The Hip Suction Seal, Part I: The Role of Acetabular Labral Height on Hip Distractive Stability

2020 ◽  
Vol 48 (11) ◽  
pp. 2726-2732 ◽  
Author(s):  
Hunter W. Storaci ◽  
Hajime Utsunomiya ◽  
Bryson R. Kemler ◽  
Samuel I. Rosenberg ◽  
Grant J. Dornan ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Clinical Effects ◽  
Acetabular Labrum ◽  
Peak Negative Pressure ◽  
Hip Stability ◽  
New Strategy ◽  
Fresh Frozen ◽  
Articular Pathology ◽  
Distraction Force ◽  
Suction Seal

Background: The acetabular labrum has been found to provide a significant contribution to the distractive stability of the hip. However, the influence of labral height on hip suction seal biomechanics is not known. Hypothesis: The smaller height of acetabular labrum is associated with decreased distractive stability. Study Design: Descriptive laboratory study. Methods: A total of 23 fresh-frozen cadaveric hemipelvises were used in this study. Hips with acetabular dysplasia or femoroacetabular impingement–related bony morphologic features, intra-articular pathology, or no measurable suction seal were excluded. Before testing, each specimen’s hip capsule was removed, a pressure sensor was placed intra-articularly, and the hip was fixed in a heated saline bath. Labral size was measured by use of a digital caliper. Maximum distraction force, distance to suction seal rupture, and peak negative pressure were recorded while the hip underwent distraction at a rate of 0.5 mm/s. Correlations between factors were analyzed using the Spearman rho, and differences between groups were detected using Mann-Whitney U test. Results: Of 23 hips, 12 satisfied inclusion criteria. The maximum distraction force and peak negative pressure were significantly correlated ( R = −0.83; P = .001). Labral height was largely correlated with all suction seal parameters (maximum distraction force, R = 0.69, P = .013; distance to suction seal rupture, R = 0.55, P = .063; peak negative pressure, R = −0.62, P = .031). Labral height less than 6 mm was observed in 5 hips, with a mean height of 6.48 mm (SD, 2.65 mm; range, 2.62-11.90 mm; 95% CI, 4.80-8.17 mm). Compared with the 7 hips with larger labra (>6 mm), the hips with smaller labra had significantly shorter distance to suction seal rupture (median, 2.3 vs 7.2 mm; P = .010) and significantly decreased peak negative pressure (median, −59.3 vs −66.9 kPa; P = .048). Conclusion: Smaller height (<6 mm) of the acetabular labrum was significantly associated with decreased distance to suction seal rupture and decreased peak negative pressure. A new strategy to increase the size of the labrum, such as labral augmentation, could be justified for patients with smaller labra in order to optimize the hip suction seal. Clinical Relevance: The height of the acetabular labrum is correlated with hip suction seal biomechanics. Further studies are required to identify the clinical effects of labral height on hip stability.

scholarly journals Nanodroplet-mediated catheter-directed sonothrombolysis of retracted blood clots

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Leela Goel ◽  
Huaiyu Wu ◽  
Bohua Zhang ◽  
Jinwook Kim ◽  
Paul A. Dayton ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Negative Pressure ◽  
Boiling Point ◽  
Clot Lysis ◽  
Control Group ◽  
Peak Negative Pressure ◽  
Blood Clots ◽  
Tissue Plasminogen ◽  
First Time

AbstractOne major challenge in current microbubble (MB) and tissue plasminogen activator (tPA)-mediated sonothrombolysis techniques is effectively treating retracted blood clots, owing to the high density and low porosity of retracted clots. Nanodroplets (NDs) have the potential to enhance retracted clot lysis owing to their small size and ability to penetrate into retracted clots to enhance drug delivery. For the first time, we demonstrate that a sub-megahertz, forward-viewing intravascular (FVI) transducer can be used for ND-mediated sonothrombolysis, in vitro. In this study, we determined the minimum peak negative pressure to induce cavitation with low-boiling point phase change nanodroplets and clot lysis. We then compared nanodroplet mediated sonothrombolysis to MB and tPA mediate techniques. The clot lysis as a percent mass decrease in retracted clots was 9 ± 8%, 9 ± 5%, 16 ± 5%, 14 ± 9%, 17 ± 9%, 30 ± 8%, and 40 ± 9% for the control group, tPA alone, tPA + US, MB + US, MB + tPA + US, ND + US, and ND + tPA + US groups, respectively. In retracted blood clots, combined ND- and tPA-mediated sonothrombolysis was able to significantly enhance retracted clot lysis compared with traditional MB and tPA-mediated sonothrombolysis techniques. Combined nanodroplet with tPA-mediated sonothrombolysis may provide a feasible strategy for safely treating retracted clots.

