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Kamenaga T, Hayashi S, Kuroda Y, Tsubosaka M, Nakano N, Kuroda R, Matsumoto T. Combined assessment of acetabular coverage and femoral head-neck shapes predicts osteoarthritis progression after periacetabular osteotomy. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05439-7. [PMID: 38967782 DOI: 10.1007/s00402-024-05439-7] [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: 12/11/2023] [Accepted: 06/27/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Postoperative osteoarthritis (OA) progression is a major determinant of failure after curved periacetabular osteotomy (CPO). A large postoperative combination angle, i.e., the combination of computed tomography-based anterior center edge and alpha angles, is associated with femoroacetabular impingement after CPO, but its association with postoperative OA progression is unclear. We aimed to identify the anatomical parameters that can lead to OA progression after CPO and the impact of the combination angle on the same. MATERIALS AND METHODS We included 90 hips that were subjected to CPO at our center between March 2013 and March 2018. Seventeen hips showed OA progression with an increase in the Tönnis classification after surgery; 73 hips showed no progression. Radiographic anatomical parameters, including the lateral and anterior center edge angles, femoral and acetabular anteversion, and combination angle, and clinical outcomes, including modified Harris Hip Scores (mHHSs), postoperative anterior impingement, and range of motion, were compared between the two groups. Statistical significance was set at P < 0.05. RESULTS Postoperative OA progression was significantly affected by preoperative OA evidence (P = 0.017), acetabular anteversion < 5.0° (P = 0.003), and a combination angle > 107.0° (P = 0.025). Patients with radiographic OA progression were associated with poor mHHSs (P = 0.017) and high frequencies of anterior impingement with a limited hip flexion and internal rotation angle. CONCLUSIONS OA progression after CPO may be associated with preoperative evidence of OA and postoperative acetabular retroversion as well as a large combination angle. Surgeons should focus on the potential effects of preoperative OA grades, postoperative reduction in acetabular anteversion, and postoperative combination angle.
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Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan
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Gonçalves BAM, Saxby DJ, Meinders E, Barrett RS, Diamond LE. Hip Contact Forces During Sprinting in Femoroacetabular Impingement Syndrome. Med Sci Sports Exerc 2024; 56:402-410. [PMID: 37882088 DOI: 10.1249/mss.0000000000003320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
PURPOSE Sprinting often provokes hip pain in individuals with femoroacetabular impingement syndrome (FAIS). Asphericity of the femoral head-neck junction (cam morphology) characteristic of FAIS can increase the risk of anterior-superior acetabular cartilage damage. This study aimed to 1) compare hip contact forces (magnitude and direction) during sprinting between individuals with FAIS, asymptomatic cam morphology (CAM), and controls without cam morphology, and 2) identify the phases of sprinting with high levels of anteriorly directed hip contact forces. METHODS Forty-six recreationally active individuals with comparable levels of physical activity were divided into three groups (FAIS, 14; CAM, 15; control, 17) based on their history of hip/groin pain, results of clinical impingement tests, and presence of cam morphology (alpha angle >55°). Three-dimensional marker trajectories, ground reaction forces, and electromyograms from 12 lower-limb muscles were recorded during 10-m overground sprinting trials. A linearly scaled electromyogram-informed neuromusculoskeletal model was used to calculate hip contact force magnitude (resultant, anterior-posterior, inferior-superior, medio-lateral) and angle (sagittal and frontal planes). Between-group comparisons were made using two-sample t -tests via statistical parametric mapping ( P < 0.05). RESULTS No significant differences in magnitude or direction of hip contact forces were observed between FAIS and CAM or between FAIS and control groups during any phase of the sprint cycle. The highest anteriorly directed hip contact forces were observed during the initial swing phase of the sprint cycle. CONCLUSIONS Hip contact forces during sprinting do not differentiate recreationally active individuals with FAIS from asymptomatic individuals with and without cam morphology. Hip loading during early swing, where peak anterior loading occurs, may be a potential mechanism for cartilage damage during sprinting-related sports in individuals with FAIS and/or asymptomatic cam morphology.
