still unlikely.
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Affiliation(s)
| | - Bradley D Nelson
- a Biomedical Engineering , Michigan Technological University , Houghton , MI , USA
| | - Robert E Guldberg
- b George W. Woodruff School of Mechanical Engineering , Georgia Institute of Technology , Atlanta , GA , USA
| | - Keat Ghee Ong
- a Biomedical Engineering , Michigan Technological University , Houghton , MI , USA
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Fottner A, Woiczinski M, Kistler M, Schröder C, Schmidutz TF, Jansson V, Schmidutz F. Influence of undersized cementless hip stems on primary stability and strain distribution. Arch Orthop Trauma Surg 2017; 137:1435-1441. [PMID: 28865042 DOI: 10.1007/s00402-017-2784-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Undersizing of cementless hip stems is a risk factor for aseptic loosening and early subsidence. The purpose of this study was to evaluate the effects of undersized stems and determine whether a biomechanical study can predict the clinical results. MATERIALS AND METHODS Three consecutive sizes of a clinically proven stem (CLS Spotorno) were implanted into six composite femora (size large, Sawbones®), respectively. According to the Canal Fill Index (CFI), two stems (size 11.25 and 12.5) were undersized (CFI < 80%) and one stem (size 13.75) had an appropriate size (CFI > 80%). The primary stability was evaluated by measurement of 3-dimensional (3D)-micromotions under physiological adapted load and surface strains were recorded before and after implantation to detect stress-shielding processes. RESULTS Both undersized stems revealed significantly higher micromotions in all regions compared to the appropriate stem. The highest micromotions were registered at the distal tip of the three stem sizes. The changes in surface strain did not show a significant difference between the three stem sizes, but the highest strain reduction was observed proximally indicating a tendency for stress shielding. CONCLUSIONS This study confirms the clinical assumption that undersized stem result in a significantly reduced primary stability. Furthermore, in vitro studies allow to determine the effects of undersizing and stress shielding processes.
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Affiliation(s)
- Andreas Fottner
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, 81377, Munich, Germany.
| | - Matthias Woiczinski
- Laboratory for Biomechanics and Experimental Orthopedics, Grosshadern Medical Center, University of Munich (LMU), Munich, Germany
| | - Manuel Kistler
- Laboratory for Biomechanics and Experimental Orthopedics, Grosshadern Medical Center, University of Munich (LMU), Munich, Germany
| | - Christian Schröder
- Laboratory for Biomechanics and Experimental Orthopedics, Grosshadern Medical Center, University of Munich (LMU), Munich, Germany
| | - Tobias F Schmidutz
- Cavendish Laboratory, University of Cambridge, J. J. Thomson Avenue, Cambridge, CB3 0HE, UK
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, 81377, Munich, Germany
| | - Florian Schmidutz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, 81377, Munich, Germany.,BG Trauma Center, Eberhard Karls University Tübingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
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Influence of different sizes of composite femora on the biomechanical behavior of cementless hip prosthesis. Clin Biomech (Bristol, Avon) 2017; 41:60-65. [PMID: 27960138 DOI: 10.1016/j.clinbiomech.2016.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 11/12/2016] [Accepted: 12/07/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND For the biomechanical evaluation of cementless stems different sizes of composite femurs have been used in the literature. However, the impact of different specimen sizes on test results is unknown. METHODS To determine the potential effect of femur size the biomechanical properties of a conventional stem (CLS Spotorno) were examined in 3 different sizes (small, medium and large composite Sawbones®). Primary stability was tested under physiologically adapted dynamic loading conditions measuring 3-dimensional micromotions. For the small composite femur the dynamic load needed to be adapted since fractures occurred when reaching 1700N. Additionally, surface strain distribution was recorded before and after implantation to draw conclusions about the tendency for stress shielding. FINDINGS All tested sizes revealed similar micromotions only reaching a significant different level at one measurement point. The highest micromotions were observed at the tip of the stems exceeding the limit for osseous integration of 150μm. Regarding strain distribution the highest strain reduction after implantation was registered in all sizes at the level of the lesser trochanter. INTERPRETATION Specimen size seems to be a minor influence factor for biomechanical evaluation of cementless stems. However, the small composite femur is less suitable for biomechanical testing since this size failed under physiological adapted loads. For the CLS Spotorno osseous integration is unlikely at the tip of the stem and the tendency for stress shielding is the highest at the level of the lesser trochanter.
