21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint femoral (hemi-hip) metallic resurfacing prosthesis. 888.3400 Section 888.3400 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3400 Hip joint...

21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint (hemi-hip) acetabular metal cemented prosthesis. 888.3370 Section 888.3370 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint...

21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint (hemi-hip) acetabular metal cemented prosthesis. 888.3370 Section 888.3370 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint...

21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint femoral (hemi-hip) metallic resurfacing prosthesis. 888.3400 Section 888.3400 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3400 Hip joint...

21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint femoral (hemi-hip) metallic resurfacing prosthesis. 888.3400 Section 888.3400 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3400 Hip joint...

21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented acetabular...

21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented acetabular...

21 CFR 888.3358 - Hip joint metal/polymer/metal semi-constrained porous-coated uncemented prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/polymer/metal semi-constrained... Devices § 888.3358 Hip joint metal/polymer/metal semi-constrained porous-coated uncemented prosthesis. (a) Identification. A hip joint metal/polymer/metal semi-constrained porous-coated uncemented prosthesis is a device...

21 CFR 888.3350 - Hip joint metal/polymer semi-constrained cemented prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint metal/polymer semi-constrained cemented prosthesis. 888.3350 Section 888.3350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... metal/polymer semi-constrained cemented prosthesis. (a) Identification. A hip joint metal/polymer semi...

21 CFR 888.3350 - Hip joint metal/polymer semi-constrained cemented prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/polymer semi-constrained cemented prosthesis. 888.3350 Section 888.3350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... metal/polymer semi-constrained cemented prosthesis. (a) Identification. A hip joint metal/polymer semi...

21 CFR 888.3300 - Hip joint metal constrained cemented or uncemented prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint metal constrained cemented or uncemented prosthesis. 888.3300 Section 888.3300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3300 Hip joint...

21 CFR 888.3300 - Hip joint metal constrained cemented or uncemented prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint metal constrained cemented or uncemented prosthesis. 888.3300 Section 888.3300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3300 Hip joint...

21 CFR 888.3300 - Hip joint metal constrained cemented or uncemented prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint metal constrained cemented or uncemented prosthesis. 888.3300 Section 888.3300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3300 Hip joint...

21 CFR 888.3350 - Hip joint metal/polymer semi-constrained cemented prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint metal/polymer semi-constrained cemented prosthesis. 888.3350 Section 888.3350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... metal/polymer semi-constrained cemented prosthesis. (a) Identification. A hip joint metal/polymer semi...

21 CFR 888.3350 - Hip joint metal/polymer semi-constrained cemented prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint metal/polymer semi-constrained cemented prosthesis. 888.3350 Section 888.3350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... metal/polymer semi-constrained cemented prosthesis. (a) Identification. A hip joint metal/polymer semi...

21 CFR 888.3350 - Hip joint metal/polymer semi-constrained cemented prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint metal/polymer semi-constrained cemented prosthesis. 888.3350 Section 888.3350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... metal/polymer semi-constrained cemented prosthesis. (a) Identification. A hip joint metal/polymer semi...

21 CFR 888.3390 - Hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis. 888.3390 Section 888.3390 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices...

21 CFR 888.3340 - Hip joint metal/composite semi-constrained cemented prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint metal/composite semi-constrained cemented prosthesis. 888.3340 Section 888.3340 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3340...

21 CFR 888.3340 - Hip joint metal/composite semi-constrained cemented prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint metal/composite semi-constrained cemented prosthesis. 888.3340 Section 888.3340 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3340...

21 CFR 888.3340 - Hip joint metal/composite semi-constrained cemented prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint metal/composite semi-constrained cemented prosthesis. 888.3340 Section 888.3340 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3340...

21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. 888.3320 Section 888.3320 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic...

21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. 888.3320 Section 888.3320 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic...

21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. 888.3320 Section 888.3320 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic...

Utility of percutaneous joint aspiration and synovial biopsy in identifying culture-positive infected hip arthroplasty.

PubMed

Cross, M Connor; Kransdorf, Mark J; Chivers, F Spencer; Lorans, Roxanne; Roberts, Catherine C; Schwartz, Adam J; Beauchamp, Christopher P

2014-02-01

Percutaneous synovial biopsy has recently been reported to have a high diagnostic value in the preoperative identification of periprosthetic infection of the hip. We report our experience with this technique in the evaluation of patients undergoing revision hip arthroplasty, comparing results of preoperative synovial biopsy with joint aspiration in identifying an infected hip arthroplasty by bacteriological analysis. We retrospectively reviewed the results of the 110 most recent revision hip arthroplasties in which preoperative synovial biopsy and joint aspiration were both performed. Revision surgery for these patients occurred during the period from September 2005 to March 2012. Using this study group, results from preoperative cultures were compared with preoperative laboratory studies and the results of intraoperative cultures. Synovial aspiration was done using an 18- or 20-gauge spinal needle. Synovial biopsy was done coaxially following aspiration using a 22-gauge Chiba needle or 21-gauge Sure-Cut needle. Standard microbiological analysis was performed on preoperative synovial fluid aspirate and synovial biopsy. Intraoperative tissue biopsy bacteriological analysis results at surgical revision were accepted as the "gold standard" for the presence or absence of infection. Seventeen of 110 (15 %) of patients had intraoperative culture-positive periprosthetic infection. Of these 17 cases, there were ten cases where either the synovial fluid aspiration and/or the synovial biopsy were true positive (sensitivity of 59 %, specificity of 100 %, positive predictive value of 100 % and accuracy of 94 %). There were seven cases where aspiration and biopsy results were both falsely negative, but no false-positive results. Similar results were found for synovial fluid aspiration alone. The results of synovial biopsy alone resulted in the identification of seven infected joints with no false-positive result (sensitivity of 41 %, specificity of 100 %, positive predictive value of 100 %, and accuracy of 91 %). Standard microbiological analyses performed on percutaneous synovial biopsy specimen during the preoperative evaluation of patients undergoing revision hip arthroplasty did not improve detection of culture-positive periprosthetic infection as compared to synovial fluid aspiration alone.

An in vitro simulation method for the tribological assessment of complete natural hip joints

PubMed Central

Fisher, John; Williams, Sophie

2017-01-01

The use of hip joint simulators to evaluate the tribological performance of total hip replacements is widely reported in the literature, however, in vitro simulation studies investigating the tribology of the natural hip joint are limited with heterogeneous methodologies reported. An in vitro simulation system for the complete natural hip joint, enabling the acetabulum and femoral head to be positioned with different orientations whilst maintaining the correct joint centre of rotation, was successfully developed for this study. The efficacy of the simulation system was assessed by testing complete, matched natural porcine hip joints and porcine hip hemiarthroplasty joints in a pendulum friction simulator. The results showed evidence of biphasic lubrication, with a non-linear increase in friction being observed in both groups. Lower overall mean friction factor values in the complete natural joint group that increased at a lower rate over time, suggest that the exudation of fluid and transition to solid phase lubrication occurred more slowly in the complete natural hip joint compared to the hip hemiarthroplasty joint. It is envisaged that this methodology will be used to investigate morphological risk factors for developing hip osteoarthritis, as well as the effectiveness of early interventional treatments for degenerative hip disease. PMID:28886084

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

PubMed

Wegener, Veronika; Jorysz, Gabriele; Arnoldi, Andreas; Utzschneider, Sandra; Wegener, Bernd; Jansson, Volkmar; Heimkes, Bernhard

2017-03-01

Evaluation of hip joint space width during child growth is important to aid in the early diagnosis of hip pathology in children. We established reference values for hip joint space and femoral head size for each age. Hip joint space development during growth was retrospectively investigated medial and cranial in 1350 hip joints of children using standard anteroposterior supine plain pelvic radiographs. Maximum capital femoral epiphysis diameter and femoral radii were further more investigated. Hip joint space values show a slow decline during growth. Joint space was statistically significantly (p < 0.006) larger in boys than girls. Our hip joint space measurements on supine subjects seem slightly larger than those reported by Hughes on standing subjects. Evaluation of the femoral head diameter and the radii showed a size curve quite parallel to the known body growth charts. Radii medial and perpendicular to the physis are not statistically significantly different. We recommend to compare measurements of hip joint space at two locations to age dependent charts using the same imaging technique. During growth, a divergence in femoral head size from the expected values or loss of the spherical shape should raise the question of hip disorder. Clin. Anat. 30:267-275, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

A model-based approach to stabilizing crutch supported paraplegic standing by artificial hip joint stiffness.

PubMed

van der Spek, Jaap H; Veltink, Peter H; Hermens, Hermie J; Koopman, Bart F J M; Boom, Herman B K

2003-12-01

The prerequisites for stable crutch supported standing were analyzed in this paper. For this purpose, a biomechanical model of crutch supported paraplegic stance was developed assuming the patient was standing with extended knees. When using crutches during stance, the crutches will put a position constraint on the shoulder, thus reducing the number of degrees of freedom. Additional hip-joint stiffness was applied to stabilize the hip joint and, therefore, to stabilize stance. The required hip-joint stiffness for changing crutch placement and hip-joint offset angle was studied under static and dynamic conditions. Modeling results indicate that, by using additional hip-joint stiffness, stable crutch supported paraplegic standing can be achieved, both under static as well as dynamic situations. The static equilibrium postures and the stability under perturbations were calculated to be dependent on crutch placement and stiffness applied. However, postures in which the hip joint was in extension (C postures) appeared to the most stable postures. Applying at least 60 N x m/rad hip-joint stiffness gave stable equilibrium postures in all cases. Choosing appropriate hip-joint offset angles, the static equilibrium postures changed to more erect postures, without causing instability or excessive arm forces to occur.

Walking patterns and hip contact forces in patients with hip dysplasia.

PubMed

Skalshøi, Ole; Iversen, Christian Hauskov; Nielsen, Dennis Brandborg; Jacobsen, Julie; Mechlenburg, Inger; Søballe, Kjeld; Sørensen, Henrik

2015-10-01

Several studies have investigated walking characteristics in hip dysplasia patients, but so far none have described all hip rotational degrees of freedom during the whole gait cycle. This descriptive study reports 3D joint angles and torques, and furthermore extends previous studies with muscle and joint contact forces in 32 hip dysplasia patients and 32 matching controls. 3D motion capture data from walking and standing trials were analysed. Hip, knee, ankle and pelvis angles were calculated with inverse kinematics for both standing and walking trials. Hip, knee and ankle torques were calculated with inverse dynamics, while hip muscle and joint contact forces were calculated with static optimisation for the walking trials. No differences were found between the two groups while standing. While walking, patients showed decreased hip extension, increased ankle pronation and increased hip abduction and external rotation torques. Furthermore, hip muscle forces were generally lower and shifted to more posteriorly situated muscles, while the hip joint contact force was lower and directed more superiorly. During walking, patients showed lower and more superiorly directed hip joint contact force, which might alleviate pain from an antero-superiorly degenerated joint. Copyright © 2015 Elsevier B.V. All rights reserved.

Joint pain undergoes a transition in accordance with signal changes of bones detected by MRI in hip osteoarthritis.

PubMed

Kamimura, Mikio; Nakamura, Yukio; Ikegami, Shota; Uchiyama, Shigeharu; Kato, Hiroyuki

2013-01-01

In this study, we aimed to investigate whether joint pain is derived from cartilage or bone alterations. We reviewed 23 hip joints of 21 patients with primary hip osteoarthritis (OA), which were classified into Kellgren-Laurence (KL) grading I to IV. Plain radiographs and magnetic resonance imaging (MRI) were obtained from all of the 23 joints. Two of the 21 patients had bilateral hip OA. Pain was assessed based on the pain scale of Denis. A Welch t test was performed for age, height, weight, body mass index, bone mineral density, and a Mann-Whitney U test was performed for KL grading. Four of 8 hip joints with pain and OA showed broad signal changes detected by MRI. Fourteen hip joints without pain, but with OA did not show broad signal changes by MRI. Collectively, MRI analyses showed that broad signal changes in OA cases without joint pain or with a slight degree of joint pain were not observed, while broad signal changes were observed in OA cases with deteriorated joint pain. Our findings suggest that hip joint pain might be associated with bone signal alterations in the hips of OA patients.

The Alpha-Defensin Test for Diagnosing Periprosthetic Joint Infection in the Setting of an Adverse Local Tissue Reaction Secondary to a Failed Metal-on-Metal Bearing or Corrosion at the Head-Neck Junction.

PubMed

Okroj, Kamil T; Calkins, Tyler E; Kayupov, Erdan; Kheir, Michael M; Bingham, Joshua S; Beauchamp, Christopher P; Parvizi, Javad; Della Valle, Craig J

2018-06-01

In patients with adverse local tissue reaction (ALTR) secondary to a failed metal-on-metal (MoM) bearing or corrosion at the head-neck junction in a metal-on-polyethylene bearing, ruling in or out periprosthetic joint infection (PJI) can be challenging. Alpha-defensin has emerged as an accurate test for PJI. The purpose of this multicenter, retrospective study was to evaluate the accuracy of the alpha-defensin synovial fluid test in detecting PJI in patients with ALTR. We reviewed medical records of 26 patients from 3 centers with ALTR that had an alpha-defensin test performed. Patients were assessed for PJI using the Musculoskeletal Infection Society criteria. Thirteen of these subjects had MoM total hip arthroplasty, 9 had ALTR secondary to head-neck corrosion, and 4 had MoM hip resurfacing. Only 1 of the 26 patients met Musculoskeletal Infection Society criteria for infection. However, 9 hips were alpha-defensin positive, including 1 true positive and 8 that were falsely positive (31%). All 8 of the false positives were also Synovasure positive, although 5 of 8 had an accompanying warning stating the results may be falsely positive due to a low synovial C-reactive protein value. Similar to synovial fluid white blood cell count, alpha-defensin testing is prone to false-positive results in the setting of ALTR. Therefore, we recommend an aggressive approach to ruling out PJI including routine aspiration of all hips with ALTR before revision surgery to integrate the synovial fluid blood cell count, differential, cultures and adjunctive tests like alpha-defensin to allow for accurate diagnosis preoperatively. Copyright © 2018 Elsevier Inc. All rights reserved.

Gender differences exist in the hip joint moments of healthy older walkers.

PubMed

Boyer, Katherine A; Beaupre, Gary S; Andriacchi, Thomas P

2008-12-05

Gender differences in the incidence of symptomatic hip osteoarthritis (OA), changes in hip cartilage volume and hip joint space and rates hip arthroplasty of older people are reported in the literature. As the rate of progression of OA is in part mechanically modulated it is possible that this gender bias may be related to inherent differences (if they exist) in walking mechanics between older males and females. The purpose of this study was to examine potential mechanisms for gender differences in hip joint mechanics during walking by testing the hypotheses that females would exhibit higher hip flexion, adduction and internal rotation moments but not significantly greater normalized ground reaction forces (GRFs). Forty-two healthy subjects (21 male, 21 female), ages 50-79yr were recruited for gait analysis. In support of the hypotheses, greater external hip adduction and internal rotation along with hip extension moments were found for females compared to males after normalizing for body size for all self-selected walking speeds. Differences in walking style (kinematics) were the main determinants in the joint kinetic differences as no differences in the normalized GRFs were found. As external joint moments are surrogate measures of the joint contact forces, the results of this study suggest the hip joint stress for the female population is higher compared to male population. This is in favor of a hypothesis that the increased joint contact stress in a female population could contribute to a greater joint degeneration at the hip in females as compared with males.

Anatomical study of the articular branches innervated the hip and knee joint with reference to mechanism of referral pain in hip joint disease patients.

PubMed

Sakamoto, Junya; Manabe, Yoshitaka; Oyamada, Joichi; Kataoka, Hideki; Nakano, Jiro; Saiki, Kazunobu; Okamoto, Keishi; Tsurumoto, Toshiyuki; Okita, Minoru

2018-07-01

Referred pain in the anterior knee joint is the most common symptom in hip disease patients. The development of referred pain is considered to be related to dichotomizing peripheral sensory fibers. However, no gross anatomical findings identify any dichotomizing fibers innervating both the hip and knee joints. We dissected the femoral and obturator nerves in human cadavers to investigate the distribution of the articular branches in the hip and knee joints. Fourteen embalmed left lower limbs from 14 Japanese adult cadavers (five from females, nine from males, average age 73.8 ± 14.1 years) were observed macroscopically. The articular branches of the femoral and obturator nerves were dissected at the anterior margin of the groin toward the thigh region. After dissections of the articular nerves of the hip joints, the femoral and obturator nerves were exposed from proximally to distally to identify the articular nerves of the knee joints. The branching pattern of the articular branches in the hip and knee joints was recorded. In six of 14 limbs (42.9%), the femoral nerve supplied articular branches to the anteromedial aspect of both the hip and knee joints. These articular branches were derived from the same bundle of femoral nerve. These gross anatomical findings suggested that dichotomizing peripheral sensory fibers innervate the hip and knee joints and these could relate to the referred pain confirmed in the anterior knee joints of patients with hip disease. Clin. Anat. 31:705-709, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

Intertester and intratester reliability of movement control tests on the hip for patients with hip osteoarthritis.

PubMed

Lenzlinger-Asprion, Rahel; Keller, Niculina; Meichtry, André; Luomajoki, Hannu

2017-01-31

Hip joint complaints are a problem associated with increasing age and impair the mobility of a large section of the elderly population. Reliable and valid tests are necessary for a thorough investigation of a joint. A fundamental function of the hip joint is movement control and a test of this function forms a part of the standard examination. Until now there have been few scientific studies which specifically investigate the reliability of measurement tests of movement control of the hip joint. The aim of this study was to examine the intratester and intertester reliability of the movement control tests of the hip joint which are in use in current clinical practice. Sixteen participants with hip joint complaints and 14 without hip joint impairment were recruited. All participants performed five active movement control tests for the hip joint and were video filmed whilst performing these tests. These films formed the basis for the evaluation and were assessed by two independent physiotherapists. For the intertester and intratester reliability calculations specially set weighted kappa values and the calculated percentages were used. The intertester reliability of the five examined movement control tests of the hip joint showed good to almost perfect values (weighted kappa (wk) = 0.56-0.87). The intratester reliability of the more experienced evaluator A was better in regards to the less experienced evaluator B (average wk = 0.62 vs 0.38). The visual evaluation of movement control tests of the hip joint is especially reliable when carried out by an experienced evaluator. 4 out of 5 tests also showed good results for intertester reliability and support their use in clinical practice.

Computational Modelling and Movement Analysis of Hip Joint with Muscles

NASA Astrophysics Data System (ADS)

Siswanto, W. A.; Yoon, C. C.; Salleh, S. Md.; Ngali, M. Z.; Yusup, Eliza M.

2017-01-01

In this study, the model of hip joint and the main muscles are modelled by finite elements. The parts included in the model are hip joint, hemi pelvis, gluteus maximus, quadratus femoris and gamellus inferior. The materials that used in these model are isotropic elastic, Mooney Rivlin and Neo-hookean. The hip resultant force of the normal gait and stair climbing are applied on the model of hip joint. The responses of displacement, stress and strain of the muscles are then recorded. FEBio non-linear solver for biomechanics is employed to conduct the simulation of the model of hip joint with muscles. The contact interfaces that used in this model are sliding contact and tied contact. From the analysis results, the gluteus maximus has the maximum displacement, stress and strain in the stair climbing. Quadratus femoris and gamellus inferior has the maximum displacement and strain in the normal gait however the maximum stress in the stair climbing. Besides that, the computational model of hip joint with muscles is produced for research and investigation platform. The model can be used as a visualization platform of hip joint.

[Range of Hip Joint Motion and Weight of Lower Limb Function under 3D Dynamic Marker].

PubMed

Xia, Q; Zhang, M; Gao, D; Xia, W T

2017-12-01

To explore the range of reasonable weight coefficient of hip joint in lower limb function. When the hip joints of healthy volunteers under normal conditions or fixed at three different positions including functional, flexed and extension positions, the movements of lower limbs were recorded by LUKOtronic motion capture and analysis system. The degree of lower limb function loss was calculated using Fugl-Meyer lower limb function assessment form when the hip joints were fixed at the aforementioned positions. One-way analysis of variance and Tamhane's T2 method were used to proceed statistics analysis and calculate the range of reasonable weight coefficient of hip joint. There were significant differences between the degree of lower limb function loss when the hip joints fixed at flexed and extension positions and at functional position. While the differences between the degree of lower limb function loss when the hip joints fixed at flexed position and extension position had no statistical significance. In 95% confidence interval, the reasonable weight coefficient of hip joint in lower limb function was between 61.05% and 73.34%. Expect confirming the reasonable weight coefficient, the effects of functional and non-functional positions on the degree of lower limb function loss should also be considered for the assessment of hip joint function loss. Copyright© by the Editorial Department of Journal of Forensic Medicine

Hip or knee replacement - after - what to ask your doctor

MedlinePlus

... chap 7. Read More Hip joint replacement Hip pain Knee joint replacement Knee pain Osteoarthritis Patient Instructions Getting your home ready - knee or hip surgery Hip or knee replacement - before - ...

Hip or knee replacement - before - what to ask your doctor

MedlinePlus

... chap 7. Read More Hip joint replacement Hip pain Knee joint replacement Knee pain Osteoarthritis Patient Instructions Getting your home ready - knee or hip surgery Hip or knee replacement - after - ...

Getting your home ready - knee or hip surgery

MedlinePlus

... Philadelphia, PA: Elsevier; 2017:chap 55. Read More ACL reconstruction Hip fracture surgery Hip joint replacement Knee ... Knee joint replacement Knee microfracture surgery Patient Instructions ACL reconstruction - discharge Hip fracture - discharge Hip or knee ...

Hip joint replacement - slideshow

MedlinePlus

... this page: //medlineplus.gov/ency/presentations/100006.htm Hip joint replacement - series—Normal anatomy To use the ... to slide 5 out of 5 Overview The hip joint is made up of two major parts: ...

Quantitative genetics of secondary hip joint osteoarthritis in a Labrador Retriever-Greyhound pedigree.

PubMed

Hays, Laurel; Zhang, Zhiwu; Mateescu, Raluca G; Lust, George; Burton-Wurster, Nancy I; Todhunter, Rory J

2007-01-01

To evaluate the quantitative inheritance of secondary hip joint osteoarthritis in a canine pedigree. 137 Labrador Retrievers, Greyhounds, and mixed-breed dogs. Necropsy scores ranging from 0 to 4 were obtained for each hip joint. Seven unaffected Greyhounds with normal hip joint conformation were also used for genetic modeling, but were not euthanized. Sixty-six male and 71 female dogs were allocated to 2 groups (< or = 12 months of age and > 12 months of age). Statistical models were developed to establish the inheritance pattern of hip joint osteoarthritis that developed secondary to hip dysplasia. 62 dogs had evidence of osteoarthritis in a hip joint, and 75 had no evidence of osteoarthritis. After sex was adjusted for, the necropsy score was found to be inherited additively but without dominance. Each Labrador Retriever allele increased the necropsy score by 0.7 to 0.9 points, compared with the Greyhound allele, and male sex increased the necropsy score 0.74 over female sex. Approximately 10% of the variation in necropsy score was attributable to the litter of puppies' origin. Because secondary hip joint osteoarthritis is inherited additively, selection pressure could be applied to reduce its incidence. Similar statistical models can be used in linkage and association mapping to detect the genes in the underlying quantitative trait loci that contribute to hip joint osteoarthritis.

Transient regional osteoporosis.

PubMed

Cano-Marquina, Antonio; Tarín, Juan J; García-Pérez, Miguel-Ángel; Cano, Antonio

2014-04-01

Transient regional osteoporosis (TRO) is a disease that predisposes to fragility fracture in weight bearing joints of mid-life women and men. Pregnant women may also suffer the process, usually at the hip. The prevalence of TRO is lower than the systemic form, associated with postmenopause and advanced age, but may be falsely diminished by under-diagnosis. The disease may be uni- or bilateral, and may migrate to distinct joints. One main feature of TRO is spontaneous recovery. Pain and progressive limitation in the functionality of the affected joint(s) are key symptoms. In the case of the form associated with pregnancy, difficulties in diagnosis derive from the relatively young age at presentation and from the clinical overlapping with the frequent aches during gestation. Densitometric osteoporosis in the affected region is not always present, but bone marrow edema, with or without joint effusion, is detected by magnetic resonance. There are not treatment guidelines, but the association of antiresorptives to symptomatic treatment seems to be beneficial. Surgery or other orthopedic interventions can be required for specific indications, like hip fracture, intra-medullary decompression, or other. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Chronic arthritis of the hip joint: an unusual complication of an inadequately treated fistula-in-ano

PubMed Central

Raghunath, Rajat; Varghese, Gigi; Simon, Betty

2014-01-01

We report a case of chronic arthritis of the right hip joint in an otherwise healthy young male athlete as a complication of inadequately treated anal fistula. A young male athlete presented with symptoms of right hip pain and difficulty in walking and intermittent fever for 2 months. He had a history of perianal abscess drainage. On examination he was found to have a tender right hip joint with severe restriction of movements. He was also found to have a partially drained right ischiorectal abscess. X-ray and MRI of the hip joint revealed chronic arthritis of the right hip joint, which was communicating with a complex fistula-in-ano. He underwent a diversion sigmoid colostomy and right ischiorectal abscess drainage along with appropriate antibiotics with a plan for definitive hip joint procedure later. He was lost to follow-up and succumbed to severe perianal sepsis within a few months. PMID:25414226

Hip Arthroscopic Synovectomy and Labral Repair in a Patient With Rheumatoid Arthritis With a 2-Year Follow-up

PubMed Central

Watanabe, Nobuyuki; Iguchi, Hirotaka; Mitsui, Hiroto; Tawada, Kaneaki; Murakami, Satona; Otsuka, Takanobu

2014-01-01

The arthroscopic surgical procedures reported previously for a rheumatic hip joint have been primarily performed as diagnostic procedures. Only a few studies have reported the success of arthroscopic surgery in hip joint preservation. We encountered a special case in which joint remodeling was seen in a patient with rheumatoid arthritis treated with biological drugs after hip arthroscopic synovectomy and labral repair. We report the case of a 39-year-old woman with rheumatism, which was controlled with tocilizumab, prednisolone, and tacrolimus. The hip joint showed Larsen grade 3 destruction, and the Harris Hip Score was 55 points. Because of the patient's strong desire to undergo a hip preservation operation, we performed hip arthroscopic synovectomy and repair of a longitudinal labral tear. After 2.5 years, the joint space had undergone rebuilding with improvement to Larsen grade 2, and the Harris Hip Score had improved to 78 points; the patient was able to return to work with the use of 1 crutch. It is possible to perform hip arthroscopic surgery for rheumatoid arthritis with a hip preservation operation with biological drugs. PMID:25276611

A rapid prototyping model for biomechanical evaluation of pelvic osteotomies.

PubMed

Pressel, Thomas; Max, Stefan; Pfeifer, Roman; Ostermeier, Sven; Windhagen, Henning; Hurschler, Christof

2008-04-01

The biomechanical consequences of Salter pelvic osteotomy are difficult to assess due to the complex three-dimensional anatomy of the pelvis. Therefore, models of the dysplastic pelvis are required to allow realistic biomechanical simulation of possible outcomes. A polyamide reversed-engineering model of the left hemipelvis and proximal femur was produced from a computed tomography dataset of an 8-year-old child with severe dysplasia of both hips using selective laser sintering. Hip joint forces before and after Salter osteotomy of the hip were measured using an experimental setup in which an industrial robot was exerting hip joint forces and moments representing one-legged stance. Hip extensor and abductor actuator forces were measured which counterbalanced the joint moments. The preoperative hip joint resultant force was 583 N (270% body weight), while after the operation a mean force of 266 N (120% body weight) was measured. The resulting bony model was geometrically accurate, while apparent joint incongruencies were due to the neglected cartilaginous structures in the model. The preoperative joint resultant force was within the limits reported in the literature. The results suggest that Salter innominate osteotomy not only increases joint contact area but also reduces the hip joint force.

Walk and roll robot

NASA Technical Reports Server (NTRS)

Wilson, Andrew (Inventor); Punnoose, Andrew (Inventor); Strausser, Katherine (Inventor); Parikh, Neil (Inventor)

2011-01-01

A mobile robotic unit features a main body, a plurality of legs for supporting the main body on and moving the main body in forward and reverse directions about a base surface, and a drive assembly. According to an exemplary embodiment each leg includes a respective pivotal hip joint, a pivotal knee joint, and a wheeled foot adapted to roll along the base surface. Also according to an exemplary embodiments the drive assembly includes a motor operatively associated with the hip and knee joints and the wheeled foot for independently driving pivotal movement of the hip joint and the knee joint and rolling motion of the wheeled foot. The hip joint may include a ball-and-socket-type joint interconnecting top portion of the leg to the main body, such that the hip joint is adapted to pivot said leg in a direction transverse to a forward-and-reverse direction.

Influence of weak hip abductor muscles on joint contact forces during normal walking: probabilistic modeling analysis.

PubMed

Valente, Giordano; Taddei, Fulvia; Jonkers, Ilse

2013-09-03

The weakness of hip abductor muscles is related to lower-limb joint osteoarthritis, and joint overloading may increase the risk for disease progression. The relationship between muscle strength, structural joint deterioration and joint loading makes the latter an important parameter in the study of onset and follow-up of the disease. Since the relationship between hip abductor weakness and joint loading still remains an open question, the purpose of this study was to adopt a probabilistic modeling approach to give insights into how the weakness of hip abductor muscles, in the extent to which normal gait could be unaltered, affects ipsilateral joint contact forces. A generic musculoskeletal model was scaled to each healthy subject included in the study, and the maximum force-generating capacity of each hip abductor muscle in the model was perturbed to evaluate how all physiologically possible configurations of hip abductor weakness affected the joint contact forces during walking. In general, the muscular system was able to compensate for abductor weakness. The reduced force-generating capacity of the abductor muscles affected joint contact forces to a mild extent, with 50th percentile mean differences up to 0.5 BW (maximum 1.7 BW). There were greater increases in the peak knee joint loads than in loads at the hip or ankle. Gluteus medius, particularly the anterior compartment, was the abductor muscle with the most influence on hip and knee loads. Further studies should assess if these increases in joint loading may affect initiation and progression of osteoarthritis. Copyright © 2013 Elsevier Ltd. All rights reserved.

Higher medially-directed joint reaction forces are a characteristic of dysplastic hips: A comparative study using subject-specific musculoskeletal models.

PubMed

Harris, Michael D; MacWilliams, Bruce A; Bo Foreman, K; Peters, Christopher L; Weiss, Jeffrey A; Anderson, Andrew E

2017-03-21

Acetabular dysplasia is a known cause of hip osteoarthritis. In addition to abnormal anatomy, changes in kinematics, joint reaction forces (JRFs), and muscle forces could cause tissue damage to the cartilage and labrum, and may contribute to pain and fatigue. The objective of this study was to compare lower extremity joint angles, moments, hip JRFs and muscle forces during gait between patients with symptomatic acetabular dysplasia and healthy controls. Marker trajectories and ground reaction forces were measured in 10 dysplasia patients and 10 typically developing control subjects. A musculoskeletal model was scaled in OpenSim to each subject and subject-specific hip joint centers were determined using reconstructions from CT images. Joint kinematics and moments were calculated using inverse kinematics and inverse dynamics, respectively. Muscle forces and hip JRFs were estimated with static optimization. Inter-group differences were tested for statistical significance (p≤0.05) and large effect sizes (d≥0.8). Results demonstrated that dysplasia patients had higher medially directed JRFs. Joint angles and moments were mostly similar between the groups, but large inter-group effect sizes suggested some restriction in range of motion by patients at the hip and ankle. Higher medially-directed JRFs and inter-group differences in hip muscle forces likely stem from lateralization of the hip joint center in dysplastic patients. Joint force differences, combined with reductions in range of motion at the hip and ankle may also indicate compensatory strategies by patients with dysplasia to maintain joint stability. Copyright © 2017 Elsevier Ltd. All rights reserved.

Higher Medially-directed Joint Reaction Forces are a Characteristic of Dysplastic Hips: A Comparative Study Using Subject-Specific Musculoskeletal Models

PubMed Central

Harris, Michael D.; MacWilliams, Bruce A.; Foreman, K. Bo; Peters, Christopher L.; Weiss, Jeffrey A.; Anderson, Andrew E.

2018-01-01

Acetabular dysplasia is a known cause of hip osteoarthritis. In addition to abnormal anatomy, changes in kinematics, joint reaction forces (JRFs), and muscle forces could cause tissue damage to the cartilage and labrum, and may contribute to pain and fatigue. The objective of this study was to compare lower extremity joint angles, moments, hip JRFs and muscle forces during gait between patients with symptomatic acetabular dysplasia and healthy controls. Marker trajectories and ground reaction forces were measured in 10 dysplasia patients and 10 typically developing control subjects. A musculoskeletal model was scaled in OpenSim to each subject and subject-specific hip joint centers were determined using reconstructions from CT images. Joint kinematics and moments were calculated using inverse kinematics and inverse dynamics, respectively. Muscle forces and hip JRFs were estimated with static optimization. Inter-group differences were tested for statistical significance (p≤0.05) and large effect sizes (d≥0.8). Results demonstrated that dysplasia patients had higher medially directed JRFs. Joint angles and moments were mostly similar between the groups, but large inter-group effect sizes suggested some restriction in range of motion by patients at the hip and ankle. Higher medially-directed JRFs and inter-group differences in hip muscle forces likely stem from lateralization of the hip joint center in dysplastic patients. Joint force differences, combined with reductions in range of motion at the hip and ankle may also indicate compensatory strategies by patients with dysplasia to maintain joint stability. PMID:28233552

[Efficacy analysis on hip replacement for hip-joint diseases with Parkinson disease].

PubMed

Sun, Qi-Cai; Ru, Xuan-Liang; Xia, Yan-Fei; Liu, Xiao-Li; Song, Bai-Shan; Qiao, Song; Yan, Shi-Gui; Wang, Xiang-Hua

2017-12-25

To explore clinical efficacy of hip replacement for hip-joint diseases with Parkinson disease. From December 2011 to December 2016, 18 patients with hip-joint diseases with Parkinson disease treated by hip replacement, including 8 males and 10 females aged from 59 to 87 years old with an average of 71 years old. Among them, 3 cases were developmental dysplasia of hip, 3 cases were femoral head necrosis and 12 cases were femoral neck fracture. All patients manifested with obvious pain and limitation of stepping ability. Postoperative complications were observed and Harris score were used to compare hip joint function after operation. The incision were healed well, and pain were alleviated or disappeared, and hip joint function were improved. Eighteen patients were followed up from 1 to 3 years with an average of 2.3 years. At the latest follow up, 14 cases recovered freedom-walk, 2 cases could walk with walking stick, 1 case could walk with walking aid and 1 case was died. Among 18 patients, 2 cases were occurred dislocation, and 1 case were died for cardiac disease at 3 months after operation. Four patients were occurred slight pain. There were significant differences in Harris scores among preoperative (41.7±1.4), 6 months after operation(80.1±5.4) and the final follow-up (83.4±2.1), and 10 cases got excellent result, 4 good, 1 fair and 2 poor. Application of hip replacement for hip-joint diseases with Parkinson disease is a safe and effective clinical therapy, and has advantages of less complications and rapid recovery of hip joint function.

Inter-joint coordination between hips and trunk during downswings: Effects on the clubhead speed.

PubMed

Choi, Ahnryul; Lee, In-Kwang; Choi, Mun-Taek; Mun, Joung Hwan

2016-10-01

Understanding of the inter-joint coordination between rotational movement of each hip and trunk in golf would provide basic knowledge regarding how the neuromuscular system organises the related joints to perform a successful swing motion. In this study, we evaluated the inter-joint coordination characteristics between rotational movement of the hips and trunk during golf downswings. Twenty-one right-handed male professional golfers were recruited for this study. Infrared cameras were installed to capture the swing motion. The axial rotation angle, angular velocity and inter-joint coordination were calculated by the Euler angle, numerical difference method and continuous relative phase, respectively. A more typical inter-joint coordination demonstrated in the leading hip/trunk than trailing hip/trunk. Three coordination characteristics of the leading hip/trunk reported a significant relationship with clubhead speed at impact (r < -0.5) in male professional golfers. The increased rotation difference between the leading hip and trunk in the overall downswing phase as well as the faster rotation of the leading hip compared to that of the trunk in the early downswing play important roles in increasing clubhead speed. These novel inter-joint coordination strategies have the great potential to use a biomechanical guideline to improve the golf swing performance of unskilled golfers.

Numerical simulation of artificial hip joint motion based on human age factor

NASA Astrophysics Data System (ADS)

Ramdhani, Safarudin; Saputra, Eko; Jamari, J.

2018-05-01

Artificial hip joint is a prosthesis (synthetic body part) which usually consists of two or more components. Replacement of the hip joint due to the occurrence of arthritis, ordinarily patients aged or older. Numerical simulation models are used to observe the range of motion in the artificial hip joint, the range of motion of joints used as the basis of human age. Finite- element analysis (FEA) is used to calculate stress von mises in motion and observes a probability of prosthetic impingement. FEA uses a three-dimensional nonlinear model and considers the position variation of acetabular liner cups. The result of numerical simulation shows that FEA method can be used to analyze the performance calculation of the artificial hip joint at this time more accurate than conventional method.

Effect of obesity on posture and hip joint moments during a standing task, and trunk forward flexion motion.

PubMed

Gilleard, W; Smith, T

2007-02-01

Effects of obesity on trunk forward flexion motion in sitting and standing, and postural adaptations and hip joint moment for a standing work task. Cross-sectional comparison of obese and normal weight groups. Ten obese subjects (waist girth 121.2+/-16.8 cm, body mass index (BMI) 38.9+/-6.6 kg m(-2)) and 10 age- and height-matched normal weight subjects (waist girth 79.6+/-6.4 cm, BMI 21.7+/-1.5 kg m(-2)). Trunk motion during seated and standing forward flexion, and trunk posture, hip joint moment and hip-to-bench distance during a simulated standing work task were recorded. Forward flexion motion of the thoracic segment and thoracolumbar spine was decreased for the obese group with no change in pelvic segment and hip joint motion. Obese subjects showed a more flexed trunk posture and increased hip joint moment and hip-to-bench distance for a simulated standing work task. Decreased range of forward flexion motion, differing effects within the trunk, altered posture during a standing work task and concomitant increases in hip joint moment give insight into the aetiology of functional decrements and musculoskeletal pain seen in obesity.

Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry.

PubMed

Lenguerrand, E; Whitehouse, M R; Beswick, A D; Jones, S A; Porter, M L; Blom, A W

2017-06-01

We used the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to investigate the risk of revision due to prosthetic joint infection (PJI) for patients undergoing primary and revision hip arthroplasty, the changes in risk over time, and the overall burden created by PJI. We analysed revision total hip arthroplasties (THAs) performed due to a diagnosis of PJI and the linked index procedures recorded in the NJR between 2003 and 2014. The cohort analysed consisted of 623 253 index primary hip arthroplasties, 63 222 index revision hip arthroplasties and 7585 revision THAs performed due to a diagnosis of PJI. The prevalence, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. We demonstrated a prevalence of revision THA due to prosthetic joint infection of 0.4/100 procedures following primary and 1.6/100 procedures following revision hip arthroplasty. The prevalence of revision due to PJI in the three months following primary hip arthroplasty has risen 2.3-fold (95% confidence interval (CI) 1.3 to 4.1) between 2005 and 2013, and 3.0-fold (95% CI 1.1 to 8.5) following revision hip arthroplasty. Over 1000 procedures are performed annually as a consequence of hip PJI, an increase of 2.6-fold between 2005 and 2013. Although the risk of revision due to PJI following hip arthroplasty is low, it is rising and, coupled with the established and further predicted increased incidence of both primary and revision hip arthroplasty, this represents a growing and substantial treatment burden. Cite this article : E. Lenguerrand, M. R. Whitehouse, A. D. Beswick, S. A. Jones, M. L. Porter, A. W. Blom. Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry. Bone Joint Res 2017;6:391-398. DOI: 10.1302/2046-3758.66.BJR-2017-0003.R1. © 2017 Lenguerrand et al.

Hip Joint Effusion-Synovitis Is Associated With Hip Pain and Sports/Recreation Function in Female Professional Ballet Dancers.

PubMed

Mayes, Susan; Ferris, April-Rose; Smith, Peter; Cook, Jill

2018-03-23

To compare hip joint effusion-synovitis prevalence in professional ballet dancers with nondancing athletes and to evaluate the relationship between effusion-synovitis and clinical measures and cartilage defects. Case-control study. Elite ballet and sport. Forty-nine professional ballet dancers and 49 age-matched and sex-matched athletes. Group (dancers/athletes), sex, age, years of training, Copenhagen Hip and Groin Outcome Scores (HAGOSs), hip rotation range of motion (ROM), generalized joint hypermobility (GJH), and hip cartilage defect scores. Hip joint effusion-synovitis (absent, grade 1 = 2-4 mm, grade 2 = >4 mm) scored with 3-Tesla magnetic resonance imaging. Hip joint effusion-synovitis was found in 22 (45%) dancers and 13 (26.5%) athletes (P = 0.06). Grade 2 effusion-synovitis was only found in dancers (n = 8, r = 0.31, P = 0.009). The prevalence of effusion-synovitis was similar in men (n = 11, 26%) and women (n = 24, 43%, P = 0.09). Female dancers with effusion-synovitis had lower HAGOS pain (r = 0.63, P = 0.001) and sports/recreation scores (r = 0.66, P = 0.001) compared with those without effusion-synovitis. The HAGOS scores were not related to effusion-synovitis in male dancers or female and male athletes (P > 0.01 for all). Effusion-synovitis was not related to hip ROM, GJH, or cartilage defect scores (P > 0.05 for all). Hip joint effusion-synovitis was related to higher levels of pain and lower sports/recreation function in female ballet dancers. Effusion-synovitis was not related to hip rotation ROM, GJH or cartilage defects. Larger sized joint effusion-synovitis was exclusively found in dancers.

Reduction of hip joint reaction force via medio-lateral foot center of pressure manipulation in bilateral hip osteoarthritis patients.

PubMed

Solomonow-Avnon, Deborah; Haim, Amir; Levin, Daniel; Elboim-Gabyzon, Michal; Rozen, Nimrod; Peled, Eli; Wolf, Alon

2016-10-01

Loading/excessive loading of the hip joint has been linked to onset and progression of hip osteoarthritis. Footwear-generated biomechanical manipulation in the frontal plane has been previously shown in a cohort of healthy subjects to cause a specific gait adaption when the foot center of pressure trajectory was shifted medially, which thereby significantly reduced hip joint reaction force. The objective of the present study was to validate these results in a cohort of female bilateral hip osteoarthritis patients. Sixteen patients underwent gait analysis while using a footworn biomechanical device, allowing controlled foot center of pressure manipulation, in three para-sagittal configurations: medial, lateral, and neutral. Hip osteoarthritis patients exhibited similar results to those observed in healthy subjects in that a medial center of pressure led to an increase in inter-maleolar distance while step width (i.e., distance between right and left foot center of pressure) remained constant. This adaptation, which we speculate subjects adopt to maintain base of support, was associated with significantly greater hip abduction, significantly decreased hip adduction moment, and significantly reduced joint reaction force compared to the neutral and lateral configurations. Recommendations for treatment of hip osteoarthritis emphasize reduction of loads on the pathological joint(s) during daily activities and especially in gait. Our results show that a medially deviated center of pressure causes a reduction in hip joint reaction force. The present study does not prove, but rather suggests, clinical significance, and further investigation is required to assess clinical implications. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1762-1771, 2016. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Pelvic rotation torque during fast-pitch softball hitting under three ball height conditions.

PubMed

Iino, Yoichi; Fukushima, Atsushi; Kojima, Takeji

2014-08-01

The purpose of this study was to investigate the relevance of hip joint angles to the production of the pelvic rotation torque in fast-pitch softball hitting and to examine the effect of ball height on this production. Thirteen advanced female softball players hit stationary balls at three different heights: high, middle, and low. The pelvic rotation torque, defined as the torque acting on the pelvis through the hip joints about the pelvic superior-inferior axis, was determined from the kinematic and force plate data using inverse dynamics. Irrespective of the ball heights, the rear hip extension, rear hip external rotation, front hip adduction, and front hip flexion torques contributed to the production of pelvic rotation torque. Although the contributions of the adduction and external rotation torques at each hip joint were significantly different among the ball heights, the contributions of the front and rear hip joint torques were similar among the three ball heights owing to cancelation of the two torque components. The timings of the peaks of the hip joint torque components were significantly different, suggesting that softball hitters may need to adjust the timings of the torque exertions fairly precisely to rotate the upper body effectively.

In vitro investigation of biomechanical changes of the hip after Salter pelvic osteotomy.

PubMed

Pfeifer, R; Hurschler, C; Ostermeier, S; Windhagen, H; Pressel, T

2008-03-01

Salter innominate osteotomy of the pelvis is widely used to improve the coverage of the femoral head in developmental dysplasia of the hip, but the biomechanical and geometric changes after this osteotomy are not well understood. A CT dataset of an 8-year-old child with severe dysplasia of both hips was used to create a polyamide model of the left hemipelvis and proximal femur. The hemipelvis was mounted to a holding device and the proximal femur attached to a sensor guided industrial robot. The robot was programmed to apply joint forces and torques based on single-leg stance. Two major muscles were represented by wires connected to hydraulic cylinders; muscle forces were adjusted to balance the joint moments. Resulting joint forces were measured using a pressure measuring sensor before and after Salter osteotomy of the hip. Geometric changes were recorded using a three-dimensional ultrasound measurement system. The preoperative hip joint resultant force was 583N (270% body weight), while after the operation a mean force of 266N (120% body weight) was measured. Postoperative muscle forces were roughly half the preoperative values. The hip joint was translated medially and caudally. Postoperatively, the length of gluteus medius and maximus muscles increased. The preoperative value of the resultant hip joint force is comparable to values reported in the literature. The results suggest that Salter innominate osteotomy leads to a reduction of hip joint and muscle forces in addition to increasing joint contact area.

Increased expression of damage-associated molecular patterns (DAMPs) in osteoarthritis of human knee joint compared to hip joint.

PubMed

Rosenberg, John H; Rai, Vikrant; Dilisio, Matthew F; Sekundiak, Todd D; Agrawal, Devendra K

2017-12-01

Osteoarthritis (OA) is a degenerative disease characterized by the destruction of cartilage. The greatest risk factors for the development of OA include age and obesity. Recent studies suggest the role of inflammation in the pathogenesis of OA. The two most common locations for OA to occur are in the knee and hip joints. The knee joint experiences more mechanical stress, cartilage degeneration, and inflammation than the hip joint. This could contribute to the increased incidence of OA in the knee joint. Damage-associated molecular patterns (DAMPs), including high-mobility group box-1, receptor for advanced glycation end products, and alarmins (S100A8 and S100A9), are released in the joint in response to stress-mediated chondrocyte and cartilage damage. This facilitates increased cartilage degradation and inflammation in the joint. Studies have documented the role of DAMPs in the pathogenesis of OA; however, the comparison of DAMPs and its influence on OA has not been discussed. In this study, we compared the DAMPs between OA knee and hip joints and found a significant difference in the levels of DAMPs expressed in the knee joint compared to the hip joint. The increased levels of DAMPs suggest a difference in the underlying pathogenesis of OA in the knee and the hip and highlights DAMPs as potential therapeutic targets for OA in the future.

Invariant hip moment pattern while walking with a robotic hip exoskeleton

PubMed Central

Lewis, Cara L.; Ferris, Daniel P.

2011-01-01

Robotic lower limb exoskeletons hold significant potential for gait assistance and rehabilitation; however, we have a limited understanding of how people adapt to walking with robotic devices. The purpose of this study was to test the hypothesis that people reduce net muscle moments about their joints when robotic assistance is provided. This reduction in muscle moment results in a total joint moment (muscle plus exoskeleton) that is the same as the moment without the robotic assistance despite potential differences in joint angles. To test this hypothesis, eight healthy subjects trained with the robotic hip exoskeleton while walking on a force-measuring treadmill. The exoskeleton provided hip flexion assistance from approximately 33% to 53% of the gait cycle. We calculated the root mean squared difference (RMSD) between the average of data from the last 15 minutes of the powered condition and the unpowered condition. After completing three 30-minute training sessions, the hip exoskeleton provided 27% of the total peak hip flexion moment during gait. Despite this substantial contribution from the exoskeleton, subjects walked with a total hip moment pattern (muscle plus exoskeleton) that was almost identical and more similar to the unpowered condition than the hip angle pattern (hip moment RMSD 0.027, angle RMSD 0.134, p<0.001). The angle and moment RMSD were not different for the knee and ankle joints. These findings support the concept that people adopt walking patterns with similar joint moment patterns despite differences in hip joint angles for a given walking speed. PMID:21333995

Effects of Imbalanced Muscle Loading on Hip Joint Development and Maturation

PubMed Central

Ford, Caleb A.; Nowlan, Niamh C.; Thomopoulos, Stavros; Killian, Megan L.

2017-01-01

The mechanical loading environment influences the development and maturation of joints. In this study, the influence of imbalanced muscular loading on joint development was studied using localized chemical denervation of hip stabilizing muscle groups in neonatal mice. It was hypothesized that imbalanced muscle loading, targeting either gluteal muscles or quadriceps muscles, would lead to bilateral hip joint asymmetry, as measured by acetabular coverage, femoral head volume and bone morphometry, and femoral-acetabular shape. The contralateral hip joints as well as age-matched, uninjected mice were used as controls. Altered bone development was analyzed using micro-computed tomography, histology, and image registration techniques at postnatal days (P) 28, 56, and 120. This study found that unilateral muscle unloading led to reduced acetabular coverage of the femoral head, lower total volume, lower bone volume ratio, and lower mineral density, at all three time points. Histologically, the femoral head was smaller in unloaded hips, with thinner triradiate cartilage at P28 and thinner cortical bone at P120 compared to contralateral hips. Morphological shape changes were evident in unloaded hips at P56. Unloaded hips had lower trabecular thickness and increased trabecular spacing of the femoral head compared to contralateral hips. The present study suggests that decreased muscle loading of the hip leads to altered bone and joint shape and growth during postnatal maturation. Statement of Clinical Significance: Adaptations from altered muscle loading during postnatal growth investigated in this study have implications on developmental hip disorders that result from asymmetric loading, such as patients with limb-length inequality or dysplasia. PMID:27391299

Muscle Strength Imbalance in the Hip Joint Caused by Fast Movements

NASA Astrophysics Data System (ADS)

Pontaga, I.

2003-07-01

Eleven male sportsmen at the age of 24.3 ± 4.5 were examined. Their hip joint flexors and extensors were tested by an "REV-9000" Technogym dynamometer system during isokinetic movements at angular velocities of 100 (low) and 200 (high) °/s. The range of hip joint movements was from 30 (in flexion) to 130° (in extension). Torque values and their ratios for hip flexors and extensors at different angular positions were obtained and compared. It is shown that, at high speeds, the flexion movement significantly raises ( p < 0.001) the torque ratios of flexors and extensors in flexion positions of the hip (50 and 60°). These ratios approximately twofold exceed their values at moderate velocities. The weakness of hip joint extensors in extreme flexion positions of the hip may cause injury of this group of muscles at fast movements.

Arthroscopy of the Nondistractable Hip: A Novel Extracapsular Approach

PubMed Central

Doron, Ran; Amar, Eyal; Rath, Ehud; Sampson, Thomas; Ochiai, Derek; Matsuda, Dean K.

2014-01-01

Adequate traction to achieve hip joint distraction is essential for avoiding iatrogenic injury to the joint during hip arthroscopy. An inability to distract the joint is a relative contraindication for hip arthroscopy. This report describes a novel technique involving an extracapsular approach to gain safe access to a hip joint that fails a trial of traction during positioning for hip arthroscopy. The anterolateral portal is established under fluoroscopic guidance. The arthroscope is positioned on the lateral rim of the acetabulum. A shaver, introduced through a modified anterior portal, is used to facilitate capsular exposure. An arthroscopic capsular incision is made proximal to the lateral acetabular rim and extended anteriorly with a radiofrequency probe. Osteoplasty of the anterolateral acetabular rim is carried out with a burr while protecting the labrum. Distraction of the hip is then possible, allowing safe central-compartment access and subsequent chondrolabral procedures. PMID:25685682

[Acetabuloplasty in cerebral palsy patients].

PubMed

Schejbalová, A; Chládek, P

2007-12-01

Acetabuloplasty as an isolated surgical procedure is one of the options allowing for hip joint realignment in cerebral palsy patients. Also, it is often involved in combined techniques used for hip joint reconstruction. In the years 2004-2005, 20 cerebral palsy patients, aged from 4 to 13 years, were indicated for acetabuloplasty. The group included children with varying degrees of locomotor disability, ranging from inability even to crawl to ability to move without support (stages 2 to 7 on the Vojta scale). Clinical and X-ray findings were evaluated at 2 and 6 months after surgical treatment and then every 6 months of follow- up. The X-ray finding was described by means of CE angle (Wiberg) values and hip migration percentage. Of 21 hips (in 20 patients) treated by acetabuloplasty in our modification during the two years, one developed recurrent dorsal dislocation which was possible to deal with by conservative treatment. All hips pre-operatively categorized as group B or group C were post-operatively assessed as group A hips. Subsequent migration of the acetabulum occurred within a year in two patients with distinct original asymmetry. Surgery on bones comprising the hip joint in cerebral palsy patients is indicated according to the degree of lateral migration and changes in hip joint geometry involving the proximal femur or pelvis, or in combination with open reduction. Acetabuloplasty is indicated as an isolated procedure or as part of combined techniques leading to a better coverage of the hip joint. It is recommended for children up to 10 years of age, but also older ones, in whom the flexibility of child bones enables us to do without internal osteosynthesis. Acetabuloplasty is indicated as an isolated surgical procedure for hip joint subluxation in cerebral palsy children. It has no adverse effects on hip abductors that, in cerebral palsy patients, are 85 % insufficient. It improves hip joint symmetry and helps to avoid more demanding reconstructive or palliative procedures. Key words: cerebral palsy, acetabuloplasty, lateral migration.

Comparison of techniques for correction of magnification of pelvic X-rays for hip surgery planning.

PubMed

The, Bertram; Kootstra, Johan W J; Hosman, Anton H; Verdonschot, Nico; Gerritsma, Carina L E; Diercks, Ron L

2007-12-01

The aim of this study was to develop an accurate method for correction of magnification of pelvic x-rays to enhance accuracy of hip surgery planning. All investigated methods aim at estimating the anteroposterior location of the hip joint in supine position to correctly position a reference object for correction of magnification. An existing method-which is currently being used in clinical practice in our clinics-is based on estimating the position of the hip joint by palpation of the greater trochanter. It is only moderately accurate and difficult to execute reliably in clinical practice. To develop a new method, 99 patients who already had a hip implant in situ were included; this enabled determining the true location of the hip joint deducted from the magnification of the prosthesis. Physical examination was used to obtain predictor variables possibly associated with the height of the hip joint. This included a simple dynamic hip joint examination to estimate the position of the center of rotation. Prediction equations were then constructed using regression analysis. The performance of these prediction equations was compared with the performance of the existing protocol. The mean absolute error in predicting the height of the hip joint center using the old method was 20 mm (range -79 mm to +46 mm). This was 11 mm for the new method (-32 mm to +39 mm). The prediction equation is: height (mm) = 34 + 1/2 abdominal circumference (cm). The newly developed prediction equation is a superior method for predicting the height of the hip joint center for correction of magnification of pelvic x-rays. We recommend its implementation in the departments of radiology and orthopedic surgery.

[Bone surgery for unstable hips in patients with cerebral palsy].

PubMed

Poul, J; Pesl, M; Pokorná, M

2004-01-01

The aim of this retrospective study was to compare the efficacy of femoral osteotomy alone with that of osteotomy combined with an acetabular procedure in patients with unstable hips due to spastic cerebral palsy. Sixty-one hip joints in 50 patients who had shown distinct subluxation or dislocation of the joint were operated on. Eleven patients underwent bilateral surgery. Before bone surgery, soft-tissue release involving both the flexors and adductors was performed on 19 hips. Femoral osteotomy alone was performed on 29 hip joints and combined femoral and pelvic osteotomy was carried out on 32 joints.Twelve resections of the proximal femur in seven patients were evaluated as a separate group. All treated hip joints were assessed by clinical and radiographic examination at a follow-up of more than 5 years. The skiagraphs taken in a strictly neutral position of the lower limbs before surgery and at the final examination were evaluated on the basis of Reimers's migration index and Wiberg's centre-edge angle. The locomotor abilities of each child were categorized according to the Vojta scoring system for locomotor development. The range of motion in the treated hip joint was assessed using the standard S. F. T. R. method. The results obtained were statistically analyzed by the Kruskal- Wallis, one-way ANOVA test. A comparison of the results of femoral osteotomy alone with those of combined femoral and pelvic osteotomy showed that the post-operative values of the migration index and centre-edge angle, as compared with the pre-operative ones, were statistically higher (p<0.05) in the latter. In a long-term perspective, the surgery had no adverse effects on a natural development of locomotor abilities of the child. The children had higher scores by the modified Vojta rating system. There was no change in the range of motion in the treated hip joints after the operation. In 28, out of the 32 joints treated by combined femoral and pelvic osteotomy, Salter osteotomy was performed and it showed a high efficacy in providing hip joint stability. The main emphasis during surgery was placed on the maximum acetabular rotation laterally. Femoral osteotomy alone was less effective in providing hip joint stability; in addition, in order to achieve this, tilting of the proximal fragment to a varus position was generally higher than in combined operations. In three patients this treatment resulted in fixed adduction of the hip joint with negative consequences for movement. In the treatment of unstable hip joints a combination of varus derotation femoral osteotomy and pelvic osteotomy provides better containment of the joint than femoral osteotomy alone.

Hip joint biomechanics in those with and without post-traumatic knee osteoarthritis after anterior cruciate ligament injury.

PubMed

Wellsandt, E; Zeni, J A; Axe, M J; Snyder-Mackler, L

2017-12-01

Anterior cruciate ligament injury results in altered kinematics and kinetics in the knee and hip joints that persist despite surgical reconstruction and rehabilitation. Abnormal movement patterns and a history of osteoarthritis are risk factors for articular cartilage degeneration in additional joints. The purpose of this study was to determine if hip joint biomechanics early after anterior cruciate ligament injury and reconstruction differ between patients with and without post-traumatic knee osteoarthritis 5years after reconstruction. The study's rationale was that individuals who develop knee osteoarthritis after anterior cruciate ligament injury may also demonstrate large alterations in hip joint biomechanics. Nineteen athletes with anterior cruciate ligament injury completed standard gait analysis before (baseline) and after (post-training) extended pre-operative rehabilitation and at 6months, 1year, and 2years after reconstruction. Weightbearing knee radiographs were completed 5years after reconstruction to identify medial compartment osteoarthritis. Five of 19 patients had knee osteoarthritis at 5years after anterior cruciate ligament reconstruction. Patients with knee osteoarthritis at 5years walked with smaller sagittal plane hip angles (P: 0.043) and lower sagittal (P: 0.021) and frontal plane (P: 0.042) external hip moments in the injured limb before and after reconstruction compared to those without knee osteoarthritis. The current findings suggest hip joint biomechanics may be altered in patients who develop post-traumatic knee osteoarthritis. Further study is needed to confirm whether the risk of non-traumatic hip pathology is increased after anterior cruciate ligament injury and if hip joint biomechanics influence its development. Copyright © 2017 Elsevier Ltd. All rights reserved.

Joint kinematics and kinetics during walking and running in 32 patients with hip dysplasia 1 year after periacetabular osteotomy

PubMed Central

Jacobsen, Julie S; Nielsen, Dennis B; Sørensen, Henrik; Søballe, Kjeld; Mechlenburg, Inger

2014-01-01

Background and purpose — Hip dysplasia can be treated with periacetabular osteotomy (PAO). We compared joint angles and joint moments during walking and running in young adults with hip dysplasia prior to and 6 and 12 months after PAO with those in healthy controls. Patients and methods — Joint kinematics and kinetics were recorded using a 3-D motion capture system. The pre- and postoperative gait characteristics quantified as the peak hip extension angle and the peak joint moment of hip flexion were compared in 23 patients with hip dysplasia (18–53 years old). Similarly, the gait patterns of the patients were compared with those of 32 controls (18–54 years old). Results — During walking, the peak hip extension angle and the peak hip flexion moment were significantly smaller at baseline in the patients than in the healthy controls. The peak hip flexion moment increased 6 and 12 months after PAO relative to baseline during walking, and 6 months after PAO relative to baseline during running. For running, the improvement did not reach statistical significance at 12 months. In addition, the peak hip extension angle during walking increased 12 months after PAO, though not statistically significantly. There were no statistically significant differences in peak hip extension angle and peak hip flexion moment between the patients and the healthy controls after 12 months. Interpretation — Walking and running characteristics improved after PAO in patients with symptomatic hip dysplasia, although gait modifications were still present 12 months postoperatively. PMID:25191933

Evaluation of the magnitude of hip joint deformation in subjects with avascular necrosis of the hip joint during walking with and without Scottish Rite orthosis.

PubMed

Karimi, Mohammad Taghi; Mohammadi, Ali; Ebrahimi, Mohammad Hossein; McGarry, Anthony

2017-02-01

The femoral head in subjects with leg calve perthes disease (LCPD) is generally considerably deformed. It is debatable whether this deformation is due to an increase in applied loads, a decrease in bone mineral density or a change in containment of articular surfaces. The aim of this study was to determine the influence of these factors on deformation of the femoral head. Two subjects with LCPD participated in this study. Subject motion and the forces applied on the affected leg were recorded using a motion analysis system (Qualsis TM ) and a Kistler force plate. OpenSim software was used to determine joint contact force of the hip joint whilst walking with and without a Scottish Rite orthosis. 3D Models of hip joints of both subjects were produced by Mimics software. The deformation of femoral bone was determined by Abaqus. Mean values of the force applied on the leg increased while walking with the orthosis. There was no difference between bone mineral density (BMD) of the femoral bone of normal and LCPD sides (p-value>0.05) and no difference between hip joint contact force of normal and LCPD sides. Hip joint containment appeared to decrease follow the use of the orthosis. It can be concluded that the deformation of femoral head in LCPD may not be due to change in BMD or applied load. Although the Scottish Rite orthosis is used mostly to increase hip joint containment, it appears to reduce hip joint contact area. It is recommended that a similar study is conducted using a higher number of subjects. Copyright © 2016 IPEM. All rights reserved.

Design, simulation and modelling of auxiliary exoskeleton to improve human gait cycle.

PubMed

Ashkani, O; Maleki, A; Jamshidi, N

2017-03-01

Exoskeleton is a walking assistance device that improves human gait cycle through providing auxiliary force and transferring physical load to the stronger muscles. This device takes the natural state of organ and follows its natural movement. Exoskeleton functions as an auxiliary device to help those with disabilities in hip and knee such as devotees, elderly farmers and agricultural machinery operators who suffer from knee complications. In this research, an exoskeleton designed with two screw jacks at knee and hip joints. To simulate extension and flexion movements of the leg joints, bearings were used at the end of hip and knee joints. The generated torque and motion angles of these joints obtained as well as the displacement curves of screw jacks in the gait cycle. Then, the human gait cycle was simulated in stance and swing phases and the obtained torque curves were compared. The results indicated that they followed the natural circle of the generated torque in joints with a little difference from each other. The maximum displacement obtained 4 and 6 cm in hip and knee joints jack respectively. The maximum torques in hip and knee joints were generated in foot contact phase. Also the minimum torques in hip and knee joints were generated in toe off and heel off phases respectively.

[Comparison of early clinical effects of two hip prosthesis designs between ceramics to ceramics and metal to polyethylene].

PubMed

Yang, Li-qing; Li, Xi; Fu, Qin; Wang, Cheng

2013-07-01

To retrospectively study early therapeutic effects of the ceramics to ceramics prosthesis design in treating hip disease. From October 2007 to September 2010, 42 patients (44 hips) with hip disease underwent replacement of total hip. Hip prosthesis designs included the Pinnacle ceramics to ceramics and the Duraloc metal to polyethylene,produced by DePuy Company, all were non-bone cement type of artificial hip joint. Twenty patients (22 hips) were performed with ceramics to ceramics total hip prosthesis (CoC group, there were 12 males and 8 females, aged from 21 to 49 years) and 22 patients (22 hips) were performed with metal to polyethylene total hip prosthesis (MoP group, there were 13 males and 9 females, aged from 42 to 55 years). All the surgical approachs were posterolateral, and the routine anticoagulation and the corresponding functional exercise were performed after operation. The follow-up time was 6 months at least including clinical and radiographic observation. Measured the motion of joint and evaluated the function of hip joint according to Harris classification. All clinical effects were satisfactory and no dislocation ,loosening,infection, deep venous thrombosis and other complications occurred. There was no statistical significance in Harris scoring and the motion of joint between two groups before and after operation (P>0.05). The clinical effect of ceramics to ceramics prosthesis design in improving clinical symptoms and the motion of joint is coordinate with metal to polyethylene total hip prosthesis, however, its advantages and long-term efficacy need further observing. The ceramics to ceramics prosthesis design may be a good choice for the young patients with hip disease because of its good wear resistance.

Invariant hip moment pattern while walking with a robotic hip exoskeleton.

PubMed

Lewis, Cara L; Ferris, Daniel P

2011-03-15

Robotic lower limb exoskeletons hold significant potential for gait assistance and rehabilitation; however, we have a limited understanding of how people adapt to walking with robotic devices. The purpose of this study was to test the hypothesis that people reduce net muscle moments about their joints when robotic assistance is provided. This reduction in muscle moment results in a total joint moment (muscle plus exoskeleton) that is the same as the moment without the robotic assistance despite potential differences in joint angles. To test this hypothesis, eight healthy subjects trained with the robotic hip exoskeleton while walking on a force-measuring treadmill. The exoskeleton provided hip flexion assistance from approximately 33% to 53% of the gait cycle. We calculated the root mean squared difference (RMSD) between the average of data from the last 15 min of the powered condition and the unpowered condition. After completing three 30-min training sessions, the hip exoskeleton provided 27% of the total peak hip flexion moment during gait. Despite this substantial contribution from the exoskeleton, subjects walked with a total hip moment pattern (muscle plus exoskeleton) that was almost identical and more similar to the unpowered condition than the hip angle pattern (hip moment RMSD 0.027, angle RMSD 0.134, p<0.001). The angle and moment RMSD were not different for the knee and ankle joints. These findings support the concept that people adopt walking patterns with similar joint moment patterns despite differences in hip joint angles for a given walking speed. Copyright © 2011 Elsevier Ltd. All rights reserved.

Joint Moment-Angle Properties of the Hip Extensors in Subjects With and Without Patellofemoral Pain.

PubMed

Kindel, Curtis; Challis, John

2018-04-01

Strength deficits of hip extension in individuals with patellofemoral syndrome are commonly reported in literature. No literature to date has examined these deficits with variable positions of the knee and hip; altering knee angle alters the length and therefore potentially the force produced by the biarticular muscles. Beyond strength, neuromuscular control can also be assessed through the analysis of isometric joint moment steadiness. Subjects consisted of a group of individuals with patellofemoral syndrome (n = 9), and a group of age- and size-matched controls with no symptoms (n = 9). Maximum isometric joint moments for hip extension were measured at 4 points within the joint's range of motion, at 2 different knee positions (0° and 90°) for each group. The joint moment signals were analyzed by computing signal Coefficient of Variation (CV). The results indicate that no significant differences were found between the groups of subjects for the hip extension moments when the knee was extended. However, there was a significant difference between the groups for the joint moments of hip extension with the knee flexed at all 4 hip positions. Results also showed hip extension CV values to be significantly higher in the patellofemoral group compared with the control group, indicating greater signal noise and therefore poorer neuromuscular control of the hip extensor musculature. This study demonstrated that individuals with patellofemoral syndrome have reduced hip extension strength and reduced neuromuscular control with the knee flexed compared with a control group. These results have implications for the etiology of patellofemoral syndrome and its rehabilitation.

Effects of imbalanced muscle loading on hip joint development and maturation.

PubMed

Ford, Caleb A; Nowlan, Niamh C; Thomopoulos, Stavros; Killian, Megan L

2017-05-01

The mechanical loading environment influences the development and maturation of joints. In this study, the influence of imbalanced muscular loading on joint development was studied using localized chemical denervation of hip stabilizing muscle groups in neonatal mice. It was hypothesized that imbalanced muscle loading, targeting either gluteal muscles or quadriceps muscles, would lead to bilateral hip joint asymmetry, as measured by acetabular coverage, femoral head volume and bone morphometry, and femoral-acetabular shape. The contralateral hip joints as well as age-matched, uninjected mice were used as controls. Altered bone development was analyzed using micro-computed tomography, histology, and image registration techniques at postnatal days (P) 28, 56, and 120. This study found that unilateral muscle unloading led to reduced acetabular coverage of the femoral head, lower total volume, lower bone volume ratio, and lower mineral density, at all three time points. Histologically, the femoral head was smaller in unloaded hips, with thinner triradiate cartilage at P28 and thinner cortical bone at P120 compared to contralateral hips. Morphological shape changes were evident in unloaded hips at P56. Unloaded hips had lower trabecular thickness and increased trabecular spacing of the femoral head compared to contralateral hips. The present study suggests that decreased muscle loading of the hip leads to altered bone and joint shape and growth during postnatal maturation. Statement of Clinical Significance: Adaptations from altered muscle loading during postnatal growth investigated in this study have implications on developmental hip disorders that result from asymmetric loading, such as patients with limb-length inequality or dysplasia. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1128-1136, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Acetabular cartilage defects cause altered hip and knee joint coordination variability during gait.

PubMed

Samaan, Michael A; Teng, Hsiang-Ling; Kumar, Deepak; Lee, Sonia; Link, Thomas M; Majumdar, Sharmila; Souza, Richard B

2015-12-01

Patients with acetabular cartilage defects reported increased pain and disability compared to those without acetabular cartilage defects. The specific effects of acetabular cartilage defects on lower extremity coordination patterns are unclear. The purpose of this study was to determine hip and knee joint coordination variability during gait in those with and without acetabular cartilage defects. A combined approach, consisting of a semi-quantitative MRI-based quantification method and vector coding, was used to assess hip and knee joint coordination variability during gait in those with and without acetabular cartilage lesions. The coordination variability of the hip flexion-extension/knee rotation, hip abduction-adduction/knee rotation, and hip rotation/knee rotation joint couplings were reduced in the acetabular lesion group compared to the control group during loading response of the gait cycle. The lesion group demonstrated increased variability in the hip flexion-extension/knee rotation and hip abduction-adduction/knee rotation joint couplings, compared to the control group, during the terminal stance/pre-swing phase of gait. Reduced variability during loading response in the lesion group may suggest reduced movement strategies and a possible compensation mechanism for lower extremity instability during this phase of the gait cycle. During terminal stance/pre-swing, a larger variability in the lesion group may suggest increased movement strategies and represent a compensation or pain avoidance mechanism caused by the load applied to the hip joint. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Juvenile rheumatoid diseases: Endoprosthetic care of destroyed hip joints].

PubMed

Rehart, S; Henniger, M

2015-07-01

Patients with juvenile idiopathic arthritis (JIA) often suffer from involvement of the hip joints, with joint destruction and related functional limitations, making hip replacement necessary. To discover what special features are to be expected in patients with JIA and hip arthroplasty and what impact they have on surgical indication, choice of implant, and technique. Selective literature review and evaluation of our patient population. Compared with osteoarthritis patients, JIA patients are on average much younger at the time of hip replacement. Owing to the onset of the disease in childhood or adolescence and the frequent glucocorticoid therapy, growth disorders or abnormal anatomical findings are common in these patients. Bone density is often reduced at an early age. The perioperative management of medication has to be planned. Special implants for patients with rheumatic diseases do not exist, but the above peculiarities of this group of patients should be considered for surgical procedure and choice of implant and material. Overall, the results of hip arthroplasty in juvenile rheumatic diseases, in terms of pain relief and functional improvement, are good. The limited life of the arthroplasty is problematic. By relieving pain, improvement of the range of motion and activity level very high patient satisfaction is usually achieved by hip arthroplasty in JIA patients. In the case of involvement of the contralateral hip or the ipsilateral knee joint it may be useful to perform a simultaneous, single-stage joint replacement of both joints.

Kinematic relationship between rotation of lumbar spine and hip joints during golf swing in professional golfers.

PubMed

Mun, Frederick; Suh, Seung Woo; Park, Hyun-Joon; Choi, Ahnryul

2015-05-14

Understanding the kinematics of the lumbar spine and hip joints during a golf swing is a basic step for identifying swing-specific factors associated with low back pain. The objective of this study was to examine the kinematic relationship between rotational movement of the lumbar spine and hip joints during a golf swing. Fifteen professional golfers participated in this study with employment of six infrared cameras to record their golf swings. Anatomical reference system of the upper torso, pelvis and thigh segments, and the location of each hip and knee joint were defined by the protocols of the kinematic model of previous studies. Lumbar spine and hip joint rotational angle was calculated utilizing the Euler angle method. Cross-correlation and angle-angle plot was used to examine the degree of kinematic relationship between joints. A fairly strong coupling relationship was shown between the lumbar spine and hip rotational movements with an average correlation of 0.81. Leading hip contribution to overall rotation was markedly high in the early stage of the downswing, while the lumbar spine contributed greater towards the end of the downswing; however, the relative contributions of the trailing hip and lumbar spine were nearly equal during the entire downswing. Most of the professional golfers participated in this study used a similar coordination strategy when moving their hips and lumbar spine during golf swings. The rotation of hips was observed to be more efficient in producing the overall rotation during the downswing when compared to the backswing. These results provide quantitative information to better understand the lumbar spine and hip joint kinematic characteristics of professional golfers. This study will have great potential to be used as a normal control data for the comparison with kinematic information among golfers with low back pain and for further investigation of golf swing-specific factors associated with injury.

Hip joint replacement

MedlinePlus

... Total hip replacement; Hip hemiarthroplasty; Arthritis - hip replacement; Osteoarthritis - hip replacement ... total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised ...

Evaluation of the Hip: History and Physical Examination

PubMed Central

2007-01-01

Examination of a painful hip is fairly concise and reliable at detecting the presence of a hip joint problem. Hip joint disorders often go undetected, leading to the development of secondary disorders. Using a thoughtful approach and methodical examination techniques, most hip joint problems can be detected and a proper treatment strategy can then be implemented based on an accurate diagnosis. The purpose of this clinical commentary is to present a systematic examination process that outlines important components in each of the evaluation areas of history and physical examination (including inspection, measurements, symptom localization, muscle strength, and special tests). PMID:21509142

Sagittal plane gait characteristics in hip osteoarthritis patients with mild to moderate symptoms compared to healthy controls: a cross-sectional study.

PubMed

Eitzen, Ingrid; Fernandes, Linda; Nordsletten, Lars; Risberg, May Arna

2012-12-20

Existent biomechanical studies on hip osteoarthritic gait have primarily focused on the end stage of disease. Consequently, there is no clear consensus on which specific gait parameters are of most relevance for hip osteoarthritis patients with mild to moderate symptoms. The purpose of this study was to explore sagittal plane gait characteristics during the stance phase of gait in hip osteoarthritis patients not eligible for hip replacement surgery. First, compared to healthy controls, and second, when categorized into two subgroups of radiographic severity defined from a minimal joint space of ≤/>2 mm. Sagittal plane kinematics and kinetics of the hip, knee and ankle joint were calculated for total joint excursion throughout the stance phase, as well as from the specific events initial contact, midstance, peak hip extension and toe-off following 3D gait analysis. In addition, the Western Ontario and McMaster Universities Osteoarthritis Index, passive hip range of motion, and isokinetic muscle strength of hip and knee flexion and extension were included as secondary outcomes. Data were checked for normality and differences evaluated with the independent Student's t-test, Welch's t-test and the independent Mann-Whitney U-test. A binary logistic regression model was used in order to control for velocity in key variables. Fourty-eight hip osteoarthritis patients and 22 controls were included in the final material. The patients walked significantly slower than the controls (p=0.002), revealed significantly reduced joint excursions of the hip (p<0.001) and knee (p=0.011), and a reduced hip flexion moment at midstance and peak hip extension (p<0.001). Differences were primarily manifested during the latter 50% of stance, and were persistent when controlling for velocity. Subgroup analyses of patients with minimal joint space ≤/>2 mm suggested that the observed deviations were more pronounced in patients with greater radiographic severity. The biomechanical differences were, however, not reflected in self-reported symptoms or function. Reduced gait velocity, reduced sagittal plane joint excursion, and a reduced hip flexion moment in the late stance phase of gait were found to be evident already in hip osteoarthritis patients with mild to moderate symptoms, not eligible for total hip replacement. Consequently, these variables should be considered as key features in studies regarding hip osteoarthritic gait at all stages of disease. Subgroup analyses of patients with different levels of radiographic OA further generated the hypothesis that the observed characteristics were more pronounced in patients with a minimal joint space ≤2 mm.

Lower extremity joint moments of collegiate soccer players differ between genders during a forward jump.

PubMed

Hart, Joseph M; Garrison, J Craig; Palmieri-Smith, Riann; Kerrigan, D Casey; Ingersoll, Christopher D

2008-05-01

Lower extremity kinetics while performing a single-leg forward jump landing may help explain gender biased risk for noncontact anterior cruciate ligament injury. Gender comparison of lower extremity joint angles and moments. Static groups comparison. Motion analysis laboratory. 8 male and 8 female varsity, collegiate soccer athletes. 5 single-leg landings from a 100cm forward jump. Peak and initial contact external joint moments and joint angles of the ankle, knee, and hip. At initial heel contact, males exhibited a adduction moment whereas females exhibited a abduction moment at the hip. Females also had significantly less peak hip extension moment and significantly less peak hip internal rotation moment than males had. Females exhibited greater knee adduction and hip internal rotation angles than men did. When decelerating from a forward jump, gender differences exist in forces acting at the hip.

Bilaterally Asymmetric Effects of Quantitative Trait Loci (QTLs): QTLs That Affect Laxity in the Right Versus Left Coxofemoral (Hip) Joints of the Dog (Canis familiaris)

PubMed Central

Chase, Kevin; Lawler, Dennis F.; Adler, Fred R.; Ostrander, Elaine A.; Lark, Karl G.