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Cannon J, Rankin JW, Lewton KL, Liu J, Powers CM. Femoral and acetabular features explain acetabular contact pressure sensitivity to hip internal rotation in persons with cam morphology: A finite element analysis. Clin Biomech (Bristol, Avon) 2023; 107:106025. [PMID: 37302302 DOI: 10.1016/j.clinbiomech.2023.106025] [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: 02/07/2023] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Femoroacetabular impingement is characterized by premature contact between the proximal femur and acetabulum. The loss of femoral head-neck concavity associated with cam morphology leads to mechanical impingement during hip flexion and internal rotation. Other femoral and acetabular features have been linked with mechanical impingement but have not been comprehensively investigated. This study sought to determine which bony features are most influential in contributing to mechanical impingement in persons with a cam morphology. METHODS Twenty individuals (10 female, 10 male) with a cam morphology participated. Finite element analyses incorporating subject-specific bony geometry derived from computed tomography scans were used to determine which femoral (alpha angle and femoral neck-shaft angle) and acetabular (anteversion angle, inclination angle, depth, and lateral center-edge angle) features accentuate acetabular contact pressure with increasing degrees of hip internal rotation with the hip flexed to 90°. To determine the best predictors of acetabular contact pressure sensitivity to internal rotation, all morphological variables were included in a stepwise regression with the final model subjected to a bootstrapping procedure. FINDINGS The stepwise regression revealed that femoral neck-shaft angle, acetabular anteversion angle, acetabular inclination angle, and acetabular depth were the best combination of variables to predict contact pressure sensitivity to internal rotation, explaining 55% of the variance. Results of the bootstrap analysis revealed that a median value of 65% [37%, 89%] variance in sensitivity could be explained by these morphological variables. INTERPRETATION Mechanical impingement and the concomitant acetabular contact pressure are modulated by multiple femoral and acetabular features in persons with a cam morphology.
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Affiliation(s)
- Jordan Cannon
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA; Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeffery W Rankin
- Rancho Research Institute, Rehabilitation Engineering Program, Downey, CA, USA
| | - Kristi L Lewton
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA; Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jia Liu
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher M Powers
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
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Gaffney BMM, Williams ST, Todd JN, Weiss JA, Harris MD. A Musculoskeletal Model for Estimating Hip Contact Pressure During Walking. Ann Biomed Eng 2022; 50:1954-1963. [PMID: 35864367 PMCID: PMC9797423 DOI: 10.1007/s10439-022-03016-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/07/2022] [Indexed: 12/31/2022]
Abstract
Cartilage contact pressures are major factors in osteoarthritis etiology and are commonly estimated using finite element analysis (FEA). FEA models often include subject-specific joint geometry, but lack subject-specific joint kinematics and muscle forces. Musculoskeletal models use subject-specific kinematics and muscle forces but often lack methods for estimating cartilage contact pressures. Our objective was to adapt an elastic foundation (EF) contact model within OpenSim software to predict hip cartilage contact pressures and compare results to validated FEA models. EF and FEA models were built for five subjects. In the EF models, kinematics and muscle forces were applied and pressure was calculated as a function of cartilage overlap depth. Cartilage material properties were perturbed to find the best match to pressures from FEA. EF models with elastic modulus = 15 MPa and Poisson's ratio = 0.475 yielded results most comparable to FEA, with peak pressure differences of 4.34 ± 1.98 MPa (% difference = 39.96 ± 24.64) and contact area differences of 3.73 ± 2.92% (% difference = 13.4 ± 11.3). Peak pressure location matched between FEA and EF for 3 of 5 subjects, thus we do not recommend this model if the location of peak contact pressure is critically important to the research question. Contact area magnitudes and patterns matched reasonably between FEA and EF, suggesting that this model may be useful for questions related to those variables, especially if researchers desire inclusion of subject-specific geometry, kinematics, muscle forces, and dynamic motion in a computationally efficient framework.