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Damm P, Kutzner I, Bergmann G, Rohlmann A, Schmidt H. Comparison of in vivo measured loads in knee, hip and spinal implants during level walking. J Biomech 2016; 51:128-132. [PMID: 27914627 DOI: 10.1016/j.jbiomech.2016.11.060] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Abstract
Walking is a task that we seek to understand because it is the most relevant human locomotion. Walking causes complex loading patterns and high load magnitudes within the human body. This work summarizes partially published load data collected in earlier in vivo measurement studies on 9 patients with telemeterized knee endoprostheses, 10 with hip endoprostheses and 5 with vertebral body replacements. Moreover, for the 19 endoprosthesis patients, additional simultaneously measured and previously unreported ground reaction forces are presented. The ground reaction force and the implant forces in the knee and hip exhibited a double peak during each step. The maxima of the ground reaction forces ranged from 100% to 126% bodyweight. In comparison, the greatest implant forces in the hip (249% bodyweight) and knee (271% bodyweight) were much greater. The mean peak force measured in the vertebral body replacement was 39% bodyweight and occurred at different time points of the stance phase. We concluded that walking leads to high load magnitudes in the knee and hip, whereas the forces in the vertebral body replacement remained relatively low. This indicates that the first peak force was greater in the hip than in the knee joint while this was reversed for the second peak force. The forces in the spinal implant were considerably lower than in the knee and hip joints.
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Affiliation(s)
- Philipp Damm
- Julius Wolff Institut Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Ines Kutzner
- Julius Wolff Institut Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Georg Bergmann
- Julius Wolff Institut Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Antonius Rohlmann
- Julius Wolff Institut Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Hendrik Schmidt
- Julius Wolff Institut Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Osterhoff G, Dodd AE, Unno F, Wong A, Amiri S, Lefaivre KA, Guy P. Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model. Clin Orthop Relat Res 2016; 474:2522-2530. [PMID: 27334321 PMCID: PMC5052190 DOI: 10.1007/s11999-016-4934-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/07/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sacroiliac screw fixation in elderly patients with pelvic fractures is prone to failure owing to impaired bone quality. Cement augmentation has been proposed as a possible solution, because in other anatomic areas this has been shown to reduce screw loosening. However, to our knowledge, this has not been evaluated for sacroiliac screws. QUESTIONS/PURPOSES We investigated the potential biomechanical benefit of cement augmentation of sacroiliac screw fixation in a cadaver model of osteoporotic bone, specifically with respect to screw loosening, construct survival, and fracture-site motion. METHODS Standardized complete sacral ala fractures with intact posterior ligaments in combination with ipsilateral upper and lower pubic rami fractures were created in osteoporotic cadaver pelves and stabilized by three fixation techniques: sacroiliac (n = 5) with sacroiliac screws in S1 and S2, cemented (n = 5) with addition of cement augmentation, and transsacral (n = 5) with a single transsacral screw in S1. A cyclic loading protocol was applied with torque (1.5 Nm) and increasing axial force (250-750 N). Screw loosening, construct survival, and sacral fracture-site motion were measured by optoelectric motion tracking. A sample-size calculation revealed five samples per group to be required to achieve a power of 0.80 to detect 50% reduction in screw loosening. RESULTS Screw motion in relation to the sacrum during loading with 250 N/1.5 Nm was not different among the three groups (sacroiliac: 1.2 mm, range, 0.6-1.9; cemented: 0.7 mm, range, 0.5-1.3; transsacral: 1.1 mm, range, 0.6-2.3) (p = 0.940). Screw subsidence was less in the cemented group (3.0 mm, range, 1.2-3.7) compared with the sacroiliac (5.7 mm, range, 4.7-10.4) or transsacral group (5.6 mm, range, 3.8-10.5) (p = 0.031). There was no difference with the numbers available in the median number of cycles needed until failure; this was 2921 cycles (range, 2586-5450) in the cemented group, 2570 cycles (range, 2500-5107) for the