Effects of lower limb and pelvic pin positions on leg length and offset measurement errors in experimental total hip arthroplasty

Abstract Background Leg length (LL) and offset (OS) are important factors in total hip arthroplasty (THA). Because most LL and OS callipers used in THA depend on fixed points on the pelvis and the femur, limb position could affect measurement error. This study was conducted on a THA simulator to clarify the effects of lower limb position and iliac pin position on LL and OS errors and to determine the permissible range of limb position for accurate LL and OS measurement. Methods An LL and OS measurement instrument was used. Two pin positions were tested: the iliac tubercle and the top of the iliac crest intersecting with the extension of the femoral axis. First, the limb was moved in one direction (flexion-extension, abduction-adduction, or internal-external rotation), and LL and OS were measured for each pin position. Next, the limb was moved in combinations of the three directions. Then, the permissible range of combined limb position, which resulted in LL and OS measurement error within ±2 mm, was determined for each pin position. Results Only 4° of abduction/adduction caused 5–7 mm error in LL and 2–4 mm error in OS, irrespective of pin position. The effects of flexion–extension and internal–external rotation on LL error were smaller for the top of the iliac crest than for the iliac tubercle, though OS error was similar for both pin positions. For LL, the permissible range of the combined limb position was wider for the top of the iliac crest than for the iliac tubercle. Conclusion To minimize LL and OS measurement errors in THA, adduction–abduction must be maintained. The iliac pin position in the top of the iliac crest is preferred because it provides less LL measurement error and a wider permissible range of combined limb position for accurate LL measurement.

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Effects of Lower Limb and Pelvic Pin Positions on Leg Length and Offset Measurement Errors in Experimental Total Hip Arthroplasty

10.21203/rs.3.rs-150248/v1 ◽

2021 ◽

Author(s):

Haruo Kawamura ◽

Yasuhiko Watanabe ◽

Tomofumi Nishino ◽

Hajime Mishima

Keyword(s):

Measurement Error ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Lower Limb ◽

Measurement Errors ◽

Iliac Crest ◽

External Rotation ◽

Limb Position ◽

Permissible Range ◽

Flexion Extension

Abstract BackgroundLeg length (LL) and offset (OS) are important factors in total hip arthroplasty (THA). Because most LL and OS callipers used in THA depend on fixed points on the pelvis and the femur, limb position could affect measurement error. This study was conducted on a THA simulator to clarify the effects of lower limb position and iliac pin position on LL and OS errors and to determine the permissible range of limb position for accurate LL and OS measurement. MethodsAn LL and OS measurement instrument was used. Two pin positions were tested: the iliac tubercle and the top of the iliac crest intersecting with the extension of the femoral axis. First, the limb was moved in one direction (flexion-extension, abduction-adduction, or internal-external rotation), and LL and OS were measured for each pin position. Next, the limb was moved in combinations of the three directions. Then, the permissible range of combined limb position, which resulted in LL and OS measurement error within ±2 mm, was determined for each pin position. ResultsOnly 4 degrees of abduction/adduction caused 5-7 mm error in LL and 2-4 mm error in OS, irrespective of pin position. The effects of flexion–extension and internal–external rotation on LL error were smaller for the top of the iliac crest than for the iliac tubercle, though OS error was similar for both pin positions. For LL, the permissible range of the combined limb position was wider for the top of the iliac crest than for the iliac tubercle. ConclusionTo minimize LL and OS measurement errors in THA, adduction–abduction must be maintained. The iliac pin position in the top of the iliac crest is preferred because it provides less LL measurement error and a wider permissible range of combined limb position for accurate LL measurement.

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Reliability of a New Portable Dynamometer for Assessing Hip and Lower Limb Strength

Applied Sciences ◽

10.3390/app11083391 ◽

2021 ◽

Vol 11 (8) ◽

pp. 3391

Author(s):

Jan Marušič ◽

Goran Marković ◽

Nejc Šarabon

Keyword(s):

