scholarly journals Venting the Central Compartment of the Hip Prior to Distraction Minimizes Overall Hip Distraction Forces

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0043
Author(s):  
O Dillon ◽  
Alex Mortensen ◽  
Temitope Adeyemi ◽  
Suzanna Ohlsen ◽  
Travis Maak ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Hip Joint ◽  
Traction Force ◽  
Central Compartment ◽  
Joint Space ◽  
Hip Surgery ◽  
Traction Forces ◽  
Paired Samples ◽  
Joint Distraction ◽  
Joint Displacement

Objectives: Arthroscopic hip surgery requires application of ipsilateral lower extremity traction to achieve adequate joint distraction and hip central compartment access. Higher traction forces applied to the lower extremity allow greater hip joint distraction, improving the working space, in order minimize iatrogenic chondral and labral injury. However, greater traction forces have demonstrated a higher potential for iatrogenic traction related injuries. Controversy exists about the clinical relevance of procedural modifications, such as venting the hip, as a means of reducing the amount of traction force required to safely distract the hip joint. This study was designed to evaluate the difference between no venting versus venting the hip prior to application of traction on the overall amount of traction needed to distract the hip joint during hip arthroscopy. Methods: A total of 55 hips in 54 consecutive patients undergoing primary arthroscopic hip surgery were retrospectively reviewed. Prior to any instrumentation, interval fluoroscopic images of the operative hip joint were taken at 0, 25, 50, 75, and 100 pound-force (lb-f) (0, 11.3, 22.7, 34.0, and 45.4 kilogram-force (kg-f)) of applied traction. The hip was then taken off traction and the joint was vented using a standard hip access 14-gauge spinal needle and injected with 20 milliliters of air. Before any additional intervention, traction was again applied to the operative extremity and fluoroscopic images were obtained at the same traction force intervals. Joint displacement was measured at each traction force interval both before and after venting. Fluoroscopic images were scaled based on AP pelvis radiographs in order to obtain millimeteric joint space measurements. Results: The mean difference in hip joint displacement without venting and with venting was 0.29, 2.24, 4.06, 4.13, and 3.80mm at 25, 50, 75, and 100 lbs-f of traction, respectively. Paired samples t-testing demonstrated statistically significant increases in distraction distance (p<0.01) at all levels of traction (Table 1). Prior to venting, 0%, 7.3%, 27.8%, 44.0% of hips distracted at least 10 mm at 25, 50, 75, and 100 lbs-f of traction, respectively. After venting, 14.6%, 45.0%, 74.0%, 86% of hips distracted at least 10 mm at 25, 50, 75, and 100 lbs-f of traction, respectively (Figure 1). Conclusion: This study demonstrates that venting the hip prior to the application of traction significantly increases the amount of distraction distance achieved for a given traction force at multiple levels of traction. With venting of the hip, the percentage of hips achieving at least 10mm of distraction for 100lbsf almost doubled. These findings suggest venting the hip prior to application of traction could serve to reduce the maximal amount of traction required to safely instrument the hip arthroscopically. [Table: see text][Figure: see text]

scholarly journals Postless Hip Arthroscopy: A Safer Alternative for Treatment of Femoracetabular Impingement Syndrome

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110067
Author(s):  
Michael B. Held ◽  
Liana J. Tedesco ◽  
Mario H. Lobao ◽  
T. Sean Lynch
Keyword(s):  
Hip Joint ◽  
Hip Arthroscopy ◽  
Pudendal Nerve ◽  
Patient Positioning ◽  
Central Compartment ◽  
Operating Table ◽  
Complication Rates ◽  
Iatrogenic Complications ◽  
Diagnostic Arthroscopy ◽  
Hip Distraction

