Relationship between muscular and bony anatomy in native hips: a theoretical background for approach-specific implant positioning

2018 ◽  
Vol 29 (2) ◽  
pp. 147-152 ◽  
Author(s):  
Doruk Akgün ◽  
Philipp von Roth ◽  
Tobias Winkler ◽  
Carsten Perka ◽  
Adam Trepczynski ◽  
...  
Keyword(s):  
Gluteus Maximus ◽  
Gluteus Medius ◽  
Theoretical Background ◽  
Surgical Approaches ◽  
Acetabular Anteversion ◽  
Joint Orientation ◽  
Combined Anteversion ◽  
Bony Anatomy ◽  
The Mean ◽  
Tensor Fasciae Latae

Introduction: The aim of this study was to analyse the relationship between bony joint orientation and the distribution of hip musculature. Methods: The bone anatomy of the hip (femoral antetorsion (AT), acetabular anteversion (AV), and combined anteversion (AV/AT)) and the muscle volume of the gluteal muscles and the tensor fasciae latae were analysed bilaterally using computed tomography data of 49 patients. Muscle force direction (MFD) was determined for each muscle. The total MFD of the hip musculature was calculated and then correlated with the bony anatomy. Results: The mean AV, AT, and AV/AT were 21.9° ± 5.9°, 7.22° ± 7.4°, and 29.2° ± 9°, respectively. We found the following mean muscle volumes: gluteus maximus: 780 ± 227 cm3, gluteus medius: 322 ± 82 cm3, gluteus minimus: 85 ± 20 cm3, and tensor fasciae latae: 68 ± 22 cm3. The mean MFD was 18.92° ± 1.29°. We found a uniform distribution of the musculature that was not correlated with the bone anatomy. Conclusion: This study highlights the variability in native acetabular and femoral anatomy and that bone hip anatomy does not correlate with the distribution of hip musculature. Although native acetabular anteversion matches the suggested targets for cup insertion, native combined anteversion is not related to current implant insertion targets. Understanding native muscular anatomy and the alterations that occur with different surgical approaches can serve as an explanatory model for THAs that has become unstable despite the components being implanted within the safe zone.

Effect of side-sling plank exercise on trunk and hip muscle activation in subjects with gluteus medius weakness

2021 ◽  
pp. 1-9
Author(s):  
Seung-Min Baik ◽  
Heon-Seock Cynn ◽  
Chung-Hwi Yi ◽  
Ji-Hyun Lee ◽  
Jung-Hoon Choi ◽  
...  
Keyword(s):  
Muscle Activation ◽  
Gluteus Maximus ◽  
Gluteus Medius ◽  
Erector Spinae ◽  
Lumbar Multifidus ◽  
Hip Muscle ◽  
Hip Abduction ◽  
Medial Rotation ◽  
Hip Muscles ◽  
Tensor Fasciae Latae

BACKGROUND: The effectiveness of side-sling plank (SSP) exercises on trunk and hip muscle activation in subjects with gluteus medius (Gmed) weakness is unclear. OBJECTIVE: To quantify muscle activation of the rectus abdominis (RA), external oblique (EO), erector spinae (ES), lumbar multifidus (LM), Gmed, gluteus maximus (Gmax), and tensor fasciae latae (TFL) during SSP with three different hip rotations compared to side-lying hip abduction (SHA) exercise in subjects with Gmed weakness. METHODS: Twenty-two subjects with Gmed weakness were recruited. SHA and three types of SSP exercises were performed: SSP with neutral hip (SSP-N), hip lateral rotation (SSP-L), and hip medial rotation (SSP-M). Surface electromyography was used to measure the activation of the trunk and hip muscles. RESULTS: The trunk and hip muscles activations were generally significantly higher level during three SSP than SHA. SSP-M showed significantly lower EO activation while significantly higher ES and LM activation than SSP-L. Gmed activation was significantly higher during SSP-M than during SSP-L. TFL activation was significantly lower during SSP-M than during SSP-N and SSP-L. CONCLUSIONS: SSP could be prescribed for patients who have reduced Gmed strength after injuries. Especially, SSP-M could be applied for patients who have Gmed weakness with dominant TFL.