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Affiliation(s)
- Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, USA
- Center of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Spencer T Williams
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Jocelyn N Todd
- Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey A Weiss
- Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Michael D Harris
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, 4444 Forest Park Ave., Suite 1101, St. Louis, MO, 63108, USA.
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, USA.
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Todd JN, Maak TG, Anderson AE, Ateshian GA, Weiss JA. How Does Chondrolabral Damage and Labral Repair Influence the Mechanics of the Hip in the Setting of Cam Morphology? A Finite-Element Modeling Study. Clin Orthop Relat Res 2022; 480:602-615. [PMID: 34766936 PMCID: PMC8846280 DOI: 10.1097/corr.0000000000002000] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Individuals with cam morphology are prone to chondrolabral injuries that may progress to osteoarthritis. The mechanical factors responsible for the initiation and progression of chondrolabral injuries in these individuals are not well understood. Additionally, although labral repair is commonly performed during surgical correction of cam morphology, the isolated mechanical effect of labral repair on the labrum and surrounding cartilage is unknown. QUESTION/PURPOSES Using a volunteer-specific finite-element analysis, we asked: (1) How does cam morphology create a deleterious mechanical environment for articular cartilage (as evaluated by shear stress, tensile strain, contact pressure, and fluid pressure) that could increase the risk of cartilage damage compared with a radiographically normal hip? (2) How does chondrolabral damage, specifically delamination, delamination with rupture of the chondrolabral junction, and the presence of a chondral defect, alter the mechanical environment around the damage? (3) How does labral repair affect the mechanical environment in the context of the aforementioned chondrolabral damage scenarios? METHODS The mechanical conditions of a representative hip with normal bony morphology (characterized by an alpha angle of 37°) and one with cam morphology (characterized by an alpha angle of 78°) were evaluated using finite-element models that included volunteer-specific anatomy and kinematics. The bone, cartilage, and labrum geometry for the hip models were collected from two volunteers matched by age (25 years with cam morphology and 23 years with normal morphology), BMI (both 24 kg/m2), and sex (both male). Volunteer-specific kinematics for gait were used to drive the finite-element models in combination with joint reaction forces. Constitutive material models were assigned to the cartilage and labrum, which simulate a physiologically realistic material response, including the time-dependent response from fluid flow through the cartilage, and spatially varied response from collagen fibril reinforcement. For the cam hip, three models were created to represent chondrolabral damage conditions: (1) "delamination," with the acetabular cartilage separated from the bone in one region; (2) "delamination with chondrolabral junction (CLJ) rupture," which includes separation of the cartilage from the labrum tissue; and (3) a full-thickness chondral defect, referred to throughout as "defect," where the acetabular cartilage has degraded so there is a void. Each of the three conditions was modeled with a labral tear and with the labrum repaired. The size and location of the damage conditions simulated in the cartilage and labrum were attained from reported clinical prevalence of the location of these injuries. For each damage condition, the contact area, contact pressure, tensile strain, shear stress, and fluid pressure were predicted during gait and compared. RESULTS The cartilage in the hip with cam morphology experienced higher stresses and strains than the normal hip. The peak level of tensile strain (25%) and shear stress (11 MPa) experienced by the cam hip may exceed stable conditions and initiate damage or degradation. The cam hip with simulated damage experienced more evenly distributed contact pressure than the intact cam hip, as well as decreased tensile strain, shear stress, and fluid pressure. The peak levels of tensile strain (15% to 16%) and shear stress (2.5 to 2.7 MPa) for cam hips with simulated damage may be at stable magnitudes. Labral repair only marginally affected the overall stress and strain within the cartilage, but it increased local tensile strain in the cartilage near the chondrolabral junction in the hip with delamination and increased the peak tensile strain and shear stress on the labrum. CONCLUSION This finite-element modeling pilot study suggests that cam morphology may predispose hip articular cartilage to injury because of high shear stress; however, the presence of simulated damage distributed the loading more evenly and the magnitude of stress and strain decreased throughout the cartilage. The locations of the peak values also shifted posteriorly. Additionally, in hips with cam morphology, isolated labral repair in the hip with a delamination injury increased localized strain in the cartilage near the chondrolabral junction. CLINICAL RELEVANCE In a hip with cam morphology, labral repair alone may not protect the cartilage from damage because of mechanical overload during the low-flexion, weightbearing positions experienced during gait. The predicted findings of redistribution of stress and strain from damage in the cam hip may, in some cases, relieve disposition to damage progression. Additional studies should include volunteers with varied acetabular morphology, such as borderline dysplasia with cam morphology or pincer deformity, to analyze the effect on the conclusions presented in the current study. Further, future studies should evaluate the combined effects of osteochondroplasty and chondrolabral treatment.