Lower Limb ◽

External Rotation ◽

Peak Torque ◽

Knee Extension ◽

Lower Limb Muscles ◽

Lower Limb Strength ◽

Flexion Extension ◽

Strength Tests ◽

Hip Abduction ◽

Maximal Peak

The purpose of this study was to evaluate intra- and inter-session reliability of the new, portable, and externally fixated dynamometer called MuscleBoard® for assessing the strength of hip and lower limb muscles. Hip abduction, adduction, flexion, extension, internal and external rotation, knee extension, ankle plantarflexion, and Nordic hamstring exercise strength were measured in three sessions (three sets of three repetitions for each test) on 24 healthy and recreationally active participants. Average and maximal value of normalized peak torque (Nm/kg) from three repetitions in each set and agonist:antagonist ratios (%) were statistically analyzed; the coefficient of variation and intra-class correlation coefficient (ICC2,k) were calculated to assess absolute and relative reliability, respectively. Overall, the results display high to excellent intra- and inter-session reliability with low to acceptable within-individual variation for average and maximal peak torques in all bilateral strength tests, while the reliability of unilateral strength tests was moderate to good. Our findings indicate that using the MuscleBoard® dynamometer can be a reliable device for assessing and monitoring bilateral and certain unilateral hip and lower limb muscle strength, while some unilateral strength tests require some refinement and more extensive familiarization.

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Hip Muscle Strength Explains Only 11% of the Improvement in HAGOS With an Intersegmental Approach to Successful Rehabilitation of Athletic Groin Pain

The American Journal of Sports Medicine ◽

10.1177/03635465211028981 ◽

2021 ◽

pp. 036354652110289

Author(s):

Samuel R. Baida ◽

Enda King ◽

Chris Richter ◽

Shane Gore ◽

Andrew Franklyn-Miller ◽

...

Keyword(s):

Lower Limb ◽

Groin Pain ◽

External Rotation ◽

Rehabilitation Program ◽

Return To Play ◽

Success Rates ◽

Level Of Evidence ◽

Hip Strength ◽

Hip Muscle ◽

Flexion Extension

Background: Exercise-based rehabilitation targeting intersegmental control has high success rates and fast recovery times in the management of athletic groin pain (AGP). The influence of this approach on hip strength and lower limb reactive strength and how these measures compare with uninjured athletes (CON) remain unknown. Additionally, the efficacy of this program after return to play (RTP) has not been examined. Purpose: First, to examine differences in isometric hip strength, reactive strength, and the Hip and Groin Outcome Score (HAGOS) between the AGP and CON cohorts and after rehabilitation; second, to examine the relationship between the change in HAGOS and the change in strength variables after rehabilitation; last, to track HAGOS for 6 months after RTP. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 42 athletes diagnosed with AGP and 36 matched controls completed baseline testing: isometric hip strength, lower limb reactive strength, and HAGOS. After rehabilitation, athletes with AGP were retested, and HAGOS was collected at 3 and 6 months after RTP. Results: In total, 36 athletes with AGP completed the program with an RTP time of 9.8 ± 3.0 weeks (mean ± SD). At baseline, these athletes had significantly lower isometric hip strength (abduction, adduction, flexion, extension, external rotation: d = –0.67 to −1.20), single-leg reactive strength ( d = −0.73), and HAGOS ( r = −0.74 to −0.89) as compared with the CON cohort. Hip strength ( d = −0.83 to −1.15) and reactive strength ( d = −0.30) improved with rehabilitation and were no longer significantly different between groups at RTP. HAGOS improvements were maintained or improved in athletes with AGP up to 6 months after RTP, although some subscales remained significantly lower than the CON group ( r = −0.35 to −0.51). Two linear regression features (hip abduction and external rotation) explained 11% of the variance in the HAGOS Sports and Recreation subscale. Conclusion: Athletes with AGP demonstrated isometric hip strength and reactive strength deficits that resolved after an intersegmental control rehabilitation program; however, improved hip strength explained only 11% of improvement in the Sports and Recreation subscale. HAGOS improvements after pain-free RTP were maintained at 6 months.

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Leg length measures appear inaccurate in the early phase following total hip arthroplasty

Scientific Reports ◽

10.1038/s41598-021-02684-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Maria Anna Smolle ◽

Stefan Franz Fischerauer ◽

Michael Maier ◽

Patrick Reinbacher ◽

Jörg Friesenbichler ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Sacroiliac Joint ◽