2009-01-01

In dogs hip joint laxity that can lead to degenerative joint disease (DJD) is frequent and heritable, providing a genetic model for some aspects of the human disease. We have used Portuguese water dogs (PWDs) to identify Quantitative trait loci (QTLs) that regulate laxity in the hip joint.A population of 286 PWDs, each characterized by ca. 500 molecular genetic markers, was analyzed for subluxation of the hip joint as measured by the Norberg angle, a quantitative radiographic measure of laxity. A significant directed asymmetry was observed, such that greater laxity was observed in the left than the right hip. This asymmetry was not heritable. However, the average Norberg angle was highly heritable as were the Norberg angles of either the right or left hips. After correction for pedigree effects, two QTLs were identified using the metrics of the left and right hips as separate data sets. Both are on canine chromosome 1 (CFA1), separated by about 95 Mb. One QTL, associated with the SSR marker FH2524 was significant for the left, but not the right hip. The other, associated with FH2598, was significant for the right but not the left hip. For both QTLs, some extreme phenotypes were best explained by specific interactions between haplotypes. PMID:14708095

Bilaterally asymmetric effects of quantitative trait loci (QTLs): QTLs that affect laxity in the right versus left coxofemoral (hip) joints of the dog (Canis familiaris).

PubMed

Chase, Kevin; Lawler, Dennis F; Adler, Fred R; Ostrander, Elaine A; Lark, Karl G

2004-01-30

In dogs hip joint laxity that can lead to degenerative joint disease (DJD) is frequent and heritable, providing a genetic model for some aspects of the human disease. We have used Portuguese water dogs (PWDs) to identify Quantitative trait loci (QTLs) that regulate laxity in the hip joint. A population of 286 PWDs, each characterized by ca. 500 molecular genetic markers, was analyzed for subluxation of the hip joint as measured by the Norberg angle, a quantitative radiographic measure of laxity. A significant directed asymmetry was observed, such that greater laxity was observed in the left than the right hip. This asymmetry was not heritable. However, the average Norberg angle was highly heritable as were the Norberg angles of either the right or left hips. After correction for pedigree effects, two QTLs were identified using the metrics of the left and right hips as separate data sets. Both are on canine chromosome 1 (CFA1), separated by about 95 Mb. One QTL, associated with the SSR marker FH2524 was significant for the left, but not the right hip. The other, associated with FH2598, was significant for the right but not the left hip. For both QTLs, some extreme phenotypes were best explained by specific interactions between haplotypes. Copyright 2003 Wiley-Liss, Inc.

The effect of angle and moment of the hip and knee joint on iliotibial band hardness.

PubMed

Tateuchi, Hiroshige; Shiratori, Sakiko; Ichihashi, Noriaki

2015-02-01

Although several studies have described kinematic deviations such as excessive hip adduction in patients with iliotibial band (ITB) syndrome, the factors contributing to increased ITB hardness remains undetermined, owing to lack of direct in vivo measurement. The purpose of this study was to clarify the factors contributing to an increase in ITB hardness by comparing the ITB hardness between the conditions in which the angle, moment, and muscle activity of the hip and knee joint are changed. Sixteen healthy individuals performed the one-leg standing under five conditions in which the pelvic and trunk inclination were changed in the frontal plane. The shear elastic modulus in the ITB was measured as an indicator of the ITB hardness using shear wave elastography. The three-dimensional joint angle and external joint moment in the hip and knee joints, and muscle activities of the gluteus maximus, gluteus medius, tensor fasciae latae, and vastus lateralis, which anatomically connect to the ITB, were also measured. ITB hardness was significantly increased in the posture with pelvic and trunk inclination toward the contralateral side of the standing leg compared with that in all other conditions (increase of approximately 32% compared with that during normal one-leg standing). This posture increased both the hip adduction angle and external adduction moment at the hip and knee joint, although muscle activities were not increased. Our findings suggest that coexistence of an increased adduction moment at the hip and knee joints with an excessive hip adduction angle lead to an increase in ITB hardness. Copyright © 2014 Elsevier B.V. All rights reserved.

Mildly disabled persons with multiple sclerosis use similar net joint power strategies as healthy controls when walking speed increases.

PubMed

Brincks, John; Christensen, Lars Ejsing; Rehnquist, Mette Voigt; Petersen, Jesper; Sørensen, Henrik; Dalgas, Ulrik

2018-01-01

To improve walking in persons with multiple sclerosis (MS), it is essential to understand the underlying mechanisms of walking. This study examined strategies in net joint power generated or absorbed by hip flexors, hip extensors, hip abductors, knee extensors, and plantar flexors in mildly disabled persons with MS and healthy controls at different walking speeds. Thirteen persons with MS and thirteen healthy controls participated and peak net joint power was calculated using 3D motion analysis. In general, no differences were found between speed-matched healthy controls and persons with MS, but the fastest walking speed was significantly higher in healthy controls (2.42 m/s vs. 1.70 m/s). The net joint power increased in hip flexors, hip extensors, hip abductors, knee extensors and plantar flexors in both groups, when walking speed increased. Significant correlations between changes in walking speed and changes in net joint power of plantar flexors, hip extensors and hip flexors existed in healthy controls and persons with MS, and in net knee extensor absorption power of persons with MS only. In contrast to previous studies, these findings suggest that mildly disabled persons with MS used similar kinetic strategies as healthy controls to increase walking speed.

Coupling motion between rearfoot and hip and knee joints during walking and single-leg landing.

PubMed

Koshino, Yuta; Yamanaka, Masanori; Ezawa, Yuya; Okunuki, Takumi; Ishida, Tomoya; Samukawa, Mina; Tohyama, Harukazu

2017-12-01

The objective of the current study was to investigate the kinematic relationships between the rearfoot and hip/knee joint during walking and single-leg landing. Kinematics of the rearfoot relative to the shank, knee and hip joints during walking and single-leg landing were analyzed in 22 healthy university students. Kinematic relationships between two types of angular data were assessed by zero-lag cross-correlation coefficients and coupling angles, and were compared between joints and between tasks. During walking, rearfoot eversion/inversion and external/internal rotation were strongly correlated with hip adduction/abduction (R=0.69 and R=0.84), whereas correlations with knee kinematics were not strong (R≤0.51) and varied between subjects. The correlations with hip adduction/abduction were stronger than those with knee kinematics (P<0.001). Most coefficients during single-leg landing were strong (R≥0.70), and greater than those during walking (P<0.001). Coupling angles indicated that hip motion relative to rearfoot motion was greater than knee motion relative to rearfoot motion during both tasks (P<0.001). Interventions to control rearfoot kinematics may affect hip kinematics during dynamic tasks. The coupling motion between the rearfoot and hip/knee joints, especially in the knee, should be considered individually. Copyright © 2017 Elsevier Ltd. All rights reserved.

Assessment of congruence and impingement of the hip joint in professional ballet dancers: a motion capture study.

PubMed

Charbonnier, Caecilia; Kolo, Frank C; Duthon, Victoria B; Magnenat-Thalmann, Nadia; Becker, Christoph D; Hoffmeyer, Pierre; Menetrey, Jacques

2011-03-01

Early hip osteoarthritis in dancers could be explained by femoroacetabular impingements. However, there is a lack of validated noninvasive methods and dynamic studies to ascertain impingement during motion. Moreover, it is unknown whether the femoral head and acetabulum are congruent in typical dancing positions. The practice of some dancing movements could cause a loss of hip joint congruence and recurrent impingements, which could lead to early osteoarthritis. Descriptive laboratory study. Eleven pairs of female dancer's hips were motion captured with an optical tracking system while performing 6 different dancing movements. The resulting computed motions were applied to patient-specific hip joint 3-dimensional models based on magnetic resonance images. While visualizing the dancer's hip in motion, the authors detected impingements using computer-assisted techniques. The range of motion and congruence of the hip joint were also quantified in those 6 recorded dancing movements. The frequency of impingement and subluxation varied with the type of movement. Four dancing movements (développé à la seconde, grand écart facial, grand écart latéral, and grand plié) seem to induce significant stress in the hip joint, according to the observed high frequency of impingement and amount of subluxation. The femoroacetabular translations were high (range, 0.93 to 6.35 mm). For almost all movements, the computed zones of impingement were mainly located in the superior or posterosuperior quadrant of the acetabulum, which was relevant with respect to radiologically diagnosed damaged zones in the labrum. All dancers' hips were morphologically normal. Impingements and subluxations are frequently observed in typical ballet movements, causing cartilage hypercompression. These movements should be limited in frequency. The present study indicates that some dancing movements could damage the hip joint, which could lead to early osteoarthritis.

Patient-specific musculoskeletal modeling of the hip joint for preoperative planning of total hip arthroplasty: A validation study based on in vivo measurements

PubMed Central

Schick, Fabian; Asseln, Malte; Damm, Philipp; Radermacher, Klaus

2018-01-01

Validation of musculoskeletal models for application in preoperative planning is still a challenging task. Ideally, the simulation results of a patient-specific musculoskeletal model are compared to corresponding in vivo measurements. Currently, the only possibility to measure in vivo joint forces is to implant an instrumented prosthesis in patients undergoing a total joint replacement. In this study, a musculoskeletal model of the AnyBody Modeling System was adapted patient-specifically and validated against the in vivo hip joint force measurements of ten subjects performing one-leg stance and level walking. The impact of four model parameters was evaluated; hip joint width, muscle strength, muscle recruitment, and type of muscle model. The smallest difference between simulated and in vivo hip joint force was achieved by using the hip joint width measured in computed tomography images, a muscle strength of 90 N/cm2, a third order polynomial muscle recruitment, and a simple muscle model. This parameter combination reached mean deviations between simulation and in vivo measurement during the peak force phase of 12% ± 14% in magnitude and 11° ± 5° in orientation for one-leg stance and 8% ± 6% in magnitude and 10° ± 5° in orientation for level walking. PMID:29649235

Effect of increased pushoff during gait on hip joint forces

PubMed Central

Lewis, Cara L.; Garibay, Erin J.

2014-01-01

Anterior acetabular labral tears and anterior hip pain may result from high anteriorly directed forces from the femur on the acetabulum. While providing more pushoff is known to decrease sagittal plane hip moments, it is unknown if this gait modification also decreases hip joint forces. The purpose of this study was to determine if increasing pushoff decreases hip joint forces. Nine healthy subjects walked on an instrumented force treadmill at 1.25 m/s under two walking conditions. For the natural condition, subjects were instructed to walk as they normally would. For the increased pushoff condition, subjects were instructed to “push more with your foot when you walk”. We collected motion data of markers placed on the subjects’ trunk and lower extremities to capture trunk and leg kinematics and ground reaction force data to determine joint moments. Data were processed in Visual 3D to produce the inverse kinematics and model scaling files. In OpenSim, the generic gait model (Gait2392) was scaled to the subject, and hip joint forces were calculated for the femur on the acetabulum after computing the muscle activations necessary to reproduce the experimental data. The instruction to “push more with your foot when you walk” reduced the maximum hip flexion and extension moment compared to the natural condition. The average reduction in the hip joint forces was 12.5%, 3.2% and 9.6% in the anterior, superior and medial directions respectively and 2.3% for the net resultant force. Increasing pushoff may be an effective gait modification for people with anterior hip pain. PMID:25468661

Effect of increased pushoff during gait on hip joint forces.

PubMed

Lewis, Cara L; Garibay, Erin J

2015-01-02

Anterior acetabular labral tears and anterior hip pain may result from high anteriorly directed forces from the femur on the acetabulum. While providing more pushoff is known to decrease sagittal plane hip moments, it is unknown if this gait modification also decreases hip joint forces. The purpose of this study was to determine if increasing pushoff decreases hip joint forces. Nine healthy subjects walked on an instrumented force treadmill at 1.25 m/s under two walking conditions. For the natural condition, subjects were instructed to walk as they normally would. For the increased pushoff condition, subjects were instructed to "push more with your foot when you walk". We collected motion data of markers placed on the subjects' trunk and lower extremities to capture trunk and leg kinematics and ground reaction force data to determine joint moments. Data were processed in Visual3D to produce the inverse kinematics and model scaling files. In OpenSim, the generic gait model (Gait2392) was scaled to the subject, and hip joint forces were calculated for the femur on the acetabulum after computing the muscle activations necessary to reproduce the experimental data. The instruction to "push more with your foot when you walk" reduced the maximum hip flexion and extension moment compared to the natural condition. The average reduction in the hip joint forces were 12.5%, 3.2% and 9.6% in the anterior, superior and medial directions respectively and 2.3% for the net resultant force. Increasing pushoff may be an effective gait modification for people with anterior hip pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

Knee joint effusion following ipsilateral hip surgery.

PubMed

Christodoulou, A G; Givissis, P; Antonarakos, P D; Petsatodis, G E; Hatzokos, I; Pournaras, J D

2010-12-01

To correlate patellar reflex inhibition with sympathetic knee joint effusion. 65 women and 40 men aged 45 to 75 (mean, 65) years underwent hip surgery. The surgery entailed dynamic hip screw fixation using the lateral approach with reflection of the vastus lateralis for pertrochantric fractures (n = 49), and hip hemiarthroplasty or total hip replacement using the Watson-Jones approach (n = 38) or hip hemiarthroplasty using the posterior approach (n = 18) for subcapital femoral fractures (n = 28) or osteoarthritis (n = 28). Knee joint effusion, patellar reflex, and thigh circumference were assessed in both legs before and after surgery (at day 0.5, 2, 7, 14, 30, and 45). Time-sequence plots were used for chronological analysis, and correlation between patellar reflex inhibition and knee joint effusion was tested. In the time-sequence plot, the peak frequency of patellar reflex inhibition (on day 0.5) preceded that of the knee joint effusion and the thigh circumference increase (on day 2). Patellar reflex inhibition correlated positively with the knee joint effusion (r = 0.843, p = 0.035). These 2 factors correlated significantly for all 3 surgical approaches (p < 0.0005). All 3 approaches were associated with patellar reflex inhibition on day 0.5 (p = 0.033) and knee joint effusion on day 2 (p = 0.051). Surgical trauma of the thigh may cause patellar reflex inhibition and subsequently knee joint effusion.

Hip joint kinetics in the table tennis topspin forehand: relationship to racket velocity.

PubMed

Iino, Yoichi

2018-04-01

The purpose of this study was to determine hip joint kinetics during a table tennis topspin forehand, and to investigate the relationship between the relevant kinematic and kinetic variables and the racket horizontal and vertical velocities at ball impact. Eighteen male advanced table tennis players hit cross-court topspin forehands against backspin balls. The hip joint torque and force components around the pelvis coordinate system were determined using inverse dynamics. Furthermore, the work done on the pelvis by these components was also determined. The peak pelvis axial rotation velocity and the work done by the playing side hip pelvis axial rotation torque were positively related to the racket horizontal velocity at impact. The sum of the work done on the pelvis by the backward tilt torques and the upward joint forces was positively related to the racket vertical velocity at impact. The results suggest that the playing side hip pelvis axial rotation torque exertion is important for acquiring a high racket horizontal velocity at impact. The pelvis backward tilt torques and upward joint forces at both hip joints collectively contribute to the generation of the racket vertical velocity, and the mechanism for acquiring the vertical velocity may vary among players.

A patterned microtexture to reduce friction and increase longevity of prosthetic hip joints

PubMed Central

Chyr, Anthony; Qiu, Mingfeng; Speltz, Jared; Jacobsen, Ronald L.; Sanders, Anthony P.; Raeymaekers, Bart

2014-01-01

More than 285,000 total hip replacement surgeries are performed in the US each year. Most prosthetic hip joints consist of a cobalt-chromium (CoCr) femoral head that articulates with a polyethylene acetabular component, lubricated with synovial fluid. The statistical survivorship of these metal-on-polyethylene prosthetic hip joints declines significantly after 10 to 15 years of use, primarily as a result of polyethylene wear and wear debris incited disease. The current engineering paradigm to increase the longevity of prosthetic hip joints is to improve the mechanical properties of the polyethylene component, and to manufacture ultra-smooth articulating surfaces. In contrast, we show that adding a patterned microtexture to the ultra-smooth CoCr femoral head reduces friction when articulating with the polyethylene acetabular liner. The microtexture increases the load-carrying capacity and the thickness of the joint lubricant film, which reduces contact between the articulating surfaces. As a result, friction and wear is reduced. We have used a lubrication model to design the geometry of the patterned microtexture, and experimentally demonstrate reduced friction for the microtextured compared to conventional smooth surrogate prosthetic hip joints. PMID:25013240

Subsequent Total Joint Arthroplasty After Primary Total Knee or Hip Arthroplasty

PubMed Central

Sanders, Thomas L.; Maradit Kremers, Hilal; Schleck, Cathy D.; Larson, Dirk R.; Berry, Daniel J.

2017-01-01

Background: Despite the large increase in total hip arthroplasties and total knee arthroplasties, the incidence and prevalence of additional contralateral or ipsilateral joint arthroplasty are poorly understood. The purpose of this study was to determine the rate of additional joint arthroplasty after a primary total hip arthroplasty or total knee arthroplasty. Methods: This historical cohort study identified population-based cohorts of patients who underwent primary total hip arthroplasty (n = 1,933) or total knee arthroplasty (n = 2,139) between 1969 and 2008. Patients underwent passive follow-up through their medical records beginning with the primary total hip arthroplasty or total knee arthroplasty. We assessed the likelihood of undergoing a subsequent total joint arthroplasty, including simultaneous and staged bilateral procedures. Age, sex, and calendar year were evaluated as potential predictors of subsequent arthroplasty. Results: During a mean follow-up of 12 years after an initial total hip arthroplasty, we observed 422 contralateral total hip arthroplasties (29% at 20 years), 76 contralateral total knee arthroplasties (6% at 10 years), and 32 ipsilateral total knee arthroplasties (2% at 20 years). Younger age was a significant predictor of contralateral total hip arthroplasty (p < 0.0001), but not a predictor of the subsequent risk of total knee arthroplasty. During a mean follow-up of 11 years after an initial total knee arthroplasty, we observed 809 contralateral total knee arthroplasties (45% at 20 years), 31 contralateral total hip arthroplasties (3% at 20 years), and 29 ipsilateral total hip arthroplasties (2% at 20 years). Older age was a significant predictor of ipsilateral or contralateral total hip arthroplasty (p < 0.001). Conclusions: Patients undergoing total hip arthroplasty or total knee arthroplasty can be informed of a 30% to 45% chance of a surgical procedure in a contralateral cognate joint and about a 5% chance of a surgical procedure in noncognate joints within 20 years of initial arthroplasty. Increased risk of contralateral total knee arthroplasty following an initial total hip arthroplasty may be due to gait changes prior to and/or following total hip arthroplasty. The higher prevalence of bilateral total hip arthroplasty in younger patients may result from bilateral disease processes that selectively affect the young hip, such as osteonecrosis, or structural hip problems, such as acetabular dysplasia or femoroacetabular impingement. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. PMID:28244910

Effect of low back pain on the kinematics and joint coordination of the lumbar spine and hip during sit-to-stand and stand-to-sit.

PubMed

Shum, Gary L K; Crosbie, Jack; Lee, Raymond Y W

2005-09-01

Experimental study to describe lumbar spine and hip joint movements during sit-to-stand and stand-to-sit. To examine differences in the kinematics and joint coordination of the lumbar spine and hips during sit-to-stand and stand-to-sit between healthy subjects and patients with subacute low back pain (LBP). There is a paucity of information on the coordination of movements of lumbar spine and hips during sit-to-stand and stand-to-sit. The effect of LBP, with or without nerve root signs, is largely unknown. A three-dimensional real-time electromagnetic tracking device was used to measure movements of the lumbar spine and hips during sit-to-stand and stand-to-sit. Sixty subacute LBP participants with or without straight leg raise signs and 20 healthy asymptomatic participants were recruited. The kinematic patterns of lumbar spine and hips were analyzed. Coordination between the two joints was studied by relative phase angle analysis. The mobility of the spine and hips was significantly limited in back pain subjects. It was observed that LBP subjects employed various strategies to compensate for the limited motions at the hips and lumbar spine. The contribution of the lumbar spine relative to that of the hip was found to be reduced for subjects with LBP. The lumbar spine-hip joint coordination was significantly altered in back pain subjects, in particular, those with positive straight leg raise sign. Back pain was related to changes in the kinematics and coordination of the lumbar spine and hips during sit-to-stand and stand-to-sit. Assessment of back pain patients should include kinematic analysis of the hips as well as the spine.

The recognition and evaluation of patterns of compensatory injury in patients with mechanical hip pain.

PubMed

Hammoud, Sommer; Bedi, Asheesh; Voos, James E; Mauro, Craig S; Kelly, Bryan T

2014-03-01

In active individuals with femoroacetabular impingement (FAI), the resultant reduction in functional range of motion leads to high impaction loads at terminal ranges. These increased forces result in compensatory effects on bony and soft tissue structures within the hip joint and hemipelvis. An algorithm is useful in evaluating athletes with pre-arthritic, mechanical hip pain and associated compensatory disorders. A literature search was performed by a review of PubMed articles published from 1976 to 2013. Level 4. Increased stresses across the bony hemipelvis result when athletes with FAI attempt to achieve supraphysiologic, terminal ranges of motion (ROM) through the hip joint required for athletic competition. This can manifest as pain within the pubic joint (osteitis pubis), sacroiliac joint, and lumbosacral spine. Subclinical posterior hip instability may result when attempts to increase hip flexion and internal rotation are not compensated for by increased motion through the hemipelvis. Prominence of the anterior inferior iliac spine (AIIS) at the level of the acetabular rim can result in impingement of the anterior hip joint capsule or iliocapsularis muscle origin against the femoral head-neck junction, resulting in a distinct form of mechanical hip impingement (AIIS subspine impingement). Iliopsoas impingement (IPI) has also been described as an etiology for anterior hip pain. IPI results in a typical 3-o'clock labral tear as well as an inflamed capsule in close proximity to the overlying iliopsoas tendon. Injury in athletic pubalgia occurs during high-energy twisting activities in which abnormal hip ROM and resultant pelvic motion lead to shearing across the pubic symphysis. Failure to recognize and address concomitant compensatory injury patterns associated with intra-articular hip pathology can result in significant disability and persistent symptoms in athletes with pre-arthritic, mechanical hip pain. B.

The influence of size, clearance, cartilage properties, thickness and hemiarthroplasty on the contact mechanics of the hip joint with biphasic layers☆

PubMed Central

Li, Junyan; Stewart, Todd D.; Jin, Zhongmin; Wilcox, Ruth K.; Fisher, John

2013-01-01

Computational models of the natural hip joint are needed to examine and optimise tissue sparing interventions where the natural cartilage remains part of the bearing surfaces. Although the importance of interstitial fluid pressurisation in the performance of cartilage has long been recognized, few studies have investigated the time dependent interstitial fluid pressurisation in a three dimensional natural hip joint model. The primary aim of this study was to develop a finite element model of the natural hip incorporating the biphasic cartilage layers that was capable of simulating the joint response over a prolonged physiological loading period. An initial set of sensitivity studies were also undertaken to investigate the influence of hip size, clearance, cartilage properties, thickness and hemiarthroplasty on the contact mechanics of the joint. The contact stress, contact area, fluid pressure and fluid support ratio were calculated and cross-compared between models with different parameters to evaluate their influence. It was found that the model predictions for the period soon after loading were sensitive to the hip size, clearance, cartilage aggregate modulus, thickness and hemiarthroplasty, while the time dependent behaviour over 3000 s was influenced by the hip clearance and cartilage aggregate modulus, permeability, thickness and hemiarthroplasty. The modelling methods developed in this study provide a basic platform for biphasic simulation of the whole hip joint onto which more sophisticated material models or other input parameters could be added in the future. PMID:23664238

Comprehensive Review of Advancements in Hip Arthroscopy

PubMed Central

Noh, Chang-Kyun

2017-01-01

Hip arthroscopy is currently being leveraged in the diagnosis and treatment of a wide range of hip joint problems. In fact, great advancements in hip arthroscopy have resulted in an ever-expanding number of indications to which it is being applied. Minimally invasive hip arthroscopy allows for quicker initiation of rehabilitation and has attracted much attention as the field becomes increasingly focused on surgeries designed to preserve joints. This review aims to summarize the recent advances, applications, and impact of hip arthroscopy. PMID:28316958

RESTRICTED HIP MOBILITY: CLINICAL SUGGESTIONS FOR SELF‐MOBILIZATION AND MUSCLE RE‐EDUCATION

PubMed Central

Matheson, J.W.

2013-01-01

Restricted hip mobility has shown strong correlation with various pathologies of the hip, lumbar spine and lower extremity. Restricted mobility can consequently have deleterious effects not only at the involved joint but throughout the entire kinetic chain. Promising findings are suggesting benefit with skilled joint mobilization intervention for clients with various hip pathologies. Supervised home program intervention, while lacking specifically for the hip joint, are demonstrating promising results in other regions of the body. Application of an accompanying home program for the purpose of complementing skilled, in clinic intervention is advisable for those clients that respond favorably to such methodology. Level of Evidence: 5 PMID:24175151

Restricted hip mobility: clinical suggestions for self-mobilization and muscle re-education.

PubMed

Reiman, Michael P; Matheson, J W

2013-10-01

Restricted hip mobility has shown strong correlation with various pathologies of the hip, lumbar spine and lower extremity. Restricted mobility can consequently have deleterious effects not only at the involved joint but throughout the entire kinetic chain. Promising findings are suggesting benefit with skilled joint mobilization intervention for clients with various hip pathologies. Supervised home program intervention, while lacking specifically for the hip joint, are demonstrating promising results in other regions of the body. Application of an accompanying home program for the purpose of complementing skilled, in clinic intervention is advisable for those clients that respond favorably to such methodology. 5.

Anterior delayed gadolinium-enhanced MRI of cartilage values predict joint failure after periacetabular osteotomy.

PubMed

Kim, Sang Do; Jessel, Rebecca; Zurakowski, David; Millis, Michael B; Kim, Young-Jo

2012-12-01

Several available compositional MRIs seem to detect early osteoarthritis before radiographic appearance. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) has been most frequently used in clinical studies and reportedly predicts premature joint failure in patients undergoing Bernese periacetabular osteotomies (PAOs). We asked, given regional variations in biochemical composition in dysplastic hips, whether the dGEMRIC index of the anterior joint would better predict premature joint failure after PAOs than the coronal dGEMRIC index as previously reported. We retrospectively reviewed 43 hips in 41 patients who underwent Bernese PAO for hip dysplasia. Thirty-seven hips had preserved joints after PAOs and six were deemed premature failures based on pain, joint space narrowing, or subsequent THA. We used dGEMRIC to determine regional variations in biochemical composition. Preoperative demographic and clinical outcome score, radiographic measures of osteoarthritis and severity of dysplasia, and dGEMRIC indexes from different hip regions were analyzed in a multivariable regression analysis to determine the best predictor of premature joint failure. Minimum followup was 24 months (mean, 32 months; range, 24-46 months). The two cohorts were similar in age and sex distribution. Severity of dysplasia was similar as measured by lateral center-edge, anterior center-edge, and Tönnis angles. Preoperative pain, joint space width, Tönnis grade, and coronal and sagittal dGEMRIC indexes differed between groups. The dGEMRIC index in the anterior weightbearing region of the hip was lower in the prematurely failed group and was the best predictor. Success of PAO depends on the amount of preoperative osteoarthritis. These degenerative changes are seen most commonly in the anterior joint. The dGEMRIC index of the anterior joint may better predict premature joint failure than radiographic measures of hip osteoarthritis and coronal dGEMRIC index. Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

Computed tomography assessment of hip joints in asymptomatic individuals in relation to femoroacetabular impingement.

PubMed

Kang, Alan C L; Gooding, Andrew J; Coates, Mark H; Goh, Tony D; Armour, Paul; Rietveld, John

2010-06-01

Femoroacetabular impingement has become a well-recognized entity predisposing to acetabular labral tears and chondral damage, and subsequently development of osteoarthritis of the hip joint. In the authors' experience, it is common to see bony abnormalities predisposing to femoroacetabular impingement in the contralateral asymptomatic hips in patients with unilateral femoroacetabular impingement. This study was undertaken to investigate the prevalence of bony abnormalities predisposing to femoroacetabular impingement in asymptomatic individuals without exposing study participants to unnecessary radiation. Cross-sectional study; Level of evidence, 4. Fifty individuals (100 hip joints), ranging from 15 to 40 years of age, who were seen at a local hospital between March and August 2008 with abdominal trauma or nonspecific abdominal pain in whom abdominal computed tomography was performed to aid diagnosis were prospectively studied. These patients were not known to have any history of hip-related problems. Raw data from the abdominal computed tomography scan, performed on a 64-slice multidetector computed tomography scanner, were reformatted using bone algorithm into several different planes. Several measurements and observations of the hip joints were made in relation to femoroacetabular impingement. The 100 hip joints from 50 patients with no history of hip problems demonstrated that 39% of the joints (31% of female, 48% of male joints) have at least 1 morphologic aspect predisposing to femoroacetabular impingement. The majority (66% to 100% ) of the findings were bilateral; 33% of female and 52% of male asymptomatic participants in our study had at least 1 predisposing factor for femoroacetabular impingement in 1 or both of their hip joints. Based on the data collected from this study, the acetabular crossover sign had a 71% sensitivity and 88% specificity for detecting acetabular retroversion. Nonquantitative assessment of the femoral head at the anterior, anterolateral, and lateral head/neck junctions demonstrated that 74% of the joints had an aspherical femoral head. The study demonstrated substantial prevalence of bony characteristics predisposing to femoroacetabular impingement in asymptomatic individuals according to the established measurement parameters in current literature.

Brief communication: Hip joint mobility in free-ranging rhesus macaques

PubMed Central

Hammond, Ashley S.; Johnson, Victoria P.; Higham, James P.

2016-01-01

Objectives We aimed to test for differences in hip joint range of motion (ROM) between captive and free-ranging rhesus macaques (Macaca mulatta), particularly for hip joint abduction, which previous studies of captive macaques have found to be lower than predicted. Materials and Methods Hip ROM was assessed following standard joint measurement methodology in anesthetized adult free-ranging rhesus macaques (n=39) from Cayo Santiago, and compared to published ROM data from captive rhesus macaques (n=16) (Hammond 2014a, American Journal of Physical Anthropology). Significant differences between populations were detected using one-way analysis of variance (p<0.05). Results In a sample of pooled sexes and ages, free-ranging macaques are capable of increased hip abduction, flexion, and internal rotation compared to captive individuals. These differences in joint excursion resulted in free-ranging individuals having significantly increased ROM for hip adduction-abduction, rotation, flexion-extension, and the distance spanned by the knee during hip abduction. When looking at data for a smaller sample of age-matched males, fewer ROM differences are significant, but free-ranging males have significantly increased hip abduction, internal rotation, range of flexion-extension, and distance spanned by the knee during hip abduction compared to captive males of similar age. Discussion Our results suggest that a spatially restrictive environment results in decreased hip mobility in cage-confined animals and ultimately limits the potential limb postures in captive macaques. These results have implications for selection of animal samples in model validation studies, as well as laboratory animal husbandry practices. PMID:27731892

Influence of altered gait patterns on the hip joint contact forces.

PubMed

Carriero, Alessandra; Zavatsky, Amy; Stebbins, Julie; Theologis, Tim; Lenaerts, Gerlinde; Jonkers, Ilse; Shefelbine, Sandra J

2014-01-01

Children who exhibit gait deviations often present a range of bone deformities, particularly at the proximal femur. Altered gait may affect bone growth and lead to deformities by exerting abnormal stresses on the developing bones. The objective of this study was to calculate variations in the hip joint contact forces with different gait patterns. Muscle and hip joint contact forces of four children with different walking characteristics were calculated using an inverse dynamic analysis and a static optimisation algorithm. Kinematic and kinetic analyses were based on a generic musculoskeletal model scaled down to accommodate the dimensions of each child. Results showed that for all the children with altered gaits both the orientation and magnitude of the hip joint contact force deviated from normal. The child with the most severe gait deviations had hip joint contact forces 30% greater than normal, most likely due to the increase in muscle forces required to sustain his crouched stance. Determining how altered gait affects joint loading may help in planning treatment strategies to preserve correct loading on the bone from a young age.

Hip proprioceptors preferentially modulate reflexes of the leg in human spinal cord injury

PubMed Central

Onushko, Tanya; Hyngstrom, Allison

2013-01-01

Stretch-sensitive afferent feedback from hip muscles has been shown to trigger long-lasting, multijoint reflex responses in people with chronic spinal cord injury (SCI). These reflexes could have important implications for control of leg movements during functional activities, such as walking. Because the control of leg movement relies on reflex regulation at all joints of the limb, we sought to determine whether stretch of hip muscles modulates reflex activity at the knee and ankle and, conversely, whether knee and ankle stretch afferents affect hip-triggered reflexes. A custom-built servomotor apparatus was used to stretch the hip muscles in nine chronic SCI subjects by oscillating the legs about the hip joint bilaterally from 10° of extension to 40° flexion. To test whether stretch-related feedback from the knee or ankle would be affected by hip movement, patellar tendon percussions and Achilles tendon vibration were delivered when the hip was either extending or flexing. Surface electromyograms (EMGs) and joint torques were recorded from both legs. Patellar tendon percussions and Achilles tendon vibration both elicited reflex responses local to the knee or ankle, respectively, and did not influence reflex responses observed at the hip. Rather, the movement direction of the hip modulated the reflex responses local to the joint. The patellar tendon reflex amplitude was larger when the perturbation was delivered during hip extension compared with hip flexion. The response to Achilles vibration was modulated by hip movement, with an increased tonic component during hip flexion compared with extension. These results demonstrate that hip-mediated sensory signals modulate activity in distal muscles of the leg and appear to play a unique role in modulation of spastic muscle activity throughout the leg in SCI. PMID:23615544

Extreme Kinematics in Selected Hip Hop Dance Sequences.

PubMed

Bronner, Shaw; Ojofeitimi, Sheyi; Woo, Helen

2015-09-01

Hip hop dance has many styles including breakdance (breaking), house, popping and locking, funk, streetdance, krumping, Memphis jookin', and voguing. These movements combine the complexity of dance choreography with the challenges of gymnastics and acrobatic movements. Despite high injury rates in hip hop dance, particularly in breakdance, to date there are no published biomechanical studies in this population. The purpose of this study was to compare representative hip hop steps found in breakdance (toprock and breaking) and house and provide descriptive statistics of the angular displacements that occurred in these sequences. Six expert female hip hop dancers performed three choreographed dance sequences, top rock, breaking, and house, to standardized music-based tempos. Hip, knee, and ankle kinematics were collected during sequences that were 18 to 30 sec long. Hip, knee, and ankle three-dimensional peak joint angles were compared in repeated measures ANOVAs with post hoc tests where appropriate (p<0.01). Peak angles of the breaking sequence, which included floorwork, exceeded the other two sequences in the majority of planes and joints. Hip hop maximal joint angles exceeded reported activities of daily living and high injury sports such as gymnastics. Hip hop dancers work at weight-bearing joint end ranges where muscles are at a functional disadvantage. These results may explain why lower extremity injury rates are high in this population.

The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres

PubMed Central

van Arkel, R. J.; Amis, A. A.; Cobb, J. P.; Jeffers, J. R. T.

2015-01-01

In this in vitro study of the hip joint we examined which soft tissues act as primary and secondary passive rotational restraints when the hip joint is functionally loaded. A total of nine cadaveric left hips were mounted in a testing rig that allowed the application of forces, torques and rotations in all six degrees of freedom. The hip was rotated throughout a complete range of movement (ROM) and the contributions of the iliofemoral (medial and lateral arms), pubofemoral and ischiofemoral ligaments and the ligamentum teres to rotational restraint was determined by resecting a ligament and measuring the reduced torque required to achieve the same angular position as before resection. The contribution from the acetabular labrum was also measured. Each of the capsular ligaments acted as the primary hip rotation restraint somewhere within the complete ROM, and the ligamentum teres acted as a secondary restraint in high flexion, adduction and external rotation. The iliofemoral lateral arm and the ischiofemoral ligaments were primary restraints in two-thirds of the positions tested. Appreciation of the importance of these structures in preventing excessive hip rotation and subsequent impingement/instability may be relevant for surgeons undertaking both hip joint preserving surgery and hip arthroplasty. Cite this article: Bone Joint J 2015; 97-B:484–91. PMID:25820886

Hip contact forces in asymptomatic total hip replacement patients differ from normal healthy individuals: Implications for preclinical testing.

PubMed

Li, Junyan; Redmond, Anthony C; Jin, Zhongmin; Fisher, John; Stone, Martin H; Stewart, Todd D

2014-08-01

Preclinical durability testing of hip replacement implants is standardised by ISO-14242-1 (2002) which is based on historical inverse dynamics analysis using data obtained from a small sample of normal healthy individuals. It has not been established whether loading cycles derived from normal healthy individuals are representative of loading cycles occurring in patients following total hip replacement. Hip joint kinematics and hip contact forces derived from multibody modelling of forces during normal walking were obtained for 15 asymptomatic total hip replacement patients and compared to 38 normal healthy individuals and to the ISO standard for pre-clinical testing. Hip kinematics in the total hip replacement patients were comparable to the ISO data and the hip contact force in the normal healthy group was also comparable to the ISO cycles. Hip contact forces derived from the asymptomatic total hip replacement patients were comparable for the first part of the stance period but exhibited 30% lower peak loads at toe-off. Although the ISO standard provides a representative kinematic cycle, the findings call into question whether the hip joint contact forces in the ISO standard are representative of those occurring in the joint following total hip replacement. Copyright © 2014. Published by Elsevier Ltd.

The Fate of DDH Hips Showing Cartilaginous or Fibrous Tissue-filled Joint Spaces Following Primary Reduction.

PubMed

Kim, Hui Taek; Lee, Tae Hoon; Ahn, Tae Young; Jang, Jae Hoon

Because the use of magnetic resonance imaging is still not universal for the patients with developmental dysplasia of the hip patients, orthopaedists do not generally distinguish widened joint spaces which are "empty" after primary treatment (and therefore still reducible), from those which are filled and much more difficult to treat. To date no studies have focused on the latter hips. We treated and observed the outcomes for 19 hips which showed filled joint spaces after primary treatment. We retrospectively reviewed 19 cases of developmental dysplasia of the hip: (1) who showed a widened joint space on radiographs after primary treatment; and (2) whose magnetic resonance imaging showed that the widened joint space was accompanied by acetabular cartilage hypertrophy and/or was filled with fibrous tissues. All patients were over 1 year old at the time of primary reduction (reduction was closed in 4 patients, open in 6, and open with pelvic osteotomy in 9). Thirteen patients received at least 1 secondary treatment. Final results were classified using a modified Severin classification. Final outcomes were satisfactory in 10 (52.6%) and unsatisfactory in 9 (47.4%). The widened joint spaces gradually filled with bone, resulting in a shallow acetabulum in the patients with unsatisfactory results. Of 9 patients who underwent combined pelvic osteotomy at the time of primary reduction, results were satisfactory in 6 (66.7%), whereas all patients who had only closed or open primary reduction had unsatisfactory results. Combined pelvic osteotomy at the time of primary reduction is advisable in hips with widened joint spaces. However, hips with filled joint spaces after primary treatment often have unsatisfactory results even after additional pelvic and/or femoral osteotomy. Level IV-prognostic study.

Vojta method in the treatment of developmental hip dysplasia – a case report

PubMed Central

Kiebzak, Wojciech; Żurawski, Arkadiusz; Dwornik, Michał

2016-01-01

Background Developmental dysplasia of the hip joint is one of the most common congenital defects and often results in functional and structural disorders. Such cases particularly demand optimizing therapeutic effects and maximally reducing the duration of therapy. Purpose The aim of this case report is to present the therapeutic process in a child with developmental hip dysplasia. Case report This is a case report of a female child with a birth weight of 2,800 g and an Apgar score of 9 points born to a gravida 3 para 3 mother at 37 weeks. The child was delivered by cesarean section, and the pregnancy was complicated by oligohydramnios. Subluxation of the left hip joint was diagnosed by an orthopedist in the third month of life. The treatment followed was the Vojta method (the first phase of reflex turning and reflex crawling). Results During the 6 weeks of the Vojta treatment, the left half of the femoral head was centralized, and the process of formation of the hip joint acetabulum was influenced effectively enough to change the acetabulum’s Graff type from the baseline D to IIb after 41 days of treatment. Conclusion The diagnostic work-up of congenital hip joint dysplasia should involve a physiotherapist who will investigate the child’s neuromuscular coordination, in addition to a neonatologist and a pediatrician. The therapy for a disorder of hip joint development of neuromotor origin should involve the application of global patterns according to Vojta. Children with congenital dysplasia of the hip joint should commence rehabilitation as early as possible. PMID:27578980

The influence of size, clearance, cartilage properties, thickness and hemiarthroplasty on the contact mechanics of the hip joint with biphasic layers.

PubMed

Li, Junyan; Stewart, Todd D; Jin, Zhongmin; Wilcox, Ruth K; Fisher, John

2013-06-21

Computational models of the natural hip joint are needed to examine and optimise tissue sparing interventions where the natural cartilage remains part of the bearing surfaces. Although the importance of interstitial fluid pressurisation in the performance of cartilage has long been recognized, few studies have investigated the time dependent interstitial fluid pressurisation in a three dimensional natural hip joint model. The primary aim of this study was to develop a finite element model of the natural hip incorporating the biphasic cartilage layers that was capable of simulating the joint response over a prolonged physiological loading period. An initial set of sensitivity studies were also undertaken to investigate the influence of hip size, clearance, cartilage properties, thickness and hemiarthroplasty on the contact mechanics of the joint. The contact stress, contact area, fluid pressure and fluid support ratio were calculated and cross-compared between models with different parameters to evaluate their influence. It was found that the model predictions for the period soon after loading were sensitive to the hip size, clearance, cartilage aggregate modulus, thickness and hemiarthroplasty, while the time dependent behaviour over 3000s was influenced by the hip clearance and cartilage aggregate modulus, permeability, thickness and hemiarthroplasty. The modelling methods developed in this study provide a basic platform for biphasic simulation of the whole hip joint onto which more sophisticated material models or other input parameters could be added in the future. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Static balance according to hip joint angle of unsupported leg during one-leg standing.

PubMed

Cha, Ju-Hyung; Kim, Jang-Joon; Ye, Jae-Gwan; Lee, Seul-Ji; Hong, Jeong-Mi; Choi, Hyun-Kyu; Choi, Ho-Suk; Shin, Won-Seob

2017-05-01

[Purpose] This study aimed to determine static balance according to hip joint angle of the unsupported leg during one-leg standing. [Subjects and Methods] Subjects included 45 healthy adult males and females in their 20s. During one-leg standing on the non-dominant leg, the position of the unsupported leg was classified according to hip joint angles of point angle was class. Static balance was then measured using a force plate with eyes open and closed. The total length, sway velocity, maximum deviation, and velocity on the mediolateral and anteroposterior axes of center of pressure were measured. [Results] In balance assessment with eyes open, there were significant differences between groups according to hip joint angle, except for maximum deviation on the anteroposterior axis. In balance assessment with eyes closed, there were significant differences between total length measurements at 0° and 30°, 60° and between 30° and 90°. There were significant differences between sway velocity measurements at 0° and 30° and between 30° and 90°. [Conclusion] Thus, there were differences in static balance according to hip joint angle. It is necessary to clearly identify the hip joint angle during one-leg standing testing.

Joint contact forces can be reduced by improving joint moment symmetry in below-knee amputee gait simulations.

PubMed

Koelewijn, Anne D; van den Bogert, Antonie J

2016-09-01

Despite having a fully functional knee and hip in both legs, asymmetries in joint moments of the knee and hip are often seen in gait of persons with a unilateral transtibial amputation (TTA), possibly resulting in excessive joint loading. We hypothesize that persons with a TTA can walk with more symmetric joint moments at the cost of increased effort or abnormal kinematics. The hypothesis was tested using predictive simulations of gait. Open loop controls of one gait cycle were found by solving an optimization problem that minimizes a combination of walking effort and tracking error in joint angles, ground reaction force and gait cycle duration. A second objective was added to penalize joint moment asymmetry, creating a multi-objective optimization problem. A Pareto front was constructed by changing the weights of the objectives and three solutions were analyzed to study the effect of increasing joint moment symmetry. When the optimization placed more weight on moment symmetry, walking effort increased and kinematics became less normal, confirming the hypothesis. TTA gait improved with a moderate increase in joint moment symmetry. At a small cost of effort and abnormal kinematics, the peak hip extension moment in the intact leg was decreased significantly, and so was the joint contact force in the knee and hip. Additional symmetry required a significant increase in walking effort and the joint contact forces in both hips became significantly higher than in able-bodied gait. Copyright © 2016 Elsevier B.V. All rights reserved.

Evolution of the human hip. Part 1: the osseous framework.

PubMed

Hogervorst, Tom; Vereecke, Evie E

2014-10-01

Extensive osseous adaptations of the lumbar spine, pelvis, hip and femur characterize the emergence of the human bipedal gait with its 'double extension' of the lumbar spine and hip. To accommodate lumbar lordosis, the pelvis was 'compacted', becoming wider and shorter, as compared with the non-human apes. The hip joint acquired a much more extended position, which can be seen in a broader evolutionary context of verticalization of limbs. When loaded in a predominantly vertical position, the femur can be built lighter and longer than when it is loaded more horizontally because bending moments are smaller. Extension of the hip joint together with elongation of the femur increases effective leg length, and hence stride length, which improves energy efficiency. At the hip joint itself, the shift of the hip's default working range to a more extended position influences concavity at the head-neck junction and femoral neck anteversion.

An artery accompanying the sciatic nerve (arteria comitans nervi ischiadici) and the position of the hip joint: a comparative histological study using chick, mouse, and human foetal specimens.

PubMed

Ishizawa, A; Hayashi, S; Nasu, H; Abe, H; Rodríguez-Vázquez, J F; Murakami, G

2013-02-01

Birds and reptiles always carry a long and thick artery accompanying the sciatic nerve (i.e., the sciatic artery), whereas mammals do not. We attempted to demonstrate a difference in courses of the nerve and artery in fetuses in relation with the hip joint posture. Eight mid-term human fetuses (15-18 weeks), five mouse fetuses (E18) and five chick embryos (11 days after incubation) were examined histologically. Thin feeding arteries in the sciatic nerve were consistently observed in human fetuses in spite of the long, inferiorly curved course of the nerve around the ischium. The tissue around the human sciatic nerve was not so tight because of the medial and inferior shift of the nerve away from the hip joint. The fetal hip joint position differed among the species, being highly flexed in humans and almost at right angle flexion in mice and chicks. Because of deep adduction of the hip joint in the mouse, the knee was located near the midline of the body. The mouse sciatic nerve ran through the tight tissue along the head of the femur, whereas the chick nerve ran through the loose space even in the gluteal region. In birds, evolution of the pelvis including the hip joint without adduction seemed to make the arterial development possible. In mammals, highly flexed or adducted hip joint seemed to be one of the disturbing factors against development of the long and thick artery. A slight change in posture may cause significant arterial variation.

Taking care of your new hip joint

MedlinePlus

Hip arthroplasty - precautions; Hip replacement - precautions; Osteoarthritis - hip; Osteoarthritis - knee ... Saunders; 2015:chap 61. Harkess JW, Crockarell JR. Arthroplasty of the hip. In: Azar FM, Beaty JH, ...

Finite element analysis of mechanical behavior of human dysplastic hip joints: a systematic review.

PubMed

Vafaeian, B; Zonoobi, D; Mabee, M; Hareendranathan, A R; El-Rich, M; Adeeb, S; Jaremko, J L

2017-04-01

Developmental dysplasia of the hip (DDH) is a common condition predisposing to osteoarthritis (OA). Especially since DDH is best identified and treated in infancy before bones ossify, there is surprisingly a near-complete absence of literature examining mechanical behavior of infant dysplastic hips. We sought to identify current practice in finite element modeling (FEM) of DDH, to inform future modeling of infant dysplastic hips. We performed multi-database systematic review using PRISMA criteria. Abstracts (n = 126) fulfilling inclusion criteria were screened for methodological quality, and results were analyzed and summarized for eligible articles (n = 12). The majority of the studies modeled human adult dysplastic hips. Two studies focused on etiology of DDH through simulating mechanobiological growth of prenatal hips; we found no FEM-based studies in infants or children. Finite element models used either patient-specific geometry or idealized average geometry. Diversities in choice of material properties, boundary conditions, and loading scenarios were found in the finite-element models. FEM of adult dysplastic hips demonstrated generally smaller cartilage contact area in dysplastic hips than in normal joints. Contact pressure (CP) may be higher or lower in dysplastic hips depending on joint geometry and mechanical contribution of labrum (Lb). FEM of mechanobiological growth of prenatal hip joints revealed evidence for effects of the joint mechanical environment on formation of coxa valga, asymmetrically shallow acetabulum and malformed femoral head associated with DDH. Future modeling informed by the results of this review may yield valuable insights into optimal treatment of DDH, and into how and why OA develops early in DDH. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The Recognition and Evaluation of Patterns of Compensatory Injury in Patients With Mechanical Hip Pain

PubMed Central

Hammoud, Sommer; Bedi, Asheesh; Voos, James E.; Mauro, Craig S.; Kelly, Bryan T.

2014-01-01

Context: In active individuals with femoroacetabular impingement (FAI), the resultant reduction in functional range of motion leads to high impaction loads at terminal ranges. These increased forces result in compensatory effects on bony and soft tissue structures within the hip joint and hemipelvis. An algorithm is useful in evaluating athletes with pre-arthritic, mechanical hip pain and associated compensatory disorders. Evidence Acquisition: A literature search was performed by a review of PubMed articles published from 1976 to 2013. Level of Evidence: Level 4. Results: Increased stresses across the bony hemipelvis result when athletes with FAI attempt to achieve supraphysiologic, terminal ranges of motion (ROM) through the hip joint required for athletic competition. This can manifest as pain within the pubic joint (osteitis pubis), sacroiliac joint, and lumbosacral spine. Subclinical posterior hip instability may result when attempts to increase hip flexion and internal rotation are not compensated for by increased motion through the hemipelvis. Prominence of the anterior inferior iliac spine (AIIS) at the level of the acetabular rim can result in impingement of the anterior hip joint capsule or iliocapsularis muscle origin against the femoral head-neck junction, resulting in a distinct form of mechanical hip impingement (AIIS subspine impingement). Iliopsoas impingement (IPI) has also been described as an etiology for anterior hip pain. IPI results in a typical 3-o’clock labral tear as well as an inflamed capsule in close proximity to the overlying iliopsoas tendon. Injury in athletic pubalgia occurs during high-energy twisting activities in which abnormal hip ROM and resultant pelvic motion lead to shearing across the pubic symphysis. Conclusion: Failure to recognize and address concomitant compensatory injury patterns associated with intra-articular hip pathology can result in significant disability and persistent symptoms in athletes with pre-arthritic, mechanical hip pain. Strength-of-Recommendation Taxonomy (SORT): B PMID:24587859

Total hip arthroplasty in dwarfism. A case report.

PubMed

De Fine, Marcello; Traina, Francesco; Palmonari, Massimo; Tassinari, Enrico; Toni, Aldo

2008-05-01

In dwarfism hip arthritis, usually secondary to hip dysplasia, is a common finding at an early age. In these patients a joint replacement is a demanding procedure due to the peculiar joint deformity and the small size of the bones. We present a case of a bilateral hip replacement in a dwarf patient. In order to reduce intraoperative complications and improve the joint kinematics a thorough preoperative planning was performed by a CT based computerised system. On the basis of the planning we chose a conical shaped stem that enable as to restore limb length and offset with a low risk of femoral fracture. In conclusion, we consider total hip replacement in dwarfism a safe and effective procedure if an accurate preoperative planning is performed.

Novel Kinetic Strategies Adopted in Asymmetric Split-Belt Treadmill Walking.

PubMed

Hinkel-Lipsker, Jacob W; Hahn, Michael E

2016-01-01

The hip and ankle strategies that affect learning of a novel gait have not been fully determined, and could be of importance in design of clinical gait interventions. The authors' purpose was to determine the effects of asymmetric split-belt treadmill walking on ankle and hip work during propulsion. Participants were randomized into either a gradual training group or a sudden training group and later returned for a retention test. The gradual training group performed significantly more work at the hip joint of the slow limb during acquisition, and decreased the hip joint work performed during retention. These findings reveal the hip joint on the slow limb during initial swing as a possible site of adaptation to a novel locomotor pattern.

Articular soft tissue anatomy of the archosaur hip joint: Structural homology and functional implications.

PubMed

Tsai, Henry P; Holliday, Casey M

2015-06-01

Archosaurs evolved a wide diversity of locomotor postures, body sizes, and hip joint morphologies. The two extant archosaurs clades (birds and crocodylians) possess highly divergent hip joint morphologies, and the homologies and functions of their articular soft tissues, such as ligaments, cartilage, and tendons, are poorly understood. Reconstructing joint anatomy and function of extinct vertebrates is critical to understanding their posture, locomotor behavior, ecology, and evolution. However, the lack of soft tissues in fossil taxa makes accurate inferences of joint function difficult. Here, we describe the soft tissue anatomies and their osteological correlates in the hip joint of archosaurs and their sauropsid outgroups, and infer structural homology across the extant taxa. A comparative sample of 35 species of birds, crocodylians, lepidosaurs, and turtles ranging from hatchling to skeletally mature adult were studied using dissection, imaging, and histology. Birds and crocodylians possess topologically and histologically consistent articular soft tissues in their hip joints. Epiphyseal cartilages, fibrocartilages, and ligaments leave consistent osteological correlates. The archosaur acetabulum possesses distinct labrum and antitrochanter structures on the supraacetabulum. The ligamentum capitis femoris consists of distinct pubic- and ischial attachments, and is homologous with the ventral capsular ligament of lepidosaurs. The proximal femur has a hyaline cartilage core attached to the metaphysis via a fibrocartilaginous sleeve. This study provides new insight into soft tissue structures and their osteological correlates (e.g., the antitrochanter, the fovea capitis, and the metaphyseal collar) in the archosaur hip joint. The topological arrangement of fibro- and hyaline cartilage may provide mechanical support for the chondroepiphysis. The osteological correlates identified here will inform systematic and functional analyses of archosaur hindlimb evolution and provide the anatomical foundation for biomechanical investigations of joint tissues. © 2014 Wiley Periodicals, Inc.

Patellofemoral pain and asymmetrical hip rotation.

PubMed

Cibulka, Michael T; Threlkeld-Watkins, Julie

2005-11-01

Patellofemoral joint problems are the most common overuse injury of the lower extremity, and altered femoral or hip rotation may play a role in patellofemoral pain. The purpose of this case report is to describe the evaluation of and intervention for a patient with asymmetrical hip rotation and patellofemoral pain. The patient was a 15-year-old girl with an 8-month history of anterior right knee pain, without known trauma or injury. Prior to intervention, her score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was 24%. Right hip medial (internal) rotation was less than left hip medial rotation, and manual muscle testing showed weakness of the right hip internal rotator and abductor muscles. The intervention was aimed at increasing right hip medial rotation, improving right hip muscle strength (eg, the muscle force exerted by a muscle or a group of muscles to overcome a resistance), and eliminating anterior right knee pain. After 6 visits (14 days), passive left and right hip medial rotations were symmetrical, and her right hip internal rotator and abductor muscle grades were Good plus. Her WOMAC score was 0%. The patient had right patellofemoral pain and an uncommon pattern of asymmetrical hip rotation, with diminished hip medial rotation and excessive hip lateral (external) rotation on the right side. The patient's outcomes suggest that femoral or hip joint asymmetry may be related to patellofemoral joint pain.

Application of individually performed acrylic cement spacers containing 5% of antibiotic in two-stage revision of hip and knee prosthesis due to infection.

PubMed

Babiak, Ireneusz

2012-07-03

Deep infection of a joint endoprosthesis constitutes a threat to the stability of the implant and joint function. It requires a comprehensive and interdisciplinary approach, involving the joint revision and removal of the bacterial biofilm from all tissues, the endoprosthesis must be often removed and bone stock infection treated. The paper presents the author's experience with the use of acrylic cement spacers, custom-made during the surgery and containing low dose of an antibiotic supplemented with 5% of a selected, targeted antibiotic for the infection of hip and knee endoprostheses. 33 two-stage revisions of knee and hip joints with the use of a spacer were performed. They involved 24 knee joints and 9 hip joints. The infections were mostly caused by staphylococci MRSA (18) and MSSA (8), and in some cases Enterococci (4), Salmonella (1), Pseudomonas (1) and Acinetobacter (1). The infection was successfully treated in 31 out of 33 cases (93.93%), including 8 patients with the hip infection and 23 patients with the knee infection. The endoprosthesis was reimplanted in 30 cases: for 7 hips and 23 knees, in 3 remaining cases the endoprosthesis was not reimplanted. Mechanical complications due to the spacer occurred in 4 cases: 3 dislocations and 1 fracture (hip spacer). The patients with hip spacers were ambulatory with a partial weight bearing of the operated extremity and those with knee spacers were also ambulatory with a partial weight bearing, but the extremity was initially protected by an orthosis. The spacer enables to maintain a limb function, and making it by hand allows the addition of the specific bacteria targeted antibiotic thus increasing the likelihood of the effective antibacterial treatment.

[Viscosity determination of synovial fluids from the canine hip and elbow joint as well as the human knee joint].

PubMed

Helms, Gabriele; Rittmann, Pia; Wefstaedt, Patrick; Windhagen, Henning; Pressel, Thomas; Behrens, Bernd-Arno; Nolte, Ingo

2008-01-01

The development of pathological changes in both human and canine hip joints is mainly caused by a lack of synovial fluid lubrication. This results in an increased joint abrasion. Even after implantation of joint prosthesis, inadequate lubrication can lead to abrasion in the tribological pair. This can finally result in aseptic loosening of the prosthesis. In spite of the enormous number of studies that have been performed on human, only little knowledge about the tribological properties of the joints in dogs is available in the literature. For this reason the viscosities of synovial fluid, derived from physiological and pathologically changed canine elbow joints were measured. The viscosities were determined by the use of a cone-plate viscometer at different temperatures and shear rates. The obtained values were compared with the viscosity values of pathologically changed synovial fluids from human knee joints as well as with pathological samples from the canine hip joint. The results show that the viscosity values vary within a series of measurements and are inversely proportional to the temperature of the sample and the shear rate. The differences between the average viscosities of canine and human synovial fluids taken from pathologically changed joints are below 4% (22.5 s(-1) at theta1 = 25 degrees C). The findings of this study are being implemented in a FE-Model for the computation of actual forces in the hip joint during different movements. This would represent a contribution to an improved prosthetic treatment of canine and human hips.

[SOMATOTYPE JOINT MOBILITY AND RANGES OF HIP AND KNEE OF COLLEGE STUDENTS].

PubMed

Godoy-Cumillaf, Andrés; Valdés-Badilla, Pablo; García Sandoval, Alan; Grandón Fuentes, Monica; Lagos Del Canto, Loreto; Aravena Turra, Raúl; Herrera-Valenzuela, Tomás; Bruneau Chavez, José; Durán Agüero, Samuel

2015-12-01

several studies indicate a consistency between the physical inactivity and low levels of mobility in hip and knee joint. to determine the differences in the motion range of the hip and knee joint between the different classifications of somatotype in students of Pedagogy in Physical Education of the Universidad Autónoma de Chile, campus Temuco. the sample included 102 physical education students (31.3% female), somatotype was obtained through the protocol of the International Society for the Advancement of Kinanthropometry (ISAK) and the motion range of the hip and knee joint (ROM) using a universal goniometer. the mean somatotype was endo-mesomorphic (4.8 - 3.4 - 2) for the women and meso-endomorphic (3.5 - 5.7 - 2) for the males, while the ROM evaluation indicated that the 50% of the students presented mobility values of joint lower than the normal ones. Furthermore, the endo-mesomorphic women showed lower ROM values of medial rotation of the right hip (45.5 ° ± 10.2 °; P = 0.0125, t = 2.732) and left hip side rotation (41.7 ° ± 10.3 °; P = 0.0256; p = 2.402) than the women meso-endomorphic. the results shows a relationship between the somatotype and hip ROM in the women, showing that in the women the most favorable results of joint mobility are related with a greater muscle mass. In contrasts, no significant differences were observed in men. It is important to encourage the development of joint mobility exercises according to the specific needs of each sex. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Interobserver repeatability of measurements on computed tomography images of lax canine hip joints from youth to maturity.

PubMed

Lopez, Mandi J; Davis, Kechia M; Jeffrey-Borger, Susan L; Markel, Mark D; Rettenmund, Christy

2009-12-01

To determine interobserver repeatability of measurements on computed tomography (CT) images of lax canine hip joints at different ages and in the presence of degenerative joint disease at maturity. Longitudinal observational investigation. Sibling crossbreed hounds. Pelvic CT was performed at 20, 24, 32, 48, 68, and 104 weeks of age. Measures were performed on 3 contiguous two-dimensional (2D) transverse CT images of both hips at each time point by 3 investigators. Center-edge angle (CEA), horizontal toit externe angle (HTEA), ventral (VASA), dorsal (DASA), and horizontal (HASA) acetabular sector angles, acetabular index (AI), and percent femoral head coverage (CPC) were measured. Interobserver repeatability was quantified with the intraclass correlation coefficient (ICC). Satisfactory repeatability was considered when ICC >or=0.75. DASA, CEA, and CPC were repeatable in all age groups. HASA and HTEA were repeatable for all but 1 time point. At 20 weeks of age, all measures but AI were repeatable, and at 104 weeks of age, DASA, CEA, CPC, and HASA were repeatable. Measures were repeatable in hips with and without degenerative changes with the exceptions of AI and HASA in normal hips and VASA and HTEA in osteoarthritic hips. Most 2D CT measurements examined were repeatable regardless of age or joint disease. Two-dimensional CT measures may augment current techniques for assessing joint changes in lax canine hips.

The tribology of metal-on-metal total hip replacements.

PubMed

Scholes, S C; Unsworth, A

2006-02-01

Total hip surgery is an effective way of alleviating the pain and discomfort caused by diseased or damaged joints. However, in the majority of cases, these joints have a finite life. The main reason for failure is osteolysis (bone resorption). It is well documented that an important cause of osteolysis, and therefore the subsequent loosening and failure of conventional metal- or ceramic-on-ultra-high molecular weight polyethylene joints, is the body's immunological response to the polyethylene wear particles. To avoid this, interest has been renewed in metal-on-metal joints. The intention of this paper is to review the studies that have taken place within different laboratories to determine the tribological performance of new-generation metal-on-metal total hip replacements. These types of joint offer a potential solution to enhance the longevity of prosthetic hip systems; however, problems may arise owing to the effects of metal ion release, which are, as yet, not fully understood.

Total hip arthroplasty of dysplastic hip after previous Chiari pelvic osteotomy.

PubMed

Minoda, Yukihide; Kadowaki, Toru; Kim, Mitsunari

2006-08-01

Many reports have suggested that Chiari pelvic osteotomy would improve the results of acetabular component placement and fixation in subsequent total hip arthroplasty. However, little is known concerning the biomechanical, radiological, and clinical effects of Chiari pelvic osteotomy on subsequent total hip arthroplasty. Ten total hip arthroplasties for developmental dysplasia of the hip after previous Chiari pelvic osteotomy (Chiari group) were compared with 20 total hip arthroplasties for developmental dysplasia of the hip without previous surgery (control group). Preoperative patient demographic data and operative technique were well matched between the groups. The mean duration of follow-up was 3.0 years. Biomechanical, radiological, and clinical evaluations were performed. No acetabular or femoral components exhibited loosening. All patients had good or excellent clinical score according to the Merle d'Aubigne-Postel rating system at the most recent follow-up. Abductor force and joint force were smaller in the Chiari group, although long operative time, more blood loss, and verticalization of joint force were noted in this group. This limited study suggested that Chiari pelvic osteotomy changed the biomechanical features of the hip joint, and that this alteration might have compromised subsequent total hip arthroplasty.

Clinical study on the unloading effect of hip bracing on gait in patients with hip osteoarthritis.

PubMed

Nérot, Agathe; Nicholls, Micah

2017-04-01

Internal hip abduction moment is a major indicator for hip loading. A new hip bracing concept was designed to unload the cartilaginous area in hip osteoarthritis via an abduction and external rotation force intended to alter the weight bearing area and reduce compression through the joint. To assess the effect of a novel brace on hip rotation in the transverse and coronal planes and on the hip abduction moment. Repeated measures. Gait analysis was performed on 14 subjects with unilateral symptomatic hip osteoarthritis. Pain, joint motion, moments and vertical ground reaction force were compared between the braced and the unbraced (control), randomly assigned, conditions. Nine participants felt an immediate reduction in pain while walking with the hip brace. Peak hip abduction moment significantly decreased on the osteoarthritis side ( p = 0.017). Peak hip adduction ( p = 0.004) and internal rotation ( p = 0.0007) angles significantly decreased at stance with the brace. Wearing the brace would appear to reduce the compressive joint reaction force at the femuroacetabular interface as indicated by a reduction in internal hip abduction moment along with immediate pain reduction in nine participants. Further long-term studies are warranted. Clinical relevance The brace rotates the hip in the transverse and coronal planes, possibly resulting in a decrease in load through the diseased area of cartilage. In some patients, an immediate decrease in pain was experienced. The brace offers an alternative solution for hip osteoarthritis patients not ready for a hip replacement.

Hip impingement: identifying and treating a common cause of hip pain.

PubMed

Kuhlman, Geoffrey S; Domb, Benjamin G

2009-12-15

Femoroacetabular impingement, also known as hip impingement, is the abutment of the acetabular rim and the proximal femur. Hip impingement is increasingly recognized as a common etiology of hip pain in athletes, adolescents, and adults. It injures the labrum and articular cartilage, and can lead to osteoarthritis of the hip if left untreated. Patients with hip impingement often report anterolateral hip pain. Common aggravating activities include prolonged sitting, leaning forward, getting in or out of a car, and pivoting in sports. The use of flexion, adduction, and internal rotation of the supine hip typically reproduces the pain. Radiography, magnetic resonance arthrography, and injection of local anesthetic into the hip joint confirm the diagnosis. Pain may improve with physical therapy. Treatment often requires arthroscopy, which typically allows patients to resume premorbid physical activities. An important goal of arthroscopy is preservation of the hip joint. Whether arthroscopic treatment prevents or delays osteoarthritis of the hip is unknown.

Development of a Wearable Assist Robot for Walk Rehabilitation After Knee Arthroplasty Surgery

NASA Astrophysics Data System (ADS)

Terada, H.; Zhu, Y.; Horiguchi, K.; Nakamura, M.; Takahashi, R.

In Japan, it is popular that the disease knee joints will be replaced to artificial joints by surgery. And we have to assist so many patients for walk rehabilitation. So, the wearable assist robot has been developed. This robot includes the knee motion assist mechanism and the hip joint support mechanism. Especially, the knee motion assist mechanism consists of a non-circular gear and grooved cams. This mechanism rotates and slides simultaneously, which has two degree-of-freedom. Also, the hip joint support mechanism consists of a hip brace and a ball-joint. This mechanism can avoid motion constraints which are the internal or external rotation and the adduction or abduction. Then, the control algorithm, which considers an assisting timing for the walk rehabilitation, has been proposed. A sensing system of a walk state for this control system uses a heel contacts sensor and knee and hip joint rotation angle sensors. Also, the prototype robot has been tested. And it is confirmed that the assisting system is useful.

Radiographic and clinical factors associated with one-leg standing and gait in patients with mild-to-moderate secondary hip osteoarthritis.

PubMed

Tateuchi, Hiroshige; Koyama, Yumiko; Akiyama, Haruhiko; Goto, Koji; So, Kazutaka; Kuroda, Yutaka; Ichihashi, Noriaki

2016-09-01

A decline in physical function associated with secondary hip osteoarthritis (OA) may be caused by both radiographic and clinical factors; however, the underlying mechanism remains unclear. The purpose of this study was to determine how joint degeneration, hip morphology, pain, hip range of motion (ROM), and hip muscle strength relate to one-leg standing (OLS) and gait in patients with mild-to-moderate secondary hip osteoarthritis. Fifty-five female patients (ages 22-65 years) with mild-to-moderate hip OA secondary to hip dysplasia were consecutively enrolled. Balance during OLS and three-dimensional hip angle changes while maintaining the OLS and at foot-off of the raised leg were measured. Gait speed and peak three-dimensional hip joint angles during gait were also measured. The associations between dependent variables (balance, gait speed, and hip kinematic changes) and independent variables (age, body mass index, pain, joint degeneration, hip morphologic abnormality, passive hip ROM, and hip muscle strength) were determined. While lower hip muscle strength was associated with hip kinematic changes such as flexion and internal rotation while maintaining OLS, decreased acetabular head index (AHI) and increased pain were associated with hip extension and abduction at foot-off in OLS. Decreased passive hip ROM was associated with decreased peak hip angles (extension, adduction, and external and internal rotation) during gait, although increased pain and decreased hip extension muscle strength were associated with slower gait speed. In this study of patients with secondary hip OA, AHI, pain, and hip impairments were associated with OLS and gait independently from age and radiographic degeneration. Copyright © 2016 Elsevier B.V. All rights reserved.

Dwarfism

MedlinePlus

... dwarfism might have: cleft palate hand and ear differences hip dysplasia club feet severe curvature of the spine early deterioration of joints and joint stiffness potential hip and knee dislocation Complications From Spondyloepiphyseal Dysplasia ...

Relationships among measurements obtained by use of computed tomography and radiography and scores of cartilage microdamage in hip joints with moderate to severe joint laxity of adult dogs.

PubMed

Lopez, Mandi J; Lewis, Brooke P; Swaab, Megan E; Markel, Mark D

2008-03-01

To evaluate correlations among measurements on radiographic and computed tomography (CT) images with articular cartilage microdamage in lax hip joints of dogs. 12 adult mixed-breed hounds. Pelvic CT and radiography were performed. Hip joints were harvested following euthanasia. Orthopedic Foundation for Animals (OFA) and PennHIP radiograph reports were obtained. Norberg angle (NA) and radiographic percentage femoral head coverage (RPC) were determined. Center-edge angle (CEA), horizontal toit externe angle (HTEA), ventral acetabular sector angle (VASA), dorsal acetabular sector angle (DASA), horizontal acetabular sector angle (HASA), acetabular index (AI), and CT percentage femoral head coverage (CPC) were measured on 2-dimensional CT images. Femoral head-acetabular shelf percentage was measured on sagittal 3-dimensional CT (SCT) and transverse 3-dimensional CT (TCT) images. Light microscopy was used to score joint cartilage. Relationships of OFA confirmation and PennHIP osteoarthritis scores with radiography, CT, and cartilage variables and relationships of cartilage scores with radiography and CT measurements were evaluated with Spearman rank correlations. Pearson correlation was used for relationships of distraction index (DI) with radiography, CT, and cartilage variables. Significant relationships included PennHIP osteoarthritis score with cartilage score, CEA, HTEA, DASA, AI, CPC, and TCT; OFA confirmation score with cartilage score, NA, RPC, CEA, HTEA, DASA, AI, CPC, and TCT; cartilage score with NA, RPC, CEA, HTEA, DASA, HASA, AI, and TCT; and DI with cartilage score, CEA, HTEA, DASA, HASA, AI, and CPC. CT appeared to be a valuable imaging modality for predicting cartilage microdamage in canine hip joints.

Evolution of the human hip. Part 1: the osseous framework

PubMed Central

Hogervorst, Tom; Vereecke, Evie E.

2014-01-01

Extensive osseous adaptations of the lumbar spine, pelvis, hip and femur characterize the emergence of the human bipedal gait with its ‘double extension’ of the lumbar spine and hip. To accommodate lumbar lordosis, the pelvis was ‘compacted’, becoming wider and shorter, as compared with the non-human apes. The hip joint acquired a much more extended position, which can be seen in a broader evolutionary context of verticalization of limbs. When loaded in a predominantly vertical position, the femur can be built lighter and longer than when it is loaded more horizontally because bending moments are smaller. Extension of the hip joint together with elongation of the femur increases effective leg length, and hence stride length, which improves energy efficiency. At the hip joint itself, the shift of the hip’s default working range to a more extended position influences concavity at the head–neck junction and femoral neck anteversion. PMID:27011802

Hip2Norm: an object-oriented cross-platform program for 3D analysis of hip joint morphology using 2D pelvic radiographs.

PubMed

Zheng, G; Tannast, M; Anderegg, C; Siebenrock, K A; Langlotz, F

2007-07-01

We developed an object-oriented cross-platform program to perform three-dimensional (3D) analysis of hip joint morphology using two-dimensional (2D) anteroposterior (AP) pelvic radiographs. Landmarks extracted from 2D AP pelvic radiographs and optionally an additional lateral pelvic X-ray were combined with a cone beam projection model to reconstruct 3D hip joints. Since individual pelvic orientation can vary considerably, a method for standardizing pelvic orientation was implemented to determine the absolute tilt/rotation. The evaluation of anatomically morphologic differences was achieved by reconstructing the projected acetabular rim and the measured hip parameters as if obtained in a standardized neutral orientation. The program had been successfully used to interactively objectify acetabular version in hips with femoro-acetabular impingement or developmental dysplasia. Hip(2)Norm is written in object-oriented programming language C++ using cross-platform software Qt (TrollTech, Oslo, Norway) for graphical user interface (GUI) and is transportable to any platform.

Prediction of hip joint load and translation using musculoskeletal modelling with force-dependent kinematics and experimental validation.

PubMed

Zhang, Xuan; Chen, Zhenxian; Wang, Ling; Yang, Wenjian; Li, Dichen; Jin, Zhongmin

2015-07-01

Musculoskeletal lower limb models are widely used to predict the resultant contact force in the hip joint as a non-invasive alternative to instrumented implants. Previous musculoskeletal models based on rigid body assumptions treated the hip joint as an ideal sphere with only three rotational degrees of freedom. An musculoskeletal model that considered force-dependent kinematics with three additional translational degrees of freedom was developed and validated in this study by comparing it with a previous experimental measurement. A 32-mm femoral head against a polyethylene cup was considered in the musculoskeletal model for calculating the contact forces. The changes in the main modelling parameters were found to have little influence on the hip joint forces (relative deviation of peak value < 10 BW%, mean trial deviation < 20 BW%). The centre of the hip joint translation was more sensitive to the changes in the main modelling parameters, especially muscle recruitment type (relative deviation of peak value < 20%, mean trial deviation < 0.02 mm). The predicted hip contact forces showed consistent profiles, compared with the experimental measurements, except in the lateral-medial direction. The ratio-average analysis, based on the Bland-Altman's plots, showed better limits of agreement in climbing stairs (mean limits of agreement: -2.0 to 6.3 in walking, mean limits of agreement: -0.5 to 3.1 in climbing stairs). Better agreement of the predicted hip contact forces was also found during the stance phase. The force-dependent kinematics approach underestimated the maximum hip contact force by a mean value of 6.68 ± 1.75% BW compared with the experimental measurements. The predicted maximum translations of the hip joint centres were 0.125 ± 0.03 mm in level walking and 0.123 ± 0.005 mm in climbing stairs. © IMechE 2015.

A Rare Case of Morel-Lavallee Syndrome Complicating an Anterior Dislocation of Hip Joint.

PubMed

Nekkanti, Supreeth; Vijay, C; Theja, Sujana; Shankar, R Ravi; Verma, Anubhav

2016-01-01

Hip dislocations are serious injuries as hip joint is an extremely stable joint. It requires a significant amount of force to produce such an injury. Anterior dislocations are uncommon. Potential complications of anterior hip dislocations are a neurovascular injury to femoral vessels or acetabular fractures. We report a rare late complication of Morel-Lavallee syndrome occurring 3 weeks after an anterior dislocation of the hip in a 43-year-old male. The patient presented to us with history. Morel-Lavallee syndrome is a rare complication. However if diagnosed early can be successfully treated with minimal burden to the patient. The authors recommend surgeons to have a high index of suspicion for this syndrome and a stringent follow-up examination of the patient.

The transport of wear particles in the prosthetic hip joint: a computational fluid dynamics investigation.

PubMed

Hölzer, Andreas; Schröder, Christian; Woiczinski, Matthias; Sadoghi, Patrick; Müller, Peter E; Jansson, Volkmar

2012-02-02

The joint fluid mechanics and transport of wear particles in the prosthetic hip joint were analyzed for subluxation and flexion motion using computational fluid dynamics (CFD). The entire joint space including a moving capsule boundary was considered. It was found that particles suspended in the joint space are drawn into the joint gap between prosthesis cup and head during subluxation, which was also documented by Lundberg et al. (2007; Journal of Biomechanics 40, 1676-1685), however, wear particles remain in the joint gap. Wear particles leave the joint gap during flexion and can finally migrate to the proximal boundaries including the acetabular bone, where the particle deposition can cause osteolysis according to the established literature. Thus, the present study supports the theory of polyethylene wear particle induced osteolysis of the acetabular bone as a major factor in the loosening of hip prosthesis cups. Copyright © 2011 Elsevier Ltd. All rights reserved.

[The effect of verticalization of the resulting force (R) of weight bearing in the hip joint on morphologic characteristics of the medullary canal in the femoral shaft in patients with coxarthrosis].

PubMed

Jovanović, S

1992-01-01

An influence of verticalization of the resulting force of weight-bearing on the hip joint "R" on the morphological characteristics of the medullar canal on the proximal edge of the shaft of femur was researched. Progressive degenerative changes of the hip joint with a consequent sideways limping or changes of the collodiaphysial angle (ccd angle) were the cause of the verticalization of the resulting force "R". The analysis of patients treated and operated on The Orthopaedic Department of the General Hospital Osijek and The Orthopaedic Clinic of The Medical Faculty of The University of Zagreb. The research, undoubtedly, proved that the patients with coxarthrosis and side-ways in the hip or with changed collodiaphysial angle experienced verticalization of the resulting force of weigh-bearing of the hip joint and the proximal edge of femur which caused morphological changes of the medular canal of the shaft of femur.

Clinical application of the modified medially-mounted motor-driven hip gear joint for paraplegics.

PubMed

Sonoda, S; Imahori, R; Saitoh, E; Tomita, Y; Domen, K; Chino, N

2000-04-15

This paper describes a motor-driven orthosis for paraplegics which has been developed. This orthosis is composed of a medially-mounted motor-driven hip joint and bilateral knee-ankle-foot orthosis. With the gear mechanism, the virtual axis of the hip joint of this orthosis is almost as high as the anatomical hip joint. A paraplegic patient with an injury level of T10/11 walked using bilateral lofstrand crutches and this new orthosis with or without the motor system. The motor is initiated by pushing a button attached at the edge of the grab of the crutches. Faster cadence and speed and smaller rotation angle of the trunk was obtained in motor walking compared with non-motor walking. The patient did not feel fearful of falling. The benefit of motor orthosis is that it can be used even in patients with lower motor lesions and that it provides stable regulation of hip flexion movement in spastic patients. In conclusion, this motor orthosis will enhance paraplegic walking.

