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Ziegler CM, Wagner F, Alleborn K, Geith T, Holzapfel BM, Heimkes B. Muscle forces acting on the greater trochanter lead to a dorsal warping of the apophyseal growth plate. J Anat 2024; 244:63-74. [PMID: 37694853 PMCID: PMC10734645 DOI: 10.1111/joa.13944] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023] Open
Abstract
The apophyseal growth plate of the greater trochanter, unlike most other growth plates of the human body, exhibits a curved morphology that results in a divergent pattern resembling an open crocodile mouth on plain antero-posterior radiographs. To quantify the angular alignment of the growth plate and to draw conclusions about the function of the muscles surrounding it, we analyzed 57 MRI images of 51 children and adolescents aged 3-17 years and of six adults aged 18-52 years. We measured the angulation of the plate relative to the horizontal plane (AY angle) and the trajectories of the muscles attaching to the greater trochanter of the proximal femur. From anterior to posterior, the AY angle shows a decrease of 33.44°. In the anterior third, the cartilage is angled at a mean of 51.64°, and in the posterior third, the mean angulation is 18.6°. This indicates that the cartilage in the anterior region of the greater trochanteric apophysis is subject to more vertically oriented force vectors compared to the posterior region, as the growth plates align perpendicular to the force vectors acting on them. Combining the measured muscle trajectories with the physiological cross-sectional areas (PCSA) available from the literature revealed that, in addition to the known internal and external lateral traction ligament systems, a third, dorsally located traction ligament system exists that may be responsible for the dorsal deformation of the AY angle.
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Affiliation(s)
- Christian Max Ziegler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University HospitalLudwig‐Maximilians‐Universität MünchenMunichGermany
| | - Ferdinand Wagner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University HospitalLudwig‐Maximilians‐Universität MünchenMunichGermany
- Department of Pediatric Surgery, Dr. von Hauner Children's HospitalLudwig‐Maximilians‐University MunichMunichGermany
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT)QueenslandBrisbaneAustralia
| | - Karoline Alleborn
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University HospitalLudwig‐Maximilians‐Universität MünchenMunichGermany
| | - Tobias Geith
- Department of Interventional RadiologyTechnical University of MunichMunichGermany
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University HospitalLudwig‐Maximilians‐Universität MünchenMunichGermany
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT)QueenslandBrisbaneAustralia
| | - Bernhard Heimkes
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University HospitalLudwig‐Maximilians‐Universität MünchenMunichGermany
- Klinikum Dritter Orden, Department of Pediatric SurgeryPediatric Orthopedic and Neuroorthopaedic SectionMunichGermany
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Mezian K, Ricci V, Mittal N, Novotný T, Chang KV, Özçakar L, Naňka O. Ultrasound-guided injection of the hip: Cadaveric description for the lateral approach. PM R 2023; 15:1150-1155. [PMID: 36515662 DOI: 10.1002/pmrj.12932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/09/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ultrasound (US)-guided intraarticular hip joint injections are commonly performed using an in-plane anterior approach, which has several limitations. OBJECTIVE To describe and report a "lateral" (lateral to medial) approach for US-guided intraarticular hip injection. DESIGN Cadaveric investigation. SETTING Academic institution, department of anatomy. PARTICIPANTS One cadaveric specimen. METHODS Both hips of a single cadaver were injected using the US-guided lateral approach. In the left hip, the needle was inserted and kept in situ. The right hip was injected with white-colored water-diluted latex dye. Subsequently, a layer-by-layer anatomical dissection was performed. MAIN OUTCOME MEASURES Presence and distribution of latex dye and location of needle tip within the joint capsule of the hip. RESULTS Anatomical dissection of the left and right hips confirmed the correct intraarticular position of the needle tip and the placement of the latex dye, respectively. During layer-by-layer dissection of the left hip, positions of the lateral cutaneous nerve and the lateral circumflex femoral artery were observed anterior to the needle, 30 mm for the nerve and 8 mm for the artery. CONCLUSIONS This preliminary study demonstrated that the US-guided lateral approach is a convenient technique to access the hip joint in a cadaveric specimen. Compared with the "classical" anterior technique, the lateral approach may provide several advantages, including improved needle visibility, theoretically decreased risk of vascular injury, and less risk of needle contamination. Because injury to the lateral epiphyseal arteries is possible when lateral approach is used, caution is required, especially in children. These preliminary conclusions will need to be validated in future/larger clinical studies.
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Affiliation(s)
- Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Nimish Mittal
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tomáš Novotný
- Department of Orthopaedics, University J.E. Purkinje, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Sadeghian SM, Lewis CL, Shefelbine SJ. Can pelvic tilt cause cam morphology? A computational model of proximal femur development mechanobiology. J Biomech 2023; 157:111707. [PMID: 37441913 DOI: 10.1016/j.jbiomech.2023.111707] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
Cam deformity of the proximal femur is a risk factor for early osteoarthritis. While cam morphology is related to mechanical force at a formative time in skeletal growth, the specific problematic forces contributing to the development of cam morphology remain unknown. Individuals with femoroacetabular impingement syndrome exhibit an increased anterior pelvic tilt during walking, which alters their hip joint forces. This study aims to investigate the influence of altered joint force caused by anterior pelvic tilt on proximal femur epiphyseal growth and the potential association between increased anterior pelvic tilt and the development of cam morphology. A computational model is utilized to simulate the endochondral ossification in the proximal femur and predict cam formation. Cartilage growth and ossification patterns for a gait cycle with and without anterior pelvic tilt were modeled. The simulated growth results indicated an increased alpha angle (53° for typically developing to 68° for anterior pelvic tilt) and aspherical femoral head in the model with anterior pelvic tilt. We conclude that anterior pelvic tilt may be sufficient to cause the formation of the cam morphology. Identifying the critical mechanical conditions that increase the risk of cam deformity could help prevent this condition by adjusting the physical activities before skeletal maturity.
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Affiliation(s)
- S Mahsa Sadeghian
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Cara L Lewis
- Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Sandra J Shefelbine
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA; Department of Bioengineering, Northeastern University, Boston, MA, USA.
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Cazenave M, Oettlé A, Pickering TR, Heaton JL, Nakatsukasa M, Francis Thackeray J, Hoffman J, Macchiarelli R. Trabecular organization of the proximal femur in Paranthropus robustus: Implications for the assessment of its hip joint loading conditions. J Hum Evol 2021; 153:102964. [PMID: 33713985 DOI: 10.1016/j.jhevol.2021.102964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 11/19/2022]
Abstract
Reconstruction of the locomotor repertoire of the australopiths (Australopithecus and Paranthropus) has progressively integrated information from the mechanosensitive internal structure of the appendicular skeleton. Recent investigations showed that the arrangement of the trabecular network at the femoral head center is biomechanically compatible with the pattern of cortical bone distribution across the neck, both suggesting a full commitment to bipedalism in australopiths, but associated with a slightly altered gait kinematics compared to Homo involving more lateral deviation of the body center of mass over the stance limb. To provide a global picture in Paranthropus robustus of the trabecular architecture of the proximal femur across the head, neck and greater trochanter compartments, we applied techniques of virtual imaging to the variably preserved Early Pleistocene specimens SK 82, SK 97, SK 3121, SKW 19 and SWT1/LB-2 from the cave site of Swartkrans, South Africa. We also assessed the coherence between the structural signals from the center of the head and those from the trabecular network of the inferolateral portion of the head and the inferior margin of the neck, sampling the so-called vertical bundle, which in humans represents the principal compressive system of the joint. Our analyses show a functionally related trabecular organization in Pa. robustus that closely resembles the extant human condition, but which also includes some specificities in local textural arrangement. The network of the inferolateral portion of the head shows a humanlike degree of anisotropy and a bone volume fraction intermediate between the extant human and the African ape patterns. These results suggest slight differences in gait kinematics between Pa. robustus and extant humans. The neck portion of the vertical bundle revealed a less biomechanically sensitive signal. Future investigations on the australopith hip joint loading environment should more carefully investigate the trabecular structure of the trochanteric region and possible structural covariation between cortical bone distribution across the neck and site-specific trabecular properties of the arcuate bundle.
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Affiliation(s)
- Marine Cazenave
- Skeletal Biology Research Centre, School of Anthropology and Conservation, University of Kent, Canterbury, UK.
| | - Anna Oettlé
- Department of Anatomy and Histology, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Travis Rayne Pickering
- Department of Anthropology, University of Wisconsin, Madison, USA; Evolutionary Studies Institute and School of Geosciences, University of the Witwatersrand, Johannesburg, South Africa; Plio-Pleistocene Palaeontology Section, Department of Vertebrates, Ditsong National Museum of Natural History (Transvaal Museum), Pretoria, South Africa
| | - Jason L Heaton
- Department of Biology, Birmingham-Southern College, Birmingham, USA; Evolutionary Studies Institute and School of Geosciences, University of the Witwatersrand, Johannesburg, South Africa; Plio-Pleistocene Palaeontology Section, Department of Vertebrates, Ditsong National Museum of Natural History (Transvaal Museum), Pretoria, South Africa
| | - Masato Nakatsukasa
- Laboratory of Physical Anthropology, Department of Zoology, Graduate School of Science, Kyoto University, Kyoto, Japan
| | - J Francis Thackeray
- Evolutionary Studies Institute and School of Geosciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jakobus Hoffman
- South African Nuclear Energy Corporation SOC Ltd., Pelindaba, South Africa
| | - Roberto Macchiarelli
- Département Homme & Environnement, UMR 7194 CNRS, Muséum national d'Histoire naturelle, 75116, Paris, France; Unité de Formation Géosciences, Université de Poitiers, Poitiers, France
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Abstract
The surgical treatment of femoroacetabular impingement has been shown to have successful early and mid-term clinical outcomes. Despite these favorable clinical outcomes that have been published in the literature, there is a subgroup of patients that present with continued or recurrent symptoms after surgical treatment. Not only has there been an increase in the number of hip arthroscopy procedures, but also there has been a corresponding increase in the number of revision hip arthroscopy and hip preservation surgeries. Previous studies have reported residual deformity to be the most common reason for revision hip arthroscopy. However, chondral, labral, and capsular considerations also are important when addressing patients not only in the primary but also, the revision setting. In this review, we outline the evaluation and treatment of the patient that presents with continued hip and groin pain after undergoing a hip.
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Affiliation(s)
- James R Ross
- BocaCare Orthopedics-Boca Raton Regional Hospital, Florida Atlantic University College of Medicine, Boca Raton, FL
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Ira Zaltz
- Department of Pediatric Orthopaedics, William Beaumont Hospital, Royal Oak, MI
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Abstract
PURPOSE In this study, we presented movable surface models to help medical students understand the multiaxial movements of the hip joint. The secondary objective was to demonstrate a simple method to make movable surface models for other researchers. METHODS We used 166 surface models of the virtual human, and the commercial software was used for all the processes described in this study. Virtual joints were created for the hip joint of the surface models to simulate realistic movements of the joints. Bone surface models were processed to maintain the original shape of the bones during movement. Muscle surface models were processed to express deformation of the muscle shapes during movement. Next, the muscle and bone surface models were moved over six movements of the hip joint (flexion, extension, abduction, adduction, lateral rotation, and medial rotation). The surface models of these six movements were saved and packaged in a PDF file. RESULTS The PDF file enabled users to see the stereoscopic shapes of the bones and muscles of the hip joint and to scrutinize the six movements on the X, Y, and Z axes of the joint. CONCLUSION The movable surface models of the hip joint of this study will be helpful for medical students to learn the multiaxial movements of the hip joint. We expect to develop simulations of other joints that can be used in the education of medical students using the materials and methods described in this study.
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Affiliation(s)
- Chung Yoh Kim
- Department of Anatomy, Dongguk University School of Medicine, 87 Dongdae-ro, Gyeongju, 38066, Republic of Korea
| | - Yong Wook Jung
- Department of Anatomy, Dongguk University School of Medicine, 87 Dongdae-ro, Gyeongju, 38066, Republic of Korea
| | - Jin Seo Park
- Department of Anatomy, Dongguk University School of Medicine, 87 Dongdae-ro, Gyeongju, 38066, Republic of Korea.
