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Tachibana T, Katagiri H, Matsuda J, Ozeki N, Watanabe T, Sekiya I, Jinno T. Biomechanical analysis of load distribution in porcine hip joints at different acetabular coverages. BMC Musculoskelet Disord 2024; 25:576. [PMID: 39049016 PMCID: PMC11267855 DOI: 10.1186/s12891-024-07701-w] [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: 03/14/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Developmental dysplasia of the hip causes secondary osteoarthritis. Finite element analysis suggests high hip joint contact pressure in patients with hip dysplasia and a reduction in contact pressure after periacetabular osteotomy. However, few biomechanical studies have examined the load distribution in the hip joint. This study aimed to investigate the biomechanical properties of load distribution in porcine hip joints at different acetabular coverages. METHODS Six porcine hip joints were analyzed using three models: 1) neutral coverage, 2) 15° under-coverage (defined as dysplasia model), and 3) 15° over-coverage created by varying the acetabular coverage. The load distribution was assessed using a pressure-mapping sensor system after applying a loading force of 100 N to the hip joint. RESULTS In the dysplasia model, the load was concentrated at the acetabular rim; in the neutral and over-coverage models, it was dispersed. The average contact pressure was significantly higher in the dysplasia model than in the neutral coverage model ([0.42 vs. 0.3 MPa]; p = 0.004). The contact area was significantly smaller in the dysplasia model than in the neutral coverage model ([250.7 vs. 345.0 mm2]; p = 0.004). No significant differences were observed in contact pressure or area between the neutral and over-coverage models. CONCLUSIONS Insufficient acetabular coverage in the dysplasia model demonstrated higher contact pressure and smaller contact area than the neutral model. Conversely, the contact pressure and area in the over-coverage model did not differ significantly from those in the normal model. Therefore, surgeons should note that acetabular coverage overcorrection has limited effect; normalization is crucial during periacetabular osteotomy.
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Affiliation(s)
- Tetsuya Tachibana
- Department of Orthopedic Surgery, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroki Katagiri
- Department of Orthopedic Surgery, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan.
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
| | - Junpei Matsuda
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Watanabe
- Department of Orthopedic Surgery, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopedic Surgery, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan
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Hatem M, Badejo M, McCarroll M, Feng R, Martin HD. The predominant insertion of the ischiofemoral ligament is a merging to the iliofemoral ligament as demonstrated on magnetic resonance arthrogram studies. Acta Radiol 2024:2841851241263584. [PMID: 39043148 DOI: 10.1177/02841851241263584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND The capsular ligaments at the hip joint work in synchrony with the acetabulum and femoral head for articular stability. There is a lack of understanding about ischiofemoral ligament (ISFL) anatomy and function. PURPOSE To assess the insertion of the ISFL in non-arthritic adult hips. MATERIAL AND METHODS A retrospective analysis was performed in 72 patients who underwent magnetic resonance arthrogram (MRA) for the assessment of hip pain. The distribution of the ISFL components, the thickness, and the insertion site were assessed by concomitantly using the axial oblique, coronal, and sagittal MRA images. RESULTS Two insertions of the ISFL anterior to the center of the femoral head were identified in 71 (99%) hips: (i) predominant anterior merging with the iliofemoral ligament as continuation of zona orbicularis, observed in all hips; and (ii) anterolateral junction of femoral neck and greater trochanter. Two ISFL parts (proximal and distal) were identified in 70 (97%) of the 72 studied hips. The proximal part was always thinner (mean 2.6 ± 0.7 mm) and originated from the ischium at the acetabular rim. The distal part was a continuation of the zona orbicularis, and the mean thickness was 6.7 ± 1.6 mm. Both parts merged as they coursed over the superior portion of the femoral head. CONCLUSION The predominant insertion of the ischiofemoral ligament is a merging to the iliofemoral ligament anteriorly. Surgical procedures such as hip arthroscopy involving the ISFL will affect the function of the iliofemoral ligament, and vice versa.
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Affiliation(s)
- Munif Hatem
- Hip Preservation Center, Baylor University Medical Center, Dallas, TX, USA
| | - Megan Badejo
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA
| | - Michael McCarroll
- Department of Radiology, Baylor University Medical Center, Dallas, TX, USA
| | - Richard Feng
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA
| | - Hal David Martin
- Hip Preservation Center, Baylor University Medical Center, Dallas, TX, USA
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Metz AK, Lewis DC, Froerer DL, Featherall J, Rosenthal RM, Khalil AZ, Aoki SK. Dysplastic Hips Have Decreased Iliofemoral Ligament Thickness on Coronal Sequences in Magnetic Resonance Imaging: A Matched Cohort Analysis. Arthroscopy 2024:S0749-8063(24)00417-1. [PMID: 38944323 DOI: 10.1016/j.arthro.2024.05.033] [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: 11/13/2023] [Revised: 05/18/2024] [Accepted: 05/30/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE To characterize hip capsule thickness on advanced imaging in patients with and without hip dysplasia and to also evaluate differences in capsular thickness between borderline and true dysplastic patients. METHODS Patients evaluated by the senior author for concerns of hip pathology from June 2020 to June 2021 were queried and images reviewed to determine dysplasia status by lateral center edge angle (LCEA) ≤ 25 degrees. A group of non-dysplastic patients was identified and matched for age, sex, and body mass index (BMI). Hip capsular thickness was quantified using MRI. A sub-analysis was conducted to compare true dysplastic patients (LCEA < 20°) to borderline dysplastic patients (LCEAs between 20 - 25°). Analysis included independent samples t-tests, Chi-square tests, and multivariable regression. RESULTS Eighty total patients were included, with a mean age of 31.8 ± 11.7 years, a mean BMI of 26.6 ± 6.5 points, and 70% (56) female patients. Dysplastic patients had a mean LCEA of 19.8 ± 4.3 degrees. Dysplastic individuals had decreased capsular thickness compared to their non-dysplastic controls (2.75 ± 0.96 vs 3.52 ± 1.22 mm, p = 0.003). Multivariable regression showed decreased capsular thickness associated with decreased LCEAs (β = 2.804, R = 0.432, p<0.001) and dysplasia (β = -0.709, R2 = 0.056, p = 0.004). Results of a sub-analysis of the dysplastic group examining differences between accepted definitions of borderline dysplasia and true dysplasia showed no significant differences in capsular thickness between the two groups (p = 0.379). CONCLUSIONS Patients with hip dysplasia were found to have thinner iliofemoral ligaments in the coronal plane on magnetic resonance imaging on magnetic resonance imaging. Further investigation is needed to evaluate any potential implications with hip instability given the thinner hip capsule demonstrated in this study.
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Affiliation(s)
- Allan K Metz
- University of Utah, Department of Orthopaedic Surgery, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Daniel C Lewis
- University of Utah, Department of Orthopaedic Surgery, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Devin L Froerer
- University of Utah, Department of Orthopaedic Surgery, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Joseph Featherall
- University of Utah, Department of Orthopaedic Surgery, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Reece M Rosenthal
- University of Utah, Department of Orthopaedic Surgery, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Ameen Z Khalil
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Stephen K Aoki
- University of Utah, Department of Orthopaedic Surgery, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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Hoffer AJ, St George SA, Lanting BA, Degen RM, Ng KCG. Hip Labral and Capsular Repair Are Unable to Restore Distractive Stability in a Biomechanical Model. Arthroscopy 2024:S0749-8063(24)00306-2. [PMID: 38697324 DOI: 10.1016/j.arthro.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 05/04/2024]
Abstract
PURPOSE To evaluate the change in hip distractive stability after a capsulotomy, labral tear, and simultaneous repair of both the capsule and the labrum in a biomechanical model. METHODS Ten fresh-frozen human cadaveric hips were analyzed using a materials testing system to measure the distractive force and distance required to disrupt the hip suction seal under the following conditions: (1) native intact capsule and labrum, (2) 2- or 4-cm interportal capsulotomy (IPC), (3) labral tear, (4) T extension, (5) labral repair, (6) T extension repair, and (7) IPC repair. Each specimen was retested at 0° of flexion, 45° of flexion, and 45° of flexion with 15° of internal rotation. RESULTS A significantly higher distractive force was required to rupture the suction seal in the intact condition compared with IPC (P = .012; 95% confidence interval [CI], 4.9-42.4); IPC and labral tear (P = .002; 95% CI, 11.3-49.4); IPC, labral tear, and T extension (P = .001; 95% CI, 13.9-51.5); IPC, labral repair, and T extension (P < .001; 95% CI, 20.8-49.7); IPC, labral repair, and T extension repair (P = .002; 95% CI, 12.5-52.4); and IPC repair, labral repair, and T extension repair (P = .01; 95% CI, 5.8-46.1). The IPC condition required a higher distractive force in isolation than when combined with a labral tear (P = .14; 95% CI, 1.2-12.0), T extension (P = .005; 95% CI, 2.8-15.3), or labral repair (P = .002; 95% CI, 4.4-18.8). CONCLUSIONS The distractive resistance of an intact hip capsule and labrum was not restored once the soft tissues were violated, despite labral repair with a loop technique and capsular repair with interrupted figure-of-8 sutures. CLINICAL RELEVANCE Time-zero complete capsular repair with concomitant labral repair may not be adequate to restore distractive hip stability after hip arthroscopy, reinforcing the use of postoperative precautions in the early postoperative period.