Biomechanical evaluation contribution of the acetabular labrum to hip stability

2015 ◽  
Vol 24 (7) ◽  
pp. 2338-2345 ◽  
Author(s):  
Pisit Lertwanich ◽  
Anton Plakseychuk ◽  
Scott Kramer ◽  
Monica Linde-Rosen ◽  
Akira Maeyama ◽  
...  
Keyword(s):  
Acetabular Labrum ◽  
Hip Stability ◽  
Biomechanical Evaluation

scholarly journals A New Differential Diagnosis: Synthetic Cannabinoid-Associated Gross Hematuria

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Osamah Hasan ◽  
Ankit A. Patel ◽  
James J. Siegert
Keyword(s):  
Unusual Case ◽  
Synthetic Cannabinoids ◽  
Fresh Frozen Plasma ◽  
Health Concern ◽  
Clinical Effects ◽  
Gross Hematuria ◽  
Fresh Frozen ◽  
History Of ◽  
Recreational Use ◽  
Frozen Plasma

Recreational use of synthetic cannabinoids (SCs), also known as “K2” or “Spice,” is becoming a major public-health concern due to their potential for abuse and harmful consequences. New substances are constantly being added to the content of SCs. The dearth of information on these newly added contents as they are introduced into the black market hinders risk assessments of these compounds. We report a highly unusual case of gross hematuria in a 28-year-old male patient after SC use. He was found to have a supratherapeutic INR with no history of prior anticoagulation. His hematuria resolved after four units of fresh-frozen plasma were administered. We include a literature review of the clinical effects of SCs and their possible mechanism of gross hematuria and management.

scholarly journals Biomechanical Characteristics of Labral Augmentation Versus Labral Reconstruction in a Hip Cadaver Model

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0042
Author(s):  
Sunikom Suppauksorn ◽  
Kevin Parvaresh ◽  
Elizabeth Shewman ◽  
Edward Beck ◽  
Laura Krivicich ◽  
...  
Keyword(s):  
Peak Force ◽  
Statistical Testing ◽  
Labral Tear ◽  
Iliotibial Band ◽  
Test Machine ◽  
Hip Stability ◽  
Significant Difference ◽  
Bone Anchors ◽  
Surgical Conditions ◽  
Suction Seal

Objectives: An integral component of hip stability is the negative pressure gradient created by the labral suction seal. No prior studies have quantitatively compared the integrity of the suction seal under normal, pathologic, and surgical conditions. The purpose of this study was to evaluate the biomechanical properties of the labral suction seal in the following four scenarios: intact labrum, labral tear, labral augmentation, and labral reconstruction. Methods: Eight fresh-frozen hemi-pelvises without osteoarthritis and with an intact labrum were dissected to the level of labrum and mounted for biomechanical testing. Each specimen was evaluated sequentially under four testing conditions: intact labrum, labral tear, labral augmentation, and labral reconstruction. Following testing of the intact labrum, the specimens were manipulated to create a labral tear from 12- to 3-o’clock. Labral augmentation was then performed with bone anchors and iliotibial band graft after debridement of only the peripheral half of the labral tear. Labral reconstruction was performed last with bone anchors and iliotibial band graft after removing the entire labral tear. In each condition the specimens were placed in the test machine to undergo pure distraction of the joint. First, the femur was compressed with 250 N of force and then distracted at 10 mm/s with force and displacement continuously recorded until the suction seal was disrupted. In each specimen, the tests were repeated for a total of three tests in each of the four conditions, and the average peak force was calculated. Data was normalized to the intact peak force for each specimen to account for gender and size differences. Statistical testing was performed via a repeated measures ANOVA with a post hoc Bonferroni correction for pairwise analysis. Results: Peak loads occurred early in displacement. The average peak force values (mean ± standard deviation) were as follows: intact (137.2 ± 40.7), labral tear (126.3 ± 43.5), labral augmentation (94.7 ± 59.7), labral reconstruction (78.9 ± 51.2). The average normalized peak force values relative to the intact condition were as follows: labral tear (91.1 ± 8.5), augmentation (66.1 ± 27.6), and reconstruction (55.6 ± 25.7). There was no statistically significant difference in peak force relative to the intact labrum for the labral tear (p = 0.34). Relative to the labral tear, there was no significant difference in peak force for the augmentation (p = 0.12), but there was a significant decrease in peak force for the reconstruction (p = 0.03). Conclusion: This model provides a new means of quantitatively evaluating the labral suction seal under various normal, pathologic, and surgical conditions. The results show that relative to the labral tear condition, labral augmentation may recreate the labral suction seal better than labral reconstruction. Clinically, these findings suggest augmentation may improve hip stability over labral reconstruction. [Figure: see text]