Iliac Crest ◽

Weight Bearing ◽

Harris Hip Score ◽

Anatomical Landmarks ◽

Leg Length ◽

Leg Extension ◽

Total Hip

AbstractThe aims of this study were to (1) assess reliability of leg length discrepancy (LLD) measurements at different anatomical landmarks, (2) longitudinally investigate LLD in patients within the first year following total hip arthroplasty (THA) and to (3) correlate changes in LLD with functional outcome. Ninety-nine patients with short stem THA (53.3% males, mean age: 61.0 ± 8.1 years) were prospectively included. Upright pelvic anteroposterior (a.p.) radiographs taken at 6 timepoints (preoperatively, discharge, 6, 12, 24, 52 weeks postoperatively) were used to assess LLD at 5 anatomical landmarks (iliac crest, upper sacroiliac joint, lower sacroiliac joint, tear drop figure, greater trochanter). WOMAC and Harris Hip Score (HHS) were obtained preoperatively and at 6 and 52 weeks. LLD measures significantly increased in the initial phase following THA, from discharge to 6 weeks postoperatively and remained constant thereafter. Documentation of LLDs is dependent on measurement site: LLDs varied significantly between trochanter and iliac crest to tear drop figure (p < 0.001). Functional assessments did not correlate with the occurrence of LLDs [WOMAC (p = 0.252); HHS (p = 0.798)]. Radiographic assessment of LLD following THA may not be performed early postoperatively, as measurements appear to inaccurately reflect actual LLDs at this time, potentially due incomplete leg extension and/or inhibited weight-bearing.

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The effectiveness and influencing factors of the ‘Y’ line technique in reducing the leg length discrepancy after total hip arthroplasty

10.21203/rs.3.rs-944319/v1 ◽

2021 ◽

Author(s):

Wenshu Jin ◽

Huaqiang Sun ◽

Xudong Duan ◽

Yange Gu ◽

zhang zhao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Lower Limb ◽

Limb Length ◽

Leg Length Discrepancy ◽

Leg Length ◽

X Ray ◽

Length Discrepancy ◽

Group A ◽

Group B

Abstract Objective: To introduce a surgical technique (the ‘Y’ line technique) which is to control the leg length discrepancy (LLD) after total hip arthroplasty.Methods: A total of 350 patients were selected; 134 patients who were used the ‘Y’ line technique to control lower limb length were included in Group A and 166 patients treated with free hand methods to control lower limb length were included in Group B. 50 patients who were taken standard anteroposterior X-ray of bilateral hips preoperatively and used the ‘Y’ line technique during the operation were included in Group C. Results: The postoperative LLD of the three groups was statistically significant (p < 0.001). There were significant differences statistically in comparison between any two groups (P<0.01). Severe unequal length rates of the lower extremities (LLD > 10 mm) were 5.97% (8/134) in Group A, 14.3% (24/166) in Group B and 0% (0/50) in Group C – the difference was statistically significant (p < 0.001). There were significant differences between Group A and Group B, Group B and Group C (P < 0.05), but there was no significant difference between Group A and Group C (P = 0.078).Conclusion: The ‘Y’ line technique, which does not increase the operation time, can effectively reduce postoperative LLD. Insufficient internal rotation of the healthy lower extremity and the low projection position in the preoperative anteroposterior X-ray of bilateral hips were important factors affecting the accuracy of the ‘Y’ line technique.

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Comparison of Lower Extremity Muscle Flexibility in Amateur and Trained Bharatanatyam Dancers and Nondancers

Medical Problems of Performing Artists ◽

10.21091/mppa.2018.1005 ◽

2018 ◽

Vol 33 (1) ◽

pp. 20-25

Author(s):

Monica Sharma ◽

Shibili Nuhmani ◽

Deepti Wardhan ◽

Qassim I Muaidi

Keyword(s):

Internal Rotation ◽

Lower Limb ◽

Knee Flexion ◽

External Rotation ◽

Lower Limb Muscle ◽

Limb Muscle ◽

Lower Extremity Muscle ◽

Significant Difference ◽

Flexion Extension ◽

Hip Flexion

OBJECTIVE: This study compared lower limb muscle flexibility between amateur and trained female Bharatanatyam dancers and nondancers. METHODS: Subjects consisted of 105 healthy female volunteers, with 70 female Bharatanatyam dancers (35 trained, 35 amateurs) and 35 controls, with a mean (±SD) age of 16.2±1.04 yrs, height 155.05±4.30 cm, and weight 54.54±2.77 kg. Participants were assessed for range of motion (ROM) in hip flexion, hip extension, hip abduction and adduction, hip external rotation, hip internal rotation, knee flexion, knee extension, ankle dorsiflexion (DF), and ankle plantar flexion (PF) by using a standardized goniometer. To assess for significant difference between groups, one-way ANOVA was applied, and multiple comparisons were made using Bonferroni correction. RESULTS: Trained dancers had a significantly greater hip flexion, extension, abduction, and external rotation ROM than amateurs and nondancers (p<0.05). Also, internal rotation and adduction were markedly less in trained dancers (p<0.05). Knee flexion, extension, and ankle DF were higher and ankle PF ROM was lesser in trained dancers. However, not much variation was found in ankle DF and PF between amateur dancers and nondancers (p>0.05). CONCLUSION: Results showed that there are significant differences in lower limb muscle flexibility between trained and amateur Bharatanatyam dancers and nondancers. These differences may be due to individual dance postures such as araimandi and muzhumandi.