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Affiliation(s)
- Jocelyn N. Todd
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Travis G. Maak
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Andrew E. Anderson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
- School of Computing, University of Utah, Salt Lake City, UT, USA
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
| | - Gerard A. Ateshian
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Jeffrey A. Weiss
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
- School of Computing, University of Utah, Salt Lake City, UT, USA
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Ng KCG. CORR Insights®: How Does Chondrolabral Damage and Labral Repair Influence the Mechanics of the Hip in the Setting of Cam Morphology? A Finite-Element Modeling Study. Clin Orthop Relat Res 2022; 480:616-618. [PMID: 34797232 PMCID: PMC8846352 DOI: 10.1097/corr.0000000000002056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/26/2021] [Indexed: 01/31/2023]
Affiliation(s)
- K C Geoffrey Ng
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Department of Medical Imaging, Western University, London, Ontario, Canada
- Department of Surgery, Western University, London, Ontario, Canada
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Wang T, Zhao B, Yan J, Shao B, Mu W. Finite element analysis of infra-acetabular screw fixation for the treatment of acetabular posterior column fracture. INTERNATIONAL ORTHOPAEDICS 2022; 46:623-634. [PMID: 34981159 DOI: 10.1007/s00264-021-05298-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infra-acetabular screws have been described to increase the fixation strength of acetabular fractures with separation of the columns. Previous studies were based on the simulation of the anterior column fractures without modelling the biomechanical effect of the screw in the posterior column fractures. The purpose of this study was to compare the stability of different internal fixation models of posterior column fracture and to provide a theoretical basis for the clinical application of infra-acetabular screws. METHODS Five internal fixation models of acetabular posterior column fracture were simulated using five implants, including one reconstruction plate (PCP model), one posterior column screw (PCS model), one infra-acetabular screw (PIS model), one infra-acetabular screw and one reconstruction plate (PIS + PCP model), and one infra-acetabular screw and one posterior column screw (PIS + PCS model). After meshing, material parameter, and boundary condition settings, a vertical downward load of 500 N was applied on the surface of the sacrum. To evaluate the biomechanical properties, the stress distribution and von Mises peak stress were recorded and analyzed, and the displacement distributions of the upper and lower fracture surfaces were compared. RESULTS In model PCP, the maximum stress of the plate is 71.952 MPa; in model PCS, the maximum stress of the screw is 52.740 MPa; in model PIS, the maximum stress of the screw is 68.985 MPa; in model PIS + PCP, the maximum stress of the plate is 64.695 MPa and the maximum stress of the screw is 39.679 MPa; and in model PIS + PCS, the maximum stress of the posterior column screw is 48.197 MPa and the maximum stress of the infra-acetabular screw is 65.201 MPa. The maximum stresses of implants are all located on the fracture surfaces. The average displacement differences of the upper and lower fracture surfaces are compared as follows: model PIS + PCS (0.03503 mm) < model PIS + PCP (0.08205 mm) < model PCP (0.10096 mm) < model PCS (0.19007 mm) < model PIS (0.23546 mm). CONCLUSION With sufficient biomechanical stability, infra-acetabular screws can be used as a supplementary fixation for the treatment of acetabular posterior column fractures. It is recommended to fix the fracture by the combined application of the infra-acetabular screw and posterior column screw.
