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1.
J Mech Behav Biomed Mater ; 153: 106495, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38460455

RESUMO

The Finite Element (FE) methods for biomechanical analysis involving implant design and subject parameters for musculoskeletal applications are extensively reported in literature. Such an approach is manually intensive and computationally expensive with longer simulations times. Although Artificial Intelligence (AI) based approaches are implemented to a limited extent in biomechanics, such approaches to predict bone strain in acetabulum of a hip joint, are hardly explored. In this context, the primary objective of this paper is to evaluate machine learning (ML) models in tandem with high-fidelity FEA data for the accelerated prediction of the biomechanical response in the acetabulum of the human hip joint, during the walking gait. The parameters used in the FEA study included the subject weight, number and distribution of fins on the periphery of the acetabular shell, bone condition and phases of the gait cycle. The biomechanical response has also been evaluated using three different acetabular liners, including pre-clinically validated HDPE-20% HA-20% Al2O3, highly-crosslinked ultrahigh molecular weight polyethylene (HC-UHMWPE) and ZrO2-toughened Al2O3 (ZTA). Such parametric variation in FEA analysis, involving 26 variables and a full factorial design resulted in 10,752 datasets for spatially varying bone strains. The bone condition, as opposed to subject weight, was found to play a statistically significant role in determining the strain response in the periprosthetic bone of the acetabulum. While utilising hyperparameter tuning, K-fold cross validation and statistical learning approaches, a number of ML models were trained on the FEA dataset, and the Random Forest model performed the best with a coefficient of determination (R2) value of 0.99/0.97 and Root Mean Square Error (RMSE) of 0.02/0.01 on the training/test dataset. Taken together, this study establishes the potential of ML approach as a fast surrogate of FEA for implant biomechanics analysis, in less than a minute.


Assuntos
Acetábulo , Prótese de Quadril , Humanos , Inteligência Artificial , Estresse Mecânico , Articulação do Quadril , Fenômenos Biomecânicos , Aprendizado de Máquina , Análise de Elementos Finitos
2.
Acta Chir Orthop Traumatol Cech ; 91(1): 24-33, 2024.
Artigo em Tcheco | MEDLINE | ID: mdl-38447562

RESUMO

PURPOSE OF THE STUDY: This manuscript aims to introduce our surgical technique, with an emphasis on the latest recommendations. The AMIS technique is discussed in more detail in patients with Class II and Class III obesity. We seek to prove the premise claiming that the anteversion and inclination values observed in this group of patients do not differ signifi cantly from those observed in patients with the recommended BMI index. We will also compare the risk of neurovascular bundle injury and postoperative complication rate regarding the surgical wound. MATERIAL AND METHODS: Patients who underwent surgery using the AMIS method in the period between 1/2020 and 4/2023 were assessed retrospectively. The study included 1150 implantations. The entire study population was assessed for neurovascular bundle injury and surgical wound healing complications. For this purpose, the patients were divided into two groups based on the BMI, namely BMI < 35 kg/m2 (n=1042) and BMI > 35 kg/m2 (n=108). In patients with the BMI ≤ 25 kg/m2 (n=280) and BMI ≥ 35 kg/m2 (n=108), the inclination and anteversion values were compared. Standard centered AP view X-rays of their operated joints were assessed. The Liaw's method was used to calculate the anteversion and inclination. RESULTS: In group one of patients with BMI ≤ 25 kg/m2 (208 women and 72 men), the arithmetic mean of acetabular anteversion was 25.4° (median 25°) and inclination was 38.3° (median 38°). In group two, which consisted of patients with BMI ≥ 35 kg/m2 (59 women and 49 men), the total arithmetic mean of acetabular anteversion was 25.1° (median 25) and inclination was 37.6° (median 37.5°). The anteversion and inclination were assessed using the Mann-Whitney test for equality of medians. The value of 0.05 was chosen as the level of signifi cance. The resulting p-value was 0.5359 in anteversion and 0.3763 in inclination. Since the p-value of both anteversion and inclination was greater than the chosen level of signifi cance, their medians have not been confi rmed to differ signifi cantly. A total of 6 cases of femoral nerve injury was reported, i.e. 0.5% out of 1150. Therefore, the risk of injury was 0.4% in the group with BMI < 35 kg/m2 (n=1042). On the contrary, in the group of patients with BMI > 35 kg/m2 (n=108), the risk was 2%. No injury to femoral artery was reported. The surgical wound healing complications were seen in a total of 87 cases (7.6%). In the group with BMI < 35 kg/m2 , healing complications of the surgical wound were observed in 7.4% of cases, with the need for revision surgery in 7 patients. In the group with BMI > 35 kg/ m2 , healing complications occurred in 13% of patients and wound revision was necessary in 4 cases. DISCUSSION: Our results are consistent with those in the published studies that also show no signifi cant difference in anteversion and inclination of components in the compared groups of obese patients. We also agree with the other authors that the rate of complications regarding surgical wound healing is higher in these patients. The risk of neurovascular bundle injury in this study population is not higher than the standard. CONCLUSIONS: The results obtained in our study population show that this method can also be used in patients with higher BMI, with no concern about the implantation of components in malposition or a higher risk of neurovascular injury. Nonetheless, potentially higher risk of surgical wound healing should be considered when this approach is opted for. With the appropriate surgical technique, AMIS is a safe method and, in our view, the fi rst choice especially for obese patients. KEY WORDS: AMIS, anteversion, inclination, hip joint, obesity, BMI, implantation, total joint replacement.


