Proximal Overresection During Femoral Osteochondroplasty Negatively Affects the Distractive Stability of the Hip Joint: A Cadaver Study

2021 ◽  
pp. 036354652110289
Author(s):  
Lionel E. Lazaro ◽  
Daniel P. Lim ◽  
Trevor J. Nelson ◽  
Sam A. Eberlein ◽  
Michael B. Banffy ◽  
...  
Keyword(s):  
Femoral Head ◽  
Hip Joint ◽  
Motion Tracking ◽  
External Rotation ◽  
Articular Surface ◽  
Tracking System ◽  
Metal Plate ◽  
Rotational Stability ◽  
Rotational Instability ◽  
Proximal Extension

Background: Contact between the acetabular labrum and articular cartilage of the femoral head creates a suction seal that helps maintain stability of the femoral head in the acetabulum. A femoral osteochodroplasty may occasionally extend proximally into the femoral head, diminishing the articular surface area available for sealing contact. Purpose: To determine whether proximal overresection decreases the rotational and distractive stability of the hip joint. Study Design: Controlled laboratory study. Methods: Six hemipelvises in the following conditions were tested: intact, T-capsulotomy, osteochondroplasty to the physeal scar, and 5- and 10-mm proximal extension. The pelvis was secured to a metal plate, and the femur was potted and attached to a multiaxial hip jig. Specimens were axially distracted using a load from 0 to 150 N. For rotational stability testing, 5 N·m of internal and external torque was applied. Both tests were performed at different angles of flexion (0°, 15°, 30°, 60°, 90°). Displacement and rotation were recorded using a 3-dimensional motion tracking system. Results: The T-capsulotomy decreased the distractive stability of the hip joint. A femoral osteochondroplasty up to the physeal scar did not seem to affect the distractive stability. However, a proximal extension of the resection by 5 and 10 mm increased axial instability at every angle of flexion tested, with the greatest increase observed at larger angles of flexion ( P < .01). External rotation increased significantly after T-capsulotomy in smaller angles of flexion (0°, P = .01; 15°, P = .01; 30°, P = .03). Femoral osteochondroplasty did not create further external rotational instability, except when the resection was extended 10 mm proximally and the hip was in 90° of flexion ( P = .04). Conclusion: This cadaveric study demonstrated that proximal extension of osteochondroplasty into the femoral head compromises the distractive stability of the hip joint but does not affect hip rotational stability. Clinical Relevance: Clinically, this study highlights the importance of accuracy when performing femoral osteochondroplasty to minimize proximal extension that may increase iatrogenic instability of the hip joint.

scholarly journals Proximal Over-resection During Femoral Osteochondroplasty Negatively Affects The Distractive Stability Of The Hip Joint

2020 ◽  
Vol 8 (3_suppl2) ◽  
pp. 2325967120S0013
Author(s):  
Lionel E. Lazaro ◽  
Daniel P. Lim ◽  
Trevor Nelson ◽  
Samuel Eberlein ◽  
Michael B. Banffy ◽  
...  
Keyword(s):  
Femoral Head ◽  
Hip Joint ◽  
Repeated Measures ◽  
External Rotation ◽  
Articular Surface ◽  
Tracking System ◽  
Rotational Stability ◽  
Dimensional Structure ◽  
Rotational Instability ◽  
Proximal Extension

Objectives: Hip microinstability is an increasingly recognized source of hip pain and disability. Femoral osteochondroplasty is usually performed with direct visualization through an arthroscope, assisted with repeated fluoroscopic imaging. However, a two-dimensional representation of a three-dimensional structure is misleading and may compromise the precision of the planned osteochondroplasty. The resection can occasionally extend proximally into the Femoral Head diminishing the articular surface area available for suction seal. The purpose of this study was to determine whether proximal over-resection decreases the rotational and distractive stability of the hip joint. Methods: Six hemi-pelvises were repeatedly tested in the following conditions: (a) intact, (b) T-capsulotomy, (c) Osteochondroplasty to the physeal scar, followed by (d) 5mm and (e) 10mm proximal extension. The pelvis was secured to a metal plate and the femur was potted and attached to a multi-axial hip jig. Specimens were axially distracted with a load from 0-150N followed by 5Nm of internal and external torque at 0o, 15o, 30o, 60o, 90o of flexion. Displacement/rotation was recorded using a 3D motion tracking system. Repeated measures ANOVA was used with significance set at p<0.05. Results: Proximal extension of the resection by 5mm and 10mm increased axial instability at every angle of flexion tested, with the greatest increase observed at higher angles of flexion,p<0.05. T-capsulotomy alone increased both internal and external rotation at all angles of flexion, p<0.05. Subsequent resection and extension of the resection did not significantly increase rotational instability compared to the capsulotomy state. Conclusion: Extending the osteochondroplasty proximally into the femoral head compromises the distractive stability of the hip joint, but doesn’t not effect hip rotational stability. Clinically, this highlights the importance of accuracy when performing femoral osteochondroplasty to minimize proximal extension that may increase iatrogenic instability of the hip joint, leading to reduced post-operative outcomes.

