Pelvic kinematics as confounding factor for cam hip impingement

The purpose of this thesis was to explore a range of biomechanical factors linked to the development of symptoms and potentially early onset hip OA in people with cam hip impingement. This was achieved through shape analysis on 3D bone models (segmented from medical images), and motion analysis performed during walking and squatting. Following ethical approval, kinematic and morphological variables were obtained from 19 pre-operative hip impingement patients and 18 healthy controls, and these were compared between groups. Patients demonstrated reduced neck-shaft-angles (-6.0°, p<.01) and increased anterior pelvic tilt during gait (+3.2°, p=.04) which are thought to predispose to impingement by decreasing the proximity between the cam and acetabular rim and making abutment more likely. The transverse pelvic plane is used to measure pelvic tilt during motion analysis, it is therefore interesting that the angle between the transverse and anterior pelvic plane is increased (+4.6°, p=.03) in patients, emphasising that the interplay between shape and function is a priority for further research. Avoidance of hip extension (-5.9°, p<.01) was also observed, which could be a compensatory mechanism to prevent further damages to the hip. Furthermore, large cams are thought to act as a mechanical constraint and limit rotation movement allowed within the acetabulum, as demonstrated by reduced peak hip internal rotation (during squat, -8.5°, p=.03). Controls were regrouped based on morphology to allow comparison between asymptomatic (CAM-; n=11) and symptomatic (CAM+, n=16) cams. Symptomatic cams have an increased width (+41.4°, p<.01), and start more superiorly (-29.4°, p<.01). Increased sagittal pelvic mobility (e.g. during a squat; -11.2° for CAM+, p<.01) is thought to be protective against hip impingement symptoms, as during high flexion angles the pelvic tilts backwards reducing the risk of abutment. These findings highlight the need to establish thresholds taking confounding factors into account.Open Acces

Patient-Specific Implants in Musculoskeletal (Orthopedic) Surgery

Most of the treatments in medicine are patient specific, aren’t they? So why should we bother with individualizing implants if we adapt our therapy to patients anyway? Looking at the neighboring field of oncologic treatment, you would not question the fact that individualization of tumor therapy with personalized antibodies has led to the thriving of this field in terms of success in patient survival and positive responses to alternatives for conventional treatments. Regarding the latest cutting-edge developments in orthopedic surgery and biotechnology, including new imaging techniques and 3D-printing of bone substitutes as well as implants, we do have an armamentarium available to stimulate the race for innovation in medicine. This Special Issue of Journal of Personalized Medicine will gather all relevant new and developed techniques already in clinical practice. Examples include the developments in revision arthroplasty and tumor (pelvic replacement) surgery to recreate individual defects, individualized implants for primary arthroplasty to establish physiological joint kinematics, and personalized implants in fracture treatment, to name but a few

Skeletal sexing standards of human remains in Turkey

The identification of victims involved in mass fatality incidents, as well as the identification of unknown individuals in criminal cases has become an increasingly important issue nowadays. Sex assessment represents a key point in forensic evaluations due to its significance in providing biological identity. Even though the availability of documented skeletal remains to forensic practitioners is a common practice in many countries, in Turkey, contemporary documented skeletal remains are not available for this purpose. For this reason, studies have been focused on living populations. Previous research has shown that modern technologies such as CT scanning present very promising potential in establishing new standards for contemporary populations. Therefore, the main aim of this project was to examine the application of the measurements taken from 3D CT images of the femur in order to assess sex, and to contribute to the establishment of discriminant function equations for the Turkish population for forensic applications. The accuracy and reproducibility of imaging methods in the assessment of the measurements taken from femora are essential when estimating sex. This research also concentrated on determining the accuracy and repeatability of CT measurements, using the femur. Prior to primary data collection, a preliminary study was performed in an effort to test the reliability of the femur measurements. The results of reliability analysis indicated no significant difference between the three observations of each measurement. Thus, the methodology employed in the current study appears reliable and reproducible. In addition, a validation study was conducted to determine the linear measurement accuracy of the 3D volume rendering models derived from a medical CT scanner and the influence of different reconstruction parameters. The differences between measurements obtained from dry bones and their 3D volume rendered models were also evaluated. The results from this study indicated that there were no statistically significant differences between measurements taken from different reconstruction parameters and measurements obtained from CT images and drybones. Using the CT data, volume-rendering function (VR), 3D Curved Multiplanar reconstruction (MPR), and Scout View on OsiriX were employed in order to compare the accuracy and reliability of each rendering method and to determine which technique is optimal for linear measurements. Overall, the measurements taken from the 3D Volume Rendering images had the highest intra-observer reliability when compared to the other two rendering methods. This research study produced data and interpretations that will inform on and improve population specific standards of sex assessment from three-dimensional postcranial osteometric landmarks. Additionally, this research is believed to provide value for a developing discipline of forensic anthropology, and integrate within the existing systems of criminal investigation and disaster victim identification practices in Turkey. A Turkish sample population, consisting of 300 adult hospital patients was examined via the interpretation of CT reconstructed images using the OsiriX software. The 3D reconstructions were then created using the volume-rendering function in OsiriX (v.5.6.). Following the 3D reconstruction, an image of each femur was segmented from the surrounding bones to ensure the correct usage of landmarks as accurately as possible. Thirteen measurements were acquired using a 3D viewer after being located and marked on each CT reconstructed femora. These thirteen anthropometric parameters were measured and analysed by basic descriptive statistics and discriminant analysis methods using the SPSS 21.0 software package. The intra-observer variation was assessed by obtaining the intraclass correlation coefficient in order to evaluate the accuracy of the linear measurements taken. Asymmetry was also tested. The results indicated that an accuracy of 92.3% was acquired from a combination of six of the measurements, and the Femur Vertical Diameter of Neck (FVDN) measurement was found to be the most dimorphic with 88.0% accuracy