Assuntos
Artroplastia de Quadril , Ferida Cirúrgica , Masculino , Humanos , Feminino , Artroplastia de Quadril/efeitos adversos , Estudos Retrospectivos , Articulação do Quadril , Obesidade/complicações
3.
Zhongguo Gu Shang ; 37(2): 179-83, 2024 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-38425070

RESUMO

OBJECTIVE: To investigate the risk factors of hip osteoarthritis(HOA) after hip arthroscopy in patients with femoro-acetabular impingement(FAI) syndrome, and to reduce and prevent HOA. METHODS: From September 2018 to September 2020, 106 patients with FAI underwent hip arthroscopy, including 40 males and 66 females, aged from 20 to 55 years old with an average age of (33.05±10.19) years old. The mechanism of injury included 51 cases for sports injury, 36 for traffic accidents, and 19 for blunt object injury. The duration of the disease ranged from 5 to 19 days with an average of (12.02±3.69) days. All patients were followed up for 18 months. Patients were divided into HOA group (23 cases) and non-HOA group (83 cases) according to the occurrence of HOA. Multivariate Logistic regression was used to analyze the risk factors of HOA after hip arthroscopy in FAI patients. RESULTS: By univariate analysis, aged from 50 to 70 years old, female, body mass index(BMI)> 30 kg·m-2, physical labor, cam type, postoperative infection, last follow-up hip degree of motion (range of motion, ROM) (flexion, abduction, adduction, internal rotation) and Tönnis grade 1 and above of the HOA group were higher than those of the non-HOA group (P<0.05), and the relative appendicular skeletal muscle index (RASM) was lower than that of non-HOA group(P<0.05). By multiple Logistic regression analysis, cam type, BMI>30 kg·m-2, last follow-up hip internal rotation ROM and Tönnis grade 1 were risk factors for HOA after hip arthroscopy in FAI patients (P<0.05). CONCLUSION: FAI classification, body mass index, hip ROM and Tönnis grade are all related to HOA after hip arthroscopy in FAI patients. Follow-up and intervention should be strengthened in high-risk FAI patients to reduce the occurrence of HOA.


Assuntos
Impacto Femoroacetabular , Osteoartrite do Quadril , Masculino , Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Impacto Femoroacetabular/cirurgia , Impacto Femoroacetabular/complicações , Osteoartrite do Quadril/cirurgia , Artroscopia/efeitos adversos , Amplitude de Movimento Articular/fisiologia , Fatores de Risco , Articulação do Quadril/cirurgia , Resultado do Tratamento
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 38(3): 298-302, 2024 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-38500422

RESUMO

Objective: To evaluate the correlation between pelvic incidence (PI) angle, hip deflection angle (HDA), combined deflection angle (CDA) and osteonecrosis of the femoral head (ONFH) after femoral neck fracture, in order to explore early predictive indicators for ONFH occurrence after femoral neck fracture. Methods: A study was conducted on patients with femoral neck fractures who underwent cannulated screw internal fixation between December 2018 and December 2020. Among them, 208 patients met the selection criteria and were included in the study. According to the occurrence of ONFH, the patients were allocated into ONFH group and non-NOFH group. PI, HDA, and CDA were measured based on the anteroposterior X-ray films of pelvis and axial X-ray films of the affected hip joint before operation, and the differences between the two groups were compared. The receiver operating characteristic curve (ROC) was used to evaluate the value of the above imaging indicators in predicting the occurrence of ONFH. Results: Among the 208 patients included in the study, 84 patients experienced ONFH during follow-up (ONFH group) and 124 patients did not experience ONFH (non-ONFH group). In the non-ONFH group, there were 59 males and 65 females, the age was 18-86 years (mean, 53.9 years), and the follow-up time was 18-50 months (mean, 33.2 months). In the ONFH group, there were 37 males and 47 females, the age was 18-76 years (mean, 51.6 years), and the follow-up time was 8-45 months (mean, 22.1 months). The PI, HDA, and CDA were significantly larger in the ONFH group than in the non-ONFH group ( P<0.05). ROC curve analysis showed that the critical value of PI was 19.82° (sensitivity of 40.5%, specificity of 86.3%, P<0.05); the critical value of HDA was 20.94° (sensitivity of 77.4%, specificity of 75.8%, P<0.05); and the critical value of CDA was 39.16° (sensitivity of 89.3%, specificity of 83.1%, P<0.05). Conclusion: There is a correlation between PI, HDA, CDA and the occurrence of ONFH after femoral neck fracture, in which CDA can be used as an important reference indicator. Patients with CDA≥39.16° have a higher risk of ONFH after femoral neck fracture.