How joint torques affect hamstring injury risk in sprinting swing-stance transition.

PubMed

Sun, Yuliang; Wei, Shutao; Zhong, Yunjian; Fu, Weijie; Li, Li; Liu, Yu

2015-02-01

The potential mechanisms of hamstring strain injuries in athletes are not well understood. The study, therefore, was aimed at understanding hamstring mechanics by studying loading conditions during maximum-effort overground sprinting. Three-dimensional kinematics and ground reaction force data were collected from eight elite male sprinters sprinting at their maximum effort. Maximal isometric torques of the hip and knee were also collected. Data from the sprinting gait cycle were analyzed via an intersegmental dynamics approach, and the different joint torque components were calculated. During the initial stance phase, the ground reaction force passed anteriorly to the knee and hip, producing an extension torque at the knee and a flexion torque at the hip joint. Thus, the active muscle torque functioned to produce flexion torque at the knee and extension torque at the hip. The maximal muscle torque at the knee joint was 1.4 times the maximal isometric knee flexion torque. During the late swing phase, the muscle torque counterbalanced the motion-dependent torque and acted to flex the knee joint and extend the hip joint. The loading conditions on the hamstring muscles were similar to those of the initial stance phase. During both the initial stance and late swing phases, the large passive torques at both the knee and hip joints acted to lengthen the hamstring muscles. The active muscle torques generated mainly by the hamstrings functioned to counteract those passive effects. As a result, during sprinting or high-speed locomotion, the hamstring muscles may be more susceptible to high risk of strain injury during these two phases.

How Joint Torques Affect Hamstring Injury Risk in Sprinting Swing–Stance Transition

PubMed Central

SUN, YULIANG; WEI, SHUTAO; ZHONG, YUNJIAN; FU, WEIJIE; LI, LI; LIU, YU

2015-01-01

ABSTRACT Purpose The potential mechanisms of hamstring strain injuries in athletes are not well understood. The study, therefore, was aimed at understanding hamstring mechanics by studying loading conditions during maximum-effort overground sprinting. Methods Three-dimensional kinematics and ground reaction force data were collected from eight elite male sprinters sprinting at their maximum effort. Maximal isometric torques of the hip and knee were also collected. Data from the sprinting gait cycle were analyzed via an intersegmental dynamics approach, and the different joint torque components were calculated. Results During the initial stance phase, the ground reaction force passed anteriorly to the knee and hip, producing an extension torque at the knee and a flexion torque at the hip joint. Thus, the active muscle torque functioned to produce flexion torque at the knee and extension torque at the hip. The maximal muscle torque at the knee joint was 1.4 times the maximal isometric knee flexion torque. During the late swing phase, the muscle torque counterbalanced the motion-dependent torque and acted to flex the knee joint and extend the hip joint. The loading conditions on the hamstring muscles were similar to those of the initial stance phase. Conclusions During both the initial stance and late swing phases, the large passive torques at both the knee and hip joints acted to lengthen the hamstring muscles. The active muscle torques generated mainly by the hamstrings functioned to counteract those passive effects. As a result, during sprinting or high-speed locomotion, the hamstring muscles may be more susceptible to high risk of strain injury during these two phases. PMID:24911288

[Relationship between muscle activity and kinematics of the lower extremity in slow motions of squats in humans].

PubMed

Khorievin, V I; Horkovenko, A V; Vereshchaka, I V

2013-01-01

Squatting can be performed on ankle strategy when ankle joint is flexed more than a hip joint and on hip strategy when large changes occur at the hip joint. The relationships between changes ofjoint angles and electromyogram (EMG) of the leg muscles were studied in five healthy men during squatting that was performed at the ankle and hip strategies with a slow changes in the knee angle of 40 and 60 degrees. It is established that at ankle strategy the ankle muscles were activated ahead of joint angle changes and shifting the center of pressure (CT) on stabilographic platform, whereas activation of the thigh muscles began simultaneously with the change of the joint angles, showing the clear adaptation in successive trials and a linear relationships between the static EMG component and the angle changes of the ankle joint. In the case of hip strategy of squatting the thigh muscles were activated simultaneously with the change in the joint angles and the displacement of CT, whereas the ankle muscles were activated later than the thigh muscles, especially the muscle tibialis anterior, showing some adaptations in consecutive attempts. At the ankle strategy the EMG amplitude was greatest in thigh muscles, reproducing contour of changes in joint angles, whereas the ankle muscles were activated only slightly during changes of joint angles. In the case of hip strategy dominated the EMG amplitude of the muscle tibialis anterior, which was activated when driving down the trunk and fixation of the joint angles that was accompanied by a slight coactivation of the calf muscles with the step-like increase in the amplitude of the EMG of the thigh muscles. Choice of leg muscles to start the squatting on both strategies occurred without a definite pattern, which may indicate the existence of a wide range of options for muscle activity in a single strategy.

Chromium content in the human hip joint tissues.

PubMed

Brodziak-Dopierała, Barbara; Kwapuliński, Jerzy; Sobczyk, Krzysztof; Wiechuła, Danuta

2015-02-01

Chromium has many important functions in the human body. For the osseous tissue, its role has not been clearly defined. This study was aimed at determining chromium content in hip joint tissues. A total of 91 hip joint samples were taken in this study, including 66 from females and 25 from males. The sample tissues were separated according to their anatomical parts. The chromium content was determined by the AAS method. The statistical analysis was performed with U Mann-Whitney's non-parametric test, P≤0.05. The overall chromium content in tissues of the hip joint in the study subjects was as follows: 5.73 µg/g in the articular cartilage, 5.33 µg/g in the cortical bone, 17.86 µg/g in the cancellous bone, 5.95 µg/g in the fragment of the cancellous bone from the intertrochanteric region, and 1.28 µg/g in the joint capsule. The chromium contents were observed in 2 group patients, it was 7.04 µg/g in people with osteoarthritis and 12.59 µg/g in people with fractures. The observed chromium content was highest in the cancellous bone and the lowest in the joint capsule. Chromium content was significantly different between the people with hip joint osteoarthritis and the people with femoral neck fractures. Copyright © 2015 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

Radiofrequency denervation of the hip joint for pain management: case report and literature review.

PubMed

Gupta, Gaurav; Radhakrishna, Mohan; Etheridge, Paul; Besemann, Markus; Finlayson, Robert J

2014-01-01

A 55-year-old male presented with severe pain and functional limitations as a result of left hip osteoarthritis. He had failed multiple treatments while waiting for a hip arthroplasty, including physical therapy, medications, and various intra-articular injections. Thermal radiofrequency lesioning of the obturator and femoral articular branches to the hip joint was offered in the interim. To our knowledge, this is the first report to describe an inferior-lateral approach for lesioning the obturator branch, the clinical application of successive lesions to increase denervation area, and outcomes in a patient receiving a second treatment with previously good results. To discuss relevant and technical factors for this specific case, we reviewed previous literature on hip joint radiofrequency and critically evaluated previous anatomic studies in the context of radiofrequency. The first treatment provided significant benefit for a period of 6 months. A second treatment was employed providing only mild to moderate benefit until his joint replacement surgery 4 months later. Literature review revealed studies of low quality secondary to small sample sizes, patient selection methodology, inclusion of patients with heterogenous etiologies for pain, variable needle placement techniques, and lack of measurement of functional outcomes. Case report and low quality studies in existing literature. Hip joint radiofrequency denervation is a promising avenue for adjunctive treatment of hip pain. Further cadaveric studies are required to clarify a multitude of technical parameters. Once these are well defined, future clinical studies should consider pain, functional, and economic outcomes in their design.

[Minimally invasive approaches to hip and knee joints for total joint replacement].

PubMed

Rittmeister, M; König, D P; Eysel, P; Kerschbaumer, F

2004-11-01

The manuscript features the different minimally invasive approaches to the hip for joint replacement. These include medial, anterior, anterolateral, and posterior approaches. The concept of minimally invasive hip arthroplasty makes sense if it is an integral part of a larger concept to lower postoperative morbidity. Besides minimal soft tissue trauma, this concept involves preoperative patient education, preemptive analgesia, and postoperative physiotherapy. It is our belief that minimal incision techniques for the hip are not suited for all patients and all surgeons. The different minimally invasive approaches to the knee joint for implantation of a knee arthroplasty are described and discussed. There have been no studies published yet that fulfill EBM criteria. The data so far show that minimally invasive approaches and implantation techniques for total knee replacements lead to quicker rehabilitation of patients.

Metabolic Bone Diseases and Total Hip Arthroplasty: Preventing Complications.

PubMed

Moya-Angeler, Joaquin; Lane, Joseph M; Rodriguez, Jose A

2017-11-01

Metabolic bone diseases are a diverse group of conditions characterized by abnormalities in calcium metabolism and/or bone cell physiology. These unbalanced processes can eventually lead to bony deformities and altered joint biomechanics, resulting in degenerative joint disease. Not infrequently, patients with metabolic bone diseases have restricting hip joint pain that ultimately necessitates hip arthroplasty. To minimize complications, the surgeon must consider the particular characteristics of these patients. The surgical and medical management of patients with metabolic bone diseases undergoing hip arthroplasty requires appropriate preoperative diagnosis, careful attention to the technical challenges of surgery, and strategies to maximize the long-term results of the surgical intervention, such as the use of bone anabolic and anticatabolic agents.

Ankle and hip postural strategies defined by joint torques

NASA Technical Reports Server (NTRS)

Runge, C. F.; Shupert, C. L.; Horak, F. B.; Zajac, F. E.; Peterson, B. W. (Principal Investigator)

1999-01-01

Previous studies have identified two discrete strategies for the control of posture in the sagittal plane based on EMG activations, body kinematics, and ground reaction forces. The ankle strategy was characterized by body sway resembling a single-segment-inverted pendulum and was elicited on flat support surfaces. In contrast, the hip strategy was characterized by body sway resembling a double-segment inverted pendulum divided at the hip and was elicited on short or compliant support surfaces. However, biomechanical optimization models have suggested that hip strategy should be observed in response to fast translations on a flat surface also, provided the feet are constrained to remain in contact with the floor and the knee is constrained to remain straight. The purpose of this study was to examine the experimental evidence for hip strategy in postural responses to backward translations of a flat support surface and to determine whether analyses of joint torques would provide evidence for two separate postural strategies. Normal subjects standing on a flat support surface were translated backward with a range of velocities from fast (55 cm/s) to slow (5 cm/s). EMG activations and joint kinematics showed pattern changes consistent with previous experimental descriptions of mixed hip and ankle strategy with increasing platform velocity. Joint torque analyses revealed the addition of a hip flexor torque to the ankle plantarflexor torque during fast translations. This finding indicates the addition of hip strategy to ankle strategy to produce a continuum of postural responses. Hip torque without accompanying ankle torque (pure hip strategy) was not observed. Although postural control strategies have previously been defined by how the body moves, we conclude that joint torques, which indicate how body movements are produced, are useful in defining postural control strategies. These results also illustrate how the biomechanics of the body can transform discrete control patterns into a continuum of postural corrections.

Hip joint torques during the golf swing of young and senior healthy males.

PubMed

Foxworth, Judy L; Millar, Audrey L; Long, Benjamin L; Way, Michael; Vellucci, Matthew W; Vogler, Joshua D

2013-09-01

Descriptive, laboratory study. To compare the 3-D hip torques during a golf swing between young and senior healthy male amateur golfers. The secondary purpose was to compare the 3-D hip joint torques between the trail leg and lead leg. The generation of hip torques from the hip musculature is an important aspect of the golf swing. Golf is a very popular activity, and estimates of hip torques during the golf swing have not been reported. Twenty healthy male golfers were divided into a young group (mean ± SD age, 25.1 ± 3.1 years) and a senior group (age, 56.9 ± 4.7 years). All subjects completed 10 golf swings using their personal driver. A motion capture system and force plates were used to obtain kinematic and kinetic data. Inverse dynamic analyses were used to calculate 3-D hip joint torques of the trail and lead limbs. Two-way analyses of covariance (group by leg), with club-head velocity as a covariate, were used to compare peak hip torques between groups and limbs. Trail-limb hip external rotator torque was significantly greater in the younger group compared to the senior group, and greater in the trail leg versus the lead leg. When adjusting for club-head velocity, young and senior healthy male amateur golfers generated comparable hip torques during a golf swing, with the exception of the trail-limb hip external rotator torque. The largest hip torque found was the trail-limb hip extensor torque.

Efficacy of using an air arthrogram for EUA and injection of the hip joint in adults.

PubMed

Shahid, Mohammad; Shyamsundar, Srinivasan; Bali, Navi; McBryde, Callum; O'Hara, John; Bache, Edward

2014-09-01

Hip arthrography usually requires the injection of iodine based dyes which can cause complications. We wanted to determine the accuracy of using air for hip arthrography. A prospective study was undertaken including all adults who had a hip arthrogram. We initially did an air arthrogram and subsequently injected iohexol to see if we were still in the joint. Forty injections were done. Mean age 32 years. There was a 100% success rate with obtaining a positive air arthrogram. Air arthrogram of the hip offers a safe, cost free and accurate alternative to iodine based arthrograms.

Ankle Dorsiflexion Displacement During Landing is Associated With Initial Contact Kinematics but not Joint Displacement.

PubMed

Begalle, Rebecca L; Walsh, Meghan C; McGrath, Melanie L; Boling, Michelle C; Blackburn, J Troy; Padua, Darin A

2015-08-01

The ankle, knee, and hip joints work together in the sagittal plane to absorb landing forces. Reduced sagittal plane motion at the ankle may alter landing strategies at the knee and hip, potentially increasing injury risk; however, no studies have examined the kinematic relationships between the joints during jump landings. Healthy adults (N = 30; 15 male, 15 female) performed jump landings onto a force plate while three-dimensional kinematic data were collected. Joint displacement values were calculated during the loading phase as the difference between peak and initial contact angles. No relationship existed between ankle dorsiflexion displacement during landing and three-dimensional knee and hip displacements. However, less ankle dorsiflexion displacement was associated with landing at initial ground contact with larger hip flexion, hip internal rotation, knee flexion, knee varus, and smaller plantar flexion angles. Findings of the current study suggest that restrictions in ankle motion during landing may contribute to contacting the ground in a more flexed position but continuing through little additional motion to absorb the landing. Transverse plane hip and frontal plane knee positioning may also occur, which are known to increase the risk of lower extremity injury.

Etidronate

MedlinePlus

... the skeleton) in people who have had total hip replacement surgery (surgery to replace the hip joint with an artificial joint) or in people ... 8 ounces [180 to 240 mL]) of plain water while you are sitting or standing. Sit or ...

[EFFECTIVENESS OF BILATERAL TOTAL HIP AND KNEE ARTHROPLASTY FOR SEVERE INFLAMMATORY ARTHROPATHIES].

PubMed

Li, Xin; Li, Heng; Ni, Ming; Li, Xiang; Song, Xinggui; Kong, Xiangpeng; Li, Yucong; Chen, Jiying

2016-11-08

To evaluate the application and effectiveness of bilateral total hip arthroplasty and total knee arthroplasty in the treatment of severe inflammatory arthropathies. Between September 2008 and September 2015, 31 patients with severe inflammatory arthropathies were treated with bilateral total hip arthroplasty and total knee arthroplasty. Of 31 cases, 22 were male and 9 were female with an average age of 30 years (range, 20 to 41 years); there were 15 cases of rheumatoid arthritis and 16 cases of ankylosing spondylitis with an average onset age of 14 years (range, 5-28 years); all 4 ankylosed joints were observed in 11 cases, 3 ankylosed joints in 2 cases, 2 ankylosed joints in 6 cases, 1 ankylosed joint in 1 case, and no ankylosed joint in 11 cases. Before operation, the hip range of motion (ROM) value was (17.82±28.18)°, and the knee ROM value score was (26.45±30.18)°; the hip Harris score was 29.64±11.58, and the hospital for special surgery (HSS) score was 27.07±11.04. The patients were grouped and compared in accordance with etiology and ankylosed joint. One-stage arthroplasty was performed in 1 case, two-stage arthroplasty in 22 cases, three-stage arthroplasty in 7 cases, and four-stage arthroplasty in 1 case. The total operation time was 325-776 minutes; the total blood loss was 900-3 900 mL; the total transfusion volume was 2 220-8 070 mL; and the total hospitalization time was 21-65 days. The patients were followed up 12-94 months (mean, 51 months). The hip and knee ROM values, Harris score and HSS score at last follow-up were significantly improved when compared with preoperative ones ( P <0.05). The subjective satisfaction degree was good in 16 cases, moderate in 10 cases, and poor in 5 cases. Periprosthetic infection occurred in 2 cases (3 knees), joint stiffness in 3 cases (6 knees), joint instability in 1 case (1 knee), leg length discrepancy of >2 cm in 2 cases, and flexion deformity of 10° in 1 case (1 knee). The hip and knee ROM values, Harris score and HSS score showed no significant difference between patients with ankylosing spondylitis and patients rheumatoid arthritis at last follow-up ( P >0.05). The hip and knee ROM values of the patients with ankylosed joint were significantly lower than those of patients with no ankylosed joint ( P <0.05); the Harris score and HSS score of the patients with ankylosed joint were lower than those of patients with no ankylosed joint, but no significant difference was found ( P >0.05). A combination of bilateral hip and knee arthroplasty is an efficient treatment for severe lower extremities deformity, arthralgia and poor quality of life caused by inflammatory arthropathies. However, the postoperative periprosthetic infection and stiffness of knee are important complications influencing the effectiveness of operation.

Behavioral effect of knee joint motion on body's center of mass during human quiet standing.

PubMed

Yamamoto, Akio; Sasagawa, Shun; Oba, Naoko; Nakazawa, Kimitaka

2015-01-01

The balance control mechanism during upright standing has often been investigated using single- or double-link inverted pendulum models, involving the ankle joint only or both the ankle and hip joints, respectively. Several studies, however, have reported that knee joint motion during quiet standing cannot be ignored. This study aimed to investigate the degree to which knee joint motion contributes to the center of mass (COM) kinematics during quiet standing. Eight healthy adults were asked to stand quietly for 30s on a force platform. Angular displacements and accelerations of the ankle, knee, and hip joints were calculated from kinematic data obtained by a motion capture system. We found that the amplitude of the angular acceleration was smallest in the ankle joint and largest in the hip joint (ankle < knee < hip). These angular accelerations were then substituted into three biomechanical models with or without the knee joint to estimate COM acceleration in the anterior-posterior direction. Although the "without-knee" models greatly overestimated the COM acceleration, the COM acceleration estimated by the "with-knee" model was similar to the actual acceleration obtained from force platform measurement. These results indicate substantial effects of knee joint motion on the COM kinematics during quiet standing. We suggest that investigations based on the multi-joint model, including the knee joint, are required to reveal the physiologically plausible balance control mechanism implemented by the central nervous system. Copyright © 2014 Elsevier B.V. All rights reserved.

Direct hip joint distraction during acetabular fracture surgery using the AO universal manipulator.

PubMed

Calafi, L Afshin; Routt, M L Chip

2010-02-01

Certain acetabular fractures may necessitate distraction of the hip joint for removal of intra-articular debris and assessment of reduction. Distraction can be accomplished by manual traction, using a traction table or an AO universal manipulator (UM). The UM is a relatively simple and an inexpensive device that can provide focal distraction in a controlled manner without the risks associated with the use of a traction table. We describe a technique using the UM for hip joint distraction during acetabular fracture surgery through a Kocher-Langenbeck surgical exposure.

[The hip joint in neuromuscular disorders].

PubMed

Strobl, W M

2009-07-01

Physiologic motor and biomechanical parameters are prerequisites for normal hip development and hip function. Disorders of muscle activity and lack of weight bearing due to neuromuscular diseases may cause clinical symptoms such as an unstable hip or reduced range of motion. Disability and handicap because of pain, hip dislocation, osteoarthritis, gait disorders, or problems in seating and positioning are dependent on the severity of the disease, the time of occurrence, and the means of prevention and treatment. Preservation of pain-free and stable hip joints should be gained by balancing muscular forces and by preventing progressive dislocation. Most important is the exact indication of therapeutic options such as movement and standing therapy as well as drugs and surgery.

A sex-specific association between incident radiographic osteoarthritis of hip or knee and incident peripheral arterial calcifications: 8-year prospective data from Cohort Hip and Cohort Knee (CHECK).

PubMed

Gielis, W P; Welsing, P M J; van Spil, W E; Runhaar, J; Weinans, H; de Jong, P A

2017-11-01

There is sparse evidence for a relationship between cardiovascular disease (CVD) and osteoarthritis (OA). We investigated the association between incidence of arterial calcifications and incidence of radiographic knee and/or hip OA. We used baseline and 8-year follow-up data of Cohort Hip and Cohort Knee (CHECK). Knees and hips were either Kellgren-Lawrence (KL) grade 0 or 1 at baseline. Arterial calcifications were scored on hip and knee radiographs using a four-grade scale. Scores were summed for patient-level analyses. To investigate incidence, participants with arterial calcifications at baseline or missing follow-up were excluded. Incident OA was defined per joint as KL ≥ 2 or prosthesis at year eight. The association between incidenct of arterial calcifications and incident OA was studied using mixed-effects logistic regression. Of 763 participants included, 623 (82%) were women. Mean (sd) age was 56 (5.1) years, mean (sd) body mass index (BMI) 26.2 (4.1) kg/m 2 . Arterial calcifications developed in 174 participants (283 joints). OA developed in 456 participants (778 joints). Sex modified the association between arterial calcification and OA. In women, incident arterial calcification around a joint was positively associated with incident OA in that joint (adjusted OR 2.51 (95% CI 1.57-4.03)). In men, no association was observed on joint-level, but at patient-level the arterial calcification sum score was negatively associated with incident OA (adjusted OR per point increase 0.70 (95% CI 0.54-0.90)) indicating a systemic effect. We observed sex-dependent associations between incident arterial calcification and incident radiographic knee and/or hip OA, which differs between joint- and patient-level. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The role of obesity, biomechanical constitution of the pelvis and contact joint stress in progression of hip osteoarthritis.

PubMed

Recnik, G; Kralj-Iglic, V; Iglic, A; Antolic, V; Kramberger, S; Rigler, I; Pompe, B; Vengust, R

2009-07-01

The aim of our study was to explore whether earlier hip arthroplasty for idiopathic osteoarthritis (OA) might be explained by enlarged contact stress in the hip joint, and to what amount can that be attributed to obesity and biomechanical constitution of the pelvis. Fifty subjects were selected from a list of consecutive recipients of hip endoprosthesis due to idiopathic OA; standard pelvic radiographs made years prior to surgery were the main selection criteria. For 65 hips resultant hip force and peak contact hip stress normalized to the body weight (R/Wb and p(max)/Wb) were determined from the radiographs with the HIPSTRESS method. Body weight and body mass index (BMI) were obtained with an interview. Regression analysis was used to correlate parameters of obesity (body weight, BMI), biomechanical constitution of the pelvis (R/Wb, p(max)/Wb) and mechanical loading within the hip joint (R, p(max)) with age at hip arthroplasty. Younger age at hip arthroplasty was associated with higher body weight (P=0.009), higher peak contact hip stress normalized to the body weight - p(max)/Wb (P=0.019), higher resultant hip force -R (P=0.027) and larger peak contact hip stress - p(max) (P<0.001), but not with BMI (P=0.121) or R/Wb (P=0.614). Our results suggest that enlarged contact stress (p(max)) plays an important role in rapid progression of hip OA with both obesity (increased body weight) and unfavorable biomechanical constitution of the pelvis (greater p(max)/Wb) contributing.

The effects of load on system and lower-body joint kinetics during jump squats.

PubMed

Moir, Gavin L; Gollie, Jared M; Davis, Shala E; Guers, John J; Witmer, Chad A

2012-11-01

To investigate the effects of different loads on system and lower-body kinetics during jump squats, 12 resistance-trained men performed jumps under different loading conditions: 0%, 12%, 27%, 42%, 56%, 71%, and 85% of 1-repetition maximum (1-RM). System power output was calculated as the product of the vertical component of the ground reaction force and the vertical velocity of the bar during its ascent. Joint power output was calculated during bar ascent for the hip, knee, and ankle joints, and was also summed across the joints. System power output and joint power at knee and ankle joints were maximized at 0% 1-RM (p < 0.001) and followed the linear trends (p < 0.001) caused by power output decreasing as the load increased. Power output at the hip was maximized at 42% 1-RM (p = 0.016) and followed a quadratic trend (p = 0.030). Summed joint power could be predicted from system power (p < 0.05), while system power could predict power at the knee and ankle joints under some of the loading conditions. Power at the hip could not be predicted from system power. System power during loaded jumps reflects the power at the knee and ankle, while power at the hip does not correspond to system power.

Management of acute calcific tendinitis around the hip joint.

PubMed

Park, Sang-Min; Baek, Ji-Hoon; Ko, Young-Bong; Lee, Han-Jun; Park, Ki Jeong; Ha, Yong-Chan

2014-11-01

Although the natural history of calcific tendinitis within the rotator cuff of the shoulder is established, the natural history of calcific tendinitis around the hip joint remains unknown. To examine the duration of symptoms including pain, the location of calcific tendinitis around the hip joint, the radiologic course of calcium phosphate crystals, and the proportion of patients who required surgical treatment. Case series; Level of evidence, 4. Thirty hips (29 patients) with acute calcific tendinitis were treated between January 2010 and December 2012. Level of subjective hip pain using the visual analog scale pain score, radiologic type, and the location and size of calcium deposits were measured during a follow-up period of 12 to 32 months. The 29 patients included 7 men (24%) and 22 women (76%) with a mean age of 51.5 years (range, 28-78 years). All visual analog scale pain scores significantly improved from a mean of 7.1 to 0.8 at the latest follow-up (P < .001). The most common site of calcium deposition was the tendon of the gluteus medius. During follow-up, calcium deposition completely resolved in 5 of 20 hips. Symptoms in 23 patients (24 hips) responded to nonoperative treatment. Two patients (2 hips) were treated with ultrasound-guided local anesthetic and steroid injection. Four patients (4 hips) with long duration (>3 months) of severe pain, solid type, and large size (range, 96-416 mm(2)) were treated with arthroscopic excision. Nonoperative treatment in patients with acute calcific tendinitis of the hip joint might be successful in most patients. Surgical treatment is of value for patients experiencing prolonged severe pain, solid type, and large size. © 2014 The Author(s).

The Use of Superselective Arteriography in the Evaluation of the Influence of Intracapsular Hip Joint Pressure on the Blood Flow of the Femoral Head.

PubMed

Wu, Kai; Huang, Jianhua; Wang, Qiugen

2016-01-01

We aimed to analyze the intracapsular pressure of the hip joint following femoral neck fracture and its relationship to the position of the hip or to traction and (using superselective arteriography) to evaluate the blood supply to the femoral head and the influence of traction and hip position on the blood supply. Twenty-six cases of fresh Garden type I-III femoral neck fractures were enrolled. After being placed in the neutral position, in internal rotation or with traction of 3 and 5 kg, respectively, intracapsular manometric changes were measured. Eight cases underwent superselective arteriography of the medial circumflex femoral artery and its branches under the manometric changes of the hip joint capsule. Twenty-four to 48 h after the injury, the intracapsular pressure was significantly higher on the fractured side than on the normal side. The mean pressure was 28.41 ± 9.339 mm Hg in fully extended hips in the neutral position, 79.92 ± 12.80 mm Hg in internally rotated hips, 51.39 ± 15.41 mm Hg in hips with 3 kg of traction and 64.81 ± 13.56 mm Hg in hips with 5 kg of traction. The arteriographic findings revealed that traction and internal rotation reduced the perfusion of the femoral head at the medial circumflex femoral artery and its branches, and also negatively influenced venous reflux. Traction and internal rotation both caused the intracapsular pressure of the hip joint to rise considerably, which reduced the femoral head perfusion and impeded venous reflux. This could lead to avascular necrosis of the femoral head. © 2015 S. Karger AG, Basel.

Lower extremity control during turns initiated with and without hip external rotation.

PubMed

Zaferiou, Antonia M; Flashner, Henryk; Wilcox, Rand R; McNitt-Gray, Jill L

2017-02-08

The pirouette turn is often initiated in neutral and externally rotated hip positions by dancers. This provides an opportunity to investigate how dancers satisfy the same mechanical objectives at the whole-body level when using different leg kinematics. The purpose of this study was to compare lower extremity control strategies during the turn initiation phase of pirouettes performed with and without hip external rotation. Skilled dancers (n=5) performed pirouette turns with and without hip external rotation. Joint kinetics during turn initiation were determined for both legs using ground reaction forces (GRFs) and segment kinematics. Hip muscle activations were monitored using electromyography. Using probability-based statistical methods, variables were compared across turn conditions as a group and within-dancer. Despite differences in GRFs and impulse generation between turn conditions, at least 90% of each GRF was aligned with the respective leg plane. A majority of the net joint moments at the ankle, knee, and hip acted about an axis perpendicular to the leg plane. However, differences in shank alignment relative to the leg plane affected the distribution of the knee net joint moment when represented with respect to the shank versus the thigh. During the initiation of both turns, most participants used ankle plantar flexor moments, knee extensor moments, flexor and abductor moments at the push leg׳s hip, and extensor and abductor moments at the turn leg׳s hip. Representation of joint kinetics using multiple reference systems assisted in understanding control priorities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Estimations of relative effort during sit-to-stand increase when accounting for variations in maximum voluntary torque with joint angle and angular velocity.

PubMed

Bieryla, Kathleen A; Anderson, Dennis E; Madigan, Michael L

2009-02-01

The main purpose of this study was to compare three methods of determining relative effort during sit-to-stand (STS). Fourteen young (mean 19.6+/-SD 1.2 years old) and 17 older (61.7+/-5.5 years old) adults completed six STS trials at three speeds: slow, normal, and fast. Sagittal plane joint torques at the hip, knee, and ankle were calculated through inverse dynamics. Isometric and isokinetic maximum voluntary contractions (MVC) for the hip, knee, and ankle were collected and used for model parameters to predict the participant-specific maximum voluntary joint torque. Three different measures of relative effort were determined by normalizing STS joint torques to three different estimates of maximum voluntary torque. Relative effort at the hip, knee, and ankle were higher when accounting for variations in maximum voluntary torque with joint angle and angular velocity (hip=26.3+/-13.5%, knee=78.4+/-32.2%, ankle=27.9+/-14.1%) compared to methods which do not account for these variations (hip=23.5+/-11.7%, knee=51.7+/-15.0%, ankle=20.7+/-10.4%). At higher velocities, the difference in calculating relative effort with respect to isometric MVC or incorporating joint angle and angular velocity became more evident. Estimates of relative effort that account for the variations in maximum voluntary torque with joint angle and angular velocity may provide higher levels of accuracy compared to methods based on measurements of maximal isometric torques.

Degenerative joint disease: multiple joint involvement in young and mature dogs.

PubMed

Olsewski, J M; Lust, G; Rendano, V T; Summers, B A

1983-07-01

Radiologic, pathologic, and ancillary methods were used to determine the occurrence of degenerative joint disease involving multiple joints of immature and adult dogs. Animals were selected for the development of hip joint dysplasia and chronic degenerative joint disease. Of disease-prone dogs, 82% (45 of 55 dogs) had radiologic changes, indicative of hip dysplasia, by 1 year of age. At necropsy, more abnormal joints were identified than by radiographic examination. Among 92 dogs between 3 to 11 months of age that had joint abnormalities, 71% had hip joint involvement; 38%, shoulder joint involvement; 22%, stifle joint involvement; and 40% had multiple joint involvement. Polyarthritis was asymptomatic and unexpected. Radiographic examination of older dogs also revealed evidence of degenerative joint disease in many joints. Multiple joint involvement was substantiated at necropsy of young and mature dogs. A similar pattern of polyarticular osteoarthritis was revealed in a survey (computer search) of necropsy reports from medical case records of 100 adult and elderly dogs. Usually, the joint disease was an incidental observation, unrelated to the clinical disease or to the cause of death. The frequent occurrence of degenerative changes in several joints of dogs aged 6 months to 17 years indicated that osteoarthritis may be progressive in these joints and raises the possibility that systemic factors are involved in the disease process.

Influence of hip joint simulator design and mechanics on the wear and creep of metal-on-polyethylene bearings

PubMed Central

Ali, Murat; Al-Hajjar, Mazen; Partridge, Susan; Williams, Sophie; Fisher, John; Jennings, Louise M

2016-01-01

Hip joint simulators are used extensively for preclinical testing of hip replacements. The variation in simulator design and test conditions used worldwide can affect the tribological performance of polyethylene. The aim of this study was to assess the effects of simulator mechanics and design on the wear and creep of ultra-high-molecular-weight polyethylene. In the first part of this study, an electromechanical simulator and pneumatic simulator were used to compare the wear and creep of metal-on-polyethylene components under the same standard gait conditions. In the second part of the study, the same electromechanical hip joint simulator was used to investigate the influence of kinematics on wear. Higher wear rates and penetration depths were observed from the electromechanical simulator compared with the pneumatic simulator. When adduction/abduction was introduced to the gait cycle, there was no significant difference in wear with that obtained under the gait cycle condition without adduction/abduction. This study confirmed the influence of hip simulator design and loading conditions on the wear of polyethylene, and therefore direct comparisons of absolute wear rates between different hip joint simulators should be avoided. This study also confirmed that the resulting wear path was the governing factor in obtaining clinically relevant wear rates, and this can be achieved with either two axes or three axes of rotations. However, three axes of rotation (with the inclusion of adduction/abduction) more closely replicate clinical conditions and should therefore be the design approach for newly developed hip joint simulators used for preclinical testing. PMID:27160559

Influence of hip joint simulator design and mechanics on the wear and creep of metal-on-polyethylene bearings.

PubMed

Ali, Murat; Al-Hajjar, Mazen; Partridge, Susan; Williams, Sophie; Fisher, John; Jennings, Louise M

2016-05-01

Hip joint simulators are used extensively for preclinical testing of hip replacements. The variation in simulator design and test conditions used worldwide can affect the tribological performance of polyethylene. The aim of this study was to assess the effects of simulator mechanics and design on the wear and creep of ultra-high-molecular-weight polyethylene. In the first part of this study, an electromechanical simulator and pneumatic simulator were used to compare the wear and creep of metal-on-polyethylene components under the same standard gait conditions. In the second part of the study, the same electromechanical hip joint simulator was used to investigate the influence of kinematics on wear. Higher wear rates and penetration depths were observed from the electromechanical simulator compared with the pneumatic simulator. When adduction/abduction was introduced to the gait cycle, there was no significant difference in wear with that obtained under the gait cycle condition without adduction/abduction. This study confirmed the influence of hip simulator design and loading conditions on the wear of polyethylene, and therefore direct comparisons of absolute wear rates between different hip joint simulators should be avoided. This study also confirmed that the resulting wear path was the governing factor in obtaining clinically relevant wear rates, and this can be achieved with either two axes or three axes of rotations. However, three axes of rotation (with the inclusion of adduction/abduction) more closely replicate clinical conditions and should therefore be the design approach for newly developed hip joint simulators used for preclinical testing. © IMechE 2016.

Radiographic evaluation of perching-joint angles in cockatiels (Nymphicus hollandicus), Hispaniolan Amazon parrots (Amazona ventralis), and barred owls (Strix varia).

PubMed

Bonin, Glen; Lauer, Susanne K; Guzman, David Sanchez-Migallon; Nevarez, Javier; Tully, Thomas N; Hosgood, Giselle; Gaschen, Lorrie

2009-06-01

Information on perching-joint angles in birds is limited. Joint immobilization in a physiologic perching angle has the potential to result more often in complete restoration of limb function. We evaluated perching-joint angles in 10 healthy cockatiels (Nymphicus hollandicus), 10 Hispaniolan Amazons (Amazona ventralis), and 9 barred owls (Strix varia) and determined intra- and interobserver variability for goniometric measurements in 2 different radiographic projections. Intra- and interobserver variation was less than 7% for all stifle and intertarsal joint measurements but frequently exceeded 10% for the hip-joint measurements. Hip, stifle, and intertarsal perching angles differed significantly among cockatiels, Hispaniolan Amazon parrots, and barred owls. The accuracy of measurements performed on straight lateral radiographic projections with superimposed limbs was not consistently superior to measurements on oblique projections with a slightly rotated pelvis. Stifle and intertarsal joint angles can be measured on radiographs by different observers with acceptable variability, but intra- and interobserver variability for hip-joint-angle measurements is higher.

Pain reduction and improvement of function following ultrasound-guided intra-articular injections of triamcinolone hexacetonide and hyaluronic acid in hip osteoarthritis.

PubMed

Araújo, J P; Silva, L; Andrade, R; Paços, M; Moreira, H; Migueis, N; Pereira, R; Sarmento, A; Pereira, H; Loureiro, N; Espregueira-Mendes, J

2016-01-01

The scientific literature has shown positive results regarding intra-articular injections of hyaluronic acid in osteoarthritic joints. When injecting in the hip joint, the guidance of ultrasound can provide higher injection accuracy and repeatability. However, due to the methodological limitations in the current available literature, its recommendation in the current practice is still controversial. This study shows that ultrasound-guided intra-articular injections of triamcinolone hexacetonide and hyaluronic acid can improve pain, function and quality of life in patients with symptomatic and radiographic hip osteoarthritis. In addition, the administration of triamcinolone hexacetonide and hyaluronic acid to the hip joint in these patients can delay the need for interventional surgery.

Positioning bedridden patients to reduce interface pressures over the sacrum and great trochanter.

PubMed

Yoshikawa, Y; Maeshige, N; Sugimoto, M; Uemura, M; Noguchi, M; Terashi, H

2015-07-01

In this study, we evaluated the effect of hip-joint rotation on the interface pressure over the sacrum and greater trochanter with a new protocol for positioning of bedridden elderly patients. The interface pressure values over the sacrum and greater trochanter in bedridden patients were evaluated. These were collected in the supine position, 90° lateral position, and 30° and 40° laterally inclined positions with external rotation or neutral positioning of the hip joint. Each interface pressure was assessed with a device measuring pressure distribution, after which, the peak pressure index (PPI) was calculated. In the 17 patients examined, the PPI over the sacrum in the supine position was significantly greater than that in other positions. In the 30° and 40° laterally inclined positions, the PPIs over the greater trochanter were significantly lower in the neutral position of the hip joint compared with those in the external rotation position. Our findings revealed the effects of hip-joint rotation on the interface pressure for the greater trochanter, possibly due to the increased distance between the greater trochanter and the sacrum caused by neutral position of the hip joint. The results demonstrate that it is to best place the hip joint in a neutral position when the legs are in contact with the bed in order to distribute the pressure over the greater trochanter in the 30° and 40° laterally inclined positions. These results can be applied to the clinical setting to improve patient positioning and decrease pressure ulcers. The authors declare that they have no competing financial interests.

[Bursitis iliopectinea].

PubMed

Koudela, K; Koudelová, J; Koudela, K; Kunesová, M

2008-10-01

PURPOSE OF THE STUDY To present clinical and radiographic findings of iliopectineal bursitis and draw attention to some related etiopathogenetic factors. MATERIAL AND METHODS Six patients followed up between 2005 and 2007 were evaluated. They included four women and two men (average age, 58 years; range, 35 to 80 years) who presented with a tender mass in the hip region (four right and two left sides). Each patient underwent an examination involving a clinical check-up, imaging methods (CT, MR, angio-CT) and standard laboratory tests. RESULTS Iliopectineal bursitis clinically manifested as a tender mass in the groin and hip region in five patients; in one it was pulsating. The sixth case was asymptomatic. In three patients iliopectineal bursitis was found in association with steroid therapy and subsequent avascular necrosis of the femoral head and chronic synovitis. It followed tularemia with hip joint involvement in one patient, salmonella arthritis in one, and kidney transplant rejection in one. Also, iliopectineal bursitis was diagnosed in a patient with rheumatoid arthritis treated with steroids, but without femoral head avascular necrosis, and was incidentally found in another patient examined for digestive problems. Of the six cases of swollen bursa detected by the imaging methods used, five were found to communicate with the hip joint cavity, with four being so large that the bursa extended into the retroperitoneum. Two patients underwent excision or resection of the bursa; in addition, one of them had revitalizing graft surgery for femoral head necrosis. The patient with salmonella arthritis had to undergo a Girdlestone procedure. One patient was treated by draining of the bursa and, after inflammation resolved, total hip replacement surgery was carried out during which the iliopectineal bursa was removed. The patient with rheumatoid arthritis was treated by bursa draining and refused further surgical therapy (total hip replacement). DISCUSSION In our group of six patients, bursitis was symptomatic in five and was associated with chronic hip synovitis accompanying femoral head necrosis following steroid therapy or inflamation, either non-specific or arthitic. Bursitis was asymptomatic in one patient and was diagnosed only incidentally on CT examination done for another reason. The communication between the bursa and the hip joint cavity, found on CT scans and magnetic resonance images, was a radiographic factor important for differential diagnosis. The underlying disease of the hip joint plays a key role in the etiopathogenesis of iliopectineal bursitis. Therefore, surgical treatment should be comprehensible and, in addition to bursa resection or excision, should also include treatment of the affected joint (alloplasty, femoral head resection or revitalization). CONCLUSION Iliopectineal bursitis is associated with chronic hip synovitis present in degenerative, infectious or rheumatic joint diseases. When a lump is diagnosed in the inguinal or hip region, iliopectineal bursitis should always be considered in addition to conditions such as abscess, cyst, hernia, pseudoaneurysm, lymphocele, etc. The finding of communication beteen the bursa and hip joint cavity, made on CT scans or magnetic resonance images, is a radiographic factor important in terms of differential diagnosis. The surgical treatment of iliopectineal bursitis includes excision or resection of the bursa and therapy for the hip joint (alloplasty, femoral head resection or revitalization).

Periacetabular osteotomy: a review of swiss experience.

PubMed

Büchler, Lorenz; Beck, Martin

2014-12-01

Symptomatic dysplasia of the hip and acetabular retroversion are possible causes of osteoarthritis in the young adult. Surgical management with reorientation of the acetabulum allows causal therapy of the deformity and preservation of the native hip joint. The Ganz' periacetabular osteotomy permits a free 3-dimensional reorientation of the acetabulum and respects the blood supply of the acetabular fragment. The posterior column remains intact with a stable fixation of the acetabular fragment and a preserved shape of the true pelvis. There is a significant learning curve with severe complications in up to 30 % of cases. Good results can be expected in the long-term follow-up if performed with correct indication at young age in hips with preserved joint cartilage and proper reorientation of the acetabular fragment. Overall survivorship is superior to the natural course of hip dysplasia with a preserved hip joint in 61 % after 20 years.

Estimation of wear in total hip replacement using a ten station hip simulator.

PubMed

Brummitt, K; Hardaker, C S

1996-01-01

The results of hip simulator tests on a total of 16 total hip joints, all of them 22.25 mm Charnley designs, are presented. Wear at up to 6.75 million cycles was assessed by using a coordinate measuring machine. The results gave good agreement with clinical estimates of wear rate on the same design of joint replacement from a number of sources. Good agreement was also obtained when comparison was made with the published results from more sophisticated simulators. The major source of variation in the results was found to occur in the first million cycles where creep predominates. The results of this study support the use of this type of simplified simulator for estimating wear in a total hip prosthesis. The capability to test a significant number of joints simultaneously may make this mechanism preferable to more complex machines in many cases.

[Relevance of MRI After Closed Reduction of Traumatic Hip Dislocation in Children].

PubMed

Strüwind, Christoph Mauritz; von Rüden, Christian; Thannheimer, Andreas; Bühren, Volker; Schneidmueller, Dorien

2018-05-14

Traumatic hip dislocation in children and adolescents is a rare entity that typically results from high-energy trauma. After closed joint reduction, further treatment depends on the specific pattern of the lesion as identified using cross sectional imaging. The aim of this retrospective analysis was to evaluate relevant side effects after traumatic hip dislocation in children and adolescents in order to examine the need for focused diagnostics. This retrospective analysis covered 8 adolescents under 18 years suffering isolated traumatic hip joint dislocation between 2001 and 2017. In all patients, closed joint reduction was performed immediately after admission to the emergency room. In order to evaluate the complete extent of the injury, 5 patients received an MRI and 3 patients a CT scan following closed joint reduction. Two female and 6 male patients with a median age of 11 (range 5 - 16) years were included. In 2 cases, a free joint body was detected in the posterior joint gap in the posttraumatic CT scan after closed joint reduction. Interposition of the labrum into the joint gap was detected intraoperatively in both cases. In one patient who received posttraumatic MRI, labral interposition into the joint gap was observed after closed reduction. These findings were confirmed intraoperatively. In 4 other patients, no posttraumatic labral lesion was detected in the MRI after closed reduction. The reported side effects included ruptured anterior inferior iliac spine and ruptured femoral head ligament. MRI is gaining increasing importance following traumatic hip dislocation in children and adolescents. A missing chondral or osteochondral fragment in the CT scan does not exclude a labral lesion or interposition. Therefore, MRI following closed reduction is mandatory in any case. Georg Thieme Verlag KG Stuttgart · New York.

Diabetes is associated with persistent pain after hip and knee replacement

PubMed Central

Rajamäki, Tuomas J; Jämsen, Esa; Puolakka, Pia A; Nevalainen, Pasi I; Moilanen, Teemu

2015-01-01

Background and purpose In some patients, for unknown reasons pain persists after joint replacement, especially in the knee. We determined the prevalence of persistent pain following primary hip or knee replacement and its association with disorders of glucose metabolism, metabolic syndrome (MetS), and obesity. Patients and methods The incidence of pain in the operated joint was surveyed 1–2 years after primary hip replacement (74 patients (4 bilateral)) or primary knee replacement (119 patients (19 bilateral)) in 193 osteoarthritis patients who had participated in a prospective study on perioperative hyperglycemia. Of the 155 patients who completed the survey, 21 had undergone further joint replacement surgery during the follow-up and were excluded, leaving 134 patients for analysis. Persistent pain was defined as daily pain in the operated joint that had lasted over 3 months. Factors associated with persistent pain were evaluated using binary logistic regression with adjustment for age, sex, and operated joint. Results 49 of the134 patients (37%) had a painful joint and 18 of them (14%) had persistent pain. A greater proportion of knee patients than hip patients had a painful joint (46% vs. 24%; p = 0.01) and persistent pain (20% vs. 4%; p = 0.007). Previously diagnosed diabetes was strongly associated with persistent pain (5/19 vs. 13/115 in those without; adjusted OR = 8, 95% CI: 2–38) whereas MetS and obesity were not. However, severely obese patients (BMI ≥ 35) had a painful joint (but not persistent pain) more often than patients with BMI < 30 (14/21 vs. 18/71; adjusted OR = 5, 95% CI: 2–15). Interpretation Previously diagnosed diabetes is a risk factor for persistent pain in the operated joint 1–2 years after primary hip or knee replacement. PMID:25953426

Inter-Joint Coordination in Producing Kicking Velocity of Taekwondo Kicks

PubMed Central

Kim, Young Kwan; Kim, Yoon Hyuk; Im, Shin Ja

2011-01-01

The purpose of this study was to investigate joint kinematics of the kicking leg in Taekwondo and to examine the role of inter-joint coordination of the leg in producing the kicking velocity. A new inter-joint coordination index that encompasses three- dimensional hip and knee motions, was defined and applied to the joint kinematic results. Twelve elite Taekwondo athletes participated in this study and performed the back kick, thrashing kick, turning-back kick and roundhouse kick. Our results indicate that the back kick utilized a combination of hip and knee extension to produce the kicking velocity, and was characterized by a pushlike movement. The thrashing kick and turning-back kick utilized a greater degree of hip abduction than the roundhouse kick and back kick, and included complicated knee motions. The new index successfully categorized the thrashing kick and turning-back kick into a push-throw continuum, indicating a change from negative index (opposite direction) to positive index (same direction) of hip and knee motions at the end of the movement. This strategy of push-throw continuum increases the kicking velocity at the moment of impact by applying a throwlike movement pattern. Key points A variety of Taekwondo kicks have unique inter-joint coordination of the kicking leg. The back kick used a combination of hip and knee extension to produce the kicking velocity, and was characterized by a pushlike movement. The new index explained well the inter-joint coordination of three DOF joint motions of two joints in producing kicking velocity (positive values for throwlike movements and negative values for pushlike movements). The index successfully categorized the thrashing kick and turning-back kick into a push-throw continuum. PMID:24149292

Inter-joint coordination in producing kicking velocity of taekwondo kicks.

PubMed

Kim, Young Kwan; Kim, Yoon Hyuk; Im, Shin Ja

2011-01-01

The purpose of this study was to investigate joint kinematics of the kicking leg in Taekwondo and to examine the role of inter-joint coordination of the leg in producing the kicking velocity. A new inter-joint coordination index that encompasses three- dimensional hip and knee motions, was defined and applied to the joint kinematic results. Twelve elite Taekwondo athletes participated in this study and performed the back kick, thrashing kick, turning-back kick and roundhouse kick. Our results indicate that the back kick utilized a combination of hip and knee extension to produce the kicking velocity, and was characterized by a pushlike movement. The thrashing kick and turning-back kick utilized a greater degree of hip abduction than the roundhouse kick and back kick, and included complicated knee motions. The new index successfully categorized the thrashing kick and turning-back kick into a push-throw continuum, indicating a change from negative index (opposite direction) to positive index (same direction) of hip and knee motions at the end of the movement. This strategy of push-throw continuum increases the kicking velocity at the moment of impact by applying a throwlike movement pattern. Key pointsA variety of Taekwondo kicks have unique inter-joint coordination of the kicking leg.The back kick used a combination of hip and knee extension to produce the kicking velocity, and was characterized by a pushlike movement.The new index explained well the inter-joint coordination of three DOF joint motions of two joints in producing kicking velocity (positive values for throwlike movements and negative values for pushlike movements).The index successfully categorized the thrashing kick and turning-back kick into a push-throw continuum.

No evidence hip joint angle modulates intrinsically produced stretch reflex in human hopping.

PubMed

Gibson, W; Campbell, A; Allison, G

2013-09-01

Motor output in activities such as walking and hopping is suggested to be mediated neurally by purported stretch reflex augmentation of muscle output. Reflex EMG activity during these tasks has been frequently investigated in the soleus muscle; with alterations in reflex amplitude being associated with changes in hip joint angle/phase of the gait cycle. Previous work has focussed on reflex activity induced by an artificial perturbation or by induction of H-reflexes. As such, it is currently unknown if stretch reflex activity induced intrinsically (as part of the task) is modulated by changes in hip joint angle. This study investigated whether hip joint angle modulated reflex EMG 'burst' activity during a hopping task performed on a custom-built partially reclined sleigh. Ten subjects participated; EMG and kinematic data (VICON motor capture system) was collected for each hop cycle. Participants completed 5 sets of 30s of self-paced hopping in (1) hip neutral and (2) hip 60° flexion conditions. There was no difference in EMG 'burst' activity or in sagittal plane kinematics (knee/ankle) in the hopping task between the two conditions. The results indicate that during a functional task such as hopping, changes in hip angle do not alter the stretch reflex-like activity associated with landing. Copyright © 2013 Elsevier B.V. All rights reserved.

Pre- and post-alpha motoneuronal control of the soleus H-reflex during sinusoidal hip movements in human spinal cord injury

PubMed Central

Knikou, Maria; Chaudhuri, Debjani; Kay, Elizabeth; Schmit, Brian D.

2006-01-01

The aim of this study was to establish the contribution of hip-mediated sensory feedback to spinal interneuronal circuits during dynamic conditions in people with incomplete spinal cord injury (SCI). Specifically, we investigated the effects of synergistic and antagonistic group I afferents on the soleus H-reflex during imposed sinusoidal hip movements. The soleus H-reflex was conditioned by stimulating the common peroneal nerve (CPN) at short (2, 3, and 4 ms) and long (80, 100, and 120 ms) conditioning test (C-T) intervals to assess the reciprocal and pre-synaptic inhibition of the soleus H-reflex, respectively. The soleus H-reflex was also conditioned by medial gastrocnemius (MG) nerve stimulation at C-T intervals ranging from 4 to 7 ms to assess changes in autogenic Ib inhibition during hip movement. Sinusoidal hip movements were imposed to the right hip joint at 0.2 Hz by the Biodex system while subjects were supine. The effects of sinusoidal hip movement on five leg muscles along with hip, knee, and ankle joint torques were also established during sensorimotor conditioning of the reflex. Phase-dependent modulation of antagonistic and synergistic muscle afferents was present during hip movement, with the reciprocal, pre-synaptic, and Ib inhibition to be significantly reduced during hip extension and reinforced during hip flexion. Reflexive muscle and joint torque responses – induced by the hip movement – were entrained to specific phases of hip movement. This study provides evidence that hip-mediated input acts as a controlling signal of pre- and post-alpha motoneuronal control of the soleus H-reflex. The expression of these spinal interneuronal circuits during imposed sinusoidal hip movements is discussed with respect to motor recovery in humans after SCI. PMID:16782072

The role of synovial fluid analysis in the detection of periprosthetic hip and knee infections: a systematic review and meta-analysis.

PubMed

De Fine, Marcello; Giavaresi, Gianluca; Fini, Milena; Illuminati, Andrea; Terrando, Silvio; Pignatti, Giovanni

2018-05-01

This study tried to ascertain (1) the accuracy of synovial fluid white blood cell count and polymorphonucleate percentage in the diagnosis of periprosthetic hip and knee infections, (2) which test yielded superior test performance, and (3) the influence on diagnostic accuracy of study characteristics such as patient number, study design, study level, anatomic site, and threshold value. A systematic search was conducted including papers assessing more effective cutoffs for synovial fluid tests, having comparative design, evaluating an exclusive cohort of hip or knee prostheses, including a clear definition of infected cases, and reporting sufficient data for the calculation of true-positive, false-positive, false-negative, and true-negative. A total of 375 articles were collected and, given the inclusion criteria, ten manuscripts were included. These studies assessed 1155 hip prostheses (276 infected cases) and 1235 knee prostheses (401 infected cases). The specificity of synovial fluid white blood cell count was significantly increased by using the threshold value ≥ 3000 cell/μL (p = 0.006); the sensitivity of polymorphonucleate percentage was significantly higher in detecting knee infections (p = 0.034). Both tests had a high specificity and sensitivity in detecting periprosthetic joint infections, and no clear superiority of one over the other existed. Furthermore, cutoff and anatomic site significantly influenced synovial fluid white blood cell count and polymorphonucleate percentage, respectively. Synovial fluid analysis is adequate in differentiating patients with periprosthetic hip and knee infections. Our data confirms international guidelines suggesting the use of 3000 cell/μL as cutoff threshold for synovial fluid white blood cell count. Since an anatomic site effect has been demonstrated, the goal of future studies will be to identify different cutoffs for hip and knee prostheses.

Lumbo-Pelvic-Hip Complex Pain in a Competitive Basketball Player

PubMed Central

Reiman, Michael P.; Cox, Kara D.; Jones, Kay S.; Byrd, J. W.

2011-01-01

Establishing the cause of lumbo-pelvic-hip complex pain is a challenge for many clinicians. This case report describes the mechanism of injury, diagnostic process, surgical management, and rehabilitation of a female high school basketball athlete who sustained an injury when falling on her right side. Diagnostics included clinical examination, radiography of the spine and hip joint, magnetic resonance imaging arthrogram, 3-dimensional computed tomography scan, and computed tomography of the hip joint. A systematic multidisciplinary clinical approach resulted in the patient’s return to previous functional levels. PMID:23015993

Effects of medially wedged foot orthoses on knee and hip joint running mechanics in females with and without patellofemoral pain syndrome.

PubMed

Boldt, Andrew R; Willson, John D; Barrios, Joaquin A; Kernozek, Thomas W

2013-02-01

We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain syndrome (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group [PFPS, control] x condition [medial wedge, no medial wedge] x standing calcaneal angle [everted, neutral, inverted]) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = .03) and hip adduction excursion decreased 0.6° (P < .01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.

A Multiple Degree of Freedom Lower Extremity Isometric Device to Simultaneously Quantify Hip, Knee and Ankle Torques

PubMed Central

Sánchez, Natalia; Acosta, Ana Maria; Stienen, Arno H.A.

2015-01-01

Characterization of the joint torque coupling strategies used in the lower extremity to generate maximal and submaximal levels of torque at either the hip, knee or ankle is lacking. Currently, there are no available isometric devices that quantify all concurrent joint torques in the hip, knee and ankle of a single leg during maximum voluntary torque generation. Thus, joint-torque coupling strategies in the hip, knee and concurrent torques at ankle and/or coupling patterns at the hip and knee driven by the ankle have yet to be quantified. This manuscript describes the design, implementation and validation of a multiple degree of freedom, lower extremity isometric device (the MultiLEIT) that accurately quantifies simultaneous torques at the hip, knee and ankle. The system was mechanically validated and then implemented with two healthy control individuals and two post-stroke individuals to test usability and patient acceptance. Data indicated different joint torque coupling strategies used by both healthy individuals. In contrast, data showed the same torque coupling patterns in both post-stroke individuals, comparable to those described in the clinic. Successful implementation of the MultiLEIT can contribute to the understanding of the underlying mechanisms responsible for abnormal movement patterns and aid in the design of therapeutic interventions. PMID:25163064

Identification of the contribution of the ankle and hip joints to multi-segmental balance control

PubMed Central

2013-01-01

Background Human stance involves multiple segments, including the legs and trunk, and requires coordinated actions of both. A novel method was developed that reliably estimates the contribution of the left and right leg (i.e., the ankle and hip joints) to the balance control of individual subjects. Methods The method was evaluated using simulations of a double-inverted pendulum model and the applicability was demonstrated with an experiment with seven healthy and one Parkinsonian participant. Model simulations indicated that two perturbations are required to reliably estimate the dynamics of a double-inverted pendulum balance control system. In the experiment, two multisine perturbation signals were applied simultaneously. The balance control system dynamic behaviour of the participants was estimated by Frequency Response Functions (FRFs), which relate ankle and hip joint angles to joint torques, using a multivariate closed-loop system identification technique. Results In the model simulations, the FRFs were reliably estimated, also in the presence of realistic levels of noise. In the experiment, the participants responded consistently to the perturbations, indicated by low noise-to-signal ratios of the ankle angle (0.24), hip angle (0.28), ankle torque (0.07), and hip torque (0.33). The developed method could detect that the Parkinson patient controlled his balance asymmetrically, that is, the right ankle and hip joints produced more corrective torque. Conclusion The method allows for a reliable estimate of the multisegmental feedback mechanism that stabilizes stance, of individual participants and of separate legs. PMID:23433148

Developmental dysplasia of the hip: impact of sonographic newborn hip screening on the outcome of early treated decentered hip joints-a single center retrospective comparative cohort study based on Graf's method of hip ultrasonography.

PubMed

Tschauner, Christian; Fürntrath, Frank; Saba, Yasaman; Berghold, Andrea; Radl, Roman

2011-12-01

PURPOSE/BACKGROUND/INTRODUCTION: The aim of this study was to retrospectively evaluate the impact of neonatal sonographic hip screening using Graf's method for the management and outcome of orthopaedic treatment of decentered hip joints with developmental dysplasia of the hip (DDH), using three decades (1978-2007) of clinical information compiled in a medical database. Three representative cohorts of consecutive cases of decentered hip joints were selected according to different search criteria and inclusion and exclusion parameters: (1) cohort 1 (1978-1982; n = 80), without sonographic screening; (2) cohort 2.1 (1994-1996; n = 91), with nationwide established general sonographic screening according to the Graf-method; (3) cohort 2.2 (2003-2005; n = 91), with sonographic screening including referred cases for open reduction from non-screened populations. These three cohorts were compared for the following parameters: age at initial treatment, successful closed reduction, necessary overhead traction, necessary adductor-tenotomy, rate of open reduction, rate of avascular necrosis (AVN) and rate of secondary acetabuloplasty. The age at initial treatment was reduced from 5.5 months in the first cohort to 2 months in the two subsequent two cohorts and the rate of successful closed reduction increased from 88.7 to 98.9 and 95.6%, respectively. There was a statistically significant improvement in six out of seven parameters with sonographic hip screening; only the rate of secondary acetabuloplasty did not improve significantly. Compared to the era before the institution of a sonographic hip screening programme according to the Graf-method in Austria in 1992, ultrasound screening based-treatment of decentered hip joints has become safer, shorter and simpler: "safer" means lower rate of AVN, "shorter" means less treatment time due to earlier onset and "simpler" means that the devices are now less invasive and highly standardized.

Pre-operative interventions (non-surgical and non-pharmacological) for patients with hip or knee osteoarthritis awaiting joint replacement surgery--a systematic review and meta-analysis.

PubMed

Wallis, Jason A; Taylor, Nicholas F

2011-12-01

To determine if pre-operative interventions for hip and knee osteoarthritis provide benefit before and after joint replacement. Systematic review with meta-analysis of randomised controlled trials (RCTs) of pre-operative interventions for people with hip or knee osteoarthritis awaiting joint replacement surgery. Standardised mean differences (SMD) were calculated for pain, musculoskeletal impairment, activity limitation, quality of life, and health service utilisation (length of stay and discharge destination). The GRADE approach was used to determine the quality of the evidence. Twenty-three RCTs involving 1461 participants awaiting hip or knee replacement surgery were identified. Meta-analysis provided moderate quality evidence that pre-operative exercise interventions for knee osteoarthritis reduced pain prior to knee replacement surgery (SMD (95% CI)=0.43 [0.13, 0.73]). None of the other meta-analyses investigating pre-operative interventions for knee osteoarthritis demonstrated any effect. Meta-analyses provided low to moderate quality evidence that exercise interventions for hip osteoarthritis reduced pain (SMD (95% CI)=0.52 [0.04, 1.01]) and improved activity (SMD (95% CI)=0.47 [0.11, 0.83]) prior to hip replacement surgery. Meta-analyses provided low quality evidence that exercise with education programs improved activity after hip replacement with reduced time to reach functional milestones during hospital stay (e.g., SMD (95% CI)=0.50 [0.10, 0.90] for first day walking). Low to moderate evidence from mostly small RCTs demonstrated that pre-operative interventions, particularly exercise, reduce pain for patients with hip and knee osteoarthritis prior to joint replacement, and exercise with education programs may improve activity after hip replacement. Copyright © 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The role of imaging in early hip OA.

PubMed

Siebelt, M; Agricola, R; Weinans, H; Kim, Y J

2014-10-01

Hip osteoarthritis (OA) is characterized by cartilage degradation, subchondral bone sclerosis and osteophyte formation. Nowadays, OA is thought to develop via different etiologies that all lead to a similar form of end stage joint degradation. One of these subtypes is related to an abnormal shaped hip joint, like acetabular dysplasia and a cam deformity. These bony abnormalities are highly predictive for development of hip OA, but they are likely to already be present from childhood. This suggests that these deformations induce OA changes in the hip, well before extensive hip degradation becomes present three to four decades later. Accurate detection and successful characterization of these early OA events might lead to better treatment options for hip OA besides nowadays available invasive joint replacement surgery. However, current diagnostic imaging techniques like radiographs or plain magnetic resonance imaging (MRI), are not sensitive enough to detect these subtle early OA changes. Nor are they able to disentangle intertwined and overlapping cascades from different OA subtypes, and neither can they predict OA progression. New and more sensitive imaging techniques might enable us to detect first OA changes on a cellular level, providing us with new opportunities for early intervention. In this respect, shape analysis using radiography, MRI, computed tomography (CT), single photon emission computed tomography (SPECT)/CT, and positron emission tomography (PET) might prove promising techniques and be more suited to detect early pathological changes in the hip joint. A broad application of these techniques might give us more understanding what can be considered physiological adaptation of the hip, or when early OA really starts. With a more clear definition of early OA, more homogenous patient populations can be selected and help with the development of new disease modifying OA interventions. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Kinematic classification of iliotibial band syndrome in runners.

PubMed

Grau, S; Krauss, I; Maiwald, C; Axmann, D; Horstmann, T; Best, R

2011-04-01

Several inconsistent causative biomechanical factors are considered to be crucial in the occurrence of iliotibial band syndrome (ITBS). The focus of this study was on assessing differences in the kinematic characteristics between healthy runners [control group (CO)] and runners with ITBS in order to recommend treatment strategies to deal with this injury. Three-dimensional kinematics of barefoot running was used in the biomechanical setup. Both groups were matched with respect to gender, height and weight. After determining drop outs, the final population comprised 36 subjects (26 male and 10 female): 18 CO and 18 ITBS (13 male and five female, each). Kinematic evaluations indicate less hip adduction and frontal range of motion at the hip joint in runners with ITBS. Furthermore, maximum hip flexion velocity and maximum knee flexion velocity were lower in runners with ITBS. Lack of joint coordination, expressed as earlier hip flexion and a tendency toward earlier knee flexion, was found to be another discriminating variable in subjects with ITBS compared with CO subjects. We assume that an increase in range of motion at the hip joint, stretching of the hip abductors, as well as stretching the hamstrings, calf muscles and hip flexors will help treat ITBS. © 2009 John Wiley & Sons A/S.

Prevalence and inheritance of and selection for hip dysplasia in seven breeds of dogs in Sweden and benefit: cost analysis of a screening and control program.

PubMed

Swenson, L; Audell, L; Hedhammar, A

1997-01-15

To determine the prevalence and changes over time in the prevalence of hip dysplasia; to ascertain whether prevalence or severity of hip dysplasia was associated with sex of the dogs, age at which coxofemoral joint status was evaluated, or ancestral background; to determine the effects of selective breeding; and to conduct an economic evaluation of the hip dysplasia program operated by the Swedish Kennel Club. Analysis of radiographic evaluations of coxofemoral joint conformity. 83,229 dogs from 7 breeds registered by the Swedish Kennel Club. All radiographs were scrutinized by a single radiologist (LA), and coxofemoral joint conformation was classified as normal or dysplastic, with the degree of dysplasia classified as 1,2,3, or 4. Decreasing prevalence of hip dysplasia corresponding to selection of breeding stock and high heritabilities was found. Sex differences were documented in 3 of the breeds. This was interpreted as breed differences in the distribution of genes related to hip dysplasia. Economic analyses showed that costs of screening and registration of coxofemoral joints was less than the value of dogs estimated to have been saved from moderate, severe, or very severe hip dysplasia in 6 of the breeds. Documented effects of age suggest that all dogs should be screened at the same age, rather than screening a few dogs at an older, more revealing age. In screening and control programs based on an open registry with access to family records, decreasing prevalence of hip dysplasia can be expected, and related to selection of breeding stock.

Psoas abscess masquerading as a prosthetic hip infection: A case report.

PubMed

Atif, Muhammad; Malik, Azeem Tariq; Noordin, Shahryar

2018-01-01

Psoas abscess is an unusual condition and is defined as a collection of pus in the iliopsoas compartment. Due to the unique anatomy of psoas muscle it forms a conduit for spread of infection from upper part of body to hip joint in neglected cases. A 67year old lady presented with left groin pain for three weeks. She underwent an uncemented unipolar hemiarthoplasty eight years back. Currently, she developed fever and was unable to do any active left hip range of motion. Passive motion of the left hip was restricted to 30° flexion, no internal rotation, 5° external rotation, and 10° abduction. Lab workup showed raised serum infective markers and radiographs of pelvis were normal with no evidence of any radiolucency. Ultrasound guided aspiration of left hip joint showed E coli. Arthrotomy revealed clear fluid in hip joint but pus was drained at psoas insertion. Later on, culture reported presence of E. coli and biopsy confirmed psoas abscess. Postoperatively CT scan abdomen showed pyelonephritis. Antibiotics were given for three months. Twenty months later, she remains asymptomatic without evidence of infection with normal gait. Psoas abscess is a rare clinical entity that may mimic symptoms of a primary prosthetic hip infection. Treatment outcomes are directly related to early detection with adequate dissection of the psoas muscle up to sites of attachment and complete eradication of infection. This case highlights importance of thorough initial clinical examination, lab workup and radiological assessment to rule out rare causes of hip joint pain. Copyright © 2017. Published by Elsevier Ltd.

Hip joint centre position estimation using a dual unscented Kalman filter for computer-assisted orthopaedic surgery.

PubMed

Beretta, Elisa; De Momi, Elena; Camomilla, Valentina; Cereatti, Andrea; Cappozzo, Aurelio; Ferrigno, Giancarlo

2014-09-01

In computer-assisted knee surgery, the accuracy of the localization of the femur centre of rotation relative to the hip-bone (hip joint centre) is affected by the unavoidable and untracked pelvic movements because only the femoral pose is acquired during passive pivoting manoeuvres. We present a dual unscented Kalman filter algorithm that allows the estimation of the hip joint centre also using as input the position of a pelvic reference point that can be acquired with a skin marker placed on the hip, without increasing the invasiveness of the surgical procedure. A comparative assessment of the algorithm was carried out using data provided by in vitro experiments mimicking in vivo surgical conditions. Soft tissue artefacts were simulated and superimposed onto the position of a pelvic landmark. Femoral pivoting made of a sequence of star-like quasi-planar movements followed by a circumduction was performed. The dual unscented Kalman filter method proved to be less sensitive to pelvic displacements, which were shown to be larger during the manoeuvres in which the femur was more adducted. Comparable accuracy between all the analysed methods resulted for hip joint centre displacements smaller than 1 mm (error: 2.2 ± [0.2; 0.3] mm, median ± [inter-quartile range 25%; inter-quartile range 75%]) and between 1 and 6 mm (error: 4.8 ± [0.5; 0.8] mm) during planar movements. When the hip joint centre displacement exceeded 6 mm, the dual unscented Kalman filter proved to be more accurate than the other methods by 30% during multi-planar movements (error: 5.2 ± [1.2; 1] mm). © IMechE 2014.

[Comparative ultrasound visualization of clinically relevant structures for evaluating the infant hip joint utilizing trapezoidal vs. parallel transducers].

PubMed

Wunsch, R; Wegener-Panzer, A; Reinehr, T; Aurisch, E; Cleaveland, B; Wunsch, C; Dudwiesus, H

2011-01-01

Sonographic evaluation of the infant hip joint according to the method of Graf has proven to be an important pediatric investigative instrument. Our goal was to investigate quantitatively whether (and in what ways) the clinically relevant infant hip joint structures visualize differently when utilizing trapezoidal as opposed to linear transducers. Our approach was both theoretical via a mathematical model and practical with in-vivo measurements in neonates. In a prospective study: 1. theoretical and computed analyses were performed for both linear and trapezoidal transducers regarding their respective accuracy for demonstrating the anatomic geometry of the infant hip, assuming not only correctly centered transducer positioning but also cases with off-centered displacement in the cranial or caudal direction; 2. both hip joints in 97 infants were examined by experienced investigators with comparison of the results for parallel vs. trapezoidal transducers. Theoretical mathematical error analysis reveals no intrinsic systemic deviations between trapezoidal vs. parallel transducers in US scanning of the infant hip and furthermore no inherent disadvantages in the trapezoidal technique. Even when off-center transducer alignments of 1.5 cm are employed in the mathematical models, there is no significant relative distortion of the required anatomic structures when comparing the characteristics of both transducers. The practical in-vivo data from our 97 neonates confirmed the theoretical considerations. No loss of accuracy or other negative factors are evident when trapezoidal transducers are used to visualize the infant hip joint in comparison with the customary parallel technique. There are no significantly measurable differences between the two approaches. © Georg Thieme Verlag KG Stuttgart · New York.

Expressing the joint moments of drop jumps and sidestep cutting in different reference frames--does it matter?

PubMed

Kristianslund, Eirik; Krosshaug, Tron; Mok, Kam-Ming; McLean, Scott; van den Bogert, Antonie J

2014-01-03

Joint moments help us understand joint loading and muscle function during movement. However, the interpretation depends on the choice of reference frame, but the different reference frames have not been compared in dynamic, high-impact sporting movements. We have compared the magnitude and the resulting ranking of hip and knee joint moments expressed in the laboratory coordinate system, the local system of the distal segment and projected or decomposed to the Joint Coordinate System (JCS) axes. Hip and knee joint moments of drop jumps and sidestep cutting in 70 elite female handball players were calculated based on recordings from an eight-camera 240 Hz system and two force platforms and expressed with the four methods. The greatest variations in magnitude between conditions were seen for drop jump hip internal rotation (range: 0.31-0.71 Nm/kg) and sidestep cutting knee flexion (2.87-3.39 Nm/kg) and hip internal rotation (0.87-2.36 Nm/kg) and knee internal rotation (0.10-0.40 Nm/kg) moments. The rank correlations were highest between conditions for flexion moments (0.88-1.00) and sidestep cutting abduction moments (0.71-0.98). The rank correlations ranged from 0.64 to 0.73 for drop jump knee abduction moments and between -0.17 and 0.67 for hip and knee internal rotation moments. Expression of joint moments in different reference systems affects the magnitude and ranking of athletes. This lack of consistency may complicate the comparison and combination of results. Projection to the JCS is the only method where joint moments correspond to muscle and ligament loading. More widespread adoption of this convention could facilitate comparison of studies and ease the interpretation of results. © 2013 Elsevier Ltd. All rights reserved.

Anatomy of the pelvic joints--a review.

PubMed

Dietrichs, E

1991-01-01

In adults, after the os ilium, os ischii and os pubis have joined together by ossification to form the os coxae, there is usually one joint between the hip bones ventrally (the pubic symphysis) and several more complex joints between the hip bones and os sacrum dorsally (sacroiliac, "axial sacroiliac" and accessory sacroiliac joints). These joints carry the weight of the upper part of the body, but they shall also enable pelvic distention during labour. Pathological conditions in these joints are common, and increased knowledge concerning their normal antomy is important for better understanding of these conditions.

On the permanent hip-stabilizing effect of atmospheric pressure.

PubMed

Prietzel, Torsten; Hammer, Niels; Schleifenbaum, Stefan; Kaßebaum, Eric; Farag, Mohamed; von Salis-Soglio, Georg

2014-08-22

Hip joint dislocations related to total hip arthroplasty (THA) are a common complication especially in the early postoperative course. The surgical approach, the alignment of the prosthetic components, the range of motion and the muscle tone are known factors influencing the risk of dislocation. A further factor that is discussed until today is atmospheric pressure which is not taken into account in the present THA concepts. The aim of this study was to investigate the impact of atmospheric pressure on hip joint stability. Five joint models (Ø 28-44 mm), consisting of THA components were hermetically sealed with a rubber capsule, filled with a defined amount of fluid and exposed to varying ambient pressure. Displacement and pressure sensors were used to record the extent of dislocation related to intraarticular and ambient pressure. In 200 experiments spontaneous dislocations of the different sized joint models were reliably observed once the ambient pressure was lower than 6.0 kPa. Increasing the ambient pressure above 6.0 kPa immediately and persistently reduced the joint models until the ambient pressure was lowered again. Displacement always exceeded half the diameter of the joint model and was independent of gravity effects. This experimental study gives strong evidence that the hip joint is permanently stabilized by atmospheric pressure, confirming the theories of Weber and Weber (1836). On basis of these findings the use of larger prosthetic heads, capsular repair and the deployment of an intracapsular Redon drain are proposed to substantially decrease the risk of dislocation after THA. Copyright © 2014 Elsevier Ltd. All rights reserved.

Inter-segmental moment analysis characterises the partial correspondence of jumping and jerking

PubMed Central

Cleather, Daniel J; Goodwin, Jon E; Bull, Anthony MJ

2014-01-01

The aim of this study was to quantify internal joint moments of the lower limb during vertical jumping and the weightlifting jerk in order to improve awareness of the control strategies and correspondence between these activities, and to facilitate understanding of the likely transfer of training effects. Athletic males completed maximal unloaded vertical jumps (n=12) and explosive push jerks at 40 kg (n=9). Kinematic data were collected using optical motion tracking and kinetic data via a force plate, both at 200 Hz. Joint moments were calculated using a previously described biomechanical model of the right lower limb. Peak moment results highlighted that sagittal plane control strategies differed between jumping and jerking (p<0.05) with jerking being a knee dominant task in terms of peak moments as opposed to a more balanced knee and hip strategy in jumping and landing. Jumping and jerking exhibited proximal to distal joint involvement and landing was typically reversed. High variability was seen in non-sagittal moments at the hip and knee. Significant correlations were seen between jump height and hip and knee moments in jumping (p<0.05). Whilst hip and knee moments were correlated between jumping and jerking (p<0.05), joint moments in the jerk were not significantly correlated to jump height (p>0.05) possibly indicating a limit to the direct transferability of jerk performance to jumping. Ankle joint moments were poorly related to jump performance (p>0.05). Peak knee and hip moment generating capacity are important to vertical jump performance. The jerk appears to offer an effective strategy to overload joint moment generation in the knee relative to jumping. However, an absence of hip involvement would appear to make it a general, rather than specific, training modality in relation to jumping. PMID:22362089

Infection burden for hip and knee arthroplasty in the United States.

PubMed

Kurtz, Steven M; Lau, Edmund; Schmier, Jordana; Ong, Kevin L; Zhao, Ke; Parvizi, Javad

2008-10-01

We quantified the current and historical incidence of periprosthetic infection associated with hip and knee arthroplasty in the United States using the Nationwide Inpatient Sample, as well as corresponding hospitalization charges and length of stay. The rate of infected knee arthroplasties was 0.92%, significantly greater than that of infected hip arthroplasties with 0.88%. Length of stay was significantly longer for infected hip (9.7 days) and knee (7.6 days) arthroplasties compared to uninfected procedures (hip, 4.3 days; knee, 3.9 days) (P < .0001). Hospitalization charges were also significantly greater for infected joint arthroplasties than for uninfected arthroplasties (hips, 1.76 times; knees, 1.52 times) (P < .0001). Urban-non-teaching hospitals experienced the highest burden of infection with 1.18% for hips and 1.26% for knees compared to rural (0.61% for hips and 0.69% for knees) and urban-teaching hospitals (0.73% for hips and 0.77% for knees). We found an increasing number of joint arthroplasties being diagnosed with periprosthetic infection.

Micro-Raman spectroscopy for the crystallinity characterization of UHMWPE hip cups run on joint simulators

NASA Astrophysics Data System (ADS)

Bertoluzza, A.; Fagnano, C.; Rossi, M.; Tinti, A.; Cacciari, G. L.