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Changes in Gait Variables in Patients with Intermittent Claudication

BioMed Research International ◽

10.1155/2019/7276865 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Bogdan Pietraszewski ◽

Marek Woźniewski ◽

Ryszard Jasiński ◽

Artur Struzik ◽

Andrzej Szuba

Keyword(s):

Intermittent Claudication ◽

Lower Limb ◽

Stride Length ◽

External Rotation ◽

Plantar Flexion ◽

Arterial Disease ◽

Healthy People ◽

Human Gait ◽

Gait Velocity ◽

Flexion Extension

Objective. Intermittent claudication (IC) is a pathological symptom with a particular effect on human gait patterns. Therefore, analyzing these patterns can facilitate rehabilitation or treatment through comparison of the values of kinematic and kinetic variables of patients with the normal values of healthy people. Therefore, the aim of this study was to find differences in the values of gait variables between patients with IC and healthy people. Methods. The study included 98 patients diagnosed with peripheral arterial disease with IC. The patients traveled a distance of 6 m at a voluntary gait velocity. Ground reaction forces while the foot contacted the ground and kinematic variables of lower limb movements were recorded. The values of normal gait variables were computed based on the results obtained in a group of 30 healthy people. Results. Patients used a gait velocity below the norm for healthy people. The velocity during the lower limb swing and the step and stride length in patients with IC were below the norm. Differences were also found in the ranges of motion between patients with IC and healthy people for the pelvic obliquity, pelvic rotation, hip flexion-extension, hip abduction-adduction, hip internal-external rotation, knee flexion-extension, ankle dorsi-plantar flexion, and foot progression angles. Conclusions. The presented kinematic and kinetic characteristics measured by gait variables suggest differences between patients with IC and healthy people. Considering kinematic and kinetic gait variables during the rehabilitation process would facilitate the development of a more economic gait technique (with increased stride length and range of motion in the lower limb joints) to obtain the desired rehabilitation effects. Patients with IC should receive rehabilitation oriented towards improving mobility and increasing muscle strength in selected lower limb joints to increase gait velocity and stride length.

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Lower Limb Malrotation Is Regularly Present in Long-Leg Radiographs Resulting in Significant Measurement Errors

The Journal of Knee Surgery ◽

10.1055/s-0039-1693668 ◽

2019 ◽

Vol 34 (01) ◽

pp. 108-114

Author(s):

Günther Maderbacher ◽

Jan Matussek ◽

Felix Greimel ◽

Joachim Grifka ◽

Jens Schaumburger ◽

...

Keyword(s):

Lower Limb ◽

Measurement Errors ◽

Orthopaedic Surgery ◽

Proximal Tibia ◽

External Rotation ◽

Weight Bearing ◽

Lower Limbs ◽

Before And After ◽

Mean Differences ◽

Long Leg Radiographs

AbstractWeight-bearing long-leg radiographs are commonly used in orthopaedic surgery. Measured parameters, however, change when radiographs are conducted in different rotational positions of the leg. It was hypothesized that rotational errors are regularly present in long-leg radiographs resulting in wrong measurements. In 100 consecutive long-leg radiographs conducted according to the method of Paley, rotation was assessed by fibular overlap. Angular parameters in radiographs (mechanical lateral proximal femoral angle (mLPFA), mechanical lateral distal femoral angle (mLDFA), angle between the anatomical and mechanical femoral axis (AMA), mechanical medial proximal tibia angle (mMPTA), mechanical lateral distal tibial angle (mLDTA), and the mechanical femoral and tibial axis (mFA–mTA) were measured and deviations related to malrotation calculated. An average internal rotation of 8 degrees was found in lower limbs showing a range between 29 degrees of internal and 22 degrees of external rotation. As a result, mean differences before and after rotational correction for measured parameters (mLPFA, mLDFA, AMA, mMPTA, mLDTA, mFA–mTA) ranged between 0.4 and 1.7 degrees (−2.1; 5.6 95% confidence interval [CI]). In conclusion, malrotation of lower limbs is regularly present in long-leg radiographs. As all measured parameters are influenced by malrotation, correct lower limb rotation needs to be verified.

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