sacroiliac specimens, and 2578 cycles (range, 2540-2623) in the transsacral group (p = 0.153). The cemented group absorbed more energy before failure (8.2 × 105 N*cycles; range, 6.6 × 105-22.6 × 105) compared with the transsacral group (6.5 × 105 N*cycles; range, 6.4 × 105-6.7 × 105) (p = 0.016). There was no difference with the numbers available in terms of fracture site motion (sacroiliac: 2.9 mm, range, 0.7-5.4; cemented: 1.2 mm, range, 0.6-1.9; transsacral: 2.1 mm, range, 1.2-4.8). Probability values for all between-group comparisons were greater than 0.05. CONCLUSIONS The addition of cement to standard sacroiliac screw fixation seemed to change the mode and dynamics of failure in this cadaveric mechanical model. Although no advantages to cement were observed in terms of screw motion or cycles to failure among the different constructs, a cemented, two-screw sacroiliac screw construct resulted in less screw subsidence and greater energy absorbed to failure than an uncemented single transsacral screw. CLINICAL RELEVANCE In osteoporotic bone, the addition of cement to sacroiliac screw fixation might improve screw anchorage. However, larger mechanical studies using these findings as pilot data should be performed before applying these preliminary findings clinically.
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Affiliation(s)
- Georg Osterhoff
- Division of Orthopaedic Trauma, Department of Orthopaedics, University of British Columbia, 3114–910 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada
| | - Andrew E. Dodd
- Division of Orthopaedic Trauma, Department of Orthopaedics, University of British Columbia, 3114–910 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada
| | - Florence Unno
- Division of Orthopaedic Trauma, Department of Orthopaedics, University of British Columbia, 3114–910 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada
| | - Angus Wong
- Division of Orthopaedic Trauma, Department of Orthopaedics, University of British Columbia, 3114–910 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada
| | - Shahram Amiri
- Division of Orthopaedic Trauma, Department of Orthopaedics, University of British Columbia, 3114–910 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada
| | - Kelly A. Lefaivre
- Division of Orthopaedic Trauma, Department of Orthopaedics, University of British Columbia, 3114–910 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada
| | - Pierre Guy
- Division of Orthopaedic Trauma, Department of Orthopaedics, University of British Columbia, 3114–910 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada
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Uvarovas V, Šatkauskas I, Urbonavičius R, Bučinskas V, Griškevičius J, Vengrauskas V, Petryla G, Masionis P, Andrijauskas A, Porvaneckas N. Different Stabilization Techniques for Type 62B3 Acetabular Fractures in Combination With Primary Total Hip Arthroplasty in Elderly Patients: A Biomechanical Comparison. Geriatr Orthop Surg Rehabil 2016; 7:153-7. [PMID: 27551574 PMCID: PMC4976741 DOI: 10.1177/2151458516658329] [Citation(s) in RCA: 2] [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] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The total hip arthroplasty (THA) as part of acute fracture management is used for acetabular fractures in elderly patients. Our objective was to assess the stability of osteosynthesis performed using 2 different techniques in combination with THA in an experimental model. MATERIALS AND METHODS We conducted 20 experiments using the left-side hemipelves composite bone models. There were 2 testing groups: 1- and 2-stage osteosynthesis. The acetabular fractures of the anterior column and posterior hemitransverse were simulated. The same THA technique was used in both groups. The stability of osteosynthesis was explored and compared between the groups by measuring the fracture displacement of anterior and posterior columns under the standardized test load (1187 N) protocol. Load distance diagrams were generated. RESULTS The 0.680-mm gap (0.518; 1.548) of the posterior column in the 1-stage group (n = 10) was higher than the 0.370-mm gap (0.255; 0.428) in the 2-stage group (n = 10; P = .002). There was no significant difference between the gap of the anterior column in the 1- and 2-stage groups (0.135 [0.078; 0.290] mm vs 0.160 [0.120; 0.210] mm; P = .579). CONCLUSION The 2-stage osteosynthesis of the anterior and posterior columns in combination with THA provides better stability of posterior column when compared to 1-stage method in composite bone models.