2000-03-01

In this work Raman microspectrometry was used to evaluate the crystallinity changes of hip cups made of ultra-high molecular weight polyethylene (UHMWPE). In vitro experiments were carried out using hip joint movement-wear simulators, run for five million cycles in water or bovine calf serum. The hip cups were subjected to mechanical friction with ceramic femoral heads (alumina-zirconia blend). The crystallinity of the polymer hip cups was studied as a function of inner surface position and thickness, from the stressed surface to the unstressed outer one. The Partial Least Square (PLS-l) calibration was used to correlate the Raman spectra with the crystallinity of the polymer measured with DSC calorimetry.

Prospective analyses of female urinary incontinence symptoms following total hip arthroplasty.

PubMed

Okumura, Keiko; Yamaguchi, Kumiko; Tamaki, Tatsuya; Oinuma, Kazuhiro; Tomoe, Hikaru; Akita, Keiichi

2017-04-01

Some patients with hip osteoarthritis report that urinary incontinence (UI) is improved following total hip arthroplasty (THA). However, the type and severity of UI remain unclear. In this study, we hypothesize that both stress urinary incontinence (SUI) and urge urinary incontinence (UUI) are improved after THA. We assess the characteristics of UI and discuss the anatomical factors related to UI and THA for improved treatment outcome. Fifty patients with UI who underwent direct anterior-approach THA were evaluated. Type of UI was assessed using four questionnaires: Core Lower Urinary Tract Symptom Score (CLSS), Urogenital Distress Inventory Short Form (UDI-6), International Prostate Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS). Uroflowmetry and postvoid residual urine were measured using ultrasound technology. Hip-joint function was evaluated using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM). Of the 50 patients, 21 had SUI, 16 had mixed urinary incontinence (MUI), and eight had urgency urinary incontinence (UUI). In total, 36 patients were better than improved (72 %). The rate of cured and improved was 76 % for SUI, 100 % MUI, and 50 % UUI. The improvement of ROM was more significant in cured or improved patients than in stable or worse patients. Improvement in mild UI may be an added benefit for those undergoing THA for hip-joint disorders. These data suggest that for patients with hip-joint disorder, hip-joint treatment could prove to also be a useful treatment for UI.

Femoroacetabular Impingement

DTIC Science & Technology

2008-04-01

the abnormal morphology of the femoral head indicative of FAI. Prominent osteophyte formation can be seen bilaterally at the femoral head-neck...marked joint space loss of the left hip which predominantly involves the superolateral aspect of the joint (Figs. 1B and 2). Subchondral sclerosis...B). Close up view of the left hip from Fig. 1A. Superolateral joint space loss, subchondral sclerosis, cystic changes of the anterolateral femoral

An approach to comparative anatomy of the acetabulum from amphibians to primates.

PubMed

Canillas, F; Delgado-Martos, M J; Touza, A; Escario, A; Martos-Rodriguez, A; Delgado-Baeza, E

2011-12-01

The objective of this study was to investigate the anatomy, both macroscopic and microscopic, of the soft tissue internal structures of the hip joint in animal species and in three human hips (an adult and two fetuses). We dissected the hip joints of 16 species and compared the anatomical features of the soft tissue from the respective acetabula. In addition, a histological study was made of the specimens studied. In amphibians, we found a meniscus in the acetabulum, which was not observed in any of the other species studied. The isolated round ligament is observed from birds onwards. In the group of mammals analysed, including the human specimens, we found a meniscoid structure in the acetabular hip joint. Furthermore, we found that the meniscoid structure forms an anatomo-functional unit with the round ligament and the transverse ligament of the coxofemoral joint. These discoveries suggest the participation of the soft tissue anatomy in adaptative changes of species. © 2011 Blackwell Verlag GmbH.

Hippotherapy effects on trunk, pelvic, and hip motion during ambulation in children with neurological impairments.

PubMed

Encheff, Jenna L; Armstrong, Charles; Masterson, Michelle; Fox, Christine; Gribble, Phillip

2012-01-01

This study investigated the effects of a 10-week hippotherapy program on trunk, pelvis, and hip joint positioning during the stance phase of gait. Eleven children (6 boys and 5 girls; 7.9 ± 2.7 years) with neurological disorders and impaired ambulation participated. Joint range of motion data were collected via 3-dimensional computerized gait analysis before and after the program. Paired t tests were performed on kinematic data for each joint. Significant improvements (P ≤ .008) and large effect sizes (ESs) for sagittal plane hip positions at initial contact and toe-off were found. No differences in pelvic or trunk positioning were determined, although sagittal plane pelvic positioning displayed a trend toward improvement with large ESs. Several trunk variables displayed moderate ESs with a trend toward more upright positioning. Improvements in pelvic and hip joint positioning and more normalized vertical trunk position may indicate increased postural control during gait after 10 sessions of hippotherapy.

The ligaments of the canine hip joint revisited.

PubMed

Casteleyn, C; den Ouden, I; Coopman, F; Verhoeven, G; Van Cruchten, S; Van Ginneken, C; Van Ryssen, B; Simoens, P

2015-12-01

Numerous conventional anatomical textbooks describe the canine hip joint, but many contradictions, in particular regarding the ligament of the femoral head, are present. This paper presents a brief overview of the different literature descriptions. These are compared with own observations that have resulted in a revised description of the anatomy of the ligament of the femoral head in the dog. To this purpose, the hip joints of 41 dogs, euthanized for reasons not related to this study and devoid of lesions related to hip joint pathology, were examined. It was observed that the ligament of the femoral head is not a single structure that attaches only to the acetabular fossa, as generally accepted, but it also connects to the transverse acetabular ligament and is complemented by a strong accessory ligament that courses in caudal direction to attach in the elongation of the acetabular notch that extends on the cranioventral surface of the body of the ischium. The description of this accessory ligament in conventional anatomical handbooks is incomplete. This description of the accessory ligament of the femoral head could support the research unravelling the etiopathogenesis of hip instability. © 2014 Blackwell Verlag GmbH.

Sex Differences in Proximal Control of the Knee Joint

PubMed Central

Mendiguchia, Jurdan; Ford, Kevin R.; Quatman, Carmen E.; Alentorn-Geli, Eduard; Hewett, Timothy E.

2014-01-01

Following the onset of maturation, female athletes have a significantly higher risk for anterior cruciate ligament (ACL) injury compared with male athletes. While multiple sex differences in lower-extremity neuromuscular control and biomechanics have been identified as potential risk factors for ACL injury in females, the majority of these studies have focused specifically on the knee joint. However, increasing evidence in the literature indicates that lumbopelvic (core) control may have a large effect on knee-joint control and injury risk. This review examines the published evidence on the contributions of the trunk and hip to knee-joint control. Specifically, the sex differences in potential proximal controllers of the knee as risk factors for ACL injury are identified and discussed. Sex differences in trunk and hip biomechanics have been identified in all planes of motion (sagittal, coronal and transverse). Essentially, female athletes show greater lateral trunk displacement, altered trunk and hip flexion angles, greater ranges of trunk motion, and increased hip adduction and internal rotation during sport manoeuvres, compared with their male counterparts. These differences may increase the risk of ACL injury among female athletes. Prevention programmes targeted towards trunk and hip neuromuscular control may decrease the risk for ACL injuries. PMID:21688868

Joint angles of the ankle, knee, and hip and loading conditions during split squats.

PubMed

Schütz, Pascal; List, Renate; Zemp, Roland; Schellenberg, Florian; Taylor, William R; Lorenzetti, Silvio

2014-06-01

The aim of this study was to quantify how step length and the front tibia angle influence joint angles and loading conditions during the split squat exercise. Eleven subjects performed split squats with an additional load of 25% body weight applied using a barbell. Each subject's movements were recorded using a motion capture system, and the ground reaction force was measured under each foot. The joint angles and loading conditions were calculated using a cluster-based kinematic approach and inverse dynamics modeling respectively. Increases in the tibia angle resulted in a smaller range of motion (ROM) of the front knee and a larger ROM of the rear knee and hip. The external flexion moment in the front knee/hip and the external extension moment in the rear hip decreased as the tibia angle increased. The flexion moment in the rear knee increased as the tibia angle increased. The load distribution between the legs changed < 25% when split squat execution was varied. Our results describing the changes in joint angles and the resulting differences in the moments of the knee and hip will allow coaches and therapists to adapt the split squat exercise to the individual motion and load demands of athletes.

Hip joint replacement using monofilament polypropylene surgical mesh: an animal model.

PubMed

Białecki, Jacek; Majchrzycki, Marian; Szymczak, Antoni; Klimowicz-Bodys, Małgorzata Dorota; Wierzchoś, Edward; Kołomecki, Krzysztof

2014-01-01

Hip joint dysplasia is a deformation of the articular elements (pelvic acetabulum, head of the femur, and/or ligament of the head of the femur) leading to laxity of the hip components and dislocation of the femoral head from the pelvic acetabulum. Diagnosis is based on symptoms observed during clinical and radiological examinations. There are two treatment options: conservative and surgical. The classic surgical procedures are juvenile pubic symphysiodesis (JPS), triple pelvic osteotomy (TPO), total hip replacement (THR), and femoral head and neck resection (FHNE). The aim of this experiment was to present an original technique of filling the acetabulum with a polypropylene implant, resting the femoral neck directly on the mesh. The experiment was performed on eight sheep. The clinical value of the new surgical technique was evaluated using clinical, radiological, and histological methods. This technique helps decrease the loss of limb length by supporting the femoral neck on the mesh equivalent to the femoral head. It also reduces joint pain and leads to the formation of stable and mobile pseudarthrosis. The mesh manifested osteoprotective properties and enabled the formation of a stiff-elastic connection within the hip joint. The method is very cost-effective and the technique itself is simple to perform.

Simulating ideal assistive devices to reduce the metabolic cost of walking with heavy loads.

PubMed

Dembia, Christopher L; Silder, Amy; Uchida, Thomas K; Hicks, Jennifer L; Delp, Scott L

2017-01-01

Wearable robotic devices can restore and enhance mobility. There is growing interest in designing devices that reduce the metabolic cost of walking; however, designers lack guidelines for which joints to assist and when to provide the assistance. To help address this problem, we used musculoskeletal simulation to predict how hypothetical devices affect muscle activity and metabolic cost when walking with heavy loads. We explored 7 massless devices, each providing unrestricted torque at one degree of freedom in one direction (hip abduction, hip flexion, hip extension, knee flexion, knee extension, ankle plantarflexion, or ankle dorsiflexion). We used the Computed Muscle Control algorithm in OpenSim to find device torque profiles that minimized the sum of squared muscle activations while tracking measured kinematics of loaded walking without assistance. We then examined the metabolic savings provided by each device, the corresponding device torque profiles, and the resulting changes in muscle activity. We found that the hip flexion, knee flexion, and hip abduction devices provided greater metabolic savings than the ankle plantarflexion device. The hip abduction device had the greatest ratio of metabolic savings to peak instantaneous positive device power, suggesting that frontal-plane hip assistance may be an efficient way to reduce metabolic cost. Overall, the device torque profiles generally differed from the corresponding net joint moment generated by muscles without assistance, and occasionally exceeded the net joint moment to reduce muscle activity at other degrees of freedom. Many devices affected the activity of muscles elsewhere in the limb; for example, the hip flexion device affected muscles that span the ankle joint. Our results may help experimentalists decide which joint motions to target when building devices and can provide intuition for how devices may interact with the musculoskeletal system. The simulations are freely available online, allowing others to reproduce and extend our work.

Simulating ideal assistive devices to reduce the metabolic cost of walking with heavy loads

PubMed Central

Silder, Amy; Uchida, Thomas K.; Hicks, Jennifer L.; Delp, Scott L.

2017-01-01

Wearable robotic devices can restore and enhance mobility. There is growing interest in designing devices that reduce the metabolic cost of walking; however, designers lack guidelines for which joints to assist and when to provide the assistance. To help address this problem, we used musculoskeletal simulation to predict how hypothetical devices affect muscle activity and metabolic cost when walking with heavy loads. We explored 7 massless devices, each providing unrestricted torque at one degree of freedom in one direction (hip abduction, hip flexion, hip extension, knee flexion, knee extension, ankle plantarflexion, or ankle dorsiflexion). We used the Computed Muscle Control algorithm in OpenSim to find device torque profiles that minimized the sum of squared muscle activations while tracking measured kinematics of loaded walking without assistance. We then examined the metabolic savings provided by each device, the corresponding device torque profiles, and the resulting changes in muscle activity. We found that the hip flexion, knee flexion, and hip abduction devices provided greater metabolic savings than the ankle plantarflexion device. The hip abduction device had the greatest ratio of metabolic savings to peak instantaneous positive device power, suggesting that frontal-plane hip assistance may be an efficient way to reduce metabolic cost. Overall, the device torque profiles generally differed from the corresponding net joint moment generated by muscles without assistance, and occasionally exceeded the net joint moment to reduce muscle activity at other degrees of freedom. Many devices affected the activity of muscles elsewhere in the limb; for example, the hip flexion device affected muscles that span the ankle joint. Our results may help experimentalists decide which joint motions to target when building devices and can provide intuition for how devices may interact with the musculoskeletal system. The simulations are freely available online, allowing others to reproduce and extend our work. PMID:28700630

Surface evaluation of orthopedic hip implants marketed in Brazil

NASA Astrophysics Data System (ADS)

Souza, M. M.; Trommer, R. M.; Maru, M. M.; Roesler, C. R. M.; Barros, W. S.; Dutra, M. S.

2016-07-01

One of the factors that contribute to the quality of total hip prostheses is the degree of accuracy in the manufacturing of the joint surfaces. The dimensional control of joint components is important because of its direct influence on the durability and, consequently, in the patients’ life quality. This work presents studies on the form and roughness of orthopedic hip prostheses marketed in Brazil. The results provide data for quality control of the surfaces of the femoral heads and acetabular components of hip prostheses and indicate the need of improvement in the procedures used to this control.

Biomechanical analysis of posture in patients with spinal kyphosis due to ankylosing spondylitis: a pilot study.

PubMed

Bot, S D; Caspers, M; Van Royen, B J; Toussaint, H M; Kingma, I

1999-05-01

Patients with ankylosing spondylitis may experience a progressive spinal kyphosis, which induces a forward and downward displacement of the centre of mass (COM) of the trunk. In this pilot study, the possible mechanisms used to compensate for the displacement of the trunk COM were analysed. Joint angles of hip, knee and ankle were determined in four patients with ankylosing spondylitis and compared to data of 18 healthy subjects. Each patient stood on a force platform and had to adopt several predefined postures, which were recorded by a video camera. In three patients, the hips were flexed when standing relaxed, and in all patients hip extension was limited. The knee angles of three patients were smaller and in two patients the angle of the ankles was larger compared to healthy subjects. The results suggest that the hip joints are at least no longer involved in balance control. This may imply that conservative therapy should focus on the prevention of restriction of the hip joints.

Giant iliopectineal bursitis presenting as neuropathy and severe edema of the lower limb: case illustration and review of the literature.

PubMed

Iwata, Takahiro; Nozawa, Satoshi; Ohashi, Minoru; Sakai, Hiroshi; Shimizu, Katsuji

2013-05-01

We report a 61-year-old woman with rheumatoid arthritis (RA: Steinblocker stage III, class 3) who developed severe swelling and neuropathy of the right lower limb caused by an iliopectineal bursa associated with destruction of the hip joint. Physical examination revealed an inguinal mass and groin pain. X-ray examination indicated destruction of the hip joint. Contrast-enhanced computed tomography showed the bursa connected with the hip joint and a markedly compressed external iliac vein among the inguinal ligament, pubis, and bursa. The patient underwent partial synovial resection and total hip arthroplasty for recovery of hip function, and this led to successful resolution of the symptoms and bursa. We present the characteristic images from this case and review all previously reported cases of RA iliopsoas bursitis causing leg swelling or neuropathy, and summarize the background. Since this lesion may cause various symptoms, clinical awareness that iliopsoas bursitis may present with unique clinical symptoms may aid correct diagnosis.

Lower extremity joint kinetics and lumbar curvature during squat and stoop lifting

PubMed Central

Hwang, Seonhong; Kim, Youngeun; Kim, Youngho

2009-01-01

Background In this study, kinematics and kinetics of the lower extremity joint and the lumbar lordosis during two different symmetrical lifting techniques(squat and stoop) were examined using the three-dimensional motion analysis. Methods Twenty-six young male volunteers were selected for the subjects in this study. While they lifted boxes weighing 5, 10 and 15 kg by both squat and stoop lifting techniques, their motions were captured and analyzed using the 3D motion analysis system which was synchronized with two forceplates and the electromyographic system. Joint kinematics was determined by the forty-three reflective markers which were attached on the anatomical locations based on the VICON Plug-in-Gait marker placement protocol. Joint kinetics was analyzed by using the inverse dynamics. Paired t-test and Kruskal-Wallis test was used to compare the differences of variables between two techniques, and among three different weights. Correlation coefficient was calculated to explain the role of lower limb joint motion in relation to the lumbar lordosis. Results There were not significant differences in maximum lumbar joint moments between two techniques. The hip and ankle contributed the most part of the support moment during squat lifting, and the knee flexion moment played an important role in stoop lifting. The hip, ankle and lumbar joints generated power and only the knee joint absorbed power in the squat lifting. The knee and ankle joints absorbed power, the hip and lumbar joints generated power in the stoop lifting. The bi-articular antagonist muscles' co-contraction around the knee joint during the squat lifting and the eccentric co-contraction of the gastrocnemius and the biceps femoris were found important for maintaining the straight leg during the stoop lifting. At the time of lordotic curvature appearance in the squat lifting, there were significant correlations in all three lower extremity joint moments with the lumbar joint. Differently, only the hip moment had significant correlation with the lumbar joint in the stoop lifting. Conclusion In conclusion, the knee extension which is prominent kinematics during the squat lifting was produced by the contributions of the kinetic factors from the hip and ankle joints(extensor moment and power generation) and the lumbar extension which is prominent kinematics during the stoop lifting could be produced by the contributions of the knee joint kinetic factors(flexor moment, power absorption, bi-articular muscle function). PMID:19183507

Lower extremity joint kinetics and lumbar curvature during squat and stoop lifting.

PubMed

Hwang, Seonhong; Kim, Youngeun; Kim, Youngho

2009-02-02

In this study, kinematics and kinetics of the lower extremity joint and the lumbar lordosis during two different symmetrical lifting techniques(squat and stoop) were examined using the three-dimensional motion analysis. Twenty-six young male volunteers were selected for the subjects in this study. While they lifted boxes weighing 5, 10 and 15 kg by both squat and stoop lifting techniques, their motions were captured and analyzed using the 3D motion analysis system which was synchronized with two forceplates and the electromyographic system. Joint kinematics was determined by the forty-three reflective markers which were attached on the anatomical locations based on the VICON Plug-in-Gait marker placement protocol. Joint kinetics was analyzed by using the inverse dynamics. Paired t-test and Kruskal-Wallis test was used to compare the differences of variables between two techniques, and among three different weights. Correlation coefficient was calculated to explain the role of lower limb joint motion in relation to the lumbar lordosis. There were not significant differences in maximum lumbar joint moments between two techniques. The hip and ankle contributed the most part of the support moment during squat lifting, and the knee flexion moment played an important role in stoop lifting. The hip, ankle and lumbar joints generated power and only the knee joint absorbed power in the squat lifting. The knee and ankle joints absorbed power, the hip and lumbar joints generated power in the stoop lifting. The bi-articular antagonist muscles' co-contraction around the knee joint during the squat lifting and the eccentric co-contraction of the gastrocnemius and the biceps femoris were found important for maintaining the straight leg during the stoop lifting. At the time of lordotic curvature appearance in the squat lifting, there were significant correlations in all three lower extremity joint moments with the lumbar joint. Differently, only the hip moment had significant correlation with the lumbar joint in the stoop lifting. In conclusion, the knee extension which is prominent kinematics during the squat lifting was produced by the contributions of the kinetic factors from the hip and ankle joints(extensor moment and power generation) and the lumbar extension which is prominent kinematics during the stoop lifting could be produced by the contributions of the knee joint kinetic factors(flexor moment, power absorption, bi-articular muscle function).

Tribological performance of the biological components of synovial fluid in artificial joint implants

NASA Astrophysics Data System (ADS)

Ghosh, Subir; Choudhury, Dipankar; Roy, Taposh; Moradi, Ali; Masjuki, H. H.; Pingguan-Murphy, Belinda

2015-08-01

The concentration of biological components of synovial fluid (such as albumin, globulin, hyaluronic acid, and lubricin) varies between healthy persons and osteoarthritis (OA) patients. The aim of the present study is to compare the effects of such variation on tribological performance in a simulated hip joint model. The study was carried out experimentally by utilizing a pin-on-disk simulator on ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoP) hip joint implants. The experimental results show that both friction and wear of artificial joints fluctuate with the concentration level of biological components. Moreover, the performance also varies between material combinations. Wear debris sizes and shapes produced by ceramic and polyethylene were diverse. We conclude that the biological components of synovial fluid and their concentrations should be considered in order to select an artificial hip joint to best suit that patient.

Serum and synovial fluid cytokine profiling in hip osteoarthritis: distinct from knee osteoarthritis and correlated with pain.

PubMed

Ren, Guomin; Lutz, Ian; Railton, Pamela; Wiley, J Preston; McAllister, Jenelle; Powell, James; Krawetz, Roman J

2018-02-05

Inflammation is associated with the onset and progression of osteoarthritis in multiple joints. It is well known that mechanical properties differ between different joints, however, it remains unknown if the inflammatory process is similar/distinct in patients with hip vs. knee OA. Without complete understanding of the role of any specific cytokine in the inflammatory process, understanding the 'profile' of inflammation in a given patient population is an essential starting point. The aim of this study was to identify serum cytokine profiles in hip Osteoarthritis (OA), and investigate the association between cytokine concentrations and clinical measurements within this patient population and compare these findings to knee OA and healthy control cohorts. In total, 250 serum samples (100 knee OA, 50 hip OA and 100 control) and 37 synovial fluid samples (8 knee OA, 14 hip OA and 15 control) were analyzed using a multiplex ELISA based approach. Synovial biopsies were also obtained and examined for specific cytokines. Pain, physical function and activity within the hip OA cohort were examined using the HOOS, SF-36, HHS and UCLA outcome measures. The three cohorts showed distinct serum cytokine profiles. EGF, FGF2, MCP3, MIP1α, and IL8 were differentially expressed between hip and knee OA cohorts; while FGF2, GRO, IL8, MCP1, and VEGF were differentially expressed between hip OA and control cohorts. Eotaxin, GRO, MCP1, MIP1β, VEGF were differentially expressed between knee OA and control cohorts. EGF, IL8, MCP1, MIP1β were differentially expressed in synovial fluid from a sub-set of patients from each cohort. Specifically within the hip OA cohort, IL-6, MDC and IP10 were associated with pain and were also found to be present in synovial fluid and synovial membrane (except IL-6) of patients with hip OA. OA may include different inflammatory subtypes according to affected joints and distinct inflammatory processes may drive OA in these joints. IL6, MDC and IP10 are associated with hip OA pain and these proteins may be able to provide additional information regarding pain in hip OA patients.

The impact of surface and geometry on coefficient of friction of artificial hip joints.

PubMed

Choudhury, Dipankar; Vrbka, Martin; Mamat, Azuddin Bin; Stavness, Ian; Roy, Chanchal K; Mootanah, Rajshree; Krupka, Ivan

2017-08-01

Coefficient of friction (COF) tests were conducted on 28-mm and 36-mm-diameter hip joint prostheses for four different material combinations, with or without the presence of Ultra High Molecular Weight Polyethylene (UHMWPE) particles using a novel pendulum hip simulator. The effects of three micro dimpled arrays on femoral head against a polyethylene and a metallic cup were also investigated. Clearance played a vital role in the COF of ceramic on polyethylene and ceramic on ceramic artificial hip joints. Micro dimpled metallic femoral heads yielded higher COF against a polyethylene cup; however, with metal on metal prostheses the dimpled arrays significantly reduced the COF. In situ images revealed evidence that the dimple arrays enhanced film formation, which was the main mechanism that contributed to reduced friction. Copyright © 2017 Elsevier Ltd. All rights reserved.

Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running.

PubMed

Snyder, Kelli R; Earl, Jennifer E; O'Connor, Kristian M; Ebersole, Kyle T

2009-01-01

Movement and muscle activity of the hip have been shown to affect movement of the lower extremity, and been related to injury. The purpose of this study was to determine if increased hip strength affects lower extremity mechanics during running. Within subject, repeated measures design. Fifteen healthy women volunteered. Hip abduction and external rotation strength were measured using a hand-held dynamometer. Three-dimensional biomechanical data of the lower extremity were collected during running using a high-speed motion capture system. Measurements were made before, at the mid-point, and after a 6-week strengthening program using closed-chain hip rotation exercises. Joint range of motion (rearfoot eversion, knee abduction, hip adduction, and internal rotation), eversion velocity, eversion angle at heel strike, and peak joint moments (rearfoot inversion, knee abduction, hip abduction, and external rotation) were analyzed using repeated measures analysis of variance (P

The association between menarche, intensity of training and passive joint ROM in young pre-professional female dancers: A longitudinal follow-up study.

PubMed

Nili, Steinberg; Shay, Tenenbaum; Myriam, Stern; Aviva, Zeev; Itzhak, Siev-Ner

2018-05-05

To determine the association between the status of menarche (yes/no), the intensity of training and the potential to improve passive joint range of motion (ROM) over a 12-month period of dance training. Prospective cohort study. Dance studio. Fifty-nine female dancers aged 12.8 ± 0.5. The dancers were asked about their dance intensity and screened for anthropometric parameters and passive joint ROM in Grades 7 and 8. Along the 12 months of dance training, we found significantly increased ankle-foot en-pointe, hip abduction, and hip external rotation (ER); significantly decreased hip internal rotation (IR); and significant increased hip ER:IR ratio. In Grade 7, 26 dancers (44.1%) reached menarche (Yes menarche); in Grade 8 an additional 23 dancers (39.0%) reached menarche (No/Yes menarche); and 10 dancers (16.9%) had not reached menarche (No menarche). MANOVA (mixed models) with repeated measures to compare joint ROM between the three menarche groups (Yes; No/Yes; No), with h/week dance practice as a co-variant, showed that hip ER, ankle-foot en-pointe, and ER:IR were significantly correlated with h/week in all three menarche groups. Most passive joint ROM can be improved over 12 months of dancing around the age onset of menarche. H/week of dance practice is a main factor contributing to improved hip ER, ankle-foot en-pointe and ER/IR ratio. Copyright © 2018 Elsevier Ltd. All rights reserved.

Hip rotation angle is associated with frontal plane knee joint mechanics during running.

PubMed

Sakaguchi, Masanori; Shimizu, Norifumi; Yanai, Toshimasa; Stefanyshyn, Darren J; Kawakami, Yasuo

2015-02-01

Inability to control lower extremity segments in the frontal and transverse planes resulting in large knee abduction angle and increased internal knee abduction impulse has been associated with patellofemoral pain (PFP). However, the influence of hip rotation angles on frontal plane knee joint kinematics and kinetics remains unclear. The purpose of this study was to explore how hip rotation angles are related to frontal plane knee joint kinematics and kinetics during running. Seventy runners participated in this study. Three-dimensional marker positions and ground reaction forces were recorded with an 8-camera motion analysis system and a force plate while subjects ran along a 25-m runway at a speed of 4m/s. Knee abduction, hip rotation and toe-out angles, frontal plane lever arm at the knee, internal knee abduction moment and impulse, ground reaction forces and the medio-lateral distance from the ankle joint center to the center of pressure (AJC-CoP) were quantified. The findings of this study indicate that greater hip external rotation angles were associated with greater toe-out angles, longer AJC-CoP distances, smaller internal knee abduction impulses with shorter frontal plane lever arms and greater knee abduction angles. Thus, there appears to exist a conflict between kinematic and kinetic risk factors of PFP, and hip external rotation angle may be a key factor to control frontal plane knee joint kinematics and kinetics. These results may help provide an appropriate manipulation and/or intervention on running style to reduce the risk of PFP. Copyright © 2014 Elsevier B.V. All rights reserved.

Performance Evaluation of a Lower Limb Exoskeleton for Stair Ascent and Descent with Paraplegia*

PubMed Central

Farris, Ryan J.; Quintero, Hugo A.; Goldfarb, Michael

2013-01-01

This paper describes the application of a powered lower limb exoskeleton to aid paraplegic individuals in stair ascent and descent. A brief description of the exoskeleton hardware is provided along with an explanation of the control methodology implemented to allow stair ascent and descent. Tests were performed with a paraplegic individual (T10 complete injury level) and data is presented from multiple trials, including the hip and knee joint torque and power required to perform this functionality. Joint torque and power requirements are summarized, including peak hip and knee joint torque requirements of 0.75 Nm/kg and 0.87 Nm/kg, respectively, and peak hip and knee joint power requirements of approximately 0.65 W/kg and 0.85 W/kg, respectively. PMID:23366287

Nerve block of articular branches of the obturator and femoral nerves for the treatment of hip joint pain.

PubMed

Yavuz, Ferdi; Yasar, Evren; Ali Taskaynatan, Mehmet; Goktepe, Ahmet Salim; Tan, Arif Kenan

2013-01-01

The aim of this retrospective study was to investigate the effectiveness of the nerve block of articular branches of obturator and femoral nerves in patients with intractable pain due to hip osteoarthritis. Twenty patients (8 female and 12 male; with a mean age 53.5 years) were retrospectively identified who had received nerve block of articular branches of obturator and femoral nerves for chronic hip joint pain due to hip osteoarthritis. The outcome measures (visual analogue pain scale, the level of patient satisfaction with nerve block, reduction rate of NSAID using) were assessed before the treatment and at the 1st and 3rd months after injection. Mean reduction in hip joint pain while walking and at night between the baseline and 1st month, and between the baseline and 3rd month were statistically significant (p< 0.05). At the 1st and 3rd months after treatment, the reduction rates of NSAID using were almost 67% and 71%; respectively. At the 1st and 3rd months after treatment, the level of patient satisfaction with nerve block were 73.00 ± 21.23 mm and 73.50 ± 18.14 mm; respectively. We found that nerve blocks of articular branches of obturator and femoral nerves were effective in short- and mid-term for reducing chronic hip joint pain.

Treatment Challenges of Prosthetic Hip Infection with Associated Iliacus Muscle Abscess: Report of 5 Cases and Literature Review.

PubMed

Lawrenz, Joshua M; Mesko, Nathan W; Higuera, Carlos A; Molloy, Robert M; Simpfendorfer, Claus; Babic, Maja

2017-01-01

Prosthetic joint infection is an unfortunate though well-recognized complication of total joint arthroplasty. An iliacus and/or iliopsoas muscle abscess is a rarely documented presentation of hip prosthetic joint infection. It is thought an unrecognized retroperitoneal nidus of infection can be a source of continual seeding of the prosthetic hip joint, prolonging attempts to eradicate infection despite aggressive debridement and explant attempts. The current study presents five cases demonstrating this clinical scenario, and discusses various treatment challenges. In each case we report the patient's clinical history, pertinent imaging, management and outcome. Diagnosis of the iliacus muscle abscess was made using computed tomography imaging. In brief, the mean number of total drainage procedures (open and percutaneous) per patient was 4.2, and outcomes consisted of one patient with a hip girdlestone, two patients with delayed revisions, and two patients with retained prosthesis. All patients ended with functional pain and on oral antibiotic suppression with an average follow up of 18 months. This article highlights an iliacus muscle abscess as an unrecognized source of infection to a prosthetic hip. It demonstrates resilience to standard treatment protocols for prosthetic hip infection, and is associated with poor patient outcomes. Aggressive surgical debridement appears to remain critical to treatment success, and early retroperitoneal debridement of the abscess should be considered.

Some new evidence on human joint lubrication.

PubMed Central

Unsworth, A; Dowson, D; Wright, V

1975-01-01

Theoretical consideration has been given to the use of pendulum machines which are used to examine the frictional properties of human joints by incorporating them as fulcra. As a result, a new type of pendulum machine has been built which incorporates the facility to apply sudden loads to the joint on starting the swinging motion, and also the ability to measure directly the frictional torque experienced by the joint. The results obtained from natural hip joints indicate the presence of squeeze film lubrication under conditions of sudden loading of a joint. In addition, a self-generated fluid film process was observed at low loads while at higher loads boundary lubrication appeared to be important. These results have been used to describe the lubrication regimens occurring in a normal activity such as walking. A single experiment carried out on a hip from a patient suffering from severe rheumatoid arthritis has also been reported and the frictional resistance was seen to be increased fifteenfold compared to a normal hip. Images PMID:1190847

Mid-term results of the BIOLOX delta ceramic-on-ceramic total hip arthroplasty.

PubMed

Lee, Y K; Ha, Y C; Yoo, J-I; Jo, W L; Kim, K-C; Koo, K H

2017-06-01

We conducted a prospective study of a delta ceramic total hip arthroplasty (THA) to determine the rate of ceramic fracture, to characterise post-operative noise, and to evaluate the mid-term results and survivorship. Between March 2009 and March 2011, 274 patients (310 hips) underwent cementless THA using a delta ceramic femoral head and liner. At each follow-up, clinical and radiological outcomes were recorded. A Kaplan-Meier analysis was undertaken to estimate survival. Four patients (four hips) died and 18 patients (20 hips) were lost to follow-up within five years. The remaining 252 patients (286 hips) were followed for a mean of 66.5 months (60 to 84). There were 144 men (166 hips) and 108 women (120 hips) with a mean age of 49.7 years (16 to 83) at surgery. The mean pre-operative Harris Hip Score of 47.1 points improved to 93.8 points at final follow-up. Six patients reported squeaking in seven hips; however, none were audible. Radiolucent lines involving Gruen zones one and/or seven were seen in 52 hips (18.2%). No hip had detectable wear, focal osteolysis or signs of loosening. One hip was revised because of fracture of the ceramic liner, which occurred due to an undetected malseating of the ceramic liner at the time of surgery. One hip was revised for a periprosthetic fracture of the femur, and one hip was treated for periprosthetic joint infection. The six-year survivorship with re-operation for any reason as the endpoint was 99.0% (95% confidence interval 97.8% to 100%). The rate of delta ceramic fracture was 0.3% (one of 286). While ceramic head fracture was dominant in previous ceramic-on-ceramic THA, fracture of the delta ceramic liner due to malseating is a concern. Cite this article: Bone Joint J 2017;99-B:741-8. ©2017 The British Editorial Society of Bone & Joint Surgery.

Relationship between movement time and hip moment impulse in the sagittal plane during sit-to-stand movement: a combined experimental and computer simulation study.

PubMed

Inai, Takuma; Takabayashi, Tomoya; Edama, Mutsuaki; Kubo, Masayoshi

2018-04-27

The association between repetitive hip moment impulse and the progression of hip osteoarthritis is a recently recognized area of study. A sit-to-stand movement is essential for daily life and requires hip extension moment. Although a change in the sit-to-stand movement time may influence the hip moment impulse in the sagittal plane, this effect has not been examined. The purpose of this study was to clarify the relationship between sit-to-stand movement time and hip moment impulse in the sagittal plane. Twenty subjects performed the sit-to-stand movement at a self-selected natural speed. The hip, knee, and ankle joint angles obtained from experimental trials were used to perform two computer simulations. In the first simulation, the actual sit-to-stand movement time obtained from the experiment was entered. In the second simulation, sit-to-stand movement times ranging from 0.5 to 4.0 s at intervals of 0.25 s were entered. Hip joint moments and hip moment impulses in the sagittal plane during sit-to-stand movements were calculated for both computer simulations. The reliability of the simulation model was confirmed, as indicated by the similarities in the hip joint moment waveforms (r = 0.99) and the hip moment impulses in the sagittal plane between the first computer simulation and the experiment. In the second computer simulation, the hip moment impulse in the sagittal plane decreased with a decrease in the sit-to-stand movement time, although the peak hip extension moment increased with a decrease in the movement time. These findings clarify the association between the sit-to-stand movement time and hip moment impulse in the sagittal plane and may contribute to the prevention of the progression of hip osteoarthritis.

Correlations among pelvic positions and differences in lower extremity joint angles during walking in female university students.

PubMed

Cho, Misuk

2015-06-01

[Purpose] This study aimed to identify correlations among pelvic positions and differences in lower extremity joint angles during walking in female university students. [Subjects] Thirty female university students were enrolled and their pelvic positions and differences in lower extremity joint angles were measured. [Methods] Pelvic position, pelvic torsion, and pelvic rotation were assessed using the BackMapper. In addition, motion analysis was performed to derive differences between left and right flexion, abduction, and external rotation ranges of hip joints; flexion, abduction, and external rotation ranges of knee joints; and dorsiflexion, inversion, and abduction ranges of ankle joints, according to X, Y, and Z-axes. [Results] Pelvic position was found to be positively correlated with differences between left and right hip flexion (r=0.51), hip abduction (r=0.62), knee flexion (r=0.45), knee abduction (r=0.42), and ankle inversion (r=0.38). In addition, the difference between left and right hip abduction showed a positive correlation with difference between left and right ankle dorsiflexion (r=0.64). Moreover, differences between left and right knee flexion exhibited positive correlations with differences between left and right knee abduction (r=0.41) and ankle inversion (r=0.45). [Conclusion] Bilateral pelvic tilt angles are important as they lead to bilateral differences in lower extremity joint angles during walking.

On-Ice Functional Assessment of an Elite Ice Hockey Goaltender After Treatment for Femoroacetabular Impingement.

PubMed

Tramer, Joseph S; Deneweth, Jessica M; Whiteside, David; Ross, James R; Bedi, Asheesh; Goulet, Grant C

2015-01-01

Femoroacetabular impingement (FAI) is a major cause of performance inhibition in elite-level athletes. The condition is characterized by pain, osseous abnormalities such as an increased alpha angle, and decreased range of motion at the affected hip joint. Arthroscopic surgical decompression is useful in reshaping the joint to alleviate symptoms. Functional kinematic outcomes of sport-specific movements after surgery, however, are presently unknown. The ability of an ice hockey goaltender to execute sport-specific movements would improve after arthroscopic surgery. Clinical research. Level 5. An ice hockey goaltender was evaluated after arthroscopic correction of FAI on the symptomatic hip. Passive range of motion and radiographic parameters were assessed from a computed tomography-derived 3-dimensional model. An on-ice motion capture system was also used to determine peak femoral shock and concurrent hip joint postures during the butterfly and braking movements. Maximum alpha angles were 47° in the surgical and 61° in the nonsurgical hip. Internal rotation range of motion was, on average, 23° greater in the surgically corrected hip compared with contralateral. Peak shock was lower in the surgical hip by 1.39 g and 0.86 g during butterfly and braking, respectively. At peak shock, the surgical hip demonstrated increased flexion, adduction, and internal rotation for both tasks (butterfly, 6.1°, 12.3°, and 30.8°; braking, 14.8°, 19.2°, and 41.4°). On-ice motion capture revealed performance differences between hips after arthroscopic surgery in a hockey goaltender. Range of motion and the patient's subjective assessment of hip function were improved in the surgical hip. While presenting as asymptomatic, it was discovered that the contralateral hip displayed measurements consistent with FAI. Therefore, consideration of preemptive treatment in a presently painless hip may be deemed beneficial for young athletes seeking a long career in sport, and future work is needed to determine the costs and benefits of such an approach. Surgical treatment of symptomatic FAI can achieve pain relief and improved kinematics of the hip joint with athletic activities. Additional studies are necessary to determine whether improved kinematics enhance the longevity of the native hip and alter the progression of osteoarthritic changes in those with asymptomatic FAI deformity. © 2015 The Author(s).

Influence of evolution on cam deformity and its impact on biomechanics of the human hip joint.

PubMed

Anwander, Helen; Beck, Martin; Büchler, Lorenz

2018-02-05

Anatomy and biomechanics of the human hip joint are a consequence of the evolution of permanent bipedal gait. Habitat and behaviour have an impact on hip morphology and significant differences are present even within the same biological family. The forces acting upon the hip joint are mainly a function of gravitation and strength of the muscles. Acetabular and femoral anatomy ensure an inherently stable hip with a wide range of motion. The femoral head in first human ancestors with upright gait was spherical (coxa rotunda). Coxa rotunda is also seen in close human relatives (great apes) and remains the predominant anatomy of present-day humans. High impact sport during adolescence with open physis however can activate an underlying genetic predisposition for reinforcement of the femoral neck, causing an epiphyseal extension and the formation of an osseous asphericity at the antero-superior femoral neck (cam deformity). The morphology of cam deformity is similar to the aspherical hips of quadrupeds (coxa recta), with the difference that in quadrupeds the asphericity is posterior. It has been postulated that this is due to the fact that humans bear weight on the extended leg, while quadrupeds bear weight at 90-100° flexion. The asphericity alters the biomechanical properties of the joint and as it is forced into the acetabulum leading to secondary cartilage damage. It is considered a risk factor for later development of osteoarthritis of the hip. Clinically this presents as reduced range of motion, which can be an indicator for the structural deformity of the hip. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:XX-XX, 2018. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Early, asymptomatic stage of degenerative joint disease in canine hip joints.

PubMed

Lust, G; Summers, B A

1981-11-01

The early stages of degenerative joint disease were investigated in coxofemoral joints from dogs with a hereditary predisposition to hip dysplasia. Alterations observed included mild nonsuppurative synovitis, increased volume of both synovial fluid and the ligamentum teres, and focal degenerative articular cartilage lesions. On radiologic examination, subluxation of the femoral head was seen, but only in the most severely affected joints. Synovial inflammation with increased synovial fluid and ligament volumes were indicators of early degenerative joint disease in dogs. These changes seemed to coincide with, or perhaps to precede, microscopic evidence for articular cartilage degeneration and occurred before radiologic abnormalities were detected.

Functional roles of lower-limb joint moments while walking in water.

PubMed

Miyoshi, Tasuku; Shirota, Takashi; Yamamoto, Shin-Ichiro; Nakazawa, Kimitaka; Akai, Masami

2005-02-01

To clarify the functional roles of lower-limb joint moments and their contribution to support and propulsion tasks while walking in water compared with that on land. Sixteen healthy, young subjects walked on land and in water at several different speeds with and without additional loads. Walking in water is a major rehabilitation therapy for patients with orthopedic disorders. However, the functional role of lower-limb joint moments while walking in water is still unclear. Kinematics, electromyographic activities in biceps femoris and gluteus maximums, and ground reaction forces were measured under the following conditions: walking on land and in water at a self-determined pace, slow walking on land, and fast walking in water with or without additional loads (8 kg). The hip, knee, and ankle joint moments were calculated by inverse dynamics. The contribution of the walking speed increased the hip extension moment, and the additional weight increased the ankle plantar flexion and knee extension moment. The major functional role was different in each lower-limb joint muscle. That of the muscle group in the ankle is to support the body against gravity, and that of the muscle group involved in hip extension is to contribute to propulsion. In addition, walking in water not only reduced the joint moments but also completely changed the inter-joint coordination. It is of value for clinicians to be aware that the greater the viscosity of water produces a greater load on the hip joint when fast walking in water.

Morphometric assessment of hip dysplasia in a cat treated by juvenile pubic symphysiodesis.

PubMed

Lai, Alen; Culvenor, John; Bailey, Craig

2016-09-20

To quantitatively evaluate the change of the coxofemoral joints using computed tomography and distraction index in a cat with hip dysplasia treated by juvenile pubic symphysiodesis. Case report. Eighteen-week-old female entire Maine Coon cat. Juvenile pubic symphysiodesis resulted in changes in the distraction index, acetabular angle, dorsal acetabular rim angle, dorsal acetabular sector angle, and clinical improvement at the six month follow-up. No intra-operative or postoperative complications were recorded. Juvenile pubic symphysiodesis performed at 18 weeks of age resulted in improvement in hip joint conformation and hip laxity in a dysplastic cat. Juvenile pubic symphysiodesis may be a promising treatment for feline hip dysplasia and is a safe and technically simple procedure to perform. Further investigations are warranted.

Movement coordination of the lumbar spine and hip during a picking up activity in low back pain subjects.

PubMed

Shum, Gary L K; Crosbie, Jack; Lee, Raymond Y W

2007-06-01

The effect of low back pain, with or without nerve root signs, on the joint coordination and kinematics of the lumbar spine and hips during everyday activities, such as picking up an object from the floor, are largely unknown. An experimental study was designed to compare lumbar spine and hip joint kinematics and coordination in subjects with and without sub-acute low back pain, while picking up an object in a sitting position. A three-dimensional real-time electromagnetic tracking device was used to measure movements of the lumbar spine and hips. Sixty participants with subacute low back pain, with or without straight leg raise signs, and twenty healthy asymptomatic participants were recruited. The ranges of motions of lumbar spine and hips were determined. Movement coordination between the two regions was examined by cross-correlation. Results showed that mobility was significantly reduced in subjects with back pain, who compensated for limited motion through various strategies. The contribution of the lumbar spine relative to that of the hip was, however, found to be similar in all groups. The lumbar spine-hip joint coordination was substantially altered in subjects with back pain, in particular, those with a positive straight leg raise sign. We conclude that changes in the lumbar and hip kinematics were related to back pain and limitation in straight leg raise. Lumbar-hip coordination was mainly affected by the presence of positive straight leg raise sign when picking up an object in a sitting position.

Hip morphologic measurements in an Egyptian population.

PubMed

Aly, Tarek A

2011-04-11

The study of acetabular morphology has shown that there are geographic differences in the morphology and prevalence of acetabular dysplasia among different ethnic groups. However, few data exist on the shape of the acetabulum in various populations around the world. In this study, we examined samples of pelvic radiographs from Egyptian adults. Acetabular dysplasia in adults is characterized by a shallow and relatively vertical acetabulum.The aim of this study was to examine acetabular morphology to determine the prevalence of hip dysplasia in adult Egyptians. This included 244 adults, 134 men and 110 women between 18 and 60 years, who were used to measure center edge angle, acetabular Sharp angle, acetabular head index on anteroposterior radiographic views of the hip joints, and vertical center anterior margin angle on false profile views. The radiographs were taken of patients with no hip complaints at Tanta University Hospital.The results were statistically studied according to the age, height, and weight of patients. The prevalence of acetabular dysplasia was 2.25% for Egyptian men and 3.6% for women with respect to center edge angles, vertical center anterior margin angle, and acetabular head index.We concluded that gender variations in the morphology of the acetabulum and sex influences geometrical measurements of the acetabulum. Egyptian women were more dysplastic than men using the 4 parameters of hip measurements. There are also racial variations in hip morphology. Copyright 2011, SLACK Incorporated.

Tuberculosis of hip: A current concept review

PubMed Central

Saraf, Shyam Kumar; Tuli, Surendra Mohan

2015-01-01

Tuberculosis (TB) of the hip is second to spine only hence a good number of cases are visiting the medical facilities every year. Many present in the advanced stage of the disease due to delayed diagnosis. In early stages of TB of hip, there is a diagnostic dilemma when plain X-rays are negative. In the present time, diagnostic modalities have improved from the days when diagnosis was based essentially on clinicoradiological presentation alone. By the time definite radiological changes appear on plain X-ray, the disease has moderately advanced. The modern diagnostic facilities like ultrasonography (USG) or magnetic resonance imaging of the hip joint, USG guided aspiration of synovial fluid and obtaining the material for polymerase chain reaction and tissue diagnosis must be utilized. In the treatment, current emphasis is more on mobility with stability at hip. Joint debridement, skeletal traction, and mobilization exercises may give more satisfying results as compared to the immobilization by hip spica. Adults with advanced arthritis and healed infection should be informed and discussed the various treatment modalities including the joint replacement. More and more surgeons are taking up the challenge of putting the total hip replacement in the active stage of the disease. Until the long term results in active disease are well established, we recommend it for the healed disease only in selected cases. PMID:25593352

Tuberculosis of hip: A current concept review.

PubMed

Saraf, Shyam Kumar; Tuli, Surendra Mohan

2015-01-01

Tuberculosis (TB) of the hip is second to spine only hence a good number of cases are visiting the medical facilities every year. Many present in the advanced stage of the disease due to delayed diagnosis. In early stages of TB of hip, there is a diagnostic dilemma when plain X-rays are negative. In the present time, diagnostic modalities have improved from the days when diagnosis was based essentially on clinicoradiological presentation alone. By the time definite radiological changes appear on plain X-ray, the disease has moderately advanced. The modern diagnostic facilities like ultrasonography (USG) or magnetic resonance imaging of the hip joint, USG guided aspiration of synovial fluid and obtaining the material for polymerase chain reaction and tissue diagnosis must be utilized. In the treatment, current emphasis is more on mobility with stability at hip. Joint debridement, skeletal traction, and mobilization exercises may give more satisfying results as compared to the immobilization by hip spica. Adults with advanced arthritis and healed infection should be informed and discussed the various treatment modalities including the joint replacement. More and more surgeons are taking up the challenge of putting the total hip replacement in the active stage of the disease. Until the long term results in active disease are well established, we recommend it for the healed disease only in selected cases.

Inflammatory disorders mimicking periprosthetic joint infections may result in false positive α-defensin.

PubMed

Plate, Andreas; Stadler, Laura; Sutter, Reto; Anagnostopoulos, Alexia; Frustaci, Dario; Zbinden, Reinhard; Fucentese, Sandro F; Zinkernagel, Annelies S; Zingg, Patrick O; Achermann, Yvonne

2018-02-26

The antimicrobial peptide α-defensin has recently been introduced as potential "single" biomarker with a high sensitivity and specificity for the preoperative diagnosis of periprosthetic joint infections (PJIs). However, most studies assessed the benefits of the test with exclusion of patients with rheumatic diseases. We aimed to evaluate the α-defensin test in a cohort study without exclusion of cases with inflammatory diseases. Between June 2016 and June 2017, we prospectively included cases with a suspected PJI and an available lateral flow test α-defensin (Synovasure®) in synovial fluid. We compared the test result to the diagnostic criteria for PJIs published by an International Consensus Group in 2013. We included 109 cases (49 hips, 60 knees) in which preoperative α-defensin tests had been performed. Thereof, 20 PJIs (16 hips, 4 knees) were diagnosed. Preoperative α-defensin tests were positive in 25 cases (22.9%) with a test sensitivity and specificity of 90% and 92.1% (95% confidence interval [CI], 68.3 - 98.8% and 84.5 - 96.8%, respectively), and a high negative predictive value of 97.6% (95% CI, 91.7 - 99.4%). We interpreted seven α-defensin tests as false positive, mainly in cases with inflammatory rheumatic diseases, including crystal deposition diseases. A negative synovial α-defensin test can reliably rule out a PJI. However, the test can be false positive in conjunction with an underlying non-infectious inflammatory disease. We therefore propose to use the α-defensin test only in addition to MSIS criteria and assessment for crystals in synovial aspirates. Copyright © 2018. Published by Elsevier Ltd.

Anticipatory postural adjustments during lateral step motion in patients with hip osteoarthritis.

PubMed

Tateuchi, Hiroshige; Ichihashi, Noriaki; Shinya, Masahiro; Oda, Shingo

2011-02-01

Patients with hip osteoarthritis (OA) have difficulty with mediolateral postural control. Since the symptom of hip OA includes joint pain, which mostly occurs upon initial movement, patients with hip OA might have disabling problems with movement initiation. This study aimed to identify the movement strategy during the anticipatory postural adjustments in the lateral step motion in patients with hip OA. We studied 18 female subjects with unilateral hip OA and 10 healthy subjects, and measured temporal, kinetic, and kinematic variables. Patients with hip OA required a longer duration of anticipation phase than the control subjects, the total duration of lateral stepping was not different between the groups. Displacement of the center of mass to the supporting (affected) side during the anticipation phase was not different between the two groups. These findings suggest that, in patients with hip OA, the center of mass slowly moved to the affected side. Furthermore, patients with hip OA showed greater shift of the trunk to the supporting side than did the control subjects. These movement characteristics might contribute to the achievement of both protection of the affected hip joint and quickness in the subsequent lateral step in patients with hip OA.

Kinetic Compensations due to Chronic Ankle Instability during Landing and Jumping.

PubMed

Kim, Hyunsoo; Son, S Jun; Seeley, Matthew K; Hopkins, J Ty

2018-02-01

Skeletal muscles absorb and transfer kinetic energy during landing and jumping, which are common requirements of various forms of physical activity. Chronic ankle instability (CAI) is associated with impaired neuromuscular control and dynamic stability of the lower extremity. Little is known regarding an intralimb, lower-extremity joint coordination of kinetics during landing and jumping for CAI patients. We investigated the effect of CAI on lower-extremity joint stiffness and kinetic and energetic patterns across the ground contact phase of landing and jumping. One hundred CAI patients and 100 matched able-bodied controls performed five trials of a landing and jumping task (a maximal vertical forward jump, landing on a force plate with the test leg only, and immediate lateral jump toward the contralateral side). Functional analyses of variance and independent t-tests were used to evaluate between-group differences for lower-extremity net internal joint moment, power, and stiffness throughout the entire ground contact phase of landing and jumping. Relative to the control group, the CAI group revealed (i) reduced plantarflexion and knee extension and increased hip extension moments; (ii) reduced ankle and knee eccentric and concentric power, and increased hip eccentric and concentric power, and (iii) reduced ankle and knee joint stiffness and increased hip joint stiffness during the task. CAI patients seemed to use a hip-dominant strategy by increasing the hip extension moment, stiffness, and eccentric and concentric power during landing and jumping. This apparent compensation may be due to decreased capabilities to produce sufficient joint moment, stiffness, and power at the ankle and knee. These differences might have injury risk and performance implications.

Hip and knee joints are more stabilized than driven during the stance phase of gait: an analysis of the 3D angle between joint moment and joint angular velocity.

PubMed

Dumas, R; Cheze, L

2008-08-01

Joint power is commonly used in orthopaedics, ergonomics or sports analysis but its clinical interpretation remains controversial. Some basic principles on muscle actions and energy transfer have been proposed in 2D. The decomposition of power on 3 axes, although questionable, allows the same analysis in 3D. However, these basic principles have been widely criticized, mainly because bi-articular muscles must be considered. This requires a more complex computation in order to determine how the individual muscle force contributes to drive the joint. Conversely, with simple 3D inverse dynamics, the analysis of both joint moment and angular velocity directions is essential to clarify when the joint moment can contribute or not to drive the joint. The present study evaluates the 3D angle between the joint moment and the joint angular velocity and investigates when the hip, knee and ankle joints are predominantly driven (angle close to 0 degrees and 180 degrees ) or stabilized (angle close to 90 degrees ) during gait. The 3D angle curves show that the three joints are never fully but only partially driven and that the hip and knee joints are mainly stabilized during the stance phase. The notion of stabilization should be further investigated, especially for subjects with motion disorders or prostheses.

Financial Analysis of Treating Periprosthetic Joint Infections at a Tertiary Referral Center.

PubMed

Waddell, Bradford S; Briski, David C; Meyer, Mark S; Ochsner, John L; Chimento, George F

2016-05-01

Periprosthetic joint infection (PJI) is a significant challenge to the orthopedic surgeon, patient, hospital, and insurance provider. Our study compares the financial information of self-originating and referral 2-stage revision hip and knee surgeries at our tertiary referral center for hip or knee PJI over the last 4 years. We performed an in-house retrospective financial review of all patients who underwent 2-stage revision hip or knee arthroplasty for infection between January 2008 and August 2013, comparing self-originating and referral cases. We found an increasing number of referrals over the study period. There was an increased cost of treating hips over knees. All scenarios generated a positive net income; however, referral hip PJIs offered lower reimbursement and net income per case (although not statistically significant), whereas knee PJIs offered higher reimbursement and net income per case (although not statistically significant). With referral centers treating increased numbers of infected joints performed elsewhere, we show continued financial incentive in accepting referrals, although with less financial gain than when treating one's own hip PJI and an increased financial gain when treating referral knee PJIs. Copyright © 2016 Elsevier Inc. All rights reserved.

[Review and prospect of analysis on UHMWPE wear debris in artificial hip joints].

PubMed

Wu, Jingping; Yuan, Chengqing; Yan, Xinping

2010-02-01

This paper briefly reviews the latest progress in the analyses of the technologies for artificial hip joints; and in the researches directed to the features of UHMWPE debris obtained from all kinds of experimental conditions, to the wear process and wear mechanism, and to the factors which influence the wear mechanism. Furthermore, the signification of debris atlas was illustrated. Finally, future directions to be furthered were considered and envisaged. It is suggested that emphases be laid on the relationship between the UHMWPE debris feature and the wear mechanism, and be laid synergistic effects of biochemical environment and loading environment so as to establish the predictive wear models of artificial hip joints.

Bioceramics for Hip Joints: The Physical Chemistry Viewpoint

PubMed Central

Pezzotti, Giuseppe

2014-01-01

Which intrinsic biomaterial parameter governs and, if quantitatively monitored, could reveal to us the actual lifetime potential of advanced hip joint bearing materials? An answer to this crucial question is searched for in this paper, which identifies ceramic bearings as the most innovative biomaterials in hip arthroplasty. It is shown that, if in vivo exposures comparable to human lifetimes are actually searched for, then fundamental issues should lie in the physical chemistry aspects of biomaterial surfaces. Besides searching for improvements in the phenomenological response of biomaterials to engineering protocols, hip joint components should also be designed to satisfy precise stability requirements in the stoichiometric behavior of their surfaces when exposed to extreme chemical and micromechanical conditions. New spectroscopic protocols have enabled us to visualize surface stoichiometry at the molecular scale, which is shown to be the key for assessing bioceramics with elongated lifetimes with respect to the primitive alumina biomaterials used in the past. PMID:28788682

Radiographic followup of joints injected with triamcinolone hexacetonide for the management of childhood arthritis.

PubMed

Sparling, M; Malleson, P; Wood, B; Petty, R

1990-06-01

Evidence of deleterious effects following intraarticular injection of triamcinolone hexacetonide was sought through a review of radiographs of 145 joints of 55 children with chronic arthritis. Possible deleterious effects were noted in 16 joints of 11 patients. These effects included: small patella (2 joints), patellar osteochondritis dissecans (1 joint), periarticular calcification (9 joints), intraarticular tibial bony spur (1 joint), avascular necrosis of the distal radial epiphysis (2 joints), and avascular necrosis of the proximal femoral epiphysis (1 joint). Only the latter possible complication was symptomatic. Serial radiographs of 76 joints of 30 children showed mild progressive changes compatible with the underlying disease, except in the hip joint, where changes were more severe. The intraarticular injection of triamcinolone hexacetonide is a procedure that appears to be associated with an acceptably low frequency of radiologic abnormalities for many joints in children with chronic arthritis, but its effects on the hip joint remain uncertain.

Interventions for Hip Pain in the Maturing Athlete

PubMed Central

Gomberawalla, M. Mustafa; Kelly, Bryan T.; Bedi, Asheesh

2014-01-01

Context: Femoroacetabular impingement (FAI) alters hip mechanics, results in hip pain, and may lead to secondary osteoarthritis (OA) in the maturing athlete. Hip impingement can be caused by osseous abnormalities in the proximal femur or acetabulum. These impingement lesions may cause altered loads within the hip joint, which result in repetitive collision damage or sheer forces to the chondral surfaces and acetabular labrum. These anatomic lesions and resultant abnormal mechanics may lead to early osteoarthritic changes. Evidence Acquisition: Relevant articles from the years 1995 to 2013 were identified using MEDLINE, EMBASE, and the bibliographies of reviewed publications. Level of Evidence: Level 4. Results: Improvements in hip arthroscopy have allowed FAI to be addressed utilizing the arthroscope. Adequately resecting the underlying osseous abnormalities is essential to improving hip symptomatology and preventing further chondral damage. Additionally, preserving the labrum by repairing the damaged tissue and restoring the suction seal may theoretically help normalize hip mechanics and prevent further arthritic changes. The outcomes of joint-preserving treatment options may be varied in the maturing athlete due to the degree of underlying OA. Irreversible damage to the hip joint may have already occurred in patients with moderate to advanced OA. In the presence of preexisting arthritis, these patients may only experience fair or even poor results after hip arthroscopy, with early conversion to hip replacement. For patients with advanced hip arthritis, total hip arthroplasty remains a treatment option to reliably improve symptoms with good to excellent outcomes and return to low-impact activities. Conclusion: Advances in the knowledge base and treatment techniques of intra-articular hip pain have allowed surgeons to address this complex clinical problem with promising outcomes. Traditionally, open surgical dislocations for hip preservation surgery have shown good long-term results. Improvements in hip arthroscopy have led to outcomes equivalent to open surgery while utilizing significantly less invasive techniques. However, outcomes may ultimately depend on the degree of underlying OA. When counseling the mature athlete with hip pain, an understanding of the underlying anatomy, degree of arthritis, and expectations will help guide the treating surgeon in offering appropriate treatment options. PMID:24427445

The breech presentation and the vertex presentation following an external version represent risk factors for neonatal hip instability.

PubMed

Andersson, J E; Odén, A

2001-08-01

The aim of this study was to evaluate the frequency and type of hip-joint instability and the frequency of hip dislocation requiring treatment in neonates who had been lying in the breech presentation and were delivered vaginally after an external version or by caesarean section, and to compare them with neonates who were naturally in the vertex presentation. Breech presentations without ongoing labour were subjected to an attempted external version and, in cases where this proved unsuccessful or where labour had started, to deliver by caesarean section. None of the breech presentations was vaginally delivered. The anterior-dynamic ultrasound method was used to assess the hip-joint status of the neonates. Out of 6,571 foetuses, 257 were in breech presentation after 36 wk of pregnancy. Sixty-two were vaginally delivered following an external version to vertex presentation and 195 were delivered by caesarean section, 75 of these following unsuccessful attempts to perform a version. Treatment for congenital hip-joint dislocation was performed on 0.2%. Out of the breech presentations, 1.0% of those delivered by caesarean section were treated, while in those with vaginal delivery following an external version the treatment frequency was 3.2%. No case of late diagnosed hip dislocation was recorded. Significant differences in frequency of hip-joint instability and treatment were found between (i) neonates delivered in breech presentation and those delivered with vertex presentation, (ii) infants delivered in vertex presentation, naturally or after successful version, and (iii) those delivered by caesarean section with or without attempted external version and those delivered with vortex presentation. Breech presentation predisposes to increased hip instability. The instability is present prior to delivery and is certainly not a primary result of delivery forces. Both breech and vertex presentations following an external or spontaneous version should be considered as risk factors for neonatal hip instability.

Outerbridge Grade IV Cartilage Lesions in the Hip Identified at Arthroscopy.

PubMed

Bhatia, Sanjeev; Nowak, Douglas D; Briggs, Karen K; Patterson, Diana C; Philippon, Marc J

2016-05-01

To determine factors associated with grade IV cartilage defects in the hip in patients undergoing hip arthroscopy with joint pain. Data from consecutive patients who underwent hip arthroscopy performed by a single surgeon over a period of 4 years were included in this study. The study group included 1,097 patients (491 women and 606 men; mean age, 37 years) who underwent hip arthroscopy for pain, had no prior hip surgery, and were aged 18 years or older. Preoperative radiographs, patient demographic characteristics, and operative details were used to identify risk factors for cartilage defects. Grade IV chondral defects were present in 308 of 1,097 hips (28%). Isolated chondral lesions were more frequently observed on the acetabulum (76%) than on the femoral head (24%). Defects of the acetabulum were more commonly anterosuperior (94.7%) and less commonly posterolateral (5.3%). Patients with less than 2 mm of joint space on preoperative radiographs were 8 times more likely to have a grade IV lesion than those with more than 2 mm. Men were more likely than women to have grade IV lesions (35% v 19%, P = .0001); patients with grade IV lesions were older than those without (42 years v 34 years, P = .0001). Hips with grade IV lesions had significantly higher alpha angles than those without (74° v 70°, P = .0001). Patients with grade IV defects reported a longer duration of symptoms than those without (37 months v 27 months, P = .007). Independent risk factors for the presence of grade IV chondral defects were less than 2 mm of joint space, male gender, increasing age, larger alpha angle, and longer duration of symptoms. Grade IV chondral defects in patients undergoing hip arthroscopy were associated with decreased joint space, increased time from symptom onset to arthroscopy, male gender, and larger alpha angles associated with femoroacetabular impingement. Level IV, prognostic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

The deep layer of the tractus iliotibialis and its relevance when using the direct anterior approach in total hip arthroplasty: a cadaver study.

PubMed

Putzer, David; Haselbacher, Matthias; Hörmann, Romed; Klima, Günter; Nogler, Michael

2017-12-01

Surgical approaches through smaller incisions reveal less of the underlying anatomy, and therefore, detailed knowledge of the local anatomy and its variations is important in minimally invasive surgery. The aim of this study was to determine the location, extension, and histomorphology of the deep layer of the iliotibial band during minimally invasive hip surgery using the direct anterior approach (DAA). The morphology of the iliotibial tract was determined in this cadaver study on 40 hips with reference to the anterior superior iliac spine and the tibia. The deep layer of the tractus iliotibialis was exposed up to the hip-joint capsule and length and width measurements taken. Sections of the profound iliotibial tract were removed from the hips and the thickness of the sections was determined microscopically after staining. The superficial tractus iliotibialis had a length of 50.1 (SD 3.8) cm, while tensor fasciae latae total length was 18 (SD 2) cm [unattached 15 (SD 2.5) cm]. Length and width of the deep layer of the tractus iliotibialis were 10.4 (SD 1.3) × 3.3 (SD 0.6) cm. The deep iliotibial band always extended from the distal part of the tensor fascia latae (TFL) muscle to the lateral part of the hip capsule (mean maximum thickness 584 μm). Tractus iliotibialis deep layer morphology did not correlate to other measurements taken (body length, thigh length, and TFL length). The length of the deep layer is dependent on the TFL, since the profound part of the iliotibial band reaches from the TFL to the hip-joint capsule. The deep layer covers the hip-joint capsule, rectus, and lateral vastus muscles in the DAA interval. To access the precapsular fat pad and the hip-joint capsule, the deep layer has to be split in all approaches that use the direct anterior interval.

Hip Joint Replacement Using Monofilament Polypropylene Surgical Mesh: An Animal Model

PubMed Central

Białecki, Jacek; Klimowicz-Bodys, Małgorzata Dorota; Wierzchoś, Edward; Kołomecki, Krzysztof

2014-01-01

Hip joint dysplasia is a deformation of the articular elements (pelvic acetabulum, head of the femur, and/or ligament of the head of the femur) leading to laxity of the hip components and dislocation of the femoral head from the pelvic acetabulum. Diagnosis is based on symptoms observed during clinical and radiological examinations. There are two treatment options: conservative and surgical. The classic surgical procedures are juvenile pubic symphysiodesis (JPS), triple pelvic osteotomy (TPO), total hip replacement (THR), and femoral head and neck resection (FHNE). The aim of this experiment was to present an original technique of filling the acetabulum with a polypropylene implant, resting the femoral neck directly on the mesh. The experiment was performed on eight sheep. The clinical value of the new surgical technique was evaluated using clinical, radiological, and histological methods. This technique helps decrease the loss of limb length by supporting the femoral neck on the mesh equivalent to the femoral head. It also reduces joint pain and leads to the formation of stable and mobile pseudarthrosis. The mesh manifested osteoprotective properties and enabled the formation of a stiff-elastic connection within the hip joint. The method is very cost-effective and the technique itself is simple to perform. PMID:24987672

Descriptive profile of hip rotation range of motion in elite tennis players and professional baseball pitchers.

PubMed

Ellenbecker, Todd S; Ellenbecker, Gail A; Roetert, E Paul; Silva, Rogerio Teixeira; Keuter, Greg; Sperling, Fabio

2007-08-01

Repetitive loading to the hip joint in athletes has been reported as a factor in the development of degenerative joint disease and intra-articular injury. Little information is available on the bilateral symmetry of hip rotational measures in unilaterally dominant upper extremity athletes. Side-to-side differences in hip joint range of motion may be present because of asymmetrical loading in the lower extremities of elite tennis players and professional baseball pitchers. Cohort (cross-sectional) study (prevalence); Level of evidence, 1. Descriptive measures of hip internal and external rotation active range of motion were taken in the prone position of 64 male and 83 female elite tennis players and 101 male professional baseball pitchers using digital photos and computerized angle calculation software. Bilateral differences in active range of motion between the dominant and nondominant hip were compared using paired t tests and Bonferroni correction for hip internal, external, and total rotation range of motion. A Pearson correlation test was used to test the relationship between years of competition and hip rotation active range of motion. No significant bilateral difference (P > .005) was measured for mean hip internal or external rotation for the elite tennis players or the professional baseball pitchers. An analysis of the number of subjects in each group with a bilateral difference in hip rotation greater than 10 degrees identified 17% of the professional baseball pitchers with internal rotation differences and 42% with external rotation differences. Differences in the elite male tennis players occurred in only 15% of the players for internal rotation and 9% in external rotation. Female subjects had differences in 8% and 12% of the players for internal and external rotation, respectively. Statistical differences were found between the mean total arc of hip range of internal and external rotation in the elite tennis players with the dominant side being greater by a clinically insignificant mean value of 2.5 degrees. Significantly less (P < .005) dominant hip internal rotation and less dominant and nondominant hip total rotation range of motion were found in the professional baseball pitchers compared with the elite male tennis players. This study established typical range of motion patterns and identified bilaterally symmetric hip active range of motion rotation values in elite tennis players and professional baseball pitchers. Asymmetric hip joint rotational active range of motion encountered during clinical examination and screening may indicate abnormalities and would indicate the application of flexibility training, rehabilitation, and further evaluation.

The effect of dynamic hip motion on the micromotion of press-fit acetabular cups in six degrees of freedom.

PubMed

Crosnier, Emilie A; Keogh, Patrick S; Miles, Anthony W

2016-08-01

The hip joint is subjected to cyclic loading and motion during activities of daily living and this can induce micromotions at the bone-implant interface of cementless total hip replacements. Initial stability has been identified as a crucial factor to achieve osseointegration and long-term survival. Whilst fixation of femoral stems achieves good clinical results, the fixation of acetabular components remains a challenge. In vitro methods assessing cup stability keep the hip joint in a fixed position, overlooking the effect of hip motion. The effect of hip motion on cup micromotion using a hip motion simulator replicating hip flexion-extension and a six degrees of freedom measurement system was investigated. The results show an increase in cup micromotion under dynamic hip motion compared to Static Flexion. This highlights the need to incorporate hip motion and measure all degrees of freedom when assessing cup micromotion. In addition, comparison of two press-fit acetabular cups with different surface coatings suggested similar stability between the two cups. This new method provides a basis for a more representative protocol for future pre-clinical evaluation of different cup designs. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

Gait alterations to effectively reduce hip contact forces.

PubMed

Wesseling, Mariska; de Groote, Friedl; Meyer, Christophe; Corten, Kristoff; Simon, Jean-Pierre; Desloovere, Kaat; Jonkers, Ilse

2015-07-01

Patients with hip pathology present alterations in gait which have an effect on joint moments and loading. In knee osteoarthritic patients, the relation between medial knee contact forces and the knee adduction moment are currently being exploited to define gait retraining strategies to effectively reduce pain and disease progression. However, the relation between hip contact forces and joint moments has not been clearly established. Therefore, this study aims to investigate the effect of changes in hip and pelvis kinematics during gait on internal hip moments and contact forces which is calculated using muscle driven simulations. The results showed that frontal plane kinetics have the largest effect on hip contact forces. Given the high correlation between the change in hip adduction moment and contact force at initial stance (R(2)  = 0.87), this parameter can be used to alter kinematics and predict changes in contact force. At terminal stance the hip adduction and flexion moment can be used to predict changes in contact force (R(2)  = 0.76). Therefore, gait training that focuses on decreasing hip adduction moments, a wide base gait pattern, has the largest potential to reduce hip contact forces. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Effects of step rate manipulation on joint mechanics during running.

PubMed

Heiderscheit, Bryan C; Chumanov, Elizabeth S; Michalski, Max P; Wille, Christa M; Ryan, Michael B

2011-02-01

the objective of this study was to characterize the biomechanical effects of step rate modification during running on the hip, knee, and ankle joints so as to evaluate a potential strategy to reduce lower extremity loading and risk for injury. three-dimensional kinematics and kinetics were recorded from 45 healthy recreational runners during treadmill running at constant speed under various step rate conditions (preferred, ± 5%, and ± 10%). We tested our primary hypothesis that a reduction in energy absorption by the lower extremity joints during the loading response would occur, primarily at the knee, when step rate was increased. less mechanical energy was absorbed at the knee (P < 0.01) during the +5% and +10% step rate conditions, whereas the hip (P < 0.01) absorbed less energy during the +10% condition only. All joints displayed substantially (P < 0.01) more energy absorption when preferred step rate was reduced by 10%. Step length (P < 0.01), center of mass vertical excursion (P < 0.01), braking impulse (P < 0.01), and peak knee flexion angle (P < 0.01) were observed to decrease with increasing step rate. When step rate was increased 10% above preferred, peak hip adduction angle (P < 0.01) and peak hip adduction (P < 0.01) and internal rotation (P < 0.01) moments were found to decrease. we conclude that subtle increases in step rate can substantially reduce the loading to the hip and knee joints during running and may prove beneficial in the prevention and treatment of common running-related injuries.

The correlation between movement of the center of mass and the kinematics of the spine, pelvis, and hip joints during body rotation.

PubMed

Wada, Osamu; Tateuchi, Hiroshige; Ichihashi, Noriaki

2014-01-01

Body rotation is associated with many activities. The concomitant movement of the center of mass (COM) is essential for effective body rotation. This movement is considered to be influenced by kinematic changes in the spine, pelvis, and hip joints. However, there is no research on the association between COM movement and kinematic changes during body rotation. We aimed to investigate the association between COM movement and the kinematics of the spine, pelvis, and hip joints during body rotation in standing. Twenty-four healthy men were included in the study. COM movement during active body rotation in a standing position was measured. We evaluated pelvic shift and changes in the angles of the spine, pelvis, and hip joints. We calculated the Pearson correlation coefficients to analyze the relationship between COM movement and kinematic changes in the spine, pelvis, and hip joints. There were significant correlations between lateral COM movement to the rotational side and pelvic shift to the rotational side, and between posterior COM movement and pelvic shift to the posterior side. In addition, lateral COM movement to the rotational side showed significant and negative correlation with spinal flexion and was significantly and positively correlated with the change in anterior pelvic tilt. Clinicians need to take particular note of both spinal and pelvic motion in the sagittal plane, as well as the pelvic shift, to speculate COM movement during body rotation in standing. Copyright © 2013 Elsevier B.V. All rights reserved.

Clinical Results of Total Hip Arthroplasty in Two Patients with Charcot Hip Joints due to Congenital Insensivity to Pain with Anhydrosis

PubMed Central

Inoue, Daisuke; Kajino, Yoshitomo; Taga, Tadashi; Yamamoto, Takashi; Takagi, Tomoharu

2018-01-01

Traditionally, Charcot arthropathy has been considered an absolute contraindication for total hip arthroplasty (THA). However, some recent reports have shown that good short- to mid-term results can be achieved by improving the durability of the implant. This paper reports the mid- to long-term results of THA in two patients with Charcot hip joints caused by congenital insensivity to pain with anhydrosis. Both patients suffered multiple posterior dislocations in the six months immediately following surgery. However, with the continuous use of a hard abduction brace, one patient was eventually able to walk with a lofstrand cane and the other with the use of one crutch. Although one patient experienced a dislocation five years after surgery, X-rays taken after nine years and five years, respectively, revealed no clinical signs of implant loosening. We conclude that, with careful planning and appropriate precautions, THA may be a viable treatment option for Charcot hip joints caused by congenital insensivity to pain with anhydrosis. PMID:29666733

[Influence of body posture in the prevalence of craniomandibular dysfunction].

PubMed

Fuentes, R; Freesmeyer, W; Henríquez, J

1999-09-01

Postural alterations of the shoulders, dorsal spine and hips could have an influence on the development of craniomandibular dysfunctions. To study the influence of body posture on the prevalence of craniomandibular dysfunction. One hundred thirty six dental students and 41 patients assisting to the temporomandibular joints (TMJ) clinic at the Freie Universität at Berlin, were studied. Masticator, cervical muscles, temporomandibular joints and occlusions were clinically examined. The position of shoulders and hips was measured with the use of an acromiopelvimeter. No relationship was found between postural alterations of the hips and shoulders, articular noises and sensibility or pain while palpating the temporomandibular joints. Among students, a relationship between postural alterations of the shoulders and the sensibility or pain while palpating the TMJ, was observed. When all muscles were considered, a significant relationship between asymmetric shoulders or hips and muscular pain while palpating was observed among students. Some symptoms, especially muscular sensibility is more pronounced in people with hip and shoulder asymmetries. This relation is more pronounced in dental students than in patients.

The effect of lower body burns on physical function.

PubMed

Benjamin, Nicole C; Andersen, Clark R; Herndon, David N; Suman, Oscar E

2015-12-01

To attenuate burn-induced catabolism, patients are often enrolled in a resistance exercise program as part of their physical rehabilitation. This study assessed how lower body burn locations affected strength and cardiopulmonary function. Children enrolled in an exercise study between 2003 and 2013, were 7-18 years of age, and burned ≥30% of their total body surface area were included. Analysis of variance was used to model the relationship of lower body strength (PTW) and cardiopulmonary function (VO2peak) due to burns which traverse the subject's lower body joints. There was a significant relationship between PTW and burns at the hip and toe joints, showing a 26 N m/kg (p=0.010) and 33 N m/kg (p=0.013) decrease in peak torque, respectively. Burns at the hip joint corresponded to a significant decrease in VO2peak by 4.9 ml kg(-1) min(-1) (p=0.010) in peak cardiopulmonary function. Physical function and performance are detrimentally affected by burns that traverse specific lower body joints. The most significant relationship on exercise performance was that of hip joint burns as it affected both strength and cardiopulmonary measurements. Ultimately, burns at hip and toe joints need to be considered when interpreting exercise test results involving the lower body. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

The Effect of Lower Body Burns on Physical Function

PubMed Central

Benjamin, Nicole C.; Andersen, Clark R.; Herndon, David N.; Suman, Oscar E.

