Tracking Translations in the Human Hip

Author(s):  
Sima Zakani ◽  
Erin J. Smith ◽  
Manuela Kunz ◽  
Gavin C. A. Wood ◽  
John Rudan ◽  
...  

Translations of the femoral head with respect to the acetabular cup, in non-impinging zones, was investigated using surgical navigation methods. An ex-vivo study was conducted on five fresh-frozen human cadaver pelvises in distinct dissection states. Each specimen underwent a series of motions that included combinations of abduction/adduction, flexion/extension and internal/external rotations, repeated in four soft-tissue states: soft tissues intact; partially dissected with capsule intact; Z-shaped capsulotomy; and fully dissected and disarticulated. The data showed significant increases of excursions (p<0.05) between the first three soft tissue states. The findings supported the recently proposed model of aspherical hip motion, and imply that the femoral head translated before and after impingement. The results bring into question many accepted ideas in hip morphology, kinematics and surgical planning.

2017 ◽  
Vol 11 (1) ◽  
pp. 1165-1172
Author(s):  
Philippe Van Overschelde ◽  
Vera Pinskerova ◽  
Peter P. Koch ◽  
Christophe Fornasieri ◽  
Sandro Fucentese

Background: To date, there is still no consensus on what soft tissues must be preserved and what structures can be safely released during total knee arthroplasty (TKA) with a medially stabilized implant. Objective: The aim of this study was to analyze the effect of a progressive selective release of the medial and lateral soft tissues in a knee implanted with a medially stabilized prosthesis. Method: Six cadaveric fresh-frozen full leg specimens were tested. In each case, kinematic pattern and mediolateral laxity were measured in three stages: firstly, prior to implantation; secondly, after the implantation of the trial components, but before any soft tissue release; and thirdly, progressively as soft tissue was released with the trial implant in place. The incremental impact of each selective release on knee balance was then analyzed. Results: In all cases sagittal stability was not affected by the progressive release of the lateral soft tissue envelope. It was possible to perform progressive lateral release provided the anterior one-third of the iliotibial band (ITB) remained intact. Progressive medial release could be performed on the medial side provided the anterior fibers of the superficial medial collateral ligament (sMCL) remained intact. Conclusion: The medially conforming implant remains stable provided the anterior fibers of sMCL and the anterior fibers of the ITB remain intact. The implant’s sagittal stability is mainly dependent on its medial ball-in-socket design.


2009 ◽  
Vol 124 (5) ◽  
pp. 564-568 ◽  
Author(s):  
M Suzuki ◽  
Y Ogawa ◽  
T Hasegawa ◽  
S Kawaguchi ◽  
K Yukawa ◽  
...  

AbstractAim:To examine the usefulness of a three-dimensional model for surgical navigation of cholesteatoma.Materials and method:A three-dimensional model was prototyped using selective laser sintering. Based on detailed computed tomography data, powder layers were laser-fused and accumulated to create a three-dimensional structure. The computed tomography threshold was adjusted to simultaneously replicate bony structures and soft tissues.Results:The cholesteatoma, major vessels and bony structures were well replicated. This laser-sintered model was used to aid surgery for recurrent cholesteatoma. The cholesteatoma, which extended from the hypotympanum through the styloid process sheath and the internal carotid artery sheath, was removed safely via a minimal skin incision.Conclusion:The laser-sintered model was useful for surgical planning and navigation in a cholesteatoma case involving complex bony structures and soft tissue.


2020 ◽  
Vol 25 (02) ◽  
pp. 177-183
Author(s):  
Akira Ikumi ◽  
Toshikazu Tanaka ◽  
Yusuke Matsuura ◽  
Kazuki Kuniyoshi ◽  
Takane Suzuki ◽  
...  

Background: The purpose of this study was to identify the optimal pin insertion point to minimize finger motion restriction for proximal phalangeal fixation in cadaver models. Methods: We used 16 fingers from three fresh-frozen cadavers (age, 82–86 years). Each finger was dissected at the level of the carpometacarpal joint and fixated to a custom-built range of motion (ROM)-measuring apparatus after skin removal. The pin was inserted into the bone through four gliding soft tissues: the interosseous hood, dorsal capsule, lateral band, and sagittal band. Then, each tendon was pulled by a prescribed weight in three finger positions (flexion, extension, and intrinsic plus position). Changes in the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) angles were measured before and after pinning. We compared the differences between the insertion points using the Tukey-Kramer post hoc test. Results: Placement of pins into the sagittal band significantly restricted MCP joint flexion, while placement into the dorsal capsule and lateral band significantly restricted PIP joint flexion. Only placement into the interosseous hood showed no significant difference in joint angles between the three finger positions compared to pre-pin insertion. There were no significant effects on MCP, PIP, and DIP joint extension. Conclusions: The ROM of the MCP joint was obstructed due to pinning in most areas of insertion. However, pin insertion to the interosseous hood did not obstruct the finger flexion ROM compared to that of other gliding soft tissues; therefore, we believe that the interosseous hood may be a suitable pin insertion point for proximal phalangeal fixation.