Role of the Acetabular Labrum and the Iliofemoral Ligament in Hip Stability

2011 ◽  
Vol 39 (1_suppl) ◽  
pp. 85-91 ◽  
Author(s):  
Casey A. Myers ◽  
Bradley C. Register ◽  
Pisit Lertwanich ◽  
Leandro Ejnisman ◽  
W. Wes Pennington ◽  
...  
Keyword(s):  
Acetabular Labrum ◽  
Hip Stability ◽  
Iliofemoral Ligament

Paper # 43: Contributions of the Iliofemoral Ligaments and the Acetabular Labrum in Hip Stability

2011 ◽  
Vol 27 (10) ◽  
pp. e96-e97 ◽  
Author(s):  
Marc J. Philippon ◽  
Casey A. Myers ◽  
W. Wesley Pennington ◽  
Pisit Lertwanich ◽  
Leandro Ejnisman ◽  
...  
Keyword(s):  
Acetabular Labrum ◽  
Hip Stability

scholarly journals On the molecular release induced by ultrasound and microbubbles in cells

2021 ◽  
Author(s):  
Farah Hussein
Keyword(s):  
Flow Cytometry ◽  
Cell Viability ◽  
Negative Pressure ◽  
Membrane Disruption ◽  
Intracellular Uptake ◽  
Recycling Endosomes ◽  
Rpe Cells ◽  
Peak Negative Pressure ◽  
Viable Cells ◽  
The Mean

Ultrasound and microbubble (USMB) enhances intracellular uptake through membrane disruption and endocytosis. This study investigates USMB effects on the molecular release incells through membrane-disruption and exocytosis. Retinal pigmented epithelial (RPE) cells were loaded with Alexa 647-transferrin (Tfn) to mark recycling endosomes, LAMP-1 antibody was used to mark lysosomes, GFP-transfected RPE cells were used to mark cytoplasm, and 7-AAD was used to assess cell viability. USMB exposure was done at 570kPa peak negative pressure for 1min. The mean fluorescent intensities (MFI) of markers were measured using flow cytometry. USMB induced the release of 19% and 67% of GFP from the cytoplasm in viable and non-viable cells respectively. LAMP-1 antibody MFI increased by 50% and 15-folds in viable and non-viable cells indicating USMB induced release from lysosomes. Furthermore, Tfn release from recycling endosomes increased by 22% only in viable cells. In conclusion, USMB enhances the molecular release from cytoplasm, lysosomes, and recycling endosomes

Vertical Extension of the T-Capsulotomy Incision in Hip Arthroscopic Surgery Does Not Affect the Force Required for Hip Distraction: Effect of Capsulotomy Size, Type, and Subsequent Repair

2018 ◽  
Vol 46 (13) ◽  
pp. 3127-3133 ◽  
Author(s):  
Alexander E. Weber ◽  
William H. Neal ◽  
Erik N. Mayer ◽  
Benjamin D. Kuhns ◽  
Elizabeth Shewman ◽  
...  
Keyword(s):  
Arthroscopic Surgery ◽  
Materials Testing ◽  
Distraction Effect ◽  
Intact State ◽  
Capsular Repair ◽  
Complete Repair ◽  
Hip Stability ◽  
Hip Distraction ◽  
Iliofemoral Ligament ◽  
Distraction Force