Perikoxale Schmerzsyndrome – nicht immer einfach zu diagnostizieren

2016 ◽  
Vol 36 (01) ◽  
pp. 9-14
Author(s):  
T. Guttke ◽  
I. Arnold
Keyword(s):  
Gluteus Maximus ◽  
Gluteus Medius ◽  
Anterior Inferior Iliac Spine ◽  
Tractus Iliotibialis ◽  
Tensor Fasciae Latae ◽  
Nervus Ischiadicus

ZusammenfassungPertrochantäre Schmerzen stellen ein häufiges klinisches Problem dar. Auch wenn perikoxale Schmerzsyndrome bereits früh beschrieben worden sind, hat die Weiterent-wicklung der arthroskopischen Techniken unter Einbezug der extrakapsulären Kompartimente die Sensibilität für diese häufig fehl -interpretierten Erkrankungsformen erhöht. Voos und Mitarbeiter veröffentlichten 2007 sehr früh ihre ersten Ergebnisse im Hinblick auf endoskopische Interventionen in diesem Zusammenhang (1). Andere Erkrankungsformen wie das “low anterior inferior iliac spine impingement” wurden sogar erst durch die Hüftarthroskopie der Beschreibung zugänglich. Zu den pertrochantären Pathologien, die das laterale Kompartiment betreffen, zählen Bursitiden und Insertionstendinosen der Glutealmuskulatur bis hin zur Ruptur und das Tractus-iliotibialis-Syndrom einschließlich der externen Schnapphüfte. Projektionsschmerzen von der proximalen Lendenwirbelsäule sind in dieser Übersicht nicht berücksichtigt, verursachen aber in bis zu 30 % pertrochantäre Beschwerden. Auf nervaler Ebene können Irritationen des inferioren Glutealnervs mit radikulärem Ursprung L5–S2 (Innervation des M. gluteus maximus) oder des N. gluteus superior (Wurzeln L4–S1; Innervation des M. gluteus medius und minimus, M. tensor fasciae latae und vordere Partien des Hüft gelenks) Trochanter-bezogene Schmerzen imitieren. Im ventralen extraartikulären Kompartiment kann eine Friktion der Sehne des M. iliopsoas ein internes Impingement und Schnappen verant-worten. Natürlich sind differenzialdiagnostisch auch Arthrose-assoziierte muskulotendinöse Kontrakturen oder auch Gangasymmetrien bzw. Störungen im lumbosakralen Übergang mit konsekutiven muskulären Dysbalancen auszuschließen. Aber auch nach Hüftgelenkersatz stellen unzureichend azetabulär-knöchern gedeckte Pfannenkomponenten eine Disposition für eine Irritation der Hüftbeuger dar. Anatomisch dem posterioren Bereich zugeordnet sind die Strukturen um den Nervus ischiadicus (z. B. Entrapmentphänomene durch fibrinöse Stränge), die Hüftaußenrotatoren und explizit der M. piriformis. Aber auch Insertionstendinopathien der Hamstrings sind differenzialdiagnostisch perikoxalen Schmerzsyndromen zuzuordnen.

scholarly journals Combined Transfer of the Gluteus Maximus and Tensor Fasciae Latae for Irreparable Gluteus Medius Tear Using Contemporary Techniques

2020 ◽  
Vol 5 (4) ◽  
pp. e00040-e00040
Author(s):  
David R. Maldonado ◽  
Shawn Annin ◽  
Jeffrey W. Chen ◽  
Mitchell J. Yelton ◽  
Jacob Shapira ◽  
...  
Keyword(s):  
Gluteus Maximus ◽  
Gluteus Medius ◽  
Tensor Fasciae Latae

scholarly journals Evaluation of muscle volume and degeneration after total hip arthroplasty: a comparison of the posterolateral approach and the anterolateral supine approach

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Taku Ukai ◽  
Goro Ebihara ◽  
Haruka Omura ◽  
Masahiko Watanabe
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Gluteus Maximus ◽  
Gluteus Medius ◽  
Muscle Volume ◽  
Posterolateral Approach ◽  
Hounsfield Units ◽  
Total Hip ◽  
Internal Obturator Muscle ◽  
Tensor Fasciae Latae