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Vles G, van Eemeren A, Taylan O, Scheys L, Ghijselings S. Anatomical Mapping of the External Obturator Footprint: A Study In Cadavers with Implications for Direct Anterior THA. Clin Orthop Relat Res 2021; 479:288-294. [PMID: 32956147 PMCID: PMC7899571 DOI: 10.1097/corr.0000000000001492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The external obturator footprint in the trochanteric fossa has been suggested as a potential landmark for stem depth in direct anterior THA. Its upper border can be visualized during surgical exposure of the femur. A recent study reported that the height of the tendon has little variability (6.4 ± 1.4 mm) as measured on CT scans and that the trochanteric fossa is consistently visible on conventional pelvic radiographs. However, it is unclear where exactly the footprint of this tendon should be templated during preoperative planning so that it can be useful intraoperatively. QUESTIONS/PURPOSES In this study, we sought: (1) to provide instructions on exactly where to template the external obturator footprint on a preoperative planning radiograph, and (2) to confirm the small variability in height of the external obturator footprint found on CT scans in a cadaver study. METHODS Two-dimensional (2-D) and three-dimensional (3-D) imaging was used to map the anatomy of the external obturator footprint. This dual approach was chosen because of their complementarity; conventional 2-D radiographs translate to clinical practice but 3-D navigation-based digitalization combined with CT allows for a better understanding of the cortical lines that comprise the outline of the trochanteric fossa. In 12 (four males, mean age 80 years, range 69 to 88) formalin-treated cadaveric lower extremities including the pelvis, the external obturator tendon was dissected, and the top and bottom end of its footprint marked with two small needles, and calibrated radiographs were taken. For another five (three males, mean age 75.7 years, range 61 to 91) fresh-frozen cadaveric lower extremities, including femoral reflective marker frames, CT scans were obtained and the exact location of the external obturator footprint was recorded using 3-D navigation-based digitalization. Qualitative analysis of both imaging modalities was used to develop instructions on where the external obturator footprint should be templated on a preoperative planning radiograph. Quantitative analysis of the dimensions of the external obturator footprint was performed. RESULTS The lowest point of the external obturator footprint was consistently found (± 1 mm) at the intersection of the vertical line comprised of the lateral wall of the trochanteric fossa and the oblique line formed by the intertrochanteric crest and therefore allows templating of this structure on the preoperative planning radiograph. The median (range) height of the footprint measured 6.4 mm and demonstrated small variability (4.7 to 7.6). CONCLUSIONS We suggest templating a 6.4-mm circle with its bottom on the intersection described above. CLINICAL RELEVANCE The distance between the templated shoulder of the stem and the top of the circle can be used intraoperatively for guidance. Discrepancy should lead to re-evaluation of stem depth and leg length. Future work will investigate the usability, validity, and reliability of the proposed methodology in daily clinical practice.
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Affiliation(s)
- Georges Vles
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Anthony van Eemeren
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Orcun Taylan
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Lennart Scheys
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Stijn Ghijselings
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
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Joseph TV, Caksa S, Misra M, Mitchell DM. Hip Structural Analysis Reveals Impaired Hip Geometry in Girls With Type 1 Diabetes. J Clin Endocrinol Metab 2020; 105:5905592. [PMID: 32929477 PMCID: PMC8161549 DOI: 10.1210/clinem/dgaa647] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/10/2020] [Indexed: 01/29/2023]
Abstract
CONTEXT Among patients with type 1 diabetes (T1D), the risk of hip fracture is up to 6-fold greater than that of the general population. However, the cause of this skeletal fragility remains poorly understood. OBJECTIVE To assess differences in hip geometry and imaging-based estimates of bone strength between youth with and without T1D using dual-energy x-ray absorptiometry (DXA)-based hip structural analysis. DESIGN Cross-sectional comparison. PARTICIPANTS Girls ages 10 to 16 years, including n = 62 with T1D and n = 61 controls. RESULTS The groups had similar age, bone age, pubertal stage, height, lean mass, and physical activity. Bone mineral density at the femoral neck and total hip did not differ in univariate comparisons but was lower at the femoral neck in T1D after adjusting for bone age, height, and lean mass. Subjects with T1D had significantly lower cross-sectional area, cross-sectional moment of inertia, section modulus, and cortical thickness at the narrow neck, with deficits of 5.7% to 10.3%. Cross-sectional area was also lower at the intertrochanteric region in girls with T1D. Among those T1D subjects with HbA1c greater than the cohort median of 8.5%, deficits in hip geometry and strength estimates were more pronounced. CONCLUSIONS DXA-based hip structural analysis revealed that girls with T1D have unfavorable geometry and lower estimates of bone strength at the hip, which may contribute to skeletal fragility and excess hip fracture risk in adulthood. Higher average glycemia may exacerbate effects of T1D on hip geometry.
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Affiliation(s)
- Taïsha V Joseph
- Endocrine Unit, Massachusetts General
Hospital, Boston, Massachusetts
| | - Signe Caksa
- Endocrine Unit, Massachusetts General
Hospital, Boston, Massachusetts
| | - Madhusmita Misra
- Pediatric Endocrine Unit, Massachusetts General
Hospital, Boston, Massachusetts
- Neuroendocrine Unit, Massachusetts General
Hospital, Boston, Massachusetts
| | - Deborah M Mitchell
- Endocrine Unit, Massachusetts General
Hospital, Boston, Massachusetts
- Pediatric Endocrine Unit, Massachusetts General
Hospital, Boston, Massachusetts
- Correspondence and Reprint Requests:
Deborah Mitchell, MD, Endocrine Unit, Massachusetts General Hospital, 50 Blossom
St., Boston, MA 02114, USA. E-mail:
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Bessa FS, Williams BT, Polce EM, Maheshwer B, Williams JC, Nho SJ, Chahla J. No Differences in Hip Joint Space Measurements Between Weightbearing or Supine Anteroposterior Pelvic Radiographs. Arthroscopy 2020; 36:2843-2848. [PMID: 32735940 DOI: 10.1016/j.arthro.2020.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To to assess whether there are any significant differences in hip joint space width (JSW) between weight-bearing versus supine pelvic radiographs. METHODS Standing and supine anteroposterior pelvic radiographs of 86 patients (146 hips) were included. Sample size was sufficiently powered to assess for equivalence between standing and supine films for JSW measurements made at the medial, lateral, and central aspects of the sourcil line. Measurements were made by 2 independent reviewers blinded to patient positioning. Each reviewer repeated a subset of the measurements to assess intra-rater reproducibility. Mean differences in joint space measurements between standing and supine radiographs were reported for each point of the sourcil. Intraclass correlation coefficients (ICCs) for inter and intra-rater reliability were also calculated. RESULTS There were no significant differences between JSW measurements made on standing and supine pelvic radiographs (P = .468). Furthermore, equivalence testing demonstrated statistical equivalence between standing and supine JSW measurements made based on an equivalence threshold of ±0.5 mm. Inter-rater reliability demonstrated good agreement with an overall ICC of 0.775 (95% confidence interval [CI] 0.734-0.809). Intra-rater reliability also demonstrated good agreement with ICCs of 0.84 (95% CI 0.758-0.889) and 0.798 (95% CI 0.721-0.851) for the 2 reviewers, respectively. CONCLUSIONS JSW measurements on standing and supine pelvic radiographs were not significantly different, and their inter-rater agreement and intra-rater reproducibility demonstrated good reliability and repeatability. Therefore, either may be used to assess JSW, including measurements that may impact treatment decisions for hip arthroscopy. LEVEL OF EVIDENCE Level III; retrospective comparative study.
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Affiliation(s)
- Felipe S Bessa
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil
| | - Brady T Williams
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Evan M Polce
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bhargavi Maheshwer
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Joel C Williams
- Hip Preservation and Orthopedic Trauma, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
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10
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Abstract
Hip arthroscopy is rapidly growing as a treatment with good outcomes for pathologic conditions such as femoroacetabular impingement syndrome and labral tears. At the same time, it is one of the most technically challenging and demanding procedures in orthopaedics with a technically demanding skill. The first challenge is to safely access the joint, which requires accurate anatomical knowledge, a strong sense of spatial orientation, and repeated practice. Iatrogenic chondrolabral injury has been reported as the most common complication in hip arthroscopy and most frequently occurs during hip joint access. As such, basic foundations cannot be overstated. These complications can be minimized with adequate patient positioning, reproducible hip joint access techniques, and proper portals placement. Nonetheless, these three points are perhaps the greatest hurdles that orthopaedic surgeons face when entering the hip arthroscopy field. In this review, we outlined a stepwise approach for a safe access to hip arthroscopy.
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Affiliation(s)
- David R Maldonado
- From American Hip Institute Research Foundation (Dr. Maldonado, Dr. Rosinsky, Dr. Shapira, and Dr. Domb), and American Hip Institute (Dr. Domb), Des Plaines, IL
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11
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Assaraf E, Blecher R, Heinemann-Yerushalmi L, Krief S, Carmel Vinestock R, Biton IE, Brumfeld V, Rotkopf R, Avisar E, Agar G, Zelzer E. Piezo2 expressed in proprioceptive neurons is essential for skeletal integrity. Nat Commun 2020; 11:3168. [PMID: 32576830 PMCID: PMC7311488 DOI: 10.1038/s41467-020-16971-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/26/2020] [Indexed: 11/24/2022] Open
Abstract
In humans, mutations in the PIEZO2 gene, which encodes for a mechanosensitive ion channel, were found to result in skeletal abnormalities including scoliosis and hip dysplasia. Here, we show in mice that loss of Piezo2 expression in the proprioceptive system recapitulates several human skeletal abnormalities. While loss of Piezo2 in chondrogenic or osteogenic lineages does not lead to human-like skeletal abnormalities, its loss in proprioceptive neurons leads to spine malalignment and hip dysplasia. To validate the non-autonomous role of proprioception in hip joint morphogenesis, we studied this process in mice mutant for proprioceptive system regulators Runx3 or Egr3. Loss of Runx3 in the peripheral nervous system, but not in skeletal lineages, leads to similar joint abnormalities, as does Egr3 loss of function. These findings expand the range of known regulatory roles of the proprioception system on the skeleton and provide a central component of the underlying molecular mechanism, namely Piezo2.
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Affiliation(s)
- Eran Assaraf
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, 76100, Israel
- Department of Orthopedic Surgery, Assaf HaRofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerrifin, 70300, Israel
| | - Ronen Blecher
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, 76100, Israel
- Department of Orthopedic Surgery, Assuta Ashdod University Hospital, Ashdod, 7747629, Israel
- Ben Gurion University of the Negev, Beer-Sheva, 8410501, Israel
| | | | - Sharon Krief
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Ron Carmel Vinestock
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Inbal E Biton
- Department of Veterinary Resources, Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Vlad Brumfeld
- Department of Chemical Research Support, Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Ron Rotkopf
- Bioinformatics Unit, Life Sciences Core Facilities, Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Erez Avisar
- Department of Orthopedic Surgery, Assaf HaRofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerrifin, 70300, Israel
| | - Gabriel Agar
- Department of Orthopedic Surgery, Assaf HaRofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerrifin, 70300, Israel
| | - Elazar Zelzer
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, 76100, Israel.
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12
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Abstract
➤Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability. ➤The zona orbicularis resists joint distraction (during neutral positions), and its aperture mechanism stabilizes the hip from adverse edge-loading (during extreme hip flexion-extension). ➤To preserve joint function and stability, it is important to minimize capsulotomy size and avoid disrupting the zona orbicularis, preserve the femoral head size and neck length, and only repair when or as necessary without altering capsular tensions. ➤It is not fully understood what the role of capsular tightness is in patients who have cam femoroacetabular impingement and if partial capsular release could be beneficial and/or therapeutic. ➤During arthroplasty surgery, a femoral head implant that is nearly equivalent to the native head size with an optimal neck-length offset can optimize capsular tension and decrease dislocation risk where an intact posterior hip capsule plays a critical role in maintaining hip stability.
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Affiliation(s)
- K C Geoffrey Ng
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jonathan R T Jeffers
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
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13
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Park J, Kim GL, Yang KH. Anatomical landmarks for acetabular abduction in adult hips: the teardrop vs. the inferior acetabular rim. Surg Radiol Anat 2019; 41:1505-1511. [PMID: 31494728 DOI: 10.1007/s00276-019-02329-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 08/31/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to compare the acetabular teardrop (the structure located inferomedially in the acetabulum, just superior to the obturator foramen. The medial lip is the interior, and the lateral lip is the exterior of the acetabular wall) with the inferior acetabular rim as anatomical landmarks to measure the acetabular abduction angle (AAD) using coronal CT images from different levels. METHODS Our retrospective study included 120 pelvic CT scans from patients with non-orthopedic pathologies or stress fractures of the proximal femur. The patients included 60 females with a mean age of 48 years (range 40-66) and 60 males with a mean age of 46 years (range 38-65). Each AAD was measured using coronal plane CT slices from five levels: AAD (+ 10) (10 mm anterior to the femoral head center), AAD (+ 5) (5 mm anterior to the femoral head center), AAD (0) (through the femoral head center), AAD (- 5) (5 mm posterior to the femoral head center), and AAD (- 10) (10 mm posterior to the femoral head center). The measurements were then divided into two groups: teardrop-based AADs [AAD (+ 10), AAD (+ 5), and AAD (0)] and rim-based AADs [AAD (- 5) and AAD (- 10)]. RESULTS There were no mean significant differences in AAD within the groups, whereas the difference between the groups was significant. The mean teardrop-based AAD was quite significantly different from the mean rim-based AAD due to the use of different anatomical landmarks. Teardrop-based AADs are lower than rim-based AADs, leading to measurement differences of more than 10°. CONCLUSIONS AAD measurements considering the inferior acetabular rim can be more accurate than those considering the acetabular teardrop because the inferior rim represents the nearly hemispheric acetabulum better than does the teardrop. It is recommended to differentiate between the teardrop and the inferior acetabular rim when measuring AAD to avoid confusion regarding acetabular abduction.