Assuntos
Fraturas do Colo Femoral , Necrose da Cabeça do Fêmur , Masculino , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/epidemiologia , Necrose da Cabeça do Fêmur/etiologia , Articulação do Quadril , Fixação Interna de Fraturas/métodos , Estudos Retrospectivos
5.
JBJS Case Connect ; 14(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38484090

RESUMO

CASE: A 43-year-old healthy man developed hip pain post-coronavirus disease 2019 (COVID-19) immobilization. Imaging confirmed bilateral bridging heterotopic ossification (HO) of the hips, Brooker Class IV. Bilateral HO caused functional arthrodesis (45° flexion: -20° internal rotation). Bilateral HO resection resulted in almost full mobility at 1-year follow-up (90° flexion; 30° internal rotation). CONCLUSION: Many cases of HO after immobilization for COVID-19 have been reported, but as far as we know, this is the first case report describing surgical intervention as an adequate treatment option for severe restricted mobility caused by HO due to COVID-19-induced prolonged immobilization. Caution and preoperative 3D planning are recommended of HO formation near neurovascular structures.


Assuntos
COVID-19 , Ossificação Heterotópica , Masculino , Humanos , Adulto , Articulação do Quadril/cirurgia , COVID-19/complicações , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/cirurgia
6.
Arthroscopy ; 40(4): 1041-1043, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38494311

RESUMO

Determining the appropriate femoral cam resection during hip arthroscopy for femoroacetabular impingement syndrome is both critical for the patient and challenging for the surgeon. Incomplete bone resection is a leading cause of failed hip arthroscopy, whereas over-resection may increase the risk of femoral neck fracture. The alpha angle is a validated 2-dimensional radiographic measurement used to both diagnose femoroacetabular impingement syndrome preoperatively and to determine resection adequacy postoperatively. Computer-assisted intraoperative guidance systems enhance the accuracy of femoral cam resection, although a preoperative 3-dimensional computed tomography scan may be required. Other systems, such as the HipCheck software (Stryker, Kalamazoo, MI), have been developed to provide intraoperative guidance with live feedback using simultaneous alpha angle measurements overlayed on fluoroscopic images without the requirement for routine preoperative computed tomography. Via intraoperative touchscreen navigation, the surgeon identifies the midpoint of the femoral neck and femoral head. A commercial software program provides real-time alpha angle measurements, as well as enhanced visualization of the femoral cam deformity with an adjustable resection curve. Before the surgeon performs the cam resection, the software provides a template for appropriate resection depth in 6 positions of the hip. Upon completion of the femoral cam resection, the hip is again assessed in the same 6 positions and the alpha angle is assessed to ensure a complete resection.


Assuntos
Impacto Femoroacetabular , Humanos , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/cirurgia , Fêmur , Cabeça do Fêmur/cirurgia , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/cirurgia , Computadores , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Artroscopia/métodos
7.
Med Eng Phys ; 124: 104105, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38418018

RESUMO

Accurate pre-operative templating of prosthesis components is an essential factor in successful total hip arthroplasty (THA), including robotically-assisted THA (RA-THA) techniques. We sought to validate the accuracy of a novel, robotic-optimized THA planning software compared to a predicate THA planner for component sizing. We analyzed a series of 199 patients who received manual THA (mTHA) and fluoroscopy-based RA-THA at a single institution. All cases were templated using a predicate pre-operative templating software. For RA-THA cases, the novel robotic-optimized pre-operative planner software was also used for templating. The differences between templated and implanted acetabular cup, femoral head, and stem component sizes were compared based on matching within 1, 2, and ≥3 sizes. Differences in templated and implanted femoral stem implant geometry were also compared. The robot-optimized pre-operative RA-THA plans demonstrated equivalent accuracy to that of predicate pre-operative plans for both RA-THA and mTHA cases. Templated acetabular cups (90.4 vs. 86.8 vs. 82.8; p = 0.421), femoral stems (76.0 vs. 65.1 vs. 67.7; p = 0.096), and femoral heads (91.3 vs. 96.2 vs. 88.2; p = 0.302) were within +/-1 size of implanted components. No significant differences were detected in the proportion of matching templated and implanted stem geometry across the study cohorts.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Artroplastia de Quadril/métodos , Articulação do Quadril/cirurgia , Reprodutibilidade dos Testes , Cuidados Pré-Operatórios/métodos , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Software , Estudos Retrospectivos
8.
Radiographics ; 44(2): e230144, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38300815