scholarly journals Proximal Over-Resection During Femoral Osteochondroplasty Negatively Affects the Distractive Stability of the Hip Joint

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0042
Author(s):  
Daniel Lim ◽  
Trevor Nelson ◽  
Samuel Eberlein ◽  
Michael Banffy ◽  
Melodie Metzger ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Femoral Head ◽  
Hip Joint ◽  
Repeated Measures ◽  
External Rotation ◽  
Statistical Significance ◽  
Dimensional Structure ◽  
Rotational Instability ◽  
Proximal Extension ◽  
Suction Seal

Objectives: Hip microinstability is an increasingly recognized source of hip pain and disability. Femoral osteochondroplasty is usually performed with direct visualization through the arthroscope, assisted with repeated fluoroscopic view for orientation and feedback. However, a two-dimensional representation of a three dimensional structure can be misleading compromising the precision of the planned osteochondroplasty. Sometimes the resection can extend proximally into the Femoral Head (FH) diminishing the surface area of the articular cartilage available to be in contact with the labrum, in order to create the suction effect (suction seal) that maintains the stability of the femoral head in the acetabulum. The purpose of the study is to evaluate the role of proximal over-resection of femoral osteochondroplasty in the rotational and distractive stability of the hip joint. We hypothesis that proximal over resection will result in decrease stability, specially at higher degrees of flexion and internal rotation where the contact between labrum and articular cartilage will be lost, and breaking the suction seal. Methods: Six hemi-pelvises were repeatedly tested in the following five conditions: (a) intact, (b) T-capsulotomy, (c) Osteochondroplasty to the level of the physeal scar, followed by a (d) 5mm and (e) 10mm proximal extension of the resection. The pelvis was secured to a metal plate and the distal portion of the femur was potted and attached to a multi-axial hip jig. (Fig.1) Specimens were axially distracted with a load from 0-150N followed by 5Nm of internal and external torque at 0 o, 15 o, 30 o, 60 o, 90o of flexion while the resultant displacement/rotation was recorded using a 3D motion tracking system. Repeated measures ANOVA was used with statistical significance set at p<0.05. Results: Proximal extension of the resection by 5mm and 10mm increased axial instability (decreased force required for hip distraction) at every angle of flexion tested, with the greatest increase observed at higher angles of flexion (60 deg and 90 deg), p<0.05. T-capsulotomy alone increased both internal and external rotation at all angles of flexion, p<0.05. (Fig. 2) Subsequent resection and extension of the resection did not significantly increase rotational instability compared to the capsulotomy state. Conclusion: Extending the osteochondroplasty proximally into the femoral head compromised the distractive stability of the hip joint. It is important to be precise when performing femoral osteochondroplasty to minimize proximal extension that can lead to iatrogenic instability of the hip joint and poor postoperative outcomes. [Figure: see text][Figure: see text]

Structure and content of infants physical rehabilitation with hip joint dysplasia

2019 ◽  
pp. 88-96
Author(s):  
Liliya I. DUBROVINA ◽  
Galina I. DERYABINA ◽  
Viktoriya L. LERNER
Keyword(s):  
Femoral Head ◽  
Medical Treatment ◽  
Hip Joint ◽  
Musculoskeletal System ◽  
Articular Surface ◽  
Rehabilitation Program ◽  
Physical Rehabilitation ◽  
Common Disease ◽  
Hip Joints ◽  
Joint Dislocation