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Affiliation(s)
- Jin Park
- Department of Orthopedic Surgery, College of Medicine, Kangdong Sacred Heart Hospital, Hallym University, 150 Sung-an-ro, Kangdonggu, Seoul, 05355, South Korea.
| | - Gab Lae Kim
- Department of Orthopedic Surgery, College of Medicine, Kangdong Sacred Heart Hospital, Hallym University, 150 Sung-an-ro, Kangdonggu, Seoul, 05355, South Korea
| | - Kyu Hyun Yang
- Department of Orthopedic Surgery, College of Medicine, Yonsei University, Seoul, South Korea
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14
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Ries MD. Relationship Between Functional Anatomy of the Hip and Surgical Approaches in Total Hip Arthroplasty. Orthopedics 2019; 42:e356-e363. [PMID: 31323107 DOI: 10.3928/01477447-20190624-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/12/2018] [Indexed: 02/03/2023]
Abstract
Multiple surgical approaches have been used successfully for total hip arthroplasty. Minimally invasive surgery, defined by the length of the incision, has been associated with less blood loss and shorter length of stay compared with conventional total hip arthroplasty. Differences in early functional outcomes, as well as the risk of early and long-term complications, have been observed between different anatomic surgical approaches. However, no single surgical approach has been established that achieves both the shortest functional recovery and the lowest rate of complications after total hip arthroplasty. [Orthopedics. 2019; 42(4):e356-e363.].
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Jia J, Zhao Q, Lu P, Fan G, Chen H, Liu C, Liu J, Chen S, Jin Z. Clinical efficacy of orthopilot navigation system versus conventional manual of total hip arthroplasty: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15471. [PMID: 31096443 PMCID: PMC6531135 DOI: 10.1097/md.0000000000015471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To compare the clinical efficacy between Orthopilot navigation system and conventional manual surgery in total hip arthroplasty (THA). METHODS Electronic databases were searched to identify randomized controlled trials (RCTs) investigating Orthopilot navigation system versus conventional manual in patients undergoing THA. Outcome measurements include anteversion angle, inclination angle, preoperative leg length discrepancy, postoperative leg length discrepancy and femoral offset. Statistical software Stata 12.0 was used for data-analysis. RESULTS A total of 5 studies were finally included in this meta-analysis. The results showed that the conventional manual group have a less anteversion angle than that in Orthopilot navigation system group (weighted mean difference (WMD) = 4.67, 95% confidence interval (CI) = 3.53, 5.82, P = .000). And pooled analysis showed that the inclination angle in Orthopilot navigation group was less than that in conventional manual group (WMD = -4.19, 95% CI = -8.00, -0.37, P = .031). There was no significant difference between the preoperative leg length discrepancy and postoperative leg length discrepancy (P > .05). Orthopilot navigation system compared with conventional manual procedure was associated with decreased of femoral offset by 2.76 (WMD = -2.76, 95%CI = -3.90, -1.62, P = .000). CONCLUSION Both Orthopilot navigation system and conventional THA result in significant improvements in patient function with similar overall complication rates and have their own edges in cup position.
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Affiliation(s)
- Jianguo Jia
- Department of Orthopedics, SuZhou WuJiang Hospital of Integrated Traditional Chinese and Western Medicine
| | - Qun Zhao
- Department of Orthopedics, SuZhou WuJiang Hospital of Integrated Traditional Chinese and Western Medicine
| | - Pei Lu
- Department of Orthopedics, the Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University
| | - Guiyong Fan
- Department of Orthopaedics, Suzhou Kowloom Hospital, Medical College of Shanghai Jiaotong University
| | - Hao Chen
- Department of Orthopaedics, Suzhou Kowloom Hospital, Medical College of Shanghai Jiaotong University
| | - Chaoqun Liu
- Department of Orthopaedics, Suzhou Kowloom Hospital, Medical College of Shanghai Jiaotong University
| | - Jinlian Liu
- Department of Orthopaedics, Suzhou Kowloom Hospital, Medical College of Shanghai Jiaotong University
| | - Sheng Chen
- Department of Orthopaedics, Jiangsu Shengze Hospital, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Zhengshuai Jin
- Department of Orthopaedics, Jiangsu Shengze Hospital, Nanjing Medical University, Suzhou, Jiangsu, China
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16
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Abstract
Studies of femoral trabecular structure have shown that the orientation and volume of bone are associated with variation in loading and could be informative about individual joint positioning during locomotion. In this study, we analyse for the first time trabecular bone patterns throughout the femoral head using a whole-epiphysis approach to investigate how potential trabecular variation in humans and great apes relates to differences in locomotor modes. Trabecular architecture was analysed using microCT scans of Pan troglodytes (n = 20), Gorilla gorilla (n = 14), Pongo sp. (n = 5) and Homo sapiens (n = 12) in medtool 4.1. Our results revealed differences in bone volume fraction (BV/TV) distribution patterns, as well as overall trabecular parameters of the femoral head between great apes and humans. Pan and Gorilla showed two regions of high BV/TV in the femoral head, consistent with hip posture and loading during two discrete locomotor modes: knuckle-walking and climbing. Most Pongo specimens also displayed two regions of high BV/TV, but these regions were less discrete and there was more variability across the sample. In contrast, Homo showed only one main region of high BV/TV in the femoral head and had the lowest BV/TV, as well as the most anisotropic trabeculae. The Homo trabecular structure is consistent with stereotypical loading with a more extended hip compared with great apes, which is characteristic of modern human bipedalism. Our results suggest that holistic evaluations of femoral head trabecular architecture can reveal previously undetected patterns linked to locomotor behaviour in extant apes and can provide further insight into hip joint loading in fossil hominins and other primates.
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Affiliation(s)
- Leoni Georgiou
- Skeletal Biology Research CentreSchool of Anthropology and ConservationUniversity of KentCanterburyUK
| | - Tracy L. Kivell
- Skeletal Biology Research CentreSchool of Anthropology and ConservationUniversity of KentCanterburyUK
- Department of Human EvolutionMax Planck Institute for Evolutionary AnthropologyLeipzigGermany
| | - Dieter H. Pahr
- Institute for Lightweight Design and Structural BiomechanicsVienna University of TechnologyViennaAustria
- Department of Anatomy and BiomechanicsKarl Landsteiner Private University of Health SciencesKrems an der DonauAustria
| | - Laura T. Buck
- Department of AnthropologyUniversity of CaliforniaDavisCAUSA
| | - Matthew M. Skinner
- Skeletal Biology Research CentreSchool of Anthropology and ConservationUniversity of KentCanterburyUK
- Department of Human EvolutionMax Planck Institute for Evolutionary AnthropologyLeipzigGermany
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17
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Ding Z, Tsang CK, Nolte D, Kedgley AE, Bull AMJ. Improving Musculoskeletal Model Scaling Using an Anatomical Atlas: The Importance of Gender and Anthropometric Similarity to Quantify Joint Reaction Forces. IEEE Trans Biomed Eng 2019; 66:3444-3456. [PMID: 30932815 DOI: 10.1109/tbme.2019.2905956] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The accuracy of a musculoskeletal model relies heavily on the implementation of the underlying anatomical dataset. Linear scaling of a generic model, despite being time and cost efficient, produces substantial errors as it does not account for gender differences and inter-individual anatomical variations. The hypothesis of this study is that linear scaling to a musculoskeletal model with gender and anthropometric similarity to the individual subject produces similar results to the ones that can be obtained from a subject-specific model. METHODS A lower limb musculoskeletal anatomical atlas was developed consisting of ten datasets derived from magnetic resonance imaging of healthy subjects and an additional generic dataset from the literature. Predicted muscle activation and joint reaction force were compared with electromyography and literature data. Regressions based on gender and anthropometry were used to identify the use of atlas. RESULTS Primary predictors of differences for the joint reaction force predictions were mass difference for the ankle (p < 0.001) and length difference for the knee and hip (p ≤ 0.017). Gender difference accounted for an additional 3% of the variance (p ≤ 0.039). Joint reaction force differences at the ankle, knee, and hip were reduced by between 50% and 67% (p = 0.005) when using a musculoskeletal model with the same gender and similar anthropometry in comparison with a generic model. CONCLUSION Linear scaling with gender and anthropometric similarity can improve joint reaction force predictions in comparison with a scaled generic model. SIGNIFICANCE The presented scaling approach and atlas can improve the fidelity and utility of musculoskeletal models for subject-specific applications.
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18
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Elhakeem A, Hartley A, Luo Y, Goertzen AL, Hannam K, Clark EM, Leslie WD, Tobias JH. Lean mass and lower limb muscle function in relation to hip strength, geometry and fracture risk indices in community-dwelling older women. Osteoporos Int 2019; 30:211-220. [PMID: 30552442 PMCID: PMC6331743 DOI: 10.1007/s00198-018-4795-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/29/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED In a population-based sample of British women aged over 70 years old, lean mass and peak lower limb muscle force were both independently associated with hip strength and fracture risk indices, thereby suggesting a potential benefit of promoting leg muscle strengthening exercise for the prevention of hip fractures in postmenopausal women. INTRODUCTION To investigate cross-sectional associations of lean mass and physical performance, including lower limb muscle function, with hip strength, geometry and fracture risk indices (FRIs) in postmenopausal women. METHODS Data were from the Cohort of Skeletal Health in Bristol and Avon. Total hip (TH) and femoral neck (FN) bone mineral density (BMD), hip geometry and total body lean mass (TBLM) were assessed by dual x-ray absorptiometry (DXA). Finite element analysis of hip DXA was used to derive FN, intertrochanteric and subtrochanteric FRIs. Grip strength, gait speed and chair rise time were measured objectively. Lower limb peak muscle force and muscle power were assessed by jumping mechanography. RESULTS In total, 241 women were included (age = 76.4; SD = 2.6 years). After adjustment for age, height, weight/fat mass and comorbidities, TBLM was positively associated with hip BMD (βTH BMD = 0.36, P ≤ 0.001; βFN BMD = 0.26, P = 0.01) and cross-section moment of inertia (0.24, P ≤ 0.001) and inversely associated with FN FRI (- 0.21, P = 0.03) and intertrochanteric FRI (- 0.11, P = 0.05) (estimates represent SD difference in bone measures per SD difference in TBLM). Lower limb peak muscle force was positively associated with hip BMD (βTH BMD = 0.28, P ≤ 0.001; βFN BMD = 0.23, P = 0.008) and inversely associated with FN FRI (- 0.17, P = 0.04) and subtrochanteric FRI (- 0.18, P = 0.04). Associations of grip strength, gait speed, chair rise time and peak muscle power with hip parameters were close to the null. CONCLUSIONS Lean mass and lower limb peak muscle force were associated with hip BMD and geometrical FRIs in postmenopausal women. Leg muscle strengthening exercises may therefore help prevent hip fractures in older women.
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Affiliation(s)
- A Elhakeem
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - A Hartley
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Y Luo
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, Canada
| | - A L Goertzen
- Department of Radiology, University of Manitoba, Winnipeg, Canada
| | - K Hannam
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - E M Clark
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - W D Leslie
- Department of Radiology, University of Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - J H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Cloos MA, Assländer J, Abbas B, Fishbaugh J, Babb JS, Gerig G, Lattanzi R. Rapid Radial T 1 and T 2 Mapping of the Hip Articular Cartilage With Magnetic Resonance Fingerprinting. J Magn Reson Imaging 2018; 50:810-815. [PMID: 30584691 DOI: 10.1002/jmri.26615] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Quantitative MRI can detect early changes in cartilage biochemical components, but its routine clinical implementation is challenging. PURPOSE To introduce a novel technique to measure T1 and T2 along radial sections of the hip for accurate and reproducible multiparametric quantitative cartilage assessment in a clinically feasible scan time. STUDY TYPE Reproducibility, technical validation. SUBJECTS/PHANTOM A seven-compartment phantom and three healthy volunteers. FIELD STRENGTH/SEQUENCE A novel MR pulse sequence that simultaneously measures proton density (PD), T1 , and T2 at 3 T was developed. Automatic positioning and semiautomatic cartilage segmentation were implemented to improve consistency and simplify workflow. ASSESSMENT Intra- and interscanner variability of our technique was assessed over multiple scans on three different MR scanners. STATISTICAL TESTS For each scan, the median of cartilage T1 and T2 over six radial slices was calculated. Restricted maximum likelihood estimation of variance components was used to estimate intrasubject variances reflecting variation between results from the two scans using the same scanner (intrascanner variance) and variation among results from the three scanners (interscanner variance). RESULTS The estimation error for T1 and T2 with respect to reference standard measurements was less than 3% on average for the phantom. The average interscanner coefficient of variation was 1.5% (1.2-1.9%) and 0.9% (0.0-3.7%) for T1 and T2 , respectively, in the seven compartments of the phantom. Total scan time in vivo was 7:13 minutes to obtain PD, T1 , and T2 maps along six radial hip sections at 0.6 × 0.6 × 4.0 mm3 voxel resolution. Interscanner variability for the in vivo study was 1.99% and 5.46% for T1 and T2 , respectively. in vivo intrascanner variability was 1.15% for T1 and 3.24% for T2 . DATA CONCLUSION Our method, which includes slice positioning, model-based parameter estimation, and cartilage segmentation, is highly reproducible. It could enable employing quantitative hip cartilage evaluation for longitudinal and multicenter studies. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:810-815.