RESUMO

The hip is a uniquely constrained joint with critical static stability provided by the labrum, capsule and capsular ligaments, and ligamentum teres. The labrum is a fibrocartilaginous structure along the acetabular rim that encircles most of the femoral head. Labral tears are localized based on the clock-face method, which determines the extent of the tear while providing consistent terminology for reporting. Normal labral variants can mimic labral disease and can be differentiated by assessment of thickness or width, shape, borders, location, and associated abnormalities. The Lage and Czerny classification systems are currently the most well-known arthroscopic and imaging systems, respectively. Femoroacetabular impingement is a risk factor for development of labral tears and is classified according to bone dysmorphisms of the femur ("cam") or acetabulum ("pincer") or combinations of both (mixed). The capsule consists of longitudinal fibers reinforced by ligaments (iliofemoral, pubofemoral, ischiofemoral) and circular fibers. Capsular injuries occur secondary to hip dislocation or iatrogenically after capsulotomy. Capsular repair improves hip stability at the expense of capsular overtightening and inadvertent chondral injury. The ligamentum teres is situated between the acetabular notch and the fovea of the femoral head. Initially considered to be inconsequential, recent studies have recognized its role in hip rotational stability. Existing classification systems of ligamentum teres tears account for injury mechanism, arthroscopic findings, and treatment options. Injuries to the labrum, capsule, and ligamentum teres are implicated in symptoms of hip instability. The authors discuss the labrum, capsule, and ligamentum teres, highlighting their anatomy, pathologic conditions, MRI features, and postoperative appearance. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.


Assuntos
Luxação do Quadril , Lesões do Quadril , Humanos , Artroscopia/efeitos adversos , Artroscopia/métodos , Acetábulo/lesões , Acetábulo/patologia , Acetábulo/cirurgia , Lesões do Quadril/diagnóstico por imagem , Lesões do Quadril/cirurgia , Imageamento por Ressonância Magnética/métodos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Articulação do Quadril/patologia
9.
BMC Musculoskelet Disord ; 25(1): 150, 2024 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-38368343

RESUMO

BACKGROUND: The Bernese Periacetabular Osteotomy (PAO) has become a popular surgery for fixing development dysplasia of the hip, yet the most common concerns of the PAO population remains ambiguous. The aim of this study was to investigate Facebook, Instagram and Twitter to further understand what the most common preoperative and postoperative questions patients undergoing PAO are asking. We hypothesized most questions would be asked by patients in the preoperative timeframe with regards to education surrounding PAO surgery. METHODS: Facebook, Instagram and Twitter were queried consecutively from February 1, 2023 to November 23, 2011. Facebook was searched for the two most populated interest groups; "Periacetabular Osteotomy (PAO)" and "Periacetabular Osteotomy Australia". Instagram and Twitter were queried for the most popular hashtags: "#PAOwarrior", "#PAOsurgery", "#periacetabularosteotomy", "#periacetabularosteotomyrecovery", and "#paorecovery". Patient questions were categorized according to preoperative and postoperative questions. Questions were further placed into specific themes in their respective preoperative or postoperative question types. RESULTS: Two thousand five hundred and fifty-nine posts were collected, with 849 (33%) posts containing 966 questions. Of the 966 questions, 443 (45.9%) and 523 (54.1%) were preoperative and postoperative questions, respectively. The majority of questions were postoperative complication related (23%) and symptom management (21%). Other postoperative questions included recovery/rehabilitation (21%), and general postoperative questions (18%). The most common preoperative questions were related to PAO education (23%). Rehabilitation (19%), hip dysplasia education (17%), and surgeon selection (12%) were other preoperative questions topics included. Most questions came from Facebook posts. Of 1,054 Facebook posts, 76% were either preoperative or postoperative questions and from the perspective of the patient (87%). CONCLUSION: The majority of patients in the PAO population sought advice on postoperative complications and symptom management. Some patients asked about education surrounding PAO surgery. Understanding the most common concerns and questions patients have can help providers educate patients and focus on more patient-relevant perioperative conversations.


Assuntos
Luxação do Quadril , Mídias Sociais , Humanos , Acetábulo/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Luxação do Quadril/cirurgia , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Articulação do Quadril/cirurgia
10.
Clin Biomech (Bristol, Avon) ; 112: 106186, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38301536

RESUMO

BACKGROUND: The suction seal of the hip plays an important role in maintaining hip stability; however, the function of the ligamentum teres in maintaining this seal remains poorly understood. This study aimed to evaluate the effectiveness of the hip suction seal in ligamentum teres deficient hips for joint positions occurring during gait. METHODS: Six fresh-frozen human cadaveric hips were dissected and mounted to an Instron materials test system. Each specimen was analyzed for average peak distraction force, stiffness, and total energy during hip displacement. Testing was performed in the native intact ligamentum teres state and the deficient ligamentum teres state. Specimens were examined in 20° of flexion, neutral, and 10° of extension. FINDINGS: In the neutral position, the ligamentum teres deficient state displayed a significant decrease in peak distraction force (mean difference: 33.2 N, p < 0.001), average stiffness (mean difference: 63.7 N/mm, p = 0.016), and total energy (mean difference: 82.3 mJ, p = 0.022) compared to the intact controls. In extension, the deficient state exhibited a significant decrease in peak distraction force (mean difference: 42.8 N, p < 0.001) and total energy (mean difference: 72.9 mJ, p = 0.007). In flexion, the deficient state displayed a significant decrease in peak distraction force relative to contols (mean difference: 7.1 N, p = 0.003). INTERPRETATION: The ligamentum teres plays a significant role in maintaining the suction seal of the hip, with its effect being most prominent when the hip is in neural alignment or in extension. The findings suggest that ligamentum teres deficiency may be a relevant treatment target in the clinical setting.