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Affiliation(s)
- Tingguang Wang
- Department of Traumatic Orthopaedics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324 Jing Wu Road, Jinan, 250012, Shandong, China
- Department of Orthopaedics, People's Hospital of Zouping City, Binzhou, Shandong, China
| | - Bei Zhao
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Jun Yan
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Bin Shao
- Department of Orthopaedics, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Weidong Mu
- Department of Traumatic Orthopaedics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324 Jing Wu Road, Jinan, 250012, Shandong, China.
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Yarwood W, Sunil Kumar KH, Ng KCG, Khanduja V. Biomechanics of Cam Femoroacetabular Impingement: A Systematic Review. Arthroscopy 2022; 38:174-189. [PMID: 34147642 DOI: 10.1016/j.arthro.2021.05.066] [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] [Received: 12/15/2020] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess how biomechanical gait parameters (kinematics, kinetics, and muscle force estimations) differ between patients with cam-type femoroacetabular impingement (FAI) and healthy controls, through a systematic search. METHODS A systematic review of the literature from PubMed, Scopus, and Medline and EMBASE via OVID SP was undertaken from inception to April 2020 using PRISMA guidelines. Studies that described kinematics, kinetics, and/or estimated muscle forces in cam-type FAI were identified and reviewed. RESULTS The search strategy identified 404 articles for evaluation. Removal of duplicates and screening of titles and abstracts resulted in full-text review of 37 articles, with 12 meeting inclusion criteria. The 12 studies reported biomechanical data on a total of 173 cam-FAI (151 cam-specific, 22 mixed-type) patients and 177 healthy age-, sex-, and body mass index-matched controls. Patients with cam FAI had reduced hip sagittal plane range of motion (mean difference -3.00° [-4.10, -1.90], P < .001), reduced hip peak extension angles (mean difference -2.05° [-3.58, -0.53] , P = .008), reduced abduction angles in the terminal phase of stance, and reduced iliacus and psoas muscle force production in the terminal phase of stance compared to the control groups. Cam FAI cohorts walked at a slower speed compared with controls. CONCLUSIONS In conclusion, patients with cam-type FAI exhibit altered sagittal and frontal plane kinematics as well as altered muscle force production during level gait compared to controls. These findings will help guide future research into gait alterations in FAI and how such alterations may contribute to pathologic progression and furthermore, how such alterations can be modified for therapeutic benefit. LEVEL OF EVIDENCE Systematic review of Level III studies.
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Affiliation(s)
- William Yarwood
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Karadi Hari Sunil Kumar
- Specialty Registrar, Addenbrooke's - Cambridge University Hospital, Cambridge, United Kingdom
| | - K C Geoffrey Ng
- MSk Lab, Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Vikas Khanduja
- Addenbrooke's - Cambridge University Hospital, Cambridge, United Kingdom.
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Seyedpour SM, Nafisi S, Nabati M, Pierce DM, Reichenbach JR, Ricken T. Magnetic Resonance Imaging-based biomechanical simulation of cartilage: A systematic review. J Mech Behav Biomed Mater 2021; 126:104963. [PMID: 34894500 DOI: 10.1016/j.jmbbm.2021.104963] [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: 09/05/2020] [Revised: 10/30/2021] [Accepted: 11/06/2021] [Indexed: 11/19/2022]
Abstract
MRI-based mathematical and computational modeling studies can contribute to a better understanding of the mechanisms governing cartilage's mechanical performance and cartilage disease. In addition, distinct modeling of cartilage is needed to optimize artificial cartilage production. These studies have opened up the prospect of further deepening our understanding of cartilage function. Furthermore, these studies reveal the initiation of an engineering-level approach to how cartilage disease affects material properties and cartilage function. Aimed at researchers in the field of MRI-based cartilage simulation, research articles pertinent to MRI-based cartilage modeling were identified, reviewed, and summarized systematically. Various MRI applications for cartilage modeling are highlighted, and the limitations of different constitutive models used are addressed. In addition, the clinical application of simulations and studied diseases are discussed. The paper's quality, based on the developed questionnaire, was assessed, and out of 79 reviewed papers, 34 papers were determined as high-quality. Due to the lack of the best constitutive models for various clinical conditions, researchers may consider the effect of constitutive material models on the cartilage disease simulation. In the future, research groups may incorporate various aspects of machine learning into constitutive models and MRI data extraction to further refine the study methodology. Moreover, researchers should strive for further reproducibility and rigorous model validation and verification, such as gait analysis.