Background: Hip arthroscopy for femoroacetabular impingement (FAI) syndrome continues to gain popularity and indications for its use are expanding. Though low complication rates have previously been reported, there are iatrogenic complications specific to the use of the perineal post, such as pudendal nerve injuries, and possible pressure skin necrosis that warrant concern in the healthy young patient. The risk of these complications are increased during simultaneous bilateral hip arthroscopy. Indications: We describe a new technique, which will prevent such problems by using a postless pink pad technique in order to achieve adequate hip distraction. Technique Description: Arthroscopic investigation begins with proper, safe patient positioning in order to gain access to the hip joint with sufficient joint distraction. In the postless technique, a dense foam pad is utilized in lieu of a perineal post. The static friction between the pad, bed, and the patient counters the manual gross traction necessary to distract the hip joint while preventing the patient from sliding down or off of the operating table. The postless technique avoids pressure to the perineum and also allows for greater range of motion during dynamic intraoperative examination and femoroplasty. After hip distraction, standard portal placement allows for access to the central compartment in order to assess intraarticular pathology. Once identified on diagnostic arthroscopy, appropriate techniques are utilized to correct acetabular-sided pincer lesions, labral tears, and femoral-sided cam deformities. Results: When discussing this technique with patients, it is important to highlight that it diminishes the possibility of iatrogenic pressure injury to the pudendal nerve and skin of the perineum. The risk of these injuries typically occurs when the pudenal nerve is compressed against the post during traction and abduction. As such, postless technique prevents any compression and pressure to these regions. Discussion/Conclusion: Hip arthroscopy is a minimally invasive, low morbidity technique for treating a variety of chondral, ligamentous, and bony conditions of the hip. However, studies suggest that pudenal nerve injury is seen in up to 4.3% of patients following hip arthroscopy. Given avoidance of iatrogenic post complications, we describe a postless technique for achieving hip distraction during hip arthroscopy.

Prosthesis Design for Bilateral Hip Disarticulation Management

2014 ◽  
Vol 664 ◽  
pp. 423-428
Author(s):  
Mauricio Plaza Torres ◽  
William Aperador
Keyword(s):  
Body Weight ◽  
Lower Extremity ◽  
Hip Joint ◽  
Joint Capsule ◽  
The Body ◽  
Body Weight Support ◽  
Patient Mobility ◽  
Weight Support ◽  
Crush Injuries ◽  
High Level

Hip disarticulation is an amputation through the hip joint capsule, removing the entire lower extremity, with closure of the remaining musculature over the exposed acetabulum. Tumors of the distal and proximal femur were treated by total femur resection; a hip disarticulation sometimes is performance for massive trauma with crush injuries to the lower extremity. This article discusses the design a system for rehabilitation of a patient with bilateral hip disarticulations. The prosthetics designed allowed the patient to do natural gait suspended between parallel articulate crutches with the body weight support between the crutches. The care of this patient was a challenge due to bilateral amputations at such a high level and the special needs of a patient mobility.

scholarly journals Dissipation of contractile forces: the missing piece in cell mechanics

2017 ◽  
Vol 28 (14) ◽  
pp. 1825-1832 ◽  
Author(s):  
Laetitia Kurzawa ◽  
Benoit Vianay ◽  
Fabrice Senger ◽  
Timothée Vignaud ◽  
Laurent Blanchoin ◽  
...  
Keyword(s):  
Cell Mechanics ◽  
Force Production ◽  
Traction Force ◽  
Structural Rearrangements ◽  
Force Transmission ◽  
Traction Forces ◽  
Cell Traction Forces ◽  
Cell Traction ◽  
Contractile Forces ◽  
Fiber Contraction

Mechanical forces are key regulators of cell and tissue physiology. The basic molecular mechanism of fiber contraction by the sliding of actin filament upon myosin leading to conformational change has been known for decades. The regulation of force generation at the level of the cell, however, is still far from elucidated. Indeed, the magnitude of cell traction forces on the underlying extracellular matrix in culture is almost impossible to predict or experimentally control. The considerable variability in measurements of cell-traction forces indicates that they may not be the optimal readout to properly characterize cell contractile state and that a significant part of the contractile energy is not transferred to cell anchorage but instead is involved in actin network dynamics. Here we discuss the experimental, numerical, and biological parameters that may be responsible for the variability in traction force production. We argue that limiting these sources of variability and investigating the dissipation of mechanical work that occurs with structural rearrangements and the disengagement of force transmission is key for further understanding of cell mechanics.