Assuntos
Luxação do Quadril , Ligamentos Redondos , Humanos , Articulação do Quadril , Fenômenos Biomecânicos , Amplitude de Movimento Articular
11.
BMC Musculoskelet Disord ; 25(1): 166, 2024 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-38383359

RESUMO

BACKGROUND: Femoroacetabular impingement (FAI) is considered one of the main causes of hip osteoarthritis in young adults, especially in athletes. In recent years, morphological changes in FAI in the hip have been linked to early and intense sports participation, but studying top-level athlete samples is not easy. This paper presents the prevalence of FAI radiological markers in 120 active white male professional football players in the Spanish First Division League (La Liga) and compares the morphological changes with those of a control group of healthy individuals without significant sport activity. METHODS: The precontract medical evaluation hip X-rays of 120 white male professional football players from four different First Division Spanish football teams were prospectively filed and retrospectively reviewed by a dedicated skeletal radiologist. The footballers' hip X-rays were compared with those of a control group of 80 healthy individuals (age-sex matched) without significant sport activity (obtained from routine work medical checks). RESULTS: The femoral head-neck deformity associated with the Cam type of femoroacetabular impingement was observed in 61.6% of professional football players and only in 11.6% of the control group (p <0.01). The presence of "herniation pit" (11.6%) and os acetabuli (13.3%) also reached statistical significance in the professional football players group. In the other analyzed parameters, no statistically significant differences between the groups were observed. CONCLUSIONS: White professional top-level football players have an increased incidence of abnormal lateral epiphyseal extension ("pistol grip deformity"), os acetabuli and herniation pits.


Assuntos
Impacto Femoroacetabular , Futebol Americano , Adulto Jovem , Humanos , Masculino , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/epidemiologia , Estudos Retrospectivos , Prevalência , Articulação do Quadril
12.
J Strength Cond Res ; 38(3): 435-443, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38416444

RESUMO

ABSTRACT: Chiu, LZF. "Knees out" or "Knees in"? Volitional lateral versus medial hip rotation during barbell squats. J Strength Cond Res 38(3): 435-443, 2024-Medial or lateral hip rotation may be present during barbell squats, which could affect the hip frontal and transverse plane moments. Male (n = 14) and female (n = 18) subjects performed squats using their normal technique and with volitional medial and lateral hip rotation. Hip net joint moments (NJM) were calculated from 3-dimensional motion capture and force platform measurements. Statistical significance was set for omnibus tests (α = 0.05) and Bonferroni's corrected for pairwise comparisons (αt-test = 0.0056). Normal squats required hip extensor, adductor, and lateral rotator NJM. Lateral rotation squats had smaller hip extensor (p = 0.002) and lateral rotator (p < 0.001) NJM and larger hip adductor (p < 0.001) NJM than normal squats. Medial rotation squats had smaller hip extensor (p = 0.002) and adductor (p < 0.001) NJM and larger hip lateral rotator (p < 0.001) NJM than normal squats. These differences exceeded the minimum effects worth detecting. As gluteus maximus exerts hip extensor and lateral rotator moments, and the adductor magnus exerts hip extensor and adductor moments, these muscles combined would be required to meet these hip demands, supporting previous research that has established these muscles as the primary contributors to the hip extensor NJM. Lateral rotation squats reduce hip lateral rotator and increase hip adductor NJM, which may be hypothesized as preferentially loading adductor magnus. Medial rotation squats increase hip lateral rotator and decrease hip adductor NJM; therefore, this variant may shift loading to the gluteus maximus.


Assuntos
Articulação do Quadril , Postura , Humanos , Feminino , Masculino , Rotação
13.
Sensors (Basel) ; 24(3)2024 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-38339587

RESUMO

The Xsens Link motion capture suit has become a popular tool in investigating 3D running kinematics based on wearable inertial measurement units outside of the laboratory. In this study, we investigated the reliability of Xsens-based lower extremity joint angles during unconstrained running on stable (asphalt) and unstable (woodchip) surfaces within and between five different testing days in a group of 17 recreational runners (8 female, 9 male). Specifically, we determined the within-day and between-day intraclass correlation coefficients (ICCs) and minimal detectable changes (MDCs) with respect to discrete ankle, knee, and hip joint angles. When comparing runs within the same day, the investigated Xsens-based joint angles generally showed good to excellent reliability (median ICCs > 0.9). Between-day reliability was generally lower than the within-day estimates: Initial hip, knee, and ankle angles in the sagittal plane showed good reliability (median ICCs > 0.88), while ankle and hip angles in the frontal plane showed only poor to moderate reliability (median ICCs 0.38-0.83). The results were largely unaffected by the surface. In conclusion, within-day adaptations in lower-extremity running kinematics can be captured with the Xsens Link system. Our data on between-day reliability suggest caution when trying to capture longitudinal adaptations, specifically for ankle and hip joint angles in the frontal plane.