Hip joint dysplasia among children - congenital hypoplasia of femoral head, or congenital increased mobility of the joint due to the weakness of the ligamentous and muscular apparatus. Such a violation of the hip joint elements development (one or both) leads to an incorrect interposition of the joint structures, whereby the femoral head is displaced relative to the articular surface, formed subluxation, pre-dislocation or joint dislocation. This is a severe and common disease of the musculoskeletal system. Since medical treatment for dysplasia among newborn is not provided, and surgery is required only in extreme cases, therefore, active methods in the fight against this pathology are: specific orthopedic devices, physiotherapy, massage and exercise therapy. Thanks to these components, treatment therapy will strengthen the muscles, accelerate recovery, it will be fast and unobtrusive for the child. In this regard, we have developed the structure and content of physical rehabilitation for infants with hip joint dysplasia. This course was designed for four weeks and was developed a set of rehabilitation measures. The content of the course of physical rehabilitation includes orthopedic correction with the help of special devices, massage, therapeutic gymnastics in combination with fitball gymnastics and therapeutic swimming, physiotherapy. To assess the effectiveness of the physical rehabilitation program developed by us, we conduct an ascertaining pedagogical experiment - testing, clearly demonstrating the functional and motor state of the hip joints of the subjects before the beginning of the forming pedagogical experiment and at its end.

Kinematics of the Ankle Joint Complex in Snowboarding

2005 ◽  
Vol 21 (4) ◽  
pp. 394-403 ◽  
Author(s):  
Sébastien Delorme ◽  
Stavros Tavoularis ◽  
Mario Lamontagne
Keyword(s):  
Ankle Joint ◽  
Motion Tracking ◽  
External Rotation ◽  
Tracking System ◽  
Plantar Flexion ◽  
Movement Patterns ◽  
Alpine Skiers ◽  
Motion Tracking System

Because snowboarders are known to injure their ankles more often than Alpine skiers, it has been postulated that stiffer snowboard boots would provide better protection to the ankle than current soft boots do. Snowboarders are also known to injure their front ankle more often than their back ankle, presumably because of the asymmetrical rotations of the ankles due to asymmetrical binding adjustement. To test these hypotheses, we measured the kinematics of the feet and legs of 5 snowboarders wearing soft boots and stiffer step-in boots during snowboarding maneuvers using an electromagnetic motion tracking system. The results were expressed in anatomically relevant rotations of the ankle joint complex, namely dorsi-/plantar flexion, eversion/inversion, and internal/external rotation. The measured ankle rotations show differences in the movement patterns of the front and back legs. Step-in boots were shown to allow less dorsiflexion, eversion, and external rotation than softer boots, possibly explaining why they are associated with a lower rate of fractures of the talus than soft boots.

scholarly journals The Popliteus Bypass Graft is biomechanically superior to the isometric Larson Technique for posterolateral instabilities of the knee

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0002
Author(s):  
Tobias C. Drenck ◽  
Christoph Domnick ◽  
Achim Preiss ◽  
Karl-Heinz Frosch ◽  
Mathias von Glahn
Keyword(s):  
External Rotation ◽  
Tracking System ◽  
Cruciate Ligament ◽  
Bypass Graft ◽  
Optical Tracking ◽  
Anatomic Reconstruction ◽  
Rotational Instability ◽  
Reconstruction Technique ◽  
Group A ◽  
Group B

Injuries of the posterior cruciate ligament (PCL) are most often accompanied by injuries of the posterolateral corner (PLC) and the ligamentum collaterale fibulare (LCL). This leads to a combined dorsal- and external rotational instability. In Germany most of these types of injuries are treated by an arthroscopic reconstruction of the PCL and combined posterolateral augmentation in the way, of an isometric “Larson-Procedure”. Techniques, which reconstruct the LCL and PLC in a more anatomic way provide better clinical results according to current literature. Comparative studies of these two types of reconstructions do not exist, biomechanical studies are inhomogeneous and the isometric Larson-technique has not been adequately tested so far. In this study the isometric (extra anatomic) Larson-technique was tested against a more anatomic reconstruction of the LCL and PLC with a popliteus bypass graft. 20 human knee specimen were divided into Group A and B. The PCL, as well as the PLC and LCL were dissected and kinematic measurements were determined using a robotic and optical tracking system. The knee kinematics were determined for 134 N posterior loads, 10 Nm varus loads and 5 Nm external rotational loads in 0°, 20°, 30°, 60° and 90° of knee flexion. All specimens underwent a double bundle PCL reconstruction. In Group A the reconstruction of the PLC was accomplished by a popliteus bypass graft and an additional anatomic LCL graft. In Group B the reconstruction was performed using a Larson-technique with a single femoral tunnel and a sling through the head of the fibular. The protocol was repeated and the differences in the two groups where analyzed (2W-Anova and t-Test, p=0,05) Both groups gained a significant increase of instability after dissecting the ligamentous structures (deficient) in all algorithms tested. Postoperatively both groups achieved a significant improvement in all these parameters. Group A with the popliteus bypass technique revealed significant 37±8% less external rotational instability compared to group B (p<0,03). In contrast to group A, group B presents a remaining increase of external rotation compared to the intact knee. The popliteus bypass in group A reduced the external rotational instability to less than 1,3 degree difference compared to the intact state on average. No significant results were found between the two groups in terms of varus instability and posterior loads. In this study we showed for the first time, that the most frequently used posterolateral reconstruction technique (isometric Larson) has limited biomechanical properties compared to a more anatomic reconstruction (popliteus bypass) in terms of reducing external rotation. Whether this is the cause of the remaining posterolateral instability in patients treated with the Larson technique and whether it can be prevented by using a popliteus bypass graft is subject of future clinical studies.