Materials ◽  
2019 ◽  
Vol 12 (15) ◽  
pp. 2473 ◽  
Author(s):  
Xiuwen Liu ◽  
Michael Pujari-Palmer ◽  
David Wenner ◽  
Philip Procter ◽  
Gerard Insley ◽  
...  

The aim of the present study was to evaluate the soft tissue bond strength of a newly developed, monomeric, biomimetic, tissue adhesive called phosphoserine modified cement (PMC). Two types of PMCs were evaluated using lap shear strength (LSS) testing, on porcine skin: a calcium metasilicate (CS1), and alpha tricalcium phosphate (αTCP) PMC. CS1 PCM bonded strongly to skin, reaching a peak LSS of 84, 132, and 154 KPa after curing for 0.5, 1.5, and 4 h, respectively. Cyanoacrylate and fibrin glues reached an LSS of 207 kPa and 33 kPa, respectively. αTCP PMCs reached a final LSS of ≈110 kPa. In soft tissues, stronger bond strengths were obtained with αTCP PMCs containing large amounts of amino acid (70–90 mol%), in contrast to prior studies in calcified tissues (30–50 mol%). When αTCP particle size was reduced by wet milling, and for CS1 PMCs, the strongest bonding was obtained with mole ratios of 30–50% phosphoserine. While PM-CPCs behave like stiff ceramics after setting, they bond to soft tissues, and warrant further investigation as tissue adhesives, particularly at the interface between hard and soft tissues.


2013 ◽  
Vol 18 (5) ◽  
pp. 504-510 ◽  
Author(s):  
Kazuhiro Hasegawa ◽  
Ko Kitahara ◽  
Haruka Shimoda ◽  
Toshiaki Hara

Object This study aimed to clarify changes in segmental instability following a unilateral approach for microendoscopic posterior decompression and muscle-preserving interlaminar decompression compared with traditional procedures and destabilized models. Methods An ex vivo experiment was performed using 30 fresh frozen porcine functional spinal units (FSUs). Each intact specimen was initially tested for flexion-extension, lateral bending, and torsion up to 1.5° using a material testing system at an angular velocity of 0.1°/second under a preload of 70 N. Microendoscopic posterior decompression, muscle-preserving interlaminar decompression, bilateral medial facetectomy, left unilateral total facetectomy, and bilateral total facetectomy were then performed, followed by mechanical testing with the same loading conditions, in 6 randomized FSUs from each group. Stiffness and neutral zone were standardized by dividing the experimental values by the baseline values and were then compared among groups. Results Mean standardized stiffness values for all loading modes tended to decrease in the order of muscle-preserving interlaminar decompression, microendoscopic posterior decompression, bilateral medial facetectomy, left unilateral total facetectomy, and bilateral total facetectomy. In contrast, mean standardized neutral zone values tended to increase in the order of muscle-preserving interlaminar decompression, microendoscopic posterior decompression, bilateral medial facetectomy, left unilateral total facetectomy, and bilateral total facetectomy. In flexion, values for standardized stiffness following microendoscopic posterior decompression and muscle-preserving interlaminar decompression were higher and standardized neutral zone following microendoscopic posterior decompression and muscle-preserving interlaminar decompression were lower than the values following left unilateral total facetectomy and bilateral total facetectomy while there was no significant difference among bilateral medial facetectomy, left unilateral total facetectomy, and bilateral total facetectomy. Values of standardized stiffness and standardized neutral zone in left torsion following microendoscopic posterior decompression, muscle-preserving interlaminar decompression, and bilateral medial facetectomy were equally superior to values of the destabilization models (left unilateral total facetectomy and bilateral total facetectomy). Except for standardized stiffness in left bending, the values of the parameters for each bending tended to be the same as in the other loading modes. Conclusions The present biomechanical study showed that overall stability of the FSUs was maintained following microendoscopic posterior decompression, muscle-preserving interlaminar decompression, and bilateral medial facetectomy compared with the destabilization models of left unilateral total facetectomy or bilateral total facetectomy. Comparison of the postoperative stability following microendoscopic posterior decompression, muscle-preserving interlaminar decompression, and bilateral medial facetectomy revealed that muscle-preserving interlaminar decompression tended to be superior, followed by microendoscopic posterior decompression and bilateral medial facetectomy.