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Affiliation(s)
- Martijn A Cloos
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, New York, USA
| | - Jakob Assländer
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Batool Abbas
- Visualization, Imaging and Data Analysis (VIDA), New York University Tandon School of Engineering, Brooklyn, New York, USA
| | - James Fishbaugh
- Visualization, Imaging and Data Analysis (VIDA), New York University Tandon School of Engineering, Brooklyn, New York, USA
| | - James S Babb
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Guido Gerig
- Visualization, Imaging and Data Analysis (VIDA), New York University Tandon School of Engineering, Brooklyn, New York, USA
| | - Riccardo Lattanzi
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, New York, USA
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20
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Ceynowa M, Rocławski M, Pankowski R, Mazurek T. The position and morphometry of the fovea capitis femoris in computed tomography of the hip. Surg Radiol Anat 2018; 41:101-107. [PMID: 30171297 PMCID: PMC6510828 DOI: 10.1007/s00276-018-2097-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022]
Abstract
Purpose The position of the fovea of the femoral head is usually considered to be inferior or inferoposterior, despite the fact that few detailed anatomical studies have been performed. This study was performed to assess the position of the fovea in computed tomography and its correlation with standard radiographic measures of the proximal femur. Methods Computed tomography scans of the hip of 107 patients (54 women and 53 men) were evaluated. The semi-coronal and transverse views were used to assess the femoral neck–shaft angle and the neck version, as well as the size and position of the fovea in relation with the femoral neck axis and the size of the head. Results The fovea was always located inferior to the neck axis in the semi-coronal plane. In the transverse plane, the fovea was always slightly posterior to the femoral neck axis, as approximately ¾ of its diameter was posterior to the axis. The position was unrelated to the neck–shaft axis and the neck–trochanter minor angle. There were no differences in the position between men and women; however, in women, the fovea is slightly larger than in men when related to the femoral head size. Conclusion The femoral neck axis in the transverse plane always crosses the anterior aspect of the fovea. Its position is unrelated to the angular geometry of the proximal femur, but related to the femoral head size. It is found to be relatively larger in women.
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Affiliation(s)
- Marcin Ceynowa
- Department of Orthopedic Surgery, Medical University of Gdańsk, ul. Nowe Ogrody 1-6, 80-803, Gdańsk, Poland.
| | - Marek Rocławski
- Department of Orthopedic Surgery, Medical University of Gdańsk, ul. Nowe Ogrody 1-6, 80-803, Gdańsk, Poland
| | - Rafał Pankowski
- Department of Orthopedic Surgery, Medical University of Gdańsk, ul. Nowe Ogrody 1-6, 80-803, Gdańsk, Poland
| | - Tomasz Mazurek
- Department of Orthopedic Surgery, Medical University of Gdańsk, ul. Nowe Ogrody 1-6, 80-803, Gdańsk, Poland
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Kim JJ, Nam J, Jang IG. Fully automated segmentation of a hip joint using the patient-specific optimal thresholding and watershed algorithm. Comput Methods Programs Biomed 2018; 154:161-171. [PMID: 29249340 DOI: 10.1016/j.cmpb.2017.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/07/2017] [Accepted: 11/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Automated segmentation with high accuracy and speed is a prerequisite for FEA-based quantitative assessment with a large population. However, hip joint segmentation has remained challenging due to a narrow articular cartilage and thin cortical bone with a marked interindividual variance. To overcome this challenge, this paper proposes a fully automated segmentation method for a hip joint that uses the complementary characteristics between the thresholding technique and the watershed algorithm. METHODS Using the golden section method and load path algorithm, the proposed method first determines the patient-specific optimal threshold value that enables reliably separating a femur from a pelvis while removing cortical and trabecular bone in the femur at the minimum. This provides regional information on the femur. The watershed algorithm is then used to obtain boundary information on the femur. The proximal femur can be extracted by merging the complementary information on a target image. RESULTS For eight CT images, compared with the manual segmentation and other segmentation methods, the proposed method offers a high accuracy in terms of the dice overlap coefficient (97.24 ± 0.44%) and average surface distance (0.36 ± 0.07 mm) within a fast timeframe in terms of processing time per slice (1.25 ± 0.27 s). The proposed method also delivers structural behavior which is close to that of the manual segmentation with a small mean of average relative errors of the risk factor (4.99%). CONCLUSION The segmentation results show that, without the aid of a prerequisite dataset and users' manual intervention, the proposed method can segment a hip joint as fast as the simplified Kang (SK)-based automated segmentation, while maintaining the segmentation accuracy at a similar level of the snake-based semi-automated segmentation.
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Affiliation(s)
- Jung Jin Kim
- The Cho Chun Shik Graduate School of Green Transportation, 373-1, Guseong-dong, Yuseong-gu, Daejeon 305-701, Korea Advanced Institute of Science and Technology, Republic of Korea.
| | - Jimin Nam
- The Cho Chun Shik Graduate School of Green Transportation, 373-1, Guseong-dong, Yuseong-gu, Daejeon 305-701, Korea Advanced Institute of Science and Technology, Republic of Korea.
| | - In Gwun Jang
- The Cho Chun Shik Graduate School of Green Transportation, 373-1, Guseong-dong, Yuseong-gu, Daejeon 305-701, Korea Advanced Institute of Science and Technology, Republic of Korea.
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22
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Pavlova AV, Saunders FR, Muthuri SG, Gregory JS, Barr RJ, Martin KR, Hardy RJ, Cooper R, Adams JE, Kuh D, Aspden RM. Statistical shape modelling of hip and lumbar spine morphology and their relationship in the MRC National Survey of Health and Development. J Anat 2017; 231:248-259. [PMID: 28561274 PMCID: PMC5522893 DOI: 10.1111/joa.12631] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 12/23/2022] Open
Abstract
The anatomical shape of bones and joints is important for their proper function but quantifying this, and detecting pathological variations, is difficult to do. Numerical descriptions would also enable correlations between joint shapes to be explored. Statistical shape modelling (SSM) is a method of image analysis employing pattern recognition statistics to describe and quantify such shapes from images; it uses principal components analysis to generate modes of variation describing each image in terms of a set of numerical scores after removing global size variation. We used SSM to quantify the shapes of the hip and the lumbar spine in dual-energy x-ray absorptiometry (DXA) images from 1511 individuals in the MRC National Survey of Health and Development at ages 60-64 years. We compared shapes of both joints in men and women and hypothesised that hip and spine shape would be strongly correlated. We also investigated associations with height, weight, body mass index (BMI) and local (hip or lumber spine) bone mineral density. In the hip, all except one of the first 10 modes differed between men and women. Men had a wider femoral neck, smaller neck-shaft angle, increased presence of osteophytes and a loss of the femoral head/neck curvature compared with women. Women presented with a flattening of the femoral head and greater acetabular coverage of the femoral head. Greater weight was associated with a shorter, wider femoral neck and larger greater and lesser trochanters. Taller height was accompanied by a flattening of the curve between superior head and neck and a larger lesser trochanter. Four of the first eight modes describing lumbar spine shape differed between men and women. Women tended to have a more lordotic spine than men with relatively smaller but caudally increasing anterior-posterior (a-p) vertebral diameters. Men were more likely to have a straighter spine with larger vertebral a-p diameters relative to vertebral height than women, increasing cranially. A weak correlation was found between body weight and a-p vertebral diameter. No correlations were found between shape modes and height in men, whereas in women there was a weak positive correlation between height and evenness of spinal curvature. Linear relationships between hip and spine shapes were weak and inconsistent in both sexes, thereby offering little support for our hypothesis. In conclusion, men and women entering their seventh decade have small but statistically significant differences in the shapes of their hips and their spines. Associations with height, weight, BMI and BMD are small and correspond to subtle variations whose anatomical significance is not yet clear. Correlations between hip and spine shapes are small.
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Affiliation(s)
- Anastasia V. Pavlova
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | - Fiona R. Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | | | - Jennifer S. Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | - Rebecca J. Barr
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
- Present address:
Medicines Monitoring Unit (MEMO)Division of Molecular & Clinical MedicineSchool of Medicine Ninewells Hospital & Medical SchoolUniversity of DundeeMailbox 2, Level 7Dundee DD1 9SYUK
| | - Kathryn R. Martin
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | | | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Judith E. Adams
- Manchester Academic Health Science CentreManchester Royal InfirmaryCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Richard M. Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
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Fasel B, Spörri J, Schütz P, Lorenzetti S, Aminian K. Validation of functional calibration and strap-down joint drift correction for computing 3D joint angles of knee, hip, and trunk in alpine skiing. PLoS One 2017; 12:e0181446. [PMID: 28746383 PMCID: PMC5528837 DOI: 10.1371/journal.pone.0181446] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/30/2017] [Indexed: 11/19/2022] Open
Abstract
To obtain valid 3D joint angles with inertial sensors careful sensor-to-segment calibration (i.e. functional or anatomical calibration) is required and measured angular velocity at each sensor needs to be integrated to obtain segment and joint orientation (i.e. joint angles). Existing functional and anatomical calibration procedures were optimized for gait analysis and calibration movements were impractical to perform in outdoor settings. Thus, the aims of this study were 1) to propose and validate a set of calibration movements that were optimized for alpine skiing and could be performed outdoors and 2) to validate the 3D joint angles of the knee, hip, and trunk during alpine skiing. The proposed functional calibration movements consisted of squats, trunk rotations, hip ad/abductions, and upright standing. The joint drift correction previously proposed for alpine ski racing was improved by adding a second step to reduce separately azimuth drift. The system was validated indoors on a skiing carpet at the maximum belt speed of 21 km/h and for measurement durations of 120 seconds. Calibration repeatability was on average <2.7° (i.e. 3D joint angles changed on average <2.7° for two repeated sets of calibration movements) and all movements could be executed wearing ski-boots. Joint angle precision was <4.9° for all angles and accuracy ranged from -10.7° to 4.2° where the presence of an athlete-specific bias was observed especially for the flexion angle. The improved joint drift correction reduced azimuth drift from over 25° to less than 5°. In conclusion, the system was valid for measuring 3D joint angles during alpine skiing and could be used outdoors. Errors were similar to the values reported in other studies for gait. The system may be well suited for within-athlete analysis but care should be taken for between-athlete analysis because of a possible athlete-specific joint angle bias.
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Affiliation(s)
- Benedikt Fasel
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Jörg Spörri
- Department of Sport Science and Kinesiology, University of Salzburg, Hallein-Rif, Austria
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Pascal Schütz
- Institute for Biomechanics, Eidgenössische Technische Hochschule Zurich, Zurich Switzerland
| | - Silvio Lorenzetti
- Institute for Biomechanics, Eidgenössische Technische Hochschule Zurich, Zurich Switzerland
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- * E-mail:
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Anders C, Patenge S, Sander K, Layher F, Biedermann U, Kinne RW. Detailed spatial characterization of superficial hip muscle activation during walking: A multi-electrode surface EMG investigation of the gluteal region in healthy older adults. PLoS One 2017; 12:e0178957. [PMID: 28582456 PMCID: PMC5459501 DOI: 10.1371/journal.pone.0178957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/12/2017] [Indexed: 12/28/2022] Open
Abstract
PURPOSE A multi-electrode array was used to generate spatially resolved Surface electromyography (SEMG) data of the hip muscles in healthy older adults. The cohort was meant to serve as an age-matched, normal control population for future surgical and rehabilitative studies in patients undergoing total hip arthroplasty, in view of the large, continuously increasing number of hip joint replacements. METHODS Bilateral hip muscle SEMG activity, including tensor fasciae latae (TFL), gluteus medius (Gmed), and gluteus maximus (Gmax), was measured during locomotion on a walkway at self-selected slow, normal, and fast walking speeds (age-matched cohort of 29 females and 25 males). Eight equally-spaced, vertically oriented bipolar channels were applied on a horizontal line at mid-distance between iliac crest and greater trochanter (length 17.5 cm; named P1 to P8). Time-independent parameters (e.g., mean amplitude) were derived from the amplitude curves expressed as root mean square. RESULTS The acquired SEMG data were not significantly influenced by gender (p = 0.202) or side (p = 0.313) and were therefore pooled. The most ventral to central electrode positions P1 to P5, representing TFL and ventral to central Gmed, showed the highest mean amplitude levels (averaged over the whole stride; 0.001 < p < 0.027 against P6 to P8; Bonferroni-adjusted paired t-test) at all walking speeds. Also, the respective curves showed two distinct amplitude peaks (representing load acceptance and hip stabilization during mid-stance), with a continuous increase of the first peak from P1 to P4 (most pronounced at fast speed) and the second peak from P1 to P3. Independently of the underlying individual muscles, both peaks displayed a continuous time shift from the most dorsal P8 to the most ventral P1 position, with the peaks for the ventral positions occurring at later time points during the normalized stride. CONCLUSIONS The continuously changing activation patterns of the superficial muscles in the gluteal region during walking may reflect function-driven, finely tuned coordination patterns of neighboring muscles and muscle segments, rather than independent activation of anatomically defined muscles. This may be important for the definition of specific target parameters for the improvement and/or normalization of muscle function during training and post-injury rehabilitation.