2015-01-01

Objective To attenuate burn-induced catabolism, patients are often enrolled in a resistance exercise program as part of their physical rehabilitation. This study assessed how lower body burn locations affected strength and cardiopulmonary function. Methods Children enrolled in an exercise study between 2003 and 2013, were 7–18 years of age, and burned ≥ 30% of their total body surface area were included. Analysis of variance was used to model the relationship of lower body strength (PTW) and cardiopulmonary function (VO2peak) due to burns which traverse the subject’s lower body joints. Results There was a significant relationship between PTW and burns at the hip and toe joints, showing a 26 Newton·meters/kilogram (p=0.010) and 33 Newton·meters/kilogram (p=0.013) decrease in peak torque, respectively. Burns at the hip joint corresponded to a significant decrease in VO2peak by 4.9 mL·kg−1·min−1 (p=0.010) in peak cardiopulmonary function. Conclusion Physical function and performance are detrimentally affected by burns that traverse specific lower body joints. The most significant relationship on exercise performance was that of hip joint burns as it affected both strength and cardiopulmonary measurements. Ultimately, burns at hip and toe joints need to be considered when interpreting exercise test results involving the lower body. PMID:26421695

A method to investigate the biomechanical alterations in Perthes' disease by hip joint contact modeling.

PubMed

Salmingo, Remel Alingalan; Skytte, Tina Lercke; Traberg, Marie Sand; Mikkelsen, Lars Pilgaard; Henneberg, Kaj-Åge; Wong, Christian

2017-01-01

Perthes' disease is a destructive hip joint disorder characterized by malformation of the femoral head in young children. While the morphological changes have been widely studied, the biomechanical effects of these changes still need to be further elucidated. The objective of this study was to develop a method to investigate the biomechanical alterations in Perthes' disease by finite element (FE) contact modeling using MRI. The MRI data of a unilateral Perthes' case was obtained to develop the three-dimensional FE model of the hip joint. The stress and contact pressure patterns in the unaffected hip were well distributed. Elevated concentrations of stress and contact pressure were found in the Perthes' hip. The highest femoral cartilage von Mises stress 3.9 MPa and contact pressure 5.3 MPa were found in the Perthes' hip, whereas 2.4 MPa and 4.9 MPa in the healthy hip, respectively. The healthy bone in the femoral head of the Perthes' hip carries additional loads as indicated by the increase of stress levels around the necrotic-healthy bone interface. Identifying the biomechanical changes, such as the location of stress and contact pressure concentrations, is a prerequisite for the preoperative planning to obtain stress relief for the highly stressed areas in the malformed hip. This single-patient study demonstrated that the biomechanical alterations in Perthes' disease can be evaluated individually by patient-specific finite element contact modeling using MRI. A multi-patient study is required to test the strength of the proposed method as a pre-surgery planning tool.

In vitro validation and reliability study of electromagnetic skin sensors for evaluation of end range of motion positions of the hip.

PubMed

Audenaert, E A; Vigneron, L; Van Hoof, T; D'Herde, K; van Maele, G; Oosterlinck, D; Pattyn, C

2011-12-01

There is growing evidence that femoroacetabular impingement (FAI) is a probable risk factor for the development of early osteoarthritis in the nondysplastic hip. As FAI arises with end range of motion activities, measurement errors related to skin movement might be higher than anticipated when using previously reported methods for kinematic evaluation of the hip. We performed an in vitro validation and reliability study of a noninvasive method to define pelvic and femur positions in end range of motion activities of the hip using an electromagnetic tracking device. Motion data, collected from sensors attached to the bone and skin of 11 cadaver hips, were simultaneously obtained and compared in a global reference frame. Motion data were then transposed in the hip joint local coordinate systems. Observer-related variability in locating the anatomical landmarks required to define the local coordinate system and variability of determining the hip joint center was evaluated. Angular root mean square (RMS) differences between the bony and skin sensors averaged 3.2° (SD 3.5°) and 1.8° (SD 2.3°) in the global reference frame for the femur and pelvic sensors, respectively. Angular RMS differences between the bony and skin sensors in the hip joint local coordinate systems ranged at end range of motion and dependent on the motion under investigation from 1.91 to 5.81°. The presented protocol for evaluation of hip motion seems to be suited for the 3-D description of motion relevant to the experimental and clinical evaluation of femoroacetabular impingement.

Meat consumption and risk of primary hip and knee joint replacement due to osteoarthritis: a prospective cohort study

PubMed Central

2011-01-01

Background There is emerging evidence for a beneficial effect of meat consumption on the musculoskeletal system. However, whether it affects the risk of knee and hip osteoarthritis is unknown. We performed a prospective cohort study to examine the relationship between meat consumption and risk of primary hip and knee replacement for osteoarthritis. Methods Eligible 35,331 participants were selected from the Melbourne Collaborative Cohort Study recruited during 1990-1994. Consumption of fresh red meat, processed meat, chicken, and fish was assessed using a food frequency questionnaire. Primary hip and knee replacement for osteoarthritis during 2001-2005 was determined by linking the cohort records to the Australian National Joint Replacement Registry. Results There was a negative dose-response relationship between fresh red meat consumption and the risk of hip replacement (hazard ratio (HR) 0.94 per increase in intake of one time/week, 95% confidence interval (CI) 0.89-0.98). In contrast, there was no association with knee replacement risk (HR 0.98, 95% CI 0.94-1.02). Consumption of processed meat, chicken and fish were not associated with risk of hip or knee replacement. Conclusion A high level consumption of fresh red meat was associated with a decreased risk of hip, but not knee, joint replacement for osteoarthritis. One possible mechanism to explain these differential associations may be via an effect of meat intake on bone strength and hip shape. Further confirmatory studies are warranted. PMID:21235820

Meat consumption and risk of primary hip and knee joint replacement due to osteoarthritis: a prospective cohort study.

PubMed

Wang, Yuanyuan; Simpson, Julie Anne; Wluka, Anita E; English, Dallas R; Giles, Graham G; Graves, Stephen; Cicuttini, Flavia M

2011-01-16

There is emerging evidence for a beneficial effect of meat consumption on the musculoskeletal system. However, whether it affects the risk of knee and hip osteoarthritis is unknown. We performed a prospective cohort study to examine the relationship between meat consumption and risk of primary hip and knee replacement for osteoarthritis. Eligible 35,331 participants were selected from the Melbourne Collaborative Cohort Study recruited during 1990-1994. Consumption of fresh red meat, processed meat, chicken, and fish was assessed using a food frequency questionnaire. Primary hip and knee replacement for osteoarthritis during 2001-2005 was determined by linking the cohort records to the Australian National Joint Replacement Registry. There was a negative dose-response relationship between fresh red meat consumption and the risk of hip replacement (hazard ratio (HR) 0.94 per increase in intake of one time/week, 95% confidence interval (CI) 0.89-0.98). In contrast, there was no association with knee replacement risk (HR 0.98, 95% CI 0.94-1.02). Consumption of processed meat, chicken and fish were not associated with risk of hip or knee replacement. A high level consumption of fresh red meat was associated with a decreased risk of hip, but not knee, joint replacement for osteoarthritis. One possible mechanism to explain these differential associations may be via an effect of meat intake on bone strength and hip shape. Further confirmatory studies are warranted.

Hip Biomechanics Are Altered in Male Runners with Achilles Tendinopathy.

PubMed

Creaby, Mark W; Honeywill, Conor; Franettovich Smith, Melinda M; Schache, Anthony G; Crossley, Kay M

2017-03-01

Achilles tendinopathy (AT) is a prevalent injury in running sports. Understanding the biomechanical factors associated with AT will assist in its management and prevention. The purpose of this study was to compare hip and ankle kinematics and kinetics in runners with and without AT. Fourteen male runners with AT and 11 healthy male runners (CTRL) ran over ground while lower-limb joint motion and ground reaction force data were synchronously captured. Hip and ankle joint angles, moments, and impulses in all three planes (sagittal, transverse, and frontal) were extracted for analysis. Independent t-tests were used to compare the differences between the AT and the CTRL groups for the biomechanical variables of interest. After Bonferroni adjustment, an alpha level of 0.0026 was set for all analyses. The AT group exhibited an increased peak hip external rotation moment (P = 0.001), hip external rotation impulse (P < 0.001), and hip adduction impulse (P < 0.001) compared with the CTRL group. No significant differences in ankle biomechanics were observed. This study presents preliminary evidence indicating that male runners with AT display altered hip biomechanics with respect to their healthy counterparts. Because of the retrospective design of the study, it is unknown whether these alterations are a predisposing factor for the disorder, a result of the condition, or a combination of both. The results of this study suggest that optimizing hip joint function should be considered in the rehabilitation of runners with AT.

A narrative overview of the current status of MRI of the hip and its relevance for osteoarthritis research - what we know, what has changed and where are we going?

PubMed

Crema, M D; Watts, G J; Guermazi, A; Kim, Y-J; Kijowski, R; Roemer, F W

2017-01-01

To review and discuss the role of magnetic resonance imaging (MRI) in the context of hip osteoarthritis (OA) research. The content of this narrative review, based on an extensive PubMed database research including English literature only, describes the advances in MRI of the hip joint and its potential usefulness in hip OA research, reviews the relevance of different MRI features in regard to symptomatic and structural progression in hip OA, and gives an outlook regarding future use of MRI in hip OA research endeavors. Recent technical advances have helped to overcome many of the past difficulties related to MRI assessment of hip OA. MRI-based morphologic scoring systems allow for detailed assessment of several hip joint tissues and, in combination with the recent advances in MRI, may increase reproducibility and sensitivity to change. Compositional MRI techniques may add to our understanding of disease onset and progression. Knowledge about imaging pitfalls and anatomical variants is crucial to avoid misinterpretation. In comparison to research on knee OA, the associations between MRI features and the incidence and progression of disease as well as with clinical symptoms have been little explored. Anatomic alterations of the hip joint as seen in femoro-acetabular impingement (FAI) seem to play a role in the onset and progression of structural damage. With the technical advances occurring in recent years, MRI may play a major role in investigating the natural history of hip OA and provide an improved method for assessment of the efficacy of new therapeutic approaches. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Compressive and shear hip joint contact forces are affected by pediatric obesity during walking

PubMed Central

Lerner, Zachary F.; Browning, Raymond C.

2016-01-01

Obese children exhibit altered gait mechanics compared to healthy-weight children and have an increased prevalence of hip pain and pathology. This study sought to determine the relationships between body mass and compressive and shear hip joint contact forces during walking. Kinematic and kinetic data were collected during treadmill walking at 1 m•s−1 in 10 obese and 10 healthy-weight 8–12 year-olds. We estimated body composition, segment masses, lower-extremity alignment, and femoral neck angle via radiographic images, created personalized musculoskeletal models in OpenSim, and computed muscle forces and hip joint contact forces. Hip extension at mid-stance was 9° less, on average, in the obese children (p<0.001). Hip abduction, knee flexion, and body-weight normalized peak hip moments were similar between groups. Normalized to body-weight, peak contact forces were similar at the first peak and slightly lower at the second peak between the obese and healthy-weight participants. Total body mass explained a greater proportion of contact force variance compared to lean body mass in the compressive (r2=0.89) and vertical shear (perpendicular to the physis acting superior-to-inferior) (r2=0.84) directions; lean body mass explained a greater proportion in the posterior shear direction (r2=0.54). Stance-average contact forces in the compressive and vertical shear directions increased by 41 N and 48 N, respectively, for every kilogram of body mass. Age explained less than 27% of the hip loading variance. No effect of sex was found. The proportionality between hip loads and body-weight may be implicated in an obese child’s increased risk of hip pain and pathology. PMID:27040390

Compressive and shear hip joint contact forces are affected by pediatric obesity during walking.

PubMed

Lerner, Zachary F; Browning, Raymond C

2016-06-14

Obese children exhibit altered gait mechanics compared to healthy-weight children and have an increased prevalence of hip pain and pathology. This study sought to determine the relationships between body mass and compressive and shear hip joint contact forces during walking. Kinematic and kinetic data were collected during treadmill walking at 1ms(-1) in 10 obese and 10 healthy-weight 8-12 year-olds. We estimated body composition, segment masses, lower-extremity alignment, and femoral neck angle via radiographic images, created personalized musculoskeletal models in OpenSim, and computed muscle forces and hip joint contact forces. Hip extension at mid-stance was 9° less, on average, in the obese children (p<0.001). Hip abduction, knee flexion, and body-weight normalized peak hip moments were similar between groups. Normalized to body-weight, peak contact forces were similar at the first peak and slightly lower at the second peak between the obese and healthy-weight participants. Total body mass explained a greater proportion of contact force variance compared to lean body mass in the compressive (r(2)=0.89) and vertical shear (perpendicular to the physis acting superior-to-inferior) (r(2)=0.84) directions; lean body mass explained a greater proportion in the posterior shear direction (r(2)=0.54). Stance-average contact forces in the compressive and vertical shear directions increased by 41N and 48N, respectively, for every kilogram of body mass. Age explained less than 27% of the hip loading variance. No effect of sex was found. The proportionality between hip loads and body-weight may be implicated in an obese child׳s increased risk of hip pain and pathology. Published by Elsevier Ltd.

Joint-specific DNA methylation and transcriptome signatures in rheumatoid arthritis identify distinct pathogenic processes

PubMed Central

Ai, Rizi; Hammaker, Deepa; Boyle, David L.; Morgan, Rachel; Walsh, Alice M.; Fan, Shicai; Firestein, Gary S.; Wang, Wei

2016-01-01

Stratifying patients on the basis of molecular signatures could facilitate development of therapeutics that target pathways specific to a particular disease or tissue location. Previous studies suggest that pathogenesis of rheumatoid arthritis (RA) is similar in all affected joints. Here we show that distinct DNA methylation and transcriptome signatures not only discriminate RA fibroblast-like synoviocytes (FLS) from osteoarthritis FLS, but also distinguish RA FLS isolated from knees and hips. Using genome-wide methods, we show differences between RA knee and hip FLS in the methylation of genes encoding biological pathways, such as IL-6 signalling via JAK-STAT pathway. Furthermore, differentially expressed genes are identified between knee and hip FLS using RNA-sequencing. Double-evidenced genes that are both differentially methylated and expressed include multiple HOX genes. Joint-specific DNA signatures suggest that RA disease mechanisms might vary from joint to joint, thus potentially explaining some of the diversity of drug responses in RA patients. PMID:27282753

Group B streptococcal arthritis in adults.

PubMed

Small, C B; Slater, L N; Lowy, F D; Small, R D; Salvati, E A; Casey, J I

1984-03-01

Group B streptococcal arthritis in adults is uncommon. This report describes seven cases seen at these institutions over the past five years and reviews the previous 17 documented cases. Of seven adults, three were diabetics, three had prosthetic hips, and one had undergone splenectomy. Six had undergone no prior dental, genitourinary, or gastrointestinal procedures. The most common clinical presentation was fever and acute joint pain. Five patients had monoarticular arthritis; two had multiple joint involvement. Underlying joint abnormalities included osteoarthritis (two), prosthetic hip (three), and neuropathic joint (one). Bacteremia was documented in three and suspected in the remaining four patients, often without a primary source. Therapy included parenteral antibiotics, usually penicillin G, and drainage of the involved joint. Two of three patients with prosthetic implants required Girdlestone procedures; the third was apparently cured. The three diabetic patients died, one with resolution of group B streptococcal arthritis. The seventh patient was cured. Group B streptococcal arthritis is a serious infection in adults with diabetes and late prosthetic hip infections.

Ipsilateral hip and knee dislocation: Case report and review of literature

PubMed Central

Sharma, Gaurav; Chahar, Deepak; Sreenivasan, Ravi; Verma, Nikhil; Pankaj, Amite

2016-01-01

Hip and knee dislocations are not uncommon but simultaneous ipsilateral dislocation of the hip and knee joint is rare; consequently, there is an inadequate amount of literature on the subject. We identified only 11 such cases reported in English literature. In the present report, we describe the case of a 23-year-old male patient who presented with ipsilateral hip and knee dislocation on the right side after being involved in a road traffic accident. The hip dislocation was associated with a posterior wall acetabular fracture. The hip as well as the knee joints was reduced in the emergency bay. The patient underwent an urgent fixation of the posterior wall acetabular fracture with delayed ligament reconstruction for the knee dislocation. At one-year follow-up, he had no pain in the hip or knee. There was grade 1 posterior sag but no symptoms of knee instability. Radiographs revealed no evidence of avascular necrosis or arthritis of the femoral head. The normal treatment protocol for individual injury is affected by the simultaneous occurrence of hip and knee dislocation. PMID:27182149

Increased risk of prosthetic joint infection associated with esophago-gastro-duodenoscopy with biopsy.

PubMed

Coelho-Prabhu, Nayantara; Oxentenko, Amy S; Osmon, Douglas R; Baron, Todd H; Hanssen, Arlen D; Wilson, Walter R; Steckelberg, James M; Baddour, Larry M; Harmsen, William S; Mandrekar, Jay; Berbari, Elie F

2013-02-01

There are no prospective data regarding the risk of prosthetic joint infection following routine gastrointestinal endoscopic procedures. We wanted to determine the risk of prosthetic hip or knee infection following gastrointestinal endoscopic procedures in patients with joint arthroplasty. We conducted a prospective, single-center, case-control study at a single, tertiary-care referral center. Cases were defined as adult patients hospitalized for prosthetic joint infection of the hip or knee between December 1, 2001 and May 31, 2006. Controls were adult patients with hip or knee arthroplasties but without a diagnosis of joint infection, hospitalized during the same time period at the same orthopedic hospital. The main outcome measure was the odds ratio (OR) of prosthetic joint infection after gastrointestinal endoscopic procedures performed within 2 years before admission. 339 cases and 339 controls were included in the study. Of these, 70 cases (21%) cases and 82 controls (24%) had undergone a gastrointestinal endoscopic procedure in the preceding 2 years. Among gastrointestinal procedures that were assessed, esophago-gastro-duodenoscopy (EGD) with biopsy was associated with an increased risk of prosthetic joint infection (OR = 3, 95% CI: 1.1-7). In a multivariable analysis adjusting for sex, age, joint age, immunosuppression, BMI, presence of wound drain, prior arthroplasty, malignancy, ASA score, and prothrombin time, the OR for infection after EGD with biopsy was 4 (95% CI: 1.5-10). EGD with biopsy was associated with an increased risk of prosthetic joint infection in patients with hip or knee arthroplasties. This association will need to be confirmed in other epidemiological studies and adequately powered prospective clinical trials prior to recommending antibiotic prophylaxis in these patients.

A review of the anatomy of the hip abductor muscles, gluteus medius, gluteus minimus, and tensor fascia lata.

PubMed

Flack, Natasha Amy May Sparks; Nicholson, Helen D; Woodley, Stephanie Jane

2012-09-01

The hip abductor muscles have the capability to contribute to numerous actions, including pelvic stabilization during gait, and abduction and rotation at the hip joint. To fully understand the role of these muscles, as well as their involvement in hip joint dysfunction, knowledge of their anatomical structure is essential. The clinical literature suggests anatomical diversity within these muscles, and that gluteus medius (GMed) and gluteus minimus (GMin), in particular, may be comprised of compartments. This systematic review of the English literature focuses on the gross anatomy of GMed, GMin, and tensor fascia lata (TFL) muscles. Although studies of this muscle group have generated useful descriptions, comparison of results is hindered by methodological limitations. Furthermore, there is no single comprehensive anatomical investigation of all three muscles. Several aspects of the morphology of attachment sites are unknown or unclear. There is little data on fascicle orientation, the interface between fascicles and tendons, and the specific patterning of the superior gluteal nerve. Consequently, the existence of anatomical compartmentalization within the hip abductor muscles is difficult to assess. Further research of the architecture and innervation of the hip abductor muscle group is required; a better understanding of the precise anatomy of these muscles should improve our understanding of their specific functions and their contribution to the pathogenesis of disorders affecting the hip joint. Copyright © 2011 Wiley Periodicals, Inc.

Total hip arthroplasty in patients with dwarfism.

PubMed

Sekundiak, Todd D

2005-09-01

Skeletal dysplasia or dwarfism presents in a host of manners. Degenerative hip disease can present as a primary problem secondary to the abnormal growth disturbance or secondarily from the abnormal load distributions through the hip joint itself. Total hip arthroplasty is a successful procedure but sought with increased risks and complications when compared to routine hip arthroplasty. Custom or modular hip implants can help a surgeon manage the abnormal bone morphology seen with this condition.

Movement-Pattern Training to Improve Function in People With Chronic Hip Joint Pain: A Feasibility Randomized Clinical Trial.

PubMed

Harris-Hayes, Marcie; Czuppon, Sylvia; Van Dillen, Linda R; Steger-May, Karen; Sahrmann, Shirley; Schootman, Mario; Salsich, Gretchen B; Clohisy, John C; Mueller, Michael J

2016-06-01

Study Design Feasibility randomized clinical trial. Background Rehabilitation may be an appropriate treatment strategy for patients with chronic hip joint pain; however, the evidence related to the effectiveness of rehabilitation is limited. Objectives To assess feasibility of performing a randomized clinical trial to investigate the effectiveness of movement-pattern training (MPT) to improve function in people with chronic hip joint pain. Methods Thirty-five patients with chronic hip joint pain were randomized into a treatment (MPT) group or a control (wait-list) group. The MPT program included 6 one-hour supervised sessions and incorporated (1) task-specific training for basic functional tasks and symptom-provoking tasks, and (2) strengthening of hip musculature. The wait-list group received no treatment. Primary outcomes for feasibility were patient retention and adherence. Secondary outcomes to assess treatment effects were patient-reported function (Hip disability and Osteoarthritis Outcome Score), lower extremity kinematics, and hip muscle strength. Results Retention rates did not differ between the MPT (89%) and wait-list groups (94%, P = 1.0). Sixteen of the 18 patients (89%) in the MPT group attended at least 80% of the treatment sessions. For the home exercise program, 89% of patients reported performing their home program at least once per day. Secondary outcomes support the rationale for conduct of a superiority randomized clinical trial. Conclusion Based on retention and adherence rates, a larger randomized clinical trial appears feasible and warranted to assess treatment effects more precisely. Data from this feasibility study will inform our future clinical trial. Level of Evidence Therapy, level 2b-. J Orthop Sports Phys Ther 2016;46(6):452-461. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6279.

Computed tomography arthrography with traction in the human hip for three-dimensional reconstruction of cartilage and the acetabular labrum

PubMed Central

Henak, C.R.; Abraham, C.L.; Peters, C.L.; Sanders, R.K.; Weiss, J.A.; Anderson, A.E.

2014-01-01

AIM To develop and demonstrate the efficacy of a computed tomography arthrography (CTA) protocol for the hip that enables accurate three-dimensional reconstructions of cartilage and excellent visualization of the acetabular labrum. MATERIALS AND METHODS Ninety-three subjects were imaged (104 scans); 68 subjects with abnormal anatomy, 11 patients after periacetabular osteotomy surgery, and 25 subjects with normal anatomy. Fifteen to 25 ml of contrast agent diluted with lidocaine was injected using a lateral oblique approach. A Hare traction splint applied traction during CT. The association between traction force and intra-articular joint space was assessed qualitatively under fluoroscopy. Cartilage geometry was reconstructed from the CTA images for 30 subjects; the maximum joint space under traction was measured. RESULTS Using the Hare traction splint, the intra-articular space and boundaries of cartilage could be clearly delineated throughout the joint; the acetabular labrum was also visible. Dysplastic hips required less traction (~5 kg) than normal and retroverted hips required (>10 kg) to separate the cartilage. An increase in traction force produced a corresponding widening of the intra-articular joint space. Under traction, the maximum width of the intra-articular joint space during CT ranged from 0.98–6.7 mm (2.46 ± 1.16 mm). CONCLUSIONS When applied to subjects with normal and abnormal hip anatomy, the CTA protocol presented yields clear delineation of the cartilage and the acetabular labrum. Use of a Hare traction splint provides a simple, cost-effective method to widen the intra-articular joint space during CT, and provides flexibility to vary the traction as required. PMID:25070373

Effects of squats accompanied by hip joint adduction on the selective activity of the vastus medialis oblique.

PubMed

Hyong, In Hyouk

2015-06-01

[Purpose] This study evaluated the effective selective activation method of the vastus medialis oblique for knee joint stabilization in patients with patellofemoral pain syndrome. [Subjects and Methods] Fifteen healthy college students (9 males, 6 females); mean age, height, and weight: 22.2 years, 167.8 cm, and 61.4 kg, respectively) participated. The knee angle was held at 60°. Muscle activities were measured once each during an ordinary squat and a squat accompanied by hip joint adduction. The muscle activities of the vastus medialis oblique and vastus lateralis were measured by electromyography for five seconds while maintaining 60° knee flexion. Electromyography signals were obtained at a sampling rate of 1,000 Hz and band pass filtering at 20-50 Hz. The obtained raw root mean square was divided by the maximal voluntary isometric contraction and expressed as a percentage. The selective activity of the vastus medialis oblique was assessed according to the muscle activity ratio of the vastus medialis oblique to the vastus lateralis. [Results] The activity ratio of the vastus medialis oblique was higher during a squat with hip joint adduction than without. [Conclusion] A squat accompanied by hip joint adduction is effective for the selective activation of the vastus medialis oblique.

Evaluation of the three-dimensional bony coverage before and after rotational acetabular osteotomy.

PubMed

Tanaka, Takeyuki; Moro, Toru; Takatori, Yoshio; Oshima, Hirofumi; Ito, Hideya; Sugita, Naohiko; Mitsuishi, Mamoru; Tanaka, Sakae

2018-02-26

Rotational acetabular osteotomy is a type of pelvic osteotomy that involves rotation of the acetabular bone to improve the bony coverage of the femoral head for patients with acetabular dysplasia. Favourable post-operative long-term outcomes have been reported in previous studies. However, there is a paucity of published data regarding three-dimensional bony coverage. The present study investigated the three-dimensional bony coverage of the acetabulum covering the femoral head in hips before and after rotational acetabular osteotomy and in normal hips. The computed tomography data of 40 hip joints (12 joints before and after rotational acetabular osteotomy; 16 normal joints) were analyzed. The three-dimensional bony coverage of each joint was evaluated using original software. The post-operative bony coverage improved significantly compared with pre-operative values. In particular, the anterolateral aspect of the acetabulum tended to be dysplastic in patients with acetabular dysplasia compared to those with normal hip joints. However, greater bony coverage at the anterolateral aspect was obtained after rotational acetabular osteotomy. Meanwhile, the results of the present study may indicate that the bony coverage in the anterior aspect may be excessive. Three-dimensional analysis indicated that rotational acetabular osteotomy achieved favorable bony coverage. Further investigations are necessary to determine the ideal bony coverage after rotational acetabular osteotomy.

[The occurance lead and cadmium in hip joint in aspect of exposure on tobacco smoke].

PubMed

Bogunia, Mariusz; Brodziak-Dopierała, Barbara; Kwapuliński, Jerzy; Ahnert, Bozena; Kowol, Jolanta; Nogaj, Ewa

2008-01-01

The objective of this study was qualification of content cadmium and lead in selected elements of the hip joint in aspect of tobacco smoking. The material for the research were 5 elements of hip joint (articular cartilage, trabecular bone and cortical bone femur head, fragment articular capsule and fragment trabecular bone from region intertrochanteric femoral bone), obtained intraoperatively during endoprothesoplastic surgeries. The samples come from habitants of Upper Silesian Region. Determination of trace elements contents were performed by ASA method (Pye Unicam SP-9) in acetylene-oxygen flame. Higher contents of lead were observed for smoking people, however in case of cadmium the differences of this element were not statistical essential between smokers and non-smokers.

Recovery of walking speed and symmetrical movement of the pelvis and lower extremity joints after unilateral THA.

PubMed

Miki, Hidenobu; Sugano, Nobuhiko; Hagio, Keisuke; Nishii, Takashi; Kawakami, Hideo; Kakimoto, Akihiro; Nakamura, Nobuo; Yoshikawa, Hideki

2004-04-01

In 17 patients with unilateral hip disease who underwent total hip arthroplasty (THA), the gait was analyzed preoperatively and 1, 3, 6, and 12 months after unilateral THA using a Vicon system to assess the recovery of walking speed and symmetrical movement of the hip, knee, ankle, and pelvis. The walking speed of these patients reached that of normal Japanese persons by 12 months after surgery. Walking speed was correlated with the range of hip motion on the operated side at 1 month postoperatively, and was correlated with the hip joint extension moment of force on both sides from 3 to 6 months after surgery. Before THA, asymmetry was observed in the range of the hip motion, maximum hip flexion, maximum hip extension, maximum knee flexion, as well as in pelvic obliquity, pelvic tilt, and pelvic rotation. There were no differences of the stride length or step length between both sides throughout the observation period. The preoperative range of hip flexion on the operated side during a gait cycle (21.3+/-7.9 degrees ) was significantly smaller than on the non-operated side (46.7+/-7.1 degrees ), and the difference between sides was still significant at 12 months after surgery (35.1+/-6.2 degrees on the operated side and 43.6+/-5.7 degrees on the non-operated side). The majority (74%) of the difference in hip motion range during this period was due to the difference in maximum extension of the hip. The increase in the range of pelvic tilt and the range of motion of the opposite hip showed an inverse correlation with the range of motion of the operated hip, suggesting a compensatory preoperative role. However, this correlation became insignificant after 6 months postoperatively. Asymmetry of the range of hip motion persisted at 12 months after THA in patients with unilateral coxoarthropathy during free level walking, while the operation normalized the spatial asymmetry of other joints and the walking speed prior to the recovery of hip motion.

Tribology considerations for hip joint articulations in relation to the "new orthopaedic patient".

PubMed

Rieker, C B

2006-01-01

The purpose of this review is to examine alternative bearings used in total hip arthroplasty (THA) and discuss the specific tribologic needs of the "New Orthopaedic Patient". As orthopaedic patients today are younger and more active, there is a clear need for hip joint implants and articulations minimising the amount of wear and guarantying better stability. Recent modern developments in tribology with highly cross-linked polyethylenes and hard-on-hard bearings allow the safe and effective use of larger diameter articulations in THA.

Bilateral total hip arthroplasty in Morquio-Brailsford's syndrome: a report of two cases.

PubMed

Tassinari, Enrico; Boriani, Luca; Traina, Francesco; Dallari, Dante; Toni, Aldo; Giunti, Armando

2008-09-01

We report two cases of bilateral cementless total hip arthroplasty in two young women affected by Morquio-Brailsford syndrome. Morquio-Brailsford disease belongs to the mucopolysaccharidoses; it shows growth retardation with disproportional dwarfism. Usually patients are affected by a severe joint degeneration from their 2nd or 3rd decade. Young age, severe dysplasia, and joint size are the main technical problems for a total hip replacement. Accurate radiographic and CT planning allows the use of standard prostheses instead of custom-made ones.

Prevention of cement leakage into the hip joint by a standard cement plug during PFN-A cement augmentation: a technical note.

PubMed

Hanke, M; Djonov, V; Tannast, M; Keel, M J; Bastian, J D

2016-06-01

Medial penetration of the helical blade into the hip joint after fixation of trochanteric fractures using the proximal femur nail antirotation (PFN-A) is a potential failure mode. In low demand patients a blade exchange with cement augmentation may be an option if conversion to total hip arthroplasty is unfeasible to salvage the cut-through. This article describes a technique to avoid intraarticular cement leakage using a cement plug to close the defect in the femoral head caused by the cut-through.

Pathological gait in children with Legg-Calvé-Perthes disease and proposal for gait modification to decrease the hip joint loading.

PubMed

Svehlík, Martin; Kraus, Tanja; Steinwender, Gerhard; Zwick, Ernst B; Linhart, Wolfgang E

2012-06-01

Legg-Calvé-Perthes disease (LCP) severely limits the range of hip motion and hinders a normal gait. Loading of the hip joint is a major consideration in LCP treatment. The aim of this study was to evaluate gait patterns in LCP and identify gait modifications to decrease the load on the affected hip. Forty children with unilateral LCP were divided into three groups based on the time base integral of the hip abductor moments during single stance on the affected side acquired during instrumented 3D gait analysis. X-rays of the affected hip were classified according to Herring and Catterall. Children in the "unloading" group spontaneously adopted a Duchenne-like gait with pelvis elevation, hip abduction and external rotation during single support phase. The "normal-loading" group showed pelvis elevation with a neutral hip position in the frontal plane. In the "overloading" group the pelvis dropped to the swinging limb at the beginning of stance accompanied by prolonged hip adduction. The time base integral of the hip abductor moments during single stance correlated positively with the X-ray classifications of Herring and Catterall, hip abduction angle and age. Older children preferred to walk in hip adduction during single stance, had more impaired hips and tended to overload them. The hip overloading pattern should be avoided in children with LCP. Gait training to unload the hip might become an integral component of conservative treatment in children with LCP.

Self-aligning exoskeleton hip joint: Kinematic design with five revolute, three prismatic and one ball joint.

PubMed

Beil, Jonas; Marquardt, Charlotte; Asfour, Tamim

2017-07-01

Kinematic compatibility is of paramount importance in wearable robotic and exoskeleton design. Misalignments between exoskeletons and anatomical joints of the human body result in interaction forces which make wearing the exoskeleton uncomfortable and even dangerous for the human. In this paper we present a kinematically compatible design of an exoskeleton hip to reduce kinematic incompatibilities, so called macro- and micro-misalignments, between the human's and exoskeleton's joint axes, which are caused by inter-subject variability and articulation. The resulting design consists of five revolute, three prismatic and one ball joint. Design parameters such as range of motion and joint velocities are calculated based on the analysis of human motion data acquired by motion capture systems. We show that the resulting design is capable of self-aligning to the human hip joint in all three anatomical planes during operation and can be adapted along the dorsoventral and mediolateral axis prior to operation. Calculation of the forward kinematics and FEM-simulation considering kinematic and musculoskeletal constraints proved sufficient mobility and stiffness of the system regarding the range of motion, angular velocity and torque admissibility needed to provide 50 % assistance for an 80 kg person.

Local dynamic stability of lower extremity joints in lower limb amputees during slope walking.

PubMed

Chen, Jin-Ling; Gu, Dong-Yun

2013-01-01

Lower limb amputees have a higher fall risk during slope walking compared with non-amputees. However, studies on amputees' slope walking were not well addressed. The aim of this study was to identify the difference of slope walking between amputees and non-amputees. Lyapunov exponents λS was used to estimate the local dynamic stability of 7 transtibial amputees' and 7 controls' lower extremity joint kinematics during uphill and downhill walking. Compared with the controls, amputees exhibited significantly lower λS in hip (P=0.04) and ankle (P=0.01) joints of the sound limb, and hip joints (P=0.01) of the prosthetic limb during uphill walking, while they exhibited significantly lower λS in knee (P=0.02) and ankle (P=0.03) joints of the sound limb, and hip joints (P=0.03) of the prosthetic limb during downhill walking. Compared with amputees level walking, they exhibited significantly lower λS in ankle joints of the sound limb during both uphill (P=0.01) and downhill walking (P=0.01). We hypothesized that the better local dynamic stability of amputees was caused by compensation strategy during slope walking.

Remote transient Lactobacillus animalis bacteremia causing prosthetic hip joint infection: a case report.

PubMed

Somayaji, R; Lynch, T; Powell, J N; Gregson, D

2016-11-04

Lactobacillus spp. are uncommon pathogens in immunocompetent hosts, and even rarer causes of prosthetic device infections. A case of chronic hip prosthetic joint infection (PJI) caused by L. animalis is described. This occurred 5 years after a transient bacteremia with the same organism. Whole genome sequencing of both isolates proved this PJI infection resulted from this remote bacteremia. We document that prosthetic joint infections may be a consequence of bacteremia as much as 3 years before the onset of symptoms.

Effects of hamstring stretching on passive muscle stiffness vary between hip flexion and knee extension maneuvers.

PubMed

Miyamoto, N; Hirata, K; Kanehisa, H

2017-01-01

The purpose of this study was to examine whether the effects of hamstring stretching on the passive stiffness of each of the long head of the biceps femoris (BFl), semitendinosus (ST), and semimembranosus (SM) vary between passive knee extension and hip flexion stretching maneuvers. In 12 male subjects, before and after five sets of 90 s static stretching, passive lengthening measurements where knee or hip joint was passively rotated to the maximal range of motion (ROM) were performed. During the passive lengthening, shear modulus of each muscle was measured by ultrasound shear wave elastography. Both stretching maneuvers significantly increased maximal ROM and decreased passive torque at a given joint angle. Passive knee extension stretching maneuver significantly reduced shear modulus at a given knee joint angle in all of BFl, ST, and SM. In contrast, the stretching effect by passive hip flexion maneuver was significant only in ST and SM. The present findings indicate that the effects of hamstring stretching on individual passive muscles' stiffness vary between passive knee extension and hip flexion stretching maneuvers. In terms of reducing the muscle stiffness of BFl, stretching of the hamstring should be performed by passive knee extension rather than hip flexion. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Design of a hip prosthetic tribometer based on salat gait cycle

NASA Astrophysics Data System (ADS)

Towijaya, T.; Ismail, R.; Jamari, J.

2017-01-01

Indonesia is the country with the largest muslim population in the world, most of the inhabitants do salat every day. THR (Total Hip Replacement) patients are prohibited from doing salat in normal gait. It leads to the damage of the hip joint prostheses due to impingement and dislocation.This paper reports the design of a pin-on-ring tribometer which is used to measure and analyze the wear volume and the impingement of hip joint prostheses during salat. The modifications of the femoral head and acetabular cup holder are performed to design the reciprocating motion for the movement of the hip prostheses. The interesting finding of the present research is a new mechanism of linked-bar which leads to the feasibility of the measurement of the wear volume and the impingement for THR patients during salat.

Lower limb joint moment during walking in water.

PubMed

Miyoshi, Tasuku; Shirota, Takashi; Yamamoto, Shin-Ichiro; Nakazawa, Kimitaka; Akai, Masami

2003-11-04

Walking in water is a widely used rehabilitation method for patients with orthopedic disorders or arthritis, based on the belief that the reduction of weight in water makes it a safer medium and prevents secondary injuries of the lower-limb joints. To our knowledge, however, no experimental data on lower-limb joint moment during walking in water is available. The aim of this study was to quantify the joint moments of the ankle, knee, and hip during walking in water in comparison with those on land. Eight healthy volunteers walked on land and in water at a speed comfortable for them. A video-motion analysis system and waterproof force platform were used to obtain kinematic data and to calculate the joint moments. The hip joint moment was shown to be an extension moment almost throughout the stance phase during walking in water, while it changed from an extension- to flexion-direction during walking on land. The knee joint moment had two extension peaks during walking on land, whereas it had only one extension peak, a late one, during walking in water. The ankle joint moment during walking in water was considerably reduced but in the same direction, plantarflexion, as that during walking on land. The joint moments of the hip, knee, and ankle were not merely reduced during walking in water; rather, inter-joint coordination was totally changed.

The tribological behaviour of different clearance MOM hip joints with lubricants of physiological viscosities.

PubMed

Hu, X Q; Wood, R J K; Taylor, A; Tuke, M A

2011-11-01

Clearance is one of the most influential parameters on the tribological performance of metal-on-metal (MOM) hip joints and its selection is a subject of considerable debate. The objective of this paper is to study the lubrication behaviour of different clearances for MOM hip joints within the range of human physiological and pathological fluid viscosities. The frictional torques developed by MOM hip joints with a 50 mm diameter were measured for both virgin surfaces and during a wear simulator test. Joints were manufactured with three different diametral clearances: 20, 100, and 200 microm. The fluid used for the friction measurements which contained different ratios of 25 percent newborn calf serum and carboxymethyl cellulose (CMC) with the obtained viscosities values ranging from 0.001 to 0.71 Pa s. The obtained results indicate that the frictional torque for the 20 microm clearance joint remains high over the whole range of the viscosity values. The frictional torque of the 100 microm clearance joint was low for the very low viscosity (0.001 Pa s) lubricant, but increased with increasing viscosity value. The frictional torque of the 200 microm clearance joint was high at very low viscosity levels, however, it reduced with increasing viscosity. It is concluded that a smaller clearance level can enhance the formation of an elastohydrodynamic lubrication (EHL) film, but this is at the cost of preventing fluid recovery between the bearing surfaces during the unloaded phase of walking. Larger clearance bearings allow a better recovery of lubricant during the unloaded phase, which is necessary for higher viscosity lubricants. The selection of the clearance value should therefore consider both the formation of the EHL film and the fluid recovery as a function of the physiological viscosity in order to get an optimal tribological performance for MOM hip joints. The application of either 25 per cent bovine serum or water in existing in vitro tribological study should also be revised to consider the relevance of clinic synovial fluid viscosities and to avoid possible misleading results.

Mechanical behaviour of hamstring muscles in low-back pain patients and control subjects.

PubMed

Tafazzoli, F; Lamontagne, M

1996-01-01

The purpose of this study was to measure and compare the passive elastic moment, the stiffness and the damping coefficient of the hip joint, as functions of the hip and knee joint angles in men with and without low-back pain. Two conventional tests, the straight-leg-raising test and the trunk forward flexion, were also performed and compared between these subjects. The passive elastic moment was measured using an isokinetic device in the passive mode. This device raised the lower limb from the horizontal position to the straight-leg-raising angle at a slow and constant angular velocity. A custom-made splint connected with the lever arm of the isokinetic device maintained the knee in extension and the ankle in the neutral position. The damping coefficient of the hip joint was measured for 0, 15, 45, 60, 75 and 90% of straight leg raising angle of each subject, using the suspension method based on small oscillation theory. To ensure that muscles were inactive during the passive hip moment tests, muscle activity was monitored with surface EMG. The stiffness was computed as the ratio of the change in passive elastic moment to the change in the hip angle. The passive elastic moment, the stiffness and the normalized trunk flexion were significantly different between the two groups respectively. There was, however, no difference between the two groups in the results of straight-leg-raise and damping coefficient of the hip. The passive elastic moment was a nonlinear function of the hip flexion angle and showed large intersubject differences, especially as the joint limit was approached. The damping coefficient was a polynomial function of the hip flexion angle. The measured variables were analysed using a discriminant function and it was shown that the two groups were clearly discriminable in a meaningful manner.

Effects of walkbot gait training on kinematics, kinetics, and clinical gait function in paraplegia and quadriplegia.

PubMed

Hwang, Jongseok; Shin, Yongil; Park, Ji-Ho; Cha, Young Joo; You, Joshua Sung H

2018-04-07

The robotic-assisted gait training (RAGT) system has gained recognition as an innovative, effective paradigm to improve functional ambulation and activities of daily living in spinal cord injury and stroke. However, the effects of the Walkbot robotic-assisted gait training system with a specialized hip-knee-ankle actuator have never been examined in the paraplegia and quadriplegia population. The aim of this study was to determine the long-term effects of Walkbot training on clinical for hips and knee stiffness in individuals with paraplegia or quadriplegia. Nine adults with subacute or chronic paraplegia resulting from spinal cord injury or quadriplegia resulting from cerebral vascular accident (CVA) and/or hypoxia underwent progressive conventional gait retraining combined with the Walkbot RAGT for 5 days/week over an average of 43 sessions for 8 weeks. Clinical outcomes were measured with the Functional Ambulation Category (FAC), Modified Rankin Scale (MRS), Korean version of the Modified Barthel Index (K-MBI), Modified Ashworth Scale (MAS). Kinetic and kinematic data were collected via a built-in Walkbot program. Wilcoxon signed-rank tests showed significant positive intervention effects on K-MBI, maximal hip flexion and extension, maximal knee flexion, active torque in the knee joint, resistive torque, and stiffness in the hip joint (P <  0.05). These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. These improvements were associated with functional recovery in gait, balance, mobility and daily activities. These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. This is the first clinical evidence for intensive, long-term effects of the Walkbot RAGT on active or resistive moments and stiffness associated with spasticity and functional mobility in individuals with subacute or chronic paraplegia or quadriplegia who had reached a plateau in motor recovery after conventional therapy.

Does aquatic exercise reduce hip and knee joint loading? In vivo load measurements with instrumented implants

PubMed Central

Kutzner, Ines; Dymke, Jörn; Damm, Philipp; Duda, Georg N.; Günzl, Reiner; Bergmann, Georg

2017-01-01

Aquatic exercises are widely used for rehabilitation or preventive therapies in order to enable mobilization and muscle strengthening while minimizing joint loading of the lower limb. The load reducing effect of water due to buoyancy is a main advantage compared to exercises on land. However, also drag forces have to be considered that act opposite to the relative motion of the body segments and require higher muscle activity. Due to these opposing effects on joint loading, the load-reducing effect during aquatic exercises remains unknown. The aim of this study was to quantify the joint loads during various aquatic exercises and to determine the load reducing effect of water. Instrumented knee and hip implants with telemetric data transfer were used to measure the resultant joint contact forces in 12 elderly subjects (6x hip, 6x knee) in vivo. Different dynamic, weight-bearing and non-weight-bearing activities were performed by the subjects on land and in chest-high water. Non-weight-bearing hip and knee flexion/extension was performed at different velocities and with additional Aquafins. Joint forces during aquatic exercises ranged between 32 and 396% body weight (BW). Highest forces occurred during dynamic activities, followed by weight-bearing and slow non-weight-bearing activities. Compared to the same activities on land, joint forces were reduced by 36–55% in water with absolute reductions being greater than 100%BW during weight-bearing and dynamic activities. During non-weight-bearing activities, high movement velocities and additional Aquafins increased the joint forces by up to 59% and resulted in joint forces of up to 301%BW. This study confirms the load reducing effect of water during weight-bearing and dynamic exercises. Nevertheless, high drag forces result in increased joint contact forces and indicate greater muscle activity. By the choice of activity, movement velocity and additional resistive devices joint forces can be modulated individually in the course of rehabilitation or preventive therapies. PMID:28319145

Does aquatic exercise reduce hip and knee joint loading? In vivo load measurements with instrumented implants.

PubMed

Kutzner, Ines; Richter, Anja; Gordt, Katharina; Dymke, Jörn; Damm, Philipp; Duda, Georg N; Günzl, Reiner; Bergmann, Georg

2017-01-01

Aquatic exercises are widely used for rehabilitation or preventive therapies in order to enable mobilization and muscle strengthening while minimizing joint loading of the lower limb. The load reducing effect of water due to buoyancy is a main advantage compared to exercises on land. However, also drag forces have to be considered that act opposite to the relative motion of the body segments and require higher muscle activity. Due to these opposing effects on joint loading, the load-reducing effect during aquatic exercises remains unknown. The aim of this study was to quantify the joint loads during various aquatic exercises and to determine the load reducing effect of water. Instrumented knee and hip implants with telemetric data transfer were used to measure the resultant joint contact forces in 12 elderly subjects (6x hip, 6x knee) in vivo. Different dynamic, weight-bearing and non-weight-bearing activities were performed by the subjects on land and in chest-high water. Non-weight-bearing hip and knee flexion/extension was performed at different velocities and with additional Aquafins. Joint forces during aquatic exercises ranged between 32 and 396% body weight (BW). Highest forces occurred during dynamic activities, followed by weight-bearing and slow non-weight-bearing activities. Compared to the same activities on land, joint forces were reduced by 36-55% in water with absolute reductions being greater than 100%BW during weight-bearing and dynamic activities. During non-weight-bearing activities, high movement velocities and additional Aquafins increased the joint forces by up to 59% and resulted in joint forces of up to 301%BW. This study confirms the load reducing effect of water during weight-bearing and dynamic exercises. Nevertheless, high drag forces result in increased joint contact forces and indicate greater muscle activity. By the choice of activity, movement velocity and additional resistive devices joint forces can be modulated individually in the course of rehabilitation or preventive therapies.

Frontal plane landing mechanics in high-arched compared with low-arched female athletes.

PubMed

Powell, Douglas W; Hanson, Nicholas J; Long, Benjamin; Williams, D S Blaise

2012-09-01

To examine ground reaction forces (GRFs); frontal plane hip, knee, and ankle joint angles; and moments in high-arched (HA) and low-arched (LA) athletes during landing. Experimental study. Controlled research laboratory. Twenty healthy female recreational athletes (10 HA and 10 LA). Athletes performed 5 barefoot drop landings from a height of 30 cm. Frontal plane ankle, knee, and hip joint angles (in degrees) at initial contact, peak vertical GRF, and peak knee flexion; peak ankle, knee, and hip joint moments in the frontal plane. Vertical GRF profiles were similar between HA and LA athletes (P = 0.78). The HA athletes exhibited significantly smaller peak ankle inversion angles than the LA athletes (P = 0.01) at initial contact. At peak vertical GRF, HA athletes had significantly greater peak knee (P = 0.01) and hip abduction angles than LA athletes (P = 0.02). There were no significant differences between HA and LA athletes in peak joint moments (hip: P = 0.68; knee: P = 0.71; ankle: P = 0.15). These findings demonstrate that foot type is associated with altered landing mechanics, which may underlie lower extremity injuries. The ankle-driven strategy previously reported in female athletes suggests that foot function may have a greater relationship with lower extremity injury than that in male athletes. Future research should address the interaction of foot type and gender during landing tasks.

Association between isometric muscle strength and gait joint kinetics in adolescents and young adults with cerebral palsy.

PubMed

Dallmeijer, A J; Baker, R; Dodd, K J; Taylor, N F

2011-03-01

The purpose of this study was to determine the association between isometric muscle strength of the lower limbs and gait joint kinetics in adolescents and young adults with cerebral palsy (CP). Twenty-five participants (11 males) with bilateral spastic CP, aged 14-22 years (mean: 18.9, sd: 2.0 yr) and Gross Motor Function Classification System (GMFCS) level II (n=19) and III (n=6) were tested. Hand held dynamometry was used to measure isometric strength (expressed in Nm/kg) of the hip, knee, and ankle muscles using standardized testing positions and procedures. 3D gait analysis was performed with a VICON system to calculate joint kinetics in the hip, knee and ankle during gait. Ankle peak moments exceeded by far the levels of isometric strength of the plantar flexors, while the knee and hip peak moments were just at or below maximal isometric strength of knee and hip muscles. Isometric muscle strength showed weak to moderate correlations with peak ankle and hip extension moment and power during walking. Despite considerable muscle weakness, joint moment curves were similar to norm values. Results suggest that passive stretch of the muscle-tendon complex of the triceps surae contributes to the ankle moment during walking and that muscle strength assessment may provide additional information to gait kinetics. Copyright © 2010 Elsevier B.V. All rights reserved.

Hip Injuries and Disorders

MedlinePlus

... end of the femur, which fits in a socket in the pelvis. Your hip is known as a ball-and-socket joint. This is because you have a ball ... of your femur, and it fits into a socket in your pelvis. This makes your hips very ...

Efficacy of lateral- versus medial-approach hip joint capsule denervation as surgical treatments of the hip joint pain; a neuronal tract tracing study in the sheep

PubMed Central

Sienkiewicz, Waldemar; Dudek, Agnieszka; Czaja, Krzysztof; Janeczek, Maciej; Chrószcz, Aleksander; Kaleczyc, Jerzy

2018-01-01

Objective To evaluate efficacy of denervation of the of the hip joint capsule (HJC), as a treatment of hip joint pain. Specifically, we tested the hypothesis that HJC denervation will significantly reduce the number of sensory neurons innervating the capsule. Study design Denervation of the HJC from a medial or lateral approach was followed by retrograde tracing of sensory neurons innervating the capsule. Animals Twenty adult male sheep (30–40 kg of body weight; Polish merino breed) were used in the study. Methods The hip joint was denervated from medial (n = 5) or lateral (n = 5) surgical approaches. Immediately after denervation, the retrograde neural tract tracer Fast Blue (FB) was injected into the HJC. An additional ten animals (n = 5 for medial and n = 5 for lateral approach) received the same treatment without HJC denervation to provide the appropriate controls. Results Results of the study revealed that the vast majority of retrogradely labelled sensory neurons innervating the HJC originate from fifth lumbar to second sacral dorsal root ganglia. Both the medial and the lateral denervations significantly reduced the number of sensory neurons innervating the HJC (39.2% and 69.0% reduction respectively). Conclusions These results show that denervation of the HJC is an effective surgical procedure for reduction of the sensory neuronal input to the HJC. Moreover, the lateral approach was found to be significantly more effective for reducing sensory innervation as compared to the medial one. PMID:29329303

Enhanced lubricant film formation through micro-dimpled hard-on-hard artificial hip joint: An in-situ observation of dimple shape effects.

PubMed

Choudhury, Dipankar; Rebenda, David; Sasaki, Shinya; Hekrle, Pavel; Vrbka, Martin; Zou, Min

2018-05-01

This study evaluates the impact of dimple shapes on lubricant film formation in artificial hip joints. Micro-dimples with 20-50 µm lateral size and 1 ± 0.2 µm depths were fabricated on CrCoMo hip joint femoral heads using a picosecond laser. Tribological studies were performed using a pendulum hip joint simulator to apply continuous swing flexion-extension motions. The results revealed a significantly enhanced lubricant film thickness (≥ 500 nm) with micro-dimpled prosthesis heads at equilibrium position after the lubricant film has fully developed. The average lubricant film thickness of dimpled prostheses with square- and triangular-shaped dimple arrays over time is about 3.5 that of the non-dimpled prosthesis (204 nm). Remarkably, the prosthesis with square-shaped dimple arrays showed a very fast lubricant film formation reaching their peak values within 0.5 s of pendulum movement, followed by prosthesis with triangular-shaped dimple arrays with a transition period of 42.4 s. The fully developed lubricant film thicknesses (≥ 700 nm) are significantly higher than the surface roughness (≈ 25 nm) demonstrating a hydrodynamic lubrication. Hardly any scratches appeared on the post-experimental prosthesis with square-shaped dimple array and only a few scratches were found on the post-experimental prosthesis with triangular-shaped dimple arrays. Thus, prostheses with square-shaped dimple arrays could be a potential solution for durable artificial hip joints. Copyright © 2018 Elsevier Ltd. All rights reserved.

Effects of Step Rate Manipulation on Joint Mechanics during Running

PubMed Central

Heiderscheit, Bryan C.; Chumanov, Elizabeth S.; Michalski, Max P.; Wille, Christa M.; Ryan, Michael B.

2010-01-01

Purpose The objective of this study was to characterize the biomechanical effects of step rate modification during running on the hip, knee and ankle joints, so as to evaluate a potential strategy to reduce lower extremity loading and risk for injury. Methods Three-dimensional kinematics and kinetics were recorded from 45 healthy recreational runners during treadmill running at constant speed under various step rate conditions (preferred, ± 5% and ± 10%). We tested our primary hypothesis that a reduction in energy absorption by the lower extremity joints during the loading response would occur, primarily at the knee, when step rate was increased. Results Less mechanical energy was absorbed at the knee (p<0.01) during the +5% and +10% step rate conditions, while the hip (p<0.01) absorbed less energy during the +10% condition only. All joints displayed substantially (p<0.01) more energy absorption when preferred step rate was reduced by 10. Step length (p<0.01), center of mass vertical excursion (p<0.01), breaking impulse (p<0.01) and peak knee flexion angle (p<0.01) were observed to decrease with increasing step rate. When step rate was increased 10% above preferred, peak hip adduction angle (p<0.01), as well as peak hip adduction (p<0.01) and internal rotation (p<0.01) moments, were found to decrease. Conclusion We conclude that subtle increases in step rate can substantially reduce the loading to the hip and knee joints during running and may prove beneficial in the prevention and treatment of common running-related injuries. PMID:20581720

Joint awareness in osteoarthritis of the hip and knee evaluated with the 'Forgotten Joint' Score before and after joint replacement.

PubMed

Thienpont, E; Vanden Berghe, A; Schwab, P E; Forthomme, J P; Cornu, O

2016-10-01

To utilize the 'Forgotten Joint' Score (FJS), a 12-item questionnaire analysing the ability to forget the joint, for comparing preoperative status in osteoarthritic patients scheduled for total hip arthroplasty (THA) or total knee arthroplasty (TKA). Higher scores represent a better result with a maximum of 100. The hypothesis of this study was that a preoperative difference in favour of hip arthritis could eventually explain why THA is cited more often as a forgotten joint than TKA. A prospective cohort study was conducted in 150 patients with either tricompartmental knee (n = 75) or hip osteoarthritis (n = 75). Patients completed FJS-12 scores preoperatively and 1 year postoperatively. A similar preoperative FJS-12 was observed for hip (22 (15)) and knee osteoarthritis (24 (17)) (n.s.). The postoperative FJS-12 score was significantly higher for THA (80 (24)) than for TKA (70 (27)) (p < 0.05). High reliability after 6 weeks was observed for the preoperative FJS-12 test-retest reliability (ICC = 0.87) in TKA. A preoperative floor effect of 15 % in THA and 0 % in TKA was found as well as a postoperative ceiling effect of 33 % in THA and 9 % in TKA. The clinical relevance of utilizing the FJS-12 as an instrument to evaluate outcome is strongly proposed for knee arthroplasty. In general, one is not aware of a healthy joint during the ADL, and it can therefore be regarded as 'forgotten'. The preoperative FJS-12 Score is a powerful tool to provide patients with clearer insights into their positive evolution after surgery. The use of the FJS-12 in THA is a topic for further research, as this study found that floor and ceiling effects limit its usefulness in studies evaluating clinical outcome in this area. II.

A validated method for modeling anthropoid hip abduction in silico.

PubMed

Hammond, Ashley S; Plavcan, J Michael; Ward, Carol V

2016-07-01

The ability to reconstruct hip joint mobility from femora and pelves could provide insight into the locomotion and paleobiology of fossil primates. This study presents a method for modeling hip abduction in anthropoids validated with in vivo data. Hip abduction simulations were performed on a large sample of anthropoids. The modeling approach integrates three-dimensional (3D) polygonal models created from laser surface scans of bones, 3D landmark data, and shape analysis software to digitally articulate and manipulate the hip joint. Range of femoral abduction (degrees) and the abducted knee position (distance spanned at the knee during abduction) were compared with published live animal data. The models accurately estimate knee position and (to a lesser extent) angular abduction across broad locomotor groups. They tend to underestimate abduction for acrobatic or suspensory taxa, but overestimate it in more stereotyped taxa. Correspondence between in vivo and in silico data varies at the specific and generic level. Our models broadly correspond to in vivo data on hip abduction, although the relationship between the models and live animal data is less straightforward than hypothesized. The models can predict acrobatic or stereotyped locomotor adaptation for taxa with values near the extremes of the range of abduction ability. Our findings underscore the difficulties associated with modeling complex systems and the importance of validating in silico models. They suggest that models of joint mobility can offer additional insight into the functional abilities of extinct primates when done in consideration of how joints move and function in vivo. Am J Phys Anthropol 160:529-548, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Changes in Knee Biomechanics After a Hip-Abductor Strengthening Protocol for Runners With Patellofemoral Pain Syndrome

PubMed Central

Ferber, Reed; Kendall, Karen D.; Farr, Lindsay

2011-01-01

Abstract Context: Very few authors have investigated the relationship between hip-abductor muscle strength and frontal-plane knee mechanics during running. Objective: To investigate this relationship using a 3-week hip-abductor muscle-strengthening program to identify changes in strength, pain, and biomechanics in runners with patellofemoral pain syndrome (PFPS). Design: Cohort study. Setting: University-based clinical research laboratory. Patients or Other Participants: Fifteen individuals (5 men, 10 women) with PFPS and 10 individuals without PFPS (4 men, 6 women) participated. Intervention(s): The patients with PFPS completed a 3-week hip-abductor strengthening protocol; control participants did not. Main Outcome Measure(s): The dependent variables of interest were maximal isometric hip-abductor muscle strength, 2-dimensional peak knee genu valgum angle, and stride-to-stride knee-joint variability. All measures were recorded at baseline and 3 weeks later. Between-groups differences were compared using repeated-measures analyses of variance. Results: At baseline, the PFPS group exhibited reduced strength, no difference in peak genu valgum angle, and increased stride-to-stride knee-joint variability compared with the control group. After the 3-week protocol, the PFPS group demonstrated increased strength, less pain, no change in peak genu valgum angle, and reduced stride-to-stride knee-joint variability compared with baseline. Conclusions: A 3-week hip-abductor muscle-strengthening protocol was effective in increasing muscle strength and decreasing pain and stride-to-stride knee-joint variability in individuals with PFPS. However, concomitant changes in peak knee genu valgum angle were not observed. PMID:21391799

Lower extremity muscle functions during full squats.

PubMed

Robertson, D G E; Wilson, Jean-Marie J; St Pierre, Taunya A

2008-11-01

The purpose of this research was to determine the functions of the gluteus maximus, biceps femoris, semitendinosus, rectus femoris, vastus lateralis, soleus, gastrocnemius, and tibialis anterior muscles about their associated joints during full (deep-knee) squats. Muscle function was determined from joint kinematics, inverse dynamics, electromyography, and muscle length changes. The subjects were six experienced, male weight lifters. Analyses revealed that the prime movers during ascent were the monoarticular gluteus maximus and vasti muscles (as exemplified by vastus lateralis) and to a lesser extent the soleus muscles. The biarticular muscles functioned mainly as stabilizers of the ankle, knee, and hip joints by working eccentrically to control descent or transferring energy among the segments during scent. During the ascent phase, the hip extensor moments of force produced the largest powers followed by the ankle plantar flexors and then the knee extensors. The hip and knee extensors provided the initial bursts of power during ascent with the ankle extensors and especially a second burst from the hip extensors adding power during the latter half of the ascent.

New application of 18F-fluoride PET for the detection of bone remodeling in early-stage osteoarthritis of the hip.

PubMed

Kobayashi, Naomi; Inaba, Yutaka; Tateishi, Ukihide; Yukizawa, Yohei; Ike, Hiroyuki; Inoue, Tomio; Saito, Tomoyuki

2013-10-01

Recent studies have reported the acceleration of subchondral bone remodeling during the development of osteoarthritis (OA). However, it is not possible to evaluate such molecular abnormalities using conventional radiographic techniques. We have applied 18F-fluoride PET to the analysis of painful or dysplastic hips at various stages of OA and then compared this with radiographic findings and clinical findings. A consecutive series of 65 joints from 48 patients (average age, 40 years; range, 19-72 years) with a hip joint complaint or radiographic dysplastic hip were enrolled in this study. Twenty-five contralateral joints without any evidence of OA or clinical symptoms were assigned as a normal control group. Radiographic evaluations were performed on the basis of Kellgren and Lawrence grade and the minimum joint space. Clinical evaluations were performed using the grading scale for pain severity and the SUVmax was measured for each joint. The association between SUVmax and the radiographic or clinical findings was evaluated. 18F-fluoride PET shows a significantly higher uptake value for progressive-stage OA cases than for early-stage cases and also shows a significantly higher uptake value in cases with severe pain. Even in early-OA-stage patients who do not show joint space narrowing on a plain x-ray, cases with severe pain show a significantly higher uptake value. 18F-fluoride PET has great potential as an imaging method for diagnosing early-stage OA without any marked radiographic changes.

Cystic lesion around the hip joint

PubMed Central

Yukata, Kiminori; Nakai, Sho; Goto, Tomohiro; Ikeda, Yuichi; Shimaoka, Yasunori; Yamanaka, Issei; Sairyo, Koichi; Hamawaki, Jun-ichi

2015-01-01

This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments. PMID:26495246

EMG activity of hip and trunk muscles during deep-water running.

PubMed

Kaneda, Koichi; Sato, Daisuke; Wakabayashi, Hitoshi; Nomura, Takeo

2009-12-01

The present study used synchronized motion analysis to investigate the activity of hip and trunk muscles during deep-water running (DWR) relative to land walking (LW) and water walking (WW). Nine healthy men performed each exercise at self-determined slow, moderate, and fast paces, and surface electromyography was used to investigate activity of the adductor longus, gluteus maxima, gluteus medius, rectus abdominis, oblique externus abdominis, and erector spinae. The following kinematic parameters were calculated: the duration of one cycle, range of motion (ROM) of the hip joint, and absolute angles of the pelvis and trunk with respect to the vertical axis in the sagittal plane. The percentages of maximal voluntary contraction (%MVC) of each muscle were higher during DWR than during LW and WW. The %MVC of the erector spinae during WW increased concomitant with the pace increment. The hip joint ROMs were larger in DWR than in LW and WW. Forward inclinations of the trunk were apparent for DWR and fast-paced WW. The pelvis was inclined forward in DWR and WW. In conclusion, the higher-level activities during DWR are affected by greater hip joint motion and body inclinations with an unstable floating situation.

Kinematic alignment technique for total hip and knee arthroplasty

PubMed Central

Rivière, Charles; Lazic, Stefan; Villet, Loïc; Wiart, Yann; Allwood, Sarah Muirhead; Cobb, Justin

2018-01-01

Conventional techniques for hip and knee arthroplasty have led to good long-term clinical outcomes, but complications remain despite better surgical precision and improvements in implant design and quality. Technological improvements and a better understanding of joint kinematics have facilitated the progression to ‘personalized’ implant positioning (kinematic alignment) for total hip (THA) and knee (TKA) arthroplasty, the true value of which remains to be determined. By achieving a true knee resurfacing, the kinematic alignment (KA) technique for TKA aims at aligning the components with the physiological kinematic axes of the knee and restoring the constitutional tibio-femoral joint line frontal and axial orientation and soft-tissue laxity. The KA technique for THA aims at restoring the native ‘combined femoro-acetabular anteversion’ and the hip’s centre of rotation, and occasionally adjusting the cup position and design based on the assessment of the individual spine-hip relation. The key element for optimal prosthetic joint kinematics (hip or knee) is to reproduce the femoral anatomy. The transverse acetabular ligament (TAL) is the reference landmark to adjust the cup position. Cite this article: EFORT Open Rev 2018;3:98-105. DOI: 10.1302/2058-5241.3.170022 PMID:29657851

Effect of the walking speed to the lower limb joint angular displacements, joint moments and ground reaction forces during walking in water.

PubMed

Miyoshi, Tasuku; Shirota, Takashi; Yamamoto, Shin-ichiro; Nakazawa, Kimitaka; Akai, Masami

2004-06-17

The purpose of this study was to compare the changes in ground reaction forces (GRF), joint angular displacements (JAD), joint moments (JM) and electromyographic (EMG) activities that occur during walking at various speeds in water and on land. Fifteen healthy adults participated in this study. In the water experiments, the water depth was adjusted so that body weight was reduced by 80%. A video-motion analysis system and waterproof force platform was used to obtain kinematics and kinetics data and to calculate the JMs. Results revealed that (1) the anterior-posterior GRF patterns differed between walking in water and walking on land, whereas the medio-lateral GRF patterns were similar, (2) the JAD patterns of the hip and ankle were similar between water- and land-walking, whereas the range of motion at the knee joint was lower in water than on land, (3) the JMs in all three joints were lower in water than on land throughout the stance phase, and (4) the hip joint extension moment and hip extensor muscle EMG activity were increased as walking speed increase during walking in water. Rehabilitative water-walking exercise could be designed to incorporate large-muscle activities, especially of the lower-limb extensor muscles, through full joint range of motion and minimization of joint moments.

Hip Kinematics During a Stop-Jump Task in Patients With Chronic Ankle Instability

PubMed Central

Brown, Cathleen N.; Padua, Darin A.; Marshall, Stephen W.; Guskiewicz, Kevin M.

2011-01-01

Context: Chronic ankle instability (CAI) commonly develops after lateral ankle sprain. Movement pattern differences at proximal joints may play a role in instability. Objective: To determine whether people with mechanical ankle instability (MAI) or functional ankle instability (FAI) exhibited different hip kinematics and kinetics during a stop-jump task compared with “copers.” Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: Sixty-three recreational athletes, 21 (11 men, 10 women) per group, matched for sex, age, height, mass, and limb dominance. All participants reported a history of a moderate to severe ankle sprain. The participants with MAI and FAI reported 2 or more episodes of giving way at the ankle in the last year and decreased functional ability; copers did not. The MAI group demonstrated clinically positive anterior drawer and talar tilt tests, whereas the FAI group and copers did not. Intervention(s): Participants performed a maximum-speed approach run and a 2-legged stop jump followed by a maximum vertical jump. Main Outcome Measure(s): An electromagnetic tracking device synchronized with a force plate collected data during the stance phase of a 2-legged stop jump. Hip motion was measured from initial contact to takeoff into the vertical jump. Group differences in hip kinematics and kinetics were assessed. Results: The MAI group demonstrated greater hip flexion at initial contact and at maximum (P = .029 and P = .017, respectively) and greater hip external rotation at maximum (P = .035) than the coper group. The MAI group also demonstrated greater hip flexion displacement than both the FAI (P = .050) and coper groups (P = .006). No differences were noted between the FAI and coper groups in hip kinematic variables or among any of the groups in ground reaction force variables. Conclusions: The MAI group demonstrated different hip kinematics than the FAI and coper groups. Proximal joint motion may be affected by ankle joint function and laxity, and clinicians may need to assess proximal joints after repeated ankle sprains. PMID:22488131

Clinical examination and physical assessment of hip joint-related pain in athletes.

PubMed

Reiman, Michael P; Thorborg, Kristian

2014-11-01

Evidence-based clinical examination and assessment of the athlete with hip joint related pain is complex. It requires a systematic approach to properly differentially diagnose competing potential causes of athletic pain generation. An approach with an initial broad focus (and hence use of highly sensitive tests/measures) that then is followed by utilizing more specific tests/measures to pare down this imprecise differential diagnosis list is suggested. Physical assessment measures are then suggested to discern impairments, activity and participation restrictions for athletes with hip-join related pain, hence guiding the proper treatment approach. 5.

Linkage analysis of candidate genes as susceptibility loci for osteoarthritis-suggestive linkage of COL9A1 to female hip osteoarthritis.

PubMed

Mustafa, Z; Chapman, K; Irven, C; Carr, A J; Clipsham, K; Chitnavis, J; Sinsheimer, J S; Bloomfield, V A; McCartney, M; Cox, O; Sykes, B; Loughlin, J

2000-03-01

To examine 11 candidate genes as susceptibility loci for osteoarthritis (OA). A total of 481 families have been ascertained in which at least two siblings have had joint replacement surgery of the hip, or knee, or hip and knee for idiopathic OA. Each candidate gene was targeted using one or more intragenic or closely linked microsatellite marker. The linkage data were analysed unstratified and following stratification by sex and by joint replaced (hip or knee). The analyses revealed suggestive linkage of the type IX collagen gene COL9A1 (6q12-q13) to a subset of 132 families that contained affected females who were concordant for hip OA (female-hip) with a P-value of 0.00053 and logarithm of the odds (LOD) score of 2.33 [corrected P-value of 0. 0016, corrected LOD score of 1.85]. COL9A1 may therefore be a susceptibility locus for female hip OA. In addition, there was weak evidence of linkage to HLA/COL11A2 (6p21.3) in female hip OA with a corrected P-value of 0.016.

Reliability Exercise for the Polymyalgia Rheumatica Classification Criteria Study: The Oranjewoud Ultrasound Substudy

PubMed Central

Scheel, Alexander K.; Matteson, Eric L.; Dasgupta, Bhaskar; Bruyn, George A. W.; Ohrndorf, Sarah; Werner, Carola; Schmidt, Wolfgang A.

2009-01-01

Objective. A study supported by the EULAR and the ACR being conducted to establish classification criteria for polymyalgia rheumatica (PMR) will include ultrasound examination of the shoulders and hips. Ultrasound (US) depicts glenohumeral joint effusion, biceps tenosynovitis, subdeltoid bursitis, hip joint synovitis, and trochanteric bursitis in PMR. These findings may aid in distinguishing PMR from other diseases. The purpose of this study was to assess standards and US interreader agreement of participants in the PMR classification criteria study. Methods. Sixteen physicians in four groups examined shoulders and hips of 4 patients and 4 healthy adults with ultrasound. Overall agreement and interobserver agreement were calculated. Results. The overall agreement (OA) between groups was 87%. The OA for healthy shoulders was 88.8%, for healthy hips 100%, for shoulders with pathology 85.2%, and 74.3% for hips with pathology, respectively. Conclusion. There was a high degree of agreement found for the examination of healthy shoulders and pathologic hips. Agreement was moderate for pathologic shoulders and perfect for healthy hips. US of shoulder and hips performed by different examiners is a reliable and feasible tool for assessment of PMR related disease pathology and can be incorporated into a classification criteria study. PMID:20130800

Robotic hip arthroscopy in human anatomy.

PubMed

Kather, Jens; Hagen, Monika E; Morel, Philippe; Fasel, Jean; Markar, Sheraz; Schueler, Michael

2010-09-01

Robotic technology offers technical advantages that might offer new solutions for hip arthroscopy. Two hip arthroscopies were performed in human cadavers using the da Vinci surgical system. During both surgeries, a robotic camera and 5 or 8 mm da Vinci trocars with instruments were inserted into the hip joint for manipulation. Introduction of cameras and working instruments, docking of the robotic system and instrument manipulation was successful in both cases. The long articulating area of 5 mm instruments limited movements inside the joint; an 8 mm instrument with a shorter area of articulation offered an improved range of motion. Hip arthroscopy using the da Vinci standard system appears a feasible alternative to standard arthroscopy. Instruments and method of application must be modified and improved before routine clinical application but further research in this area seems justified, considering the clinical value of such an approach. Copyright 2010 John Wiley & Sons, Ltd.

Joint registries as continuous surveillance systems: the experience of the Catalan Arthroplasty Register (RACat).

PubMed

Allepuz, Alejandro; Martínez, Olga; Tebé, Cristian; Nardi, Joan; Portabella, Frederic; Espallargues, Mireia

2014-03-01

The aim was to present results on prosthesis performance in Catalonia for the period 2005-2010. All publicly funded hospitals submit in an electronic format data on hip and knee arthroplasties: patients' insurance identification number, hospital, joint (hip/knee), type of arthroplasty (primary/revision), side (right/left), date of surgery and prosthesis (manufacturer name and catalogue number). A standard survival analysis based on Kaplan-Meier estimation was carried out. Fifty-two hospitals have sent information to the RACat which has data on 36,951 knee and 26,477 hip arthroplasties. Cumulative prostheses revision risks at 3 years were 3.3% (95% CI: 3.1-3.6) for knee, 2.9% (95% CI: 2.5-3.3) for total hip and 2.5% (95% CI: 2.0-3.1) for partial hip. When compared to other registries a higher risk of revision was observed. © 2013.

Evaluation of gait performance of a participant with Perthes disease while walking with and without a Scottish-Rite orthosis.

PubMed

Karimi, Mohammad; Sedigh, Jafar; Fatoye, Francis

2013-06-01

Scottish-Rite orthosis is one of the conservative methods used to treat Legg-Calvé-Perthes disease. As there was not enough evidence to show the effects of using this orthosis on reducing the loads applied on the limb, this research aimed to find the influence of this orthosis. A participant with Perthes disease on the left hip joint was recruited into this study to walk with and without the orthosis. The kinetic and kinematic parameters were collected by a motion analysis system and a Kistler force platform. No significant differences were noted between the hip joint flexion/extension range of motion and the moments between the sound side and the side affected by Legg-Calvé-Perthes disease. It may be concluded that use of orthosis may not have any positive effects to decrease the loads or to improve the alignment of the hip joint in participants with Perthes disease, as expected. The use of Scottish-Rite orthosis not only does not improve the containment of the hip joint, but also does not have any significant influence on loads applied on the joint during walking of the subject with Perthes disease. The results of this research can be used by clinicians involved in treatment of patients with Legg-Calvé-Perthes disease.

Influence of footwear and equipment on stride length and range of motion of ankle, knee and hip joint.

PubMed

Schulze, Christoph; Lindner, Tobias; Woitge, Sandra; Schulz, Katharina; Finze, Susanne; Mittelmeier, Wolfram; Bader, Rainer

2014-01-01

Footwear and equipment worn by military personnel is of importance for them to be able to meet the physical demands specific to their profession daily activities. The aim of the present study was to investigate by means of gait analysis how army-provided footwear and equipment influence the range of motion of hip, knee and ankle joints as well as stride length. Thirty-two soldiers were subjected to gait analysis on a treadmill by way of video recordings and goniometric measurements. The stride length increased when military shoes are worn. We found no influence on stride length in connection to increased loading. The weight of the shoes represents the decisive factor. Neither shoes nor equipment changed the range of motion of the knee joint. Weight of equipment affected range of motion of the hip joint. The range of motion of the upper and lower ankle joints was mainly influenced by the properties of the shoes. Military footwear and weight of equipment influence stride length and range of motion of joints of the lower extremities in a specific way. Shape of material is the decisive factor.

Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021.

PubMed

Kurtz, Steven M; Ong, Kevin L; Lau, Edmund; Bozic, Kevin J

2014-04-16

Few studies have explored the role of the National Health Expenditure and macroeconomics on the utilization of total joint replacement. The economic downturn has raised questions about the sustainability of growth for total joint replacement in the future. Previous projections of total joint replacement demand in the United States were based on data up to 2003 using a statistical methodology that neglected macroeconomic factors, such as the National Health Expenditure. Data from the Nationwide Inpatient Sample (1993 to 2010) were used with United States Census and National Health Expenditure data to quantify historical trends in total joint replacement rates, including the two economic downturns in the 2000s. Primary and revision hip and knee arthroplasty were identified using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Projections in total joint replacement were estimated using a regression model incorporating the growth in population and rate of arthroplasties from 1993 to 2010 as a function of age, sex, race, and census region using the National Health Expenditure as the independent variable. The regression model was used in conjunction with government projections of National Health Expenditure from 2011 to 2021 to estimate future arthroplasty rates in subpopulations of the United States and to derive national estimates. The growth trend for the incidence of joint arthroplasty, for the overall United States population as well as for the United States workforce, was insensitive to economic downturns. From 2009 to 2010, the total number of procedures increased by 6.0% for primary total hip arthroplasty, 6.1% for primary total knee arthroplasty, 10.8% for revision total hip arthroplasty, and 13.5% for revision total knee arthroplasty. The National Health Expenditure model projections for primary hip replacement in 2020 were higher than a previously projected model, whereas the current model estimates for total knee arthroplasty were lower. Economic downturns in the 2000s did not substantially influence the national growth trends for hip and knee arthroplasty in the United States. These latest updated projections provide a basis for surgeons, hospitals, payers, and policy makers to plan for the future demand for total joint replacement surgery.

A systematic literature review of synovial chondromatosis and pigmented villonodular synovitis of the hip.