Kinematics of the Human Pelvis Following Open Book Injury

2002 ◽  
Author(s):  
Dumitru I. Caruntu ◽  
Mohamed Samir Hefzy ◽  
Nabil Ebraheim ◽  
Anis Mekhail ◽  
Richard Yeasting
Keyword(s):  
Motion Tracking ◽  
Articular Surface ◽  
Tracking System ◽  
Three Dimensional ◽  
Vertical Displacement ◽  
X Rays ◽  
Open Book ◽  
Sacroiliac Joints ◽  
Pure Rotation ◽  
Planar Surfaces

The objective of this study is to determine the three dimensional kinematics of the human pelvis including both sacroiliac joints following a simulated open book fracture induced on cadavers by applying anterior-posterior compressive loads to the pelvis. An electromagnetic digitizing and motion tracking system was utilized to measure the morphology of the pelvis and the relative movements of its bones during this simulated open book fracture. The screw displacement axis method was used to describe the relative motions between the sacrum and each hip bone. Morphologically, it was found that the articular surfaces forming the sacroiliac joints can be approximated with planar surfaces directed from proximal and lateral to distal and medial and from posteromedial to anterolateral. The kinematic data indicate that the motion of the hip bone with respect to the sacrum on the side of the sacroiliac joint (SIJ) opening is almost a pure rotation which translates clinically on the A-P x-rays as pure opening of the SIJ without vertical displacement. The average axis of rotation was found to be almost parallel to the SIJ planar articular surface.

Sex Differences During an Overhead Squat Assessment

2015 ◽  
Vol 31 (4) ◽  
pp. 244-249 ◽  
Author(s):  
Timothy C. Mauntel ◽  
Eric G. Post ◽  
Darin A. Padua ◽  
David R. Bell
Keyword(s):  
Lower Extremity ◽  
Motion Tracking ◽  
External Rotation ◽  
Tracking System ◽  
Male And Female ◽  
Lower Extremity Injuries ◽  
Valgus Angle ◽  
Peak Knee ◽  
Males And Females ◽  
Extremity Injuries

A disparity exists between the rates of male and female lower extremity injuries. One factor that may contribute to this disparity is high-risk biomechanical patterns that are commonly displayed by females. It is unknown what biomechanical differences exist between males and females during an overhead squat. This study compared lower extremity biomechanics during an overhead squat and ranges of motion between males and females. An electromagnetic motion tracking system interfaced with a force platform was used to quantify peak lower extremity kinematics and kinetics during the descent phase of each squat. Range of motion measurements were assessed with a standard goniometer. Differences between male and female kinematics, kinetics, and ranges of motion were identified with t tests. Males displayed greater peak knee valgus angle, peak hip flexion angle, peak vertical ground reaction forces, and peak hip extension moments. Males also displayed less active ankle dorsiflexion with the knee extended and hip internal and external rotation than females. No other differences were observed. The biomechanical differences between males and females during the overhead squat may result from differences in lower extremity ranges of motion. Therefore, sex-specific injury prevention programs should be developed to improve biomechanics and ranges of motion.

scholarly journals Contributions of the Capsule and Labrum to Hip Mechanics in the Context of Hip Microinstability