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Affiliation(s)
- Christoph Anders
- Division of Motor Research, Pathophysiology and Biomechanics, Clinic for Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Jena, Germany
| | - Steffen Patenge
- Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Eisenberg, Germany
| | - Klaus Sander
- Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Eisenberg, Germany
| | - Frank Layher
- Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Eisenberg, Germany
| | - Uta Biedermann
- Institute of Anatomy I, Jena University Hospital, Jena, Germany
| | - Raimund W. Kinne
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Eisenberg, Germany
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Flato R, Passanante GJ, Skalski MR, Patel DB, White EA, Matcuk GR. The iliotibial tract: imaging, anatomy, injuries, and other pathology. Skeletal Radiol 2017; 46:605-622. [PMID: 28238018 DOI: 10.1007/s00256-017-2604-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 02/02/2023]
Abstract
The iliotibial tract, also known as Maissiat's band or the iliotibial band, and its associated muscles function to extend, abduct, and laterally rotate the hip, as well as aid in the stabilization of the knee. A select group of associated injuries and pathologies of the iliotibial tract are seen as sequela of repetitive stress and direct trauma. This article intends to educate the radiologist, orthopedist, and other clinicians about iliotibial tract anatomy and function and the clinical presentation, pathophysiology, and imaging findings of associated pathologies. Specifically, this article will review proximal iliotibial band syndrome, Morel-Lavallée lesions, external snapping hip syndrome, iliotibial band syndrome and bursitis, traumatic tears, iliotibial insertional tendinosis and peritendonitis, avulsion fractures at Gerdy's tubercle, and Segond fractures. The clinical management of these pathologies will also be discussed in brief.
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Affiliation(s)
- Russell Flato
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA
| | - Giovanni J Passanante
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA
| | - Matthew R Skalski
- Department of Radiology, Palmer College of Chiropractic-West Campus, San Jose, CA, 95134, USA
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA
| | - Eric A White
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA
| | - George R Matcuk
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA.
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Hui-Hui Wu, Dong Wang, An-Bang Ma, Dong-Yun Gu. Hip joint geometry effects on cartilage contact stresses during a gait cycle. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2016:6038-41. [PMID: 28269629 DOI: 10.1109/EMBC.2016.7592105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The cartilage surface geometry of natural human hip joint is commonly regarded as sphere. It has been widely applied in computational simulation and hip joint prosthesis design. Some new geometry models have been developed and the sphere assumption has been questioned recently. The objective of this study was to analyze joint geometry effects on cartilage contact stress distribution and investigate contact patterns during a whole gait cycle. Hip surface was reconstructed from CT data of a healthy volunteer. Three finite element (FE) models of hip joint were developed from different cartilage geometries: natural geometry, sphere and rotational ellipsoid. Loads at ten instants of gait cycle were applied to these models based on published in-vivo data. FE predictions of peak contact pressure during gait of natural hip were compared with sphere and rotational ellipsoid replaced hip joint. Contact occurs mainly in upper anterior region of both acetabulum and femur distributing along sagittal plane of human body. It moves towards inferolateral aspect as the resultant joint reaction force changes during walking for natural hip. Peak pressures at the instant with maximum contact force were 7.48 MPa, 14.97 MPa and 13.12 MPa for models with natural hip surface, sphere replaced and rotational ellipsoid replaced surface respectively. During the whole gait cycle, contact pressure of natural hip ranked lowest in most of the instants, followed by rotational ellipsoid replaced and sphere replaced hip. The results indicate that rotational ellipsoid is more consistent with natural hip cartilage geometry than sphere during normal walking. This means rotational ellipsoid prosthesis could give a better description of physiological structure compared with standard sphere prosthesis. Therefore, rotational ellipsoid would be a better choice for prosthesis design.
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Kepley AL, Nishiyama KK, Zhou B, Wang J, Zhang C, McMahon DJ, Foley KF, Walker MD, Guo XE, Shane E, Nickolas TL. Differences in bone quality and strength between Asian and Caucasian young men. Osteoporos Int 2017; 28:549-558. [PMID: 27638138 DOI: 10.1007/s00198-016-3762-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED This is a cross-sectional study to assess differences in bone quality in young Asian and Caucasian (n = 30/group) men between 25 and 35 years. We found that Asians had smaller bones, thicker and denser cortices, and more plate-like trabeculae, but stiffness did not differ between groups. INTRODUCTION We conducted a cross-sectional study to assess differences in bone quality in young Asian and Caucasian (n = 30/group) men between 25 and 35 years. METHODS We measured bone mineral density (BMD) at the spine, total hip (TH), femoral neck (FN), and forearm by dual energy X-ray absorptiometry (DXA), and bone geometry, density, microarchitecture, and mechanical competence at the radius and tibia by high-resolution peripheral quantitative computed tomography (HR-pQCT) with application of individual trabecula segmentation (ITS) and trabecular and whole bone finite element analysis (FEA). We measured load-to-strength ratio to account for differences in bone size and height, respectively. We used Wilcoxon rank sum and generalized linear models adjusted for height, weight, and their interaction for comparisons. RESULTS Asians were 3.9 % shorter and weighed 6.5 % less than Caucasians. In adjusted models: by DXA, there were no significant race-based differences in areal BMD; by HR-pQCT, at the radius, Asians had smaller total and trabecular area (p = 0.003 for both), and denser (p = 0.01) and thicker (p = 0.04) cortices at the radius; by ITS, at the radius Asians, had more plate-like than rod-like trabeculae (PR ratio p = 0.01), greater plate trabecular surface (p = 0.009) and longer rod length (p = 0.002). There were no significant race-based differences in FEA or the load-to-strength ratio. CONCLUSIONS Asians had smaller bones, thicker and denser cortices, and more plate-like trabeculae, but biomechanical estimates of bone strength did not differ between groups. Studies are needed to determine whether these differences persist later in life.
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Affiliation(s)
- A L Kepley
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - K K Nishiyama
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - B Zhou
- Biomedical Engineering, Department of Medicine, Columbia University, New York, NY, USA
| | - J Wang
- Biomedical Engineering, Department of Medicine, Columbia University, New York, NY, USA
| | - C Zhang
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - D J McMahon
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - K F Foley
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - M D Walker
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - X Edward Guo
- Biomedical Engineering, Department of Medicine, Columbia University, New York, NY, USA
| | - E Shane
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - T L Nickolas
- Department of Medicine, Nephrology, Columbia University Medical Center, 622 West 168th Street, PH4-124, New York, NY, 10032, USA.
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Aydin M, Kircil C, Polat O, Arikan M, Erdemli B. Adult acetabulo - pelvic parameters in Turkish society: A descriptive radiological study. Acta Orthop Traumatol Turc 2016; 50:623-627. [PMID: 27825760 PMCID: PMC6197353 DOI: 10.1016/j.aott.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/07/2016] [Accepted: 02/15/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to measure the prevalences of the acetabular index, collodiaphyseal angle, CE angle, articulo-trochanteric distance, cross-over sign and posterior wall sign in healthy Turkish people, in order to shed light on the production of orthopedic medical products. METHODS In this study, both hips (a total of 3960 hips) of 1980 individuals (1178 males, 802 females) from nine different cities between the ages of 18 and 65 years were measured and statistically analyzed. RESULTS The right articulo-trochanteric distance of all participants was 19.67 ± 4.52 mm and the left articulo-trochanteric distance was 19.10 ± 4.58 mm. The CE angle was 35.11°±7.41° in the right hip and 35.37°±6.76° in the left hip. The acetabular index was 37.58°±5.30° in the right hip and 37.80°±4.82° in the left hip. The collodiaphyseal angle was 138.60°±8.27° in the right and 137.84°±8.01° in the left hip. The prevalence of cross-over sign in the right hip was 6.46% and 6.66% for the left hip. The prevalence of posterior wall sign was 4.24% for the right hip and 4.19% for the left hip. CONCLUSION This study has provided prevalence values of cross-over sign, posterior wall sign, acetabular index, collodiaphyseal angle, CE angle and articulo-trochanteric distances of a healthy Turkish population between the ages of 18 and 65 years.
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Affiliation(s)
- Murat Aydin
- Department of Orthopedics and Traumatology, Afyonkarahisar Suhut Public Hospital Medicine, Afyonkarahisar, Turkey.
| | - Cihan Kircil
- Department of Orthopaedics and Traumatology, Koru Hospital, Ankara, Turkey
| | - Onur Polat
- Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Murat Arikan
- Department of Orthopaedics and Traumatology, Oncology Training and Research Hospital, Ankara, Turkey
| | - Bülent Erdemli
- Department of Orthopaedics and Traumatology, Ankara University School of Medicine, Ankara, Turkey
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Abstract
There are no data regarding the acetabular orientation on magnetic resonance imaging (MRI); this study investigates the changes of acetabular orientation with age in normal Chinese children.We retrospectively analyzed the medical records of children who underwent hip MRI examination at our hospital from January 2009 to December 2015. A total of 180 patients with normal MRI reading of the hip joints were included and were divided into 14 groups according to age: from 6 months of age and then for each year from 1 to 16 years. The bony and cartilage acetabular anteversion angle (AAA), acetabular inclination angle (AIA), and acetabular index (AI) were measured. Total bony and cartilage femoral head coverage angles were measured on axial section total femoral head coverage angle (a-TCA) and coronal section total femoral head coverage angle (c-TCA).The mean bony AAA and AIA were 12.2 ± 2.5° and 50.9 ± 2.5°, respectively; both of them stayed constant from the age of 6 months to 16 years. Similar results were found in cartilage AAA (12.1 ± 2.5°) and AIA (41.2 ± 3.0°). There was no difference between bony and cartilage AAA, but bony AIA was significantly larger than cartilage AIA. Bony AI was 24.1 ± 2.4° at the age of 6 months, decreasing to 12.5 ± 2.3° by 12 to 13 years of age; cartilage AI (5.9 ± 1.7°) maintained a steady value with age. The mean bony a-TCA and c-TCA at 6 months were 117.0 ± 5.8° and 127.5 ± 5.1°, increasing to 144.5 ± 4.6° and 140.7 ± 2.5° at the age of 16 years. However, the cartilage a-TCA (145.2 ± 7.2°) and c-TCA (154.1 ± 5.7°) did not change significantly with age.Both bony and cartilage AAA and AIA remain constant up to the age of 16 years in normal Chinese pediatric population. Although the cartilage coverage of femoral head by the acetabulum remains unchanged with age, the bony coverage of femoral head increases.
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Affiliation(s)
- YiQiang Li
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University
| | - YuanZhong Liu
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University
| | - QingHe Zhou
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University
| | - WeiDong Chen
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University
| | - JingChun Li
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University
| | - LingJia Yu
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University
| | - HongWen Xu
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University
- Correspondence: HongWen Xu, Department of Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th JinSui Road, Guangzhou 510623, China (e-mail: ); DengHui Xie, Department of Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th JinSui Road, Guangzhou 510623, China; Southern Medical University, Guangzhou 510515, China (e-mail: )
| | - DengHui Xie
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University
- Southern Medical University, Guangzhou, China
- Correspondence: HongWen Xu, Department of Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th JinSui Road, Guangzhou 510623, China (e-mail: ); DengHui Xie, Department of Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th JinSui Road, Guangzhou 510623, China; Southern Medical University, Guangzhou 510515, China (e-mail: )
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Walters AL, Semevolos SA, Baker RE. Goniometrie evaluation of standing extension and maximum flexion joint angles of llamas and alpacas. Am J Vet Res 2016; 77:1000-4. [PMID: 27580112 DOI: 10.2460/ajvr.77.9.1000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine and compare mean standing extension and maximum flexion angles of various joints in healthy adult alpacas and llamas, and determine the reliability of goniometric data within and between 2 observers for each joint of interest. SAMPLE 6 healthy adult llamas and 6 healthy adult alpacas. PROCEDURES The shoulder joint, elbow joint, carpal, and metacarpophalangeal (MCP) joints of the forelimbs and the hip joint, stifle joint, tarsal, and metatarsophalangeal (MTP) joints of the hind limbs were investigated. Each articulation was measured with a universal goniometer by 2 observers, who each obtained 2 measurements when each joint was maintained in standing extension and in maximal passive flexion. Two sample (unpaired) t tests were performed for comparisons of mean standing extension and maximum passive flexion angles between alpacas and llamas. Intraclass correlation coefficients were calculated for each articulation to assess interobserver and intra-observer reliability of measurements. RESULTS Llamas had larger mean standing extension angles than alpacas for the tarsal and elbow joint, but there were no significant differences between species for all other joints. For all joints, flexion measurements did not differ significantly between the 2 species. For most joints, the reliability of goniometric data between observers was good to excellent (intraclass correlation coefficients, 0.6 to 0.95) CONCLUSIONS AND CLINICAL RELEVANCE Except for the elbow joint and tarsus in extension, the angle of limb articulations during flexion and extension can be considered similar for alpacas and llamas. These measurements have relevance for veterinary surgeons when assessing joint mobility and conformation and determining appropriate angles for arthrodesis.