PubMed

Startzman, Ashley; Collins, Devin; Carreira, Dominic

2016-11-01

Benign synovial diseases of the hip including Synovial Chondromatosis (SC) and Pigmented Villonodular Synovitis (PVNS) are devastating diseases. Initially, patients present with hip pain unrelieved by conservative measures. The diagnosis of PVNS and SC are often delayed, leading to progression of joint damage. The purpose of this review is to present the latest on the diagnosis, management, and prognosis of SC and PVNS of the hip. An extensive systematic search of MEDLINE and PUBMED Databases was performed. Data parameters were set from 2005 to present day with set inclusion criteria. Systematic reviews were excluded. 427 abstracts were identified, with 12 articles meeting all inclusion criteria. Eight studies focused on SC, and 5 on PVNS. 233 patients with SC of the hip and 98 patients with PVNS of the hip were identified, a total of 331 patients. Benign Synovial disorders of the hip are rare. In patients with chronic hip pain secondary to benign synovial disorders, early diagnosis and surgical intervention demonstrate good outcomes, and patients may benefit due to prevention of morbidity from further joint destruction. There is no clear consensus between higher successes through open versus arthroscopic surgical debridement. In the final phase of benign synovial disorders of the hip, THA of different types based on the patient's age should be considered.

Lower limb joint work and joint work contribution during downhill and uphill walking at different inclinations.

PubMed

Alexander, Nathalie; Strutzenberger, Gerda; Ameshofer, Lisa Maria; Schwameder, Hermann

2017-08-16

Work performance and individual joint contribution to total work are important information for creating training protocols, but were not assessed so far for sloped walking. Therefore, the purpose of this study was to analyze lower limb joint work and joint contribution of the hip, knee and ankle to total lower limb work during sloped walking in a healthy population. Eighteen male participants (27.0±4.7yrs, 1.80±0.05m, 74.5±8.2kg) walked on an instrumented ramp at inclination angles of 0°, ±6°, ±12° and ±18° at 1.1m/s. Kinematic and kinetic data were captured using a motion-capture system (Vicon) and two force plates (AMTI). Joint power curves, joint work (positive, negative, absolute) and each joint's contribution to total lower limb work were analyzed throughout the stance phase using an ANOVA with repeated measures. With increasing inclination positive joint work increased for the ankle and hip joint and in total during uphill walking. Negative joint work increased for each joint and in total work during downhill walking. Absolute work was increased during both uphill (all joints) and downhill (ankle & knee) walking. Knee joint contribution to total negative and absolute work increased during downhill walking while hip and ankle contributions decreased. This study identified, that, when switching from level to a 6° and from 6° to a 12° inclination the gain of individual joint work is more pronounced compared to switching from 12° to an 18° inclination. The results might be used for training recommendations and specific training intervention with respect to sloped walking. Copyright © 2017 Elsevier Ltd. All rights reserved.

Computer Assisted Surgery and Current Trends in Orthopaedics Research and Total Joint Replacements

NASA Astrophysics Data System (ADS)

Amirouche, Farid

2008-06-01

Musculoskeletal research has brought about revolutionary changes in our ability to perform high precision surgery in joint replacement procedures. Recent advances in computer assisted surgery as well better materials have lead to reduced wear and greatly enhanced the quality of life of patients. The new surgical techniques to reduce the size of the incision and damage to underlying structures have been the primary advance toward this goal. These new techniques are known as MIS or Minimally Invasive Surgery. Total hip and knee Arthoplasties are at all time high reaching 1.2 million surgeries per year in the USA. Primary joint failures are usually due to osteoarthristis, rheumatoid arthritis, osteocronis and other inflammatory arthritis conditions. The methods for THR and TKA are critical to initial stability and longevity of the prostheses. This research aims at understanding the fundamental mechanics of the joint Arthoplasty and providing an insight into current challenges in patient specific fitting, fixing, and stability. Both experimental and analytical work will be presented. We will examine Cementless total hip arthroplasty success in the last 10 years and how computer assisted navigation is playing in the follow up studies. Cementless total hip arthroplasty attains permanent fixation by the ingrowth of bone into a porous coated surface. Loosening of an ingrown total hip arthroplasty occurs as a result of osteolysis of the periprosthetic bone and degradation of the bone prosthetic interface. The osteolytic process occurs as a result of polyethylene wear particles produced by the metal polyethylene articulation of the prosthesis. The total hip arthroplasty is a congruent joint and the submicron wear particles produced are phagocytized by macrophages initiating an inflammatory cascade. This cascade produces cytokines ultimately implicated in osteolysis. Resulting bone loss both on the acetabular and femoral sides eventually leads to component instability. As patients are living longer and total hip arthroplasty is performed in younger patients the risks of osteolysis associated with cumulative wear is increased. Computer-assisted surgery is based on sensing feedback; vision and imaging that help surgeons align the patient's joints during total knee or hip replacement with a degree of accuracy not possible with the naked eye. For the first time, the computer feedback is essential for ligament balancing and longevity of the implants. The computers navigation systems also help surgeons to use smaller incisions instead of the traditional larger openings. Small-incision surgery offers the potential for faster recovery, less bleeding and less pain for patients. The development of SESCAN imaging technique to create a patient based model of a 3D joint will be presented to show the effective solution of complex geometry of joints.

Hypothyroidism: Does It Cause Joint Pain?

MedlinePlus

Hypothyroidism: Does it cause joint pain? Can hypothyroidism cause joint pain? I have hypothyroidism and have been experiencing severe arthritis-like pain in my shoulders and hips. Answers from Todd B. ...

Comparison of lower limb kinetics during vertical jumps in turnout and neutral foot positions by classical ballet dancers.

PubMed

Imura, Akiko; Iino, Yoichi

2017-03-01

The purpose of this study was to investigate the effect of hip external rotation (turnout) on lower limb kinetics during vertical jumps by classical ballet dancers. Vertical jumps in a turnout (TJ) and a neutral hip position (NJ) performed by 12 classical female ballet dancers were analysed through motion capture, recording of the ground reaction forces, and inverse dynamics analysis. At push-off, the lower trunk leaned forward 18.2° and 20.1° in the TJ and NJ, respectively. The dancers jumped lower in the TJ than in the NJ. The knee extensor and hip abductor torques were smaller, whereas the hip external rotator torque was larger in the TJ than in the NJ. The work done by the hip joint moments in the sagittal plane was 0.28 J/(Body mass*Height) and 0.33 J/(Body mass*Height) in the TJ and NJ, respectively. The joint work done by the lower limbs were not different between the two jumps. These differences resulted from different planes in which the lower limb flexion-extension occurred, i.e. in the sagittal or frontal plane. This would prevent the forward lean of the trunk by decreasing the hip joint work in the sagittal plane and reduce the knee extensor torque in the jump.

Comparison of 3D Joint Angles Measured With the Kinect 2.0 Skeletal Tracker Versus a Marker-Based Motion Capture System.

PubMed

Guess, Trent M; Razu, Swithin; Jahandar, Amirhossein; Skubic, Marjorie; Huo, Zhiyu

2017-04-01

The Microsoft Kinect is becoming a widely used tool for inexpensive, portable measurement of human motion, with the potential to support clinical assessments of performance and function. In this study, the relative osteokinematic Cardan joint angles of the hip and knee were calculated using the Kinect 2.0 skeletal tracker. The pelvis segments of the default skeletal model were reoriented and 3-dimensional joint angles were compared with a marker-based system during a drop vertical jump and a hip abduction motion. Good agreement between the Kinect and marker-based system were found for knee (correlation coefficient = 0.96, cycle RMS error = 11°, peak flexion difference = 3°) and hip (correlation coefficient = 0.97, cycle RMS = 12°, peak flexion difference = 12°) flexion during the landing phase of the drop vertical jump and for hip abduction/adduction (correlation coefficient = 0.99, cycle RMS error = 7°, peak flexion difference = 8°) during isolated hip motion. Nonsagittal hip and knee angles did not correlate well for the drop vertical jump. When limited to activities in the optimal capture volume and with simple modifications to the skeletal model, the Kinect 2.0 skeletal tracker can provide limited 3-dimensional kinematic information of the lower limbs that may be useful for functional movement assessment.

Relationships between ground reaction force parameters during a sit-to-stand movement and physical activity and falling risk of the elderly and a comparison of the movement characteristics between the young and the elderly.

PubMed

Yamada, Takayoshi; Demura, Shin-ichi

2009-01-01

This study aimed to examine the relationships between ground reaction force during a sit-to-stand (STS) movement and physical activity and falling risk of the elderly and the difference of the movement characteristics between the young and the elderly. Sixty elderly females who can achieve a STS movement by themselves and 30 healthy young females were measured for ground reaction force during STS movement from a chair, adjusted for lower leg length height. The elderly's physical activity and falling risk were also assessed. Physical activity and falling risk significantly correlated with parameters on force exertion during hip lift-off and knee-hip joint extension phases (|r|=0.26-0.41). Significant differences were found in ground reaction force parameters of all phases between the young and the elderly and STS movement of the elderly was suggested to result in poor force exertion and slowing down. The above tendency was noticeable in the hip lift-off and knee-hip joint extension phases. In conclusion, force exertion in hip lift-off and knee-hip joint extension phases of STS movement is related to physical activity and falling risk in the elderly. These phases may be useful to evaluate the elderly's physical activity and falling risk.

Modeling of Human Joint Structures.

DTIC Science & Technology

1982-09-01

Acromioclavicular Joint .... ............. ... 20 Glenohumeral Joint .... ................ . 20 HIP JOINT .................. ...... 21 Iliofemoral Ligament...clavicle articulates with the manubrium of the sternum, and the acromioclavicular joint, where the clavicle articulates with the acromion process of the...the interclavicular ligament. Acromioclavicular Joint This articulation between the distal end of the clavicle and the acromion of the scapula is

Pelvis x-ray

MedlinePlus

X-ray - pelvis ... Tumors Degenerative conditions of bones in the hips, pelvis, and upper legs ... hip joint Tumors of the bones of the pelvis Sacroiliitis (inflammation of the area where the sacrum ...

Parallel facilitatory reflex pathways from the foot and hip to flexors and extensors in the injured human spinal cord

PubMed Central

Knikou, Maria; Kay, Elizabeth; Schmit, Brian D.

2007-01-01

Spinal integration of sensory signals associated with hip position, muscle loading, and cutaneous sensation of the foot contributes to movement regulation. The exact interactive effects of these sensory signals under controlled dynamic conditions are unknown. The purpose of the present study was to establish the effects of combined plantar cutaneous afferent excitation and hip movement on the Hoffmann (H) and flexion reflexes in people with a spinal cord injury (SCI). The flexion and H-reflexes were elicited through stimulation of the right sural (at non-nociceptive levels) and posterior tibial nerves respectively. Reflex responses were recorded from the ipsilateral tibialis anterior (TA) (flexion reflex) and soleus (H-reflex) muscles. The plantar cutaneous afferents were stimulated at three times the perceptual threshold (200 Hz, 24-ms pulse train) at conditioning–test intervals that ranged from 3 to 90 ms. Sinusoidal movements were imposed to the right hip joint at 0.2 Hz with subjects supine. Control and conditioned reflexes were recorded as the hip moved in flexion and extension. Leg muscle activity and sagittal-plane joint torques were recorded. We found that excitation of plantar cutaneous afferents facilitated the soleus H-reflex and the long latency flexion reflex during hip extension. In contrast, the short latency flexion reflex was depressed by plantar cutaneous stimulation during hip flexion. Oscillatory joint forces were present during the transition phase of the hip movement from flexion to extension when stimuli were delivered during hip flexion. Hip-mediated input interacts with feedback from the foot sole to facilitate extensor and flexor reflex activity during the extension phase of movement. The interactive effects of these sensory signals may be a feature of impaired gait, but when they are appropriately excited, they may contribute to locomotion recovery in these patients. PMID:17543951

Laboratory studies on the tribology of hard bearing hip prostheses: ceramic on ceramic and metal on metal.

PubMed

Vassiliou, K; Scholes, S C; Unsworth, A

2007-01-01

Total hip replacements offer relief to a great many patients every year around the world. With an expected service life of around 25 years on most devices, and with younger and younger patients undergoing this surgery, it is of great importance to understand the mechanisms of their function. Tribological testing of both conventional and hard bearing joint combinations have been conducted in many centres throughout the world, and, after being initially abandoned owing to premature failures, hard bearing combinations have been revisited as viable options for joint replacements. Improved design, manufacturing procedures, and material compositions have led to improved performance over first-generation designs in both metal-on-metal and ceramic-on-ceramic hip prostheses. This paper offers a review of the work conducted in an attempt to highlight the most important factors affecting joint performance and tribology of hard bearing combinations. The tribological performance of these joints is superior to that of conventional metal- or ceramic-on-polymer designs.

Study of Wearable Knee Assistive Instruments for Walk Rehabilitation

NASA Astrophysics Data System (ADS)

Zhu, Yong; Nakamura, Masahiro; Ito, Noritaka; Fujimoto, Hiroshi; Horikuchi, Kenichi; Wakabayashi, Shojiro; Takahashi, Rei; Terada, Hidetsugu; Haro, Hirotaka

A wearable Knee Assistive Instrument for the walk rehabilitation was newly developed. Especially, this system aimed at supporting the rehabilitation for the post-TKA (Total Knee Arthroplasty) which is a popular surgery for aging people. This system consisted of an assisting mechanism for the knee joint, a hip joint support system and a foot pressure sensor system. The driving system of this robot consisted of a CPU board which generated the walking pattern, a Li-ion battery, DC motors with motor drivers, contact sensors to detect the state of foot and potentiometers to detect the hip joint angle. The control method was proposed to reproduce complex motion of knee joint as much as possible, and to increase hip or knee flexion angle. Especially, this method used the timing that heel left from the floor. This method included that the lower limb was raised to prevent a subject's fall. Also, the prototype of knee assisting system was tested. It was confirmed that the assisting system is useful.

Single-leg hop testing following fatiguing exercise: reliability and biomechanical analysis.

PubMed

Augustsson, J; Thomeé, R; Lindén, C; Folkesson, M; Tranberg, R; Karlsson, J

2006-04-01

A fatiguing exercise protocol was combined with single-leg hop testing to improve the possibilities of evaluating the effects of training or rehabilitation interventions. In the first test-retest experiment, 11 healthy male subjects performed two trials of single-leg hops under three different test conditions: non-fatigued and following fatiguing exercise, which consisted of unilateral weight machine knee extensions at 80% and 50%, respectively, of 1 repetition maximum (1 RM) strength. Intraclass correlation coefficients ranged from 0.75 to 0.98 for different hop test conditions, indicating that all tests were reliable. For the second experiment, eight healthy male subjects performed the fatiguing exercise protocol to investigate how fatigue influences lower-extremity joint kinematics and kinetics during single-leg hops. Hip, knee and ankle joint angles, moments and powers, as well as ground-reaction forces were recorded with a six-camera, motion-capture system and a force platform. Recovery of hop performance following the fatiguing exercise was also measured. During the take-off for the single-leg hops, hip and knee flexion angles, generated powers for the knee and ankle joints, and ground-reaction forces decreased for the fatigued hop conditions compared with the non-fatigued condition (P<0.05). Compared with landing during the non-fatigued condition, hip moments and ground-reaction forces were lower for the fatigued hop conditions (P<0.05). The negative joint power was two to three times greater for the knee than for the hip and five to 10 times greater for the knee than for the ankle during landing for all test conditions (P<0.05). Most measured variables had recovered three minutes post-exercise. It is concluded that the fatiguing exercise protocol combined with single-leg hop testing was a reliable method for investigating functional performance under fatigued test conditions. Further, subjects utilized an adapted hop strategy, which employed less hip and knee flexion and generated powers for the knee and ankle joints during take-off, and less hip joint moments during landing under fatigued conditions. The large negative power values observed at the knee joint during the landing phase of the single-leg hop, during which the quadriceps muscle activates eccentrically, indicate that not only hop distance but also the ability to perform successful landings should be investigated when assessing dynamic knee function.

[X-ray characteristics of sacroiliac joint disorders and its clinical significance].

PubMed

Shi, Ning-Ning; Shen, Guo-Quan; He, Shui-Yong; Guo, Ru-bao

2013-02-01

To study the X-ray characteristics of sacroiliac joint disorders and its clinical significance,so as to provide clinical diagnosis basis for Tuina treatment of sacroiliac joint disorder. From July 2009 to March 2011,104 patients with sacroiliac joint disorder were reviewed,including 64 males and 40 females,ranging in age from 18 to 81 years, with an average of (45.39 +/- 1.30) years. The duration of the disease ranged from 1 to 144 months,with an average of (12.64 +/- 2.19) months. One hundred and four pelvic plain films and 97 lumbar spine lateral films of the patients with sacroiliac joint disorder were taken. On the lateral X-ray of lumbar,the sacral horizontal angles (lumbosacral angle) were measured; and on the X-ray of pelvis,the vertical distance of two side iliac crest (iliac crest difference), the distance from lateral border to medial margin of two hips (hip width),the clip angle between sacral spin connection and vertical axis were measured,and then the data were analyzed. The mean difference of iliac crest was (10.34+/-0.73) mm; the mean width difference of hip'was (6.73+/-1.01) mm; and the mean difference of the iliac crest was larger than that of mean difference of hip (P<0.01). The occurrence rate of inequal width of hip was higher(P<0.01). The mean abnormal lumbosacral angle was (7.29 +/- 1.86) degrees,and the mean angle of sacral crest tilting to left or right was (3.18 +/- 0.47) degrees; the mean abnormal lumbosacral angle was larger than that of angle of sacral crest tilting to left or right (P<0.01), and the occurrence rate of sacral crest tilting to left or right was higher

Severity mapping of the proximal femur: a new method for assessing hip osteoarthritis with computed tomography.

PubMed

Turmezei, T D; Lomas, D J; Hopper, M A; Poole, K E S

2014-10-01

Plain radiography has been the mainstay of imaging assessment in osteoarthritis for over 50 years, but it does have limitations. Here we present the methodology and results of a new technique for identifying, grading, and mapping the severity and spatial distribution of osteoarthritic disease features at the hip in 3D with clinical computed tomography (CT). CT imaging of 456 hips from 230 adult female volunteers (mean age 66 ± 17 years) was reviewed using 3D multiplanar reformatting to identify bone-related radiological features of osteoarthritis, namely osteophytes, subchondral cysts and joint space narrowing. Scoresheets dividing up the femoral head, head-neck region and the joint space were used to register the location and severity of each feature (scored from 0 to 3). Novel 3D cumulative feature severity maps were then created to display where the most severe disease features from each individual were anatomically located across the cohort. Feature severity maps showed a propensity for osteophytes at the inferoposterior and superolateral femoral head-neck junction. Subchondral cysts were a less common and less localised phenomenon. Joint space narrowing <1.5 mm was recorded in at least one sector of 83% of hips, but most frequently in the posterolateral joint space. This is the first description of hip osteoarthritis using unenhanced clinical CT in which we describe the co-localisation of posterior osteophytes and joint space narrowing for the first time. We believe this technique can perform several important roles in future osteoarthritis research, including phenotyping and sensitive disease assessment in 3D. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Characterization of CuCrZr and CuCrZr/SS joint strength for different blanket components manufacturing conditions

NASA Astrophysics Data System (ADS)

Gillia, Olivier; Briottet, Laurent; Chu, Isabelle; Lemoine, Patrick; Rigal, Emmanuel; Peacock, Alan

2009-04-01

This work describes studies on the strength of CuCrZr/SS joints for different manufacturing conditions foreseen for the fabrication of blanket components. In the meantime, as junction strength is expected to be strongly related to CuCrZr properties, investigation on the properties of the CuCrZr itself after the different manufacturing conditions is also presented. The initial manufacturing conditions retained were made of a HIP treatment combined with a fast cooling plus a subsequent ageing treatment. For security reasons, the HIP-quenching operation was not possible. A supplementary solutionning cycle with fast cooling has thus been inserted in the heat treatment process just after the HIP bonding treatment. The influence of solutionning temperature (1040 °C or 980 °C), the cooling rate after solutionning (70 °C/min to water quench), the ageing temperature (480 °C or 560 °C) and the HIP temperature (1040 °C or 980 °C) have been addressed. Test results show that the ageing temperature is very important for keeping high strength of material whereas elongation properties are not very sensible to the manufacturing conditions. 1040 °C HIP or solutionning temperature gives better strength properties, as well as a higher cooling rate after solutionning. Concerning samples with joints, it appears that CT test is more selective than other tests since tensile test does not give rupture at joint and KCU test eliminates a route without classifying other routes.

Effect of ankle braces on lower extremity joint energetics in single-leg landings.

PubMed

Gardner, Jacob K; McCaw, Steven T; Laudner, Kevin G; Smith, Peter J; Stafford, Lindsay N

2012-06-01

Ankle sprains are one of the most common injuries in competitive and recreational athletics. Studies have shown that the use of prophylactic ankle braces effectively reduces the frequency of ankle sprains in athletes. However, although it is generally accepted that the ankle braces are effective at reducing frontal plane motion, some researchers report that the design of the brace may also reduce ankle sagittal plane motion. The purpose of this study was to quantify lower extremity joint contributions to energy absorption during single-legged drop landings in three ankle brace conditions (no brace, boot brace, and hinged brace). Eleven physically active females experienced in landing and free of lower extremity injury (age = 22.3 ± 1.7 yr, height = 1.66 ± 0.04 m, mass = 58.43 ± 5.83 kg) performed 10 single-leg drop landings in three conditions (one unbraced, two braced) from a 0.33-m height. Measurements taken were hip, knee, and ankle joint impulse; hip, knee, ankle, and total work; and hip, knee, and ankle joint relative work. Total energy absorption remained consistent across the braced conditions (P = 0.057). Wearing the boot brace reduced relative ankle work (P = 0.04, Cohen d = 0.43) but did not change relative knee (P = 0.08, Cohen d = 0.32) or hip (P = 0.14, Cohen d = 0.20) work compared with the no-brace condition. In an ankle-braced condition, ankle, knee, and hip energetics may be altered depending on the design of the brace.

Adaptation of multijoint coordination during standing balance in healthy young and healthy old individuals

PubMed Central

Pasma, J. H.; Schouten, A. C.; Aarts, R. G. K. M.; Meskers, C. G. M.; Maier, A. B.; van der Kooij, H.

2015-01-01

Standing balance requires multijoint coordination between the ankles and hips. We investigated how humans adapt their multijoint coordination to adjust to various conditions and whether the adaptation differed between healthy young participants and healthy elderly. Balance was disturbed by push/pull rods, applying two continuous and independent force disturbances at the level of the hip and between the shoulder blades. In addition, external force fields were applied, represented by an external stiffness at the hip, either stabilizing or destabilizing the participants' balance. Multivariate closed-loop system-identification techniques were used to describe the neuromuscular control mechanisms by quantifying the corrective joint torques as a response to body sway, represented by frequency response functions (FRFs). Model fits on the FRFs resulted in an estimation of time delays, intrinsic stiffness, reflexive stiffness, and reflexive damping of both the ankle and hip joint. The elderly generated similar corrective joint torques but had reduced body sway compared with the young participants, corresponding to the increased FRF magnitude with age. When a stabilizing or destabilizing external force field was applied at the hip, both young and elderly participants adapted their multijoint coordination by lowering or respectively increasing their neuromuscular control actions around the ankles, expressed in a change of FRF magnitude. However, the elderly adapted less compared with the young participants. Model fits on the FRFs showed that elderly had higher intrinsic and reflexive stiffness of the ankle, together with higher time delays of the hip. Furthermore, the elderly adapted their reflexive stiffness around the ankle joint less compared with young participants. These results imply that elderly were stiffer and were less able to adapt to external force fields. PMID:26719084

Biotribology of artificial hip joints

PubMed Central

Di Puccio, Francesca; Mattei, Lorenza

2015-01-01

Hip arthroplasty can be considered one of the major successes of orthopedic surgery, with more than 350000 replacements performed every year in the United States with a constantly increasing rate. The main limitations to the lifespan of these devices are due to tribological aspects, in particular the wear of mating surfaces, which implies a loss of matter and modification of surface geometry. However, wear is a complex phenomenon, also involving lubrication and friction. The present paper deals with the tribological performance of hip implants and is organized in to three main sections. Firstly, the basic elements of tribology are presented, from contact mechanics of ball-in-socket joints to ultra high molecular weight polyethylene wear laws. Some fundamental equations are also reported, with the aim of providing the reader with some simple tools for tribological investigations. In the second section, the focus moves to artificial hip joints, defining materials and geometrical properties and discussing their friction, lubrication and wear characteristics. In particular, the features of different couplings, from metal-on-plastic to metal-on-metal and ceramic-on-ceramic, are discussed as well as the role of the head radius and clearance. How friction, lubrication and wear are interconnected and most of all how they are specific for each loading and kinematic condition is highlighted. Thus, the significant differences in patients and their lifestyles account for the high dispersion of clinical data. Furthermore, such consideration has raised a new discussion on the most suitable in vitro tests for hip implants as simplified gait cycles can be too far from effective implant working conditions. In the third section, the trends of hip implants in the years from 2003 to 2012 provided by the National Joint Registry of England, Wales and Northern Ireland are summarized and commented on in a discussion. PMID:25621213

Hip joint injection

MedlinePlus

... medicine into the joint. The provider uses a real-time x-ray (fluoroscopy) to see where to place ... Wakefield RJ. Arthrocentesis and injection of joints and soft tissue. In: Firestein GS, Budd RC, Gabriel SE, ...

Exploring the mechanical basis for acceleration: pelvic limb locomotor function during accelerations in racing greyhounds (Canis familiaris)

PubMed Central

Williams, S. B.; Usherwood, J. R.; Jespers, K.; Channon, A. J.; Wilson, A. M.

2009-01-01

Summary Animals in their natural environments are confronted with a regular need to perform rapid accelerations (for example when escaping from predators or chasing prey). Such acceleration requires net positive mechanical work to be performed on the centre of mass by skeletal muscle. Here we determined how pelvic limb joints contribute to the mechanical work and power that are required for acceleration in galloping quadrupeds. In addition, we considered what, if any, biomechanical strategies exist to enable effective acceleration to be achieved. Simultaneous kinematic and kinetic data were collected for racing greyhounds undergoing a range of low to high accelerations. From these data, joint moments and joint powers were calculated for individual hindlimb joints. In addition, the mean effective mechanical advantage (EMA) of the limb and the `gear ratio' of each joint throughout stance were calculated. Greatest increases in joint work and power with acceleration appeared at the hip and hock joints, particularly in the lead limb. Largest increases in absolute positive joint work occurred at the hip, consistent with the hypothesis that quadrupeds power locomotion by torque about the hip. In addition, hindlimb EMA decreased substantially with increased acceleration – a potential strategy to increase stance time and thus ground impulses for a given peak force. This mechanism may also increase the mechanical advantage for applying the horizontal forces necessary for acceleration. PMID:19181903

Direct and indirect markers of cartilage metabolism in synovial fluid obtained from dogs with hip dysplasia and correlation with clinical and radiographic variables.

PubMed

Fujita, Yukihiro; Hara, Yasushi; Nezu, Yoshinori; Yamaguchi, Shinya; Schulz, Kurt S; Tagawa, Masahiro

2005-12-01

To compare activities of interleukin (IL)-1beta, IL-6, tumor necrosis factor (TNF)-alpha, and matrix metalloproteinase (MMP)-3 and contents of sulfated glycosaminoglycan (S-GAG) in joint fluid obtained from dogs with hip dysplasia (HD) and clinically normal dogs, evaluate correlations among these markers in joint fluid obtained from dogs with HD, and evaluate correlations between each marker and clinical and radiographic variables. Animals-26 dogs with HD (clinical group) and 43 clinically normal Beagles (control group). Joint fluid was aseptically collected from the hip joints of all dogs. For each dog in the clinical group, age, duration of lameness, radiographic osteoarthritis (OA) score, and Norberg angle in each affected joint were recorded. Activities of IL-1beta, IL-6, TNF-alpha, and MMP-3 and S-GAG contents were measured. Values were compared between groups by use of Mann-Whitney U tests, and the Spearman rank correlation test was used to evaluate correlations among markers and between each marker and clinical or radiographic variables. Values of all markers were significantly higher for the clinical group, compared with values for the control group. There was a moderate positive correlation between lameness duration and IL-6 activity and a strong negative correlation between the Norberg angle and IL-1beta activity. Analysis of our results indicated that there was a significant increase in markers of OA in dogs with HD. Activities of IL-1beta and IL-6 in joint fluid of dogs with HD may be influenced by the severity of laxity in the hip joint and lameness duration, respectively.

The role of muscular co-contraction of the hip during movement.

PubMed

Catani, F; Hodge, A; Mann, R W; Ensini, A; Giannini, S

1995-01-01

The joint biomechanics of the hip was studied analyzing the kinematic, kinetic, electromyographic and in vivo pressure parameters during walking, going up stairs, and getting up from a chair. The most significant clinical and biomechanical data emerged when the temporal correlation between intra-articular pressure variations and electric activity of the bi-articular muscles was studied. The presence of co-contraction of the bi-articular muscles during the support and oscillation phases was evident. The maximum joint pressure values were measured while getting up from a chair when the hip was flexed more than 100 degrees. The posterior region of the acetabulum was that most submitted to loading. This data is useful in gaining an understanding of joint physiology, in correctly setting up physio-kinesitherapeutic protocols, and in setting up pre-clinical prosthetic mechanical tests.

Development of a hip joint model for finite volume simulations.

PubMed

Cardiff, P; Karač, A; FitzPatrick, D; Ivanković, A

2014-01-01

This paper establishes a procedure for numerical analysis of a hip joint using the finite volume method. Patient-specific hip joint geometry is segmented directly from computed tomography and magnetic resonance imaging datasets and the resulting bone surfaces are processed into a form suitable for volume meshing. A high resolution continuum tetrahedral mesh has been generated, where a sandwich model approach is adopted; the bones are represented as a stiffer cortical shells surrounding more flexible cancellous cores. Cartilage is included as a uniform thickness extruded layer and the effect of layer thickness is investigated. To realistically position the bones, gait analysis has been performed giving the 3D positions of the bones for the full gait cycle. Three phases of the gait cycle are examined using a finite volume based custom structural contact solver implemented in open-source software OpenFOAM.

Modulation of joint moments and work in the goat hindlimb with locomotor speed and surface grade

PubMed Central

Arnold, Allison S.; Lee, David V.; Biewener, Andrew A.

2013-01-01

SUMMARY Goats and other quadrupeds must modulate the work output of their muscles to accommodate the changing mechanical demands associated with locomotion in their natural environments. This study examined which hindlimb joint moments goats use to generate and absorb mechanical energy on level and sloped surfaces over a range of locomotor speeds. Ground reaction forces and the three-dimensional locations of joint markers were recorded as goats walked, trotted and galloped over 0, +15 and −15 deg sloped surfaces. Net joint moments, powers and work were estimated at the goats' hip, knee, ankle and metatarsophalangeal joints throughout the stance phase via inverse dynamics calculations. Differences in locomotor speed on the level, inclined and declined surfaces were characterized and accounted for by fitting regression equations to the joint moment, power and work data plotted versus non-dimensionalized speed. During level locomotion, the net work generated by moments at each of the hindlimb joints was small (less than 0.1 J kg−1 body mass) and did not vary substantially with gait or locomotor speed. During uphill running, by contrast, mechanical energy was generated at the hip, knee and ankle, and the net work at each of these joints increased dramatically with speed (P<0.05). The greatest increases in positive joint work occurred at the hip and ankle. During downhill running, mechanical energy was decreased in two main ways: goats generated larger knee extension moments in the first half of stance, absorbing energy as the knee flexed, and goats generated smaller ankle extension moments in the second half of stance, delivering less energy. The goats' hip extension moment in mid-stance was also diminished, contributing to the decrease in energy. These analyses offer new insight into quadrupedal locomotion, clarifying how the moments generated by hindlimb muscles modulate mechanical energy at different locomotor speeds and grades, as needed to accommodate the demands of variable terrain. PMID:23470662

Lower Limb Osteoarthritis and the Risk of Falls in a Community-Based Longitudinal Study of Adults with and without Osteoarthritis

PubMed Central

Doré, Adam L.; Golightly, Yvonne M.; Mercer, Vicki S.; Shi, Xiaoyan A.; Renner, Jordan B.; Jordan, Joanne M.; Nelson, Amanda E.

2014-01-01

Objective Knee and hip osteoarthritis (OA) are known risk factors for falls, but whether they together additionally contribute to falls risk is unknown. This study utilizes a biracial cohort of men and women to examine the influence of lower limb OA burden on the risk for future falls. Methods A longitudinal analysis was performed using data from 2 time points of a large cohort. The outcome of interest was falls at follow up. Covariates included age, sex, race, body mass index, a history of prior falls, symptomatic OA of the hip and/or knee, a history of neurologic or pulmonary diseases, and current use of narcotic medications. Symptomatic OA was defined as patient reported symptoms and radiographic evidence of OA in the same joint. Logistic regression analyses were used to determine associations between covariates and falls at follow-up. Results The odds of falling increased with an increasing number of lower limb symptomatic OA joints: those with 1 joint had 53% higher odds, those with 2 joints had 74% higher odds, those with 3–4 OA joints had 85% higher odds. When controlling for covariates, patients who had symptomatic knee or hip OA had an increased likelihood of falling (aOR 1.39 95% CI [1.02, 1.88]; aOR 1.60 95% CI [1.14, 2.24], respectively). Conclusions This study reveals the risk for falls increases with additional symptomatic OA lower limb joints and confirms that symptomatic hip and knee OA are important risk factors for falls. PMID:25331686

Effect of walking velocity on hindlimb kinetics during stance in normal horses.

PubMed

Khumsap, S; Clayton, H M; Lanovaz, J L

2001-04-01

The objectives of this study were to measure the effect of walking velocity on net joint moments and joint powers in the hindlimb during stance and to use the data to predict these variables at different walking velocities. Videographic and force data were collected synchronously from 5 sound horses walking over a force plate at a range of velocities. Force and kinematic data from 56 trials were combined using an inverse dynamic solution to determine net joint moments and joint powers. Analysis by simple regression and correlation (P < 0.05, r2 > or = 0.30, r > 0.50) showed that, in early stance, there were significant velocity-dependent increases in the peak magnitudes of the following variables: extensor moment and positive power at the hip, flexor moment and positive power at the stifle, extensor moment, negative and positive power at the tarsus, and flexor moment and negative power at the fetlock. In late stance, there were significant velocity-dependent increases in the peak magnitudes of the following variables: flexor moment at the hip, negative power at the stifle and flexor moment and positive power at the tarsus. As velocity increased, the hip showed an increase in energy generation, whereas the tarsus showed increases in both energy generation and absorption. It is concluded that an increase in walking velocity is associated with increases in peak magnitudes of the net joint moments and joint powers in the hindlimb; and that energy generation at the hip makes the largest contribution to the increase in velocity.

Hip Surveillance in Children with Cerebral Palsy.

PubMed

Huser, Aaron; Mo, Michelle; Hosseinzadeh, Pooya

2018-04-01

The hip is the second most common involved joint in cerebral palsy. Hip displacement occurs in more than 33% of children with cerebral palsy, with a higher prevalence in nonambulatory children. Hip displacement in this population is typically progressive. Hip dislocation can result in pain and difficulty with sitting and perineal care. Since early stage of hip displacement can be silent, and hip surveillance programs are recommended. Most programs use the degree of hip dysplasia and Growth Motor Function Classification System level for screening recommendations. Treatment depends on the degree of dysplasia, functional status of the patient, and patient's age. Copyright © 2017 Elsevier Inc. All rights reserved.

Lower Limb Kinematics and Dynamic Postural Stability in Anterior Cruciate Ligament-Reconstructed Female Athletes

PubMed Central

Delahunt, Eamonn; Chawke, Mark; Kelleher, Judy; Murphy, Katie; Prendiville, Anna; Sweeny, Lauren; Patterson, Matt

2013-01-01

Context: Deficits in lower limb kinematics and postural stability are predisposing factors to the development of knee ligamentous injury. The extent to which these deficits are present after anterior cruciate ligament (ACL) reconstruction is still largely unknown. The primary hypothesis of the present study was that female athletes who have undergone ACL reconstruction and who have returned to sport participation would exhibit deficits in dynamic postural stability as well as deficiencies in hip- and knee-joint kinematics when compared with an age-, activity-, and sex-matched uninjured control group. Objective: To investigate dynamic postural stability as quantified by the Star Excursion Balance Test (SEBT) and simultaneous hip- and knee-joint kinematic profiles in female athletes who have undergone ACL reconstruction. Design: Descriptive laboratory study. Setting: University motion-analysis laboratory. Patients or Other Participants: Fourteen female athletes who had previously undergone ACL reconstruction (ACL-R) and 17 age- and sex-matched uninjured controls. Intervention(s): Each participant performed 3 trials of the anterior, posterior-medial, and posterior-lateral directional components of the SEBT. Main Outcome Measure(s): Reach distances for each directional component were quantified and expressed as a percentage of leg length. Simultaneous hip- and knee-joint kinematic profiles were recorded using a motion-analysis system. Results: The ACL-R group had decreased reach distances on the posterior-medial (P < .01) and posterior-lateral (P < .01) directional components of the SEBT. During performance of the directional components of the SEBT, ACL-R participants demonstrated altered hip-joint frontal-, sagittal-, and transverse-plane kinematic profiles (P < .05), as well as altered knee-joint sagittal-plane kinematic profiles (P < .05). Conclusions: Deficits in dynamic postural stability and concomitant altered hip- and knee-joint kinematics are present after ACL reconstruction and return to competitive activity. The extent to which these deficits influence potential future injury is worthy of investigation. PMID:23672381

Effect of exoskeletal joint constraint and passive resistance on metabolic energy expenditure: Implications for walking in paraplegia.

PubMed

Chang, Sarah R; Kobetic, Rudi; Triolo, Ronald J

2017-01-01

An important consideration in the design of a practical system to restore walking in individuals with spinal cord injury is to minimize metabolic energy demand on the user. In this study, the effects of exoskeletal constraints on metabolic energy expenditure were evaluated in able-bodied volunteers to gain insight into the demands of walking with a hybrid neuroprosthesis after paralysis. The exoskeleton had a hydraulic mechanism to reciprocally couple hip flexion and extension, unlocked hydraulic stance controlled knee mechanisms, and ankles fixed at neutral by ankle-foot orthoses. These mechanisms added passive resistance to the hip (15 Nm) and knee (6 Nm) joints while the exoskeleton constrained joint motion to the sagittal plane. The average oxygen consumption when walking with the exoskeleton was 22.5 ± 3.4 ml O2/min/kg as compared to 11.7 ± 2.0 ml O2/min/kg when walking without the exoskeleton at a comparable speed. The heart rate and physiological cost index with the exoskeleton were at least 30% and 4.3 times higher, respectively, than walking without it. The maximum average speed achieved with the exoskeleton was 1.2 ± 0.2 m/s, at a cadence of 104 ± 11 steps/min, and step length of 70 ± 7 cm. Average peak hip joint angles (25 ± 7°) were within normal range, while average peak knee joint angles (40 ± 8°) were less than normal. Both hip and knee angular velocities were reduced with the exoskeleton as compared to normal. While the walking speed achieved with the exoskeleton could be sufficient for community ambulation, metabolic energy expenditure was significantly increased and unsustainable for such activities. This suggests that passive resistance, constraining leg motion to the sagittal plane, reciprocally coupling the hip joints, and weight of exoskeleton place considerable limitations on the utility of the device and need to be minimized in future designs of practical hybrid neuroprostheses for walking after paraplegia.

Knee contact forces and lower extremity support moments during running in young individuals post-partial meniscectomy.

PubMed

Willy, R W; Bigelow, M A; Kolesar, A; Willson, J D; Thomas, J S

2017-01-01

While partial meniscectomy results in a compromised tibiofemoral joint, little is known regarding tibiofemoral joint loading during running in individuals who are post-partial meniscectomy. It was hypothesized that individuals post-partial meniscectomy would run with a greater hip support moment, yielding reduced peak knee extension moments and reduced tibiofemoral joint contact forces. 3-D Treadmill running mechanics were evaluated in 23 athletic individuals post-partial meniscectomy (37.5 ± 19.0 months post-partial meniscectomy) and 23 matched controls. Bilateral hip, knee and ankle contributions to the total support moment and the peak knee extension moment were calculated. A musculoskeletal model estimated peak and impulse tibiofemoral joint contact forces. Knee function was quantified with the Knee injury and Osteoarthritis Outcome Score (KOOS). During running, the partial meniscectomy group had a greater hip support moment (p = 0.002) and a reduced knee support moment (p < 0.001) relative to the total support moment. This movement pattern was associated with a 14.5 % reduction (p = 0.019) in the peak knee extension moment. Despite these differences, there were no significant group differences in peak or impulse tibiofemoral joint contact forces. Lower KOOS Quality of Life scores were associated with greater hip support moment (p = 0.004, r = -0.58), reduced knee support moment (p = 0.006, r = 0.55) and reduced peak knee extension moment (p = 0.01, r = 0.52). Disordered running mechanics are present long term post-partial meniscectomy. A coordination strategy that shifts a proportion of the total support moment away from the knee to the hip reduces the peak knee extension moment, but does not equate to reduced tibiofemoral joint contact forces during running in individuals post-partial meniscectomy. III.

Association between contact hip stress and RSA-measured wear rates in total hip arthroplasties of 31 patients.

PubMed

The, Bertram; Hosman, Anton; Kootstra, Johan; Kralj-Iglic, Veronika; Flivik, Gunnar; Verdonschot, Nico; Diercks, Ron

2008-01-01

The main concern in the long run of total hip replacements is aseptic loosening of the prosthesis. Optimization of the biomechanics of the hip joint is necessary for optimization of long-term success. A widely implementable tool to predict biomechanical consequences of preoperatively planned reconstructions still has to be developed. A potentially useful model to this purpose has been developed previously. The aim of this study is to quantify the association between the estimated hip joint contact force by this biomechanical model and RSA-measured wear rates in a clinical setting. Thirty-one patients with a total hip replacement were measured with RSA, the gold standard for clinical wear measurements. The reference examination was done within 1 week of the operation and the follow-up examinations were done at 1, 2 and 5 years. Conventional pelvic X-rays were taken on the same day. The contact stress distribution in the hip joint was determined by the computer program HIPSTRESS. The procedure for the determination of the hip joint contact stress distribution is based on the mathematical model of the resultant hip force in the one-legged stance and the mathematical model of the contact stress distribution. The model for the force requires as input data, several geometrical parameters of the hip and the body weight, while the model for stress requires as input data, the magnitude and direction of the resultant hip force. The stress distribution is presented by the peak stress-the maximal value of stress on the weight-bearing area (p(max)) and also by the peak stress calculated with respect to the body weight (p(max)/W(B)) which gives the effect of hip geometry. Visualization of the relations between predicted values by the model and the wear at different points in the follow-up was done using scatterplots. Correlations were expressed as Pearson r values. The predicted p(max) and wear were clearly correlated in the first year post-operatively (r = 0.58, p = 0.002), while this correlation is weaker after 2 years (r = 0.19, p = 0.337) and 5 years (r = 0.24, p = 0.235). The wear values at 1, 2 and 5 years post-operatively correlate with each other in the way that is expected considering the wear velocity curve of the whole group. The correlation between the predicted p(max) values of two observers who were blinded for each other's results was very good (r = 0.93, p < 0.001). We conclude that the biomechanical model used in this paper provides a scientific foundation for the development of a new way of constructing preoperative biomechanical plans for total hip replacements.

Lower limb joint motion during a cross cutting movement differs in individuals with and without chronic ankle instability.

PubMed

Koshino, Yuta; Yamanaka, Masanori; Ezawa, Yuya; Ishida, Tomoya; Kobayashi, Takumi; Samukawa, Mina; Saito, Hiroshi; Takeda, Naoki

2014-11-01

To compare the kinematics of lower limb joints between individuals with and without chronic ankle instability (CAI) during cross-turn and -cutting movements. Cross-sectional study. Motion analysis laboratory. Twelve subjects with CAI and twelve healthy controls. Hip flexion, adduction, and internal rotation, knee flexion, and ankle dorsiflexion and inversion angles were calculated in the 200 ms before initial ground contact and from initial ground contact to toe-off (stance phase) in a cross-turn movement during gait and a cross-cutting movement from a forward jump, and compared across the two groups. In the cross-cutting movement, the CAI group exhibited greater hip and knee flexion than the control group during the stance phase, and more hip abduction during the period before initial contact and the stance phase. In the cross-turn movement the joint kinematics were similar in the two groups. CAI subjects exhibited an altered pattern of the proximal joint kinematics during a cross-cutting movement. It is important for clinicians to assess the function of the hip and knee as well as the ankle, and to incorporate coordination training for the entire lower limb into rehabilitation after lateral ankle sprains. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Case report of a patient with ochronosis and arthroplasty of the hip and both knees].

PubMed

Moslavac, Aleksandra; Moslavac, Sasa; Cop, Renata

2003-01-01

Alkaptonuria is a rare hereditary metabolic disorder characterised by absence of the enzyme homogentisic acid oxidase. As a result of this defect homogentisic acid accumulates and is excreted in the urine. The term ochronosis is used to describe bluish-black pigmentation of connective tissue. Ochronotic arthropathy results from the pigmented deposits in the joints of the appendicular and axial skeleton. Findings simulate those of uncomplicated degenerative joint disease, with effusion, articular space narrowing, and bony sclerosis. Our patient is a 70-year old male with ochronotic arthropathy. He has typical ears and sclera discoloration, and had arthroplasty of knees 7 and 4 years ago, respectively. In year 2002, he had undergone total right hip arthroplasty and has been admitted for rehabilitation 14th postoperative day. Individually designed rehabilitation regimen included kinesitherapy, hydrokinesitherapy, and ambulation training with gradual increase in weight bearing exercises and electro-analgesia of associated low back pain. In course of rehabilitation our patient improved his endurance with satisfying range of motion of right hip (flexion 90 degrees, abduction 40 degrees) and strength of hip and thigh musculature. The patient was able to walk with crutches without limitation. We conclude that joint destruction followed by painful locomotion due to ochronotic arthropathy is best treated by total joint arthroplasty, as described in our patient.

The role of triple pelvic osteotomy in therapy of residual hip dysplasia and sequel of AVN: long-term experience.

PubMed

Dungl, P; Rejholec, M; Chomiak, J; Grill, F

2007-01-01

Triple pelvic osteotomy was performed for sequel of DDH including AVN between 1981 and 2002 for 329 patients (351 hips, 280 females, 49 males, average age at surgery 16.5 years, range 9-41 years, follow-up 4-25 years). A small modification of Steel's technique consisting of strictly subperiostal resection of segment from both pubic and ischial bone was used. Average gain of lengthening extremity was 1.8 cm. The average CE angle was improved from 7.8 to 35.5 degrees. Clinical results were evaluated according to Merle d'Aubigne and reflected to the preoperative clinical and radiological findings. There were 146 hip joints in 128 patients (76%) with excellent results in the group of congruent hips without arthrosis. In 182 hips in 178 patients with hip joints with some deformity, limited ROM and decentration, 40% were excellent, 32% good, 23% fair and 5% unsatisfactory results were achieved. The group of decentrated hip joints in young adults in incongruency, limited ROM and sometimes severe arthrosis consisted of 23 monolateral surgeries with 39% unsatisfactory, 39% fair and 22% good results, respectively. No major neurovascular complications were seen. Non-unions were recorded in 19 patients (5.4%), including 2 triple and 2 double non-unions. Based on our long-term experience, we can conclude that triple pelvic osteotomy according to Steel in our modification is a safe method and gives regularly excellent or good results for correction of clinical and radiographic appearance of acetabular dysplasia when there is a proper indication.

Computational measurement of joint space width and structural parameters in normal hips.

PubMed

Nishii, Takashi; Shiomi, Toshiyuki; Sakai, Takashi; Takao, Masaki; Yoshikawa, Hideki; Sugano, Nobuhiko

2012-05-01

Joint space width (JSW) of hip joints on radiographs in normal population may vary by related factors, but previous investigations were insufficient due to limitations of sources of radiographs, inclusion of subjects with osteoarthritis, and manual measurement techniques. We investigated influential factors on JSW using semiautomatic computational software on pelvic radiographs in asymptomatic subjects without radiological osteoarthritic findings. Global and local JSW at the medial, middle, and lateral compartments, and the hip structural parameters were measured in asymptomatic, normal 150 cases (300 hips), using a customized computational software. Reliability of measurement in global and local JSWs was high with intraobserver reproducibility (intraclass correlation coefficient) ranging from 0.957 to 0.993 and interobserver reproducibility ranging from 0.925 to 0.985. There were significant differences among three local JSWs, with the largest JSW at the lateral compartment. Global and medial local JSWs were significantly larger in the right hip, and global, medial and middle local JSWs were significantly smaller in women. Global and local JSWs were inversely correlated with CE angle and positively correlated with horizontal distance of the head center, but not correlated with body mass index in men and women. They were positively correlated with age and inversely correlated with vertical distance of the head center only in men. There were interindividual variations of JSW in normal population, depending on sites of the weight-bearing area, side, gender, age, and hip structural parameters. For accurate diagnosis and assessment of hip osteoarthritis, consideration of those influential factors other than degenerative change is important.

Relationships among body weight, joint moments generated during functional activities, and hip bone mass in older adults

PubMed Central

Wang, Man-Ying; Flanagan, Sean P.; Song, Joo-Eun; Greendale, Gail A.; Salem, George J.

2012-01-01

Objective To investigate the relationships among hip joint moments produced during functional activities and hip bone mass in sedentary older adults. Methods Eight male and eight female older adults (70–85 yr) performed functional activities including walking, chair sit–stand–sit, and stair stepping at a self-selected pace while instrumented for biomechanical analysis. Bone mass at proximal femur, femoral neck, and greater trochanter were measured by dual-energy X-ray absorptiometry. Three-dimensional hip moments were obtained using a six-camera motion analysis system, force platforms, and inverse dynamics techniques. Pearson’s correlation coefficients were employed to assess the relationships among hip bone mass, height, weight, age, and joint moments. Stepwise regression analyses were performed to determine the factors that significantly predicted bone mass using all significant variables identified in the correlation analysis. Findings Hip bone mass was not significantly correlated with moments during activities in men. Conversely, in women bone mass at all sites were significantly correlated with weight, moments generated with stepping, and moments generated with walking (p < 0.05 to p < 0.001). Regression analysis results further indicated that the overall moments during stepping independently predicted up to 93% of the variability in bone mass at femoral neck and proximal femur; whereas weight independently predicted up to 92% of the variability in bone mass at greater trochanter. Interpretation Submaximal loading events produced during functional activities were highly correlated with hip bone mass in sedentary older women, but not men. The findings may ultimately be used to modify exercise prescription for the preservation of bone mass. PMID:16631283

Weightlifting performance is related to kinematic and kinetic patterns of the hip and knee joints.

PubMed

Kipp, Kristof; Redden, Josh; Sabick, Michelle B; Harris, Chad

2012-07-01

The purpose of this study was to investigate the correlations between biomechanical outcome measures and weightlifting performance. Joint kinematics and kinetics of the hip, knee, and ankle were calculated while 10 subjects performed a clean at 85% of 1 repetition maximum (1RM). Kinematic and kinetic time-series patterns were extracted with principal components analysis. Discrete scores for each time-series pattern were calculated and used to determine how each pattern was related to body mass-normalized 1RM. Two hip kinematic and 2 knee kinetic patterns were significantly correlated with relative 1RM. The kinematic patterns captured hip and trunk motions during the first pull and hip joint motion during the movement transition between the first and second pulls. The first kinetic pattern captured a peak in the knee extension moment during the second pull. The second kinetic pattern captured a spatiotemporal shift in the timing and amplitude of the peak knee extension moment. The kinematic results suggest that greater lift mass was associated with steady trunk position during the first pull and less hip extension motion during the second-knee bend transition. Further, the kinetic results suggest that greater lift mass was associated with a smaller knee extensor moments during the first pull, but greater knee extension moments during the second pull, and an earlier temporal transition between knee flexion-extension moments at the beginning of the second pull. Collectively, these results highlight the importance of controlled trunk and hip motions during the first pull and rapid employment of the knee extensor muscles during the second pull in relation to weightlifting performance.

Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis.

PubMed

Reiman, Michael P; Goode, Adam P; Hegedus, Eric J; Cook, Chad E; Wright, Alexis A

2013-09-01

Hip Physical Examination (HPE) tests have long been used to diagnose a myriad of intra-and extra-articular pathologies of the hip joint. Useful clinical utility is necessary to support diagnostic imaging and subsequent surgical decision making. Summarise and evaluate the current research and utility on the diagnostic accuracy of HPE tests for the hip joint germane to sports related injuries and pathology. A computer-assisted literature search of MEDLINE, CINHAL and EMBASE databases (January 1966 to January 2012) using keywords related to diagnostic accuracy of the hip joint. This systematic review with meta-analysis utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the search and reporting phases of the study. Der-Simonian and Laird random effects models were used to summarise sensitivities (SN), specificities (SP), likelihood ratios and diagnostic OR. The employed search strategy revealed 25 potential articles, with 10 demonstrating high quality. Fourteen articles qualified for meta-analysis. The meta-analysis demonstrated that most tests possess weak diagnostic properties with the exception of the patellar-pubic percussion test, which had excellent pooled SN 95 (95% CI 92 to 97%) and good specificity 86 (95% CI 78 to 92%). Several studies have investigated pathology in the hip. Few of the current studies are of substantial quality to dictate clinical decision-making. Currently, only the patellar-pubic percussion test is supported by the data as a stand-alone HPE test. Further studies involving high quality designs are needed to fully assess the value of HPE tests for patients with intra- and extra-articular hip dysfunction.

Robotic gait trainer in water: development of an underwater gait-training orthosis.

PubMed

Miyoshi, Tasuku; Hiramatsu, Kazuaki; Yamamoto, Shin-Ichiro; Nakazawa, Kimitaka; Akai, Masami

2008-01-01

To develop a robotic gait trainer that can be used in water (RGTW) and achieve repetitive physiological gait patterns to improve the movement dysfunctions. The RGTW is a hip-knee-ankle-foot orthosis with pneumatic actuators; the control software was developed on the basis of the angular motions of the hip and knee joint of a healthy subject as he walked in water. Three-dimensional motions and electromyographic (EMG) activities were recorded in nine healthy subjects to evaluate the efficacy of using the RGTW while walking on a treadmill in water. The device could preserve the angular displacement patterns of the hip and knee and foot trajectories under all experimental conditions. The tibialis anterior EMG activities in the late swing phase and the biceps femoris throughout the stance phase were reduced whose joint torques were assisted by the RGTW while walking on a treadmill in water. Using the RGTW could expect not only the effect of the hydrotherapy but also the standard treadmill gait training, in particular, and may be particularly effective for treating individuals with hip joint movement dysfunction.

The Immediate Effect of Neuromuscular Joint Facilitation (NJF) Treatment on Hip Muscle Strength.

PubMed

Wang, Hongdan; Huo, Ming; Huang, Qiuchen; Li, Desheng; Maruyama, Hitoshi

2013-11-01

[Purpose] This study investigated the change in hip muscle strength of younger persons after neuromuscular joint facilitation (NJF) treatment. [Subjects] The subjects were 45 healthy young people, who were divided into two groups: a NJF group and a proprioceptive neuromuscular facilitation (PNF) group. The NJF group consisted of 21 subjects (11 males, 10 females), and the PNF group consisted of 24 subjects (11 males, 13 females). [Methods] Participants in the NJF group received NJF treatment. We measured the maximal flexor strength and the maximal extensor strength during isokinetic movement of the hip joint before and after intervention in both groups. The angular velocities used were 60°/sec and 180°/sec. [Results] The NJF group showed significant increases in the maximal flexor strength and the maximal extensor strength after the intervention at each angular velocity. In the PNF group, the maximal flexor strength of 60°/sec and the maximal extensor strength of 180°/sec were significant increases. [Conclusion] These results suggest that there is an immediate effect of NJF intervention on hip muscle strength.

In-situ Generated Tribomaterial in Metal/Metal Contacts: current understanding and future implications for implants.

PubMed

Espallargas, N; Fischer, A; Muñoz, A Igual; Mischler, S; Wimmer, M A

2017-06-01

Artificial hip joints operate in aqueous biofluids that are highly reactive towards metallic surfaces. The reactivity at the metal interface is enhanced by mechanical interaction due to friction, which can change the near-surface structure of the metal and surface chemistry. There are now several reports in the literature about the in-situ generation of reaction films and tribo-metallurgical transformations on metal-on-metal hip joints. This paper summarizes current knowledge and provides a mechanistic interpretation of the surface chemical and metallurgical phenomena. Basic concepts of corrosion and wear are illustrated and used to interpret available literature on in-vitro and in-vivo studies of metal-on-metal hip joints. Based on this review, three forms of tribomaterial, characterized by different combinations of oxide films and organic layers, can be determined. It is shown that the generation of these tribofilms can be related to specific electrochemical and mechanical phenomena in the metal interface. It is suggested that the generation of this surface reaction layer constitutes a way to minimize (mechanical) wear of MoM hip implants.

In-situ Generated Tribomaterial in Metal/Metal Contacts: current understanding and future implications for implants

PubMed Central

Espallargas, N.; Fischer, A.; Muñoz, A. Igual; Mischler, S.; Wimmer, M.A.

2017-01-01

Artificial hip joints operate in aqueous biofluids that are highly reactive towards metallic surfaces. The reactivity at the metal interface is enhanced by mechanical interaction due to friction, which can change the near-surface structure of the metal and surface chemistry. There are now several reports in the literature about the in-situ generation of reaction films and tribo-metallurgical transformations on metal-on-metal hip joints. This paper summarizes current knowledge and provides a mechanistic interpretation of the surface chemical and metallurgical phenomena. Basic concepts of corrosion and wear are illustrated and used to interpret available literature on in-vitro and in-vivo studies of metal-on-metal hip joints. Based on this review, three forms of tribomaterial, characterized by different combinations of oxide films and organic layers, can be determined. It is shown that the generation of these tribofilms can be related to specific electrochemical and mechanical phenomena in the metal interface. It is suggested that the generation of this surface reaction layer constitutes a way to minimize (mechanical) wear of MoM hip implants. PMID:28808674

Prednisone

MedlinePlus

... improves when the drug is decreased or discontinued. Avascular Necrosis of Bone For reasons that are not known, ... joint damage, most often of the hips. In avascular necrosis (or osteonecrosis, meaning “bone death”) of the hip, ...

Healthcare Utilization and Costs of Knee or Hip Replacements versus Pain-Relief Injections

PubMed Central

Pasquale, Margaret K.; Louder, Anthony M.; Cheung, Raymond Y.; Reiners, Andrew T.; Mardekian, Jack; Sanchez, Robert J.; Goli, Veerainder

2015-01-01

Background Given the dramatic increase in total knee and hip replacement procedures among the US population aged 45 years and older, there is a need to compare the downstream healthcare utilization and costs between patients who undergo joint replacement and those who receive intraarticular injections as a low-cost alternative. Objective To compare changes in osteoarthritis (OA)-related healthcare utilization and costs for Medicare members with OA who underwent knee or hip replacement versus those receiving steroid or viscosupplementation injections. Methods Medicare members aged ≥45 years diagnosed with OA were identified for this retrospective longitudinal study. Data were compared for patients who underwent primary knee or hip replacement surgery between July 1, 2007, and June 30, 2012, and those receiving injection of pain-relief medication during the same period. The date of joint replacement surgery was considered the index date. For the comparison cohort, the index date was 180 days postinjection of the first intraarticular injection. Medical and pharmacy claims were examined longitudinally in 90-day increments, from 180 days preindex until 360 days postindex. Difference-in-difference analyses were conducted to compare the change in OA-related healthcare costs, postindex versus preindex, between the study cohorts. Time-to-event analyses were used to measure rates of readmissions and venous thromboembolism (VTE). Results The mean age was 70.7 years for patients with knee replacement, 71.7 years for those with hip replacement, and 71.1 years for those receiving pain-relief injection (P <.0001). The RxRisk-V comorbidity index scores were 4.7, 4.4, and 4.8, respectively (P <.0001). Difference-in-difference analyses indicated that decreases in OA-related costs were greater for the joint replacement cohorts (coefficient for knee replacement*time: −0.603; hip replacement*time: −0.438; P <.001 for both) than for the comparison cohort. The VTE rates were 5.6% (knee) and 5.1% (hip) postsurgery versus 1.4% (knee) and 1.3% (hip) presurgery. Conclusion The overall difference-in-difference results showed a greater decrease in healthcare utilization and costs for the members with joint replacement than for those receiving injection. PMID:26557232

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers.

PubMed

Boelch, Sebastian Philipp; Weissenberger, Manuel; Spohn, Frederik; Rudert, Maximilian; Luedemann, Martin

2018-01-10

Evaluation of infection persistence during the two-stage exchange of the hip is challenging. Joint aspiration before reconstruction is supposed to rule out infection persistence. Sensitivity and specificity of synovial fluid culture and synovial leucocyte count for detecting infection persistence during the two-stage exchange of the hip were evaluated. Ninety-two aspirations before planned joint reconstruction during the two-stage exchange with spacers of the hip were retrospectively analyzed. The sensitivity and specificity of synovial fluid culture was 4.6 and 94.3%. The sensitivity and specificity of synovial leucocyte count at a cut-off value of 2000 cells/μl was 25.0 and 96.9%. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values were significantly higher before prosthesis removal and reconstruction or spacer exchange (p = 0.00; p = 0.013 and p = 0.039; p = 0.002) in the infection persistence group. Receiver operating characteristic area under the curve values before prosthesis removal and reconstruction or spacer exchange for ESR were lower (0.516 and 0.635) than for CRP (0.720 and 0.671). Synovial fluid culture and leucocyte count cannot rule out infection persistence during the two-stage exchange of the hip.

Hip and knee extensor moments predict vertical jump height in adolescent girls.

PubMed

Ford, Kevin R; Myer, Gregory D; Brent, Jensen L; Hewett, Timothy E

2009-07-01

Biomechanical factors, such as hip and knee extensor moments, related to drop jump (DJ) performance have not been investigated in adolescent girls. The purpose of this study was to determine the key independent biomechanical variables that predict overall vertical jump performance in adolescent girls. Sixteen high school adolescent girls from club-sponsored and high school-sponsored volleyball teams performed DJ at 3 different drop heights (15, 30, and 45 cm). A motion analysis system consisting of 10 digital cameras and a force platform was used to calculate vertical jump height, joint angles, and joint moments during the tasks. A multiple linear regression was used to determine the biomechanical parameters that were best predictive of vertical jump height at each box drop distance. The 2 predictor variables in all 3 models were knee and hip extensor moments. The models predicted 82.9, 81.9, and 88% of the vertical jump height variance in the 15, 30, and 45 cm trials, respectively. The results of the investigation indicate that knee and hip joint moments are the main contributors to vertical jump height during the DJ in adolescent girls. Strength and conditioning specialists attempting to improve vertical jump performance should target power and strength training to the hip and knee extensors in their athletes.

A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis of the hip or knee: protocol of a prospective randomised controlled clinical trial

PubMed Central

Schencking, Martin; Otto, Adriane; Deutsch, Tobias; Sandholzer, Hagen

2009-01-01

Background The increasing age of the population, especially in the western world, means that the prevalence of osteoarthritis is also increasing, with corresponding socioeconomic consequences. Although there is no curative intervention at present, in accordance with US and European guidelines, pharmacotherapeutic and non-pharmacological approaches aim at pain control and the reduction of functional restriction. It has been established that hydrotherapy for osteoarthritis of the hip or knee joint using serial cold and warm water stimulation not only improves the range of movement but also reduces pain significantly and increases quality of life over a period of up to three months. Weight reduction is important for patients with osteoarthritis of the hip or knee. In addition, conventional physiotherapy and exercise therapy have both been shown, at a high level of evidence, to be cost-effective and to have long-term benefits for pain relief, movement in the affected joint, and patient quality of life. Methods/design The study design consists of a prospective randomised controlled three-armed clinical trial, which will be carried out at a specialist clinic for integrative medicine, to investigate the clinical effects of hydrotherapy on osteoarthritis of the knee or hip joint, in comparison with conventional physiotherapy. One hundred and eighty patients diagnosed with osteoarthritis of hip or knee will be randomly assigned to one of three intervention groups: hydrotherapy, physiotherapy, and both physiotherapy and hydrotherapy of the affected joint. In the first group, patients will receive Kneipp hydrotherapy daily, with water applied in the form of alternate cold and warm thigh affusions (alternating cold and warm water stimulation is particularly relevant to the knee and hip regions). Patients in the second group will receive physiotherapy of the hip or knee joint three times a week. Patients in the physiotherapy-hydrotherapy combination group will receive both joint-specific physiotherapy three times a week and alternate cold and warm thigh affusions every day. Follow-up assessments will be on three levels: clinical assessment by the investigator; subjective patient assessment consisting of a patient diary, and questionnaires on admission and at the end of the treatment phase; and a final telephone assessment by the external evaluation centre. Assessments will be made at baseline, after two weeks of inpatient treatment, and finally after a further ten weeks of follow-up. The primary outcome measure will be pain intensity of the affected joint in the course of inpatient treatment, judged by the patient and the investigator. Secondary outcomes include health-related quality of life and joint-specific pain and mobility in the course of the study. Statistical analysis of the results will be on an intention-to-treat basis. Conclusion This study methodology has been conceived according to the standards of the CONSORT recommendations. The results will contribute to establishing hydrotherapy as a non-invasive, non-interventional, reasonably priced, therapeutic option with few side effects, in the concomitant treatment of osteoarthritis of the hip or knee. Trial Registration Trial registration number: NCT 00950326 PMID:19689824

A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis of the hip or knee: protocol of a prospective randomised controlled clinical trial.

PubMed

Schencking, Martin; Otto, Adriane; Deutsch, Tobias; Sandholzer, Hagen

2009-08-19

The increasing age of the population, especially in the western world, means that the prevalence of osteoarthritis is also increasing, with corresponding socioeconomic consequences. Although there is no curative intervention at present, in accordance with US and European guidelines, pharmacotherapeutic and non-pharmacological approaches aim at pain control and the reduction of functional restriction.It has been established that hydrotherapy for osteoarthritis of the hip or knee joint using serial cold and warm water stimulation not only improves the range of movement but also reduces pain significantly and increases quality of life over a period of up to three months. Weight reduction is important for patients with osteoarthritis of the hip or knee. In addition, conventional physiotherapy and exercise therapy have both been shown, at a high level of evidence, to be cost-effective and to have long-term benefits for pain relief, movement in the affected joint, and patient quality of life. The study design consists of a prospective randomised controlled three-armed clinical trial, which will be carried out at a specialist clinic for integrative medicine, to investigate the clinical effects of hydrotherapy on osteoarthritis of the knee or hip joint, in comparison with conventional physiotherapy.One hundred and eighty patients diagnosed with osteoarthritis of hip or knee will be randomly assigned to one of three intervention groups: hydrotherapy, physiotherapy, and both physiotherapy and hydrotherapy of the affected joint. In the first group, patients will receive Kneipp hydrotherapy daily, with water applied in the form of alternate cold and warm thigh affusions (alternating cold and warm water stimulation is particularly relevant to the knee and hip regions).Patients in the second group will receive physiotherapy of the hip or knee joint three times a week. Patients in the physiotherapy-hydrotherapy combination group will receive both joint-specific physiotherapy three times a week and alternate cold and warm thigh affusions every day. Follow-up assessments will be on three levels: clinical assessment by the investigator; subjective patient assessment consisting of a patient diary, and questionnaires on admission and at the end of the treatment phase; and a final telephone assessment by the external evaluation centre. Assessments will be made at baseline, after two weeks of inpatient treatment, and finally after a further ten weeks of follow-up. The primary outcome measure will be pain intensity of the affected joint in the course of inpatient treatment, judged by the patient and the investigator. Secondary outcomes include health-related quality of life and joint-specific pain and mobility in the course of the study. Statistical analysis of the results will be on an intention-to-treat basis. This study methodology has been conceived according to the standards of the CONSORT recommendations. The results will contribute to establishing hydrotherapy as a non-invasive, non-interventional, reasonably priced, therapeutic option with few side effects, in the concomitant treatment of osteoarthritis of the hip or knee. NCT 00950326.

Is twin pregnancy a risk factor for devolopmental dysplasia of the hip - retrospective analysis using ultrasonography.

PubMed

Czubak, Jarosław; Mazela, Jan L; Majda, Waldemar; Woźniak, Waldemar

2003-12-30

Background. Disorders in development of the hip in the uterus are caused mainly by mechanical factors. Their influence has been established on the basis of the results of examinations of newborns from singleton pregancies. Malposition of the fetus and the lack of space in the uterus are present in higher frequency in twin pregnancies. Thus, it is probable, that twin pregnacy may be a risk factor in developmental dysplasia of the hip.
Material and methods. We examined clinically and ultrasonographically 308 hip joints of 154 newborn twins and compare the values of the alpha related to different position in uterus, birthweight, gender, length of gestation and mode of delivery. The only pathological position of the fetus in the uterus is the tranverse one.
Results and Conclusions. The results of ultrasound examinations reveal that in the cramped space inside the uterus in twin pregnancies hip joints develop in different conditions than in singleton pregnancies and the twin pregnancy cannot be regarded as a risk factor which may cause developmental dysplasia of the hip.

Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living.

PubMed

Yoshida, H; Faust, A; Wilckens, J; Kitagawa, M; Fetto, J; Chao, Edmund Y-S

2006-01-01

Estimation of the hip joint contact area and pressure distribution during activities of daily living is important in predicting joint degeneration mechanism, prosthetic implant wear, providing biomechanical rationales for preoperative planning and postoperative rehabilitation. These biomechanical data were estimated utilizing a generic hip model, the Discrete Element Analysis technique, and the in vivo hip joint contact force data. The three-dimensional joint potential contact area was obtained from the anteroposterior radiograph of a subject and the actual joint contact area and pressure distribution in eight activities of daily living were calculated. During fast, normal, and slow walking, the peak pressure of moderate magnitude was located at the lateral roof of the acetabulum during mid-stance. In standing up and sitting down, and during knee bending, the peak pressures were located at the edge of the posterior horn and the magnitude of the peak pressure during sitting down was 2.8 times that of normal walking. The peak pressure was found at the lateral roof in climbing up stairs which was higher than that in going down stairs. These results can be used to rationalize rehabilitation protocols, functional restrictions after complex acetabular reconstructions, and prosthetic component wear and fatigue test set up. The same model and analysis can provide further insight to soft tissue loading and pathology such as labral injury. When the pressure distribution on the acetabulum is inverted onto the femoral head, prediction of subchondral bone collapse associated with avascular necrosis can be achieved with improved accuracy.

Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging.

PubMed

Battaglia, Patrick J; D'Angelo, Kevin; Kettner, Norman W

2016-12-01

The purpose of this study was to present a narrative review of the literature of musculoskeletal causes of adult hip pain, with special attention to history, physical examination, and diagnostic imaging. A narrative review of the English medical literature was performed by using the search terms "hip pain" AND "anterior," "lateral," and "posterior." Additionally, specific entities of hip pain or pain referral sources to the hip were searched for. We used the PubMed search engine through January 15, 2016. Musculoskeletal sources of adult hip pain can be divided into posterior, lateral, and anterior categories. For posterior hip pain, select considerations include lumbar spine and femoroacetabular joint referral, sacroiliac joint pathology, piriformis syndrome, and proximal hamstring tendinopathy. Gluteal tendinopathy and iliotibial band thickening are the most common causes of lateral hip pain. Anterior hip pain is further divided into causes that are intra-articular (ie, labral tear, osteoarthritis, osteonecrosis) and extra-articular (ie, snapping hip and inguinal disruption [athletic pubalgia]). Entrapment neuropathies and myofascial pain should also be considered in each compartment. A limited number of historical features and physical examination tests for evaluation of adult hip pain are supported by the literature and are discussed in this article. Depending on the clinical differential, the gamut of diagnostic imaging modalities recommended for accurate diagnosis include plain film radiography, computed tomography, magnetic resonance imaging, skeletal scintigraphy, and ultrasonography. The evaluation of adult hip pain is challenging. Clinicians should consider posterior, lateral, and anterior sources of pain while keeping in mind that these may overlap.

Relative Intensity Influences the Degree of Correspondence of Jump Squats and Push Jerks to Countermovement Jumps.

PubMed

Cushion, Emily J; Goodwin, Jon E; Cleather, Daniel J

2016-05-01

The aim of this study was to determine the mechanical similarity between push jerk (PJ) and jump squat (JS) to countermovement jump (CMJ) and further understand the effect increasing external load may have on this relationship. Eight physically trained men (age 22 ± 3; height 176 ± 7 kg; weight 83 ± 8 kg) performed an unloaded CMJ followed by JS under a range of loads (10, 25, 35, and 50% 1RM back squat) and PJ (30, 50, 65, and 75% 1RM push jerk). A portable force platform and high-speed camera both collecting at 250 Hz were used to establish joint moments and impulse during the propulsive phase of the movements. A standard inverse dynamics model was used to determine joint moment and impulse at the hip, knee, and ankle. Significant correlations (p ≤ 0.05) were shown between CMJ knee joint moment and JS knee joint moment at 25% load and PJ knee joint moment at 30 and 50% load. Significant correlations were also observed between CMJ knee joint impulse and JS knee joint impulse at 10% load and PJ knee joint moment at 30 and 65% load. Significant correlation was also observed between CMJ hip joint impulse and PJ hip joint impulse at 30% load. No significant joint × load interaction was shown as load increased for either PJ or JS. Results from the study suggest partial correspondence between PJ and JS to CMJ, where a greater mechanical similarity was observed between the PJ and CMJ. This interaction is load and joint dependent where lower relative loads showed greatest mechanical similarity. Therefore using lower relative loads when programming may provide a greater transfer of training effect.

Knee joint contact mechanics during downhill gait and its relationship with varus/valgus motion and muscle strength in patients with knee osteoarthritis.

PubMed

Farrokhi, Shawn; Voycheck, Carrie A; Gustafson, Jonathan A; Fitzgerald, G Kelley; Tashman, Scott

2016-01-01

The objective of this exploratory study was to evaluate tibiofemoral joint contact point excursions and velocities during downhill gait and assess the relationship between tibiofemoral joint contact mechanics with frontal-plane knee joint motion and lower extremity muscle weakness in patients with knee osteoarthritis (OA). Dynamic stereo X-ray was used to quantify tibiofemoral joint contact mechanics and frontal-plane motion during the loading response phase of downhill gait in 11 patients with knee OA and 11 control volunteers. Quantitative testing of the quadriceps and the hip abductor muscles was also performed. Patients with knee OA demonstrated larger medial/lateral joint contact point excursions (p < 0.02) and greater heel-strike joint contact point velocities (p < 0.05) for the medial and lateral compartments compared to the control group. The peak medial/lateral joint contact point velocity of the medial compartment was also greater for patients with knee OA compared to their control counterparts (p = 0.02). Additionally, patients with knee OA demonstrated significantly increased frontal-plane varus motion excursions (p < 0.01) and greater quadriceps and hip abductor muscle weakness (p = 0.03). In general, increased joint contact point excursions and velocities in patients with knee OA were linearly associated with greater frontal-plane varus motion excursions (p < 0.04) but not with quadriceps or hip abductor strength. Altered contact mechanics in patients with knee OA may be related to compromised frontal-plane joint stability but not with deficits in muscle strength.

Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial.

PubMed

Hoeksma, Hugo L; Dekker, Joost; Ronday, H Karel; Heering, Annet; van der Lubbe, Nico; Vel, Cees; Breedveld, Ferdinand C; van den Ende, Cornelia H M

2004-10-15

To determine the effectiveness of a manual therapy program compared with an exercise therapy program in patients with osteoarthritis (OA) of the hip. A single-blind, randomized clinical trial of 109 hip OA patients was carried out in the outpatient clinic for physical therapy of a large hospital. The manual therapy program focused on specific manipulations and mobilization of the hip joint. The exercise therapy program focused on active exercises to improve muscle function and joint motion. The treatment period was 5 weeks (9 sessions). The primary outcome was general perceived improvement after treatment. Secondary outcomes included pain, hip function, walking speed, range of motion, and quality of life. Of 109 patients included in the study, 56 were allocated to manual therapy and 53 to exercise therapy. No major differences were found on baseline characteristics between groups. Success rates (primary outcome) after 5 weeks were 81% in the manual therapy group and 50% in the exercise group (odds ratio 1.92, 95% confidence interval 1.30, 2.60). Furthermore, patients in the manual therapy group had significantly better outcomes on pain, stiffness, hip function, and range of motion. Effects of manual therapy on the improvement of pain, hip function, and range of motion endured after 29 weeks. The effect of the manual therapy program on hip function is superior to the exercise therapy program in patients with OA of the hip.

Mechanical Characteristics of Reflex Durign Upright Posture in Paralyzed Subjects

NASA Astrophysics Data System (ADS)

Kim, Yongchul; Youm, Youngil; Lee, Bumsuk; Kim, Youngho; Choi, Hyeonki

The characteristics of flexor reflexes have been investigated in the previous studies with human subjects who were seated or supine position. However, researchers did not describe how the spinal circuits are used in different hip angles for paralyzed subjects, such as the standing position with walker or cane. In upright posture the compatibility between a flexor reflex of leg and body balance is a special problem for lower limb injured subjects. Therefore, the purpose of this study was to investigate the effects of hip angle change on the flexor reflex evoked in standing paralyzed subjects supported by walker. In this study, six spinal cord injured and four stroke subjects were recruited through the inpatient physical therapy clinics of Korea national rehabilitation hospital. A single axis electronic goniometer was mounted on the lateral side of the hip joint of the impaired limb to record movements in the sagittal plane at this joint. The electronic goniometer was connected to a data acquisition system, through amplifiers to a computer. Since subject' posture influenced characteristics of the flexion reflex response, the subjects were supported in an upright posture by the help of parallelogram walder. Two series of tests were performed on each leg. The first series of the tests investigated the influence of hip angle during stationary standing posture on flexion reflex response. The hip angle was adjusted by the foot plate. The second examined the effect of the voluntary action of subject on swing motion during the gait. The electrically induced flexion reflex simultaneously produced the flexion of the hip, knee and dorsiflexion of the ankle enabling the swing phase of walking. Form the experimental results we observed that the reflex response of hip joint was largerwith the hip in the extended position than in the flexed position during standing posture. Under voluntary movement on flexion reflex during gaint, the peak hip angle induced by stimulation was increased in spinal cord injury and stroke patients by subject' voluntary movement.

Older Person's Guide to Joint Replacement

MedlinePlus

... he or she will refer you to an orthopedic surgeon who does hip and knee replacement surgery. ... The Arthritis Foundation Web The American Academy of Orthopedic Surgeons ' The American Association of Knee and Hip ...

Deciding to have knee or hip replacement

MedlinePlus

... joint replacement surgery References Harkess JW, Crockarell JR. Arthroplasty of the hip. In: Azar FM, Beaty JH, ... Philadelphia, PA: Elsevier; 2017:chap 3. Mihalko WM. Arthroplasty of the knee. In: Azar FM, Beaty JH, ...