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Affiliation(s)
- S M Seyedpour
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Pfaffenwaldring 27, 70569 Stuttgart, Germany; Biomechanics Lab, Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Pfaffenwaldring 27, 70569 Stuttgart, Germany
| | - S Nafisi
- Faculty of Pharmacy, Istinye University, Maltepe, Cirpici Yolu B Ck. No. 9, 34010 Zeytinburnu, Istanbul, Turkey
| | - M Nabati
- Department of Mechanical Engineering, Faculty of Engineering, Boğaziçi University, 34342 Bebek, Istanbul, Turkey
| | - D M Pierce
- Department of Mechanical Engineering, University of Connecticut, 191 Auditorium Road, Unit 3139, Storrs, CT, 06269, USA; Department of Biomedical Engineering, University of Connecticut, 260 Glenbrook Road, Unit 3247, Storrs, CT, 06269, USA
| | - J R Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany; Center of Medical Optics and Photonics, Friedrich Schiller University Jena, Germany; Michael Stifel Center for Data-driven and Simulation Science Jena, Friedrich Schiller University Jena, Germany
| | - T Ricken
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Pfaffenwaldring 27, 70569 Stuttgart, Germany; Biomechanics Lab, Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Pfaffenwaldring 27, 70569 Stuttgart, Germany.
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10
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Mayes S, Smith P, Stuart D, Semciw A, Cook J. Hip Joint Cartilage Defects in Professional Ballet Dancers: A 5-year Longitudinal Study. Clin J Sport Med 2021; 31:e335-e341. [PMID: 32079824 DOI: 10.1097/jsm.0000000000000818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A causal link between ballet, hip pain, and pathology has not been established. Change in ballet dancers' hip pain and cartilage defect scores were investigated over 5 years. DESIGN Longitudinal. SETTING Professional ballet company. PARTICIPANTS Twenty-one professional ballet dancers (52% men). INDEPENDENT VARIABLES Baseline and follow-up Copenhagen Hip and Groin Outcome Score (HAGOS-pain subscale); incidence of hip-related pain and levels of dance participation collected daily over 5 years; bony morphology measured on baseline 3T magnetic resonance imaging (MRI). MAIN OUTCOME MEASURE Change in cartilage defect score on MRI between baseline and 5-year follow-up. RESULTS Cartilage scores did not increase in 19 (90%) dancers. There was one new cartilage defect and one progressed in severity. At follow-up, all 6 dancers with cartilage defects were men. Group HAGOS pain scores were high 97.5 (7.5) and not related to cartilage defects (P = 0.12). Five (83%) dancers with baseline cartilage defects reported HAGOS pain scores <100 at follow-up. There were no time-loss hip injuries over 5 years. Two (33%) dancers with cartilage defects recorded hip-related pain (one reported minor training modification). Femoral neck-shaft angles (NSAs) were lower in men with cartilage defects [129.3 degrees (3.4 degrees)] compared with those without cartilage defects [138.4 degrees (4.5 degrees); P = 0.004]. CONCLUSIONS Elite level ballet did not negatively affect cartilage health over 5 years. Cartilage defects were related to low femoral NSAs. Most cartilage defects did not progress and there was minimal impact on dance participation and pain levels. Longer follow-up is required to determine the long-term sequelae for those with cartilage defects. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Susan Mayes
- The Australian Ballet, Southbank, Victoria, Australia
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia ; and
| | - Peter Smith
- MIA East Melbourne Radiology, East Melbourne, Victoria, Australia
| | - Debbie Stuart
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia ; and
| | - Adam Semciw
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia ; and
| | - Jill Cook
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia ; and