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Affiliation(s)
| | | | - Brent A Lanting
- Department of Surgery, Western University, London, Ontario, Canada
| | - Ryan M Degen
- Department of Surgery, Western University, London, Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada
| | - K C Geoffrey Ng
- Department of Surgery, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Medical Imaging, Western University, London, Ontario, Canada; Robarts Research Institute, Western University, London, Ontario, Canada.
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Mortensen AJ, Featherall J, Metz AK, Rosenthal RM, O’Neill DC, Froerer DL, Khalil AZ, Tomasevich KM, Aoki SK. The Role of the Hip Capsule in Restoring Stability in the Initial Phase of Hip Distraction: An In Vivo Analysis. Orthop J Sports Med 2024; 12:23259671241249719. [PMID: 38784788 PMCID: PMC11113053 DOI: 10.1177/23259671241249719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 05/25/2024] Open
Abstract
Background The labral suction seal has been shown to provide the majority of resistance in the initial phase of hip distraction. However, the effect of an unrepaired interportal capsulotomy and capsular repair on the initial phase of hip distractive stability in vivo is not well understood. Purpose To investigate the effect of capsular repair on the initial phase of distractive stability of hip joints in patients with femoroacetabular impingement (FAI) syndrome. Study Design Controlled laboratory study. Methods Patients undergoing primary hip arthroscopy for FAI between March and August 2020 were prospectively enrolled. Total joint space was measured on fluoroscopic images at the medial and lateral edges of the sourcil at 12.5-lb (5.7-kg) axial traction intervals (up to 100 lb [45.4 kg]) in 3 capsular states: (1) native capsule, (2) interportal capsulotomy, and (3) capsular repair. Distraction on anteroposterior radiographs was calculated as the difference between total joint space at each traction interval and baseline joint space at 0 lb, normalized to millimeters. The native, capsulotomy, and capsular repair states were compared using Wilcoxon signed-rank and McNemar tests. Results Included were 36 hips in 35 patients. The median force required to distract ≥3 mm was 75 lb (34.0 kg; 95% CI, 70-80 lb [31.8-36.3 kg]) in both the native and capsular repair states (P = .629), which was significantly greater than the median force required to distract ≥3 mm in the capsulotomy state (50 lb [22.7 kg]; 95% CI, 45-55 lb [20.4-24.9 kg]) (P < .001). The most rapid rates of change in joint space were observed at the traction interval at which hips first achieved ≥3 mm of distraction (n = 33 hips; 92%). Conclusion The traction force at which hips distracted ≥3 mm was 75 lb (34.0 kg) in both the native capsular and capsular repair states. Significantly less traction force (50 lb [22.7 kg]) distracted hips ≥3 mm in the capsulotomy state. Complete capsular closure after interportal capsulotomy resulted in restoration of initial distractive stability relative to the unrepaired capsulotomy state at time zero after primary hip arthroscopy. Clinical Relevance This study provides surgeons with an improved understanding of the additional stability to the hip joint from capsular repair after hip arthroscopy for FAI syndrome.
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Affiliation(s)
| | - Joseph Featherall
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Allan K. Metz
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Reece M. Rosenthal
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Dillon C. O’Neill
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Devin L. Froerer
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ameen Z. Khalil
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | | | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
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6
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Hoffer AJ, Beel W, Ng KCG, Degen RM. The Contribution of Soft Tissue and Bony Stabilizers to the Hip Suction Seal: A Systematic Review of Biomechanical Studies. Am J Sports Med 2024:3635465231208193. [PMID: 38318815 DOI: 10.1177/03635465231208193] [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] [Indexed: 02/07/2024]
Abstract
BACKGROUND Previous biomechanical studies have identified capsular closure, labral repair or reconstruction, and osteochondroplasty as important surgical interventions to improve hip stability. PURPOSE To investigate the outcome metrics used to quantify hip stability and assess and measure the relative contributions of the labrum, capsule, and bone to hip stability through a quantitative analysis. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS PubMed and Embase databases were searched using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies evaluated cadaveric hip biomechanics related to capsular, labral, and bony management during hip arthroscopy. Studies were assessed for distraction force and distance, fluid measures, and contact forces used to quantify the suction seal. Exclusion criteria included open surgery, arthroplasty, reorientation osteotomy, or traumatic dislocation. RESULTS A total of 33 biomechanical studies comprising 322 hips that evaluated 1 or more of the following were included: distraction force or distance (24 studies), fluid measures (10 studies), and contact forces (6 studies). Compared with a capsulotomy or capsulectomy, capsular repair or reconstruction demonstrated greater resistance to distraction (standardized mean difference [SMD], 1.13; 95% CI, 0.46-1.80; P = .0009). Compared with a labral tear, a labral repair or reconstruction demonstrated less resistance to distraction (SMD, -0.67; 95% CI, -1.25 to -0.09; P = .02). Compared with a labral debridement, repair or reconstruction demonstrated greater resistance to distraction (SMD, 1.74; 95% CI, 1.23 to 2.26; P < .00001). No quantitative analysis was feasible from studies evaluating the effect of osseous resection due to the heterogeneity in methodology and outcome metrics assessed. CONCLUSION Most biomechanical evidence supports capsulotomy repair or reconstruction to improve hip distractive stability at the end of hip arthroscopic surgery. While the repair of a torn labrum does not improve distractive resistance, it is superior to labral debridement in most biomechanical studies.
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Affiliation(s)
- Alexander J Hoffer
- Department of Surgery, The University of Western Ontario, London, Ontario, Canada
- Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada
| | - Wouter Beel
- Department of Surgery, The University of Western Ontario, London, Ontario, Canada
- Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada
| | - K C Geoffrey Ng
- Department of Surgery, The University of Western Ontario, London, Ontario, Canada
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada
- Department of Medical Imaging, The University of Western Ontario, London, Ontario, Canada
- Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Ryan M Degen
- Department of Surgery, The University of Western Ontario, London, Ontario, Canada
- Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada
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Maldonado DR, Owens JS, George T, Curley AJ, Domb BG. Acetabular Labral Reconstruction Does Not Demonstrate Superior Biomechanical Properties Compared to Labral Repair or Intact Native Labrum but Is Superior to Labral Excision: A Systematic Review of Cadaveric Studies. Arthroscopy 2024; 40:614-629. [PMID: 37270115 DOI: 10.1016/j.arthro.2023.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To systematically review and compare biomechanical properties of labral reconstruction to labral repair, intact native labrum, and labral excision in cadaveric studies. METHODS A search of the PubMed and Embase databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Cadaveric studies focused on hip biomechanics related to intact labrum, labral repair, labral reconstruction, labral augmentation, and labral excision were included. Investigated parameters included biomechanical data measures, such as distraction force, distance to suction seal rupture, peak negative pressure, contact area, and fluid efflux. Review articles, duplicates, technique reports, case reports, opinion articles, articles written in a language other than English, clinical studies focusing on patient-reported outcomes, studies performed in animals, and articles with no abstract available were also excluded. RESULTS Fourteen cadaveric biomechanical studies were included that compared labral reconstruction to labral repair (4 studies), labral reconstruction to labral excision (4 studies); and evaluation of distractive force of the labrum (3 studies), the distance to suction seal rupture (3 studies), fluid dynamics (2 studies), displacement at peak force (1 study), and stability ratio (1 study). Data pooling was not performed because of methodological heterogenicity of the studies. Labral reconstruction did not outperform labral repair in restoring the hip suction seal or any other biomechanical property. Labral repair significantly prevented greater fluid efflux when compared to labral reconstruction. Labral repair and reconstruction improved the distractive stability of the hip fluid seal from the labral tear and labral excision stage, respectively. Furthermore, labral reconstruction demonstrated to have better biomechanical properties than labral excision. CONCLUSIONS In cadaveric studies, labral repair or intact native labrum was biomechanically more superior than labral reconstruction; however, labral reconstruction can restore acetabular labral biomechanical properties and was biomechanically superior to labral excision. CLINICAL RELEVANCE In cadaveric models, labral repair outperforms segmental labral reconstruction in preserving the hip suction seal; nonetheless, segmental labral reconstruction biomechanically outperforms labral excision at time 0.