Background: Interportal and T-capsulotomies are popular techniques for exposing femoroacetabular impingement deformities. The difference between techniques with regard to the force required to distract the hip is currently unknown. Purpose: To quantify how increasing interportal capsulotomy size, conversion to T-capsulotomy, and subsequent repair affect the force required to distract the hip. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric hip specimens were dissected and fixed in a materials testing system, such that pure axial distraction of the iliofemoral ligament could be achieved. The primary outcome measure was the load required to distract the hip to a distance of 6 mm at a rate of 0.5 mm/s. Each hip was tested in the intact state and then sequentially under varying capsulotomy conditions: 2-cm interportal, 4-cm interportal, half-T (4-cm interportal and 2-cm T-capsulotomy), and full-T (4-cm interportal and 4-cm T-capsulotomy). After serial testing, isolated T-limb repair and then subsequent complete repair were performed. Repaired specimens underwent distraction testing as previously stated to assess the ability to restore hip stability to the native profile. Distraction force as well as the relative distraction force (percentage normalized to the intact capsule) were compared between all capsulotomy and repair conditions. Results: Increasing interportal capsulotomy size from 2 to 4 cm resulted in significantly less force required to distract the hip ( P < .001). The largest relative decrease in force was seen between the intact state (274.6 ± 71.2 N; 100%) and 2-cm interportal (209.7 ± 73.2 N; 76.4% ± 15.6%; P = .0008). There was no significant mean difference in distraction force when 4-cm interportal (160.4 ± 79.8 N) was converted to half-T (140.7 ± 73.5 N; P = .270) and then full-T (112.0 ± 70.2 N; P = .204). When compared with the intact state, isolated T-limb repair partially restored stability (177.3 ± 86.3 N; 63.5% ± 19.8%; P < .0001), while complete repair exceeded native values (331.7 ± 103.7 N; 122.7% ± 15.1%; P = .0008). Conclusion: The conversion of interportal capsulotomy to T-capsulotomy did not significantly affect the force required to distract the hip in a cadaveric model. However, larger interportal capsulotomies resulted in significant stepwise decreases in distraction force. When performing interportal or T-capsulotomy, the iliofemoral ligament strength is significantly decreased, but complete capsular repair demonstrated the ability to restore joint stability to the native, intact hip. Clinical Relevance: Increasing interportal capsulotomy size decreases the force required to distract the hip. In an effort to maximize visualization and minimize the magnitude of iliofemoral ligament fibers cut, many surgeons have moved from extended interportal capsulotomy to T-capsulotomy. Interportal and T-capsulotomies result in equivalent hip distraction, partial capsular repair marginally improves hip stability, and only complete repair has the ability to restore the hip to its native biomechanical profile.

scholarly journals Ozonated water lavage and physiological saline irrigation combined with vacuum-sealed drainage in the treatment of 18 cases of chronic osteomyelitis

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199953
Author(s):  
Tayierjiang Yasheng ◽  
Aini Mijiti ◽  
Maimaiaili Yushan ◽  
Zhenhui Liu ◽  
Yanshi Liu ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Negative Pressure ◽  
Chronic Osteomyelitis ◽  
Physiological Saline ◽  
Clinical Effects ◽  
Saline Irrigation ◽  
Closed Drainage ◽  
Length Of Hospitalization ◽  
Ozonated Water

Objective Ozone is a colorless gas used as a disinfectant and to treat diseases by limiting the effects of bacteria, viruses, fungi, yeast, and protozoa. In this study, we investigated the clinical efficacy of ozonated water lavage and physiological saline irrigation combined with vacuum-sealed drainage (VSD) in the treatment of chronic osteomyelitis. Methods Eighteen patients (14 men and 4 women) with chronic osteomyelitis in the limbs (tibia: 13 cases; femur: 4 cases; humerus: 1 case) admitted to our hospital between April 2012 and October 2018 were selected. The patients were aged 9 to 52 years, with a mean age of 31 years. All patients underwent ozonated water lavage and physiological saline irrigation combined with VSD negative pressure closed drainage during hospitalization. The patients were followed up for 18 to 84 months, with a mean of 31 months. Results Osteomyelitis recurred in only one case of nonunion. The length of hospitalization was 18 to 29 days, with a mean of 21 days. Conclusions A combination of ozonated water lavage, physiological saline irrigation, and VSD provided good clinical effects in the treatment of chronic osteomyelitis, and thus, is recommended for such treatment.

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