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Abstract
Purpose: To determine the normal values of the anterior and posterior capsular distances of the hip joint in healthy children by means of US, using MR imaging as reference, and to evaluate any possible correlation between age, length, weight and anterior capsular distance (ACD). Material and Methods: In our first study both hips in 14 healthy children (5-18 years old) were examined with US and MR to obtain measurements of the ACD and the posterior capsular distance (PCD). The distance from the anterior or posterior aspect of the femoral neck to the anterior or posterior aspect, respectively, of the outer limit of the capsule was determined. The distances were measured both with the hips in spontaneous external rotation of 10-15° and in internal rotation of 45°. In our second study, both hips in 28 healthy children (3-16 years old) were examined with US to determine the ACD. Age, length and weight were recorded. Results: Study I: There was good correlation between the US and MR measurements in all positions. The ACD measured by US was significantly increased in inward rotation of the hip. Study II: There was no correlation between ACD and age, length or weight. Conclusion: The PCD of the hip joint can be accurately measured by US with the hip in internal rotation of 45°. When compared with MR values, the ACD measured by US was dependent on the degree of rotation of the leg and increased significantly in internal rotation. Because the outer limit of the external layer of the joint capsule is sonographically more distinct, we suggest that the capsular distance should be measured from the outer limit of the joint capsule to the anterior or posterior aspect of the femoral neck. The measurement should be made perpendicular to the femoral neck, at the position where the greatest numerical value is obtained.
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Affiliation(s)
- L Laurell
- Department of Paediatrics, Lund University Hospital, Sweden
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Li J, Hua X, Jones AC, Williams S, Jin Z, Fisher J, Wilcox RK. The influence of the representation of collagen fibre organisation on the cartilage contact mechanics of the hip joint. J Biomech 2016; 49:1679-1685. [PMID: 27079623 PMCID: PMC4894261 DOI: 10.1016/j.jbiomech.2016.03.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/01/2016] [Accepted: 03/28/2016] [Indexed: 11/30/2022]
Abstract
The aim of this study was to develop a finite element (FE) hip model with subject-specific geometry and biphasic cartilage properties. Different levels of detail in the representation of fibre reinforcement were considered to evaluate the feasibility to simplify the complex depth-dependent fibre pattern in the native hip joint. A FE model of a cadaveric hip with subject-specific geometry was constructed through micro-computed-tomography (µCT) imaging. The cartilage was assumed to be biphasic and fibre-reinforced with different levels of detail in the fibre representation. Simulations were performed for heel-strike, mid-stance and toe-off during walking and one-leg-stance over 1500s. It was found that the required level of detail in fibre representation depends on the parameter of interest. The contact stress of the native hip joint could be realistically predicted by simplifying the fibre representation to being orthogonally reinforced across the whole thickness. To predict the fluid pressure, depth-dependent fibre organisation is needed but specific split-line pattern on the surface of cartilage is not necessary. Both depth-dependent and specific surface fibre orientations are required to simulate the strains.
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Affiliation(s)
- Junyan Li
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK.
| | - Xijin Hua
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK
| | - Alison C Jones
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK
| | - Sophie Williams
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK
| | - Zhongmin Jin
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK; School of Mechanical Engineering, Xi'an Jiaotong University, China
| | - John Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK
| | - Ruth K Wilcox
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK
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Zhang H, Song C, Zhao W, Yin A, Zhu J, Ren G. [Influence of Different Abduction Angles of Hip Joint on Stress Distribution of Femoral Neck]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2016; 33:274-278. [PMID: 29708660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The stress distribution and different abduction angles have a close relation to the hip joint.The purpose of this study is to provide biomechanical evidence for the treatment or precaution of hip joint injuries.A three-dimensional model of the hip was established through a series of processing based on the normal human hip joint computed tomograph(CT)image data which were applied to reverse engineering software Mimics14.0in this study.Firstly,a three-dimensional finite element model was generated with meshing and assigned material and then it was imported into the finite element analysis software Ansys13.0.At last the stress at the femoral neck was solved,computed and analyzed in the positive orthostatic position with 7hip abduction angles of the hip joint:0°,5°,10°,15°,20°,25°,and 30°,respectively.The results showed that the stresses of femoral neck and outer region were obviously higher than those of front and rear area of the neck of femur in the upright position or abduction of a different angle.With the increase of abduction angle,femoral neck in front of the regional stress value basically unchanged and rear area decreased,but the more obvious changes occurred in the outer region although the stress of inner and outer area also increased gradually.The hip abduction may cause changes in stress distribution because of the femoral neck stress mostly concentrated in the inner and outer cortex,and therefore it has an important role in guiding for hip surgery injury patients to choose the most reasonable solutions and prevention initiatives.
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Kwok IHY, Pallett SJC, Massa E, Cundall-Curry D, Loeffler MD. Pre-operative digital templating in cemented hip hemiarthroplasty for neck of femur fractures. Injury 2016; 47:733-6. [PMID: 26797019 DOI: 10.1016/j.injury.2015.12.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/27/2015] [Accepted: 12/27/2015] [Indexed: 02/02/2023]
Abstract
Pre-operative digital templating allows the surgeon to foresee any anatomical anomalies which may lead to intra-operative problems, and anticipate appropriate instruments and implants required during surgery. Although its role is well-established in successful elective total hip arthroplasty, little work has been done on its use in hip hemiarthroplasty in neck of femur fractures. We describe our initial experience of digital templating in 40 consecutive patients who have undergone cemented hip hemiarthroplasty, assessing templating accuracy between templated implant sizes to actual implant sizes. 81% of implanted heads were templated to within two head sizes, and 89% of implanted stems were templated to within two sizes. Although there was a moderately strong correlation of 0.52 between templated and actual head sizes, this correlation was not demonstrated in femoral stem sizes. Mean leg length discrepancy was -2.5mm (S.D. 8.5), and the mean difference in femoral offset between the operated and non-operated hip was -1mm (S.D. 4.4). Digital templating is a useful adjunct to the surgeon in pre-operative planning of hip hemiarthroplasty in the restoration of leg length and femoral offset. However, its accuracy is inferior to that of elective total hip arthroplasty.
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Affiliation(s)
- Iris H Y Kwok
- Colchester General Hospital, Turner Road, Colchester, Essex, CO4 5JL, United Kingdom.
| | - Scott J C Pallett
- Colchester General Hospital, Turner Road, Colchester, Essex, CO4 5JL, United Kingdom
| | - Edward Massa
- Colchester General Hospital, Turner Road, Colchester, Essex, CO4 5JL, United Kingdom
| | - Duncan Cundall-Curry
- Colchester General Hospital, Turner Road, Colchester, Essex, CO4 5JL, United Kingdom
| | - Mark D Loeffler
- Colchester General Hospital, Turner Road, Colchester, Essex, CO4 5JL, United Kingdom
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Sang W, Zhu L, Ma J, Lu H, Wang C. The Influence of Body Mass Index and Hip Anatomy on Direct Anterior Approach Total Hip Replacement. Med Princ Pract 2016; 25:555-560. [PMID: 27287341 PMCID: PMC5588501 DOI: 10.1159/000447455] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/07/2016] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To investigate the influence of body mass index (BMI) and hip anatomy on direct anterior approach (DAA) total hip replacement. SUBJECTS AND METHODS The study is a retrospective analysis of 124 cases of DAA total hip replacement from 2009 to 2012. The BMI, the ratio of the greater trochanter (GT) and anterior superior iliac spine (ASIS) bilaterally (GT/ASIS), and the vertical distance between the ASIS and GT (AGVD) were obtained from medical records. All cases were categorized into three groups (43, 49, and 32 cases in each group, respectively) based on BMI (BMI <18.5, BMI 18.5-25, and BMI >25) or divided into two groups based on GT/ASIS (≤1.17 or >1.17) or AGVD (≤86 or >86 mm). Operating time, intraoperative bleeding, and surgical complications were compared between different groups. RESULTS A longer average operating time, more intraoperative bleeding, and a higher rate of complications were observed in the group with the highest BMI. The complications included a case of intraoperative femur fracture, a wound hematoma, and a lateral femoral cutaneous nerve injury. The group with higher GT/ASIS had a shorter average operating time, less bleeding, and a lower complication rate than the group with lower GT/ASIS. Moreover, the group with higher AGVD showed a shorter average operating time, less bleeding, and a lower complication rate compared with the group with lower AGVD. CONCLUSION Our study suggests that lower BMI and larger GT/ASIS and AGVD are associated with a shorter operating time, less bleeding, and a lower complication rate in DAA total hip replacement. These findings are valuable for clinicians to make the appropriate choice of surgery types for different individuals.
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Affiliation(s)
| | | | - Jinzhong Ma
- *Jinzhong Ma, Department of Orthopedics, The First People's Hospital, Affiliated to Shanghai Jiaotong University, No. 100 Haining Road, 200080 Shanghai (China), E-Mail
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Philippon MJ, Michalski MP, Campbell KJ, Rasmussen MT, Goldsmith MT, Devitt BM, Wijdicks CA, LaPrade RF. A quantitative analysis of hip capsular thickness. Knee Surg Sports Traumatol Arthrosc 2015; 23:2548-53. [PMID: 24817105 DOI: 10.1007/s00167-014-3030-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/19/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to provide a comprehensive quantitative analysis of capsular thickness adjacent to the acetabular rim in clinically relevant locations. METHODS Dissections were performed and hip capsular measurements were recorded on 13 non-paired, fresh-frozen cadaveric hemi-pelvises using a coordinate measuring device. Measurements were taken for each clock-face position at 0, 5, 10 and 15 mm distances from the labral edge. RESULTS The capsule was consistently thickest at 2 o'clock for each interval from the labrum with a maximum thickness of 8.3 at 10 mm [95 % CI 6.8, 9.8] and 15 mm [95 % CI 6.8, 9.7]. The capsule was noticeably thinner between 4 and 11 o'clock with a minimum thickness of 4.1 mm [95 % CI 3.3, 4.9] at 10 o'clock at the labral edge. Direct comparison between 0 and 5 mm between 9 and 3 o'clock showed that the hip capsule was significantly thicker at 5 mm from the labrum at 9 o'clock (p = 0.027), 10 o'clock (p = 0.032), 1 o'clock (p = 0.003), 2 o'clock (p = 0.001) and 3 o'clock (p = 0.001). CONCLUSIONS The hip capsule was thickest between the 1 and 2 o'clock positions for all measured distances from the acetabular labrum and reached its maximum thickness at 2 o'clock, which corresponds to the location of the iliofemoral ligament.
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Affiliation(s)
- Marc J Philippon
- Department of BioMedical Engineering, Steadman Philippon Research Institute, 181 West Meadow Drive Suite 1000, Vail, CO, 81657, USA,
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Liu H, Xu N, Zhang Y, Gu Y, Sun J, Tong J. [MORPHOLOGICAL STUDY ON PROXIMAL FEMUR IN ADULT PATIENTS WITH CROWE TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP AND ITS CLINICAL SIGNIFICANCE]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2015; 29:931-935. [PMID: 26677611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the anatomical morphology of the proximal femur in adult patients with Crowe type IV developmental dysplasia of the hip (DDH) so as to provided a reference for the selection of femoral components or personalized artificial prosthesis for DDH. METHODS Between June 2004 and December 2014, 49 patients (58 hips) with Crowe type IV DDH were included in this study. There were 7 males (8 hips) with an average age of 47.3 years and 42 females (50 hips) with an average age of 30.0 years. X-ray films were taken in all cases and CT scanning in 17 cases (17 hips). The anatomical parameters were measured through Osirix V 5.8.5 software. RESULTS The distance of femoral head dislocation was (6.09 ± 1.04) cm; the femoral head and neck disappeared completely in 8 hips (13.8%); femoral head atrophy and deformation and femoral neck disappearance were observed in 11 hips (19.0%). The midpoint width of the small trochanteric canal was (1.53 ± 0.29) cm; the isthmus diameter was (0.69 ± 0.09) cm; the canal flare index-(CFI) value was (3.50 ± 0.42) cm; the femoral neck anteversion angle was (37.0 ± 18.2); and all indexes showed significant difference when compared with ones of normal population and Crowe type I, II, and III patients. But there was no significant difference in femoral neck-shaft angle (132.3 ± 9.1°), isthmus height (11.66 ± 2.67) cm (P > 0.05). The chimney type cavity (CFI < 3) accounted for 51.7%, which was significantly higher than the value of normal population. There was a positive correlation between metaphyseal CFI and CFI (r = 0.63, P = 0.00), but there was no correlation between metaphyseal CFI and distal CFI (r = -0.17, P = 0.21). CONCLUSION The proximal femur has the morphological characteristics of narrow medullary cavity, increased anteversion angle, and high ratio of chimney type cavity, so it is necessary to design specialized femoral components or personalized artificial prosthesis for the DDH.