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Affiliation(s)
- David R Maldonado
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Tracy George
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew J Curley
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A..
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Kolaczko JG, Wait T, Stevanovic O, Orahovats A, Griffith E, Genuario JW. A Modified "Shuttle" Method Technique for Arthroscopic Hip Capsular Reconstruction in Capsular Deficiency. Arthrosc Tech 2023; 12:e1479-e1485. [PMID: 37780666 PMCID: PMC10533681 DOI: 10.1016/j.eats.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/18/2023] [Indexed: 10/03/2023] Open
Abstract
The hip capsule has been recognized as a vital structure in the stability and proper function of the hip. Preserving its integrity during arthroscopic surgery is one of the utmost important principles in hip preservation surgery. When capsular deficiency is present, capsular reconstruction may be indicated to restore stability and proper hip mechanics. In this technical note, we introduce a simple and reproducible shuttle method technique for hip capsular reconstruction using a dermal allograft.
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Affiliation(s)
- Jensen G. Kolaczko
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
- Steadman Hawkins Clinic Denver, Cleveland, Ohio, U.S.A
| | - Trevor Wait
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
| | - Ognjen Stevanovic
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
| | - Alexandra Orahovats
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
| | - Eric Griffith
- Steadman Hawkins Clinic Denver, Cleveland, Ohio, U.S.A
| | - James W. Genuario
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
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9
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Melugin HP, Comfort SM, Shelton TS, Day HK, Ruzbarsky JJ, Dornan GJ, Philippon MJ. The revision hip arthroscopy complex: capsular deficiency, labral deficiency, femoral over-resection and adhesions can result in good survivorship with revision hip arthroscopy. J Hip Preserv Surg 2023; 10:197-203. [PMID: 38162272 PMCID: PMC10757422 DOI: 10.1093/jhps/hnad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 06/18/2023] [Accepted: 08/16/2023] [Indexed: 01/03/2024] Open
Abstract
To evaluate the patient-reported outcomes (PROs) and survivorship of combined arthroscopic hip labral reconstruction/augmentation, capsular reconstruction, femoral neck remplissage and lysis of adhesions. Patients ≥18 years old who underwent this combination of procedures during revision hip arthroscopy and were eligible for minimum 2-year follow-up were identified. PRO scores including Hip Outcome Score (HOS)-Activities of Daily Living scale, HOS-Sports scale, modified Harris Hip Score, Short Form 12, and Western Ontario & McMaster Universities Osteoarthritis Index, patient satisfaction and failure rates were analyzed. Seven patients (5 females and 2 males) with average age of 45.0 ± 5.2 (range: 40-54 years) met inclusion criteria. Patients had a median of 1 (range: 1-3) prior hip surgery at an outside institution. All patients had previously undergone femoral osteoplasty, and 85% (6/7) of patients had a labral repair performed. Four patients had no capsule closure performed in their prior procedures. Six patients were available for minimum 2-year follow-up. Two patients converted to total hip arthroplasty: one patient with four prior hip arthroscopies and the other had advanced osteoarthritis with outerbridge grade 3/4 defects requiring microfracture. Mean patient satisfaction was 7 (range: 2-9). At mean follow-up of 3 years, most patients who underwent the combination of labral reconstruction, capsular reconstruction, femoral neck remplissage and lysis of adhesions during revision hip arthroscopy demonstrated improved PROs. This salvage procedure has the potential to restore hip function in patients who have failed an initial hip arthroscopy procedure. In patients with these pathologies present and concomitant joint space narrowing, a total hip arthroplasty may be a more appropriate salvage option.
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Affiliation(s)
- Heath P Melugin
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
- Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, 181 W Meadow Dr, Ste 400, Vail, CO 81657, USA
| | - Spencer M Comfort
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
| | - Trevor S Shelton
- Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, 181 W Meadow Dr, Ste 400, Vail, CO 81657, USA
| | - Hannah K Day
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
| | - Joseph J Ruzbarsky
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
- Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, 181 W Meadow Dr, Ste 400, Vail, CO 81657, USA
| | - Grant J Dornan
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
| | - Marc J Philippon
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
- Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, 181 W Meadow Dr, Ste 400, Vail, CO 81657, USA
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10
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Mortensen AJ, Metz AK, Featherall J, O’Neill DC, Rosenthal RM, Aoki SK. Hip Joint Venting Decreases the Traction Force Required to Access the Central Compartment During Hip Arthroscopy. Arthrosc Sports Med Rehabil 2023; 5:e589-e596. [PMID: 37388887 PMCID: PMC10300549 DOI: 10.1016/j.asmr.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/19/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To investigate the effect of hip joint venting on the magnitude of traction force required to arthroscopically access the central compartment of the hip. Methods Patients who underwent hip arthroscopy for femoroacetabular impingement syndrome prospectively underwent an intraoperative traction protocol. Joint space was measured on fluoroscopic images obtained at 50 and 100 lbs of axial traction in the prevented and vented state, and joint space values were normalized to millimetric values using preoperative anteroposterior pelvis radiographs. Venting was performed by inserting a large gauge spinal needle into the hip joint through the hip capsule and removing the stylet. Joint space differences were compared with paired t-tests, Wilcoxon signed-rank tests, and McNemar tests. Results Fifty hips in 46 patients were included. Mean joint space before venting was 7.4 ± 2.6 mm and 13.3 ± 2.8 mm at 50 and 100 lbs of traction, respectively. Mean joint space after venting was 13.9 ± 2.3 mm and 15.5 ± 2.4 mm at 50 and 100 lbs of traction, respectively. Mean differences in joint space at 50 and 100 lbs were 6.5 mm (P < .001) and 2.2 mm (P < .001), respectively. Mean joint space at 50 lbs in the vented state was significantly greater than in the pre-vented state at 100 lbs (13.9 mm vs. 13.3 mm; P = .002). The increase in joint space between 50 and 100 lbs of traction was significantly greater in the prevented state than in the vented state (5.9 mm vs 1.6 mm; P = .021). Conclusions Venting the hip reduces the traction force necessary to arthroscopically visualize and instrument the central compartment of the hip by at least 50%. Further, residual negative pressurization of the hip joint remains after breaking the labral suction seal and venting effectively eliminates this phenomenon to aid in hip joint distraction at lower traction force. Level of Evidence Level IV, case series.
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Affiliation(s)
| | | | | | | | | | - Stephen K. Aoki
- Address correspondence to Stephen K. Aoki, M.D., Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108
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Mameri ES, Batra AK, Kerzner B, Jackson GR, Jawanda H, Khan ZA, Chahla J. Hip Capsular Reconstruction With Indirect Head of the Rectus Femoris Tendon. Arthrosc Tech 2023; 12:e503-e509. [PMID: 37138681 PMCID: PMC10149979 DOI: 10.1016/j.eats.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/03/2022] [Indexed: 05/05/2023] Open
Abstract
Hip capsulotomy is performed during arthroscopic hip procedures to achieve adequate visualization of the joint and instrument access. The hip capsule, and in particular the iliofemoral ligament, is an important stabilizer of the hip joint, and patients who undergo capsulotomy without subsequent repair may experience hip pain and instability, with increased risk of requiring revision hip arthroscopy. Therefore, restoring watertight closure of the capsule is necessary to restore native biomechanics and achieve desired postoperative outcomes. Although primary repair or plication suffice in most cases, capsule reconstruction may instead be necessary when there is insufficient tissue, often due to capsular insufficiency following index surgery. The purpose of this Technical Note is to describe the authors' current technique for arthroscopic hip capsular reconstruction using the indirect head of the rectus femoris tendon in the setting of capsular iatrogenic hip instability, as well as its advantages and disadvantages and technical pearls and pitfalls.