Hip Replacement: MedlinePlus Health Topic

MedlinePlus

... damage. The most common cause of damage is osteoarthritis . Osteoarthritis causes pain, swelling, and reduced motion in your ... Food and Drug Administration) Genetics Genetics Home Reference: osteoarthritis (National Library of Medicine) Images Hip joint replacement - ...

Hip joint center localisation: A biomechanical application to hip arthroplasty population

PubMed Central

Bouffard, Vicky; Begon, Mickael; Champagne, Annick; Farhadnia, Payam; Vendittoli, Pascal-André; Lavigne, Martin; Prince, François

2012-01-01

AIM: To determine hip joint center (HJC) location on hip arthroplasty population comparing predictive and functional approaches with radiographic measurements. METHODS: The distance between the HJC and the mid-pelvis was calculated and compared between the three approaches. The localisation error between the predictive and functional approach was compared using the radiographic measurements as the reference. The operated leg was compared to the non-operated leg. RESULTS: A significant difference was found for the distance between the HJC and the mid-pelvis when comparing the predictive and functional method. The functional method leads to fewer errors. A statistical difference was found for the localization error between the predictive and functional method. The functional method is twice more precise. CONCLUSION: Although being more individualized, the functional method improves HJC localization and should be used in three-dimensional gait analysis. PMID:22919569

Survivorship of the native hip joint after percutaneous repair of acetabular fractures in the elderly.

PubMed

Gary, Joshua L; Lefaivre, Kelly A; Gerold, Frank; Hay, Michael T; Reinert, Charles M; Starr, Adam J

2011-10-01

Our purpose was to examine survivorship of the native hip joint in patients ages 60 and over who underwent percutaneous reduction and fixation of acetabular fractures. A retrospective review at a University Level I Trauma Center was performed. Our institutional trauma database was reviewed. Patients aged 60 or older treated with percutaneous reduction and fixation of acetabular fractures between 1994 and 2007 were selected. 79 consecutive patients with 80 fractures were identified. Rate of conversion to total hip arthroplasty were used to construct a Kaplan-Meier curve showing survivorship of the native hip joint after treatment. 75 fractures had adequate clinical follow-up with a mean of 3.9 years (range 0.5-11.9 years). Average blood loss was 69 cc and there were no postoperative infections. 19/75 (25%) were converted to total hip arthroplasty at a mean time of 1.4 years after the index procedure. Survivorship analysis demonstrated a cumulative survival of 65% at 11.9 years of follow-up. There were no conversions to arthroplasty beyond 4.7 years postoperatively. There were no statistically significant associations between conversion to arthroplasty and age, sex, closed vs. limited open reduction, and simple vs. complex fracture pattern. Percutaneous fixation is a viable treatment option for patients age 60 or greater with acetabular fractures. Rates of conversion to total hip arthroplasty are comparable to open treatment methods and if conversion is required, soft tissues are preserved for future surgery. Copyright © 2010 Elsevier Ltd. All rights reserved.

A hip joint simulator study using simplified loading and motion cycles generating physiological wear paths and rates.

PubMed

Barbour, P S; Stone, M H; Fisher, J

1999-01-01

In some designs of hip joint simulator the cost of building a highly complex machine has been offset with the requirement for a large number of test stations. The application of the wear results generated by these machines depends on their ability to reproduce physiological wear rates and processes. In this study a hip joint simulator has been shown to reproduce physiological wear using only one load vector and two degrees of motion with simplified input cycles. The actual path of points on the femoral head relative to the acetabular cup were calculated and compared for physiological and simplified input cycles. The in vitro wear rates were found to be highly dependent on the shape of these paths and similarities could be drawn between the shape of the physiological paths and the simplified elliptical paths.

Analysis of fluid film lubrication in artificial hip joint replacements with surfaces of high elastic modulus.

PubMed

Jin, Z M; Dowson, D; Fisher, J

1997-01-01

Lubrication mechanisms and contact mechanics have been analysed for total hip joint replacements made from hard bearing surfaces such as metal-on-metal and ceramic-on-ceramic. A similar analysis for ultra-high molecular weight polyethylene (UHMWPE) against a hard bearing surface has also been carried out and used as a reference. The most important factor influencing the predicted lubrication film thickness has been found to be the radial clearance between the ball and the socket. Full fluid film lubrication may be achieved in these hard/hard bearings provided that the surface finish of the bearing surface and the radial clearance are chosen correctly and maintained. Furthermore, there is a close relation between the predicted contact half width and the predicted lubrication film thickness. Therefore, it is important to analyse the contact mechanics in artificial hip joint replacements. Practical considerations of manufacturing these bearing surfaces have also been discussed.

Influence of age on the outcome of single stage reconstructive surgery for congenital dislocation of the hip joint.

PubMed

Bhatti, Anisuddin; Jamali, A R; Mehboob, Ghulam

2009-01-01

This study was conducted to assess the effect of age on the ultimate outcome measures following single stage surgical procedure of soft tissue release, relocation, capsulorrhaphy, femoral shortening with varus/derotation osteotomy and pelvic osteotomy. A case series. The study with two groups of pretest-posttest design was conducted at Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, from 1993 to January 2008. Patients included were having neglected, congenital dislocation of the hip joint, aged over 3 years. Patients with failed previous surgery, paralytic, teratological, traumatic or septic dislocations and patients with less than 5 years follow-up were excluded from the study. The patients were divided into two groups, 3-7 years (37 hip joints) and over 7 years (13 hip joints). The single stage surgical procedure of open relocation, femoral shortening/derotation/ varus osteotomy and pelvic osteotomy was the dependent variable; whereas, the final clinico-radiological results based upon Tonnis grading, Severin's clinical/radiological grading, Klisic's overall rating and acetabular index were the independent variables of the study. Pre- and postoperative data was assessed for overall improvement and the difference in outcome measures between the two age groups. Significant overall improvement on all parameters was achieved after surgery. When results were compared between two age groups, there was no significant difference in the final outcome as per Tonnis grading and Severin's clinical typing as modified by Gibson (97.3% versus 84.4% normal hip joints or Tonnis grade 1 and 78.37% versus 53.85% Severin's type 1) but the results based upon Severin's radiological grading (62.16% versus 15.38%) and Klisic's overall rating (62.16% versus 15.38%) were significantly better in 3-7 years as compared to those over 7 years. There was no significant difference between the two age groups when compared for improvement in acetabular index. On further analysis, a progressive deterioration of results with increasing age was observed, yet the results in those aged over 7 years were reasonably justified surgical correction of congenital dislocation of the hip joint. Majority of the complications were seen in children operated at the age of 4-5 years. There were 7 cases (14%) of redislocation/subluxation and 6 were in 3-7 years age group. There were 4 cases (8%) of the avascular necrosis of the femoral head. Three patients had residual coxa vara and 2 had significant limb shortening. Limb lengthening was done in these 2 cases. The final results displayed progressive deterioration of clinical, radiological and functional outcome measures with aging after single stage reconstructive surgery for the congenital dislocation of hip joint. However, despite this, the results in children over 7 years were also good/excellent in most of the cases justifying surgery.

Load Dependency of Postural Control--Kinematic and Neuromuscular Changes in Response to over and under Load Conditions.

PubMed

Ritzmann, Ramona; Freyler, Kathrin; Weltin, Elmar; Krause, Anne; Gollhofer, Albert

2015-01-01

Load variation is associated with changes in joint torque and compensatory reflex activation and thus, has a considerable impact on balance control. Previous studies dealing with over (OL) and under loading (UL) used water buoyancy or additional weight with the side effects of increased friction and inertia, resulting in substantially modified test paradigms. The purpose of this study was to identify gravity-induced load dependency of postural control in comparable experimental conditions and to determine the underlying neuromuscular mechanisms. Balance performance was recorded under normal loading (NL, 1 g), UL (0.16 g 0.38 g) and OL (1.8 g) in monopedal stance. Center of pressure (COP) displacement and frequency distribution (low 0.15-0.5 Hz (LF), medium 0.5-2 Hz (MF), high 2-6 Hz (HF)) as well as ankle, knee and hip joint kinematics were assessed. Soleus spinal excitability was determined by H/M-recruitment curves (H/M-ratios). Compared to NL, OL caused an increase in ankle joint excursion, COP HF domain and H/M-ratio. Concomitantly, hip joint excursion and COP LF decreased. Compared to NL, UL caused modulations in the opposite direction: UL decreased ankle joint excursions, COP HF and H/M-ratio. Collaterally, hip joint excursion and COP LF increased. COP was augmented both in UL and in OL compared to NL. Subjects achieved postural stability in OL and UL with greater difficulty compared to NL. Reduced postural control was accompanied by modified balance strategies and compensatory reflex activation. With increasing load, a shift from hip to ankle strategy was observed. Accompanying, COP frequency distribution shifted from LF to HF and spinal excitability was enhanced. It is suggested that in OL, augmented ankle joint torques are compensated by quick reflex-induced postural reactions in distal muscles. Contrarily, UL is associated with diminished joint torques and thus, postural equilibrium may be controlled by the proximal segments to adjust the center of gravity above the base of support.

The effects of age and type of carrying task on lower extremity kinematics

PubMed Central

Gillette, Jason C.; Stevermer, Catherine A.; Miller, Ross H.; Meardon, Stacey A.; Schwab, Charles V.

2009-01-01

The purpose of this study was to determine the effects of age, load amount, and load symmetry on lower extremity kinematics during carrying tasks. Forty-two participants in four age groups (8-10 years, 12-14 years, 15-17 years, and adults) carried loads of 0%, 10%, and 20% body weight (BW) in large or small buckets unilaterally and bilaterally. Reflective markers were tracked to determine total joint ROM and maximum joint angles during the stance phase of walking. Maximum hip extension, hip adduction, and hip internal rotation angles were significantly greater for each of the child/adolescent age groups as compared to adults. In addition, maximum hip internal rotation angles significantly increased when carrying a 20% BW load. The observation that the 8-10 year old age group carried the lightest absolute loads and still displayed the highest maximum hip internal rotation angles suggests a particular necessity in setting carrying guidelines for the youngest children. PMID:20191410

Does hip joint positioning affect maximal voluntary contraction in the gluteus maximus, gluteus medius, tensor fasciae latae and sartorius muscles?

PubMed

Bernard, J; Beldame, J; Van Driessche, S; Brunel, H; Poirier, T; Guiffault, P; Matsoukis, J; Billuart, F

2017-11-01

Minimally invasive total hip arthroplasty (THA) is presumed to provide functional and clinical benefits, whereas in fact the literature reveals that gait and posturographic parameters following THA do not recover values found in the general population. There is a significant disturbance of postural sway in THA patients, regardless of the surgical approach, although with some differences between approaches compared to controls: the anterior and anterolateral minimally invasive approaches seem to be more disruptive of postural parameters than the posterior approach. Electromyographic (EMG) study of the hip muscles involved in surgery [gluteus maximus (GMax), gluteus medius (GMed), tensor fasciae latae (TFL), and sartorius (S)] could shed light, the relevant literature involves discordant methodologies. We developed a methodology to assess EMG activity during maximal voluntary contraction (MVC) of the GMax, GMed, TFL and sartorius muscles as a reference for normalization. A prospective study aimed to assess whether hip joint positioning and the learning curve on an MVC test affect the EMG signal during a maximal voluntary contraction. Hip positioning and the learning curve on an MVC test affect EMG signal during MVC of GMax, GMed, TFL and S. Thirty young asymptomatic subjects participated in the study. Each performed 8 hip muscle MVCs in various joint positions recorded with surface EMG sensors. Each MVC was performed 3 times in 1 week, with the same schedule every day, controlling for activity levels in the preceding 24h. EMG activity during MVC was expressed as a ratio of EMG activity during unipedal stance. Non-parametric tests were applied. Statistical analysis showed no difference according to hip position for abductors or flexors in assessing EMG signal during MVC over the 3 sessions. Hip abductors showed no difference between abduction in lateral decubitus with hip straight versus hip flexed: GMax (19.8±13.7 vs. 14.5±7.8, P=0.78), GMed (13.4±9.0 vs. 9.9±6.6, P=0.21) and TFL (69.5±61.7 vs. 65.9±51.3, P=0.50). Flexors showed no difference between hip flexion/abduction/lateral rotation performed in supine or sitting position: TFL (70.6±45.9 vs. 61.6±45.8, P=0.22) and S (101.1±67.9 vs. 72.6±44.6, P=0.21). The most effective tests to assess EMG signal during MVC were for the hip abductors: hip abduction performed in lateral decubitus (36.7% for GMax, 76.7% for GMed), and for hip flexors: hip flexion/abduction/lateral rotation performed in supine decubitus (50% for TFL, 76.7% for S). The study hypothesis was not confirmed, since hip joint positioning and the learning curve on an MVC test did not affect EMG signal during MVC of GMax, GMed, TFL and S muscles. Therefore, a single session and one specific test is enough to assess MVC in hip abductors (abduction in lateral decubitus) and flexors (hip flexion/abduction/lateral rotation in supine position). This method could be applied to assess muscle function after THA, and particularly to compare different approaches. III, case-matched study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Three-Dimensional Biomechanical Analysis of Rearfoot and Forefoot Running.

PubMed

Knorz, Sebastian; Kluge, Felix; Gelse, Kolja; Schulz-Drost, Stefan; Hotfiel, Thilo; Lochmann, Matthias; Eskofier, Björn; Krinner, Sebastian

2017-07-01

In the running community, a forefoot strike (FFS) pattern is increasingly preferred compared with a rearfoot strike (RFS) pattern. However, it has not been fully understood which strike pattern may better reduce adverse joint forces within the different joints of the lower extremity. To analyze the 3-dimensional (3D) stress pattern in the ankle, knee, and hip joint in runners with either a FFS or RFS pattern. Descriptive laboratory study. In 22 runners (11 habitual rearfoot strikers, 11 habitual forefoot strikers), RFS and FFS patterns were compared at 3.0 m/s (6.7 mph) on a treadmill with integrated force plates and a 3D motion capture analysis system. This combined analysis allowed characterization of the 3D biomechanical forces differentiated for the ankle, knee, and hip joint. The maximum peak force (MPF) and maximum loading rate (LR) were determined in their 3 ordinal components: vertical, anterior-posterior (AP), and medial-lateral (ML). For both strike patterns, the vertical components of the MPF and LR were significantly greater than their AP or ML components. In the vertical axis, FFS was generally associated with a greater MPF but significantly lower LR in all 3 joints. The AP components of MPF and LR were significantly lower for FFS in the knee joint but significantly greater in the ankle and hip joints. The ML components of MPF and LR tended to be greater for FFS but mostly did not reach a level of significance. FFS and RFS were associated with different 3D stress patterns in the ankle, knee, and hip joint, although there was no global advantage of one strike pattern over the other. The multimodal individual assessment for the different anatomic regions demonstrated that FFS seems favorable for patients with unstable knee joints in the AP axis and RFS may be recommended for runners with unstable ankle joints. Different strike patterns show different 3D stress in joints of the lower extremity. Due to either rehabilitation after injuries or training in running sports, rearfoot or forefoot running should be preferred to prevent further damage or injuries caused by inadequate biomechanical load. Runners with a history of knee joint injuries may benefit from FFS whereas RFS may be favorable for runners with a history of ankle joint injuries.

Three-Dimensional Biomechanical Analysis of Rearfoot and Forefoot Running

PubMed Central

Knorz, Sebastian; Kluge, Felix; Gelse, Kolja; Schulz-Drost, Stefan; Hotfiel, Thilo; Lochmann, Matthias; Eskofier, Björn; Krinner, Sebastian

2017-01-01

Background: In the running community, a forefoot strike (FFS) pattern is increasingly preferred compared with a rearfoot strike (RFS) pattern. However, it has not been fully understood which strike pattern may better reduce adverse joint forces within the different joints of the lower extremity. Purpose: To analyze the 3-dimensional (3D) stress pattern in the ankle, knee, and hip joint in runners with either a FFS or RFS pattern. Study Design: Descriptive laboratory study. Methods: In 22 runners (11 habitual rearfoot strikers, 11 habitual forefoot strikers), RFS and FFS patterns were compared at 3.0 m/s (6.7 mph) on a treadmill with integrated force plates and a 3D motion capture analysis system. This combined analysis allowed characterization of the 3D biomechanical forces differentiated for the ankle, knee, and hip joint. The maximum peak force (MPF) and maximum loading rate (LR) were determined in their 3 ordinal components: vertical, anterior-posterior (AP), and medial-lateral (ML). Results: For both strike patterns, the vertical components of the MPF and LR were significantly greater than their AP or ML components. In the vertical axis, FFS was generally associated with a greater MPF but significantly lower LR in all 3 joints. The AP components of MPF and LR were significantly lower for FFS in the knee joint but significantly greater in the ankle and hip joints. The ML components of MPF and LR tended to be greater for FFS but mostly did not reach a level of significance. Conclusion: FFS and RFS were associated with different 3D stress patterns in the ankle, knee, and hip joint, although there was no global advantage of one strike pattern over the other. The multimodal individual assessment for the different anatomic regions demonstrated that FFS seems favorable for patients with unstable knee joints in the AP axis and RFS may be recommended for runners with unstable ankle joints. Clinical Relevance: Different strike patterns show different 3D stress in joints of the lower extremity. Due to either rehabilitation after injuries or training in running sports, rearfoot or forefoot running should be preferred to prevent further damage or injuries caused by inadequate biomechanical load. Runners with a history of knee joint injuries may benefit from FFS whereas RFS may be favorable for runners with a history of ankle joint injuries. PMID:28812039

Medium-term results of ceramic-on-polyethylene Zweymüller-Plus total hip arthroplasty.

PubMed

Li, H; Zhang, S; Wang, X M; Lin, J H; Kou, B L

2017-08-01

The need for better durability and longevity in total hip arthroplasty for patients with various hip joint diseases remains a challenge. This study aimed to obtain medium-term results at a follow-up of >10 years for Zweymüller-Plus total hip arthroplasty with ceramic-on-polyethylene bearing. A retrospective study was conducted to review the results after a minimum of 12.4 years of 207 consecutive total hip arthroplasties in 185 patients in Peking University People's Hospital in China using the Zweymüller SL-Plus stem in combination with the Bicon-Plus threaded cup and ceramic-on-polyethylene bearing between October 1994 and April 2000. During the study period, two patients (2 hips) died and 25 patients (28 hips) were lost to follow-up. Two hips were revised for aseptic loosening of the Bicon-Plus cup. The mean clinical and radiological follow-up was 14.1 years (range, 12.4-16.5 years) for the remaining 156 patients (175 hips). The mean (standard deviation) Harris Hip score for the 175 hips increased significantly from 39.3 (3.8) preoperatively to 94.1 (2.5) postoperatively at a mean follow-up of 14.1 years (P<0.05). Focal osteolysis was observed in seven (4.0%) of 175 stems and three (1.7%) of 175 cups. The Kaplan-Meier survival with revision for any reason as the end-point was 99.03% (95% confidence interval, 95%-100%). The high survival rate of the cementless Zweymüller-Plus system with ceramic-on-polyethylene bearing at mid-term follow-up makes this total hip arthroplasty system reliable for patients with various hip joint diseases.

Effect of timing of hip extension assistance during loaded walking with a soft exosuit.

PubMed

Ding, Ye; Panizzolo, Fausto A; Siviy, Christopher; Malcolm, Philippe; Galiana, Ignacio; Holt, Kenneth G; Walsh, Conor J

2016-10-03

Recent advances in wearable robotic devices have demonstrated the ability to reduce the metabolic cost of walking by assisting the ankle joint. To achieve greater gains in the future it will be important to determine optimal actuation parameters and explore the effect of assisting other joints. The aim of the present work is to investigate how the timing of hip extension assistance affects the positive mechanical power delivered by an exosuit and its effect on biological joint power and metabolic cost during loaded walking. In this study, we evaluated 4 different hip assistive profiles with different actuation timings: early-start-early-peak (ESEP), early-start-late-peak (ESLP), late-start-early-peak (LSEP), late-start-late-peak (LSLP). Eight healthy participants walked on a treadmill at a constant speed of 1.5 m · s -1 while carrying a 23 kg backpack load. We tested five different conditions: four with the assistive profiles described above and one unpowered condition where no assistance was provided. We evaluated participants' lower limb kinetics, kinematics, metabolic cost and muscle activation. The variation of timing in the hip extension assistance resulted in a different amount of mechanical power delivered to the wearer across conditions; with the ESLP condition providing a significantly higher amount of positive mechanical power (0.219 ± 0.006 W · kg -1 ) with respect to the other powered conditions. Biological joint power was significantly reduced at the hip (ESEP and ESLP) and at the knee (ESEP, ESLP and LSEP) with respect to the unpowered condition. Further, all assistive profiles significantly reduced the metabolic cost of walking compared to the unpowered condition by 5.7 ± 1.5 %, 8.5 ± 0.9 %, 6.3 ± 1.4 % and 7.1 ± 1.9 % (mean ± SE for ESEP, ESLP, LSEP, LSLP, respectively). The highest positive mechanical power delivered by the soft exosuit was reported in the ESLP condition, which showed also a significant reduction in both biological hip and knee joint power. Further, the ESLP condition had the highest average metabolic reduction among the powered conditions. Future work on autonomous hip exoskeletons may incorporate these considerations when designing effective control strategies.

Can We Predict Those With Osteoarthritis Who Will Worsen Following a Chronic Disease Management Program?

PubMed

Eyles, Jillian P; Mills, Kathryn; Lucas, Barbara R; Williams, Matthew J; Makovey, Joanna; Teoh, Laurence; Hunter, David J

2016-09-01

To identify predictors of worsening symptoms and overall health of the treated hip or knee joint following 26 weeks of a nonsurgical chronic disease management program for hip and knee osteoarthritis (OA) and to examine the consistency of these predictors across 3 definitions of worsening. This prospective cohort study followed 539 participants of the program for 26 weeks. The 3 definitions of worsening included symptomatic worsening based on change in the Western Ontario and McMaster Universities Osteoarthritis Index Global score (WOMAC-G) measuring pain, stiffness, and function; a transition scale that asked about overall health of the treated hip or knee joint; and a composite outcome including both. Multivariate logistic regression models were constructed for the 3 definitions of worsening. Complete data were available for 386 participants: mean age was 66.3 years, 69% were female, 85% reported knee joint pain as primary symptom (signal joint), 46% were waitlisted for total joint arthroplasty (TJA). TJA waitlist status, signal joint, 6-Minute Walk Test (6MWT), depressive symptoms, pain, and age were independently associated with at least 1 definition of worsening. TJA waitlist status and 6MWT remained in the multivariate models for the transition and composite definitions of worsening. Participants reporting worsening on the transition scale did not consistently meet the WOMAC-G definition of worsening symptoms. TJA waitlist status was predictive of the composite definition of worsening, a trend apparent for the transition definition. However, variables that predict worsening remain largely unknown. Further research is required to direct comprehensive and targeted management of patients with hip and knee OA. © 2016, American College of Rheumatology.

Making Better Lives: Patient-Focused Care for Low Back Pain (LBP)

ClinicalTrials.gov

2018-03-26

Chronic Low Back Pain; Hip Ostearthritis; Myofascial Pain Syndrome; Fibromyalgia; Depression; Maladaptive Coping; Lumbar Spinal Stenosis; Insomnia; Sacroiliac Joint Pain; Lateral Hip and Thigh Pain; Anxiety; Dementia; Recent Leg Length Discrepancy

Leg length discrepancy and osteoarthritis in the knee, hip and lumbar spine

PubMed Central

Murray, Kelvin J.; Azari, Michael F.

2015-01-01

Osteoarthritis (OA) is an extremely common condition that creates substantial personal and health care costs. An important recognised risk factor for OA is excessive or abnormal mechanical joint loading. Leg length discrepancy (LLD) is a common condition that results in uneven and excessive loading of not only knee joints but also hip joints and lumbar motion segments. Accurate imaging methods of LLD have made it possible to study the biomechanical effects of mild LLD (LLD of 20mm or less). This review examines the accuracy of these methods compared to clinical LLD measurements. It then examines the association between LLD and OA of the joints of the lower extremity. More importantly, it addresses the largely neglected association between LLD and degeneration of lumbar motion segments and the patterns of biomechanical changes that accompany LLD. We propose that mild LLD may be an important instigator or contributor to OA of the hip and lumbar spine, and that it deserves to be rigorously studied in order to decrease OA’s burden of disease. PMID:26500356

Rapid-Onset Diffuse Skeletal Fluorosis from Inhalant Abuse: A Case Report.

PubMed

Cohen, Eric; Hsu, Raymond Y; Evangelista, Peter; Aaron, Roy; Rubin, Lee E

A thirty-year-old man presented with severely debilitating left hip pain and stiffness. Radiographs demonstrated diffuse osteosclerosis and heterotopic bone formation with near ankylosis of the left hip. The patient underwent successful joint-preserving surgery to restore hip range of motion. After disclosing a history of inhalant abuse, which was confirmed by elevated serum fluoride levels, he was diagnosed with diffuse skeletal fluorosis. To the best of our knowledge, we present the first reported case of diffuse skeletal fluorosis caused by inhalant abuse of 1,1-difluoroethane. Skeletal fluorosis is uncommon in the United States but is important to consider in the differential diagnosis when a patient presents with otherwise unexplained joint pain and osteosclerosis.

Hip and knee joint loading during vertical jumping and push jerking

PubMed Central

Cleather, Daniel J; Goodwin, Jon E; Bull, Anthony MJ

2014-01-01

Background The internal joint contact forces experienced at the lower limb have been frequently studied in activities of daily living and rehabilitation activities. In contrast, the forces experienced during more dynamic activities are not well understood, and those studies that do exist suggest very high degrees of joint loading. Methods In this study a biomechanical model of the right lower limb was used to calculate the internal joint forces experienced by the lower limb during vertical jumping, landing and push jerking (an explosive exercise derived from the sport of Olympic weightlifting), with a particular emphasis on the forces experienced by the knee. Findings The knee experienced mean peak loadings of 2.4-4.6 × body weight at the patellofemoral joint, 6.9-9.0 × body weight at the tibiofemoral joint, 0.3-1.4 × body weight anterior tibial shear and 1.0-3.1 × body weight posterior tibial shear. The hip experienced a mean peak loading of 5.5-8.4 × body weight and the ankle 8.9-10.0 × body weight. Interpretation The magnitudes of the total (resultant) joint contact forces at the patellofemoral joint, tibiofemoral joint and hip are greater than those reported in activities of daily living and less dynamic rehabilitation exercises. The information in this study is of importance for medical professionals, coaches and biomedical researchers in improving the understanding of acute and chronic injuries, understanding the performance of prosthetic implants and materials, evaluating the appropriateness of jumping and weightlifting for patient populations and informing the training programmes of healthy populations. PMID:23146164

Hip and knee joint loading during vertical jumping and push jerking.

PubMed

Cleather, Daniel J; Goodwin, Jon E; Bull, Anthony M J

2013-01-01

The internal joint contact forces experienced at the lower limb have been frequently studied in activities of daily living and rehabilitation activities. In contrast, the forces experienced during more dynamic activities are not well understood, and those studies that do exist suggest very high degrees of joint loading. In this study a biomechanical model of the right lower limb was used to calculate the internal joint forces experienced by the lower limb during vertical jumping, landing and push jerking (an explosive exercise derived from the sport of Olympic weightlifting), with a particular emphasis on the forces experienced by the knee. The knee experienced mean peak loadings of 2.4-4.6×body weight at the patellofemoral joint, 6.9-9.0×body weight at the tibiofemoral joint, 0.3-1.4×body weight anterior tibial shear and 1.0-3.1×body weight posterior tibial shear. The hip experienced a mean peak loading of 5.5-8.4×body weight and the ankle 8.9-10.0×body weight. The magnitudes of the total (resultant) joint contact forces at the patellofemoral joint, tibiofemoral joint and hip are greater than those reported in activities of daily living and less dynamic rehabilitation exercises. The information in this study is of importance for medical professionals, coaches and biomedical researchers in improving the understanding of acute and chronic injuries, understanding the performance of prosthetic implants and materials, evaluating the appropriateness of jumping and weightlifting for patient populations and informing the training programmes of healthy populations. Copyright © 2012 Elsevier Ltd. All rights reserved.

Evolution of central nervous system multidrug-resistant Mycobacterium tuberculosis and late relapse of cryptic prosthetic hip joint tuberculosis: complications during treatment of disseminated isoniazid-resistant tuberculosis in an immunocompromised host.

PubMed

Upton, Arlo; Woodhouse, Andrew; Vaughan, Ross; Newton, Sandie; Ellis-Pegler, Rod

2009-02-01

We report a case of disseminated isoniazid-resistant tuberculosis in an immunocompromised patient with evolution of rifampin (rifampicin) resistance in the central nervous system. This was cured with intraventricular and oral treatment but was followed by a late relapse of the original infection in a prosthetic hip joint. We provide drug levels in cerebrospinal fluid and serum.

Intraoperative Considerations for Treatment/Prevention of Prosthetic Joint Infection.

PubMed

Suleiman, Linda I; Mesko, Daniel R; Nam, Denis

2018-06-23

Innovative measures have recently been proposed to prevent periprosthetic joint infection following total hip and knee arthroplasty. We sought to review these recent innovations to determine the reported reduction in periprosthetic joint infection. The most recent literature demonstrates promising results in regard to hydrofiber dressings as an independent risk factor for primary prosthetic joint infection reduction, which in turn is also linked with cost savings. As our understanding of safe yet effective concentrations of antiseptic solutions develops, dilute betadine in particular has demonstrated encouraging efficacy which warrants continued investigation through controlled trials. In summary, we found that the application of a hydrofiber dressing may prove beneficial in decreasing the risk of prosthetic joint infection following primary total hip and knee arthroplasty. The gold standard for an infection prevention protocol continues to be explored and optimized.

Effects of load carriage and footwear on lower extremity kinetics and kinematics during overground walking.

PubMed

Dames, Kevin D; Smith, Jeremy D

2016-10-01

Kinetic and kinematic responses during walking vary by footwear condition. Load carriage also influences gait patterns, but it is unclear how an external load influences barefoot walking. Twelve healthy adults (5 women, 7 men) with no known gait abnormalities participated in this study (age=23±3years, height=1.73±0.11m, and mass=70.90±12.67kg). Ground reaction forces and 3D motion were simultaneously collected during overground walking at 1.5ms -1 in four conditions: Barefoot Unloaded, Shod Unloaded, Barefoot Loaded, and Shod Loaded. Barefoot walking reduced knee and hip joint ranges of motion, as well as stride length, stance time, swing time, and double support time. Load carriage increased stance and double support times. The 15% body weight load increased GRFs ∼15%. Walking barefoot reduced peak anteroposterior GRFs but not peak vertical GRFs. Load carriage increased hip, knee, and ankle joint moments and powers, while walking barefoot increased knee and hip moments and powers. Thus, spatiotemporal and kinematic adjustments to walking barefoot decrease GRFs but increase knee and hip kinetic measures during overground walking. The ankle seems to be less affected by these footwear conditions. Regardless of footwear, loading requires larger GRFs, joint loads, and joint powers. Copyright © 2016 Elsevier B.V. All rights reserved.

Full Step Cycle Kinematic and Kinetic Comparison of Barefoot Walking and a Traditional Shoe Walking in Healthy Youth: Insights for Barefoot Technology.

PubMed

Xu, Yi; Hou, Qinghua; Wang, Chuhuai; Sellers, Andrew J; Simpson, Travis; Bennett, Bradford C; Russell, Shawn D

2017-01-01

Barefoot technology shoes are becoming increasingly popular, yet modifications are still needed. The present study aims to gain valuable insights by comparing barefoot walking to neutral shoe walking in a healthy youth population. 28 healthy university students (22 females and 6 males) were recruited to walk on a 10-meter walkway both barefoot and in neutral running shoes at their comfortable walking speed. Full step cycle kinematic and kinetic data were collected using an 8-camera motion capture system. In the early stance phase, the knee extension moment (MK1), the first peak absorbed joint power at the knee joint (PK1), and the flexion angle of knee/dorsiflexion angle of the ankle were significantly reduced when walking in neutral running shoes. However, in the late stance, barefoot walking resulted in decreased hip joint flexion moment (MH2), second peak extension knee moment (MK3), hip flexors absorbed power (PH2), hip flexors generated power (PH3), second peak absorbed power by knee flexors (PK2), and second peak anterior-posterior component of joint force at the hip (APFH2), knee (APFK2), and ankle (APFA2). These results indicate that it should be cautious to discard conventional elements from future running shoe designs and rush to embrace the barefoot technology fashion.

Anatomical and biomechanical investigations of the iliotibial tract.

PubMed

Birnbaum, K; Siebert, C H; Pandorf, T; Schopphoff, E; Prescher, A; Niethard, F U

2004-12-01

Divergent descriptions of the anatomic location and biomechanical function of the iliotibial tract (IT) can be found in the literature. This study attempted to obtain exact data regarding the anatomic course and material characteristics including the biomechanical properties of this structure. The following were its aims: (1) anatomical investigations of the IT; (2) mechanical properties of the IT; (3) femoral head centralizing force of the IT and subligamentous forces in the height of the greater trochanter in different joint positions by using a custom-made measuring prosthesis and a subligamentous positioned sensor; (4) construction of a finite element model of the proximal femur including the IT and measuring the femoral neck angle under variation. The hip joints and IT in a total of 18 unfixed corpses were evaluated. We studied the anatomic relationship to surrounding structures, as well as the material properties with the help of tensile strength testing utilizing an uniaxial apparatus. During the test, a load-displacement curve was registered, documenting the maximum load and deformation of the IT. To measure the subligamentous pressure at the height of the greater trochanter, a custom-made sensor with a power-recording instrument was constructed. Furthermore, an altered hip prosthesis with a pressure gauge at the height of the femoral neck was used to measure the forces which are directed at the acetabulum. The investigations were done in neutral-0 position and ab/adduction of the hip joint of the unfixed corpse. In addition, we varied the femoral neck angle between 115 degrees and 155 degrees in 5 degrees steps. To confirm the subligamentous forces, we did the same measurements intraoperatively at the height of the greater trochanter before and after hip joint replacement in 12 patients. We constructed a finite element model of the proximal femur and considering the IT. The acquisition of the data was done at physiological (128 degrees), varus (115 degrees), and valgus (155 degrees) femoral neck angles. The influencing forces of the IT at the height of the greater trochanter and the forces at the femoral head or the acetabulum could be measured. Our anatomical investigations revealed a splitting of the IT into a superficial and a deep portion, which covers the tensor fasciae latae. The tensor fasciae latae has an insertion on the IT. The IT continues down the femur, passing over the greater trochanter without developing an actual fixation to the bone. Part of the insertion of the gluteus maximus radiates into the IT. The IT passes over the vastus lateralis and inserts at the infracondylar tubercle of the tibia or Gerdy's tubercle, at the head of the fibula, as well as at the lateral intermuscular septum. Portions also insert on the transverse and longitudinal retinaculum of the patella. Concerning the material properties of the IT, we found a structural stiffness of 17 N/mm extension on average (D = 17 N/mm). The subligamentous measurements at the height of the greater trochanter in the unfixed corpse and intraoperatively during hip joint replacement showed an increase of the forces during adduction and a decrease during abduction of the hip joint. We found thereby a maximum increase up to 106 N with 40 degrees adduction. Concerning the femoral neck angle, we can state that valgus leads to lower subligamentous forces and varus to higher subligamentous forces. The forces directed at the acetabulum, which were measured by the prosthesis with a sensor along the femoral neck, showed a decrease with varus angles and an increase with valgus angles. The highest force of 624 N was measured with 40 degrees adduction and an angle of 155 degrees. The finite element model of the proximal femur showed a sole hip joint-centralizing force of the IT of 655 N with a femoral neck angle of 128 degrees after subtraction of the gluteal muscle force and the body weight. At 115 degrees, we found an increase up to 997 N and a decrease to 438 N at 155 degrees. Concerning the resulting forces in the acetabulum, we found opposite forces in comparison with the force of the IT at the height of the greater trochanter: at 115 degrees, a femoral head-centralizing force of 1601 N; at 128 degrees, 2360 N; and at 155 degrees, 2422 N. By our investigations, we can approximately prove the hip joint-centralizing force of the IT. By variation of the femoral neck angle and the position of the hip joint, we can predict the subligamentous force of the IT and the resulting force at the femoral head or at the acetabulum. The intraoperative measurement of the subligamentous forces of the IT is a good monitoring mechanism for the persistent hip-centralizing function of the IT in the course of hip joint replacement. The surgeon has the opportunity to check the stability of the hip joint after replacement. The finite element model gives the opportunity to check the divergent relative strength by variation of the femoral neck angle and the tension of the IT. In this way, the changes in the forces induced by a displacement osteotomy could be estimated preoperatively.

Effect of leisure time physical activity on severe knee or hip osteoarthritis leading to total joint replacement: a population-based prospective cohort study

PubMed Central

2012-01-01

Background Studies on leisure time physical activity as risk factor or protective factor for knee or hip osteoarthritis (OA) show divergent results. Longitudinal prospective studies are needed to clarify the association of physical activity with future OA. The aim was to explore in a prospective population-based cohort study the influence of leisure time physical activity on severe knee or hip OA, defined as knee or hip replacement due to OA. Methods Leisure time physical activity was reported by 28320 participants (mean age 58 years (SD 7.6), 60% women) at baseline. An overall leisure time physical activity score, taking both duration and intensity of physical activities into account, was created. The most commonly reported activities were also used for analysis. The incidence of knee or hip replacement due to OA over 11 years was monitored by linkage with the Swedish hospital discharge register. Cox’s proportional hazards model (crude and adjusted for potential confounding factors) was used to assess the incidence of total joint replacement, or osteotomy (knee), in separate analyses of leisure time physical activity. Results There was no significant overall association between leisure time physical activity and risk for knee or hip replacement due to OA over the 11-year observation time. For women only, the adjusted RR (95% CI) for hip replacement was 0.66 (0.48, 0.89) (fourth vs. first quartile), indicating a lower risk of hip replacement in those with the highest compared with the lowest physical activity. The most commonly reported activities were walking, bicycling, using stairs, and gardening. Walking was associated with a lower risk of hip replacement (adjusted RR 0.76 (95% CI 0.61, 0.94), specifically for women (adjusted RR 0.75 (95% CI 0.57, 0.98)). Conclusions In this population-based study of middle-aged men and women, leisure time physical activity showed no consistent overall relationship with incidence of severe knee or hip OA, defined as joint replacement due to OA, over 11 years. For women, higher leisure time physical activity may have a protective role for the incidence of hip replacement. Walking may have a protective role for hip replacement, specifically for women. PMID:22595023

Hip ontogenesis: how evolution, genes, and load history shape hip morphotype and cartilotype.

PubMed

Hogervorst, Tom; Eilander, Wouter; Fikkers, Joost T; Meulenbelt, Ingrid

2012-12-01

Developmental hip disorders (DHDs), eg, developmental dysplasia of the hip, slipped capitis femoris epiphysis, and femoroacetabular impingement, can be considered morphology variants of the normal hip. The femoroacetabular morphology of DHD is believed to induce osteoarthritis (OA) through local cumulative mechanical overload acting on genetically controlled patterning systems and subsequent damage of joint structures. However, it is unclear why hip morphology differs between individuals with seemingly comparable load histories and why certain hips with DHD progress to symptomatic OA whereas others do not. We asked (1) which mechanical factors influence growth and development of the proximal femur; and (2) which genes or genetic mechanisms are associated with hip ontogenesis. We performed a systematic literature review of mechanical and genetic factors of hip ontogeny. We focused on three fields that in recent years have advanced our knowledge of adult hip morphology: imaging, evolution, and genetics. WHERE ARE WE NOW?: Mechanical factors can be understood in view of human evolutionary peculiarities and may summate to load histories conducive to DHD. Genetic factors most likely act through multiple genes, each with modest effect sizes. Single genes that explain a DHD are therefore unlikely to be found. Apparently, the interplay between genes and load history not only determines hip morphotype, but also joint cartilage robustness ("cartilotype") and resistance to symptomatic OA. WHERE DO WE NEED TO GO?: We need therapies that can improve both morphotype and cartilotype. HOW DO WE GET THERE?: Better phenotyping, improving classification systems of hip morphology, and comparative population studies can be done with existing methods. Quantifying load histories likely requires new tools, but proof of principle of modifying morphotype in treatment of DDH and of cartilotype with exercise is available.

A preliminary study on effects of increment of loads to lower extremity joints during kettlebell swing activity

NASA Astrophysics Data System (ADS)

Zin, Muhammad Athif Mat; Rambely, Azmin Sham; Ariff, Noratiqah Mohd

2018-04-01

The purpose of the study was to determine the effects of increment of loads to lower extremity joints during the two-hand kettlebell swing (KS) activity with loads of 4 kg, 6 kg and 8 kg. Three male adults participated in this study. Subjects were required to perform a two-hand KS with three different loads which were 4 kg, 6 kg and 8 kg. A Vicon Nexus system (v1.5.2) with three infrared cameras adjusted with 100 Hz speed were used to capture KS motion to produce kinematics data for lower extremity joints which were ankle, knee and hip joints. The results showed that mean maximum flexion angle (MFA) of ankle, knee and hip joints decreased as load increased. Mean MFA of knee joint was the highest while mean MFA of ankle joint was the smallest recorded. Mean MFA of ipsilateral leg was higher than that of contralateral leg for a right-dominant subject.

Kinematic analysis of hip and knee rotation and other contributors to ballet turnout.

PubMed

Quanbeck, Amy E; Russell, Jeffrey A; Handley, Sara C; Quanbeck, Deborah S

2017-02-01

Turnout, or external rotation (ER) of the lower extremities, is essential in ballet. The purpose of this study was to utilise physical examination and a biomechanical method for obtaining functional kinematic data using hip and knee joint centres to identify the relative turnout contributions from hip rotation, femoral anteversion, knee rotation, tibial torsion, and other sources. Ten female dancers received a lower extremity alignment assessment, including passive hip rotation, femoral anteversion, tibial torsion, weightbearing foot alignment, and Beighton hypermobility score. Next, turnout was assessed using plantar pressure plots and three-dimensional motion analysis; participants performed turnout to ballet first position on both a plantar pressure mat and friction-reducing discs. A retro-reflective functional marker motion capture system mapped the lower extremities and hip and knee joint centres. Mean total turnout was 129±15.7° via plantar pressure plots and 135±17.8° via kinematics. Bilateral hip ER during turnout was 49±10.2° (36% of total turnout). Bilateral knee ER during turnout was 41±5.9° (32% of total turnout). Hip ER contribution to total turnout measured kinematically was less than expected compared to other studies, where hip ER was determined without functional kinematic data. Knee ER contributed substantially more turnout than expected or previously reported. This analysis method allows precise assessment of turnout contributors.

Historical review of arthroscopic surgery of the hip.

PubMed

Magrill, Abigail C L; Nakano, Naoki; Khanduja, Vikas

2017-10-01

Increasing our appreciation of the historical foundations of hip arthroscopy offers greater insight and understanding of the field's current and future applications. This article offers a broad history of the progress of hip arthroscopy. Hip arthroscopy's development from the early technologies of endoscopy to the present day is described through a review of the available literature. Endoscopic science begins with the Lichtleiter, developed by Phillip Bozzini (1779-1809) in 1806, but endoscopes were not applied to joints until 1912, as presented by Severin Nordentoft (1866-1922). The work of Kenji Takagi (1888-1963), especially, was instrumental in the arthroscope's development, allowing Michael Burman (1901-75) to perform the first recorded hip arthroscopy, detailed in a 1931 paper after extensive cadaveric research. Although World War II stalled further development, a renewed application of fibre optics following post-war innovations in glass manufacture heralded the modern arthroscope's invention. During the 1970s hip arthroscopy was first mobilized for diagnosis and exploration, leading to its later adoption for therapeutic surgical interventions. Modern hip arthroscopy has been facilitated by international research into optimum distraction, portals of entry, positioning of patients, and the technology of arthroscopic instruments. In 2008, the International Society for Hip Arthroscopy (ISHA) was founded to represent this international expert community. Technology, communication and evidence-based medicine have jointly facilitated the development of this young but promising corner of Orthopaedics.

The influence of resting periods on friction in the artificial hip.

PubMed

Nassutt, Roman; Wimmer, Markus A; Schneider, Erich; Morlock, Michael M

2003-02-01

Insufficient tribologic performance of total joint components is a major cause of prostheses failure. Wear has been studied intensively using testing machines that apply continuous motions. Human locomotion, however, is not well represented by continuous motions alone. Singular events and resting periods are a substantial part of daily activities. Resting does influence adhesion in the artificial joint with possible effects on friction, wear, and loosening. The current study evaluated the effects of resting on the frictional properties of hip prosthesis components. The activity measurements of 32 patients with artificial hip replacements were analyzed for resting durations of the hip. A pin-on-ball screening device was used to determine friction after characteristic resting periods and during continuous oscillating motion. All common articulation pairings were investigated. Prolonged and frequent resting periods of the hip were found for the patients. Initial friction increased with increasing resting duration for all tested materials (between 41% and 191%). The metal-on-metal articulations showed the highest friction level (0.098 for sliding) and the highest increase (191%) in friction with resting duration (0.285 after resting periods of 60 seconds). A high static frictional moment after resting periods might present a risk for aseptic implant loosening. Therefore, large head diameters of metal-on-metal joints should be used with caution, especially when additional unfavorable risk factors such as obesity, weak bone-implant interface, or high activity level are present.

Frontal Joint Dynamics when Initiating Stair Ascent from a Walk versus a Stand

PubMed Central

Vallabhajosula, Srikant; Yentes, Jennifer M.; Stergiou, Nicholas

2011-01-01

Ascending stairs is a challenging activity of daily living for many populations. Frontal plane joint dynamics are critical to understand the mechanisms involved in stair ascension as they contribute to both propulsion and medio-lateral stability. However, previous research is limited to understanding these dynamics while initiating stair ascent from a stand. We investigated if initiating stair ascent from a walk with a comfortable self-selected speed could affect the frontal plane lower-extremity joint moments and powers as compared to initiating stair ascent from a stand and if this difference would exist at consecutive ipsilateral steps on the stairs. Kinematics data using a 3-D motion capture system and kinetics data using two force platforms on the first and third stair treads were recorded simultaneously as ten healthy young adults ascended a custom-built staircase. Data were collected from two starting conditions of stair ascent, from a walk (speed: 1.42±0.21m/s) and from a stand. Results showed that subjects generated greater peak knee abductor moment and greater peak hip abductor moment when initiating stair ascent from a walk. Greater peak joint moments and powers at all joints were also seen while ascending the second ipsilateral step. Particularly, greater peak hip abductor moment was needed to avoid contact of the contralateral limb with the intermediate step by counteracting the pelvic drop on the contralateral side. This could be important for therapists using stair climbing as a testing/training tool to evaluate hip strength in individuals with documented frontal plane abnormalities (i.e. knee and hip osteoarthritis, ACL injury). PMID:22172606

The influence of muscles on knee flexion during the swing phase of gait.

PubMed

Piazza, S J; Delp, S L

1996-06-01

Although the movement of the leg during swing phase is often compared to the unforced motion of a compound pendulum, the muscles of the leg are active during swing and presumably influence its motion. To examine the roles of muscles in determining swing phase knee flexion, we developed a muscle-actuated forward dynamic simulation of the swing phase of normal gait. Joint angles and angular velocities at toe-off were derived from experimental measurements, as were pelvis motions and muscle excitations. Joint angles and joint moments resulting from the simulation corresponded to experimental measurements made during normal gait. Muscular joint moments and initial joint angular velocities were altered to determine the effects of each upon peak knee flexion in swing phase. As expected, the simulation demonstrated that either increasing knee extension moment or decreasing toe-off knee flexion velocity decreased peak knee flexion. Decreasing hip flexion moment or increasing toe-off hip flexion velocity also caused substantial decreases in peak knee flexion. The rectus femoris muscle played an important role in regulating knee flexion; removal of the rectus femoris actuator from the model resulted in hyperflexion of the knee, whereas an increase in the excitation input to the rectus femoris actuator reduced knee flexion. These findings confirm that reduced knee flexion during the swing phase (stiff-knee gait) may be caused by overactivity of the rectus femoris. The simulations also suggest that weakened hip flexors and stance phase factors that determine the angular velocities of the knee and hip at toe-off may be responsible for decreased knee flexion during swing phase.

Arthroscopic treatment of femoral nerve paresthesia caused by an acetabular paralabral cyst.

PubMed

Kanauchi, Taira; Suganuma, Jun; Mochizuki, Ryuta; Uchikawa, Shinichi

2014-05-01

This report describes a rare case of femoral nerve paresthesia caused by an acetabular paralabral cyst of the hip joint. A 68-year-old woman presented with a 6-month history of right hip pain and paresthesia along the anterior thigh and radiating down to the anterior aspect of the knee. Radiography showed osteoarthritis with a narrowed joint space in the right hip joint. Magnetic resonance imaging showed a cyst with low T1- and high T2-weighted signal intensity arising from a labral tear at the anterior aspect of the acetabulum. The cyst was connected to the joint space and displaced the femoral nerve to the anteromedial side. The lesion was diagnosed as an acetabular paralabral cyst causing femoral neuropathy. Because the main symptom was femoral nerve paresthesia and the patient desired a less invasive procedure, arthroscopic labral repair was performed to stop synovial fluid flow to the paralabral cyst that was causing the femoral nerve paresthesia. After surgery, the cyst and femoral nerve paresthesia disappeared. At the 18-month follow-up, the patient had no recurrence. There have been several reports of neurovascular compression caused by the cyst around the hip joint. To the authors' knowledge, only 3 cases of acetabular paralabral cysts causing sciatica have been reported. The current patient appears to represent a rare case of an acetabular paralabral cyst causing femoral nerve paresthesia. The authors suggest that arthroscopic labral repair for an acetabular paralabral cyst causing neuropathy can be an option for patients who desire a less invasive procedure. Copyright 2014, SLACK Incorporated.

Effect of motion inputs on the wear prediction of artificial hip joints

PubMed Central

Liu, Feng; Fisher, John; Jin, Zhongmin

2013-01-01

Hip joint simulators have been largely used to assess the wear performance of joint implants. Due to the complexity of joint movement, the motion mechanism adopted in simulators varies. The motion condition is particularly important for ultra-high molecular weight polyethylene (UHMWPE) since polyethylene wear can be substantially increased by the bearing cross-shear motion. Computational wear modelling has been improved recently for the conventional UHMWPE used in total hip joint replacements. A new polyethylene wear law is an explicit function of the contact area of the bearing and the sliding distance, and the effect of multidirectional motion on wear has been quantified by a factor, cross-shear ratio. In this study, the full simulated walking cycle condition based on a walking measurement and two simplified motions, including the ISO standard motion and a simplified ProSim hip simulator motion, were considered as the inputs for wear modelling based on the improved wear model. Both the full simulation and simplified motions generated the comparable multidirectional motion required to reproduce the physiological wear of the bearing in vivo. The predicted volumetric wear of the ProSim simulator motion and the ISO motion conditions for the walking cycle were 13% and 4% lower, respectively, than that of the measured walking condition. The maximum linear wear depths were almost the same, and the areas of the wear depth distribution were 13% and 7% lower for the ProSim simulator and the ISO condition, respectively, compared with that of the measured walking cycle motion condition. PMID:25540472

Joint Coordination and Muscle Activities of Ballet Dancers During Tiptoe Standing.

PubMed

Tanabe, Hiroko; Fujii, Keisuke; Kouzaki, Motoki

2017-01-01

We aimed to investigate joint coordination of lower limbs in dancers during tiptoe standing and the relationship between joint coordination and muscle coactivation. Seven female ballet dancers performed tiptoe standing with six leg positions (fi e classical dance positions and one modern dance position) for 10 s. The kinematic data of the metatarsophalangeal (MP), ankle, knee, and hip joints was collected, and surface electromyography (EMG) of over 13 lower limb muscles was conducted. Principal component analysis was performed to determine joint coordination. MP-ankle and ankle-knee had in-phase coordination, whereas knee-hip showed anti-phase coordination in the sagittal plane. In addition, most EMG-EMG coherence around the MP and ankle joints was significant up to 50 Hz when these two joints swayed with in-phase. This suggests that different joint coordination patterns are associated with neural processing related to different muscle coactivation patterns. In conclusion, ballet dancers showed in-phase coordination from the MP to knee joints, which was associated with muscle coactivation to a higher frequency domain (up to 50 Hz) in comparison with anti-phase coordination.

A Robust Parameterization of Human Gait Patterns Across Phase-Shifting Perturbations

PubMed Central

Villarreal, Dario J.; Poonawala, Hasan A.; Gregg, Robert D.

2016-01-01

The phase of human gait is difficult to quantify accurately in the presence of disturbances. In contrast, recent bipedal robots use time-independent controllers relying on a mechanical phase variable to synchronize joint patterns through the gait cycle. This concept has inspired studies to determine if human joint patterns can also be parameterized by a mechanical variable. Although many phase variable candidates have been proposed, it remains unclear which, if any, provide a robust representation of phase for human gait analysis or control. In this paper we analytically derive an ideal phase variable (the hip phase angle) that is provably monotonic and bounded throughout the gait cycle. To examine the robustness of this phase variable, ten able-bodied human subjects walked over a platform that randomly applied phase-shifting perturbations to the stance leg. A statistical analysis found the correlations between nominal and perturbed joint trajectories to be significantly greater when parameterized by the hip phase angle (0.95+) than by time or a different phase variable. The hip phase angle also best parameterized the transient errors about the nominal periodic orbit. Finally, interlimb phasing was best explained by local (ipsilateral) hip phase angles that are synchronized during the double-support period. PMID:27187967

Imaging of Sports-Related Hip and Groin Injuries

PubMed Central

Lischuk, Andrew W.; Dorantes, Thomas M.; Wong, William; Haims, Andrew H.

2010-01-01

A normally functioning hip joint is imperative for athletes who use their lower extremities with running, jumping, or kicking activities. Sports-related injuries of the hip and groin are far less frequent than injuries to the more distal aspect of the extremity, accounting for less than 10% of lower extremity injuries. Despite the lower incidence, hip and groin injuries can lead to significant clinical and diagnostic challenges related to the complex anatomy and biomechanical considerations of this region. Loads up to 8 times normal body weight have been documented in the joint in common daily activities, such as jogging, with significantly greater force expected during competitive athletics. Additionally, treatment for hip and groin injuries can obviate the participation of medical and surgical specialties, with a multidisciplinary approach frequently required. Delay in diagnosis and triage of these injuries may cause loss of time from competition and, potentially, early onset of degenerative changes. Magnetic resonance imaging (MRI) of the hip has proven to be the gold standard for the diagnosis of sports-related hip and groin injuries in the setting of negative radiographs. With its exquisite soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation, MRI is unmatched in the noninvasive diagnosis of intra-articular and extra-articular pathology, as well as intraosseous processes. This review focuses on MRI of common athletic injuries of the hip and groin, including acetabular labral tears, femoral acetabular impingement syndrome, muscle injuries around the hip and groin (including athletic pubalgia), and athletic osseous injuries. PMID:23015946

Imaging of sports-related hip and groin injuries.

PubMed

Lischuk, Andrew W; Dorantes, Thomas M; Wong, William; Haims, Andrew H

2010-05-01

A normally functioning hip joint is imperative for athletes who use their lower extremities with running, jumping, or kicking activities. Sports-related injuries of the hip and groin are far less frequent than injuries to the more distal aspect of the extremity, accounting for less than 10% of lower extremity injuries. Despite the lower incidence, hip and groin injuries can lead to significant clinical and diagnostic challenges related to the complex anatomy and biomechanical considerations of this region. Loads up to 8 times normal body weight have been documented in the joint in common daily activities, such as jogging, with significantly greater force expected during competitive athletics. Additionally, treatment for hip and groin injuries can obviate the participation of medical and surgical specialties, with a multidisciplinary approach frequently required. Delay in diagnosis and triage of these injuries may cause loss of time from competition and, potentially, early onset of degenerative changes. Magnetic resonance imaging (MRI) of the hip has proven to be the gold standard for the diagnosis of sports-related hip and groin injuries in the setting of negative radiographs. With its exquisite soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation, MRI is unmatched in the noninvasive diagnosis of intra-articular and extra-articular pathology, as well as intraosseous processes. This review focuses on MRI of common athletic injuries of the hip and groin, including acetabular labral tears, femoral acetabular impingement syndrome, muscle injuries around the hip and groin (including athletic pubalgia), and athletic osseous injuries.

MRI-based hip cartilage measures in osteoarthritic and non-osteoarthritic individuals: a systematic review

PubMed Central

Aguilar, Hector N; Battié, Michele C

2017-01-01

Osteoarthritis is a common hip joint disease, involving loss of articular cartilage. The prevalence and prognosis of hip osteoarthritis have been difficult to determine, with various clinical and radiological methods used to derive epidemiological estimates exhibiting significant heterogeneity. MRI-based methods directly visualise hip joint cartilage, and offer potential to more reliably define presence and severity of osteoarthritis, but have been underused. We performed a systematic review of MRI-based estimates of hip articular cartilage in the general population and in patients with established osteoarthritis, using MEDLINE, EMBASE and SCOPUS current to June 2016, with search terms such as ‘hip’, ‘femoral head’, ‘cartilage’, ‘volume’, ‘thickness’, ‘MRI’, etc. Ultimately, 11 studies were found appropriate for inclusion, but they were heterogeneous in osteoarthritis assessment methodology and composition. Overall, the studies consistently demonstrate the reliability and potential clinical utility of MRI-based estimates. However, no longitudinal data or reference values for hip cartilage thickness or volume have been published, limiting the ability of MRI to define or risk-stratify hip osteoarthritis. MRI-based techniques are available to quantify articular cartilage signal, volume, thickness and defects, which could establish the sequence and rate of articular cartilage changes at the hip that yield symptomatic osteoarthritis. However, prevalence and rates of progression of hip osteoarthritis have not been established in any MRI studies in the general population. Future investigations could fill this important knowledge gap using robust MRI methods in population-based cross-sectional and longitudinal studies. PMID:28405471

Does the Dual-Mobility Hip Prosthesis Produce Better Joint Kinematics During Extreme Hip Flexion Task?

PubMed

Catelli, Danilo S; Kowalski, Erik; Beaulé, Paul E; Lamontagne, Mario

2017-10-01

Total hip arthroplasty (THA) using dual-mobility (DM) design permits larger hip range of motion. However, it is unclear how it benefits the patients during activities of daily living. The purpose was to compare kinematic variables of the operated limb between THA patients using either DM or single-bearing (SB) implants during a squat task. Twenty-four THA patients were randomly assigned to either a DM or SB implant and matched to 12 healthy controls (CTRLs). They underwent 3-dimensional squat motion analysis before and 9 months after surgery. Sagittal and frontal plane angles of the pelvis and the hip were analyzed using statistical parametric mapping. Paired analyses compared presurgery and postsurgery squat depth. Peak sagittal pelvis angle of DM was closer to normal compared with that of SB. Both implant groups had similar hip angle patterns and magnitude but significantly lower than the CTRLs. SB reached a much large hip abduction compared with the other groups. Both surgical groups had significantly worst squat depth than the CTRLs. Neither THA implant groups were able to return pelvis and hip kinematics to the level of CTRLs. The deficit of DM implants at the pelvis combined with the poorer functional scores should caution clinicians to use this implant design in active patients. SB design causes a larger hip abduction to reach their maximum squat depth. Post-THA rehabilitation should focus on improving joint range of motion and strength. Copyright © 2017 Elsevier Inc. All rights reserved.

Alteration of swing leg work and power during human accelerated sprinting

PubMed Central

Matsubayashi, Takeo; Matsuo, Akifumi; Zushi, Koji

2017-01-01

ABSTRACT This study investigated changes in lower-extremity joint work and power during the swing phase in a maximal accelerated sprinting. Twelve male sprinters performed 60 m maximal sprints while motion data was recorded. Lower-extremity joint work and power during the swing phase of each stride for both legs were calculated. Positive hip and negative knee work (≈4.3 and ≈−2.9 J kg−1) and mean power (≈13.4 and ≈−8.7 W kg−1) during the entire swing phase stabilized or decreased after the 26.2±1.1 (9.69±0.25 m s−1) or 34.3±1.5 m mark (9.97±0.26 m s−1) during the acceleration phase. In contrast, the hip negative work and mean power during the early swing phase (≈7-fold and ≈3.7-fold increase in total), as well as the knee negative work and power during the terminal swing phase (≈1.85-fold and ≈2-fold increase in total), increased until maximal speed. Moreover, only the magnitudes of increases in negative work and mean power at hip and knee joints during the swing phase were positively associated with the increment of running speed from the middle of acceleration phase. These findings indicate that the roles of energy generation and absorption at the hip and knee joints shift around the middle of the acceleration phase as energy generation and absorption at the hip during the late swing phase and at the knee during early swing phase are generally maintained or decreased, and negative work and power at hip during the early swing phase and at knee during the terminal swing phase may be responsible for increasing running speed when approaching maximal speed. PMID:28396485

The Sequence of Hip and Selected Upper-Extremity Joint Movements During the Golf Drive.

ERIC Educational Resources Information Center

Hunter, Charles L.

This study analyzed wrist, elbow, and hip actions of golfers who were accurately driving a golf ball a maximum distance. Electrogoniometry and cinematography were used to measure wrist, forearm, elbow, and hip actions during the downswing of 10 low-handicap golfers who were attempting to drive a minimum of 225 yards within a 50-yard corridor.…

Cartilage collagen damage in hip osteoarthritis similar to that seen in knee osteoarthritis; a case-control study of relationship between collagen, glycosaminoglycan and cartilage swelling.

PubMed

Hosseininia, Shahrzad; Lindberg, Lisbeth R; Dahlberg, Leif E

2013-01-09

It remains to be shown whether OA shares molecular similarities between different joints in humans. This study provides evidence for similarities in cartilage molecular damage in osteoarthritic (OA) joints. Articular cartilage from osteoarthritic hip joints were analysed and compared to non-OA controls regarding collagen, glycosaminoglycan and water content. Femoral heads from 16 osteoarthritic (OA) and 20 reference patients were obtained from hip replacement surgery due to OA and femoral neck fracture, respectively. Cartilage histological changes were assessed by Mankin grading and denatured collagen type II immunostaining and cartilage was extracted by α-chymotrypsin. Hydroxyproline and Alcian blue binding assays were used to measure collagen and glycosaminoglycan (GAG) content, respectively. Mankin and immunohistology scores were significantly higher in hip OA samples than in reference samples. Cartilage water content was 6% higher in OA samples than in references. 2.5 times more collagen was extracted from OA than from reference samples. There was a positive association between water content and percentage of extractable collagen pool (ECP) in both groups. The amounts of collagen per wet and dry weights did not differ statistically between OA and reference cartilage. % Extractable collagen was not related to collagen per dry weight in either group. However when collagen was expressed by wet weight there was a negative correlation between % extractable and collagen in OA cartilage. The amount of GAG per wet weight was similar in both groups but the amount of GAG per dry weight was higher in OA samples compared to reference samples, which suggests a capacity for GAG biosynthesis in hip OA cartilage. Neither of the studied parameters was related to age in either group. Increased collagen extractability and water content in human hip cartilage is associated with OA pathology and can be observed at early stages of the degenerative hip OA process. Our results suggest a common degradative pathway of collagen in articular cartilage of different joints. Furthermore, the study suggests that biochemical changes precede more overt OA changes and that chondrocytes may have a capability to compensate molecular loss in the early phase of OA.

Augmented Reality Visualization with Use of Image Overlay Technology for MR Imaging–guided Interventions: Assessment of Performance in Cadaveric Shoulder and Hip Arthrography at 1.5 T

PubMed Central

Fritz, Jan; U-Thainual, Paweena; Ungi, Tamas; Flammang, Aaron J.; Fichtinger, Gabor; Iordachita, Iulian I.

2012-01-01

Purpose: To prospectively assess overlay technology in providing accurate and efficient targeting for magnetic resonance (MR) imaging–guided shoulder and hip joint arthrography. Materials and Methods: A prototype augmented reality image overlay system was used in conjunction with a clinical 1.5-T MR imager. A total of 24 shoulder joint and 24 hip joint injections were planned in 12 human cadavers. Two operators (A and B) participated, each performing procedures on different cadavers using image overlay guidance. MR imaging was used to confirm needle positions, monitor injections, and perform MR arthrography. Accuracy was assessed according to the rate of needle adjustment, target error, and whether the injection was intraarticular. Efficiency was assessed according to arthrography procedural time. Operator differences were assessed with comparison of accuracy and procedure times between the operators. Mann-Whitney U test and Fisher exact test were used to assess group differences. Results: Forty-five arthrography procedures (23 shoulders, 22 hips) were performed. Three joints had prostheses and were excluded. Operator A performed 12 shoulder and 12 hip injections. Operator B performed 11 shoulder and 10 hip injections. Needle adjustment rate was 13% (six of 45; one for operator A and five for operator B). Target error was 3.1 mm ± 1.2 (standard deviation) (operator A, 2.9 mm ± 1.4; operator B, 3.5 mm ± 0.9). Intraarticular injection rate was 100% (45 of 45). The average arthrography time was 14 minutes (range, 6–27 minutes; 12 minutes [range, 6–25 minutes] for operator A and 16 minutes [range, 6–27 min] for operator B). Operator differences were not significant with regard to needle adjustment rate (P = .08), target error (P = .07), intraarticular injection rate (P > .99), and arthrography time (P = .22). Conclusion: Image overlay technology provides accurate and efficient MR guidance for successful shoulder and hip arthrography in human cadavers. © RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12112640/-/DC1 PMID:22843764

A review of viscosupplementation for osteoarthritis of the hip and a description of an ultrasound-guided hip injection technique.

PubMed

Mulvaney, Sean W

2009-01-01

Viscosupplementation of the hip for symptomatic osteoarthritis appears to be safe and effective in more than 25 yr of use in Europe. More than 11 studies suggest that viscosupplementation in the hip is as effective as viscosupplementation in the knee. It appears to be a safe and reasonable alternative to nonsteroidal antiinflammatory drugs or intra-articular steroids for the treatment of osteoarthritis pain. Viscosupplementation in the hip may delay the need for hip replacement surgery. Viscosupplementation in the hip appears to work better in patients with fewer radiographic changes of osteoarthritis. Placement of viscosupplement in the hip under real-time ultrasound or fluoroscopic guidance is safe and well tolerated. Hip joint communication with the iliopsoas bursa may be a factor in studies of the effectiveness of viscosupplementation in the hip.

Landing Biomechanics in Participants With Different Static Lower Extremity Alignment Profiles

PubMed Central

Nguyen, Anh-Dung; Shultz, Sandra J.; Schmitz, Randy J.

2015-01-01

Context: Whereas static lower extremity alignment (LEA) has been identified as a risk factor for anterior cruciate ligament injury, little is known about its influence on joint motion and moments commonly associated with anterior cruciate ligament injury. Objective: To cluster participants according to combinations of LEA variables and compare these clusters in hip- and knee-joint kinematics and kinetics during the landing phase of a drop-jump task. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: A total of 141 participants (50 men: age = 22.2 ± 2.8 years, height = 177.9 ± 9.3 cm, weight = 80.9 ± 13.3 kg; 91 women: age = 21.2 ± 2.6 years, height = 163.9 ± 6.6 cm, weight = 61.1 ± 8.7 kg). Main Outcome Measure(s): Static LEA included pelvic angle, femoral anteversion, quadriceps angle, tibiofemoral angle, genu recurvatum, tibial torsion, and navicular drop. Cluster analysis grouped participants according to their static LEA profiles, and these groups were compared on their hip- and knee-joint kinematics and external moments during the landing phase of a double-legged drop jump. Results: Three distinct clusters (C1–C3) were identified based on their static LEAs. Participants in clusters characterized with static internally rotated hip and valgus knee posture (C1) and externally rotated knee and valgus knee posture (C3) alignments demonstrated greater knee-valgus motion and smaller hip-flexion moments than the cluster with more neutral static alignment (C2). Participants in C1 also experienced greater hip internal-rotation and knee external-rotation moments than those in C2 and C3. Conclusions: Static LEA clusters that are positioned anatomically with a more rotated and valgus knee posture experienced greater dynamic valgus along with hip and knee moments during landing. Whereas static LEA contributes to differences in hip and knee rotational moments, sex may influence the differences in frontal-plane knee kinematics and sagittal-plane hip moments. PMID:25658815

Biomechanical Profiles When Towing a Sled and Wearing a Weighted Vest Once Cleared for Sports Post-ACL Reconstruction.

PubMed

Hartigan, Erin; Lawrence, Michael; Murray, Thomas; Shaw, Bernadette; Collins, Erin; Powers, Kaitlin; Townsend, James

2016-09-01

Though rehabilitation attempts to correct "stiff knee gait" and control for dynamic limb valgus after anterior cruciate ligament reconstruction (ACLR), impaired biomechanics often persist when an individual is cleared to return to sport (RTS). Reduced knee extension moments (KEMs) and knee flexion angles (KFAs) often continue. While at the hip, increased hip adduction angles (HADDAs) and hip internal rotation angles (HIRAs) often persist in spite of dynamic hip stabilization exercises. Sled towing and weighted vest tasks increase KEM and hip extension moments (HEMs) in healthy individuals, yet biomechanical profiles during these tasks after ACLR are unknown. Weighted gait will increase KEM, HEM, hip abduction moments (HABDMs), and hip external rotation moments (HERMs) and will not increase unwanted biomechanics (limb asymmetries, HIRA, HADDA) compared with normal gait. Controlled laboratory study. Level 4. Fourteen men and 24 women who were 5 to 12 months after ACLR, had no concomitant ligament injuries, and were cleared to RTS were recruited. Sexes were evaluated independently given the sex-specific incidence to ACL injury, reinjury, and gait responses to certain interventions. Joint moment impulses and peak angles over the first 25% of stance were compared between limbs and across tasks (eg, unweighted gait, sled 50% body weight [BW], and vest 50% BW). Men showed that weighted gait increased KEM, HEM, HERM, HADBM (vest only), HADDA, HIRA (sled only), and KFA. Asymmetrical KEM and KFA existed across tasks. Women showed that weighted gait increased KEM, HEM, HERM, HADBM (vest only), HFA (sled only), HADDA, and KFA. Asymmetrical KEM, HEM, HIRA, and KFA (sled only) existed across tasks. Weighted gait generally increased joint moments. Unwanted biomechanics were unique for each weighted gait task. Though joint moments increased, both tasks created unwanted biomechanics after ACLR. Persistent hip (women only) and KEM asymmetries across tasks when cleared to RTS are concerning given the relationship among these biomechanics and decreased functional performance. © 2016 The Author(s).

Gait dynamics in Pisa syndrome and Camptocormia: The role of stride length and hip kinematics.

PubMed

Tramonti, C; Di Martino, S; Unti, E; Frosini, D; Bonuccelli, U; Rossi, B; Ceravolo, R; Chisari, C

2017-09-01

This is an observational cross-sectional study evaluating gait dynamics in patients with Parkinson's Disease (PD) and severe postural deformities, PD without axial deviations and healthy subjects. Ten PS individuals with Pisa syndrome (PS) and nine subjects with Camptocormia (CC) performed 3-D Gait Analysis and were evaluated with walking and balance scales. Correlations with clinical and functional scales were investigated. Spatio-temporal and kinematic data were compared to ten PD subjects without postural deformities (PP) and ten healthy matched individuals (CG). Data obtained showed decreased walking velocity, stride and step length in PP, PS and CC groups compared to controls. The correlation analysis showed that stride and step length were associated with reduced functional abilities and disease severity in PS and CC groups. Kinematic data revealed marked reduction in range of movements (ROMs) at all lower-extremity joints in PS group. While, in CC group the main differences were pronounced in hip and knee joints. PS and CC groups presented a more pronounced reduction in hip articular excursion compared to PP subjects, revealing an increased hip flexion pattern during gait cycle. Moreover, the increased hip and knee flexion pattern adversely affected functional performance during walking tests. Results obtained provide evidence that step length, along with stride length, can be proposed as simple and clear indicators of disease severity and reduced functional abilities. The reduction of ROMs at hip joint represented an important mechanism contributing to decreased walking velocity, balance impairment and reduced gait performance in PD patients with postural deformities. Copyright © 2017 Elsevier B.V. All rights reserved.

[Incidence of hip and knee prosthetic infections in a specialized center of Mexico City].

PubMed

Franco-Cendejas, Rafael; Contreras-Córdova, Erika Lizbeth; Mondragón-Eguiluz, Jaime Arturo; Vanegas-Rodríguez, Edgar Samuel; Ilizaliturri-Sánchez, Víctor Manuel; Galindo-Fraga, Arturo

Hip and knee prosthetic replacements have proven to be the most appropriate treatment in the joints that do not benefit from medical or arthroscopic interventions; however, infections are the most feared complication. It is recommended that the incidence of infection should not exceed 2%. This was an observational, prospective, longitudinal and observational study conducted in patients fitted with a prosthetic joint from August 2011 to July 2012. Patients were followed up pre and post-surgery for one year to identify a prosthetic infection, diagnosed using international parameters. We calculated the incidence of prosthetic infection, as well as the incidence density. A total of 339 patients (179 hip and 160 knee) were included. Variations in the time of pre-operative antibiotics' administration were observed. Six prosthetic infections were identified with an incidence rate of 1.79/339 arthroplasties, 2.2/179 hip procedures, and 1.25/160 knee arthroplasties. An incidence density of 0.02/year for hip arthroplasties and 0.11/year for knee procedures was identified. There were 4 infections of hip and 2 of knee. Five infections were acute and one chronic. The isolated microorganisms were E. faecalis, S. epidermidis (2), S. mitis, S. aureus and P. stomatis. The incidence of prosthetic joint infection in the first year of follow-up at our centre is within the recommended parameters. Surgical techniques and organizational practices influence the results. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Celiac disease is not increased in women with hip fractures and low vitamin D levels.

PubMed

Leboff, M S; Cobb, H; Gao, L Y; Hawkes, W; Yu-Yahiro, J; Kolatkar, N S; Magaziner, J

2013-01-01

Celiac disease is associated with decreased bone density; however, the risk of fractures in celiac disease patients is unclear. We compared the prevalence of celiac disease between a group of women with hip fractures and a group of women undergoing elective joint replacement surgery and the association between celiac disease and vitamin D levels. Two hundred eight community dwelling and postmenopausal women were recruited from Boston, MA (n=81) and Baltimore, MD (n=127). We measured tissue transglutaminase IgA by ELISA to diagnose celiac disease and 25-hydroxyvitamin D (25(OH)D) levels by radioimmunoassay in both women with hip fractures (n=157) and a control group (n=51) of total hip replacement subjects from Boston. Subjects were excluded if they took any medications or had medical conditions that might affect bone. Median serum 25(OH)D levels were significantly lower (p< 0.0001) in the hip fracture cohorts compared to the elective joint replacement cohort (14.1 ng/ml vs. 21.3 ng/ml, respectively). There were no differences in the percentage of subjects with a positive tissue transglutaminase in the women with hip fractures versus the control group (1.91% vs. 1.96%, respectively). Vitamin D levels are markedly reduced in women with hip fractures, however hip fracture patients did not show a higher percentage of positive tissue transglutaminase levels compared with controls. These data suggest that routine testing for celiac disease among hip fracture patients may not be necessary in the absence of clinical signs and symptoms, although data from larger studies among hip fracture subjects are needed.

A New Sensor for Measurement of Dynamic Contact Stress in the Hip

PubMed Central

Rudert, M. J.; Ellis, B. J.; Henak, C. R.; Stroud, N. J.; Pederson, D. R.; Weiss, J. A.; Brown, T. D.

2014-01-01

Various techniques exist for quantifying articular contact stress distributions, an important class of measurements in the field of orthopaedic biomechanics. In situations where the need for dynamic recording has been paramount, the approach of preference has involved thin-sheet multiplexed grid-array transducers. To date, these sensors have been used to study contact stresses in the knee, shoulder, ankle, wrist, and spinal facet joints. Until now, however, no such sensor had been available for the human hip joint due to difficulties posed by the deep, bi-curvilinear geometry of the acetabulum. We report here the design and development of a novel sensor capable of measuring dynamic contact stress in human cadaveric hip joints (maximum contact stress of 20 MPa and maximum sampling rate 100 readings/s). Particular emphasis is placed on issues concerning calibration, and on the effect of joint curvature on the sensor's performance. The active pressure-sensing regions of the sensors have the shape of a segment of an annulus with a 150-deg circumferential span, and employ a polar/circumferential “ring-and-spoke” sensel grid layout. There are two sensor sizes, having outside radii of 44 and 48 mm, respectively. The new design was evaluated in human cadaver hip joints using two methods. The stress magnitudes and spatial distribution measured by the sensor were compared to contact stresses measured by pressure sensitive film during static loading conditions that simulated heel strike during walking and stair climbing. Additionally, the forces obtained by spatial integration of the sensor contact stresses were compared to the forces measured by load cells during the static simulations and for loading applied by a dynamic hip simulator. Stress magnitudes and spatial distribution patterns obtained from the sensor versus from pressure sensitive film exhibited good agreement. The joint forces obtained during both static and dynamic loading were within ±10% and ±26%, respectively, of the forces measured by the load cells. These results provide confidence in the measurements obtained by the sensor. The new sensor's real-time output and dynamic measurement capabilities hold significant advantages over static measurements from pressure sensitive film. PMID:24763632

Effect of exoskeletal joint constraint and passive resistance on metabolic energy expenditure: Implications for walking in paraplegia

PubMed Central

Kobetic, Rudi; Triolo, Ronald J.

