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Doehrmann R, Comer BJ, Chatterji R, Diedring B, Knapp P, Afsari A. Accuracy of Leg Length and Hip Offset Measurements Using a Fluoroscopic Grid During Anterior Approach Total Hip Arthroplasty. Arthroplast Today 2023; 22:101154. [PMID: 37502102 PMCID: PMC10369392 DOI: 10.1016/j.artd.2023.101154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/08/2023] [Indexed: 07/29/2023] Open
Abstract
Background Minimizing leg length (LLD) and hip offset (OD) discrepancies is critical for tissue tension and implant longevity in total hip arthroplasty (THA). The direct anterior approach (DAA) helps surgeons recreate these values under fluoroscopy. Several methods to accomplish this have been described, with no consensus on which is superior. This study evaluated the ability to minimize LLD and OD using a surgeon-controlled, adjustable fluoroscopic grid. We hypothesized that this tool would recreate parameters to within 10 mm of the contralateral side. Methods One hundred eleven primary THAs performed with an adjustable radiopaque grid to equalize leg length and hip offset were retrospectively reviewed. These values were measured on postoperative radiographs and compared to the contralateral hip. Patients were excluded if they had inadequate imaging, revision arthroplasty, preexisting deformities, or underwent approaches other than DAA. Results Mean age was 59.1 ± 11.1 years, 63.1% of patients were female, and average body mass index was 27.8 ± 7.0. Mean LLD was 3.7 ± 3.0 mm, while mean OD was 4.6 ± 3.6 mm. 95.5% of hips showed LLD < 10 mm, while 93.7% of hips had OD < 10 mm. Furthermore, 76.6% of hips had LLD < 5 mm, while 62.2% of hips had OD < 5 mm. Conclusions The described technique restored limb length and hip offset during DAA THA. This technique yields consistent results and offers an inexpensive alternative to costly digital software and more cumbersome fixed grid systems.
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Affiliation(s)
- Ross Doehrmann
- Department of Orthopaedic Surgery, Ascension St. John Hospital, Detroit, MI, USA
| | - Brendan J. Comer
- Department of Orthopaedic Surgery, Ascension Providence Hospital, Southfield, MI, USA
| | - Rishi Chatterji
- Department of Orthopaedic Surgery, Ascension Providence Hospital, Southfield, MI, USA
| | - Benjamin Diedring
- Department of Orthopaedic Surgery, Ascension St. John Hospital, Detroit, MI, USA
| | - Paul Knapp
- Department of Orthopaedic Surgery, Ascension St. John Hospital, Detroit, MI, USA
| | - Alan Afsari
- Department of Orthopaedic Surgery, Ascension St. John Hospital, Detroit, MI, USA
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Mirzayan R, Andelman SM, Sethi PM, Baldino JB, Comer BJ, Obopilwe E, Morikawa D, Otto A, Mehl J, Murphy M, Mazzocca AD. Acellular dermal matrix augmentation significantly increases ultimate load to failure of pectoralis major tendon repair: a biomechanical study. J Shoulder Elbow Surg 2020; 29:728-735. [PMID: 31859037 DOI: 10.1016/j.jse.2019.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/26/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Biomechanical studies have demonstrated that standard pectoralis major tendon (PMT) repairs have inferior strength compared with native tendon. HYPOTHESIS Augmentation of PMT repair with an acellular dermal matrix (ADM) will increase the ultimate load to failure. METHODS Eighteen cadaveric specimens were allocated to 3 repair groups: standard repair (SR); augmented repair (AR) with ADM; and intact, native tendon (NT). Specimens were tested for cyclic elongation, linear stiffness, load to 5 mm displacement, maximum load to failure, and method of failure. RESULTS Maximum load to failure in AR (1450 ± 295 N) was significantly higher than SR (921 ± 159 N; P = .0042) and equivalent to NT (1289 ± 240 N; P = .49). NT required the highest load to displace 5 mm (709 ± 202 N), which was higher than AR (346 ± 95 N; P < .001) and SR (375 ± 55; P = .0015). NT stiffness (125 ± 42 N/mm) was greater than the AR (69 ± 19 N/mm; P = .0073) or SR (75 ± 11 N/mm; P = .015). The mode of failure for SR was suture pullout from the PMT as opposed to button pullout from the humerus (fracture) for AR. CONCLUSION ADM augmentation of PMT repair significantly increases ultimate load to failure.