Assuntos
Extremidade Inferior , Corrida , Masculino , Humanos , Feminino , Reprodutibilidade dos Testes , Articulação do Joelho , Articulação do Quadril , Fenômenos Biomecânicos , Marcha
14.
Bone Joint J ; 106-B(3 Supple A): 59-66, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38423117

RESUMO

Aims: Surgical approaches that claim to be minimally invasive, such as the direct anterior approach (DAA), are reported to have a clinical advantage, but are technically challenging and may create more injury to the soft-tissues during joint exposure. Our aim was to quantify the effect of soft-tissue releases on the joint torque and femoral mobility during joint exposure for hip resurfacing performed via the DAA. Methods: Nine fresh-frozen hip joints from five pelvis to mid-tibia cadaveric specimens were approached using the DAA. A custom fixture consisting of a six-axis force/torque sensor and motion sensor was attached to tibial diaphysis to measure manually applied torques and joint angles by the surgeon. Following dislocation, the torques generated to visualize the acetabulum and proximal femur were assessed after sequential release of the joint capsule and short external rotators. Results: Following initial exposure, the ischiofemoral ligament (7 to 8 o'clock) was the largest restrictor of exposure of the acetabulum, contributing to a mean 25% of overall external rotational restraint. The ischiofemoral ligament (10 to 12 o'clock) was the largest restrictor of exposure of the proximal femur, contributing to 25% of overall extension restraint. Releasing the short external rotators had minimal contribution in torque generated during joint exposure (≤ 5%). Conclusion: Adequate exposure of both proximal femur and acetabulum may be achieved with minimal torque by performing a full proximal circumferential capsulotomy while preserving short external rotators. The joint torque generated and exposure achieved is dependent on patient factors; therefore, some cases may necessitate further releases.


Assuntos
Artroplastia de Quadril , Humanos , Liberação da Cápsula Articular , Acetábulo , Articulação do Quadril/cirurgia , Fêmur/cirurgia
15.
Am J Sports Med ; 52(4): 998-1004, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38353059

RESUMO

BACKGROUND: Minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds have been previously defined for the Patient-Reported Outcomes Measurement Information System (PROMIS) at 1-year follow-up in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome; however, the MCID and PASS thresholds are yet to be defined for the PROMIS at 2-year follow-up. PURPOSE: (1) To establish MCID and PASS thresholds for the PROMIS Pain Interference (PROMIS-PI) and PROMIS Physical Function (PROMIS-PF) at 2-year follow-up and (2) to correlate PROMIS scores with hip-specific patient-reported outcome measure (PROM) scores. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome between August and November 2020 with preoperative and minimum 2-year postoperative data were identified. Collected scores included those for the PROMIS-PI, PROMIS-PF, Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), International Hip Outcome Tool-12 (iHOT-12), and visual analog scale (VAS) for pain. MCID thresholds were calculated using the distribution-based method and PASS thresholds using the anchor-based method. Pearson correlation coefficients were used to compare scores between PROMs. RESULTS: A total of 65 patients met the criteria for inclusion (72.3% female; mean age, 36.9 ± 13.5 years; mean body mass index, 26.2 ± 6.0). The mean follow-up was 25.3 ± 3.3 months. Significant preoperative to postoperative improvements were observed for all PROMs (P < .001). MCID thresholds and achievement rates were as follows: HOS-ADL, 10.1 and 75%, respectively; HOS-SS, 13.8 and 79%, respectively; iHOT-12, 14.0 and 67%, respectively; VAS pain, -13.8 and 78%, respectively; PROMIS-PI, -4.7 and 65%, respectively; and PROMIS-PF, 5.8 and 60%, respectively. PASS thresholds and achievement rates were as follows: HOS-ADL, 78.7 and 67%, respectively; HOS-SS, 76.4 and 62%, respectively; iHOT-12, 67.4 and 60%, respectively; VAS pain, 25.5 and 61%, respectively; PROMIS-PI, 57.0 and 65%, respectively; and PROMIS-PF, 45.6 and 58%, respectively. PROMIS-PI scores correlated most strongly with HOS-ADL (r = -0.836), HOS-SS (r = -0.767), and iHOT-12 (r = -0.719) scores and exhibited at least moderate correlations (r≥-0.595) with the other PROM scores. PROMIS-PF demonstrated moderate correlations with all the other PROM scores (r≥-0.586). Strong correlations were seen between the hip-specific PROM scores (r≥-0.745). CONCLUSION: This study defined 2-year MCID and PASS thresholds for the PROMIS-PI and PROMIS-PF and demonstrated moderate to strong correlations between PROMIS scores and hip-specific PROM scores.