2015 ◽  
Author(s):  
◽  
Henry P. Tsai

Archosaurs (crocodylians, birds and their extinct relatives) underwent numerous evolutionary transitions in limb morphology and body size, reflecting a diverse suite of postural and behavioral adaptations. Among archosaurs, saurischians (sauropodomorph and theropod dinosaurs) evolved a wide diversity of hip joint morphology and locomotor postures, as well as spanning seven orders of magnitude in body size. The very largest saurischians possessed incongruent hip joints, in which the bony ends of the femur and the acetabulum (hip socket) differ in shape and size. This observation has led to the suggestion that gigantic saurischians built their joints using large volumes of soft tissues. Nevertheless, the lack of hip joint anatomical data in extant archosaurs and the general poor preservation of joint soft tissues in fossils hinder functional inferences of archosaur hip joints, thus complicating our attempts to understand the posture, locomotor behavior, ecology, and evolution of this diverse clade. This thesis investigates the anatomy and homology of articular soft tissue in the archosaur hip joint, reconstructs the evolutionary transition of hip joints in Saurischia, and infers the correlated evolution of hip joints and body size in the sauropod and theropod lineages. In the first study, I described the soft tissue anatomies and their osteological correlates in the hip joint of archosaurs and their sauropsid outgroups, and infer structural homology across extant sauropsids using dissection, imaging, and histology. This study provides new insight into soft tissue structures and their osteological correlates in the archosaur hip joint, allowing anatomical inferences of once-present joint soft tissues in fossil archosaurs. In the second study, I used maximum likelihood ancestral state reconstruction and osteological correlates to infer major trends in hip joint soft tissue transitions within sauropodomorphs and theropods, and tested the integration between femoral and acetabular structures. Results of this study indicate that sauropodomorph hip joints underwent few concerted transitions, followed by subsequent stasis in soft tissue anatomy throughout Sauropoda. In contrast, the theropod hip joint is characterized by mosaic evolution within the stem lineage, such that bird-like hip joints independently evolved in multiple theropod clades. In the final study, I used 3D imaging techniques and phylogenetically correlated correlations to test the relationship among hip joint dimensions, morphological characters, and body size of saurischian dinosaurs. Giant theropods and sauropods convergently evolved highly incongruent bony hip joints. In sauropods, the femoral head was capped a thick layer of hyaline cartilage, which functioned to resist massive axial compressive loads. In contrast, theropods covered their femoral head and neck with thinner hyaline cartilage, and maintained the femoral neck-antitrochanter articulation to accommodate shear forces during femoral abduction and axial rotation. These results indicate that the archosaur hip joint underwent divergent transformations in soft tissue morphology reflective of body size, locomotor posture, and joint loading. Moreover, these studies provides the basis for reconstructing hip joint function, hindlimb posture, and locomotor evolution of archosaurs, as well as expanding the body of comparative knowledge on vertebrate joint and cartilage biology.


Foot & Ankle ◽  
1993 ◽  
Vol 14 (8) ◽  
pp. 435-442 ◽  
Author(s):  
Patricia D. C. Chamberland ◽  
Judith W. Smith ◽  
Lamar L. Fleming

The purpose of this study was to define the intraosseous and extraosseous blood supply of the hallucal sesamoids by studying a total of 10 fresh-frozen, below-knee specimens with no evidence of vascular disease. Most specimens were injected with high grade India ink, cleared using a standard Spalteholz technique, and processed to delineate the extraosseous and intraosseous blood supply to include soft tissue dissection and coronal sectioning. Two additional specimens were injected with blue Mercox acrylic solution to further define the extraosseous vasculature. The major extraosseous blood supply to the sesamoids is via the posterior tibial artery. This vessel then branches into the medial plantar artery which further divides upon entering the medial and lateral sesamoids in their proximal poles. Vessels in the peripheral soft tissues, although abundant, do not seem to penetrate the cortex of the sesamoids. The intraosseous blood supply to the sesamoids seems to be threefold. Mainly, sesamoid arteries enter the lateral and medial sesamoids from the proximal aspect via a single vessel. This proximal vessel proceeds distally with a network of branching. Plantar, nonarticular vessels enter the sesamoids, constituting a second source of vascularity. Finally, small vessels also enter the sesamoids through medial and lateral capsular attachments. Based on this study, a possible explanation for avascular necrosis and nonunion of sesamoids is proposed, and an optimal surgical approach is discussed. A medial operative approach avoiding the proximal pole of the sesamoids will preserve the main arterial source. The plantar surface of the sesamoids should also be avoided. Minimal dissection through the circumferential soft tissue vascular sleeve is recommended.