2017-01-01

An important consideration in the design of a practical system to restore walking in individuals with spinal cord injury is to minimize metabolic energy demand on the user. In this study, the effects of exoskeletal constraints on metabolic energy expenditure were evaluated in able-bodied volunteers to gain insight into the demands of walking with a hybrid neuroprosthesis after paralysis. The exoskeleton had a hydraulic mechanism to reciprocally couple hip flexion and extension, unlocked hydraulic stance controlled knee mechanisms, and ankles fixed at neutral by ankle-foot orthoses. These mechanisms added passive resistance to the hip (15 Nm) and knee (6 Nm) joints while the exoskeleton constrained joint motion to the sagittal plane. The average oxygen consumption when walking with the exoskeleton was 22.5 ± 3.4 ml O2/min/kg as compared to 11.7 ± 2.0 ml O2/min/kg when walking without the exoskeleton at a comparable speed. The heart rate and physiological cost index with the exoskeleton were at least 30% and 4.3 times higher, respectively, than walking without it. The maximum average speed achieved with the exoskeleton was 1.2 ± 0.2 m/s, at a cadence of 104 ± 11 steps/min, and step length of 70 ± 7 cm. Average peak hip joint angles (25 ± 7°) were within normal range, while average peak knee joint angles (40 ± 8°) were less than normal. Both hip and knee angular velocities were reduced with the exoskeleton as compared to normal. While the walking speed achieved with the exoskeleton could be sufficient for community ambulation, metabolic energy expenditure was significantly increased and unsustainable for such activities. This suggests that passive resistance, constraining leg motion to the sagittal plane, reciprocally coupling the hip joints, and weight of exoskeleton place considerable limitations on the utility of the device and need to be minimized in future designs of practical hybrid neuroprostheses for walking after paraplegia. PMID:28817701

A new sensor for measurement of dynamic contact stress in the hip.

PubMed

Rudert, M J; Ellis, B J; Henak, C R; Stroud, N J; Pederson, D R; Weiss, J A; Brown, T D

2014-03-01

Various techniques exist for quantifying articular contact stress distributions, an important class of measurements in the field of orthopaedic biomechanics. In situations where the need for dynamic recording has been paramount, the approach of preference has involved thin-sheet multiplexed grid-array transducers. To date, these sensors have been used to study contact stresses in the knee, shoulder, ankle, wrist, and spinal facet joints. Until now, however, no such sensor had been available for the human hip joint due to difficulties posed by the deep, bi-curvilinear geometry of the acetabulum. We report here the design and development of a novel sensor capable of measuring dynamic contact stress in human cadaveric hip joints (maximum contact stress of 20 MPa and maximum sampling rate 100 readings/s). Particular emphasis is placed on issues concerning calibration, and on the effect of joint curvature on the sensor's performance. The active pressure-sensing regions of the sensors have the shape of a segment of an annulus with a 150-deg circumferential span, and employ a polar/circumferential "ring-and-spoke" sensel grid layout. There are two sensor sizes, having outside radii of 44 and 48 mm, respectively. The new design was evaluated in human cadaver hip joints using two methods. The stress magnitudes and spatial distribution measured by the sensor were compared to contact stresses measured by pressure sensitive film during static loading conditions that simulated heel strike during walking and stair climbing. Additionally, the forces obtained by spatial integration of the sensor contact stresses were compared to the forces measured by load cells during the static simulations and for loading applied by a dynamic hip simulator. Stress magnitudes and spatial distribution patterns obtained from the sensor versus from pressure sensitive film exhibited good agreement. The joint forces obtained during both static and dynamic loading were within ±10% and ±26%, respectively, of the forces measured by the load cells. These results provide confidence in the measurements obtained by the sensor. The new sensor's real-time output and dynamic measurement capabilities hold significant advantages over static measurements from pressure sensitive film.

Single-leg drop landing movement strategies in participants with chronic ankle instability compared with lateral ankle sprain 'copers'.

PubMed

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

2016-04-01

To compare the movement patterns and underlying energetics of individuals with chronic ankle instability (CAI) to ankle sprain 'copers' during a landing task. Twenty-eight (age 23.2 ± 4.9 years; body mass 75.5 ± 13.9 kg; height 1.7 ± 0.1 m) participants with CAI and 42 (age 22.7 ± 1.7 years; body mass 73.4 ± 11.3 kg; height 1.7 ± 0.1 m) ankle sprain 'copers' were evaluated 1 year after incurring a first-time lateral ankle sprain injury. Kinematics and kinetics of the hip, knee and ankle joints from 200 ms pre-initial contact (IC) to 200 ms post-IC, in addition to the vertical component of the landing ground reaction force, were acquired during performance of a drop land task. The CAI group adopted a position of increased hip flexion during the landing descent on their involved limb. This coincided with a reduced post-IC flexor pattern at the hip and increased overall hip joint stiffness compared to copers (-0.01 ± 0.05 vs. 0.02 ± 0.05°/Nm kg(-1), p = 0.03). Individuals with CAI display alterations in hip joint kinematics and energetics during a unipodal landing task compared to LAS 'copers'. These alterations may be responsible for the increased risk of injury experienced by individuals with CAI during landing manoeuvres. Thus, clinicians must recognise the potential for joints proximal to the affected ankle to contribute to impaired function following an acute lateral ankle sprain injury and to develop rehabilitation protocols accordingly. Level III.

Preservation of the articular capsule and short lateral rotator in direct anterior approach to total hip arthroplasty.

PubMed

Kanda, Akio; Kaneko, Kazuo; Obayashi, Osamu; Mogami, Atsuhiko; Morohashi, Itaru

2018-03-09

In total hip arthroplasty via a direct anterior approach, the femur must be elevated at the time of femoral implant placement. For adequate elevation, division of the posterior soft tissues is necessary. However, if we damage and separate the posterior muscle tissue, we lose the benefits of the intermuscular approach. Furthermore, damage to the posterior soft tissue can result in posterior dislocation. We investigate that protecting the posterior soft tissue increases the joint stability in the early postoperative period and results in a lower dislocation rate. We evaluated muscle strength recovery by measuring the maximum width of the internal obturator muscle on CT images (GE-Healthcare Discovery CT 750HD). We compared the maximum width of the muscle belly preoperatively versus 10 days and 6 months postoperatively. As clinical evaluations, we also investigated the range of motion of the hip joint, hip joint function based on the Japanese Orthopaedic Association hip score (JOA score), and the dislocation rate 6 months after surgery. The width of the internal obturator muscle increased significantly from 15.1 ± 3.1 mm before surgery to 16.4 ± 2.8 mm 6 months after surgery. The JOA score improved significantly from 50.8 ± 15.1 points to 95.6 ± 7.6 points. No dislocations occurred in this study. We cut only the posterosuperior articular capsule and protected the internal obturator muscle to preserve muscle strength. We repaired the entire posterosuperior and anterior articular capsule. These treatments increase joint stability in the early postoperative period, thus reducing the dislocation rate. Therapeutic, Level IV.

An arthroscopic safety zone for the medial compartment of the hip joint.

PubMed

Lee, Je-Hun; Lee, Jung-Bum; Lee, Nam Seob; Han, Seung Yun; Kim, In-Beom; Han, Seung-Ho

2015-10-01

The purpose of this study was to investigate the safety zone without any neurovascular injury to the medial compartment of hip joint through an anatomical method and describe the relationship of the extra-articular anatomic structures from the surface of the hip joint. Thirty-two fresh specimens from 17 adult Korean cadavers (8 males and 9 females, age range 54-79 years at death) were used for this study. For the measurements, the most superolateral point of the pubic symphysis (PS) and prominent point of the anterior superior iliac spine (ASIS) were identified before dissection. The line connecting the PS and ASIS was defined as a reference line and the PS was a starting point for measurements. All 19 variables measured in this study were related to the femoral head, neck, and surrounding neurovascular structures. The variables were measured according to the x- and y-coordinates in relation to the reference line. The femoral head was generally located 39.5-71.0 mm on the x-coordinate and located 33.5-34.6 mm on the y-coordinate. The junction of the femoral neck and body was located at 52.8 mm on the x-coordinate, and 65.3 mm on the y-coordinate. The junction of the femoral head and neck was located at 47.1 mm on the x-coordinate, and 51.4 mm on the y-coordinate. The location of the medial compartment of the hip joint was located from 38.0 to 43.0 % on the x-coordinate and located from 5.1 to 6.5 cm. These results of this study provide detailed anatomy for arthroscopic hip surgeons.

The effects of load carriage and muscle fatigue on lower-extremity joint mechanics.

PubMed

Wang, He; Frame, Jeff; Ozimek, Elicia; Leib, Daniel; Dugan, Eric L

2013-09-01

Military personnel are commonly afflicted by lower-extremity overuse injuries. Load carriage and muscular fatigue are major stressors during military basic training. To examine effects of load carriage and muscular fatigue on lower-extremity joint mechanics during walking. Eighteen men performed the following tasks: unloaded walking, walking with a 32-kg load, fatigued walking with a 32-kg load, and fatigued walking. After the second walking task, muscle fatigue was elicited through a fatiguing protocol consisting of metered step-ups and heel raises with a 16-kg load. Each walking task was performed at 1.67 m x s(-1) for 5 min. Walking movement was tracked by a VICON motion capture system at 120 Hz. Ground reaction forces were collected by a tandem force instrumented treadmill (AMTI) at 2,400 Hz. Lower-extremity joint mechanics were calculated in Visual 3D. There was no interaction between load carriage and fatigue on lower-extremity joint mechanics (p > .05). Both load carriage and fatigue led to pronounced alterations of lower-extremity joint mechanics (p < .05). Load carriage resulted in increases of pelvis anterior tilt, hip and knee flexion at heel contact, and increases of hip, knee, and ankle joint moments and powers during weight acceptance. Muscle fatigue led to decreases of ankle dorsiflexion at heel contact, dorsiflexor moment, and joint power at weight acceptance. In addition, muscle fatigue increased demand for hip extensor moment and power at weight acceptance. Statistically significant changes in lower-extremity joint mechanics during loaded and fatigued walking may expose military personnel to increased risk for overuse injuries.

Evidence of compensatory joint kinetics during stair ascent and descent in Parkinson's disease.

PubMed

Conway, Zachary J; Silburn, Peter A; Blackmore, Tim; Cole, Michael H

2017-02-01

Stair ambulation is a challenging activity of daily life that requires larger joint moments than walking. Stabilisation of the body and prevention of lower limb collapse during this task depends upon adequately-sized hip, knee and ankle extensor moments. However, people with Parkinson's disease (PD) often present with strength deficits that may impair their capacity to control the lower limbs and ultimately increase their falls risk. To investigate hip, knee and ankle joint moments during stair ascent and descent and determine the contribution of these joints to the body's support in people with PD. Twelve PD patients and twelve age-matched controls performed stair ascent and descent trials. Data from an instrumented staircase and a three-dimensional motion analysis system were used to derive sagittal hip, knee and ankle moments. Support moment impulses were calculated by summing all extensor moment impulses and the relative contribution of each joint was calculated. Linear mixed model analyses indicated that PD patients walked slower and had a reduced cadence relative to controls. Although support moment impulses were typically not different between groups during stair ascent or descent, a reduced contribution by the ankle joint required an increased knee joint contribution for the PD patients. Despite having poorer knee extensor strength, people with PD rely more heavily on these muscles during stair walking. This adaptation could possibly be driven by the somewhat restricted mobility of this joint, which may provide these individuals with an increased sense of stability during these tasks. Copyright © 2016 Elsevier B.V. All rights reserved.

Methodological considerations of task and shoe wear on joint energetics during landing.

PubMed

Shultz, Sandra J; Schmitz, Randy J; Tritsch, Amanda J; Montgomery, Melissa M

2012-02-01

To better understand methodological factors that alter landings strategies, we compared sagittal plane joint energetics during the initial landing phase of drop jumps (DJ) vs. drop landings (DL), and when shod vs. barefoot. Surface electromyography, kinematic and kinetic data were obtained on 10 males and 10 females during five consecutive drop landings and five consecutive drop jumps (0.45m) when shod and when barefoot. Energy absorption was greater in the DJ vs. DL (P=.002), due to increased energy absorption at the hip during the DJ. Joint stiffness/impedance was more affected by shoe condition, where overall stiffness/impedance was greater in shod compared to barefoot conditions (P=.036). Further, hip impedance was greater in shod vs. barefoot for the DL only (via increased peak hip extensor moment in DL), while ankle stiffness was greater in the barefoot vs. shod condition for the DJ only (via decreased joint excursion and increased peak joint moment in DJ vs. DL) (P=.011). DJ and DL place different neuromechanical demands upon the lower extremities, and shoe wear may alter impact forces that modulate stiffness/impedance strategies. The impact of these methodological differences should be considered when comparing landing biomechanics across studies. Copyright © 2011 Elsevier Ltd. All rights reserved.

Hip Abductor Muscle Volume and Strength Differences Between Women With Chronic Hip Joint Pain and Asymptomatic Controls.

PubMed

Mastenbrook, Matthew J; Commean, Paul K; Hillen, Travis J; Salsich, Gretchen B; Meyer, Gretchen A; Mueller, Michael J; Clohisy, John C; Harris-Hayes, Marcie

2017-12-01

Study Design Secondary analysis, cross-sectional study. Background Chronic hip joint pain (CHJP) can lead to limitations in activity participation, but the musculoskeletal factors associated with the condition are relatively unknown. Understanding the factors associated with CHJP may help develop rehabilitation strategies to improve quality of life of individuals with long-term hip pain. Objectives To compare measures of hip abductor muscle volume and hip abductor muscle strength between women with CHJP and asymptomatic controls. Methods Thirty women, 15 with CHJP and 15 matched asymptomatic controls (age range, 18-40 years), participated in this study. Magnetic resonance imaging was used to determine the volume of the primary hip abductor muscles, consisting of the gluteus medius, gluteus minimus, a small portion of the gluteus maximus, and the tensor fascia latae, within a defined region of interest. Break tests were performed using a handheld dynamometer to assess hip abductor strength. During the strength test, the participant was positioned in sidelying with the involved hip in 15° of abduction. Independent-samples t tests were used to compare muscle volume and strength values between those with CHJP and asymptomatic controls. Results Compared to asymptomatic controls, women with CHJP demonstrated significantly increased gluteal muscle volume (228 ± 40 cm 3 versus 199 ± 29 cm 3 , P = .032), but decreased hip abductor strength (74.6 ± 16.8 Nm versus 93.6 ± 20.2 Nm, P = .009). There were no significant differences in tensor fascia lata muscle volume between the 2 groups (P = .640). Conclusion Women with CHJP appear to have larger gluteal muscle volume, but decreased hip abductor strength, compared to asymptomatic controls. J Orthop Sports Phys Ther 2017;47(12):923-930. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7380.

Sacroiliac joint dysfunction as a reason for the development of acetabular retroversion: a new theory.

PubMed

Cibulka, Michael T

2014-05-01

Acetabular retroversion has been recently implicated as an important factor in the development of femoral acetabular impingement and hip osteoarthritis. The proper function of the hip joint requires that the anatomic features of the acetabulum and femoral head complement one another. In acetabular retroversion, the alignment of the acetabulum is altered where it opens in a posterolaterally instead of anterior direction. Changes in acetabular orientation can occur with alterations in pelvic tilt (anterior/posterior), and pelvic rotation (left/right). An overlooked problem that alters pelvic tilt and rotation, often seen by physical therapists, is sacroiliac joint dysfunction. A unique feature that develops in patients with sacroiliac joint dysfunction (SIJD) is asymmetry between the left and right innominate bones that can alter pelvic tilt and rotation. This article puts forth a theory suggesting that acetabular retroversion may be produced by sacroiliac joint dysfunction.

Periprosthetic bone loss in total hip arthroplasty. Polyethylene wear debris and the concept of the effective joint space.

PubMed

Schmalzried, T P; Jasty, M; Harris, W H

1992-07-01

Thirty-four hips in which there had been prosthetic replacement were selected for study because of the presence of linear (diffuse) or lytic (localized) areas of periprosthetic bone loss. In all hips, there was careful documentation of the anatomical location of the material that had been obtained for histological analysis, and the specific purpose of the removal of the tissue was for examination to determine the cause of the resorption of bone. Specimens from twenty-three hips were retrieved during an operation and from eleven hips, at autopsy. The area of bone loss was linear only in sixteen hips, lytic only in thirteen, and both linear and lytic in five. In all thirty-four hips, intracellular particulate debris was found in the macrophages that were present in the area of bone resorption. All thirty-four had intracellular particles of polyethylene, many of which were less than one micrometer in size. Thirty-one hips had extracellular particles of polyethylene as well. Twenty-two of the thirty-four hips had intracellular metallic debris; in ten, metallic debris was found extracellularly as well. Ten of the sixteen cemented specimens had intracellular and extracellular polymethylmethacrylate debris. In the mechanically stable prostheses--cemented and uncemented--polyethylene wear debris was identified in areas of bone resorption far from the articular surfaces. The number of macrophages in a microscopic field was directly related to the amount of particulate polyethylene debris that was visible by light microscopy. Although the gross radiographic appearances of linear bone loss and lytic bone loss were different, the histological appearance of the regions in which there was active bone resorption was similar. Regardless of the radiographic appearance and anatomical origin of the specimen, bone resorption was found to occur in association with macrophages that were laden with polyethylene debris. In general, the number of macrophages present had a direct relationship to the degree of bone resorption that was seen. We believe that these findings indicate that joint fluid penetrates far more extensively than previously thought, even in a well fixed component, along the interface between the prosthesis and bone and in the periprosthetic tissues; it is often more extensive than is shown by arthrography. We therefore suggest the concept of the effective joint space to include all periprosthetic regions that are accessible to joint fluid and thus accessible to particulate debris.(ABSTRACT TRUNCATED AT 400 WORDS)

Serum N-propeptide of collagen IIA (PIIANP) as a marker of radiographic osteoarthritis burden.

PubMed

Daghestani, Hikmat N; Jordan, Joanne M; Renner, Jordan B; Doherty, Michael; Wilson, A Gerry; Kraus, Virginia B

2017-01-01

Cartilage homeostasis relies on a balance of catabolism and anabolism of cartilage matrix. Our goal was to evaluate the burden of radiographic osteoarthritis and serum levels of type IIA procollagen amino terminal propeptide (sPIIANP), a biomarker representing type II collagen synthesis, in osteoarthritis. OA burden was quantified on the basis of radiographic features as total joint faces with an osteophyte, joint space narrowing, or in the spine, disc space narrowing. sPIIANP was measured in 1,235 participants from the Genetics of Generalized Osteoarthritis study using a competitive enzyme-linked immunosorbent assay. Separate multivariable linear regression models, adjusted for age, sex, and body mass index and additionally for ipsilateral osteophytes or joint/disc space narrowing, were used to assess the independent association of sPIIANP with osteophytes and with joint/disc space narrowing burden in knees, hips, hands and spine, individually and together. After full adjustment, sPIIANP was significantly associated with a lesser burden of hip joint space narrowing and knee osteophytes. sPIIANP was associated with a lesser burden of hand joint space narrowing but a greater burden of hand osteophytes; these results were only evident upon adjustment for osteoarthritic features in all other joints. There were no associations of sPIIANP and features of spine osteoarthritis. Higher cartilage collagen synthesis, as reflected in systemic PIIANP concentrations, was associated with lesser burden of osteoarthritic features in lower extremity joints (knees and hips), even accounting for osteoarthritis burden in hands and spine, age, sex and body mass index. These results suggest that pro-anabolic agents may be appropriate for early treatment to prevent severe lower extremity large joint osteoarthritis.

Variability of Plyometric and Ballistic Exercise Technique Maintains Jump Performance.

PubMed

Chandler, Phillip T; Greig, Matthew; Comfort, Paul; McMahon, John J

2018-06-01

Chandler, PT, Greig, M, Comfort, P, and McMahon, JJ. Variability of plyometric and ballistic exercise technique maintains jump performance. J Strength Cond Res 32(6): 1571-1582, 2018-The aim of this study was to investigate changes in vertical jump technique over the course of a training session. Twelve plyometric and ballistic exercise-trained male athletes (age = 23.4 ± 4.6 years, body mass = 78.7 ± 18.8 kg, height = 177.1 ± 9.0 cm) performed 3 sets of 10 repetitions of drop jump (DJ), rebound jump (RJ) and squat jump (SJ). Each exercise was analyzed from touchdown to peak joint flexion and peak joint flexion to take-off. Squat jump was analyzed from peak joint flexion to take-off only. Jump height, flexion and extension time and range of motion, and instantaneous angles of the ankle, knee, and hip joints were measured. Separate 1-way repeated analyses of variance compared vertical jump technique across exercise sets and repetitions. Exercise set analysis found that SJ had lower results than DJ and RJ for the angle at peak joint flexion for the hip, knee, and ankle joints and take-off angle of the hip joint. Exercise repetition analysis found that the ankle joint had variable differences for the angle at take-off, flexion, and extension time for RJ. The knee joint had variable differences for flexion time for DJ and angle at take-off and touchdown for RJ. There was no difference in jump height. Variation in measured parameters across repetitions highlights variable technique across plyometric and ballistic exercises. This did not affect jump performance, but likely maintained jump performance by overcoming constraints (e.g., level of rate coding).

21 CFR 888.3390 - Hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... includes prostheses that have a femoral component made of alloys, such as cobalt-chromium-molybdenum, and a snap-fit acetabular component made of an alloy, such as cobalt-chromium-molybdenum, and ultra-high...

21 CFR 888.3390 - Hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... includes prostheses that have a femoral component made of alloys, such as cobalt-chromium-molybdenum, and a snap-fit acetabular component made of an alloy, such as cobalt-chromium-molybdenum, and ultra-high...

21 CFR 888.3390 - Hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... includes prostheses that have a femoral component made of alloys, such as cobalt-chromium-molybdenum, and a snap-fit acetabular component made of an alloy, such as cobalt-chromium-molybdenum, and ultra-high...

A narrative review of evidence-based recommendations for the physical examination of the lumbar spine, sacroiliac and hip joint complex.

PubMed

Wong, C K; Johnson, E K

2012-09-01

Non-specific low back pain is a frequent complaint in primary care, but the differential diagnosis for low back pain can be complex. Despite advances in diagnostic imaging, a specific pathoanatomical source of low back pain can remain elusive in up to 85% of individuals. Best practice guidelines recommend that clinicians conduct a focused physical examination to help to identify patients with non-specific low back pain and an evidence-based course of clinical management. The use of sensitive and specific clinical methods to assess the lumbar spine, sacroiliac and hip joints is critical for effective physical examination. Psychosocial factors also play an important role in the evaluation of individuals with low back pain, but are not included in this narrative review of physical examination methods. Physical examination of the lumbar spine, sacroiliac and hip joints is presented, organized around patient position for efficient and effective clinical assessment. Copyright © 2012 John Wiley & Sons, Ltd.

Maximum voluntary joint torque as a function of joint angle and angular velocity: model development and application to the lower limb.

PubMed

Anderson, Dennis E; Madigan, Michael L; Nussbaum, Maury A

2007-01-01

Measurements of human strength can be important during analyses of physical activities. Such measurements have often taken the form of the maximum voluntary torque at a single joint angle and angular velocity. However, the available strength varies substantially with joint position and velocity. When examining dynamic activities, strength measurements should account for these variations. A model is presented of maximum voluntary joint torque as a function of joint angle and angular velocity. The model is based on well-known physiological relationships between muscle force and length and between muscle force and velocity and was tested by fitting it to maximum voluntary joint torque data from six different exertions in the lower limb. Isometric, concentric and eccentric maximum voluntary contractions were collected during hip extension, hip flexion, knee extension, knee flexion, ankle plantar flexion and dorsiflexion. Model parameters are reported for each of these exertion directions by gender and age group. This model provides an efficient method by which strength variations with joint angle and angular velocity may be incorporated into comparisons between joint torques calculated by inverse dynamics and the maximum available joint torques.

Endoscopic treatment of snapping hips, iliotibial band, and iliopsoas tendon.

PubMed

Ilizaliturri, Victor M; Camacho-Galindo, Javier

2010-06-01

Indications for endoscopic surgery of the hip have expanded recently. The technique has found a clear indication in the management of snapping hip syndromes, both external snapping hip and internal snapping hip. Even though the snapping hips (external and internal) share a common name, they are very different in origin. The external snapping hip is produced by the iliotibial band snapping over the prominence of the greater trochanter during flexion and extension. Indication for surgical treatment is painful snapping with failure of conservative treatment. The endoscopic technique is designed to release the iliotibial band producing a diamond shape defect on the iliotibial band lateral to the greater trochanter. The defect allows the greater trochanter to move freely without snapping. The greater trochanteric bursa is resected through the defect and the abductor tendons inspected. This procedure is performed without traction and usually only the peritrochanteric space is accessed. If necessary, hip arthroscopy can also be performed. There is limited literature regarding the results of endoscopic treatment for the external snapping hip syndrome, but early reports are encouraging. The internal snapping hip syndrome is produced by the iliopsoas tendon snapping over the iliopectineal eminence or the femoral head. The snapping phenomenon usually occurs with extension of the hip from a flexed position of more than 90 degree. Two different endoscopic techniques have been described to treat this condition. Iliopsoas tendon release at the level of the hip joint, with this technique the iliopsoas bursa is accessed through an anterior hip capsulotomy and is frequently referred to as a transcapsular release. The second technique is a release at the insertion of the iliopsoas tendon on the lesser trochanter, with this technique the iliospaos bursa is accessed directly. In every report the iliopsoas tendon release has been combined with arthroscopy of the hip joint. It has been documented that more than half of the patients with internal snapping hip syndrome have intra-articular hip pathology. The results of endoscopic release of the iliopsoas tendon in the treatment of internal snapping hip syndrome are encouraging and seem to be better than those reported for open procedures.

Hip Imaging in Athletes: Sports Imaging Series.

PubMed

Agten, Christoph A; Sutter, Reto; Buck, Florian M; Pfirrmann, Christian W A

2016-08-01

Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam- and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. (©) RSNA, 2016.

Hip Implant Modified To Increase Probability Of Retention

NASA Technical Reports Server (NTRS)

Canabal, Francisco, III

1995-01-01

Modification in design of hip implant proposed to increase likelihood of retention of implant in femur after hip-repair surgery. Decreases likelihood of patient distress and expense associated with repetition of surgery after failed implant procedure. Intended to provide more favorable flow of cement used to bind implant in proximal extreme end of femur, reducing structural flaws causing early failure of implant/femur joint.

The effect of soft tissue release of the hips on walking in myelomeningocele.

PubMed

Correll, J; Gabler, C

2000-06-01

Walking and standing capacity in myelomeningocele is highly dependent on the level of the neurological lesion. Deformities, mainly flexion deformities, of the hip can severely interfere with mobility. In a retrospective study, undertaken in our hospital, we evaluated the role of soft tissue release of the hip in patients with hip flexion contractures. A special surgical technique was performed in 55 hips. The results show a good effect on verticalization, even if the hip joints cannot be extended actively. A subluxated or dislocated hip did not influence the final outcome. During the mean follow-up of approximately 4 years, only a slight recurrence of the former deformity was observed. Most of the patients obtained great advantage from the operation.

Lower extremity joint loads in habitual rearfoot and mid/forefoot strike runners with normal and shortened stride lengths.

PubMed

Boyer, Elizabeth R; Derrick, Timothy R

2018-03-01

Our purpose was to compare joint loads between habitual rearfoot (hRF) and habitual mid/forefoot strikers (hFF), rearfoot (RFS) and mid/forefoot strike (FFS) patterns, and shorter stride lengths (SLs). Thirty-eight hRF and hFF ran at their normal SL, 5% and 10% shorter, as well as with the opposite foot strike. Three-dimensional ankle, knee, patellofemoral (PF) and hip contact forces were calculated. Nearly all contact forces decreased with a shorter SL (1.2-14.9% relative to preferred SL). In general, hRF had higher PF (hRF-RFS: 10.8 ± 1.4, hFF-FFS: 9.9 ± 2.0 BWs) and hip loads (axial hRF-RFS: -9.9 ± 0.9, hFF-FFS: -9.6 ± 1.0 BWs) than hFF. Many loads were similar between foot strike styles for the two groups, including axial and lateral hip, PF, posterior knee and shear ankle contact forces. Lateral knee and posterior hip contact forces were greater for RFS, and axial ankle and knee contact forces were greater for FFS. The tibia may be under greater loading with a FFS because of these greater axial forces. Summarising, a particular foot strike style does not universally decrease joint contact forces. However, shortening one's SL 10% decreased nearly all lower extremity contact forces, so it may hold potential to decrease overuse injuries associated with excessive joint loads.

Deep brain stimulation enhances movement complexity during gait in individuals with Parkinson's disease.

PubMed

Powell, Douglas W; Blackmore, Sarah E; Puppa, Melissa; Lester, Deranda; Murray, Nicholas G; Reed-Jones, Rebecca J; Xia, Rui-Ping

2018-05-08

Deep brain stimulation (DBS) is associated with substantial improvements in motor symptoms of PD. Emerging evidence has suggested that nonlinear measures of complexity may provide greater insight into the efficacy of anti-PD treatments. This study investigated sample entropy and complexity index values in individuals with PD when DBS was OFF compared to ON. Five individuals with PD using DBS performed a four-minute treadmill walking task while 3D kinematics were collected over two periods of 30 s. Participants were tested in the DBS-ON and DBS-OFF conditions. Sample entropy (SE) and complexity index (CI) values were calculated for ankle, knee and hip joint angles. Paired samples t-tests were used to compare mean SE and CI values between the DBS-OFF and DBS-ON conditions, respectively. No differences in SE or CI were observed between the DBS-ON and DBS-OFF conditions at the ankle. At the knee, the DBS-ON was associated with greater SE and CI values than the DBS-OFF condition. At the hip, DBS-ON was associated with greater SE and CI values than the DBS-OFF condition. DBS enhances complexity of movement at the hip and knee joints while complexity at the ankle joint is not significantly altered. Greater complexity of knee and hip joint motion may represent increased adaptability and a greater number of available strategies to complete the gait task. Copyright © 2018 Elsevier B.V. All rights reserved.

Landing Mechanics During Side Hopping and Crossover Hopping Maneuvers in Noninjured Women and Women With Anterior Cruciate Ligament Reconstruction

PubMed Central

Ortiz, Alexis; Olson, Sharon; Trudelle-Jackson, Elaine; Rosario, Martin; Venegas, Heidi L.

2011-01-01

Objective To compare, landing mechanics and electromyographic activity of the lower extremities during side hopping and crossover hopping maneuvers, in noninjured women and women with anterior cruciate ligament (ACL) reconstruction. Design A case-control study. Setting A 3-dimensional motion analysis laboratory. Participants Twenty-eight young women (range, 21–35 years) (15 control subjects and 13 subjects with ACL reconstruction). Patients and Methods All participants performed a side-to-side hopping task that consisted of hopping single-legged 10 times consecutively from side to side across 2 lines marked 30 cm apart on 2 individual force plates. The task was designated as a side hopping when the hop was to the opposite side of the stance leg and as crossover hopping when the hop was toward the side of the stance leg. Main Outcome Measurements Peak hip-/knee-joint angles; peak knee extension/abduction joint moments; electromyographic studies of the gluteus maximus, gluteus medius, rectus femoris, and hamstring muscles; and quadriceps/hamstring co-contraction ratio were compared between the groups by means of 2 × 2 multivariate analysis of variance tests (group × maneuver). Results Noninjured women and women with ACL reconstruction exhibited similar hip-and knee-joint angles during both types of hopping. Hip-joint angles were greater during the crossover hopping in both groups, and knee-joint angles did not differ between the groups or hops. Knee-joint moments demonstrated a significant group × maneuver interaction. Greater knee extension and valgus moments were noted in the control group during crossover hopping, and greater knee abduction moments were noted in the ACL group during side hopping. Electromyographic data revealed no statistically significantly differences between the groups. Conclusions Women with ACL reconstruction exhibited the restoration of functional biomechanical movements such as hip-/knee-joint angles and lower extremity neuromuscular activation during side-to-side athletic tasks. However, not all biomechanical strategies are restored years after surgery, and women who have undergone a procedure such as ACL reconstruction may continue to exhibit knee-joint abduction moments that increase the risk of additional knee injury. PMID:21257128

Lumbar disc degeneration was not related to spine and hip bone mineral densities in Chinese: facet joint osteoarthritis may confound the association.

PubMed

Pan, Jianjiang; Lu, Xuan; Yang, Ge; Han, Yongmei; Tong, Xiang; Wang, Yue

2017-12-01

A sample of 512 Chinese was studied and we observed that greater disc degeneration on MRI was associated with greater spine DXA BMD. Yet, this association may be confounded by facet joint osteoarthritis. BMD may not be a risk factor for lumbar disc degeneration in Chinese. Evidence suggested that lumbar vertebral bone and intervertebral disc interact with each other in multiple ways. The current paper aims to determine the association between bone mineral density (BMD) and lumbar disc degeneration using a sample of Chinese. We studied 165 patients with back disorders and 347 general subjects from China. All subjects had lumbar spine magnetic resonance (MR) imaging and dual- energy X-ray absorptiometry (DXA) spine BMD studies, and a subset of general subjects had additional hip BMD measurements. On T2-weighted MR images, Pfirrmann score was used to evaluate the degree of lumbar disc degeneration and facet joint osteoarthritis was assessed as none, slight-moderate, and severe. Regression analyses were used to examine the associations between lumbar and hip BMD and disc degeneration, adjusting for age, gender, body mass index (BMI), lumbar region, and facet joint osteoarthritis. Greater facet joint osteoarthritis was associated with greater spine BMD (P < 0.01) in both patients and general subjects. For general subjects, greater spine BMD was associated with severe disc degeneration, controlling for age, gender, BMI, and lumbar region. When facet joint osteoarthritis entered the regression model, however, greater spine BMD was associated with greater facet joint osteoarthritis (P < 0.01) but not greater disc degeneration (P > 0.05). No statistical association was observed between spine BMD and lumbar disc degeneration in patients with back disorders (P > 0.05), and between hip BMD and disc degeneration in general subjects (P > 0.05). BMD may not be a risk factor for lumbar disc degeneration in Chinese. Facet joint osteoarthritis inflates DXA spine BMD measurements and therefore, may confound the association between spine BMD and disc degeneration.

Load Dependency of Postural Control - Kinematic and Neuromuscular Changes in Response to over and under Load Conditions

PubMed Central

Ritzmann, Ramona; Freyler, Kathrin; Weltin, Elmar; Krause, Anne; Gollhofer, Albert

2015-01-01

Introduction Load variation is associated with changes in joint torque and compensatory reflex activation and thus, has a considerable impact on balance control. Previous studies dealing with over (OL) and under loading (UL) used water buoyancy or additional weight with the side effects of increased friction and inertia, resulting in substantially modified test paradigms. The purpose of this study was to identify gravity-induced load dependency of postural control in comparable experimental conditions and to determine the underlying neuromuscular mechanisms. Methods Balance performance was recorded under normal loading (NL, 1g), UL (0.16g; 0.38g) and OL (1.8g) in monopedal stance. Center of pressure (COP) displacement and frequency distribution (low 0.15-0.5Hz (LF), medium 0.5-2Hz (MF), high 2-6Hz (HF)) as well as ankle, knee and hip joint kinematics were assessed. Soleus spinal excitability was determined by H/M-recruitment curves (H/M-ratios). Results Compared to NL, OL caused an increase in ankle joint excursion, COP HF domain and H/M-ratio. Concomitantly, hip joint excursion and COP LF decreased. Compared to NL, UL caused modulations in the opposite direction: UL decreased ankle joint excursions, COP HF and H/M-ratio. Collaterally, hip joint excursion and COP LF increased. COP was augmented both in UL and in OL compared to NL. Conclusion Subjects achieved postural stability in OL and UL with greater difficulty compared to NL. Reduced postural control was accompanied by modified balance strategies and compensatory reflex activation. With increasing load, a shift from hip to ankle strategy was observed. Accompanying, COP frequency distribution shifted from LF to HF and spinal excitability was enhanced. It is suggested that in OL, augmented ankle joint torques are compensated by quick reflex-induced postural reactions in distal muscles. Contrarily, UL is associated with diminished joint torques and thus, postural equilibrium may be controlled by the proximal segments to adjust the center of gravity above the base of support. PMID:26053055

[A therapeutic effect analysis of femur first principle and combined anteversion technique during total hip arthroplasty].

PubMed

Wang, X Q; Wu, C S; Sun, S; Wang, J; Li, W; Zhang, W

2018-04-01

Objective: To investigate the situation of hip dislocation with the application of "femur first" principle and "combined anteversion technique" during total hip arthroplasty. Methods: A retrospective analysis has been done on the clinical data about 104 patients(133 hips)who were diagnosed as hip disease and were treated with total hip arthroplasty by the doctors from the Department of Joint Orthorpaedics of Shandong Provincial Hospital Affiliated to Shandong University from June 2014 to June 2016, and all the prostheses applied in the operation were cementless ones.Among them, 65 patients were males, 39 females and their age was 46.6 years (ranging from 23 to 76 years) .And 29 of them underwent bilateral hip operations and 75 unilateral ones.Seventy-six cases of aseptic necrosis of the femoral head in the terminal stage, 28 cases of hip dysplasia and osteoarthritis.Surgical approach: of all the operations, 103 hips were operated on with hardinge approach, 30 with posterolateral approach.During the operation, first of all, the femoral medullary cavity was broached and then the anteversion of intramedullary broacher was measured.After that, the anteversion of the acetabular cup was calculated as 37° minus the anteversion of the broacher, and the acetabular cup was implanted at that angle.The patients' prosthesis combined anteversion, range of motion of the hip joint, operation time, hemorrhage amount, and complications had been kept record.One, three, and six months respectively after the operation, all the patients received outpatient review, and took anteroposterior and lateral position X-ray examination.Harris hip score had been applied to evaluate their hip function before the operation and six months after the operation. Results: All the patients had been operated on smoothly, with the operation time of(57.6±14.5)minutes(36-115 minutes)and hemorrhage amount of (336.5±50.8)ml(180-620 ml). The operation finding showed that the combined anteversion by employing"femur first"principle and combined anteversion techniqueis was (36.6±6.8)°. Also, range of motion of the patients' hip conforms to the D'Lima criterion and no patients had experienced dislocation and some other serious complications.The follow-up ended at August 2017, which lasted for 12.2 months(6-18 months), and 88 cases(119 hips) were interviewed. The Harris hip score for the affected sides of the hip joints 6 months after the surgery was 94.6(86-100). Compared with the score of 29.8(12-43) before surgery, the t -test had proven its statistical significance( t =12.82, P =0.003). Conclusion: Based upon the "femoral first" principle and "combined anteversion technique" during total hip arthroplasty, these operations has been carried out well enough to meet the patients' needs of performing normal daily activities.

[Osteoarthritic changes in hip joint in patients with fractures of femoral neck].

PubMed

Kravtsov, Vladimir; Saranga, Dan; Kidron, Debora

2013-06-01

Fractures of proximal femur are common among elderly people. They are associated with considerable morbidity and mortality. Identification of etiopathogenetic factors associated with fractures might facilitate prevention. Osteoporosis is commonly present in the heads of femurs. The prevalence of osteoarthritic changes in hip joints is controversial. Some authorities report low prevalence and even speculate on the protective effect of osteoarthritis against fractures. The goal of the study was to examine the association between osteoarthritic changes (radiologic and histologic) and fractures of the neck of the femur. The patient population included 41 patients undergoing replacement of femoral head for subcapital fracture; their ages ranged from 61 - 93 years of age. Radiologic criteria for osteoarthritis included: (a)narrowing of joint space (b) subchondral sclerosis (c) deformation of head of femur (d) subchondra cysts and (e] osteophytes. Osteoarthritic changes, usually mild, were present in 22 (54%) patients, regardless of age and gender The frequency of radioLogical changes was similar to the general population. HistoLogic findings included subchondral fibrosis and subchondral cysts. Mild subchondral fibrosis was present in 78% of cases. The findings support lack of association between osteoarthritic changes in hip joint and fracture of proximal femur, without a protective effect.

Measurements of hip-bone distortions caused by the stress of inserted prosthesis by means of the speckle photography method

NASA Astrophysics Data System (ADS)

Gajda, Jerzy K.; Niesterowicz, Andrzej; Mazurkiewicz, Henryk

1995-03-01

A high number of osseous diseases, particularly of the backbone and hip-joint regions, result in a need for their overall treatment and prevention. Two basic treatment methods are used: physical exercises at an early stage of the illness, and surgical treatment in an advanced stage. Recently, in operational treatment of coxarthrosis the elements of the joint (acetabulum and capitellum) were replaced by their artificial counterparts, despite some drawbacks and unknowns related to this kind of treatment. In order to check the effectiveness of this treatment and to eliminate its drawbacks we have tested the joint by means of speckle photography method. The objective of this paper is an attempt to evaluate stress and displacement distributions in a system consisting of artificial acetabulum and capitellum and a natural bone in order to determine an optimum fitting of artificial acetabulum and capitellum and a natural bone in order to determine an optimum fitting of artificial elements that guarantees uniform distribution of stresses corresponding to anatomical and physiological parameters of the hip-joint. Speckle photographs have been analyzed point by point with the help of the algorithm for striped images processing.

Test-Retest Reliability of Innovated Strength Tests for Hip Muscles

PubMed Central

Meyer, Christophe; Corten, Kristoff; Wesseling, Mariska; Peers, Koen; Simon, Jean-Pierre; Jonkers, Ilse; Desloovere, Kaat

2013-01-01

The burden of hip muscles weakness and its relation to other impairments has been well documented. It is therefore a pre-requisite to have a reliable method for clinical assessment of hip muscles function allowing the design and implementation of a proper strengthening program. Motor-driven dynamometry has been widely accepted as the gold-standard for lower limb muscle strength assessment but is mainly related to the knee joint. Studies focusing on the hip joint are less exhaustive and somewhat discrepant with regard to optimal participants position, consequently influencing outcome measures. Thus, we aimed to develop a standardized test setup for the assessment of hip muscles strength, i.e. flexors/extensors and abductors/adductors, with improved participant stability and to define its psychometric characteristics. Eighteen participants performed unilateral isokinetic and isometric contractions of the hip muscles in the sagittal and coronal plane at two separate occasions. Peak torque and normalized peak torque were measured for each contraction. Relative and absolute measures of reliability were calculated using the intraclass correlation coefficient and standard error of measurement, respectively. Results from this study revealed higher levels of between-day reliability of isokinetic/isometric hip abduction/flexion peak torque compared to existing literature. The least reliable measures were found for hip extension and adduction, which could be explained by a less efficient stabilization technique. Our study additionally provided a first set of reference normalized data which can be used in future research. PMID:24260550

Long-term outcome of total hip arthroplasty in patients with haemophilia.

PubMed

Strauss, A C; Rommelspacher, Y; Nouri, B; Bornemann, R; Wimmer, M D; Oldenburg, J; Pennekamp, P H; Schmolders, J

2017-01-01

Besides the target joints (elbow, knee and ankle), the hip is one of the commonly affected joints in haemophilic arthropathy. Hip arthroplasty is the therapy of choice after failure of conservative treatment. There are only limited data on long-term results after primary total hip arthroplasty (THA). The aim of this retrospective study was to analyse clinical outcome and complication rate after total hip replacement in patients with severe haemophilic arthropathy. Forty-three patients with haemophilia (PWH), one patient with von Willebrand disease and one patient with a Factor-VII-deficiency undergoing 49 total hip arthroplasties, were evaluated in a retrospective study. Harris hip score (HHS), range of motion (ROM), pain status (visual analogue scale, VAS) complication rate and patient satisfaction were assessed at a mean follow-up of 11.5 years (range: 3-32). HSS, ROM and VAS improved significantly combined with high patient satisfaction. In total, three (6.1%) periprosthetic infections and five (10.2%) aseptic implant loosenings occurred after THA leading to revision arthroplasty. In two (4.1%) cases, a pseudotumour and one (2.0%) periarticular ossification had to be resected after THA. Total hip replacement in PWH leads to a significant increase of function, reduction of pain and a high satisfaction. Due to the relatively high complication rate (infections and aseptic loosening) compared to patients without haemophilia, an individual assessment of the risk-benefit ratio from surgical and haemostaseological point of view is needed. © 2016 John Wiley & Sons Ltd.

Selection of contact bearing couple materials for hip prosthesis using finite element analysis under static conditions

NASA Astrophysics Data System (ADS)

Arirajan, K. A.; Chockalingam, K.; Vignesh, C.

2018-04-01

Implants are the artificial parts to replace the missing bones or joints in human anatomy to give mechanical support. Hip joint replacement is an important issue in orthopaedic surgery. The main concern limiting the long-run success of the total hip replacement is the limited service life. Hip replacement technique is widely used in replacing the femur head and acetabular cup by materials that are highly biocompatible. The success of the artificial hip replacement depends upon proper material selection, structure, and shape of the hip prosthesis. Many orthopaedic analyses have been tried with different materials, but ended with partial success on the application side. It is a critical task for selecting the best material pair in the hip prosthesis design. This work develops the finite element analysis of an artificial hip implant to study highest von Mises stress, contact pressure and elastic strain occurs for the dissimilar material combination. The different bearing couple considered for the analysis are Metal on Metal, Metal on Plastic, Metal on Ceramic, Ceramic on Plastic, Ceramic on Ceramic combinations. The analysis is carried out at different static positions of a human (i.e) standing, sitting. The results reveals that the combination with metal in contact with plastic (i.e) Titanium femoral head paired with Ultra High Molecular Weight Poly Ethylene acetabular cup reduces maximum von Mises stress and also it gives lowest contact pressure than other combination of bearing couples.

Frontal joint dynamics when initiating stair ascent from a walk versus a stand.

PubMed

Vallabhajosula, Srikant; Yentes, Jennifer M; Stergiou, Nicholas

2012-02-02

Ascending stairs is a challenging activity of daily living for many populations. Frontal plane joint dynamics are critical to understand the mechanisms involved in stair ascension as they contribute to both propulsion and medio-lateral stability. However, previous research is limited to understanding these dynamics while initiating stair ascent from a stand. We investigated if initiating stair ascent from a walk with a comfortable self-selected speed could affect the frontal plane lower-extremity joint moments and powers as compared to initiating stair ascent from a stand and if this difference would exist at consecutive ipsilateral steps on the stairs. Kinematics data using a 3-D motion capture system and kinetics data using two force platforms on the first and third stair treads were recorded simultaneously as ten healthy young adults ascended a custom-built staircase. Data were collected from two starting conditions of stair ascent, from a walk (speed: 1.42 ± 0.21 m/s) and from a stand. Results showed that subjects generated greater peak knee abductor moment and greater peak hip abductor moment when initiating stair ascent from a walk. Greater peak joint moments and powers at all joints were also seen while ascending the second ipsilateral step. Particularly, greater peak hip abductor moment was needed to avoid contact of the contralateral limb with the intermediate step by counteracting the pelvic drop on the contralateral side. This could be important for therapists using stair climbing as a testing/training tool to evaluate hip strength in individuals with documented frontal plane abnormalities (i.e. knee and hip osteoarthritis, ACL injury). Copyright © 2011 Elsevier Ltd. All rights reserved.

Tribology and total hip joint replacement: current concepts in mechanical simulation.

PubMed

Affatato, S; Spinelli, M; Zavalloni, M; Mazzega-Fabbro, C; Viceconti, M

2008-12-01

Interest in the rheology and effects of interacting surfaces is as ancient as man. This subject can be represented by a recently coined word: tribology. This term is derived from the Greek word "tribos" and means the "science of rubbing". Friction, lubrication, and wear mechanism in the common English language means the precise field of interest of tribology. Wear of total hip prosthesis is a significant clinical problem that involves, nowadays, a too high a number of patients. In order to acquire further knowledge on the tribological phenomena that involve hip prosthesis wear tests are conducted on employed materials to extend lifetime of orthopaedic implants. The most basic type of test device is the material wear machine, however, a more advanced one may more accurately reproduce some of the in vivo conditions. Typically, these apparatus are called simulators, and, while there is no absolute definition of a joint simulator, its description as a mechanical rig used to test a joint replacement, under conditions approximating those occurring in the human body, is acceptable. Simulator tests, moreover, can be used to conduct accelerated protocols that replicate/simulate particularly extreme conditions, thus establishing the limits of performance for the material. Simulators vary in their level of sophistication and the international literature reveals many interpretations of the design of machines used for joint replacement testing. This paper aims to review the current state of the art of the hip joint simulators worldwide. This is specified through a schematic overview by describing, in particular, constructive solutions adopted to reproduce in vivo conditions. An exhaustive commentary on the evolution and actually existing simulation standards is proposed by the authors. The need of a shared protocol among research laboratories all over the world could lead to a consensus conference.

Strength deficit of knee flexors is dependent on hip position in adults with chronic hemiparesis.

PubMed

Michaelsen, Stella M; Ovando, Angélica C; Bortolotti, Adriano; Bandini, Bruno

2013-01-01

The extent to which muscle length affects force production in paretic lower limb muscles after stroke in comparison to controls has not been established. To investigate knee flexor strength deficits dependent on hip joint position in adults with hemiparesis and compare with healthy controls. a cross-sectional study with ten subjects with chronic (63±40 months) hemiparesis with mild to moderate lower limb paresis (Fugl-Meyer score 26±3) and 10 neurologically healthy controls. Isometric knee flexion strength with the hip positioned at 90° and 0° of flexion was assessed randomly on the paretic and non-paretic side of hemiparetic subjects and healthy controls. Subjects were asked to perform a maximal isometric contraction sustained for four seconds and measured by a dynamometer. The ratio of knee flexor strength between these two hip positions was calculated: Hip 0°/Hip 90°. Also, locomotor capacity was evaluated by the timed up and go test and by walking velocity over 10 meters. In subjects with hemiparesis, absolute knee flexion torque decreased (p<0.001) with the hip in extension (at 0°). The ratio of knee flexor torque Hip 0°/Hip 90° on the paretic side in hemiparetics was lower than in controls (p=0.02). Weakness dependent on joint position is more significant in the paretic lower limb of adults with hemiparesis when compared to controls. More attention should be given to lower limb muscle strengthening exercises in individuals with stroke, with emphasis on the strengthening exercises in positions in which the muscle is shortened.

Validation of a standardized mapping system of the hip joint for radial MRA sequencing.

PubMed

Klenke, Frank M; Hoffmann, Daniel B; Cross, Brian J; Siebenrock, Klaus A

2015-03-01

Intraarticular gadolinium-enhanced magnetic resonance arthrography (MRA) is commonly applied to characterize morphological disorders of the hip. However, the reproducibility of retrieving anatomic landmarks on MRA scans and their correlation with intraarticular pathologies is unknown. A precise mapping system for the exact localization of hip pathomorphologies with radial MRA sequences is lacking. Therefore, the purpose of the study was the establishment and validation of a reproducible mapping system for radial sequences of hip MRA. Sixty-nine consecutive intraarticular gadolinium-enhanced hip MRAs were evaluated. Radial sequencing consisted of 14 cuts orientated along the axis of the femoral neck. Three orthopedic surgeons read the radial sequences independently. Each MRI was read twice with a minimum interval of 7 days from the first reading. The intra- and inter-observer reliability of the mapping procedure was determined. A clockwise system for hip MRA was established. The teardrop figure served to determine the 6 o'clock position of the acetabulum; the center of the greater trochanter served to determine the 12 o'clock position of the femoral head-neck junction. The intra- and inter-observer ICCs to retrieve the correct 6/12 o'clock positions were 0.906-0.996 and 0.978-0.988, respectively. The established mapping system for radial sequences of hip joint MRA is reproducible and easy to perform.

High prevalence of noise following Delta ceramic-on-ceramic total hip arthroplasty.

PubMed

Salo, P P; Honkanen, P B; Ivanova, I; Reito, A; Pajamäki, J; Eskelinen, A

2017-01-01

We evaluated the short-term functional outcome and prevalence of bearing-specific generation of audible noise in 301 patients (336 hips) operated on with fourth generation (Delta) medium diameter head, ceramic-on-ceramic (CoC) total hip arthroplasties (THAs). There were 191 female (63%) and 110 male patients (37%) with a mean age of 61 years (29 to 78) and mean follow-up of 2.1 years (1.3 to 3.4). Patients completed three questionnaires: Oxford Hip Score (OHS), Research and Development 36-item health survey (RAND-36) and a noise-specific symptom questionnaire. Plain radiographs were also analysed. A total of three hips (0.9%) were revised. There were 52 patients (54 hips, 17%) who reported noise, and in 25 (48%) of them the noise was frequently heard. In the multiple regression analysis, the only independent risk factor for noise was a specific THA brand, with a threefold increased risk (95% confidence intervals 1.39 to 6.45, p = 0.005) of noise compared with the reference THA brand. Patients with noisy hips had lower median OHS (43 versus 46.5, p = 0.002) and their physical functioning (p = 0.021) subscale in RAND-36 was reduced. Noise was surprisingly common in this population. Cite this article: Bone Joint J 2017;99-B:44-50. ©2017 The British Editorial Society of Bone & Joint Surgery.

Developmental dysplasia of the hip: What has changed in the last 20 years?

PubMed Central

Kotlarsky, Pavel; Haber, Reuben; Bialik, Victor; Eidelman, Mark

2015-01-01

Developmental dysplasia of the hip (DDH) describes the spectrum of structural abnormalities that involve the growing hip. Early diagnosis and treatment is critical to provide the best possible functional outcome. Persistence of hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength and increased rate of degenerative hip and knee joint disease. Despite efforts to recognize and treat all cases of DDH soon after birth, diagnosis is delayed in some children, and outcomes deteriorate with increasing delay of presentation. Different screening programs for DDH were implicated. The suspicion is raised based on a physical examination soon after birth. Radiography and ultrasonography are used to confirm the diagnosis. The role of other imaging modalities, such as magnetic resonance imaging, is still undetermined; however, extensive research is underway on this subject. Treatment depends on the age of the patient and the reducibility of the hip joint. At an early age and up to 6 mo, the main treatment is an abduction brace like the Pavlik harness. If this fails, closed reduction and spica casting is usually done. After the age of 18 mo, treatment usually consists of open reduction and hip reconstruction surgery. Various treatment protocols have been proposed. We summarize the current practice for detection and treatment of DDH, emphasizing updates in screening and treatment during the last two decades. PMID:26716085

Increasing hip and knee flexion during a drop-jump task reduces tibiofemoral shear and compressive forces: implications for ACL injury prevention training.

PubMed

Tsai, Liang-Ching; Ko, Yi-An; Hammond, Kyle E; Xerogeanes, John W; Warren, Gordon L; Powers, Christopher M

2017-12-01

Although most ACL injury prevention programmes encourage greater hip and knee flexion during landing, it remains unknown how this technique influences tibiofemoral joint forces. We examined whether a landing strategy utilising greater hip and knee flexion decreases tibiofemoral anterior shear and compression. Twelve healthy women (25.9 ± 3.5 years) performed a drop-jump task before and after a training session (10-15 min) that emphasised greater hip and knee flexion. Peak tibiofemoral anterior shear and compressive forces were calculated using an electromyography (EMG)-driven knee model that incorporated joint kinematics, EMG and participant-specific muscle volumes and patella tendon orientation measured using magnetic resonance imaging (MRI). Participants demonstrated a decrease in peak anterior tibial shear forces (11.1 ± 3.3 vs. 9.6 ± 2.7 N · kg -1 ; P = 0.008) and peak tibiofemoral compressive forces (68.4 ± 7.6 vs. 62.0 ± 5.5 N · kg -1 ; P = 0.015) post-training. The decreased peak anterior tibial shear was accompanied by a decrease in the quadriceps anterior shear force, while the decreased peak compressive force was accompanied by decreased ground reaction force and hamstring forces. Our data provide justification for injury prevention programmes that encourage greater hip and knee flexion during landing to reduce tibiofemoral joint loading.

Estimation of Quasi-Stiffness of the Human Hip in the Stance Phase of Walking

PubMed Central

Shamaei, Kamran; Sawicki, Gregory S.; Dollar, Aaron M.

2013-01-01

This work presents a framework for selection of subject-specific quasi-stiffness of hip orthoses and exoskeletons, and other devices that are intended to emulate the biological performance of this joint during walking. The hip joint exhibits linear moment-angular excursion behavior in both the extension and flexion stages of the resilient loading-unloading phase that consists of terminal stance and initial swing phases. Here, we establish statistical models that can closely estimate the slope of linear fits to the moment-angle graph of the hip in this phase, termed as the quasi-stiffness of the hip. Employing an inverse dynamics analysis, we identify a series of parameters that can capture the nearly linear hip quasi-stiffnesses in the resilient loading phase. We then employ regression analysis on experimental moment-angle data of 216 gait trials across 26 human adults walking over a wide range of gait speeds (0.75–2.63 m/s) to obtain a set of general-form statistical models that estimate the hip quasi-stiffnesses using body weight and height, gait speed, and hip excursion. We show that the general-form models can closely estimate the hip quasi-stiffness in the extension (R2 = 92%) and flexion portions (R2 = 89%) of the resilient loading phase of the gait. We further simplify the general-form models and present a set of stature-based models that can estimate the hip quasi-stiffness for the preferred gait speed using only body weight and height with an average error of 27% for the extension stage and 37% for the flexion stage. PMID:24349136

Cost-Effectiveness of Total Hip and Knee Replacements for the Australian Population with Osteoarthritis: Discrete-Event Simulation Model

PubMed Central

Higashi, Hideki; Barendregt, Jan J.

2011-01-01

Background Osteoarthritis constitutes a major musculoskeletal burden for the aged Australians. Hip and knee replacement surgeries are effective interventions once all conservative therapies to manage the symptoms have been exhausted. This study aims to evaluate the cost-effectiveness of hip and knee replacements in Australia. To our best knowledge, the study is the first attempt to account for the dual nature of hip and knee osteoarthritis in modelling the severities of right and left joints separately. Methodology/Principal Findings We developed a discrete-event simulation model that follows up the individuals with osteoarthritis over their lifetimes. The model defines separate attributes for right and left joints and accounts for several repeat replacements. The Australian population with osteoarthritis who were 40 years of age or older in 2003 were followed up until extinct. Intervention effects were modelled by means of disability-adjusted life-years (DALYs) averted. Both hip and knee replacements are highly cost effective (AUD 5,000 per DALY and AUD 12,000 per DALY respectively) under an AUD 50,000/DALY threshold level. The exclusion of cost offsets, and inclusion of future unrelated health care costs in extended years of life, did not change the findings that the interventions are cost-effective (AUD 17,000 per DALY and AUD 26,000 per DALY respectively). However, there was a substantial difference between hip and knee replacements where surgeries administered for hips were more cost-effective than for knees. Conclusions/Significance Both hip and knee replacements are cost-effective interventions to improve the quality of life of people with osteoarthritis. It was also shown that the dual nature of hip and knee OA should be taken into account to provide more accurate estimation on the cost-effectiveness of hip and knee replacements. PMID:21966520

Atraumatic tears of the ligamentum teres are more frequent in professional ballet dancers than a sporting population.

PubMed

Mayes, Susan; Ferris, April-Rose; Smith, Peter; Garnham, Andrew; Cook, Jill

2016-07-01

To compare the frequency of atraumatic ligamentum teres (LT) tear in professional ballet dancers with that of athletes, and to determine the relationship with clinical and imaging findings. Forty-nine male and female professional ballet dancers (98 hips) and 49 age and sex-matched non-dancing athletes (98 hips) completed questionnaires on hip symptoms and physical activity levels, underwent hip rotation range of movement (ROM) and hypermobility testing, and 3.0-Tesla magnetic resonance imaging (3 T MRI) on both hips to detect LT tears, acetabular labral tears, and articular cartilage defects, and to measure the lateral centre edge angles (LCE). A higher frequency of LT tear was found in dancers (55 %) compared with athletes (22 %, P = 0.001). The frequency and severity of LT tears in dancers increased with older age (P = 0.004, P = 0.006, respectively). The Hip and Groin Outcome Score (HAGOS) pain scores or hip rotation ROM did not differ significantly among participants with normal, partial, or complete tears of LT (P > 0.01 for all). Neither the frequency of generalised joint hypermobility (P = 0.09) nor the LCE angles (P = 0.32, P = 0.16, left and right hips respectively) differed between those with and those without LT tear. In most hips, LT tear co-existed with either a labral tear or a cartilage defect, or both. The higher frequency of atraumatic LT tears in professional ballet dancers suggests that the LT might be abnormally loaded in ballet, and caution is required when evaluating MRI, as LT tears may be asymptomatic. A longitudinal study of this cohort is required to determine if LT tear predisposes the hip joint to osteoarthritis.

[Effects of surgery on muscles on clinical and radiographic findings in the hip joint region in cerebral palsy patients].

PubMed

Schejbalová, A; Havlas, V

2008-10-01

PURPOSE OF THE STUDY Isolated or combined surgical procedures on muscles around the hip joint are currently indicated by many authors. In cerebral palsy patients they are regarded as essential intervention. MATERIAL In the years 2005-2007, surgery in the hip joint region was essential for 150 children between 3 and 18 years of age. At the time of surgery, the patients' locomotion ranged from stage 1 to stage 7 of the Vojta system. METHODS The outcome was evaluated by clinical and radiographic examination at 2 and 6 months post-operatively and hip migration percentage and Wiberg's CE angle were measured. RESULTS The best clinical and radiographic outcomes were achieved in children younger than 6 years of age. On the other hand, isolated transfer of the distal rectus femoris muscle significantly affected pelvis anteflexion in adolescent patients. The most marked decrease in migration percentage was found after adductor tenotomy combined with surgery on the iliopsoas muscle (55.6 %) or when the two procedures were combined with distal rectus femoris transfer. DISCUSSION Combined surigical procedures, i.e., adductor tenotomy, surgery on the iliopsoas muscle or rectus femoris muscle and medial hamstrings, with fixation using an abduction modified Atlanta brace, are effective in patients with marked lateral hip migration who are younger that 6 years. Isolated adductor tenotomy and distal transfer of the rectus femoris muscle markedly improve standing position in walking patients. CONCLUSION An appropriate combination of surgical procedures on muscles in the hip region and on medial hamstrings can significantly improve the patient's locomotion and, if lateral migration is present, help to avoid surgery on bones.

The diagnostic test accuracy of magnetic resonance imaging, magnetic resonance arthrography and computer tomography in the detection of chondral lesions of the hip.

PubMed

Smith, Toby O; Simpson, Michael; Ejindu, Vivian; Hing, Caroline B

2013-04-01

The purpose of this study was to assess the diagnostic test accuracy of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) and multidetector arrays in CT arthrography (MDCT) for assessing chondral lesions in the hip joint. A review of the published and unpublished literature databases was performed to identify all studies reporting the diagnostic test accuracy (sensitivity/specificity) of MRI, MRA or MDCT for the assessment of adults with chondral (cartilage) lesions of the hip with surgical comparison (arthroscopic or open) as the reference test. All included studies were reviewed using the quality assessment of diagnostic accuracy studies appraisal tool. Pooled sensitivity, specificity, likelihood ratios and diagnostic odds ratios were calculated with 95 % confidence intervals using a random-effects meta-analysis for MRI, MRA and MDCT imaging. Eighteen studies satisfied the eligibility criteria. These included 648 hips from 637 patients. MRI indicated a pooled sensitivity of 0.59 (95 % CI: 0.49-0.70) and specificity of 0.94 (95 % CI: 0.90-0.97), and MRA sensitivity and specificity values were 0.62 (95 % CI: 0.57-0.66) and 0.86 (95 % CI: 0.83-0.89), respectively. The diagnostic test accuracy for the detection of hip joint cartilage lesions is currently superior for MRI compared with MRA. There were insufficient data to perform meta-analysis for MDCT or CTA protocols. Based on the current limited diagnostic test accuracy of the use of magnetic resonance or CT, arthroscopy remains the most accurate method of assessing chondral lesions in the hip joint.

Effect of the sagittal ankle angle at initial contact on energy dissipation in the lower extremity joints during a single-leg landing.

PubMed

Lee, Jinkyu; Song, Yongnam; Shin, Choongsoo S

2018-05-01

During landing, the ankle angle at initial contact (IC) exhibits relatively wide individual variation compared to the knee and hip angles. However, little is known about the effect of different IC ankle angles on energy dissipation. The purpose of this study was to investigate the relationship between individual ankle angles at IC and energy dissipation in the lower extremity joints. Twenty-seven adults performed single-leg landings from a 0.3-m height. Kinetics and kinematics of the lower extremity joints were measured. The relationship between ankle angles at IC and negative work, range of motion, the time to peak ground reaction force, and peak loading rate were analyzed. The ankle angle at IC was positively correlated with ankle negative work (r = 0.80, R 2  = 0.64, p < 0.001) and the contribution of the ankle to total (ankle, knee and hip joint) negative work (r = 0.84, R 2  = 0.70, p < 0.001), but the ankle angle was negatively correlated with hip negative work (r = -0.46, R 2  = 0.21, p = 0.01) and the contribution of the hip to total negative work (r = -0.61, R 2  = 0.37, p < 0.001). The knee negative work and the contribution of the knee to total negative work were not correlated with the ankle angle at IC. The ankle angle at IC was positively correlated with total negative work (r = 0.50, R 2  = 0.25, p < 0.01) and negatively correlated with the peak loading rate (r = -0.76, R 2  = 0.57, p < 0.001). These results indicated that landing mechanics changed as the ankle angle at IC increased, such that the ankle energy dissipation increased and redistributed the energy dissipation in the ankle and hip joints. Further, these results suggest that increased ankle energy dissipation with a higher IC plantar flexion angle may be a potential landing technique for reducing the risk of injury to the anterior cruciate ligament and hip musculature. Copyright © 2018 Elsevier B.V. All rights reserved.

Kinematics and Kinetics of Squat and Deadlift Exercises with Varying Stance Widths

NASA Technical Reports Server (NTRS)

DeWitt, John K.; Fincke, Renita S.; Logan, Rachel L.

2011-01-01

The primary motion of squat and deadlift exercise involves flexion and extension of the hips, knees, and ankles, but each exercise can be performed with variations in stance width. These variations may result in differing kinematics and ground reaction forces (GRF), which may in turn affect joint loading. PURPOSE: The purpose of this investigation was to compare ankle, knee, and hip kinematics and kinetics of normal squat (NS), wide-stance squat (WS), normal deadlift (ND), and sumo deadlift (SD). We hypothesized that hip joint kinematics and work at each joint would differ between exercise variations. METHODS: Six subjects (3 m/3 f; 70.0 plus or minus 13.7 kg; 168 plus or minus 9.9 cm) performed each lift in normal gravity on the ground-based version of the Advanced Resistive Exercise Device (ARED) used on the International Space Station. The ARED provided resistance with a combination vacuum tube/flywheel mechanism designed to replicate the gravitational and inertial forces of free weights. Subjects completed each lift with their 10-repetition maximum load. Kinematic data were collected at 250 Hz by a 12-camera motion-capture system (Smart-D, BTS Bioengineering, Milan, Italy), and GRF data were collected at 1000 Hz with independent force platforms for each leg (Model 9261, Kistler Instruments AG, Winterhur, Switzerland). All data were captured simultaneously on a single workstation. The right leg of a single lift for each motion was analyzed. Modeling software (OpenSim 2.2.0, Simbios, Palo Alto, CA) determined joint kinematics and net positive and negative work at each lower extremity joint. Total work was found as the sum of work across all joints and was normalized by system mass. Effect sizes and their 95% confidence intervals were computed between conditions. RESULTS: Peak GRF were similar for each lift. There were no differences between conditions in hip flexion range of motion (ROM). For hip adduction ROM, there were no differences between the NS, WS, and SD. However, hip adduction ROM was greater during the NS and SD than during the ND. Hip rotation ROM was greater during the WS than during the NS and SD, and was greater during the SD than during the ND. For knee and ankle flexion ROM, the ND, WS, and SD were not different, but ROM was greater during the NS than the ND and greater during the WS than the SD. Total eccentric work was greater during the WS than the SD. Otherwise, there were no differences in eccentric or concentric work between conditions. CONCLUSIONS: Although squat and deadlift exercises consist of similar motions, there are kinematic differences between them that depend on stance width. Total eccentric and concentric work are similar for different lifts, but differing kinematics may require activation of different musculature for each variation. With respect to each condition, in the ND the ROM of each joint tended to be less, and the WS tended to trade knee motion for hip motion. PRACTICAL APPLICATIONS: Knowledge of differences in kinematics and kinetics between different squat and deadlift variations is important for coaches and rehabilitation personnel to understand when prescribing exercise. Our results suggest that each variation of the squat and deadlift should be considered a separate exercise that may induce different long-term training effects.

Body size and lower limb posture during walking in humans.

PubMed

Hora, Martin; Soumar, Libor; Pontzer, Herman; Sládek, Vladimír

2017-01-01

We test whether locomotor posture is associated with body mass and lower limb length in humans and explore how body size and posture affect net joint moments during walking. We acquired gait data for 24 females and 25 males using a three-dimensional motion capture system and pressure-measuring insoles. We employed the general linear model and commonality analysis to assess the independent effect of body mass and lower limb length on flexion angles at the hip, knee, and ankle while controlling for sex and velocity. In addition, we used inverse dynamics to model the effect of size and posture on net joint moments. At early stance, body mass has a negative effect on knee flexion (p < 0.01), whereas lower limb length has a negative effect on hip flexion (p < 0.05). Body mass uniquely explains 15.8% of the variance in knee flexion, whereas lower limb length uniquely explains 5.4% of the variance in hip flexion. Both of the detected relationships between body size and posture are consistent with the moment moderating postural adjustments predicted by our model. At late stance, no significant relationship between body size and posture was detected. Humans of greater body size reduce the flexion of the hip and knee at early stance, which results in the moderation of net moments at these joints.

Lessons from a non-domestic canid: joint disease in captive raccoon dogs (Nyctereutes procyonoides).

PubMed

Lawler, Dennis F; Evans, Richard H; Nieminen, Petteri; Mustonen, Anne-Mari; Smith, Gail K

2012-01-01

The purpose of this study was to describe pathological changes of the shoulder, elbow, hip and stifle joints of 16 museum skeletons of the raccoon dog (Nyctereutes procyonoides). The subjects had been held in long-term captivity and were probably used for fur farming or research, thus allowing sufficient longevity for joint disease to become recognisable. The prevalence of disorders that include osteochondrosis, osteoarthritis and changes compatible with hip dysplasia, was surprisingly high. Other changes that reflect near-normal or mild pathological conditions, including prominent articular margins and mild bony periarticular rim, were also prevalent. Our data form a basis for comparing joint pathology of captive raccoon dogs with other mammals and also suggest that contributing roles of captivity and genetic predisposition should be explored further in non-domestic canids.

Granulicatella adiacens prosthetic hip joint infection after dental treatment.

PubMed

Aweid, Osama; Sundararajan, Sabapathy; Teferi, Abraham

2016-06-01

Granulicatella adiacens is a Gram-positive bacteria and a normal component of oral flora. It is also found in dental plaques, endodontic abscesses and can rarely cause more serious infections. We describe a prosthetic hip joint infection in an 81-year-old fit and healthy man due to Granulicatella adiacens who underwent a prolonged dental intervention two days earlier without antibiotic prophylaxis. The infection was successfully treated with surgical intervention and a combination of antibiotics. The patient eventually succumbed to severe community-acquired pneumonia two months later. Current guidelines recommend avoidance of antibiotic prophylaxis prior to dental treatment in patients who have no co-morbidities and no prior operation on the index prosthetic joint. This case report indicates that infections of prosthetic joints may be associated with dental procedures even in fit and healthy patients without the recognized risk factors.

Knee joint changes in patients with neglected developmental hip dysplasia: a prospective case-control study.

PubMed

Li, Qiwei; Kadhim, Muayad; Zhang, Lijun; Cheng, Xiangjun; Zhao, Qun; Li, Lianyong

2014-12-01

Few reports are available describing knee changes in neglected developmental dysplasia of the hip (DDH). The purpose of this study was to assess the radiographic morphology of knee joints in adults with neglected DDH. Thirty-seven patients (35 females and two males) with neglected DDH were prospectively recruited with an average age of 32.6 years. Twenty-three patients had unilateral and 14 patients had bilateral neglected DDH. Thirty-seven healthy individuals were recruited to form a matched control group. Three groups of knee joints were examined: affected knees (on the same side of the neglected DDH), unaffected knees (contralateral to the neglected DDH in patients with unilateral involvement), and control knees. A series of radiographic parameters of the knee joint were measured in the coronal and sagittal plane, and they were compared between patients and normal controls. In the coronal plane, the affected knees had increased valgus angulation related to increased height of the medial femoral condyle, decreased height of the lateral femoral condyle and decreased lateral distal femoral angle compared to control knees. In the sagittal plane, both distal femoral and proximal tibial joints of the affected knees developed a decrease in posterior angles. Additionally, the unaffected knees also developed radiographic changes compared to control knees. Patients with neglected DDH may develop changes in both knee joints. These changes should be considered during surgery to the hip, femur and knee to prevent potential complications. Level 2. Copyright © 2014 Elsevier B.V. All rights reserved.

Lower-limb proprioceptive awareness in professional ballet dancers.

PubMed

Kiefer, Adam W; Riley, Michael A; Shockley, Kevin; Sitton, Candace A; Hewett, Timothy E; Cummins-Sebree, Sarah; Haas, Jacqui G

2013-09-01

Enhanced proprioceptive feedback strengthens synergistic muscle groups and stabilizes the coordination of limbs, thus contributing to the movement efficiency of ballet dancers. The present study compared lower-limb proprioceptive awareness in professional ballet dancers to matched controls who had no dance training. Two assessment methods were used to test the hypothesis that ballet dancers would demonstrate increased proprioceptive awareness in the ankle, knee, and hip: 1. a joint-position matching task to assess static proprioceptive joint awareness, and 2. an eyes-closed, quiet standing task to assess both static and dynamic proprioceptive awareness through measures of center of pressure (COP) variability. Results of the matching task indicated that the dancers exhibited greater proprioceptive awareness than controls for all three joints (p < 0.001). Also, dancers were equally aware of the positioning of their ankle, knee, and hip joints (p > 0.05), whereas controls were less aware of their ankle position compared to their knee and hip joints (p < 0.001). Measures indexing COP variability during quiet standing did not differ between groups and thus failed to reflect increased proprioceptive awareness in dancers (all p > 0.05). This indicates that quiet stance may have limited value as a means for evaluating proprioception. These findings provide preliminary evidence that enhanced proprioceptive awareness of lower limb joints should be considered as an evaluative criterion for dancers' ability to learn complex ballet skills. They also indicate that quiet standing tasks may not provide sufficient challenge for dancers' enhanced proprioceptive awareness to manifest.

Articulated distraction.

PubMed

Hosny, Gamal Ahmed

2011-07-01

Articular hip distraction can be applied either by using a monolateral articulated distractor or a circular fixator. The fixator should be aligned such that its axis is aligned with the transverse axis of the hip joint. Following distraction, the range of motion is maintained with regular physiotherapy. It is a useful salvage procedure in older children with hip stiffness, when other methods of containment are not applicable. Copyright © 2011 Elsevier Inc. All rights reserved.

Cervical hip fractures do not occur in arthrotic joints. A clinicoradiographic study of 256 patients.

PubMed

Dretakis, E K; Steriopoulos, K A; Kontakis, G M; Giaourakis, G; Economakis, G; Dretakis, K E

1998-08-01

We studied endogenic factors for the occurrence of cervical hip fractures in 256 patients. 230 underwent hemiarthroplasty, and 26 were treated with internal fixation or without surgery. The condition of the fractured hip and of the ipsilateral knee, as well as the mobility of the patient before the fracture, were studied in all 256 patients. The removed femoral heads were examined, photographed and radiographs were taken with sensitive film. The acetabulum and the femoral head were macroscopically normal in all 230 cases and there was no radiographic evidence of arthrosis. 64% of the patients were fully mobile before the fracture, 34% were mobile with the aid of a cane and 2% were dependent. In 88%, the ipsilateral knee was normal both clinically and radiographically, and in 12%, there was moderate arthrosis. When comparing the mobility before the fracture and the condition of the ipsilateral hip and knee in 100 patients having a cervical fracture with 100 patients having a trochanteric fracture matched for age and sex, we found that a normal hip joint was sine qua non while a normal ipsilateral knee and a fully mobile individual were important additional conditions for the occurrence of a cervical hip fracture, instead of a trochanteric one, after a fall in an elderly person.

Manual therapy in osteoarthritis of the hip: outcome in subgroups of patients.

PubMed

Hoeksma, H L; Dekker, J; Ronday, H K; Breedveld, F C; Van den Ende, C H M

2005-04-01

To investigate whether manual therapy has particular benefit in subgroups of patients defined on the basis of hip function, range of joint motion, pain and radiological deterioration. The study was performed in the out-patient clinic of physical therapy of a large hospital. Data on 109 patients with OA of the hip (clinical ACR criteria) participating in a randomized clinical trial on the effects of manual therapy were used. The outcomes for hip function (Harris hip score), range of joint motion (ROM) and pain (VAS) were compared for specific subgroups. Subgroups were assigned by the median split method. The interaction effect between subgroup and treatment was tested using multiple regression analysis. No differences were observed in the effect of manual therapy in specific subgroups of patients defined on the basis of baseline levels of hip function, pain and ROM. On the basis of radiological grading of osteoarthritis (OA), we found that patients with severe radiological grading of OA had significantly worse outcome on ROM as a result of manual therapy than patients with mild or moderate radiological grading of OA. A significant interaction effect was found for only 1 out of 12 hypotheses investigated. Therefore, we conclude that there is no evidence for the particular benefit of manual therapy in subgroups of patients.

Uphill walking: Biomechanical demand on the lower extremities of obese adolescents.

PubMed

Strutzenberger, Gerda; Alexander, Nathalie; Bamboschek, Dominik; Claas, Elisabeth; Langhof, Helmut; Schwameder, Hermann

2017-05-01

The number of obesity prevalence in adolescents is still increasing. Obesity treatment programs typically include physical activity with walking being recommended as appropriate activity, but limited information exists on the demand uphill walking places on the joint loading and power of obese adolescents. Therefore, the purpose of this study was to investigate the effect of different inclinations on step characteristics, sagittal and frontal joint angles, joint moments and joint power of obese adolescents in comparison to their normal-weight peers. Eleven obese (14.5±1.41 years, BMI: 31.1±3.5kg/m 2 ) and eleven normal-weight adolescents (14.3±1.86 years, BMI: 19.0±1.7kg/m 2 ) walked with 1.11m/s on a ramp with two imbedded force plates (AMTI, 1000Hz) at three inclinations (level, 6°, 12°). Kinematic data were collected via an infrared-camera motion system (Vicon, 250Hz). The two-way (inclination, group) ANOVA indicated a significant effect of inclination on almost all variables analysed, with the hip joint being the most affected by inclination, followed by the knee and ankle joint. The obese participants additionally spent less time in swing phase, walked with an increased knee flexion and valgus angle and an increased peak hip flexion and adduction moment. Hip joint power of obese adolescents was especially in the steepest inclination significantly increased compared to their normal-weight peers. Obese adolescents demonstrate increased joint loading compared to their normal-weight peers and in combination with a musculoskeletal malalignment they might be prone to an increased overuse injury risk. Copyright © 2017 Elsevier B.V. All rights reserved.