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Kainz H, Carty CP, Modenese L, Boyd RN, Lloyd DG. Estimation of the hip joint centre in human motion analysis: a systematic review. Clin Biomech (Bristol, Avon) 2015; 30:319-29. [PMID: 25753697 DOI: 10.1016/j.clinbiomech.2015.02.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inaccuracies in locating the three-dimensional position of the hip joint centre affect the calculated hip and knee kinematics, force- and moment-generating capacity of muscles and hip joint mechanics, which can lead to incorrect interpretations and recommendations in gait analysis. Several functional and predictive methods have been developed to estimate the hip joint centre location, and the International Society of Biomechanics recommends a functional approach for use with participants that have adequate range of motion at the hip, and predictive methods in those with insufficient range of motion. The purpose of the current systematic review was to substantiate the International Society of Biomechanics recommendations. This included identifying the most accurate functional and predictive methods, and defining 'adequate' range of motion. METHODS A systematic search with broad search terms was performed including five databases. FINDINGS The systematic search yielded to 801 articles, of which 34 papers were included. Eleven different predictive and 13 different functional methods were identified. The results showed that the geometric sphere fit method and Harrington equations are the most accurate functional and predictive approaches respectively that have been evaluated in vivo. INTERPRETATION In regard to the International Society of Biomechanics recommendations, the geometric sphere fit method should be used in people with sufficient active hip range of motion and the Harrington equations should be used in patients without sufficient hip range of motion. Multi-plane movement trials with at least 60° of flexion-extension and 30° of ab-adduction range of motion are suggested when using functional methods.
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Affiliation(s)
- Hans Kainz
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Queensland Children's Gait Laboratory, Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
| | - Christopher P Carty
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Queensland Children's Gait Laboratory, Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Luca Modenese
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - David G Lloyd
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Hind K, Gannon L, Brightmore A, Beck B. Insights into relationships between body mass, composition and bone: findings in elite rugby players. J Clin Densitom 2015; 18:172-8. [PMID: 25659180 DOI: 10.1016/j.jocd.2014.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/14/2014] [Accepted: 11/14/2014] [Indexed: 11/20/2022]
Abstract
Recent reports indicate that bone strength is not proportional to body weight in obese populations. Elite rugby players have a similar body mass index (BMI) to obese individuals but differ markedly with low body fat, high lean mass, and frequent skeletal exposure to loading through weight-bearing exercise. The purpose of this study was to determine relationships between body weight, composition, and bone strength in male rugby players characterized by high BMI and high lean mass. Fifty-two elite male rugby players and 32 nonathletic, age-matched controls differing in BMI (30.2 ± 3.2 vs 24.1 ± 2.1 kg/m²; p = 0.02) received 1 total body and one total hip dual-energy X-ray absorptiometry scan. Hip structural analysis of the proximal femur was used to determine bone mineral density (BMD) and cross-sectional bone geometry. Multiple linear regression was computed to identify independent variables associated with total hip and femoral neck BMD and hip structural analysis-derived bone geometry parameters. Analysis of covariance was used to explore differences between groups. Further comparisons between groups were performed after normalizing parameters to body weight and to lean mass. There was a trend for a positive fat-bone relationship in rugby players, and a negative relationship in controls, although neither reached statistical significance. Correlations with lean mass were stronger for bone geometry (r(2): 0.408-0.520) than for BMD (r(2): 0.267-0.293). Relative to body weight, BMD was 6.7% lower in rugby players than controls (p < 0.05). Rugby players were heavier than controls, with greater lean mass and BMD (p < 0.01). Relative to lean mass, BMD was 10%-14.3% lower in rugby players (p < 0.001). All bone geometry measures except cross-sectional area were proportional to body weight and lean mass. To conclude, BMD in elite rugby players was reduced in proportion to body weight and lean mass. However, their superior bone geometry suggests that overall bone strength may be adequate for loading demands. Fat-bone interactions in athletes engaged in high-impact sports require further exploration.
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Affiliation(s)
- Karen Hind
- Institute of Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Metropolitan University, Leeds, UK.
| | - Lisa Gannon
- Institute of Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Metropolitan University, Leeds, UK
| | - Amy Brightmore
- Institute of Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Metropolitan University, Leeds, UK
| | - Belinda Beck
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
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Henak CR, Ateshian GA, Weiss JA. Finite element prediction of transchondral stress and strain in the human hip. J Biomech Eng 2014; 136:021021. [PMID: 24292495 DOI: 10.1115/1.4026101] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 11/27/2013] [Indexed: 11/08/2022]
Abstract
Cartilage fissures, surface fibrillation, and delamination represent early signs of hip osteoarthritis (OA). This damage may be caused by elevated first principal (most tensile) strain and maximum shear stress. The objectives of this study were to use a population of validated finite element (FE) models of normal human hips to evaluate the required mesh for converged predictions of cartilage tensile strain and shear stress, to assess the sensitivity to cartilage constitutive assumptions, and to determine the patterns of transchondral stress and strain that occur during activities of daily living. Five specimen-specific FE models were evaluated using three constitutive models for articular cartilage: quasilinear neo-Hookean, nonlinear Veronda Westmann, and tension-compression nonlinear ellipsoidal fiber distribution (EFD). Transchondral predictions of maximum shear stress and first principal strain were determined. Mesh convergence analysis demonstrated that five trilinear elements were adequate through the depth of the cartilage for precise predictions. The EFD model had the stiffest response with increasing strains, predicting the largest peak stresses and smallest peak strains. Conversely, the neo-Hookean model predicted the smallest peak stresses and largest peak strains. Models with neo-Hookean cartilage predicted smaller transchondral gradients of maximum shear stress than those with Veronda Westmann and EFD models. For FE models with EFD cartilage, the anterolateral region of the acetabulum had larger peak maximum shear stress and first principal strain than all other anatomical regions, consistent with observations of cartilage damage in disease. Results demonstrate that tension-compression nonlinearity of a continuous fiber distribution exhibiting strain induced anisotropy incorporates important features that have large effects on predictions of transchondral stress and strain. This population of normal hips provides baseline data for future comparisons to pathomorphologic hips. This approach can be used to evaluate these and other mechanical variables in the human hip and their potential role in the pathogenesis of osteoarthritis (OA).
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Engelhart D, Schouten AC, Aarts RGKM, van der Kooij H. Assessment of Multi-Joint Coordination and Adaptation in Standing Balance: A Novel Device and System Identification Technique. IEEE Trans Neural Syst Rehabil Eng 2014; 23:973-82. [PMID: 25423654 DOI: 10.1109/tnsre.2014.2372172] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The ankles and hips play an important role in maintaining standing balance and the coordination between joints adapts with task and conditions, like the disturbance magnitude and type, and changes with age. Assessment of multi-joint coordination requires the application of multiple continuous and independent disturbances and closed loop system identification techniques (CLSIT). This paper presents a novel device, the double inverted pendulum perturbator (DIPP), which can apply disturbing forces at the hip level and between the shoulder blades. In addition to the disturbances, the device can provide force fields to study adaptation of multi-joint coordination. The performance of the DIPP and a novel CLSIT was assessed by identifying a system with known mechanical properties and model simulations. A double inverted pendulum was successfully identified, while force fields were able to keep the pendulum upright. The estimated dynamics were similar as the theoretical derived dynamics. The DIPP has a sufficient bandwidth of 7 Hz to identify multi-joint coordination dynamics. An experiment with human subjects where a stabilizing force field was rendered at the hip (1500 N/m), showed that subjects adapt by lowering their control actions around the ankles. The stiffness from upper and lower segment motion to ankle torque dropped with 30% and 48%, respectively. Our methods allow to study (pathological) changes in multi-joint coordination as well as adaptive capacity to maintain standing balance.
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Srivastava S, Kao PC, Kim SH, Stegall P, Zanotto D, Higginson JS, Agrawal SK, Scholz JP. Assist-as-Needed Robot-Aided Gait Training Improves Walking Function in Individuals Following Stroke. IEEE Trans Neural Syst Rehabil Eng 2014; 23:956-63. [PMID: 25314703 DOI: 10.1109/tnsre.2014.2360822] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A novel robot-aided assist-as-needed gait training paradigm has been developed recently. This paradigm encourages subjects' active participation during training. Previous pilot studies demonstrated that assist-as-needed robot-aided gait training (RAGT) improves treadmill walking performance post-stroke. However, it is not known if there is an over-ground transfer of the training effects from RAGT on treadmill or long-term retention of the effects. The purpose of the current study was to examine the effects of assist-as-needed RAGT on over-ground walking pattern post-stroke. Nine stroke subjects received RAGT with visual feedback of each subject's instantaneous ankle malleolus position relative to a target template for 15 40-minute sessions. Clinical evaluations and gait analyses were performed before, immediately after, and 6 months post-training. Stroke subjects demonstrated significant improvements and some long-term retention of the improvements in their self-selected over-ground walking speed, Dynamic Gait Index, Timed Up and Go, peak knee flexion angle during swing phase and total hip joint excursion over the whole gait cycle for their affected leg . These preliminary results demonstrate that subjects improved their over-ground walking pattern and some clinical gait measures post-training suggesting that assist-as-needed RAGT including visual feedback may be an effective approach to improve over-ground walking pattern post-stroke.
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Machado MM, Fernandes PR, Zymbal V, Baptista F. Human proximal femur bone adaptation to variations in hip geometry. Bone 2014; 67:193-9. [PMID: 25016094 DOI: 10.1016/j.bone.2014.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
Abstract
The study of bone mass distribution at proximal femur may contribute to understand the role of hip geometry on hip fracture risk. We examined how bone mineral density (BMD) of proximal femur adapts to inter individual variations in the femoral neck length (FNL), femoral neck width (FNW) and neck shaft angle (NSA). A parameterized and dimensionally scalable 3-D finite element model of a reference proximal femur geometry was incrementally adjusted to adopt physiological ranges at FNL (3.90-6.90cm), FNW (2.90-3.46cm), and NSA (109-141º), yielding a set of femora with different geometries. The bone mass distribution for each femur was obtained with a suitable bone remodelling model. The BMDs at the integral femoral neck (FN) and at the intertrochanteric (ITR) region, as well as the BMD ratio of inferomedial to superolateral (IM:SL) regions of FN and BMD ratio of FN:ITR were used to represent bone mass distribution. Results revealed that longer FNLs present greater BMD (g/cm(3)) at the FN, mainly at the SL region, and at the ITR region. Wider FNs were associated with reduced BMD at the FN, particularly at the SL region, and at the ITR region. Larger NSAs up to 129° were associated with BMD diminutions at the FN and ITR regions and with increases of the IM:SL BMD ratio while NSAs larger than 129° resulted in decrease of the IM:SL BMD ratio. These findings suggest hip geometry as moderator of the mechanical loading influence on bone mass distribution at proximal femur with higher FNL favoring the BMD of FN and ITR regions and greater FNW and NSA having the opposite effect. Augmented values of FNL and FNW seem also to favor more the BMD at the superolateral than at the inferomedial FN region.
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Affiliation(s)
- M M Machado
- LAETA, IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1 1049-001 Lisboa, Portugal.
| | - P R Fernandes
- LAETA, IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1 1049-001 Lisboa, Portugal.
| | - V Zymbal
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz Quebrada, Dafundo, Portugal.
| | - F Baptista
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz Quebrada, Dafundo, Portugal.
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Papavasiliou A, Siatras T, Bintoudi A, Milosis D, Lallas V, Sykaras E, Karantanas A. The gymnasts' hip and groin: a magnetic resonance imaging study in asymptomatic elite athletes. Skeletal Radiol 2014; 43:1071-7. [PMID: 24756337 DOI: 10.1007/s00256-014-1885-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/04/2014] [Accepted: 03/26/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Specific patterns of developmental adaptation of the proximal femur have been recognized in some sports. Gymnastics are characterized by repetitive axial loading and hip rotations in combination with extreme hip positions. It is unknown how and if these forces can affect an immature skeleton in the long term. We sought to evaluate this, by means of magnetic resonance imaging of the hip and groin of such elite asymptomatic athletes. MATERIALS AND METHODS We performed a case-control comparative MR imaging study of both hips and groin of 12 (7 male, 5 female) skeletally mature young (mean age 18.6 years) asymptomatic international level gymnasts with a minimum of 10 years' training with age-matched non-athletes. At the time of recruitment, none of the athletes had a recorded musculoskeletal complaint or injury in the anatomical area around the hip. RESULTS The study showed that elite gymnasts share four common morphological characteristics on MRI that deviate from normal and are considered to be the result of adaptational changes to the specific sport: high centre-column-diaphysis angle (coxa valga140° on average), ligamentum teres hypertrophy, friction of the iliotibial band with oedema surrounding the greater trochanter, and a high incidence (62.5 %) of radiological appearances of ischiofemoral impingement. CONCLUSION Our study showed that elite gymnasts share four common morphological characteristics on MRI that deviate from normal. These findings were in asymptomatic subjects; hence, radiologists and sports physicians should be aware of them in order to avoid unnecessary treatment.