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Affiliation(s)
- Valentinas Uvarovas
- Clinic of Rheumatology, Traumatology Orthopaedic and Reconstructive Surgery, Medical Faculty, Centre of Orthopedics and Traumatology, Republican Vilnius University Hospital, Vilnius University, Vilnius, Lithuania
| | - Igoris Šatkauskas
- Clinic of Rheumatology, Traumatology Orthopaedic and Reconstructive Surgery, Medical Faculty, Centre of Orthopedics and Traumatology, Republican Vilnius University Hospital, Vilnius University, Vilnius, Lithuania
| | - Robertas Urbonavičius
- Department of Mechatronics and Robotics, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Vytautas Bučinskas
- Department of Mechatronics and Robotics, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Julius Griškevičius
- Department of Biomechanics, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Vytautas Vengrauskas
- Department of Orthopedics and Traumatology, Republican Vilnius University Hospital, Vilnius, Lithuania
| | - Giedrius Petryla
- Department of Orthopedics and Traumatology, Republican Vilnius University Hospital, Vilnius, Lithuania
| | - Povilas Masionis
- Department of Orthopedics and Traumatology, Republican Vilnius University Hospital, Vilnius, Lithuania
| | - Audrius Andrijauskas
- Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Narūnas Porvaneckas
- Clinic of Rheumatology, Traumatology Orthopaedic and Reconstructive Surgery, Medical Faculty, Centre of Orthopedics and Traumatology, Republican Vilnius University Hospital, Vilnius University, Vilnius, Lithuania
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Wesseling M, de Groote F, Meyer C, Corten K, Simon JP, Desloovere K, Jonkers I. Gait alterations to effectively reduce hip contact forces. J Orthop Res 2015; 33:1094-102. [PMID: 25676535 DOI: 10.1002/jor.22852] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 02/03/2015] [Indexed: 02/04/2023]
Abstract
Patients with hip pathology present alterations in gait which have an effect on joint moments and loading. In knee osteoarthritic patients, the relation between medial knee contact forces and the knee adduction moment are currently being exploited to define gait retraining strategies to effectively reduce pain and disease progression. However, the relation between hip contact forces and joint moments has not been clearly established. Therefore, this study aims to investigate the effect of changes in hip and pelvis kinematics during gait on internal hip moments and contact forces which is calculated using muscle driven simulations. The results showed that frontal plane kinetics have the largest effect on hip contact forces. Given the high correlation between the change in hip adduction moment and contact force at initial stance (R(2) = 0.87), this parameter can be used to alter kinematics and predict changes in contact force. At terminal stance the hip adduction and flexion moment can be used to predict changes in contact force (R(2) = 0.76). Therefore, gait training that focuses on decreasing hip adduction moments, a wide base gait pattern, has the largest potential to reduce hip contact forces.