Assuntos
Impacto Femoroacetabular , Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Masculino , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/cirurgia , Estudos de Coortes , Resultado do Tratamento , Artroscopia/métodos , Atividades Cotidianas , Dor , Medidas de Resultados Relatados pelo Paciente , Sistemas de Informação , Estudos Retrospectivos , Seguimentos
16.
Sci Rep ; 14(1): 3813, 2024 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-38361017

RESUMO

This study is designed to compare the extent of sacroiliac joint (SIJ) degeneration at total hip arthroplasty (THA) for two pathologies: osteoarthritis of the hip (OA) and osteonecrosis of the femoral head (ON). We also assessed the prevalence of SIJ degeneration in patients with lumbar spondylolisthesis or degenerative scoliosis. A total of 138 hips from 138 patients (69 OA and 69 ON) were assessed in this study, including 66 hips affected by OA secondary to developmental dysplasia of the hip. The degenerative changes in the SIJ and lumbar spine were evaluated prior to THA using radiographs and computed tomography (CT) scans, showing 9 instances of spondylolisthesis and 38 of degenerative scoliosis. The OA group exhibited longer duration from onset to surgery than the ON group. The OA group also included more cases with significant pelvic obliquity (3 degrees or more) and with significant increases in SIJ sclerosis and irregularities. Patients with lumbar spondylolisthesis or degenerative scoliosis were significantly more likely to have SIJ irregularities. The prevalence of SIJ degeneration was higher in cases of THA for OA than for ON. This study also suggests the possibility of Hip-SIJ-Spine syndrome in THA patients with OA.


Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril , Escoliose , Espondilolistese , Humanos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Articulação Sacroilíaca/cirurgia , Espondilolistese/cirurgia , Escoliose/complicações , Escoliose/diagnóstico por imagem , Escoliose/epidemiologia , Articulação do Quadril/cirurgia , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Quadril/cirurgia , Estudos Retrospectivos
17.
Gait Posture ; 109: 213-219, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38359697

RESUMO

BACKGROUND: Femoroacetabular impingement (FAI) is a condition where the femoral head-neck junction collides with the acetabulum. Open or arthroscopic treatment of FAI aims to increase hip motion while reducing impingement during passive or dynamic movements. RESEARCH QUESTION: What are the biomechanical characteristics of the hip and pelvis in adolescents and young adults diagnosed with FAI syndrome 1) pre-operatively compared to controls and 2) pre- to post-operatively? METHODS: 43 patients with FAI and 43 controls were included in the study. All patients with FAI had cam deformities and underwent unilateral hip preservation surgery (either open or arthroscopic). Pre- and post-operative imaging, patient-reported outcomes, and gait analysis were performed. Joint angles and internal joint moments were evaluated with an emphasis on the pelvis and hip. A comparative analysis was conducted to evaluate the gait patterns before and after surgical treatment, as well as to compare pre-operative gait patterns to a control group. RESULTS: 43 patients with FAI (28 female, 16.5 ± 1.5 yrs) and 43 controls (28 female, 16.0 ± 1.5 yrs) were included. Pre-operative patients with FAI had decreased stride length and walking speed compared to controls, with no significant change following surgery. There were no differences in sagittal and coronal plane hip and pelvis kinematics comparing pre- to post-operative and pre-operative to controls. Pre-operatively, differences in internal hip rotation angle (pre: 3.3˚, post: 3.9˚, controls: 7.7˚) and hip extensor moment (pre: 0.121, post: 0.090, controls: 0.334 Nm/kg) were observed compared to controls with no significant changes observed following surgery. SIGNIFICANCE: Compensatory movement strategies in pelvic and hip motion are evident during gait in patients with FAI, particularly in the sagittal and transverse planes. These strategies remained consistent two years post-surgery. While surgery improved radiographic measures and patient-reported outcomes, gait did not elicit biomechanical changes following surgical treatment.


Assuntos
Impacto Femoroacetabular , Adulto Jovem , Humanos , Feminino , Adolescente , Impacto Femoroacetabular/cirurgia , Articulação do Quadril , Fenômenos Biomecânicos , Marcha , Acetábulo , Amplitude de Movimento Articular
18.
Gait Posture ; 109: 277-283, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38377744

RESUMO

BACKGROUND: Perinatal running participation has increased recently; however, pregnancy related symptoms can limit activity. Perinatal running biomechanics could inform interventions to help perinatal individuals maintain an active lifestyle. RESEARCH QUESTION: Are perinatal running biomaechanics and muscle activation different compared to nulligravida females? METHODS: Sixteen pregnant participants completed self-selected velocity running during second trimester (2 T), third trimester (3 T), and postpartum (PP) and 16 matched controls completed these procedures once in this case control study. Kinematic, kinetic, and electromyography (EMG) data were collected using a motion capture system, force plates, and EMG electrodes. Peak trunk, pelvis, hip, knee, and ankle kinematics and hip, knee, and ankle moments during stance phase, and average and peak erector spinae (ES), gluteus maximus (GMax), and gluteus medius (GMed) EMG amplitude and duration of activation during stance and swing phases were calculated. Independent t-tests were used to compare 2 T, 3 T, and PP to control participants (α < 0.05). RESULTS: Running velocity was slower during 3 T compared to control participants. At all pregnancy timepoints compared to the control group, peak trunk contralateral rotation was smaller. During 2 T and 3 T peak hip flexor moments were smaller. At 3 T pelvis contralateral rotation was smaller, ES average amplitude was greater during swing, GMax percent duration during stance and GMed percent duration during swing were smaller. At PP trunk flexion was smaller and knee abduction was greater (all p < 0.05). CONCLUSIONS: Decreased running velocity may help offset increased demand during pregnancy. During 3 T, greater ES activation, smaller trunk and pelvis motion, and altered gluteal activation could indicate trunk rigidity combined with modified hip stabilizer muscle utilization. During PP, the rigid trunk combined with greater knee abduction may indicate hip and trunk strength deficits. Altered trunk and hip motion and activation could be relevant to pathologies such as perinatal low back, pelvic girdle, or knee pain.