Author(s):  
Adam James Farrier ◽  
Lauren Moore ◽  
Will Manning ◽  
Carolina Avila ◽  
Simon N Collins ◽  
...  

Hip resurfacing is an attractive alternative to total hip replacement preserving bone and reducing dislocation risk. Recent metal-on-metal designs have caused failure due to metal wear debris. Ceramic implants may mitigate this risk. Deformation of the acetabular cup can affect the lubrication, producing high friction torques between the femoral head and the cup that would increase wear and/or lead to cup loosening due to femoral head clamping. Our objective was to quantify the deformation of a novel monobloc ceramic hip resurfacing cup component compared to a metal standard, in a fresh frozen cadaveric model using a press-fit technique representative of standard surgical conditions. For this study eight acetabula were prepared from four fresh frozen cadavers. One surgeon with extensive experience in hip resurfacing surgery (J.H.) prepared the acetabulum by sequential reaming. The implants were then impacted into the acetabulum. Four ceramic and four metal implants were used of equal and varying size. Deformation was measured peri-implantation, and at 30 min, using an optical high-precision deformation sensor (GOM GmbH, Braunschweig, Germany). The maximum inscribed circle and the measurement of radial segment techniques were used. Deformation was greater in the metal implants (mean: 34–22mm) immediately after implantation. At 30 min after implantation, the deformation increased to 36mm in the metal and 26mm in the ceramic cup. Greater diameter changes were observed in larger cups. Metal and ceramic implants did not return to the initial diameter. We conclude the ceramic resurfacing acetabular implants undergo similar deformation to existing metal-on-metal implants. The deformation observed was significantly less in the ceramic component at 30 min on one measure. Less deformation may result in better surface conditions and wear characteristics. Deformation change did not resolve after 30 min for both implants.


Author(s):  
V Saikko

Frictional behaviour of 22 different femoral head-acetabular cup combinations was studied on a new servo-hydraulic microcomputer-controlled hip joint simulator using various flexion-extension angle and superior-inferior load set value waveforms and using distilled water at 37 ± 1°C as lubricant. Six different head materials were included in the study, whereas all cups were ultra-high molecular weight polyethylene (UHMWPE). Most head-cup combinations studied are commercially available. No distinctly superior joint design can he pointed out, but the frictional behaviour of alumina ceramic against UHMWPE proved overall most favourable ( μmin was 0.02), whereas that of non-ion-implanted titanium alloy Ti-6Al-4V against UHMWPE proved strikingly poor ( μmax was 0.15). The lowest frictional torque was in 22 mm joints, but frictional torque did not always increase straightforwardly with increasing diameter of the femoral head. The measurements form an extensive comparison between a wide variety of head-cup combinations. The simulator is apparently a useful instrument in the study of frictional behaviour of new designs, materials, surface treatments and coatings that are frequently introduced.


Author(s):  
Filippo Boriani ◽  
Edoardo Raposio ◽  
Costantino Errani

: Musculoskeletal tumors of the hand are a rare entity and are divided into skeletal and soft tissue tumors. Either category comprises benign and malignant or even intermediate tumors. Basic radiology allows an optimal resolution of bone and related soft tissue areas, ultrasound and more sophisticated radiologic tools such as scintigraphy, CT and MRI allow a more accurate evaluation of tumor extent. Enchondroma is the most common benign tumor affecting bone, whereas chondrosarcoma is the most commonly represented malignant neoplasm localized to hand bones. In the soft tissues ganglions are the most common benign tumors and epithelioid sarcoma is the most frequently represented malignant tumor targeting hand soft tissues. The knowledge regarding diagnostic and therapeutic management of these tumors is often deriving from small case series, retrospective studies or even case reports. Evidences from prospective studies or controlled trials are limited and for this lack of clear and supported evidences data from the medical literature on the topic are controversial, in terms of demographics, clinical presentation, diagnosis prognosis and therapy.The correct recognition of the specific subtype and extension of the tumor through first line and second line radiology is essential for the surgeon, in order to effectively direct the therapeutic decisions.


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