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Affiliation(s)
- Enzo S. Mameri
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
- Escola Paulista de Medicina, Federal University of São Paulo, São Paulo - SP, Brazil
- Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro - RJ, Brazil
| | - Anjay K. Batra
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benjamin Kerzner
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Garrett R. Jackson
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Harry Jawanda
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Zeeshan A. Khan
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
- Address correspondence to Jorge Chahla, M.D., Ph.D., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Suite 300, Chicago, IL 60612
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Metz AK, Featherall J, Froerer DL, Mortensen AJ, Tomasevich KM, Aoki SK. Female Patients and Decreased Hip Capsular Thickness on Magnetic Resonance Imaging Associated With Increased Axial Distraction Distance on Examination Under Anesthesia: An In Vivo Study. Arthroscopy 2022; 38:3133-3140. [PMID: 35550416 DOI: 10.1016/j.arthro.2022.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the relation of hip capsular thickness as measured on preoperative magnetic resonance imaging (MRI) and intraoperative hip joint axial distraction distance on an examination under anesthesia. METHODS A retrospective review of primary arthroscopic hip procedures performed between November 2018 and June 2021 was conducted. The inclusion criteria included a diagnosis of femoroacetabular impingement syndrome and preoperative radiographic imaging and MRI. Fluoroscopic images were obtained at 0 lb and 100 lb of axial traction force. Total distraction distance was calculated by comparing the initial joint space with the total joint space at 100 lb. Hip capsular thickness was measured on MRI. Analysis was conducted using multiple linear regression, independent-samples t tests, and Mann-Whitney U tests. RESULTS Eighty patients were included. Bivariable regression showed an association between an increased distraction distance and female sex (β = 4.303, R = 0.561, P < .001), as well as decreased anterior axial (β = -1.291, R = 0.365, P < .001) and superior coronal (β = -1.433, R = 0.501, P < .001) capsular thickness. Multivariable regression (R = 0.645) showed an association between an increased distraction distance and female sex (β = 3.175, P < .001), as well as decreased superior coronal capsular thickness (β = -0.764, P = .022). Independent-samples t tests showed that female patients had significantly decreased superior coronal capsular thickness (2.92 ± 1.14 mm vs 3.99 ± 1.15 mm, P < .001). CONCLUSIONS Female sex and decreased hip capsular thickness in the superior aspect of the coronal plane on magnetic resonance scans were found to be predictors of increased hip joint axial distraction distance on examination under anesthesia prior to hip arthroscopy, with anterior axial capsular thickness being a moderate predictor. Poor predictors of distraction distance were posterior axial and inferior coronal capsular thickness, age, body mass index, and lateral center-edge angle. Female patients were also found to have thinner hip capsules in the superior region, which may explain the association between female patients and increased distraction. These findings further characterize the relation between capsular thickness and hip laxity. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Allan K Metz
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Joseph Featherall
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Devin L Froerer
- School of Medicine, University of Utah, Salt Lake City, Utah, U.S.A
| | | | - Kelly M Tomasevich
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Stephen K Aoki
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A..
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Maldonado DR, Banffy MB, Huang D, Nelson TJ, Kanjiya S, Metzger MF. An Increased Allograft Width for Circumferential Labral Reconstruction Better Restores Distractive Stability of the Hip: A Cadaveric Biomechanical Analysis. Am J Sports Med 2022; 50:2462-2468. [PMID: 35722810 DOI: 10.1177/03635465221101126] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Questions remain about whether circumferential labral reconstruction (CLR) using an iliotibial band (ITB) allograft can effectively restore the labral suction seal of the hip. HYPOTHESES (1) CLR with an ITB allograft >6.5 mm would restore distractive stability force to that of the intact labrum. (2) CLR with an ITB allograft >6.5 mm would achieve significantly superior distractive stability force compared with CLR with an ITB allograft <6.5 mm. STUDY DESIGN Controlled laboratory study. METHODS A total of 6 fresh-frozen pelves with attached femurs (n = 12 matched hemipelves) from male donors were procured and dissected free of all soft tissue, including the hip capsule but preserving the native labrum, transverse acetabular ligament, and ligamentum teres. Potted hemipelves were placed in a saline bath and securely fixed to the frame of a hydraulic testing system. A 500-N compressive load was applied, followed by femoral distraction at a rate of 5.0 mm/s until the suction seal ruptured. Force and femoral displacement were continually recorded. Force versus displacement curves were plotted, the maximum force was recorded, and the amount of femoral distraction to rupture the suction seal was determined. After intact testing, the labrum was excised, and specimens were retested using the same protocol. CLR was subsequently performed twice in a randomized fashion using (1) an ITB allograft with a width >6.5 mm (7.5-9.0 mm) and (2) an ITB allograft with a width <6.5 mm (4.5-6.0 mm). Specimens were retested after each CLR procedure. Force (in Newtons) and femoral distraction (in millimeters) required to rupture the suction seal were measured and compared between the 4 testing states (intact, deficient, CLR <6.5 mm, and CLR >6.5 mm) using repeated-measures analysis of variance. RESULTS On average, intact specimens required 148.4 ± 33.1 N of force to rupture the hip suction seal, which significantly decreased to 44.3 N in the deficient state (P < .001). CLR with ITB allografts <6.5 mm did not improve the maximum force (63 ± 62 N) from the deficient state (P = .42) and remained significantly lower than the intact state (P < .01). CLR with ITB allografts >6.5 mm recorded significantly greater force to rupture the suction seal (135.8 ± 44.6 N) compared with both the deficient and CLR <6.5 mm states (P < .01), with a mean force comparable with the intact labrum (P = .59). The amount of femoral distraction to rupture the suction seal demonstrated similar findings. CONCLUSION In a cadaveric model, CLR using ITB allografts >6.5 mm restored the distractive force and distance to the suction seal rupture to values comparable with hips with an intact labrum. CLR using ITB allografts >6.5 mm outperformed CLR with ITB allografts <6.5 mm, demonstrated by a significantly higher force to rupture the suction seal and increased distraction before the rupture. CLINICAL RELEVANCE The results of this cadaveric investigation suggest that using wider labral allografts during CLR will provide the distractive force required to rupture the suction seal and immediate postoperative stability of the hip, although further studies are required to determine if these results translate to improved clinical outcomes.
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Affiliation(s)
| | - Michael B Banffy
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - Dave Huang
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Trevor J Nelson
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shrey Kanjiya
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - Melodie F Metzger
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Ruzbarsky JJ, Seiter MN, Comfort SM, Soares RW, Briggs KK, Philippon MJ. Arthroscopic Hip Capsular Reconstruction Using Iliotibial Band Allograft as a Salvage Option for Unrepairable Capsular Defects Demonstrates Good Survivorship and Improved Patient-Reported Outcomes. Arthroscopy 2022; 38:2219-2226. [PMID: 34990758 DOI: 10.1016/j.arthro.2021.12.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe patient outcomes 3 to 5 years after arthroscopic hip capsule reconstruction. METHODS Between January 2007 and December 2016, patients aged 18 to 50 years who underwent arthroscopic hip capsular reconstruction using an Iliotibial band allograft by the senior author and had minimum of 3-year follow-up were identified. Patients were excluded if they had previous open hip surgery, advanced osteoarthritis (Tönnis grade >2), significant acetabular dysplasia (lateral center edge angle <20°), avascular necrosis, or Legg-Calve-Perthes disease. Outcome scores including the Hip Outcome Score (HOS)-Activities of Daily Living scale, modified Harris Hip Score, HOS-Sports scale, SF-12, and Western Ontario & McMaster Universities Osteoarthritis Index were compared in addition to failure rate, revision rate, and patient satisfaction rate with the outcome (range, 1-10). All patients were assessed by the senior author pre- and postoperatively. RESULTS Thirty-nine patients met the inclusion criteria. The mean age of the cohort was 32 ± 10 years, with 6 male and 33 female patients. The average number of previous hip arthroscopy surgeries was 2 ± 1. Six patients (15%) converted to total hip arthroplasty at an average of 2.1 years (range 7 months to 6 years) following capsular reconstruction. Four patients required revision hip arthroscopy after the arthroscopic capsular reconstruction. All arthroscopic revisions occurred in female patients with the primary intraoperative finding of capsulolabral adhesions at the time of revision. At mean follow-up of 4.3 years (range 3-6.8 years), the 29 patients who did not require subsequent surgery had significant improvements from preoperatively to postoperatively in HOS-Activities of Daily Living and HOS-Sport with 90% reaching minimal clinically important difference. All other scores showed significant improvement. Survival for patients not requiring total hip arthroplasty was 86% at 3 years, with a mean survival of 5.7 years (95% confidence interval 4.97-6.4). CONCLUSIONS Arthroscopic hip capsular reconstruction with iliotibial band allograft is a successful treatment option for patients with symptomatic capsular defects, demonstrating improved patient-reported outcomes maintained at mean follow-up time of 4 years. This technique offers restoration of the anatomic structure and function of the capsular ligaments to improve pain and instability. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Joseph J Ruzbarsky
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, U.S.A
| | - Max N Seiter
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, U.S.A
| | | | - Rui W Soares
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Karen K Briggs
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, U.S.A..