Assuntos
Articulação do Quadril , Corrida , Humanos , Feminino , Gravidez , Articulação do Quadril/fisiologia , Fenômenos Biomecânicos , Estudos de Casos e Controles , Músculo Esquelético/fisiologia , Eletromiografia/métodos , Nádegas
19.
Sci Rep ; 14(1): 2838, 2024 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-38310142

RESUMO

In this work, the effect of adding Magnesium Oxide (MgO) and Titanium Dioxide (TiO2) nanoparticles to enhance the properties of the bone cement used for hip prosthesis fixation. Related to previous work on enhanced bone cement properties utilizing MgO and TiO2, samples of composite bone cement were made using three different ratios (0.5%:1%, 1.5%:1.5%, and 1%:0.5%) w/w of MgO and TiO2 to determine the optimal enhancement ratio. Hardness, compression, and bending tests were calculated to check the mechanical properties of pure and composite bone cement. The surface structure was studied using Fourier transform infrared spectroscopy (FTIR) and Field emission scanning electron microscopy (FE-SEM). Setting temperature, porosity, and degradation were calculated for each specimen ratio to check values matched with the standard range of bone cement. The results demonstrate a slight decrease in porosity up to 2.2% and degradation up to 0.17% with NP-containing composites, as well as acceptable variations in FTIR and setting temperature. The compression strength increased by 2.8% and hardness strength increased by 1.89% on adding 0.5%w/w of MgO and 1.5%w/w TiO2 NPs. Bending strength increases by 0.35% on adding 1.5% w/w of MgO and 0.5% w/w TiO2 NPs, however, SEM scan shows remarkable improvement for surface structure.


Assuntos
Óxido de Magnésio , Nanopartículas , Cimentos Ósseos , Titânio/química , Nanopartículas/química , Articulação do Quadril , Espectroscopia de Infravermelho com Transformada de Fourier
20.
Am J Sports Med ; 52(2): 401-405, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38166446

RESUMO

BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is common among ice hockey and soccer players. To evaluate the prevalence of return to sports after hip arthroscopy or level of sports before surgery, self-reported questionnaires such as the Hip Sports Activity Scale (HSAS) are frequently used. There is a risk of self-reporting bias when using these tools. PURPOSE: To evaluate how self-reported levels of sports using HSAS correspond to objective data. STUDY DESIGN: Cohort study, Level of evidence: 3. METHOD: Ice hockey and soccer players undergoing hip arthroscopy for FAIS between 2011 and 2019 and included in the local hip arthroscopy registry in Gothenburg, Sweden, aged ≥18 years at the time of surgery, with a self-reported HSAS level of 7 or 8 before onset of symptoms, were included. Objective data on level of sports were collected through sports-specific sources (https://football.instatscout.com, https://hockey.instatscout.com, https://www.eliteprospects.com, and Swedish Football Association). Objective data were collected for the corresponding season when the athletes reported their symptom onset. Agreement between subjective and objective data was described using descriptive statistics, and comparison between subgroups was made. RESULTS: A total of 483 athletes met the inclusion criteria: 80 ice hockey and 403 soccer players. The majority were men (90%). The mean age was 26.5 years (SD, 8.3 years). When comparing HSAS level with objective data, 112 athletes (23%) had a correct self-reported HSAS level. Of 251 athletes with a self-reported HSAS level of 8, 76 (30%) had a matching objective HSAS level, and 36 of 232 (16%) athletes with a self-reported HSAS level of 7 had a matching objective HSAS level. Of the erroneous subjective ratings, 98% were higher than the objective data. Athletes reporting a correct HSAS level were younger (24.6 vs 26.4 years; P = .04) and had a shorter symptom duration (18 vs 24 months; P < .001). Ice hockey players scored themselves correctly more often than soccer players (P < .001). CONCLUSION: Only 23% of athletes undergoing hip arthroscopy for FAIS self-reported an HSAS level before onset of symptoms that was accurate according to the objectively recorded data. The majority self-reported an HSAS level above their correct level of sports. Ice hockey players, younger age, and shorter symptom duration were associated with correct self-assessment.


Assuntos
Impacto Femoroacetabular , Futebol , Masculino , Humanos , Feminino , Adolescente , Adulto , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/cirurgia , Autorrelato , Estudos de Coortes , Atletas , Artroscopia , Resultado do Tratamento , Volta ao Esporte , Estudos Retrospectivos
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