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711989084 ◽  
Author(s):  
Adam M. Johannsen ◽  
Leandro Ejnisman ◽  
Anthony W. Behn ◽  
Kotaro Shibata ◽  
Timothy Thio ◽  
...  
Keyword(s):  
Femoral Head ◽  
External Rotation ◽  
Tracking System ◽  
Head Motion ◽  
Materials Testing ◽  
Relative Role ◽  
Hip Stability ◽  
Labral Tears ◽  
Hip Capsule ◽  
Head Translation

Background: Hip microinstability and labral pathology are commonly treated conditions with increasing research emphasis. To date, there is limited understanding of the biomechanical effects of the hip capsule and labrum on controlling femoral head motion. Purpose/Hypothesis: The purpose of this study was to determine the relative role of anterior capsular laxity and labral insufficiency in atraumatic hip microinstability. Our hypotheses were that (1) labral tears in a capsular intact state will have a minimal effect on femoral head motion and (2) the capsule and labrum work synergistically in controlling hip stability. Study Design: Controlled laboratory study. Methods: Twelve paired hip specimens from 6 cadaveric pelvises (age, 18-41 years) met the inclusion criteria. Specimens were stripped of all soft tissue except the hip capsule and labrum, then aligned, cut, and potted using a custom jig. A materials testing system was used to cyclically stretch the anterior hip capsule in extension and external rotation, while rotating about the mechanical axis of the hip. Labral insufficiency was created with a combined radial and chondrolabral tear under direct visualization. A motion tracking system was used to record hip internal-external rotation and displacement of the femoral head relative to the acetabulum in the anterior-posterior, medial-lateral, and superior-inferior directions. Testing variables included baseline, postventing, postcapsular stretching, and postlabral insufficiency. Results: When comparing the vented state with each experimental pathologic state, increases in femoral head motion were noted in both the capsular laxity state and the labral insufficiency state. The combined labral insufficiency and capsular laxity state produced statistically significant increases ( P < .001) in femoral head translation compared with the vented state in all planes of motion. Conclusion: Both the anterior capsule and labrum play a role in hip stability. In this study, the anterior hip capsule was the primary stabilizer to femoral head translation, but labral tears in the setting of capsular laxity produced the most significant increases in femoral head translation. Clinical Relevance: This study provides a physiologic biomechanical assessment of the hip constraints in the setting of hip microinstability. It also sheds light on the importance of the hip capsule in the management of labral tears. Our study demonstrates that labral tears in isolation provide minimal changes in femoral head translation, but in the setting of a deficient capsule, significant increases in femoral head translation are seen, which may result in joint-related symptoms.

scholarly journals Desktop lighting for comfortable use of a computer screen

Work ◽  
2021 ◽  
Vol 68 (s1) ◽  
pp. S209-S221
Author(s):  
Lu Han ◽  
Hechen Zhang ◽  
Zhongxia Xiang ◽  
Jinze Shang ◽  
Shabila Anjani ◽  
...  
Keyword(s):  
High Intensity ◽  
Motion Tracking ◽  
Tracking System ◽  
Computer User ◽  
Eye Tracker ◽  
Computer Screen ◽  
Task Load ◽  
Trunk Movements ◽  
Motion Tracking System ◽  
Nasa Task Load Index

BACKGROUND: The contrast between a bright computer screen and a dark ambient environment may influence comfort of the users, especially on their eyes. OBJECTIVE: The objective of this research is to identify the optimal desktop lighting for the comfortable use of the computer screen in a dark environment. METHODS: An experiment was designed where seven illumination setups were introduced for the users to perform their leisure tasks on a computer screen. Fifteen healthy subjects participated in the experiments. During each session, durations of the eye blinks, fixations and saccades of the user were recorded by an eye tracker. His/her neck and trunk movements were recorded by a motion tracking system as well. The comfort/discomfort questionnaire, localized postural discomfort questionnaire, NASA task load index and computer user questionnaire were used to record the overall comfort/discomfort, the local perceived physical discomfort, the cognitive workload, and general/eye health problems, respectively. RESULTS: Subjective and objective measurement results indicated that users felt more comfortable with high intensity warm lights using a computer screen. We also identified that the eye fixation durations, as well as the scores of two questions in the computer user questionnaire, have significant negative correlations with comfort. On the other side, the durations of blinks and the scores of three questions in the computer user questionnaire, were significantly correlated with discomfort. CONCLUSION: The warm (3000K) and high intensity (1500 lux) light reduced the visual and cognitive fatigue of the user and therefore improve the comfort of the user during the use of a computer screen.

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