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Mortensen AJ, Tomasevich KM, Ohlsen SM, O'Neill DC, Featherall J, Aoki SK. Previous Arthroscopic Hip Surgery Increases Axial Distractibility Compared to the Native Contralateral Hip and May Suggest Instability. Arthroscopy 2022; 38:1466-1477. [PMID: 34582993 DOI: 10.1016/j.arthro.2021.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/04/2021] [Accepted: 09/20/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare intraoperative hip joint distractibility between hips that previously underwent arthroscopic surgery and the contralateral hip with no history of surgical manipulation. METHODS Patients undergoing revision hip arthroscopy between April 2019 and December 2020, who previously underwent arthroscopic hip surgery for femoroacetabular impingement syndrome, were prospectively enrolled. Exclusion criteria were any contralateral hip surgery. Before instrumentation, fluoroscopic images of both hips were obtained at 25 lbs traction intervals up to 100 lbs. Total joint space was measured at each traction interval. Distraction was calculated as the difference between the baseline joint space and the total joint space at each subsequent traction interval. Wilcoxon signed ranks tests and McNemar tests were used to compare distraction between revision and native contralateral hips. RESULTS Forty-seven patients were included. Mean distraction of operative hips was significantly greater than mean distraction of nonoperative hips at traction intervals of 50 lbs (2.13 vs 1.04 mm, P = .002), 75 lbs (6.39 vs 3.70 mm, P < .001), and 100 lbs (8.24 vs 5.39, P < .001). Mean total joint space of operative hips was significantly greater than mean total joint space of nonoperative hips at traction intervals of 50 lbs (6.60 vs 5.39 mm, P < .001), 75 lbs (10.86 vs 8.05 mm, P < .001), and 100 lbs (12.73 vs 9.73, P < .001). A greater percentage of operative hips achieved all distraction thresholds, in 2-mm intervals up to 10-mm, at each traction interval. CONCLUSIONS In the majority of patients undergoing revision hip arthroscopy, previous arthroscopic hip surgery increases axial distractibility of the hip joint compared with the native contralateral hip at axial traction forces of 50-100 lbs. Increased axial distractibility following hip arthroscopy may be suggestive of hip instability and can be assessed on a stress examination with the patient under anesthesia. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
| | - Kelly M Tomasevich
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Suzanna M Ohlsen
- School of Medicine, University of Utah, Salt Lake City, Utah, U.S.A
| | - Dillon C O'Neill
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Joseph Featherall
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A..
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16
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Jimenez AE, Lee MS, George T, Owens JS, Maldonado DR, Saks BR, Lall AC, Domb BG. Effect of Cigarette Smoking on Outcomes in Patients Undergoing Primary Hip Arthroscopy and Labral Reconstruction: A Propensity-Matched Controlled Study With Minimum 2-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221075642. [PMID: 35237697 PMCID: PMC8882953 DOI: 10.1177/23259671221075642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: There is a paucity of literature evaluating the effect of cigarette smoking
on outcomes in patients undergoing hip arthroscopy and labral
reconstruction. Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores for
patients who smoke cigarettes and underwent primary hip arthroscopic labral
reconstruction and (2) to compare these results with those of a
propensity-matched control group of patients who have never smoked. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected for all patients who underwent primary hip arthroscopy
for labral reconstruction between January 2011 and January 2019. Patients
were eligible for the study if they indicated that they smoked cigarettes
within 1 month of surgery and had minimum 2-year postoperative outcome
scores for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score
(NAHS), and the visual analog scale (VAS) for pain. The percentage of
patients achieving the minimal clinically important difference (MCID) and
patient-acceptable symptom state (PASS) was recorded. Rates of revision
surgery were also documented. These patients were then propensity matched in
a 1:3 ratio to patients who had never smoked (controls) for comparison. Results: A total of 20 patients (20 hips) were included with a mean follow-up of 39.9
± 13.0 months and mean age of 41.4 ± 10.4 years. These patients demonstrated
significant improvement from preoperatively to the minimum 2-year follow-up
for mHHS, NAHS, and VAS (P < .05). They also achieved
MCID for mHHS and VAS at acceptable rates, 70% for both. When outcomes were
compared with those of 60 control patients (60 hips), patients who smoke
demonstrated lower preoperative PRO scores but similar minimum 2-year
postoperative PRO scores for mHHS and NAHS. Patients who smoke demonstrated
lower rates of achieving PASS for mHHS (55% vs 75%) and NAHS (40% vs 61.7%)
compared with controls; however, these findings were not statistically
significant. Rates of secondary surgery were statistically significantly
higher in the smoking group compared with controls (25% vs 5%;
P = .031). Survivorship for the smoking patients was
80% and 98.3% for the control group. At the two-year mark survivorship was
90% for the smoking group and 100% for the control group (P
= .06) Conclusion: While smokers can still derive significant improvement from hip arthroscopy,
their ultimate functional outcome and rate of secondary surgeries are
inferior to those of nonsmokers. As smoking is a significant and modifiable
risk factor, we should continue to counsel smokers on smoking cessation
prior to and after surgery
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Affiliation(s)
| | - Michael S. Lee
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Tom George
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S. Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Benjamin R. Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C. Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
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Ankem HK, Ouyang VW, Saks BR, Jimenez AE, Sabetian PW, Maldonado DR, Lall AC, Domb BG. Is there enough evidence to support hip capsular reconstruction? A systematic review of biomechanical studies. J Hip Preserv Surg 2021; 8:156-163. [PMID: 35145712 PMCID: PMC8826158 DOI: 10.1093/jhps/hnab059] [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: 04/22/2021] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to review and summarize the available biomechanical data on hip capsular reconstruction to guide clinical decision-making. A literature search was completed in December 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify biomechanical cadaver studies on hip capsular reconstruction, hip capsulectomy or hip capsular defect. The investigated parameters included maximum distraction force, capsular state affecting range of motion (ROM), rotation and translation. Four studies met al. the inclusion–exclusion criteria. The median effective force for resisting maximum distraction for the reconstruction state, capsular defect state and the intact state was 171, 111 and 206 N, respectively. The defect capsule force was significantly lower (P = 0.00438) than the intact capsule force. The reconstruction state had a higher distraction force than that of the capsular defect, but due to heterogeneity, the overall effect size was not statistically significant. The capsular reconstruction state reduced excess motion and the degree of instability compared to the capsular defect state but restored the hip close to its native capsular state in the cadaveric model. When compared to capsulectomy/defect state, hip capsular reconstruction significantly improved the rotational stability and effective force at maximum distraction and minimized translation. However, no conclusions can be made regarding the most effective protocol due to the high heterogeneity between the four studies. Further biomechanical studies are needed to test various types of grafts under the same protocol.
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Affiliation(s)
- Hari K Ankem
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
| | - Vivian W Ouyang
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
| | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
- AMITA Health St. Alexius Medical Center, Hoffman Estates, IL 60169, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
| | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
| | | | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
- American Hip Institute, Chicago, IL 60018, USA
- AMITA Health St. Alexius Medical Center, Hoffman Estates, IL 60169, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
- American Hip Institute, Chicago, IL 60018, USA
- AMITA Health St. Alexius Medical Center, Hoffman Estates, IL 60169, USA
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Jimenez AE, Owens JS, Shapira J, Saks BR, Ankem HK, Sabetian PW, Lall AC, Domb BG. Hip Capsular Management in Patients With Femoroacetabular Impingement or Microinstability: A Systematic Review of Biomechanical Studies. Arthroscopy 2021; 37:2642-2654. [PMID: 33940133 DOI: 10.1016/j.arthro.2021.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/16/2020] [Accepted: 04/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the correlation between hip capsular management (repair or reconstruction) and biomechanical results in the setting of femoroacetabular impingement and microinstability. METHODS A search of the PubMed and Embase databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies focused on hip biomechanics related to capsular release, repair of I- and T-capsulotomy, or capsular reconstruction. Studies were assessed for external/internal rotation of the femur, femoral head translation, rotational torque, and distraction force. Articles were excluded if they discussed treatment of the hip capsule related to surgical dislocation, mini-open surgery, arthroplasty, reorientation osteotomy, or traumatic dislocation. RESULTS Twenty-four biomechanical studies were included that evaluated rotation/translation (11 studies), distraction (3 studies), the capsular role in microinstability (simulated with anterior capsule pie crusting [2 studies] and cyclical loading [2 studies]), allograft reconstruction (3 studies), and anatomic properties (3 studies). Repair and reconstruction demonstrated improvements in maximum distractive force, total ROM, and torsional stability when compared to capsular release. Significant differences were observed between capsular repair and release in total ROM in the coronal plane with improved stability in the repair groups (standardized mean difference [SMD]: -1.3°, 95% confidence interval [CI] -1.68 , -0.854; P < .001). There was significantly increased total motion in the coronal plane in the capsular laxity state compared to the native state (SMD: 1.4° (95% CI 0.32, 2.49; P = .012). CONCLUSIONS Biomechanical evidence supports closure of the capsule after hip arthroscopy to reverse the significant effects of capsulotomy. Simulated capsule laxity models created altered joint motion and translation. Capsule reconstruction appears to restore the hip to its native capsule state. CLINICAL RELEVANCE Investigating the biomechanical outcomes of capsular repair and reconstruction will help surgeons better understand the rationale and implications of these capsular management strategies.