Abstract Background Muscle strength around the hip after total hip arthroplasty (THA) is crucial for preventing dislocation and limping. This study aimed to assess and compare muscle volume and degeneration after THA using the posterolateral (PL) and anterolateral (AL) approaches. Methods Sixty-four hips in 64 patients who underwent primary THA were retrospectively analyzed. Patients were segregated into the PL group (35 hips) and AL group (29 hips) for evaluating pre- and postoperative muscle volumes and degeneration around the hip. Computed tomography (CT) examinations were performed preoperatively and 6 months post THA. The muscle volume and Hounsfield units (HU) of the gluteus maximus (G-max), gluteus medius (G-med), tensor fasciae latae, internal obturator muscle, and external obturator muscle were measured. Results In the PL group, the postoperative muscle volume of the G-max significantly increased than the preoperative muscle volume. In contrast, the postoperative muscle volume of the internal obturator muscle was significantly lower than the preoperative muscle volume. The postoperative HU of the internal and external obturator muscles were significantly lower than the preoperative HU. In the AL group, the postoperative muscle volumes of the G-max, G-med, and tensor fasciae latae significantly increased than their preoperative muscle volumes. The postoperative HU of the G-med and tensor fasciae latae were significantly higher than the preoperative HU values. Conclusion The PL approach can lead to degeneration of the internal and external obturator. The AL approach is more beneficial for recovering the G-med, tensor fasciae latae, and internal obturator muscle than the PL approach.

Combined Anteversion Technique in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia of the Hip

2017 ◽  
Vol 27 (6) ◽  
pp. 589-594 ◽  
Author(s):  
Biao Zhu ◽  
Changzheng Su ◽  
Yeteng He ◽  
Xingyu Chai ◽  
Zhen Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Anteversion ◽  
Safe Zone ◽  
Developmental Dysplasia ◽  
Acetabular Anteversion ◽  
Combined Anteversion ◽  
The Mean ◽  
Postoperative Dislocation ◽  
Dysplasia Of The Hip

Background A high rate of postoperative dislocation in total hip arthroplasty (THA) for Crowe IV developmental dysplasia of the hip (DDH) has been reported, 1 of the main reasons being higher true acetabular anteversion. If the cup is fixed with normal anteversion, the anterior rim will be excessively exposed, which reduces the contact areas of the cup and bone, affects prosthesis stability, and leads to iliopsoas tendinitis and persistent hip pain after THA. The aim of this study was to demonstrate that when cup anteversion is larger, adjusting femoral anteversion to bring the combined anteversion (CA) into the “safe zone” might prevent dislocation. Methods After having fixed the cup in the acetabulum according to the patients’ native acetabular anteversion, we shortened and rotated the proximal femur to reduce femoral anteversion, adjusting the CA into the “safe zone”. The Harris Hip Score (HHS) was used to evaluate hip joint function. Computerised tomography scanning was used to measure the anteversion angles. Results All patients were followed up without any dislocation. Preoperative and 12 months after surgery, the mean HHS were 43.3 ± 2.6 (38-47) and 88.1 ± 3.3 (78-92) respectively. Pre- and post-operation, the mean CA angles were 88.6° ± 9.4° (80.3°-119.4°) and 49.2° ± 2.6° (43.4°-54.4°) respectively. The bone healing time of femoral osteotomy ranged from 4 to 14 months, with a mean time of 7.5 months. Conclusions This CA technique in THA for Crowe IV DDH can effectively prevent postoperative dislocation and provide good hip function.

scholarly journals Effects of Log Rolling Position on Hip Abductor Muscles Activity During Side-Lying Hip Abduction Exercise in Participants with Gluteus Medius Weakness

2020 ◽  
Author(s):  
Seung-min Baik ◽  
Heon-seock Cynn ◽  
Jae-hun Shim ◽  
Ji-hyun Lee ◽  
A-reum Shin ◽  
...  
Keyword(s):  
Analysis Of Variance ◽  
Repeated Measures ◽  
Statistical Significance ◽  
Frontal Plane ◽  
Gluteus Maximus ◽  
Gluteus Medius ◽  
Neutral Position ◽  
Hip Abduction ◽  
Hip Abductor ◽  
Tensor Fasciae Latae