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Affiliation(s)
- Mariska Wesseling
- Department of Kinesiology, KU Leuven, Human Movement Biomechanics, Heverlee, Belgium
| | - Friedl de Groote
- Department of Mechanical Engineering, KU Leuven, Division PMA, Heverlee, Belgium
| | - Christophe Meyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kristoff Corten
- Department of Orthopaedic, Hip Unit, Ziekenhuis Oost-limburg, Genk, Belgium
| | - Jean-Pierre Simon
- Department of Orthopedic, UZ Pellenberg, University Hospitals Leuven, Pellenberg, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Department of Kinesiology, KU Leuven, Human Movement Biomechanics, Heverlee, Belgium
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Damm P, Bender A, Bergmann G. Postoperative changes in in vivo measured friction in total hip joint prosthesis during walking. PLoS One 2015; 10:e0120438. [PMID: 25806805 PMCID: PMC4373913 DOI: 10.1371/journal.pone.0120438] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/22/2015] [Indexed: 12/02/2022] Open
Abstract
Loosening of the artificial cup and inlay is the most common reasons for total hip replacement failures. Polyethylene wear and aseptic loosening are frequent reasons. Furthermore, over the past few decades, the population of patients receiving total hip replacements has become younger and more active. Hence, a higher level of activity may include an increased risk of implant loosening as a result of friction-induced wear. In this study, an instrumented hip implant was used to measure the contact forces and friction moments in vivo during walking. Subsequently, the three-dimensional coefficient of friction in vivo was calculated over the whole gait cycle. Measurements were collected from ten subjects at several time points between three and twelve months postoperative. No significant change in the average resultant contact force was observed between three and twelve months postoperative. In contrast, a significant decrease of up to 47% was observed in the friction moment. The coefficient of friction also decreased over postoperative time on average. These changes may be caused by ‘running-in’ effects of the gliding components or by the improved lubricating properties of the synovia. Because the walking velocity and contact forces were found to be nearly constant during the observed period, the decrease in friction moment suggests an increase in fluid viscosity. The peak values of the contact force individually varied by 32%-44%. The friction moment individually differed much more, by 110%-129% at three and up to 451% at twelve months postoperative. The maximum coefficient of friction showed the highest individual variability, about 100% at three and up to 914% at twelve months after surgery. These individual variations in the friction parameters were most likely due to different ‘running-in’ effects that were influenced by the individual activity levels and synovia properties.
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Affiliation(s)
- Philipp Damm
- Julius Wolff Institute, Charité—Universitaetsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Alwina Bender
- Julius Wolff Institute, Charité—Universitaetsmedizin Berlin, Berlin, Germany
| | - Georg Bergmann
- Julius Wolff Institute, Charité—Universitaetsmedizin Berlin, Berlin, Germany
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Li J, Redmond AC, Jin Z, Fisher J, Stone MH, Stewart TD. Hip contact forces in asymptomatic total hip replacement patients differ from normal healthy individuals: Implications for preclinical testing. Clin Biomech (Bristol, Avon) 2014; 29:747-51. [PMID: 24975901 DOI: 10.1016/j.clinbiomech.2014.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 06/04/2014] [Accepted: 06/05/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preclinical durability testing of hip replacement implants is standardised by ISO-14242-1 (2002) which is based on historical inverse dynamics analysis using data obtained from a small sample of normal healthy individuals. It has not been established whether loading cycles derived from normal healthy individuals are representative of loading cycles occurring in patients following total hip replacement. METHODS Hip joint kinematics and hip contact forces derived from multibody modelling of forces during normal walking were obtained for 15 asymptomatic total hip replacement patients and compared to 38 normal healthy individuals and to the ISO standard for pre-clinical testing. FINDINGS Hip kinematics in the total hip replacement patients were comparable to the ISO data and the hip contact force in the normal healthy group was also comparable to the ISO cycles. Hip contact forces derived from the asymptomatic total hip replacement patients were comparable for the first part of the stance period but exhibited 30% lower peak loads at toe-off. INTERPRETATION Although the ISO standard provides a representative kinematic cycle, the findings call into question whether the hip joint contact forces in the ISO standard are representative of those occurring in the joint following total hip replacement.
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Affiliation(s)
- Junyan Li
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, LS2 9JT, UK
| | - Anthony C Redmond
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, LS2 9JT, UK; NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Zhongmin Jin
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, LS2 9JT, UK; NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - John Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, LS2 9JT, UK; NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Martin H Stone
- Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK; NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Todd D Stewart
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, LS2 9JT, UK; NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK.
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In-vivo 6 degrees-of-freedom kinematics of metal-on-polyethylene total hip arthroplasty during gait. J Biomech 2014; 47:1572-6. [DOI: 10.1016/j.jbiomech.2014.03.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/23/2022]
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