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Affiliation(s)
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois
| | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois
| | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, Illinois
| | | | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois; American Hip Institute, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A.
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Gursoy S, Vadhera AS, Singh H, Perry AK, Nho SJ, Chahla J. Remplissage and Labral Reconstruction Technique Correlated With Dynamic Hip Examination Using the Kite Technique for Restoration of the Suction Seal in Revision Hip Arthroscopy. Arthrosc Tech 2021; 10:e1995-e2004. [PMID: 34401245 PMCID: PMC8355511 DOI: 10.1016/j.eats.2021.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/22/2021] [Indexed: 02/03/2023] Open
Abstract
The hip suction seal plays a key role in distractive stability and maintenance of intra-articular fluid pressure of the hip. Preservation of the suction seal relies on the acetabular labrum and the congruence between the labrum and the femoral head-neck junction. During the treatment of cam-type impingement, iatrogenic over-resection in the femoral head-neck junction or labrum deficiency can cause loss of this suction seal. In this technical note, we describe a remplissage procedure performed in addition to labral reconstruction in a patient with loss of the suction seal due to a dysfunctional labrum and previous over-resection of a cam deformity.
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Affiliation(s)
| | | | | | | | | | - Jorge Chahla
- Address correspondence to Jorge Chahla, M.D., Ph.D., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL 60612.
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20
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Mazek J, Gnatowski M, Salas AP, Domżalski M, Wójcicki R, Skowronek J, Skowronek P. Ligamentum teres reconstruction with labrum and capsule repair after posterior acetabular wall fracture: a case report. J Hip Preserv Surg 2021; 8:i41-i45. [PMID: 34178370 PMCID: PMC8221382 DOI: 10.1093/jhps/hnab029] [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: 01/15/2021] [Accepted: 03/16/2021] [Indexed: 01/12/2023] Open
Abstract
The aim of this case study is to present arthroscopic treatment of recurrent hip instability after acute post-traumatic posterior hip dislocation with a fracture of the posterior acetabular wall. A male patient aged 35 suffered a dislocation of the right hip joint with a fracture of the posterior acetabular wall due to an accident. The fracture was stabilized during emergency surgery with a locking compression plate, and the patient was released home in a hip brace. Multiple dislocations of the hip joint followed with the implant being confirmed as stable. Decision was made to qualify the patient for a right hip arthroscopy. During the surgery, ligamentum teres was reconstructed using gracilis and semitendinous muscle grafts, followed by the labrum and joint capsule repair, where the surgery that stabilized the acetabular wall fracture had damaged them. There were no complications following the procedure. Short-term follow-up of 3 months demonstrates the patient has a stable hip, reduced pain and has returned to pre-injury activities.
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Affiliation(s)
- Jacek Mazek
- Jan Kochanowski University in Kielce, Orthopaedic and Traumatology Clinic, Kielce, Poland.,Center for Specialized Surgery Ortopedika, 03-152 Warsaw, Poland
| | - Maciej Gnatowski
- Center for Specialized Surgery Ortopedika, 03-152 Warsaw, Poland
| | | | - Marcin Domżalski
- Orthopaedic and Trauma Department, Medical University of Lodz, Lodz, Poland
| | - Rafał Wójcicki
- Jan Kochanowski University in Kielce, Orthopaedic and Traumatology Clinic, Kielce, Poland
| | - Jacek Skowronek
- Jan Kochanowski University in Kielce, Orthopaedic and Traumatology Clinic, Kielce, Poland
| | - Paweł Skowronek
- Jan Kochanowski University in Kielce, Orthopaedic and Traumatology Clinic, Kielce, Poland
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21
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DeFroda SF, Alter TD, Wichman DM, Browning RB, Nho SJ. Arthroscopic Anchor-Based Hip Capsular Reconstruction Without Graft Augmentation. Arthrosc Tech 2021; 10:e1511-e1515. [PMID: 34258198 PMCID: PMC8252822 DOI: 10.1016/j.eats.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/09/2021] [Indexed: 02/03/2023] Open
Abstract
The hip capsule is one of the most important static stabilizers of the hip joint. Routine capsulotomy without closure during hip arthroscopy increases instability of the hip joint, leading to pain and dysfunction. Capsular repair is now part of routine practice for most hip arthroscopists with restoration of normal hip biomechanics. In patients requiring revision surgery due to ongoing pain and instability as a result of deficient capsule, capsular reconstruction often is necessary to restore hip stability. Although there are many techniques available both with and without the use of allograft tissue, the purpose of this report is to describe a novel technique for capsular reconstruction without the use of graft augmentation using suture anchors at the acetabular rim.
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Affiliation(s)
| | - Thomas D. Alter
- Address correspondence to Thomas D. Alter, M.Sc., Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
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22
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Arthroscopic Triple Reconstruction in the Hip Joint: Restoration of Soft-Tissue Stabilizers in Revision Surgery for Gross Instability. Arthrosc Tech 2021; 10:e1239-e1248. [PMID: 34141538 PMCID: PMC8185569 DOI: 10.1016/j.eats.2021.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023] Open
Abstract
Gross hip instability in an active adult with previous normal hip anatomy is usually due to disruption of the static stabilizers of the hip joint. Although such a disruption can result from a high-grade injury, it can be iatrogenic after previous hip arthroscopy. The patient may present with a painful limp and recurrent subluxation sensation in the affected hip joint. Revision hip arthroscopy in this scenario is generally complicated, and it is not uncommon for all the soft-tissue stabilizers to be compromised. The labrum, ligamentum teres (LT), and capsule of the hip joint are often so damaged that reparation is not an option. Reconstruction of the torn LT is an established method to add secondary stability while addressing the labral pathology in the hip joint with microinstability. Concomitant reconstruction of all the static restraints has yet to be described addressing triple instability. This Technical Note presents a stepwise approach, including tips and pearls, for arthroscopic triple reconstruction of the labrum, LT, and capsule. We believe this method is a safe and reproducible way to effectively treat gross hip instability in young patients.
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23
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Wong S, Newhouse A, Chahla J, Nho S. Arthroscopic Treatment of Hip Dislocation After Previous Hip Arthroscopy: Capsular Reconstruction With Labral Augmentation. Arthrosc Tech 2021; 10:e867-e872. [PMID: 33738226 PMCID: PMC7953356 DOI: 10.1016/j.eats.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/01/2020] [Indexed: 02/03/2023] Open
Abstract
The hip capsule and acetabular labrum are critical structures that function to protect and stabilize the hip joint. As the use of hip arthroscopy increases, there is increasing interest in the integrity of the hip capsule and labrum in optimizing postoperative function and outcomes. In this report, we describe the surgical technique for capsular reconstruction with dermal allograft and labral augmentation with tibialis anterior allograft for the treatment of gross instability after hip arthroscopy. This technique may be applied in situations with large capsular defects and deficient labral tissue.
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Affiliation(s)
| | | | | | - Shane Nho
- Address correspondence to Shane J. Nho, M.D., Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St., Suite 300, Chicago, IL 60612.