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Affiliation(s)
- A Papavasiliou
- Sport Injuries Laboratory, Department of Physical Education and Sport Sciences, Aristotle University of Thessaloniki, Thermi, 54124, Thessaloniki, Greece,
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Cardadeiro G, Baptista F, Rosati N, Zymbal V, Janz KF, Sardinha LB. Influence of physical activity and skeleton geometry on bone mass at the proximal femur in 10- to 12-year-old children--a longitudinal study. Osteoporos Int 2014; 25:2035-45. [PMID: 24809809 DOI: 10.1007/s00198-014-2729-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Physical activity (PA) have long been identified as a determining factor of the mineralization of the skeleton, particularly in children. Our research supports the hypothesis that the geometry of the pelvis and proximal femur (PF) might moderate the effect of PA in the relative mineralization of the PF subregions. INTRODUCTION Using a longitudinal observational study with two evaluations and a 1-year follow-up interval, we investigated the influence of PA and skeletal geometry in bone mineral density (BMD) and bone mass distribution at the PF in 96 girls and 81 boys (10-12 years). It is plausible that the geometry of the pelvis-PF structure moderates mechanical forces exerted at the hip and therefore creates different degrees of mineralization among PF subregions. METHODS Whole body and left hip dual X-ray absorptiometry scans were used to derive geometric measures of the pelvis-inter-acetabular distance (IAD) and PF abductor lever arm (ALA). BMD was measured at the integral, superolateral (SL), and inferomedial (IM) femoral neck (FN), and at the trochanter (TR). These subregions were used to represent bone mass distribution via three BMD ratios: FN/PF, IM/SL, and TR/PF. PA was measured using accelerometry and a bone-specific PA questionnaire (BPAQ). RESULTS A longitudinal data approach revealed BPAQ as a positive predictor for all BMD variables (p < 0.05) except TR BMD in girls and FN BMD in boys. Comparing the most active with the less-active participants, the greatest benefits of PA were observed at the FN of the girls with the lowest IAD (p < 0.001), at the FN of the boys with the highest IAD (p < 0.001) and at the TR of the boys with the lowest ALA (p < 0.01). CONCLUSIONS Geometric measures of IAD and ALA seem to moderate the effect of PA role in the relative mineralization of the PF regions. On the other hand, absolute BMD levels appear to be determined by mechanical loading.
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Affiliation(s)
- G Cardadeiro
- Exercise and Health Laboratory, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
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Taormina DP, Marcano AI, Karia R, Egol KA, Tejwani NC. Symptomatic atypical femoral fractures are related to underlying hip geometry. Bone 2014; 63:1-6. [PMID: 24565751 DOI: 10.1016/j.bone.2014.02.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 02/13/2014] [Accepted: 02/14/2014] [Indexed: 11/21/2022]
Abstract
The benefits of bisphosphonates are well documented, but prolonged use has been associated with atypical femur fractures. Radiographic markers for fracture predisposition could potentially aid in safer medication use. In this case-control designed study, we compared hip radiographic parameters and the demographic characteristics of chronic bisphosphonate users who sustained an atypical femoral fracture with a group of chronic bisphosphonate users who did not sustain an atypical femur fracture and also a group who sustained an intertrochanteric hip fracture. Radiographic parameters included were neck-shaft angle (NSA), hip-axis length (HAL) and center-edge angle (CE). Multivariate regression was used to evaluate the relationship between radiographic measures and femur fracture. Receiver-operating characteristic analysis determined cut-off points for neck-shaft angle and risk of atypical femur fracture. Ultimately, pre-fracture radiographs of 53 bisphosphonate users who developed atypical fracture were compared with 43 asymptomatic chronic bisphosphonate users and 64 intertrochanteric fracture patients. Duration of bisphosphonate use did not statistically differ between users sustaining atypical fracture and those without fracture (7.9 [±3.5] vs. 7.7 [±3.3] years, p=0.7). Bisphosphonate users who fractured had acute/varus pre-fracture neck-shaft angles (p<0.001), shorter hip-axis length (p<0.01), and narrower center-edge angles (p<0.01). Regression analysis revealed associations between neck-shaft angle (OR=0.89 [95% CI=0.81-0.97; p=0.01), center edge angle (OR=0.89 [95% CI=0.80-0.99]; p=0.03), and BMI (OR=1.15 [95% CI=1.02-1.31; p=0.03) with fracture development. ROC curve analysis (AUC=0.67 [95% CI=0.56-0.79]) determined that a cut-off point for neck-shaft angle <128.3° yielded 69% sensitivity and 63% specificity for development of atypical femoral fracture. Ultimately, an acute/varus angle of the femoral neck, high BMI, and narrow center-edge angle were associated with development of atypical femur fracture in long-term bisphosphonate users. Patients on long-term bisphosphonates should be regularly radiographically evaluated in order to assess for potential risk of atypical fracture.
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Affiliation(s)
- David P Taormina
- Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, 301 East 17th Street, Suite 1402, New York, NY 10003, USA.
| | - Alejandro I Marcano
- Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, 301 East 17th Street, Suite 1402, New York, NY 10003, USA.
| | - Raj Karia
- Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, 301 East 17th Street, Suite 1402, New York, NY 10003, USA.
| | - Kenneth A Egol
- Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, 301 East 17th Street, Suite 1402, New York, NY 10003, USA; Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, NY 11418, USA.
| | - Nirmal C Tejwani
- Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, 301 East 17th Street, Suite 1402, New York, NY 10003, USA.
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Iyem C, Güvençer M, Karatosun V, Unver B. Morphometric evaluation of proximal femur in patients with unilateral total hip prosthesis. Clin Anat 2014; 27:478-88. [PMID: 23650122 DOI: 10.1002/ca.22245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 02/09/2013] [Accepted: 03/03/2013] [Indexed: 02/05/2023]
Abstract
It is important to know the morphometric characteristics of the proximal femur. This is necessary to reduce the risk of complications related to surgical procedures performed in the area due to vascular, metabolic, or traumatic causes. It is of importance for achieving the alignment of the prosthesis to be implanted as well. The aim of this study was to evaluate the morphometric characteristics of the proximal femur and to establish a database for making and performing total hip prosthesis. Anteroposterior (AP) pelvic radiographs of 162 cases, with a mean age of 65.6 years, who had undergone unilateral total hip arthroplasty were used in this study. Femoral head diameter (FHD), femoral neck width (FNW), femoral neck length (FNL), femoral neck axis length (FNAL), intertrochanteric line length (ILL), and neck-shaft angle (NSA) were measured on radiographs obtained digitally using setrapacs media. FHD was found to be 48.1 ± 3.7 mm, FNW 35.4 ± 4.2 mm, FNL 30.8 ± 6.1 mm, FNAL 98.6 ± 9.4 mm, ILL 81.1 ± 7.9 mm, and NSA 130.4 ± 5.1° on average. The comparison of the mean values for females and males revealed a statistically significant difference between the FHD, FNW, FNL, FNAL, and ILL (P = 0.000). There was no statistically significant difference in NSA between males and females (P = 0.356). A weak correlation was found between age and parameter values using correlation analysis (r < 0.24, P > 0.05). In morphometric assessment of the proximal femur, taking into consideration regional and sexual differences is of importance for prosthesis design and surgical success.
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Affiliation(s)
- Cıhan Iyem
- Department of Anatomy, Faculty of Medicine, Giresun University, Giresun, Turkey
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Bonneau N, Baylac M, Gagey O, Tardieu C. Functional integrative analysis of the human hip joint: the three-dimensional orientation of the acetabulum and its relation with the orientation of the femoral neck. J Hum Evol 2014; 69:55-69. [PMID: 24602366 DOI: 10.1016/j.jhevol.2013.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 09/24/2013] [Accepted: 12/22/2013] [Indexed: 01/25/2023]
Abstract
In humans, the hip joint occupies a central place in the locomotor system, as it plays an important role in body support and the transmission of the forces between the trunk and lower limbs. The study of the three-dimensional biomechanics of this joint has important implications for documenting the morphological changes associated with the acquisition of a habitual bipedal gait in humans. Functional integration at any joint has important implications in joint stability and performance. The aim of the study was to evaluate the functional integration at the human hip joint. Both the level of concordance between the three-dimensional axes of the acetabulum and the femoral neck in a bipedal posture, and patterns of covariation between these two axes were analysed. First, inter-individual variations were quantified and significant differences in the three-dimensional orientations of both the acetabulum and the femoral neck were detected. On a sample of 57 individuals, significant patterns of covariation were identified, however, the level of concordance between the axes of both the acetabulum and the femoral neck in a bipedal posture was lower than could be expected for a key joint such as the hip. Patterns of covariation were explored regarding the complex three-dimensional biomechanics of the full pelvic-femoral complex. Finally, we suggest that the lower degree of concordance observed at the human hip joint in a bipedal posture might be partly due to the phylogenetic history of the human species.
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Affiliation(s)
- Noémie Bonneau
- UMR 7179, CNRS - Muséum National d'Histoire Naturelle, 75005 Paris, France; JE 2494, University Paris-Sud Orsay, Paris F-91405, France.
| | - Michel Baylac
- UMR 7205, CNRS - Muséum National d'Histoire Naturelle, 75005 Paris, France
| | - Olivier Gagey
- Bicêtre University Hospital, AP-HP, Paris F-94270, France; JE 2494, University Paris-Sud Orsay, Paris F-91405, France
| | - Christine Tardieu
- UMR 7179, CNRS - Muséum National d'Histoire Naturelle, 75005 Paris, France
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Hammond AS. In vivo baseline measurements of hip joint range of motion in suspensory and nonsuspensory anthropoids. Am J Phys Anthropol 2014; 153:417-34. [PMID: 24288178 PMCID: PMC4023689 DOI: 10.1002/ajpa.22440] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/11/2013] [Accepted: 11/12/2013] [Indexed: 11/08/2022]
Abstract
Hominoids and atelines are known to use suspensory behaviors and are assumed to possess greater hip joint mobility than nonsuspensory monkeys, particularly for range of abduction. This assumption has greatly influenced how extant and fossil primate hip joint morphology has been interpreted, despite the fact that there are no data available on hip mobility in hominoids or Ateles. This study uses in vivo measurements to test the hypothesis that suspensory anthropoids have significantly greater ranges of hip joint mobility than nonsuspensory anthropoids. Passive hip joint mobility was measured on a large sample of anesthetized captive anthropoids (nonhuman hominids = 43, hylobatids = 6, cercopithecids = 43, Ateles = 6, and Cebus = 6). Angular and linear data were collected using goniometers and tape measures. Range of motion (ROM) data were analyzed for significant differences by locomotor group using ANOVA and phylogenetic regression. The data demonstrate that suspensory anthropoids are capable of significantly greater hip abduction and external rotation. Degree of flexion and internal rotation were not larger in the suspensory primates, indicating that suspension is not associated with a global increase in hip mobility. Future work should consider the role of external rotation in abduction ability, how the physical position of the distal limb segments are influenced by differences in ROM proximally, as well as focus on bony and soft tissue differences that enable or restrict abduction and external rotation at the anthropoid hip joint.
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Affiliation(s)
- Ashley S. Hammond
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, M263 Medical Sciences Building, Columbia, Missouri 65212
- Department of Anatomical Sciences, Stony Brook University, Stony Brook, NY 11794
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Abstract
Accurate localisation of the hip joint centre is required to obtain accurate kinematics, kinetics and musculoskeletal modelling results. Literature data showed that conclusions drawn from synthetic data, adult normal subjects and cerebral palsy children may vary markedly. This study investigated the localisation accuracy of the hip joint centre against EOS. The EOS system allowed us to register the hip joint centres with respect to the skin markers on standing subjects. A comprehensive set of predictive and functional calibration techniques were tested. For the functional calibration techniques, our results showed that algorithm, range of motion and self-performance of the movement were factors significantly affecting the results. Best results were obtained for comfortable range and self-performance of the movement. The best method in this scenario was the functional geometrical sphere fitting method which localised the hips 1.1cm from the EOS reference in average and 100% of the time within 3 cm. Worst results for functional calibration methods occurred when the movement was assisted with a reduced range of movement. The best method in this scenario was the Harrington et al. regression equations since it does not rely on a functional calibration movement. Harrington et al. equations put the hips 1.7 cm from the EOS reference in average and 97% of the time within 3 cm. We conclude that accurate localisation of the hip joint centre is possible in gait analysis providing that method to localise the hip joint centres are adapted to the population studied: functional geometrical sphere fitting when hip calibration movements are not a problem and Harrington et al. predictive equations otherwise.
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Affiliation(s)
- Morgan Sangeux
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, 50 Flemington Road, Parkville 3052, Australia; Murdoch Childrens Research Institute, Flemington Road, Parkville 3052, Australia; Melbourne School of Engineering, The University of Melbourne, Student Centre Building 173, Parkville 3052, Australia.
| | - Hélène Pillet
- Arts et Metiers ParisTech, LBM, 151 bd de l'hôpital, 75013 Paris, France
| | - Wafa Skalli
- Arts et Metiers ParisTech, LBM, 151 bd de l'hôpital, 75013 Paris, France
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