Abstract Context: Weakness of the gluteus medius and the gluteus maximus is associated with a variety of musculoskeletal disorders. However, activation of synergist muscles that are not targeted should be considered when prescribing side-lying hip abduction (SHA) exercises. Log-rolling positions may affect hip abductors activity during SHA. Objectives: To determine the effects of log-rolling positions on the gluteus medius, the gluteus maximus, and the tensor fasciae latae activity during SHA in participants with gluteus medius weakness. Design: The effects of different log-rolling positions on hip abductor activity during SHA were analyzed by one-way repeated-measures analysis of variance. Setting: University research laboratory. Participants: Twenty-one participants with gluteus medius weakness were recruited. Interventions: Three types of SHA were performed: SHA in the frontal plane with a neutral position (SHA-neutral), SHA in the frontal plane with an anterior log-rolling position (SHA-anterior rolling), and SHA in the frontal plane with a posterior log-rolling position (SHA-posterior rolling). Main Outcome Measures: Surface electromyography was used to measure the hip abductor activity. One-way repeated-measure analysis of variance was used to assess the statistical significance of the muscle activity. Results: SHA-anterior rolling showed significantly greater gluteus medius and gluteus maximus activation than SHA-neutral (P = .003 and P < .001, respectively) and SHA-posterior rolling (P < .001 and P < .001, respectively). SHA-neutral showed significantly greater gluteus medius and gluteus maximus activation than SHA-posterior rolling (P < .001 and P = .001, respectively). SHA-anterior rolling showed significantly less tensor fasciae latae activation than SHA-neutral (P < .001) and SHA-posterior rolling (P < .001). SHA-neutral showed significantly less tensor fasciae latae activation than SHA-posterior rolling (P < .001). Conclusion: SHA-anterior rolling may be an effective exercise to increase activation of the gluteus medius and the gluteus maximus while decreasing the tensor fasciae latae in participants with gluteus medius weakness.

scholarly journals Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

2009 ◽  
Vol 1 (1) ◽  
pp. 4 ◽  
Author(s):  
Marcus Jaeger ◽  
Michael Schmidt ◽  
Alexander Wild ◽  
Bernd Bittersohl ◽  
Susanne Courtois ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Mean Value ◽  
Surgical Approaches ◽  
Radiological Outcome ◽  
Scarf Osteotomy ◽  
Post Surgery ◽  
The Mean

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years). Surgical indications were: intermetatarsal angle (IMA) of 12-23°; increased proximal articular angle (PAA>8°), and range of motion of the metatarsophalangeal joint in flexion and extension >40°. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8±1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7±2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1±2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6° (pre-operative mean value: 37.5°) which was statistically significant (p<0.01). The IMA improved by an average of 5.96° from a pre-operative mean value of 15.4° (p<0.01). Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

scholarly journals Effects of rehabilitation and arthroplasty on the hip isometric muscle strength in patients with osteoarthritis of the hip

2009 ◽  
Vol 62 (5-6) ◽  
pp. 236-240 ◽  
Author(s):  
Slavica Jandric
Keyword(s):  
Muscle Strength ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Gluteus Medius ◽  
Treated Group ◽  
Early Rehabilitation ◽  
Control Group ◽  
Osteoarthritis Of The Hip ◽  
Total Hip ◽  
Tensor Fasciae Latae

Introduction Periarticular muscles have a significant role in keeping the mobility and integrity of the hip joint. The aim of this article was to investigate the effects of the total hip arthroplasty and early rehabilitation on the muscle strength. Patients Three groups of examined persons (matched in relation to musculosceletal conditions, sex, age and occupation) were included in the investigation. The first group (40 of the involved hip) and the second group (with 33 involved hips) were groups of patients with late-stage of osteoarthritis of the hip. The first group of patients was managed conservatively and the second group operatively (total cemented hip endoprosthesis was performed). The third group was control group with 123 healthy hips. Material and methods The maximal voluntary isometric strength was measured with dynamometer. The muscle strength was tested in all three groups: in the first group of patients at the beginning and at the end of the therapy and in patients of the second group 6?3 months postoperatively. Results A significant improvement of the muscle strength was noted for the flexors (t=2.45, p<0.05), musculus tensor fasciae latae (t=2.35, p<0.05), extensors (t=2.85, p<0.01), adductors (t=3.02, p<0.01), external rotators (t=3.1, p<0.01), m. gluteus medius (t=5.28, p<0.001) and internal rotators (t=5.77, p<0.001) after total hip arthroplasty and early rehabilitation in comparison to the conservatively treated group. Conclusion The muscle strength in the patients with osteoarthritis of the hip after arthroplasty was significantly higher than after rehabilitation for all hip muscles but did not reach values of the strength of the muscles in the corresponding control group.

Sign in / Sign up

Export Citation Format

Share Document