Normal radiological unossified hip joint space and femoral head size development during growth in 675 children and adolescents

2016 ◽  
Vol 30 (2) ◽  
pp. 267-275 ◽  
Author(s):  
Veronika Wegener ◽  
Gabriele Jorysz ◽  
Andreas Arnoldi ◽  
Sandra Utzschneider ◽  
Bernd Wegener ◽  
...  
Keyword(s):  
Femoral Head ◽  
Children And Adolescents ◽  
Hip Joint ◽  
Joint Space ◽  
Head Size ◽  
Femoral Head Size

Ultrasound-guided Musculoskeletal Interventions for the Most Common Hip and Pelvis Conditions: A Step-by-Step Approach

2019 ◽  
Vol 23 (03) ◽  
pp. e58-e67 ◽  
Author(s):  
Georgina Allen ◽  
Marina Obradov ◽  
Vito Chianca ◽  
Carmelo Messina ◽  
Luca Maria Sconfienza
Keyword(s):  
Hip Joint ◽  
Ultrasound Guidance ◽  
Pubic Symphysis ◽  
Joint Space ◽  
Common Condition ◽  
Sacroiliac Joints ◽  
Ultrasound Guided ◽  
Therapeutic Procedures

AbstractPain around the hip and pelvis is a very common condition. Pain may be generated within the joint space (i.e. the hip joint itself, the sacroiliac joints or the pubic symphysis) or from surrounding myotendinous, bursal, or nerve structures. Over the years, percutaneous musculoskeletal procedures have become increasingly popular to diagnose and treat painful conditions around the hip and the pelvis. Most intra- and extra-articular procedures are performed under ultrasound guidance. This article reviews the most common diagnostic and therapeutic procedures that can be performed around the hip and the pelvis under ultrasound guidance.

scholarly journals Transmission of growth cone traction force through apCAM–cytoskeletal linkages is regulated by Src family tyrosine kinase activity

2001 ◽  
Vol 155 (3) ◽  
pp. 427-438 ◽  
Author(s):  
Daniel M. Suter ◽  
Paul Forscher
Keyword(s):  
Tyrosine Kinase ◽  
Growth Cone ◽  
Kinase Activity ◽  
Kinase Inhibitors ◽  
Traction Force ◽  
Tyrosine Kinase Activity ◽  
Cellular Mechanisms ◽  
Traction Forces ◽  
Kinase Activation ◽  
Neuronal Growth Cone

Tyrosine kinase activity is known to be important in neuronal growth cone guidance. However, underlying cellular mechanisms are largely unclear. Here, we report how Src family tyrosine kinase activity controls apCAM-mediated growth cone steering by regulating the transmission of traction forces through receptor–cytoskeletal linkages. Increased levels of tyrosine phosphorylation were detected at sites where beads coated with apCAM ligands were physically restrained to induce growth cone steering, but not at unrestrained bead binding sites. Interestingly, the rate and level of phosphotyrosine buildup near restrained beads were decreased by the myosin inhibitor 2,3-butanedione-2-monoxime, suggesting that tension promotes tyrosine kinase activation. While not affecting retrograde F-actin flow rates, genistein and the Src family selective tyrosine kinase inhibitors PP1 and PP2 strongly reduced the growth cone's ability to apply traction forces through apCAM–cytoskeletal linkages, assessed using the restrained bead interaction assay. Furthermore, increased levels of an activated Src family kinase were detected at restrained bead sites during growth cone steering events. Our results suggest a mechanism by which growth cones select pathways by sampling both the molecular nature of the substrate and its ability to withstand the application of traction forces.

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