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24
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Characterizing irreparable: a retrospective machine learning analysis of patients who undergo primary labral reconstruction during hip arthroscopy. J Hip Preserv Surg 2021. [DOI: 10.1093/jhps/hnab005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Abstract
Hip labrum reconstruction has been demonstrated to be a viable option for patients with irreparable labral tears. However, there is a lack of data analyzing patient and labral characteristics in those undergoing primary hip labral reconstruction. To use a machine learning technique to subcategorize patients who underwent labral reconstruction during primary hip arthroscopy and to determine if there may be varying pathology resulting in severe labral damage. Patients who underwent primary labral reconstruction between 2015 and 2018 were included. Patients with a prior ipsilateral hip surgery, who were unwilling to participate, or had incomplete preoperative data were excluded. Agglomerative hierarchical clustering analysis was conducted to identify the subgroups of patients. A comparison was performed for preoperative characteristics, intraoperative findings and procedures. Of the 191 patients who underwent primary labral reconstruction and were eligible, 174 were included in the clustering analysis. Two distinct groups were identified (Group 1: 112 patients, 64.4%; Group 2: 62 patients, 35.6%). Group 1 had a significantly higher proportion of females (61.6% versus 43.5%; P < 0.05), combined Seldes I and II labral tears (94.6% versus 54.8%; P < 0.05), and larger tears. Group 2 had a significantly higher rate of labral calcification (82.3% versus 3.6%; P < 0.05). The results of this study demonstrate two distinct groups of patients who underwent primary hip labral reconstruction: those with severe labral damage, and those with a calcified labrum. Approximately two-thirds were placed in the group with severe labral damage, while the other third had diminished quality secondary to calcific changes. Retrospective comparative trial; Level of Evidence, 3.
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25
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Scheidt M, Bhatia S, Fenoglio Z, Ellman MB. Capsular Reconstruction of the Hip Using Modified Kite Technique: A Technical Guide for Efficient Graft Management and Fixation. Arthrosc Tech 2021; 10:e209-e216. [PMID: 33532230 PMCID: PMC7823145 DOI: 10.1016/j.eats.2020.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/23/2020] [Indexed: 02/03/2023] Open
Abstract
Preserving capsular integrity has become an important principle of hip preservation surgery given the increasingly recognized deleterious effects of instability in cases of capsular insufficiency. When capsular tissue is deficient, capsular reconstruction may be indicated to restore function of the iliofemoral ligament and improve hip biomechanics. To date, few studies have presented technical guidance on performing arthroscopic capsular reconstruction of the hip. In this Technical Note, we introduce a modified kite technique for arthroscopic entry, control, and fixation of a capsular reconstruction graft. Similar to flying a kite with multiple fly lines, and to the previously described kite technique for hip labral reconstruction, the principles of this method are founded on the belief that control sutures within a pulley system facilitate safe and efficient graft management during capsular reconstruction procedures.
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Affiliation(s)
- Michael Scheidt
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, U.S.A
| | - Sanjeev Bhatia
- Hip & Knee Joint Preservation Center, Northwestern Medicine West Region, Northwestern University Feinberg School of Medicine, Warrenville, Illinois, U.S.A
| | - Zach Fenoglio
- Stryker Endoscopy & Sports Medicine, Denver, Colorado, U.S.A
| | - Michael B. Ellman
- Panorama Orthopedics and Spine Center, Denver, Colorado, U.S.A.,Address correspondence to Michael B. Ellman, M.D., 660 Golden Ridge Rd., Suite 250, Golden, CO 80401, U.S.A.
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26
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Ng KCG, El Daou H, Bankes MJK, Rodriguez Y Baena F, Jeffers JRT. Cam Osteochondroplasty for Femoroacetabular Impingement Increases Microinstability in Deep Flexion: A Cadaveric Study. Arthroscopy 2021; 37:159-170. [PMID: 32927001 DOI: 10.1016/j.arthro.2020.08.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this in vitro cadaveric study was to examine the contributions of each surgical stage during cam femoroacetabular impingement (FAI) surgery (i.e., intact-cam hip, T-capsulotomy, cam resection, and capsular repair) toward hip range of motion, translation, and microinstability. METHODS Twelve cadaveric cam hips were denuded to the capsule and mounted onto a robotic tester. The hips were positioned in several flexion positions-full extension, neutral (0°), 30° of flexion, and 90° of flexion-and performed internal-external rotations to 5 Nm of torque in each position. The hips underwent a series of surgical stages (T-capsulotomy, cam resection, and capsular repair) and were retested after each stage. Changes in range of motion, translation, and microinstability (overall translation normalized by femoral head radius) were measured after each stage. RESULTS Regarding range of motion, cam resection increased internal rotation at 90° of flexion (change in internal rotation = +6°, P = .001) but did not affect external rotation. Capsular repair restrained external rotation compared with the cam resection stage (change in external rotation = -8° to -4°, P ≤ .04). In terms of translation, the hip translated after cam resection at 90° of flexion in the medial-lateral plane (change in translation = +1.9 mm, P = .04) relative to the intact and capsulotomy stages. Regarding microinstability, capsulotomy increased microinstability in 30° of flexion (change in microinstability [ΔM] = +0.05, P = .003), but microinstability did not further increase after cam resection. At 90° of flexion, microinstability did not increase after capsulotomy (ΔM = +0.03, P = .2) but substantially increased after cam resection (ΔM = +0.08, P = .03), accounting for a 31% change with respect to the intact stage. CONCLUSIONS Cam resection increased microinstability by 31% during deep hip flexion relative to the intact hip. This finding suggests that iatrogenic microinstability may be due to separation of the labral seal and resected contour of the femoral head. CLINICAL RELEVANCE Our in vitro study showed that, at time zero and prior to postoperative recovery, excessive motion after cam resection could disrupt the labral seal. Complete cam resection should be performed cautiously to avoid disruption of the labral seal and postoperative microinstability.
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Affiliation(s)
- K C Geoffrey Ng
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, England; Department of Mechanical Engineering, Imperial College London, London, England.
| | - Hadi El Daou
- Department of Mechanical Engineering, Imperial College London, London, England
| | - Marcus J K Bankes
- Department of Orthopaedics, Guy's and St. Thomas' NHS Foundation Trust, London, England; Fortius Clinic, London, England
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27
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Pasic N, Burkhart TA, Baha P, Ayeni OR, Getgood A, Degen RM. A Biomechanical Comparison of 2 Hip Capsular Reconstruction Techniques: Iliotibial Band Autograft Versus Achilles Tendon Allograft. Am J Sports Med 2020; 48:3288-3295. [PMID: 33044838 DOI: 10.1177/0363546520962071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several techniques for hip capsular reconstruction have been described to address gross instability or microinstability due to capsular deficiency. However, objective biomechanical data to support their use are lacking. PURPOSE To compare the kinematic effect of 2 capsular reconstruction techniques (iliotibial band [ITB] graft and Achilles tendon graft). Kinematic effect encompassed rotational range of motion (ROM) as well as joint translation in the coronal, sagittal, and axial planes. STUDY DESIGN Controlled laboratory study. METHODS 8 paired, fresh-frozen hemi-pelvises (16 hips) were tested on a custom-designed joint motion simulator in the intact state and after capsulectomy. Pairs were randomly allocated to either ITB or Achilles reconstruction and retested. Testing was performed at 0°, 45°, and 90° of flexion. Internal-external rotation (IR-ER) torques and abduction-adduction torques of 3 N·m were applied to the femur via a load cell at each position, and rotational ROM and joint translation in the coronal, sagittal, and axial planes were recorded. RESULTS At 45° and 90°, there was a significant effect of the condition of the hip on the total IR-ER (P = .004, effect size [ES] = 0.305; and P < .001, ES = 0.497; respectively). At 45°, mean ± SD total rotation was significantly greater for the capsulectomy (59.7°± 15.9°) state compared with intact (53.3°± 13.2°; P = .007). At 90°, reconstruction significantly decreased total rotation to 49.0°± 18.9° compared with a mean total rotation of 52.8°± 18.7° after capsulectomy (P = .02). No difference was seen in the total abduction-adduction of the hip between conditions. Comparisons of the 2 different reconstruction techniques showed no significant differences in total IR-ER or abduction-adduction ROM or joint translation in the coronal, sagittal, or axial planes. For translation, at both 0° and 45° there was a statistically significant effect of the condition on the medial-lateral translation (P = .033; ES = 0.204). Reconstruction, independent of technique, was successful in significantly decreasing (P = .030; P = .014) the mean medial-lateral translation at 0° and 45° of hip flexion from 5.2 ± 3.8 mm and 5.6 ± 4.0 mm to 2.8 ± 1.9 mm and 3.9 ± 3.2 mm, respectively. CONCLUSION The integrity of the native hip capsule played a significant role in rotational stability, where capsulectomy significantly increased rotational ROM. Both ITB and Achilles reconstruction techniques restored normal rotational ROM of the hip at 90° of flexion as well as coronal plane stability at 0° and 45° of hip flexion. No differences were seen between ITB and Achilles reconstruction techniques. CLINICAL RELEVANCE Both capsular reconstruction techniques provide comparable joint kinematics, restoring rotation and translation to normal values with the exception of rotational ROM at 45°, which remained significantly greater than the intact state. The most significant results were the rotational stability at 90° of hip flexion and coronal plane stability at 0° and 45° of hip flexion, which were significantly improved compared with the capsulectomy state.