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Zhang JY, Zhang HR, Tian DM, Wang F, Zhang H, Hu YC. Spherical center axial hinge knee prosthesis causes lower contact stress on tibial insert and bushing compared with biaxial hinge knee prosthesis. Knee 2021; 29:1-8. [PMID: 33524657 DOI: 10.1016/j.knee.2021.01.005] [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: 07/28/2020] [Revised: 10/09/2020] [Accepted: 01/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Motion axial system may affect contact stress of hinge knee prosthesis. However, it is unclear which axial system provides the better biomechanical effect. Therefore, the aim of this study was to compare the contact stress and stress distribution on the tibial insert and the bushing of hinge knee prostheses with a biaxial (BA) system and a spherical center axial (SA) system during a gait cycle. METHODS Three-dimensional finite-element (FE) models of the prostheses with different motion systems were included. The comparisons between experimental tests and FE analyses were performed to verify the models. Dynamic implicit FE analyses were performed to investigate the peak contact stresses and stress distributions on the tibial insert and the bushing. RESULTS The peak contact stresses on the tibial insert and the bushing of the BA prosthesis were higher than those of the SA prosthesis during most gait cycles. The contact time on the bushing is short in the SA prosthesis. The stress distributions on the superior surface of the tibial insert in the BA prosthesis were at the posterior side, but of the SA prosthesis were not fixed. CONCLUSION The SA prosthesis has a lower peak contact stress on tibial insert and bushing than the BA prosthesis; in addition, the SA prosthesis has a 'self-adjustment' mechanism which could disperse high stress on the tibial insert to decrease the risk of wear and damage. The comparison could help designers and surgeons to better understand the future design of rotating hinge knee prostheses which should be able to achieve multiaxial motion and complete weight bearing by the tibial condylar to transmit the axial force better.
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Affiliation(s)
- Jing-Yu Zhang
- Tianjin Hospital, Tianjin, China; Second Hospital of Tangshan, Hebei, China
| | - Hao-Ran Zhang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Dong-Mu Tian
- Beijing Weigao Yahua Artificial Joint Development Company, Beijing, China
| | | | - Hao Zhang
- Graduate School, Tianjin Medical University, Tianjin, China
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Abstract
➤Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability. ➤The zona orbicularis resists joint distraction (during neutral positions), and its aperture mechanism stabilizes the hip from adverse edge-loading (during extreme hip flexion-extension). ➤To preserve joint function and stability, it is important to minimize capsulotomy size and avoid disrupting the zona orbicularis, preserve the femoral head size and neck length, and only repair when or as necessary without altering capsular tensions. ➤It is not fully understood what the role of capsular tightness is in patients who have cam femoroacetabular impingement and if partial capsular release could be beneficial and/or therapeutic. ➤During arthroplasty surgery, a femoral head implant that is nearly equivalent to the native head size with an optimal neck-length offset can optimize capsular tension and decrease dislocation risk where an intact posterior hip capsule plays a critical role in maintaining hip stability.
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Affiliation(s)
- K C Geoffrey Ng
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jonathan R T Jeffers
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
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13
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CORR Insights®: Cam FAI and Smaller Neck Angles Increase Subchondral Bone Stresses During Squatting: A Finite Element Analysis. Clin Orthop Relat Res 2019; 477:1064-1065. [PMID: 30624318 PMCID: PMC6494339 DOI: 10.1097/corr.0000000000000603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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