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Affiliation(s)
- Raffy Mirzayan
- Kaiser Permanente Southern California, Baldwin Park, CA, USA.
| | - Steven M Andelman
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - Paul M Sethi
- Orthopaedic & Neurosurgery Specialists, Greenwich, CT, USA
| | - Joshua B Baldino
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - Brendan J Comer
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA; Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - Alexander Otto
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Julian Mehl
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Matthew Murphy
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA
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Imhoff FB, Mehl J, Comer BJ, Obopilwe E, Cote MP, Feucht MJ, Wylie JD, Imhoff AB, Arciero RA, Beitzel K. Slope-reducing tibial osteotomy decreases ACL-graft forces and anterior tibial translation under axial load. Knee Surg Sports Traumatol Arthrosc 2019; 27:3381-3389. [PMID: 30687890 DOI: 10.1007/s00167-019-05360-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/14/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Posterior tibial slope (PTS) represents an important risk factor for anterior cruciate ligament (ACL) graft failure, as seen in clinical studies. An anterior closing wedge osteotomy for slope reduction was performed to investigate the effect on ACL-graft forces and femoro-tibial kinematics in an ACL-deficient and ACL-reconstructed knee in a biomechanical setup. METHODS Ten cadaveric knees with a relatively high native slope (mean ± SD): (slope 10° ± 1.4°, age 48.2 years ± 5.8) were selected based on prior CT measurements. A 10° anterior closing-wedge osteotomy was fixed with an external fixator in the ACL-deficient and ACL-reconstructed knee (quadruple Semi-T/Gracilis-allograft). Each condition was randomly tested with both the native tibial slope and the post-osteotomy reduced slope. Axial loads (200 N, 400 N), anterior tibial draw (134 N), and combined loads were applied to the tibia while mounted on a free moving and rotating X-Y table. Throughout testing, 3D motion tracking captured anterior tibial translation (ATT) and internal tibial rotation (ITR). Change of forces on the reconstructed ACL-graft (via an attached load-cell) were recorded, as well. RESULTS ATT was significantly decreased after slope reduction in the ACL-deficient knee by 4.3 mm ± 3.6 (p < 0.001) at 200 N and 6.2 mm ± 4.3 (p < 0.001) at 400N of axial load. An increase of ITR of 2.3° ±2.8 (p < 0.001) at 200 N and by 4.0° ±4.1 (p < 0.001) at 400 N was observed after the osteotomy. In the ACL-reconstructed knee, ACL-graft forces decreased after slope reduction osteotomy by a mean of 14.7 N ± 9.8 (p < 0.001) at 200 N and 33.8 N ± 16.3 (p < 0.001) at 400N axial load, which equaled a relative decrease by a mean of 17.0% (SD ± 9.8%), and 33.1% (SD ± 18.1%), respectively. ATT and ITR were not significantly changed in the ACL-reconstructed knee. Testing of a tibial anterior drawing force in the ACL-deficient knee led to a significantly increased ATT by 2.7 mm ± 3.6 (p < 0.001) after the osteotomy. The ACL-reconstructed knee did not show a significant change (n.s.) in ATT after the osteotomy. However, ACL-graft forces detected a significant increase by 13.0 N ± 8.3 (p < 0.001) after the osteotomy with a tibial anterior drawer force, whereas the additional axial loading reduced this difference due to the osteotomy (5.3 N ± 12.6 (n.s.)). CONCLUSIONS Slope-reducing osteotomy decreased anterior tibial translation in the ACL-deficient and ACL-reconstructed knee under axial load, while internal rotation of the tibia increased in the ACL-deficient status after osteotomy. Especially in ACL revision surgery, the osteotomy protects the reconstructed ACL with significantly lower forces on the graft under axial load.
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Affiliation(s)
- Florian B Imhoff
- Department of Orthopaedic Sports Surgery, Technical University of Munich, Munich, Germany.,Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Julian Mehl
- Department of Orthopaedic Sports Surgery, Technical University of Munich, Munich, Germany.,Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Brendan J Comer
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Matthias J Feucht
- Department of Orthopaedic Sports Surgery, Technical University of Munich, Munich, Germany
| | - James D Wylie
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.,Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Surgery, Technical University of Munich, Munich, Germany.
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Knut Beitzel
- Department of Orthopaedic Sports Surgery, Technical University of Munich, Munich, Germany.,Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
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