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Affiliation(s)
- Nicholas Pasic
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Timothy A Burkhart
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada.,Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada.,School of Kinesiology, Western University, London, Ontario, Canada
| | - Pardis Baha
- School of Kinesiology, Western University, London, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Ryan M Degen
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
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28
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Suppauksorn S, Beck EC, Chahla J, Cancienne JM, Krivicich LM, Rasio J, Shewman E, Nho SJ. Comparison of Suction Seal and Contact Pressures Between 270° Labral Reconstruction, Labral Repair, and the Intact Labrum. Arthroscopy 2020; 36:2433-2442. [PMID: 32504714 DOI: 10.1016/j.arthro.2020.05.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To biomechanically compare the suction seal, contact area, contact pressures, and peak forces of the intact native labrum, torn labrum, 12- to 3-o'clock labral repair, and 270° labral reconstruction in the hip. METHODS A cadaveric study was performed using 8 fresh-frozen hemipelvises with intact labra and without osteoarthritis. Intra-articular pressure maps were produced for each specimen using an electromechanical testing system under the following conditions: (1) intact labrum, (2) labral tear, (3) labral repair between the 12- and 3-o'clock positions, and (4) 270° labral reconstruction using iliotibial band allograft. Specimens were examined in neutral position, 20° of extension, and 60° of flexion. In each condition, contact pressure, contact area, and peak force were obtained. Repeated-measures analysis of variance was used to identify differences in biomechanical parameters among the 3 conditions. Qualitative differences in suction seal were compared between labral repair and labral reconstruction using the Fisher exact test. RESULTS Repeated-measures analysis of variance for contact area in neutral position, extension, and flexion showed statistically significant differences between the normalized study states (P < .05). Post hoc analysis showed significantly larger contact areas measured in labral repair specimens than in labral reconstruction specimens in the extension and flexion positions. Region-of-interest analysis for the normalized contact area in the extension and flexion positions, as well as normalized contact pressures in neutral position, showed statistically significant differences between the labral states (P < .05). Finally, 8 labral repairs (100%) versus only 1 labral reconstruction (12.5%) retained the manually tested suction seal (P < .001). CONCLUSIONS In this in vitro biomechanical model, 270° labral reconstruction resulted in decreased intra-articular contact area and loss of suction seal when compared with labral repair. Clinically, labral reconstruction may not restore the biomechanical characteristics of the native labrum as compared with labral repair. CLINICAL RELEVANCE Labral reconstruction may result in lower intra-articular hip contact area and loss of suction seal, affecting the native biomechanical function of the acetabular labrum. Further biomechanical studies and clinical studies are necessary to determine whether there are any long-term consequences of 270° labral reconstruction.
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Affiliation(s)
- Sunikom Suppauksorn
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edward C Beck
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A..
| | - Jorge Chahla
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jourdan M Cancienne
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Laura M Krivicich
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jonathan Rasio
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Elizabeth Shewman
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Utsunomiya H, Storaci HW, Rosenberg SI, Kemler BR, Dornan GJ, Brady AW, Philippon MJ. The Hip Suction Seal, Part II: The Effect of Rim Trimming, Chondrolabral Junction Separation, and Labral Repair/Refixation on Hip Distractive Stability. Am J Sports Med 2020; 48:2733-2739. [PMID: 32762632 DOI: 10.1177/0363546520941859] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The acetabular labrum contains free nerve endings, and an unstable labrum can result in increased femoral head movement during hip motion. This can be caused by chondrolabral junction (CLJ) separation, especially in association with pincer-type femoroacetabular impingement, and may contribute to hip pain. HYPOTHESIS Rim resection alone has no effect on suction seal biomechanics. Further, separation of the CLJ changes hip suction seal biomechanics when compared with those of the native state, whereas repair and refixation with suture anchors restore these biomechanical parameters. STUDY DESIGN Controlled laboratory study. METHODS A total of 12 fresh-frozen human cadaveric hips were used in this study. Hips were mounted in a saline bath on a dynamic tensile testing machine and were distracted at a rate of 0.5 mm/s from neutral position. A total of 3 parameters (force, displacement, and intra-articular pressure) were measured throughout testing. Before testing, hips were randomly allocated to 1 of 2 groups: 1 that included the CLJ separation (CLJ Cut group) and 1 that did not (CLJ Intact group). Hips were tested in the following states: (1) native, (2) rim trimming, (3) separated CLJ (CLJ Cut group only), and (4) labral repair/refixation. For each group a linear mixed-effects model was used to compare biomechanical parameters between states. RESULTS Rim trimming did not affect any suction seal parameters relative to those of the native state. In the CLJ Cut group, no significant difference in distance to break the suction seal was observed for any states compared with that of the native state. In the CLJ Intact group, the distance to break the suction seal was significantly shorter in the labral refixation state (1.8 mm) than the native state (5.6 mm; P = .002). The maximum distraction force (62.1 ± 54.1 N) and the peak negative pressure (-36.6 ± 24.2 kPa) of the labral repair/refixation state were significantly lower than those of the native state in both groups (93.4 ± 41.7 N, P = .01; -60.7 ± 20.4 kPa, P = .02). CONCLUSION Rim trimming did not change the biomechanical properties of the labral suction seal. Labral refixation resulted in a shorter distance to break the labral suction seal. This indicates that labral mobility is reduced by the labral refixation procedure, which could be beneficial in postoperative pain relief and labral healing. CLINICAL RELEVANCE The labral refixation reduced labral mobility, which could be beneficial for both pain relief and labral healing to the acetabulum after pincer-type femoroacetabular impingement resection.
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Affiliation(s)
| | | | | | | | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Alex W Brady
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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30
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Storaci HW, Utsunomiya H, Kemler BR, Rosenberg SI, Dornan GJ, Brady AW, Philippon MJ. The Hip Suction Seal, Part I: The Role of Acetabular Labral Height on Hip Distractive Stability. Am J Sports Med 2020; 48:2726-2732. [PMID: 32762634 DOI: 10.1177/0363546520941855] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The acetabular labrum has been found to provide a significant contribution to the distractive stability of the hip. However, the influence of labral height on hip suction seal biomechanics is not known. HYPOTHESIS The smaller height of acetabular labrum is associated with decreased distractive stability. STUDY DESIGN Descriptive laboratory study. METHODS A total of 23 fresh-frozen cadaveric hemipelvises were used in this study. Hips with acetabular dysplasia or femoroacetabular impingement-related bony morphologic features, intra-articular pathology, or no measurable suction seal were excluded. Before testing, each specimen's hip capsule was removed, a pressure sensor was placed intra-articularly, and the hip was fixed in a heated saline bath. Labral size was measured by use of a digital caliper. Maximum distraction force, distance to suction seal rupture, and peak negative pressure were recorded while the hip underwent distraction at a rate of 0.5 mm/s. Correlations between factors were analyzed using the Spearman rho, and differences between groups were detected using Mann-Whitney U test. RESULTS Of 23 hips, 12 satisfied inclusion criteria. The maximum distraction force and peak negative pressure were significantly correlated (R = -0.83; P = .001). Labral height was largely correlated with all suction seal parameters (maximum distraction force, R = 0.69, P = .013; distance to suction seal rupture, R = 0.55, P = .063; peak negative pressure, R = -0.62, P = .031). Labral height less than 6 mm was observed in 5 hips, with a mean height of 6.48 mm (SD, 2.65 mm; range, 2.62-11.90 mm; 95% CI, 4.80-8.17 mm). Compared with the 7 hips with larger labra (>6 mm), the hips with smaller labra had significantly shorter distance to suction seal rupture (median, 2.3 vs 7.2 mm; P = .010) and significantly decreased peak negative pressure (median, -59.3 vs -66.9 kPa; P = .048). CONCLUSION Smaller height (<6 mm) of the acetabular labrum was significantly associated with decreased distance to suction seal rupture and decreased peak negative pressure. A new strategy to increase the size of the labrum, such as labral augmentation, could be justified for patients with smaller labra in order to optimize the hip suction seal. CLINICAL RELEVANCE The height of the acetabular labrum is correlated with hip suction seal biomechanics. Further studies are required to identify the clinical effects of labral height on hip stability.
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Affiliation(s)
| | | | | | | | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Alex W Brady
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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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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